Gastroenterology Flashcards
8 drugs/supplements that commonly cause esophagitis?
Abx(tetracycline, doxycycline, clindamycin), Vit C, FeSO4, KCl, NSAIDs/ASA, Bisphosphonates
First line management of GERD?
- Weight loss
- Elevate head of bed 6 inches
- Dietary modification: no chocolate, peppermint, alcohol, fatty foods, acidic foods
- PPI or H2 for 8 weeks
Complications of PPI use?
Osteoporosis, pneumonia, increase CV risk, increase risk of enteric infections, absorption of(B12, Mag, Fe)
Treatment of H.Pylori? What if pt has PCN allergy?
PPI BID + Clarithromycin 500 mg BID + Amoxicillin 1g BID x14 days +/- Bismuth 525 QID.
*if PCN allergy use Flagyl in place of amoxicillin
When should you repeat testing for H.Pylori after finishing treatment?
4 weeks
When should you get a stool O&P for a patient with diarrhea?
If they have risk factors/travel to developing countries OR persistent diarrhea > 2 weeks
What is CHRONIC diarrhea?
diarrhea > 4 weeks
Treat fat-soluble vitamin deficiencies by supplementing — to — times the recommended daily value.
5-10 x
*often needs water soluble preparations
Individuals with celiac disease are at risk for which vitamin deficiencies?
iron, folic acid, Ca, vitamin D & rarely B12
Pt with short gut syndrome should be checked for — deficiency & replaced every —.
B12, month IM B12 injections
Bacterial overgrowth in the gut can be caused by – & lead to —.
abnormal gut stasis(decreased motility, fistulas)
*lead to: cabohydrate malabsorption(bacteria consume), Fat malabsorption (de conjugation of bile), B12 deficiency(bacteria consume)
Which IBD is more commonly associated with pyoderma gangrenosum?
UC! – may also see in crohns but more common in UC
Which IBD is associated with ankylosing spondylitis, VTE, Sclerosing cholangitis, uveitis, erythema nodosum?
UC!
1st line management of IBS
FODMAP diet
Which is best for IBS TCA or SSRI?
can use both but TCA > SSRI
whats the minimum period a patient must be abstinent to be consider for liver transplant?
6 months
Treatment of acetaminophen toxicity
N-acetyl cystine
Why is it recommended pt with hemochromatosis avoid shellfish?
they are at increased risk for vibrio vulnificus infection
Gene mutations associated with hemochromatosis
HFE gene on chromosome 6 - causes inappropriate absorption of Fe & elevated ferritin.
What supplement can be used to manage wilsons disease?
PO Zinc = interferes with copper absorption in the GI tract
Mutation & inheritance pattern of wilsons disease?
AR, mutation in ATP7B causing decrease trans membrane transport(excretion) of copper = builds up in multiple tissues
Which has neurological symptoms: wilsons disease of hemochromatosis?
wilsons
What is Primary Biliary Cirrhosis? Mutation? tx? Association?
autoimmune disorder causing granulomatous destruction of intrahepatic bile ducts and cholestasis. Usually effects females - insidious & usually starts with puritis & fatigue.
+anti-mitochondrial antibodies
+treatment with ursodeoxycholic acid(delays progress & improves survival), cholestyramine(for itching) & liver transplant
+associated w/Sjogren & CREST Scleroderma
What is Primary Sclerosis Cholangitis? Mutation? tx? Association?
diffuse inflammation, fibrosis, and stricturing of the biliary tract as well as an increased risk of cholangiocarcinoma. M > F;
+ANCA, +ANA, +cardiolipin, TPO+, RF+
+treatment - bx to r/o carcinoma, stent placement, balloon dilation - liver transplant
+associated with Ulcerative colitis
What is the MELD score used for? What do you use to calculate it?
Used to determine 90-day mortality risk in patients with end stage liver disease.
+T.Bili, INR & Creatinine
Patients with ascites should have Na restricted to —- a day.
