MKSAP: GI

Question 0

Why are alcoholics at a higher risk of developing acetaminophen hepatotoxicity?

Answer 0

-chronic alcohol use causes a depletion in the stores of glutathione (used for metabolism of alcohol) –> also needed for the metabolism of acetaminophen –> so they can develop toxicity at lower doses

Question 1

3 Most common causes of aminotransferase values of > 5000 U/L?

Answer 1

1. Acetaminophen hepatotox
2. Hepatic ischemia
3. Viral hepatitis (ex. Herpes simplex)

Question 2

Tx for acetaminophen toxicity?

Answer 2

-N-acetylcysteine

Question 3

5 Ssx of achalasia?

Answer 3

1. Dysphagia
2. Regurgitation
3. Weight loss
4. Chest discomfort
5. “Bird beak” sign on barium swallow = dilated esophageal lumen and smooth muscle narrowing at esophageal outlet

Question 4

What is elevated in Gilbert’s syndrome?

Answer 4

-indirect (unconjugated) bilirubin

Question 5

What does the acronym HELLP syndrome stand for?

Answer 5

• Hemolysis
• Elevated Liver enzymes
• Low Platelets

Question 6

Tx for HELLP syndrome?

Answer 6

• delivery of fetus

- usually resolves within 48 hrs of delivery

Question 7

What 2 groups of pts is herpes hepatitis seen most often in?

Answer 7

1. Pregnant pts

2. Immunocomp pts

Question 8

Aminotransferase values in a pt with hepatic ischemia?

Answer 8

-will be high (>5000), but then will rapidly improve over a few days

Question 9

Pseudoachalasia: what is it?

Answer 9

• sx of achalasia caused by a tumor

- usually seen in pts >60 yrs –> do an endoscopy on elderly pts that present with sx of achalasia!

Question 10

6 “Alarm sx” of abdominal pts?

Answer 10

1. Hematochezia
2. Weight loss
3. Family Hx of colon cancer
4. Fever
5. Anemia
6. Chronic severe diarrhea
   * *require careful evaluation

Question 11

Relationship of nausea and vomiting in relationship to the pain of acute appendicitis?

Answer 11

-n/v follow the onset of pain

Question 12

How does uncomplicated diverticulitis present?

Answer 12

-left lower quadrant abdominal pain and fever

Question 13

Dx of diverticulitis?

Answer 13

• abdominal CT
• colonoscopy should be done several weeks after resolution –> do not do colonoscopy during acute flare up bc complications such as: can occur
  1. Abscess
  2. Fistula
  3. Obstruction

Question 14

Tx for diarrhea predominant IBS?

Answer 14

-loperamide

Question 15

What is a common cause of self-limited, mild pain, hematochezia in eldery pts?

Answer 15

-ischemic colitis

Question 16

How does acute mesenteric artery ischemia usually present?

Answer 16

-sudden, severe, generalized abdominal pain

Question 17

What is the most common cause of acute mesenteric artery ischemia?

Answer 17

-arterial embolism originating from the heart, most often due to afib

Question 18

What is the best initial imaging study for a pt with possible pancreatic adenocarcinoma?

Answer 18

-helical CT scan of abdomen

Question 19

How do pts with severe cholangitis usually present (4)?

Answer 19

1. Fever
2. Jaundice
3. Altered mental status
4. Abdominal pain

Question 20

Ssx of acute cholecystitis (4)?

Answer 20

1. Prolonged right upper quadrant abdominal pain
2. Fever
3. Leukocytosis
4. Hyperbilirubinemia

Question 21

What liver dz are pts with inflammatory bowel dz at higher risk for developing?

Answer 21

-primary sclerosing cholangitis

Question 22

Grey-Turner’s sign?

Answer 22

• ecchymosis of the flanks
• suggests pancreatitc hemorrhage due to pancreatic necrosis
• very rare presentation of acute pancreatitis

Question 23

When should repeat endoscopies be done for pts with barrett’s esopagitis?

Answer 23

-endoscope with bx every 3 yrs

Question 24

What 3 situations would make you suspicious of a gastrinoma in a pt?

Answer 24

1. Multiple ulcers 2. Ulcers in unusual locations 3. Ulcers that recur frequently, esp in absence of NSAID use! **zollinger-ellison syndrome

Question 25

5 alarm features for gastric malignancy with dyspepsia?

Answer 25

1. Weight loss 2. Bleeding 3. Early satiety 4. Vomiting 5. Anemia

Question 26

Serologic testing for H. Pylori

Answer 26

- can be done if the pt doesnt have any alarm sx (if they do, they need an endoscopy!) - test blood, serum, &/or saliva for IgG antibody to H. Pylori --> will remain positive for months

Question 27

What is the most common cause of occult gastrointestinal bleeding in pts > 60yrs?

Answer 27

-angiodysplasia = vascular malformations

Question 28

What is fulminant hepatic failure? What is the first thing that should be done?

Answer 28

- clinical syndrome of severe acute liver failure and encephalopathy in a pt w/out a hx of liver dz - immediate evaluation for liver transplant should be done!

Question 29

4 Ssx of primary biliary cirrhosis?

Answer 29

1. Puritis 2. Hypercholesterolemia 3. Cholestatic liver dz 4. Positive antimicrobial antibody titer

Question 30

What prophylaxtic tx should pts with large esophageal varicies undergo?

Answer 30

-nonselective beta-blocker --> decrease splanchnic blood flow

Question 31

How often should a lt with pan-colitis (for more than 10 yrs) undergo a colonoscopy with bx?

Answer 31

-every 1-2yrs for cancer surveillance