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MKSAP > Gastroenterology and Hepatology > Flashcards

Gastroenterology and Hepatology Flashcards

(59 cards)

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1
Q

Dysphagia lusoria

A

Vascular extrinsic compression seen on CTA Head/Neck that causes dysphagia

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2
Q

Peroral endoscopic myotomy

A

Procedure for achalsia which involves creating a submucosal tunnel extending to the LES and then performing a myotomy

Resolves symptoms in 80% of patients
; need to do Nissen fundopilcation as well when doing this

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3
Q

Management of achalasia

A

Surgical = Definitive

Nifedipine = Patients who are poor surgical candidates

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4
Q

Diffuse esophageal spasm

A

Hypercontractile esophageal disorder associated w/ chest pain and dysphagia; responds to nitroglycerin therapy

Manometry shows >30mmHg w/ intermittent aperistaltic contractions

Tx: Trazadone, imipramine, or sildenafil

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5
Q

Screening for patient w/ indefinite dysplasia on EGD

A

PPI for 6 months then repeat endoscopy

If still present, repeat in one year again

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6
Q

Screening for patient w/ low-grade or high-grade dysplasia on EGD

A

Endoscopic ablation therapy

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7
Q

Management of HBV in an expectant mother

A

Treat for HBV DNA levels >200,000 w/ tenofovir or lamivudine

Treat newborn w/ HBV vaccine and immunization if mother is positive for HBeAg

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8
Q

Bactrim injury to the liver

A

Cholestatic in nature w/ elevated AP and bilirubin levels weeks after taking the medication

-Is still a diagnosis of exclusion and requires periodic CMP monitoring

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9
Q

Treatment of laxative-resistant, opioid induced constipation

A

Two peripherally acting opioid antagonists, oral naldemedine or subq methylnatrexone, and nalogegol, a pegylated form of naloxone

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10
Q

Patient with Hereditary Hemochromatosis and consideration for liver biopsy

A

If ferritin >1000 and elevated LFTs, patient needs liver biopsy to evaluate for cirrhosis

If cirrhosis is present, then EGD and RUQ US q6months should be obtained

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11
Q

Risk factor that increases risk of upper GI Bleed w/ NSAID use

A

Concomitant ASA use for CV prophylaxis

Raises risk 2-4x fold

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12
Q

Gastric polyps

A

Hyperplastic => Malignant potential (esp. if >1cm or pedunculated)

Adenoma => FAP, Lynch; rescope at 1 yr then q3yrs after

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13
Q

What do 2/3 of pancreatic cancer patients develop in the 36 months preceding their diagnosis?

A

Type II DM

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14
Q

Most common cystic lesion found in the pancreas

A

Intraductal Papillary Mucinous Neoplasm (IPMN)

Arise from a branched duct and have a LOW rate of malignant transformation

RFs for transformation = Size >3cm, symptoms, solid component to cyst

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15
Q

Mucinous cystic neoplasm

A

90% found in women; they have a thick fibrous capsule w/ epitheliod cells similar to ovarian stroma surrounding the lesion

CEA levels can be elevated; these lesions should be monitored

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16
Q

Initial eval of a pancreatic neuroendocrine tumor

A 
Chromogranin A 
5-hydroxyindoleacetic acid
Gastrin 
Glucagon
Insulin
Proinsulin
Pancreatic polypeptide
Vasoactive intestinal polypeptide

*Most secrete gastrin or insulin but only 10-25% are active anyways

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17
Q

Lab you can order when you are unsure of nature of diarrhea

A

Stool osmotic gap

<50 = Secretory diarrhea; >100 = osmotic

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18
Q

Meds to treat Short Bowel Syndrome

A

Glucagon-like peptide 2, teduglutide

Increase intestinal wet weight absorption and decrease parenteral support required in these patients

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19
Q

Isolated AP level rising in IBD patient

A

Suspect primary sclerosing cholangitis

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20
Q

Way to differentiate IBD from IBS

A

Fecal calprotectin

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21
Q

Steroid used to treat Crohn’s flares

A

Budesonide; experiences high first pass metabolism in the liver so there are minimal systemic effects

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22
Q

Azathioprine or 6-Mercaptopurine considerations when treating IBD

A

Test for TPMT gene =» patients w/ low activity are at higher risk for toxicity

Monitor CBC, LFTs

Rarely can cause hepatosplenic T-cell lymphoma

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23
Q

What to do if you identify latent TB prior to starting a TNF-a inhibitor

A

Treat for 2 months w/ isoniazid

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24
Q

Agent to use in severe Crohn’s if TNF-a inhibitors have failed

Study These Flashcards
A

Ustekinumab (Stelera): anti IL-12 and IL-23 antibody that inhibits cytokine receptors on T cells

