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Pneumo/gastro c’est bow > Celiac/IBD/Esophageal disorders/Pancreatitis > Flashcards

Celiac/IBD/Esophageal disorders/Pancreatitis Flashcards

1
Q

% links between celiac disease and dermatitis herpetiformis ?

A

> 90% DH pts have CD
up to 25% CD pts have DH

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2
Q

5 ASA in ulcerative colitis : do you give suppository or enema ?

A

Suppository if up to 18cm disease only
Enema if beyong this but distal to splenic flexure

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3
Q

Achalasia : common sx that are not GI ?

A

Chest pain
Weight loss

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4
Q

Achalasia : what kind of dysphagia ?

A

Progressive solid and liquid dysphagia
Regurgitation and reflux sx
Sx refractory to PPI therapy

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5
Q

Achalasia puts you at risk of which cancer ? Do you need surveillance ?

A

Esophageal squamous cell carcinoma
No routine endoscopic surveillance

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6
Q

Acute GI bleeding with life threatening hemorrhage, what to do with warfarin or DOAC ?

A

Warfarin : PCC could be considered
DOAC : selective use of PCC or idarucizumab (dabigatran) for those who took DOAC within 24h

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7
Q

Anti LKM in what disease ?

A

AIH type 2

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8
Q

Anti thrombotic management in elective endoscopy setting : what to do with ASA, DAPT, P2Y12 monotherapy ?

A

ASA : no interruption
DAPT : interrupte only P2Y12 inhibitor and restart 0-7d post endoscopy
P2Y12 : no consensus

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9
Q

Anti thrombotic management in elective endoscopy setting : what to do with DOACs or warfarin ?

A

DOACs : interuption and restart 0-7d post endoscopy (no consensus)
Warfarin : no interruption, if interrupted no need to bridge

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10
Q

Aphtous ulcers : crohn or ulcerative colitis ?

A

Crohn

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11
Q

Are primary sclerosing cholangitis highly symptomatic ?

A

No up to 50% asx at presentation
Sx include abdo pain, pruritus, fatigue

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12
Q

Autoimmune pancreatitis mimic ?

A

It can mimic pancreatic cancer, but it responds to steroids

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13
Q

Barrett’s : management if metaplasia with indefinite dysplasia ? dysplasia ?

A

Indefinite dysplasia : PPI BID, repeat EGD w biopsy in 6 mos
Dyplasia : get expert path review

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14
Q

Barrett’s : management if metaplasia with no dysplasia ?

A

EGD in 3y if >3cm segment, otherwise in 5years

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15
Q

Barrett’s management if no metaplasia ?

A

Repeat endo w biopsy in 1-2 y

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16
Q

Barret’s management : what to do if high grade dysplasia or T1a (intramucosal carcinoma)?

A
  • Endoscopic eradication therapy and surveillance in 3,6,12 mo then q1y
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17
Q

Barret’s management : what to do if LOW GRADE DYSPLASIA ?

A

• Surveillance endoscopy q6mos x 2 then annually
• Endoscopic eradication therapy -> complete eradication -> surveillance endo 1 year then q2y after

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18
Q

Clinical manifestation of proctitis in ulcerative colitis ?

A

Small volume + frequent BMs w/ blood, tenesmus, urgency, crampy abdo pain

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19
Q

Cobble stone mucosa : Crohn or ulcerative colitis ?

A

Crohn

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20
Q

Crohn disease : cold stricture ?

A

Fibrostenotic disease with no active inflammation
Conservative (bowel rest, NG tube), endoscopic dilatation or surgery

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21
Q

Crohn disease : hot stricture what tx ?

A

Steroid bridge to maintenance tx (biologics)

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22
Q

Crohn disease : tx if fistulas ?

A

Biologics : infliximab with most evidence then vedolizumab
Anti TNF to induce and maintain
Characterize with EUS or MRI

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23
Q

Crohn disease: what tx if perianal disease ?

