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GI Flashcards

1
Q

What drugs cause medication induced esophagitis?

A

Abx (tetracyc), Antiinflammatory (NSAID/aspirin), Bisphosphonates, iron/KCL

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2
Q

Tx. esophageal perforation?

A

ABx and supportive care with surgical repair for significant leakage or systemic inflammatory response.

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3
Q

Diagnosis/Tx of zenker?

A

Diagnosis-barium swallow/manometry, Tx-open/endoscopic surgery or cricopharyngeal myotomy

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4
Q

Best initial/most accurate Diagnosis of esophageal cancer and treatment?

A

Best initial: Barium swallow?
Most accurate: Endoscopy w/ biopsy, CT (PET/CT) for staging
Treatment: Resection and chemo/radiation

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5
Q

Diagnosis/Tx of esophageal spasm?

A

Diagnosis-most accurate-manometry (intermittent peristalsis or mutiple simultaneous contractions) or best initial-esophagram (corkscrew)
Tx-Ca2+ channel blocker (1), nitrates (additional)

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6
Q

Best initial/most accurate for Diagnosis/Management achalasia?

A

Diagnosis: most accurate-Manometry (increased LES and decreased peristalsis in distal esophagus), best initial-esophagram (“bird beak” at GE Junction)
Management: Upper endoscopy to rule out malignancy. Lap myotomy or pneumatic balloon dilation or botulinum toxin injection, nitrates or CCB

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7
Q

Presentation acute gastritis and cause?

A

Hematemesis and abdominal pain secondary to acid penetrating lamina propria and injury to vasculature.

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8
Q

Gastric outlet obstruction presentation, findings, diagnosis and management?

A

> 3 hours retained gastric material. “succussion splash” on physical exam with stethoscope over upper abdomen and rocking, endoscopy, and NG suction stomach/IV hydration.

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9
Q

Management acute diverticulitis?

A

Bowel rest, abx (eg cipro, metro)

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10
Q

Angiodysplasia most common location?

A

Right colon

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11
Q

Management for minimal bright red blood per rectum (hematochezia) for various categories: 50 or red flags?

A

50-colonscopy

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12
Q

Biopsy presentation celiac disease?

A

Lymphocyte intraepithelial and flattened villi

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13
Q

Laxative abuse biopsy?

A

Dark brown discoloration of colon with lymph follicles shining through as pale patches (melanosis coli)

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14
Q

Cause and tx of porcelain gallbladder?

A

Cause-chronic cholecystitis with tx is cholecystectomy

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15
Q

Management of gallstones w/o symp, w/typical biliary colic, or complicated (cholecystitis, choledocholithiasis, gallstone pancreatitis)

A

No symp-no tx
Biliary colic-elective lap chole or ursodeoxycholic acid for poor surgical candidates
Chole within 72 hours for complicated

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16
Q

ALT level in gallstone pancreatitis

A

> 150

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17
Q

Managment emphysematous cholecystitis

A

IV fluids/electrolytes, lap chole, parenteral antibiotic therapy against gram + anaerobic clostridium

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18
Q

Test and Tx. of sphincter of oddi dysfunction?

A

Test is high biliary sphincter pressure and ERCP with sphincterotomy for tx

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19
Q

Charcot triad and reynolds pentad

A

Fever, jaundice, RUQ pain; mental status cahnges, hypotension (reynolds pentad)

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20
Q

Imaging/tx for acute cholangitis?

A

U/S or CT scan shows CBD dilation, increased biliary drainage: ERCP with sphincterotomy or percutaneous transhepatic cholangiography, Broad spectrum ABX (B-lactam/b-lactamase inhibitor, third gen cehalosporin + metronidazole

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21
Q

Liver biopsy and other assoc conditions for primary sclerosing cholangitis?

A
  • Alternating stricture and dilation w/ “beading” of intra/extrahepatic bile ducts.
  • Assoc with ulcerative colitis with both having P-ANCA
  • Increase risk cholangiocarcinoma and colon cancer as well as cholangitis, cholestasis and cholelithiasis
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22
Q

Triad of hereditary hemochromatosis and diagnosis best initial and accurate?

