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Gastro Review > D&C@ > Flashcards

D&C@ Flashcards

1
Q

If IgA def, what is best next step for celiac dz w/u?

A

deaminated gliadin IgG +/- TTG IgG

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2
Q

Which celiac test has best NPV?

A

HLA DQ2 and 8 testing

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3
Q

Pt with slow transit constipation - trial secretagogue and no improvement, what next?

A

Repeat transit study on meds and if abnormal consider GES to check for possible UGI motility issue

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4
Q

T/F: Should be careful when using methylnaltrexone in pts with diverticulosis due to perf risk

A

True

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5
Q

What is the path of solitary rectal ulcer?

A

fibromuscular obliteration of LP

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6
Q

If SRU, what should be done testing wise?

A

Defecography to determine why and treat that cause

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7
Q

What is best ppx for travelers diarrhea?

A

Rifaximin

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8
Q

Fatty stool with neg CT for CP or panc mass, what test to get?

A

13 C breath test with med chain TG

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9
Q

Which type of bariatric surg has highest risk of constipation?

A

Gastric banding - 39% of pts

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10
Q

Which bariatric surg has risk of diarrhea?

A

Roux, biliopanc diversion

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11
Q

Which bariatric surg do not change bowel habits?

A

Vertical banded gastropplasty, sleeve gastrectomy

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12
Q

What is ancylostoma duodenale or necator americanus?

A

Hookworm

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13
Q

Classic hookworm findings

A

Eos, IDA, travel to endemic area, pruritic rash that precedes sxs

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14
Q

Stages of hookworm

A

Initial rash, pulm stage (many asxatic), GI phase (upper SI)

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15
Q

T/F: Hookworm is located in upper SI and not colon.

A

True

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16
Q

T/F: Given poor testing, if suspect hookworm should just treat for it.

A

True

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17
Q

What to use to tx hookworm?

A

Albendazole 3 day course

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18
Q

T/F: Probiotics can be used in tx of IBS.

A

False, not recommended based on Rome

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19
Q

What is the fecal osmotic gap and how is it useful?

A

290 - 2 (Fecal Na + Fecal K).
Secretory diarrhea has gap < 50
Osmotic diarrhea has gap > 100

20
Q

What would be expected on stool studies in factitious diarrhea?

A

Stool mag > 90

Stool Phos > 33

21
Q

List the types of bile acid diarrhea

A

Type 1 - Ileal dysfcn
Type 2 - Idiopathic
Type 3 - AW other GI DOs (SIBO, celiac CPanc, etc)
Type 4 - Med induced inc in bile acid synthesis

22
Q

How to proceed? Pt with dysenergia on ARM undergoes 8 weeks of biofeedback but does not improve - what is the best next step and then what to do after that based on results?

A

Repeat ARM testing - if now normal, do colon transit time. If still abnormal, consider defecography.

23
Q

Pt with colonic slow motility on marker study started on meds and does not improve. What to do next?

A

Repeat marker study on meds. If now improved, consider GES to check for systemic dz.

24
Q

Pt with slow transit constipation does not improve despite all measures. What is next step?

A

Colonic manometry - if abnormal consider IRA

If normal, consider loop and if benefit then, proceed with IRA

25
Q

Intact recto-anal inhibitory reflex is code for what?

A

NOT Hirschsprungs

26
Q

If balloon testing and ARM are discordant, what should be done next to clarify dx?

A

Defecography

27
Q

What is MOA of linaclotide?

A

minimally absorbed peptide agonsit of guanylate cyclase C receptor that stims intestinal fluid secretion and transit

28
Q

What is MOA of lubiprostone?

A

Cl channel inhibitor

29
Q

Best px med for travelers diarrhea?

A

Rifaximin

30
Q

Who tends to get MAI of the gut?

A

HIV with CD4 < 75

31
Q

Which infxn has ferritin > 10K and high LDH?

A

Histoplasmosis

32
Q

How to tx MAI of the gut?

A

Azithromycin and ethambutol

33
Q

How to treat histo of the gut?

A

Ampho and itraconazole

34
Q

Which med to use for diarrhea due to HIV meds?

A

Crofelemer

35
Q

HIV, weight loss, pain - what to consider?

A

Lymphoma - should get CT CAP

36
Q

Which vitamin def can be seen in carcinoid syndrome?

A

Niacin (causes 4 D’s) - due to tryptophan being used to go to serotonin so less available for niacin

37
Q

Acarbose can cause CHO malabs - this can cause what stool study finding in pt with diarrhea?

A

Low stool pH and high osm gap (>100)

38
Q

SIBO breath test - what to use for substrate?

A

Lactulose

39
Q

SIBO - what blood/urine test can be done and what will it show?

A

D-xylose of urine and blood - will be negative in both bc SB cannot absorb xylose in SIBO; in nl pts will be in urine in 4-5 hours

40
Q

T/F: Prochlorperazine can lead to constipation.

A

False, ondansetron can

41
Q

T/F: Phenytoin can lead to constipation.

A

True

42
Q

WHat dz is AW mi-2 AB?

A

Dermatomyositis

43
Q

If pt has normal pelvic floor fcn, how long to expel balloon?

A

< 60 sec

44
Q

What is the best tx of constipation in pregnancy?

A

Lactulose, preg cat B

45
Q

Overall mechanisms for stool osmotic gap?

A 
HIGH gap (>100) = LOW absorption (celiac, IBD, CP, laxative use)
LOW gap (<50) = HIGH secretion of elecrolytes (infxn, VIPoma, glucagonoma, etc)

Gastro Review (15 decks)

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