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Flashcards in Gastroenterology Deck (256)
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1

Colonoscopy screening for ulcerative colitis

Every one to two years beginning 10 years after diagnosis for patients with disease extending beyond rectum

2

Irritable bowel syndrome workup with history of autoimmune disease

Check TTG rule out celiac disease - especially with type one diabetes and autoimmune thyroid disease

3

Acute fatty liver of pregnancy

Liver failure and coagulopathy

4

HELLP HEMOLYSIS, elevated liver enzymes, low plateletS

Microangiopathic hemolytic anemia

5

Resolved acute diverticulitis next step

After appropriate antibiotic therapy will require full colonoscopy to rule out other causes mimicking diverticulitis

6

Chest pain intermittent unrelated to exertion no reflux symptoms retrosternal pain seconds to minutes corkscrew on x-ray dysphasia to both liquids and solids

Diffuse esophageal spasm treat with calcium channel blockers/ppi - multiple simultaneous contractions on manometry

7

Many month history of dyspepsia looking like Gerd no alarm symptoms no physical exam abnormality what is treatment

Proton pump inhibitor

8

Hematochezia hypotension syncopal symptoms use of NSAIDs anemia what is next test to perform

Suspect upper G.I. source of bleeding needs upper endoscopy first - absence of blood or coffee ground material in NG tube does not rule out upper G.I. bleed - if negative then do colonoscopy

9

Treatment of new onset severely active Crohn's disease

Antitumor necrosis factor therapy like infliximab is best and better than immunomodulators such as mesalamine because Crohn's disease is transmural

10

Treatment of severe alcoholic hepatitis

Mandry discriminant function score of greater than 32 benefit from pentoxifylline if corticosteroids are contraindicated - like with kidney failure G.I. bleed active infections

11

How long to keep patient in hospital after high-risk peptic ulcer and a scopic treatment

72 hours - takes this long for high-risk peptic ulcer to become peptic ulcer

12

Patient with G.I. bleed due to angioectasias and aortic stenosis

replace aortic valve - heyde syndrome e - mechanical destruction of von Willebrand multimers during non-laminar flow through narrow aortic valve

13

Young patient history of several food impaction's history of allergies and asthma egd with concentric rings

Eosinophilic esophagitis treat with PPI or budesonide

14

Food regurgitation barium swallow dilated esophagus tapering gastroesophageal junction manometry decreased peristalsis increased lower esophageal pressure

Achalasia then do a EGD to rule out lymphoma cancer then a surgical myotomy

15

Regurgitating food eaten several days ago with halitosis

Zenkers diverticulum pouch in hypopharynx

16

odynophasia for more than 10 days

Egd to rule out esophagitis consider pill induced, radiation, infections like Candida CMV herpes

17

HIV patient with oral thrush complaining of odynophasia

No need for EGD right away treat empirically then if no improvement EGD to rule out CMV and herpes

18

Progressive dysphasia two solids heartburn several years

Peptic stricture

19

Patient with CVA hemiparesis with coughing and choking sensation was regurgitation of fluids to knows best diagnostic test

Video fluoroscopic swallowing study or modified barium swallow

20

Heartburn not remove by antacid initial diagnostic step is

Ppi challenge - step down to H2 if better in 3 months

21

If patient doesn't get better with PPI

EGD - if no esophagitis then ambulatory pH monitoring if little reflux than likely psychiatric give citalopram

22

Heartburn not respond – since with weight loss

Directly to EGD

23

Treatment of GERD with PPI's or fundoplication surgery effect on existing Barrett's

No effect

24

Barrett's esophagus EGD guidelines

After diagnosis the EGD one year later
NO Dysplasia ON REPEAT EGD NEXT ONE THREE-YEARs
Low-grade dysplasia repeat Egdsix months if still low-grade repeat yearly
If changes back to metaplasia continually EGD every three years
HIGH-GRADE DYSPLASIA ENDOSCOPIC HIGH FREQUENCY ABLATION

25

Severe retrosternal chest pain worse with swallowing and breathing - chest x-ray with left plural effusion subcutaneous emphysema

Esophageal rupture diagnosed with Gastrografin study

26

Best H. pylori test if taking PPI

Antibody ie serology test - only for diagnosis

27

Best H pylori test if not taking PPI

Fecal antigen test used for diagnosis and follow up

28

Urease breath test for H. pylori

Diagnosis and follow up

29

H pylori treatment failure with triple therapy

Quadruple therapy tetracycline Flagyl bismuth ppi

30

NSAID induced PUD

Gastric ulcers higher with old age higher dose steroids with NSAIDs give worse risk bleeding