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Internal Medicine Boards > Gastroenterology > Flashcards

Gastroenterology Flashcards

(49 cards)

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1
Q

When to EGD Barrett’s Patients

A
  1. EGD shows Barretts -> next EGD 1 year
  2. 1 year later repeat EGD no dysplasia (only metaplasia) -> EGD q3yr
  3. Low Grade dysplasia - EGD 6 months -> still low dysplasia -> q1yr
  4. Dysplasia->metaplasia -> q3yr
  5. High Grade Dysplasia -> Endoscopic RF Ablation
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2
Q

H Pylori Testing

A
  1. Non Endo - Ab test for dx only, Urea breath/Fecal antigen Dx AND f/u
  2. Endo - for culture, urease testing - GOLD STANDARD but expensive
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3
Q

Treatment H Pylori

A
  1. PAC x 14 days (PPI, Amox, Clarithro

2. MOC x 14 days (Metronidazole, omep, clarithro)

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4
Q

H Pylori Tx failure

A
  1. Quad Tx - Tetra, metronidaz, bismuth, PPI

DO NOT REPEAT triple therapy with same abx (high clarithro resistance rates)

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5
Q

Who to test for H pylori

A

45yo M with abd pain and PUD

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6
Q

Are steroids ulcerogenic

A

NO but with NSAIDS increase bleeding by 10x

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7
Q

Dysphasia solids AND liquids with CP

A

Diffuse Esophageal spasm/corkscrew esophagus–>barium swallow–>manometric study (non-perstaltic rxn–>PPI (if no response CCB)

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8
Q

First bite dysphagia (intermittent)

A

Schatzki ring/esophageal strictures -> Pneumatic dilation

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9
Q

Food Regurg hours after, dyphagia solids and liquids

A

Barium swallow -> Birdsbeak -> Achalaisa-> EGD r/o secondary acalasia (cancer) -> surgical myotomy

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10
Q

Food impaction several times, EGD concentric rings, h/o allergies

A

Eosinophillic esophagitis -> PPI then aerosolized steroid (fluticasone/budesonide) then if refractory EGD dilation

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11
Q

Dysphagia with osteoporosis, acrne on tetracycline erythromcin

A

Pill esophagitis -> EGD

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12
Q

regurigating food from days ago, halotosis

A

zenker’s diverticulum

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13
Q

HIV with oral thrush

A

empiric fluconazole/itraconazole -> if no response -> EGD r/o CMV/herpes

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14
Q

Long standing heartburn with progressive dysphagia solids

A

Peptic stricture

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15
Q

Heartburn not relieved with antacids

A

trial of PPI -> if doesn’t work EGD -> if EGD no esophagitis -> ambulatory pH monitoring to prove GERD

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16
Q

Heartburn no response to PPI + weight loss

A

EGD

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17
Q

Can PPI/fundoplication reverse barretts

A

NO

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18
Q

PUD Tx

A

H2 blocker, PPI, sucralafte (cover ulcer)

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19
Q

Zollinger Ellison

A 
MC radiographic finding=single duodenal ulcer
Pancrease or duodenal tumors
2/3 tumors are malignant
1/4 a/w MEN I
Serum fasting gastrin >1000, low pH dx
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20
Q

How long to monitor acute GI bleed after EGD

21
Q

High risk bleed

Study These Flashcards
A 
Visible vessel
Adherent clot
Ulcer >2cm
Variceal bleeding
Arterial Bleed
22
Q

Prevent rebleed PUD

23
Q

Cirrhosis with spider angiomata

Study These Flashcards
A

Screening EGD, PPI (propranolol, nadolol) non selective (if asthma - no beta blocker - band ligation)

24
Q

Only H Pylori test NOT affected by PPI use or GI bleed.

Study These Flashcards
A

H Pylori SEROLOGY

25
Dilation of bile duct without evidence of obstruction
Biliary cyst
26
Primary Biliary Cirrhosis
Disease of microcopic bile ducts, no extrahepatic duct dilation -> jaundice, liver inflamm, liver failure NEVER ACUTE liver failure (progressive) Elevated alk phos from bile duct inflamm Dx: Cholestatic LFT profile, serum anti Mitox Ab Tx: Ursodeoxycholic Acid Monitor: serial LFT's
27
Fulminant Hepatic Failure
within 1 week, hepatic encephalopathy, jaundice without pre-existing liver dz,
28
Pancreatic CA dx
Older pt with painless jaundice, focal cutoff of bile duct on CT (without mass lesion seen) -> use EUS (better sensitivity for tumors AND can biopsy)
29
Large Esophageal varices
Non-selective beta blockers OR endoscopic LIGATION (not sclerotherapy) -> if refractory then TIPS
30
Erythema Nodosum
2/2 infections, drugs, systemic (inflamm) dz's -> treat underlying d/o (IF NO underlying d/o, tx with corticosteroids or immunomodulators)
31
Colonoscopy Surveillence
If complete resection -> surveillence in 1 year | If incomplete resection -> surveillence in 3-6 months after surgery then again in 1 year
32
Gallbladder polyps
10mm - cholecystectomy (high potential for malignancy) (or if gallstones >3cm, calcified GB)
33
Oropharyngeal Dysphagia (difficulty swallowing)
Video fluoroscopy - chocking, coughing, h/o asp PNA, (ALS)
34
Acute Acalculous Cholecystitis
BEST test = Abd US -> CT doesn't show GB wall thickening -> needs cholecystectomy (if not perc cholecystomy tube)
35
Celiac Dz
Anti TTG best test, don't check anti-gliadin Ab
36
Wilson's Dz
Young patient with acute liver failure, high retic ct, large fraction unconjugated bilirubin, low alk phos (
37
Acute Cholangitis
bacterial infection of biliary tree in obstructed system (high alk phos) Charcot's Trial: fever, jaundice, RUQ pain Reynauds pentad: add confusion, septic shock Start Abx -> ERCP for biliary decompression/stenting and stone removal if needed
38
Acute Pancreatitis
Elevated amylase/lipase, hypoperfusion of pancrease on CT=necrotizing pancreatitis -> IV hydration first - no Abx at first, ERCP only if gallstone
39
Achalasia
Laproscopy myotomy | if NOT surgical candidate then Botox injection EGD
40
Celiac Dz
IDA -> upper/lower scope neg -> repeat EGD with SBowel bx (even with TTG neg)
41
Microscopic Colitis
chronic watery diarrhea - abn thickened mucosa in colon - can be caused by lansaprozole, NSAIDS, raniditine, setraline withdraw meds then given mesalamine/budesondie
42
Opioid Induced Constipation
Add methylnaltrexone (micro opiod antagonist)
43
Refractory Hepatic Encephalopathy despite lactulose
Rifaxamine
44
Chronic Mesenteric Ishemia
abd pain after eating in vasculopath -> Wt loss Dx: Angiography (high lactate) Tx: Angioplastic vs surgical revascularization
45
Inadequate Bowel Prep Screening colonoscopy
Reprep bowel and screen again NOW
46
Colonoscopy Polyp Surveillence
10 years - no polyps or only small rectal hyperplastic polyps 5 years - 1 or 2 small (<1cm)
47
Hereditary nonpolyposis Colorectal CA syndrome
Colonoscopy age 20-25 or 10 years before youngest family member dx
48
Non ETOH steatohepatitis
Serial LFT monitoring, weight loss, excercise, agressive control of glucose, lipids, BP Continue Statin even if LFTs elevated
49
SBP with hepatic and renal dysfxn
Cefotaxime AND albumin - don't use diuretics or large volume paracentesis with renal failure

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