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GI Flashcards

1
Q

First step in obscure GI bleed

A

Repeat EGD/c-scope, NOT push enteroscopy

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2
Q

Treatment of opioid-induced constipation

A 
Oral naloxegol (opioid receptor antagonist)
OR 
oral nadlemedine
OR
subcutaneous methylnaltrexone
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3
Q

When to initiate therapy for chronic HBV

A
  • In the immune-active phase, HBeAg-postive and reactivation, HBeAg-negative phase
    AND Elevated aminotransferase levels and hepatic fibrosis
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4
Q

Management of patient with chronic hep B in immune tolerant phase (active viral load)

A

Serial monitoring of aminotransferase levels.

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5
Q

Preoperative aspirin management for colonoscopies

A
  • Continue for patients with established cardiovascular disease
  • Discontinue after polypectomy in patients without established cardiovascular disease
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6
Q

NAFLD on liver ultrasound

A

Hyperechoic

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7
Q

Autoimmune hepatitis diagnosis

A

HIGH titer antibody (20-30% of patients with NALFD can have low titer antibody levels) + requires liver biopsy

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8
Q

What is pseudoachalasia?

A

TUmor at GEJ infiltrating the myenteric plexus causing esophageal motor abnormalities (symptoms, barium-imaging and manometry and endoscopy are similar to achalasia)

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9
Q

How to differentiate pseudoachalasia from achalasia

A 
Achalasia = insidious onset, long duration of symptoms (years) before patients seek attention
Pseudoachalasia = short duration of symptoms, rapid weight loss
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10
Q

Treatment for diarrhea-predominant IBS

A

low-FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) diet

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11
Q

How to diagnose zenker diverticulum

A

Barium esophagram (you can see it with endoscopy but too high risk for perforation if endoscope enters diverticulum)

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12
Q

Presentation of zenker diverticulum

A
  • Regurgitation of undigested food + halitosis + esophageal dysphagia
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13
Q

Diagnosis of hepatopulmonary syndrome

A

TTE w/ agitated saline demonstrating that shunting of blood is not intracardiac

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14
Q

Pathophys of hepatopulmonary syndrome

A

Dilation of pulmonary vasculature in setting of advanced liver disease

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15
Q

Classic features of hepatopulmonary syndrome

A

Platypnea (worsening shortness of breath in upright position)
Orthodeoxia (worsening o2 sat in upright position)

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16
Q

Presentation of acalculous cholecystitis

A

biliary colic + sepsis-like + jaundice + critically ill patient + soft palpable mass

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17
Q

Treatment for acalculous cholecystitis

A

IF unstable –> cholecystostomy tube placement
IF stable –> cholecystectomy
IV abx, bcx

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18
Q

Management of patient requiring NSAID with history of PUD

A

celecoxib + PPI

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19
Q

Follow-up colonoscopy interval if hyper plastic polyps

A

10 years (unless greater than 10 mm), they are non neoplastic

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20
Q

Follow-up colonoscopy interval if sessile serrated polyps

A

5 years

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21
Q

Follow-up colonoscopy interval if 3 or more adenomas

A

3 years

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22
Q

Follow-up colonoscopy interval if polyp with villous or high-grade dysplasia

A

3 years

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23
Q

Next step for ascending cholangitis

A

ERCP

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24
Q

Treatment of toxic megacolon

A

1) Urgent colectomy
2) IV high dose steroids,
3) broad spectrum abx

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25
Q

Microscopic colitis clinical features

A

Nonbloody, watery diarrhea + older adults

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26
Q

Microscopic colitis diagnosis

A

Colonoscopy with random biopsies

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27
Q

SIBO clinical features

A

Diarrhea + bloating/flatulence + weight loss (malabsorption symptoms) + commonly after gastric bypass surgery

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28
Q

Autoimmune pancreatitis radiographic features

A
  • “sausage shaped” pancreas
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29
Q

Autoimmune pancreatitis treatment

A

Oral prednisone

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30
Q

Management of acute fatty liver of pregnancy

A

Immediate delivery of fetus

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31
Q

Management of a gallbladder polyp

A

IF larger than 1 cm OR associated with gallstones –> cholecystectomy (increased risk for gallbladder cancer)

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32
Q

How to test for eradication of h pylori

A

Urea breath test OR fecal antigen test

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33
Q

Management of gallstone pancreatitis

A

same-admission cholecystectomy

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34
Q

Presentation of narcotic bowel syndrome

A

Increase in pain with increasing doses of narcotics + chronic pain and nausea

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35
Q

Management of pain in chronic pancreatitis

A

NSAIDs/tylenol
TCA’s + gabapentin
smoking and drinking cessation

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36
Q

Management of HBV-related polyarteritis nodosa

A

Entecavir

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37
Q

Management of patient with acute pancreatitis who hasn’t eaten for 4 days

A

enteral nutrition

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38
Q

SBP prophylaxis

A

ciprofloxacin

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39
Q

Next step for patient with new ascites with negative tap

A

Prophylactic antibiotics if high risk (low ascitic fluid protein, advanced CHF)

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40
Q

Why is albumin infusion used for SBP?