A

Anti TNF +/- ATB PRN

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24
Q

Crohn’s treatment options for moderate to severe ? Induction and maintenance ?

A

Induction
- Budesonide, pred
- MTX
- Biologics
Anti TNF: infliximab, adalimumab
Anti integrin: vedolizumab
Anti IL12/23): ustekinumab

Maintenance :
- MTX
- Thiopurines (AZP, 6 MP)
- Biologics

WHEN STARTING ANTI TNF : combine with thiopurine (SONIC trial)

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25
Q

Crohn’s tx for mild disease ? Induction and maintenance ?

A

Induction :
5-ASA (if mild colonic)
Budesonide

Maintenance
Thiopurine (AZP, 6MP)

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26
Q

Crypt abcessess, lamina propria cellularity : crohn or UC ?

A

UC

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27
Q

Cryptitis/architectural distortion ; crypt abscesses, atrophy : crohn or UC ?

A

UC

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28
Q

Dx in case of narrow GEJ with bird beak appearance, poor barium appearance ?

A

Achalasia

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29
Q

Dysphagia : two diseases with intermittent sx ?

A
  • Primary oesophageal motility disorders
  • Oesophageal ring (Schatzki ring)
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30
Q

GERD : when is sucralfate indicated ?

A

Recommend AGAINST in PPI non responders
In pregnancy OK though

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31
Q

H pylori 1st line treatment ?

A

PBMT or PAMC x 14 days is 1st line
- PPI/Bismuth/Metronidazole/Tetracycline
- PPI/Amox/Metro/Clarithro

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32
Q

H pylori tx if tx failure ?

A
  • PBMT x 14d if prior triple therapy
  • PPI/Amox/Levoflox x 14d
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33
Q

H pylori, should you test GERD patients ?

A

Do not test those with GERD without dyspepsia or PUD
Tx will generally not improve sx

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34
Q

H pylory and risk of cancer ?

A

Higher risk of gastric cancer
Controversial whether to tx pts solely to prevent cancer but offer tx to everyone testing positive

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35
Q

H pylori, who should you test ?
Name 6.

A
  • PUD
  • Uninvestigated dyspepsia
  • Long term NSAIDs/ASA
  • Unexplained iron deficiency
  • ITP
  • MALT lymphoma, resected early gastric cancer
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36
Q

How do you diagnose microscopic colitis ?

A

Normal appearing colonoscopy but bx confirm dx

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37
Q

How do you diagnose primary sclerosing cholangitis ?

A

1- Elevated ALP
2- Multifocal biliary strictures (beads on a string, usually on MRCP)
3- Exclude 2nd sclerosing cholangitis
4- Liver bx if PSC-AIH overlap of small duct PSD suspected

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38
Q

How do you differentiate achalasia from chagas disease ?

A

Via serology

Esophageal involvement is indistinguishable on endoscopy, bx not helpful
Tx is the same

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39
Q

How do you dx crohn’s disease ?

A
  • Ileocolonoscopy and bx
  • Small bowel imaging (CT/MR enterography, capsule) +/- EGD
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40
Q

How do you manage ischemic colitis ?

A
  • Most resolve with supportive care
  • Empiric ATB if moderate-severe
  • Gen chx if pancolitis or isolated right sided severe
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41
Q

How do you treat acute pancreatitis ? Name 3 points.

A
  • IV fluids ONLY effective therapy in first 24-48h (LR, 1.5ml/kg/h)
    = reduced mortality
  • Analgesia
  • Nutrition (clear fluids or low fat diet within 24h)
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42
Q

How do you treat primary biliary cholangitis ?

A
  • Urso 15mg/kg
  • Bone density testing, lipid profile
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43
Q

How long does thiopurines take to have effect ?

A

8-12 weeks

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44
Q

How many bx for barrett’s oesophagus ?

A

Obtain ≥ 8 bx if > 1cm salmon mucosa extending from GE jxn

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45
Q

How much gluten in diet to be able to ask for TTG antibodies ?

