GI 1 pt 2 highlights

Question 1

What is an important sign of conjugated hyperbilirubinemia (direct)?

Answer 1

Pruritis

Question 2

Caput medusae, Ascites, gynecomastia, Palmar erythema, Vascular spider telangiectasia, Asterixis
(“liver flap”) are all S/Sx of what?

Answer 2

Conjugated hyperbilirubinemia

Question 3

Diverticulitis is commonly a cause of pain in what quadrant?

Answer 3

Left lower quadrant

Question 4

Inflammatory bowel disease/ IBD is a common cause of pain in what quadrant?

Answer 4

Right lower quadrant

Question 5

____________________ pain can be caused by psychiatric disease

Answer 5

Diffuse nonlocalized

Question 6

What is a common cause of diffuse nonlocalized pain?

Answer 6

Small intestine related disorders/ conditions

Question 7

Describe the patterns of referred abd pain

Answer 7

Question 8

What pain is commonly on the upper right quadrant, and can wrap around the back and onto the shoulders?

Answer 8

Gallbladder

(diaphragmatic pain also on shoulders)

Question 9

Differentiate between dysphagia and esophageal obstruction

Answer 9

Dysphagia is just the subjective sensation of difficulty swallowing, obstruction is obstruction

Question 10

Why is esophageal variceal hemorrhage prognosis so poor?

Answer 10

1) Pt is very unstable and losing a lot of blood
2) They have cirrhosis (major underlying disease)

Question 11

1) What is Barrett’s metaplasia?
2) What is Heliobacter pylori linked to?

Answer 11

1) Premalignancy of the esophagus (having reflux for like 10 yrs)
2) Ulcers

Question 12

Odynophagia is a key Sx of what?

Answer 12

Non-reflux esophagitis (medications, infections, radiation injury)

Question 13

Eosinophilic esophagitis (EoE; non card. chest pain):
1) What age group & sex is it common in?
2) What can it cause?
3) Name one Tx

Answer 13

1) M>F, 20-30 y/o
2) Dysphagiawith solids, food impaction
3) Dupilumab

Question 14

Esophageal motility disorder (non-card chest pain): What is the main Sx?

Answer 14

Dysphagia with solids and liquids

(key point)

Question 15

Esophageal strictures and allergies are both linked to what?

Answer 15

EoE

Question 16

Esophageal candidiasis
Herpes simplex virus (HSV)
Cytomegalovirus (CMV)

These are the 3 most common causes of what?

Answer 16

Infectious esophagitis

Question 17

Esophagitis via esophageal candidiasis: What is the hallmark symptom?

Answer 17

Odynophagia

Question 18

HSV induced esophagitis usually presents with what symptom(s)?

Answer 18

Odynophagia and/or dysphagia

Question 19

Esophagitis via CMV: List 2 main clinical features

Answer 19

Odynophagia + ulcers

Question 20

CMV esophagitis:
1) Endoscopy with biopsy for what?
2) Endoscopy for initial evaluation of who?

Answer 20

1) Failure of empiric therapy
2) Severely symptomatic patients requiring hospitalization

Question 21

CMV esophagitis:
1) What Tx should all pts receive?
2) What should severe disease be treated with?

Answer 21

1) Anti-CMV therapy
2) IV therapy

Question 22

Medication/Pill-Induced esophagitis: Give examples of causes

Answer 22

1) Abx
2) Aspirin & anti-inflammatories
3) Biphosphates
4) Others

Question 23

What are 2 important groups of meds that can cause esophagitis?

Answer 23

1) Abx
2) NSAIDs

Question 24

What is a key symptom of Medication/Pill-Induced esophagitis?

Answer 24

Odynophagia

Question 25

Medication/Pill-Induced esophagitis: What are 2 key features of management?

Answer 25

1) D/c culprit medication 2) Switch to liquid formulation

Question 26

Esophageal dysmotility: What is a key feature of achalasia on barium-esophagram?

Answer 26

“Bird beak” distal esophagus

Question 27

Esophageal dysmotility: What is a key feature of achalasia?

Answer 27

Dysphagia for solids and liquids

Question 28

Lower esophageal spasm (esophageal dysmotility): 1) When may it occur? 2) Barium-esophagram can show what in severe cases? 3) How is it diagnosed?

Answer 28

1) At rest, with swallowing, or with emotional stress 2) “Corkscrew” esophagus 3) Manometry

Question 29

Hypercontractile esophagus (esophageal dysmotility): 1) What will you see on exam w this condition? 2) How is it Dx'd?

