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Flashcards in gastroenterology Deck (72)
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1
Q

likely diagnosis with solid food dysphagia episodially for months or years

A

esophageal web or schatzki ring

2
Q

likely diagnosis with progressively increasing solid food dysphagia

A

peptic stricture or esophageal CA

3
Q

progression of tests required to dx achalasia

A

1: barium swallow
2: manometry
3: upper endoscopy (r/o CA)

4
Q

1st line tx for achalasia

A

myotomy or dilation
botulinum is second line
meds only if can’t tolerate the above

5
Q

what do you do if gerd sx don’t respond to PPI

A

increase to bid for 4-8 weeks (if no alarm sx)
then up[per endoscopy
and if normal correlate sx with amb pH monitoring

6
Q

when do you tx barrets esophagus

A

high grade dysplasia (endoscopic tx)

other than PPI of course

7
Q

frequency of EGD for barrets without dysplasia

A

q3-5 yrs

q6-12 months if low grade dysplasia

8
Q

Dx of eosinophilic esophagitis

A

food impaction/dysphagia/young
EGD with stacked circular rings, mucosal furrowing and friability and white specks
trial 8 weeks PPI to determine if GERD associated or not

9
Q

tx for eosinophilic esophagitis

A

PPI if GERD associated

if primary swallowed fluticasone or budesonide

10
Q

which PUD ulcers need biopsy

A

any gastric

duodenal only if refractory to therapy (lower risk for CA)

11
Q

which PUD patients need H. Pylori testing

A

ALL

12
Q

approach to patient <50 with dyspepsia without alarm sx

A

test and tx for h pylori

13
Q

thing you need to look for prior to gastric emptying study in DM

A

make sure glucose <275 because hyperglycemia alone can slow gastric emptying

14
Q

diagnosis and tx for post-gastric bypass
loose stools and cramps 15 min after meals
+ lightheadedness/diaphoresis 90 min after

A

dumping syndrome

small low carb meals

15
Q

diagnosis and tx for loose stools and malabsorption post gastric bypass

A

blind loop syndrome

antibiotics and supplements

16
Q

test you need to do in a young patient with chronic pancreatitis

A

CF testing

17
Q

tests you need to do in older patients with chronic pancreatitis

A

exclude autoimmune pancreatitis and pancreatic cancer

18
Q

autoimmune pancreatitis presentation (sx and imaging)

A

painless obstructive jaundice!
or rarely acute pancreatitis
image shows sausage shaped pancreas

19
Q

TypeI vs II autoimmune pancreatitis

A

type I-asosciated with sjogren, psc, ibd in older men, IgG4

type II-chronic pancreatitis without disease associations and with nl igg4

20
Q

Tx of autoimmune pancreatitis

A

steroids

21
Q

food poisoning that happens 6 hrs after eating

A

staph aureus or b cereus

22
Q

food poisoning that happens 8-14 hrs after eating

A

c. perfringens

23
Q

food poisoning >14 hrs after eating

A

ehec/viral/etec

24
Q

whipple disease presentation

A

arthralgia, fever, neurologic, ocular, cardiac

+ chronic diarrhea

25
Q

celiac sprue presenation

A

chronic diarrhea in someone who went to india or puerto rico (obvious combination)

26
Q

celiac sprue treatment

A

sulfonamide or tetracycline + folate

27
Q

what do you do if celiac patient has recurrent symptoms and is confirmed gluten compliant

A

look for lymphoma (or could be microscopic ibs)

28
Q

how do you confirm diet compliance in celiac

A

antittg or small bowel biopsy

29
Q

tx for mild vs moderate vs severe UC

A

mild-just start sulfasalazine or mesalamine (timed release mesalamine if small bowel involved!)
moderate-prednisone or budesonide to achieve remission + sulfasala/mesalamine
severe-iv steroids and just start an anti TNF

30
Q

first and second agents for chron’s maintenance

A

try 5 asa (mesala/sulfasala) often doesn’t work

then move on to 6mp/azathio/mtx which work better

31
Q

meds for fistulizing chron’s

A

azathioprine, 6 mp or especially anti tnf (not mtx)

32
Q

test required before starting azathioprine or 6 mp

A

thiopurine methyltransferase levels (some patients lack activity, causes toxicity)

33
Q

colonosocopy finding after prolonged senna use

A

benign hyperpigmentation (melanosis coli)

34
Q

when do you do surgical resection in diverticulitis

A

complicated of course but more importantly

after second episode (50% risk of recurrence at that point)

