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GI 3 Flashcards

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1
Q

Patients with achalasia are at increased risk of what

A

Esophageal cancer (usually SCC) (stasis and fermentation cause mucosal inflammation, epithelial hyperplasia and dysplasia)

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2
Q

Splenic vein thrombosis clinical features

A

history of chronic pancreatitis (splenic vein runs along posterior surface of pancreas so chronic inflammation can lead to thrombosis) + *isolated gastric varices (near gastric fundus only, never esophageal varices)
- variceal hemorrhage + epigastric pain

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3
Q

Management of splenic vein thrombosis

A

splenectomy

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4
Q

what is non-ulcer dyspepsia?

A

Functional dyspepsia (diagnosis of exclusion)

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5
Q

Next step after cirrhotic with mass on US + elevated AFP

A

IF less than 1 cm – repeat US in 3 months
IF greater than 1 cm – MRI liver with contrast (better sensitivity and specificity than CT for differentiating malignant nodule from regenerative nodules)

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6
Q

Management of diarrhea after ileal resection

A

cholestyramine (ileal resection leads to bile salt malabsorption and thus can’t absorb fats or fat-soluble vitamins. cholestyramine binds to bile acids)

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7
Q

Initial management of non-GERD-sounding dyspepsia (without alarm features)

A

IF under ago 60 + NO compelling indication for EGD – h pylori testing
IF over 60 or compelling indication for EGD –> EGD

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8
Q

Boerhaave syndrome clinical features + imaging

A
  • hx of vomiting + chest pain + often rapid development of pleural effusion
  • subcutaneous emphysema + mediastinal air (described as “retrocardiac air shadow”)
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9
Q

Chronic diarrhea in patient with systemic sclerosis

A

SIBO (due to reduced peristalsis and intestinal dilation)

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10
Q

antibiotic for SIBO

A

rifaximin

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11
Q

Multiple stomach ulcers OR thickened gastric folds think

A

gastrinoma (zollinger-ellison syndrome)

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12
Q

gastrinoma (zollinger-ellison syndrome) diagnosis

A

serum gastrin level

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13
Q

PBC is

A

primary biliary cholangitis

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14
Q

sequela of PBC

A
  • Metabolic bone disease (osteoporosis and/or osteomalacia)
  • hepatocellular carcinoma
  • malabsorption, fat-soluble vitamin deficiencies
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15
Q

Additional management of PBC

A

calcium and vitamin D supplementation

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16
Q

Initial step in hemodynamically unstable GI bleed

A

NOT PRBC transfusion (as per MKSAP) if Hgb WNL

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17
Q

initial steps in management of variceal bleed

A
  • volume resuscitation
  • IV octreotide
  • abx (7 day course of prophylactic abx, even if cultures remain negative)
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18
Q

Management of IDA if initial c-scope and EGD are negative

A
  • small bowel evaluation with capsule endoscopy
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19
Q

Appearance of biopsy in microscopic colitis

A
  • mononuclear lymphocytic infiltrates (high levels of intraepithelial lymphocytes)
  • abnormally thickened sub epithelial collagen band
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20
Q

other clinical features of microscopic colitis

A
  • fecal urgency and incontinence
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21
Q

Pancreatic pseudocyst clinical features

A
  • develop after pancreatitis episode commonly

- persistently elevated lipase after pancreatitis episode + abdominal fullness OR early satiety

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22
Q

Management of pancreatic pseudocysts

A
  • nothing (most pseudocysts resolve spontaneously)
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23
Q

IBS features

A
  • recurrent abdominal pain

- diarrhea alternating with constipation

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24
Q

First step in workup of IBS

A

rule out red flags (Bleeding, nocturnal symptoms or worsening abdominal pain, weight loss, abnormal labs)

