GI

Question 1

What are the recommendations for colon cancer screening in a patient with a first-degree relative that was diagnosed with colorectal cancer before age 60?

Answer 1

Patients who have one first degree relative diagnosed with colorectal cancer or adenomatous polyps before age 60, or at least two second degree relatives with colorectal cancer, are in the highest risk group. They should start colon cancer screening at age 40, or 10 years before the earliest age at which an affected relative was diagnosed (whichever comes first) and be rescreened every 5 years. Colonoscopy is the preferred screening method.

Question 2

What is the presentation of intussusception?

Answer 2

It usually occurs in children under the age of 2 years and is characterized by paroxysms of colicky abdominal pain. A mass is palpable in about two-thirds of patients.

Question 3

What colonic polyp type is most likely to become malignant?

Answer 3

Villous adenoma

Question 4

What herbal remedy has been shown to be useful in the treatment of IBS?

Answer 4

Daily peppermint oil

Question 5

Generalized puritis, jaundice and right upper quadrant pain post cholecystectomy may be a sign of what?

Answer 5

Retained gallstone in the common bile duct

Question 6

What are the criterion for gastric bypass surgery? e trea

Answer 6

Indications for laparoscopic bariatric surgery for morbid obesity include a BMI >40 kg/m2 or a BMI of 35–40 kg/m2 with significant obesity-related co-morbidities. Weight loss by nonoperative means should be attempted before surgery, and patients should be evaluated by a multidisciplinary team that includes a dietician and a mental health professional before surgery.

Question 7

What are the treatment guidelines for ascites management?

Answer 7

In patients with grade 2 ascites (visible clinically by abdominal distention, not just with ultrasonography), the initial treatment of choice is diuretics along with salt restriction. Aldosterone antagonists such as spironolactone are more effective than loop diuretics such as furosemide (SOR A). Chlorthalidone, a thiazide diuretic, is not recommended. Large-volume paracentesis is the recommended treatment of grade 3 ascites (gross ascites with marked abdominal distention), and is followed by salt restriction and diuretics.

Question 8

What is the best way to verify if a chronic cough is due to GERD?

Answer 8

Do a trial of a PPI for 3-4 months, twice daily

Question 9

What is the colon cancer screening recommendation for a patient with a 1st degree relative with the diagnosis of colon cancer under the age of 60?

Answer 9

Screening should consist of colonoscopy, beginning either at age 40 or 10 years before the age at diagnosis of the youngest affected relative, whichever comes first.

Question 10

Because an elevated alkaline phosphatase can point to conditions affecting the bones, liver, small intestine, and placenta, what additional blood test should be ordered to verify a liver condition?

Answer 10

5’-nucleotidase (elevated)

Question 11

What are the recommendations for feeding in a patient with acute pancreatitis?

Answer 11

Early initiation of a low-fat, solid diet. NPO and clear liquid diets have been shown to cause worse outcomes

Question 12

What findings on screening colonoscopy would warrant a repeat scope in 3 years?

Answer 12

Risk factors for proximal neoplasia include high-grade dysplasia, three or more adenomas, adenomas with villous features, and an adenoma ≥1 cm in size. For patients with one or more of these findings, follow-up colonoscopy in 3 years is recommended. 1-2 small (<1 cm) hyperplastic polyps that are removed should be considered a “normal” colonoscopy with routine follow-up in 10 years.

Question 13

What are the most common causes of death following bariatric surgery?

Answer 13

Pulmonary emboli, anastomotic leaks, and respiratory failure are responsible for 80% of deaths in the 30 days following bariatric surgery, with death from pulmonary embolism being the most frequent cause.

Question 14

A neutrophil count of what is diagnostic of peritonitis?

Answer 14

> 250/mL

Question 15

What is megestrol (Megace) used for?

Answer 15

Megestrol has been used successfully to treat cachexia in patients with AIDS or cancer. When given in a dosage of at least 320 mg/day, megestrol has produced weight gain, but side effects of edema, constipation, and delirium may limit its usefulness.