A

Reduces incidence of hepatorenal syndrome + improves survival

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41
Q

Dumping syndrome presentation

A

vasomotor symptoms (palpitations, tachycardia, diaphoresis, lightheadedness) + abdominal pain + diarrhea

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42
Q

Features of secretory diarrhea

A

High volume stool leading to severe dehydration/electrolyte disturbances + diarrhea persistent when stooling despite fasting

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43
Q

When you should think hematochezia may be due to UGIB

A

Hemodynamic instability from rapid UGIB in a young patient

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44
Q

Management of asymptomatic, low risk pancreatic cyst

A

Surveillance MRI abdomen in 1 year

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45
Q

Management of main-duct intraductal papillary mucinous pancreatic cancer

A

Pancreatic resection

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46
Q

Best screening test for celiac disease

A

Anti-tissue transglutaminase IgA antibody

47
Q

When to restart anticoagulation after GI bleed and hemostasis has been achieved endoscopically

A

Same day

48
Q

Treatment of baby born to mother with chronic HBV infection

A

Active HBV vaccination + passive immunization

49
Q

How to prevent vertical transmission of hepatitis B viral infection

A

Tenofovir

50
Q

Treatment for chronic idiopathic constipation unresponsive to first-line treatment

A

linaclotide

51
Q

Clinical features of SIBO

A

diarrhea + bloating + weight loss

52
Q

gastroparesis presentation

A

Nausea and vomiting after eating

53
Q

Predictive gene assays for CRC?

A

Multiple are available that predict risk of recurrence but questionable value per NCCN

54
Q

Timing of colonoscopy after uncomplicated diverticulitis

A

1 to 2 months after first episode (is associated with CRC + IBD)

55
Q

Next step after diagnosis of pernicious anemia

A

EGD w/ biopsy looking for gastric adenocarcinomas and gastric carcinoid

56
Q

Use of glucose breath test

A

Test for SIBO

57
Q

Treatment of anal fissue

A

Daily warm-water sits baths + psyllium (bulk laxative)

58
Q

Clinical significance of multiple fundic gand polyps in the stomach at a young age + next step after finding them

A
  • FAP

- need colonoscopy

59
Q

Initial test for evaluation of achalasia

A

Barium esophagram

60
Q

Healthcare maintenance that patients with cirrhosis need

A

DEXA + vitamin D/calcium/phosphate for osteoporosis

61
Q

DVT prophylaxis for hospitalized patients with IBD

A

Subcu heparin (IBD is prothrombotic because of systemic inflammation and VTE is a significant cause of morbidity and mortality in patients with IBD)

62
Q

Next step in patient with persistent GERD + extra esophageal symptoms

A

Ambulatory pH testing (supports diagnosis of laryngopharyngeal reflux)

63
Q

BP management in cirrhotics

A

Discontinue ACEi’s + NSAIDS (decreased renal perfusion, cirrhosis results in reduced renal blood flow and GFR. RAS uptitration is physiologic in this setting)

64
Q

Management of ascites in cirrhotics

A
  • sodium restriction

- diuretics

65
Q

Treatment of acute liver failure

A

Immediate referral to a liver transplantation center

66
Q

Definition of acute liver failure

A

Hepatic encephalopathy within 26 weeks of developing symptoms of liver disease

67
Q

Treatment of left-sided UC

A

Combined mesalamine therapy (oral + topical) (superior for induction of remission in mild to moderately active disease combined with oral or topical therapies alone)

68
Q

First in evaluation of dyspepsia (sounding like PUD)

A

IF <60 yo –> Test for H pylori, followed by eradication therapy if positive
IF >60 –> EGD to rule out gastric cancer

69
Q

Treatment for amebic liver abscess (entamoeba histolytica)

A

Metronidazole + paromomycin (luminal agent)

pyogenic abscesses are drained percutaneously but amoebic liver abscesses usually resolve with antibiotics

70
Q

Biopsy result in UC

A

Crypt abscesses + distorted and branching colonic crypts (similar to Crohns)

71
Q

How is UC generally distinguished from Crohn’s

A

Endoscopic findings

72
Q

Wilson’s disease clinical features

A

Young + liver disease + neurologic + hemolytic anemia (copper release from liver cells)

73
Q

Management of achalasia

A

IF surgical candidate –> myotome or endoscopic dilation

IF nonsurgical candidate –> botox injection (inhibiting acetylcholine release, resulting in LES relaxation

