GI

Question 1

if abnormal D-xylose absorption, think ?

Answer 1

small intestinal mucosal disease (celiac), NOT enzyme deficiencies as it doesn’t need degradation to be absorbed

Question 2

LFT levels in alcoholic hepatitis

Answer 2

AST and ALT usually not over 300, ^GGT (in liver) and ^ferritin (acute phase reactant)

Question 3

if marked elevations in AST and ALT (+25x upper limit) think??

Answer 3

toxin induced (tylenol), ischemic, or viral hepatitis

Question 4

SBP diagnosis

Answer 4

t 100+, abd pain, AMS
PMNs 250+, +Cx (E. coli, Kleb)
Protein less than 1, SAAG more than 1.1

Question 5

SBP treatment

Answer 5

3rd gen cephs (cefotaxime)

FQs for ppx

Question 6

lactose intolerance is characterized by what test results

Answer 6

+ H+ breath test, + stool test for reducing substances, low stool pH, increased stool osmotic gap

Question 7

acalculous cholecystitis typically presents in the setting of ?

Answer 7

severe trauma, burns, recent surgery, prolonged fasting/TPM, critical illness

Question 8

meds guilty in pill-induced esophagitis

Answer 8

tetracyclines, ASA and NSAIDs, bisphosphonates, KCl, iron

Question 9

when to begin colonoscopys for UC pts?

Answer 9

8 years after dx, then every 1-2 years

Question 10

complications of PBC include ?

Answer 10

severe hyperlipidemia, malabsorption, metabolic bone disease (osteoporosis, osteomalacia), and hepatocellular carcinoma

Question 11

suspect ? in chronic pancreatitis pts presenting with abdominal pain in weight loss
what imaging to dx?

Answer 11

if jaundiced, US for tumors in head of pancreas

if not jaundiced, CT for tumors in body/tail of pancreas

Question 12

ppx for esophageal variceal hemorrhage

Answer 12

nonselective B blockers: propranolol, nadolol

Question 13

When should patients with typical GERD symptoms get an EGD with biopsy?

Answer 13

if present with dysphagia, odynophagia, weight loss, anemia, GIB, recurrent vomiting
or male over 50 with chronic (5+ yrs) symptoms and cancer risk factors (smoking)
other pts just get PPI trial

Question 14

in ascites, a SAAG (serum-ascites albumin gradient) greater than 1.1 indicates? while a SAAG less than 1.1 indicates?

Answer 14

greater than/= 1.1: portal HTN including cirrhosis, cardiac ascites, Budd-Chiari
less than 1.1: TB, peritoneal carcinomatosis, pancreatic ascites, nephrotic syndrome

Question 15

labs for ascending cholangitis

imaging?

Answer 15

^alk phos, ^GGT, ^direct bili, ^WBCs, ^CRP

biliary dilation on US or CT

Question 16

ascending cholangitis tx

Answer 16

ERCP with sphincterotomy or percutaneous transhepatic cholangiography
abx: B-lactam + inhib or 3rd gen ceph + metro

Question 17

dermatitis, diarrhea, dementia, think?

what are causes?

Answer 17

pellagra: Niacin deficiency
etiologies: dietary lack in developing countries that rely on corn
developed: impaired nutritional intake (etOH, chronic disease), carcinoid syndrome Hartnup (disorder of tryptophan absorption), Isoniazid therapy (interferes with tryp. metab)

Question 18

meds associated with acute pancreatitis

Answer 18

anti-seizure (esp. valproic acid)
diuretics (furosemide, thiazides)
IBD drugs (sulfasalazine, 5-ASA)
immunosuppressives (azathioprine)
HIV meds (didanosine, pentamidine)
abx (metro, tetra)

Question 19

first step in identifying toxic megacolon

Answer 19

abdominal XR

Question 20

risk factors for C. dif besides abx and hospitalization

Answer 20

gastric acid suppression with PPI

age 65+

Question 21

features of vitamin malabsorption in celiac

Answer 21

iron: pallor, fatigue
calcium and vit D: bone pain (osteomalacia) fx (osteoporosis)
vit K: easy bruising
vit A: hyperkeratosis

Question 22

if IgA anti-TTG negative but still suspect celiac, think?

Answer 22

selective IgA deficiency

Question 23

stool osmotic gap (SOG)

SOG in osmotic and secretory diarrhea

Answer 23

plasma Osm - 2x (stool Na + stool K)
elevated in osmotic (125+)
decreased in secretory (less than 50)

Question 24

causes of secretory diarrhea

Answer 24

caused by increased secretion of ions
infection (v. cholerae, rotavirus), CF, ileocolitis, postsurgical changes (unabs. bile acids reach colon and stimulate ion release)

Question 25

signs of worsening acute liver failure (ALF)

what is indicated?

Answer 25

prolonged PT and INR (1.5+), rising serum bilirubin, renal insufficiency (Cr 3.4+), hep enceph grade III+
liver transplant is indicated

Question 26

if suspect ZES and gastrinoma is confirmed, what next studies?

Answer 26

screen for MEN1 with PTH, ionized calcium, prolactin

Pit tumors, Pancreatic endocrine tumors, Parathyroid adenomas

Question 27

pancreatic carcinoma may show what on imaging?

Answer 27

intra- and extrahepatic biliary tract dilation

“double duct” sign