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Flashcards in GI Deck (133):
1

alarming symptoms to do endoscopy

weight loss
blood in stool
anemia

2

alarming symptoms to do endoscopy

weight loss
blood in stool
anemia

3

YOUNG patient with progressive dysphagia for solids and liquids

achalasia

4

most accurate test in achalasia

manometry

5

tx of achalasia

DILATION, no cure
1. botox injections
2. pneumatic balloon dilations
3. heller myotomy

6

chance of perforation with pneumatic balloon dilation

7

dx of esophagus disorders

RADIOLOGIC tests okay to do first, but always lack the specificity of endoscopy

BIOPSY-- only diagnostic of cancer and baretts

8

most important clue for esophageal cancer

PROGRESSIVE dysphagia

9

PROGRESSIVE DYSPHAGIA by age

YOUNG- achalasia+ NO smoking/alcohol
OLD- esophageal cancer+ YES smoking/alcohol

10

best initial test for esophageal cancer

BARIUM

11

DIAGNOSTIC test for esophageal cancer

BIOPSY ie. most accurate

12

generally for cancer the radiologic test is...

NEVER the most accurate

13

YOUNG patient with progressive dysphagia for solids and liquids

achalasia

14

most accurate test in achalasia

manometry

15

tx of achalasia

DILATION, no cure
1. botox injections
2. pneumatic balloon dilations
3. heller myotomy

16

chance of perforation with pneumatic balloon dilation

less than 3%

17

dx of esophagus disorders

RADIOLOGIC tests okay to do first, but always lack the specificity of endoscopy

BIOPSY-- only diagnostic of cancer and baretts

18

most important clue for esophageal cancer

PROGRESSIVE dysphagia

19

PROGRESSIVE DYSPHAGIA by age

YOUNG- achalasia+ NO smoking/alcohol
OLD- esophageal cancer+ YES smoking/alcohol

20

best initial test for esophageal cancer

BARIUM

21

DIAGNOSTIC test for esophageal cancer

BIOPSY ie. most accurate

22

generally for cancer the radiologic test is...

NEVER the most accurate

23

sudden onset chest pain
worsened by drinking COLD LIQUIDS

diffuse esophageal spasm

24

most accurate diagnosis of eso spasm

MANOMETRY

25

treatment of diffuse esophageal spasm

CCB's

26

drugs a/w esophagitis

1. alendronate
2. doxycycline
3. KCl

27

intermittent dysphagia

shatzki ring

28

barium for diffuse esophageal spasm

corkscrew esophagus

29

2 investigations contra-indicated in zenkers

NG tube
endoscopy

since can--> PERFORATION--> more dangerous

30

manometry= answer for

1. spasm
2. achalasia
3. scleroderm

31

pain= symptom,
equivalent to....

tenderness=sign

32

MCC of epigastric pain

NON-ulcer dyspepsia= 50-90%
(which is not admitted to the hospital, thus we don't see on wards majority of the time)

33

PC:
- epigastric pain
- no significant hx
- patient less than 50 years old

NON-ulcer dyspepsia

34

PC:
- diabetes
- bloating

GASTROPARESIS

35

WRONG TX answer for epigastric pain

= MISOPROSTOL

36

which quadrant does IBS classically present in?

LUQ-- since splenic flexure syndrome

37

diagnosis of GERD

can be clinical alone (not all symptoms have to be present)

38

isolated pyrosis on OGD--->

NORMAL

39

when does GERD--> Barrett's: 5 YEARS

invasive treatment for GERD:
1. nissen fundoplication
2. endocinch: LES suture
3. local heat/radiation

40

can gastritis be made from a clinical diagnosis alone?

NOOOOOOO-- definitive diagnosis from endoscopy

41

capsule endscopy for upper GI bleed

WRONG answer!

42

do alcohol and smoking cause peptic ulcer disease

NOOOOOO, they do DELAY HEALING of ulcers

43

most accurate test for H.pylori diagnosis

ENDSCOPY

44

stress ulcer prophylaxis indicated in

1. mechanical ventilation
2. burns (curling)
3. head trauma (cushings)
4. coagulaopathy

45

random but HY risk factor for acute gastritis

URAEMIA

46

GI bleeding WITHOUT pain

gastritis

47

can PUD dx be made from clinical alone?

