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GI Flashcards

1
Q

If a patient who is on opiates has constipation despite multiple laxatives, what is the next step?

A

oral naloxegol

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2
Q

Patient with HBV since birth, normal LFTs, positive HBeAg and DNA >20k

what’s the next step?

A

This is the immune tolerant phase

Do not need to treat

Tx: serial LFT checks, if LFTs increase to >2x ULN, THEN you would treat

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3
Q

Should you hold ASA for patient with CAD having a colo?

A

No, do not need to discontinue ASA prior to a colo for any reason

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4
Q

65M with dysphagia to solids and liquids, 16lb weight loss in 3 months..what is the most likely dx?

A

pseudoachalasia from a tumor!

Pseudoachalasia is caused by a tumor at the gastroesophageal junction infiltrating the myenteric plexus causing esophageal motor abnormalities; symptoms, barium-imaging and manometric findings, and endoscopic appearance are similar to achalasia.

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5
Q

Cirrhotic with a drop in sat from sitting to standing - dx and evaluation?

A

Likely hepatopulmonary syndrome - echo with saline to rule out intracardiac shunt

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6
Q

Patient with gallbladder polyp and gallstones - what is the next step?

A

Cholecystectomy is indicated for this patient with a gallbladder polyp and gallstones because of the increased risk for gallbladder cancer when the two conditions coexist. Doesn’t matter if patient is symptomatic or not.

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7
Q

What are appropriate ways to confirm eradication of H Pylori?

A

Stool Ag or urea breath testing

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8
Q

Patient with dyspepsia > 60 yo, what should be part of their mgmt?

A

upper endoscopy

high value care

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9
Q

patient with asymptomatic pancreatic necrosis that is walled off - next step in mgmt?

A

nothing!

high value care

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10
Q

what intervention improves rates of gallstone complications in patients with gallstone pancreatitis?

A

same admission cholecystectomy

high value care

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11
Q

Does acute diverticulitis require imaging?

A

usually not

high value care

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12
Q

patient with small hyperplastic polyps - what should their colo screening interval be?

A

no sooner than 10 years

high value care

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13
Q

What is the treatment for uncomplicated diverticulitis

A

oral abx

high value care

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14
Q

what is the mgmt for asymptomatic hepatic cysts?

A

no follow up needed

high value care

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15
Q

What is the diagnosis?

Positive Anti–smooth muscle antibody

A

Autoimmune hepatitis

also associated with anti-LKM1 Ab

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16
Q

diagnostic workup for suspected achalasia

A
  1. barium swallow

2. endoscopy to rule out cancer and esophageal manometry

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17
Q

What is the treatment for achalasia

A

laparaoscopic myotomy of LES and endoscopic pneumatic dilation of the esophagus

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18
Q

what should patients undergo before surgery for GERD?

A

pH monitoring to demonstrate true reflux with symptom correlation and manometry to rule out a motility disorder before surgery

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19
Q

Who needs screening for Barrett’s

A

men > 50 with GERD sx for >5 years and add’l risk factors:

  • noctural reflux
  • hiatal hernia
  • elevated BMI
  • active tobacco use
  • intra abdominal distribution of fat
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20
Q

What is the treatment for Barrett’s

A

no dysplasia -> PPE, surveillance q 3-5 years with EGD

endoscopic ablation if low or high grade dysplasia

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21
Q

do women with GERD require routine screening for Barrett’s

A

no

don’t be tricked!

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22
Q

patients who are immunosuppresed and have odynophagia - best next step?

A

start empiric therapy for esophageal candidiasis

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23
Q

young adult with extreme dysphasia and food impaction

What is the diagnosis?

A

eosinophilic esophagitis

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24
Q

how diagnose eosinophilic esophagitis?

A

upper endoscopy and biopsy

empiric trial of PPI x 8 weeks -> diagnose EE if symptoms persist

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25
Q

does the absence of oral candida rule out esophageal candida?

A

no!

don’t be tricked!

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26
Q

What is the treatment for eosinophilic esophagitis

A

swallowed fluticasone or budesonide

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27
Q

All patients with PUD should be tested for what?

A

H Pylori

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28
Q

how long before testing for H Pylori should you stop antibiotics and PPIs

A

28 days for antibiotics
2 weeks for PPIs

don’t be tricked!