25
Colonoscopy screening w/ severe IBD
Start 8 years after diagnosis then repeat annually
26
Treatment of IBS-Diarrhea
1st: Rifaximin (14 day course; can be repeated if needed) Other lines should be prescribed by GI doc Otherwise, loperamide, antispasmodics (peppermint oil), and TCAs all may have some benefit
27
Stool softener
Docusate
28
Classic triad in Chronic Mesenteric Ischemia
1. Postprandial abdominal pain 2. Sitophobia (fear of eating) 3. Weight loss -only seen in 30% of CMI patients
29
Stimulant Laxatives
Senne | Bisacodyl
30
Main cause for a chronic anal fissure
Rectal spasm; treat w/ CCBs or nitrates Can also consider botulinum injection
31
Treatment of IBS-Constipation
1st: Linaclotide 2nd: Lubiprostone 3rd: Miralax
32
Treatment of IBS-Diarrhea
1st: Rifaximin (14 day course; can be repeated if needed) Otherwise, loperamide, antispasmodics (peppermint oil), and TCAs all may have some benefit
33
Narcotic-bowel syndrome
Paradoxical increase in abdominal pain w/ increasing doses of opioid medications (hyperalgesia) Tx is to taper off if you can lol
34
Classic triad in Chronic Mesenteric Ischemia
1. Postprandial abdominal pain 2. Sitophobia (fear of eating) 3. Weight loss
35
Imaging study to order if CT is concerning for right sided colonic ischemia
CT Abdomen Angiogram -Need to r/out acute mesenteric ischemia
36
Main cause for a chronic anal fissure
Rectal spasm; treat w/ CCBs or nitrates
37
First test to order in elderly patient who has urge fecal incontinence
Abdominal XR Want to make sure it is not due to excess stool burden
38
Meds to discontinue in cirrhotics w/ portal HTN
NSAIDs, ACEIs -This is because the compensatory upregulation of the RAAS is required to maintain systemic pressures
39
Test to order when primary biliary cholangitis is suspected but anti-mitochondrial antibodies are negative
sp100 and gp210 antibodies Will occur in 10% of patients
40
Polyp location in FAP and Lynch syndromes
Lynch = Proximal colon FAP= Distal colon
41
Attenuated FAP
Version of FAP causing less polyps and usually in more proximal colonic distribution; patients have a 70% risk of cancer by age 80 (relative to 93% by 50 in classic FAP) Screening can be delayed to age 20
42
Other screening to perform on FAP patients
Upper endoscopy to screen for duodenal adenocacrinoma May see gastric polyps as well but these do NOT have malignant potential
43
MutYH-associated polyposis
AR condition caused by mutations in the mutYH gene that is a component in base-excision repair; management is similar to that of traditional FAP
44
Polymerase Proofreading-Associated Polyposis
AD conditions with features of both Lynch and RAP; caused by mutations in polymerase-proofreading genes in POLE and POLD1 Endometrial cancer has also been described in this syndrome; current management is similar to FAP
45
Juvenile Polyposis Syndrome
Caused by mutation in BMPR1A or SMAD4 genes; characterized by juvenile polyps (appear erythematous and waxy serrated-type) Increased risk for colon, stomach, and small bowel cancer in young age
46
Peuthz-Jeghers Syndrome
Caused by mutations in the STK11 gene and associated w/ hyperpigmented mucocutaneous lesions most commonly on the lips but also seen in the nose, perianal, and genital ares ***Patients at high risk for small bowel hamartomas tha may develop at young age and present w/ intussusception, obstruction, and bleeding
47
PTEN Hamartoma Syndrome
Cowden Syndrome; caused by mutation in the tumor suppressor gene PTEN Associated w/ GI hamartomas and breast, kidney, thyroid, and colon cancer **Also associated w/ macrocephaly, esophageal glycogenic acanthosis (hyperkeratinzed, pale appearing lesions on EGD), and other dermatological manifestations
48
Candidates for pegylated interferon therapy for management of HBV
Patients who desire finite therapy, are not pregnant, and do not have significant coexisting cardiac/seizure/psychiatric/AI disease Additionally, patients must have high ALT levels, low HBV DNA levels, and no cirrhosis
49
Target goal of HBV therapy for immune active phase
HBeAg loss and anti-HBe seroconversion; f/up for 12 more months of tenofovir treatment after this
50
Duration of HBV therapy who are in immune reactivation
Indefinitely, even after viral load decreases
51
Renal association w/ HBV
Membranous glomerulonephritis
52
When to use prophylactic instead of supportive therapy for someone who has HBsAg
Receiving B-cell depleting therapy (rituximab) Prednisone >10mg/day for at least 4 weeks Anthracycline therapy (rubicins)
53
Management of severe alcoholic hepatitis
Prednisolone; reduces short term mortality by 46%; should be discontinued if bilirubin does not decrease by Day 7 due to increased infection risk
54
Modern management of Wilson's Disease
Trientine; works like penicillamine but less ADRs Additionally, give zinc supplements to decrease intestinal absorption of copper
55
Management of asymptomatic esophageal varices <5mm in size
Repeat EGD in 2 years unless decompensation occurs
56
Stellate scar seen on liver on abdominal CT
Focal nodular hyperplasia; does not have malignant potential and does not require f/up unless it is a woman on OCPs
57
Diagnosis of hepatocellular carcinoma
Multiphase-contrast enhanced CT or MRI
58
Resection candidate for hepatocellular carcinoma
CTP Class A cirrhosis No portal HTN or jaundice Single lesion 5cm or less
59
Management of acute and chronic portal vein thrombosis
Acute: Anticoagulate if Hgb is stable (may have variceal hemorrhaging) and there is concern for extension to the superior mesenteric vein risking intestinal ischemia Chronic: Nothing

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