GI Flashcards
(526 cards)
1
Q
When is a colonoscopy typically performed after complicated diverticulitis?
A
About 6 weeks after the acute episode has resolved.
2
Q
What are the suggested symptoms for the diagnosis of acute cholangitis?
A
Jaundice, fever, and tenderness in the right upper quadrant.
3
Q
What is classified as transudative pleural fluid in terms of ldh
A
Pleural fluid LDH/serum LDH ratio ≤ 0.6.
4
Q
What is classified as exudative pleural fluid in terms of ldh
A
Pleural fluid LDH/serum LDH ratio > 0.6.
5
Q
What characterizes tropical sprue?
A
Diarrhea, weight loss, and malabsorption due to villous atrophy.
6
Q
What are the cases where liver enzymes are typically in the 1000s?
A
Acetaminophen toxicity, Hepatitis A, and ischemic liver damage.
7
Q
What treatments are included for severe hypertriglyceridemia?
A
Insulin and possibly plasmapheresis.
8
Q
What is the diagnosis for a young man with palpable purpura, arthralgias, and abdominal pain after a upper respiratory infection?
A
IgA vasculitis.
9
Q
What diagnostics should patients with a history suggestive of hereditary polyposis syndrome undergo?
A
Genetic testing and a colonoscopy.
10
Q
Who should have twice yearly abdominal ultrasounds for hepatocellular carcinoma surveillance?
A
All patients with cirrhosis, Asian male HBV carriers over 40, Asian female HBV carriers over 50, any HBV carrier with a family history of hepatocellular carcinoma, and African/northern American black people with HBV infection.
11
Q
What is diagnostic of eosinophilic esophagitis?
A
Symptoms of esophageal dysfunction and esophageal biopsy.
12
Q
What nutrients are typically missing in a vegan diet?
A
Calcium, vitamin D, B12, iron, and protein.
13
Q
What is the typical use of a Dobhoff tube?
A
Enteric feeding.
14
Q
What is recommended for severe diverticulitis requiring IV antibiotics?
A
Broad-spectrum coverage with gram-negative and anaerobic coverage.
15
Q
What is the first-line treatment for reflux esophagitis and Barrett’s esophagus without dysplasia?
A
PPI therapy for indefinite duration.
16
Q
What is the appropriate treatment for a patient with MALT lymphoma and H. pylori?
A
Antibiotic therapy.
17
Q
What cancers are associated with HNPCC?
A
Endometrial cancer, gastric cancers, biliary cancers, and gliomas.
18
Q
What is IBS related to?
A
Changes in defecation, stooling frequency, and stool appearance.
19
Q
What will FeNA be in liver failure?
A
FeNA will almost always be decreased due to pre-renal injury.
20
Q
What is the diagnosis for a person with HIV who has a CD4 count of <50, chronic diarrhea, tenesmus, and colonic ulcers?
A
Cytomegalovirus.
21
Q
What is the definition of IBS?
A
Recurrent abdominal pain during the past 6 months that has been present at least one day/week of the past three months.
22
Q
What is the most common cause of isolated unconjugated hyperbilirubinemia in a healthy patient?
A
Gilbert syndrome.
23
Q
What does niacin deficiency typically cause?
A
Diarrhea, dermatitis, dementia, and death.
24
Q
What does biliary ductal dilation and gallstones in a patient with pancreatitis imply?
A
Diagnosis of acute biliary pancreatitis.
25
What should be done in biliary pancreatitis when stones are visualized on CT and there is evidence of acute cholangitis?
ERCP should be performed in 24 hours.
26
What are the two criteria of Barrett esophagus?
Columnar epithelium lining the distal esophagus and biopsy specimens must reveal intestinal metaplasia.
27
What is the most appropriate strategy for managing a small asymptomatic pancreatic pseudocyst?
Observation.
28
What must be ruled out before confirming IBS?
IBD, Giardia, and celiacs.
29
What is the MELD-Na score of less than 17 indicative of?
Less than 2% 90-day mortality rate.
30
What is the treatment for microscopic colitis?
Budesonide; many cases resolve from dietary restriction or avoidance of medications, but many need treatment.
31
What is the most common cause of isolated unconjugated hyperbilirubinemia in a healthy patient?
Gilbert syndrome
32
What are the typical symptoms of niacin deficiency?
Diarrhea, dermatitis, dementia, and death
33
What is bilirubin?
A heme degradation product
34
What does biliary ductal dilation and gallstones in a patient with pancreatitis imply?
Diagnosis of acute biliary pancreatitis
35
When should ERCP be performed in biliary pancreatitis?
Within 24 hours when stones are visualized on CT and there is evidence of acute cholangitis
36
What is the diagnosis in a young man with palpable purpura, arthralgias, and abdominal pain after a streptococcal throat infection?
IgA vasculitis
37
What is IBS related to?
Changes in defecation, stooling frequency, and stool appearance
38
What is classified as transudative pleural fluid?
Pleural fluid protein/serum protein ratio ≤ 0.5
39
What cancers are associated with FAP?
Colon cancer, thyroid cancer, hepatoblastoma, and medulloblastoma
40
What is classified as exudative pleural fluid?
Pleural fluid protein/serum protein ratio > 0.5
41
What is better for diagnosing inactive GI bleeds?
Video capsule endoscopy
42
What is the second-line treatment of eosinophilic esophagitis?
Aerosolized steroids
43
What are the endoscopic findings of eosinophilic esophagitis?
Circumferential mucosal lesions and longitudinal furrows
44
What does Gilbert syndrome result from?
Decreased expression of UDP glucuronyl transferase
45
What are the four most common causes of pancreatitis?
Gallstones, alcohol, ERCP, and triglyceridemia
46
What is a common associated feature of eosinophilic esophagitis?
Atopy, leading to hypersensitivity reactions such as allergic rhinitis, eczema, and asthma
47
What is the first-line treatment for reflux esophagitis and Barrett's esophagus without dysplasia?
PPI therapy of indefinite duration
48
What are the criteria for MELD-Na Score?
Creatinine, bilirubin, INR, sodium, and dialysis at least 2x in the past week
49
What suggests a diagnosis of acute cholangitis?
Jaundice, fever, and tenderness in the right upper quadrant
50
What is associated with HNPCC?
Endometrial cancer, gastric cancers, biliary cancers, and gliomas
51
What can zinc deficiency cause?
Alopecia, night blindness, and hypogonadism
52
What is the diagnosis for a person with HIV who has a CD4 count of <50, chronic diarrhea, tenesmus, and colonic ulcers?
Cytomegalovirus
53
Who should have twice yearly abdominal ultrasounds for hepatocellular carcinoma surveillance?
All patients with cirrhosis, Asian male HBV carriers over 40, Asian female HBV carriers over 50, any HBV carrier with a family history of hepatocellular carcinoma, and African/northern American black people with HBV infection
54
What autoimmune markers increase when celiac disease patients eat gluten?
Endomysial antibody or TTG–IgA
55
What is the next diagnostic step for an older patient with signs of GI bleed but nonrevealing upper and lower endoscopy?
Video capsule endoscopy
56
What is the treatment for H. pylori?
PPI, bismuth subsalicylate, metronidazole, and tetracycline
57
What is the typical presentation of colonic ischemia?
Cramping abdominal pain and bloody diarrhea
58
What are the two criteria of Barrett's esophagus?
Columnar epithelium lining the distal esophagus and biopsy specimens must reveal intestinal metaplasia
59
What is the most effective way to prepare a patient for colonoscopy?
Half preparation given the night before the procedure, after preparation given the morning of the procedure
60
What is the most appropriate diagnostic for suspected acute cholangitis?
Ultrasound of the RUQ
61
Does meningococcemia typically have GI manifestations?
No, it typically does not
62
What should patients with a strong family history of cancer and a personal history of duodenal adenoma undergo?
Genetic testing and a colonoscopy
63
What is the treatment for tropical sprue?
Oral tetracycline for 3 to 6 months
64
What are the typical nutrients missing in a vegan diet?
Calcium, vitamin D, B12, iron, and protein
65
What is the diagnosis for a patient with INR >1.5, hepatic encephalopathy, and symptomatic for less than 26 weeks without previous liver disease?
Acute liver failure
66
What is the recommended treatment for a patient with confirmed functional gallbladder disorder and a low gallbladder ejection fraction?
Cholecystectomy
67
Why is rifamixin beneficial in hepatic encephalopathy?
It is minimally absorbed and concentrated in the GI tract, killing enteric bacteria that produce ammonia
68
What is the secondary prevention of recurrent hepatic encephalopathy in a patient with cirrhosis?
Consistent treatment with lactulose and rifamixin
69
What is the most likely cause of portal hypertension in a patient with normal liver function who recently emigrated from North Africa?
Schistosomiasis
70
What is the association between microscopic colitis and other GI autoimmune diseases?
There is an association with celiac disease
71
What is the treatment for severe diverticulitis requiring IV antibiotics?
Broad-spectrum coverage with gram-negative and anaerobic coverage
72
What must be ruled out before confirming IBS?
IBD, Giardia, and celiac disease
73
What is the typical presentation of acute colonic pseudo-obstruction?
Conservative treatment includes use of nasogastric and rectal tubes
74
True or False: Meningococcemia typically does not have GI manifestations.
True
75
What is likely for a patient with a strong family history of cancer and a personal history of duodenal adenoma?
Hereditary polyposis syndrome
76
Who should have twice yearly abdominal ultrasounds as surveillance for hepatocellular carcinoma?
All patients with cirrhosis, Asian male HBV carriers over 40, Asian female HBV carriers over 50, any HBV carrier with a family history of hepatocellular carcinoma, and African/northern American black people with HBV infection
77
What does niacin deficiency typically cause?
Diarrhea, dermatitis, dementia, and death
78
What is a characteristic of a Dobhoff tube?
It has a weight at the end
79
True or False: Peripartum injury to the sphincter apparatus can lead to decades long fecal incontinence but with normal sensation.
True
80
Why is a colonoscopy not recommended in the acute setting of severe diverticulitis?
Due to the risk of perforation
81
What is the most useful initial diagnostic for a cirrhotic presenting with abdominal pain, ascites, low BP, and signs of AKI and UTI?
Diagnostic paracentesis
82
What type of drug is Neostigmine?