Answer 29

1) Normal peristalsis, esophageal transit & no structural disease on barium-esophagram 2) Manometry

Question 30

1) Dysphagia: is it different from dysphasia? 2) What should you first determine?

Answer 30

1) Yes; not to be confused with dysphasia 2) Acuity (acute onset suggests impaction)

Question 31

Drooling & inability to swallow liquids/saliva and hypersalivation are the main Sx of what?

Answer 31

Esophageal obstruction

Question 32

Barrett's Esophagus: 1) How is it diagnosed? 2) What does it predispose you to the development of?

Answer 32

1) Upper endoscopy with biopsy of the distal esophagus 2) Esophageal adenocarcinoma

Question 33

True or false: A barium swallow would not help Dx Barrett's esophagus

Answer 33

True

Question 34

Who should be screened for Barrett’s esophagus? (starred slide)

Answer 34

Pts w. multiple risk factors: 1) Hiatal hernia 2) Age ≥50 3) Male gender 4) Chronic GERD 5) Caucasian 6) Central obesity 7) Cigarette smoking 8) Confirmed history of Barrett's esophagus or esophageal adenocarcinoma in a first-degree relative

Question 35

Gastroesophageal reflux disease (GERD): What are the 2 classic Sx?

Answer 35

Heartburn (pyrosis) & regurgitation

Question 36

If a pt w. GERD has odynophagia or dysphagia, what should you do?

Answer 36

Send for endoscopy (also if Hematemesis/coffe-ground emesis, melena, wt loss, odynophagia or dysphagia.)

Question 37

True or false: To Dx a pt w. GERD, they must have classic symptoms

Answer 37

True

Question 38

What 2 things is initial mgmt of GERD based on?

Answer 38

1) Frequency & severity of symptoms and 2) Presence of erosive esophagitis or Barrett’s on endoscopy

Question 39

List 2 important lifestyle modifications for GERD

Answer 39

1) Weight loss 2) Elevate head of bed

Question 40

List 2 H2 blockers

Answer 40

1) Cimetidine 2) Famotidine

Question 41

Name 2 PPIs

Answer 41

Omeprazole + Esomeprazole (all end in -azole)

Question 42

Which patients with GERD need endoscopy (EGD)? -

Answer 42

1) Other symptoms (complications of GERD) in absence of classic symptoms (heartburn and/or regurgitation) 2) Confirm unclear diagnosis (ie, no response to therapy) 3) Abnormal imaging 4) Alarm features 5) Risk factors for Barrett’s esophagus

Question 43

What may forceful retching cause?

Answer 43

Mallory-Weiss Tear

Question 44

What is another name for indigestion?

Answer 44

Dyspepsia

Question 45

Dyspepsia (indigestion): 1) What may it be assoc. with? 2) What must you distinguish it from?

Answer 45

1) Heartburn, nausea, fullness, belching, vomiting 2) Heartburn

Question 46

List 6 etiologies of dyspepsia

Answer 46

1) NSAIDs 2) Antibiotics 3) Iron 4) Opioids 5) GERD 6) Biliary tract disease

Question 47

What is a common cause of gastroparesis?

Answer 47

DM

Question 48

When should EGD be considered for dyspepsia?

Answer 48

>/= 60 y/o

Question 49

When does EGD need to be done for dyspepsia? -

Answer 49

1) Pts <60 with prominent alarm features 2) Pts ~45 with higher incidence of gastric cancer

Question 50

Helicobacter pylori induced injury: Direct alteration of signal transduction in mucosal and immune cells leading to increased _____________ and diminished ______________

Answer 50

acid secretion; mucosal defenses

Question 51

1) What is the MOA of NSAID induced injury? 2) What is the main Sx?

Answer 51

1) Inhibits cyclo-oxygenase activity (COX-1 & COX-2) 2) Ulcers

Question 52

H. pylori & NSAIDs: ________________ also promotes the development of ulcers and may interact with H pylori and NSAIDs to increase mucosal injury

Answer 52

Cigarette smoking

Question 53

Differentiate between progressive and rapid onset of esophageal stricture Sx

Answer 53

1) Progressive = benign 2) Rapid = cancerous

Question 54

_____% of those who bleed from varices will die from the bleed

Answer 54

15%

Question 55

Esophageal varices variceal hemorrhage: _________ prognosis due to high rates of rebleeding, even in patients with spontaneous resolution (70% will rebleed over long term)

Answer 55

Poor