GI Flashcards
First step in obscure GI bleed
Repeat EGD/c-scope, NOT push enteroscopy
Treatment of opioid-induced constipation
Oral naloxegol (opioid receptor antagonist) OR oral nadlemedine OR subcutaneous methylnaltrexone
When to initiate therapy for chronic HBV
- In the immune-active phase, HBeAg-postive and reactivation, HBeAg-negative phase
AND Elevated aminotransferase levels and hepatic fibrosis
Management of patient with chronic hep B in immune tolerant phase (active viral load)
Serial monitoring of aminotransferase levels.
Preoperative aspirin management for colonoscopies
- Continue for patients with established cardiovascular disease
- Discontinue after polypectomy in patients without established cardiovascular disease
NAFLD on liver ultrasound
Hyperechoic
Autoimmune hepatitis diagnosis
HIGH titer antibody (20-30% of patients with NALFD can have low titer antibody levels) + requires liver biopsy
What is pseudoachalasia?
TUmor at GEJ infiltrating the myenteric plexus causing esophageal motor abnormalities (symptoms, barium-imaging and manometry and endoscopy are similar to achalasia)
How to differentiate pseudoachalasia from achalasia
Achalasia = insidious onset, long duration of symptoms (years) before patients seek attention Pseudoachalasia = short duration of symptoms, rapid weight loss
Treatment for diarrhea-predominant IBS
low-FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) diet
How to diagnose zenker diverticulum
Barium esophagram (you can see it with endoscopy but too high risk for perforation if endoscope enters diverticulum)
Presentation of zenker diverticulum
- Regurgitation of undigested food + halitosis + esophageal dysphagia
Diagnosis of hepatopulmonary syndrome
TTE w/ agitated saline demonstrating that shunting of blood is not intracardiac
Pathophys of hepatopulmonary syndrome
Dilation of pulmonary vasculature in setting of advanced liver disease
Classic features of hepatopulmonary syndrome
Platypnea (worsening shortness of breath in upright position)
Orthodeoxia (worsening o2 sat in upright position)
Presentation of acalculous cholecystitis
biliary colic + sepsis-like + jaundice + critically ill patient + soft palpable mass
Treatment for acalculous cholecystitis
IF unstable –> cholecystostomy tube placement
IF stable –> cholecystectomy
IV abx, bcx
Management of patient requiring NSAID with history of PUD
celecoxib + PPI
Follow-up colonoscopy interval if hyper plastic polyps
10 years (unless greater than 10 mm), they are non neoplastic
Follow-up colonoscopy interval if sessile serrated polyps
5 years
Follow-up colonoscopy interval if 3 or more adenomas
3 years
Follow-up colonoscopy interval if polyp with villous or high-grade dysplasia
3 years
Next step for ascending cholangitis
ERCP
Treatment of toxic megacolon
1) Urgent colectomy
2) IV high dose steroids,
3) broad spectrum abx
Microscopic colitis clinical features
Nonbloody, watery diarrhea + older adults
Microscopic colitis diagnosis
Colonoscopy with random biopsies
SIBO clinical features
Diarrhea + bloating/flatulence + weight loss (malabsorption symptoms) + commonly after gastric bypass surgery
Autoimmune pancreatitis radiographic features
- “sausage shaped” pancreas
Autoimmune pancreatitis treatment
Oral prednisone
Management of acute fatty liver of pregnancy
Immediate delivery of fetus
Management of a gallbladder polyp
IF larger than 1 cm OR associated with gallstones –> cholecystectomy (increased risk for gallbladder cancer)
How to test for eradication of h pylori
Urea breath test OR fecal antigen test
Management of gallstone pancreatitis
same-admission cholecystectomy
Presentation of narcotic bowel syndrome
Increase in pain with increasing doses of narcotics + chronic pain and nausea
Management of pain in chronic pancreatitis
NSAIDs/tylenol
TCA’s + gabapentin
smoking and drinking cessation
Management of HBV-related polyarteritis nodosa
Entecavir
Management of patient with acute pancreatitis who hasn’t eaten for 4 days
enteral nutrition
SBP prophylaxis
ciprofloxacin
Next step for patient with new ascites with negative tap
Prophylactic antibiotics if high risk (low ascitic fluid protein, advanced CHF)
Why is albumin infusion used for SBP?