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29
Q

do duodenal ulcers need biopsies

A

no, little risk of malignancy

don’t be tricked!

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30
Q

when should you test for H Pylori eradication

A

at least 4 weeks after treatment

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31
Q

what is the workup for gastroparesis

A

nuclear medicine solid phase gastric emptying study

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32
Q

when reglan is used for gastroparesis what signs shuld prompt abrupt cessation of reglan?

A

dystonia and parkinsonian-like tardive dyskinesia

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33
Q

What is the diagnosis?

loose stools and malabsorption following bypass surgery

A

blind loop syndrome (SIBO)

tx with antibiotics and nutritional supplements

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34
Q

all patients with acute pancreatitis require what?

A

RUQUS to evaluate for obstructed biliary tract

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35
Q

if there are no calcifications on CT of pancreas and you suspect chronic pancreatitis, what’s the next step?

A

MRI, MRCP or EUS to detect abnormalities of the main and branch pancreatic ducts

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36
Q

sausage shaped pancreas on imaging

What is the diagnosis?

A

autoimmune pancreatitis

37
Q

how can you distinguish between type I and II autoimmune pancreatitis

A

Serum IgG4 is increased in type 1

38
Q

What is the treatment for autoimmune pancreatitis

A

steroids

39
Q

workup for chronic diarrhea?

A

Select colonoscopy for most patients with chronic diarrhea. The terminal ileum should be viewed to assess for Crohn disease; random biopsies of the colonic mucosa should be performed to assess for microscopic colitis.

40
Q

What is the diagnosis?

Bloating, abdominal discomfort relieved by a bowel movement, no weight loss or alarm features

A

IBS, test for celiac dz

41
Q

What is the diagnosis?

Diarrhea mainly in women aged 45-60 years, unrelated to food intake (nocturnal diarrhea), normal colonoscopy

A

Microscopic colitis; stop NSAIDs/PPIs, biopsy

42
Q

What is the diagnosis?

diarrhea associate with Use of artificial sweeteners or fructose

A

carbohydrate intolerance, dietary exclusion or hydrogen breath test

43
Q

What is the diagnosis?

Diarrhea with dairy products

A

Lactose intolerance; dietary exclusion or hydrogen breath test

44
Q

What is the diagnosis?

Nocturnal diarrhea and diabetes mellitus or SSc

A

SIBO, hydrogen breath test or empiric Abx trial

45
Q

What is the diagnosis?

Somatization or other psychiatric syndromes, history of laxative use

A

self induced diarrhea

obtain tests for stool osmolality, electrolytes, magnesium, and laxative screen

46
Q

What is the diagnosis?

Severe secretory diarrhea and flushing

A

Carcinoid syndrome; obtain test for 24-hour urinary excretion of 5-HIAA

47
Q

what are the 4 most common malabsorptive disorders?

A

celiac

SIBO

short bowel syndrome

pancreatic insufficiency

48
Q

What is the diagnosis?

Travel to India or Puerto Rico, malabsorption, weight loss, malaise, folate or vitamin B12 deficiency, steatorrhea

A

Diagnose tropical sprue.
Order a small bowel biopsy.
Treat with a sulfonamide or tetracycline and folic acid.

49
Q

What is the diagnosis?

History of resection of <100 cm of distal ileum, with voluminous diarrhea, weight loss, and malnutrition

A

Diagnose short-bowel syndrome with bile acid enteropathy. Order empiric trial of cholestyramine.

50
Q

How do you diagnose celiac disease?

A

Diagnostic tests include an IgA anti-tTG antibody assay with small bowel biopsy for those with a positive antibody assay.

51
Q

what test do all celiac patients need

A

DEXA

52
Q

Celiac adherent patients with recurrent malabsorption should be evaluated for what?

A

intestinal lymphoma.

53
Q

Why is it important that all celiac patients adhere to a gluten free diet

A

to prevent intestinal lymphoma

54
Q

how often should patients wtih IBD have screening colonoscopies?

A

beginning 8 years after diagnosis -> every 1-2 years

if dysplasia is found -> protocolectomy

55
Q

What is the treatment for microscopic colitis

A

bismuth or loperamide

56
Q

What is the diagnosis?

LLQ abdominal pain and self limited bloody diarrhea

A

ischemic colitis

dx colonoscopy: patchy segmental ulcerations

can also see thumbprinting on barium x ray

57
Q

how do you diagnose Gilbert’s disease?

