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GI 2 Flashcards

1
Q

Management of aspirin following endoscopy for bleeding ulcer and treatment of ulcer

A

Resume within 1 to 7 days + start PPI

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2
Q

Vaccines contraindicated for immunocompromised patients

A

live attenuated –

1) **Varicella
2) yellow fever
- live attenuated zoster
- MMR
- BCG

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3
Q

Diagnostic criteria for eosinophilic esophagitis

A

1) dysphagia
2) esophageal biopsies showing 15 eosinophils per high powered field
3) exclusion of other causes of esophageal eosinophilic

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4
Q

NASH diagnosis

A

Elevated liver chemistries + negative workup for other causes + evidence of metabolic syndrome + characteristic abdominal imaging

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5
Q

Screening threshold for hemochromatosis

A

Transferrin saturation greater than 45%

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6
Q

PBC clinical features

A
  • middle aged woman

- pruritus, fatigue

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7
Q

PBC lab features

A
  • elevated ALP
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8
Q

Workup of PBC appearing patient with negative anti-mitochondrial antibody

A

sp100 and gp210 antibodies

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9
Q

Antibody positive in PBC

A

Antimitochondrial antibody

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10
Q

Treatment of mild to moderate left-sided ulcerative colitis

A

Combined mesalamine therapy (oral and topical)

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11
Q

Distribution categories of ulcerative colitis

A
  • proctitis (rectal involvement only)
  • left sided colitis (doesn’t extend beyond the splenic flexure)
  • pan colitis (extends above splenic flexure)
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12
Q

Treatment of moderate to severe flares of IBD

A

oral and IV steroids

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13
Q

Presentation of Hep B-related polyarteritis nodosa

A

Fever, arthralgia, cutaneous vasculitis (looks like cryoglobulinemia) + evidence of active hep b

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14
Q

First step in evaluation of dyspepsia

A
  • test for h pylori (can’t start PPI without testing for h pylori first)
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15
Q

Management of achalasia

A

IF low surgical risk – endoscopic pneumatic dilation
IF high surgical risk – botox injections
*medical therapy is third line

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16
Q

Specificity of crypt abscesses and colonic crypts

A
  • nonspecific, found in both Crohn’s and UC
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17
Q

Indications for HBV treatment

A

1) Elevated aminotransferase levels
2) all cirrhotics
3) undergoing treatment with certain immunosuppressive or chemo regimens

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18
Q

When patients with HBV need HCC screening

A
  • Southeast Asians patients at age 40
  • Patients from sub-saharan Africa at age 20
  • persistently elevated liver enzymes
  • FH of HCC
  • Patients with above indications need screening even absent
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19
Q

First step in management of suspected overflow fecal incontinence

A

KUB

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20
Q

Cause of GI bleed following aortic graft surgery

A

Aortoenteric fistula (communication between aorta and GI tract

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21
Q

Workup of suspected aortoenteric fistula

A

CT with contrast

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22
Q

Autoimmune hepatitis diagnosis

A
  • required biopsy

- can’t diagnose base on anti-smooth muscle antibody test

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23
Q

Indications for 5 year follow-up after c-scope

A
  • 2 or fewer adenomas (or sessile serrated polyps)

- 1st degree relative with CRC diagnosed at an age younger than 60

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24
Q

Indications for 3 year follow-up after c-scope

A
  • 3 or more adenomas
  • 1 adenoma larger than 10 mm
  • adenoma with any degree of villous or high-grade dysplasia
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25
Q

Management of chronic constipation unresponsive to first line treatment

A

linaclotide

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26
Q

Indications for prophylactic abx in cirrhotics with ascites

A

High risk of SBP:

  • very low ascitic fluid protein levels (less than 1.5g/dl)
  • advanced liver failure
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27
Q

Syndrome that presents similarly to celiac’s

A
  • medication-induced enteropathy
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28
Q

Med that is common culprit of medication-induced enteropathy

A

Olmesartan

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29
Q

When CRC screening needs to be performed in patient with family member with CRC

A
  • Age 40 or 10 years earlier than the youngest age
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30
Q

High risk categories for CRC

A
  • first degree relative with colon cancer diagnosed younger than 60
  • 2 or more relatives with CRC at any age
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31
Q

Repeat interval if initial c-scope normal in high risk individual

A

5 years if first-degree relative younger than 60

- 10 years otherwise

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32
Q

Evaluation of persistent GERD + why

A
  • ambulatory pH testing (extra esophageal symptoms like cough/asthma/globus/hoarseness can be due to laryngopharyngeal reflux so need to exclude this)
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33
Q

Treatment of amebic liver abscess

A

Metronidazole + paromomycin

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34
Q

Microscopic colitis diagnosis

A
  • colonoscopy with random biopsies from multiple segments
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35
Q