A

Bronze skin, micronodular cirrhosis, DM II. Best initial (iron studies showing increased iron and ferritin with decreased TIBC). Liver biopsy for increased iron

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23
Q

Colon cancer MC site of metastases?

A

Liver

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24
Q

Diagnosis of acute pancreatitis requires what?

A

2 of the following:

1) acute epigastric pain radiating to back
2) Increase amylase/lipase>3 times normal limit
3) Abdominal imaging showing pancreatic enlargement with heterogenous enhancement

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25
Q

Cullen vs Gray turner severe pancreatitis?

A

Cullen-periumbilical bluish coloration periumbilical indicating hemoperitoneum
Gray-Turner-reddish brown around flanks indicating retroperitoneal bleed

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26
Q

Management chronic pancreatitis?

A

-Pain management, small meals, alcohol/smoking cessation, pancreatic enzyme supplements

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27
Q

Most important risk factor pancreatic adenocarcinoma?

A

Smoking

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28
Q

Conditions with mainly conjugated and elevated AST/ALT?

A

Variety of hepatitis (viral, ischemic, alcoholic, autoimmune etc.)

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29
Q

Signs/symptoms of carcinoid?

A

Skin-flushing, GI-diarrhea/cramping, Cardiac-valvular lesions (rt>left), Pulmonary-bronchospasm, niacin deficiency w/tryptophan depletion for making serotonin

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30
Q

Tx carcinoid

A

Octreotide for symptomatic and surgery for liver mets

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31
Q

What is shock liver?

A

Ischemic hepatic injury with AST/ALT elevation (the thousands) short after septic shock or heart failure

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32
Q

Management for cirrhosis with imagin

A

Screening endoscopy and ultrasound surveillance for HCC every 6 months

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33
Q

Prophylaxis for variceal hemorrhage?

A

Non selective B-blockers

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34
Q

What is hepatorenal syndrome?

A

decrease GFR in absence of shock, proteinuria, or other clear causes of renal dysfunction, and failure to respond to 1.5L NS bolus (resuscitation) as a complicaton of cirrohosis

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35
Q

Type 1 vs Type 2 Crigler Najjar?

A

Type I->25-30 bilirubin, kernicterus, no phenobartital help, tx. w/ plasmapharesis/phototherapy w/ liver transplant definitive
Type 2–>

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36
Q

Ascites fluid color and disease: bloody, milky, turbid, or straw color?

A

Bloody-Malignancy, trauma, TB
Milky-Chylous, pancreatic
Turbid-Possible infection
Straw-likely more benign

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37
Q

Neutrophils 250

A

250: Peritonitis

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38
Q

Total protein>2.5 (high protein ascites) and

A

> 2.5-CHF, constrictive pericarditis, peritoneal carcinomatosis, TB, Budd-Chiari syndrome, fungal (eg coccidiomycosis)

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39
Q

SAAG >1.1 and SAAG

A

> 1.1 (indicates portal hypertension)-cardiac ascites, cirrhosis, Budd-Chiari

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40
Q

SBP presentation and diagnosis and tx?

A

Presentation->100F, abdominal pain/tenderness, alterned mentation
Diagnosis->250 neutrophil (best initial) w/ fluid culture (most accurate but takes too long)
Tx. E. coli (cefotaxime or ceftriaxone) w norfloxacin or TMPSMX for prophylaxis

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41
Q

Diagnosis and tx for small intestinal bacterial overgrowth?

A

Diagnosis-Endoscopy w/ jejunal aspiration, glucose breath hydrogen testing
Tx-7-10 day course of ABX (eg rifamixin, amoxicillin-clavulonate), avoid antimotility like narcotics, dietary changes (eg high fat, low carb), triad of promotility agents (eg metoclopramide)

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42
Q

Diagnosis of colovesical fistula?

A

Abdominal CT with oral or rectal contrast (contrast material in bladder and thickened colonic and vesicular walls)

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43
Q

Rome diagnostic criteria for IBS?

A

> 3 days/month for past 3 month of abdominal pain/discomfort and 2 of following: Symptom improvement with BM, change in frequency of stool, change in form of stool.

