GI Test And Treatments Flashcards Preview

Step 2 High Yield > GI Test And Treatments > Flashcards

Flashcards in GI Test And Treatments Deck (204):
0

How do you diagnose oropharyngeal dysphagia?

Video fluoroscopy

1

How do you diagnose esophageal dysphagia?

Barium swallow (esophagram)
Followed by: endoscopy
Manometry
Ph monitoring

2

How do you diagnose an esophageal obstruction?

Endoscopy with bx

3

How do you diagnose odynophagia?

Upper endoscopy

4

How do you diagnose diffuse esophageal spasm?

Barium swallow followed by manometry which will show a corkscrew esophagus and high amplitude simultaneous contractions

5

What is the treatment for diffuse esophageal spasm?

Nitrates and CCBs for symptoms
Surgery if debilitating

6

What are the diagnostic tests for achalasia?

Barium swallow : shows bird's beak
Manometry: shows increased resting LES pressure, incomplete LES relaxation, decreased peristalsis
Endoscopy: to r/o obstruction

7

What is are the treatments for achalasia?

Nitrates
CCB
Botox in the LES

8

What are the definitive treatments of achalasia?

Pneumatic balloon dilation
Surgical Heller myotomy

9

How do you diagnose Zenker's diverticulum?

Barium swallow

10

How do you treat diverticulum?

Surgical excision

11

How do you treat zenker's?

Myotomy of cricopharyngeus muscle
Excision of diverticulum

12

How do you diagnose esophageal cancer?

Barium swallow: will show narrowing of esophagus with an irregular border protruding into the lumen

13

How do you confirm the diagnosis of esophageal cancer?

EGD with bx

14

What tests are used for staging of esophageal cancer?

CT and endoscopic US

15

What is the treatment for esophageal cancer?

Chemoradiation and surgical resection

16

What is the treatment for high grade Barrett's dysplasia?

Surgical resection

17

When should someone with GERD undergo EGD with bx?

When they don't respond to empiric medical tx
They've had it for a long time
They have alarm sx

18

What are the lifestyle modifications for GERD?

Weight loss
Elevation of head of bed
Small but frequent meals
Avoid nocturnal meals

19

What are the medications for GERD?

Antacids
H2 receptor antagonists
PPIS

20

What is the surgical treatment for GERD?

Nissen fundoplication

21

How do you diagnose hiatal hernia?

Incidental finding on CXR
Barium swallow
EGD

22

What is the treatment for a sliding hiatal hernia?

Same as GERD

23

What is the treatment for a paraesophageal hernia?

Surgical gastropexy to prevent gastric volvulus

24

What can be used to look for mets in esophageal cancer?

MRI with contrast
PET scan

25

What is the diagnostic test of choice for gastritis?

EGD

26

What test demonstrates exposure to H. Pylori?

IgG Ab

27

What tests can be done to determine infection with H. Pylori?

Stool antigen
Urease breath test
EGD bx

28

What is the treatment of gastritis?

Same as GERD

29

What is the treatment for h. Pylori?

Amoxicillin + omeprazole + clarithromycin
Metro is patient is penicillin allergic

30

How do you diagnose gastric cancer?

Upper endoscopy with bx

31

What is the treatment of gastric cancer?

Resection if early

32

How do you rule out perforation from a gastric ulcer?

Ab XR: look for free air under diaphragm

33

How do you rule out perforation from a duodenal ulcer?

CT with contrast - will show air in retroperitoneal space
Order CBC to detect GI bleeding

34

How do you confirm/rule out gastric bleeding?

Upper EGD with bx

35

How do you diagnose PUD?

H. Pylori testing

36

What should you order if patient is refractory or recurrent PUD.

Serum gastrin level to check for ZES

37

What should you do if you suspect perforation?

CT with IV contrast

38

What should you do if there is a perforation?

Surgical laparotomy
Bp check
Blood transfusions
IV PPIs

39

How do you rule out active bleeding?

Rectal vault exam
NG lavage
Serial hematocrits

40

How do you manage acute PUD?

Rule out active bleeding
IV PPI
Blood transfusions
IVF
urgent EGD for an suspected bleeding

41

When is a EGD with targeted bx indicated?

In patients with refractory sx to rule out cancer

42

How do you diagnose ZES?

