Day 7 - GI2 Quiz

Question 1

EGD w/ bx in 75 yo M reveals gastric CA - next step in mgt

Answer 1

CT scan ab/pelvis (staging - size & metastasis)

Question 2

Next step in mgt of pt w/ recurrent ulcers seen on at least 2 EGDs

Answer 2

Serum Gastrin level (r/o Zollinger-Ellison syndrome)

Question 3

Duodenal v. Gastric ulcers p/w

Answer 3

DUODENAL: 2-4 hrs after eating, pain initially improves w/ eating; GASTRIC: pain soon after eating, eating (also n/v) worsens pain

Question 4

Most effective mgt duodenal ulcers not due to Zollinger-Ellison syndrome

Answer 4

Most all duodenal ulcers due to H. pylori (PPI, clarithromycin, metronidazole or amoxicillin)

Question 5

Chem 7 lab abnormality often elevated in pts w/ GI bleed

Answer 5

BUN (bacteria in gut break down Hb & elevate BUN)

Question 6

Ranson’s criteria for determining prognosis in pts w/ acute pancreatitis

Answer 6

Upon admission, GA-LAW: Glucose > 200, AST > 250, LDH > 350, Age > 55, Elevated WBC > 16,000; In initial 48 hrs, C-HOBBS: Ca 4, Sequestration of fluid > 6L

Question 7

Causes of Acute pancreatitis

Answer 7

Alcohol & Gallstones most common; Trauma, Hypertriglyceridemia, Hypercalcemia, Drugs (e.g., certain HIV meds)

Question 8

Tumor markers for pancreatic CA

Answer 8

CEA & CA-19-9

Question 9

Tumor marker for gastric cancer

Answer 9

CEA

Question 10

Tx H. pylori

Answer 10

PPI + Clarithromycin + Metronidazole/Amoxicillin

Question 11

Tx Gastric CA

Answer 11

Depends on location; Distal third: Subtotal gastrectomy, Middle/Upper: Total gastrectomy; In either case, chemotherapy and radiation adjuvants recommended

Question 12

Tx pancreatic CA in head of pancreas

Answer 12

Whipple procedure; Additionally, chemotherapy

Question 13

Specific lab test for chronic pancreatitis

Answer 13

Low fecal elastase (regardless of whether giving pancreatic enzyme replacement)

Question 14

Tx chronic pancreatitis

Answer 14

Pancreatic enzyme replacement; Stop alcohol; Pain control