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ABIM > GI 1 > Flashcards

GI 1 Flashcards

1
Q

Oropharyngeal Dysphagia of undigested food and halitosis, gurlging.

Best initial test?
Dx?
Rx?

A

Barium Esophagram/Swallow

Zenker diverticulum

Treatment is surgery

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2
Q

Name the most likely cause of this type of dysphagia:

  1. Dysphagia to Solids and Liquids from the START?
  2. Intermittent SOLID foods ONLY
  3. PROGRESSIVE Solids THEN Liquids?
A
  1. Motility Achalasia/DES/Neurologic (Stroke, ALS, MS)
  2. Schatzki ring
  3. Cancer/Stricture
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3
Q

First test in any patient with dysphagia?

A

EGD to rule out cancer, then Barium Swallow.

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4
Q

Tumors that involve the Neuronal Plexus and cause dysphagia. It presents in older patients with significant weightloss.

A

Pseudoachalaisia

Caused by invading cancer (pancreatic, lung, breast, liver)

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5
Q

Diagnostic test for Achalasia? (1,2,3)

Treatment?

Treatment for high-risk surgical candidates (severe cardiac co-morbidities?

A
  1. Barium Swallow
  2. Manometry confirms
  3. Upper endoscopy (r/o pseudo achalasia) - do not order first if achalasia is suspected

Laproscopic surgical Myotomy of LES and endoscopic pneumatic dilation

High risk botulinum toxin injection

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6
Q

Simultaneous uncoordinated, non peristaltic contractions, dysphagia to solids and liquids (especially cold), pt present with atypical chest pain.

Dx?
Test?
Rx?

A

DES (diffuse esophageal spasm)

Barium swallow may be normal or may show “corkscrew pattern” .

Manometry

EGD

Diltiazem

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7
Q

Rx for Schatzki Ring (steakhouse syndrome) and peptic stricture caused by prolonged GERD?

A

Dilation and PPI

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8
Q

Post-menopausal women, associated with iron deficiency anemia?

A

Plummer-Vinson Syndrome

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9
Q

Pt with PPI Twice Daily and Normal EGD still has reflux symptoms associated with cough.

Next step?

A

Ambulatory PH monitoring.

Extrasophageal manifestation of GERD (Globus, hoarseness, cough)

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10
Q

Rx for young patient (hx of food allergies, asthma, eczema with eosinophilic esophagitis (eosinophils on biopsy of esophagus) with refractory dysphagia despite fluticasone therapy (swallowed aerosolized steroid) and stricture on endoscopy?

A

Endoscopy with Dilation

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11
Q

Dysphagia in a person whole traveled to South America?

Dx?
Complication?

A

Chagas disease (heart dz, dysphagia) - Dilated Cardiomyopathy.

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12
Q

Rx of Barrett’s with Low Grade Dysplasia?

Who may benefit from screening?

A
  1. Endoscopic Ablation
  2. Optimize medical therapy increase PPI to BID Repeat endoscopy

Men age > 50 with GERD > 5 year.

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13
Q

Pt presenting with Postprandial Fullness, Epigastric pain and Burning. They were on PPI therapy for 4 weeks. Upper endoscopy with negative biopsies, H. pylori test negative.

Dx?

Next step?

A

Functional dyspepsia

Initiate tricyclic antidepressant

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14
Q

What should be considered in an older patient with new diagnosis of acute pancreatitis and no underlying cause found?

A

Pancreatic neoplasm

Do CT abd w/ Contrast

Especially if they present with 6 months of weight loss

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15
Q
  1. Triple therapy for H. pylori ?
  2. Quadruple therapy for H. pylori?
A
  1. Clarithromycin, Amox (can replace with Metronidazole for PCN Allergy,) PPI
  2. PPI,Bismuth, Metronidazole, textracycline
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16
Q

What type of nutrition is preferred in patients with acute pancreatitis?

A

Enteral nutrition (maintains healthy gut mucosa to prevent translocation of bacteria)

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17
Q
  1. Rx of H. pylori and complicated duodenal ulcer?
  2. Rx of H. pylori and gastric ulcer?
  3. Rx of NSAID and ulcer?
  4. When is surgery indicated?
A
  1. Up to 8 weeks PPI
  2. Up to 12 weeks PPI (treat longer with gastric ulcer if cant stop NSAID then PPI definitely)
  3. PPI up to 8 weeks
  4. Perforation (free air under abdomen), bleeding, refractory
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18
Q

Multiple Ulcers in GI system Dx?

What are the common lab findings?
Next step after labs?
What is commonly associated with it?
Rx?

A

ZE syndrome (Gastrinoma)

Gastrin level > 1000 and PH < 4

Next do an Endoscopic US or Somatostatin Receptor Scintigraphy, CT or MRI to localize

Associated with MEN1

Surgery

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19
Q

Acanthos nigrans and abdominal pain?