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44
Q

Hallmark of UC?

A

Crypt abscesses

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45
Q

Tx of toxic megacolon?

A

IV steroids, NG decompression, antibiotics (ceftriaxone and metronidazole), and fluid management

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46
Q

Best initial/most accurate test SCC of neck

A

Best initial-panendoscopy (triple endoscopy-esophagoscopy, bronchoscopy, laryngoscopy)
Most accurate-biopsy when primary tumor is detected

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47
Q

Hallmark of crohn disease?

A

Non-caseating granulomas

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48
Q

PUD symptoms?

A

Epigastric pain, tenderness, and possible occult blood nausea and vomiting

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49
Q

Tx of PUD perforation?

A

Abx (ceftriaxone, metranidazole) and laparotomy with repair of perforation.

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50
Q

What causes achlorhydria?

A

Pernicious anemia (autoimmune destruction of parietal cells)

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51
Q

Imaging studies to localize GI bleed?

A

Radionuclide=slow/intermittent; Angiography=more rapid bleeds. Capsule when upper/lower endoscopy show no etiology

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52
Q

How do you diagnose diverticulitis and what do all patients need after treated episode?

A

CT abdomen with contrast. Colonoscopy after (because colon cancer with perforation can mimic diverticulitis clinically and on CT)

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53
Q

What is osmotic diarrhea?

A

Nonabsorbable solutes that remain in the bowel and attract water (eg lactose)

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54
Q

What is secretory diarrhea?

A

Too much fluid secretion by bowel. Occurs with cholera, VIPoma, and in ileal resection when can’t reabsorb bile salts

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55
Q

Common cause of malabsorptive diarrhea?

A

Celiac disease

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56
Q

Infectious diarrhea clues?

A

Fever and WBC in stool (invasive bacteria such as Shigella, Salmonella, Yersinia, and Campylobacter)

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57
Q

Infectious diarrhea tx

A

Metronidazole

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58
Q

What is exudative diarrhea?

A

Inflammation of bowel causing seepage of fluid commonly seen in IBD where WBC in stool and fever, but lack pathogenic organisms.

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59
Q

What pericpitates toxic megacolon?

A

Antidiarrheal medications

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60
Q

What is HBcAb

A

IgM hepatitis B core antibody appears in window phase when both HBsAg and HbsAb are negative.

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61
Q

Tx acute hep B exposure?

A

Hep B Ig and Hep B vaccination

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62
Q

Tx acute hepatitis C

A

Pegylated interferon alfa and ribavirin and either telaprevir or boceprevir

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63
Q

What population is hepatitis E fatal in?

A

Pregnant women

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64
Q

Tx of autoimmune hepatitis

A

Steroids or azathioprine

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65
Q

Labs of wilson disease?

A

Low serum ceruloplasmin

66
Q

Two common causes of cholestasis?

A

Medications (eg OCP, TMPSMX, phenothiazines, androgens) and pregnancy

67
Q

Tx primary biliary cirrhosis?

A

Cholestyramine with symptoms, but only tx is liver transplantation

68
Q

Rule about contrast when GI perforation suspected?

A

For GI studies, barium is preferred. For GI perforation, do not use barium because chemical peritonitis or mediastinitis when perforation/leak is present. Use water soluble (eg Gastrografin).

69
Q

Identifying physiologic jaundice in newborns based on bilirubin levels?

A

Full term infants: bilirubin

70
Q

Difference in etiology from dysphagia from solids–>liquids vs dysphagia (solids+liquids)

A

Progressive-obstruction

Both-motility disorder

71
Q

tx infectious esophagitis (candida_

A

fluconazole

72
Q

Dysphagia w/ CD4

A

1) Empiric fluconazole
2) Improvement, continue with HAART
3) No improvement, upper endoscopy and if large ulcerations–>CMV (tx. ganciclovir) or small ulcerations–>HSV (tx. acyclovir)

73
Q

Schatzki Ring vs Plummer Vinson location, association, treatment?

A

Ring (distal, reflux and hiatal hernia, pneumatic dilation)

PV (proximal, iron deficiency, web, and glossitis, iron replacement)

74
Q

Most accurate for scleroderma manifestations of GERD?