Reduces incidence of hepatorenal syndrome + improves survival
Dumping syndrome presentation
vasomotor symptoms (palpitations, tachycardia, diaphoresis, lightheadedness) + abdominal pain + diarrhea
Features of secretory diarrhea
High volume stool leading to severe dehydration/electrolyte disturbances + diarrhea persistent when stooling despite fasting
When you should think hematochezia may be due to UGIB
Hemodynamic instability from rapid UGIB in a young patient
Management of asymptomatic, low risk pancreatic cyst
Surveillance MRI abdomen in 1 year
Management of main-duct intraductal papillary mucinous pancreatic cancer
Pancreatic resection
Best screening test for celiac disease
Anti-tissue transglutaminase IgA antibody
When to restart anticoagulation after GI bleed and hemostasis has been achieved endoscopically
Same day
Treatment of baby born to mother with chronic HBV infection
Active HBV vaccination + passive immunization
How to prevent vertical transmission of hepatitis B viral infection
Tenofovir
Treatment for chronic idiopathic constipation unresponsive to first-line treatment
linaclotide
Clinical features of SIBO
diarrhea + bloating + weight loss
gastroparesis presentation
Nausea and vomiting after eating
Predictive gene assays for CRC?
Multiple are available that predict risk of recurrence but questionable value per NCCN
Timing of colonoscopy after uncomplicated diverticulitis
1 to 2 months after first episode (is associated with CRC + IBD)
Next step after diagnosis of pernicious anemia
EGD w/ biopsy looking for gastric adenocarcinomas and gastric carcinoid
Use of glucose breath test
Test for SIBO
Treatment of anal fissue
Daily warm-water sits baths + psyllium (bulk laxative)
Clinical significance of multiple fundic gand polyps in the stomach at a young age + next step after finding them
- FAP
- need colonoscopy
Initial test for evaluation of achalasia
Barium esophagram
Healthcare maintenance that patients with cirrhosis need
DEXA + vitamin D/calcium/phosphate for osteoporosis
DVT prophylaxis for hospitalized patients with IBD
Subcu heparin (IBD is prothrombotic because of systemic inflammation and VTE is a significant cause of morbidity and mortality in patients with IBD)
Next step in patient with persistent GERD + extra esophageal symptoms
Ambulatory pH testing (supports diagnosis of laryngopharyngeal reflux)
BP management in cirrhotics
Discontinue ACEi’s + NSAIDS (decreased renal perfusion, cirrhosis results in reduced renal blood flow and GFR. RAS uptitration is physiologic in this setting)
Management of ascites in cirrhotics
- sodium restriction
- diuretics
Treatment of acute liver failure
Immediate referral to a liver transplantation center
Definition of acute liver failure
Hepatic encephalopathy within 26 weeks of developing symptoms of liver disease
Treatment of left-sided UC
Combined mesalamine therapy (oral + topical) (superior for induction of remission in mild to moderately active disease combined with oral or topical therapies alone)
First in evaluation of dyspepsia (sounding like PUD)
IF <60 yo –> Test for H pylori, followed by eradication therapy if positive
IF >60 –> EGD to rule out gastric cancer
Treatment for amebic liver abscess (entamoeba histolytica)
Metronidazole + paromomycin (luminal agent)
pyogenic abscesses are drained percutaneously but amoebic liver abscesses usually resolve with antibiotics
Biopsy result in UC
Crypt abscesses + distorted and branching colonic crypts (similar to Crohns)
How is UC generally distinguished from Crohn’s
Endoscopic findings
Wilson’s disease clinical features
Young + liver disease + neurologic + hemolytic anemia (copper release from liver cells)
Management of achalasia
IF surgical candidate –> myotome or endoscopic dilation
IF nonsurgical candidate –> botox injection (inhibiting acetylcholine release, resulting in LES relaxation
Describe the common variant of hep A
Relapsing, remitting hep A – multiple relapses with spontaneous improvement
Management of chronic PPI therapy
- 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
PPI adverse effects with long term therapy
- increased risk for fractures due to calcium malabsoprtion
- b12 and magnesium malabsorption
Term for hyperbilirubinemia condition associated with pregnancy
Intrahepatic cholestasis of pregnancy
Management of intrahepatic cholestasis of pregnancy
Ursodeoxycholic acid
HELLP presentation
abdominal pain + nausea/vomiting + pruritus + jaundice
Clinical significance of isolated right-colon ischemia
- warning sign of acute mesenteric ischemia due to embolism or thrombosis of the SMA
Clinical features of medication-induced enteropathy?
