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.
When are antibiotics indicated for pancreatitis?
- Necrosis evident on CT
- Failure to improve in one week
- Sepsis
What is the most specific clinical indicator of appendicitis?
Tenderness at Mcburney’s point.
What imaging modality is first line in children with suspected appendicitis?
First line will be ultrasound. If positive, the patient goes to the OR. If unequivocal or negative but high suspicion remains, the next step is CT scan.
A positive tissue transglutimase antibody and endomysial antibody are seen in what disease?
This is used to diagnose celiac disease.
What antibiotics are used in diverticulitis?
- Augmentin
OR - Ciprofloxacin and metronidazole
What is the diagnostic test of choice for diverticulitis?
Patients should have CT scan done. Six weeks after resolution patients should have a colonoscopy done. Never perform colonoscopy with active diverticulitis as there is in- creased risk of perforation
pANCA will be positive in what disease?
Ulcerative colitis will be pANCA positive. Crohns will be ASCA positive.
What is the first line treatment for IBD?
5-ASA
A 6 month old male presents abdominal pain and currant jelly stool. You palpate an epigastric mass. What is the first line treatment for this patient?
Diagnostic enema is also considered to be therapeutic. If this does not reduce, then surgery is indicated.
What is the screening guideline for colon cancer?
Screening starts at age 50 and stopped at 75.
- Colonoscopy every 10 years
- Sigmoidoscopy every 5 years
- Fecal occult testing yearly
What imaging test should be ordered for a suspected small bowel obstruction?
The first test should be an abdominal X-ray. Very few indications exist for abdominal x- ray; know this one.
What is borchadts triad?
- Abdominal/Chest pain
- Vomiting
- Inability to pass nasograstic tube
This is indicative of small bowel obstruction
Toxic megacolon is defined as dilation over what number?
> 6cm of dilation noted on abdominal x-ray = toxic megacolon.
What type of hernia will present with a scrotal mass or bulge?
Indirect Hernia
By what age should most congenital umbilical hernias resolve by?
Most resolve by three years of age. If it hasn’t, then surgery is indicated.
What antibiotic is most commonly associated with C-Diff?
Clindamycin, but be aware that any antibiotic can lead to c-diff infection.
How would you classify inflammatory diarrhea?
Diarrhea that contains white blood cells or blood.
What is the most commonly isolated bacteria in infectious diarrhea?
Campylobacter infection.
