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GI Flashcards

1
Q

Indications for Endoscopy

A

Weight loss
Blood in stool
Anemia

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2
Q

Dx test for anatomical issue in esophagus

A

Barium then EGD if +

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3
Q

Dx test for physiological issue in esophagus

A

Barium then EGD if -

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4
Q

Dx test for mucosal issue in esophagus

A

EGD

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5
Q

Dx test for Acid issue in esophagus

A

24hr pH

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6
Q

Dx test for small bowel issue

A

Capsule endoscopy

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7
Q

Features of pts with achalasia

A 
Under 50
Both solids and liquids
No smoking or alcohol
Halitosis
Regurgitation
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8
Q

Most accurate test for Achalasia

A

Manometry

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9
Q

What is Dx with Bx in esophagus

A

Barrett

Cancer

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10
Q

Features of pts with esophageal cancer

A

Over 50
Solids then liquids
Alcohol and smoking
>5-10 yrs of GERD sx

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11
Q

Best initial test for esophageal CA

A

Barium

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12
Q

Rx esophageal CA

A

Resection along with chemo and radiation

Stent if cannot resect (sx rx)

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13
Q

2 forms of esophageal spasms

A

Diffuse esophageal spasm

Nutcracker esophagus

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14
Q

Precipitate esophageal spasm

A

Drinking cold liquid

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15
Q

Best initial test esophageal spasm

A

Esophogram

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16
Q

Most accurate test for esophageal spasm

A

Manometry (also used to distinguish types)

