GI and Hepatology

Question 1

risk factors for cholesterol gallstones include the 5 Fs and what ethnicity?

Answer 1

Native American

Question 2

risk factors for PIGMENT gallstones is caused by __________. increased risk for what ethnicity?

Answer 2

hemolytic dz

Question 3

medical management of gallstones aka cholelithiasis NOT cholecystitis (if not surgical candidate)

Answer 3

ursodeoxycholic acid

note, this can also treat primary biliary cirrhosis

Question 4

use US to dx cholecystitis and choledocholithiasis. if US is equivocal, what is next test (and treatment) to use for each?

Answer 4

cholecystitis - HIDA scan -> cholecystectomy now

choledocho - MRCP -> ERCP now -> cholecystectomy later

Question 5

3 abx regimens that can cover GI bugs, like for cholecystitis or diverticulitis (gram neg rods and anaerobes)

Answer 5

1. ciprofloxacin + metronidazole
2. ampicillin-gentamycin + metronidazole
3. pip/tazo, esp if also covering for skin flora

Question 6

Gardner syndrome

Answer 6

Familial Adenamatous Polyposis (FAP colon cancer)
+ osseous and soft tissue tumors, congenital hypertrophy of retinal pigment epithelium, impacted/supernumerary teeth. fibromatosis.

Question 7

what is colon adenoma-carcinoma sequence?

what can impede progression?

Answer 7

1. APC increases risk of forming polyps.
2. k-ras mutation leads to polyp formation.
3. p53 mutation and increase COX expression = progression to carcinoma.

ASPIRIN impedes progression from adenoma to carcinoma

Question 8

what is gene mutation in FAP colon cancer? and ppx/screening recommendation?

Answer 8

Autosomal dominant APC gene mutation.

start colonoscopy age 10-12, Qyearly prophylactic colectomy or else 100% progress to carcinoma!

Question 9

Hereditary nonpolyposis colorectal cancer aka Lynch syndrome what is gene mutation and prophylaxis/screening recommendation?

Answer 9

DNA mismatch repair gene
start screening (colonoscopy) at age 20 or 10 years prior to first CRC dx in family, whichever comes first. Q1-2yrs

Question 10

apple core lesion on KUB barium enema

Answer 10

colon cancer

Question 11

what is function of CEA levels in colorectal cancer? (dx vs following vs other)

Answer 11

used for regression or relapse. never diagnostic

Question 12

tx of colon cancer with lymph nodes or mets. (if no spread, simple resection is curative)

Answer 12

1. FOLFOX(5-Fu + leucovorin + oxaliplatin)
   OR
2. FOLFIRI (Irinotecan with fluorouracil (5FU) and folinic acid)

• also bevacizumab (VEGF inhibitor) can improve remission

Question 13

if someone has screening colonoscopy, what would indication be for them to have another one in <10 yrs?

Answer 13

Q5-10yrs if: 1-2 polyps <1cm, tubular/low grade

Q1-3yrs if: 3+ polyps 1+ cm, villous/high grade

Q2-6mo if more than that

Question 14

PUD that’s not caused by h.pylori or nsaids or malignancy can be curlings or cushing ulcers. what are those 2 caused by?

Answer 14

curlings - burn patients. from stress?

cushings - increased ICP, ventilated patients, or on steroids

Question 15

what symptom should clue you in on gastronoma aka zollinger ellison syndrome besides refractory PUD?

Answer 15

diarrhea

Question 16

all ulcers in PUD regardless of cause are helped by what 3 things (besides treating underlying cause)

Answer 16

PPI
alcohol cessation
smoking cessation

Question 17

triple and quad therapy for h.pylori

Answer 17

triple: amox OR metroniadzole + azithro/clarithro + PPI
quad: tetracycline + metronidazole + bismuth salt + PPI

Question 18

best NONINVASIVE test to confirm diagnosis of h.pylori infection (obvis egd + bx is best)

Answer 18

urea breath test

Question 19

best test to confirm eradication of h.pylori

Answer 19

stool antigen test

Question 20

what study to localize gastrinoma tumor

Answer 20

somatostatin receptor scintigraphy scan

Question 21

what is the real danger of a gastrinoma/zollinger ellison synrome?

Answer 21

gastrinoma itself is benign. but must be resected, bc high levels of gastrin can cause malignant gastric cancer

Question 22

test and cutoff values for diagnosing gastrinoma/Z-E syndrome

Answer 22

serum gastrin level. MAKE SURE TO HOLD PPI or they will falsely increase the gastrin level
positive >1000
negative <250

if in between and equivocal -> secretin stimulation test . increased gastrin after secretin = positive test

Question 23

when do you need to do EGD with bx for GERD?

