Gastroenterology & Hepatology

Question 1

What is the mnemonic for cirrhosis complications?

Answer 1

A-SITE

(Ascites, Splenomegaly, Increased INR, Thrombocytopenia, Encephalopathy)

Question 1

How is cirrhosis evaluated?

(lab findings and imaging orders)

Answer 1

Labs: ↓ Albumin, ↑ INR, ↑ bilirubin, thrombocytopenia
Imaging: liver ultrasound, elastography

Question 2

What is the treatment for cirrhosis?

Answer 2

Treat underlying cause
1. antivirals for hepatitis
2. lactulose for encephalopathy (add rifaximin if needed)
3. beta-blockers for varices

(Rifaximin kills ammonia producing bacteria)

Question 3

How are esophageal varices treated?

Answer 3

acute = octreotide and EGD banding
prevention = propranolol

Question 4

HCC screening (2) for all cirrhotic patients and those with Hep B.

(cirrhosis is the #1risk factor)

Answer 4

1. abdominal U/S q. 6 mo.
2. alpha-fetoprotein marker (AFP)

(if u/s +, → Get a contrast-enhanced CT or MRI!)

Question 5

What screening must be done for ALL patients with Hepatitis B?

Answer 5

HCC screening (u/s q. 6 mo and AFP marker)

(If Hep B + family history of HCC → Screen at age 40 for men, 50 for women. If Hep B + African descent → Screen at any age)

Question 6

GOLD standard for cirrhosis dx

Answer 6

bx

Question 7

What are the 5 metabolic causes of cirrhosis?

Answer 7

1. Hemochromatosis
2. Wilson’s
3. Alpha-1 antitrypsin
4. PBC
5. PSC

(there is also alcohol, NAFLD, and viral causes)

Question 8

Alarm symptoms for GERD (requires endoscopy)

Answer 8

Dysphagia
Odynophagia
Weight loss
GI Bleeding (melena, hematemesis)

Question 9

tx of Barrett’s esophagius (w/o dysplasia vs. w/dysplasia)

Answer 9

PPI + endoscopy q. 3-5 yrs.
PPIs + endoscopy q. 6-12 mo.

(If dysplasia is present = ablate!)

Question 10

2 MCC of upper GI bleed

Answer 10

1. PUD (MC)
2. Varices

Question 11

2 MCC of lower GI bleed

Answer 11

1. diverticulosis (over 50 y/o)
2. IBD (young adults)

Question 12

GI Bleed: management (6)

(ER setting)

Answer 12

1. Always Start with ABCs & Resuscitation!
2. IV Fluids (2 large bore IVs)
3. Type & Cross + Blood Transfusion if Hb < 7
4. IV PPI if upper GI bleed suspected
5. Octreotide if variceal bleeding
6. Endoscopy or Colonoscopy for diagnosis

(Resuscitate FIRST → Then scope! If unstable → Intubate before endoscopy!)

Question 13

If patient has an active GI bleed & hemodynamically unstable → next step?

Answer 13

Skip scope, go straight to CTA or embolization.

Question 14

patient presents with hematochezia + postprandial abdominal pain → dx?

Answer 14

ischemic colitis

Question 15

cirrhotic patient with hematemesis & hypotension → next step in management?

Answer 15

Start Octreotide before EGD!

Question 16

variceal bleeding tx (4)

Answer 16

1. Octreotide → Reduces portal pressure
2. IV PPI → If unclear if varices vs. PUD
3. EGD for band ligation
4. TIPS (Transjugular Intrahepatic Portosystemic Shunt) if refractory bleeding

Question 17

diagnostic criteria for acute pancreatitis

(need 2/3)

Answer 17

1. severe epigastric pain (radiating to back)
2. ↑ Lipase or Amylase (>3x normal)
3. Imaging findings (only if uncertain)

(You do NOT need imaging to diagnose if clinical + labs are clear)

Question 18

signs of severe pancreatitis

Answer 18

1. shock
2. ARDS
3. necrosis

(admit to ICU)

Question 19

pancreatits complications (2)

Answer 19

1. necrosis (CT scan)
2. pseudocyst (drain if symptomatic)

Question 20

Alarm features for constipation (6)

Answer 20

1. Weight loss
2. Blood in stool
3. Iron-deficiency anemia
4. Family hx of colon cancer or IBD
5. New-onset in older patient (>50)
6. Signs of obstruction (N/V, no gas/stool)

Question 21

First-line treatment for constipation

Answer 21

• First-line = lifestyle changes (fiber, fluids, activity)
• Then → bulk-forming agents (psyllium), osmotic laxatives (PEG polyethylene glycol), stool softeners
• Suppositories/enemas = next-level when oral fails

Question 22

MCC of lower GI bleed

(2, other than hemorrhoids, IBD or cancer…)

Answer 22

1. diverticulosis (not diverticulitis)
2. angiodysplasia

Question 23

MCC of painless GI bleeding in patients over 60 y/o

Answer 23

diverticulosis

Question 24

4 Diagnostic labs for upper GI bleeding

Answer 24

1. CBC 1. BUN/Cr ratio (↑ BUN suggests upper GI bleed) 1. type & cross 1. PT/INR if on anticoagulants

Question 25

Coffee-ground emesis + orthostatic hypotension → treatment (immediate, and next step)

Answer 25

**Immediate:** 2 large-bore IVs, fluids, type and cross, transfusion if Hgb <7 (or <9 if unstable). **THEN**: IV PPI ± octreotide (if varices suspected), urgent EGD.

Question 26

treatment for unstable upper GI Bleed (labs to order: CBC, type & cross, BUN/Cr, PT/INR if anticoagulated)

Answer 26

* stabilize (ABCs, fluids, transfuse) * PPI IV, octreotide (if varices suspected), balloon tamponade if EGD delayed

Question 27

Cutoff for bariatric surgery? (BMI)

Answer 27

* BMI ≥40, or * BMI ≥35 with weight-related comorbidities (e.g., diabetes, hypertension, OSA)

Question 28

What are the components of the MELD score?

Answer 28

1. Creatinine 1. Bilirubin 1. INR 1. Sodium (score > 15 = transplant)

Question 29

What is the first-line treatment for ascites in cirrhosis (4)?

Answer 29

1. Sodium restriction 1. Spironolactone ± furosemide 1. Paracentesis if tense ascites 1. Albumin replacement if large-volume paracentesis

Question 30

What medication is used to prevent recurrent variceal bleeds?

Answer 30

Non-selective beta blockers (e.g., propranolol, nadolol)