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Gastroenterology II Flashcards

1
Q

What is appropriate mgmt of esophageal cancer?

A

Resection followed by 5-fluorouracil chemotherapy

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2
Q

With regard to what complication is variceal banding superior to sclerosing agents for the treatment of esophageal varices?

A

Sclerosing agents are associated with the formation of strictures

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3
Q

What are two presenting components of Plummer-Vinson Syndrome? What is it associated with developing? What is tx?

A

Proximal strictures and IDA
Squamous Cell Carcinoma
Iron replacement

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4
Q

How does Schatzki’s ring present? What is tx?

A

Distal ring of esophagus presenting with intermittent dysphagia
Tx: pneumatic dilation

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5
Q

Mgmt of peptic strictures

A

Pneumatic dilation

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6
Q

What is cause of Zenker’s diverticulum?
Best initial test?
Tx?

A

Dilation of posterior pharyngeal constrictor muscles
Barium swallow
Surgical resection

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7
Q

What is the most accurate test for diagnosing diffuse esophageal spasm? What is seen on Barium studies?
What is tx?

A

Manometry
Barium will show corkscrew appearance only during an episode
Tx: CCBs and nitrates

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8
Q

Your patient with hx of HIV (CD4 99) presents with pain on swallowing and progressive dysphagia. What/do do you diagnose? What is tx?

A

Oral Candidiasis is common in HIV patients with CD4

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9
Q

What are common causes of pill-induced esophagitis?

A

Doxycycline and bisphosphonates

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10
Q

If a patient presents with odynophagia due to esophagitis how should it be appropriately managed?

A

If CD4 > 100 then proceed to endoscopy. If

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11
Q

If a case of Mallory-Weiss tear continues to bleed what can be provided to tamponade it?

A

Epinephrine

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12
Q

What are the alarm symptoms warranting endoscopy for evaluation of GERD?

A

Anemia
Dysphagia
Weight loss
Blood in stool

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13
Q

If a patient has GERD unresponsive to PPIs what is the next treatment step?

A

Procedure (surgical or endoscopic) to reconstrict the lower esophageal sphincter and narrow the distal esophagus (e.g. Nissen fundoplication or endoscopic suturing). It is rare to need surgery.

  • Make sure esophageal motility is good before doing this.
  • If symptoms are blatantly from GERD then H. pylori treatment isn’t truly necessary.
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14
Q

Where is squamous cell carcinoma vs adenocarcinoma in the esophagus?

A

Squamous cell carcinoma is upper esophagus

Adenocarcinoma is lower esophagus

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15
Q

When is endoscopy warranted to evaluate for Barret’s esophagus?

A

Patients with GERD and alarm symptoms (e.g. weight loss anemia, dysphagia, blood in stool) and in patients with GERD for 5-10 years

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16
Q

Endoscopy finds Barret’s esophagus. What is long-term mgmt?

A

PPI and repeat endoscopy every 2-3 years

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17
Q

Endoscopy finds low-grade dysplasia of esophagus. What is long-term management?

A

PPI and repeat endoscopy every 3-6 months

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18
Q

Endoscopy finds high-grade dysplasia of esophagus. What is management?

A

Endoscopic mucosal resection
Ablative removal
Distal esophagectomy

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19
Q

57 yo patient presents with epigastric pain for the last several weeks. Besides ruling out other diseases with labs what is the next step in mgmt?

A

Endoscopy for all patients >55yo with epigastric discomfort symptoms to rule out gastric cancer

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20
Q

Most common cause of epigastric discomfort

A

Non-ulcer dyspepsia

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21
Q

What is the most common cause of peptic ulcers?

A

H. pylori

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22
Q

What is the most accurate test for gastritis?

A

Endoscopy with biopsy

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23
Q

What is tx of H. pylori infection?

A

PPI, clarithromycin, amoxicillin

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24
Q

If a patient has failed attempt at treating H. pylori infection with standard triple therapy then what may be used next?