A

3g gluten daily for 8 weeks

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46
Q

How often should you do colonoscopy for primary sclerosing cholangitis ?

A

Colo with surveillance bx at dx and q1-2 years

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47
Q

How should you screen for cancer in primary sclerosing cholangitis ?

A

MRCP +/- CA 19-9 q1y to screen for GB cancer and cholangiocarcinoma

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48
Q

IBD general principles, what is the pre biologic work up ?
Name 4 points.

A
  • HBV, HCV
  • TB skin test ; if BCG vaccinated : CXR and/or IGRA
  • VZV titres
  • Strongyloides if high pretest probability
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49
Q

IBT : when should you susepct bile salt diarrhea ?

A

Occurs with ileitis or after ileal resection
ALWAYS assess for (CT or C scope) and treat active IBD before tx for bile salt diarrhea

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50
Q

If low IgA, which antibody should you ask to diagnose celiac disease ?

A

Anti-deamidated gliadin peptide IgG

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51
Q

In case of autoimmune hepatitis, you should screen for ?

A

Screen all patients for celiac disease and thyroid diseases

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52
Q

Inpatient IBD : how long should you wait for a response on steroids before considering another therapy ?

A

If minimal response after 72h IV steroids : infliximab

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53
Q

Life threatening hemorrhage on acute GI bleed, should you give platelets transfusions to reverse effect of antiplatelet ?

A

No

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54
Q

Lymphoid aggregates : crohn or UC ?

A

Crohn

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55
Q

Non caseating granulomas : crohn or UC ?

A

Crohn

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56
Q

Non variceal UGIB : what is the post endoscopy management if high-risk vs low-risk ulcer ?

A

High risk : IV PPI BID or PPI infusion x 72h then oral PPI BID for 2weeks minimum

Low risk : oral PPI BID x 2-4 weeks then stop

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57
Q

Non variceal UGIB : when should endoscopy be performed and which lesion should you treat ?

A

Endoscopy within 24 h (12h in high risk pts or variceal bleed suspected)
Endoscopic therapy ONLY for high risk ulcers (Forest IA, IB, IIA ulcers)

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58
Q

Non variceal UGIB : when should you restart anti platelets and anticoag ?

A

As soon as possible
Not associated with increased GI bleed but is associated with a reduction in all cause mortality

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59
Q

Non variceal UGIB : who should you test for H pylori ?

A

Test ALL with PUD or gastritis : bx at time of EGD or check serology

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60
Q

Patchy inflammation and skip lesions : crohn or ulcerative colitis ?

A

Crohn

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61
Q

Positive AMA in which hepatic disease ?

A

Primary biliary cholangitis

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62
Q

Primary sclerosing cholangitis : typical epidemiology and presentation ?

A

Male with IBD (2/3 have IBD, UC ++++)
Up to 50% asx at presentation
Sx includes pain, pruritus, fatigue

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63
Q

Risk factors for Barrett’s oesophagus : tobacco or ROH ?

A

Tobacco
ROH is risk factor for squamous cell carcinoma

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64
Q

Risk factors for barrett’s oesophagus ?

A

Chronic GERD (>5y)
> 50y
Male
Caucasian
Tobacco
Central obesity
Fm hx

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65
Q

Risk factors for celiac disease ?

A
  • Northern european descent
    • family hx to 1st degree relatives
  • T1DM
  • AI disease
  • Down (x6)
  • Turner
  • IgA deficiency
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66
Q

Should you give tranexamic acid in case of UGI bleed ?

A

Do not use routinely as does not reduce mortality

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67
Q

Should you give urso in primary sclerosing cholangitis ?

A

Frequently used but NO evidence

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68
Q

Should you stop DVT prophylaxis for inpatient IBD with bloody diarrhea ?

A

No

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69
Q

The Atlanta Classification : what are the three pancreatitis complications that occur ≥ 4 weeks ?

A
  • Pseudocysts
  • Pancreatic abscess
  • Walled off pancreatic necrosis
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70
Q

Transmural inflammation : crohn or UC ?

