GI review Flashcards
(39 cards)
Which of the following is not a cause of organic abdominal pain?
a. Cancer
b. IBD
c. IBS
d. Chronic mesenteric ischemia
a. Cancer
b. IBD
c. IBS
d. Chronic mesenteric ischemia
Which of the following is not a cause of functional abdominal pain?
a. Depression
b. Dyspepsia
c. IBS
d. Chronic pancreatitis
d. Chronic pancreatitis
What is the Rome criteria and what disease does it diagnose?
pain associated with changes in bowel habits relieved by defecation or accompanied by distension or bloating for IBS
What vitamin and mineral deficiencies are patients with a total gastrectomy or gastric bypass surgery at risk for?
(Fe, Ca, B12).
Your patient is a 40 year old male who was diagnosed with GERD 2 years ago. He is now complaining of difficulty swallowing. What is the most likely cause of this patient’s dysphagia?
Schatzki’s ring or esophageal web
a. You perform an EGD with biopsy on this patient with Schatzki’s ring or esophageal web and discover that he has low grade dysplasia Barretts esophagus. You inform the patient that with a diagnosis of Barrett’s esophagus he will need an upper endoscopy every…..?
After a dx of barrett’s esophagus (greater than 5 years or pt is over 50yo), pt will need EGD with biopsy every 2 years. With high grade dysplasia, he will need an esophagectomy.
With oral/pharyngeal dysphagia, which type of physician would you want to refer your patient to? And what is the best test to diagnose this problem?
ENT, barium swallow
What is the classic finding on barium swallow study in a patient with Achalasia?
Birds beak esophagus
A 70 year old woman presents to your ED with a history of forceful, bloody vomiting and is complaining of diffuse chest pain. She has a history of osteoporosis and takes Alendronate for it. What dangerous syndrome are you concerned with in this patient and how would you diagnose it?
a. Borehaave’s syndrome, could also be corrosive esophagitis causing perforation of her esophagus. Look for free air in the mediastinum on CT!!
Your patient is a 50 year old man who is having an upper endoscopy because of chronic epigastric pain. Upon examination, he is found to have significant esophageal varices. You test the patient for hepatitis, inquire about his alcohol consumption (none, he is a Mormon) and his BMI is 23 and he is quite physically active. Given this information, what do you think is causing his esophageal varices?
Budd-chiari syndrome
What medications should this patient avoid indefinitely in a pt with Budd-chiari syndrome?
NSAIDS
How long should your patient with PUD take a PPI?
4 weeks for DU, 8 weeks for GU
Can you have dyspepsia without having an ulcer?
yes
You have a patient with recurring PUD who has had multiple EGDs with biopsy for H pylori which have all come back negative. On each endoscopy the patient has had duodenal ulcers and has begun to have severe diarrhea. What syndrome are you suspecting in this patient and what diagnostic test will you run to confirm your suspicions?
Zollinger-Ellison syndrome, caused by an pancreatic gastrinoma (in most cases), dx with a serum gastrin level >1000pg/mL).
What is the gold standard for diagnosing IBD?
colonoscopy with bx
What’s the most common extra intestinal manifestation of IBD?
(arthritis)
What is the first line tx for IBD?
Aminosalicylates, metronidazole for fistulizing disease in chrons, corticosteroids for acute flair
How long can diarrhea last for it to still be considered acute?
- Which of the following medications are not major contributors to developing C.diff?
a. Cephalosproins
b. Fluoroquinolones
c. Ampicillin
d. Amoxicillin
e. Clindamycin
f. Metronidazole
f. Metronidazole
What are some sx that you might see with fistulizing diverticular disease?
urinary tract symptoms, tracks into bladder, pneumaturia)
Your patient presents to the ER complaining of bloody stool. The patient tells you that they are constipated frequently and sometimes have to strain to defecate. You perform a rectal exam, which is unremarkable. What is the most likely cause of this patient lower GI bleed?
diverticulosis
Your patient presents to the ER with intermittent RUQ that has been going on for a few days and they tell you that they have had gallstones in the past. They also tell you that their eyes looked a little yellow and they felt itchy two days ago but they seem better now. What is your initial diagnostic exam in this patient?
us
You note a dilated common bile duct with gallstones on US, what are the next diagnostic/therapeutic exams that you need to order?
MCRP and then ERCP
You have a patient who presents to your ER with fever, acute jaundice, RUQ pain and hypotension. The patients husband tells you that she was saying strange things in the car as well. Her WBC, total bilirubin and alk phos are elevated. What are this patient symptoms consistent with and how will you treat her?
a. Consistent with acute suppurative cholangitis (Reynolds Pentad of sx) and she needs borad spectrum antibiotic and decompression with a percutaneous drain or ERCP and then a lap chole when she is stable.