NOOOOO need endoscopy and biopsy

48

what can help in resolution of PUD

bismuth with triple therapy

49

H.PYLORI TESTS OF CURE (and treatment failure)

1. UREA BREATH TEST
2. STOOL ANTIGEN
3. SEROLOGY
4. Endoscopy and bx

50

repeat bx and endoscopy for which type of ulcer

GU since chance of getting cancerous

51

failed therapy to PUD

1. non-adherence
2. NSAID's
3. alcohol
4. smoking

52

when to scope if PC= DYSPEPSIA

1. age>55
2. alarming symptoms:
- dysphagia
- weight loss
- anemia

53

treatment for Non-Ulcer Dyspepsia

1. PPI's
2. IF symptoms persists + H.pylori present= treat H.pylori

54

PC gastrinoma:

recurrent LARGE intractable MULTIPLE ulcers on endoscopy

DIARHEA, gnawing, burning abdominal pain with some GI bleeding

55

after endoscopy with gastrinoma....

high gastrin levels off antisecretory therapy with high gastric acidity

56

most accurate test gastrinoma

SECRETIN functional test

57

excluding metastatic disease with gastronome (after CT/MRI normal)

somatostatin receptor nuclear scintigraphy
AND
endoscopic US

58

any need for special tests for diabetic gastroparesis

NO, clinical PC (note: most accurate test: nuclear gastric emptying study, rarely needed)

59

tx for diabetic gastroparesis

INCREASE MOTILITY:
- erythromycin
- metoclopromide

60

most nb initial mgmt of GI bleeding

BLOOD PRESSURE
--> Bolus normal saline

61

role of NG tube

LIMITED,
guide where to start with endoscopy
- pr bleed--- can identify upper GI bleed-- upper endoscopy for banding before colonoscopy
- malenia with cirri without hematemesis-- NG tube with red blood--> use octreotide for varies and arrange urgent endoscopy for possible banding of varices

62

MAJORITY of GI bleeding stops with.....

ADEQUATE FLUID RESUSCITATION
= most important step in mgmt GI bleeding

63

mgmt GI bleeding

1. fluid resusc
2. packed RBCs if Hct

64

when are platelets transfuse ACTIVE bleeding GI

65

tx variceal bleeding

1. fluid
2. blood
3. FFP
4. platelets
5. octreotide
6. banding
7. TIPS
8. propanolol= PREVENTS subsequent episodes of bleeding
9. antibiotics to prevent ascites

66

recurrent episode of C.diff after treated well with metronidazole first time

TRY AGAIN with metronidazole orally

67

FAILED treatment of C.diff with metronidazole

oral vancomycin or
fidaxomicin

68

diagnostic tests of chronic pancreatitis

1. abdo XR- Ca
2. abdo CT- Ca
3. secretin stimulation test (if normal will release large amounts of bicarb rich fluid)

69

is it okay to eat rice and drink wine in celiac?

YES

70

tx whipples

ceftriaxone
TMP/SMX

71

tx tropical sprue

TMP/SMX
tetracycline

72

any weight loss in lactose intolerance and IBS

NOOOOOOOO

73

any calorie deficiency in lactose intolerance

NOOOOOOO

74

tx of lactose intolerance

oral lactase replacement

75

2 antispasmodics for IBS

hyosycamine
dicyclomine

76

weird new antibody for crohns

anti-saccharomyces cervesiae

77

fistulae tx in crohns disease

infliximab

78

specific steroid in IBD

budesonide

79

conservative tx of diverticulosis

brain
psyllium
methylcelluose
increase distally fiber

80

best initial test in diverticulitis

abdominal CT

81

contraindicated in diverticulitis

colonoscopy and barium

82

tx of diverticulitis

cipro and metro

83

routine colon cancer screening

every 10 years starting at 50yo

84

single fam member colon cancer screening

10yrs BEFORE onset or 40yo (whichever is younger),
repeat every 5 years if family member

85

3 family members, 2 generations, 1 premature-- HNPCC colon cancer screening

start at 25yo, with colonoscopy every 1-2yrs

86

FAP colon cancer screening

sigmoidoscopy age 12, every year

87

need for frequent screening colonoscopy for peutz, turbot, gardner, juvenile polyposis?

