Gastroenterology Flashcards
1
Q
Next step in patient with recurrent duodenal ulcers despite medical treatment?
A
Test for Zollinger-Ellison syndrome , gastrin levels
2
Q
Most effective treatment of duodenal ulcers not due to ZE syndrome?
A
Triple therapy treatment for H. pylori
3
Q
What presenting factors help differentiate between gastric and duodenal ulcer?
A
Gastric ulcer: pain is worsened with eating
Duodenal ulcer: pain occurs 2-4 hours after eating and is alleviate with food
4
Q
What Chem7 abnormality is seen in upper GI bleed?
A
Increased BUN
5
Q
What is Ranson’s criteria for prognosis in acute pancreatitis (24 and 48 hours)
A
24 hours: Glu>200,AST>250,LDH>350,Age>55 years,WBC>16,000
48hours: Ca5, base deficit >4, sequestration of fluid >6L
If calcium is decreasing it means it is binding to triglycerides in saponification
6
Q
Serum markers of pancreatic cancer
A
CEA and CA19-9
7
Q
Common causes of acute pancreatitis
A
ETOH, gallstones, trauma, hypertriglyceridemia, hypercalcemia, medications (antiretroviral)
8
Q
What is the triple therapy for H.pylori?
A
PPI, clarithromycin, methotrexate/amoxicillin
9
Q
Treatment for gastric carcinoma
A
If upper stomach then subtotal gastrectomy
If mid and lower stomach then total gastrectomy
Both followed by chemo and radiation
10
Q
Treatment of pancreatic cancer isolated to pancreatic head?
A
Whipple’s procedure
11
Q
Most specific and sensitive test for chronic pancreatitis
A
Decreased fecal elastase
12
Q
Treatment for chronic pancreatitis
A
Stop ETOH!!
Replace enzymes
Pain control
13
Q
Organism that causes food poisoning associated with mayonnaise or creamy foods stays out too long
A
Staph aureus
14
Q
“Rice water stools”
A
Vibrio cholera and ETEC
15
Q
Diarrhea transmitted via pet feces
A
Yersenia entercolitica
16
Q
Diarrheal organism associated with reheated rice
A
Bacillus cereus
17
Q
MCC of traveler’s diarrhea
A
ETEC
18
Q
Diarrheal organism associated with drinking from a stream
A
Giardia lamblia
19
Q
Diarrheal organism associated with recent antibiotic treatment
A
C. Difficile; pseudomembranous colitis
20
Q
Mild diarrheal infection that can turn into a Life threatening CNS infection
A
Taenia solium can cause neurocysticircosis
21
Q
Diarrheal organism associated with undercooked hamburger meat
A
EHEC
22
Q
Diarrheal organism associated with seafood
A
Vibrio cholera, vulnificus and parahemolyticus
23
Q
Diarrheal organism associated with poultry
A
Salmonella and campylobacter
24
Q
Diarrheal illness associated with pink eye
A
Adenovirus
25
Bloody Diarrheal organism associated with liver abscess
Entamoeba histolytica
26
Diarrheal organism associated with HIV
Cryptosporidium and isospora
27
Diarrheal illness associated with dehydration in children, especially during winter months
Rotavirus
28
Next step in 65 year old patient found to have gastric carcinoma on EGD Biopsy?
CT scan of abdomen and pelvis to see the extend of spread(staging)
29
Common side effects of the following antacids: aluminum hydroxide, mg hydroxide and ca carbonate
Aluminum- constipation
magnesium- diarrhea
Calcium- increased risk of peptic ulcers
30
Common side effects of H2 blockers and PPIs?
H2 blockers (cimetidine, rinatadine) neutropenia/thrombocytopenia, gynecomastia and impotence
PPI (omeprazole) well tolerated but can increase the dosages of medications like benzos, warfarin and carbamazepine
31
Treatment for gastroenteritis caused by: enteoameba
Metronidazole
32
Treatment for gastroenteritis caused by: giardia
Metronidazole
33
Treatment for gastroenteritis caused by: shigella
Fluoroquinilones or TMP SMX
34
Treatment for gastroenteritis caused by: campylobacter
Erythromycin
35
Treatment for gastroenteritis caused by:salmonella
Fluoroquinilone or TMP SMX
36
Next step in management in patient that comes to ER complaining of abdominal pain and xray shows free air in the abdomen?
