GI Flashcards
Most effective study for evaluating suspected oropharyngeal dysphagia
Videofluoroscopy (aka modified barium swallow)
Diagnosis: solid-food dysphagia that occurs episodically for months to years
Esophageal web or distal esophageal ring (Schatzki ring)
Preferred screening test when achalasia is suspected clinically
Barium swallow
Confirmatory test for achalasia
Esophageal manometry
First-line therapies for achalasia (2)
Laparoscopic myotomy of the LES or endoscopic pneumatic dilatation
First-line therapy for the extraesophageal manifestations of GERD
PPIs
Use of this class of drugs is associated with infectious esophagitis in otherwise healthy patients
Inhaled corticosteroids
Characteristic symptom of infectious esophagitis
Odynophagia
Most common cause of infectious esophagitis
Candida albicans
followed by CMV and HSV
Esophageal condition that presents with extreme dysphagia and food impaction
Eosinophilic esophagitis
Treatment for esophageal candidiasis
Fluconazole or itraconazole
Treatment for HSV esophagitis
Oral acyclovir or famciclovir
give IV if patient cannot swallow
Treatment for HSV esophagitis unresponsive to acyclovir or famciclovir
IV foscarnet
Treatment for CMV esophagitis
Ganciclovir or foscarnet
Age at which patients with nonulcer dyspepsia require investigation with upper endoscopy
> 55 years
Recommended management for patients 55 years old or less with nonulcer dyspepsia and negative H. pylori testing.
Empiric PPI for 4-6 weeks
Best way to diagnose PUD
Upper endoscopy
Aside from a PPI, this drug may be given to patients at high risk for developing NSAID-induced PUD but needs NSAID treatment
Misoprostol
Initial treatment of gastric outlet obstruction in PUD
Nasogastric suction and IV PPI
Diagnosis: abdominal pain, bloating, difficulty belching after fundoplication surgery
Gas-bloat syndrome
Tx: diet modification
Diagnosis: loose stools and malabsorption after gastric bypass
Blind loop syndrome
Tx: antibiotics and nutritional supplements
Diagnosis: abdominal cramps, nausea, loose stools 15 minutes after eating followed within 90 minutes by lightheadedness, diaphoresis, tachycardia; post-gastric resection or bypass surgery
Dumping syndrome
Tx: small frequent feedings, low-carb meals
Initial study in patients with acute symptoms of gastroparesis
Upper endoscopy
Imaging test for chronic symptoms of gastroparesis or acute symptoms with negative upper endoscopy
Nuclear medicine solid-phase gastric emptying study
Treatment for acute gastroparesis
IV erythromycin
Treatment for chronic gastroparesis
Metoclopramide
Serious complication of metoclopramide therapy
Tardive dyskinesia
Diagnostic tests for celiac disease (2)
IgA anti-tissue transglutaminase or IgA anti-endomysial antibody assay
Diagnostic tests for celiac disease in patients with IgA deficiency (3)
IgG anti-tissue transglutaminase, IgG antiendomysial antibodies, IgG antigliadin antibodies
Definitive diagnosis for celiac disease requires either of these 2
Small bowel biopsy or presence of dermatitis herpetiformis
Common endocrine conditions in patients with celiac disease (2)
Type 1 diabetes mellitus and autoimmune thyroid disease
Malignancy with increased incidence in celiac disease
Small bowel lymphoma
Pruritic papulovesicular rash on the extensor surfaces seen in patients with celiac disease
Dermatitis herpetiformis
Treatment of celiac disease or dermatitis
Gluten-free diet
Most common reason for failure of a gluten-free diet in celiac disease
Nonadherence
Tests to assss effectiveness of diet therapy in patients with celiac disease
IgA antigliadin or IgA anti-tissue transglutaminase antibody
Diagnosis: chronic diarrhea/malabsorption with history of IBS and iron deficiency anemia
Celiac disease
Diagnosis: chronic diarrhea/malabsorption with chronic pancreatitis, hyperglycemia, hx of panc resection, cystic fibrosis
Pancreatic insufficiency
Tx: pancreatic enzyme replacement
Diagnosis: chronic diarrhea/malabsorption with previous surgery, small bowel diverticulosis, dysmotility
Bacterial overgrowth (Tx: empiric trial of antibiotics or do hydrogen breath test)
Diagnosis: chronic diarrhea/malabsorption after resection of >200 cm distal small bowel
Short-bowel syndrome
Tx: replace nutrient and electrolyte deficiencies
Diagnosis: resection of <100 cm distal ileum, now with nonfatty diarrhea
Short-bowel syndrome with bile acid enteropathy
Tx: empiric trial of cholestyramine
Diagnosis: chronic diarrhea/malabsorption with arthralgia, fever, neurologic, ocular, or cardiac disease
Whipple disease
Dx: small bowel biopsy and PCR; tx: antibiotics for 12 months
Diagnosis: chronic diarrhea/malabsorption with hx of travel to India or Puerto Rico, weight loss, malaise, folate or vit B12 def, steatorrhea
