Stomach

Question 1

1. GERD with presence of Alarm symptoms ( Hx of gastric CA, IDA, Weightloss)?
2. Treatment for GERD with mild symptoms < 2x week ?
3. Treatment of GERD with severe symptoms > 2x a week?
4. Next step in management when a patient is not getting relief in symptoms with GERD when taking PPI once daily? and Why?
5. Whats the next step if that doesnt improve ?

Answer 1

1. Endoscopy
2. Anti-acids (Calcium Carbonate, H2 blocker
3. PPI

4.Increase twice daily to help with breakthrough nighttime symptoms. Morning and night

5. Esophageal pH monitoring and Upper Endoscopy to rule out other causes.

Question 1

3 common causes of Gastroparesis?

First diagnostic test for suspected Gastroparesis ?

Answer 1

1. Post Viral (Norwalk Virus)
2. DM
3. Medications

Do Upper Endoscopy first - shows visible retained food

Emptying studying will see > 10% of the tracer left in stomach after 4 hrs.

Question 2

What is the next imaging test to order if a pancreatic mass is not seen on CT scan when a patient presents with Extrahepatic Cholestasis?

Answer 2

ERCP gives better visualization for diagnostic and therapeutic purposes.

Question 3

What is the next step in management when a patient with H. pylori from East Asia/Latin America presents with peptic ulcer disease?

Answer 3

Endoscopy with biopsies to R/O cancer.

They are at risk for gastric mucosa associated lymphoid tissue lymphomas (MALT Lymphoma).

Question 4

What is concerning for a patient with a hx of celiac disease presenting with fevers, chronic abdominal pain, diarrhea, melena?

Answer 4

They may have complications related to celiac disease.

Question 5

Who else should be tested for celiac disease if a patient has a hx of celiac dz?

Answer 5

Family members should be tested.

Question 6

What is the next step for a patient with a hx of celiac dz who has persistent pathological symptoms despite a gluten-free diet?

Answer 6

Further evaluation for other conditions is needed.

Question 7

In what 3 conditions is ERCP beneficial?

Answer 7

1. Acute Cholangitis
2. Gallstone Pancreatitis with Evidence of bile duct obstruction.

Question 8

When should a cholecystectomy be performed during a bout of gallstone pancreatitis?

Answer 8

After recovery to prevent recurrence.

Question 9

What is the role of cholestyramine in Crohn’s disease?

Answer 9

It helps bind to bile acids that reach the colon because they were not reabsorbed in the colon.

When they are not reabsorbed, this leads to colonic malabsorption of water, causing diarrhea.

Question 10

What are common causes of upper GI bleeding?

Answer 10

Peptic ulcer disease, esophageal varices, Mallory-Weiss tear.

Question 11

What is the first step in managing suspected upper GI bleeding?

Answer 11

IV fluids, PPI, type and cross, then EGD.

Question 12

What test confirms H. pylori infection non-invasively?

Answer 12

Urea breath test or stool antigen.

Question 13

What are the Rome IV criteria used for?

Answer 13

Diagnosing irritable bowel syndrome (IBS).

Question 14

What is the most common cause of cirrhosis in the US?

Answer 14

Nonalcoholic fatty liver disease (NAFLD).