A

Manometry

75
Q

Tx mallory weiss?

A

Supportive, severe may need epi to stop bleeding

76
Q

Pain epigastric pain without any other symptoms?

A

Non-ulcer dyspepsia

77
Q

Best initial/most accurate epigastric pain for tests

A

Endoscopy

78
Q

Best initial tx for epigastric pain?

A

PPI

79
Q

Management of Barrett alone (metaplasia), low grade dysplasia, and high-grade dysplasia?

A

Barrett alone-PPi and rescope every 2-3 years
Low grade dysplasia-PPi and rescope every 6-12 months
High-grade dysplasia-Ablation w/ endoscopy: photodynamic therapy, radiofreq ablation, endoscopic mucosal resection

80
Q

Gastritis presentation and tx.?

A

GI bleeding without pain. From mild “coffee ground” emesis, to large-volume vomiting of red blood, to black stool (melena). PPi

81
Q

H pylori testing most accurate?

A

Endoscopy with biopsy

82
Q

Triple therapy for H pylori with or without penicillin allergy?

A

No allergy-PPi, amoxicillin, clarithromycin

Allergy-PPi, methotrexate, clarithormycin

83
Q

No response to DU therapy for H pylori

A

Check antibiotic resistance of organizm with method of detecting persistent infection (urea breath, stool antigen, or repeat endoscopy)

84
Q

Tx of refractory ulcers to H pylori triple therapy?

A

GU-endoscopy+biopsy to rule out cancer

DU-switch to metranidazole and tetracycline for amoxicillin

85
Q

Most accurate test PUD?

A

Upper endoscopy

86
Q

Difference btwn GU and DU?

A

Pain often worsened by food, GU routinely biopsied, GU associated with cancer, routinely repeating endoscopy to confirm healing is standard with GU

87
Q

No ulcer dyspepsia management 55

A

55: PPi+ Endoscopy

88
Q

Best initial/most accurate ZE syndrome?

A

Best initial-endoscopy

Most accurate-Secretin response test with persistent high levels of gastrin

89
Q

Imaging best initial/most accurate once gastrinoma confirmed and tx.?

A

Best initial-CT/MRI (poor sensitivity)
Most accurate-Somatostatin receptor scintigraphy (nuclear octreotide scan) with endoscopic U/S
Tx. Localized with resection and metastatic is unresectable

90
Q

Tx diabeteic gastroparesis?

A

Erythromycin and metoclopramide

91
Q

Define orthostasis?

A

->10 point rise in pulse from laying to sitting and >20 SBP drop (indicates 15-20% blood loss)

92
Q

What indicates 30% blood loss in terms of pulse and BP?

A

Pulse>100 and BP

93
Q

Why is NG tube useful for acute bleeding from rectum?

A

Guide where to start endoscopy

94
Q

What are current guidelines for keeping Hb>9 g/dL in variceal hemorrhage?

A

1) PRBC for GI bleed

95
Q

Tx of bleeding vs nonbleeding varices after hemodynamic support (ie fluids, blood, platelets, and plasma)?

A

Bleeding: 1) octreotide 2) banding 3) TIPS not controlled by octreotide/banding 4) Propranolol/nadolol for preventing subsequent episodes
Nonbleeding: 1) nonselective B-blockers decrease progression 2) Endoscopic variceal ligation w/ B-blocker contraindication

96
Q

2 Abx with highest incidence of C diff with best initial test

A

Clindamycin or ampicillin/C. diff toxin test

97
Q

Tx of recurrent C diff associated diarrhea?

A

Oral metronidazole

98
Q

Tropical sprue vs celiac disease involvement?

A

Celiac-duodenum (can have iron deficiency)

Tropical-jejunum/ileum (can have B12/folate deficiency)

99
Q

How do you differentiate chronic pancreatitis and gluten sensitive enteropathy?

A

Presence of iron deficiency in gluten sensitive enteropathy

100
Q

Tx. dermatitis herpetiformis

A

Dapsone and gluten free diet

101
Q

Most accurate test whipple?

A

PAS+ of LP in small intestine with foamy macrophages.

