Gastroenterology Flashcards
What is the most important cause of gastric and duodenal erosions?
a. H. pylori infection
b. Alcohol intake
c. NSAID use
d. Stress-related mucosal injury
NSAID use
♡ H. pylori (3.7) and NSAIDs (3.3)
– most common risk factors for PUD
■ UGIB
• Black tarry stool
• Coffee ground emesis
• Most common complication (likely NSAID-related)
■ Perforation
• Severe, generalized abdominal pain
• Second most common complication (likely NSAID-related)
Which of the following is the correct management of an ulcer visible as an adherent clot during endoscopy?
a. Endoscopic therapy + intensive PPI therapy + clear liquids for 2 days
b. Endoscopic therapy + once daily PPI therapy + clear liquids for 1 day
c. No endoscopic therapy + once daily PPI therapy + clear liquids for 1 day
d. No endoscopic therapy + once daily PPI therapy + regular diet
a. Endoscopic therapy + intensive PPI therapy + clear liquids for 2 days
A 72/F with osteoarthritis and chronic NSAID use came in at the emergency department due to hematochezia. Initial vital signs were BP 80/50, HR 121, RR 22. Hypotension was unresponsive to fluid resuscitation hence an inotrope was started. Her BP remains labile while on inotropes. What is the best course of management?
a. Upper endoscopy
b. Flexible sigmoidoscopy
c. Colonoscopy
d. Angiography
d. Angiography
35/F presented at the ER due to melena. She was already treated for peptic ulcer disease 6 months ago with proton pump inhibitors. Review of systems also revealed intermittent diarrhea, sometimes steatorrhea. Review of the endoscopic report revealed multiple ulcers, involving the antrum, and the first and second part of the duodenum. H. pylori test was negative. Which of the following should be considered in this patient?
a. Dieulafoy lesion
b. Heyde’s syndrome
c. Zollinger-Ellison syndrome
d. MEN2 syndrome
■GASTRINOMA (ZOLLINGER-ELLISON SYNDROME)
– Gastrinoma is an NET that secretes gastrin
• resultant hypergastrinemia
• Results in marked gastric acid hypersecretion and growth of the gastric mucosa with increased numbers of parietal cells and proliferation of gastric ECL cells
– Clinical Manifestations:
🔅 Peptic ulcer disease (PUD) and Diarrhea often refractory and severe
🔅 Most common presenting symptoms
• Abdominal pain (70–100%)
• diarrhea (37–73%)
• Gastroesophageal reflux disease (GERD) (30–35%)
Which of the following common causes of acute pancreatitis can present with normal amylase and lipase levels?
a. Gallstones
b. Alcohol
c. Hypertriglyceridemia
d. Anti-HIV medications
c. Hypertriglyceridemia
Amylase values may be normal if (1) there is a delay (2–5 days) before blood samples are obtained, (2) the under-lying disorder is chronic pancreatitis rather than acute pancreatitis, or (3) hypertriglyceridemia is present.
45/F is consulting at the ER due to severe epigastric pain, described as steady and boring, radiating to the back, with associated loss of appetite. Vital signs are as follows: BP 100/60, HR 112, RR 21, Temp 37.8°C. Bowel sounds are diminished. She is not jaundiced. Murphy’s, psoas, obturator, Cullen and Turner signs are also negative. Which of the following should be part of the initial management plan for this patient?
a. Low-fat solid diet
b. Initial bolus of 1L of plain normal saline
c. Abdominal CT scan to look for necrosis
d. ERCP within 24 hours of diagnosis
b. Initial bolus of 1L of plain normal saline
¤ Bowel rest: NPO
¤ Place on O2
¤ Hydration: aggressive intravenous fluid resuscitation.
1. PLRS bolused at 15–20 mL/kg (1050–1400 mL) followed by
2. PLRS 2–3 mL/kg per hour (200–250 mL/h),
• Maintain urine output >0.5 mL/kg per hour.
• Decrease in HCT and BUN during the first 12–24 is strong evidence that sufficient fluids are being administered.
• Increase hematocrit or BUN during serial measurement should be treated with a repeat volume challenge with a 2-L crystalloid bolus followed by increasing the fluid rate by 1.5 mg/kg per hour.
• If the BUN or hematocrit fails to respond (i.e., remains elevated or does not decrease) to this bolus challenge and increase in fluid rate, consideration of transfer to an intensive care unit is strongly recommended for hemodynamic monitoring.
** Lactated Ringer decreases systemic inflammation and is better than crystalloid
** BUN, HCT every 8-12 hours
** Serial bedside evaluation every 6-8 hours
35/F experiences chest pain described as substernal warmth that moves to the neck, with associated dysphagia and occasional nonproductive cough. She has weight loss of 1 kg over the last 2 months after taking diet pills. Her mother died of breast cancer. Which of the following is a concerning feature of her dyspepsia?
a. Dysphagia
b Nonproductive cough
c. Weight loss
d. Family history of malignancy
Dysphagia
Which of the following patients can be diagnosed with functional dyspepsia in the absence of organic cause?
a. 2-week history of bothersome postprandial fullness
b. 4-week history of early satiety
c. 3-month history of vague epigastric pain
d. 6-month history of epigastric burning pain
d. 6-month history of epigastric burning pain
■ Functional Dyspepsia
– bothersome postprandial fullness, early satiety, or epigastric pain or burning
– onset at least 6 months before diagnosis in the absence of organic cause.
