GI Flashcards
1
Q
First step in obscure GI bleed
A
Repeat EGD/c-scope, NOT push enteroscopy
2
Q
Treatment of opioid-induced constipation
A
Oral naloxegol (opioid receptor antagonist) OR oral nadlemedine OR subcutaneous methylnaltrexone
3
Q
When to initiate therapy for chronic HBV
A
- In the immune-active phase, HBeAg-postive and reactivation, HBeAg-negative phase
AND Elevated aminotransferase levels and hepatic fibrosis
4
Q
Management of patient with chronic hep B in immune tolerant phase (active viral load)
A
Serial monitoring of aminotransferase levels.
5
Q
Preoperative aspirin management for colonoscopies
A
- Continue for patients with established cardiovascular disease
- Discontinue after polypectomy in patients without established cardiovascular disease
6
Q
NAFLD on liver ultrasound
A
Hyperechoic
7
Q
Autoimmune hepatitis diagnosis
A
HIGH titer antibody (20-30% of patients with NALFD can have low titer antibody levels) + requires liver biopsy
8
Q
What is pseudoachalasia?
A
TUmor at GEJ infiltrating the myenteric plexus causing esophageal motor abnormalities (symptoms, barium-imaging and manometry and endoscopy are similar to achalasia)
9
Q
How to differentiate pseudoachalasia from achalasia
A
Achalasia = insidious onset, long duration of symptoms (years) before patients seek attention Pseudoachalasia = short duration of symptoms, rapid weight loss
10
Q
Treatment for diarrhea-predominant IBS
A
low-FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) diet
11
Q
How to diagnose zenker diverticulum
A
Barium esophagram (you can see it with endoscopy but too high risk for perforation if endoscope enters diverticulum)
12
Q
Presentation of zenker diverticulum
A
- Regurgitation of undigested food + halitosis + esophageal dysphagia
13
Q
Diagnosis of hepatopulmonary syndrome
A
TTE w/ agitated saline demonstrating that shunting of blood is not intracardiac
14
Q
Pathophys of hepatopulmonary syndrome
A
Dilation of pulmonary vasculature in setting of advanced liver disease
15
Q
Classic features of hepatopulmonary syndrome
A
Platypnea (worsening shortness of breath in upright position)
Orthodeoxia (worsening o2 sat in upright position)
16
Q
Presentation of acalculous cholecystitis
A
biliary colic + sepsis-like + jaundice + critically ill patient + soft palpable mass
17
Q
Treatment for acalculous cholecystitis
A
IF unstable –> cholecystostomy tube placement
IF stable –> cholecystectomy
IV abx, bcx
18
Q
Management of patient requiring NSAID with history of PUD
A
celecoxib + PPI
19
Q
Follow-up colonoscopy interval if hyper plastic polyps
A
10 years (unless greater than 10 mm), they are non neoplastic
20
Q
Follow-up colonoscopy interval if sessile serrated polyps
A
5 years
21
Q
Follow-up colonoscopy interval if 3 or more adenomas
A
3 years
22
Q
Follow-up colonoscopy interval if polyp with villous or high-grade dysplasia
A
3 years
23
Q
Next step for ascending cholangitis
A
ERCP
24
Q
Treatment of toxic megacolon
A
1) Urgent colectomy
2) IV high dose steroids,
3) broad spectrum abx
25
Microscopic colitis clinical features
Nonbloody, watery diarrhea + older adults
26
Microscopic colitis diagnosis
Colonoscopy with random biopsies
27
SIBO clinical features
Diarrhea + bloating/flatulence + weight loss (malabsorption symptoms) + commonly after gastric bypass surgery
28
Autoimmune pancreatitis radiographic features
- "sausage shaped" pancreas
29
Autoimmune pancreatitis treatment
Oral prednisone
30
Management of acute fatty liver of pregnancy
Immediate delivery of fetus
31
Management of a gallbladder polyp
IF larger than 1 cm OR associated with gallstones --> cholecystectomy (increased risk for gallbladder cancer)
32
How to test for eradication of h pylori
Urea breath test OR fecal antigen test
33
Management of gallstone pancreatitis
same-admission cholecystectomy
34
Presentation of narcotic bowel syndrome
Increase in pain with increasing doses of narcotics + chronic pain and nausea
35
Management of pain in chronic pancreatitis
NSAIDs/tylenol
TCA's + gabapentin
smoking and drinking cessation
36
Management of HBV-related polyarteritis nodosa
Entecavir
37
Management of patient with acute pancreatitis who hasn't eaten for 4 days
enteral nutrition
38
SBP prophylaxis
ciprofloxacin
39
Next step for patient with new ascites with negative tap
Prophylactic antibiotics if high risk (low ascitic fluid protein, advanced CHF)
40
Why is albumin infusion used for SBP?
