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
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
3
Q
Achalasia : common sx that are not GI ?
A
Chest pain
Weight loss
4
Q
Achalasia : what kind of dysphagia ?
A
Progressive solid and liquid dysphagia
Regurgitation and reflux sx
Sx refractory to PPI therapy
5
Q
Achalasia puts you at risk of which cancer ? Do you need surveillance ?
A
Esophageal squamous cell carcinoma
No routine endoscopic surveillance
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
7
Q
Anti LKM in what disease ?
A
AIH type 2
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
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
10
Q
Aphtous ulcers : crohn or ulcerative colitis ?
A
Crohn
11
Q
Are primary sclerosing cholangitis highly symptomatic ?
A
No up to 50% asx at presentation
Sx include abdo pain, pruritus, fatigue
12
Q
Autoimmune pancreatitis mimic ?
A
It can mimic pancreatic cancer, but it responds to steroids
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
14
Q
Barrett’s : management if metaplasia with no dysplasia ?
A
EGD in 3y if >3cm segment, otherwise in 5years
15
Q
Barrett’s management if no metaplasia ?
A
Repeat endo w biopsy in 1-2 y
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
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
18
Q
Clinical manifestation of proctitis in ulcerative colitis ?
A
Small volume + frequent BMs w/ blood, tenesmus, urgency, crampy abdo pain
19
Q
Cobble stone mucosa : Crohn or ulcerative colitis ?
A
Crohn
20
Q
Crohn disease : cold stricture ?
A
Fibrostenotic disease with no active inflammation
Conservative (bowel rest, NG tube), endoscopic dilatation or surgery
21
Q
Crohn disease : hot stricture what tx ?
A
Steroid bridge to maintenance tx (biologics)
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
23
Q
Crohn disease: what tx if perianal disease ?
A
Anti TNF +/- ATB PRN
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)
25
Crohn’s tx for mild disease ? Induction and maintenance ?
Induction :
5-ASA (if mild colonic)
Budesonide
Maintenance
Thiopurine (AZP, 6MP)
26
Crypt abcessess, lamina propria cellularity : crohn or UC ?
UC
27
Cryptitis/architectural distortion ; crypt abscesses, atrophy : crohn or UC ?
UC
28
Dx in case of narrow GEJ with bird beak appearance, poor barium appearance ?
Achalasia
29
Dysphagia : two diseases with intermittent sx ?
- Primary oesophageal motility disorders
- Oesophageal ring (Schatzki ring)
30
GERD : when is sucralfate indicated ?
Recommend AGAINST in PPI non responders
In pregnancy OK though
31
H pylori 1st line treatment ?
PBMT or PAMC x 14 days is 1st line
- PPI/Bismuth/Metronidazole/Tetracycline
- PPI/Amox/Metro/Clarithro
32
H pylori tx if tx failure ?
- PBMT x 14d if prior triple therapy
- PPI/Amox/Levoflox x 14d
33
H pylori, should you test GERD patients ?
Do not test those with GERD without dyspepsia or PUD
Tx will generally not improve sx
34
H pylory and risk of cancer ?
Higher risk of gastric cancer
Controversial whether to tx pts solely to prevent cancer but offer tx to everyone testing positive
35
H pylori, who should you test ?
Name 6.
- PUD
- Uninvestigated dyspepsia
- Long term NSAIDs/ASA
- Unexplained iron deficiency
- ITP
- MALT lymphoma, resected early gastric cancer
36
How do you diagnose microscopic colitis ?
Normal appearing colonoscopy but bx confirm dx
37
How do you diagnose primary sclerosing cholangitis ?
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
38
How do you differentiate achalasia from chagas disease ?
Via serology
Esophageal involvement is indistinguishable on endoscopy, bx not helpful
Tx is the same
39
How do you dx crohn’s disease ?
- Ileocolonoscopy and bx
- Small bowel imaging (CT/MR enterography, capsule) +/- EGD
40
How do you manage ischemic colitis ?
- Most resolve with supportive care
- Empiric ATB if moderate-severe
- Gen chx if pancolitis or isolated right sided severe
41
How do you treat acute pancreatitis ? Name 3 points.
- 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)
42
How do you treat primary biliary cholangitis ?