A

Crohn

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71
Q

Transmural inflammation : crohn or ulcerative colitis ?

A

Crohn

72
Q

Type 1 auto immune hepatitis : antibodies and age of presentation ?

A

ANA > 1:80, ASMA > 1:80
ANA, AAA, anti soluble liver/liver pancreas antigen

Presents at any age

73
Q

Type 2 auto immune hepatitis : antibodies and age of presentation ?

A

Anti LKM1 > 1/80
Anti liver cytosol

Presents in children and young adults

74
Q

Ulcerative colitis : disease location left sided colitis definition ?

A

Sigmoid to splenic flexure

75
Q

Ulcerative colitis : disease location pancolitis definition ?

A

Beyond the splenic flexure

76
Q

Ulcerative colitis : disease location proctitis definition ?

A

w/in 18cm from the anal verge

77
Q

Ulcerative Colitis : treatment options for mild disease ? Induction and maintenance ?

A

Induction
- 5 ASA PO, PR
- Budesonide

Maintenance
- 5 ASA PO, PR

78
Q

Ulcerative Colitis : treatment options for moderate to severe disease ? Induction and maintenance ?

A

Induction
- Budesonide, prednisone
- Biologics
Anti TNF (infliximab, adalimumab, golimumab)
Vedolizumab, ustekimuman
JAK inhibitor (tofacitinib)

Maintenance
- Thiopurine (AZP, 6 MP)
- Anti TNF, vedo, ustekin, JAKi

If anti TNF COMBINE WITH a thiopurine (UC SUCCESS TRIAL)
THIOPURINE/MTZ MONOTHERAPY NOT RECOMMENDED

79
Q

What are disease manifestations of IgG4 disease ?

A

AI pancreatitis, biliary sclerosis, RP fibrosis
Chronic sclerosing aortitis
Thyroiditis
Interstitial pneumonitis
Tubulointerstitial nephritis

80
Q

What are high risk ulcers based on forest classification ?

A

Forest IA, IB, IIA ulcers

81
Q

What are secondary causes of esophageal eosinophilia ?

A

GERD, achalasia, connective tissue diseases, hypermobility syndromes, pill esophagitis, pemphigus, hyper IgE syndrome

82
Q

What are side effects of 5 ASA ?

A

Headache, diarrhea, nausea, pancreatitis
interstitial nephritis

83
Q

What are the associated disorders with type 1 AIH ?

A

AI thyroid disease, Grave’s, UC celiac, T1DM

84
Q

What are the criterias for Severe Ulcerative Colitis ?

A
  1. Bowel movements ≥ 6
  2. Visible blood in stool
  3. Pyrexia T ≥ 37.8C*
  4. Pulse > 90bpm*
  5. Anemia Hgb ≤ 105*
  6. ESR>30*
    Severe UC when criteria for frequency ofbowelmovementand≥1featuresof systemicupset(*)aresatisfied.
85
Q

What are the dx criteria of primary biliary cholangitis ?

A

1- Persistent ALP elevation > 6 months
2- Positive AMA > 1:40 or specific ANAs
3- Liver bx (only needed when dx unclear)

86
Q

What are the endoscopic findings of oesinophilic esophagitis ?

A

Trachealization of the esophagus (feline esophagus), white exudates/papules, crate paper esophagus, strictures

87
Q

What are the gluten containing foods ?

A

BROW
Barley, Rye, Oats, Wheat

88
Q

What are the possible etiology of ischemic colitis ?

A
  • Cardio embolic (FA ? endocarditis ? LV thrombus ?)
  • Athero embolic (AAA, dissection…)
  • Shock/Low flow
  • Vasculitis / PAN particularly if SEGMENTAL
89
Q

What are the three etiologies of pancreatitis ?

A
  1. Gall stones (order U/S)
  2. EtOH
  3. Other
90
Q

What are the two exams you shoul;d ask for to dx achalasia ?

