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Flashcards in GI Deck (160):
1

What drugs cause medication induced esophagitis?

Abx (tetracyc), Antiinflammatory (NSAID/aspirin), Bisphosphonates, iron/KCL

2

Tx. esophageal perforation?

ABx and supportive care with surgical repair for significant leakage or systemic inflammatory response.

3

Diagnosis/Tx of zenker?

Diagnosis-barium swallow/manometry, Tx-open/endoscopic surgery or cricopharyngeal myotomy

4

Best initial/most accurate Diagnosis of esophageal cancer and treatment?

Best initial: Barium swallow?
Most accurate: Endoscopy w/ biopsy, CT (PET/CT) for staging
Treatment: Resection and chemo/radiation

5

Diagnosis/Tx of esophageal spasm?

Diagnosis-most accurate-manometry (intermittent peristalsis or mutiple simultaneous contractions) or best initial-esophagram (corkscrew)
Tx-Ca2+ channel blocker (1), nitrates (additional)

6

Best initial/most accurate for Diagnosis/Management achalasia?

Diagnosis: most accurate-Manometry (increased LES and decreased peristalsis in distal esophagus), best initial-esophagram ("bird beak" at GE Junction)
Management: Upper endoscopy to rule out malignancy. Lap myotomy or pneumatic balloon dilation or botulinum toxin injection, nitrates or CCB

7

Presentation acute gastritis and cause?

Hematemesis and abdominal pain secondary to acid penetrating lamina propria and injury to vasculature.

8

Gastric outlet obstruction presentation, findings, diagnosis and management?

>3 hours retained gastric material. "succussion splash" on physical exam with stethoscope over upper abdomen and rocking, endoscopy, and NG suction stomach/IV hydration.

9

Management acute diverticulitis?

Bowel rest, abx (eg cipro, metro)

10

Angiodysplasia most common location?

Right colon

11

Management for minimal bright red blood per rectum (hematochezia) for various categories: 50 or red flags?

50-colonscopy

12

Biopsy presentation celiac disease?

Lymphocyte intraepithelial and flattened villi

13

Laxative abuse biopsy?

Dark brown discoloration of colon with lymph follicles shining through as pale patches (melanosis coli)

14

Cause and tx of porcelain gallbladder?

Cause-chronic cholecystitis with tx is cholecystectomy

15

Management of gallstones w/o symp, w/typical biliary colic, or complicated (cholecystitis, choledocholithiasis, gallstone pancreatitis)

No symp-no tx
Biliary colic-elective lap chole or ursodeoxycholic acid for poor surgical candidates
Chole within 72 hours for complicated

16

ALT level in gallstone pancreatitis

>150

17

Managment emphysematous cholecystitis

IV fluids/electrolytes, lap chole, parenteral antibiotic therapy against gram + anaerobic clostridium

18

Test and Tx. of sphincter of oddi dysfunction?

Test is high biliary sphincter pressure and ERCP with sphincterotomy for tx

19

Charcot triad and reynolds pentad

Fever, jaundice, RUQ pain; mental status cahnges, hypotension (reynolds pentad)

20

Imaging/tx for acute cholangitis?

U/S or CT scan shows CBD dilation, increased biliary drainage: ERCP with sphincterotomy or percutaneous transhepatic cholangiography, Broad spectrum ABX (B-lactam/b-lactamase inhibitor, third gen cehalosporin + metronidazole

21

Liver biopsy and other assoc conditions for primary sclerosing cholangitis?

-Alternating stricture and dilation w/ "beading" of intra/extrahepatic bile ducts.
-Assoc with ulcerative colitis with both having P-ANCA
-Increase risk cholangiocarcinoma and colon cancer as well as cholangitis, cholestasis and cholelithiasis

22

Triad of hereditary hemochromatosis and diagnosis best initial and accurate?

Bronze skin, micronodular cirrhosis, DM II. Best initial (iron studies showing increased iron and ferritin with decreased TIBC). Liver biopsy for increased iron

23

Colon cancer MC site of metastases?

Liver

24

Diagnosis of acute pancreatitis requires what?

2 of the following:
1) acute epigastric pain radiating to back
2) Increase amylase/lipase>3 times normal limit
3) Abdominal imaging showing pancreatic enlargement with heterogenous enhancement

25

Cullen vs Gray turner severe pancreatitis?

Cullen-periumbilical bluish coloration periumbilical indicating hemoperitoneum
Gray-Turner-reddish brown around flanks indicating retroperitoneal bleed

26

Management chronic pancreatitis?

