Gastro 27 Qns Flashcards
(282 cards)
1
Q
What ix to diagnose portal hypertension?
A
Hepatic venous pressure gradient >5mmHg diagnostic
2
Q
when to restart aspirin for secondary CV prevention after bleeding PUD 2’ aspirin use?
A
1-7 days after initiation of PPI and cessation of bleeding
3
Q
when is repeat upper endoscopy repeated to verify ulcer resolution?
A
- persistent symptoms after 8-12/52 of therapy
- ulcers of unknown cause
- did not undergo gastric ulcer biopsy during the initial upper endoscopy
4
Q
diagnosis of autoimmune pancreatitis involves?
A
- presence of narrowed main pancreatic duct and parenchymal swelling (sausage shaped pancreas) on imaging
+
disease response to glucocorticoids
5
Q
Type 1 vs Type 2 autoimmune pancreatitis?
A
Type 1: high igG4 positive cells in pancreatic tissue +/- High serum IgG4
type 2: normal IgG4 positive cell counts
6
Q
treatment of type 1/2 autoimmune pancreatitis?
A
glucocorticoids
- usually high dose oral prednisone tapered over 2-3 months
7
Q
tx of autoimmune pancreatitis?
A
prednisolone + azathioprine
- usually treat for 2-3 years before consideration of withdrawal
8
Q
what liver lesion can be caused by OCP?
A
hepatic adenomas
- should stop OCP and undergo f/u imaging to confirm stability or regression in lesion size
9
Q
in patients with selective IgA deficiency, what ix to test for coeliac disease?
A
IgG antibodies to deamidated gliadin peptide or TTG
10
Q
what ix is required to diagnose small intraheptic duct stenosis in PSC?
A
liver biopsy
- when MRCP negative for large bile duct stenosis, may still be small duct PSC
11
Q
when to start screening for colorectal cancer in patients with IBD?
A
surveillance colonoscopy should be done 8 years after diagnosis and then every 1 - 2 years thereafter
12
Q
what other specific cancer to screen for in women with IBD?
A
pap smear annually to screen for cervical cancer
13
Q
what are causes of ascites with high SAAG (ie >11g/L)
A
cirrhosis and non cirrhotic causes e.g. heart failure
14
Q
how to differentiate between ascites caused by cirrhosis vs heart failure?
A
total protein level in cirrhosis ascites is low: <25g/L
total protein level in cardiac ascites is high > 25g/L
15
Q
most common cause of cholestatic hepatitis causing obstructive LFT derangement?
A
drug induced liver injury
16
Q
need for follow up of incidental fundic gland polyps seen on endoscopy?
A
no follow up required
funds gland polyps are the most common benign epithelial gastric polyp
17
Q
when to restart warfarin in patients with GI bleeding after endoscopic treatment?
A
within 7 days after discontinuation
18
Q
screening for colon cancer/stomach and small bowel cancers in Lynch syndrome?
A
Lynch syndrome: caused by mutations in mismatch repair genes MLH1, MSH2, MSH6, PMS2
colonoscopy from age 20-25,
upper endoscopy from age 30-35
19
Q
what size of gallbladder polyps would you be worried about?
A
size >1cm - Risk factor for malignancy
- should treat with cholecystectomy
*gallbladder polyps associated with gallbladder stones or PSC more likely to be neoplastic regardless of polyp size
20
Q
tx of functional dyspepsia not responsive to trial of PPI?
A
tricyclic antidepressant
21
Q
treatment of persistent H pylori infection after initial tx with triple therapy?
A
Bismuth + metronidazole, tetracycline + PPI
22
Q
ix to diagnose gastroparesis?
A
4 hour gastric scintigraphy
22
Q
what medications may cause microscopic colitis?
A
NSAIDs, PPIs, SSRIs
23
Q
management of microscopic colitis?
