GI

Question 0

What are the criteria for diagnosis of irritable bowel syndrome?

Answer 0

At least three days of abdominal pain per month for at least three months, a change in the frequency of stool, improvement with defecation. IBS can be diagnosed by history and physical examination and routine lab testing as long as there are no warning signs.

Question 1

How do you diagnose celiac sprue?

Answer 1

Serum IGA tissue transglutaminase (TTG)antibodies are highly sensitive and specific for celiac sprue. A small bowel biopsy showing villous atrophy is the gold standard for diagnosis.

Question 2

What are the warning signs that would warrant further investigation beyond routine in a patient with possible irritable bowel syndrome?

Answer 2

Rectal bleeding, anemia, weight loss, fever, a family history of colon cancer, onset of symptoms after age 50, and a major change in symptoms.

Question 3

Describe the features of and treatment for achalasia.

Answer 3

Involves the absence of peristaltic progression. Clinically it involves dysphagia of solids and liquids and increased risk of squamous cell carcinoma. Diagnosed by barium swallow or manometry. It is treated with long-acting nitrates, calcium channel blockers, pneumatic dilatation of the lower esophageal sphincter,.

Question 4

Describe the features of and treatment for diffuse esophageal spasm.

Answer 4

It is a spastic motor disorder. Symptoms involve heartburn, chest pain or dysphagia which are often swallow induced. CAD should always be excluded. It is diagnosed with a barium swallow. Treatments include long-acting nitrates and calcium channel blockers.

Question 5

What are the features of and management of scleroderma esophagus?

Answer 5

90% of patients with scleroderma have esophageal involvement. There may be no symptoms or there may be severe reflux, often with strictures or other motility abnormalities. It is diagnosed by barium swallow and manometry. It is treated with management of the reflux with H2-blockers and PPI’s and with prokinetic drugs.

Question 6

Who should be screened for Barrett’s esophagus?

Answer 6

Patients who have heartburn symptoms for greater than five years or patients who need medication for heart burn symptoms for greater than five years. It may be reasonable to screen patients with multiple risk factors for Barrett’s esophagitis. These include male sex, Caucasian, age over 50, hiatal hernia, increasing BMI, and abdominal fat distribution.

Question 7

What are the possible treatments for H. pylori infection?

Answer 7

B.i.d. for 7 to 14 days:
PPI, amoxicillin 1 g, clarithromycin 500 mg

All QID with PPI b.i.d. for 7 to 14 days:
Bismuth 525 mg, metronidazole 500 mg, tetracycline 500 mg

All b.i.d. for 14 days. These are rescue for prior treatments:
PPI, amoxicillin one gm metronidazole 500 mg

Also a rescue treatment:
PPI b.i.d. and amoxicillin TID for 14 days

PPI, levofloxacin 250 to 500 mg, amoxicillin 1 g

PPI, rifabutin 150 mg, amoxicillin 1 g

Question 8

What is the treatment including duration for gastric versus duodenal ulcers?

Answer 8

A PPI or an H2 blocker, usually 4 to 6 weeks for duodenal ulcer and 12 weeks for a gastric ulcer. PPI’s lead to faster healing than H2-blockers.

Question 9

What happens when a patient with GERD is treated for H. pylori infection?

Answer 9

The GERD may become worse because H pylori has a suppressive effect on acid secretion.

Question 10

What drives are useful for inducing or maintaining my mission in patients with Crohn’s disease?

Answer 10

Budesonide is effective in inducing but not maintaining remission. Corticosteroids are more effective than placebo and 5-ASA products in inducing remission. Azathioprine and 6-MP are effective in inducing remission in patients with active disease. Methotrexate is i effective in inducing and maintaining remission.

Question 11

What is the most common cause of infectious diarrhea in United States?

Answer 11

Rotavirus

Question 12

What is the most common cause of bloody diarrhea in the United States?

Answer 12

Shigella

Question 13

What is the treatment for Campylobacter diarrhea?

Answer 13

It is usually supportive care. It may be treated with erythromycin if it is culture proven. There is emerging fluoroquinolone resistance.

Question 14

What is the treatment for E histolytica diarrhea?

Answer 14

Metronidazole

Question 15

What is the most common antibiotic associated with pseudomembranous enterocolitis?

Answer 15

Amoxicillin

Question 16

What is the treatment for pseudomembranous enterocolitis?

Answer 16

Stop the offending antibiotic. Use metronidazole or vancomycin. (There is no reported resistance to either one.). Replace fluids.

The treatment in the elderly is vancomycin if there are two or more of the following factors: age greater than 60, albumen less than 2.5 or WBC greater than 15,000.

Question 17

What is the most common cause of foodborne disease in the US?

Answer 17

Salmonella

Question 18

What antibiotics are indicated for the treatment of E. coli 0157: H7?

Answer 18

None

Question 19

What are the CDC recommendations for prophylaxis for travelers diarrhea?

Answer 19

None is indicated. Prophylactic antibiotics may actually increase the risk of complications from travelers diarrhea.

Question 20

What is the best way to diagnosed diverticulitis?

Answer 20

CT is the preferred method. Endoscopy and barium enema should be avoided because they cause diverticular perforations. A CBC will show leukocytosis with a left shift. Urinalysis may sometimes reveal white and red blood cells, and plain films will sometimes show free air. Ultrasound sometimes will show an abscess.

Question 21

Are the top three types of cancers of the small intestine?

Answer 21

Adenocarcinoma is the most common, followed by lymphoma and carcinoid.

Question 22

What are the treatments for irritable bowel syndrome?

Answer 22

Education and reassurance with validation of the patient’s symptoms. Patients should be counseled that it’s a chronic disease and they should be helped to establish realistic expectations.

Dietary modifications including: elimination of specific foods that cause problems; exclusion of gas producing foods such as beans onions celery carrots raisins bananas apricots prunes brussels sprouts wheat germ pretzels and bagels as well as alcohol and caffeine; or changing to a diet low in fermentable oligo-, di-, and monosaccharides, and polyols (low FODMAP diet), A trial of both lactose avoidance and gluten avoidance maybe attempted. Increased soluble fiber consumption may possibly slightly decrease symptoms of constipation.

Increased exercise.

If the above measures are not successful in controlling symptoms then pharmacological treatment can be instituted. For IBS with constipation, first-line treatment would be polyethylene glycol or PEG. If PEG is unsuccessful, Luboprostone or linaclotide.

For IBS with diarrhea, first-line treatment would be loperamide. Second line treatment includes bile acid sequestrants such as cholestyramine, colestipol and colesevelam. If all other measures have failed a trial of alosetron can be attempted. However be aware that this can only be prescribed under restricted conditions at a relatively low starting dose due to its previous withdrawal for side effects of ischemic colitis and complications of severe constipation.

Question 23

What findings upon examination of paracentesis fluid support the diagnosis of spontaneous bacterial peritonitis?

Answer 23

A neutrophil count of greater than 250 per milliliter his diagnostic. A pH of 7.2 supports the diagnosis but is a relatively late finding. Protein levels are usually less than 1 g/dL.

Question 24

Are antibiotics indicated for pancreatitis, and if so which?

Answer 24

intravenous antibiotics, especially imipenem, have been shown to be beneficial in patients with pancreatitis.