Gastroenterology Flashcards
Core principle in treating relapsed H. pylori infection
Use different antibiotics
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This approach helps prevent antibiotic resistance.
What are the gastric emptying tests?
Scintigraphy, wireless capsule, gastric emptying breath test
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These tests assess how quickly food leaves the stomach.
Which infectious agents cause watery diarrhea?
C. difficile, viruses, E. coli, cholera, cryptosporidia, G. duodenalis
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These pathogens are common culprits in gastrointestinal infections.
What is the treatment for constipation after ineffective lifestyle and dietary interventions?
Bulking agents, stimulant and osmotic laxatives, secretagogues, biofeedback
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These options can help stimulate bowel movements.
What is the treatment for dumping syndrome?
Frequent small meals
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This dietary modification helps manage symptoms.
What are the indications for ERCP in chronic pancreatitis?
None
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ERCP is not routinely indicated in chronic pancreatitis cases.
What are the SIBO diagnostic criteria?
Symptoms plus positive breath test or improvement with empiric treatment
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These criteria help confirm the diagnosis of small intestinal bacterial overgrowth.
What bone test should be considered at the time of celiac disease diagnosis?
DXA
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Dual-energy X-ray absorptiometry (DXA) assesses bone density.
What diagnosis is suggested by painless jaundice and a ‘sausage-shaped’ pancreas?
Autoimmune pancreatitis
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This condition can mimic pancreatic cancer but has distinct features.
What is the treatment of mild colonic ischemia?
Supportive care
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Management includes hydration and monitoring.
What are the indications for drainage of pancreatic pseudocysts?
Significant symptoms, infection
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These factors necessitate intervention to relieve symptoms or prevent complications.
Which ARB is associated with celiac-like enteropathy?
Olmesartan
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This medication has been linked to gastrointestinal side effects resembling celiac disease.
What diseases are associated with autoimmune gastritis?
Pernicious anemia, iron deficiency, SIBO, gastric neoplasms
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These conditions can arise due to chronic inflammation of the gastric mucosa.
What are the most common causes of upper gastrointestinal bleeding (UGIB)?
PUD, varices, Mallory-Weiss tears
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These causes are prevalent in clinical practice.
At what age should CRC screening begin if CRC is diagnosed in two first-degree relatives?
Age 40 years or 10 years before youngest relative’s diagnosis, whichever is earliest
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This guideline helps catch colorectal cancer early in high-risk individuals.
What is the supporting test for GERD extraesophageal manifestations?
Ambulatory pH monitoring off acid-suppressive therapy
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This test helps identify acid reflux contributing to non-esophageal symptoms.
What is the most common cause of small-bowel bleeding?
Angiodysplasia
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This vascular abnormality often leads to gastrointestinal hemorrhage.
What are the indications for H. pylori testing?
Active PUD, PUD history without documented H. pylori cure, MALT lymphoma, endoscopic resection of early gastric cancer
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Testing is crucial in these clinical scenarios to guide treatment.
Which bowel segment is most commonly affected in Crohn disease?
Ileocecal area
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This region is frequently involved in inflammatory bowel disease.
What is the treatment for all patients with Barrett esophagus?
PPI and lifestyle changes (smoking cessation, weight loss)
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These interventions help manage the condition and reduce cancer risk.
What is the initial test for fecal incontinence?
Rectal examination
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This assessment is critical in evaluating anal function.
What is the timing of colonoscopy after removal of 3-4 adenomas <10 mm?
3-5 years
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Follow-up colonoscopies are essential for monitoring polyp recurrence.
What diagnosis is suggested by dysphagia to solids alone?
Mechanical obstruction
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This symptom typically indicates a physical blockage in the esophagus.
What is the gold standard celiac disease diagnostic test?
Duodenal biopsy
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This procedure confirms the diagnosis by assessing intestinal damage.
What are the IBS dietary restrictions?
Avoidance of trigger foods, gluten, dairy, and FODMAPs
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These dietary changes can alleviate symptoms for many patients.
Infectious agents causing dysentery or bloody diarrhea
Campylobacter, hemorrhagic E. coli, E. histolytica, Shigella, Salmonella
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These agents are important to consider in differential diagnoses of gastrointestinal infections.
Acute anal fissure treatment
Sitz bath and bulk laxatives
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Sitz baths help relieve pain and promote healing, while bulk laxatives prevent straining.
Most common causes of chronic diarrhea
IBS-D, functional causes, medications
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Understanding these causes is crucial for effective management of chronic diarrhea.
Transfusion threshold for UGIB in stable patient without CVD
7 g/dL
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This threshold helps guide transfusion decisions in acute gastrointestinal bleeding.
