More GI exam 2 studying

Question 1

Treatment with specific abx is NOT recommended for which infectious bacterial diarrhea?

Answer 1

Campylobacter or STEC

Question 2

When do you usually see hepatocellular adenomas?

Answer 2

Long term PCP use

Question 3

What are 3 predictors of development of future advanced adenomas or cancers at baseline colonoscopy?

Answer 3

1) 3 or more adenomas
2) Adenoma size greater than 1 cm
3) Adenoma with high-grade dysplasia

Question 4

Tx of H. pylori in positive patients is a key part of the mgmt of what?

Answer 4

Gastric lymphoma

Question 5

Name a medication that can cause acute diarrhea

Answer 5

Metformin

Question 6

List the Rome IV criteria for IBS diagnosis

Answer 6

Recurrent abdominal pain, on average, at least one day per week in the last three months, associated with two or more of the following criteria:
1) Related to defecation
2) Associated with a change in stool frequency
3) Associated with a change in stool form (appearance)

Question 7

What is a key feature of IBS?

Answer 7

Chronic abd pain relieved with defecation

Question 8

How is c diff diagnosed?

Answer 8

Stool sample NAAT

(Also send samples for GDH enzyme and toxin a&b testing)

Question 9

When should you not use PPIs?

Answer 9

With c diff

Question 10

List and describe the 3 main and arteries

Answer 10

• Celiac artery = stomach & duodenum
• Superior mesenteric artery (SMA) = distal duodenum to mid-transverse colon
• Inferior mesenteric artery (IMA) = transverse colon to rectum

Question 11

When does acute mesenteric ischemia have up to a 90% survivability rate?

Answer 11

If no peritonitis

Question 12

List the diagnostic criteria for toxic megacolon

Answer 12

Radiographic evidence of colonic distention
* PLUS at least 3: fever (>38C, >100.4F), HR >120 BPM, neutrophilic leukocytosis (>10,500/microL), anemia
* PLUS at least 1: dehydration, AMS, electrolyte disturbances, hypotension

Question 13

How do you Dx toxic megacolon?

Answer 13

• CT abd/pelvis with PO & IV contrast (rectal contrast CT), then serial plain films
• Baseline plain abdominal films upon admission- DO THIS FIRST

Question 14

Digital clubbing, asterixis, & splenomegaly are all Sx of what?

Answer 14

Decompensated cirrhosis

Question 15

What makes up the child pugh scores?

Answer 15

HE, ascites, t bili, albumin, PT/INR P

Question 16

Lactulose and/or rifaximin (Xifaxan) can help manage what?

Answer 16

Hepatic encephalopathy (of cirrhosis)

Question 17

Name an early sign of hepatic encephalopathy

Answer 17

Disturbance in diurnal sleep pattern (insomnia & hypersomnia)

Question 18

_______ is not specific for HCC since it can also be seen in patients with gonadal tumors and pregnancy.

Answer 18

AFP

Question 19

If INR elevates with vit k, what does this suggest?

Answer 19

Obstructive jaundice

Question 20

Hyperbilirubinemia:
IF predominant ALP elevation, this suggests what 2 possibilities?

Answer 20

Biliary obstruction or intrahepatic cholestasis

Question 21

Hyperbilirubinemia:
If predominant AST & ALT elevation, this suggests?

Answer 21

Jaundice caused by intrinsic hepatocellular disease

Question 22

List the hyperbilirubinemia labs

Answer 22

Order Sr total & unconjugated bilirubin, ALP, ALT & AST, PT/INR, albumin

Question 23

List the signs of unconjugated hyperbilirubinemia (vs conjugated)

Answer 23

• Stool & urine color are normal
• Mild jaundice
• No bilirubin in urine

Question 24

List 3 causes of unconjugated hyperbilirubinemia

Answer 24

• Increased bilirubin production
• Decreased hepatic uptake
• Impaired conjugation

Question 25

List 3 causes of conjugated/indirect hyperbilirubinemia

Answer 25

• Biliary obstruction (extra-hepatic) • Intra-hepatic cholestasis • Hepatocellular injury

Question 26

Give 4 examples of diarrhea without tissue invasion

Answer 26

Adenovirus, Giardia lamblia, enterohemorrhagic E. coli, salmonella

Question 27

List 2 meds for traveler's diarrhea

Answer 27

• Ciprofloxacin 500 mg • Rifaximin 200 mg

Question 28

• Fever and/or bloody diarrhea in areas where toxin-producing bacteria is major cause (Latin America, Africa) should be given what tx

Answer 28

• single PO dose ciprofloxacin 750 mg (or levofloxacin 500 mg, or ofloxacin 200 mg)

Question 29

• Bloody diarrhea that persists despite single dose fluoroquinolone, take single dose of what?

Answer 29

azithromycin 1000 mg

Question 30

4-9 watery stools/day; may be >15/day is the symptom of what?

Answer 30

Microscopic colitis

Question 31

Describe c diff Sx

Answer 31

greenish, foul-smelling watery diarrhea 5–15+ times per day with lower abdominal cramps; mucus but seldom bloody • Mild -mod abdominal tenderness • Most have WBC counts >15,000

Question 32

Chronic hepatitis B Chronic hepatitis C Cirrhosis Are major risk factors for what?

Answer 32

HCC

Question 33

Patients with h/o pre-cancerous polyps should have interval screening colonoscopy every ___________ years

Answer 33

3-5

Question 34

Virchow node, Sister Mary Joseph nodule are features of what?

Answer 34

Gastric adenocarcinoma

Question 35

What May involve wide resection?

Answer 35

Enteric adenocarcinoma