GI 2

Question 1

management of BRBPR

Answer 1

less than age 40, anoscopy
40-50 sig or colonoscopy
above 50 OR alarm signs, colonoscopy

alarm signs:
change in bowel habits
abd pain
weight loss
IDA
fam hx colon CA

Question 2

ALT greater than 150

Answer 2

biliary pancreatitis

Question 3

dx of acute pancreatitis

Answer 3

at least 2 of 3

• acute severe epigastric pain radiating to back
• elev amylase or lipase greater than 3 times nl
• imaging

Question 4

triple bubble sign

& risk factors

Answer 4

jejunal atresia

mom: vasoconstrictive drugs, cocaine, smoking

Question 5

indications for draining pancreatic pseudocyst

Answer 5

lasts longer than 6 weeks
larger than 5 cm
becomes secondarily infected

Question 6

sphincter of oddi has high pressures, which show sphincter of oddi dysfunction. next step?

Answer 6

ERCP with sphincterotomy

Question 7

all patients with cirrhosis should get what test

Answer 7

endoscopy (to r/o esophageal varices, because it’s the #1 cause of death in cirrhosis patients)

ultrasound every 6 months to evaluate for liver masses

Question 8

D-xylose test shows decreased amounts in urine :( not normal!

Answer 8

proximal small intestine disease (celiac)

Question 9

HELLP liver manifestations

Answer 9

centrilobular necrosis
hematoma formation
thrombi in portal capillary system

all lead to distention of liver capsule

Question 10

eggshell calcifications in liver

Answer 10

hydatid cyst from Echinococcus

Question 11

worse prognoses for polyp

Answer 11

villous adenoma
sessile adenoma
greater than 2.5 cm

Question 12

diagnosed AFP. next step?

Answer 12

proctocolectomy at time of diagnosis

Question 13

emphysematous cholecystitis vs gallstone ileus

Answer 13

emphysematous cholecystitis: GB wall infection from gas producing organism; causes decreased or absent bowel sounds
gallstone ileus: hyperactive bowel sounds

Question 14

sxs of VIPoma

Answer 14

watery diarrhea
hypokalemia (muscle weakness)
achlorhydria
flushing
N/V
pancreatic tail tumor

Question 15

sxs of carcinoid

Answer 15

flushing
diarrhea
bronchospasm
tumor in small intestine usually

Question 16

liver path of Reye syndrome (ASA)

Answer 16

microvesicular fatty infiltration / steatosis

Question 17

liver path: cirrhosis and periportal eosinophilic inclusion bodies

Answer 17

alpha 1 antitrypsin deficiency

Question 18

liver: macrovesicular fatty infiltration

Answer 18

alcoholic hepatitis

NAFLD

Question 19

endoscopy / biopsy of stomach positive for adenocarcinoma. next step? and management?

Answer 19

CT for staging
if low stage, resect
if high stage, chemo, maybe palliative surgery

Question 20

liver: Mallory bodies

Answer 20

alcohol

Wilsons disease

Question 21

liver: PAS positive

Answer 21

alpha 1 antitrypsin deficiency

Question 22

causes of gastric outlet obstruction

Answer 22

gastric CA
PUD
crohns disease
stricture with pyloric stenosis from caustic ingestion
bezoar

Question 23

colon CA screen for IBD

Answer 23

start 8 yrs after dx
ever 1-2 yrs
if find dysplasia, do prophylactic colectomy

Question 24

colon CA screen for FAP

Answer 24

start age 10-12

every year

Question 25

colon CA screen for HNPCC

Answer 25

start age 20-25

every 1-2 yrs

Question 26

only meds that work for crippler najjar, type 1 and 2

Answer 26

1: phenobarbital
2: phenobarbital or clofibrate

Question 27

labs of Reye syndrome

Answer 27

incr ALT, AST, bilirubin, Alk Phos, ammonia, PT, LDH

Question 28

definition of fulminant hepatic failure and management

Answer 28

hepatic encephalopathy that develops within 8 weeks of onset of acute liver failure

liver transplant

Question 29

hepatic hydrothorax

• sxs
• management

Answer 29

right sided transudative pleural effusion

salt restriction and diuretics
TIPS or liver transplant

Question 30

variceal hemorrhage… transfuse if Hb

Answer 30

less than 9

Question 31

initial management of variceal bleed

Answer 31

IVF
octreotide
ATBs

beta blocker if stopped
balloon tamponade if didn’t, then TIPS