A
- discontinue potentially causative medications
- symptomatic tx with loperamide
- possibly progression to oral budesonide
24
after GI bleeding, when to continue and when to stop aspirin afterwards?
aspirin for primary prevention of CVD should be stopped
aspirin for secondary prevention of MI/Stroke should be restarted as soon as haemostasis is achieved
25
when to do cholecystectomy in patients who have had gallstone pancreatitis?
cholecystectomy before hospital discharge
26
what antibiotics are indicated for infected pancreatic necrosis?
- carbapenem alone (e.g. imipenem)
or
- quinolone, ceftazidime, cefepime + metronidazole
27
when to start screening colonoscopy in patients with first degree relative with colon cancer or advanced polyp
age 40 or 10 years earlier than the age at which relative was diagnosed
28
what is menetrier disease?
overproduction of TGF alpha stimulates EGF and proliferation of epithelial cells
-> leading to protein losing hypertrophic gastropathy, presenting with epigastric pain, weight loss, nausea/vomiting, oedema
29
diagnosis of menetrier disease?
low albumin, upper endoscopy with biopsy: giant mucosal folds in gastric fungus and body
- should also test for CMV, h pylori
30
what is the mechanism of action of cetuximab?
monoclonal antibody that targets EGFR
31
SIBO: how does this affect B12/ folate levels?
Usually high folate (may be elevated due to bacterial synthesis), low B12
32
mx of hydatid liver cyst?
albendazole + surgery
33
what tx for secondary prophylaxis for patients who are at high risk of c diff infection?
can given oral vancomycin prophylaxis for those receiving systemic abx
34
first line tx of achalasia?
endoscopy + pneumatic dilation
35
where are majority of gastrinomas found?
duodenum
- minority in pancreas
36
how to differentiate between gastrinomas and other causes of hypergastrinaemia?
secretin stimulation test
- gastrinoma cells release gastrin in response to secretin, while secretin inhibits normal gastric G cells
37
how often to repeat colonoscopy in patients with UC and PSC?
yearly
38
Initial treatment for PBC
Ursodeoxycholic acid
38
Liver transplantation indications
Acute liver failure, MELD 3.0 score ≥15, decompensated cirrhosis, or hepatocellular carcinoma
38
PSC gold standard treatment
Liver transplantation
39
Most common antibiotic causing cholestatic liver damage
Amoxicillin-clavulanate
40
Common hepatic encephalopathy precipitants
Infection, GI bleeding, medications, volume depletion
41
Bowel disease associated with PSC
IBD
42
Diagnosis suggested by elevated alkaline phosphatase and positive antimitochondrial antibody
PBC
43
HCV-associated extrahepatic diseases
Non-Hodgkin lymphoma, membranoproliferative glomerulonephritis, mixed cryglobulinemia, porphyria cutanea tarda
44
Intrahepatic cholestasis of pregnancy treatment
Ursodeoxycholic acid
44
Diagnosis characterized by cirrhosis-related orthodeoxia and platypnea
Hepatopulmonary syndrome
44
Treatment for SBP
Third-generation cephalosporin plus albumin
45
Hepatopulmonary syndrome test
Echocardiography with administration of agitated saline
- diagnosis is confirmed by intrapulmonary shunting with agitated saline administration during echo
46
Cholecystectomy indications for asymptomatic gallstones
Gallstones >3 cm, porcelain gallbladder, gallbladder polyp >1 cm
47
Focal nodular hyperplasia treatment
None
48
Treatment for liver disease and iron overload secondary to hereditary hemochromatosis
Phlebotomy
49
Diagnosis suggested by hepatomegaly, caudate lobe hypertrophy, ascites, RUQ pain
Budd-Chiari syndrome
50
PSC ERCP indications
Dominant stricture, bile duct mass
51
Diagnosis suggested by acute hepatitis and hemolytic anemia in a young adult
wilsons disease
52
Hepatitis B first-line treatments
Entecavir or tenofovir
53
MASLD treatment
