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UW3 (2020) > UW3 (07 GI) > Flashcards

UW3 (07 GI) Flashcards

1
Q

Colonoscopy FU

1) Small / Rectal / Hyperplasia / Polyp
2) Tubular # < 2 or Size < 1cm
3) Adenoma / Villi # < 10 or Size > 1cm
High grade dysplasia
4) Adenoma > 10
5) Sessile > 2cm
Polyp + AdenoCarcinoma

A

1) q10y
2) q5y
3) q3y
4) q1-3y
5) q2-6m

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2
Q

Hepatic Adenoma

1) Risk?
2) Typical symptom?
3) Complications? 3
4) Pathology?
5) Labs?
6) Image finding?
7) Management?

A

1) OCP / Female
2) Asymptomatic
3) Rupture / Hemorrhage / Malignancy
4) Benign epithelial tumor
5) LFT = normal
6) CT Liver (Demarcation, Peripheral enhancement)
7) Asymptomatic or < 5cm = Stop OCP
Symptomatic or > 5cm = Resection

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3
Q

Colon Cancer Screening

Ave risk indication? Start? Screening? 5

High risk indication? Start? Screening?

A

General population
1° Family age > 60

Start @ age 50
Colonoscopy q10y
Sigmidoscopy q5y
CT angio q5y
FOBT q1y
DNA q1-3y

1° Family age < 60
> 2 any FH

Start @ age 40 or -10y
Colonoscopy q3-5y

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4
Q

Gastroparesis

2 tests to r/o what?
Confirmatory test?
Treatment? 3

A 
EGD = r/o obstruction
CT = r/o mass

Gastric empty

Meal = small / freq / fat ↓
Erythromycin
Metoclopramide

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5
Q

Pancreatitis – drug cause

Analgesic? 5
Anti-biotic? 4
Anti-psychotic? 2
Diuretics? 4
Anti-viral? 2
Others? 5
A 
Acetaminophen
Ibuprofen
Mesalamine
Sulfasalazine
Opiate

Isoniazid
TetraCycline
MetroNidazole
Bactrim

Valproate
Carbamazepine

Thiazide
Furosemide
Enalapril
Losartan

Lamivudine
Didanosine

Azathioprine
Mercaptopurine
Corticosteroid
Asparaginase
Estrogen
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6
Q

Sudden & severe periumbilical pain
Nausea / vomit / no peritoneal sign
Diagnosed with Mesenteric ischemia

Pathology?
Labs? 3
CT/CTA findings? 3

A

Ischemia/Occlusion @ SMA/SMV

Lactic Acid ↑
WBC ↑
Hct ↑

Bowel wall thickening
Mesentric stranding
Thrombosis @ portal/mensetry

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7
Q

Pancreatitis

Diagnosis criteria?
Management? 3

A

Meets at least 2/3:
Epigastric pain
Lipase > 3n
Imaging ⊕

IVF
Pain control
NPO / NGT

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8
Q

Mal absorption diarrhea (type/cause?)

Stool osmotic gap ↑
Stool pH ↓
Lactose H breath ⊕

Greasy Stool
Radiating abdominal pain

Stool osmotic gap
Fe ↓ / MCV ↓ / Hb ↓
Intraepithelial lymphocytic infiltration
Crypt hyperplasia

B12 ↓
MCV ↑ / Hb ↓
Lactose H breath ⊕

A

Lactose Intolerance
Chronic Pancreatitis
Celiac
Bacterial Overgrowth

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9
Q

Celiac

4 Deficiencies + Complications + management?
Diagnostic? 2
Treatment? 3

A

Fe ↓ / Ca ↓ / Folate ↓ / Thiamine ↓
Osteopenia / Osteoporosis
DEXA q1y

Anti-EndoMysial Ab
Anti-Tissue TransGlutaminase Ab

No gluten diet
Pneumococcal vaccine
Dapsone @ dermatitis herpatiformis

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10
Q

Straining / Abdominal discomfort
Fecal incontinence + Mucus
Red mass with concentric ring @ rectal exam

1) Diagnosis?
2) Treatment? 3
3) Surgery indication? 2

A

1) Rectal Prolapse
2) Fiber / Fluid / Pelvic floor exercise
3) Full thickness / Symptomatic

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11
Q

Intussusception

Risks? 6
Management? 2
Complication + initial test?