-Pain management, small meals, alcohol/smoking cessation, pancreatic enzyme supplements

27

Most important risk factor pancreatic adenocarcinoma?

Smoking

28

Conditions with mainly conjugated and elevated AST/ALT?

Variety of hepatitis (viral, ischemic, alcoholic, autoimmune etc.)

29

Signs/symptoms of carcinoid?

Skin-flushing, GI-diarrhea/cramping, Cardiac-valvular lesions (rt>left), Pulmonary-bronchospasm, niacin deficiency w/tryptophan depletion for making serotonin

30

Tx carcinoid

Octreotide for symptomatic and surgery for liver mets

31

What is shock liver?

Ischemic hepatic injury with AST/ALT elevation (the thousands) short after septic shock or heart failure

32

Management for cirrhosis with imagin

Screening endoscopy and ultrasound surveillance for HCC every 6 months

33

Prophylaxis for variceal hemorrhage?

Non selective B-blockers

34

What is hepatorenal syndrome?

decrease GFR in absence of shock, proteinuria, or other clear causes of renal dysfunction, and failure to respond to 1.5L NS bolus (resuscitation) as a complicaton of cirrohosis

35

Type 1 vs Type 2 Crigler Najjar?

Type I->25-30 bilirubin, kernicterus, no phenobartital help, tx. w/ plasmapharesis/phototherapy w/ liver transplant definitive
Type 2-->

36

Ascites fluid color and disease: bloody, milky, turbid, or straw color?

Bloody-Malignancy, trauma, TB
Milky-Chylous, pancreatic
Turbid-Possible infection
Straw-likely more benign

37

Neutrophils 250

250: Peritonitis

38

Total protein>2.5 (high protein ascites) and

>2.5-CHF, constrictive pericarditis, peritoneal carcinomatosis, TB, Budd-Chiari syndrome, fungal (eg coccidiomycosis)

39

SAAG >1.1 and SAAG

>1.1 (indicates portal hypertension)-cardiac ascites, cirrhosis, Budd-Chiari

40

SBP presentation and diagnosis and tx?

Presentation->100F, abdominal pain/tenderness, alterned mentation
Diagnosis->250 neutrophil (best initial) w/ fluid culture (most accurate but takes too long)
Tx. E. coli (cefotaxime or ceftriaxone) w norfloxacin or TMPSMX for prophylaxis

41

Diagnosis and tx for small intestinal bacterial overgrowth?

Diagnosis-Endoscopy w/ jejunal aspiration, glucose breath hydrogen testing
Tx-7-10 day course of ABX (eg rifamixin, amoxicillin-clavulonate), avoid antimotility like narcotics, dietary changes (eg high fat, low carb), triad of promotility agents (eg metoclopramide)

42

Diagnosis of colovesical fistula?

Abdominal CT with oral or rectal contrast (contrast material in bladder and thickened colonic and vesicular walls)

43

Rome diagnostic criteria for IBS?

>3 days/month for past 3 month of abdominal pain/discomfort and 2 of following: Symptom improvement with BM, change in frequency of stool, change in form of stool.

44

Hallmark of UC?

Crypt abscesses

45

Tx of toxic megacolon?

IV steroids, NG decompression, antibiotics (ceftriaxone and metronidazole), and fluid management

46

Best initial/most accurate test SCC of neck

Best initial-panendoscopy (triple endoscopy-esophagoscopy, bronchoscopy, laryngoscopy)
Most accurate-biopsy when primary tumor is detected

47

Hallmark of crohn disease?

Non-caseating granulomas

48

PUD symptoms?

Epigastric pain, tenderness, and possible occult blood nausea and vomiting

49

Tx of PUD perforation?

Abx (ceftriaxone, metranidazole) and laparotomy with repair of perforation.

50

What causes achlorhydria?

Pernicious anemia (autoimmune destruction of parietal cells)

51

Imaging studies to localize GI bleed?

Radionuclide=slow/intermittent; Angiography=more rapid bleeds. Capsule when upper/lower endoscopy show no etiology

52

How do you diagnose diverticulitis and what do all patients need after treated episode?

CT abdomen with contrast. Colonoscopy after (because colon cancer with perforation can mimic diverticulitis clinically and on CT)

53

What is osmotic diarrhea?

Nonabsorbable solutes that remain in the bowel and attract water (eg lactose)

54

What is secretory diarrhea?

Too much fluid secretion by bowel. Occurs with cholera, VIPoma, and in ileal resection when can't reabsorb bile salts

55

Common cause of malabsorptive diarrhea?