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17
Q

Rx esophageal spasm

A

CCB and nitrates

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18
Q

Dysphagia in HIV w/ CD4

A

Fluconazole

EGD if rx fails

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19
Q

Rare sequelae of Plummer-Vinson

A

Squamous cell carcinoma

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20
Q

Rx Schatzki ring

A

Pneumatic dilation

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21
Q

Main Sx in Schatzki ring

A

Intermittent dysphagia of solids

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22
Q

Rx in Plummer-Vinson

A

Fe replacement

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23
Q

Cause of Schatzki ring

A

Acid reflux

Associated with hiatial hernia

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24
Q

Best test for Zenker

A

Barium

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25
Rx Zenker
Surgery
26
Pills causing esophagitis
Doxy Alendronate KCl
27
Pt presentation for schleroderma esophagitis
Reflux with hx of scleroderma or progressive systemic sclerosis
28
When is Manometry used
Achalasia Scleroderma Spasm
29
Management of scleroderma
PPIs
30
Problem with esophagus in scleroderma
LES doesn't close
31
Sx difference between mallory-weiss and borhaave
``` M-W = blood Borhaave = no blood ```
32
What is Borhaave
Full penetration of esophagus | M-W is only mucosal tear
33
MCC epigastric pain
Non-ulcer dyspepsia
34
Hx Pain worse with food
Gastric ulcer
35
Hx Pain better with food
Duodenal ulcer
36
Hx Weight loss
Cancer, gastric ulcer
37
Hx Tenderness
Pancreatitis
38
Hx Bad taste, cough, hoarse
Gastroesophageal reflux
39
Hx Diabetes, bloating
Gastroparesis
40
No Hx
Non-ulcer dyspepsia
41
Only way to understand etiology of epigastric pain from ulcer
EGD
42
AE of H2 blockers
Tachyphylaxis
43
What is GERD
Inappropriate relaxation of LES
44
Complaints in GERD
Sore throate Metallic taste Hoarseness Cough
45
EGD in GERD
Signs of obstruction Weight loss Anemia or heme + stool >5-10 yrs of sx
46
Confirm etiology of GERD if Dx is not clear
24hr pH monitoring
47
Rx GERD
Weight loss (BEST) Avoid EtOH, nicotine, caffeine, chocolate, peppermint NO eating 3hrs before bed Elevate head of bed 6-8 inches
48
What does peppermint do in GERD
Dilate LES
49
Rx mild/intermittent sx in GERD
Liquid antacids | H2 blockers
50
Rx persistent sx/erosive esophagitis
PPIs for 4-6wks
51
Surgical optionsin GERD (when meds fail)
Nissen fundoplication Endocinch Heat/radiation to scar
52
Should be avoided after nissen fundoplication
Carbonated beverages | Rx Simethicone then NG
53
How long does columnar metaplasia take to develop with reflux
5yrs
54
Only way to be certain of Barrett
Bx
55
Rate of progression of Barrett to CA
0.5% of Barrett per year
56
Rx Barrett
PPIs and rescope every 2-3yrs
57
Rx low-grade dysplasia
PPIs and rescope every 6-12 months
58
Rx high grade dysplasia
Ablation - Photodynamic therapy, radiofrequency, mucosal resection
59
Main causes of gastritis
``` Alcohol NSAIDs H. pylori Portal HTN Stress - Burns, trauma, sepsis, multiorgan failure ```
60
Cause of atrophic gastritis
B12 deficiency
61
MC presentation of gastritis
Painless GI bleeding
62
Volume of blood loss in coffee ground emesis
5-10mL
63
Volume of blood loss in heme+ stool
5-10mL
64
Volume of blood loss in melena
50-100mL
65
Most accurate test for gastritis
EGD
66
Problem with serology for H. pylori
Only works on 1st dx
67
Problem with urea breath test
Only good to test for eradication
68
Problem with sucralfate
Only works in acidic environment
69
Who can't get sucralfate (AlOH)
Dialysis pts cannot excrete Al containing compounds
70
Who gets stress ulcer prophylaxis
Mechanic ventilation Burns Head trauma Coagulopathy
71
Most accurate test for H. pylori
EGD with Bx
72
Less common causes of PUD
``` Burns Head trauma Crohn Gastric CA ZES ```
73
Effect of alcohol/smoking of gastric ulcers
Delay healing
74
Most accurate test for PUD
Upper endoscoply
75
Only method for detecting gastric CA
