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DIT Level 3 > Clinical questions - Gastroenterology > Flashcards

Clinical questions - Gastroenterology Flashcards

1
Q

Distinguishing between upper and lower GI bleeds

A

UGI is typically melenic stools
LGI is typically red blood or hematochezia

Ligament of Treitz is the landmark dividing upper and lower

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2
Q

Most important aspect of managing an acute, large volume GI bleed

A

IVF resuscitation

Hypotension surpasses all other findings - you have to perfuse the body

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3
Q

HBsAg -
HBsAb -
HBcAB +
HBeAg -

A

Window period

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4
Q

HBsAg +
HBsAb -
HBcAB +
HBeAg +

A

Acute disease

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5
Q

HBsAg -
HBsAb +
HBcAB +
HBeAg -

A

Recovered

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6
Q

HBsAg -
HBsAb +
HBcAB -
HBeAg -

A

Vaccinated

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7
Q

Ulcerative colitis (presentation, lab markers, endoscopy findings, treatment)

A

Presentation: intermittently bloody diarrhea with colicky abdominal pain and fatigue

Labs: pANCA positive

Scope: continuous circumferential inflammation of the rectum that may include more proximal colon

Treatment:
Mild/all patients: 5-ASA (mesalamine) can be given orally or suppositories or enemas

More severe disease:

  • Steroids
  • Immunosuppressants: cyclosporine, azathioprine, 6-mercaptopurine
  • Anti-TNFalpha durgs: infliximab

Colectomy is curative

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8
Q

Cause of diarrhea in a patient with HIV and CD4 less than 100

A

Cryptosporidium

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9
Q

Cause of diarrhea in a patient with vomiting and diarrhea after eating reheated Chinese fried rice

A

Bacillus cereus

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10
Q

Cause of diarrhea in a patient with vomiting and diarrhea after eating raw oysters

A

Vibrio parahaemolyticus

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11
Q

Cause of diarrhea in a patient with diarrhea beginning after backpacking in the mounts

A

Giardia lamblia

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12
Q

Cause of diarrhea in a patient with recent treatment for UTI

A

C. diff

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13
Q

Type of hepatitis with AST 2 times as high as ALT

A

Alcohol hepatitis

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14
Q

In general, causes of direct vs indirect hyperbilirubinemia

A

Direct (conjugated) bilirubin is elevated in hepatobiliary disease

Indirect (unconjugated) bilirubin is elevated in hemolysis

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15
Q

Crohn disease (presentation, lab markers, endoscopy, treatment)

A

Colicky abdominal pain, occasional low grade fevers

Lab: ASCA (Anti-Saccharomyces cerevisiae antibodies) positive (ANCAs negative)

Scope: cobblestoning and skip lesions
Path: transmural inflammation, non-caseating granulomas

Treatment:
5-ASA
Steroids
Immunosuppressants
Anti-TNF alpha drugs

Colectomy no curative in Crohn dz

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16
Q

Irritable bowel syndrome

A

Intermittent abdominal bloating and crampy lower abdominal pain without nausea or vomiting; alternating between diarrhea and constipation with defecation often relieving the abdominal pain. No blood or mucus in stools

Tx:
Avoid gas producing foods
Diet low in fermentable short chain saccharides (lactose, fructose)
GF diet
High fiber diet
Exercise
17
Q

Celiac disease

A

Chronic diarrhea - steatorrhea
Occasional nausea/vomiting and abdominal pain

Lab markers: anti-endomysial Ab and anti-tissue transglutaminase Ab positive

GF diet: “BROW” - barley, rye, oats (often contaminated), wheat

18
Q

Hereditary Hemochromatosis

A

AR - increased Fe absorption

Presentation: pruritis, jaundice, fatigue, infertility, joint pain, fat malabsorption

Advanced disease: skin hyperpigmentation, DM, cirrhosis
-“Bronze diabetes”

Labs: elevated Fe, ferritin, transferrin, %sat; decreased TIBC

Dx: Liver biopsy
Most common - HFE gene mutation

Tx: phlebotomy

19
Q

Criteria to use ppx against stress ulcers in the ICU

A 
Coagulopathy
intubation/ventillation > 48 hrs
GI ulceration/bleeding within 1 yr
Head trauma
Spinal cord trauma
burn injury
2 or more of the following:
Sepsis
ICU > 1 week
Occult GI bleed 6 or more days
Glucocorticoid tx
20
Q

What infectious risk is associated with PPIs and H2 blockers

A

C diff risk increased

21
Q

Acute pancreatitis: presentation, an Initial lab testing, an Initial lab testing, management