An acetylcholinesterase inhibitor
83
What is the next step in management for acute biliary pancreatitis with signs of acute cholangitis?
ERCP
84
What defines IBS?
Recurrent abdominal pain during the past 6 months that has been present at least one day/week of the past three months
85
True or False: Folate intake is typically adequate in a vegan diet.
True
86
What is the most indicated first step in imaging for suspected SBO?
CT
87
What happens during a KUB imaging?
The patient is typically on their back, and air rises to the surface of the abdomen, obstructing the view
88
What are the colonoscopy findings for 1-2 tubular adenomas <10mm?
Repeat in 7-10 years
89
What are the colonoscopy findings for 3-4 tubular adenomas <10mm?
Repeat in 3-5 years
90
What are the colonoscopy findings for 5-10 tubular adenomas <10mm?
Repeat in 3 years
91
What are the colonoscopy findings for >10mm villous/tubulovillous adenomas?
Repeat in 3 years
92
What is the follow-up for >10 adenomas?
Repeat in 1 year
93
What is the likely diagnosis for a patient with eosinophilic infiltrate in the small intestinal mucosa and chronic diarrhea?
Eosinophilic gastroenteritis
94
What is the treatment for eosinophilic gastroenteritis?
Systemic steroids
95
What is the diagnosis for a person with HIV who has a CD4 count of <50, chronic diarrhea, and colonic ulcers?
Cytomegalovirus
96
Where can AST be found?
In liver, bone, and heart tissue
97
What are the two criteria of Barrett esophagus?
Columnar epithelium lining the distal esophagus and biopsy specimens must reveal intestinal metaplasia
98
What cancers are associated with HNPCC?
Endometrial cancer, gastric cancers, biliary cancers, and gliomas
99
What is the first-line therapy for mild oropharyngeal candidiasis?
Clotrimazole troches or miconazole mucoadhesive buccal tablets
## Footnote
Alternative choices include nystatin suspension or pastilles.
100
What is recommended for more severe oropharyngeal candidiasis or if there is no response to local therapy?
Oral fluconazole
101
What symptoms may indicate esophageal candidiasis?
Odynophagia or retrosternal pain
102
What is the first-line therapy for esophageal candidiasis?
Oral fluconazole
103
What is usually reserved for fluconazole-refractory candidiasis?
Itraconazole
104
Fill in the blank: Nystatin suspension or pastilles are _______ choices for mild oropharyngeal candidiasis.
alternative
105
True or False: Clotrimazole troches is an alternative therapy for mild oropharyngeal candidiasis.
False
106
What are the two first-line therapies for mild oropharyngeal candidiasis?
Clotrimazole troches and miconazole mucoadhesive buccal tablets
107
What is the leading diagnosis for a patient with heavy alcohol and tobacco use and a nonhealing oral ulcer with white exudate?
Squamous-cell carcinoma
## Footnote
This diagnosis is supported by the patient's age and lifestyle factors.
108
How do squamous-cell carcinomas of the oral cavity typically manifest?
As nonhealing papules, erosions, or ulcerations, frequently with associated pain
## Footnote
Symptoms can vary but often include discomfort.
109
What percentage of squamous-cell carcinomas of the head and neck occur in individuals with a history of alcohol and tobacco use?
Up to 80%
## Footnote
This statistic highlights the significant risk factors associated with these cancers.
110
Fill in the blank: Squamous-cell carcinomas of the oral cavity often present with _______.
nonhealing papules, erosions, or ulcerations
111
True or False: Squamous-cell carcinoma is rarely associated with alcohol and tobacco use.
False
## Footnote
A significant correlation exists between these lifestyle factors and the incidence of this cancer.
112
What is oral hairy leukoplakia?
An opportunistic infection caused by the Epstein-Barr virus in immunocompromised patients
113
Which virus causes oral hairy leukoplakia?
Epstein-Barr virus
114
In which type of patients does oral hairy leukoplakia commonly occur?
Immunocompromised patients, usually people with HIV
115
Describe the appearance of oral hairy leukoplakia.
A white, corrugated, hairy-looking area on the side of the tongue
116
Can the lesions associated with oral hairy leukoplakia be removed by scraping?
No
117
What are recurrent ulcers on the buccal mucosa and the tongue that are round, shallow, and have a gray base most consistent with?
A diagnosis of aphthous stomatitis.
118
vitamin b12 is absorbed by which organ structure
the distal ileum
119
What vitamin does sulfasalazine inhibit?
Folate absorption
120
What condition can long-term treatment with sulfasalazine cause?
Megaloblastic anemia
121
What supplementation should all patients starting on sulfasalazine receive?
Folate supplementation
122
Fill in the blank: Long-term treatment with sulfasalazine can cause _______ anemia.
Megaloblastic anemia
123
True or False: All patients starting sulfasalazine should be given folate supplementation.
True
124
List some medications that interfere with folic-acid metabolism.
* Methotrexate
* Phenytoin
* Pyrimethamine
125
Fill in the blank: Other common causes of folic-acid deficiency include _______.
Poor folate intake, alcoholism, increased requirements due to pregnancy and hemolytic anemia
126
What are the differential diagnosis possibilities for salivary swellings?
* Benign neoplasms
* Malignancy
* Salivary stones and stenosis
* Salivary swelling secondary to a systemic illness such as Sjögren syndrome or HIV infection
## Footnote
The order of frequency is important in clinical evaluation.
127
What is the risk percentage for malignancy in patients with salivary-gland lumps or enlargement?
45%–70%
## Footnote
This high risk necessitates further evaluation.
128
What should patients with salivary-gland lumps or enlargement (not associated with infection) be referred for?
Imaging and evaluation by a head and neck surgeon
## Footnote
This is crucial due to the risk of malignancy.
129
What is the best initial imaging approach for evaluating salivary swellings?
CT of the head and neck
## Footnote
CT is preferred for its ability to distinguish between diffuse enlargement and focal masses.
130
What are the advantages of using CT over MRI for initial imaging of salivary swellings?
* Lower cost
* Greater availability
## Footnote
These factors make CT the typical choice for initial assessment.
131
What does CT imaging allow for in the evaluation of salivary swellings?
* Distinguishing diffuse enlargement from focal masses
* Characterizing the parenchyma
* Evaluating levels 2 and 3 lymph nodes
## Footnote
These elements are critical for accurate diagnosis.
132
Fill in the blank: Salivary swelling (adenosis) can be secondary to a systemic illness such as _______.
Sjögren syndrome or HIV infection
## Footnote
Recognizing systemic causes is important in differential diagnosis.
133
True or False: MRI is the preferred initial imaging method for salivary swellings.
False
## Footnote
CT is typically preferred due to cost and availability.
134
What are classic symptoms of esophagitis induced by medication?
Odynophagia and retrosternal chest pain
## Footnote
These symptoms are indicative of esophagitis, which is inflammation of the esophagus.
135
Where do endoscopic findings typically show esophagitis in medication-induced cases?
Mid- to upper esophagus
## Footnote
This differs from gastroesophageal reflux disease, which is typically seen in the lower esophagus.
136
Name medications that can cause medication-induced esophagitis.
* Tetracyclines
* Bisphosphonates
* Potassium chloride
* Nonsteroidal antiinflammatory medications
## Footnote
These medications can cause direct caustic irritation of the esophagus.
137
What are risk factors for pill esophagitis?
* Older age (> 70 years)
* Lack of adequate fluid bolus
* Delayed peristalsis
* Recent thoracotomy
* Recumbent positioning after pill ingestion
## Footnote
These factors increase the likelihood of developing esophagitis after taking pills.
138
What is the most appropriate intervention for medication-induced esophagitis?
Discontinue the offending medication
## Footnote
In this case, doxycycline is the medication that should be stopped.
139
True or False: Medication-induced esophagitis is typically found in the lower esophagus.
False
## Footnote
It is typically found in the mid- to upper esophagus.
140
What is Zenker diverticulum typically associated with in terms of age and gender?
Typically seen after age 70 and usually in men
141
What is the most common presentation of Zenker diverticulum?
Dysphagia
142
What symptoms do patients with Zenker diverticulum commonly describe?
Regurgitation of undigested food, bad breath, gurgling sensation in the throat, hoarseness
143
What is the etiology of Zenker diverticulum thought to be?
Weakness in the pharyngeal wall above the upper esophageal sphincter due to poor compliance of the upper esophageal sphincter
144
What symptoms suggest oropharyngeal dysphagia in patients with Zenker diverticulum?
Presence of sore throat and a raspy voice
145
True or False: Zenker diverticulum is primarily found in women.
False
146
Fill in the blank: The presence of _______ and a raspy voice suggest oropharyngeal dysphagia.
sore throat
147
What noninvasive measurement should patients with cirrhosis undergo to determine the need for a non-selective beta blocker?
Measurement of liver stiffness by transient elastography
148
What is the threshold measurement in kPa by liver elastography for starting a nonselective beta blocker in patients with cirrhosis?
≥25 kPa
149
What treatment should be started if liver stiffness measurement is ≥25 kPa?
Nonselective beta-blockers for primary prevention of variceal bleeding
150
Fill in the blank: Patients with cirrhosis should be started on _______ for primary prevention of variceal bleeding if liver stiffness is ≥25 kPa.
nonselective beta-blockers
151
What disorder is characterized by simultaneous contractions of the distal esophageal smooth muscle?
Diffuse esophageal spasm
## Footnote
This disorder leads to dysphagia and chest pain.
152
What test can reveal areas of spasm in the esophagus?
Barium swallow test
## Footnote
It may show a corkscrew appearance.
153
What confirms the diagnosis of diffuse esophageal spasm?
Esophageal manometry revealing simultaneous contractions of the distal esophageal smooth muscle
## Footnote
Minimum amplitude of 30 mm Hg in ≥ 20% of wet swallows and presence of some normal peristaltic waves.
154
What is the initial approach to treatment for diffuse esophageal spasm?
Acid suppression
## Footnote
This is because it is sometimes associated with esophageal reflux.
155
What medication class may provide symptomatic improvement for diffuse esophageal spasm?
Proton pump inhibitor
## Footnote
Used for patients with acid reflux symptoms.
156
If patients do not respond to acid suppression in diffuse esophageal spasm, what should they be treated with?
CCB or nitrate
## Footnote
Examples include calcium-channel blockers or nitrates.