EGD
76
H.pylori presence in PUD by location
Duodenal - 80-90% | Gastric - 50-70%
77
What can you add to ABX rx if ulcer is treatment resistant
Bismuth
78
MCC Rx failure for ulcers
Nonadherence Alcohol Tobacco NSAIDs
79
What percentage of gastric ulcers are associated with CA
4
80
When to scope pts with dyspepsia
``` >45-55 Alarm sx (dysphagia, wt loss, anemia) ```
81
Rx non-ulcer dyspepsia
Empirically with PPIs if
82
What is non-ulcer dyspepsia
Epigastric pain with normal EGD
83
Features of gastrinoma
Large (>1-2cm) Recurrent (H.pylori eradicated) Distal (in duodenum) Multiple
84
Why are gastrinomas associated with diarrhea
Acid inactivates lipase
85
Most accurate diagnostic test for ZES
High gastrin levels with high gastric acidity High gastrin levels despite high gastric acid output Persistent high gastrin despite injecting secretin
86
Single most accurate test for gastrinoma
Response to secretin
87
Exclude metastatic disease in pancreas with dx of gastrinoma
Somatostatin receptor scintigraphy (nuclear octreotide scan) combined with endoscopic U/S if CT and MRI nl
88
Rx ZES
Surgery | Mets get lifelong PPI w/o resection
89
Meds to improve gut motility in diabetic gastroparesis
Erythromycin | Metoclopromide
90
Most accurate test for diabetic gastroparesis
Nuclear gastric emptying study
91
Why isn't D5W used in fluid resucitation
Doesn't stay in the vascular space
92
MCC UGI bleed
Ulcer
93
MCC LGI bleed
Diverticulosis followed by angiodysplasia
94
Orthostasis
>10 rise in pulse lying to sitting or standing OR 20pt drop in SBP when sitting up
95
Percent of blood loss in orthostasis
15-20%
96
Percent of blood loss when HR>100
30%
97
Percent of blood loss when SBP
30%
98
Who gets variceal bleeds
Cirrhosis
99
When to give pRBCs in GI bleed
HCT
100
When do give FFP in GI bleed
INR
101
When to give platelets in GI bleed
Platelet count
102
Rx variceal bleed
Octreotide
103
Role of PPI in UGI bleed
Reduces mortality
104
Role of propranolol in GI bleed
Prevent subsequent episodes
105
Main ABX implicated in c. diff diarrhea
Clindamycin
106
Best initial test for C. diff
Stool toxin or PCR
107
When to give oral vanco in C. diff
2 failed trials of metro
108
Alternative to vanco in C. diff
Fidaxomicin
109
MCC malabsorption in adults
Celiac
110
Main malabsorption syndromes
``` Celiac (autoimmune) Whipple (infectious) Chronic pancreatitis (acquired) ```
111
Vit D def manifestation
Hypocalcemia | Osteoporosis
112
Vit K def manifestation
Bleeding | Easy bruising
113
Vit B12 def manifestation
Anemia Hypersegmented neutrophils Neuropathy
114
Main presentation of malabsorption
Steatorrhea | Weight loss
115
10% of celiac present with
Dermatitis herpetiformis
116
Key word in Whipple
PAS+ Macrophages
117
Rx Whipple
Ceftriaxone followed by TMP/SMX
118
Distinction between chronic pancreatitis and celiac
Fe deficiency (celiac)
119
Most specific test for celiac
Anti-tissue transglutaminase
120
3 tests for celiac
Anti-tissue transglutaminase Antiendomysial Ab IgA antigliadin Ab (retest for IgG if -ve)
121
Still gluten sensitive after 3mos of gluten free diet
Non-compliance
122
Gluten sensitivity after 10yrs of gluten free diet
Lymphoma
123
Why do Bowel Bx in Celiac
R/O Lymphoma
124
Dx tests for Chronic pancreatitis
ABD XR - 50-60% sensitive for calcifications ABD CT - 80-90% sensitive for calcifications Secretin stimulation
125
Most accurate test for chronic pancreatitis
Secretin stimulation - Place NG. NL pancreas releases tons of bicarb after IV secretin
126
Rx chronic pancreatitis
Enzyme replacement
127
Rx celiac
Gluten free diet
128
Rx tropical sprue
TMP/SMX | Tetracycline
129
Main sx in carcinoid
Intermittent diarrhea Flushing Wheezing R sided cardiac abnormalities
130
Best initial dx test for carcinoid
5-HIAA
131
Rx for carcinoid
Octreotide
132
Weight loss in lactose intolerance
No
133
Dx lactose intolerance
Remove all milk products from diet and wait 1 day for sx resolution
134
What is IBS
Pain syndrome with diarrhea, constipation or both
135
Weight loss in IBS
No
136