Reduces incidence of hepatorenal syndrome + improves survival
41
Dumping syndrome presentation
vasomotor symptoms (palpitations, tachycardia, diaphoresis, lightheadedness) + abdominal pain + diarrhea
42
Features of secretory diarrhea
High volume stool leading to severe dehydration/electrolyte disturbances + diarrhea persistent when stooling despite fasting
43
When you should think hematochezia may be due to UGIB
Hemodynamic instability from rapid UGIB in a young patient
44
Management of asymptomatic, low risk pancreatic cyst
Surveillance MRI abdomen in 1 year
45
Management of main-duct intraductal papillary mucinous pancreatic cancer
Pancreatic resection
46
Best screening test for celiac disease
Anti-tissue transglutaminase IgA antibody
47
When to restart anticoagulation after GI bleed and hemostasis has been achieved endoscopically
Same day
48
Treatment of baby born to mother with chronic HBV infection
Active HBV vaccination + passive immunization
49
How to prevent vertical transmission of hepatitis B viral infection
Tenofovir
50
Treatment for chronic idiopathic constipation unresponsive to first-line treatment
linaclotide
51
Clinical features of SIBO
diarrhea + bloating + weight loss
52
gastroparesis presentation
Nausea and vomiting after eating
53
Predictive gene assays for CRC?
Multiple are available that predict risk of recurrence but questionable value per NCCN
54
Timing of colonoscopy after uncomplicated diverticulitis
1 to 2 months after first episode (is associated with CRC + IBD)
55
Next step after diagnosis of pernicious anemia
EGD w/ biopsy looking for gastric adenocarcinomas and gastric carcinoid
56
Use of glucose breath test
Test for SIBO
57
Treatment of anal fissue
Daily warm-water sits baths + psyllium (bulk laxative)
58
Clinical significance of multiple fundic gand polyps in the stomach at a young age + next step after finding them
- FAP
| - need colonoscopy
59
Initial test for evaluation of achalasia
Barium esophagram
60
Healthcare maintenance that patients with cirrhosis need
DEXA + vitamin D/calcium/phosphate for osteoporosis
61
DVT prophylaxis for hospitalized patients with IBD
Subcu heparin (IBD is prothrombotic because of systemic inflammation and VTE is a significant cause of morbidity and mortality in patients with IBD)
62
Next step in patient with persistent GERD + extra esophageal symptoms
Ambulatory pH testing (supports diagnosis of laryngopharyngeal reflux)
63
BP management in cirrhotics
Discontinue ACEi's + NSAIDS (decreased renal perfusion, cirrhosis results in reduced renal blood flow and GFR. RAS uptitration is physiologic in this setting)
64
Management of ascites in cirrhotics
- sodium restriction
| - diuretics
65
Treatment of acute liver failure
Immediate referral to a liver transplantation center
66
Definition of acute liver failure
Hepatic encephalopathy within 26 weeks of developing symptoms of liver disease
67
Treatment of left-sided UC
Combined mesalamine therapy (oral + topical) (superior for induction of remission in mild to moderately active disease combined with oral or topical therapies alone)
68
First in evaluation of dyspepsia (sounding like PUD)
IF <60 yo --> Test for H pylori, followed by eradication therapy if positive
IF >60 --> EGD to rule out gastric cancer
69
Treatment for amebic liver abscess (entamoeba histolytica)
Metronidazole + paromomycin (luminal agent)
| pyogenic abscesses are drained percutaneously but amoebic liver abscesses usually resolve with antibiotics
70
Biopsy result in UC
Crypt abscesses + distorted and branching colonic crypts (similar to Crohns)
71
How is UC generally distinguished from Crohn's
Endoscopic findings
72
Wilson's disease clinical features
Young + liver disease + neurologic + hemolytic anemia (copper release from liver cells)
73
Management of achalasia
IF surgical candidate --> myotome or endoscopic dilation
| IF nonsurgical candidate --> botox injection (inhibiting acetylcholine release, resulting in LES relaxation
74
Describe the common variant of hep A
Relapsing, remitting hep A -- multiple relapses with spontaneous improvement
75
Management of chronic PPI therapy
- You should give PPI's at lowest effective dose possible and try to reduce or stop PPI therapy at least once a year.