Microscopic colitis clinical features + biopsy findings

A
  • chronic, watery diarrhea in an old person + abdominal pain + weight loss + arthralgias
  • biopsy = lymphocyte-predominant mononuclear lymphocytic infiltrates + focal cryptitis
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36
Q

SIBO clinical features

A
  • malabsorption symptoms bloating, flatulance, weight loss
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37
Q

SIBO vs. microscopic colitis

A

microscopic colitis = isolated watery diarrhea

SIBO = malabsorption syndromes

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38
Q

other reasons to treat HBV

A
  • pregnant with viral load over 200k
  • acute liver failure
  • nephropathy, PAN, or cryoglobulinemia
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39
Q

Go to for HBV treatment

A

Tenofovir or entecavir

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40
Q

management of chronic hep c

A
  • evaluate for fibrosis/cirrhosis
  • treat
  • confirm cure at 12 weeks post treatment by checking RNA level
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41
Q

treatment of acute liver failure

A
  • NAC (regardless of etiology)

- transplant

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42
Q

other workup of PBC

A

monitor for autoimmune thyroid disease

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43
Q

Next step after diagnosis of PSC

A

colonoscopy

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44
Q

Chronic management of PSC

A

serial US + CA19-9

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45
Q

Portal HTN etiologies

A

1) intrinsic liver disease

2) cardiac

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46
Q

Cutoff for SAAG indicating portal HTN

A

Greater than 1.1

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47
Q

Etiologies of SAAG less than 1.1

A
  • malignancy
  • nephrotic syndrome
  • TB
48
Q

management of HE

A
  • avoid sedating medications
  • lactulose
  • rifaximin if no resolution with lactulose
49
Q

US frequency for HCC screening in cirrhotics

A

q6 months

50
Q

oropharyngeal dysphagia clinical features

A

coughing, choking with swallowing, aspiration

51
Q

esophageal dysphagia

A

goes down okay then gets stuck

52
Q

pills that cause odynophagia

A

doxy
ferrous sulfate
potassium

53
Q

Management of esophageal dysphagia if EGD WNL

A

Manometry

54
Q

Corkscrew on esophagram

A

Nutcracker or jackhammer esophagus

55
Q

when to perform EGD with dyspepsia (alarm symptoms)

A
  • weight loss
  • IDA, melena
  • dysphagia
  • persistent vomiting
56
Q

Management of dyspepsia if no improvement with PPI

A

TCA

57
Q

Diagnosis of dumping syndrome

A

Oral glucose challenge test

58
Q

dumping syndrome treatment

A

small frequent meals

59
Q

next step after CT of pancreatic cancer

A

EUS

60
Q

Initial management of pancreatic cyst

A

EUS (for characterization) with FNA

61
Q

feature of osmotic diarrhea

A

worse after eating

62
Q

feature of secretory diarrhea

A

occurs despite fasting

63
Q

walking up at night with diarrhea?

A

inflammatory or secretory

64
Q

celiac diagnosis

A
  • serology now sufficient (Don’t need endoscopy anymore)
65
Q

Celiac patients are at risk for what else (in addition to IDA)?

A
  • GI lymphoma + microscopic colitis
66
Q

Treatment of microscopic colitis

A
  • antidiarrheals (loperamide)
  • review meds, stop NSAIDS, PPI, and SSRI
    IF refractory – budesonide
67
Q

what to do before starting azathioprine or 6-mercaptopurine

A
  • check TPMT (enzyme deficiency of which will cause toxicity)
  • monitor for leukopenia and T cell lymphoma
68
Q

C-scope interval for IBD patients

A

8 years after diagnosis then annually

69
Q

Chronic maintenance for IBD patients

A

1) smoking cessation (higher risk of CRC)
2) annual PAP (higher risk for cervical cancer)
3) c-scopes
4) increased risk for osteoporosis

70
Q

Lynch syndrome management

A

1) c-scope at 20 then annually
2) egd at 30 then q2 years
3) hysterectomy and salphingo oophorectomy at 40

71
Q

When to start EGD screening for FAP patients

A

age 25

72
Q

choledocholithiasis clinical features

A

abnormal LFTs + RUQ pain

73
Q

choledocholithiasis other management

A

cholecystectomy before discharge

74
Q

PPI management of clots

A

IF high risk stigmata (clot visible vessel, red spot) – need high dose PPI for 72 hours

75
Q

initial test of choice in LGIB patient with unstable bleed

A

CTA (without prep or if bleeding, won’t be able to see anything with scope)

76
Q

SAAG calculation

A

Serum albumin - ascites albumin

77
Q

Indications for SBP ppx

A

1) cirrhosis + GI bleed
2) hx of SBP
3) hypoalbuminemia (ascitic fluid protein less than 1.5 g/L)
* should not be used for all cirrhotic patients because indiscriminate use is associated with abx resistance.