Increased fasting gastrin levels
Increased gastrin levels with administration of secretin

43

What is indicated after diagnosing ZES.

CT to characterize and stage

44

What is the treatment of ZES?

PPI
Surgical resection

45

How do you localize a ZES tumor?

CT or octreotide scan

46

What is the treatment for Campylobacter ?

Erythromycin

47

What is the treatment for C. Difficile?

Po metronidazole or vanc

48

How do you treat entamoeba histolytica?

Metronidazole

49

What can lead to fatal perforation with entamoeba histolytica?

Steroids

50

What is the treatment for E. coli O157:H7?

Nothing
Do not give antibiotics because it increases the risk of HUS

51

What is the treatment for salmonella?

Oral quinolones or Bactrim only if sickle cell patient because otherwise this prolongs the carrier state

52

What can be given to decrease the spread of shigella?

Bactrim to decrease person to person spread

53

What is the diagnostic test for lactose intolerance?

Hydrogen breath test (increased hydrogen after milk ingestion)

54

What is the treatment of carcinoid syndrome?

Octreotide
Surgical resection

55

What is the diagnostic criteria for IBS.

At least 3 months of episodic abdominal discomfort that is relieved by defecation and associated with a change in stool frequency or consistency

56

How do you diagnose SBO?

Ab XR : step ladder pattern of dilated small bowel loops, air fluid levels, no gas in the colon

57

What acid base abnormality would you see with SBO?

Metabolic alkalosis due to contraction

58

What is the treatment of SBO?

IVF
NPO
NG tube
Foley
Correct electrolytes

59

When is an exploratory lap indicated for an SBO?

Partial SBO after 3 days
Complete SBO
Ischemic necrosis

60

What is required in an elderly patient if ileus is suspected?

A rectal exam to rule out fecal impaction

61

How do you diagnose ileus?

Abdominal films show distend loops of small and large bowel with air seen throughout the colon and rectum

62

What is the treatment of ileus?

Discontinue offending meds
Temporary NPO
NG tube
Replete electrolytes
IVF

63

What do labs show with mesenteric ischemia?

Leukocytosis
Metabolic acidosis
Increased LDH, amylase, lactate, CK

64

What is seen on Ab XR and CT with mesenteric ischemia?

Bowel wall edema
Air in the bowel wall (pneumatosis intestinal is)

65

What is the gold standard for diagnosing mesenteric ischemia/arterial occlusive disease?

Mesenteric angiography

66

What is the treatment of mesenteric ischemia?

IVF
Broad spectrum antibiotics

67

How do you definitively diagnose diverticulum disease?

Colonoscopy

68

What should be avoided in patients with early diverticulitis and why?

Sigmoidoscopy or colonoscopy because of the risk of perforation

69

What is the treatment for uncomplicated diverticulosis?

High fiber diet or fiber supplements

70

What is the treatment for bleeding that doesn't stop in diverticulosis ?

Hemostasis by colonoscopy, angiography with embolization or surgery

71

What is the treatment of diverticulitis?

NPO
NG tube placement
Broad spectrum antibiotics (metro + quinolones or 2/3 gen ceph)

72

How do you treat a LBO?

Gastrogaffin enema
Rectal tube
Colonoscopy
Surgery

73

How do you diagnose colon cancer?

Colonoscopy with bx

74

What should you order to evaluate for mets of colon CA?

CXR
LFTs
Abdominal/pelvic CT

75

What is the treatment for colon cancer with positive nodes?

Adjuvant chemo with surgery

76

What is the treatment for ischemic colitis?

NPO, IVF, antibiotics
Bowel resection is infarct, fulminant colitis, or obstruction

77

What is the diagnostic test for ischemic bowel?

CT
Colonoscopy : pale mucosa with petechia

78

How do you diagnose upper GI bleed?

NG tube and lavage
Endoscopy (if stable)

79

What is the treatment of UGI?

Endoscopy with treatment

80

What is the diagnostic test of choice for LGI?

Anoscopy/sigmoidoscopy for patients greater than 45 with small volume of bleeding
Colonoscopy

81

What is the diagnostic test of choice if patient is unstable?

Arteriography
Exploratory laparotomy

82

What is the treatment for diverticulosis causing lower GI bleed?

Epi injection
Intra arterial vasopressin or embolization
Surgery

83

What is the test of choice for gallstones?

RUQ US

84

How do you diagnose cholecystitis?

