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Step 3 UW /FA > GI > Flashcards

GI Flashcards

1
Q

When to repeat colonoscopy if: 1. 1-2 tubular adenomas 2. Hyperplasia polyps 3. 3-10 adenomas 4. Adenomas with high grade displays is or villous features 5. >1cm polyp 6. <1 cm poly

A
  1. 5 years 2. 10 years 3. 3 years 4. 3 years 5. 3 years 6. 5 years
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2
Q

Pt w/heart burn not resolved with 6m antiacids. EGD done showing NO dysplasia. Next step?

A

continue PPI & repeat EGD in 3-5 years

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3
Q

Pt w/heart burn not resolved with 6m antiacids. EGD done showing low grade dysplasia. Next step?

A

PPI & repeat endoscopy in 6m to 1 year

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4
Q

Pt w/heart burn not resolved with 6m antiacids. EGD done showing high grade dysplasia. Next step?

A

endoscopic eradication therapy

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5
Q

What causes Refeeding Syndrome?

A

Ingestion of carbs after prolonged fasting causes insulin release = cellular uptake of P, K, Mg, B1. Rapid hypophosphatemia can cause arrhythmias & CHF 2/2 massive fluid shifts. –prevent by monitoring electrolytes especially Phosphate

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6
Q

s/p cholecystectomy diarrhea..whats a good treatment for this?

A

Cholestyramine!

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7
Q

Risk factors for esophageal squamous cell carcinoma

A

Tobacco use, alcohol use, poor diet

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8
Q

Risk factors for esophageal adenocarcinoma

A

Tobacco use, obesity, Gerd, poor diet

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9
Q

What medications are commonly associated with pill esophagitis

A

Doxycycline, NSAIDs, bisphosphonates

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10
Q

CREST Scleroderma

A

Calcinosis cutis, Raynauds, Esophageal dysmotility, Sclerodactyly and Telangiectasia

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11
Q

Hx & sx of esophageal spasm? What were you see on barium swallow?

A

Intermittent symptoms with chest pain, and often triggered by acid, stress and hot and cold liquids. Look for “corkscrew esophagus” on barium swallow.

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12
Q

Tx Hpylori

A

Amoxicillin, clarithromycin +/- metronidazole with PPI for 10-14 days

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13
Q

Sx & Tx IBS

A

Sx: Abdominal pain with diarrhea and or constipation averaging at least one day a week lasting for three months with feelings of incomplete rectal evacuation and/or complete or partial relief with defecation. Tx: high-fiber diet, exercise, adequate fluid intake and TCA anti-depressants(improves pain)

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14
Q

Crohns Disease vs Ulcerative Colitis Which has skip lesions?

A

Crohn’s disease

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15
Q

Crohns Disease vs Ulcerative Colitis Which has noncaseating granulomas?

A

Crohns. UC is limited to the mucosa

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16
Q

Crohns Disease vs Ulcerative Colitis Which has ulcers vs transmural inflammation?

A

UC = ulcers Crohns = transmural inflammation

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17
Q

Crohns Disease vs Ulcerative Colitis Which is associated with primary sclerosing cholangitis and AI liver disease?

A

Ulcerative colitis

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18
Q

Crohns Disease & Ulcerative Colitis When to start colonoscopy ?

A

8-10yr after diagnosis then yearly

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19
Q

Duration acute diarrhea

A

<2 weeks - usually infectious

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20
Q

Duration chronic diarrhea

A

>4-6 weeks

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21
Q

Pancreatitis tx

A

NPO/bowel rest, IVF, pain management Of concern for infection: metronidazole & FQ

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22
Q

Tx acute cholecystitis

A

IV abx(3rd generation cephalosporin and metro), IVF and cholecystectomy within 72 HR or ERCP if stone

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23
Q

SX & Tx cholangitis

A

Sx: Charcot triad: RUQ pain, fever, Jaundice +/- shock & AMS(Reynolds pentad) Tx: NPO, IVF, pressers if needed and IV Abx(ciprofloxacin preferred) *may need urgent ERCP w/stent placement or PC drainage

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24
Q

What does the MELD(Model for End-Stage Liver Disease) use to calculate 90 day mortality in ESLD?

A

Bilirubin, INR, serum creatinine and serum sodium

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25
Q

Treatment for liver cirrhosis? Tx ascites?

A

Cirrhosis alone: no alcohol!, restrict fluid to 1-1.5L per day especially if hyponatremic, rifaximin and lactulose if hep Tati can encephalopathy, liver transplant. Cirrhosis w/ascites: Na <2g a day, diuretics(furosemide and spironolactone), paracentesis and possible TIPS

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26
Q

Abx for spontaneous bacterial peritonitis

A

3rd generation cephalosporin or a FQ

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27
Q

Tx for acetaminophen toxicity

A

N-Acetylcystine if within 4 hrs and activated charcoal.

