OME - GI Flashcards
(120 cards)
1
Q
How to treat HepC genotype 1b?
SEs?
A
Peg-I + Ribavirin
Psychosis, depression, flu-like sx
2
Q
What are the 4 MC causes of infectious esophagitis?
A
Candida
Herpes
CMV
HIV
4
Q
Colonoscopy shows low risk, f/u in 5-10 years, what is found:
polyps?
Size?
Type?
Grade?
A
1-2 polyps
< 1 cm
Tubular
Low-grade
7
Q
What Abx do you treat ascending cholangitis with?
A
Cipro + Metronidazole
OR
Ampicillin-Gentamycin + Metronidazole
8
Q
GI erosion = ?
Ulcer?
A
Break < 5mm
> 5mm
9
Q
How to screen for HCC in HepB?
Treat how?
A
AFP and US
Peg IFN-alpha-2a and antiviral (Lamivudine, entecavir)
10
Q
MCRP shows beads on a string is what?
Treatment?
What pathology?
A
PSC
cholestyramine, do NOT stent
Ultimately need TRANSPLANT
Extrahepatic ducts
12
Q
Diagnose PSC how?
See what?
What else can you use, what will you see?
A
MRCP
Beads on a string
ERCP will show onion-skin fibrosis
13
Q
What are the etiologies of Cirrhosis?
A
VW HAPPENS
Viral - HepB + C Wilsons Hemochromatosis A1-anti-trypsin PSC PBC Ethanol NASH/NAFLD Something rare
14
Q
Pt w/colicky RUQ pain that radiates to the shoulder has what?
A
Cholelithiasis
16
Q
What is the major black box SE of metoclopramide?
A
Tardive dyskinesia
18
Q
Mild UC treat how?
What makes it mild?
A
5-ASA or Mesalamine/Sulfasalazine
Normal vitals, labs, and weight
19
Q
Pt that has virulent ulcers refractory to PPI has what?
How do you work it up?
A
Gastrinoma
1 - endoscopy
2 - serum gastrin
3 - secretin stim test
4 - SRS/CT to find
20
Q
What is the best test to Dx pancreatitis?
What else can you use?
A
Lipase > 3x Upper limit of normal
CT scan
21
Q
What is an anatomical variant in the cardia of the stomach that becomes easily eroded by gastritis or ulcers?
A
Dieulafoy’s lesion —> superficial artery
23
Q
Pt that has malabsorption w/brain, lymph, and joint problems has what?
Treatment?
A
Whipple disease
Bactrim or Doxy
25
Q
Pt w/low severity from caustic esophagitis treat how?
High?
A
Liquid —> solid w/in 48 hours
NPO x 72 hours
26
Q
Before you can give Abx for pancreatitis that is infected, what must you do first?
A
Get a biopsy
27
Q
What is Courvosier’s sign?
Means what?
A
NonTender palpable enlarged GB
Pancreatic cancer
28
Q
How do you test for Wilson’s?
Tx:
A
24 hour urine copper
Slit lamp
Serum Ceruloplasmin
Penicillamine
29
Q
Liver biopsy shows PAS+ hepatocytes, what is the Dx?
A
Alpha-1-anti-trypsin deficiency
30
Q
HCC is screened when?
Obtain what tests?
Confirmatory test is what?
A
Q6m
RUQ US, AFP
Triple phase CT scan
31
Q
When should you get a colonoscopy after a bout of diverticulitis?
A
2-6 weeks after resolution as to not miss any cancer
36
Q
What is the histological PATH of scleroderma?
Presents how?
Treat how?
A
Collagen in esophagus, LES cannot contract
Relentless GERD
PPI but no cure
37
How to Dx SBP?
Treat how?
Prophylax for what?
Secondary SBP pts need what?
> 250 neutrophils in fluid
Ceftriaxone
Total protein < 1 need prophylax w/FQ
Metronidazole, Ex-LAP for perf
38
Pt w/chronic N/V, early satiety and negative EGD has what?
Common in what pts?
Have what additional sx?
Gastroparesis
Diabetics
Peripheral neuropathy
39
What is the most sensitive test for invasive bacteria?