Answer 23

PPI trial 6 wks + lifestyle failed
alarm sx present: dysphagia, odynophagia (painful swallowing); gastrointestinal bleeding or anemia; weight loss; and chest pain (different from just burning)

Question 24

once GERD person has metaplasia (barretts) how does management change?

Answer 24

change from low dose to high dose PPIs and annual EGD surveillance required to watch for adenocarcinoma

Question 25

once GERD person has dysplasia how does management change?

Answer 25

treat with local ablative therapies and more frequent EGD surveillance

Question 26

what kind of diet leads to diverticulosis?

Answer 26

lots of red meat, little fiber

Question 27

LLQ post prandial pain that is relieved by a bowel movement in an NONELDERLY patient and an ELDERLY patient?

Answer 27

nonelderly - IBS | elderly - diverticular spasm. treat with high fiber diet to prevent future spasms

Question 28

diverticular hemorrhage is dx by colnoscopy, tagged RBC scan, or angiogram. but diverticuLITIS is dx how?

Answer 28

CT scan. DONT do colonoscopy for increased risk of perforation bc

Question 29

acute diarrhea is defined as < ___ weeks with _____ as the most common cause

Answer 29

< 2 weeks. any diarrhea < 2 weeks is most likely infectious

Question 30

what is most SENSITIVE test for invasive diarrhea in gut causing diarrhea? (pt has acute bloody diarrhea)

Answer 30

LACTOFERRIN | NOT fecal WBC!

Question 31

mnemonic for invasive bacteria that can cause bloody dairrhea

Answer 31

MESSY CACA ``` Medical Dz (IBD) E. coli EHEC Shigella Salmonella Yersinia histolytica ``` C. diff (but can also just be watery) Amoeba histolytica Campylobacter Aeromonas

Question 32

travelers diarrhea (esp Central america) is caused by what bug?

Answer 32

ETEC

Question 33

food poisoning from reheated rice is caused by what bug

Answer 33

bacillus cereus

Question 34

for non toxic megacolon c.diff use oral vanc or oral metronidazole, but what do you use for recurrent infection?

Answer 34

fidoxamicin. if refractory or keeps recurring do fecal transplant.

Question 35

tx for toxic megacolon c.diff

Answer 35

IV metronidazole AND po vanc

Question 36

treatment of HUS (bloody diarrhea + anemia/hemolysis + worsening Creatinine) blood smear will show shistocytes from hemolysis

Answer 36

supportive care, dialysis, and PLASMA EXCHANGE

Question 37

if person has secretory diarrhea (normal osmotic gap, normal fecal fat + nocturnal sx, not affected by eating) what 3 etiologies should you consider? besides c.diff obvis

Answer 37

1. gastrinoma/zollinger-ellison syndrome 2. VIPoma 3. carcinoid - confirm dx with urinary 5-HIAA

Question 38

treatment for oral cadidiasis aka oral thrush vs candida esophagitis

Answer 38

oral thrush - nystatin oral wash | candida esophagitis - systemic dz, requires oral fluconazole (also it's an AIDS defining illness)

Question 39

causes of esophagitis (PIECE)

Answer 39

Pill induced - NSIDs, Abx (Doxy, Clinda, Trimeth/sulf), NRT Infectious - HIV, CMV, Herpes, Candida Eosinophilic - asthma, eczema, food allergy Caustic Everything else - GERD, other.

Question 40

person has esophagitis. get egd + bx. shows eosinophilia. what is treatment?

Answer 40

FIRST treat like GERD with PPI (bc GERD can cause eosinophilia sometimes) if PPI fails, THEN use swallowed aerosolized steroids.

Question 41

2 specific exam findings/signs found in pancreatitis

Answer 41

1. Grey turner sign- flank ecchymosis | 2. Cullen's sign - umbilical ecchymosis

Question 42

causes of pancreatitis (mnemonic PANCREATITIS)

Answer 42

``` PTH Alcohol Neoplasia Calcium Rocks (gallstones) Estrogens AceI Triglyceridemia high Infarction/ischemia Trauma (ERCP, MVA) Infection (mumps) Scorpion stings ```

Question 43

person who had acute pancreatitis few weeks ago now comes with early satiety or abdominal fullness. you suspect pancreatic pseudocyst and confirm dx with CT. what is treatment? (theres a cutoff for different treatments)

Answer 43

<6cm AND < 6 weeks watch and wait >6cm AND > 6 weeks surgical drainage and Meropenem

Question 44

colonoscopy screening rec for UC or Crohn's with colonic involvement?

Answer 44

start colonoscopies 8-10 yrs after dx, Q1-3yrs