Weight loss, diet modification, and moderate exercise
54
Diagnosis suggested by normal ALT/AST, positive HBsAg, positive HBeAg, high HBV DNA
Hepatitis B infection immune-tolerant phase
55
Most common causes of drug-induced liver injury
Acetaminophen, amoxicillin-clavulanate, phenytoin, valproate
56
Diagnosis suggested by fever, RUQ abdominal pain, jaundice
Cholangitis
57
Hepatitis B treatment indications
ALF, immune-active or reactivation phase, immunosuppression, cirrhosis, pregnant patients with viral load >200,000 U/mL in third trimester
58
Test for all patients with cirrhosis not receiving nonselective β-blocker
Upper endoscopy to assess for varices
59
PSC cancer associations
Cholangiocarcinoma, colorectal cancer, gallbladder cancer
60
Diagnosis suggested by fever, jaundice, tender hepatomegaly, alcohol use disorder, abdominal distention from ascites
Alcoholic hepatitis
61
USPSTF hepatitis C screening indication
All patients age 18-79 years
62
Diagnostic testing for chronic hepatitis C
HCV antibody followed by HCV RNA
63
Most common cause of abnormal liver test results
MASLD
64
Ascites leukocyte count diagnostic for SBP
≥250/µL
65
Diagnosis suggested by first-trimester pregnancy, prolonged vomiting, elevated AST/ALT
Hyperemesis gravidarum
66
Treatment for autoimmune hepatitis
Prednisone, usually with azathioprine
67
HCC screening test in patients with cirrhosis
Ultrasonography and AFP measurement every 6 months
68
Diagnosis suggested by pruritus and total bile acid level >10 μmol/L in the second- or third-trimester of pregnancy
Intrahepatic cholestasis of pregnancy
69
Cirrhosis-related bone disease and screening test
Osteoporosis, DXA
70
HCC screening in at-risk patients with hepatitis B and no cirrhosis
Ultrasonography and AFP measurement every 6 months
71
Obstructive cholangitis treatment
Antibiotics and ERCP
72
Differential diagnosis for Gilbert syndrome
Hemolysis, drug-induced hyperbilirubinemia
73
Common autoimmune hepatitis antibodies
ANA and smooth-muscle antibody
74
Hepatic encephalopathy drug treatments
Lactulose (initial), rifaximin (second)
75
Diagnosis suggested by ALF, neuropsychiatric symptoms, Coombs-negative hemolytic anemia in patient <40 years
Wilson disease
76
Hepatitis B vertical transmission prevention drugs
Lamivudine, tenofovir
77
Amebic liver abscess diagnostic tests
Liver imaging, E. histolytica serologic testing
78
Treatment for HELLP syndrome and fatty liver of pregnancy
Delivery
79
Alcoholic hepatitis indications for prednisolone
MELD score >20
80
Diagnostic criterion for acute hepatitis A
HAV IgM antibodies
81
Hepatitis B–associated vasculitides
Polyarteritis nodosa, cryoglobulinemia
82
Causes of high elastography scores
ALT >100 U/L, hepatic congestion or severe steatosis, infiltrative disorders, bile duct obstruction
83
Hepatic tumor associated with oral contraceptive agent in women
Hepatic adenoma
84
Recommended hepatitis C pretreatment assessment
Cirrhosis assessment with serologic biomarkers and/or elastography
85
Medical treatment for ascites
Sodium restriction, spironolactone, furosemide
86
Hepatitis C–related vasculitis
Mixed cryoglobulinemia
87
Hepatitis C treatment indication
All patients with infection (unless short life expectancy)
88
Most common cause of ALF
Acetaminophen overdose
89
SBP prophylaxis after an episode of SBP
Long-term antibiotics
ciprofloxacin
90
Test for acute cholecystitis if high clinical likelihood but negative ultrasound
HIDA scan
- Lack of gallbladder filling on hepatobiliary iminodiacetic acid (HIDA) scanning
91
Diagnosis suggested by RUQ pain without gallstones on ultrasound in critically ill patient
Acalculous cholecystitis
92
Mandatory test in patients with cirrhosis with new-onset ascites
Diagnostic paracentesis
93
Recommended tests for suspected liver fibrosis and cirrhosis