- Urso 15mg/kg
- Bone density testing, lipid profile
43
How long does thiopurines take to have effect ?
8-12 weeks
44
How many bx for barrett’s oesophagus ?
Obtain ≥ 8 bx if > 1cm salmon mucosa extending from GE jxn
45
How much gluten in diet to be able to ask for TTG antibodies ?
3g gluten daily for 8 weeks
46
How often should you do colonoscopy for primary sclerosing cholangitis ?
Colo with surveillance bx at dx and q1-2 years
47
How should you screen for cancer in primary sclerosing cholangitis ?
MRCP +/- CA 19-9 q1y to screen for GB cancer and cholangiocarcinoma
48
IBD general principles, what is the pre biologic work up ?
Name 4 points.
- HBV, HCV
- TB skin test ; if BCG vaccinated : CXR and/or IGRA
- VZV titres
- Strongyloides if high pretest probability
49
IBT : when should you susepct bile salt diarrhea ?
Occurs with ileitis or after ileal resection
ALWAYS assess for (CT or C scope) and treat active IBD before tx for bile salt diarrhea
50
If low IgA, which antibody should you ask to diagnose celiac disease ?
Anti-deamidated gliadin peptide IgG
51
In case of autoimmune hepatitis, you should screen for ?
Screen all patients for celiac disease and thyroid diseases
52
Inpatient IBD : how long should you wait for a response on steroids before considering another therapy ?
If minimal response after 72h IV steroids : infliximab
53
Life threatening hemorrhage on acute GI bleed, should you give platelets transfusions to reverse effect of antiplatelet ?
No
54
Lymphoid aggregates : crohn or UC ?
Crohn
55
Non caseating granulomas : crohn or UC ?
Crohn
56
Non variceal UGIB : what is the post endoscopy management if high-risk vs low-risk ulcer ?
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
57
Non variceal UGIB : when should endoscopy be performed and which lesion should you treat ?
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)
58
Non variceal UGIB : when should you restart anti platelets and anticoag ?
As soon as possible
Not associated with increased GI bleed but is associated with a reduction in all cause mortality
59
Non variceal UGIB : who should you test for H pylori ?
Test ALL with PUD or gastritis : bx at time of EGD or check serology
60
Patchy inflammation and skip lesions : crohn or ulcerative colitis ?
Crohn
61
Positive AMA in which hepatic disease ?
Primary biliary cholangitis
62
Primary sclerosing cholangitis : typical epidemiology and presentation ?
Male with IBD (2/3 have IBD, UC ++++)
Up to 50% asx at presentation
Sx includes pain, pruritus, fatigue
63
Risk factors for Barrett’s oesophagus : tobacco or ROH ?
Tobacco
ROH is risk factor for squamous cell carcinoma
64
Risk factors for barrett’s oesophagus ?
Chronic GERD (>5y)
> 50y
Male
Caucasian
Tobacco
Central obesity
Fm hx
65
Risk factors for celiac disease ?
- Northern european descent
- + family hx to 1st degree relatives
- T1DM
- AI disease
- Down (x6)
- Turner
- IgA deficiency
66
Should you give tranexamic acid in case of UGI bleed ?
Do not use routinely as does not reduce mortality
67
Should you give urso in primary sclerosing cholangitis ?
Frequently used but NO evidence
68
Should you stop DVT prophylaxis for inpatient IBD with bloody diarrhea ?
No
69
The Atlanta Classification : what are the three pancreatitis complications that occur ≥ 4 weeks ?
- Pseudocysts
- Pancreatic abscess
- Walled off pancreatic necrosis
70
Transmural inflammation : crohn or UC ?
Crohn
71
Transmural inflammation : crohn or ulcerative colitis ?
Crohn
72
Type 1 auto immune hepatitis : antibodies and age of presentation ?
ANA > 1:80, ASMA > 1:80
ANA, AAA, anti soluble liver/liver pancreas antigen
Presents at any age
73
Type 2 auto immune hepatitis : antibodies and age of presentation ?
Anti LKM1 > 1/80
Anti liver cytosol
Presents in children and young adults
74
Ulcerative colitis : disease location left sided colitis definition ?
Sigmoid to splenic flexure
75
Ulcerative colitis : disease location pancolitis definition ?
