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Clin Med > GI > Flashcards

GI Flashcards

1
Q

What presents with symptoms such as heartburn, regurgitation, dysphagia, and normally has a normal physical exam?

A

GERD

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2
Q

What diagnostic tool is used when working a pt up for GERD?

A

Upper EGD

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3
Q

What are the treatments for GERD?

A

Lifestyle mods (weight loss, avoid triggers)
H2 blockers (famotidine/Pepcid)
PPI (omeprazole)
Surgery for severe/unresponsive disease

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4
Q

What can occur as a result of GERD, infection, or use of meds (such as NSAIDs)?

A

Esophagitis

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5
Q

What signs/symptoms would a pt with eosinophilic esophagitis (EoE) present with?

A

Recurrent dysphagia w/food impaction
Ringed appearance in esophagus on EGD
Esophageal narrowing

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6
Q

What is 1st line treatment for EoE?

A

PPI

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7
Q

What would cause you to suspect Barrett’s esophagus in a pt being treated for GERD?

A

Epithelial changes in the esophagus on EGD

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8
Q

What is the treatment for Barrett’s esophagus?

A

Long term PPI
Possible resection

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9
Q

What is the most common cause of esophageal cancer in the US?

A

Adenocarcinoma

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10
Q

What is achalasia?

A

Failure of the LES relaxation and peristalsis

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11
Q

What are signs/symptoms of achalasia?

A

Progressive dysphagia
Regurgitation of undigested food
Chest pain
Globus sensation
Bird beak sign on barium swallow

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12
Q

What is the gold standard test for esophageal motility disorders?

A

Esophageal manometry

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13
Q

What is the treatment for achalasia?

A

Botox injections
Pneumatic dilation
Heller myotomy

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14
Q

What 2 things commonly cause gastritis?

A

NSAIDs
H. pylori

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15
Q

What are the signs/symptoms of gastritis?

A

Burning epigastric pain
Indigestion
Epigastric bloating

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16
Q

What is the treatment for gastritis?

A

Discontinue PPIs (if no H. pylori) and NSAIDs
Treat if H. pylori

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17
Q

How long does a pt have to be off PPIs/H2 blockers before you can do a urea breath test for H. pylori?

A

2 weeks

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18
Q

How do you treat H. pylori?

A

Triple or quad therapy
Quad: bismuth, metro, tetracycline, PPI
Triple: clarithromycin, metro or amoxicillin, PPI

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19
Q

What are the signs/symptoms of peptic ulcer disease (PUD)?

A

Epigastric pain that is achy, gnawing, hunger-like
May have anorexia, weight loss, hematemesis, melena, and anemia

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20
Q

What is the gold standard diagnostic test for PUD?

A

Upper EGD

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21
Q

What is the treatment for PUD?

A

EGD w/ 1 of the following: electrocautery, epinephrine, thermocoagulation, multipolar electrocoagulation
Hospital admission if recurrence of bleeding/hemodynamically unstable
High dose PPI x 2 weeks (IV 3 days) then switch to low dose PPI x 4-8 weeks
Treat for H. pylori (if detected)

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22
Q

What condition is characterized by refractory peptic ulcers and diarrhea that is 2/2 gastric acid hypersecretion?

A

Zollinger-Ellison Syndrome (ZES)

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23
Q

What commonly causes gastric acid hypersecretion?

A

Gastrinomas

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24
Q

What diagnostic tests are ordered if pt is suspected to have ZES?

A

Upper EGD
Fasting gastrin level (>10x ULN)
Gastric pH (< 2)
Secretin stimulation test

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25
Q

What is the treatment for ZES?

A

Long-term high dose PPI
Anti-tumor treatment if metastatic disease present (octreotide, alfa-interferon)
Resection of gastrinoma if no hx of MEN I
Early bone density testing

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26
Q

What presents with symptoms such as reflux that is unresponsive to typical therapeutics, epigastric fullness, early satiety, nausea, vomiting of food eaten hours to days after intake, and weight loss with abdominal distention, and decreased frequency of bowel sounds?

A

Gastroparesis

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27
Q

What constitutes a positive gastric emptying study?

A

> 10% retention of solid food after 4 hours

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28
Q

What is the treatment for gastroparesis?