NOOOOOOOO NEED

88

prognostic factor for pancreatitis

LOW calcium (because used up in saponification)

89

best initial tests for pancreatitis

amylase and lipase

90

most specific test for pancreatitis

abdo CT with IV and oral contrast

91

extensive necrosis of the pancreas in pancreatitis?

>30%

92

abdo CT ALWAYS given with....

IV and ORAL contrast-- to better define and outline abdominal structures

93

infected necrotic pancreatitis tx:

necrectomy-- surgically debride pancreas to prevent ARDS and death

94

if suspect >30% necrosis on CT or MRI for pancreatitis...

ADD antibiotics: imipenem or meropenem
DECREASE mortality

95

SAAG liver disease

serum ascites albumin gradient

96

SAAG

infection (Except SBP)
cancer
nephrotic syndrome

97

SAAG>1.1g/dL

portal HTN
CHF
hepatic vein thrombosis
constrictive pericarditis

98

any perforation in SBP?

NOOOOOO

99

best initial test in SBP?

cell count> 250neutrophils

100

variceal bleeding + ascites,
prophylaxis for........

SBP prophylaxis

101

tx SBP

ceftriaxone or cefotaxime

102

after SBP, fu tx

LIFE LONG ABX PROPHYLAXIS

103

tx for hepatorenal syndrome

octreotide
midodrine

104

ORTHODEOXIA

hypoxia when standing upright= hepatopulmonary syndrome

105

only cause of cirrhosis when DO NOT need bx

PSC: since MRCP--> string of bead appearance

106

infections in HFE

YLV
yersinia
listeria
vibrio vulnificus

since all feed off of iron

107

confirming dx of HFE

try and spare doing a biopsy---
abdominal MRI + HFE gene (C282Y)

108

phlebotomy in HFE

if done when have liver fibrosis--> can resolve liver fibrosis BEFORE CIRRHOSIS develops

109

active chronic hepatitis and
persistent chronic hepatitis

NO LONGER RELEVANT

110

biopsy with viral hepatitis

can better understand urgency of treatment if fibrosis is present or worsening

111

tx hep B

MONOTHERAPY
lamivudine
telbivudine
adefovir
tenofovir
entecavir
interfron

112

tx hep C

COMBO THERAPY
only for ACUTE HEP C

113

tx hep C genotype 1:

ledipasvir + sofosbuvir

114

tx hep C genotypes 2 and 3:

ribavirin + sofosbuvir

115

SE's of interferon

arthralgias
thrombocytopenia
leukopenia
depression

116

SE's of ribavarin

anaemia

117

SE's adefovir

RENAL dysfunction

118

SE's of lamivudine

NONE

119

new thing for wilsons

coombs NEGATIVE haemolytic anaemia

120

moa of zinc in wilsons disease

INTERFERES with copper intestinal ABSORPTION

121

decreased caeruloplasmin

NOT the most accurate test in wilsons disease;
because in all liver disorders will have decreased liver proteins

122

dysphagia and HIV CD levels

CD less than 100

123

tx of dysphagia and HIV empirically

fluconazole

124

if no response to fluconazole in HIV

upper endoscopy with bx

125

tx of barretts alone

PPI's
rescope every 2-3 years

126

low grade eso dysplasia

PPI's
rescue every 6-12months

127

high grade dysplasia eso

ablation with endoscopy: photodynamic, radio frequency, endoscopic mucosal

128

5-10ml of GI blood loss

coffee ground, and guac positive

129

50-100ml of GI blood loss

melena

130

if patient has allergy to penicillin and needs H.pylori tx

- PPI
- clarithromycin
- metronidazole

131

when to do surgery in diverticulitis

unreponsive to medical tx
recurrent infection
complications: perforation, fistula, abscess, stricture, obstruction

132

most accurate test for chronic pancreatitis

secretin stimulation test (normal test= bicarb in fluid)

133

does treating UC improve PSC?

NOOOOOO, the patient will evidently end up with OLT