A
  • 1st step EGD
  • 2nd step high resolution manometry +/- barium swallow
91
Q

What are the two things you should consider if recurrent acute pancreatitis ?

A

MRCP to R/O divisum, stricture, tumor, stone
Consider genetics workup, esp if young

92
Q

What are the typical labs in acute cholangitis ?

A
  • WBC >10 or <4
  • ALP/GGT > 1.5x ULN, ALT > 1.5x ULN
  • Bilirubin > 34

HIGH BILI AND ALP NOT COMMON in acute cholecystitis

93
Q

What are the typical sx of microscopic colitis ?

A

Relapsing/remitting watery non bloody diarrhea
Weight loss
Abdo pain

94
Q

What are three complications of achalasia ?

A
  • Megaoesophagus > 6cm
  • Sigmoid esophagus
  • Esophageal squamous cell carcinoma&raquo_space;» adenoCA
95
Q

What disease is associated with primary biliary cholangitis ?

A

Sjogren, celiac disease, AI thyroid disease

96
Q

What do you see typically on MRCP/CT + EUS in case of autoimmune pancreatitis ?

A

Sausage pancreas
Biliary strictures (IgG4 associated cholangitis)

97
Q

What H pylori test detect current OR prior infection ?

A

Serology (serum IgG)

If negative in a patient with bleeding ulcer, repeat testing is recommended when acute bleeding episode resolves

98
Q

What is the cancer risk in Crohn ? Ulcerative colitis ?

A

Crohn : colorectal CA (colitis only)

UC : colorectal CA and if PSC : risk of hepatobiliray cancers (HCC, cholangio, GB cancer)

99
Q

What is the Charcot’s Triad or Raynaud’s Pentad of acute cholangitis ?

A

Fever, abdominal pain + jaundice +/- hypotension and confusion

100
Q

What is the clinical presentation of eosinophilic esophagitis ?

A

Intermittent solid food dysphagia
Food bolus obstruction

101
Q

What is the complication of ulcerative colitis ?

A

Toxic megacolon

102
Q

What is the definition of achalasia ?

A

loss of esophageal peristalsis and incomplete relaxation of lower esophageal sphincter

103
Q

What is the definition of acute pancreatitis ?
Need 2/3 criteria for dx.

A
  1. Abdo pain consistent with disease
  2. Lipase and or amylase ≥ 3x ULN
  3. Characteristic findings on imaging
104
Q

What is the definition of toxic megacolon ?

A
  • Radiographic megacolon (>6cm)
  • PLUS at least 3 of :
    • Fever (>38C)
    • HR >120
    • Neutrophils >10.5
    • Anemia
    PLUS at least 1 of :
    • Dehydration
    • Altered sensorium
    • Electrolyte disturbances
    • Hypotension
105
Q

What is the dx algorithm if ongoing GI bleeding despite negative EGD/colonoscopy ?

A

IN THIS ORDER
1. Second look EGD with push enteroscopy (look up proximal jejunum) +/- colonoscopy
2. Video capsule endoscopy if no obstruction
3. CT enterography if obstruction or 3rd choice

Tagged RBC scan if slow bleed / CTA if brisk

106
Q

What is the epidemiology and clinical presentation of primary biliary cholangitis ?

A

Middle aged women
Jaundice, pruritus, fatigue, elevated ALP

107
Q

What is the epidemiology of IgG4 disease ?

A

Mostly older men age > 60

(in contrast type II age > 40 M=F)

108
Q

What is the epidemiology of microscopic colitis ? Comorbidities and rx?

A
  • Older women, mean age 65
  • Comorbid AI diseases
  • Associated rx : NSAIDs, PPIs (lansoprazole), SSRIs, pembro…
109
Q

What is the gold standard test for achalasia ?

A

Manometry
Impaired relaxation of LES and abnormal persitalsis are dx

110
Q

What is the malignancy potential of Barrett’s oesophagus ?

