GI 4

Question 1

What is the mainstay of TRX for chronic pancreatitis?

Answer 1

1. STOP Etoh/Smoking
2. frequent small meals
3. Pancreatic Enzymes.

Question 2

In patients whom you suspect have a vaticeal bleed and are awaiting EGD…what medication do you want to give?

Answer 2

IV OCTREOTIDE –> Decreased portal venous pressure.

Question 3

For a Cirrhotic patient with portal HTN, what medication reduces risk of bleed?

Answer 3

Non-specific BB (NADALOL, PROPRANOLOL)

Question 4

ASTHMA only at night…you shoudl consider what dx?

Answer 4

GERD.

Question 5

Peritonitis from perforation of a hallow viscus organ should be suspected if patient has SUDDEN-onset and pain + tenderness + guarding….

How do you dx?

TRX>

Answer 5

DX = Upright CXR shows pneumoperitoneum.

TRX = Emergent Surgery.

Question 6

You suspect PUD perforation…how do you DX and TRX?

Answer 6

DX = Upright CXR

TRX = IVF + Broad spec ABX + IV PPI + emergent surgery

Question 7

What are the 3 scenarios where you would see an ISOLATED Anti-HBc?

Answer 7

1. WINDOW PERIOD (when HBsAg and HbEAg falls, but body did not have enough time to mount Anti-HBs Abs yet)
2. Years after recovery (once anti-HBs Ab has waned off)
3. Years of Chronic infection (when HBsAg has fallen to undetectable amounts)

Question 8

When you see an elevated ISOLATED total Anti-HBc Ab…what test can you order to differentiate between cases?

Answer 8

Anti-HBc IgM ( if positive then in window)

Also, repeat all HBV serology and get LFTs (should be elevated in window period bc acute infection)

Question 9

What is the preferred route of hydration in SEVERELY MALNUTRITION?

Answer 9

ORAL,

AVOID IVF bc can heart failure (but may need if shock/severe hypovolemia)

Question 10

Functional Gastro Esophageal Reflux is considered normal in babies “spitting up” and is considered normal up to what age?

What is the management?

Answer 10

2 yo.

Management = thickening formula with cereal.

Question 11

Gall bladder calcifications or “Porcelain gall bladder” can be caused by chronic cholelithiasis. The diagnosis is usually incidental..

What is the difference in management between:

1. PUNCTATE calcifications?
2. CURVILINEAR calcifications?

Answer 11

1. PUNCTATE = Prophylactic cholecystectomy bc increased risk of cancer
2. CURVILINEAR = No increased risk of cancer, so don’t need to do cholecystectomy UNLESS biliary colic present.

Question 12

Long term Chronic PPI use is associated with what adverse side effects?

Answer 12

1. Osteoperosis/Hip fracture
2. Increased C. diff
3. HypoMg
4. Iron def
5. B12 def.

Question 13

Angiodysplasia are vascular malformations in the GI tract, that commonly are the cause of occult bleeds.

In what age group do you classically see Angiodysplasia in?

What is the classic appearance on colonoscopy?

Answer 13

Elderly

Colonoscopy= cherry red, flat, lesion.

Question 14

Higher rates of bleeding is seen in Angiodysplasia when these three conditions present/comorbid?

Answer 14

1. ESRD
2. vWD
3. Aortic Stenosis

Question 15

What is the standard calorie and protein parenteral feed rate for an adult?

Answer 15

30 kcal/kg/day
+
1 gm/kg of protein/day