Alleviating factors in IBS pain
BMs Night Change in bowel habit (like diarrhea)
137
Rx IBS
``` Fiber Antispasmodic agents (Hyoscyamine, Dicyclomine) TCAs Antimotility agents (loperamide) Lubiprostone (Ca channel activator) ```
138
Extraintestinal similarities in UC and Crohn's
Arthralgias Uveitis, Iritis Erythema nodosum, Pyoderma gangrenosum Sclerosing cholangitis (more in UC)
139
Which form of IBD leads to colon CA
Both
140
What is the risk of colon CA from IBD related to
Duration of colon involvement
141
Colon CA screening in IBD
8yrs after initial Dx, then every 1-2yrs
142
Crohn's specific features
``` Skip lesions Transmural granulomas Fistulas and abscesses Masses and obstruction Perianal disease ```
143
UC specific features
Curable by surgery | Entirely mucosal
144
Most accurate test for IBD
Colonoscopy
145
Which IBD has anemia
Both
146
Serology in IBD
UC - ANCA | Crohn - ASCA
147
When is serology +ve in IBD
148
Rx IBD exacerbations
Steroids - Prednisone, Budesonide
149
Chronic maintenance of IBD remission
Asacol - UC Pentasa - Crohn's Rowasa - Rectal UC All 5-ASA derivatives (mesalamine)
150
Wean IBD pts off steroids with
Azathioprine | 6-MP
151
Rx Crohn's perianal disease
Cipro | Metro
152
Rx fistulae Crohn's
Infliximab - TNF inhibitor
153
Cure for UC
Colectomy
154
When to do surgery for Crohn's
Obstruction
155
Features of diverticulosis
``` Meat-filled diet 65-70yrs LLQ pain Constipation Bleeding Maybe Infection ```
156
When is diverticulitis the most likely Dx
LLQ pain Fever Leukocytosis Palpable mass sometimes
157
Best initial test for diverticulitis
ABD CT
158
Most accurate test for diverticulosis
Colonoscopy | Barium isn't as accurate
159
Decrease rate of complications from diverticulosis
Bran Psyllium Methylcellulose Increased dietary fiber
160
Rx diverticulitis
``` Cipro and metro Amoxicillin/clavulanate Pipercillin/tazobactam Ticarcillin/calvulanate Ertapenem ```
161
Organisms in diverticulitis
E. coli and anaerobes
162
When to do surgery in diverticulitis
Meds fail Recurrences Perf, fistula, abscess, stricture, obstruction Younger
163
Feed pts with acute diverticulitis
NO
164
Routine colon CA screening
At 50 and every 10 years
165
Single family member with Hx colon CA screening
10yrs earlier than age of family member dx or 40 (whichever comes first)
166
3 family members, 2 gen, 1 before 50 colon CA screening
HNPCC | Start at 25 and then every 1-2 yrs
167
FAP colon CA screening
Sigmoidoscopy at age 12 and then every year | Colectomy with presence of polyp
168
Colon CA screening with hx of polyp
Every 3-5yrs
169
Screening for colon CA w/ hx of colon CA
Colonoscopy at 1yr after resection then at 3yrs then every 5yrs
170
Features of Peutz-Jeghers
Melanotic spots on lips and skin | Increased freq or breast, gonadal and pancreatic CA
171
Gardner syndrome
Colon CA associated w/ osteomas, desmoid tumors, other soft tissue tumors
172
Turcot syndrome
Colon CA with CNS malignancy
173
Juvenile polyposis
Colon CA with multiple hamartomatous polyps
174
MCC acute pancreatitis
Alcohol | Cholelithiasis
175
Cause of gallstones
Increased estrogen | Leads to SM relaxation --> bile stasis --> stones
176
Best dx test for gallstones
U/S
177
Less common cause of pancreatitis
``` Trauma Hypertriglyceridemia Hypercalcemia Infection Drugs (toxicity and allergy) Obstruction, ERCP, CF Scorpion sting ```
178
MC presentation of acute pancreatitis
Acute epigastric pain + tenderness | N/V
179
Best Dx test for choledocolithiasis
MRCP
180
Rx choledocolithiasis
ERCP
181
Sx cholangitis
``` RUQ pain Fever Jaundice Changing MS Hypotension ```
182
Next step in suspected cholangitis
ABX for enteric G+ and G-
183
After ABX in cholangitis
ERCP (If stone confirmed)
184
Best initial test in pancreatitis
Amylase and Lipase
185
Most specific test in pancreatitis
CT
186
How much is extensive necrosis
>30%
187
Labs in pancreatitis
Leukocytosis, drop in HCT over time with rehydration Elevated LDH, AST Hypoxia, Hypocalcemia Elevated urinary trypsinogen activation peptide
188
Rx acute pancreatitis