A

30 fold increase risk of oesophagal ADK
Low overall annual risk (0.1 - 3%)
+++ if dysplastic and long segment

111
Q

What is the management of gallstone pacnreatitis ?

A

ERCP if severe ongoing pancreatitis
Otherwise if not improving > 48h and persistent stone
Cholecystectomy before discharge

112
Q

What is the management of hyperTg induced pancreatitis ?

A

If sick : IV insulin, STRICT NPO +/= plasmapheresis

Long term : fibrates, restrict dietary fat, tx 2nd causes of hyperTg (diabetes, ETOH)

113
Q

What is the most common location of crohn disease ?

A

Terminal ileal involvement is most common
Can affect anywhere from gum to bum

114
Q

What is the serology in crohn disease ?

A

ASCA

115
Q

What is the serology in ulcerative colitis ?

A

P anca

116
Q

What is the tx of achalasia for poor surgical candidates ?

A

Endoscopic botox injection
Smooth muscle relaxants (Nifedipine…)

117
Q

What is the tx of autoimmune hepatitis ?

A

Steroids +/- AZA (but not used if severe acute AIH)

118
Q

What is the tx of autoimmune pancreatitis ?

A

Pred 40 x 4-6w then taper
Look for radiologic improvement

119
Q

What is the tx of bile salt diarrhea ?

A

Cholestyramine

120
Q

What is the tx of dermatitis herpetiformis ?

A

Gluten free diet (takes months to work)
Dapson (R/O G6PD deficiency)

121
Q

What is the tx of eosinophilic esophagitis ?

A
  • 6 food elimination diet (eggs, soy, cow’s milk, wheat, tree nuts, seafood)
  • PPI, topical steroids
  • Prednisone
  • Dupilumab
122
Q

What is the tx of IgG4 related disease ?

A

Pred 40mg daily then taper over 2 months
If unable to taper, consider ritux, AZA or MMF
Follow response to tx by sx and imaging

123
Q

What is the tx of microscopic colitis ?

A

Imodium, stop NSAIDs, stop offending meds
1st line : budesonide PO
2nd line : 5ASA PO

124
Q

What is the tx of primary sclerosing cholangitis ?

A
  • ERCP PRN for strictures
  • MCRP +/- CA 19-9 q1y to screen for GB cancer and cholangiocarcinoma
  • Colonoscopy with surveillance bx at dx and q1-2y
  • Urso often used but NO evidence
125
Q

What is the workup for autoimmune pancreatitis ? Name 2 points.

A
  • CT/MRCP + EUS
  • Serum IgG4 > 2X ULN suggestive of type 1 (but can be negative)
126
Q

What is type 1 vs type 2 auto immune pancreatitis ?

A

Type 1 : IgG4, has biliary, salivary, pulm, renal, thyroid, LN involvement
Mostly older men > 60yo
Type 2 : isolated to pancreas and // IBD
> 40 yo

127
Q

What should goblet cells make you think of ?

A

Barret’s oesophagus
Bx : columnar intestinal metaplasia +/- goblet cells

128
Q

What should you check before starting ASA/6MP ?

A

check TMPT

129
Q

What test should you order to dx coeliac disease if pt on gluten free diet ?

A

Consider HLA DQ2/DQ8

130
Q

What to do if pancreatic necrosis found on CT scan in context of acute pancreatitis ?

A

If pt well : CT guided FNA
If septic : necrosis penetrating ATB (carbapenem or quinolone + metronidazole)

131
Q

What type of tx is sulfasalazine and when is it indicated in crohn ?

A

5-ASA
Only for mild colonic crohn’s disease
NOT EFFECTIVE otherwise

132
Q

When is MTX used in IBD mangement ?

A

For Crohn’s induction and maintenance

133
Q

When is tofacitinib used in IBD management ?

A

Moderate-severe UC with loss of response/lack of response/intolerance of conventional therapy or anti-TNF

134
Q

When should you ask for HLA DA2/DQ8 in celiac disease ?