Role of routine antibiotics in acute pancreatitis
None
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Antibiotics are not recommended unless there is an infection.
Indications for repeat endoscopy for gastric ulcer
Persistent symptoms, ulcer of unknown cause, no biopsy at initial endoscopy
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Repeat endoscopy is vital for management and surveillance.
Role of systemic glucocorticoids in IBD
Induction of remission, not maintenance therapy
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They are effective in managing flare-ups but not for long-term control.
Recommended surveillance in serrated polyposis syndrome
Colonoscopy every 1-3 years, removal of polyps >5 mm
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This protocol helps reduce the risk of colorectal cancer.
Preferred diagnostic tests in LGIB with instability or rapid ongoing bleeding
CTA; immediate upper endoscopy if no source on CT
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These tests aid in quick diagnosis and management of lower gastrointestinal bleeding.
Diagnosis suggested by postprandial vasomotor symptoms, abdominal cramping, diarrhea
Dumping syndrome
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This condition is often seen after gastric surgery.
Crohn disease colonoscopy finding
Mucosal inflammation with skip areas
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Skip lesions are characteristic of Crohn’s disease, distinguishing it from ulcerative colitis.
Angiographic findings suggesting chronic mesenteric ischemia
> 70% stenosis of two of three mesenteric arteries
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This finding indicates significant vascular compromise.
Colonoscopy timing after acute diverticulitis
6-8 weeks after symptom resolution
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This timing allows for healing and better visualization.
Measures to prevent acute diverticulitis recurrence
High-fiber diet; lifestyle changes; avoidance of NSAIDs, glucocorticoids, opioid analgesics
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These interventions are essential for prevention.
Age to initiate screening for gastric cancer in Lynch syndrome
30-40 years
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Early screening is critical due to the increased risk in this population.
Secondary drug prophylaxis for variceal bleeding
Nonselective β-blockers (propranolol, nadolol, preferably carvedilol)
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These medications help reduce the risk of bleeding from varices.
Diagnosis suggested by moderate cramping pain followed by bloody diarrhea
Colonic ischemia
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This presentation warrants immediate evaluation due to potential complications.
Preferred diagnostic test in stable LGIB without rapid bleeding
Colonoscopy
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It allows for direct visualization and potential intervention.
Colorectal cancer screening frequency in IBD
8 years after diagnosis, every 1-2 years
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Increased surveillance is necessary due to heightened cancer risk.
IBS-C first-line treatment
Polyethylene glycol
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This osmotic laxative is effective for constipation-predominant IBS.
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
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Early screening is crucial for those with family history.
Preferred agent for preventing NSAID-related upper GI complications
PPIs
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Proton pump inhibitors are effective in reducing the risk of ulcers.
Diagnoses to exclude in suspected IBS-D
Giardiasis, celiac disease, IBD
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These conditions can mimic IBS-D and require different management.
Treatment of chronic pancreatitis steatorrhea
Pancreatic enzymes
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Enzyme replacement therapy is essential for nutrient absorption.
Colonic ischemia imaging
Abdominal CT
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This imaging modality is helpful in diagnosing colonic ischemia.
First test to evaluate dyspepsia in patients age <60 years
Noninvasive H. pylori testing
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Diagnosis to exclude in achalasia
Tumor at GE junction (pseudoachalasia)
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Most common cause of acute pancreatitis
Biliary disease, including gallstones, biliary sludge, and biliary crystals
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Treatment duration of PPI in uncomplicated GERD
8 weeks; then lowest dose possible with annual attempt to discontinue
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Diagnosis suggested by continuous colonic inflammation beginning at anorectal verge, extending proximally
Ulcerative colitis
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Diagnostic criteria for Candida esophagitis
Symptoms plus oral candidiasis
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Adjunctive drug treatment for patients with cirrhosis and upper GI bleeding
Antibiotics
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H. pylori eradication tests
Urea breath test, fecal antigen test, or gastric biopsy
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Factors suggesting an upper GI source of hematochezia
Melena, liver disease, hemodynamic instability
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Symptoms and signs of pancreatic cancer
Abdominal pain, back pain, weight loss, jaundice, new-onset diabetes mellitus
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Preferred test for histologic confirmation of pancreatic cancer
Endoscopic ultrasonography–guided FNA biopsy
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Initial diagnostic imaging test in acute pancreatitis
Abdominal ultrasonography
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Preferred celiac disease screening test
Anti–tissue transglutaminase IgA antibody
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Indications for upper endoscopy for dyspepsia
Age ≥60 years
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Treatment for gastric adenoma and large gastric hyperplastic polyp
Resection
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Endoscopy timing for rapid UGIB
Within 12 hours of presentation
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Most common causes of PUD
NSAIDs and H. pylori
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Gastroparesis drug treatment
Metoclopramide
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Indications for surgical treatment of GERD
Failure of PPIs, desire to stop PPI, intolerable PPI adverse effects
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Indications for surgery in Crohn disease
Medically refractory fistula, fibrotic stricture with obstructive symptoms, refractory symptoms, cancer
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Confirmatory tests for SIBO
Small-bowel aspirate culture, carbohydrate substrate–based breath testing
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Key lifestyle modifications in chronic pancreatitis
Smoking cessation, alcohol abstinence
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Endoscopic findings in eosinophilic esophagitis
Rings and furrows, luminal narrowing
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Preferred diagnostic test for acute mesenteric ischemia
CTA
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Adjunctive therapies for short bowel syndrome
Loperamide, PPI
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Treatment for moderate to severe Crohn disease in patients with high-risk disease or severe disease activity
Anti-TNF agents
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Anti-TNF agents are biologic therapies that target tumor necrosis factor, a key player in inflammation.