US
If US is equivocal do HIDA scan

85

What is the treatment of cholecystitis?

IV antibiotics and IVF
Surgical cholecystectomy

86

How can definitive diagnosis of UC and Crohn's be made?

Colonoscopy with bx

87

What are the treatments for UC and crohn's ?

5-ASA agents
Azathioprine
Corticosteroids

88

What treatment can be curative of UC?

Total proctolectomy

89

What is the hallmark of choledocholithiasis?

Increased alk phos and total and direct bilirubin

90

What is the treatment of choledocholithiasis?

ERCP with sphincterotomy and cholecystectomy

91

What is diagnostic of ascending cholangitis?

ERCP

92

What is the treatment for ascending cholangitis?

ICU admission
IV antibiotics
emergent bile duct decompression!!! -->. ERCP

93

How do you diagnose gallstone ileus?

Ab XR that shows characteristics of SBO

94

What is the treatment of gallstone ileus?

Laparotomy with stone extraction and closure of the fistula + cholecystectomy

95

How do you diagnose PSC?

MRCP/ERCP: shows beading from multiple duct stricture/dilation
Liver bx: shows onion skinning of periductal stenosis

96

What is the treatment for PSC.

High dose ursodiol
ERCP with dilation and stenting of strictures
Liver transplant (definitive)

97

What is the marker for autoimmune hepatitis?

Anti-smooth muscle antibodies

98

What is the treatment for chronic HBV infection?

INF And Lamivudine
Or adefovir

99

What is the treatment for INF and ribavirin for?

Chronic Hep C

100

How is SBP diagnosed?

Paracentesis
With greater than 250 PMNs/ml in the ascitic fluid and positive gram stain

101

What does an SAAG less than 1.1 mean?

The ascites is not related to portal HTN

Due to TB, malignancy or nephrotic syndrome

102

What is the treatment of SBP.

IV antibiotics (ceftriaxone)
IV albumin

103

What should be given to prevent recurrence of SBP?

Fluoroquinolone

104

What is the treatment of ascites?

Sodium restriction
Diuretics (furosemide and spironolactone)
Large volume paracentesis

105

What is hepatorenal syndrome?

Acute preferably failure (decreased GFR, urine osmolality great than 500, urine sodium less than 10, FeNa less than 1%, bun/cr greater than 20) + cirrhosis

106

What is the cure for hepatorenal syndrome?

Liver transplant

107

What is the treatment for hepatic encephalopathy?

Protein restriction
Lactulose
And/or rifampin

108

What is the medical prophylaxis for esophageal varices?

Bb

109

What is the treatment for esophageal varices?

Endoscopy with band ligation or sclerotherapy

110

What is the treatment for coagulopathy associated with liver cirrhosis?

FFP

111

What are the treatments for PBC?

Ursodeoxycholic acid for slowing disease progression
Cholestyramine for pruritis
Liver transplant

112

When is a partial hepatectomy ok to do for HCC?

For single lesions less than 5 cm and no cirrhosis

113

What is the surgical treatment for patients with HCC and cirrhosis?

Ortho topic liver transplant

114

What is the non surgical treatment for advanced disease?

Transarterial chemoembolization and/or sorafenib

115

What should be monitored for recurrence of HCC?

AFP levels

116

How is HCC diagnosed?

Mass on US or CT
Abnormal LFTs
Elevated AFP

117

How is hemochromatosis diagnosed?

Increased serum iron, percent saturation of iron and ferritin
Transferrin saturation over 45%

118

What should you do if you suspect hemochromatosis?

Liver bx
MRI or HFE mutation screen

119

What is the treatment of hemochromatosis?

Weekly phlebotomy then maintenance
Deferoxamine for maintenance

120

How do you diagnose Wilson's disease?

Decreased serum ceruloplasmin
Increased urinary excretion of copper
Liver bx
Rhodamine or orceine stain

121

What are the diagnostic tests for acute pancreatitis?

Amylase, lipase, calcium
Ab US or CT- show sentinel loop or colon cut-off sign

122

What is the treatment of acute pancreatitis?

Same as SBO
IVF
NPO
NG tube
Nutritional support

123

What is the diagnostic sign on AXR and CT for chronic pancreatitis?

"Chains of lakes"
Calcification

124

What is decreased in chronic pancreatitis?