A

Consider if
- Equivocal histology in seroneg pts
- Eval in pts on gluten free diet where testing can be falsely negative
- Discordant sero and histo
- Patients with DOWN SYNDROME

135
Q

When should you confirm eradication after H pylori tx ?

A

Wait ≥ 4w after completing ATB and ≥ 1-2w after PPI therapy before testig for H pylory to improve test accuracy

Use urea breath / stool antigen test / gastric biopsy

136
Q

When should you consider progression to Enteropathy associated T cell lymphoma (EATL) in celiac patients ?

A

If celiac pt stops responding to gluten free diet

137
Q

When should you do a CT scan for pancreatitis ?

A
  • NOT required for dx or prognosis
  • YES if clinical deterioration 48-72h after dx
138
Q

When should you do follow up serology in celiac disease pts ?

A

Follow up serology 6 and 12 m post dx then annually
Check for micronutrient : Fe, folate, vit D, B12
BMD per guidelines

139
Q

When should you do urgent ERCP < 24h ?

A
  • Cholangitis
  • Persistent biliary obstruction
  • Severe ongoing pancreatitis
    (otherwise to consider if > 48h not clinically improving and persistent stone)
140
Q

When should you suspect CMV colitis in IBD patients ?

A

Can co exist, has to be R/O for inpatient IBD
Bx and look for owl eye inclusion bodies on pathology and CMV+ immunohistochem off bx

141
Q

Where does dermatitis herpetiformis present?

A

Grouped, pruritic papules and vesicles on extensor surfaces

142
Q

Where should you do bx to dx coeliac disease ?

A

Small bowel biopsy + marsh classification

143
Q

Which antibodies in primary biliary cholangitis ?

A

AMA + > 95%

144
Q

Which antibodies in primary sclerosing cholangitis ?

A

No antibodies, rarely IgG4 related

145
Q

Which ATB in case of abscess in crohn disease ?

A

Drain and ATB : cipro/flagyl or CTX/flagyl prior to immunosuppression

146
Q

Which drugs cause pancreatitis ?

A

GLP1 Rc agonists
5 ASA
Thiazides
AZA

147
Q

Which heme cancer is associated with celiac disease ?

A

Enteropathy associated T cell lymphoma (EATL)

148
Q

Which lab aN do you see in celiac disease ?

A

Anemia
Elevated transaminases (mild)
Vitamine + mineral deficiencies : A D E B12 Fe Ca

149
Q

Which meds to review if case of chronic pancreatitis ? (etiology)

A

AZA, cyclosporine

150
Q

Who should you screen for Barrett’s oesophagus ?

A

Canadian task force : NO SCREENING

151
Q

When is a HIDA scan indicated ?

A

Indicated if dx remains uncertain following US for cholecytitis
If prolonged fever, murphy sign and/or leukocytosis : do US : gallstones without GB edema or murphy sign or GB edema and murphy’s sign without gallstones : cholescintigraphy

152
Q

Which medication combined with NSAIDs is susceptible to cause GI bleed ?

A

ISRS like citalopram

153
Q

ATB en colite ischémique ?

A

YES ATB for most patients with colonic ischemia, except possible those with mild disease and no evidence of bleeding from ulceration
Theoriquement pour prevenir translocation

154
Q

Quel consommation d’alcool nécéssaire pour faire une pancréatite alcoolique ?

A

Consommation chronique d’alcool de plus de 5 ans à plus de 50g par jour

155
Q

Indication du misoprostol ?

A

Prophylaxie digestive
IPP généralement essayé en 1e car mieux toléré (vs effets 2nd GI ++) et doses QID

156
Q

Chez qui on continue un IPP long terme ?

A
  • Giant ulcer over 2cm and over 50y or multiple comorbidities
  • Hpylori negative and AINS negative ulcer disease
  • Failure to eradicate H pylori
  • Frequently recurrent peptic ulcers (over 2 in a year)
  • Continued AINS use
157
Q

Quand suspecter un gastrinome ?

