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Step 3 > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

What type of kidney stones may be seen in Crohn’s disease?

A

Calcium oxalate stones

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2
Q

What is useful for diagnosis of Crohn’s or UC?

A

Endoscopy

Barium studies

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3
Q

What disease is ASCA + and ANCA - ?

A

Crohn’s Disease

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4
Q

What disease is ASCA - and ANCA + ?

A

UC

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5
Q

What is the best initial therapy for UC and Crohn’s?

A

Mesalamine

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6
Q

What steroid has utility in managing Crohn’s and UC?

A

Budesonide

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7
Q

When patients have Crohn’s/UC with recurrent symptoms off steroids or severe disease what meds can be started?

A

Azathioprine and 6-mercaptopurine

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8
Q

What drug is most useful in managing Crohn’s disease with associated fistula formation?

A

Infliximab

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9
Q

When there is perianal involvement in Crohn’s what drugs are helpful?

A

Metronidazole and ciprofloxacin

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10
Q

Should you give platelets and antibiotics in patients with HUS from E. coli O157:H7?

A

No!

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11
Q

If blood is not mentioned in a diarrhea case what test should you run to look for invasive pathogens?

A

Fecal Leukocytes

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12
Q

In severe diarrheal disease thought to be due to an infectious etiology what is an appropriate antibiotic to start?

A

Ciprofloxacin (fluoroquinolones)

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13
Q

What medication is used in cryptosporidiosis diarrhea effectively?

A

Nitazoxanide

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14
Q

What pathogen has the fastest onset of diarrhea? What is tx?

A

Scombroid (histamine fish poisoning) can cause nonbloody diarrhea within 10 mins
Diphenydramine

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15
Q

Flushing and episodes of hypotension in a patient with chronic diarrhea should raise concern for what cause of diarrhea? How is it diagnosed and what is tx?

A

Carcinoid syndrome
Check urinary 5-HIAA level
Octreotide

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16
Q

What electrolyte/chemical abnormalities may be present in patients with fat malabsorption issues?

A

Vitamins A, D, E, and K
Hypocalcemia (failed vitamin D absorption)
Oxalate overabsorption (leading to calcium oxalate stones)
Loss of vit. K leads to easy bruising and prolonged PT/INR
Reduced vit B12 absorption

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17
Q

What is best initial test for fat malabsorption?

A

Sudan black stain of stool

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18
Q

What is the most sensitive test for fat malabsorption?

A

72 hr fecal fat

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19
Q

What skin lesion is Celiac’s disease assd with?

A

Dermatitis herpetiformis

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20
Q

What type of anemia may Celiac’s disease present with and how?

A

Microcytic due to iron deficiency from failed iron absorption

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21
Q

What is the best initial testing for Celiac’s?

Most accurate?

A

Initial: antigliadin, antiendomysial, or antitissue transglutaminase antibodies
Accurate: small bowel biopsy

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22
Q

What is D-xylose testing and what does it show in Celiac’s, tropical sprue, and Whipple’s disease?

A

Reduced D-xylose absorption due to villi destruction

*Rarely used test anymore

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23
Q

What will a small bowel biopsy show in a patient with tropical sprue?
What is tx?

A

Bx: microorganisms
Tx: doxycycline or TMP/SMX

*Tropical sprue will present similarly to Celiac’s but patient will have visited tropics and be negative for antibody serologies

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24
Q

What are additional findings in Whipple’s disease besides GI?

A

Ocular findings
Neurologic abnormalities
Arthralgia

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25
Q

What is the best test for diagnosing Whipple’s disease? Tx?

A

Diagnose with small bowel biopsy showing PAS positive organisms (alterantively could do PCR of stool showing Tropheryma whippelii)

Tx: tetracycline or TMP/SMX

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26
Q

What are the best initial radiologic tests for diagnosing chronic pancreatitis?
What is the most accurate test?

A

Initial: abdominal x-ray or abdominal CT
Accurate: secretin stimulation testing (normal person should release large amt of bicarbonate rich fluid when IV secretin given)

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27
Q

What is treatment of chronic pancreatitis?

A

Replace pancreatic enzymes regularly by mouth (e.g. give amylase, lipase, and trypsin)

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28
Q

In a patient who you suspect irritable bowel syndrome in what should you order on CCS?

