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Internal Medicine Boards > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

When to EGD Barrett’s Patients

A
  1. EGD shows Barretts -> next EGD 1 year
  2. 1 year later repeat EGD no dysplasia (only metaplasia) -> EGD q3yr
  3. Low Grade dysplasia - EGD 6 months -> still low dysplasia -> q1yr
  4. Dysplasia->metaplasia -> q3yr
  5. High Grade Dysplasia -> Endoscopic RF Ablation
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2
Q

H Pylori Testing

A
  1. Non Endo - Ab test for dx only, Urea breath/Fecal antigen Dx AND f/u
  2. Endo - for culture, urease testing - GOLD STANDARD but expensive
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3
Q

Treatment H Pylori

A
  1. PAC x 14 days (PPI, Amox, Clarithro

2. MOC x 14 days (Metronidazole, omep, clarithro)

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4
Q

H Pylori Tx failure

A
  1. Quad Tx - Tetra, metronidaz, bismuth, PPI

DO NOT REPEAT triple therapy with same abx (high clarithro resistance rates)

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5
Q

Who to test for H pylori

A

45yo M with abd pain and PUD

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6
Q

Are steroids ulcerogenic

A

NO but with NSAIDS increase bleeding by 10x

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7
Q

Dysphasia solids AND liquids with CP

A

Diffuse Esophageal spasm/corkscrew esophagus–>barium swallow–>manometric study (non-perstaltic rxn–>PPI (if no response CCB)

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8
Q

First bite dysphagia (intermittent)

A

Schatzki ring/esophageal strictures -> Pneumatic dilation

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9
Q

Food Regurg hours after, dyphagia solids and liquids

A

Barium swallow -> Birdsbeak -> Achalaisa-> EGD r/o secondary acalasia (cancer) -> surgical myotomy

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10
Q

Food impaction several times, EGD concentric rings, h/o allergies

A

Eosinophillic esophagitis -> PPI then aerosolized steroid (fluticasone/budesonide) then if refractory EGD dilation

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11
Q

Dysphagia with osteoporosis, acrne on tetracycline erythromcin

A

Pill esophagitis -> EGD

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12
Q

regurigating food from days ago, halotosis

A

zenker’s diverticulum

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13
Q

HIV with oral thrush

A

empiric fluconazole/itraconazole -> if no response -> EGD r/o CMV/herpes

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14
Q

Long standing heartburn with progressive dysphagia solids

A

Peptic stricture

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15
Q

Heartburn not relieved with antacids

A

trial of PPI -> if doesn’t work EGD -> if EGD no esophagitis -> ambulatory pH monitoring to prove GERD

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16
Q

Heartburn no response to PPI + weight loss

A

EGD

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17
Q

Can PPI/fundoplication reverse barretts

A

NO

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18
Q

PUD Tx

A

H2 blocker, PPI, sucralafte (cover ulcer)

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19
Q

Zollinger Ellison

A 
MC radiographic finding=single duodenal ulcer
Pancrease or duodenal tumors
2/3 tumors are malignant
1/4 a/w MEN I
Serum fasting gastrin >1000, low pH dx
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20
Q

How long to monitor acute GI bleed after EGD

A

72 hours

21
Q

High risk bleed

A 
Visible vessel
Adherent clot
Ulcer >2cm
Variceal bleeding
Arterial Bleed
22
Q

Prevent rebleed PUD

A

PPI

23
Q

Cirrhosis with spider angiomata

A

Screening EGD, PPI (propranolol, nadolol) non selective (if asthma - no beta blocker - band ligation)

24
Q

Only H Pylori test NOT affected by PPI use or GI bleed.