AST-to-platelet ratio index, Fibrosis-4 score, and elastography
94
Common cause of refractory celiac disease
Continued gluten exposure
95
Indications for surgical treatment of GERD
Failure of PPIs, desire to stop PPI, intolerable PPI adverse effects
96
Drugs causing microscopic colitis
NSAIDs, SSRIs, PPIs
97
Timing of next colonoscopy after removal of adenoma ≥10 mm
3 years
98
Treatment for refractory chronic anal fissure
Sphincterotomy or botulinum injection
99
H. pylori eradication tests
Urea breath test, fecal antigen test, or gastric biopsy
100
Key lifestyle modifications in chronic pancreatitis
Smoking cessation, alcohol abstinence
101
Diagnosis to exclude in achalasia
Tumor at GE junction (pseudoachalasia)
102
Diagnosis suggested by fistula, perianal disease, strictures, abscess
Crohn disease
102
Treatment of mild colonic ischemia
Supportive care
102
Dumping syndrome treatment
Frequent small meals
102
Bowel segment most commonly affected in Crohn disease
Ileocecal area
103
Most common cause of acute pancreatitis
Biliary disease, including gallstones, biliary sludge, and biliary crystals
104
SIBO diagnostic criteria
Symptoms plus positive breath test or improvement with empiric treatment
105
Confirmatory tests for SIBO
Small-bowel aspirate culture, carbohydrate substrate–based breath testing
106
Diagnosis suggested by large-volume watery diarrhea despite fasting
Secretory diarrhea
107
Gold standard celiac disease diagnostic test
Duodenal biopsy
107
IBS-C first-line treatment
Polyethylene glycol
108
Most common cause of small-bowel bleeding
Angiodysplasia
109
Factors associated with increased risk for rebleeding and death in UGI bleeding
Tachycardia, hypotension, age >60 years, major comorbid conditions
110
Age and interval for CRC screening in classic FAP
Age 10-15 years, repeated annually
111
Nutritional approach in severe acute pancreatitis
Early enteral feeding
112
Recommended surveillance in serrated polyposis syndrome
Colonoscopy every 1-3 years, removal of polyps >5 mm
113
Crohn disease colonoscopy finding
Mucosal inflammation with skip areas
114
Colitis with symptoms similar to IBS and celiac disease
Microscopic colitis
115
which conditions are assoc w gastrointestinal neuroendocrine tumors
Zollinger-Ellison syndrome and atrophic gastritis
116
Bone test to consider at time of celiac disease diagnosis
DXA
117
Symptoms and signs of pancreatic cancer
Abdominal pain, back pain, weight loss, jaundice, new-onset diabetes mellitus
118
When to resume aspirin for secondary prevention of CVD in GI bleeding
As soon as possible after hemostasis
119
Measures to prevent acute diverticulitis recurrence
High-fiber diet; lifestyle changes; avoidance of NSAIDs, glucocorticoids, opioid analgesics
120
Preferred test for histologic confirmation of pancreatic cancer
Endoscopic ultrasonography–guided FNA biopsy
121
Most common causes of chronic diarrhea
IBS-D, functional causes, medications
122
Treatment of chronic pancreatitis steatorrhea
Pancreatic enzymes
123
Endoscopic findings in eosinophilic esophagitis
Rings and furrows, luminal narrowing, edema, exudates
124
Core principle in treating relapsed H. pylori infection
Use different antibiotics/regimen
125
Acute anal fissure treatment
Sitz bath and bulk laxatives
126
Gold standard diagnostic test for achalasia
Esophageal manometry
127
Primary variceal bleeding treatment
Octreotide, somatostatin, or terlipressin; endoscopic therapy
128
Most common causes of UGIB
PUD, varices, Mallory-Weiss tears
128
Postprandial abdominal pain, fear of eating, weight loss
Chronic mesenteric ischemia
128
Test for small-bowel bleeding after negative upper and lower endoscopy in stable patient
Capsule endoscopy
128
Rash pathognomonic for celiac disease
Dermatitis herpetiformis
128