A

Gastric cancer

20
Q
  1. Test for all patients with acute pancreatitis?
  2. When to do CT or ERCP?
  3. Management of asymptomatic patients with walled off necrosis s/p acute pancreatitis?
  4. if the patient has worsening fever, pain with pancreatic necrosis?
A
  1. RUQ to r/o gall stone pancreatitis, lipase level
  2. do not need CT- only if severeERCP if there is biliary obstruction or ascending cholangitis (Rx with abx).
  3. Observation. No rx if they are asymptomatic
  4. Surgical resection
21
Q

What should you r/o in young patient with chronic pancreatitis?

A

CF

22
Q

Narrow main pancreatic duct, parenchymal swelling (sausage-shaped pancreas) on imaging and elevated IgG4 levels ?

A

Type 1 autoimmune pancreatitis

Type 2 has normal IgG4 levels

23
Q

What additional test should be done for pt with FAP diagnosis ?

A

EGD for duodenal cancer

Done at diagnosis or by age 25 whichever comes first

Need to screen for periampullary and duodenal adenomas and adenocarcinoma.

24
Q

Management of high risk cystic pancreatitic lesions such as intraductal papillary mucinous neoplasm that involve the main duct ( CT scan shoes diffusely dilated main pancreatic duct with normal intra and extrahepatic bile ducts and a normal gallbladder, no tumor seen on pancreas)?

A

Surgical resection

25
Q

Name the cause of Chronic Diarrhea:

  1. Bloating, abdominal pain, relieve with bowel movement ?
  2. Watery Diarrhea mainly in old women using NSAID, PPI, normal colonoscopy?
  3. Use of artificial sweeteners, dairy products?
  4. Nocturnal diarrhea, bloating, flatulence, weight loss, gastric bypass surgery?
  5. Somatic , psychiatric
  6. Secretary diarrhea, flushing?
A
  1. IBS, r/o celiac
  2. Microscopic Colitis, stop NSAID/PPI, do biopsy
  3. Carbohydrate intolerance, lactose intolerance, hydrogen breath test
  4. Small bowel bacterial overgrowth
  5. Laxative abuse
  6. Carcinoid syndrome , obtain 24 hr urinary 5-HIAA
26
Q
  1. What is the Stool Osmol Gap Equation?
  2. What does it mean when Gap > 100
  3. < 50 ?
  4. What if stool osmolality < 250 ?
A
  1. 290- (2 x [Na+K])
  2. GAP > 100= Osmotic diarrhea, stops with fasting, no nocturnal symptoms (lactose) - elevated osmols
  3. Osmal Gap < 50=Secretory diarrhea - large volume stool unchanged with fasting/nocturnal diarrhea (Celiac)
  4. Laxative abuse ( Dilute Stool Adding water to stool, not much osmols)
27
Q

Chronic diarrhea and Malabsorption syndromes:

  1. Chronic pancreatitis, hyperglycemia, CF?
  2. Previous surgery, dysmotility, blind loops, strictures, small bowel diverticulosis?
  3. Resection of > 200cm of distal small bowel
  4. Hx of resection of distal ileum < 100cm, with voluminous diarrhea, weight-loss, malnutrition?
  5. Arthralgia, fevers, neuro, ocular and cardiac disease?
  6. Travel to India or PR, malabsorption, weight loss, malaise, steatorrhea, anemia?
  7. Watery diarrhea > 4 weeks, camping , lakes, children?
A
  1. Pancreatic insufficiency, obtain test for fecal fat, enzyme replacement
  2. SIBO
  3. Short bowel syndrome, replace nutrients
  4. Short bowel syndrome with Bile Acid Enteropathy, rx with empiric Cholestyramine
  5. Whipple disease, Bowel Biopsy and PCR for Tropheryma whippelii
  6. Tropical sprue, abx
  7. Giardiasis, metronidazole
28
Q
  1. Women presenting with Weight-loss, Loose Stool, Diarrhea, Abdominal pain, Bloating hx of type 1 DM.
  2. Dx?
  3. Test?

Rx?

Complication?

  1. Diagnosis if a patient presents with Vitiligo and Hypothyroidism as well as Iron deficiency Anemia and Elevated LFTs?
A
  1. Celiac Dz (Secretory diarrhea.)

2.Check IgA trans Glutaminase and bowel biopsy to confirm
If IgA deficient then check Anti-gliadin

Rx: Gluten free diet.
Rx to Prevent Small Bowel Lymphoma

  1. Celiac Disease
29
Q

Pt presenting with predominant abdominal pain, diarrhea, Linear stellate, serpiginous ulcerations with skip areas of inflammation, involving full GI tract, branched distorted crypts, does not have to involve rectum. Dx?

A

Crohn Disease

30
Q

Pt presents with predominantly diarrhea, abdominal pain, mucosal edema, erythema, loss of vascular pattern, granularity, friability, ulceration, altered crypt architecture with short, branch crypts and crypt abscess. Rectum always involved.

  1. Dx?
  2. Rx for Mild-Moderate Dz?
  3. Rx for Moderate to severe Dz?
A
  1. UC
  2. Steroid and Start Mesalamine
  3. Azathioprine , 6-mercaptopurine, Anti-TNF
31
Q

This is Increasing abdominal pain with Increasing Doses of Opioids?

