MTB 2 CK - Gastroenterology Flashcards Preview

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Flashcards in MTB 2 CK - Gastroenterology Deck (102):
1

What's the presentation of GERD ? 5 ( Yeah you keep getting this wrong motherfu*ka )

- Substernal Chest Pain without cardiac disease
- Chronic Cough
- Belching
- Metallic or Sour Taste
- Wheezing Without Reactive airway disease

2

What is a uncommon cause of GERD ?

- Hyper-Ca2
- Calcium is a Secondary Messenger for Gastrin
- Ca increased acid production

3

Which meds are risk factors GERD ? 5

- Theophylline
- Diazepam
- Prochlorperazine
- Promethazine
- Estrogen Replacement
All relax the LES

4

What's the best initial test ? Most accurate test ? When is endoscopy indicated ? for GERD ?

- Best initial Test / tx = PPI for 4-6 weeks
- Most accurate Tx = 24 hour pH monitoring
- Endoscopy indicated when Sx persists or Alarm Sx :
Dysphagia
Odynophagia
GI bleeding or Anemia
Weight Loss

5

What are the Alarm Sx for GERD ?

- Needs immediate Endoscopic Eval
Dysphagia
Odynophagia
GI Bleeding or Anemia
Weight loss

6

When is 24 hour pH is indicated for GERD ?

- Asthma begins in a adult with GERD
- Hoarseness
- Sleep Apnea is comorbid
- Med Tx has failed

7

What's the Tx for Gerd ?

- Lifestyle Change
- Medical Tx - PPI
- Surgical Tx - Nissen Fundoplication when PPI fail

8

What are the FYI's of GERD ?

- H. Pylori Doesn't cause GERD
- Carafate is always the wrong answer
- Antacids have only 20% short term relief

9

What are the findings of schatzki ring ?

- Intermittent dysphagia
- Midesophagel narrowing on barium swallowing

10

What is contraindicated in a pt with Zenker Diverticulum ?

- NG tube
- Risks perforation

11

45 y.o. presents to the ED severe crushing chest pain. Troponin is normal. Ekg is normal. Fat b*tch just hit the startbucks drive thru for a cold frap. Pain doesn't get worse with exertion. Can't swallow and is drooling . What's the Dx ? what's the best test ? most accurate test ? tx ?

- Esophageal Spasm
- Best test - Barium
- Most Accurate test - Manometry shows abnormal only at time of spasm difficult to time
- Tx - CCB

12

Odynophagia vs Dysphagia ?

- Odynophagia = usually infectious needs a biopsy
- Dysphagia =
younger pt = motility problem
older pt = cancer / stroke

13

How can you tell Candidal Esophagitis vs CMV or HSV ?

- Candidal can have normal esophagus without ULCERS

14

Which medications have Pill Esophagitis Reactions ?

1) Alendronate
2) Doxy
3) NSAIDS
4) Potassium

15

72 y.o. Pt has severe substernal chest pain. Burning in nature. Intermittent for several weeks. Sometimes worse with food. PmHx of Osteoperosis. She is Diaphoretic , Distressed . No Crepitus around the clavicles . Had a Hematemesis before admission . What's the Dx ? most accurate test ?

- Pill Esophagitis
- Most accurate test = Endoscopy

16

Eosinophilic Esophagitis Seen with what sx ?

- Young Pt with odynophagia
- Asthmatics
- Furrowed appearing esophagus
- Concentric grooves
Tx Steroids

17

HSV , CMV Esophagitis viral culture must be taken at the margin. Otherwise you may get a false negative .

- just FYI

18

What is the tx for Barrett's esophagus ?

Depends on the Endoscopic Findings
- Non Dysplastic or Barrett Esophagus = PPI repeat endoscopy in 3 yrs
- Low Grade Dysplasia: Give PPIs and repeat EGD in 3-6 ( 6-12 months ? ) months
- High Grade Dysplasia or Carcinoma : Surgery

19

Mallory Weiss vs Boerhaave's Syndrome ?

MW =
*Chest Pain
*Hematemesis no SUB-Q Air
*no Neck Pain tear's usually Distal LES

Boerhaave's =
*full thickness tear 2/2 to retching
*SUB-Q Air
*Neck Pain

20

How does Esophageal Perforation present ? 4

-Severe Retrosternal Chest pain after vomiting
-Odynophagia and Hematemesis
-SUB-Q Air
-Radiation of pain to left shoulder

21

What is the most accurate test for Esophageal Perf? tx ?

- most accurate = gastrografin esophogram
shows contrast outside the lumen of the esophagus

- Surgery of Esophagus and Debridement of the Mediastinum
- Esophageal Stents

22

What are the warning signs for PUD / Gastric Ulcer ?

Weight loss
Early Satiety
Anemia

23

What is the Dx testing for PUD/Gastric ulcer ?