Lactoferrin
40
Liver biopsy shows balloon degeneration and Mallory bodies, what is the Dx?
Alcoholic cirrhosis
42
Pt w/SIRS criteria after pancreatitis generally occurs when?
Dx how?
Treat how?
1-3 weeks, but mostly day 7
CT and Bx
Meropenem
43
SAAG < 1.1 means what?
Caused by what?
Non-portal HTN related, lots of STUFF in fluid
Cancer, TB
47
What is the simplest test that can be done for GI bleed?
What is almost always done?
NG tube
EGD
49
C diff diagnosed how?
Treated with what for repeated recurrences?
NAAT
Fidaxomicin
50
What causes ischemic colitis?
Presents how?
Dx how?
HoTN in watershed area
Painful, self-limiting bleed
Colonoscopy
51
What chemical is able to cross the BB barrier and cause hepatic encephalopathy?
Ammonia (NH3)
54
What are the causes of Esophagitis?
```
PIECE
Pill induced
Infectious
Eosinophilic
Caustic
GERD
```
55
Young woman presents w/pruritis and jaundice, what do they have?
Dx how?
Tx?
PBC
Biopsy ONLY
Ursodeoxycholic acid
56
Pt w/elevated AST/ALT and conjugated bilirubin w/pruritus and jaundice has what?
Choledocholithiasis
57
Pt that you clinically suspect has pancreatitis but does not have an elevated lipase, what should you do?
order CT scan
58
What are the typical symptoms of GERD?
Retrosternal burning chest pain
Better w/sitting up and antacids
Worse w/spicy foods and recumbency
60
Pt w/esophageal spasm presents how?
Barium swallow shows what?
Treat how?
MI —> crushing retrosternal chest pain
Corkscrew esophagus / beads on a string
CCB, Nitros
61
What are the characteristics of unconjugated bilirubin?
Lipid-soluble
Crosses BBB
Not excreted in the urine
+ Kernicterus
63
Pt w/early satiety or abdominal fullness 3-7 weeks after acute pancreatitis has what?
Treat how?
Pseudocyst
Spontaneous resolve if < 6cm and < 6 weeks old
If NOT
Then surgical drainage
65
Pt w/suspected choledocholithiasis but US does NOT show dilated ducts, what to do next?
MRCP
69
SE of TIPS procedure?
Why?
Encephalopathy
Bypasses the liver
74
Pouts-Jeghers presents how?
No Malignant polyps, Hyperpigmented buccal mucosa, hamartomas (s.i. Tumors)
76
Pt that has acute pancreatitis but does not drink, what should you do next?
RUQ US to look for gallstones
77
SAAG > 1.1 means what?
Caused by what?
Portal HTN related, not much STUFF in the fluid
MC: Cirrhosis and Right-sided CHF
Budd Chiari
Portal/Splenic thrombosis
Schistosomiasis
78
Steakhouse dysphagia is what disease?
Barium shows what?
Tx?
Schatzki ring
Narrow lumen
Lyse the ring
80
What organisms to worry about in SBP?
Strep
| G(-) Rods
81
Jaundice d/t hemolysis or hematoma is what kind of bilirubin?
Dysfunction where?
Unconjugated
Prehepatic
83
Liver biopsy shows onion skin fibrosis, what is the Dx?
PSC
84
Pt w/acute chest pain, tachypnea, and left-sided pleural effusion after EGD has what?
Diagnose how?
Esophageal rupture
Water-soluble contrast (gastrografin) Esophagram
85
LLQ ABD pain 1st step in w/u?
Next?
KUB
CT ABD
87
What is Plummer Vinson syndrome?
Dx how?
Woman w/dysphagia, Fe def anemia, Webs, Esophageal Cancer
EGD w/Bx (Screen)
88
US that is inconclusive for cholecystitis what should you do next?
HIDA scan
89
What is the Gold standard to diagnose H pylori?
EGD w/biopsy, then rapid urease test or histology
91
What is the SAAG score?
Determine it how?
Serum ascites albumin gradient
Paracentesis
92
Hemochromatosis can cause what else?
D/t what?
Sexual dysfunction
Iron deposition in the pituitary
93
Pt w/chronic diarrhea (> 4 weeks), how do you work up?