Stool elastase

125

What is the treatment for chronic pancreatitis?

Analgesia
Celiac nerve block
Pancreatic enzyme replacement

126

What is used for diagnosis of pancreatic cancer?

CT with contrast

127

What can be used to assess extent of pancreatic cancer

Ct with contrast

128

What can be used if cant see mass on CT?

Endoscopy
ERCP with bx

129

What is often elevated in pancreatic cancer?

CA-19-9

130

What is the treatment?

Chemo with 5-FU and gemcitabine

131

When can a whipped procedure be done?

If tumor is small in the head of the pancreas with no mets

132

What Hep B drug is reserved for younger patients with compensated liver disease?

INF

133

What are the preferred drugs for hep b?

Entecavir
Tenofovir

134

What med is added to INF and ribavirin for patients who have genotype 1 hep c?

Telepravir

135

What is the treatment for severe C dif. With WBC over 15 or Creatinine over 1.5?

Oral vanc

136

What if the patient has severe c.dif and has an ileus being treated with oral vanc?

Add IV metro
Or switch or rectal vanc

137

What is the treatment for C.dif when WBC is above 20K, lactic acid is greater than 2.2, if they have toxic megacolon or severe ileus?

Subtotal colectomy
Diverting loop ileostomy

138

What is the treatment for mild C.dif?

Oral metro

139

How do you diagnose C.dif?

Stool studies for c. Dif toxin

140

What drug can be used for recurrent colitis or in patients who can't tolerate oral vanc?

Fidaxomicin

141

What is IV vanc commonly used for?

Bacteremia secondary to an skin source (central line)

142

What is the D-xylose test used for?

Celiac disease because it is a monosaccharide so it doesn't need enzymatic breakdown, just an intact mucosa
Positive test = low D-xylose in urine because it gets excreted in the feces instead

143

What is the treatment of hepatic hydrothorax?

Salt restriction and furosemide
Therapeutic thoracentesis
TIPS

144

What is part of the management of Hep A?

Giving immunoglobulin to contacts
Giving vaccine to those at high risk

145

What is the treatment of NEC?

IV antibiotics
NPO
TPN
IVF
Surgery

146

What is the test of choice for intussception?

US - shows target sign

147

What should you do for breast feeding failure jaundice?

Increase feeds to every 2-3 hours for 10-20 minutes

148

When does a baby need an exchange transfusion?

When unconjugated bilirubin is over 25 or 20 for preterm infants

149

When should the bilirubin level be rechecked if baby has jaundice?

In 2 days

150

What is the treatment for galactosemia?

Soy based formula
No cow based or breast milk

151

What is the first step after BRBPR if under 50 with no other risk factors

Anoscopy or proctoscopy

152

What if a patient over 50 has BRBPR.

Do a colonoscopy or sigmoidoscopy

153

What is the diagnostic test for retroperitoneal abscess?

CT

154

What is the treatment of a retroperitoneal abscess?

Immediate placement of percutaneous Catheter for drainage
Cultures
Surgical debridement

155

What should management of cirrhosis entail?

Periodic LFTs, albumin, INR, bilirubin

156

What should management of compensated cirrhosis include?

US for surveillance of HCC +/- AFP q 6 months
EGD for varices

157

What should management of uncompensated cirrhosis include?

Bb for varices + EGD annually
Sodium restriction, diuretics and paracentesis for ascites, abstinence from EtOH
Hepatic enceph ? Lactulose, fix etiology

158

What is the gold standard for diagnosing small bowel bacterial overgrowth?

EGD with jejunum aspirate showing greater than 10^5 organisms

159

What is the treatment for bacterial overgrowth?

7-10 days of antibiotics (rifamixin, augmentin)
Avoid anti-motility drugs
Try promotility drugs
Change diet

160

What is the treatment of hepatorenal syndrome?

Midodrine
Octreotide
Dialysis

161

What is done for diagnosis of tropical sprue?

Mucosal bx : shows blunting of villi with infiltration of inflammatory cells

162

When do you diagnose SBP?

When neutrophil count is greater than 250

163

What is the tx for SBP?

IV antibiotics : ceftriaxone, Fluoroquinolones, or extended spectrum penicillin

164

How do you confirm esophageal rupture?

CT chest
Contrast esophagram

165

What is recommended after gastric bypass surgery to prevent gallstones?

