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IM Rotation 2018 > GI > Flashcards

GI Flashcards

1
Q

A patient is diagnosed with Ulcerative colitis. What is the best management for maintenance?

A

Sulfasalazine-works primarily in the colon

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2
Q

Where in the bowel is oral Mesalamine (Asacol HD) active?

A

Terminal small bowel & colon

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3
Q

Where is topical Mesalamine active in the bowel?

A

Rectal suppositories & enemas (Rowesa):

-effective in the DISTAL colon

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4
Q

Where does Pentasa long-acting oral Mesalamine active?

A

-works throughout the entire small intestine & colon

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5
Q

If a patient with UC is taking Sulfasalazine, what vitamin should you advise the patient to take simultaneously?

A

Folic acid

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6
Q

The side effect profile with Sulfasalazine is higher than Mesalamine. What are the side effects of Sulfasalazine?

A
  1. Fever
  2. Rash
  3. Allergic reaction
  4. Pancreatitis
  5. Hepatitis
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7
Q

A patient is experiencing a flapping tremor of the hand with wrist extension, hyperreflexia, seizures, and continues to vomit. Based on this information, what is the best method to diagnose this patient?

A

Laboratory studies:

  • Increased ammonia level is SERUM
  • Increased PT/INR (> or = to 1.5)
  • Increased LFTs
  • Hypoglycemia
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8
Q

What is the definitive treatment for Fulminant Hepatitis?

A

Liver transplant

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9
Q

What is the management of Diverticulitis?

A

Abx: Ciprofloxacin OR Bactrim + Metronidizaole

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10
Q

What is the most common cause of esophageal cancer worldwide?

A

Squamous cell

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11
Q

Where is Squamous cell Esophageal cancer most commonly found?

A

MC in upper 1/3 of the esophagus

-Peaks 50-70 y/o

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12
Q

What are some risk factors for Esophageal cancer?

A
  1. Smoking
  2. ETOH use
  3. Decreased intake of fruits/vegetables
  4. Achalasia
  5. Hot beverage ingestions
  6. Exposure of esophagus to noxious stimuli (dysplasia leads to neoplasia)
  7. Men
  8. Nitrates
  9. African American
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13
Q

What are two factors associated with decreased incidence of esophageal neoplasm?

A

Coffee consumption

NSAIDS

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14
Q

Which esophageal cancer is most common in the US and MC in younger, obese, Caucasians?

A

Adenocarcinoma

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15
Q

Where is Adenocarcinoma of the esophagus most commonly located?

A

MC in lower 1/3 esophagus

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16
Q

What study is best used to diagnose Esophageal carcinoma?

A

Upper endoscopy with biopsy TOC

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17
Q

How is esophageal carcinoma managed?

A

Esophageal resection
Radiation therapy
Chemotherapy (5 FU) depending on stage

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18
Q

What is the gold standard study of Gastritis?

A

Endoscopy: will see thick, edematous erosions < 5 cm

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19
Q

What is the management for H. pylori gastritis?

A

Clarithromycin + Amoxicillin + PPI = “CAP”

20
Q

What is the management for non-H. pylori gastritis?

A

Acid suppression:

  1. PPI
  2. H2 blocker
  3. Anatacids
  4. Sucralfate
21
Q

A patient is diagnosed with having stress-related gastritis, what is the best way to manage this patient?

A

Pharmacologic prophylaxis:

  1. IV PPI
  2. H2 blockers
22
Q

A patient is experiencing increased bilirubin levels with normal LFTs. What is in your differentials list?

A
  1. Dubin-Johnson syndrome
  2. Gilberts syndrome
  3. Hemolysis
23
Q

What disorder is caused by an increase in mild isolated conjugated (direct) hyperbilirubinemia?

A

Dubin-Johnson syndrome

24
Q

Why is bilirubin and biliverdin sent to the liver?

A

Becuase it is UNconjugated and not soluble in water, therefore cannot be excreted

25
Which increased bilirubin condition will there be a grossly black liver on biopsy?
Dubin-Johnson syndrome
26
A neonatal patient is jaundice with severe progression in the 2nd week leading to kernicterus. The patient has hypotonia, deafness, lethargy, and oculomotor palsy. Labs reveal an increase in unconjugated bilirubin. What is the most likely diagnosis?
Crigler-Najjar Syndrome Type I
27
A neonatal patient is jaundice with severe progression in the 2nd week leading to kernicterus. The patient has hypotonia, deafness, lethargy, and oculomotor palsy. Labs reveal an increase in unconjugated bilirubin. What is the best management for this patient?
Phototherapy*
28
A patient is diagnosed with Cholelithiasis. She is an Asian American with a concurrent bacterial infection. What type of gallstone is she most at risk for?
Brown stones: Increased in Asian population, parasitic infections
29
A patient is diagnosed with Cholelithiasis. She is a 45 y/o Caucasian female with ETOH Cirrhosis. What type of gallstone is she most at risk for?
Black stones: Hemolysis or ETOH Cirrhosis
30
What is the most common type of gallstone?
Cholesterol (mixed & pure) 90% | Pigmented 10%
31
What is the test of choice for Cholelithiasis?
U/S
32
A patient with a history of gallstones is seen with fever, RUQ pain, and jaundice. What is this set of symptoms called?
RUQ pain + fever + jaundice = Chargot's triad
33
A patient with a history of gallstones is seen with fever, RUQ pain, and jaundice. What would you expect her labs to look like?
1. Leukocytosis 2. Cholestasis 3. Increased ALP with GTT 4. Increased bilirubin
34
A patient with a history of gallstones is seen with fever, RUQ pain, and jaundice. What is the gold standard for this condition?
Cholangiography via ERCP
35
What is the abx management needed for Acute Cholangitis?
Monotherapy: 1. Ampicillin/Sulbactam (Unasyn) 2. Piperacillin/Tazobactam (Zosyn) OR: 3. Metronidazole + Ceftriaxone* 4. Metronidazole + Fluroroquinolone 5. Ampicillin + Gentamycin
36
What is the management for Acute cholecystitis?
NPO, IV fluids, Abx: Metronidazole + Ceftriaxone* --> Cholecystectomy (usually w/in 72 hours)
37
What treatment is available for Cholecytitis patients unable to undergo surgery?
Percutaneous drainage
38
Which GI condition is a small bowel autoimmune inflammation secondary to alpha-gliadin in Gluten?
Celiac disease
39
What can you expect to see on a colonoscopy of a Celiac sprue patient?
Loss of villi
40
What are the implications of Celiac disease?
Impaired fat absorption
41
How is Celiac disease diagnosed?
+ Endomysial IgA Ab & Transglutaminase Ab | -Small bowel biopsy = definitive diagnosis
42
Since there is no "treatment" for Celiac disease. How should you educate your patients on managing this condition?
-Gluten free diet: | Avoid wheat, rye, barley
43
A patient is dead set that her "Celiac" condition was brought on by her eating rice, corn, and oats. How do you respond?
Oats, rice, and corn do not cause Celiac disease
44
What diagnostic test is used to diagnose Hepatocellular carcinoma?
U/S
45
What lab value will be increased in Hepatocellular carcinoma?
Alpha feto-protein
46
What is primary liver neoplasm?
Hepatocellular carcinoma
47
What is the hallmark of Irritable Bowel syndrome?
Abdominal pain associated with altered defecation/bowel habits

IM Rotation 2018 (5 decks)

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