35
Q

tx of acute mesenteric ischemia without peritonitis and with non-occlusive disaease

A

intra-arterial papaverine

36
Q

normal conjugated/unconjugated ratio

A

normally-80% unconjugated

37
Q

what do you need to test for in suspected gilberts

A

confirm ast/alt oare ok, confirm no hemolysis (nl cbc/retic)

38
Q

who gets hep A immunoglobulin

A

close contacts, people who ate infected food, or traveling within 2 weeks to endemic areas

39
Q

post-exposure prophylaxis for hep b

A

immune globulin + vaccine

40
Q

who gets hep b tx

A

acute liver failure
chronic with elevated ALT AND HBV DNA >10,000
immunosuppressive tx

41
Q

how do you treat hep b (which meds)

A

entecavir or tenofovir

42
Q

what do you need to monitor with interferon alpha tx

A

thyroid levels (hypothyroid common

43
Q

who gets HCC monitoring with chronic hep b

A

cirrhosis
>20,000 DNA, and elevated ALT
asian (>40-50 yo)
black (>20 yo)

44
Q

which HCV patients get HCC monitoring

A

cirrhosis, q6 mo

45
Q

score cut offs for steroids in alcoholic hepatitis

A

maddrey >32, meld >18, or just encephalopathy and ascites

stop if bili not better by day 7

46
Q

when should you avoid steroids in alcoholic hepatitis

A

avoid if kidney disease, gi bleed, pancreatitis or infection

47
Q

alcoholic hepatitis antibodies

A
anti sm musc
ana
   pANCA
anti LKM 1
\+ elevated igG (i.e. low albumin, high protein)
48
Q

main demographic of alcoholic hepatitis

A

women 20-40 yo

49
Q

characteristic arthritis in hemochromatosis

A

second and third mcps with hook like osteophites, OA in weird joints like ankle, shoulder, elbow

50
Q

differentiate advanced liver disease vs hemochromatosis on iron studies

A

advanced liver disease increases ferritin, but usually maintains nl percent sat (i.e. <55%)

51
Q

classic triad in PBC

A

cholestasis
anti mito antibody
granulomatous inflammation on septal bile duct
(women 40-60)

52
Q

complications of PBC

A

fat soluble vitamin deficiencies and osteoporosis/malacia

53
Q

tx for PBC

A

ursodeoxycholic acid

54
Q

Bile duct pathology in PBC vs PSC

A

PBC: small bile ducts
PSC: large bile ducts

55
Q

demographics of PBC vs PSC

A

PBC: women 40-60, various autoimmune diseases coexist
PSC: men 20-30, IBD

56
Q

“string of beads” on MRCP/ERCP diagnosis

A

PSC

57
Q

positive anti mitochondrial ab disease

A

PBC

58
Q

tx for PSC

A

tx strictures endoscopically and liver txpl (cholestyramine for itching)

59
Q

use ascitic protein to differentiate etiology of high saag ascites

A

<2.5-cirrhosis

>2.5-HF or budd chiari

60
Q

use ascitic protein to differentiate etiology of low saag ascites

A

<2.5-nephrotic syndrome

>2.5-malignancy or TB

61
Q

test to confirm hepatopulmonary syndrome

A

agitated saline enhanced echo

62
Q

what osteoporosis tx is appropriate in cirrhosis

A

only IV if they have esophageal varices

63
Q

differentiate AFLP from HELLP

A

encephalopathy or hypoglycemia suggest AFLP
hellp has more TMA
AFLP has more coag problems
(who cares, schedule delivery)

64
Q

tx for wilson disease

A

chelation with penicillamine or trientine

65
Q

tx for amanita mushroom poisoning

A

penicillin g or silymarin

66
Q

tx for biliary colic

A

nsaids decrease risk of progression to cholecystitis

67
Q

what is mirizzi syndrome

A

gall stone is in cystic duct (so cholecystitis), stone extrinsically compresses cbd so cbd is NOT dilated but liver enzymes are elevated

68
Q

findings on egd suggesting low risk ulcer

A

clean base or nonprotruberant pigmented spot

69
Q

timeline to endoscopy in UGIB

A

w/in 24 hrs or 12 hrs if expect varices

70
Q

likely source of gib in young patient with painless hematochezia and nl egd/colo

A

meckel diverticulum

71
Q

first step for recurrent gib without identified source after egd/colo

A

repeat egd colo (diagnostic 40% of the time)

72
Q

recommended next steps for active obscure gib

A

apparently tagged scan first then cta
then consider push enteroscopy
then surgery