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28
Q

Inheritance and sx of hereditary hemochromatosis

A

AR mutation in HFE causing excess iron: fatigue, bronze diabetes, arthritis, bronze skin pigmentation, infertility, transaminitis, cardiomyopathy +/- cirrhosis

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29
Q

Lab abnormalities with hereditary hemochromatosis Tx?

A

Elevated Fe saturation, elevated ferritin, elevated transferritin, HFE gene mutation Tx with phlebotomy

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30
Q

HFE gene mutation causes? What’s the error?

A

Hereditary hemochromatosis Mutation in hepcidin causing the body to stop responding it to. Iron absorption increases.

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31
Q

Wilson’s disease Mutation? Sx?

A

AR mutation impairing copper excretion SX: liver disease, cirrhosis, neuropsychiatric sx, kayser-fleischer rings

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32
Q

Lab abnormalities with Wilson’s disease

A

Low serum copper, low ceruloplasmin, increased urinary copper excretion, liver bx shows increased hepatic copper content

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33
Q

Wilson’s disease Tx?

A

Life long(chelation w/ penicillamine, trientine ), high dose PO zinc(prevents GI absorption of Cu) and liver transplant

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34
Q

A1AT disorder Sx, dx, tx?

A

SX: panacinar emphysema in nonsmoker, liver cirrhosis Dx: genotype BG and serum A1AT TX: AAT augmentation to avoid disease, lung and liver transplant

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35
Q

Primary biliary cholangitis Sx? Lab findings? What’s it associated with?

A

Sx: fatigue, pruritus , jaundice, fat malabsorption, osteoporosis Lab: elevated ALP, bilirubin +/- LFT absorption. +ANA, +anti-mitochondrial ab *Autoimmune distruction of intrahepatic bile ducts increasing the risk for cirrhosis and hepatocellular carcinoma, associated with hypothyroidism and arthritis

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36
Q

Primary biliary cholangitis Tx?

A

Ursodeoxycholic acid, cholestyramine, fat soluble vitamins

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37
Q

Primary sclerosing cholangitis Sx? Labs? What’s it’s associated with?

A

Sx: often asymptomatic, fatigue, pruritis, RUQ pain Labs: elevated ALP & bilirubin, +ANA and +smooth muscle ab, perinuclear antineutrophil cytoplasmic ab Intra & extrahepatic bile duct fibrosis associated with IBD, increased risk for cholangiocarcinoma, gallbladder cancer, CRC and HCC *dx with bx

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38
Q

Primary sclerosing cholangitis Tx?

A

Ursodeoxycholic acid, cholestyramine, fat soluble vitamins, balloon dilation, >50% will require liver transplant as most do not respond to medical management

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39
Q

Achalasia vs esophageal structure on presentation

A

Achalasia has dysphasia to both solids and liquids vs esophageal stricture is solids only

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40
Q

Healthy 37 yo presents to establish. Everything’s normal except his father was dx with CRC at age 53. When so you start screening on him and how often?

A

40 yoa q3-5 *if <60 start 10 yrs prior to dx or at age 40 which ever comes first and repeat q3-5years

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41
Q

Achalasia dx? sx? tx?

A

inability of the LES to relax due to loss of nerve plexus sx: young nonsmoker who has dysphagia to both solids and liquids dx: barium swallow or esophageal manometry tx: pneumatic dilation, heller myotomy, botulinum toxin injection

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42
Q

young nonsmoking male who just got back from a mission trip to south american. presents with dysphagia to both solids and liquids. dx?

A

chagas disease! causing achalasia

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43
Q

Esophageal cancer sx? pt population? dx?

A

sx: dysphagia to solids first then liquids pt: >50 yoa smokers or drinkers dx: endoscopy

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44
Q

tx of esophageal cancer

A

resection + 5FU

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45
Q

Plummer-Vinson Syndrome sx? tx?

A

PROXIMAL stricture in esophagus due to iron deficiency anemia. tx: iron replacemnt F>M, increased risk of cancer

46
Q

Schatzki’s Ring(peptic stricture) sx? tx?

A

repeat acid reflux causes stricture = DISTAL *steak-house syndrome tx: pneumatic dilation

47
Q

Zenker Diverticulum sx? dx? tx?

A

true diverticulum, dysphagia with horrible bad breath + regurge of undigested food. dx: barium study showing outpouching tx: surgical resection

48
Q

Spastic Esophagus aka nutcracker esophagus sx? dx?