78
Q

Triple therapy for HP

A
  • clarithromycin
  • amoxicillin
  • PPI
79
Q

Quadruple therapy for HP

A
  • bismuth
  • flagyl
  • tetracyline
  • PPI
80
Q

dieulafoy lesion clinical features

A
  • located in proximal stomach near esophagogastric junction
81
Q

hep b and incidence of chronic hep b after acute infection

A
  • few people develop chronic hep B but 90% of newborns develop chronic hep b
82
Q

Hep B serology with acute infection

A 
HBsAg -- +
Anti-HBs -- -
Anti-HBc -- + (IgM)
HBeAg -- +
Anti-HBe -- -
*Only IgM to anti-HBc is positive among immunoglobulins, anti-HBs antibody only exists when immunized or infection resolves
83
Q

Hep B serology with inactive chronic hep b

A 
HBsAg -- +
Anti-HBs -- -
Anti-HBc -- + (IgG)
HBeAg -- -
Anti-HBe -- +
84
Q

Hep B serology with immune active chronic hep b

A 
HBsAg -- +
Anti-HBs -- -
Anti-HBc -- + (IgG)
HBeAg -- +
Anti-HBe -- -
85
Q

Other indications for treating hep B

A
  • pregnancy with viral load over 200K

- nephropathy, PAN, or cyroglobulinemia

86
Q

Treatment of hep B

A

Tenofovir
or
Entecavir

87
Q

Alcoholic hepatitis management

A

1) Calculate Maddrey Discriminant Function score

2) If steroids started, calculate Lille score at 7 days to determine response to treatment

88
Q

When to start steroids for alcoholic hepatitis

A

Maddrey discriminant function score greater than 32

89
Q

Management of NAFLD and NASH

A

Treat underlying HTN, HLD, and DM2

90
Q

Sequelae of PSC

A

Increased risk for cholangiocarcinoma and gallbladder cancer

91
Q

maintenance management of PSC

A

q6 month Ca 19-9 and US or MRCP

92
Q

portal HTN from SAAG differential

A

Cardiac disease or cirrhosis

93
Q

Interval for HCC screening in cirrhosis

A

q6 months

94
Q

Treatment of nutcracker esophagus

A

CCB or PDEi

95
Q

Corkscrew on esophagram think

A

nutcracker or jackhammer esophagus

96
Q

Treatment of functional dyspepsia if in improvement with PPI

A

TCA

97
Q

Complications of gastric surgery

A

1) Dumping syndrome

2) Increased risk for malignancy in gastric remnant

98
Q

Diagnosis of gastric dumping syndrome

A

Oral glucose challenge test

99
Q

Next step after CT or MRI suggesting pancreatic cancer

A
  • endoscopic US to determine extent and obtain tissue diagnosis
100
Q

Biomarkers of pancreatic cysts

A

high amylase = pseudocyst

high CEA = mucinous cyst

101
Q

Diagnosis of malabsorptive diarrhea in chronic diarrhea

A

72hr fecal fat

102
Q

Management of suspected choledocholithiasis if US is negative

A

MRCP

103
Q

Evidence for PPI’s with UGIB

A

Decreases likelihood of high-risk stigmata at endoscopy, but haven’t been shown to change outcomes

104
Q

Next step after lesion noted on capsule endoscopy in the small bowel

A

balloon enteroscopy

105
Q

Boerhaave syndrome clinical features

A

Violent retching that leads to transmural usually distal esophageal wall rupture with pneumomediastinum

106
Q

Boerhaave syndrome treatment

A

surgical emergency

107
Q

PSC treatment

A

IF stricture –> tenting
IF recurrent cholangitis –> long term abx
IF advanced liver disease –> transplant

108
Q

How to differentiate cardiac from liver ascites on SAAG

A

IF total protein greater than 2.5 – cardiac
IF less than 2.5 – liver
*basically low total protein = cirrhosis

109
Q

What is nutcracker esophagus? treatment?

A
  • motility abnormality of esophagus
  • thus diagnosed by esophageal motility study
  • treatment = CCB’s
110
Q

Screening modality for HCC in cirrhosis

A
  • US q6months + AFP or US q6 months

* Never AFP alone

111
Q

UC vs. Crohn’s in terms of location and clinical features

A
  • UC = confined to colon. UC can occur anywhere in GI tract

- clinical features = fistulas and perianal disease more common in Crohn’s

112
Q

Pathologic features differentiating UC from Crohn’s

A

Crohn’s = transmural mucosal inflammation, fissures and skip lesions, granulomas

113
Q

management of persistent microscopic colitis

A

budesonide

114
Q

initial management of microscopic colitis

A
  • discontinue triggers (smoking, meds – NSAIDS, PPIs, SSRIs, ranitidine)
  • antidiarrheal meds
115
Q

Treatment of moderate to severe IBS

A

TCA’s (amitryptiline)

116
Q

Basic presentation of IBS

A

chronic abdominal pain + altered bowel habits

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