A 
Virus / RotaVirus
Meckel diverticulum
HSP
Celiac
GI tumor
GI polyp

Air/Saline enema
Surgery

perforation
XR abd

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12
Q

Fecal Impaction (management)

A

1) Disimpaction
2) Enema
3) Fiber / Stool softner

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13
Q

Symptoms of diarrhea, mucus, tenesmus, rectal bleed, stricture & fistula
Diagnosed with radiation proctitis

Colonoscopy findings?
Treatment? 2

A 
Continuous
Pale
Telenectasia
Friable
Musocal hemorrhage

Fluids
Anti-diarrheal

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14
Q

SAAG > 1.1 (Type & specifics 3?)

SAAG < 1.1 (causes? 5)

A

Portal hypertension:
CHF
Cirrhosis
Hepatitis

Carcinomatosis
TB
Nephrotic
Pancreatitis
Serositis
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15
Q

Primary Biliary Cholangitis

Symptoms? 3
Labs? 3
Complications?
Treatment? 2

A

Fatigue + Pruritis
RUQ
Xanthelassemia

ALP ↑ / LFT ↑
AMA ⊕

Osteopenia
Osteoporosis

UrsoDeoxycholic
Liver Transplant

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16
Q

Vitamin B deficiency (symptoms)

Angular cheliosis
Stomatitis

Dilated CardioMyopathy
PolyNeuropathy

NeuroCog impair
OcculoMotor dysfunction
Ataxia
Encephalopathy
Amnesia

PhotoDermatitis
Diarrhea
Dementia

A

B2 Riboflavin
B1 Thiamine (Wet Beriberi)
B1 Thiamine (Dry Beriberi - Wernicke / Korsakoff)
B3 Niacin?

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17
Q

HypoThyroidism
Effects on thyroid med treatment?

1) Celiac
2) Fe / Ca consumption
3) Pheytoin / Carbamazepine / Rifampin
4) Obesity / Pregnancy / Proteinuria

General management?

A

1) MalAbsroption - reduce thyroid med absorption
2) Interfere absorption - reduce thyroid med absorption
3) Increase Thyroid metabolism
4) Other effects

↑ Thyroid Meds

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18
Q

At what INR FFP should be considered?

A

INR > 2

19
Q

Stress ulcer prophylaxis indication

2 symptoms of? 4

Any 1 symptom of? 8

A

Steroid use
ICU > 1w
GI bleed > 6d
Sepsis

Plt < 50
INR > 1.5
PTT > 2n
Mech Vent > 48h
GI bleed/ulcer < 12m
Head trauma
Burn
Spinal cord injury
20
Q

Age > 60
Occult Gi bleed
Endoscopy = cherry red

Diagnosis?
Association? 3

A

AngioDysplasia

ESRD
Von Wilibrand
Aortic stenosis

21
Q

Acute pancreatitis

Severe indication? 3

A

Hct > 44
BUN > 20
CRP > 150

22
Q

Mallory Weiss vs Boerhaave

Pathology?
Symptoms?
Study & findings?
Management?

A

Pathology
• Mucosal tear
• Transmural tear

Symptoms
• Hematemesis, BP ↓
• VS Crepitation (hammon), Odynophagia, Dysphagia, Sepsis, Fever

Study & findings?
• EGD
• XR: Pneumothorax, Pleural effusion, PneumoMediastinum
CT/Esophogram (water soluble)

Management?
• PPI
• NPO / PPI / Abx / Surgery

23
Q

Diverticulitis
Repeat CT

When to do it?
Why? 4 (which one is most common)

A

If persistent / worse > 2-3d

Perforation
Abscess (most common)
Obstruction
Fistula

24
Q

Esophageal Varices

Medication therapy?
Prevention medication? 2

A

Octreotide @ bleed

Beta blocker (↓ portal P)
Nitrates
25
Q 
Celiac
Presentations & complications
1)	GI? 
2)	Derm?
3)	Endo?
4)	Neuro?
5)	Heme?

Complications? 3

A

1) Diarrhea / Steatorrhea / Weight ↓ / Ulcerative jejunitis
2) Dermatitis Herpatiformia / Atrophic glossitis
3) 2° PTH ↑ (Vit D ↓ ) / OsteoMalacia / Osteoporosis / Rickett’s
4) Neuropathy / Depression / Anxiety
5) Fe↓+Hb↓

T-cell Lymphoma @ proximal jejunum
Bowel obstruction & Perforation
GI bleed

26
Q 
Weight ↓
Jaundice
Abd pain
Cirrhosis
Portal HTN
Diagnosed with hepatic sarcoma

Labs? 3
2 studies & finding?
Treatment?