A

Stool ova/parasites/white cells/guaiac, stool culture, fetal leukocytes
Colonoscopy
Abdominal CT

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29
Q

What are the three lines of therapy for irritable bowel syndrome?

A

1) Fiber
2) Antispasmodics/anticholinergics (e.g. dicycloamine or hyoscyamine)
3) TCA (e.g. amitryptiline)

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30
Q

If you have one family member who had colon cancer when should you get screened with colonoscopy?

A

At age 40 or 10 yrs before the age of dx of family member, whatever is first.

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31
Q

For patients who have concern for Lynch syndrome when should they be screened for colon cancer and how often?

A

Colonoscopy every 1-2 years starting at age 25

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32
Q

Describe Gardener’s syndrome

A

Benign bone tumors (osteomas) and other soft tissue tumors (e.g. colon cancer)

33
Q

Describe Peutz-Jeghers syndrome

Is there extra screening recommended?

A

Melanotic spots on lips and hamartomatous polyps through small bowel and colon
Lifetime risk of colon cancer only slightly elevated so no additional screening recommended

34
Q

Multiple extra hamartomas in the bowel is suggestive of what disease? Is there extra screening recommended?

A

Juvenille polyposis

No extra screening recommended

35
Q

If a DYSPLASTIC polyp is found on colonoscopy when should it be repeated?

A

3-5 years

36
Q

What is the utility of CEA?

A

It is a test to track progression NOT for screening

37
Q

What is the most accurate test for diagnosis of diverticulosis?

A

Barium enema

*Caution: this is CONTRAINDICATED in diverticulITIS

38
Q

Mgmt diverticulosis

A

High fiber diet

39
Q

Best test for dx of diverticulitis?

Mgmt?

A

Dx: abdominal and pelvic CT scan

Ciprofloxacin (against gram negs) and metronidazole (against anaerobes)

40
Q

How can the color of excretus distinguish bleeding location, i.e. red blood per rectum vs black stool vs coffee ground emesis?

A

Red blood per rectum often from lower GI bleed
Black stool indicates upper GI bleed
Coffee ground emesis from upper GI where acid involved (e.g. gastric, esophageal, duodenal)

41
Q

What is the most common cause of death in GI bleeding?

A

Myocardial ischemia, therefore be sure to obtain an EKG

42
Q

What are priorities in large GI bleeding before doing endoscopy?

A

Fluid resuscitation
Correcting thrombocytopenia, coagulopathy, or anemia
Oxygenate and get an EKG

43
Q

Unnecessary use of stress ulcer ppx increases the risk of what conditions?

A

Pneumonia

C. diff colitis

44
Q

What is the order of treatments done for variceal bleeding?

A

1) octreotide
2) endoscopy for variceal banding
3) if bleeding persists then can do TIPS procedure

45
Q

What is the most common complication of TIPS?

A

Hepatic encephalopathy

46
Q

What diagnostic test can tell you the source of bleeding in a patient with GI bleed unable to be found by endoscopy?

A

Technetium bleeding scan (“target red cell scan”)

47
Q

What is the most accurate test for acute mesenteric ischemia?

A

Angiography

48
Q

What class of anti-hypertensive meds may cause constipation?

A

CCBs

49
Q

Distinguish the etiology of black stool per rectum which is passing quickly and often vs black stool per rectum which is passing seldomly (i.e. constipated).

A

If passing seldom the stool may be black from ferrous sulfate replacement and the iron causes constipation.

True black stool from upper GI bleeding leads to lots of defecation since blood is cathartic

50
Q

What are mainstays of treatment of constipation?

A

Fiber and hydration

51
Q

How does dumping syndrome present and why?

What is mgmt. generally?

A

Shaking, sweatiness, and weakness. Often in patient with previous gastric surgery. Due to large osmotic draw into bowel from large meal and can also cause reactive hypoglycemia.

Treatment is frequent small meals

52
Q

How can you treat diabetic gastroparesis?

A

Erythromycin or metoclopramide

53
Q

What urinary test can be used to assess the severity of pancreatitis?