Celiac disease

56

Infectious diarrhea clues?

Fever and WBC in stool (invasive bacteria such as Shigella, Salmonella, Yersinia, and Campylobacter)

57

Infectious diarrhea tx

Metronidazole

58

What is exudative diarrhea?

Inflammation of bowel causing seepage of fluid commonly seen in IBD where WBC in stool and fever, but lack pathogenic organisms.

59

What pericpitates toxic megacolon?

Antidiarrheal medications

60

What is HBcAb

IgM hepatitis B core antibody appears in window phase when both HBsAg and HbsAb are negative.

61

Tx acute hep B exposure?

Hep B Ig and Hep B vaccination

62

Tx acute hepatitis C

Pegylated interferon alfa and ribavirin and either telaprevir or boceprevir

63

What population is hepatitis E fatal in?

Pregnant women

64

Tx of autoimmune hepatitis

Steroids or azathioprine

65

Labs of wilson disease?

Low serum ceruloplasmin

66

Two common causes of cholestasis?

Medications (eg OCP, TMPSMX, phenothiazines, androgens) and pregnancy

67

Tx primary biliary cirrhosis?

Cholestyramine with symptoms, but only tx is liver transplantation

68

Rule about contrast when GI perforation suspected?

For GI studies, barium is preferred. For GI perforation, do not use barium because chemical peritonitis or mediastinitis when perforation/leak is present. Use water soluble (eg Gastrografin).

69

Identifying physiologic jaundice in newborns based on bilirubin levels?

Full term infants: bilirubin

70

Difference in etiology from dysphagia from solids-->liquids vs dysphagia (solids+liquids)

Progressive-obstruction
Both-motility disorder

71

tx infectious esophagitis (candida_

fluconazole

72

Dysphagia w/ CD4

1) Empiric fluconazole
2) Improvement, continue with HAART
3) No improvement, upper endoscopy and if large ulcerations-->CMV (tx. ganciclovir) or small ulcerations-->HSV (tx. acyclovir)

73

Schatzki Ring vs Plummer Vinson location, association, treatment?

Ring (distal, reflux and hiatal hernia, pneumatic dilation)
PV (proximal, iron deficiency, web, and glossitis, iron replacement)

74

Most accurate for scleroderma manifestations of GERD?

Manometry

75

Tx mallory weiss?

Supportive, severe may need epi to stop bleeding

76

Pain epigastric pain without any other symptoms?

Non-ulcer dyspepsia

77

Best initial/most accurate epigastric pain for tests

Endoscopy

78

Best initial tx for epigastric pain?

PPI

79

Management of Barrett alone (metaplasia), low grade dysplasia, and high-grade dysplasia?

Barrett alone-PPi and rescope every 2-3 years
Low grade dysplasia-PPi and rescope every 6-12 months
High-grade dysplasia-Ablation w/ endoscopy: photodynamic therapy, radiofreq ablation, endoscopic mucosal resection

80

Gastritis presentation and tx.?

GI bleeding without pain. From mild "coffee ground" emesis, to large-volume vomiting of red blood, to black stool (melena). PPi

81

H pylori testing most accurate?

Endoscopy with biopsy

82

Triple therapy for H pylori with or without penicillin allergy?

No allergy-PPi, amoxicillin, clarithromycin
Allergy-PPi, methotrexate, clarithormycin

83

No response to DU therapy for H pylori

Check antibiotic resistance of organizm with method of detecting persistent infection (urea breath, stool antigen, or repeat endoscopy)

84

Tx of refractory ulcers to H pylori triple therapy?

GU-endoscopy+biopsy to rule out cancer
DU-switch to metranidazole and tetracycline for amoxicillin

85

Most accurate test PUD?

Upper endoscopy

86

Difference btwn GU and DU?

Pain often worsened by food, GU routinely biopsied, GU associated with cancer, routinely repeating endoscopy to confirm healing is standard with GU

87

No ulcer dyspepsia management 55

55: PPi+ Endoscopy

88

Best initial/most accurate ZE syndrome?

Best initial-endoscopy
Most accurate-Secretin response test with persistent high levels of gastrin

89

Imaging best initial/most accurate once gastrinoma confirmed and tx.?

Best initial-CT/MRI (poor sensitivity)
Most accurate-Somatostatin receptor scintigraphy (nuclear octreotide scan) with endoscopic U/S
Tx. Localized with resection and metastatic is unresectable

90

Tx diabeteic gastroparesis?