A

Narcotic bowel syndrome

32
Q

Pt with hx of CAD Postprandial Abdominal Pain, Sitophobia (fear of eating), and Weight loss.

Dx?
Test?
Rx?

A

Chronic Mesenteric Ischemia

CT or MR angiogram

Endovascular Stenting and Surgical Revascularization

33
Q
  1. Sudden onset of LLQ abdominal pain, with hematochezia in Age > 60, Patients DO NOT appear severly ILL.

Dx?

Next step in management

What confirms?

Treatment?

A
  1. Colonic Ischemia (lack of blood flow to watershed areas.) - Common with Hemodialysis.
  2. CT to check for extent of Necrotic Bowel

3.Colonoscopy with Biopsy to Confirm the Diagnosis of Colonic Ischemia.

Most cases are mild and resolve on its own

34
Q

Older patient with Neurological Dz presents with passage of explosive, loose, watery stool, pt unable to get to bathroom on time.

Dx?
Test?
Rx?

A

Fecal loading (over flow stool).

AXR

Avoidance of triggers, reverse the cause, (diarrhea, constipation, medications) physical activity, pelvic floor muscle training with physical therapist, anal plugs.

35
Q

When to get screening:

  1. First degree relative with Adenomatous Polyps or Cancer < 60?
  2. Two second degree relative diagnosed with adenomatous Polyps or Colon Cancer at any age?
  3. HPNPCC (Lynch)
  4. FAP?
  5. Panncolitis (UC or Crohns)
A
  1. Age 40 or 10 years younger then age dx, screen every 5
  2. Age 40 or 10 years younger then age dx, screen every 5
  3. Age 20 or 25 or 10 years earlier than age of dx, Screen Every 1-2 yrs
  4. Age 10-12 years then screen every 1- 2 years
  5. 8 years after initial diagnosis, screening every 1-2 years
36
Q

Pt presents with Persistently Elevated Lipase, Abdominal fullness and Early Satiety after have an Episode of pancreatitis. It is common in patients with hx of Chronic Pancreatitis.

  1. Dx?
  2. Management?
  3. What if complicated or Patient is Symptomatic?
A
  1. Pancreatic Psuedocyst (Different Management from Necrotizing Pancreatitis)
  2. Most resolved without intervention if Asymptomatic
  3. Drain
37
Q

Pt presents with Upper Abdominal Discomfort, Bloating, Anorexia, Scleral Icterus, 17lb Weight Loss in 2 months, Hx of Active Smoking.
US shows dilated Intrahepatic and Extrahepatic ducts.

Next step in Management?

A

CT scan of Abdomen to evaluate for Pancreatic Cancer

Depending on findings of CT, ERCP,MRCP are done after

38
Q

Pt with possible Hepatocellular Carcinoma, (Persistent abdominal discomfort and failed Hep C treatment 6 years ago, has small fluid wave present.)

US shows nodule with poorly defined borders

Next step in management?

A

MRI

39
Q

What is the management of Dyspepsia?

A
  1. Eliminate NSAIDS, Alcohol
  2. Typical GERD then treat PPI
  3. NO GERD then asses Age
  4. Age >60 Endoscopy
  5. Age <60 H pylori testing, if negative PPI trial
40
Q

Pt presents with Epigastric pain and Vomiting. He has low grade fever and epigastric tenderness. CXR shows Pneumomediastinum and Left Sided pleural Effusion.

Dx?

Test?

A

Spontaneous Esophageal Rupture (Boerhaven Syndrome).

CT or Contrast Esophagography (Esophogram)

41
Q

Name 3 Non-pancreatic causes of Lipase elevation?

A

Renal insufficiency

DKA

Intestinal Obstruction

42
Q

Next step management for a patient with Barrett’s Esophagus and HIGH GRADE dysplasia?

A

Endoscopic Eradication Therapy

43
Q

What is the First study that needs to be done before diagnosing someone with Gastroparesis?

A

EGD (need to exclude Mechanical or Mucosal etiologies)

44
Q

HIV Patient presents with Pain with Solids and Liquids .
CD4 count is 90.
He has poor follow up.
IV drug abuse.
He has no oral lesions on exam.

Next Step in management?

A

EGD with Biopsy and Culture to ensure correct diagnosis since he is not presenting with Classic Candidal Esophagitis.

45
Q
  1. Esophagitis that invovles the Entire Esophagus, Pain with Solids MORE than Liquids. EGD Shows White Exudate. DX? Rx?
  2. Odynophagia and Substernal CHEST PAIN. EGD Shows SHARP DEMARCATED ULCERS. Associated with Retinitis as well. INTRANUCLEAR INCLUSIONS biopsy DX? Rx?
  3. Odynophagia and Substernal Chest Pain. Dx? Rx? with ORAL LESIONS. ABRUPT ONSET.
A
  1. Candida Esophagitits. Flucanazole
  2. Cytomegalovirus. IV Gangciclovir
  3. Herpes Simple. Acyclovir
46
Q

What 2 factors can cause a False Negative H. Pyori Biopsy?

A

PPI and Active GI bleeding during Endoscopy.

ABIM (45 decks)

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