Gastroenterology Flashcards
What are alarm symptoms in GERD?
- Dysphagia
- Odynophagia
- Weight loss
- Anemia
Anyone with alarm symptoms needs endoscopy!
What are the three most common medications responsible for esophagitis?
- Tetracyclines
- NSAIDs
- Alendronate
36 year old patient with HIV is presenting with odynophagia. What is the next best step?
The next best step is a trial dose of fluconazole. By far, the most common etiology will be esophageal candidiasis.
A patient presenting with regurgitation of undigested food and foul smelling breath is most likely suffering from what condition?
Zenker diverticulum - this is an outpouching of the pharynx.
Barrium swallow in achalasia will show what finding?
Barrium swallow will show a birds beak.
What is the treatment for plummer vincent syndrome?
Treatment of choice is oral iron therapy.
What is the medication of choice to control esophageal variceal bleeding?
Octreotide. After bleeding has been controlled, the next step is to have TIPS or a surgical shunt placed.
Non bleeding varices are treated with what medication for prophylaxis?
These patients are treated with a beta blocker and is continued indefinitely.
What is the most common medication responsible for gastritis?
NSAIDs
Why does a gastric ulcer require follow up endoscopy to document resolution?
These are at increased risk for gastric cancer, therefore, documented resolution is re- quired to rule out malignancy.
What is the test of choice to diagnose H-pylori?
Urea breath test is the test of choice. An acceptable alternative is stool antigen testing. Both can be used to test for cure.
Endoscopy is indicated for first time dyspepsia in patients over what age?
Anyone over 50 years of age with first time dyspepsia requires endoscopy.
Gastric cancers are usually what type?
Most will be adenocarcinoma
What are three risk factors for gastric cancer?
- H-pylori infection
- Smoking
- Alcohol
A 2 month old patient presents with projectile vomiting after feeding. What is the next best test?
The next best step is abdominal ultrasound to look for pyloric stenosis.
What physical exam finding will point towards the diagnosis of cholecystitis?
Murphys Sign - Palpatation of the RUQ while the patient inhales will cause patient to stop breathing secondary to pain.
What is charcots triad?
- Fever
- Jaundice
- RUQ Pain
This is the classic triad seen in cholangitis.
What are risk factors for cholelithiasis?
- Obesity
- Rapid weight loss
- Pregnancy
What is the most accurate and predictive test of liver function?
PT and INR is the most accurate marker for liver function.
Who should be universally screened for hepatitis C?
The CDC recommends that all patients born 1945-1965 be screened for hepatitis C once, even if asymptomatic.
What is the next best test to order if a patient has a positive hepatitis C antibody?
Remember, antibodies stay positive for life. Therefore, this might simply be past infec- tion. The next step is hepatitis C RNA to look for active infection.
What are the two most common causes of cirrhosis?
- Hepatitis C
2. Alcohol
What AST:ALT ratio is indicative of alcoholic liver disease?
A ratio of 2:1 is indicative of alcoholic liver disease.
A patient is presenting with epigastric pain that radiates to the back. Nausea and vomiting are also noted. Bilateral flank discoloration is noted - what is this sign?
This is the classic presentation for pancreatitis. This is called Grey-Turner sign which in- dicates hemorrhage.