Empiric therapy for functional dyspepsia
PPI
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Proton pump inhibitors are used to reduce stomach acid and help alleviate symptoms.
Colitis with symptoms similar to IBS and celiac disease
Microscopic colitis
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Microscopic colitis is characterized by inflammation visible only under a microscope.
Laboratory test that may help distinguish IBD from IBS
Elevated fecal calprotectin
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Fecal calprotectin is a marker of intestinal inflammation.
Timing of next colonoscopy after removal of adenoma ≥10 mm
3 years
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Follow-up colonoscopy is recommended to monitor for recurrence.
Effect of tobacco use on IBD risk
Increased Crohn disease risk, decreased ulcerative colitis risk
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Tobacco smoking has a complex relationship with different types of IBD.
Diagnosis suggested by dysphagia to liquids
Motility disorder
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Dysphagia can indicate problems with esophageal motility.
Test required before thiopurine use
TPMT genotype or phenotype assay
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Thiopurines can cause myelosuppression, so TPMT testing is crucial.
Celiac disease treatment
Lifelong avoidance of wheat, rye, and barley
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This is essential to manage symptoms and prevent intestinal damage.
Age and interval for CRC screening in classic FAP
Age 10-15 years, repeated annually
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Classic familial adenomatous polyposis (FAP) necessitates early and regular screening.
IBS-D antibiotic treatment
Rifaximin
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Rifaximin is an antibiotic effective in treating IBS-D symptoms.
Serologic test for celiac disease in IgA deficiency
Anti–deamidated gliadin peptide IgG antibodies or tissue transglutaminase IgG antibodies
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These tests are alternatives when IgA is deficient.
Preneoplastic gastropathy due to chronic inflammation associated with H. pylori
Gastric intestinal metaplasia
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This condition is linked to an increased risk of gastric cancer.
Primary diagnostic tool for colonic causes of chronic diarrhea
Colonoscopy
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Colonoscopy allows direct visualization and biopsy of the colon.
Management of diarrhea and colitis caused by immune checkpoint inhibitors
Medication discontinuation; glucocorticoids or biologic therapy
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These are critical for managing immune-mediated adverse effects.
Settings for gastrointestinal neuroendocrine tumors
Zollinger-Ellison syndrome and atrophic gastritis
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These conditions are associated with increased risk for neuroendocrine tumors.
Factors associated with increased risk for rebleeding and death in UGI bleeding
Tachycardia, hypotension, age >60 years, major comorbid conditions
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These factors can significantly impact patient outcomes.
Anal cancer infectious risk factor
HPV
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Human papillomavirus is a well-known risk factor for anal cancer.
Treatment for Barrett esophagus with dysplasia
Endoscopic mucosal resection, followed by radiofrequency ablation or cryotherapy
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This approach is aimed at preventing progression to esophageal cancer.
IBD diagnostic test
Colonoscopy with biopsy
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This is the gold standard for diagnosing inflammatory bowel disease.
Diagnosis suggested by fistula, perianal disease, strictures, abscess
Crohn disease
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These symptoms are highly indicative of Crohn’s disease.
Postprandial abdominal pain, fear of eating, weight loss
Chronic mesenteric ischemia
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This condition results from inadequate blood flow to the intestines.
Treatments for eosinophilic esophagitis
Elimination diets, PPI, topical glucocorticoids
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These treatments help manage eosinophilic esophagitis symptoms.
Ocular manifestations of IBD
Episcleritis, uveitis
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These are common extraintestinal manifestations of inflammatory bowel disease.
Acute pancreatitis lab tests predicting poor outcome
Elevated hematocrit and BUN
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These lab values are associated with increased severity in pancreatitis cases.