74
Q

Describe the common variant of hep A

A

Relapsing, remitting hep A – multiple relapses with spontaneous improvement

75
Q

Management of chronic PPI therapy

A
  • You should give PPI’s at lowest effective dose possible and try to reduce or stop PPI therapy at least once a year.
  • Maintenance PPI therapy is really only recommended for patients with GERD who continue to have symptoms after initial course of PPI is discontinued
76
Q

PPI adverse effects with long term therapy

A
  • increased risk for fractures due to calcium malabsoprtion

- b12 and magnesium malabsorption

77
Q

Term for hyperbilirubinemia condition associated with pregnancy

A

Intrahepatic cholestasis of pregnancy

78
Q

Management of intrahepatic cholestasis of pregnancy

A

Ursodeoxycholic acid

79
Q

HELLP presentation

A

abdominal pain + nausea/vomiting + pruritus + jaundice

80
Q

Clinical significance of isolated right-colon ischemia

A
  • warning sign of acute mesenteric ischemia due to embolism or thrombosis of the SMA
81
Q

Clinical features of medication-induced enteropathy?

A

Very similar to celiac disease (malabsorption + severe diarrhea and weight loss + villous atrophy and increased intraepithelial lymphocytes in duodenum)

82
Q

Causes of medication-induced enteropathy

A
  • Olmesartan

- ARBs

83
Q

Management of Barrett esophagus with low-grade or high grade dysplasia

A
  • Endoscopic ablation

- Esophagectomy only if ablation does not eradicate dysplasia

84
Q

Diagnosis of gastroparesis

A

Gastric emptying scintigraphy

85
Q

Symptoms of gastroparesis

A

Early satiety + postprandial fullness + nausea/vomiting + upper abdominal pain + bloating + weight loss

86
Q

Indication for TIPS procedure

A

Variceal bleeding in which hemostasis cannot be achieved by endoscopic therapy

87
Q

Protein restriction for hepatic encephalopathy?

A

Debunked

88
Q

Screening recommendation for person with first-degree relative with colon cancer

A

40 years (or 10 years earlier than the youngest age at which colon cancer was diagnosed – whichever comes first)

89
Q

Management of HCC

A

IF cirrhosis –> liver transplant

90
Q

Name of criteria for determining liver transplantation for HCC

A

Milan criteria

91
Q

HCC diagnosis

A

Radiographic, no biopsy (biopsies are dangerous in cirrhotics given coagulopathy and tumor seeding)

92
Q

Management of diverticulitis

A

UNCOMPLICATED
- outpatient antibiotics (ciprofloxacin + metronidazole)
COMPLICATED
- Admit + IV antibiotics

93
Q

Complicated vs. uncomplicated diverticulitis

A

Complicated = abscess, fistula,

94
Q

Management of fecal loading with overflow diarrhea in elderly person

A

KUB

95
Q

Treatment of moderate to severe Crohn’s (requiring multiple courses of pred)

A

Infliximab

96
Q

Screening for Lynch syndrome

A
  • C-scope at age 20 or 5 years before earliest age

- Repeat c-scope q2 years

97
Q

Cancers associated with lynch syndrome

A

CRC, endometrial, ovarian, pancreatic

98
Q

Cause of Lynch syndrome

A

Germline mutation in one of the DNA mismatch repair genes

99
Q

Hereditary cancer syndrome associated with gastric cancer

A

Hereditary diffuse gastric cancer

100
Q

Gene mutation associated with hereditary diffuse gastric cancer

A

CDH1 gene

101
Q

cancers associated with hereditary diffuse gastric cancer

A

gastric + breast

102
Q

term for drug removal

A

dechallenge

103
Q

clinical features of centrally mediated abdominal pain syndrome

A

near-constant abdominal pain + long duration + generalized

104
Q

Management of centrally mediated abdominal pain syndrome

A

CBT

105
Q

Treatment of functional dyspepsia

A

PPI daily for 4 weeks

IF no benefit from PPI –> TCA

106
Q

Treatment of cryoglobulinemia from chronic hep c

A 
Treat the hep C (ledipasvir and sofosbuvir)
IF severe (end organ failure) --> rituximab + pulse dose steroids
107
Q

Management of microscopic colitis

A

Discontinue potentially causative medication

  • Loperamide
  • Budesonide if no benefit from loperamide
108
Q

Risk for malignant transformation of hepatic adenomas

A

10%

109
Q

Next step in IDA evaluation if negative upper endoscopy and colonoscopy x2

A

Capsule endoscopy

110
Q

Treatment of hep B in immune-active, hep B e antigen-positive phase

A

Tenofovir or entecavir

111
Q

Management of constipation-predominant IBS

A

Miralax

112
Q

Salvage therapy for H pylori that persists after eradication therapy

A
  • Different antibiotics from original regimen (decrease risk of resistance)
    Bismuth + flatly + PPI + tetracycline
113
Q

Management of pancreatic necrosis

A

IF walled-off + asymptomatic –> no intervention

114
Q

indications for liver transplant

A

MELD of 15

Decompensated cirrhosis

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