A

H Pylori SEROLOGY

25
Q

Dilation of bile duct without evidence of obstruction

A

Biliary cyst

26
Q

Primary Biliary Cirrhosis

A

Disease of microcopic bile ducts, no extrahepatic duct dilation -> jaundice, liver inflamm, liver failure
NEVER ACUTE liver failure (progressive)
Elevated alk phos from bile duct inflamm
Dx: Cholestatic LFT profile, serum anti Mitox Ab
Tx: Ursodeoxycholic Acid
Monitor: serial LFT’s

27
Q

Fulminant Hepatic Failure

A

within 1 week, hepatic encephalopathy, jaundice without pre-existing liver dz,

28
Q

Pancreatic CA dx

A

Older pt with painless jaundice, focal cutoff of bile duct on CT (without mass lesion seen) -> use EUS (better sensitivity for tumors AND can biopsy)

29
Q

Large Esophageal varices

A

Non-selective beta blockers OR endoscopic LIGATION (not sclerotherapy) -> if refractory then TIPS

30
Q

Erythema Nodosum

A

2/2 infections, drugs, systemic (inflamm) dz’s -> treat underlying d/o (IF NO underlying d/o, tx with corticosteroids or immunomodulators)

31
Q

Colonoscopy Surveillence

A

If complete resection -> surveillence in 1 year

If incomplete resection -> surveillence in 3-6 months after surgery then again in 1 year

32
Q

Gallbladder polyps

A

10mm - cholecystectomy (high potential for malignancy) (or if gallstones >3cm, calcified GB)

33
Q

Oropharyngeal Dysphagia (difficulty swallowing)

A

Video fluoroscopy - chocking, coughing, h/o asp PNA, (ALS)

34
Q

Acute Acalculous Cholecystitis

A

BEST test = Abd US -> CT doesn’t show GB wall thickening -> needs cholecystectomy (if not perc cholecystomy tube)

35
Q

Celiac Dz

A

Anti TTG best test, don’t check anti-gliadin Ab

36
Q

Wilson’s Dz

A

Young patient with acute liver failure, high retic ct, large fraction unconjugated bilirubin, low alk phos (

37
Q

Acute Cholangitis

A

bacterial infection of biliary tree in obstructed system (high alk phos)
Charcot’s Trial: fever, jaundice, RUQ pain
Reynauds pentad: add confusion, septic shock
Start Abx -> ERCP for biliary decompression/stenting and stone removal if needed

38
Q

Acute Pancreatitis

A

Elevated amylase/lipase, hypoperfusion of pancrease on CT=necrotizing pancreatitis -> IV hydration first - no Abx at first, ERCP only if gallstone

39
Q

Achalasia

A

Laproscopy myotomy

if NOT surgical candidate then Botox injection EGD

40
Q

Celiac Dz

A

IDA -> upper/lower scope neg -> repeat EGD with SBowel bx (even with TTG neg)

41
Q

Microscopic Colitis

A

chronic watery diarrhea - abn thickened mucosa in colon - can be caused by lansaprozole, NSAIDS, raniditine, setraline
withdraw meds then given mesalamine/budesondie

42
Q

Opioid Induced Constipation

A

Add methylnaltrexone (micro opiod antagonist)

43
Q

Refractory Hepatic Encephalopathy despite lactulose

A

Rifaxamine

44
Q

Chronic Mesenteric Ishemia

A

abd pain after eating in vasculopath -> Wt loss
Dx: Angiography (high lactate)
Tx: Angioplastic vs surgical revascularization

45
Q

Inadequate Bowel Prep Screening colonoscopy

A

Reprep bowel and screen again NOW

46
Q

Colonoscopy Polyp Surveillence

A

10 years - no polyps or only small rectal hyperplastic polyps
5 years - 1 or 2 small (<1cm)

47
Q

Hereditary nonpolyposis Colorectal CA syndrome

A

Colonoscopy age 20-25 or 10 years before youngest family member dx

48
Q

Non ETOH steatohepatitis

A

Serial LFT monitoring, weight loss, excercise, agressive control of glucose, lipids, BP
Continue Statin even if LFTs elevated

49
Q

SBP with hepatic and renal dysfxn

A

Cefotaxime AND albumin - don’t use diuretics or large volume paracentesis with renal failure

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