Ursodeoxycholic acid for 6 months

166

What is the tx of pruritis due to pancreatic cancer?

Endoscopic stent placement in th common bie duct via ERCP

167

Which chemo therapeutic agent is used to treat unresectable metastatic pancreatic cancer?

5-FU with radiotherapy

168

How do you diagnose a midgut volvulus?

Upper GI series

169

What is the tx of a midgut volvulus?

NG tube
ICF
Emergent surgical repair

170

How do you assess for cardiac iron overload in hemochromatosis?

Cardiac MRI

171

What is the tx for fluid collection less than 3 cm in complicated diverticulitis?

IV antibiotics and observation

172

What is the tx for uncomplicated diverticulitis?

Bowel rest
Antibiotics
Obs

173

What is the next step if CT drainage of fluid collection in diverticulitis does not improve sx within 5 days?

Surgical debridement

174

What is the tx for ascites in patients who are maxed out on furosemide and spironolactone?

Therapeutic daily tap of ascitic fluid

175

What are the steps in the management of ascites?

1. Salt and water restriction
2. Spironolactone
3. Furosemide
4. Tapping

176

How do you diagnose toxic megacolon?

Plain Ab XR
Fever over 100.4, WBC over 10,500, and anemia

177

What is the tx for toxic megacolon?

IVF
Broad spectrum antibiotics
Bowel rest
IV corticosteroids if due to IBD
Emergency surgery if it doesn't resolve

178

What test is used for diagnosing chronic pancreatitis?

Secretin test which directly measures the ability of the pancreatic ducts to make bicarb

179

How do you diagnose splenic abscess?

CT abdomen

180

What is the tx for splenic abscess?

Splenectomy

181

When is ERCP indicated?

Chronic pancreatitis
Ampullary cancers
Bile duct exploration
Tissue bx

182

What is the diagnostic test for appendiceal abscess?

CT

183

What can be used to tx severe alcoholic hepatitis?

Prednisone

184

What should be done after confirming achalasia?

Endoscopy to rule out malignancy

185

What is the criteria for diagnosing toxic megacolon?

Evidence of colonic distention + 3 of the following:
Fever over 38
HR over 120
Neutrophil of leukocytosis over 10,500
Anemia

Plus one of the following:
Volume depletion
Altered sensorium
Electrolyte imbalance
Hypotension

186

What is the initial test of choice when suspecting toxic megacolon?

AbXR to confirm dilation of colon over 6 cm

187

What is the best test to evaluate for complications of diverticulitis.

CT scan

188

When should a patient have the secretin stimulation test?

When suspected of having ZES but serum gastrin levels are non diagnostic

189

What level of gastrin is diagnostic of ZES?

Over 1000

190

What is important to check for when suspecting ZES?

Gastric ph levels to r/o achlorhydria causing secondary hypergastrinemia

191

When is the calcium infusion test used?

In patients suspected of ZES with a negative secretin stimulation test

192

How do you diagnose a pancreatic pseudo cyst?

US

193

What are the criteria for treating chronic Hep C?

Age over 18
Detectable HCV RNA in serum
Liver bx with bridging fibrosis and chronic hep
Compensate liver disease
Stable labs

194

What are the contraindications for treating chronic hep C?

Ongoing alcohol or drug abuse
Major uncontrolled depression

195

What should be done when considering treatment for chronic hep C?

Liver bx - the degree of inflammation and fibrosis predicts the response to treatment, stage of disease and surveillance guidelines

196

How often is HCC checked for in cirrhosis patients?

Every 6 months by US

197

How do you diagnose someone with hep B?

HbsAg and Anti-Hbc IgM

198

What is the tx of an amebic liver abscess?

Metronidazole
And paromomycin, or iodoquinol, or diloxanide

199

How do you diagnose Dubin Johnson syndrome?

Conjugated hyperbilirubinemia with a direct bilirubin fraction over 50% and an otherwise normal LFT

200

What is the confirmatory test of Dubin Johnson?

Urinary coproporhyrin - look for unusually high levels of coproporhyrin I

201

What are the short term tx for Crigler Najjar?

Phototherapy
Plasmapheresis

202

What is the tx for cryoglobulinemia?

Plasmapheresis
Immunosuppressants

203

How do you diagnose mixed cryoglobulinemia?

Serology
Kidney or skin bx