Beyond the splenic flexure
76
Ulcerative colitis : disease location proctitis definition ?
w/in 18cm from the anal verge
77
Ulcerative Colitis : treatment options for mild disease ? Induction and maintenance ?
Induction
- 5 ASA PO, PR
- Budesonide
Maintenance
- 5 ASA PO, PR
78
Ulcerative Colitis : treatment options for moderate to severe disease ? Induction and maintenance ?
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
What are disease manifestations of IgG4 disease ?
AI pancreatitis, biliary sclerosis, RP fibrosis
Chronic sclerosing aortitis
Thyroiditis
Interstitial pneumonitis
Tubulointerstitial nephritis
80
What are high risk ulcers based on forest classification ?
Forest IA, IB, IIA ulcers
81
What are secondary causes of esophageal eosinophilia ?
GERD, achalasia, connective tissue diseases, hypermobility syndromes, pill esophagitis, pemphigus, hyper IgE syndrome
82
What are side effects of 5 ASA ?
Headache, diarrhea, nausea, pancreatitis
interstitial nephritis
83
What are the associated disorders with type 1 AIH ?
AI thyroid disease, Grave’s, UC celiac, T1DM
84
What are the criterias for Severe Ulcerative Colitis ?
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
What are the dx criteria of primary biliary cholangitis ?
1- Persistent ALP elevation > 6 months
2- Positive AMA > 1:40 or specific ANAs
3- Liver bx (only needed when dx unclear)
86
What are the endoscopic findings of oesinophilic esophagitis ?
Trachealization of the esophagus (feline esophagus), white exudates/papules, crate paper esophagus, strictures
87
What are the gluten containing foods ?
BROW
Barley, Rye, Oats, Wheat
88
What are the possible etiology of ischemic colitis ?
- Cardio embolic (FA ? endocarditis ? LV thrombus ?)
- Athero embolic (AAA, dissection…)
- Shock/Low flow
- Vasculitis / PAN particularly if SEGMENTAL
89
What are the three etiologies of pancreatitis ?
1. Gall stones (order U/S)
2. EtOH
3. Other
90
What are the two exams you shoul;d ask for to dx achalasia ?
- 1st step EGD
- 2nd step high resolution manometry +/- barium swallow
91
What are the two things you should consider if recurrent acute pancreatitis ?
MRCP to R/O divisum, stricture, tumor, stone
Consider genetics workup, esp if young
92
What are the typical labs in acute cholangitis ?
- 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
What are the typical sx of microscopic colitis ?
Relapsing/remitting watery non bloody diarrhea
Weight loss
Abdo pain
94
What are three complications of achalasia ?
- Megaoesophagus > 6cm
- Sigmoid esophagus
- Esophageal squamous cell carcinoma >>>> adenoCA
95
What disease is associated with primary biliary cholangitis ?
Sjogren, celiac disease, AI thyroid disease
96
What do you see typically on MRCP/CT + EUS in case of autoimmune pancreatitis ?
Sausage pancreas
Biliary strictures (IgG4 associated cholangitis)
97
What H pylori test detect current OR prior infection ?
Serology (serum IgG)
If negative in a patient with bleeding ulcer, repeat testing is recommended when acute bleeding episode resolves
98
What is the cancer risk in Crohn ? Ulcerative colitis ?
Crohn : colorectal CA (colitis only)
UC : colorectal CA and if PSC : risk of hepatobiliray cancers (HCC, cholangio, GB cancer)
99
What is the Charcot’s Triad or Raynaud’s Pentad of acute cholangitis ?
Fever, abdominal pain + jaundice +/- hypotension and confusion
100
What is the clinical presentation of eosinophilic esophagitis ?
Intermittent solid food dysphagia
Food bolus obstruction
101
What is the complication of ulcerative colitis ?
Toxic megacolon
102
What is the definition of achalasia ?
loss of esophageal peristalsis and incomplete relaxation of lower esophageal sphincter
103
What is the definition of acute pancreatitis ?
Need 2/3 criteria for dx.
1. Abdo pain consistent with disease
2. Lipase and or amylase ≥ 3x ULN
3. Characteristic findings on imaging
104
What is the definition of toxic megacolon ?
