Gastroenterology & Hepatology

Question 1

What is the mnemonic for cirrhosis complications?

Answer 1

A-SITE

(Ascites, Splenomegaly, Increased INR, Thrombocytopenia, Encephalopathy)

Question 1

How is cirrhosis evaluated?

(lab findings and imaging orders)

Answer 1

Labs: ↓ Albumin, ↑ INR, ↑ bilirubin, thrombocytopenia
Imaging: liver ultrasound, elastography

Question 2

What is the treatment for cirrhosis?

Answer 2

Treat underlying cause
1. antivirals for hepatitis
2. lactulose for encephalopathy (add rifaximin if needed)
3. beta-blockers for varices

(Rifaximin kills ammonia producing bacteria)

Question 3

How are esophageal varices treated?

Answer 3

acute = octreotide and EGD banding
prevention = propranolol

Question 4

HCC screening (2) for all cirrhotic patients and those with Hep B.

(cirrhosis is the #1risk factor)

Answer 4

1. abdominal U/S q. 6 mo.
2. alpha-fetoprotein marker (AFP)

(if u/s +, → Get a contrast-enhanced CT or MRI!)

Question 5

What screening must be done for ALL patients with Hepatitis B?

Answer 5

HCC screening (u/s q. 6 mo and AFP marker)

(If Hep B + family history of HCC → Screen at age 40 for men, 50 for women. If Hep B + African descent → Screen at any age)

Question 6

GOLD standard for cirrhosis dx

Answer 6

bx

Question 7

What are the 5 metabolic causes of cirrhosis?

Answer 7

1. Hemochromatosis
2. Wilson’s
3. Alpha-1 antitrypsin
4. PBC
5. PSC

(there is also alcohol, NAFLD, and viral causes)

Question 8

Alarm symptoms for GERD (requires endoscopy)

Answer 8

Dysphagia
Odynophagia
Weight loss
GI Bleeding (melena, hematemesis)

Question 9

tx of Barrett’s esophagius (w/o dysplasia vs. w/dysplasia)

Answer 9

PPI + endoscopy q. 3-5 yrs.
PPIs + endoscopy q. 6-12 mo.

(If dysplasia is present = ablate!)

Question 10

2 MCC of upper GI bleed

Answer 10

1. PUD (MC)
2. Varices

Question 11

2 MCC of lower GI bleed

Answer 11

1. diverticulosis (over 50 y/o)
2. IBD (young adults)

Question 12

GI Bleed: management (6)

(ER setting)

Answer 12

1. Always Start with ABCs & Resuscitation!
2. IV Fluids (2 large bore IVs)
3. Type & Cross + Blood Transfusion if Hb < 7
4. IV PPI if upper GI bleed suspected
5. Octreotide if variceal bleeding
6. Endoscopy or Colonoscopy for diagnosis

(Resuscitate FIRST → Then scope! If unstable → Intubate before endoscopy!)

Question 13

If patient has an active GI bleed & hemodynamically unstable → next step?

Answer 13

Skip scope, go straight to CTA or embolization.

Question 14

patient presents with hematochezia + postprandial abdominal pain → dx?

Answer 14

ischemic colitis

Question 15

cirrhotic patient with hematemesis & hypotension → next step in management?

Answer 15

Start Octreotide before EGD!

Question 16

variceal bleeding tx (4)

Answer 16

1. Octreotide → Reduces portal pressure
2. IV PPI → If unclear if varices vs. PUD
3. EGD for band ligation
4. TIPS (Transjugular Intrahepatic Portosystemic Shunt) if refractory bleeding

Question 17

diagnostic criteria for acute pancreatitis

(need 2/3)

Answer 17

1. severe epigastric pain (radiating to back)
2. ↑ Lipase or Amylase (>3x normal)
3. Imaging findings (only if uncertain)

(You do NOT need imaging to diagnose if clinical + labs are clear)

Question 18

signs of severe pancreatitis

Answer 18

shock
ARDS
necrosis

(admit to ICU)

Question 19

pancreatits complications (2)

Answer 19

1. necrosis (CT scan)
2. pseudocyst (drain if symptomatic