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Flashcards in GI Deck (38)
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1

Diagnosis of achalasia

Manometry is the most accurate test and will show failure of the LES to relax
Barium esophagram will show a birds beak
Upper endoscopy is useful to rule out malignancy

2

Achalasia treatment

Pneumatic dilation, myomectomy or surgical sectioning is more effective but more dangerous
Botox injections – last 3 to 6 months

3

For cancer, what is never the most accurate test?

Radiologic tests, For example, esophageal cancer needs an endoscopy and biopsy

4

Best test for diffuse esophageal spasm and nutcracker esophagus

Manometry, which will show a different pattern of abnormal contraction and each of them
Corkscrew appearance when spasm is occurring
Treated with CCBs and nitrates, similar to Prinzmetal angina, PPIs can help

5

Dysphagia and HIV patient with CD4 less than 100, what to do next?

Empirically start flucanazole, assuming esophageal candidiasis
If no improvement, upper endoscopy with biopsy and if large ulcerations it's CMV treat with ganciclovir, if small – HSV, acyclovir

6

How to detect rings and webs

Barium studies of the esophagus

7

Zenker is diagnosed with? Treatment?

Barium studies, surgery
Not NG tube or endoscopy, dangerous for these people they may perforate

8

How to scleroderma present, management?

Reflux, inability to close the LES, manage with PPI's

9

Manometry for

Achalasia, spasm, Scleroderma

10

Stress ulcer prophylaxis indicated in

Mechanical ventilation, burns, head trauma, coagulopathy

11

Cancer and gastric versus duodenal ulcers

4% of gastric, virtually no duodenal

12

Therapy for H. Pylori

PPI + clarithromycin + amoxicillin
If refractory: metronidazole + tetracycline
If gastric ulcer, repeat ulcer to exclude malignancy
Test of cure: stool antigen or breath test

13

Non ulcer dyspepsia management

If under 45, empiric with PPI
If over 55, endoscopy
Also if dysphagia weight loss, anemia

14

Gastrinoma is often associated with?

Diarrhea since the acid inactivated lipase

15

If gastrinoma + hypercalcemia?

MEN 1: hyperparathyroidism

16

Once gastrinoma confirmed, next best step is to?

Exclude mets: CT/MRI of abdomen, if normal then somatostatin receptor scintigraphy + endoscopic US

17

GIB treatment

IVF
transfuse PRBCs when HCT below 30 in elderly/CAD pts
If drops below 20-25 in others
FFP
platelets if below 50k + bleeding
Varices: Octreotide decreases portal pressure, banding, TIPS, propranolol/nadolol, abx to prevent SBP

18

Treatment for Whipple
Tropical sprue?

Ceftriaxone followed by Bactrim
Tropical sprue: bactrim, tetracycline

19

Distinction between chronicle pancreatitis and celiac

Celiac will have iron deficiency as it requires an intact bowel wall to be absorbed, but does not need pancreatic enzymes
In contrast vitamin B12 needs both

20

Diagnosis of chronic pancreatitis

Abdominal XR, CT
Most accurate: secretin stim test: healthy will release large volume HCO3- rich fluid

21

IBS treatment

Hyocyamine, Diclocyamine
TCAs, loperamide, lubiprostone, linaclotide

22

Treatment of IBD

5-ASA agent: mesalamine
Azathioprine, 6-MP to wean of steroids
Calcium, vitamin D
Perianal Crohns: cipro and metro
Anti-TNF: infliximab if severe
Surgery especially for UC

23

Diverticulitis treatment

Cipro + Flagyl
Augmentin
Zosyn
Timentin
Carbapenem
NPO
Surgery if no response, recurrent infections, perforation, abscess, fistula, obstruction

24

HNPCC screening
FAP?

Begin at 25, scope every 1-2 yrs

FAP: sigmoidoscopy at 12 every year

25

paracentesis should be performed if?

new-onset ascites, abdominal pain/tenderness, fever

26

SAAG over 1.1

think "dilute" ascites fluid- pushed out: portal HTN, CHF, hepatic vein thrombosis, constrictive pericarditis

27

SAAG less than 1.1

think leakage ("exudate" like): infections (except SBP), cancer, nephrotic syndrome?

28

MC etiologies of SBP
treatment

E. coli, S. pneumo, NOT anaerobes
treat with cefotaxime or ceftriaxone
frequently recur, prophylax with norfloxacin or bacterium if low albumin in ascites
all variceal bleeding with ascites needs SBP ppx

29

treatment of hepatorenal syndrome

somatostatin (octreotide), midodrine

30

when to think hepatopulmonary syndrome

orthodexia
hypoxia with sitting upright