- 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
What is the dx algorithm if ongoing GI bleeding despite negative EGD/colonoscopy ?
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
What is the epidemiology and clinical presentation of primary biliary cholangitis ?
Middle aged women
Jaundice, pruritus, fatigue, elevated ALP
107
What is the epidemiology of IgG4 disease ?
Mostly older men age > 60
(in contrast type II age > 40 M=F)
108
What is the epidemiology of microscopic colitis ? Comorbidities and rx?
- Older women, mean age 65
- Comorbid AI diseases
- Associated rx : NSAIDs, PPIs (lansoprazole), SSRIs, pembro…
109
What is the gold standard test for achalasia ?
Manometry
Impaired relaxation of LES and abnormal persitalsis are dx
110
What is the malignancy potential of Barrett’s oesophagus ?
30 fold increase risk of oesophagal ADK
Low overall annual risk (0.1 - 3%)
+++ if dysplastic and long segment
111
What is the management of gallstone pacnreatitis ?
ERCP if severe ongoing pancreatitis
Otherwise if not improving > 48h and persistent stone
Cholecystectomy before discharge
112
What is the management of hyperTg induced pancreatitis ?
If sick : IV insulin, STRICT NPO +/= plasmapheresis
Long term : fibrates, restrict dietary fat, tx 2nd causes of hyperTg (diabetes, ETOH)
113
What is the most common location of crohn disease ?
Terminal ileal involvement is most common
Can affect anywhere from gum to bum
114
What is the serology in crohn disease ?
ASCA
115
What is the serology in ulcerative colitis ?
P anca
116
What is the tx of achalasia for poor surgical candidates ?
Endoscopic botox injection
Smooth muscle relaxants (Nifedipine…)
117
What is the tx of autoimmune hepatitis ?
Steroids +/- AZA (but not used if severe acute AIH)
118
What is the tx of autoimmune pancreatitis ?
Pred 40 x 4-6w then taper
Look for radiologic improvement
119
What is the tx of bile salt diarrhea ?
Cholestyramine
120
What is the tx of dermatitis herpetiformis ?
Gluten free diet (takes months to work)
Dapson (R/O G6PD deficiency)
121
What is the tx of eosinophilic esophagitis ?
- 6 food elimination diet (eggs, soy, cow’s milk, wheat, tree nuts, seafood)
- PPI, topical steroids
- Prednisone
- Dupilumab
122
What is the tx of IgG4 related disease ?
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
What is the tx of microscopic colitis ?
Imodium, stop NSAIDs, stop offending meds
1st line : budesonide PO
2nd line : 5ASA PO
124
What is the tx of primary sclerosing cholangitis ?
- 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
What is the workup for autoimmune pancreatitis ? Name 2 points.
- CT/MRCP + EUS
- Serum IgG4 > 2X ULN suggestive of type 1 (but can be negative)
126
What is type 1 vs type 2 auto immune pancreatitis ?
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
What should goblet cells make you think of ?
Barret’s oesophagus
Bx : columnar intestinal metaplasia +/- goblet cells
128
What should you check before starting ASA/6MP ?
check TMPT
129
What test should you order to dx coeliac disease if pt on gluten free diet ?
Consider HLA DQ2/DQ8
130
What to do if pancreatic necrosis found on CT scan in context of acute pancreatitis ?
If pt well : CT guided FNA
If septic : necrosis penetrating ATB (carbapenem or quinolone + metronidazole)
131
What type of tx is sulfasalazine and when is it indicated in crohn ?
5-ASA
Only for mild colonic crohn’s disease
NOT EFFECTIVE otherwise
132
When is MTX used in IBD mangement ?
For Crohn’s induction and maintenance
133
When is tofacitinib used in IBD management ?
Moderate-severe UC with loss of response/lack of response/intolerance of conventional therapy or anti-TNF
134
When should you ask for HLA DA2/DQ8 in celiac disease ?
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
When should you confirm eradication after H pylori tx ?
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
When should you consider progression to Enteropathy associated T cell lymphoma (EATL) in celiac patients ?
If celiac pt stops responding to gluten free diet
137
When should you do a CT scan for pancreatitis ?