This xray confirms perforation, so immediately to OR for laparotomy with repair
37
Dx and Tx for recent Cuban immigrant with signs of malabsorption and megaloblastic anemia?
Tropical sprue, tx with folic acid and possibly tetracycline antibiotics for 3-6 months
38
Time frame for resolution of post-operative ileus at the stomach, small bowel and large bowel?
Stomach: 48-72 hours
Small bowel: within 24 hours
Large bowel: 3-5 days
39
Dx and Tx: pt comes to the ER with vomiting, abdominal pain and distention; xray shows two distinct areas of the sigmoid that are distended?
This is the classic double bubble sign of sigmoid volvulus; colonoscopy for detorsion of colon
40
Clinical signs that are seen in appendicitis patients
Psoas sign: pain with hip extension
Rovsings sign: pain in RLQ upon palpate on of LLQ
Obturator sign: pain with passive internal rotation of the flexed hip
41
Treatment of Crohn's disease
Acute flare: steroids
Chronic tx: mesalamine (5-ASA), sulfasalazine (colonic involvement), 6-mercaptopurine , azathioprine, and for severe cases anti-TNFa medications
42
Most common causes of small bowel obstruction
ABC
| Adhesions, bulge (incarcerated hernia) and cancer (metastatic CRC)
43
Classic question stem for acute mesenteric ischemia
Abdominal pain out of proportion to physical findings
44
Findings that are classically associated with IBS; and findings that are worrisome and should question Dx of IBS
Findings associated with IBS: abdominal discomfort 12wk/year, relief with defecation, increased frequency of BM, change in BM appearance, straining, urgency, feeling of incomplete voiding, mucus with BM
WORRISOME: any signs of malabsorption like weight loss or anorexia, worsening pain, pain that awakens patient from sleep
45
What is the most likely malabsorptive syndrome in a patient with +Sudan stain of stool but normal D-xylose testing?
Fat in stool suggests pancreatic insufficiency; normal D-xylose shows normal villus architecture in bowel capable of absorbing carbohydrates
46
Treatment for Whipple's disease
12 months of antibiotic treatment with TMP-SMX OR CEFTRIAXONE
47
Antibodies seen in celiac sprue
+ anti-endomysial and anti-gliadin antibodies
48
What kinds of tumors can cause a secretory diarrhea?
Gastrinoma, VIPoma, carcinoid, medullary thyroid tumor
49
What serum findings can help differentiate Crohn's and ulcerative colitis
Crohn's +ASCA
| Ulcerative colitis +P-ANCA
50
Treatment for acute mesenteric ischemia
NPO, bowel rest with IVF aNd NGT with suction for decompression
Broad spectrum antibiotics, papauvarin to decrease arterial spasm
Diagnose with angiography
Embololectomy or surgical resection (necrosis) if needed
51
Most common causes of acute pancreatitis
Alcohol, gallstones
| Hypercalcemia, hypertriglyceridemia, trauma and medications
52
Next step in management in a pt>50 years old with minimal bright red blood per rectum on toilet paper but not on BM?
Anoscopy, look for hemorrhoids or fissures that may explain bleeding
53
MCC of pain, swelling or the mid-coccygeal area of the skin and subcutaneous tissue?
Pilonidal cyst
54
MCC of recurrent LLQ pain that is relieved by defecation
Diverticulosis
55
Patients at increased risk for acalculous cholecytitis
TPN, critically ill patients, burn patients
56
What is charcot's triad and what is it used for? What is Reynolds pentad?
Triad: fever, RUQ pain and jaundice
It is used to diagnose ascending cholangitis
Pentad: add hypotension and altered mental status
57
What is the next step in management of a Patient found to have a calcified gallbladder (aka porcelain gallbladder)?
