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Medicine > GI and Hepatology > Flashcards

GI and Hepatology Flashcards

1
Q

risk factors for cholesterol gallstones include the 5 Fs and what ethnicity?

A

Native American

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2
Q

risk factors for PIGMENT gallstones is caused by __________. increased risk for what ethnicity?

A

hemolytic dz

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3
Q

medical management of gallstones aka cholelithiasis NOT cholecystitis (if not surgical candidate)

A

ursodeoxycholic acid

note, this can also treat primary biliary cirrhosis

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4
Q

use US to dx cholecystitis and choledocholithiasis. if US is equivocal, what is next test (and treatment) to use for each?

A

cholecystitis - HIDA scan -> cholecystectomy now

choledocho - MRCP -> ERCP now -> cholecystectomy later

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5
Q

3 abx regimens that can cover GI bugs, like for cholecystitis or diverticulitis (gram neg rods and anaerobes)

A
  1. ciprofloxacin + metronidazole
  2. ampicillin-gentamycin + metronidazole
  3. pip/tazo, esp if also covering for skin flora
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6
Q

Gardner syndrome

A

Familial Adenamatous Polyposis (FAP colon cancer)
+ osseous and soft tissue tumors, congenital hypertrophy of retinal pigment epithelium, impacted/supernumerary teeth. fibromatosis.

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7
Q

what is colon adenoma-carcinoma sequence?

what can impede progression?

A
  1. APC increases risk of forming polyps.
  2. k-ras mutation leads to polyp formation.
  3. p53 mutation and increase COX expression = progression to carcinoma.

ASPIRIN impedes progression from adenoma to carcinoma

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8
Q

what is gene mutation in FAP colon cancer? and ppx/screening recommendation?

A

Autosomal dominant APC gene mutation.

start colonoscopy age 10-12, Qyearly prophylactic colectomy or else 100% progress to carcinoma!

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9
Q

Hereditary nonpolyposis colorectal cancer aka Lynch syndrome what is gene mutation and prophylaxis/screening recommendation?

A 
DNA mismatch repair gene
start screening (colonoscopy) at age 20 or 10 years prior to first CRC dx in family, whichever comes first. Q1-2yrs
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10
Q

apple core lesion on KUB barium enema

A

colon cancer

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11
Q

what is function of CEA levels in colorectal cancer? (dx vs following vs other)

A

used for regression or relapse. never diagnostic

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12
Q

tx of colon cancer with lymph nodes or mets. (if no spread, simple resection is curative)

A
  1. FOLFOX(5-Fu + leucovorin + oxaliplatin)
    OR
  2. FOLFIRI (Irinotecan with fluorouracil (5FU) and folinic acid)
  • also bevacizumab (VEGF inhibitor) can improve remission
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13
Q

if someone has screening colonoscopy, what would indication be for them to have another one in <10 yrs?

A

Q5-10yrs if: 1-2 polyps <1cm, tubular/low grade

Q1-3yrs if: 3+ polyps 1+ cm, villous/high grade

Q2-6mo if more than that

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14
Q

PUD that’s not caused by h.pylori or nsaids or malignancy can be curlings or cushing ulcers. what are those 2 caused by?

A

curlings - burn patients. from stress?

cushings - increased ICP, ventilated patients, or on steroids

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15
Q

what symptom should clue you in on gastronoma aka zollinger ellison syndrome besides refractory PUD?

A

diarrhea

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16
Q

all ulcers in PUD regardless of cause are helped by what 3 things (besides treating underlying cause)

A

PPI
alcohol cessation
smoking cessation

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17
Q

triple and quad therapy for h.pylori

A

triple: amox OR metroniadzole + azithro/clarithro + PPI
quad: tetracycline + metronidazole + bismuth salt + PPI

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18
Q

best NONINVASIVE test to confirm diagnosis of h.pylori infection (obvis egd + bx is best)

A

urea breath test

19
Q

best test to confirm eradication of h.pylori

A

stool antigen test

20
Q

what study to localize gastrinoma tumor

A

somatostatin receptor scintigraphy scan

21
Q

what is the real danger of a gastrinoma/zollinger ellison synrome?

A

gastrinoma itself is benign. but must be resected, bc high levels of gastrin can cause malignant gastric cancer

22
Q

test and cutoff values for diagnosing gastrinoma/Z-E syndrome

A

serum gastrin level. MAKE SURE TO HOLD PPI or they will falsely increase the gastrin level
positive >1000
negative <250

if in between and equivocal -> secretin stimulation test . increased gastrin after secretin = positive test

23
Q

when do you need to do EGD with bx for GERD?