2g
SAAG score of — is associated with portal HTN.
SAAG > 1.1
What is the PMN cut off for dx of spontaneous bacterial peritonitis?
PMN > 250 cell/mm3
Patient with alcoholic hepatitis presents with ascites. Tap shows PMN < 250, cultures are negative. Continue abx?
continue abx for 48 hrs then discontinue if all cultures negative
Pt w/ascites. Tap shows PMN >250, cultures negative. continue abx?
yes! treat like SBP & complete full course of abx.
Pt with esophageal varicies should be started on —- for ppx & rx titrated to —–.
nonselective BB(propranolol or nadalol) & titrated to HR 50-60 bpm
1st line imaging for acute pancreatitis?
US > CT w/contrast > MRI/MRCP
Does all acute pancreatitis need abx?
no! only if sx of extra pancreatic infection
When should you feed the patient with acute pancreatitis?
As soon as they can tolerate it! = fat restricted diet.
*if unable to eat within 5-7 days consider J-tube
Esophageal squamous cell carcinoma is associated with…
chronic alcohol use & smoking
Esophageal adenocarcinoma is associated with…
barretts esophagus
Most common gastric cancer? risk factors?
Adenocarcinoma
RF: hispanic, african american, asian, H.Pylori, diet high in salt, nitrous compounds, tobacco use, alcohol use, chronic atropic gastritis, pernicious anemia, hx of gastric resection
CRC is the —- leading cause of death in America.
3rd
Risk factors for hepatocellular carcinoma?
alcohol use, tobacco use, aflatoxin exposure, hemochromatosis, A1AT deficiency, NAFLD, Diabetes
Lubiprostone(amitiza) and linaclotide(Linzess) are effective for…
IBS-C — fiber is an ineffective treatment
I’m order to diagnose celiac disease you need to check…
Serological(IGA anti-tissue transglutaminase antibody > endomysial antibody) THEN endoscopy if test are positive
When do you need to start colonoscopies on someone who has ulcerative colitis? How often do they need this?
First colonoscopy 10 years after diagnosis then repeated every 2 to 5 years depending on findings
Window of time kids can receive rotavirus vaccination?
Kid must be a minimum of six weeks old up to 15 weeks for the first dose. No doses of the vaccine can be given after eight months of age
Normal: Two months, four months, six months
Drug of choice for treatment of Campylobacter?
 usually resolves on its own, if needed can use azithromycin
Treatment of shigella diarrhea?
Bactrim
Treatment of salmonella diarrhea?
Self limiting, no treatment necessary. If for some reason patient becomes toxic can use Levaquin 500 mg a day for 7 to 10 days
Treatment of pseudomembranous enter colitis? What is the most common cause?
Vancomycin is used for treatment, stop other antibiotics. Most commonly caused by amoxicillin however does occur with other antibiotics
What medication can you use for treatment of travelers diarrhea if it’s needed?
Single dose of a flora quinolone however there is increasing resistance. Alternatively you can use azithromycin 500 mg a day for 1 to 3 days. Loperamide is safe to use for diarrhea
Antibiotics for treatment of cholera?
Doxycycline and rehydration
LONG TERM PPI therapy increases your risk of…
low magnesium, B12 deficiency, C.Diff infection, risk of fracture
SHORT TERM PPI therapy increases your risk of…
CAP
Hiatal hernia will increase your risk for…
Barrett’s Esophagus - adenocarcinoma
*alcohol increases risk for SCC
Who needs screening for Barrets esophagus?
MEN w/5+ years GERD with 2+ risk factors(white, 50+, central obesity, hx smoking, FH of esophageal cancer or barretts)
**if completely normal then NO REPEAT NEEDED
Which type of esophageal cancer is obesity and tobacco use a risk for?
adenocarcinoma
Which type of esophageal cancer is alcohol & tobacco a risk for?
SCC