157
What is an example of a calcium-channel blocker used in treating diffuse esophageal spasm?
Diltiazem
## Footnote
It is one of the smooth-muscle relaxants recommended.
158
True or False: Diffuse esophageal spasm is associated with chest pain.
True
## Footnote
Chest pain is one of the symptoms experienced by patients.
159
Fill in the blank: The presence of some _______ waves is noted in the diagnosis of diffuse esophageal spasm.
Normal peristaltic
## Footnote
These waves are part of the diagnostic criteria.
160
What symptoms frequently manifest with paraesophageal hernias?
Symptoms of esophageal reflux
## Footnote
Paraesophageal hernias can cause discomfort and complications related to the reflux of stomach contents into the esophagus.
161
What additional evaluation is required when dysphagia is present in paraesophageal hernias?
Esophagogastroduodenoscopy
## Footnote
Dysphagia, or difficulty swallowing, may indicate more serious underlying issues that need to be investigated.
162
What is Barrett esophagus?
A condition where the tissue lining the esophagus changes, often due to chronic acid reflux.
## Footnote
Barrett esophagus is associated with an increased risk of esophageal cancer.
163
What is low-grade dysplasia in the context of Barrett esophagus?
A precancerous condition indicating abnormal cell changes in Barrett esophagus.
## Footnote
Low-grade dysplasia suggests a risk for progression to high-grade dysplasia or cancer.
164
What is the recommended management strategy for Barrett esophagus with newly diagnosed low-grade dysplasia?
Surveillance endoscopy or endoscopic ablation.
## Footnote
Surveillance endoscopy is typically performed initially every 6 months.
165
How often should surveillance endoscopy be performed for newly diagnosed low-grade dysplasia?
Initially every 6 months.
## Footnote
This frequency is aimed at closely monitoring for any progression of dysplasia.
166
What is endoscopic ablation?
A procedure to remove or destroy abnormal tissue in the esophagus.
## Footnote
Endoscopic ablation can help prevent progression to esophageal cancer.
167
True or False: The only management option for Barrett esophagus with low-grade dysplasia is endoscopic ablation.
False.
## Footnote
Both surveillance endoscopy and endoscopic ablation are recommended options.
168
What condition is responsible for about half the cases of recurrent food impaction in nonelderly men?
Eosinophilic esophagitis
## Footnote
Eosinophilic esophagitis often affects younger males.
169
What is the likely mechanism of dysphagia in eosinophilic esophagitis?
Inflammatory response causing remodeling of the esophagus
## Footnote
This remodeling can lead to the development of rings and strictures.
170
What allergic conditions are strongly associated with eosinophilic esophagitis?
Atopic dermatitis, rhinitis, asthma, and food allergies
## Footnote
These associations highlight the allergic nature of the condition.
171
How long do symptoms of eosinophilic esophagitis often occur before a diagnosis is made?
For months or years
## Footnote
This delay in diagnosis can complicate management and treatment.
172
Fill in the blank: Eosinophilic esophagitis causes remodeling of the esophagus, resulting in the development of _______.
rings and strictures
## Footnote
These structural changes can lead to significant swallowing difficulties.
173
What percentage of patients with systemic sclerosis develop gastrointestinal problems?
Up to 90%
174
What part of the esophagus is most affected by systemic sclerosis?
Distal esophagus
175
What physiological changes occur in the esophagus due to systemic sclerosis?
Smooth-muscle atrophy and fibrosis
176
What does esophageal manometry show in patients with systemic sclerosis?
Diminished peristalsis in the lower two-thirds of the esophagus and decreased pressure in the lower esophageal sphincter
177
What are typical symptoms of scleroderma of the esophagus?
* Heartburn
* Dysphagia
* Regurgitation
178
What is the primary cause of dysphagia in patients with scleroderma of the esophagus?
Dysmotility
179
What lifestyle modification can benefit patients with scleroderma of the esophagus?
Eating multiple small meals throughout the day
180
What type of therapy can help relieve symptoms of scleroderma of the esophagus?
Antisecretory therapy with a proton pump inhibitor
181
Which prokinetic agents can be added to treatment for esophageal motility disorders?
* Metoclopramide
* Domperidone
182
What serious adverse effect is associated with metoclopramide?
Irreversible tardive dyskinesia
183
What is the maximum recommended duration for metoclopramide therapy?
No more than 12 weeks
184
What cardiac concern is associated with domperidone?
Long-QT syndrome
185
True or False: Domperidone is available in the United States without any application process.
False
186
What is a common long-term complication after exposure to caustic substances?
Stricture formation
187
What procedure should be performed as part of the evaluation after caustic substance exposure?
Upper endoscopy
188
What is the mainstay of treatment if endoscopic findings are mild in caustic ingestion?
Observation for complications and supportive care
189
What supportive care is recommended for patients with mild symptoms after caustic exposure?
Nothing by mouth and later advancing diet as tolerated
190
What protocol is recommended for severe cases of caustic ingestion with deep ulcerations?
Usta protocol
191
What medications are included in the Usta protocol for caustic ingestion?
Methylprednisolone, ranitidine, and ceftriaxone
192
Is the Usta protocol for caustic injection needed in milder cases?
No
193
What should be obtained if there are areas of necrosis or perforation on egd in a case of caustic ingestion?
CT scan and surgical consultation
194
What is the most likely diagnosis in an immunosuppressed kidney transplant recipient with dysphagia?
Cytomegalovirus (CMV)-related esophagitis
## Footnote
This condition is particularly associated with immunosuppressed patients.
195
What does a positive CMV immunoglobulin G titer indicate in the context of kidney transplant evaluation?
It indicates prior exposure to Cytomegalovirus (CMV)
## Footnote
This is relevant for assessing risk in transplant recipients.
196
What diagnostic procedure should be performed to confirm viral esophagitis?
Upper endoscopy
## Footnote
This procedure allows direct visualization and biopsy of the esophagus.
197
What symptom is commonly associated with CMV-related esophagitis in kidney transplant recipients?
Dysphagia
## Footnote
Dysphagia refers to difficulty swallowing.
198
Before treatment for CMV-related esophagitis is initiated, what must be confirmed?
The presence of viral esophagitis
## Footnote
Confirmation is critical to ensure appropriate management.
199
What is the purpose of botulinum toxin injection into the lower esophageal sphincter?
To treat achalasia, particularly in patients who are not candidates for surgery.
200
What symptoms does achalasia typically cause?
Dysphagia to both solid foods and liquids, as well as regurgitation of undigested food.
201
What does a barium esophagram demonstrate in cases of achalasia?
A dilated esophagus with a narrowed esophagogastric junction.
202
What appearance does achalasia present on a barium esophagram?
A bird-beak appearance.
203
What causes the bird-beak appearance in achalasia?
Loss of peristalsis in the distal esophagus and a persistently contracted lower esophageal sphincter.
204
Fill in the blank: Achalasia results in dysphagia to both _______ and _______.
solid foods; liquids
205
What are Schatzki rings?
Benign, mucosal structures at the gastroesophageal junction
206
What symptom do Schatzki rings classically cause?
Intermittent solid-food dysphagia
207
What types of food commonly trigger dysphagia in patients with Schatzki rings?
* Meat
* Bread
208
How do Schatzki rings appear on an upper gastrointestinal series?
As a narrowing in the distal esophagus
209
What additional imaging in addition to egd and barium swallow can help identify the site of functional obstruction in Schatzki rings?
Barium-covered tablet
210
How do Schatzki rings appear during upper endoscopy when the esophagus is widely distended?
As a thin, smooth, circumferential membrane
211
What is the first-line therapy for Schatzki rings?
Balloon or Savary dilation
212
What is the outcome associated with balloon or Savary dilation for Schatzki rings?
Prompt symptom resolution and a low rate of recurrence
213
What treatment is recommended after dilation of Schatzki rings?
Acid suppression
214
In which patients is acid suppression particularly recommended after dilation for Schatzki rings?
Patients with recurrent strictures and symptomatic gastroesophageal reflux disease
215
What is the most common malignant cause of stricture in the esophagus?
The most common malignant cause of stricture in the esophagus is gastroesophageal cancer.
## Footnote
Gastroesophageal cancer includes both esophageal and stomach cancers that affect the junction area.
216
After endoscopy, and discovery of a GI malignancy, what imaging should be conducted to evaluate for metastatic disease?
CT of the chest, abdomen, and pelvis should be conducted to evaluate for metastatic disease.
## Footnote
CT scans help assess the spread of cancer to other organs.
217
What are the findings on barium swallow indicative of a diagnosis of achalasia?
A bird’s beak deformity and dilated esophagus on a barium-swallow study.
## Footnote
These findings are crucial for diagnosis.
218
What must be ruled out before confirming a diagnosis of achalasia?
Pseudoachalasia and other structural diseases.
## Footnote
This is particularly important for patients who are older, have a short duration of symptoms, or have been losing weight.
219
What is pseudoachalasia?
Diseases that cause esophageal motor abnormalities similar to primary achalasia, such as malignancy, eosinophilic gastroenteritis, and Chagas disease.
## Footnote
Differentiating pseudoachalasia from primary achalasia is essential for appropriate treatment.
220
Which diagnostic tool is used to confirm achalasia?
Manometry.
## Footnote
Manometry measures the pressure and pattern of muscle contractions in the esophagus.
221
What is the significance of patient age in diagnosing achalasia?
Older age can indicate the need to rule out pseudoachalasia and other structural diseases.
## Footnote
A thorough evaluation is critical to avoid misdiagnosis.
222
Fill in the blank: Pseudoachalasia can be caused by _______.
malignancy, eosinophilic gastroenteritis, Chagas disease.
223
True or False: Weight loss is not a concerning symptom in diagnosing achalasia.
False.
## Footnote
Weight loss can be an important indicator that warrants further investigation.
224
What anatomical position is associated with paraesophageal herniation?
Supradiaphragmatic position of the stomach fundus
## Footnote
This indicates that the stomach is positioned above the diaphragm, which is abnormal.
225
True or False: Vomiting is a common symptom of paraesophageal herniation.
True
## Footnote
Patients often experience vomiting due to obstruction or compression caused by the herniation.
226
Fill in the blank: The symptom that typically precedes acute chest and abdominal discomfort in paraesophageal herniation is _______.
Vomiting
## Footnote
Vomiting can occur due to the displacement of the stomach.