Do a Biopsy because this is suspicious for gallbladder cancer
58
How does interventional treatment in diverticulosis and diverticulitis differ?
In diverticulosis you would diagnose with barium enema and colonoscopy, this would be dangerous in diverticulitis because there is inflammation so in this case you would do a ct scan.
59
How does interventional treatment for cholecytitis and ascending cholangitis differ?
In both IVF and antibiotics would be given
In cholecystitis a cholecystectomy would be done; unless the patient is unstable and the. An ERCP would be done first
In ascending cholangitis drainage would be performed via ERCP first and theN a cholecystectomy would be done once inflammation has reduced
60
What stage Dx: patient with CRC that has positive lymph nodes? And why is this important?
This is stage III disease and requires chemo after resection of the colon
61
A 60 year old male undergoes colonoscopy and is found to have 3 small tubular adenomatous polyps that are then removed, when should he have a follow up colonoscopy?
Every 3 years; if he had 1-2 polyps he would get a colonoscopy every 5 years
62
Pt is a 40 year old male that says father had CRC at the age of 55 when should he have his first colonoscopy?
Begin screening these patients (family hx
63
What antibiotics should be used for diverticulosis outpatient?
Oral antibiotics: coverage for gram - and anaerobes
flouroquinilones and metro
Amoxicillin and clauvalanic acid
TMP-SMX and metronidazole
64
How are anal fissures managed?
Stool softeners, topical NG/CCB or Botox if refractory to reduce spasms. Sx for repair
65
What are the MCC of upper GI bleeding
Esophageal varies, Mallory Weiss tears, gastritis, esophagitis, peptic ulcer disease
66
What is the most common cause of lower GI Bleeding?
Hemorrhoids, fissures, IBD, diverticulosis, meckles diverticulum, AVM, mesenteric ischemia, colon cancer
67
What is the best way to asses volume status in acute GI bleed?
In these cases HCT and hemoglobin will tell us nothing because the patient is not hemodiluted by treatment yet, he just has low volume.
This is better monitored with blood pressure, urine output and heart rate
68
What causes Whipple's disease and how is it diagnosed?
Caused by a bacteria.
| Diagnosed by showing PAS positive foamy macrophages and villus atrophy on biopsy
69
What are some differences seen between chronic pancreatitis and celiac sprue?
Celiac sprue will also have iron def anemia and serum antibodies
70
Treatment for celiac sprue
Remove gluten from diet and give steroids if refractory
71
Treatment for tropical sprue
Tetracycline or TMP-SMX for 3-6 months
| Folic acid replacement
72
Symptoms of carcinoid syndrome, diagnosis and treatment
Intermittent diarrhea, flushing, wheezing and cardiac abnormalities (right)
Diagnose with 5-HIAA in urine
Treat: octreotide or local resection; treat niacin deficiency
73
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Condition associated with the following deficiencies:
Vit DEAK
Folate def anemia
Iron def anemia
B12 def
Niacin def
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Vit DEAK can be lost in all malabsorptive conditions where fat is lost
Folate def anemia associated with tropical sprue
Iron def anemia associated with celiac disease
B12 def in any disease where bowel wall or panc enzymes affected
Niacin def in carcinoid syndrome
74
When should colonoscopic screening occur in patients with Crohns or ulcerative colitis?
Start 8-10 years after disease states
| Scope every 1-2 years
75
How is the diagnosis of Crohns different from ulcerative colitis?
Because crohns can happen anywhere In the GI you need both small bowel barium follow through and colonoscopy; will show string sign or skip lesions. If still unclear check for ASCA IN CROHNS
Ulcerative colitis is restricted to colon so only need colonoscopy; will show lead piping with colonic shortening. If still unclear check for ANCA
76
Treatment of Crohns and Ulcerative colitis:
Acute: steroids, taper off, if recur then azathioprine or 6-MP to wean
Chronic: 5-ASA derivatives (asacol and pentasa=mesalamine)
If severe or unresponsive therapy: TNF alpha agents
If bowel obstruction in Crohns then surgery; colectomy is rarely done but is curative for UC