A

severe chest pain often occuring without risk factors for heart disease, comes and goes, triggered by drinking cold beverages dx: manometry

49
Q

Spastic Esophagus aka nutcracker esophagus tx?

A

CCB + nitrates

50
Q

Odynophagia in HIV negative person. whatcha gonna do?

A

endoscopy

51
Q

Odynophagia in HIV + person. whatcha gonna do?

A

fluconazole, if no response think esophagitis

52
Q

mallory weiss tear dx and tx?

A

dx: endoscopy tx: self resolving or epinephrine

53
Q

1st line tx for GERD

A

PPI(omeprazole, lansoprazol)

54
Q

what type of cancer can barretts esophagus lead to?

A

adenocarcinoma

55
Q

tx for barretts esophagus

A

PPI & repeat endo every 2-3 years

56
Q

tx of low grade esophageal dysplasia

A

PPI & repeat endo in 3-6 months

57
Q

Duodenal Ulcer pain gets —– with food.

A

better

58
Q

Peptic Ulcer pain gets —– with food.

A

worse

59
Q

Pt age>— and has epigastric pain must be scoped.

A

45

60
Q

tx of Hpylori. what if resistance?

A

tx: PPI + Clarithromycin + Amoxicillin resistant: Metronidazole & tetracyclin + PPI

61
Q

52 year old man with epigastric discomfort. +Hpylori, upper endoscopy shows no gastritis, no ulcer disease, bx shows Hpylori. tx?

A

PPI alone! no ulcer = no need to tx Hpylori.

62
Q

Zollinger-Ellison Syndrome(ZES)/Gastrinoma sx?

A

Diarrhea(acid inactivates lipase), Ab pain, Anemia, Heme + stools,elevated gastrin, elevated gastric acid, large ulcer, multiple ulcers, ulcers distal to ligament of treitz, recurrent dispite Hpylori tx

63
Q

Zollinger-Ellison Syndrome(ZES)/Gastrinoma dx?

A
  1. U/S 2. Nuclear Somatostatin Scan = pt with ZES have increased number of somatostatin receptors 3. Secretin supression = should decrease gastrin, if not = ZES
64
Q

Zollinger-Ellison Syndrome(ZES)/Gastrinoma tx?

A

resection + PPI

65
Q

what should u be thinking if you see Zollinger-Ellison Syndrome(ZES)/Gastrinoma + hypercalcemia?

A

MEN2! 2b: Pheo, Medullary thryoid, mucosal tumors

66
Q

tx of diabetic gastroparesis

A

erythromycin

67
Q

diabetic with NV, bloating, constipation, early satiety, succusion splash. dx?

A

diabetic gastroparesis

68
Q

screening colonoscopy with IBD

A

start 8-10 years after dx and repeat every 1-2 years

69
Q

UC vs CD which is more often bloody?

A

UC

70
Q

Extraintestinal manifestations of IBD?

A

joint pain, eye shit, erythema nodosum, pyoderma gangrenosum, sclerosing cholangitis

71
Q

Tx of IBD

A

Mesalamine > sulfasalazine, steroids severe: azathioprine & 6MP, Infliximab

72
Q

tx of severe IBD

A

severe: azathioprine & 6MP, Infliximab

73
Q

tx of C.diff

A

metronidazole or PO vanc

74
Q

when do you give somthign else for C.diff? what do you give?

A

once metro has failed x2 then give oral vancomycin

75
Q

lactose Intolerance sx? dx? tx?

A

episodic diarrhea, flatulence dx: stool-osmolality test tx: remove milk shit from diet

76
Q

Carcinoid Syndrome sx? dx? tx?

A

flushing, episodes of hypotension, wheezing, diarrhea, CV murmer(tricuspid valve) dx: urinary 5-HIAA level tx: octreotide

77
Q

what murmer is associated with carcinoid syndrome?

A

tricuspid valve

78
Q

4 common shits that cause malabsorption

A

celiac dz, tropical sprue, chronic pancreatitis, whipple dz

79
Q

Celiac Disease cause? sx?

A

anti-gliadin, anti-endomysial & anti-transflutaminase ab cause flattening of villi sx: weight loss, fat malabsorption, iron malabsorption, microcytic anemia, folate malabsorption, dermatitis herpetiformis

80
Q

which malabsorption dz is associated with Dermatitis Herpetiformis?

A

celiac disease

81
Q

Tropical Sprue sx? tx?

A

just like celiacs! but with hx of the tropics tx: doxy or TMP/SMX

82
Q

Whipple Disease sx? tx? dx?