227
What are the typical symptoms of paraesophageal herniation?
* Vomiting
* Acute chest discomfort
* Abdominal discomfort
## Footnote
Symptoms can vary, but these are some of the most common presentations.
228
What percentage of intrathoracic hernias do paraesophageal hernias represent?
5% to 10%
## Footnote
Paraesophageal hernias are a specific type of intrathoracic hernia.
229
How do paraesophageal hernias differ from sliding hiatal hernias?
Paraesophageal hernias develop when the fundus herniates through the diaphragm alongside the esophagus; sliding hiatal hernias are characterized by cephalad movement of the gastroesophageal junction.
## Footnote
This distinction is crucial for diagnosis and treatment.
230
What are some potentially life-threatening complications of paraesophageal hernias?
* Intrathoracic incarceration of the stomach
* Reduced pulmonary reserve
* Bleeding
* Perforation
## Footnote
These complications highlight the seriousness of paraesophageal hernias.
231
Historically, what percentage of patients with paraesophageal hernias were thought to experience complications?
30% to 45%
## Footnote
This statistic has influenced historical treatment recommendations.
232
What type of repair is currently offered for patients with symptomatic paraesophageal hernias?
Laparoscopic repair
## Footnote
This minimally invasive approach is preferred for symptomatic cases.
233
What management strategy may be suggested for asymptomatic patients with paraesophageal hernias?
Expectant management
## Footnote
This approach allows monitoring without immediate intervention.
234
Are gastric residual volumes recommended for routine care in patients on enteral nutrition in the ICU?
No, gastric residual volumes are no longer recommended as part of routine care.
235
What should be done if gastric residuals are still used in clinical locations?
Enteral nutrition should not be held for residuals < 500 mL in the absence of other signs of intolerance.
236
When should enteral feedings be stopped?
Enteral feedings should be stopped only if the residual is > 500 mL or if the patient regurgitates or aspirates.
237
Fill in the blank: Enteral nutrition should not be held for residuals _______ in the absence of other signs of intolerance.
< 500 mL
238
True or False: Enteral feedings should be stopped after a single elevated gastric residual volume.
False
239
What is the threshold gastric residual volume that warrants stopping enteral feedings?
> 500 mL
240
What is tropical sprue?
A syndrome that occurs in tropical climates characterized by chronic diarrhea, weight loss, and malabsorption of nutrients due to villous atrophy.
## Footnote
Villous atrophy refers to the flattening of the villi in the intestine, which impairs nutrient absorption.
241
What are the symptoms of tropical sprue?
Chronic diarrhea, weight loss, and malabsorption of nutrients.
## Footnote
Glossitis can also occur due to iron deficiency associated with the condition.
242
What can cause glossitis in tropical sprue?
Iron deficiency.
## Footnote
Glossitis is an inflammation of the tongue, which can be a symptom of nutritional deficiencies.
243
What is the known cause of tropical sprue?
The cause is unknown but thought to be due to a microbial infection.
## Footnote
The precise microbial agent has not been definitively identified.
244
What is the empiric treatment for tropical sprue?
Oral tetracycline 250 mg four times daily.
## Footnote
Empiric treatment refers to treatment initiated before a definitive diagnosis is made.
245
The most appropriate treatment for tropical sprue is oral tetracycline for how long?
3 to 6 months.
246
What is pernicious anemia?
A condition characterized by vitamin B12 deficiency and megaloblastic anemia in patients with autoimmune gastritis.
247
What leads to vitamin B12 deficiency in pernicious anemia?
Autoimmune destruction of gastric parietal cells in autoimmune gastritis (AIG) leads to reduced intrinsic factor production.
248
What role does intrinsic factor play in vitamin B12 absorption?
Intrinsic factor is necessary for absorption of vitamin B12 at the terminal ileum.
249
What antibodies are often present in pernicious anemia?
Antibodies to intrinsic factor are often present.
250
Fill in the blank: Pernicious anemia is associated with _______ anemia.
megaloblastic
251
True or False: Pernicious anemia is solely caused by dietary deficiency of vitamin B12.
False
252
What is the primary autoimmune condition linked to pernicious anemia?
Autoimmune gastritis (AIG)
253
What tests have the highest positive and negative predictive values for H. pylori testing?
Urea breath test and fecal antigen tests
## Footnote
These tests are preferred for their accuracy in diagnosing H. pylori infection.
254
Why is serological testing not preferred as a first-line test for diagnosing H. pylori infection in asymptomatic individuals?
It cannot distinguish active from past infections and has lower diagnostic specificity compared to other methods
## Footnote
This limitation affects its reliability in diagnosing current infections.
255
What conditions are associated with H. pylori infection?
Ulcer disease and certain gastric malignancies, such as:
* Gastric adenocarcinoma
* Gastric mucosa-associated lymphoid tissue lymphoma
## Footnote
These associations highlight the potential severity of H. pylori infections.
256
True or False: Most patients infected with H. pylori develop complications such as gastric malignancies.
False
## Footnote
Only a very small minority of infected patients develop these complications.
257
Fill in the blank: The _______ breath test is a preferred method for H. pylori testing.
urea
## Footnote
This test is known for its high diagnostic accuracy.
258
What is a key reason for the preference of fecal antigen tests in H. pylori diagnosis?
High positive and negative predictive values
## Footnote
This ensures reliable results in identifying active infections.
259
What does the 2024 American College of Gastroenterology guidelines recommend for active peptic ulcer disease, what should you test for?
H. pylori testing
## Footnote
This includes individuals with a history of peptic ulcer disease without prior H. pylori eradication therapy.
260
In which scenario is H. pylori testing recommended for individuals with dyspepsia?
Uninvestigated dyspepsia
## Footnote
This applies when dyspepsia has not been previously assessed.
261
What condition associated with gastric mucosa prompts H. pylori testing?
Gastric mucosa-associated lymphoid tissue lymphoma
## Footnote
This is a type of cancer that can be related to H. pylori infection.
262
When should H. pylori testing be performed in relation to early gastric cancer?
Before endoscopic resection of early gastric cancer
## Footnote
Testing is recommended to determine the presence of H. pylori prior to the procedure.
263
What type of anemia warrants H. pylori testing according to the guidelines?
Unexplained iron deficiency anemia
## Footnote
This is significant as H. pylori can contribute to iron deficiency.
264
What is a hematological condition in adults that requires H. pylori testing?
Immune thrombocytopenia
## Footnote
This condition involves low platelet counts and can be associated with H. pylori infection.
265
Who should be tested for H. pylori if they are on chronic therapy?
Individuals on chronic NSAID therapy
## Footnote
Chronic NSAID use can increase the risk of peptic ulcers, necessitating testing.
266
Before starting what common preventative/anti-platelet therapy should H. pylori testing be conducted?
Chronic low-dose aspirin therapy
## Footnote
This is to prevent potential gastrointestinal complications.
267
Who should be tested for H. pylori if they share a household with an infected individual?
Adults who share a household with an individual diagnosed by a nonserological test
## Footnote
Close contact increases the risk of transmission.
268
What is gastrin?
An intestinal hormone secreted into the blood by antral G cells in response to a meal or high gastric pH level
## Footnote
Gastrin plays a key role in digestive processes.
269
Where is gastrin secreted from?
Antral G cells
## Footnote
Antral G cells are located in the stomach.
270
What triggers the secretion of gastrin?
A meal or high gastric pH level
## Footnote
Gastrin helps stimulate gastric acid secretion.
271
What effect do proton pump inhibitors (PPIs) have on gastrin levels?
They may cause elevated gastrin levels
## Footnote
Examples of PPIs include omeprazole.
272
How can hypergastrinemia be confirmed in the setting of PPI use?
By remeasuring the serum gastrin level at least 2 weeks after discontinuing the PPI
## Footnote
This helps to determine if the elevated level is due to medication.
273
When should gastrin levels be measured for accuracy?
Under fasting conditions
## Footnote
Elevated gastrin levels are common postprandially.
274
What does the American College of Gastroenterology recommend regarding H. pylori eradication?
Eradication of Helicobacter pylori should be confirmed in any patient who has an H. pylori-associated ulcer with complications such as bleeding.
## Footnote
This recommendation aims to ensure proper management of complications related to H. pylori infections.
275
What is a simple method for confirming H. pylori eradication?
H. pylori stool antigen testing.
## Footnote
This testing method is preferred due to its simplicity and effectiveness.
276
When should H. pylori stool antigen testing be performed after therapy?
At least 4 weeks after the completion of therapy.
## Footnote
Performing the test too early may lead to false results.
277
What other test, besides stool testing, can be used to confirm H. pylori eradication?
Urea breath test.
## Footnote
The urea breath test is another reliable method for verifying eradication.
278
How long should proton pump inhibitors be discontinued before testing for H. pylori eradication?
2 weeks.
## Footnote
Discontinuing proton pump inhibitors is crucial to avoid interference with test results.
279
What is the primary symptom of dyspepsia?
Epigastric pain
## Footnote
This pain is often described as burning and may be associated with other symptoms.
280
How long must symptoms persist to diagnose dyspepsia?
At least one month
## Footnote
Symptoms must be present for a month to meet the criteria for diagnosis.
281
What are common additional symptoms associated with dyspepsia?
Bothersome postprandial fullness or early satiation
## Footnote
Dyspepsia can also be associated with heartburn, nausea, and vomiting.
282
What distinguishes dyspepsia from gastroesophageal reflux disease (GERD)?
Dyspepsia is characterized by epigastric discomfort, while GERD involves regurgitation and retrosternal burning pain
## Footnote
The management of dyspepsia differs from that of GERD.
283
What is the recommended approach for patients under 60 years old with dyspepsia?
Testing for Helicobacter pylori and treatment if positive
## Footnote
This test-and-treat strategy is considered beneficial and cost-effective.
284
What should patients aged 60 years or older undergo when evaluating dyspepsia?
Upper endoscopy
## Footnote
This is the recommended evaluation for older patients.
285
True or False: Dyspepsia is primarily managed with a proton pump inhibitor (PPI).
False
## Footnote
The test-and-treat strategy for Helicobacter pylori is preferred over empiric PPI treatment for younger patients.
286
What is the initial treatment for a patient with Helicobacter pylori infection and MALT lymphoma?