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25
Management of patient following up after an episode of diverticulitis
- colonoscopy (rule out malignancy AND assess severity of diverticulitis) * indicated even if c-scope within the last 10 years
26
General pressure ulcer management
1) Nutritional support 2) Pressure relief measures (scheduled turning) 3) Rule out infection
27
Dressing for pressure ulcers
``` Stage 1 (intact skin, just localized redness) -- transparent film dressing Stage 2 (shallow, open ulcer) -- occlusive or semipermeable dressing (maintain moist wound environment) Stage 3 (full thickness skin loss) -- hydrocolloid (NO OCCLUSIVE IF FULL THICKNESS) Stage 4 (exposed bone, tendon, or muscle) -- wound closure ```
28
Management of Schatzki ring
- dilation + *acid suppression therapy
29
Most frequent complication of schatzki ring
recurrence (frequently reoccur)
30
Syndrome for hepatic vein thrombosis
Budd-Chiari
31
Acute Budd-Chiari clinical features
- young woman with *rapid onset abdominal pain + ascites + some underlying hyper coagulable disorder or trigger (HCC, OCP use, pregnancy)
32
Diagnosis of boerhaave syndrome
- CT or esophagography with gastrografin (similar to barium swallow but gastrografin is used)
33
Infected pancreatic necrosis management
CT-guided aspiration OR empiric abx (carbapenem) | IF no response to antibiotics -- surgery
34
antibiotics for treatment of infected pancreatic necrosis
carbapenem or quinolone + metronidazole (anaerobe coverage and superior penetration into pancreatic tissue)
35
SAAG cutoffs
1. 1 (portal HTN) | 2. 5 (heart failure vs. cirrhosis)
36
treatment of chronic mesenteric ischemia
- surgery or stenting
37
acute mesenteric ischemia clinical presentation
- rapid onset periumbilical pain
38
treatment of acute mesenteric ischemia
- broad spectrum abx - NG tube decompression - surgery for infarction or perforation
39
Other PBC features
- significant fatigue + pruritus * skin hyperpigmentation - can have inflammatory arthritis
40
hemochromatosis vs PBC in terms of labs
``` hemochromatosis = hepatocellular injury pattern PBC = primarily cholestatic liver injury pattern ```
41
Alarm features of GERD that required EGD prior to PPI trial
- age over 50 * dysphagia - weight loss - anemia - hematemesis, melena - failure of PPI trial after a month * not lack of response to OTC antacids
42
Initial evaluation of cirrhosis
EGD (initial varices screening)
43
Indications for SBP prophylaxis
1) prior episode of SBP 2) GI bleed 3) ascitic protein less than **1.5 if also impaired renal function or liver failure 4) Child-Pugh class C with bilirubin (greater than 3)
44
Age cutoff requiring EGD prior to h pylori testing
Over age 60 need EGD
45
other lab features of autoimmune hepatitis
- multiple circulating autoantibodies (ANA, anti smooth muscle, may have antimitochrondial in low titer, anti liver-kidney microsomal-1 antibody)
46
presentation of acute hep b
- serum sickness like syndrome (fever, poly arthritis, *urticaial skin lesions) * can also present with fulminant liver failure
47
ischemic colitis clinical features
- abrupt onset abdominal pain followed quickly by hematochezia * commonly in watershed areas (splenic flexure, rectosigmoid colon)
48
ischemic colitis vs. small bowel mesenteric ischemia
- mesenteric ischemia = typically AF severe pain without significant abdominal tenderness, hematochezia is a late complication - ischemic colitis = early hematochezia
49
Initial evaluation of suspected ischemic colitis
CT with contrast, followed by colonoscopy
50
Definition + management of atypical + persistent anal fissures
- atypical = lateral or anterior, multiple, painless, very deep, recurrent, non healing, no improvement with treatment - c-scope for evaluation of Crohn disease
51
presentation of external hemorrhoids
IF thrombosed -- pain | IF nonthrombosed -- typically painless
52
alcoholic hepatitis presentation
*fever abdominal distension other features I know about
53
Meds causing medication-induced esophagitis
* NSAIDS - tetracyclines - bisphosphonates * iron supplements - potassium chloride
54
Management of medication-induced esophagitis
- stop offending medication | - no need for EGD unless severe, atypical or persistent symptoms after 1 week)
55
postexposure prophylaxis for hep A
- vaccinate all household contacts (vaccine is more available than immune globulin and is easier to administer) * immune globulin in children under age 1 and immunocompromised individuals
56
abdominal pain following colonoscopy think
- perforation at polypectomy site | * may also have fever OR chest OR scapular pain
57
Initial management of suspected abdominal perforation from colonoscopy
- STAT abdominal x-ray plain and upright | - IF negative but high clinical suspicion -- CT with contrast
58
Acute hep B management
- supportive care (most adult patients will improve clinically and cldar the infection)
59
Presentation of proximal small-bowel obstruction
- vomiting | - *have less abdominal distension
60
Alternative causes of elevated lipase
- CKD - DKA - intestinal obstruction or ileus
61
Initial workup of SBO
- plain upright CXR + upright and supine abdominal films
62
Management of rectovaginal fistulas in IBD patients
IF asymptomatic -- no treatment (most will heal spontaneously) - prolonged antibiotics + anti-TNF inhibitors - IF failed medical therapy: surgery
63
Modified triple therapy for patient with pencillin allergy
flagyl instead of amoxicillin
64
management of moderate to severe hypertriglyceridemia-induced pancreatitis
IF blood glucose is over 500 -- start insulin drip to correct triglyceride levels If glucose below 500 or severe pancreatitis -- therapeutic plasma exchange apheresis
65
next step in patient with celiac features and positive serology
Endoscopy with biopsy to establish diagnosis OR cutaneous biopsy with dermatitis herpetiformis
66
next step in patient with celiac features and negative serology
IgA level
67
healthcare maintenance for celiac
- pneumococcal vaccination (associated with hyposplenism) | - screen for nutritional deficiencies and bone loss
68
cause of respiratory alkalosis in cirrhotics
- Increased minute ventilation (cause of which is unclear)
69
Next step after patient with h pylori is found to have a peptic ulcer
- obtain multiple biopsies ulcer to rule out malignancy (Peptic ulcer disease is strongly associated with gastric cancer and gastric MALT lymphoma)
70
features of lactose intolerance
- abdominal pain + bloating + flatulence | - secondary lactose intolerance can develop after acute infection or inflammation (destruction of lactase enzyme)
71
Evaluation of PUD for H pylori
*Even if negative biopsy, stilll need a second test (urea breath or stool antigen) after patient has stopped PPI for 1-2 weeks (significant false negatives due to bleeding, PPI, or abx)
72
When repeat endoscopy is indicated following diagnosis of PUD
*bleeding gastric ulcers
73
Eosinophilic esophagitis clinical features
young man + atopy + intermittent solid-food dysphagia | - commonly food bolus
74
Endoscopy in eosinophilic esophagitis
- furrows, concentric rings, eosinophilic microabscesses (whitish papules and exudates)
75
Treatment of eosinophilic esophagitis
- dietary modification | - topical steroids
76
Initial step in work up of suspected PSC
colonoscopy to rule out underlying IBD + colorectal cancer (significantly elevated risk)

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