- Upper Endoscopy with Biopsy to rule out cancer
- Duodenal ulcer don't get cancer

24

How do you dx H. Pylori ? -

- If Endoscopy and Biopsy are done no test needed for
H. Pylori

- If not then :
1. Serology : Very Sensitive but can't tell old vs new infections

2. Breath Test and Stool Antigen: Useful to see if tx worked. Sensitivity of both is affected with PPI and antibiotics.

25

What's the best test for CURED H. Pylori infection ?

- Urea Breath Test
or
- STool sample

26

After PUD is resolved . Pt must be RE-Scoped . why ?

- the only way to exclude cancer 100%
- even if biopsy is normal

27

What's the greatest risk factor for developing Duodenal Ulcer Disease ?

- H. pylori

28

What is a important agent that doesn't not cause GERD ?

- H. pylori

29

When is a 24 hour pH monitoring indicated in pts with GERD sx ? 4

- Asthma begins with GERD Sx
- Hoarseness persists
- Sleep Apnea is comorbid
- Medical Tx has Failed

30

What's the best initial test for GERD ?

- PPI administration

31

What are the best tx for Achalasia ?

- Pneumatic Dilation
OR
- Surgical Myotomy

32

What's the clinical sx for Schatzki ring ? tx

- Intermittent dysphagia
- Mid Esophageal narrowing on barium swallow
- Pneumatic Dilation ( same tx in Achalasia ) 4% risk of Perforation

33

What are Schatzki ring almost always 97% associated with ?

- Hiatal Hernia

34

What are the esophageal spasms ?

- Sx - starts when drinking cold water
- Diffuse Esophageal Spasm = 20% more contractions on manometry
- Hypertensive Peristalsis ( Nutcracker) = normal contraction in smooth muscle via manometry

- Tx : CCB or Imipramine

- Barium swallow shows Rosebead or Corkscrew shape for Nutcracker

35

Odynophagia in a old vs young pt etiology ?

- Old = Stroke or Cancer
- young = infectious

36

What's the MCC of Infective Esophagitis in a AIDs/HIV pt w/

- Candidiasis 90% of the time
- Start with Oral Fluconazole
- Then IV Amphotericin
- Nystatin Oral = Treats only ORAL Candidiasis not Esophageal Candidiasis
- Candida doesn't need to be present to have pt infected vs CMV or HSV causing infective esophagitis

37

What are the causes of dysphagia ?

- Achalasia
- Esophageal Cancer
- Peptic Rings from acid exposure
- Zeneker
- Esophageal Spasm

38

What are the caused of Esophagitis ?

- CMV , HSV , Candidiasis
- Pill Esophagitis
- Eosinophilic Esophagitis

39

What's the Tx for Plummer Vinson Syndrome ?

Treat Iron Deficiency first = sometimes resolves sx

40

What esophageal dx needs manometry ?

- Achalasia
- Spasm
- Scleroderma

41

What is the only way to truly understand the etiology of epigastric pain from ulcer diseases ?

- Endoscopy w/ possible biopsy

42

When is Endoscopy Indicated for GERD ? -

- Signs of Obstruction like dysphagia or odynophagia
- Weight loss
- Anemia or Heme Positive Stools
- > 5 years of Sx to exclude Barrett's

43

What are the Sx of Esophageal Perforation ? what's the Dx Test ?

- Retrosternal Chest Pain
- Odynophagia
- SUB-Q air especially with Heart Beat = Hamman's Sign
- Radiation of pain to left shoulder

Dx
- gastrografin esophogram = shows contrast outside the lumen

44

what's the common presentation of Gastritis ? DX ?

- Bleeding without Pain
- but Severe Erosive gastritis can have pain
- you can't usually answer the Dx question from H/P alone

Dx = needs a endoscopy to diagnose

45

Which Dx need endoscopy ?

- Barrett's
- Cancer
- PUD - Peptic Ulcer ( duodenal and gastric ulcer disease)
- Gastritis ( No Ulcer )
- Non-Ulcer Dyspepsia
- H.Pylori - not needed but most accurate way to diagnose

46

Stress ulcer prophylaxis is indicated in which pts?

- Mechanical ventilation
- Burns
- Head Trauma
- Coagulopathy

47

PPI is the first line tx in ?

- GERD
- Scleroderma
- PUD

48

Whats the causes of Gastritis vs PUD ?

Gastritis
- ETOH
- NSAIDS
- H. Pylori
- Portal HTN
- Stress - burns , trauma , sepsis , uremia

PUD - Gastric Ulcer and Duodenal Ulcer
- MC = H. pylori
- NSADIS = 2nd MC

49

What common irritants do not cause ulcers ?

- Alcohol
- Tobacco
they delay healing of ulcers

50

What is the most accurate test for H. Pylori?

- Biopsy

51

What's the best initial test ? Most accurate test for Zollinger Ellison ?