Antibiotics for the Helicobacter pylori infection
## Footnote
This treatment is crucial as it targets the underlying infection contributing to the lymphoma.
287
What percentage of patients experience remission with antibiotics for H. pylori-associated gastric MALT lymphoma?
50% to 80%
## Footnote
The response rate indicates a significant potential for treatment effectiveness.
288
What type of lymphoma is associated with Helicobacter pylori infection?
Mucosal-associated lymphoid tissue (MALT) lymphoma
## Footnote
MALT lymphoma is a type of cancer that affects the lymphoid tissue in the mucosa.
289
Fill in the blank: The presence of _______ infiltrates of B-cells in the mucosal lymphoid tissue indicates MALT lymphoma.
dense
## Footnote
Dense B-cell infiltrates are characteristic of MALT lymphoma.
290
What is the recommended first-line treatment for H. pylori infection?
Bismuth-based quadruple therapy
291
What are the components of bismuth-based quadruple therapy?
* Proton pump inhibitor (PPI) twice daily
* Bismuth subsalicylate
* Metronidazole
* Tetracycline
292
What is the recommended discharge protocol for a patient with a clean-based peptic ulcer?
Discharged the same day on a once-daily oral proton pump inhibitor (PPI), such as omeprazole.
293
What should patients with high-risk stigmata of GI bleeding receive?
An 80-mg bolus of omeprazole, followed by high-dose PPI therapy.
294
What are the options for high-dose PPI therapy after the initial bolus?
* Continuous infusion of omeprazole at a rate of 8 mg/hr
* Intermittent boluses of 40 mg two to four times daily for at least 72 hours
295
Fill in the blank: Patients with a clean-based peptic ulcer and no complicating comorbidities may be discharged on a once-daily oral _______.
proton pump inhibitor (PPI)
296
True or False: Patients with active bleeding should not receive immediate PPI therapy.
False
297
What is the duration for which high-dose PPI therapy should be administered?
At least 72 hours.
298
What type of ulcer is mentioned as having a clean base?
Peptic ulcer.
299
What is the most likely cause of new-onset diarrhea in a patient with celiac disease who adheres to a gluten-free diet?
Development of microscopic colitis
## Footnote
Microscopic colitis can occur even when patients are asymptomatic and following dietary restrictions.
300
What are the two types of microscopic colitis?
* Lymphocytic colitis
* Collagenous colitis
## Footnote
Both types manifest with watery diarrhea.
301
What is the typical appearance of the colonic mucosa during colonoscopy in microscopic colitis?
Normal appearance
## Footnote
Biopsy is required to identify the abnormality in microscopic colitis.
302
True or False: Biopsy is necessary to confirm a diagnosis of microscopic colitis.
True
## Footnote
Biopsy reveals the specific abnormalities associated with microscopic colitis.
303
What symptom is commonly associated with both types of microscopic colitis?
Watery diarrhea
## Footnote
This symptom is a key feature of lymphocytic and collagenous colitis.
304
What is the most common deficiency syndrome following surgical resection of the terminal ileum in patients with Crohn disease?
Deficiency of vitamin B12
## Footnote
The terminal ileum is crucial for the absorption of vitamin B12, and its surgical resection can lead to significant deficiencies.
305
What type of process is mesenteric venous thrombosis commonly associated with?
Intra-abdominal inflammatory processes such as diverticulitis or appendicitis
## Footnote
Inflammation can extend to the venous walls, leading to thrombosis.
306
What can increase the risk of mesenteric venous thrombosis?
Conditions such as malignancy, estrogen treatment, or other hypercoagulable states
## Footnote
These factors contribute to a higher risk of venous thrombosis.
307
What are common symptoms of mesenteric venous thrombosis?
Acute or subacute onset of dull abdominal pain, abdominal distention, and occult blood in feces
## Footnote
Symptoms are often out of proportion to the physical examination findings.
308
How does the abdominal pain in mesenteric venous thrombosis typically present?
Dull abdominal pain that is out of proportion to the physical examination
## Footnote
This characteristic can help differentiate it from other abdominal conditions.
309
True or False: Chronic presentations of mesenteric venous thrombosis are uncommon.
False
## Footnote
More chronic presentations may also be seen.
310
Fill in the blank: Mesenteric venous thrombosis is most commonly seen after _______ processes.
[intra-abdominal inflammatory]
## Footnote
These processes include conditions like diverticulitis and appendicitis.
311
What malignancies are patients with celiac disease at increased risk for?
* Enteropathy-associated T-cell lymphoma
* Hodgkin lymphoma
* Small-bowel adenocarcinoma
* Oropharyngeal cancers
* Esophageal cancers
## Footnote
These malignancies are associated with the complications of celiac disease.
312
What are the common symptoms indicating enteropathy-associated T-cell lymphoma?
* Diarrhea
* Abdominal pain
* Weight loss
* Unexplained fever
## Footnote
These symptoms may indicate a relapse of celiac disease and the potential presence of lymphoma.
313
At what age does the incidence of enteropathy-associated T-cell lymphoma peak?
The sixth decade of life
## Footnote
This refers to individuals in their 60s.
314
Where does enteropathy-associated T-cell lymphoma usually develop?
In the jejunum
## Footnote
It may also be found in the ileum or extraintestinal sites.
315
What is the prognosis for enteropathy-associated T-cell lymphoma?
Poor
## Footnote
This indicates a low survival rate and unfavorable outcomes.
316
True or False: Enteropathy-associated T-cell lymphoma can develop in extraintestinal sites.
True
## Footnote
Extraintestinal sites include the liver, brain, chest, or bone.
317
What should patients with a strong family history of cancer and a personal history of duodenal adenoma undergo?
Colonoscopy to check for colonic polyps
## Footnote
This is important for detecting potential hereditary polyposis syndrome.
318
What type of mutation is most likely carried by patients with hereditary polyposis syndrome?
Germline mutation in the tumor suppressor gene adenomatous polyposis coli (APC)
## Footnote
This mutation is associated with familial adenomatous polyposis, including Gardner syndrome and Turcot syndrome.
319
Which syndromes are associated with mutations in the APC gene?
Familial adenomatous polyposis, Gardner syndrome, Turcot syndrome
## Footnote
These are conditions linked to the APC gene mutation.
320
What is another possibility for patients with a hereditary polyposis syndrome aside from APC mutations?
Mutation in DNA mismatch-repair genes
## Footnote
This can lead to Lynch syndrome or Muir-Torre syndrome.
321
Fill in the blank: Patients with a personal history of duodenal adenoma are likely to have a _______.
hereditary polyposis syndrome
## Footnote
This condition necessitates further examination for colonic polyps.
322
What is indicative of an eosinophilic enteropathy?
An eosinophilic infiltrate in the small intestinal mucosa in a patient with chronic diarrhea
## Footnote
This condition highlights the presence of eosinophils in the intestinal tissue.
323
What is eosinophilic gastroenteritis (EG)?
An inflammatory disorder characterized by eosinophilic infiltration of the stomach and small intestine
## Footnote
The etiology of EG is unclear.
324
What is the most appropriate therapy for a patient with newly diagnosed EG presenting with severe protein-losing enteropathy?
A systemic glucocorticoid, such as methylprednisolone
## Footnote
This treatment often produces an immediate clinical response.
325
What are some treatments for milder forms of eosinophilic gastroenteritis?
An elimination diet, mast-cell stabilizers, and leukotriene-receptor antagonists
## Footnote
These treatments aim to reduce symptoms and inflammation.
326
Why must the diagnosis of strongyloides infection be excluded before initiating glucocorticoid therapy for eosinophilic gastroenteritis?
Because glucocorticoid treatment can induce a hyperinfection that can be fatal
## Footnote
Strongyloidiasis can mimic EG, making accurate diagnosis critical.
327
What test is most sensitive and specific for diagnosing strongyloides infection?
Hemagglutination antibodies for strongyloides
## Footnote
This test helps confirm or rule out the presence of strongyloides before treatment.
328
What is an aortoduodenal fistula?
A communication between the abdominal aorta and duodenum
329
What commonly causes the development of aortoduodenal fistulas?
They most frequently develop after an aortic aneurysm is repaired with a synthetic graft
330
What is the most appropriate initial test if an aortoduodenal fistula is suspected?
CT angiogram with delayed images
331
What are typical radiographic findings of an aortoduodenal fistula? List them.
* Air in the retroperitoneum
* Loss of the aneurysmal wall
* Loss of the fat plane between the aorta and duodenum
332
What is the preferred initial test for celiac disease?
Measurement of tissue transglutaminase immunoglobulin A antibody (tTG-IgA)
## Footnote
tTG-IgA has high sensitivity and specificity for diagnosing celiac disease.
333
What are the sensitivity and specificity percentages of tTG-IgA for celiac disease?
Sensitivity: 94%
Specificity: 97%
## Footnote
These percentages indicate the effectiveness of the test in correctly identifying those with and without the disease.
334
What additional test should be performed alongside tTG-IgA?
Measurement of serum IgA
## Footnote
This is to ensure that a false-negative result is not due to IgA deficiency.
335
What is the sensitivity and specificity of tissue transglutaminase IgG antibody testing for celiac disease?
Widely variable
## Footnote
The variability means that this test is not as reliable as tTG-IgA for diagnosing celiac disease.
336
For which patients is tissue transglutaminase IgG antibody testing indicated?
Patients with IgA deficiency
## Footnote
These patients may not have reliable results from tTG-IgA testing.
337
What type of anemia can be caused by vitamin B12 deficiency?
Megaloblastic anemia
## Footnote
Megaloblastic anemia is characterized by defective DNA synthesis leading to the production of large, abnormal red blood cells.
338
Where is vitamin B12 absorption restricted to in the gastrointestinal tract?
Terminal ileum
## Footnote
The terminal ileum is the last part of the small intestine before the large intestine.
339
Which IBD can cause impaired vitamin B12 absorption?
Crohn disease
## Footnote
Crohn disease is a type of inflammatory bowel disease that can affect any part of the gastrointestinal tract.
340
What can a palpable mass in Crohn disease likely indicate?
Inflammation of the ileum, phlegmon, abscess, or small-bowel dilatation due to stricture formation
## Footnote
A phlegmon is a localized area of inflammation, while an abscess is a collection of pus.
341
What is the usual scenario for Crohn disease producing B12 deficiency?
