GI Flashcards
When is a colonoscopy typically performed after complicated diverticulitis?
About 6 weeks after the acute episode has resolved.
What are the suggested symptoms for the diagnosis of acute cholangitis?
Jaundice, fever, and tenderness in the right upper quadrant.
What is classified as transudative pleural fluid?
Pleural fluid LDH/serum LDH ratio ≤ 0.6.
What is classified as exudative pleural fluid?
Pleural fluid LDH/serum LDH ratio > 0.6.
What characterizes tropical sprue?
Diarrhea, weight loss, and malabsorption due to villous atrophy.
What are the cases where liver enzymes are typically in the 1000s?
Acetaminophen toxicity, Hepatitis A, and ischemic liver damage.
What treatments are included for severe hypertriglyceridemia?
Insulin and possibly plasmapheresis.
What is the diagnosis for a young man with palpable purpura, arthralgias, and abdominal pain after a streptococcal throat infection?
IgA vasculitis.
What should patients with a history suggestive of hereditary polyposis syndrome undergo?
Genetic testing and a colonoscopy.
Who should have twice yearly abdominal ultrasounds for hepatocellular carcinoma surveillance?
All patients with cirrhosis, Asian male HBV carriers over 40, Asian female HBV carriers over 50, any HBV carrier with a family history of hepatocellular carcinoma, and African/northern American black people with HBV infection.
What is the diagnosis of eosinophilic esophagitis?
Symptoms of esophageal dysfunction and esophageal biopsy.
What nutrients are typically missing in a vegan diet?
Calcium, vitamin D, B12, iron, and protein.
What is a vascular emergency?
Acute Mesenteric Ischemia.
What is the typical use of a Dobhoff tube?
Enteric feeding.
What is recommended for severe diverticulitis requiring IV antibiotics?
Broad-spectrum coverage with gram-negative and anaerobic coverage.
What is the first-line treatment for reflux esophagitis and Barrett’s esophagus without dysplasia?
PPI therapy for indefinite duration.
What is the appropriate treatment for a patient with MALT lymphoma and H. pylori?
Antibiotic therapy.
What cancers are associated with HNPCC?
Endometrial cancer, gastric cancers, biliary cancers, and gliomas.
What is IBS related to?
Changes in defecation, stooling frequency, and stool appearance.
What will FeNA be in liver failure?
FeNA will almost always be decreased due to pre-renal injury.
What is the diagnosis for a person with HIV who has a CD4 count of <50, chronic diarrhea, tenesmus, and colonic ulcers?
Cytomegalovirus.
What is the definition of IBS?
Recurrent abdominal pain during the past 6 months that has been present at least one day/week of the past three months.
What is the most common cause of isolated unconjugated hyperbilirubinemia in a healthy patient?
Gilbert syndrome.
What does niacin deficiency typically cause?
Diarrhea, dermatitis, dementia, and death.
What does biliary ductal dilation and gallstones in a patient with pancreatitis imply?
Diagnosis of acute biliary pancreatitis.
What should be done in biliary pancreatitis when stones are visualized on CT and there is evidence of acute cholangitis?
ERCP should be performed in 24 hours.
What are the two criteria of Barrett esophagus?
Columnar epithelium lining the distal esophagus and biopsy specimens must reveal intestinal metaplasia.
What is the most appropriate strategy for managing a small asymptomatic pancreatic pseudocyst?
Observation.
What must be ruled out before confirming IBS?
IBD, Giardia, and celiacs.
What is the MELD-Na score of less than 17 indicative of?
Less than 2% 90-day mortality rate.
What is the treatment for microscopic colitis?
Budesonide; many cases resolve from dietary restriction or avoidance of medications, but many need treatment.
What is the most common cause of isolated unconjugated hyperbilirubinemia in a healthy patient?
Gilbert syndrome
What are the typical symptoms of niacin deficiency?
Diarrhea, dermatitis, dementia, and death
What is bilirubin?
A heme degradation product
What does biliary ductal dilation and gallstones in a patient with pancreatitis imply?
Diagnosis of acute biliary pancreatitis
When should ERCP be performed in biliary pancreatitis?
Within 24 hours when stones are visualized on CT and there is evidence of acute cholangitis
What is the diagnosis in a young man with palpable purpura, arthralgias, and abdominal pain after a streptococcal throat infection?
IgA vasculitis
What is IBS related to?
Changes in defecation, stooling frequency, and stool appearance
What is classified as transudative pleural fluid?
Pleural fluid protein/serum protein ratio ≤ 0.5
What cancers are associated with FAP?
Colon cancer, thyroid cancer, hepatoblastoma, and medulloblastoma
What is classified as exudative pleural fluid?
Pleural fluid protein/serum protein ratio > 0.5
What is better for diagnosing inactive GI bleeds?
Video capsule endoscopy
What is the second-line treatment of eosinophilic esophagitis?
Aerosolized steroids
What are the endoscopic findings of eosinophilic esophagitis?
Circumferential mucosal lesions and longitudinal furrows
What does Gilbert syndrome result from?
Decreased expression of UDP glucuronyl transferase
What are the four most common causes of pancreatitis?
Gallstones, alcohol, ERCP, and triglyceridemia
What is a common associated feature of eosinophilic esophagitis?
Atopy, leading to hypersensitivity reactions such as allergic rhinitis, eczema, and asthma
What is the first-line treatment for reflux esophagitis and Barrett’s esophagus without dysplasia?
PPI therapy of indefinite duration
What are the criteria for MELD-Na Score?
Creatinine, bilirubin, INR, sodium, and dialysis at least 2x in the past week
What suggests a diagnosis of acute cholangitis?