Very similar to celiac disease (malabsorption + severe diarrhea and weight loss + villous atrophy and increased intraepithelial lymphocytes in duodenum)
Causes of medication-induced enteropathy
- Olmesartan
- ARBs
Management of Barrett esophagus with low-grade or high grade dysplasia
- Endoscopic ablation
- Esophagectomy only if ablation does not eradicate dysplasia
Diagnosis of gastroparesis
Gastric emptying scintigraphy
Symptoms of gastroparesis
Early satiety + postprandial fullness + nausea/vomiting + upper abdominal pain + bloating + weight loss
Indication for TIPS procedure
Variceal bleeding in which hemostasis cannot be achieved by endoscopic therapy
Protein restriction for hepatic encephalopathy?
Debunked
Screening recommendation for person with first-degree relative with colon cancer
40 years (or 10 years earlier than the youngest age at which colon cancer was diagnosed – whichever comes first)
Management of HCC
IF cirrhosis –> liver transplant
Name of criteria for determining liver transplantation for HCC
Milan criteria
HCC diagnosis
Radiographic, no biopsy (biopsies are dangerous in cirrhotics given coagulopathy and tumor seeding)
Management of diverticulitis
UNCOMPLICATED
- outpatient antibiotics (ciprofloxacin + metronidazole)
COMPLICATED
- Admit + IV antibiotics
Complicated vs. uncomplicated diverticulitis
Complicated = abscess, fistula,
Management of fecal loading with overflow diarrhea in elderly person
KUB
Treatment of moderate to severe Crohn’s (requiring multiple courses of pred)
Infliximab
Screening for Lynch syndrome
- C-scope at age 20 or 5 years before earliest age
- Repeat c-scope q2 years
Cancers associated with lynch syndrome
CRC, endometrial, ovarian, pancreatic
Cause of Lynch syndrome
Germline mutation in one of the DNA mismatch repair genes
Hereditary cancer syndrome associated with gastric cancer
Hereditary diffuse gastric cancer
Gene mutation associated with hereditary diffuse gastric cancer
CDH1 gene
cancers associated with hereditary diffuse gastric cancer
gastric + breast
term for drug removal
dechallenge
clinical features of centrally mediated abdominal pain syndrome
near-constant abdominal pain + long duration + generalized
Management of centrally mediated abdominal pain syndrome
CBT
Treatment of functional dyspepsia
PPI daily for 4 weeks
IF no benefit from PPI –> TCA
Treatment of cryoglobulinemia from chronic hep c
Treat the hep C (ledipasvir and sofosbuvir) IF severe (end organ failure) --> rituximab + pulse dose steroids
Management of microscopic colitis
Discontinue potentially causative medication
- Loperamide
- Budesonide if no benefit from loperamide
Risk for malignant transformation of hepatic adenomas
10%
Next step in IDA evaluation if negative upper endoscopy and colonoscopy x2
Capsule endoscopy
Treatment of hep B in immune-active, hep B e antigen-positive phase
Tenofovir or entecavir
Management of constipation-predominant IBS
Miralax
Salvage therapy for H pylori that persists after eradication therapy
- Different antibiotics from original regimen (decrease risk of resistance)
Bismuth + flatly + PPI + tetracycline
Management of pancreatic necrosis
IF walled-off + asymptomatic –> no intervention
indications for liver transplant
MELD of 15
Decompensated cirrhosis