- Endoscopy has to confirm ulcer first then ....

Best initial Test
- Secretin challenge - pt shows high gastrin = positive
- High Gastrin with high gastric acidity despite PPI use

Most Accurate test
- Somatostatin Receptor Scintigraphy with endoscopic Ultrasound exclude metastatic disease

52

Gastrinoma is usually seen with what sx ?

- Diarrhea because acidity inhibits lipase

53

What's the most common cause of UPPER vs Lower GI bleed ?

- Upper GI = Ulcer Disease
- Lower GI = Diverticular Disease

54

When a confirmed case of Gastrinoma is seen what's the next step ?

- Have to exclude metastatic disease
- CT / MRI usually are done but have poor sensitivity


***- Use Somatostatin Scintigraphy ( Nuclear Octreotide Scan) with Endoscopic Ultrasound
- Do this if MRI and CT are normal

55

What is the cause of diabetic gastroparesis ?

- autonomic damage
- unable to sense stretch of in the GI tract

56

What's the most accurate test for diabetic gastroparesis ?

- Nuclear Gastric Emptying Study
-

57

What sx are seen diabetic gastroparesis ?

- DMII for a long time

58

Normal Saline or Ringer lactate > 5% dextrose in water why ?

- D5W doesn't stay in the vascular space to raise blood pa as well as Normal Saline

59

Which is the only type of GI bleed can a Physical exam determine ?

- Variceal Bleeding

60

What's the MGMT goal of an GI Bleed ?

- Fluid Resus First
- 80% die of inadequate fluid replacement

61

56 y.o. Cirrhotic Pt has black stool . No hematemesis . NG tube shows bright red blood. What's the Dx ?

- Variceal rupture

62

What is the sign for NG tube is fully sensitive ?

- Bile in the Aspirate

63

What's the indication for capsule endoscopy ?

- Small intestine bleeding that can't be reached by endoscopy

64

What's the TX for GI bleeding ? 6

1) Fluid Resus
2) Packed RBC if HCT =

65

What's the Tx for Esophageal Varice and Gastric Varice ? 5

1) octreotide
2) Banding
3) TIPS = associated with portosystemic encephalopathy . Connects the hepatic vein and Portal Vein
4) Propranolol - prevent future bleeding
5) Antibiotics - prevent SBP with Ascites

66

Sclerotherapy for Variceal Bleeding is NEVER RIGHT if BANDING is possible

just fyi

67

What's the tx for C. Diff ?

- Metronidazole
- Only Switch to PO Vancomycin if the Metronidazole didn't work or it's a severe case

68

What's the main diff in Sx for chronic pancreatitis vs gluten sensitive enteropathy celiac disease ?

- Celiac = has Iron DEFICIENCY - needs a intact bowel to absorb Fe
- doesn't Need Pancreatic Juices

69

What's the best initial test? What's most accurate diagnostic test why else do we do it ? for Celiac ?

Best initial test = anti- gliadin , anti transglutaminase , anti endomysial

Most Accurate = Small Bowel Biopsy to prove villous architecture abnormal and to EXCLUDE LYMPHOMA

70

What's the most accurate test? what's the best initial test ? for Chronic Pancreatitis ?

- Most accurate = NG tube Secretin Challenge - Normal response is bicarb release

- Best initial = XR or CT for Calcifications on Pancreas

71

What's the best initial test ? what's the tx ? for Carcinoid ?

- best initial = Urinary 5 hydroxyindoleacetic acid
- tx = octreotide

72

What's the tx for IBS ?

Anti-Spasmodic Agents and Rest And Exercise
- Dicyclomine
- Hyoscyamine

73

What's the antibody seen in crohns vs ulcerative colitis ?

- Chrons - Anti-saccharomyces cerevisiae pos, ANCA negative

- Ulcerative colitis - Anti-saccharomyces cerevisiae NEG, ANCA POS

74

what are the extraintestinal manifestations of crohns vs UC ?

- Chronic = Kidney Stones, Erythema Nodosum , Episcleritis , Aphthous Ulcers

- UC = Pyoderma Gangrenosum , Sclerosing Cholangitis

75

What' the tx in Crohns vs UC ? acute ? chronic ?

- Crohn's - Anti-TNF-Alpha - Infliximab - Surgery is not Curative - Surgery only done for obstruction

- UC - Cyclosporine , Infliximab , Hemi to Total Hemicolectomy - Surgery is curative

Acute = Steroids
Chronic = 5ASA-mesalamine

76

WHat's the purpose of Azathioprine and 6 mercaptopurine in IBD pts ?

- Used to wean pts of Steroids - Budesonide Specific for IBD
- Give Calcium and Vitamin D

77

Specific Differences between Crohn's VS UC ?