After resection
## Footnote
Resection refers to the surgical removal of a part of the intestine affected by Crohn disease.
342
Can vitamin B12 deficiency occur with severe Crohn disease in the terminal ileum?
Yes, likely secondary to poor absorption and bacterial overgrowth
## Footnote
Bacterial overgrowth can lead to malabsorption of nutrients, including vitamin B12.
343
What symptom should prompt suspicion for impaired gastrointestinal motility in patients with long-standing type 2 diabetes? and what type of intestinal infection can the loss of motility lead to?
Persistent bloating. SIBO
## Footnote
Impaired gastrointestinal motility can lead to complications such as small-intestine bacterial overgrowth.
344
What laboratory findings are typically associated with small intestinal bacterial overgrowth?
Macrocytosis, elevated serum folate levels, and B12 level at the lower limit of normal
## Footnote
The bacteria consume dietary B12 and release folate as a by-product.
345
What is the preferred antibiotic for treating small intestinal bacterial overgrowth?
Rifaximin
## Footnote
Rifaximin has demonstrated superior efficacy in many randomized studies and is not absorbed systemically.
346
List some antibiotics that can be used to treat small intestinal bacterial overgrowth.
* Ciprofloxacin
* Metronidazole
* Amoxicillin-clavulanate
## Footnote
These antibiotics cover both aerobic and anaerobic enteric bacteria.
347
True or False: Small intestinal bacterial overgrowth can lead to macrocytosis.
True
## Footnote
Macrocytosis is a common finding due to the bacterial consumption of dietary B12, and production of folate after
348
Fill in the blank: Effective antibiotic therapy for small intestinal bacterial overgrowth should cover both _______ and anaerobic enteric bacteria.
[aerobic]
## Footnote
Covering both types of bacteria is crucial for effective treatment.
349
What is Immunoglobulin A (IgA) vasculitis formerly known as?
Henoch-Schönlein purpura
## Footnote
IgA vasculitis is a type of leukocytoclastic vasculitis.
350
What body systems does IgA vasculitis affect?
Skin, gastrointestinal tract, joints, kidneys
## Footnote
These are the primary systems involved in IgA vasculitis.
351
What percentage of IgA vasculitis cases are preceded by an upper respiratory infection?
About half
## Footnote
This is typically due to infections from streptococcus.
352
What is a characteristic symptom of IgA vasculitis?
Palpable purpura
## Footnote
This occurs in the absence of thrombocytopenia.
353
What are the most common gastrointestinal symptoms of IgA vasculitis?
Abdominal pain and gastrointestinal bleeding
## Footnote
These symptoms are caused by mucosal and submucosal hemorrhage.
354
Which part of the gastrointestinal tract is most commonly affected in IgA vasculitis?
Small intestine
## Footnote
This is the primary site of involvement.
355
What is the most common surgical complication of IgA vasculitis?
Intussusception
## Footnote
This complication occurs more frequently in children than in adults.
356
What is the general approach to treating IgA vasculitis?
Supportive treatment
## Footnote
This is the standard care for most patients.
357
When might glucocorticoid use be considered in IgA vasculitis treatment?
For high-risk kidney involvement and severe abdominal pain
## Footnote
Glucocorticoid use is controversial and typically reserved for these cases.
358
What is acute mesenteric ischemia commonly secondary to?
Acute embolism to the superior mesenteric artery
359
What type of medical condition is acute mesenteric ischemia?
A medical emergency
360
What classic symptom do patients with acute mesenteric embolism present with?
Abdominal pain that is out of proportion to findings on examination
361
What is the first-line diagnostic evaluation for suspected mesenteric ischemia?
CT mesenteric angiography
362
What is Typhlitis also known as?
Neutropenic enterocolitis
363
What are the classic symptoms of Typhlitis?
Fever, abdominal pain, and diarrhea
364
In which patients is Typhlitis commonly seen?
Patients with neutropenia secondary to chemotherapy-induced bone-marrow suppression or primary bone-marrow failure
365
What are the CT findings in a patient with Typhlitis?
Abnormal wall thickening of the ascending colon and distal terminal ileum, with associated soft-tissue stranding in the surrounding fat
366
What type of contrast is recommended for CT imaging in suspected Typhlitis?
Enteric and intravenous contrast
367
What is the most appropriate treatment for Typhlitis?
Broad-spectrum antibiotics
368
Which types of bacteria should broad-spectrum antibiotics cover in Typhlitis treatment?
* Hospital-acquired gram-negative rods
* Gram-positive cocci
* Anaerobic bacteria
369
Name an example of an appropriate antibiotic regimen for Typhlitis.
* Piperacillin-tazobactam alone
* Cefepime plus metronidazole
370
True or False: Infection with Clostridioides difficile can present with features similar to Typhlitis.
True
371
What must be excluded before initiating broad-spectrum antibiotics in suspected Typhlitis?
Infection with Clostridioides difficile
372
What does FAP stand for?
Familial Adenomatous Polyposis
## Footnote
FAP is the most common inherited polyposis syndrome.
373
What type of mutation is responsible for FAP?
Germline mutation in the APC gene
## Footnote
The APC gene is located on chromosome 5.
374
How is FAP inherited?
Autosomal dominant
## Footnote
This means that only one copy of the mutated gene is sufficient to cause the disease.
375
What is the consequence of untreated FAP?
Leads invariably to colorectal cancer
## Footnote
This highlights the importance of early detection and intervention.
376
What is the optimal treatment for patients with polyposis and FAP?
Colectomy
## Footnote
Colectomy refers to the surgical removal of the colon.
377
What is Entamoeba histolytica?
A parasite often seen in Central and South America, Africa, and Asia
378
How many people are thought to be infected by Entamoeba histolytica per year worldwide?
Up to 50 million people
379
What is the incubation period for Entamoeba histolytica infection?
7 to 21 days
380
What is a characteristic finding in an intestinal biopsy for Entamoeba histolytica infection?
Flask-shaped enteric ulcers
381
What is the most appropriate treatment for Entamoeba histolytica infection?
A course of metronidazole followed by paromomycin
382
What is the purpose of using paromomycin after metronidazole in the treatment of Entamoeba histolytica?
To prevent recurrent infection
383
Why is paromomycin not recommended as concurrent treatment with metronidazole?
It causes diarrhea in many individuals
384
What is toxic megacolon?
Nonobstructive total or segmental colonic dilatation (>5.5 cm) associated with systemic toxicity.
## Footnote
Toxic megacolon is a serious complication that can occur in patients with ulcerative colitis.
385
What is the typical size of colonic dilatation in toxic megacolon?
>5.5 cm
## Footnote
This measurement is crucial for diagnosing toxic megacolon.
386
What is the appropriate management for toxic megacolon?
Urgent surgical consultation
## Footnote
Prompt intervention is critical to prevent complications.
387
What surgical procedures are typically performed for toxic megacolon?
Urgent subtotal or total colectomy and end ileostomy
## Footnote
These procedures are considered the standard of care in managing this condition.
388
What is bacterial acute hemorrhagic colitis caused by?
Ingestion of undercooked meat
389
What bacterium is primarily responsible for acute hemorrhagic colitis?
Enterohemorrhagic Escherichia coli (EHEC)
390
What is the most common strain of E. coli associated with acute hemorrhagic colitis?
Escherichia coli O157:H7
391
What symptoms do patients typically develop after EHEC infection?
Fever, nausea, abdominal pain, bloody diarrhea
392
How many days after bacterial ingestion do symptoms usually appear?
3 to 4 days
393
Do routine stool cultures test for E. coli O157:H7?
No
394
What toxins are produced by E. coli O157:H7 and shigella?
Shiga toxins
395
What is the most appropriate therapy for a patient with EHEC infection?
Supportive care, including hydration and antiemetics
396
Should antimotility agents be given to patients with EHEC infection?
No
397
Why should antimotility agents not be given to EHEC patients?
They can delay toxin exit and exacerbate symptoms
398
Are antibiotics recommended routinely for all patients with acute diverticulitis?
No
399
In terms of antibiotics, what did controlled trials in patients with uncomplicated diverticulitis show?
No difference in outcomes between patients who received antibiotics and those who did not
400
When are antibiotics recommended for patients with diverticulitis?
In cases of severe infection, sepsis, or complications
401
What type of antibiotics are recommended as first-line therapy for severe diverticulitis?
Broad-spectrum antibiotics with gram-negative and anaerobic coverage
402
What is the recommended follow-up for a normal colonoscopy?
Repeat in 10 years
## Footnote
This is the standard interval for a normal colonoscopy result.
403
What is the follow-up interval for 1–2 tubular adenomas less than 10 mm?
Repeat in 7–10 years
## Footnote
This interval is based on the low risk associated with a small number of tubular adenomas.
404
How often should a colonoscopy be repeated if 3–4 tubular adenomas less than 10 mm are found?
Repeat in 3–5 years
## Footnote
The presence of multiple adenomas increases the risk, warranting a shorter follow-up interval.
405
What is the follow-up recommendation for 5–10 tubular adenomas less than 10 mm?
Repeat in 3 years
## Footnote
This reflects a higher risk of progression due to the number of adenomas.
406
If at least 1 advanced adenoma (≥10 mm, tubulovillous/villous histology, or high-grade dysplasia) is found, when should the next colonoscopy occur?
Repeat in 3 years
## Footnote
Advanced adenomas are associated with a higher cancer risk, necessitating closer surveillance.
407
What is the recommended follow-up for more than 10 adenomas found on a single exam?
Repeat in 1 year
## Footnote
This high number indicates a significantly increased risk of colorectal cancer.
408
If a piecemeal resection of an adenoma ≥20 mm is performed, when should the next colonoscopy be scheduled?
Repeat in 6 months
## Footnote
Close follow-up is crucial after a large adenoma is removed to monitor for recurrence.
409
What is Ogilvie syndrome?
Ogilvie syndrome, or acute colonic pseudo-obstruction, is large-bowel dilation without evidence of mechanical obstruction.
410
What is thought to cause Ogilvie syndrome?
It is thought to result from alterations in the autonomic regulation of colonic motor function.
411
What does an abdominal radiograph show in Ogilvie syndrome?
Diffuse colonic dilation with air extending all the way to the rectum.
412
What is the first-line therapy for acute colonic pseudo-obstruction?
Conservative management.