Tropical sprue
Dx: small bowel biopsy; tx: sulfonamide or tetracycline and folic acid
Diagnosis: prolonged traveler’s diarrhea, diarrhea after a camping trip, or outbreak in a day-care center
Giardiasis
Dx: identify parasites or antigen in stool; tx: metronidazole
Drug contraindicated in cases of ileal resection >100 cm because it will worsen bile salt deficiency and steatorrhea
Cholestyramine
Most common complication of acute pancreatitis
Pancreatic pseudocysts
Preferred route of nutrition for moderate to severe pancreatitis
Enteral jejunal feedings
Most sensitive imaging study for chronic pancreatitis
Abdominal CT
Young adults with chronic pancreatitis require genetic testing for this condition
Cystic fibrosis
Diagnosis: hypergammaglobulinemia (IgG4), diffuse pancreatic enlargement and/or a mass lesion, irregular main pancreatic duct
Autoimmune pancreatitis
Cornerstone of treatment for autoimmune pancreatitis
Corticosteroids
Most common cause of upper abdominal pain among patients aged >50 years
Biliary pain
Treatment for biliary colic that can decrease the risk of progression to acute cholecystitis
NSAIDs
Contraindications to the use of interferon alfa in chronic hepatitis B (4)
Decompensated cirrhosis, active autoimmune disorders, severe cytopenias, major depression
Endocrine disorder seen in 10% of patients taking interferon alfa
Hypothyroidism
Most prevalent bloodborne infection in the US
Hepatitis C
Standard treatment for chronic hepatitis C genotypes 2, 3, and 4
Pegylated interferon alfa plus ribavirin
Treatment for hepatitis C genotype 1
Protease inhibitor (boceprevir or telaprevir) in combination with interferon alfa plus ribavirin
HFE gene testing for hemochromatosis is indicated when the fasting serum transferrin saturation is at this level
> 45%
Destructive arthropathy of the 2nd and 3rd MCP joints characterized by distinctive hook-like osteophytes are seen in this disorder
Hemochromatosis
Indications for liver biopsy in hemochromatosis (2)
(1) Confirmed hemochromatosis and abnormal liver enzymes to determine severity of liver disease, (2) negative HFE genotype but elevated serum transferrin saturation and serum ferritin level >1000 ng/mL to establish diagnosis
HFE genotypes diagnostic of hemochromatosis
Homozygous C282Y or compound heterozygous C282Y/H63D
Treatment of choice for hemochromatosis
Phlebotomy
Target serum ferritin in the treatment of hemochromatosis
<50 ng/mL
Type of anti-LKM antibodies in autoimmune hepatitis
Anti-LKM1
also seen in hepatitis C
Diagnostic triad of primary biliary cirrhosis
(1) Cholestatic liver profile, (2) positive antimitochondrial antibody, (3) compatible histologic findings on liver biopsy
Primary therapeutic agent for primary biliary cirrhosis
Ursodeoxycholic acid
Most common type of IBD associated with primary sclerosing cholangitis
Ulcerative colitis
Initial diagnostic study for primary sclerosing cholangitis
Abdominal ultrasonography
Malignancies that should be screened annually in patients with primary sclerosing cholangitis (2)
Hepatocellular carcinoma and colon cancer
No recommendations regarding cholangiocarcinoma or gallbladder cancer but incidence is also increased in PSC
Organisms associated with AIDS cholangiopathy (2)
CMV and Cryptosporidium infection
Treatment for pruritus in primary sclerosing cholangitis
Cholestyramine
Criteria used to define severe alcoholic hepatitis (4)
Any one of the ff: (1) Maddrey Discriminant Function 32 or >, (2) MELD score 18 or >, (3) Glasgow Alcoholic Hepatitis Score 9 or >, (4) encephalopathy or ascites
Medications associated with the development of NASH (4)
Tamoxifen, estrogen, amiodarone, corticosteroids
Most common cause of acute liver failure
Acetaminophen overdose
Cause of outbreaks of acute liver failure associated with foods such as raspberries and scallions
Acute HAV infection
Presence of these findings is suggestive of acute fatty liver of pregnancy rather than HELLP syndrome (2)
Hypoglycemia and encephalopathy
Treatment for acute liver failure in Wilson disease
D-penicillamine or trientine
Treatment for elevated intracranial pressure in acute liver failure
Mannitol
Do not use corticosteroids
Diagnostic test for hepatopulmonary syndrome
Contrast-enhanced transthoracic echocardiography with agitated saline administration
Urine sodium concentration in hepatorenal syndrome
<10 meq/L (10 mmol/L)
First choice treatment for primary prophylaxis of variceal bleeding
Propranolol or nadolol
Second choice: endoscopic band ligation
First choice treatment for acute variceal bleeding
Octreotide with endoscopic band ligation and prophylactic antibiotics
