GI CIS

Question 1

how is smoking related to UC?

Answer 1

-stopping smoking is a risk factor for developing UC

Question 2

What is the BUN:Cr ratios in an upper HIB?

Answer 2

30:1

Question 3

What is the AST:ALT ratio in an alcoholic?

Answer 3

2:1

Question 4

What is the anatomical division of an upper GIB vs a lower GIB?

Answer 4

ligament of Treitz

Question 5

What can abruptly stopping a beta blocker lead to?

Answer 5

rebound tachycardia

Question 6

What skin condition do ppl with IBD present with sometimes?

Answer 6

Erythema nodosum

Question 7

What do you need to obtain before a blood transfusion?

Answer 7

iron studies

-they could be inaccurate after the transfusion

Question 8

What IBD is associated with Pigmented galltone formation for some reason?

Answer 8

Crohn disease

Question 9

How fast can potassium chloride be given through a peripheral IV?

Answer 9

10 mEq per hour (otherwise it is irritating to the vein)

Question 10

How many g/dL would you expect the hemoglobin to raise from 1 unit of packed RBC’s?

Answer 10

giving 1 unit of PRBC’s should increase the Hgb by 1 g/dL

-it’s 1 to 1

Question 11

During an acute IBD flare, what is the primary treatment?

Answer 11

-Corticosteroids (IV or PO)

Question 12

How often do people get a colonoscopy?

Answer 12

every 10 years

Question 13

Which patients might refuse blood products?

Answer 13

Jehova’s witnesses

Question 14

What are some risk factor for gallstone formation?

Answer 14

female
old
indians
obesity
rapid weight loss
DM
Crohn disease (pigmented gallstones)
-oral contraceptives

Question 15

What are some protective things for gallstone formation

Answer 15

Low carb diet
physical activity
cardiorespiratory fitness
consumption of caffeinated coffee
high intake of Mg and good fats
high fiber diet
ASA and NSAIDs

Question 16

What is ascending cholangitis

Answer 16

infection of the biliary tract secondary to bile duct obstruction or bile stasis

Question 17

What are some lab changes with ascending cholangitis?

Answer 17

hyperbilirubinemia,
leukocytosis
transaminitis,
alk phos elevation

Question 18

What are some causes of Ascending cholangitis?

Answer 18

• choledocholithiasis

- pancreatic/biliary neoplasm, postoperative strictures, choledocal cysts

Question 19

What organisms are involved with ascending cholangitis?

Answer 19

E. coli, klebsiella, enterobacter (gram -)

• Enterococcus (gram +)
• anaerobes: Bacteroides fragilis, clostridia

Question 20

What is Charcot’s triad?

Answer 20

• Jaundice
• RUQ pain
• Fever

Question 21

What is Reynold’s pentad?

Answer 21

Charcot’s triad plus confusion and hypotension

-associated with significant morbidity and mortality

Question 22

What is the tx of ascending cholangitis?

Answer 22

urgent ERCP (within 12-24 hrs)
abx geared towards colonic bacteria
-supportive care like IVF

Question 23

What are some antibiotic options for treating cholangitis?

Answer 23

monotherapy with a “bactam” or

-or ceftriaxone plus metranidazole

Question 24

What labs should be ordered and followed for ascending cholangitis?

Answer 24

AST/ALT, alk phos, fractionated bilirubin, amylase/lipase

• pre procedure INR
• follow up on the blood cultures and bile cultures that were ordered and are pending

Question 25

What are some possible complications status post ERCP

Answer 25

Pancreatitis
ascending cholangitis
less commonly: hemobilia, perforation, and bile leaks

Question 26

What is Mirizzi syndrome?

Answer 26

common hepatic duct obstruction caused by an extrinsic compression from and impacted stone in the cystic duct
-may be presence of cholecystonenteric fistula

Question 27

What do we use TNF alpha inhibitors for?

Answer 27

tx of inflammatory conditions like RA and IBD

-there’s a lot of side effects

Question 28

What annual screening should you do for people on TNF alpha inhibitors?

Answer 28

PPD
Hepatitis panel
Dermatology exam

Question 29

What lab screening should you do for people on a TNF alpha inhibitor?

Answer 29

CBC with diff, CMP every 2 months