A

Urinary trypsinogen activation peptide

54
Q

If a patient presents with acute pancreatitis and it is found that there is common bile duct dilation and no pancreatic head mass what should be done next test-wise?

A

ERCP which can be diagnostic and therapeutic

55
Q

What is therapy for acute pancreatitis?

A

NPO
Hydration
Pain meds

56
Q

What is the utility of Ranson’s criteria?

A

Assesses severity of pancreatitis and who would need surgical debridement

57
Q

If CT scan shows a patient with > 30% necrosis of the pancreas what should be the ensuing mgmt?

A

Imipenem

CT-guided biopsy –> if CT shows infection and necrosis of pancreas then move on to surgical debridement

58
Q

What diseases are Hep B and C assd with respectively?

A

HBV: polyarteritis nodosa
HCV: cryoglobulinemia

59
Q

All patients with hepatitis will have what lab finding?

A

Elevated direct bilirubin which causes jaundice and darkening of urine

60
Q

Best initial test for HCV

Most accurate test for HCV

A

Initial: Hep C antibody
Accurate: HCV PCR of RNA and liver biopsy

61
Q

What are some agents used to treat chronic HBV (keep in mind there is no treatment for acute HBV)?

A 
Lamivudine
Adefovir
Entecavir
Telebivudine
Tenofovir
IFN
62
Q

What is the most common adverse effect of ribavirin?

A

Anemia

63
Q

What oral protease inhibitors are added to ribavirin for the treatment of chronic HCV?

A

Ledipasvir, simeprevi, or sofosbuvir

64
Q

What is ppx of variceal bleeding in cirrhotic pts?

A

Propranolol

65
Q

What is the utility of the SAAG?

A

Serum ascites to albumin gradient

If > 1.1 then the cause of ascites is likely portal HTN or CHF

66
Q

What lab value needs to present upon paracentesis of ascetic fluid to make a diagnosis of SBP?

A

> 250 neutrophils

67
Q

What is treatment of SBP?

A

Ceftriaxone

68
Q

For cirrhosis:
If ascites present then treat with ….
If encephalopathy present then treat with …

A

Ascites: spironolactone
Encephalopathy: lactulose

69
Q

What is the best initial test for primary biliary cirrhosis? Most accurate test?

A

Initial: Elevated ALP with nl bilirubin. IgM elevated
Accurate: Antimitochondrial antibody, liver biopsy

70
Q

What is treatment of primary biliary cirrhosis?

A

Ursodeoxycholic acid

71
Q

What does primary sclerosing cholangitis often co-present with? How can it be distinguished from PBS on labs?

A

Primary sclerosing cholangitis: inflammatory bowel disease, itching
Should have elevated ALP and also elevated bilirubin (PBS has nl bilirubin)

72
Q

What are the most accurate tests in diagnosing primary sclerosing cholangitis?
What is tx?

A

ERCP shows “beading” of biliary system
Antismooth muscle antibody (ASMA)
ANCA positive

Tx: Ursodeoxycholic acid

73
Q

What symptoms do patients with Wilson’s disease present with?

A

Cirrhosis
Choreiform disorder
Neuropsychiatric abnormalities
Hemolysis

74
Q

What are the best initial tests for Wilson’s disease?
Most accurate?
Tx?

A

Initial: slit lamp exam looking for Kayser Fleischer rings; low ceruloplasmin level
Accurate: liver biopsy

Tx: penicillamine or trientine

75
Q

How may hemochromatosis present?

A

Restrictive cardiomyopathy
Skin darkening
Joint pain (d/t calcium pyrophosphate deposition)
Pancreatic damage (“bronze diabetes”)
Pituitary accumulation of Fe with panhypopituitarism
Infertility
Hepatoma

76
Q

What is best initial and most accurate tests for hemochromatosis?

A

Initial: elevated serum iron and ferritin with low iron binding capacity
Accurate: liver biopsy; OR MRI of liver and HFe gene mutation

77
Q

What is tx of hemochromatosis?

A

Phlebotomy

78
Q

What is best initial and accurate test for autoimmune hepatitis?

A

Initial: ANA and anti-smooth muscle antibody. Serum protein electrophoresis shows hypergammaglobulinemia. (may also have positive ANA and liver/kidney microsomal antibody)
Accurate: liver biopsy

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