Osmotic gap
Blood/mucous
bowel habit pattern
94
What is the age distribution of CD?
BiMODAL:
| 20-30 and 50-75
95
Pt in the ICU that is getting WORSE, think of what?
```
ARDS
Nutritional def (low alb, Vit K)
Polyneuropathy
AMS
Stress ulcer (prophylax w/PPI)
```
96
In dysphagia is mechanical (obstructive) or motility (functional) progressive with liquids and solids?
Mechanical
97
Pt w/cholecystitis what are you looking for?
US shows pericholecystic fluid
Gallstones
Gallbladder thickening
98
Pt that is presenting with signs and symptoms of gastroparesis, what do you want to get 1st?
EGD to r/o obstruction
99
How to treat gastroparesis?
PO metoclopramide for chronic
| IV erythromycin for acute flare
100
Person with cirrhosis will have what lab abnormalities?
Increased INR
Low Albumin
Thrombocytopenia (TPO made in liver)
103
Pt w/cirrhosis that has ascites, Treat how?
Na < 2 g
H2O < 2 L/day
Diuresis w/Lasix and spironolactone
Tap 4-6 L if needed
104
What vitamins are absorbed in the duodenum?
What else?
FIC
Folate, iron, calcium
Carbohydrates
109
What are some red flags in diarrhea?
```
Fever > 104
Severe dehydration
Blood, pus
Recent travel
> 3 days
ABD pain
Abx
Hospitalization
```
112
Pt that is not a surgical candidate w/cholelithiasis is treated how?
Ursodeoxycholic acid
113
What causes biliary cholestasis?
What labs will be evaluated?
Sepsis
Meds
Cirrhosis
ALP, direct bili
116
Stomach ulcers w/necrotic base and heaped margins has what origin?
Malignancy
117
Colonoscopy shows high risk, f/u in 5-10 years, what is found:
polyps?
Size?
Type?
Grade?
3 or more polyps
1cm or bigger
Villous
High-grade
118
1st step in w/u of malabsorption?
2nd?
3rd?
Fecal fat: > 6g of fat in stool in 24 hours = malabsorption
D-xylose scan: no absorption = intestinal border deficiency
EGD w/Bx
119
What test do you get to Dx: hemochromatosis?
Treatment?
Ferritin in 1000s or Transferrin > 50%
Deferoxamine + serial phlebotomy
120
Anti-Smooth muscle Ab means what?
Autoimmune hepatitis
123
Gilbert’s and Crigler-Najjar are d/t build up of what?
Dysfunction where?
Unconjugated bilirubin
Intrahepatic
128
```
What is the MC cause of pancreatitis?
#2?
```
What else?
Gallstones
EtOH
Toxins (HIV meds), trauma (ERCP), TGs
129
What causes mesenteric ischemia?
Presents how?
Atherosclerosis or AFib
Postprandial ABD pain, weight loss, POOP
130
How do you treat varices acutely?
Chronic?
Banding
Nadolol
131
What are the motility disorders?
Dx how?
2nd?
3rd?
Achalasia, scleroderma, spasm
Barium swallow
Manometry
EGD w/Bx
132
Predominant symptoms of hoarseness, cough, and nocturnal asthma indicate what?
Atypical GERD
133
When do early complications occur in acute pancreatitis?
What are they?
Best Dx lab for prognosis?
Treatment?
1-3 days post
ARDS, HypoCa, Pleural effusion, ascites
BUN, also use CXR or iCa
Intubation, give Calcium
135
Pt that has extracolonic involvement of colon cancer, what is the treatment?
FOLFOX
5-Fu, Leucovorin, Oxaliplatin
Also can add Bevacizumab
138
How do you medically manage Metaplasia (Barrett’s)?
If there is dysplasia?
High dose PPI
Annual EGD
If stable, then q3 years
Photoablation
140
Pt w/painless jaundice, elevated ALP, elevated Direct bilirubin and dilated ducts has what?
Treat how?
Normally d/t what?
Stricture
Stent
ERCP or cholecystectomy
145
How to diagnose gastroparesis?
+ test is what?
Emptying study
> 60% food in 2 hours
> 10% in 4 hours
146
Pt w/hematemesis, fever, leukocytosis, and esophageal crepitus (Hamman’s Crunch) has what?