Diagnosis suggested by postprandial vasomotor symptoms, abdominal cramping, diarrhea
Dumping syndrome
128
Indications for upper endoscopy for dyspepsia
Age ≥60 years
128
Colonic ischemia imaging
Abdominal CT
129
Duration of high-dose intravenous PPI therapy in bleeding PUD with high-risk endoscopic appearance
3 days
129
Acute pancreatitis lab tests predicting poor outcome
Elevated hematocrit and BUN
129
Diagnosis suggested by continuous colonic inflammation beginning at anorectal verge, extending proximally
Ulcerative colitis
130
Laboratory test that may help distinguish IBD from IBS
Elevated fecal calprotectin
131
Adjunctive therapies for short bowel syndrome
Loperamide, PPI
132
Treatment for Barrett esophagus with dysplasia
Endoscopic mucosal resection, followed by radiofrequency ablation or cryotherapy
133
Endoscopy timing for rapid UGIB
Within 12 hours of presentation
134
Diagnosis suggested by dysphagia, late regurgitation of undigested food
Pharyngoesophageal (Zenker) diverticulum
135
Adjunctive therapies for short bowel syndrome
Loperamide, PPI
136
Anal cancer infectious risk factor
HPV
137
Colonoscopy timing after acute diverticulitis
6-8 weeks after symptom resolution
*Follow-up colonoscopy may identify a misdiagnosed colorectal carcinoma
**can defer if high quality colonoscopy has alr been done in last 12 months
137
Indications for ERCP in chronic pancreatitis
None
137
Diagnosis suggested by moderate cramping pain followed by bloody diarrhea
Colonic ischemia
138
Treatment for uncomplicated diverticulitis
Close observation without antibiotics
139
Preferred diagnostic test in stable LGIB without rapid bleeding
Colonoscopy
140
Gastroparesis initial diagnostic test
Upper endoscopy
141
Diagnosis suggested by dysphagia to solids alone
Mechanical obstruction
142
Management of diarrhea and colitis caused by immune checkpoint inhibitors
Medication discontinuation; glucocorticoids or biologic therapy
143
Diagnosis suggested by dysphagia to solids alone
Mechanical obstruction
144
Indications for colonoscopy for perianal symptoms
Age >45 years, altered bowel habits, anemia, IBD, weight loss, family history of CRC
145
Indications for drainage of pancreatic pseudocysts
Significant symptoms, infection
146
Earliest age to initiate colonoscopy in Lynch syndrome
Age 20-25 years or 2-5 years before youngest relative's diagnosis
147
Colon cancer screening frequency in IBD
8 years after diagnosis, every 1-2 years
148
Role of systemic glucocorticoids in IBD
Induction of remission, not maintenance therapy
149
Most common dermatologic manifestations of IBD
Erythema nodosum, pyoderma gangrenosum
150
Preferred celiac disease screening test
Anti–tissue transglutaminase IgA antibody
151
Serologic test for celiac disease in IgA deficiency
Anti–deamidated gliadin peptide IgG antibodies or tissue transglutaminase IgG antibodies
152
Preferred celiac disease screening test
Anti–tissue transglutaminase IgA antibody
153
Fecal incontinence initial test
Rectal examination
154
Histologic characteristic of type 1 autoimmune pancreatitis
Elevated IgG4-positive cell count
155
Factors suggesting an upper GI source of hematochezia
Melena, liver disease, hemodynamic instability
156
Secondary drug prophylaxis for variceal bleeding
Nonselective β-blockers (propranolol, nadolol, preferably carvedilol)
157
Primary diagnostic tool for colonic causes of chronic diarrhea
Colonoscopy
158
Diseases associated with autoimmune gastritis
Pernicious anemia, iron deficiency, SIBO, gastric neoplasms
159
First test to evaluate dyspepsia (ie. postprandial bloating/fullness) in patients age <60 years
Noninvasive H. pylori testing
160
Diagnoses to exclude in suspected IBS-D
Giardiasis, celiac disease, IBD
160
First test to evaluate dyspepsia in patients age <60 years
Noninvasive H. pylori testing
161
Age to initiate screening for gastric cancer in Lynch syndrome