NPO IV hydration Analgesia PPIs
189
Rx of acute pancreatitis with extensive necrosis
ABX (imipenem, meropenem) Needle Bx Surgical resection
190
Role of ERCP in acute pancreatitis
Remove stones, dilate stricture | Place stent
191
Sx common to all chronic liver disease
``` Ascites Coagulopathy Asterixis, encephalopathy Hypoalbuminemia and edema Spider angiomata and palmar erythema Portal HTN and varices Thrombocytopenia Renal insufficiency Hepatopulmonary syndrome ```
192
When to perform paracentesis in ascites
New-onset ABD pain and tenderness Fever
193
SAAG score >1.1
Portal HTN CHF Hepatic vein thrombosis Constrictive pericarditis
194
SAAG score
Infections (except SBP) Cancer Nephrotic syndrome
195
SBP
Infection w/o perforation of the bowel
196
MC organism in SBP
E. coli | Can also be cause by pneumococcus
197
Best initial test for SBP
Cell count with >250 neutrophils
198
Most accurate test for SBP
Fluid culture
199
Rx SBP
Ceftriaxone or Cefotaxime
200
Prophylaxis for recurrent SBP
Norfloxacin or TMP/SMX
201
Rx ascites and edema in cirrhosis
Spironolactone and other diuretics | Serial paracentesis
202
Rx coagulopathy and thrombocytopenia in cirrhosis
FFP | Platelets (only in active bleeding)
203
Rx Encephalopathy in cirrhosis
Lactulose and rifaximin
204
Rx varices in cirrhosis
Propranolol and banding via endoscopy
205
Rx hepatorenal syndrome in cirrhosis
Somatostatin | Midodrine
206
Sign of hepatopulmonary syndrome
Orthodexia - Hypoxia upon sitting upright
207
Most accurate test to dx cirrhosis
Liver Bx (except sclerosing cholangitis)
208
Features of PBC
Woman 40s-50s Fatigue, itching Normal bili with elevated ALP
209
Unique features of PBC
Xanthelasma/Xanthoma | Osteoporosis
210
Only cure for PBC
Liver transplant
211
Most accurate test to dx PBC
Liver Bx
212
Most accurate blood test for PBC
AMA
213
Rx PBC
Ursodeoxycholic acid
214
80% PSC associated with
IBD
215
Most accurate test for PSC
ERCP
216
Rx PSC
Cholestyramine | Ursodeoxycholic acid
217
What to look for in A1AT def
Liver disease | Emphysema (COPD)
218
Problem in hemochromatosis
C282y mutation | Overabsorption of Fe in duodenum
219
Why do men present earlier than women in hemochromatosis
Menstruation delays onset of fibrosis and cirrhosis
220
Presentation of hemochromatosis
``` 50s, Increased AST, ALP with: Fatigue and joint pain (pseudogout) Erectile dysfunction, Amenorrhea Skin darkening DM Cardiomyopathy ```
221
Best initial test for hemachromatosis
Increased serum Fe and ferritin | Decreased TIBC
222
Most accurate test for hemochromatosis
Liver Bx for increased Fe
223
Spare pt from liver bx in hemochromatosis
MRI with abnormal genetic test
224
Fe chelation in hemochromatosis
Pts who cannot be managed with phlebotomy | Anemia and have hemochromatosis from overtransfusion
225
Fe chelation agents
Deferoxamine Deferasirox Deferiprone
226
Chronic Hep B
Surface Ag+ for >6mos
227
Hep B agents
``` Adefovir Lamivudine Telbivudine Entecavir Tenofovir IFN ```
228
AE IFN
Arthralgias Thrombocytopenia Depression Leukopenia
229
AE Ribavirin
Anemia
230
AE Adefovir
Renal dysfunction
231
Defect in Wilson
Decreased ceruloplasmin --> Cu not excreted --> builds up
232
Features of Wilson
Cirrhosis, hepatic insufficiency Neuro sx (psychosis, tremor, dysarthria, ataxia, seizures) Coombs neg hemolytic anemia RTA or nephrolithiasis
233
Best initial test for Wilson
Slit-lamp
234
Most accurate test for Wilson
Increased urine Cu after penicillamine
235
Therapies for Wilson
Penicillamine (chelates and removes) Zinc - Stops intestinal absorption Trientine - chelates
236
What to look for in autoimmune Hep
Young woman Signs of liver inflammation +ve ANA
237
Specific tests for autoimmune Hep
Liver-kidney microsomal Abs High gamma globulin Anti-SM Abs
238
Most accurate test for autoimmune Hep
Liver Bx
239
Rx autoimmune Hep
Prednisone | Azathioprine
240
MCC mildly abnormal LFTs
NASH
241
Most accurate test for NASH
Liver Bx
242
Associations with NASH
Obesity DM Hyperlipidemia Steroid use

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