A

PPI, metronidazole, tetracycline

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25
If both triple therapy regimens fail for managing H. pylori infection then what should be evaluated for next?
Zollinger-Ellison Syndrome
26
When should stress ulcer prophylaxis be used? (Hint: 4 scenarios)
Burns Head trauma Intubation and mechanical ventilation Coagulopathy and steroid use
27
How should you manage patients with no signs of gastritis or PUD on endoscopy but are seropositive for H. pylori?
PPI
28
When should you consider testing gastrin levels and gastric acid output?
Large ulcers (>1cm) Multiple ulcers Ulcers distal near ligament of Treitz Recurrent/persistent ulcers despite H. pylori
29
What are the most accurate tests for diagnosing/localizing Zollinger-Ellison Syndrome?
``` Endoscopic ultrasound Nuclear somatostatin scan Secretin suppresion (most accurate test but may not help with localizing much) ```
30
Patient has elevated gastrin levels. What does this suggest?
More likely they are on a PPI or H2 blocker. ZE syndrome is consideration however
31
What happens in secretin test in patients with ZE syndrome?
No change in gastrin secretion or gastric acid output
32
What is treatment of ZES?
Local disease: surgical resection | Metastatic disease: lifelong PPI
33
What are appropriate tests for making diagnosis of CD or UC?
Endoscopy primarily Barium enema also can help give dx Blood tests can be used if the above aren't helpful
34
ASCA positive IBD is ....
Crohn's Disease
35
What are adverse effects of sulfasalazine?
Hemolytic anemia Rash Interstitial nephritis
36
What are treatments for inflammatory bowel disease?
1) Mesalamine 2) Budesonide 3) Sulfasalazine (not first line due to adverse effects) 4) Azathiprine, 6-mercaptopurine for those which aren't responding well to steroids 5) Infliximab most helpful for CD with associated fistula formation 6) Metronidazole and ciprofloxacin helpful for CD with perianal involvement 7) Surgery can be helpful, especially in UC
37
What is the natural reservoir for Yersinia? How is it transmitted?
Rodents are natural reservoir | Transmitted via food; often meats, produce, and dairy
38
What is the best initial test for an infectious diarrhea? What is most accurate test?
Initial: Fecal leukocytes Accurate: Stool culture
39
If you had to pick one antibiotic which is generally good for managing infectious diarrhea what would you choose?
Ciprofloxacin or other fluoroquinolone
40
Besides 3-stool ova and parasite exam what is a sensitive and specific test for the detection of Giardia?
ELISA antigen
41
Tx of Giardia
Metronidazole
42
How is bacilus cereus managed?
Will pass on its own
43
Tx of Cryptosporidiosis
Nitazoxanide
44
How do you manage lactose intolerance?
Diagnosis and treatment is to remove all dairy products from diet except yogurt
45
Tx Carcinoid syndrome
Octreotide
46
Dx of Carcinoid Syndrome
Urinary 5-HIAA
47
What are signs of malabsorption diarrhea which may come from failure to observe certain vitamins and minerals?
Easy bruising and elevated INR Calcium oxalate stones Hypocalcemia B12 malabsorption and thus anemia
48
Best initial test for malabsorption? | Most accurate?
Initial: Sudan stain for fat Accurate: 72hr fecal fat
49
Best initial test for Celiac disease | Most accurate
Initial: antigliadin, anti tissue transglutaminase, antiendomysial Accurate: small bowel biopsy
50
If antibodies are positive in Celiac disease do you have to do a small bowel biopsy?
Yes. You need to rule out a bowel wall lymphoma
51
Most accurate test for tropical sprue? | Tx?
Accurate: micro-organisms in small bowel biopsy Tx: doxycycline or TMP-SMX
52
Tx of Whipple Disease
Tetracycline or TMP-SMX for 1 year
53
What is the most accurate test to diagnose chronic pancreatitis?
Secretin stimulation test (bc pancreatic function will be diminished)
54
What are appropriate therapies for irritable bowel syndrome?
Fiber Antispasmodics/anticholinergics (dicyclomine, hyoscyamine) TCA (e.g. amitryptiline)
55
Is a hyperplastic polyp benign or malignant? | Dysplastic?
Hyperplastic: Benign Dysplastic: Malignant
56
Any extra screening for Peutz-Jeghers?
No
57
Extra screening in juvenille polyposis?
No
58
You find a dysplastic polyp and remove it in your patient. When should his next colonoscopy be performed?
In 3-5 years
59
What is the most accurate test for diverticulosis?
Barium enema
60
Tx diverticulosis?
High fiber diet
61
What diagnostic tests are contraindicated in diverticulitis?
Colonoscopy and barium enema
62
What is the best diagnostic test for diverticulitis? | Tx?
CT Abdomen | Metronidazole and Ciprofloxacin (need anaerobic and gram negative coverage)

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