Jaundice, fever, and tenderness in the right upper quadrant
What is associated with HNPCC?
Endometrial cancer, gastric cancers, biliary cancers, and gliomas
What can zinc deficiency cause?
Alopecia, night blindness, and hypogonadism
What is the diagnosis for a person with HIV who has a CD4 count of <50, chronic diarrhea, tenesmus, and colonic ulcers?
Cytomegalovirus
Who should have twice yearly abdominal ultrasounds for hepatocellular carcinoma surveillance?
All patients with cirrhosis, Asian male HBV carriers over 40, Asian female HBV carriers over 50, any HBV carrier with a family history of hepatocellular carcinoma, and African/northern American black people with HBV infection
What autoimmune markers increase when celiac disease patients eat gluten?
Endomysial antibody or TTG–IgA
What is the next diagnostic step for an older patient with signs of GI bleed but nonrevealing upper and lower endoscopy?
Video capsule endoscopy
What is the treatment for H. pylori?
PPI, bismuth subsalicylate, metronidazole, and tetracycline
What is the typical presentation of colonic ischemia?
Cramping abdominal pain and bloody diarrhea
What are the two criteria of Barrett’s esophagus?
Columnar epithelium lining the distal esophagus and biopsy specimens must reveal intestinal metaplasia
What is the most effective way to prepare a patient for colonoscopy?
Half preparation given the night before the procedure, after preparation given the morning of the procedure
What is the most appropriate diagnostic for suspected acute cholangitis?
Ultrasound of the RUQ
Does meningococcemia typically have GI manifestations?
No, it typically does not
What should patients with a strong family history of cancer and a personal history of duodenal adenoma undergo?
Genetic testing and a colonoscopy
What is the treatment for tropical sprue?
Oral tetracycline for 3 to 6 months
What are the typical nutrients missing in a vegan diet?
Calcium, vitamin D, B12, iron, and protein
What is the diagnosis for a patient with INR >1.5, hepatic encephalopathy, and symptomatic for less than 26 weeks without previous liver disease?
Acute liver failure
What is the recommended treatment for a patient with confirmed functional gallbladder disorder and a low gallbladder ejection fraction?
Cholecystectomy
Why is rifamixin beneficial in hepatic encephalopathy?
It is minimally absorbed and concentrated in the GI tract, killing enteric bacteria that produce ammonia
What is the secondary prevention of recurrent hepatic encephalopathy in a patient with cirrhosis?
Consistent treatment with lactulose and rifamixin
What is the most likely cause of portal hypertension in a patient with normal liver function who recently emigrated from North Africa?
Schistosomiasis
What is the association between microscopic colitis and other GI autoimmune diseases?
There is an association with celiac disease
What is the treatment for severe diverticulitis requiring IV antibiotics?
Broad-spectrum coverage with gram-negative and anaerobic coverage
What must be ruled out before confirming IBS?
IBD, Giardia, and celiac disease
What is the typical presentation of acute colonic pseudo-obstruction?
Conservative treatment includes use of nasogastric and rectal tubes
True or False: Meningococcemia typically does not have GI manifestations.
True
What is likely for a patient with a strong family history of cancer and a personal history of duodenal adenoma?
Hereditary polyposis syndrome
Who should have twice yearly abdominal ultrasounds as surveillance for hepatocellular carcinoma?
All patients with cirrhosis, Asian male HBV carriers over 40, Asian female HBV carriers over 50, any HBV carrier with a family history of hepatocellular carcinoma, and African/northern American black people with HBV infection
What does niacin deficiency typically cause?
Diarrhea, dermatitis, dementia, and death
What is a characteristic of a Dobhoff tube?
It has a weight at the end
True or False: Peripartum injury to the sphincter apparatus can lead to decades long fecal incontinence but with normal sensation.
True
Why is a colonoscopy not recommended in the acute setting of severe diverticulitis?
Due to the risk of perforation
What is the most useful initial diagnostic for a cirrhotic presenting with abdominal pain, ascites, low BP, and signs of AKI and UTI?
Diagnostic paracentesis
What type of drug is Neostigmine?
An acetylcholinesterase inhibitor
What is the next step in management for acute biliary pancreatitis with signs of acute cholangitis?
ERCP
What defines IBS?
Recurrent abdominal pain during the past 6 months that has been present at least one day/week of the past three months
True or False: Folate intake is typically adequate in a vegan diet.
True
What is the most indicated first step in imaging for suspected SBO?
CT
What happens during a KUB imaging?
The patient is typically on their back, and air rises to the surface of the abdomen, obstructing the view
What are the colonoscopy findings for 1-2 tubular adenomas <10mm?
Repeat in 7-10 years
What are the colonoscopy findings for 3-4 tubular adenomas <10mm?
Repeat in 3-5 years
What are the colonoscopy findings for 5-10 tubular adenomas <10mm?
Repeat in 3 years
What are the colonoscopy findings for >10mm villous/tubulovillous adenomas?
Repeat in 3 years
What is the follow-up for >10 adenomas?
Repeat in 1 year
What is the likely diagnosis for a patient with eosinophilic infiltrate in the small intestinal mucosa and chronic diarrhea?
Eosinophilic gastroenteritis
What is the treatment for eosinophilic gastroenteritis?
Systemic steroids
What is the diagnosis for a person with HIV who has a CD4 count of <50, chronic diarrhea, and colonic ulcers?
Cytomegalovirus
Where can AST be found?
In liver, bone, and heart tissue
What are the two criteria of Barrett esophagus?
Columnar epithelium lining the distal esophagus and biopsy specimens must reveal intestinal metaplasia
What cancers are associated with HNPCC?
Endometrial cancer, gastric cancers, biliary cancers, and gliomas
