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MKSAP > Gastro > Flashcards

Gastro Flashcards

1
Q

What ix to diagnose portal hypertension?

A

Hepatic venous pressure gradient >5mmHg diagnostic

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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

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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
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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

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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

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6
Q

treatment of type 1/2 autoimmune pancreatitis?

A

glucocorticoids

  • usually high dose oral prednisone tapered over 2-3 months
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7
Q

tx of autoimmune pancreatitis?

A

prednisolone + azathioprine
- usually treat for 2-3 years before consideration of withdrawal

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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

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9
Q

in patients with selective IgA deficiency, what ix to test for coeliac disease?

A

IgG antibodies to deamidated gliadin peptide or TTG

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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
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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

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12
Q

what other specific cancer to screen for in women with IBD?

A

pap smear annually to screen for cervical cancer

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13
Q

what are causes of ascites with high SAAG (ie >11g/L)

A

cirrhosis and non cirrhotic causes e.g. heart failure

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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

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15
Q

most common cause of cholestatic hepatitis causing obstructive LFT derangement?

A

drug induced liver injury

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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
Q

after GI bleeding, when to continue and when to stop aspirin afterwards?

A

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
Q

when to do cholecystectomy in patients who have had gallstone pancreatitis?

A

cholecystectomy before hospital discharge

26
Q

what antibiotics are indicated for infected pancreatic necrosis?

A
  • carbapenem alone (e.g. imipenem)

or

  • quinolone, ceftazidime, cefepime + metronidazole
27
Q

when to start screening colonoscopy in patients with first degree relative with colon cancer or advanced polyp <age 60

A

age 40 or 10 years earlier than the age at which relative was diagnosed

28
Q

what is menetrier disease?

A

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
Q

diagnosis of menetrier disease?

A

low albumin, upper endoscopy with biopsy: giant mucosal folds in gastric fungus and body
- should also test for CMV, h pylori

30
Q

what is the mechanism of action of cetuximab?

A

monoclonal antibody that targets EGFR

31
Q

SIBO: how does this affect B12/ folate levels?

A

Usually high folate (may be elevated due to bacterial synthesis), low B12

32
Q

mx of hydatid liver cyst?

A

albendazole + surgery

33
Q

what tx for secondary prophylaxis for patients who are at high risk of c diff infection?

A

can given oral vancomycin prophylaxis for those receiving systemic abx

34
Q

first line tx of achalasia?

A

endoscopy + pneumatic dilation

35
Q

where are majority of gastrinomas found?

A

duodenum

  • minority in pancreas
36
Q

how to differentiate between gastrinomas and other causes of hypergastrinaemia?

A

secretin stimulation test

  • gastrinoma cells release gastrin in response to secretin, while secretin inhibits normal gastric G cells
37
Q

how often to repeat colonoscopy in patients with UC and PSC?

A

yearly

MKSAP (9 decks)

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