Chrons -
-Perianal Disease/Abscess ( comes from Anal crypts, don't mix up with crypt abscess of UC that can happen elsewhere)
-Mass and Obstructions
-Fistulas
- Anti-Sacchromyces Cerevisiae Pos but ANCA neg

UC
- Cure by surgery
- None of the above
- ANCA pos but ASCA neg

78

What's the most accurate test for IBD ?

- Endoscopy
-

79

What's the purpose of Azathioprine and 6 mercaptopurine in IBD treatment ?

- Used to wean pt off of steroids
- Everyone needs Calcium and Vitamin D = prevents kidney stones

80

What's the tx for fistulae in in Crohn's ?

- Infliximab
- Unresponsive ? = Surgery

81

What's the most accurate test for Diverticulosis ?

- Colonoscopy

82

What can help to dec complications of diverticulosis ? 4

- Bran
- Psyllium
- Methylcellulose
- Inc Dietary Fiber

83

Diverticulitis sx ?

- LLQ tenderness ( with palpation )
- Fever
- Leukocytosis
- Palpable mass sometimes

84

What's the best initial test for Diverticulitis ?

- CT scan
- Don't Colonoscopy or Barium Swallow = Will Perforate

85

What are the Causes of Lower GI bleeding ? 6

- AVM / Angiodysplasia = Most Common
- Diverticular Bleed = Right Sided Most Common
- IBD
- Hemorrhoids
- Ischemic Colitis
- Cancer

86

Where's the most common Diverticular bleed vs Diverticulitis ?

- DiverticulaR bleed = Right Sided Most Common
- Diverticulitis = Left Sided

87

What's the Tx for Diverticulitis ?

- Cipro = Covers GM-
AND
- Metronidazole = Covers Anaerobes

or

Beta Lactam / Lactamase combo

88

When do you operate on a pt with Diverticular Disease ? 3

- No response to med
- Recurrence is frequent
- Perforation , Abscess , Stricture or Obstruction
- Young Pt more often than a old pt

89

Whats the MGMT of GI bleed ?

- Endoscopy - therapeutic and Dx
- Technetium Bleeding scan

90

What's the dx of Spontaneous Bacterial Peritonitis ?

- Infection without perforation
- Best initial test : > 250 Neutrophils
- Most Accurate test : Fluid Culture with no Gram Stain Findings

91

What's the Tx ? What's the special MGMT for Spontaneous Bacterial Peritonitis ?

- Tx = Cefotaxime and Ceftriaxone

- HIGH RATE OF RECURRENCE ***
Must prophylaxis with TMP-SMX or Norfloxacin

92

When are antibiotics needed on Pancreatitis Case ?

- 30% of Necrosis seen
- Use Impenem or Mereopenem
- only way to confirm is biopsy

93

What's the Triad for Primary Biliary Cirrhosis ?

- Woman in 40-50's
- Fatigue and Itching
- Normal Bilirubin with increased ALK Phos

94

P. Sclerosing Cholangitis vs P. Biliary Cirrhosis ?

- PSC -
Women in 40's 50's
Fatigue and Itching
Normal Bilirubin with Inc ALK Phos

-PBC
Pruritus
High ALK Phos
High GGTP
High Bilirubin

95

PSC vs PBC Dx test most accurate ?

- PBC = Biopsy and Anti-Mito-Ab
vs
- PSC = MRCP or ERCP

96

P. Sclerosing Cholangitis is the only cause of Cirrhosis where you DON'T BIOPSY ***

Just FYI

97

When is Iron Chelation Therapy indicated for Hemochromatosis ?

- Can't be managed with phlebotomy
- Are Anemic and Hemochromatosis from overtransfusion like thalassemia

98

What's the tx for Chronic HEP B vs Chronic HEP C

- Hep B - can be monotherapy drug
any vir , dine , or interferon

- Hep C - can never be monotherapy
Genotype 1 - ledipasvir and sofosbuvir both orally
Genotype 2,3 - Sofosbuvir and ribavirin orally

99

What's the best initial test for Wilson's Disease ?

- Slit Lamp for Kayser Fleischer Rings
- Not ceruloplasmin - not the most accurate test b/c all proteins are down with liver dysfunction and cirrhosis

100

What are the most likely Sx seen with Wilson's Disease ? 3

- Neurological Sx- Psychosis , tremor , dysarthria , ataxia or seizures
- Coombs Neg Hemolytic Anemia
- Renal Tubular Acidosis or Nephrolithiasis

- Wilson's aka Hepatolenticular Degeneration : gives Psychosis and Delusions not DELIRIUM that you would get with LIVER FAILURE

101

What's the most accurate test for Hepatolenticular Degeneration ?

- Wilson's
- Abnormally increased Copper Excretion in the urine after Penicillamine

102

What's the Tx for WIlson's besides drugs ?

- Penicillamine
- Zinc - Stops Copper Absorption in the intestine
-