(Second choice: TIPS or shunt surgery)
In cirrhosis, treatment for ascites not responding to low-sodium diet
Spironolactone with or without furosemide
Volume of paracentesis that requires albumin administration
> 5 L
Treatment for spontaneous bacterial peritonitis
Cefotaxime and albumin
Primary complication of TIPS
Portosystemic encephalopathy
Most common cause of jaundice during the first and second trimester of pregnancy
Viral hepatitis
Treatment of choice for intrahepatic cholestasis of pregnancy
Ursodeoxycholic acid
Symptom duration in the definition of irritable bowel syndrome
3 months
Patients with IBS and diarrhea should be evaluated for this disorder
Celiac disease
First-line treatments for pain in IBS
Antispasmodic agents (dicyclomine, hyoscyamine)
This drug should not be used to treat IBS because of the risk of ischemic colitis
Alosetron
Least common inflammatory bowel disease
Microscopic colitis
Prominent symptom in ulcerative colitis (compared with Crohn disease)
Diarrhea
Prominent symptom in Crohn disease (compared with ulcerative colitis)
Abdominal pain
IBD that is alleviated by smoking
Ulcerative colitis
Smoking is a risk factor for Crohn disease
Barium enema is contraindicated in moderate to severe ulcerative colitis because this procedure may precipitate this complication
Toxic megacolon
Condition that must be considered in a patient with Crohn disease and cystitis
Enterovesical fistula
Frequency of bowel movements in mild ulcerative colitis
<4 per day
With occasional blood in stool, normal VS, Hgb, ESR
Treatment for mild ulcerative colitis
5-ASA agents (mesalamine or sulfasalazine)
Treatment for moderate UC
Induction with prednisone, maintenance with 5-ASA or 6-MP or azathioprine
Frequency of bowel movements in severe UC
> 6 per day
With bleeding, fever, PR >90/min, ESR >30 mm/h, anemia
Treatment for severe UC
IV corticosteroids ff. by cyclosporine or infliximab if no response; surgery if refractory
Treatment for mild to moderate CD involving the small or large bowel
5-ASA
Treatment for mild to moderate CD involving the ileum or right colon
Budesonide
Treatment for fistula in Crohn disease
Infliximab or adalimumab
Drug with best documented efficacy in microscopic colitis
Budesonide
Drugs which may contribute to symptoms of microscopic colitis
NSAIDs
Disease duration of IBD at which surveillance colonoscopy is needed
8 years
Done every 1-2 years
Rate of recurrence of acute diverticulitis
30%
Risk of subsequent attacks after a second episode of acute diverticulitis
50%
Surgical resection of affected colon is indicated
Most common cause of acute mesenteric ischemia
Emboli
Inotropic drug which can cause ischemic colitis
Digitalis
Intra-arterial thrombolysis may be done for acute mesenteric ischemia without peritoneal signs if initiated within this time after onset
12 hours
Etiologic agent: foodborne diarrhea 6 hours after ingestion
Staphylococcus aureus or Bacillus cereus
Etiologic agent: foodborne diarrhea 8-14 hours after ingestion
Clostridium perfringens
Etiologic agent: foodborne diarrhea >14 h after ingestion
Virus, ETEC, EHEC
Bacterial cause of colitis that can mimic appendicitis or Crohn disease
Yersinia enterocolitica
Loperamide and diphenoxylate are contraindicated in EHEC colitis due to this possible complication
HUS
Loperamide and diphenoxylate are contraindicated in C. difficile infection due to this possible complication
Toxic megacolon
Most common illness to affect visitors to developing countries
Traveler’s diarrhea
Most common causative agent of traveler’s diarrhea
ETEC
Causative agent of shipboard epidemics of viral gastroenteritis
Caliciviruses (e.g., Norwalk virus)
Most common cause of acute care hospital-acquired diarrhea
Clostridium difficile
Treatment for pregnant patients with C. difficile antibiotic-associated diarrhea
Oral vancomycin
Use of antimotility agents in CDAD is associated with this complication and is therefore contraindicated
Toxic megacolon
Drug of choice for amebic colitis and amebic liver abscess
Metronidazole
Chronic diarrhea is defined as lasting longer than this duration
4 weeks
Fecal osmotic gap in secretory diarrhea
<50 mosm/kg
Formula for fecal osmotic gap
290 - 2 x (Stool Na + Stool K)
Fecal osmotic gap in osmotic diarrhea
> 125 mosm/kg
Stool osmolarity in factitious diarrhea due to chronic laxative abuse
<250 mosm/kg
Most common cause of osmotic diarrhea
Lactase deficiency
Diagnosis: chronic diarrhea, coexistent pulmonary diseases, and/or recurrent Giardia infection
Common variable immunodeficiency
Test of choice following negative repeat upper endoscopy/colonoscopy in patients with obscure bleeding
Wireless capsule endoscopy