102
Q

Presentation whipple and treatment?

A

Cardiac, Arthralgias, Neurologic (dementia/seeizures). Tx. ceftriax followed by TMP/SMX

103
Q

Best initial/most accurate celiac?

A

Anti-tissue transglutaminase (may be absent with IgA deficiency patient), small bowel biopsy showing flattening of villi (also for whipple and tropic sprue)

104
Q

What is D-xylose test?

A

Differentiate malabsorption due to small intestine degradation or pancreatic insufficiency. Degradation NO d-xylose absorption, but pancreatic or lactase insufficiency allow d-xylose absoprtion becaue it is already a simple sugar not needing degradation.

105
Q

Most accurate test chronic pancreatitis?

A

Secretin stimulation test

106
Q

Tx. tropical sprue?

A

TMPSMX, tetracycline

107
Q

Tx IBS?

A

1) Fiber in diet
2) Antispasmodic (hyoscyamine, dicyclomine)
3) TCA (eg amitriptyline or SSRI)
4) Antimotility such as loperamide for diarrhea

108
Q

When and how often shoul screening occur for IBD?

A

After 8 to 10 years of COLONIC involvement, with cononoscopy every 1-2 years

109
Q

ANCA and ASCA with IBD as serology when diagnosis is still unclear.

A

ANCA-UC

ASCA-Crohn

110
Q

Most accurate test IBD?

A

Endoscopy

111
Q

Steroid specific for IBD?

A

Budenoside

112
Q

USed to wean patients off steroids in disease so severe recurrences develop as steroids are stopped?

A

Azathioprine and 6-MP

113
Q

Chronic maintainence remission?

A

5 ASA (mesalamine)

114
Q

Fistulae and severe disease unresponsive to other agens?

A

Infliximab (anti TNF)

115
Q

Most accurate test for Diverticulosis?

A

Accurate-colonoscopy

116
Q

Best initial test Diverticulitis?

A

CT scan. Colonoscopy and barium dangerous because of increased risk of perforation where infection weakens colonic wall

117
Q

Tx diverticulitis?

A

1) Cipro and metro OR

2) amox/clavulonate, ticarcillin/clavulonate

118
Q

Colonoscopy screening with or without family hx?

A

-With family hx. 10 years before diagnosis or age 40, whatever is younger. If family diagnosed

119
Q

Options if they dont want colonoscopy?

A

High sensitivity fecal occulty annually OR flex sig every 5 years combined with FOBT every 3 years

120
Q

Screening HNPCC (3 fam members, 2 gen, 1 premature (

A

start at age 25 with every 1-2 years after with colonoscopy.

121
Q

Lynch syndrome I vs Lynch syndrome II

A

I-hereditary site specific colon cancer

II-cancer family syndrome. Assoc with endometrial (43%), ovarian, and skin cancers

122
Q

FAP screening?

A

At 12 yearly with sigmoidoscopy

123
Q

Previous adenomatous polyp?

A

Every 3-5 years colonoscopy

124
Q

Previous history colon cancer screening?

A

Colonoscopy at 1 yr after resection, then 3 years, then every 5 years

125
Q

Puetz Jeghers presentaiton?

A

Multiple hamartomatous polyps in association with melanotic (hyperpigmented) spots on lips and skin. Increased friequency of breast, gonadal, pancreatic, colorectal, stomach cancers

126
Q

Turcot/Gardner syndrome?

A

Turcot-FAP and CNS malignancy

Gardner-FAP and osteomas, desmoid, or other soft tissue tumors

127
Q

Juvenile polyposis syndrome?

A

Multiple hamartomatous polyps in colon, stomach, small bowel iin children

128
Q

Best initial and most accurate for acute pancreatitis?

A

-Amylase and lipase initial, CT scan most accurate

129
Q

MRCP vs ERCP

A

MRCP is diagnostic. ERCP for therapy

130
Q

Type of contrast for abdominal CT scan?

A

IV and oral contrast

131
Q

When you use antibiotics in pancreatitis?

A

> 30% necrosis can benefit from imipenem or meropenem to prevent development of infected, necrotic pancreatitis

132
Q

Hyperestrogen manifestations for chronic liver disease?