A

ALP ↑
GGT ↑
Ca ↑

CXR = Hilar adenopathy
Liver biopsy = non-caseating granuloma

Treatment = prednisone

27
Q

Barret Esophagus (management)

1) No dysplasia
2) Low grade
3) High grade

A

1) PPI + EGD (q3-5y)
2) PPI + EGD (q6-12m) / Endoscopic eradication
3) Endoscopy eradication

28
Q

Hematochezia

Initial diagnostic studies
Stable? 2
Unstable? 3

If persistent & stable? 2

A

Colonoscopy
EGD

EGD
Angiogram
Colonoscopy when stable

Repeat scope
Capsule

29
Q

Dyspepsia

Alarming indication? 7

Management@
Age > 60?
Age < 60?

A 
Progressive dysphagia
Odynophagia
Fe↓+Hb↓
Palpable mass
LymphAdenopathy
Persistent Emesis
FH GI cancer

Endoscope

H pylori test
EGD @ bleed / weight ↓ / Alarm

30
Q

Fever / Jaundice / RUQ pain
BP ↓ / AMS

1) Diagnosis?
2) Lab results? 3
3) Imaging test?
4) Management? 2

A

1) CholAngitis
2) Conj Bili ↑ / ALP ↑ / LFT ↑
3) US / CT
4) Abx –> ERCP

31
Q

Pyloric stenosis

Complication risk?
Prevention? 2

A

Pertussis

Azithromycin
Erythromycin

32
Q

What additional test to do when patient is diagnosed with Scleroderma?

A

PFT

33
Q

Patient with IBD diagnosed with toxic megacolon

Treatment?

A

Steroids

34
Q

Splenic vein thrombosis

Risks? 4
Lab test? 4

A

Pancreatitis
Pancreatic cancer
Gastric varices
Splenomegaly

Hb ↓
Plt ↓
Amylase / Lipase

35
Q

Splenic rupture

Caused by which viral infection? 2
Management? 4

A

CMV
EBV

1) Stabilize
2) CT contrast (check bleeding severity)
3) Observation / Serial Hb check
4) Laparotomy / Splenectomy

36
Q

Dumping syndrome

Cause?
Symptoms? 4
Management?

A

Cause = Gastrectomy

Nausea / Vomit / Diarrhea
Dizziness
Diaphoresis
Dyspnea

Meal (small + freq)
↑ Protein
↓ Carb

37
Q

Diarrhea after cholecystectomy

Medication? Class/mech?

A

CholeStyramine

bile salt binder/sequester

38
Q

H Pylori treatment

Standard
Alternative
Resistant/Persistent

A

PPI
Amoxicillin
Clarithromycin

PPI
Metronidazole
Clarithromycin

PPI
Metronidazole
Tetracycline
Bismuth

39
Q

Dysentery / Bacterial Enteritis

Microbial cause? 5
No anti-biotics at which microbe?

A 
Salmonella
Shigella
E coli
Campylobacter
Yersinia

E coli O157:H7

40
Q

PUD / H Pylori

Eradication confirmation

1) When to check?
2) What test? 2

A

1) 4w after treatment completion

2) Urea breath / Stool antigen

41
Q

Chronic Pancreatitis

Presentation? 4
Diagnosis? Findings? 3
Treatment? 4

A

Fat malabsorption (Weight loss, Steatorrhea)
DM
Epigastric pain

MRCP
Pancreatic calcification / enlargement
Pancreatic duct dilation
PseudoCyst

1) Pain management
2) Alcohol & Smoking cessation
3) Frequent small meals
4) Pancreatic enzyme replacement

42
Q

Femoral hernia

1) Complication?
2) Treatment?

A

1) Higher risk for strangulation than inguinal hernia

2) All hernia treatment = surgery

43
Q

SBP

1) Ascites fluid? 3
2) Empiric treatment?
3) Prophylaxis?
4) What is known to reduce AKI & mortality?
5) 2 medication for hepatorenal
6) Mortality indicator? 4

A

1) PMN > 250, Protein < 1, SAAG > 1.1
2) Empiric: ceftriaxone
3) Prophylaxis: FQ
4) Albumin (↓ AKI & mortality)
5) Octreotide, Midodrine
6) Bilirubin ↑, INR ↑, Cr ↑, Na ↓

UW3 (2020) (19 decks)

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