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Flashcards in GI Deck (34):
1

Dysphagia for solid and liquids

Bird's beak

Travel to South America

Dx?

Chagas' disease

2

Testing for Achalasia:

1.

2.

3.

Treatment?

Barium swallow

Esophageal manometry

EGD


Tx - surgical myotomy or endo dilation, (Botox second line), (CCB or nitrates 3rd line)

3

Causes of pill-induced esophagitis

NSAIDs

Tetracyclines

Potassium chloride

Iron

Alendronate

4

Pancreatitis

Sjogren, PSC, IBD

Increased IgG4

Autoimmune pancreatitis Type I

5

Chronic pancreatitis

No systemic disease

Normal IgG4

AIP Type II

6

Secretory diarrhea

Flushing

Dx?

Tx?

Carcinoid

Urinary 5-HIAA excretion

7

Chronic diarrhea with

Arthralgia, fever, cardiac disease, neurological or ocular disease

Dx, treatment

Whipple disease (tropherema whippeli)

12 months ABx

8

Chronic diarrhea plus

Travel to India/Puerto Rico, malabsorption, WL, b12 deficiency

Dx, Tx

Tropical sprue (small bowel biopsy)

Sulfonamide or tertracycline PLUSfolate

9

Ascitic fluid

SAAG cutoff/meaning

Total Protein cutoff/meaning

Phtn, cirrhosis, heart failure > 1.1
TB or infection < 1.1

Heart failure prot > 2.5
Phtn cirrhosis <2.5

10

Anti smooth muscle Ab

PSC

11

Dx PSC, then do what?

Colonoscopy

80% have UC

12

Cirrhosis with AKI mgmt

Definition of HRS

Fluid challenge with albumin

1. AKI > 1.5 from baseline over days to weeks

2. Not responsive to colloid challenge

3. Absence of shock, proteinuria, US evidence of kidney disease, nephrotoxic agents, etc

13

Acute liver failure
Less than 40 yo
HL anemia
Low alk phos

Wilson disease

14

Polyps and gallstone indications for chole

Polyp > 1 cm

Any polyp with gallstones

15

Crohns treatment in pregnancy

Certolizumab

Anti-TNFs are safe and effective during pregnancy

16

Colonoscopy screening in

Patients with UC AND Crohns involving 1/3 of colon

Lynch syndrome

Large >1cm, or dysplastic serrated sessile polyps

Every 1-2 years after 8-10 years of disease

Every 1-2 years after age 20-25, or 2-3 years before youngest first degree relative diagnosed

Repeat in 3 years

17

Ulcerative painful pustular rash in IBD

Pyoderma gangrenosum

18

Ab in PBC

Ab in autoimmune hep

Anti mitochondrial

Anti smooth muscle Ab

19

Treatment of PBC

Suspected disease but negative Ab, next step?

Ursodiol

Biopsy

20

GIB who don't need hospitalization

Need all 4

Age < 60
No HD instability
No gross rectal bleeding
ID of obvious anorectal source on exam

21

Hepatocellular adenoma criteria for resection

Size > 5 cm
Beta-catenin/glutamine synthetics activity positive
Males
Hemorrhage

22

Amsterdam II criteria for HNPCC RFs

Screening for HNPCC

3+ relatives with colorectal, endometrial, ovarian, urothelial, gastric, brain, small bowel, hepatobiliary, or skin cancers

2 successive generations of affected relatives

One affected 1st degree relative and 2 others

AND

One cancer dx before age 50


Screen: every 1-2 years at 25 or 2-5 years prior to youngest dx

23

GIB obscure

Workup

EGD and colo

Repeat EGD or colo depending on symptoms

Capsule
+ then push

24

MELD cutoff for liver transplant

15

25

Milan criteria for HCC

3 tumors < 3 cm

One tumor < 5 cm

Indication for liver transplant because they do well

26

Cirrhotic with UGIB

Mgmt?

Octreotide and Abx (cipro or norfloxacin, or rocephin)

Then EGD

27

When to resume ASA after GO bleed in CV patient

3-5 days

28

First line tx H pylori

Second line (2)

Clarithromycin, amox, ppi

1. Bismuth subsalicylate, metronidazole, tetracycline, ppi x 10-14 d
2. Levofloxacin, amox, ppi x 10 d

29

H/o colon cancer

Screening after surgery

1, 3 yr then every 5

30

Adenoma features needing colo in 3 years (4)

Adenoma > 10 mm
3-10 adenomas
Adenoma with villous component
Adenoma with high grade dysplasia

31

NET size requiring partial gastrectomy

2 cm

32

Treatment for UC if low TPMT level

TNF inhibitors

(High chance of bone marrow tox if 6-MP or azathioprine)

33

Who needs HCC surveillance for chronic Hep B? (6)

African patient > 20 yo
Cirrhotics
Asian men > 40 yo
Asian women > 50 yo
Fam hx of HCC
Persistently elevated ALT or HBV DNA > 10,000

34

How to diagnose insulinoma

72 hr fast

If +, CT pancreas

If negative, EUS