Erythromycin and metoclopramide

91

Define orthostasis?

->10 point rise in pulse from laying to sitting and >20 SBP drop (indicates 15-20% blood loss)

92

What indicates 30% blood loss in terms of pulse and BP?

Pulse>100 and BP

93

Why is NG tube useful for acute bleeding from rectum?

Guide where to start endoscopy

94

What are current guidelines for keeping Hb>9 g/dL in variceal hemorrhage?

1) PRBC for GI bleed

95

Tx of bleeding vs nonbleeding varices after hemodynamic support (ie fluids, blood, platelets, and plasma)?

Bleeding: 1) octreotide 2) banding 3) TIPS not controlled by octreotide/banding 4) Propranolol/nadolol for preventing subsequent episodes
Nonbleeding: 1) nonselective B-blockers decrease progression 2) Endoscopic variceal ligation w/ B-blocker contraindication

96

2 Abx with highest incidence of C diff with best initial test

Clindamycin or ampicillin/C. diff toxin test

97

Tx of recurrent C diff associated diarrhea?

Oral metronidazole

98

Tropical sprue vs celiac disease involvement?

Celiac-duodenum (can have iron deficiency)
Tropical-jejunum/ileum (can have B12/folate deficiency)

99

How do you differentiate chronic pancreatitis and gluten sensitive enteropathy?

Presence of iron deficiency in gluten sensitive enteropathy

100

Tx. dermatitis herpetiformis

Dapsone and gluten free diet

101

Most accurate test whipple?

PAS+ of LP in small intestine with foamy macrophages.

102

Presentation whipple and treatment?

Cardiac, Arthralgias, Neurologic (dementia/seeizures). Tx. ceftriax followed by TMP/SMX

103

Best initial/most accurate celiac?

Anti-tissue transglutaminase (may be absent with IgA deficiency patient), small bowel biopsy showing flattening of villi (also for whipple and tropic sprue)

104

What is D-xylose test?

Differentiate malabsorption due to small intestine degradation or pancreatic insufficiency. Degradation NO d-xylose absorption, but pancreatic or lactase insufficiency allow d-xylose absoprtion becaue it is already a simple sugar not needing degradation.

105

Most accurate test chronic pancreatitis?

Secretin stimulation test

106

Tx. tropical sprue?

TMPSMX, tetracycline

107

Tx IBS?

1) Fiber in diet
2) Antispasmodic (hyoscyamine, dicyclomine)
3) TCA (eg amitriptyline or SSRI)
4) Antimotility such as loperamide for diarrhea

108

When and how often shoul screening occur for IBD?

After 8 to 10 years of COLONIC involvement, with cononoscopy every 1-2 years

109

ANCA and ASCA with IBD as serology when diagnosis is still unclear.

ANCA-UC
ASCA-Crohn

110

Most accurate test IBD?

Endoscopy

111

Steroid specific for IBD?

Budenoside

112

USed to wean patients off steroids in disease so severe recurrences develop as steroids are stopped?

Azathioprine and 6-MP

113

Chronic maintainence remission?

5 ASA (mesalamine)

114

Fistulae and severe disease unresponsive to other agens?

Infliximab (anti TNF)

115

Most accurate test for Diverticulosis?

Accurate-colonoscopy

116

Best initial test Diverticulitis?

CT scan. Colonoscopy and barium dangerous because of increased risk of perforation where infection weakens colonic wall

117

Tx diverticulitis?

1) Cipro and metro OR
2) amox/clavulonate, ticarcillin/clavulonate

118

Colonoscopy screening with or without family hx?

-With family hx. 10 years before diagnosis or age 40, whatever is younger. If family diagnosed

119

Options if they dont want colonoscopy?

High sensitivity fecal occulty annually OR flex sig every 5 years combined with FOBT every 3 years

120

Screening HNPCC (3 fam members, 2 gen, 1 premature (

start at age 25 with every 1-2 years after with colonoscopy.

121

Lynch syndrome I vs Lynch syndrome II

I-hereditary site specific colon cancer
II-cancer family syndrome. Assoc with endometrial (43%), ovarian, and skin cancers

122

FAP screening?

At 12 yearly with sigmoidoscopy

123

Previous adenomatous polyp?

Every 3-5 years colonoscopy

124

Previous history colon cancer screening?

Colonoscopy at 1 yr after resection, then 3 years, then every 5 years

125

Puetz Jeghers presentaiton?

Multiple hamartomatous polyps in association with melanotic (hyperpigmented) spots on lips and skin. Increased friequency of breast, gonadal, pancreatic, colorectal, stomach cancers

126

Turcot/Gardner syndrome?