Cholecystectomy timing after biliary pancreatitis
Before hospital discharge
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Common cause of refractory celiac disease
Continued gluten exposure
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Rash pathognomonic for celiac disease
Dermatitis herpetiformis
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Nutritional approach in severe acute pancreatitis
Early enteral feeding
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Earliest age to initiate colonoscopy in Lynch syndrome
Age 20-25 years or 2-5 years before youngest relative’s diagnosis
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Test for oropharyngeal dysphagia
Video fluoroscopic swallow study (modified barium swallow)
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Treatment for refractory chronic anal fissure
Sphincterotomy or botulinum injection
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Diagnosis suggested by large-volume watery diarrhea despite fasting
Secretory diarrhea
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Most common cause of secondary constipation
Medications
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Diagnostic test for hemodynamically significant or rapid small-bowel bleeding
CTA
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High-risk findings for PUD rebleeding
- Active bleeding
- Nonbleeding visible vessels
- Adherent clots
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Duration of high-dose intravenous PPI therapy in bleeding PUD with high-risk endoscopic appearance
3 days
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Diagnosis suggested by severe abdominal pain out of proportion to physical exam findings
Acute mesenteric ischemia
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Treatment of moderate to severe colonic ischemia in high-risk patients
- Hospitalization for supportive care
- Volume restoration
- Close observation
- Antimicrobials
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Gold standard diagnostic test for achalasia
Esophageal manometry
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Gastroparesis initial diagnostic test
Upper endoscopy
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Most common dermatologic manifestations of IBD
- Erythema nodosum
- Pyoderma gangrenosum
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When to resume aspirin for secondary prevention of CVD in GI bleeding
As soon as possible after hemostasis
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First step in managing uncomplicated GERD
Empiric PPI
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Best initial radiographic study for constipation
Abdominal flat-plate radiography
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Indications for colonoscopy for perianal symptoms
- Age >45 years
- Altered bowel habits
- Anemia
- IBD
- Weight loss
- Family history of CRC
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Drugs causing microscopic colitis
- NSAIDs
- SSRIs
- PPIs
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FAP genetic testing
APC gene testing
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Gastric cancer screening indications
- FAP
- Lynch syndrome
- Peutz-Jeghers syndrome
- Juvenile polyposis
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Treatment for acute mesenteric ischemia
- Surgery
- Endovascular intervention
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Preferred induction treatment for ulcerative colitis unresponsive to 5-ASA
Infliximab
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Infliximab is a monoclonal antibody used in patients who do not respond to traditional therapies.
Test for small-bowel bleeding after negative upper and lower endoscopy in stable patient
Capsule endoscopy
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Capsule endoscopy allows visualization of the small intestine, which is not easily accessible by traditional endoscopy.
Treatment for uncomplicated diverticulitis
Close observation without antibiotics
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This approach is often sufficient for mild cases that do not present with complications.
PUD prevention in at-risk patients who must take NSAIDs
COX-2 inhibitor plus PPI
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This combination helps to reduce the risk of peptic ulcer disease in patients requiring NSAID therapy.
Primary variceal bleeding treatment
Octreotide, somatostatin, or terlipressin; endoscopic therapy
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These treatments help control bleeding from varices in patients with portal hypertension.
Histologic characteristic of type 1 autoimmune pancreatitis
Elevated IgG4-positive cell count
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This finding is key in diagnosing type 1 autoimmune pancreatitis.
Indication for early CT in suspected acute pancreatitis
Diagnostic uncertainty
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Early imaging may be necessary to confirm the diagnosis or assess complications.
Induction treatment of mild to moderate ulcerative colitis
Oral and topical 5-ASAs
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5-ASA compounds are the first line in managing mild to moderate cases.
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Common symptoms of gastroparesis
Nausea, vomiting, upper abdominal pain, early satiety
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These symptoms reflect delayed gastric emptying.
Medications causing false-negative noninvasive H. pylori tests
PPIs, antibiotics
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These medications can suppress H. pylori detection in testing.
Conditions causing false-negative noninvasive H. pylori tests
Atrophic gastritis, intestinal metaplasia, MALT lymphoma
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These conditions can affect the accuracy of H. pylori testing.
When to restart aspirin for secondary CV prevention in bleeding peptic ulcer
Immediately after hemostasis is endoscopically confirmed
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This timing helps to balance the risk of further bleeding with cardiovascular protection.
Autoimmune pancreatitis treatment
Glucocorticoids
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Steroids are effective in managing inflammation in autoimmune pancreatitis.
Diagnosis suggested by dysphagia, late regurgitation of undigested food
Pharyngoesophageal (Zenker) diverticulum
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This condition is characterized by a pouch that forms in the esophagus, leading to swallowing difficulties.