Require what?
Boerhaave syndrome
Emergent surgery
147
What are the obstructive dysphagia diseases?
Dx how?
Next?
Rings, stricture, cancer
Barium swallow
EGD w/Bx
148
What are the characteristics of conjugated bilirubin?
Water-soluble
Does NOT cross BBB
Will have DARK urine
No kernicterus
152
What is the best noninvasive test to confirm diagnosis?
Confirm eradication?
Urea breath test
Stool Ag test
153
HepA can be treated w/post exposure prophylaxis how?
IgG vaccine w/in 2 weeks of exposure
155
Pt that has burns, has increased ICP, is in the ICU, or intubated needs what prophylaxis?
PPI
157
MC causes of peptic ulcer?
Less common?
H. Pylori and NSAIDs
Curling - burns
Cushing - Steroids, ventilator causes Inc ICP
Gastrinoma - ZE
159
What pills cause esophagitis?
NSAIDs
Tetracyclines, Bactrim
Bisphosphonates
HAART
160
If C diff is negative and you are working up diarrhea, what do you want to order next?
Lastly?
Fecal leukocytes (wbc) and FOB (rbc)
Ova+parasites
Stool Cx, bx
161
How do you diagnose Boerhaave syndrome?
Follow up how?
Gastrografin swallow
EGD
162
Secretory diarrhea will have what findings?
Normal osmotic gap
+ Nocturnal symptoms
No change w/NPO
Normal fecal fat
164
Thin walled GB seen in what setting?
What special sign?
Means what?
Pancreatic cancer
Courvesier’s sign
NonTender but palpable
165
What causes Stricture?
Pt presents how?
Path from EGD shows what?
Treat how?
Long standing GERD
Weight loss
Symmetric stricture
PPI, resection
167
What is Charcot’s triad?
Reynold’s Pentad?
RUQ pain, jaundice, fever
HoTN, AMS
168
Pt that has GI and Jaw tumors has what?
Gardner syndrome
170
HepC gets transmitted how?
What complications?
Blood and IV drug users
Cirrhosis, HCC
171
Pt w/asthma, atony, and allergic reaction has what? EGD shows what.
Treat how?
If it fails?
EoE, Eosinophils > 15 hpf
Trial PPI
Aersolized steroids
172
What is the triple therapy for H pylori?
PPI
Clarithromycin
Amoxicillin
174
Pt w/constant RUQ pain has what?
Means what?
What other sx?
Cholecystitis
Stone in cystic duct
Mild fever and leukocytosis
177
+ murphy sign in what path?
Cholecystitis
OR
Choledocholithiasis
181
How to calculate osmotic gap?
Secretory indicated by what value?
Osmotic?
290 - 2*(Na + K)
< 50
> 100
182
What are alarm symptoms for GERD?
N/V
Anemia
Weight loss
Dysphagia
186
Pt w/esophageal varices, when do you get Propanolol?
Treat how in refractory disease?
Once bleeding stopped
TIPS
189
Multiple shallow ulcers in stomach = what etiology?
Single large ulcer?
NSAID
H pylori
193
Osmotic diarrhea will have what findings?
Inc osmotic gap
+ change w/NPO
Inc fecal fat
195
Pt that has C diff w/renal failure, sepsis/shock may have what?
Toxic megacolon —> UC
196
How to calculate stool osmoles?
What is normal?
2 * (Na + K)
280
199
UC flare treated with what?
Prednisone + cipro/metro
202
Treat HepC genotype 2 or 3 how?
Direct acting antiviral (end in -Vir)
Ie Borceprevir
215
Pt w/GI bleed, how do you stabilize?
2 large bore IVs
IVF
Type + Cross
CBC
PT/PTT
EKG —> r/o mesenteric ischemia
216
Pt that has a Brisk GI Bleed image how?
Slow bleed?
NO bleeding?
Angiogram
Tagged rbc
Colonoscopy
222
Moderate UC treated with what?
Severe?
Azathioprine, 6-MP
Infliximab, cyclosporine
225
Salmon-colored velvety mucosa in pt w/long hx of GERD has what?
Barrett’s