413
What medication can be administered if conservative measures fail in Ogilvie syndrome?
Neostigmine.
414
What type of drug is neostigmine?
An acetylcholinesterase inhibitor that stimulates colonic motility.
415
What was the outcome of the randomized, placebo-controlled trial regarding neostigmine?
Neostigmine was shown to be an effective treatment in patients with a cecal diameter of > 10 cm who had failed 24 hours of conservative management.
416
What vital sign should be monitored closely during the administration of neostigmine?
Hr, Bradycardia can occur.
417
What is the appropriate timing for surveillance colonoscopies in a patient with extensive ulcerative colitis?
8 to 10 years after the initial onset of symptoms, repeated every 1 to 5 years thereafter.
## Footnote
This schedule is recommended to detect dysplasia.
418
What is the recommended age to begin colorectal cancer screening for first-degree relatives of individuals that were diagnosed with colorectal cancer after age 60?
As early as age 40 and no later than age 50.
419
Fill in the blank: First-degree relatives of individuals that were diagnosed with colorectal cancer after age 60 can be offered colorectal cancer screening with colonoscopy as early as age _______.
40
420
Fill in the blank: First-degree relatives of individuals diagnosed with colorectal cancer after age 60 should be screened no later than age _______.
50
421
What is microscopic colitis?
A common cause of chronic watery diarrhea, especially in older people
422
In which gender demographic is microscopic colitis more frequent?
In women than in men
423
What is the etiology of microscopic colitis?
Unknown but may result from autoimmunity or an immune-mediated or inflammatory response to intraluminal antigens
424
Which medications are associated with microscopic colitis?
* Aspirin
* Nonsteroidal antiinflammatory drugs
* Proton pump inhibitors
* Histamine-2-receptor antagonists
* Selective serotonin-reuptake inhibitors
* Ticlopidine
* Acarbose
* Statins
425
How is microscopic colitis diagnosed?
By clinical history and characteristic histopathologic findings on biopsies, especially from the right colon
426
What is the clinical course of microscopic colitis?
More often intermittent than continuous
427
What is the first-line therapy for microscopic colitis?
Cessation of any offending agents and a trial of bismuth, 5-aminosalicylic medications, or budesonide
428
True or False: The etiology of microscopic colitis is well understood.
False
429
Fill in the blank: Microscopic colitis is especially common in _______.
[older people]
430
What type of diarrhea is associated with microscopic colitis?
Chronic watery diarrhea
431
What condition should be evaluated in a patient with chronic watery, nonbloody diarrhea who is using nonsteroidal antiinflammatory medicines?
Microscopic colitis
## Footnote
Microscopic colitis is a condition that can be associated with the use of nonsteroidal antiinflammatory drugs (NSAIDs) and presents with chronic diarrhea.
432
What condition should be suspected in a patient with a history of radiation exposure to the rectum, with symptoms of rectal pain, urgency, and hematochezia?
Chronic radiation proctitis
## Footnote
This condition is characterized by specific symptoms and findings following radiation therapy.
433
What are the symptoms of chronic radiation proctitis?
* Hematochezia
* Rectal pain
* Fecal urgency
## Footnote
Symptoms typically develop 8 to 12 months after completion of radiation therapy.
434
What characteristic findings can be observed on sigmoidoscopy in chronic radiation proctitis?
* Pale mucosa
* Telangiectasias
* Ulceration
* Friability
* Bleeding
* Strictures
* Fistulas
## Footnote
Findings can vary in severity.
435
After failure of hydrocortisone, what is the first-line intervention for chronic radiation proctitis?
Sucralfate enemas
## Footnote
These enemas are noninvasive and have a success rate greater than 50%.
436
What is the effectiveness of sucralfate enemas in treating chronic radiation proctitis?
Success rate greater than 50%
## Footnote
They are particularly effective in diffuse, distal disease.
437
List other proposed treatments for mild-to-moderate radiation proctitis.
* Mesalamine suppositories
* Short-chain fatty acid enemas
* Vitamin E
* Hyperbaric oxygen
## Footnote
There is limited evidence supporting the effectiveness of these treatments.
438
True or False: Severe radiation proctitis may require surgical intervention.
True
## Footnote
Surgical intervention is considered for severe cases.
439
What is the first-line treatment for a non-fulminant Clostridioides difficile infection?
Either fidaxomicin or vancomycin
## Footnote
Fulminant infections are characterized by hypotension, ileus, or megacolon, which may require different treatment strategies.
440
What characterizes a fulminant Clostridioides difficile infection?
Hypotension, ileus, or megacolon
## Footnote
Fulminant infections may necessitate alternative treatment approaches compared to non-fulminant cases.
441
What are the criteria for severe C. diff disease?
An elevated leukocyte count (≥ 15,000 per mm3) and an elevated creatinine level (> 1.5 mg/dL)
## Footnote
These criteria are used to assess the severity of Clostridium difficile infection.
442
What is muscle contraction is reduced following peripartum injury to the sphincter apparatus?
Anal sphincter and puborectalis muscle contraction
443
What remains normal despite fecal incontinence from peripartum injury?
Sensation, motor control is decreased given muscle damage to the sphincter
444
What is the first-line medical treatment for mild ulcerative colitis?
5-aminosalicylate formulation (such as mesalamine)
## Footnote
Administered orally, rectally, or both.
445
What is methylnaltrexone?
Methylnaltrexone is a peripheral opioid-receptor antagonist that does not induce opioid withdrawal.
## Footnote
It is used in the treatment of opioid-induced constipation.
446
What condition is subcutaneous methylnaltrexone used to treat?
It is used to treat refractory opioid-induced constipation.
## Footnote
This condition often affects patients with chronic pain management.
447
How does methylnaltrexone affect bowel movements?
Methylnaltrexone has been shown to rapidly induce a bowel movement.
## Footnote
This effect is particularly beneficial for patients suffering from constipation due to opioid use.
448
True or False: Methylnaltrexone induces opioid withdrawal.
False
## Footnote
Methylnaltrexone specifically does not produce withdrawal symptoms.
449
Fill in the blank: Methylnaltrexone is a _______ opioid-receptor antagonist.
peripheral
## Footnote
This means it works outside the central nervous system.
450
How can anal fissures be diagnosed?
On the basis of history and examination findings alone
## Footnote
Diagnosis does not require additional tests or procedures.
451
What symptoms do patients with anal fissures typically report?
Perianal pain with defecation and small amounts of blood on toilet paper after wiping
## Footnote
These symptoms indicate irritation and trauma in the anal region.
452
What usually causes primary anal fissures?
Secondary to trauma
## Footnote
Trauma can include factors such as straining during bowel movements.
453
What leads to high sphincter tone or spasm in anal fissures?
The resulting anal-mucosa tear
## Footnote
This tear can cause pain and local ischemia.
454
What are the consequences of increased sphincter tone in anal fissures?
* Pain
* Impaired healing
* Further tearing of the mucosa with subsequent bowel movements
## Footnote
These factors contribute to a vicious cycle of pain and injury.
455
What is the most appropriate initial therapy for an acute anal fissure?
Conservative therapy aimed at reducing spasm and preventing further injury
## Footnote
This approach focuses on non-invasive treatment methods.
456
What does initial treatment for an acute anal fissure include?
* Warm sitz baths
* Fiber supplementation
## Footnote
Sitz baths help relax the sphincter, while fiber softens the stool to prevent constipation.
457
Fill in the blank: The initial treatment for an acute anal fissure includes _______ to reduce sphincter tone.
[warm sitz baths]
## Footnote
Warm sitz baths are an effective way to alleviate sphincter spasm.
458
True or False: Anal fissures require surgical intervention for diagnosis.
False
## Footnote
Diagnosis is based on patient history and physical examination.
459
What is the most effective approach to improving the quality of a colonic preparation?
Split the preparation, with half given the night before the procedure and half given the morning of the procedure.
460
What are the Mayo Clinic's HISORt criteria for autoimmune pancreatitis?
The criteria include:
* Histology (lymphoplasmacytic sclerosing pancreatitis)
* Imaging (diffuse, sausage-shaped, pancreatic enlargement)
* Serology (elevated serum immunoglobin G4)
* Other organ involvement (biliary strictures, retroperitoneal fibrosis, salivary gland involvement)
* Response to glucocorticoid therapy
## Footnote
These criteria are essential for diagnosing autoimmune pancreatitis.
461
How many criteria is required for a diagnosis of autoimmune pancreatitis according to the HISORt criteria?
At least one of the criteria is required for a diagnosis.
## Footnote
This emphasizes the flexibility in diagnosis, allowing for a single criterion to support the condition.
462
Fill in the blank: The HISORt criteria include elevated serum _______ as part of the serology criterion.
immunoglobin G4
## Footnote
Elevated serum immunoglobin G4 is a significant marker in diagnosing autoimmune pancreatitis.
463
True or False: Imaging criteria for autoimmune pancreatitis includes pancreatic shrinkage.
False
## Footnote
The imaging criteria specify diffuse, sausage-shaped pancreatic enlargement, not shrinkage.
464
What is the most likely diagnosis in a patient with recurrent pancreatitis and a diffusely enlarged pancreas?
Autoimmune pancreatitis
## Footnote
Autoimmune pancreatitis is characterized by the absence of necrosis or a focal mass and the presence of an irregular pancreatic duct.
465
What are the key characteristics of autoimmune pancreatitis?
* Recurrent pancreatitis
* Diffusely enlarged pancreas
* Absence of necrosis
* Absence of focal mass
* Irregular pancreatic duct
## Footnote
These characteristics help differentiate autoimmune pancreatitis from other forms of pancreatitis.
466
True or False: Autoimmune pancreatitis presents with a focal mass.
False
## Footnote
Autoimmune pancreatitis is noted for the absence of a focal mass.
467
Fill in the blank: The pancreatic duct in autoimmune pancreatitis is typically _______.
irregular
## Footnote
An irregular pancreatic duct is a notable feature in cases of autoimmune pancreatitis.
468
What is the complication rate of double-balloon enteroscopy?
Less than 5%
## Footnote
This indicates a relatively low risk associated with the procedure.
469
What percentage of complications from double-balloon enteroscopy is due to pancreatitis?
Fewer than half
## Footnote
This suggests that while pancreatitis is a concern, it is not the majority of complications.