A

elevated indirect (>80% indirect bili), normal AST and ALT and lack of hemolysis

58
Q

post exposure prophylaxis for Hep A?

A

vaccine if <40yo

immune globulin if older or immunocompromised

59
Q

how vaccine for Hep A prior to travel

A

1 dose if <40 and healthy

1 dose vaccine + immune globulin if older or immunocompromised or have chronic liver dz

60
Q

Post-exposure prophylaxis for Hep B?

A

vaccine + HBIG after needle stick injury, for sexual and household contacts of patients with HBV

61
Q

Which patients with HBV need monitoring for HCC

A 
asian women >50
asian men >40
cirrhotics
black patients >20
elevated ALT and HBV DNA >10k
family history of HCC
62
Q

What is the diagnostic work-up for HCV

A

anti HCV ab
then HCV RNA

HCV genotyping if infected

63
Q

Can normal LFTs exclude a diagnosis of HCV?

A

no

don’t be tricked!

64
Q

What should you test for before treating for HCV?

A

HBV, can be reactivated iso HCV

don’t be tricked!

65
Q

What is the treatment for HBV iso pregnancy

A

pegylated interferon

66
Q

What is the treatment for hemochromatosis

A

monitoring if positive for HFE gene but normal serum ferritin levels

phlebotomy if elevated ferritin

67
Q

patients with hemochromatosis and cirrhosis should be screened for HCC how often

A

q 6 months

68
Q

Can patients with fatty liver and elevated LFTs be treated wtih statins

A

yes

don’t be tricked!

69
Q

What is the management of PBC

A

biliary US to rule out extrahepatic bile duct obstruction

70
Q

What is the treatment for PBC

A

ursodeoxycholic acid

71
Q

what Ab is associated with PBC

A

antimitochondrial

72
Q

PSC is associated with what other illness?

A

IBD, found in 80% of patients, mostly UC

73
Q

granulomatous inflammation centered on the septal bile duct

What is the diagnosis?

A

PBC

74
Q

What screening do patients with PSC need

A

colonoscopy q1-2 years starting at diagnosis with PSC

annual MRCP and carb 19-9 level for cholangiocarcinoma surveillance

if have cirrhosis - q6 month screening for HCC with US

75
Q

what is the neutrophil cut off for SBP

A

250

76
Q

what is the SAAG cut off for cirrhosis or R sided HF or budd chiari

A

> 1.1

77
Q

cirrhosis patients with varices should receive what form of bisphosphonates

A

IV

don’t be tricked!

78
Q

What is the treatment for SBP in board basics

A

cefotaxime and albumin infusions

79
Q

how treat acute wilson’s dz

A

trientine or penicillamine

80
Q

pregnant patient with ithing, ALT 5x ULN, elevated bile acids and alk phos

What is the diagnosis?

A

intrahepatic cholestasis of pregnancy

tx: ursodiol

81
Q

What is the diagnosis?

pregnant woman in 3rd trimester with HTN, edema, proteinuria and mild ALT elevation

A

preeclampsia

tx: delivery

82
Q

What is the diagnosis?

pregnant woman in 3rd trimester with HTN, edema, proteinuria and mild ALT elevation also with lab abnormalities: hemolysis, elevated ALT, thrombocytopenia

A

HELLP syndrome

tx: delivery

83
Q

What is the diagnosis?

pregnant woman with HTN, edema, abd pain, nausea, ALT 200-1000, hemolysis, low platelets, encephalopathy, prolonged INR

A

Acute fatty liver of pregnancy

tx: delivery

84
Q

What is the diagnosis?

RUQ pain, diarrhea and obstructive jaundice in advanced HIV

A

AIDS cholangiopathy

cryptosporidium infection

85
Q

What is the treatment for biliary cholic

A

NSAIDs

elective chole if gallstones seen on imaging

86
Q

What is the treatment for acute cholecystitis

A

antibiotics and surgery before hospital discharge

87
Q

What is the treatment for ascending cholangitis

A

antibiotics and ERCP to remove common bile duct stones

elective chole within 6 weeks

88
Q

What is the Hgb transfusion threshold for patients with colonic bleeding?

A

Hgb 9.0

89
Q

First step in undiagnosed GI bleeding

A

repeat EGD or colo

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