- Maintenance PPI therapy is really only recommended for patients with GERD who continue to have symptoms after initial course of PPI is discontinued
76
PPI adverse effects with long term therapy
- increased risk for fractures due to calcium malabsoprtion
| - b12 and magnesium malabsorption
77
Term for hyperbilirubinemia condition associated with pregnancy
Intrahepatic cholestasis of pregnancy
78
Management of intrahepatic cholestasis of pregnancy
Ursodeoxycholic acid
79
HELLP presentation
abdominal pain + nausea/vomiting + pruritus + jaundice
80
Clinical significance of isolated right-colon ischemia
- warning sign of acute mesenteric ischemia due to embolism or thrombosis of the SMA
81
Clinical features of medication-induced enteropathy?
Very similar to celiac disease (malabsorption + severe diarrhea and weight loss + villous atrophy and increased intraepithelial lymphocytes in duodenum)
82
Causes of medication-induced enteropathy
- Olmesartan
| - ARBs
83
Management of Barrett esophagus with low-grade or high grade dysplasia
- Endoscopic ablation
| - Esophagectomy only if ablation does not eradicate dysplasia
84
Diagnosis of gastroparesis
Gastric emptying scintigraphy
85
Symptoms of gastroparesis
Early satiety + postprandial fullness + nausea/vomiting + upper abdominal pain + bloating + weight loss
86
Indication for TIPS procedure
Variceal bleeding in which hemostasis cannot be achieved by endoscopic therapy
87
Protein restriction for hepatic encephalopathy?
Debunked
88
Screening recommendation for person with first-degree relative with colon cancer
40 years (or 10 years earlier than the youngest age at which colon cancer was diagnosed -- whichever comes first)
89
Management of HCC
IF cirrhosis --> liver transplant
90
Name of criteria for determining liver transplantation for HCC
Milan criteria
91
HCC diagnosis
Radiographic, no biopsy (biopsies are dangerous in cirrhotics given coagulopathy and tumor seeding)
92
Management of diverticulitis
UNCOMPLICATED
- outpatient antibiotics (ciprofloxacin + metronidazole)
COMPLICATED
- Admit + IV antibiotics
93
Complicated vs. uncomplicated diverticulitis
Complicated = abscess, fistula,
94
Management of fecal loading with overflow diarrhea in elderly person
KUB
95
Treatment of moderate to severe Crohn's (requiring multiple courses of pred)
Infliximab
96
Screening for Lynch syndrome
- C-scope at age 20 or 5 years before earliest age
| - Repeat c-scope q2 years
97
Cancers associated with lynch syndrome
CRC, endometrial, ovarian, pancreatic
98
Cause of Lynch syndrome
Germline mutation in one of the DNA mismatch repair genes
99
Hereditary cancer syndrome associated with gastric cancer
Hereditary diffuse gastric cancer
100
Gene mutation associated with hereditary diffuse gastric cancer
CDH1 gene
101
cancers associated with hereditary diffuse gastric cancer
gastric + breast
102
term for drug removal
dechallenge
103
clinical features of centrally mediated abdominal pain syndrome
near-constant abdominal pain + long duration + generalized
104
Management of centrally mediated abdominal pain syndrome
CBT
105
Treatment of functional dyspepsia
PPI daily for 4 weeks
| IF no benefit from PPI --> TCA
106
Treatment of cryoglobulinemia from chronic hep c
```
Treat the hep C (ledipasvir and sofosbuvir)
IF severe (end organ failure) --> rituximab + pulse dose steroids
```
107
Management of microscopic colitis
Discontinue potentially causative medication
- Loperamide
- Budesonide if no benefit from loperamide
108
Risk for malignant transformation of hepatic adenomas
10%
109
Next step in IDA evaluation if negative upper endoscopy and colonoscopy x2
Capsule endoscopy
110
Treatment of hep B in immune-active, hep B e antigen-positive phase
Tenofovir or entecavir
111
Management of constipation-predominant IBS
Miralax
112
Salvage therapy for H pylori that persists after eradication therapy
- Different antibiotics from original regimen (decrease risk of resistance)
Bismuth + flatly + PPI + tetracycline
113
Management of pancreatic necrosis
IF walled-off + asymptomatic --> no intervention
114
indications for liver transplant
MELD of 15
| Decompensated cirrhosis
