Flashcards in Gastroenterology II Deck (62):
What is appropriate mgmt of esophageal cancer?
Resection followed by 5-fluorouracil chemotherapy
With regard to what complication is variceal banding superior to sclerosing agents for the treatment of esophageal varices?
Sclerosing agents are associated with the formation of strictures
What are two presenting components of Plummer-Vinson Syndrome? What is it associated with developing? What is tx?
Proximal strictures and IDA
Squamous Cell Carcinoma
How does Schatzki's ring present? What is tx?
Distal ring of esophagus presenting with intermittent dysphagia
Tx: pneumatic dilation
Mgmt of peptic strictures
What is cause of Zenker's diverticulum?
Best initial test?
Dilation of posterior pharyngeal constrictor muscles
What is the most accurate test for diagnosing diffuse esophageal spasm? What is seen on Barium studies?
What is tx?
Barium will show corkscrew appearance only during an episode
Tx: CCBs and nitrates
Your patient with hx of HIV (CD4 99) presents with pain on swallowing and progressive dysphagia. What/do do you diagnose? What is tx?
Oral Candidiasis is common in HIV patients with CD4
What are common causes of pill-induced esophagitis?
Doxycycline and bisphosphonates
If a patient presents with odynophagia due to esophagitis how should it be appropriately managed?
If CD4 > 100 then proceed to endoscopy. If
If a case of Mallory-Weiss tear continues to bleed what can be provided to tamponade it?
What are the alarm symptoms warranting endoscopy for evaluation of GERD?
Blood in stool
If a patient has GERD unresponsive to PPIs what is the next treatment step?
Procedure (surgical or endoscopic) to reconstrict the lower esophageal sphincter and narrow the distal esophagus (e.g. Nissen fundoplication or endoscopic suturing). It is rare to need surgery.
*Make sure esophageal motility is good before doing this.
*If symptoms are blatantly from GERD then H. pylori treatment isn't truly necessary.
Where is squamous cell carcinoma vs adenocarcinoma in the esophagus?
Squamous cell carcinoma is upper esophagus
Adenocarcinoma is lower esophagus
When is endoscopy warranted to evaluate for Barret's esophagus?
Patients with GERD and alarm symptoms (e.g. weight loss anemia, dysphagia, blood in stool) and in patients with GERD for 5-10 years
Endoscopy finds Barret's esophagus. What is long-term mgmt?
PPI and repeat endoscopy every 2-3 years
Endoscopy finds low-grade dysplasia of esophagus. What is long-term management?
PPI and repeat endoscopy every 3-6 months
Endoscopy finds high-grade dysplasia of esophagus. What is management?
Endoscopic mucosal resection
57 yo patient presents with epigastric pain for the last several weeks. Besides ruling out other diseases with labs what is the next step in mgmt?
Endoscopy for all patients >55yo with epigastric discomfort symptoms to rule out gastric cancer
Most common cause of epigastric discomfort
What is the most common cause of peptic ulcers?
What is the most accurate test for gastritis?
Endoscopy with biopsy
What is tx of H. pylori infection?
PPI, clarithromycin, amoxicillin
If a patient has failed attempt at treating H. pylori infection with standard triple therapy then what may be used next?
PPI, metronidazole, tetracycline
If both triple therapy regimens fail for managing H. pylori infection then what should be evaluated for next?
When should stress ulcer prophylaxis be used? (Hint: 4 scenarios)
Intubation and mechanical ventilation
Coagulopathy and steroid use
How should you manage patients with no signs of gastritis or PUD on endoscopy but are seropositive for H. pylori?
When should you consider testing gastrin levels and gastric acid output?
Large ulcers (>1cm)
Ulcers distal near ligament of Treitz
Recurrent/persistent ulcers despite H. pylori
What are the most accurate tests for diagnosing/localizing Zollinger-Ellison Syndrome?
Nuclear somatostatin scan
Secretin suppresion (most accurate test but may not help with localizing much)
Patient has elevated gastrin levels. What does this suggest?
More likely they are on a PPI or H2 blocker. ZE syndrome is consideration however
What happens in secretin test in patients with ZE syndrome?
No change in gastrin secretion or gastric acid output
What is treatment of ZES?
Local disease: surgical resection
Metastatic disease: lifelong PPI
What are appropriate tests for making diagnosis of CD or UC?
Barium enema also can help give dx
Blood tests can be used if the above aren't helpful
ASCA positive IBD is ....
What are adverse effects of sulfasalazine?
What are treatments for inflammatory bowel disease?
3) Sulfasalazine (not first line due to adverse effects)
4) Azathiprine, 6-mercaptopurine for those which aren't responding well to steroids
5) Infliximab most helpful for CD with associated fistula formation
6) Metronidazole and ciprofloxacin helpful for CD with perianal involvement
7) Surgery can be helpful, especially in UC
What is the natural reservoir for Yersinia? How is it transmitted?
Rodents are natural reservoir
Transmitted via food; often meats, produce, and dairy
What is the best initial test for an infectious diarrhea? What is most accurate test?
Initial: Fecal leukocytes
Accurate: Stool culture
If you had to pick one antibiotic which is generally good for managing infectious diarrhea what would you choose?
Ciprofloxacin or other fluoroquinolone
Besides 3-stool ova and parasite exam what is a sensitive and specific test for the detection of Giardia?
Tx of Giardia
How is bacilus cereus managed?
Will pass on its own
Tx of Cryptosporidiosis
How do you manage lactose intolerance?
Diagnosis and treatment is to remove all dairy products from diet except yogurt
Tx Carcinoid syndrome
Dx of Carcinoid Syndrome
What are signs of malabsorption diarrhea which may come from failure to observe certain vitamins and minerals?
Easy bruising and elevated INR
Calcium oxalate stones
B12 malabsorption and thus anemia
Best initial test for malabsorption?
Initial: Sudan stain for fat
Accurate: 72hr fecal fat
Best initial test for Celiac disease
Initial: antigliadin, anti tissue transglutaminase, antiendomysial
Accurate: small bowel biopsy
If antibodies are positive in Celiac disease do you have to do a small bowel biopsy?
Yes. You need to rule out a bowel wall lymphoma
Most accurate test for tropical sprue?
Accurate: micro-organisms in small bowel biopsy
Tx: doxycycline or TMP-SMX
Tx of Whipple Disease
Tetracycline or TMP-SMX for 1 year
What is the most accurate test to diagnose chronic pancreatitis?
Secretin stimulation test (bc pancreatic function will be diminished)
What are appropriate therapies for irritable bowel syndrome?
Antispasmodics/anticholinergics (dicyclomine, hyoscyamine)
TCA (e.g. amitryptiline)
Is a hyperplastic polyp benign or malignant?
Any extra screening for Peutz-Jeghers?
Extra screening in juvenille polyposis?
You find a dysplastic polyp and remove it in your patient. When should his next colonoscopy be performed?
In 3-5 years
What is the most accurate test for diverticulosis?
High fiber diet
What diagnostic tests are contraindicated in diverticulitis?
Colonoscopy and barium enema