A

Gastroparesis diet (small/frequent meals low in fat/fiber)
Vitamin supplementation
Antiemetic (zofran)
Pro-kinetic agents (short term) (reglan)
TPN (if nutrition issues)

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29
Q

What is a common cause of intestinal failure that is characterized by the inability to absorb nutrients from food 2/2 having a small bowel that is too short (usually from previous bowel resections)?

A

Short bowel syndrome

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30
Q

What is a malabsorptive disorder that develops 2/2 gut stasis and a resulting change in the normal microbiome?

A

Small Intestinal Bacterial Overgrowth (SIBO)

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31
Q

What are the signs/symptoms of SIBO?

A

Food sensitivities
Abdominal cramping/bloating
Constipation
Steatorrhea
Diarrhea
Increased flatus

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32
Q

What is the gold standard diagnostic test for SIBO?

A

Small bowel aspiration and culture

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33
Q

What is the treatment for SIBO?

A

Rifaximin 550mg PO TID x 7-14 days OR
Neomycin 500mg BID + Rifaximin or Augmentin 500mg TID

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34
Q

What is a disorder of the small intestine lining resulting from an immunomodulated inflammatory response to gluten?

A

Celiac disease

35
Q

90% of pt’s who have _____ _____ have celiac disease

A

Dermatitis herpetiformis

36
Q

What is the gold standard diagnostic test for celiac disease?

A

Duodenal biopsy

37
Q

What is the standard of care in terms of treatment of celiac disease?

A

Lifelong gluten-free diet

38
Q

What are common signs/symptoms of lactose intolerance?

A

Children: watery or frothy stools
Adults: borborygmi, abdominal cramping/bloating, increased flatulence, diarrhea

39
Q

What is the test of choice for diagnosing lactose intolerance?

A

Lactose hydrogen breath test

40
Q

What are the signs/symptoms of whipple disease?

A

Progressive symptoms
Vitamin & mineral malabsorption
Weight loss
Skin darkening
Migratory arthralgias
Chronic diarrhea
Neuro deficits (maybe)

41
Q

What is the diagnostic test of choice for whipple disease?

A

Upper EGD w/biopsy

42
Q

What is an ileus?

A

Sudden onset of non-mechanical colonic obstruction without a clear etiology

43
Q

What are the signs/symptoms of an ileus?

A

May or may not have pain (pain if perf’d)
Decreased bowel sounds

44
Q

How do you treat an ileus?

A

NG tube
Electrolytes
Walking

45
Q

What is chronic intestinal pseudo-obstruction (CIBO)?

A

A disorder of the small bowel motility characterized by recurrent symptoms of intestinal obstruction, radiological findings of small bowel dilation but no evidence of mechanical obstruction

46
Q

What commonly causes viral and bacterial gastroenteritis?

A

Viral: norovirus, rotavirus, adenovirus
Bacterial: campylobacter, E. coli, salmonella, shigella, staph

47
Q

What is the treatment for gastroenteritis?

A

Viral: supportive, BRAT diet, antiemetics
Bacterial: by bug

48
Q

How do you treat traveler’s diarrhea?

A

Cipro 500mg QD x 3 days OR
Azithro

49
Q

How do you treat C. diff?

A

Initial: PO vanc or fidaxomicin
Recurrent: vanc or fidaxomicin (can be standard dose, taper, or pulsed)
Multiple recurrence: vanc followed by rifaximin & FMT

50
Q

How do you treat hemorrhoids?

A

Treat constipation
Conservative: sitz baths, topical hydrocortisone &/or lidocaine (Prep H)
Thrombectomy (if thrombosed)
Surgery if unresponsive to tx

51
Q

Are internal or external hemorrhoids typically more painful?

A

External

52
Q

What test is performed for a patient with pruritus ani to test for pinworms?

A

Tape test

53
Q

What is the treatment for pinworms?

A

OTC options OR
Mebendazole (Vermox 100mg QD)
Topical capsaicin (.006%) or topical hydrocortisone for itching/burning

54
Q

What is the gold standard surgical treatment for an anal fissure?

A

Lateral internal sphincterotomy

55
Q

What is the 4th most common cause of cancer in the US?

A

Colorectal cancer

56
Q

What are signs/symptoms of colorectal cancer?

A

Unexplained weight loss
Bright red blood in stool (not explained by other etiologies)
Persistent change in bowel habits
Change in stool caliber (“pencil thin”)

57
Q

When do you screen patients for colorectal cancer?