30-40 years
162
Treatment for all patients with Barrett esophagus
PPI and lifestyle changes (smoking cessation, weight loss)
162
Age to initiate screening for gastric cancer in Lynch syndrome
30-40 years
* repeat every 2-4 years
163
Indications for surgery in Crohn disease
163
Preferred induction treatment for ulcerative colitis unresponsive to 5-ASA
Infliximab
164
Indications for surgery in Crohn disease
Medically refractory fistula, fibrotic stricture with obstructive symptoms, refractory symptoms, cancer
164
Preferred induction treatment for ulcerative colitis unresponsive to 5-ASA
Infliximab
165
Mx of functional dyspepsia without response to trial of PPI
Antidepressant eg buspirone
166
Diagnosis of serrated polyposis syndrome
- Five or more serrated lesions proximal to the rectum, all at least 5 mm and with two or more at least 10 mm
Or
-More than 20 serrated lesions throughout the colon, with at least five located proximal to the rectum
167
When to repeat OGD in pt with PUD?
1) to verify ulcer resolution in patients who have persistent symptoms after 8 to 12 weeks of therapy
2) ulcers of unknown cause
3) did not undergo gastric ulcer biopsy during initial scope
168
High-risk findings for PUD rebleeding
Active bleeding, nonbleeding visible vessels, adherent clots
169
IBS dietary restrictions
Avoidance of trigger foods, gluten, dairy, and FODMAPs
170
Treatment for moderate to severe Crohn disease in patients with high-risk disease or severe disease activity
Anti-TNF agents
171
Cholecystectomy timing after biliary pancreatitis
Before hospital discharge
172
Timing of colonoscopy after removal of 3-4 adenomas <10 mm
3-5 years
173
Effect of tobacco use on IBD risk
Increased Crohn disease risk, decreased ulcerative colitis risk
174
PUD prevention in at-risk patients who must take NSAIDs
COX-2 inhibitor plus PPI
175
Preferred diagnostic tests in LGIB with instability or rapid ongoing bleeding
CTA; immediate upper endoscopy if no source on CT
176
ARB associated with celiac-like enteropathy
Olmesartan
177
Test required before thiopurine use
TPMT genotype or phenotype assay
178
FAP genetic testing
APC gene testing
179
Treatment for acute mesenteric ischemia
Surgery or endovascular intervention
180
Preferred agent for preventing NSAID-related upper GI complications
PPIs
181
Conditions causing false-negative noninvasive H. pylori tests
Atrophic gastritis, intestinal metaplasia, MALT lymphoma
182
Treatment of moderate to severe colonic ischemia in high-risk patients
Hospitalization for supportive care, volume restoration, close observation, antibiotics
182
Induction treatment of mild to moderate ulcerative colitis
Oral and topical 5-ASAs
183
Treatment duration of PPI in uncomplicated GERD
8 weeks; then lowest dose possible with annual attempt to discontinue
184
Medications causing false-negative noninvasive H. pylori tests
PPIs, antibiotics
185
Most common cause of secondary constipation
Medications
186
Ocular manifestations of IBD
Episcleritis, uveitis
187
Infectious agents causing watery diarrhea
C. difficile, viruses, E. coli, cholera, cryptosporidia, G. duodenalis
188
189
Age to begin CRC screening if CRC diagnosed in first-degree relative age <60 years
Age 40 years or 10 years before relative's diagnosis, whichever is earliest
189
Infectious agents causing dysentery or bloody diarrhea
Campylobacter, hemorrhagic E. coli, E. histolytica, Shigella, Salmonella
189
Role of routine antibiotics in acute pancreatitis
None
190
Angiographic findings suggesting chronic mesenteric ischemia
>70% stenosis of two of three mesenteric arteries
191
Diagnostic criteria for Candida esophagitis
Symptoms plus oral candidiasis
192
Diagnosis suggested by painless jaundice, “sausage-shaped” pancreas
Autoimmune pancreatitis
193