A

Presentation: epigastric pain, nausea, vomiting, anorexia
Exam: epigastric tenderness without guarding, may have ecchymosis at bilateral flanks (Grey-turner sign) or at umbilicus ( Cullen sign)

Lab: elevated serum lipase

Management:
Admit +/- ICU
Monitor for hemodynamic instability and organ failure
Aggressive hydration
NPO
Pain control (morphine)
Established underlying cause

If worsening, CT A/P to r/o pseudocyst

22
Q

Common causes of pancreatitis

A

Most common - gallstone
Alcohol abuse
Medications
Elevated triglycerides

23
Q

Causes of cirrhosis and portal vein hypertension

A 
Alcohol abuse
Chronic hepatitis B or C
Fatty liver disease
Hemachromatosis
Chronic biliary obstruction
Chronic cholestasis
24
Q

Exam findings consistent with cirrhosis

A

Jaundice, spider angiomata, gynecomastia, abdominal distention with shifting dullness and a fluid wave

25
Q

Lab testing to determine cause of ascitic fluid

A

Serum albumin compared with ascitic fluid albumin

Calculate SAAG
> or = 1.1 - cirrhosis, CHF, budd chiari (portal vein thrombosis)
less than 1.1 - pancreatitis, chronic nephrotic syndrome (losing protein)

26
Q

Achalasia - presentation, diagnosis and management

A

Presentation:
Progressive difficulty swallowing to both liquids and solids, with a sensation of sticking in chest

Barium esophageal shows narrowing of the esophagogastric junction - “bird’s beak” appearance, with a dilation of the proximal esophagus

Confirm diagnosis with esophageal manometry - high LES pressure, lack peristaltic distally

Tx:
Esophageal dilation
Surgical myotomy
Botox to LES

Medical tx: nifedipine, nitrates

27
Q

Primary sclerosing cholangitis - cause, presentation, diagnosis, tx, risk

A

Inflammation and stricturing of the biliary tree, leading to cholestasis, jaundice, and pruritic
- Common in young men, hx of IBD esp. UC

Lab: elevated direct bill and ALP
pANCA strongly positive (30-80:1)
ERCP with beads on a string

Tx:
No proven medical treatment
ERCP for a dominant stricture - dilate
Liver transplant for advanced liver disease and cirrhosis

Risk: cholangiocarcinoma, gallbladder cancer, hepatocellular carcinoma (2/2 cirrhosis)

28
Q

gastritis management

A

Get EGD to r/o gastric CA with bx

Tx:
PPI
triple antibiotic tx if H. pylori cause
Limit use of NSAIDs, tobacco, etoh

29
Q

alpha 1 antitrypsin deficiency

A

Increased elastase activity leads to lung disease - panacinar emphysema - obstructive pattern on PFTs

Mutated protein accumulates in the liver which is toxic to the cells -> liver disease - early onset cirrhosis

Tx:

  • infusion of alpha 1 antitrypisn (A1AT)
  • Lung transplant
  • liver transplant is curative as it makes normal alpha1 antitrypsin
30
Q

Treatment for c. diff

A

Most common initial therapy is metronidazole

If initial therapy fails or recurrent diarrhea or more severe:

  • PO Vanc
  • Fidoxamicin
  • rifaximin
  • fecal bacteriotherapy - enema
31
Q

Primary biliary cirrhosis - presentation, exam findings, diagnosis, management

A

Presents with generalized pruritic, fatigue, RUQ pain
Associated with other autoimmune disorders, middle aged females - 90%

Exam:
mild hyperpigmentation of skin without jaundice or scleral icterus (unless advanced then + jaundice)
Liver moderately enlarged - contender

Labs:
Mild elevated AST, ALT
markedly elevated ALP
normal t bili
ANA (antinuclear) and AMA (antimitochondrial) Ab positive

Confirm dx: liver bx

Tx:

  • Ursodeoxycholic acid
  • cholestyramine for pruritis
  • ultimately transplant
32
Q

Treatment of GERD

A

mild - lifestyle modifications: Weight loss, elevate head of bed, stop smoking, limit alcohol, caffeine, chocolate, avoid eating 3 to 4 hours before bed
next option: H2 blocker or PPI

33
Q

Wilson’s disease

A

Effects liver, brain, eyes

Exam:
Kayser Fleischer rings on slip lamp exam

Labs:

  • slightly elevated AST, ALT
  • normal t bili, ALP
  • ferritin normal
  • Serum ceruloplasmin low or normal -> low serum copper
  • high 24 hr urine copper

Dx:
liver bx
genetic testing - multiple mutations

Tx:
Chelation - penicillamine or trientine

DIT Level 3 (32 decks)

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