A
  • Multiple or refractory peptic ulcers
  • Ulcers distal to the duodenum
  • MEN1
  • Diarrhea responsive to PPI
158
Q

How do you diagnose syndrome zollinger ellison ?

A

Pour le diagnostic il faut les 2 critères (IPP doivent être cessés):
- Gastrine sérique à jeun augmenté 10x LSN
- Mesure du pH gastrique < 2
La mesure du pH gastrique est nécessaire pour
exclure hypergastrinémie 2e en lien avec achlorhydie (gastrite atrophie, infection H pylori, IR, vagotomie, ingestion IPP) : dans ces cas la gastrine sera augmentée mais le pH sera > 2)

159
Q

Syndrome Zollinger Ellison, trouvaille typique a l’OGD?

A

Prominent gastric folds
Maladie ulcéreuse

160
Q

Epidemiologie de la maladie de Chagas ?

A

Parasite trypanosoma cruzi
Amérique latine

161
Q

Trois sortes d’arthrites associées aux MII ?

A
  • Spondyloarthropathie : Indistinguable de la spondylite ankylosante, évolue indépendamment de la MII
  • Atteinte périphérique Type 1 : Oligoarthrite asymétrique non-destructrice surtout des
    grosses articulations des membres inférieurs qui tend à suivre l’activité de la MII
  • Atteinte périphérique de Type 2 : Distribution polyarticulaire parfois d’allure rhumatoïde qui
    évolue indépendamment de la MII
162
Q

Treatment for IBD associated arthritis ?

A
  • NSAIDs for two weeks
  • Sulfasalazine or MTX if no axial disease
  • TNF if axial disease
163
Q

Which disease : infiltrat inflammatoire avec éosinophiles et lésions en cryptes et cellules géantes ?

A

CMV GI disease

164
Q

Should you treat diarrhea from E coli O157:H7 ?

A

No
Association between ATB and development of HUS in patients with STEC infection

165
Q

When should you suspect chronic mesenteric ischemia ?

A

Douleur abdo post prandial, perte de poids, souffle épigastrique, FDR MVAS
Angio CT or angio IRM or echo doppler

166
Q

Which drug is bad for the liver ?
Statine, estradiol, levonorgestrel, saxagliptine

A

Estradiol

167
Q

Oesophageal cancer : upper mid oesophagus ?

A

Squamous cell

168
Q

Oesophageal cancer : distal oesophagus ?

A

ADK

169
Q

Adenocarcinoma cancer : localisation on oesophagus ?

A

Distal

170
Q

Squamous cell cancer : localisation on oesophagus ?

A

Upper mid oesophagus

171
Q

Risk factors for squamous cell oesophageal cancer ?

A

Et OH
Caustic injury
Smoking

172
Q

Risk factors for AKD oesophagal cancer ?

A

Barrett’s
GERD
Obesity
Smoking

173
Q

What is the tx for initial first C diff episode ?

A

Fidaxo 200 BID x 10 days preferred
Vanco 125 QID x 10 days
Metronidazole 500 TID x 10-14 days only if non severe and above not available

174
Q

What is the tx for a first CDI re ocurrence ?

A

Fidaxo 200 BID x 10 days or bid X 5 days then q2days x 20 days
Vanco with tapered regimen
Alternative : vanco 125 QID x 10 days

175
Q

What is the tx for second or subsequent CDI recurrence ?

A

Fidaxo 200 BID x 10d or BID x 5d then q2d x 20 d
Vanco with tapered regimen
Vanco 125 QID x 10d then rifaximin TID x 20 d

176
Q

Can you give vaccines to pts on biologics ?

A
  • No LIVE vaccines if on TNFi without holding and if in flare don’t delay tx ( MMR, intranasal flu, shingrix)
  • For NON LIVE attenuated vaccines : defer until < 20mg/d of pred per day
  • For NON LIVE like IM influenza give that anytime

Pneumo/gastro c’est bow (5 decks)

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