Transfusion threshold for UGIB in stable patient without CVD
7 g/dL
194
Gastric emptying tests
Scintigraphy, wireless capsule, gastric emptying breath test
195
Constipation treatment after ineffective lifestyle and dietary interventions
Bulking agents, stimulant and osmotic laxatives, secretagogues, biofeedback
196
Gastroparesis drug treatment
Metoclopramide
196
Preneoplastic gastropathy due to chronic inflammation associated with H. pylori
Gastric intestinal metaplasia
197
IBS-D antibiotic treatment
Rifaximin
198
Diagnosis suggested by severe abdominal pain out of proportion to physical exam findings
Acute mesenteric ischemia
199
Empiric therapy for functional dyspepsia
PPI
200
Adjunctive drug treatment for patients with cirrhosis and upper GI bleeding
Antibiotics
201
Initial diagnostic imaging test in acute pancreatitis
Abdominal ultrasonography
202
First-line treatments for eosinophilic esophagitis
Elimination diets, PPI, swallowed topical glucocorticoids
203
Celiac disease treatment
Lifelong avoidance of wheat, rye, and barley
204
Age to begin CRC screening if CRC diagnosed in two first-degree relatives
Age 40 years or 10 years before youngest relative's diagnosis, whichever is earliest
205
Indication for early CT in suspected acute pancreatitis
Diagnostic uncertainty
206
Diagnostic test for hemodynamically significant or rapid small-bowel bleeding
CTA
207
Most common causes of PUD
NSAIDs and H. pylori
208
Supporting test for GERD if diagnosis unclear or OGD unrevealing
Ambulatory pH monitoring off acid-suppressive therapy
209
Treatment for gastric adenoma
Resection
210
treatment of zenker diverticulum
cricopharyngeal myotomy
211
mx of ulcerative colitis flare if not responding to iv steroids?
consider colectomy or trial of infliximab/ intravenous cyclosporine
212
mx of primary eosinophilic gastritis
1st: empiric elimination diet, a six-food elimination diet, or an elemental diet
if no improvement, steroids
213
mx of eosophageal candidiasis?
systemic antifungal e.g. fluconazole
214
diagnostic criteria for eosinophilic eosophagitis?
symptoms of esophageal dysfunction, endoscopy with biopsy showing >/=15 eosinophils/hpf, exclusion of other causes of esophageal eosinophilia
215
management of refractory hepatic hydrothorax?
TIPS
216
mx of IBS-C refractory to osmotic laxatives
intestinal secretagogues e.g. linaclotide, plecanatide, tenapanor, lubiprostone
217
treatment of mild non bloody travellers diarrhoea
hydration, bismuth/loperamide to relieve symptoms
218
further assessment if FIB-4 score shows intermediate risk for advanced liver disease?
assess with transient elastography
219
indications for emergent exploratory laparotomy in acute mesenteric ischaemia
when imaging findings suggest mesenteric infarction, such as pneumatosis intestinalis (i.e., gas within the intestinal wall) or portal venous gas
220
hallmark anatomic features, such as pancreatic calcifications on CT scan
chronic pancreatitis
221
tx for pts w typical biliary colic symptoms (right-upper-quadrant pain or epigastric pain associated with nausea, vomiting, and diaphoresis) and gallstones on imaging
cholecystectomy
222
inadequate relaxation of the lower esophageal sphincter and absent peristalsis on manometry
achalasia
223
associated conditions of type 1 autoimmune pancreatitis?
- sclerosing cholangitis
- sclerosing sialadenitis
- retroperitoneal fibrosis.
224
Postexposure prophylaxis for hepatitis A virus (HAV) infection
HAV vaccine in all nonvaccinated persons >= 12 months of age
&
immune globulin in
immunocompromised / chronic liver disease
225
When to screen for Barrett’s
- weekly gastroesophageal reflux disease symptoms for >= 5y
+ >=3 risk factors. male, >50yo, White race, tobacco use, obesity, and history of Barrett esophagus or esophageal adenocarcinoma in a first-degree relative.