A

arthralgias, neurological abnormalities(dementia & seizures), ocular findings dx: PAS + organisms tx: tetracycline, TMP/SMX

83
Q

tx of whipples

A

tetracycline, TMP/SMX

84
Q

IBS sx?

A

abnormal pain relieved by bowel movements, abdominal pain that is less at night, abdominal pain w/diarrhea or constipation alternating

85
Q

IBS tx?

A

fiber, dicyclomine or hyoscyamine(antispasmodic/anticholinergic)

86
Q

colon cancer screening in lynch syndrome?

A

starting at age 25q1/2

87
Q

Hereditary nonpolyposis colon cancer syndrome(Lynch Syndrome)

A

CEO: Colon = 3 family members, 2 generations, 1 premature(<50) E = endometrial cancer O = Ovarian cancer

88
Q

Screening for FAP?

A

start at age 12

89
Q

Gardner’s Syndrome

A

GI & jaw tumors(osteomas)

90
Q

Peutz-Jeghers Syndrome

A

melanotic spots on lips, hamartomatous polyps

91
Q

Turcot Syndrome

A

colon, brain tumors + seizures

92
Q

screening if dysplastic colonic polyp found?

A

repeat 3-5 years after

93
Q

screening if previous colon cancer?

A

colonoscopy 1y s/p resection, 3y then q5 years

94
Q

tx of diverticulosis

A

Ciprofloxacin, metronidazole

95
Q

W/U of GI bleed

A
  1. NG tube 2. Endoscopy 3. Brisk? angiogram; slow?tagged RBC; no bleed?colonoscopy
96
Q

tx of active variceal bleeding?

A

octreotide

97
Q

drug to shrinkk esophageal variceals

A

propanolol

98
Q

complication from Transjugular Intrahepatic Portosystemic Shunts(TIPS)

A

used to tx esophageal varicies *hepatic encephalopathy

99
Q

What is dumping syndrome?

A

rapid release of gastric contents into the duodenum causing osmotic draw into the bowel causing a rapid rise in glucose = shaking, sweating, weakness, hypoglycemia

100
Q

what lab can tell u how severe pancreatitis is?

A

calcium! = worsening hypocalcemia = worse shit

101
Q

tx of pancreatitis with >30% necrosis

A

imipenem + surgery

102
Q

SAAG

A

Serum Albumin - Ascites Albumin Gradient SAAG > 1.1 = portal HTN or CHF/transudate SAAG <1.1 = exudative

103
Q

tx of Spontaneous Bacterial Peritonitis

A

Cefotaxime or Ceftriaxone

104
Q

Primary Biliary Cirrhosis sx?

A

PBC is for the bitches = subtle sx: 40-50yoa, osteoporosis, xanthomas, normal bili, increased ALP, ANTI-MITOCHONDRIAL AB

105
Q

Primary Biliary Cirrhosis tx?

A

Ursodeoxycholic acid

106
Q

Primary Sclerosis Cholangitis sx?

A

PSC is for sons of bitches sx: itching, elevated bilirubin & ALP, jaundice, ERCP shows beading

107
Q

Primary Sclerosis Cholangitis tx?

A

ursodeoxycholic acid or Cholestyramine

108
Q

Wilson’s Disease cause? sx? tx?

A

AR, decrease in ceruloplasma = decrease Cu excretion sx: cirrhosis, Choreiform movement, neuropsychiatric abnormalities, parkinsons tremor, kayser fleischer rings tx: penicillamine or trientine

109
Q

Hemochromatosis sx?

A

HFe gene mutation = excess Fe absorption from duodenum. sx: >50 yo with elevated AST, ALP, restrictive cardiomyopathy, skin darkening, jonit pain, bronze diabetes, pituitary accumulation(panhypopituitarism), Infertility, Hypatoma, Pseudogout, ED, Amenorrhea, elevated Fe & ferritin but low TIBC

110
Q

tx of hemochromatosis

A

phlebotomy or defoxamine

111
Q

Autoimmune Hepatitis

A

Autoimmune Hepatitis – often associated with other AI disease - SX: o elevated AST & ALT (~40s) & elevated alkaline phosphatase(ALP)(~1000s) o Elevated bilirubin o Extreme fatigue - DX: bx - TX: steroids +/- Azathioprine - Associated with: Celiac disease, thyroiditis, vasculitits - EX: o 42 yo AA female with SLE, extreme fatigue, lupus is stable on hydroxychloroquine, scleral icterus, hepatosplenomegaly, urine bilirubin +, AST 48, ALT 40, ALP 1000, bili 5. Dx?

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