A

1) Gynecomastia
2) Palmar erythema
3) Loss of body hair
4) Testicular atrophy
5) Angiomas (spider)

133
Q

All patients with chronic liver disease should be immunized against what?

A

Hep A and B

134
Q

Indications for paracentesis?

A

new onset ascites, abdominal pain or tenderness, fever

135
Q

treatment of SBP cases?

A

Cefotaxime or ceftriaxone. All patients need life long prophylaxis with norfloxacin (fluoroquinolone) or TMP/SMX

136
Q

What to use if patient not responsive to lactulose in lowering serum ammonia?

A

Rifaximin

137
Q

Tx hepatorenal?

A

Somatostatin (octreotide) or midodrine w/ liver transplant as only established benefit

138
Q

Primary biliary cirrhosis presentation?

A

Autoimmune destruction of intrahepatic bile ducts with lymphocytic infiltrate and granulomas

139
Q

Tx of PBC and PSC?

A

PBC: Ursodeoxycholic acid, PSC: Ursodeoxycholic or cholestyramine

140
Q

Most accurate test PBC vs PSC?

A

PBC biopsy or ANA; PSC is ERCP or MRCP showing beading, narrowing of strictures in biliary

141
Q

Tx chronic hep B

A

Any one of following: Adefovir, Lamivudine, Telbivudine, Entecavir, Tenofovir, Interferon

142
Q

Tx chronic hep C

A

combination of ledipasvir and sofosbuvir oral (genotype 1) or sofosbuvir and ribavirin (genotype 2 and 3)

143
Q

Adverse effect interferon

A

Arthralgias, thrombocytopenia, depression, leukopenia

144
Q

Adverse effect ribavirin

A

Anemia

145
Q

Adverse effect adefovir

A

Renal dysfunction

146
Q

Adverse effect lamivudin

A

None

147
Q

Adverse effect bocepevir

A

Anemia

148
Q

Adverse effect telaprevir

A

Rash

149
Q

Feature of Wilson disease?

A

Copper is Hella BAD (Decrease Ceruloplasmin, Cirrhosis, Corneal deposits, Copper accumulation, Carcinoma), Hemolytic anemia, Basal ganglia degeneration, Asterixis, Dementia, Dyskinesia, Dysarthria

150
Q

Best initial and most accurate for Wilson disease?

A

Best initial-Slit lamp

Most accurate-increase copper in urine after penicillamine

151
Q

Indications for pseudocyst drainage?

A

Secondary infection, >5 cm, >6 weeks, symptomatic

152
Q

Why gallstones present in females who are pregnant?

A

Estrogen induced increase in cholesterol secretion underlying mechanisms for cholesterol gallstones. Decreased progesterone means decreased motility and increased stasis predisposing to formation as well

153
Q

Risk factor acalculous cholecystitis?

A

Severe trauma, burns, recent surgery, prolonged fasting or TPN, sepsis ICU or mechanical ventilation

154
Q

Why is T3 and T4 total levels decreased with normal TSH in chronic liver disease?

A

Decreased TBG production by liver so decreased total T3 and T4 with normal free T3 and T4 levels

155
Q

Most likely cause of UGI vs LGI bleed?

A

UGI-PUD; LGI-diverticulosis

156
Q

Drugs that cause pancreatitis (3)?

A

Azathioprine, valproic acid, thiazides

157
Q

Most common underlying cause of cirrhosis

A

Chronic alcohol, hepatitis (C>B), nonalcoholic fatty liver, hemochromatosis

158
Q

Zinc deficiency features?

A

Alopecia, abnormal taste, bullous pustulous lesions on body orifices, and impaired wound healing

159
Q

Extrahepatic manifestation of chronic hep C

A

Heme-mixed cryoglobulinemia, Renal-membranoprolif glomerulonephritis, Skin-porphyria cutanea tarda, lichen planus, Endocrine-increase risk diabetes

160
Q

Differential for marked AST and ALT (>25 times upper limit)?

A

Toxin induced (eg acetaminophen), ischemic (eg shock liver), or viral hepatitis

Step 2 CK (16 decks)

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