Question 16

What are the colonoscopy guidelines?

Answer 16

Starting at age 50. The evidence supports a 10-year interval for colonoscopy in patients less than 80 years old. For patients with a family history of colon cancer a 5-year interval is recommended, or 3 years if benign polyps are found. Screening in patients over 80 years old is controversial.

Question 17

What is the most effective initial management of Crohn’s disease?

Answer 17

Systemic corticosteroids

Question 18

What common class of painkiller is contraindicated in liver cirrhosis?

Answer 18

NSAIDs - can lead to hepatorenal syndrome. Acetaminophen is actually safe at doses of 2-3g/day

Question 19

What are potential treatments for irritable bowel syndrome?

Answer 19

SSRIs, peppermint oil, psychological treatments, exercise, and probiotics.

Question 20

What is the Rockall risk scoring system for GI bleeds

Answer 20

Score 0: age <60, no shock (normal BP and pulse), no comorbidities, Mallory-Weiss tear.
Score 1: age 60-79, pulse >100, SBP >100
Score 2: age > 80, SBP <100, CHF, IHD, major morbidity, GI malignancy, evidence of bleeding
Score 3: renal failure, liver failure, metastatic cancer.
Add up number; <3 is low risk, >8 is high risk

Question 21

How is chronic cough from GERD diagnosed?

Answer 21

First chest x-ray is needed to rule-out other causes of chronic cough. Successful resolution of cough with PPI is diagnostic.

Question 22

Patients with celiac disease are at increased risk for what MSK-related problem?

Answer 22

Osteoporosis due to malabsorption of calcium and vitamin D.

Question 23

Prophylactic cholecystectomy for asymptomatic gallstones is indicated for which patients?

Answer 23

Sickle cell patients. Patients with hemoglobinopathies are at a significantly increased risk for developing pigmented stones. Gallstones have been reported in up to 70% of sickle cell patients, up to 85% of hereditary spherocytosis patients, and up to 24% of thalassemia patients. In sickle cell patients, complications from asymptomatic gallstones have been reported to be as high as 50% within 3–5 years of diagnosis. Furthermore, cholecystectomy can and should be performed at the time of splenectomy in sickle cell patients, whether open or laparoscopic.

Question 24

What treatments have been shown to be helpful for the management of IBS?

Answer 24

Exercise, probiotics, antibiotics, antispasmodics, antidepressants (e.g. SSRIs or tricyclics), psychological treatments, and peppermint oil all have evidence that they may improve IBS symptoms.

Question 25

In patients with advanced dementia with difficulty eating, what is the preferred for feeding?

Answer 25

Hand feeding. Careful hand feeding for patients with severe dementia is at least as good as tube feeding with regard to the outcomes of death, aspiration pneumonia, functional status, and patient comfort. Regular food is preferred. Tube feeding is associated with agitation, increased use of physical and chemical restraints, and worsening pressure ulcers.

Question 26

What are the colon cancer screening guidelines for patients with UC?

Answer 26

Current guidelines recommend beginning screening colonoscopy 10 years after the initial diagnosis and continuing every 2–5 years, with the interval based on the findings.

Question 27

What is a first-line agent for UC?

Answer 27

Sulfasalazine - should be taken indefinitely as long as it is controlling symptoms

Question 28

What are the best initial screening tests for hereditary hemochromatosis?

Answer 28

Serum ferritin and transferrin saturation (elevated warrants further testing)

Question 29

In diarrhea-predominant IBS, what antidepressants are helpful?

Answer 29

TCAs (e.g. amitriptyline) have been shown to be beneficial (likely in part to anticholinergic effect), as have SSRIs, but TCAs appear to have more efficacy.

Question 30

What is the downside to using loperamide in diarrhea-predominant IBS?

Answer 30

Helps with diarrhea but not with abdominal pain