A

Any patient > or = 45 yo

58
Q

What is the gold standard test for screening/diagnosing colorectal cancer?

A

Colonoscopy

59
Q

What is the most common inherited colorectal cancer syndrome?

A

Hereditary Nonpolyposis Colorectal Cancer (HNPCC) AKA Lynch Syndrome

60
Q

What are the diagnostic testing/treatment for HNPCC (Lynch Syndrome)?

A

Dx: colonoscopy every 1-2 years starting at age 25
Tx: prophylactic colon resection at site of identified cancer (as soon as dx confirmed)

61
Q

What occurs to the adenomas in pts with Familial Adenomatous Polyposis (FAP)?

A

Adenomas progress to cancer in 100% of patients

62
Q

What is the diagnostic testing/treatment for FAP?

A

Dx: annual colonoscopy starting at age 10-12
Tx: prophylactic colectomy or proctocolectomy (as soon as diagnosis confirmed)

63
Q

What are the gold standard testing for an upper & lower GI bleed?

A

Upper: upper EGD
Lower: colonoscopy

64
Q

What is the difference between Crohn’s and ulcerative colitis?

A

Crohn’s: discontinuous inflammation from mouth to anus
UC: continuous mucosal inflammation limited to the colon

65
Q

What are the signs/symptoms of Crohn’s?

A

Skip lesions
Cobblestoning
Colonic fistulas
B12 deficiency

66
Q

What are the diagnostic studies for Crohn’s and UC?

A

Magnetic resonance enterography (MRE) (preferred)
Colonoscopy (study of choice)

67
Q

What are the signs/symptoms of UC?

A

Pseudopolyps
Continuous areas of inflammation
Can have bleeding

68
Q

What are the treatments for Crohn’s and UC?

A

Mild: Mesalamine (5-ASA)
Mod/Severe: corticosteroids, DMARDs, methotrexate, biologics (anti-TNF, anti-interleukin)
Abx if infection (cipro or metronidazole)
UC only: bowel resection

69
Q

What is characterized by “cramping” abdominal pain that is recurrent and episodic and improves with defecation?

A

Irritable bowel syndrome (IBS)

70
Q

What is the treatment for IBS?

A

Exercise
Diet
CBT
Antidepressants (celexa or prozac)
Imodium
Laxatives
Probiotics
Antispasmodics (bentyl, levsin)

71
Q

If a pt presents complaining of epigastric pain that radiates to the back and has amylase and lipase levels that are severely elevated (> 3x the upper limit of normal), what is the suspected diagnosis?

A

Pancreatitis

72
Q

What is the test of choice for diagnosing pancreatitis?

A

Abdominal ultrasound
CT used more often

73
Q

If a child comes in with complaints of abdominal pain and red current jelly stool, what is the most likely diagnosis?

A

Intussusception

74
Q

What is the test of choice for intussusception and what will be seen on the scan?

A

CT
Target sign

75
Q

What is the treatment for intussusception?

A

Children: reduce with air, barium, or water enema; surgery if that fails
Adults: surgical resection

76
Q

Bowel obstructions are commonly caused by what?

A

Adhesions

77
Q

What is the treatment for a bowel obstruction?

A

Uncomplicated: bowel rest, NG tube, IV hydration, treat underlying cause
Complicated: surgical exploration/intervention

78
Q

What is the criteria for toxic megacolon?

A

Radiographic evidence of colonic dilation > 6 cm AND
At least 3 of the following:
Fever > 100.4*F
Pulse > 120
Anemia
Neutrophilic leukocytosis AND
At least 1 of the following:
Dehydration
AMS
Electrolyte disturbance
Hypotension

79
Q

What is the treatment of choice for toxic megacolon?

A

Subtotal colectomy w/subsequent ileostomy

80
Q

Toxic megacolon can be a complication that arises from what infection?

A

C. diff

81
Q

What is the classic triad of symptoms in a pt who is having an abdominal aortic aneurysm (AAA) rupture?

A

Abdominal pain
Shock
Pulsatile mass

82
Q

What is described as severe, abrupt abdominal pain that is typically out of proportion to exam?

A

Ischemic bowel disease

83
Q

What is the gold standard diagnostic test for ischemic bowel disease?

A

Mesenteric angiography

84
Q

What is the treatment for ischemic bowel disease?

A

Endovascular or open revascularization
Emergent laparotomy (if perforation suspected)

Clin Med (15 decks)

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