470
What are possible mechanisms for pancreatitis 2/2 double-balloon enteroscopy?
Pancreatic duct obstruction and duodenal intraluminal hypertension
## Footnote
These mechanisms can lead to complications during the procedure.
471
Fill in the blank: Pancreatitis accounts for _______ of the complications that occur during double-balloon enteroscopy.
fewer than half
472
True or False: The complication rate of double-balloon enteroscopy is greater than 5%.
False
## Footnote
The complication rate is actually less than 5%.
473
What can cause direct obstruction of the pancreatic duct during double-balloon enteroscopy?
Direct compression of the papilla by the inflated balloon
## Footnote
This is one of the mechanisms leading to pancreatitis.
474
What should be done with pancreatic cysts of any size?
They should be followed to determine if they grow or develop features that might indicate a tumor.
475
How do surveillance recommendations vary for pancreatic cysts?
They vary depending on the size and type of cyst.
476
What is the follow-up for asymptomatic cysts measuring <3 cm without worrisome features?
They can be followed with serial MRI or MRCP.
477
What features are considered 'worrisome' for pancreatic cysts?
* Main pancreatic duct diameter >5 mm
* Change in main bile duct caliber
* Obstructive jaundice
* Associated mass
478
What is the recommended follow-up for patients with a cyst <1 cm in size?
An MRI should be performed in 2 years.
479
What is the recommended follow-up for patients with a cyst measuring 1 to 2 cm in size?
An MRI should be performed in one year.
480
What does the presence of biliary ductal dilation and gallstones in a patient with pancreatitis imply?
Diagnosis of acute biliary pancreatitis
## Footnote
This condition indicates that the pancreatitis is likely due to gallstones obstructing the bile duct.
481
When should urgent endoscopic retrograde cholangiopancreatography (ERCP) be performed in biliary pancreatitis?
Within 24 hours when stones are visualized on imaging and there is evidence for acute cholangitis
## Footnote
Timely intervention is crucial to manage complications associated with cholangitis.
482
What are the potential benefits of ERCP for stone extraction and sphincterotomy in acute biliary pancreatitis?
Can reduce the severity of the pancreatitis by relieving the obstruction
## Footnote
This procedure helps to alleviate the pressure and inflammation caused by blocked bile ducts.
483
Is urgent ERCP recommended for acute biliary pancreatitis in the absence of cholangitis?
No
## Footnote
The absence of cholangitis suggests that the risks of the procedure may outweigh the benefits.
484
What are some extraintestinal manifestations of ulcerative colitis (UC)?
Thromboembolism, episcleritis, erythema nodosum, peripheral arthritis
## Footnote
These manifestations parallel disease activity in UC.
485
What are the characteristics of erythema nodosum?
Tender, red, smooth, and shiny nodules
## Footnote
These nodules are typically located on the lower extremities but can occur elsewhere.
486
Where are erythema nodosum nodules usually found?
Lower extremities
## Footnote
They can also occur in other locations.
487
What treatment is needed for erythema nodosum in a patient with UC?
Systemic therapy to treat the UC flare
## Footnote
This is necessary for effective treatment of erythema nodosum.
488
What percentage of patients with necrotizing pancreatitis develop infected necrosis?
Approximately one-third
## Footnote
This statistic highlights the prevalence of infected necrosis among necrotizing pancreatitis patients.
489
When does infected necrosis typically develop after initial presentation of necrotizing pancreatitis?
7 to 14 days
## Footnote
This time frame is crucial for monitoring and intervention.
490
What are the systemic symptoms of infection associated with infected necrosis?
* Fever
* Malaise
* Hypotension
* Sepsis
## Footnote
These symptoms indicate a systemic response to infection.
491
What laboratory finding is commonly associated with infected pancreatic necrosis?
Leukocytosis
## Footnote
An elevated white blood cell count suggests infection.
492
What is the recommended empiric antibiotic therapy for suspected infected pancreatic necrosis?
* A carbapenem alone
* Metronidazole in combination with either a quinolone or a third- or later-generation cephalosporin
## Footnote
These combinations are effective in treating suspected infections.
493
Is the routine use of antifungal agents recommended for infected pancreatic necrosis?
No
## Footnote
Antifungal agents are not typically indicated in this clinical scenario.
494
What condition increases the risk for calcium oxalate kidney stones due to enteric hyperoxaluria?
Malabsorption of fatty acids
## Footnote
Malabsorption can occur in conditions such as inflammatory bowel disease, Roux-en-Y gastric bypass, or terminal ileocecal resection.
495
Which part of the intestine is primarily responsible for reabsorption of bile acids?
Terminal ileum
## Footnote
The terminal ileum plays a crucial role in bile acid reabsorption.
496
What normally limits oxalate absorption in the colon?
Calcium binding to oxalate in the gastrointestinal tract
## Footnote
This binding prevents excess oxalate from being absorbed in the colon.
497
What are the two factors that contribute to increased oxalate absorption in the case of fatty-acid malabsorption?
* Fatty acids bind to calcium, allowing free oxalate absorption
* Fatty acids irritate the colon, increasing oxalate absorption
498
How does increased dietary calcium intake affect oxalate absorption?
It binds to free oxalate and reduces its absorption
## Footnote
This reduction lowers the risk for oxalate stones.
499
What is the mainstay of therapy for pancreatic pseudocysts?
Watchful waiting
## Footnote
Watchful waiting involves monitoring the condition without immediate intervention, allowing for natural resolution.
500
What is the typical outcome for most pancreatic pseudocysts?
Most pseudocysts resolve without intervention
## Footnote
This is particularly true for smaller pseudocysts and those associated with acute pancreatitis.
501
What size of pancreatic pseudysts is typically mentioned as having a higher chance of resolving without intervention?
<6 cm
## Footnote
Pseudocysts larger than this may require different treatment approaches.
502
In what context do pancreatic pseudocysts most commonly resolve without intervention?
Acute pancreatitis
## Footnote
Chronic pancreatitis may complicate the resolution of pseudocysts.
503
What is the optimal approach for patients recovering from mild acute pancreatitis?
The early introduction of a low-fat diet
## Footnote
This approach minimizes complications and promotes recovery.
504
What has been associated with the early introduction of a full diet in patients recovering from mild acute pancreatitis?
Recurrence of pain
## Footnote
This suggests that full diets may not be suitable during the early recovery phase.
505
What is pancreas divisum?
The most common pancreatic congenital abnormality, occurring when the ducts of the dorsal and ventral parts of the pancreas fail to fuse during embryonic development.
## Footnote
Seen in approximately 6% of persons.
506
What occurs as a result of pancreas divisum?
The two parts of the pancreas maintain distinct drainage into the duodenum.
## Footnote
This leads to separate drainage paths for the dorsal and ventral ducts.
507
Where does the dorsal duct enter the duodenum in pancreatic divisum?
At the smaller minor papilla.
## Footnote
It is responsible for the majority of secretions entering the duodenum.
508
Where does the ventral duct drain into the duodenum in pancreatic divisum?
At the major papilla.
## Footnote
It drains a smaller part of the pancreas.
509
What percentage of patients with pancreas divisum are asymptomatic?
Most patients.
## Footnote
The condition is often discovered incidentally.
510
Is it proven that pancreas divisum leads to recurrent episodes of pancreatitis?
No, it seems likely but is unproven.
## Footnote
A small subgroup of patients may experience this due to the small caliber of the minor papilla.
511
Fill in the blank: The dorsal duct of the pancreas in pancreatic divisum enters the duodenum at the _______.
minor papilla
512
True or False: The ventral duct drains the majority of the pancreas in pancreatic divisum.
False
## Footnote
The dorsal duct drains the majority of the pancreas.
513
What is thought to cause recurrent episodes of pancreatitis in some patients with pancreas divisum?
Obstruction due to the small caliber of the minor papilla.
## Footnote
This may lead to subsequent pancreatitis.
514
What combination of symptoms in an older patient should raise suspicion for pancreatic cancer?
Jaundice and weight loss
## Footnote
These symptoms can indicate underlying malignancies, particularly in older adults.
515
Where does pancreatic cancer typically develop?
In the head of the pancreas
## Footnote
This location is significant as it affects the presentation of symptoms.
516
What condition does pancreatic cancer manifest as?
Obstructive cholestasis
## Footnote
This occurs due to bile duct obstruction.
517
What are some common symptoms of pancreatic cancer?
* Nausea
* Vague abdominal discomfort
* Symptoms of duodenal obstruction
## Footnote
These symptoms can vary in intensity and presentation among patients.
518
What can obstruction of the pancreatic duct by a neoplasm cause?
Dilation of the duct and, in some cases, pancreatitis
## Footnote
This complication can lead to additional health issues.
519
What is the imaging modality of choice for assessing pancreatic cancer?
CT scan
## Footnote
CT scans provide detailed images of the pancreas and surrounding structures.
520
What should be done if a CT scan is not diagnostic of pancreatic cancer, but clinical suspicion is high?
Further imaging with magnetic resonance cholangiopancreatography (MRCP) is recommended
## Footnote
MRCP is non-invasive and can provide additional information about the pancreatic ducts.
521
What laboratory abnormalities are associated with acute gallstone pancreatitis?
Elevated amylase or lipase levels, elevated liver enzyme and bilirubin levels
## Footnote
These abnormalities indicate pancreatic inflammation and potential bile duct obstruction.
522
What indicates a high probability of persistent CBD stones in acute gallstone pancreatitis?
Persistently elevated liver chemistries
## Footnote
This suggests ongoing obstruction or inflammation in the biliary tract.
523
What is the baseline normal diameter of the common bile duct (CBD) in adults?
4 mm
## Footnote
The diameter increases by 1 mm with each decade above 40 years old.
524
True or False: The risk for complications from acute gallstone pancreatitis is reduced if patients undergo endoscopic retrograde cholangiopancreatography and sphincterotomy after 72 hours of admission.
False
## Footnote
The risk is significantly reduced when these procedures are performed within 24 to 72 hours after admission.
525
What is the significance of randomised trials regarding acute gallstone pancreatitis treatment?
They show that early intervention reduces the risk for complications
## Footnote
Specifically, complications from laboratory abnormalities or cholangitis.
526
Fill in the blank: The CBD size differs with age; the baseline normal diameter of 4 mm increases by _______ with each decade above 40 years old.
1 mm