A

PPI trial 6 wks + lifestyle failed
alarm sx present: dysphagia, odynophagia (painful swallowing); gastrointestinal bleeding or anemia; weight loss; and chest pain (different from just burning)

24
Q

once GERD person has metaplasia (barretts) how does management change?

A

change from low dose to high dose PPIs and annual EGD surveillance required to watch for adenocarcinoma

25
Q

once GERD person has dysplasia how does management change?

A

treat with local ablative therapies and more frequent EGD surveillance

26
Q

what kind of diet leads to diverticulosis?

A

lots of red meat, little fiber

27
Q

LLQ post prandial pain that is relieved by a bowel movement in an NONELDERLY patient and an ELDERLY patient?

A

nonelderly - IBS

elderly - diverticular spasm. treat with high fiber diet to prevent future spasms

28
Q

diverticular hemorrhage is dx by colnoscopy, tagged RBC scan, or angiogram. but diverticuLITIS is dx how?

A

CT scan. DONT do colonoscopy for increased risk of perforation bc

29
Q

acute diarrhea is defined as < ___ weeks with _____ as the most common cause

A

< 2 weeks. any diarrhea < 2 weeks is most likely infectious

30
Q

what is most SENSITIVE test for invasive diarrhea in gut causing diarrhea? (pt has acute bloody diarrhea)

A

LACTOFERRIN

NOT fecal WBC!

31
Q

mnemonic for invasive bacteria that can cause bloody dairrhea

A

MESSY CACA

Medical Dz (IBD)
E. coli EHEC
Shigella
Salmonella
Yersinia histolytica

C. diff (but can also just be watery)
Amoeba histolytica
Campylobacter
Aeromonas

32
Q

travelers diarrhea (esp Central america) is caused by what bug?

A

ETEC

33
Q

food poisoning from reheated rice is caused by what bug

A

bacillus cereus

34
Q

for non toxic megacolon c.diff use oral vanc or oral metronidazole, but what do you use for recurrent infection?

A

fidoxamicin. if refractory or keeps recurring do fecal transplant.

35
Q

tx for toxic megacolon c.diff

A

IV metronidazole AND po vanc

36
Q

treatment of HUS (bloody diarrhea + anemia/hemolysis + worsening Creatinine)

blood smear will show shistocytes from hemolysis

A

supportive care, dialysis, and PLASMA EXCHANGE

37
Q

if person has secretory diarrhea (normal osmotic gap, normal fecal fat + nocturnal sx, not affected by eating) what 3 etiologies should you consider? besides c.diff obvis

A
  1. gastrinoma/zollinger-ellison syndrome
  2. VIPoma
  3. carcinoid - confirm dx with urinary 5-HIAA
38
Q

treatment for oral cadidiasis aka oral thrush vs candida esophagitis

A

oral thrush - nystatin oral wash

candida esophagitis - systemic dz, requires oral fluconazole (also it’s an AIDS defining illness)

39
Q

causes of esophagitis (PIECE)

A

Pill induced - NSIDs, Abx (Doxy, Clinda, Trimeth/sulf), NRT
Infectious - HIV, CMV, Herpes, Candida
Eosinophilic - asthma, eczema, food allergy
Caustic
Everything else - GERD, other.

40
Q

person has esophagitis. get egd + bx. shows eosinophilia. what is treatment?

A

FIRST treat like GERD with PPI (bc GERD can cause eosinophilia sometimes)
if PPI fails, THEN use swallowed aerosolized steroids.

41
Q

2 specific exam findings/signs found in pancreatitis

A
  1. Grey turner sign- flank ecchymosis

2. Cullen’s sign - umbilical ecchymosis

42
Q

causes of pancreatitis (mnemonic PANCREATITIS)

A 
PTH
Alcohol
Neoplasia
Calcium
Rocks (gallstones)
Estrogens
AceI
Triglyceridemia high
Infarction/ischemia
Trauma (ERCP, MVA)
Infection (mumps)
Scorpion stings
43
Q

person who had acute pancreatitis few weeks ago now comes with early satiety or abdominal fullness. you suspect pancreatic pseudocyst and confirm dx with CT. what is treatment? (theres a cutoff for different treatments)

A

<6cm AND < 6 weeks
watch and wait

> 6cm AND > 6 weeks
surgical drainage and Meropenem

44
Q

colonoscopy screening rec for UC or Crohn’s with colonic involvement?

A

start colonoscopies 8-10 yrs after dx, Q1-3yrs

Medicine (9 decks)

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