- NOT required for dx or prognosis
- YES if clinical deterioration 48-72h after dx
138
When should you do follow up serology in celiac disease pts ?
Follow up serology 6 and 12 m post dx then annually
Check for micronutrient : Fe, folate, vit D, B12
BMD per guidelines
139
When should you do urgent ERCP < 24h ?
- Cholangitis
- Persistent biliary obstruction
- Severe ongoing pancreatitis
(otherwise to consider if > 48h not clinically improving and persistent stone)
140
When should you suspect CMV colitis in IBD patients ?
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
Where does dermatitis herpetiformis present?
Grouped, pruritic papules and vesicles on extensor surfaces
142
Where should you do bx to dx coeliac disease ?
Small bowel biopsy + marsh classification
143
Which antibodies in primary biliary cholangitis ?
AMA + > 95%
144
Which antibodies in primary sclerosing cholangitis ?
No antibodies, rarely IgG4 related
145
Which ATB in case of abscess in crohn disease ?
Drain and ATB : cipro/flagyl or CTX/flagyl prior to immunosuppression
146
Which drugs cause pancreatitis ?
GLP1 Rc agonists
5 ASA
Thiazides
AZA
147
Which heme cancer is associated with celiac disease ?
Enteropathy associated T cell lymphoma (EATL)
148
Which lab aN do you see in celiac disease ?
Anemia
Elevated transaminases (mild)
Vitamine + mineral deficiencies : A D E B12 Fe Ca
149
Which meds to review if case of chronic pancreatitis ? (etiology)
AZA, cyclosporine
150
Who should you screen for Barrett’s oesophagus ?
Canadian task force : NO SCREENING
151
When is a HIDA scan indicated ?
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
Which medication combined with NSAIDs is susceptible to cause GI bleed ?
ISRS like citalopram
153
ATB en colite ischémique ?
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
Quel consommation d'alcool nécéssaire pour faire une pancréatite alcoolique ?
Consommation chronique d'alcool de plus de 5 ans à plus de 50g par jour
155
Indication du misoprostol ?
Prophylaxie digestive
IPP généralement essayé en 1e car mieux toléré (vs effets 2nd GI ++) et doses QID
156
Chez qui on continue un IPP long terme ?
- 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
Quand suspecter un gastrinome ?
- Multiple or refractory peptic ulcers
- Ulcers distal to the duodenum
- MEN1
- Diarrhea responsive to PPI
158
How do you diagnose syndrome zollinger ellison ?
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
Syndrome Zollinger Ellison, trouvaille typique a l’OGD?
Prominent gastric folds
Maladie ulcéreuse
160
Epidemiologie de la maladie de Chagas ?
Parasite trypanosoma cruzi
Amérique latine
161
Trois sortes d’arthrites associées aux MII ?
- 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
Treatment for IBD associated arthritis ?
- NSAIDs for two weeks
- Sulfasalazine or MTX if no axial disease
- TNF if axial disease
163
Which disease : infiltrat inflammatoire avec éosinophiles et lésions en cryptes et cellules géantes ?
CMV GI disease
164
Should you treat diarrhea from E coli O157:H7 ?
No
Association between ATB and development of HUS in patients with STEC infection
165
When should you suspect chronic mesenteric ischemia ?
Douleur abdo post prandial, perte de poids, souffle épigastrique, FDR MVAS
Angio CT or angio IRM or echo doppler
166
Which drug is bad for the liver ?
Statine, estradiol, levonorgestrel, saxagliptine
Estradiol
167
Oesophageal cancer : upper mid oesophagus ?
Squamous cell
168
Oesophageal cancer : distal oesophagus ?
ADK
169
Adenocarcinoma cancer : localisation on oesophagus ?
Distal
170
Squamous cell cancer : localisation on oesophagus ?
Upper mid oesophagus
171
Risk factors for squamous cell oesophageal cancer ?
Et OH
Caustic injury
Smoking
172
Risk factors for AKD oesophagal cancer ?
Barrett’s
GERD
Obesity
Smoking
173
What is the tx for initial first C diff episode ?
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
What is the tx for a first CDI re ocurrence ?
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
What is the tx for second or subsequent CDI recurrence ?
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
Can you give vaccines to pts on biologics ?
- 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