226
Any further ix if H pylori testing during acute GI bleed is negative?
Should repeat 13C-urea breath test / stool antigen test once pt stops PPI for 2 weeks to confirm
227
When to give steroids in alcoholic hepatitis
MELD >20
228
Mx of mild microscopic colitis
Symptomatic tx eg loperamide
229
Mx of mod-severe microscopic colitis
Oral Budesonide
230
Imaging to diagnose acute pancreatitis
CT/ MRI abdomen
231
Autoimmune pancreatitis in the setting of IBD + normal IgG4 cell count
Type 2 autoimmune pancreatitis
232
Diagnosis of IBS
recurrent abdo pain at least once a week for 3 months
+
at least two other criteria: defecation-related pain, change in stool frequency, or change in stool consistency.
233
treatment for acute, symptomatic portal vein thrombosis in the setting of cirrhosis.
Anticoagulation
234
Definition of acute liver failure
severe acute liver injury associated with hepatic encephalopathy and impaired synthetic liver function in a patient without preexisting liver disease
*always refer to hospital w transplant program
235
Features of chronic hep b immune control (inactive carrier) phase
normal ALT, negativity for HBeAg, positivity for HBe antibody, and low HBV DNA level (<2000 U/mL)
236
Mx of chronic hep b in immune control (inactive carrier phase)
ALT + HBV DNA every 6 to 12 months
- to monitor for reactivation
237
Ix of choice to confirm perforated PUD
Contrasted CT abdomen
238
Cholecystectomy after acute cholecystitis
Before hospital discharge
239
How often to do colonoscopy in patients with less then 10 Tubular adenoca that are less then 10mm
Every 3 years
240
Colono how often if more then 10 adenomas
Yearly
241
Test before starting ozanimod for UC and why
ECG
Contraindicated in heart block
Retinal exam
Because causes macular oedema
242
Management of GB polyp
Cholecystextomy required if 10mm or more or symptomatic .
243
GB polyp 8mm
5-10mm 6 monthly surveillance US
244
GB polyp 3mm
1-5mm gb polyp, yearly US
245
most common cause of acquired porphyria cutanea tarda?
chronic hep C
246
statin usage in NAFLD or compensated cirrhosis even if there is transaminitis
continue if ALT <3 times ULN
247
abrupt onset of mild to moderate lower abdominal discomfort, followed by the urge to defecate and development of hematochezia.
colonic ischaemia
248
H pylori in the setting of idiopathic thrombocytopenic purpura?
H pylori associated with ITP. eradication can help plt counts improve
248
genetic testing for pancreatic cancer?
all pts with pancreatic cancer should undergo genetic testing
and if dead, first degree relatives are recommended to do genetic testing
249
indications for primary prophylaxis of SBP?
very low ascitic fluid protein levels assoc w Na <130, serum Cr >106 or urea >8.9mmol/L
+
if advanced liver failure
250
surveillance screening for those at high risk of pancreatic cancer e.g family history of pancreatic cancer in at least two first-degree relatives
endoscopic ultrasonography or MRI with MRCP annually
251
how often to conduct surveillance endoscopy in those with high risk gastrointestinal metaplasia or any gastrointestinal metaplasia with risk factors for gastric cancer, including a first-degree relative with gastric cancer; birth in or emigration from a high-incidence nation; or East Asian, Latino, Black, American Indian, or Alaska native race/ethnicity.
every 3 yrs
252
scope surveillance in those with Barretts oesophagus without dysplasia?
3 years for segments >/=3 cm long and every 5 years if <3cm long
253
high-resolution CT scan demonstrating emphysematous changes in the upper lobes with fibrotic changes in the lower lobes
Combined pulmonary fibrosis and emphysema
254
Treatment for Combined pulmonary fibrosis and emphysema
Lung transplant is only curative therapy