– Subdivided into
• Postprandial distress syndrome: meal-induced fullness and early satiety
• Epigastric pain syndrome: epigastric pain or burning which may or may not be meal-related. Most cases follow a benign course, but some with H. pylori infection or on nonsteroidal anti-inflammatory drugs (NSAIDs) develop ulcers.
Which of the following is a rare gastropathy characterized by large, tortuous mucosal folds most prominent in the body and fundus, sparing the antrum, eventually developing protein-losing gastropathy accompanied by hypoalbuminemia and edema?
a. Menetrier’s disease
b. Russel body gastritis
c. Zollinger-Ellison syndrome
d. Afferent loop syndrome
a. Menetrier’s disease
– mucosal folds in MD are often most prominent in the body and fundus, sparing the antrum.
– Clinical Presentation
• insidious and progressive.
• Epigastric pain, nausea, vomiting, anorexia
• peripheral edema, and weight loss
• Occult GI bleeding may occur, but overt bleeding is unusual and, when present, is due to superficial mucosal erosions
• protein-losing gastropathy due to hypersecretion of gastric mucus accompanied by hypoalbuminemia and edema.
Which of the following patients has a disease traditionally associated with type A gastritis?
a. Patient who tested positive for urea breath test
b. Patient with friable, ulcerated mass with irregular, thickened margins on the stomach
c. Patient with impaired production of intrinsic factor
d. Patient with colicky abdominal pain, transmural inflammation of the ileum, with fistula formation
c. Patient with impaired production of intrinsic factor
Which of the following hepatitis profiles is consistent with acute hepatitis B infection?
a. HBsAg negative, anti-HBs negative, anti-HBc IgG positive, anti-HBe positive
b. HBsAg negative, anti-HBs positive, anti-HBc negative, anti-HBe negative
c. HBsAg positive, anti-HBs negative, anti-HBc IgM positive, HBeAg positive
d. HBsAg positive, anti-HBs negative, anti-HBc IgG positive, HBeAg positive
d. HBsAg positive, anti-HBs negative, anti-HBc IgG positive, HBeAg positive
- HBsAg negative, anti-HBs negative, anti-HBc IgG positive, anti-HBe positive (low-level chronic carrier)
- HBsAg negative, anti-HBs positive, anti-HBc negative, anti-HBe negative (immunization)
- HBsAg positive, anti-HBs negative, anti-HBc IgM positive, HBeAg positive (Acute; high infectivity)
Which of the following is TRUE of hepatitis B infection in adults?
a. Can be transmitted thru orofecal route
b. Neonatal transmission is related to breastfeeding from infected mothers
c. Does not usually progress to a chronic infection
d. Not documented to cause hepatocellular cancer
c. Does not usually progress to a chronic infection
A 26/F was referred to you by a company physician. She just had her routine annual physical examination and check-up and laboratory results showed anti-HBc IgM was positive, but HBsAg, anti-HBs, HBeAg, and anti-Hbe were negative. Which of the following is a correct interpretation of this hepatitis profile?
a. Low level hepatitis B carrier
b. Immunized (after vaccination)
c. HBeAg-negative “precure mutant”
d. Anti-HBc “window”
Anti-HBc “window
Which of the following laboratory findings is most compatible with alcoholic hepatitis?
a. ALT > 400 IU/L
b. AST/ALT ratio <1
c. Elevated GGTP
d. Hyperbilirubinemia with marked increase in alkaline phosphatase
ALT/AST
• Modest increase = fatty liver
• may be 2-7x elevated (but rarely >400IU)
Lipid profile
• Hypertriglyceridemia, hypercholesterolemia
TB, DB
• Hyperbilirubinemia
Albumin, PTPA
• deranged synthetic function indicates a more serious disease
Liver biopsy
• can be helpful to confirm a diagnosis
withheld until abstinence has been maintained for at least 6 months to determine residual, nonreversible disease
γ-glutamyl transpeptidase (GGTP)= elevated
Which risk assessment score predicts failure of glucocorticoid treatment in alcoholic liver disease?
a. Discriminant function ≥ 32
b. Model for end-stage liver disease (MELD) score ≥ 21
c. MELD-Na score ≥ 21
d. Lille score > 0.45
d. Lille score > 0.45
Lille Score
– Pretreatment variables + change in total bilirubin at day 7 of glucocorticoids
• If > 0.45: improved survival at 6 months; hence continue steroids
• If<0.45: poor survival at 6 months; steroids not beneficial
• May stop steroids at this time
• Indications for steroid therapy (either one of the following)
• Maddrey’s Discriminant Function>32 + Parameters: total bilirubin and PT/INR
• MELD>21
• Infection can be concurrently treated with antibiotics and steroids.
• Women with encephalopathy
• Exclusion criteria: active GI bleeding, renal failure, or pancreatitis