Turcot-FAP and CNS malignancy
Gardner-FAP and osteomas, desmoid, or other soft tissue tumors

127

Juvenile polyposis syndrome?

Multiple hamartomatous polyps in colon, stomach, small bowel iin children

128

Best initial and most accurate for acute pancreatitis?

-Amylase and lipase initial, CT scan most accurate

129

MRCP vs ERCP

MRCP is diagnostic. ERCP for therapy

130

Type of contrast for abdominal CT scan?

IV and oral contrast

131

When you use antibiotics in pancreatitis?

>30% necrosis can benefit from imipenem or meropenem to prevent development of infected, necrotic pancreatitis

132

Hyperestrogen manifestations for chronic liver disease?

1) Gynecomastia
2) Palmar erythema
3) Loss of body hair
4) Testicular atrophy
5) Angiomas (spider)

133

All patients with chronic liver disease should be immunized against what?

Hep A and B

134

Indications for paracentesis?

new onset ascites, abdominal pain or tenderness, fever

135

treatment of SBP cases?

Cefotaxime or ceftriaxone. All patients need life long prophylaxis with norfloxacin (fluoroquinolone) or TMP/SMX

136

What to use if patient not responsive to lactulose in lowering serum ammonia?

Rifaximin

137

Tx hepatorenal?

Somatostatin (octreotide) or midodrine w/ liver transplant as only established benefit

138

Primary biliary cirrhosis presentation?

Autoimmune destruction of intrahepatic bile ducts with lymphocytic infiltrate and granulomas

139

Tx of PBC and PSC?

PBC: Ursodeoxycholic acid, PSC: Ursodeoxycholic or cholestyramine

140

Most accurate test PBC vs PSC?

PBC biopsy or ANA; PSC is ERCP or MRCP showing beading, narrowing of strictures in biliary

141

Tx chronic hep B

Any one of following: Adefovir, Lamivudine, Telbivudine, Entecavir, Tenofovir, Interferon

142

Tx chronic hep C

combination of ledipasvir and sofosbuvir oral (genotype 1) or sofosbuvir and ribavirin (genotype 2 and 3)

143

Adverse effect interferon

Arthralgias, thrombocytopenia, depression, leukopenia

144

Adverse effect ribavirin

Anemia

145

Adverse effect adefovir

Renal dysfunction

146

Adverse effect lamivudin

None

147

Adverse effect bocepevir

Anemia

148

Adverse effect telaprevir

Rash

149

Feature of Wilson disease?

Copper is Hella BAD (Decrease Ceruloplasmin, Cirrhosis, Corneal deposits, Copper accumulation, Carcinoma), Hemolytic anemia, Basal ganglia degeneration, Asterixis, Dementia, Dyskinesia, Dysarthria

150

Best initial and most accurate for Wilson disease?

Best initial-Slit lamp
Most accurate-increase copper in urine after penicillamine

151

Indications for pseudocyst drainage?

Secondary infection, >5 cm, >6 weeks, symptomatic

152

Why gallstones present in females who are pregnant?

Estrogen induced increase in cholesterol secretion underlying mechanisms for cholesterol gallstones. Decreased progesterone means decreased motility and increased stasis predisposing to formation as well

153

Risk factor acalculous cholecystitis?

Severe trauma, burns, recent surgery, prolonged fasting or TPN, sepsis ICU or mechanical ventilation

154

Why is T3 and T4 total levels decreased with normal TSH in chronic liver disease?

Decreased TBG production by liver so decreased total T3 and T4 with normal free T3 and T4 levels

155

Most likely cause of UGI vs LGI bleed?

UGI-PUD; LGI-diverticulosis

156

Drugs that cause pancreatitis (3)?

Azathioprine, valproic acid, thiazides

157

Most common underlying cause of cirrhosis

Chronic alcohol, hepatitis (C>B), nonalcoholic fatty liver, hemochromatosis

158

Zinc deficiency features?

Alopecia, abnormal taste, bullous pustulous lesions on body orifices, and impaired wound healing

159

Extrahepatic manifestation of chronic hep C

Heme-mixed cryoglobulinemia, Renal-membranoprolif glomerulonephritis, Skin-porphyria cutanea tarda, lichen planus, Endocrine-increase risk diabetes

160

Differential for marked AST and ALT (>25 times upper limit)?

Toxin induced (eg acetaminophen), ischemic (eg shock liver), or viral hepatitis