GI

Question 1

What are the symptoms of cholelithiasis?

Answer 1

COlicky RUQ pain that radiates to the shoulder worse with fatty foods. Typically asymptomatic

Question 2

How is cholelithiasis diagnosed? Treated?

Answer 2

RUQ ultrasound showing stones in the gallbladder. Treat with cholecystecomy or ursodeoxycholic acid for nonsurgical candidates

Question 3

What are the symptoms of cholecystitis?

Answer 3

COlicky to constant RUQ pain when a stone gets stuck in the cystic duct

Question 4

How is cholecystitis diagnosed?

Answer 4

Mild fever and leukocytosis, pain, and a positive murphy sign. Diagnose definitively with RUQ ultrasound showing pericholecystic fluid, gallstones, and gallbladder thickening.

Question 5

How is cholecystitis treated?

Answer 5

NPO, IV fluids, IV antibiotics, urgen cholecystectomy. Cholecystostomy is possible for poor surgical candidates

Question 6

What is the alternative to US when youre thinking cholecystitis?

Answer 6

HIDA scan

Question 7

How is choledocolithiasis diagnosed?

Answer 7

Painful jaundice from obstruction of bile flow. Jaundice, increased liver enzymes, increased conjugated bili, increased amylase or lipase (if pancreas involved). Definitive diagnosis made with RUQ U/S showing dilated ducts. If ducts arent dilated do MRCP

Question 8

Tx for Choledocolithiasis

Answer 8

ERCP for stone removal. Prophylactic antibiotics awaiting the procedure are recommended. NPO, IVF, IV abx for acute.

Question 9

Ascending cholangitis organisms

Answer 9

E coli, Klebsiella, Enterobacter

Question 10

Charcot’s triad? Reynolds Pentad?

Answer 10

• RUQ, Jaundice, Fever
• Reynolds: Charcots + Hypotension + AMS

Question 11

What antibiotics do you choose for ascending cholangitis?

Answer 11

• Ciprofloxacin + Metro
• Ampicillin-Gentamycin + Metro
• Pip/Tazo

Question 12

Pill induced esophagitis? How is it prevented?

Answer 12

• NSAIDs, Anti-Retrovirals, antibiotics, non-enteric coated pills
• Drink with water and erect and upright

Question 13

How is Pill induced esophagitis treated?

Answer 13

Can endoscope to retrieve pill but it takes time to heal. Use a PPI

Question 14

What is the risk factor that leaves you at risk for infectious esophagitis?

Answer 14

Immunosuppression from leukemia, lymphoma, steroids, HIV/AIDs

Question 15

What organisms cause infectious esophagitis? What finding do we see?

Answer 15

• Candida: Thrush
• Herpes: Oral ulvers
• CMV: Nothing
• HIV: AIDS

Question 16

Treatment for infectious endocarditis?

Answer 16

• Candida: Nystatin and fluconazole
• Herpes: Val or acyclovir or foscarnet
• CMV: Val or gancyclovir or foscarnet
• HIV: HAART

Question 17

What are the treament methods for eosinophilic esophagitis?

Answer 17

PPI and if that fails use aerosolized steroids

Question 18

What is the treatment for caustic esophagitis?

Answer 18

• DONT induce vomiting
• Endoscopiy to diagnose
• Treat
  
  • High severity: NPO for 72 ohurs
  • Low severity: Liquid to solid diet in 48 hours

Question 19

Diagnosis of Achalasia?

Answer 19

• Barium swallow demonstrates birds beak
• Manometry shows hyperactive contraction and inactivity of esophagus.
• EGD to rule out cancer and reveal absent myenteric plexus

Question 20

Treatment for achalasia

Answer 20

• Botulinum for poor sugical candidates
• Dilation carries perforation risk, so myotomy is best

Question 21

Scleroderma affects on the throat

Answer 21

COllagen deposition meaning LES cann