GI Disease Flashcards
Female, elevated LFTs, positive ANA, and positive smooth muscle antibody, and elevated IgG (titer > 1:80), and liver histology?
Autoimmune hepatitis
Treatment is prednisone and azathiprine
What three things does the MELD score make up? Besides Dialysis
Dialysis
Creatinine, Bilirubin, and Na
What is the MDF score?
What does it use?
Maddrey Discriminant Function
Prothrombin and Bilirbuin
MELD score over 20 and MDF over 32 can be given what?
Prednisolone
Augmentin, Valproic Acid, and phenytoin can cause what damage?
Liver Damage
If more than 5L of fluid removed via paracentesis, what should be given?
Albumin
MELD score greater than what should be referred for transplant?
Greater than 15
New onset Liver Cirrhosis, unknown cause, what should be evaluated?
Heart, get an echo
Celiac’s disease with IgA deficiency, what should be evaluated?
IgG Anti-Gliadin and IgA antibody measurement
Salvage therapy for H. Pylori is what for 14 days?
Bismuth, tetracycline, metronidazole, and PPI 14 days
What is the therapy for H. Pylori, initial therapy?
Clarithyomycin, Amoxicillin, and Omeprazole 10 days
Metastatic Pancreatic Cancer, should a patient be treated for HCV?
No further treatment
If a patient has hepatic decompensation with Liver failure, what should be done? Even if the MELD-Na score is less than 15
Liver transplant
Oral thrush, what should be given, even with a low CD4 count?
Think about Fluconazole, hold off on acyclovir right away, particularly if no biopsy
Esophageal Hypmotility Disorder is assoicated with poor peristalsis, what is the correct treatment?
Lifestyle Changes and PPI
Primary Sclerosing Cholangitis occurred what is another test that should be done?
Colonoscopy soon
GI bleed on AC, held AC, when can a person restart?
After waiting 7 days, maybe restarted
If there is concern for gastroparesis, what test should be done?
4 hour gastric scintigraphy
Mild travel’s diarrhea, what should be given?
Loperamide
A patient with a well-defined 1.5cm lesion in the left lower lobe, HCC concern, what should be done?
Hepatic Liver Mass resection
If a patient is taking aspirin for stroke prevention only, has a high ASCVD score, and he has a GI bleed, what should be done with his ASA?
Hold his ASA
Functional Dyspepsia, does not respond to a PPI, what is the next best step?
Nortriptyline
Patient with portal hypertension and cirrhosis of liver, what medication should be stopped?
Lisinopril, this will decrease blood flow to kidney, want to maintain adequate blood flow
Patient has intestinal metaplasia, they should have what medical therapy?
The patient should have surveillance endoscopy performed
Autoimmune Pancreatitis that shows type 1 autoimmune pancreatitis, what is a good treatment for this?
Prednisone
Chronic Constipation, weight loss history, 52 year old male, what should be done?
Colonoscopy
Best chronic pancreatitis recommendation for treatment?
Tobacco Cessation/Alcohol Cessation
Dysphagia with solids to liquids, iron deficiency anemia, and weight loss. What is the first test that should be ordered?
Endoscopy with biopsy
Cirrhosis and Portal hypertension patient, they have an AKI, what should be done?
D/C diuretics
Beta Blockers can decrease renal perfusion, worsening the situation, hold them
5 month history of diarrhea, characterized as bowel movements containing oil droplets, needing multiple flushes, consistent with steatorrhea, how can this be confirmed?
Glucose breath test, small bowel overgrowth
Woman with inflammatory bowel disease receiving immunosuppressive therapy should undergo what testing annually?
Pap Smear
Adenoma x 1 greater than 10mm, should have a repeat colonoscopy when?
3 years
Severe Crohn’s disease requires what?
Infliximab
Old gentleman wants to go back on NSAID after ulcer, what should be done?
PPI and Celecoxib
Cefotaxime and albumin should be used in what scenario?
SBP
PBC is diagnosed with what lab test?
Anti-mitochondrial antibody
Dermatitis Herpetiformis on physical exam, can be treated with dapsone, what testing should be done for then?
G6PD testing
Autoimmune hepatitis treatment has a high rate of relapse, how long should treatment continue before drug cessation?
2-3 years before cessation
Hereditary Hemochromatosis will be suggested by what two lab values?
What is usually defective in this disease?
Elevated Ferritin and Transferrin Saturation
Bad Hepcidin
What is a condition commonly associated with dysphagia and food bolus obstruction? Usually found in younger men with atopic conditions
Eosinophilic Esophagitis
Moderate to Severe Relapse Ulcerative Colitis, what is the recommended treatment?
Azathioprine and Infliximab
If a patient has a pancreatic cyst collection of 12cm, what is the best recommendation for treatment?
Observation
Gastric Polyps are found and removed. When should a follow up endoscopy be performed?
No follow up needed
Gallbladder polyp greater than 1.0 cm should have what done?
Gallbladder removal, polyp that size is concerning for neoplasm
Cirrhosis should be evaluated if the patient does or does not have what underlying liver pathology?
Portal Hypertension
Patients with Varices should have what done yearly?
Endoscopy screening and platelets, think about Coreg (non-selective beta blocker)
Upper GI bleed, what two drugs should be given?
Octreotide and PPI
Ceftriaxone 1g q24hr can be given for what type of GI bleed?
Upper GI bleed
What is one IV medication that could help with an EGD?
IV Reglan
When a patient has cirrhosis, what two medications can be given to help?
Lasix 20: Aldactone 50, should be in a 2:5 ratio
What does colestipol and cholestyramine do?
Why are these medications added?
Help slow down diarrhea
Patient had their terminal illeum removed via surgery
What criteria need to be met to discuss a potential liver transplant?
Think about Milan Criteria
IBS-D (Irritable Bowel Syndrome, Diarrhea), what are three tests that should be done first before a confirmed diagnosis?
1) Celiac’s Disease
2) Giardia Evaluation
3) Fecal Calprotectin
Recurrent abdominal pain, at least one day a week, for 3 months along with defecation related pain, changes in stool frequency, or change in stool consistency, is what?
Irritable Bowel Syndrome
Ulcerative Colitis, Crohn’s Disease, and Microscopic Colitis is under what umbrella of diagnosis?
Irritable Bowel Disease
Ulcerative Colitis and Crohn’s Disease should undergo what annual screening?
Melanoma Screening
Ulcerative Colitis/Crohn’s Disease women patients (on immunosuppressive therapy) should undergo what type of annual screening?
Pap Testing annually and HPV vaccination via vaccine history/guidelines
Ulcervative Colitis/Crohn’s Disease patients have an elevated mental health concern. What medication should be avoided in this group?
NSAIDs, may make disease worse
Ulcerative Colitis/Crohn’s Disease patients should have their first colonoscopy when?
8-10 years after a confirmed diagnosis
Irritable Bowel Syndrome with constipation (IBS-C), can be treated with lubiprostone, what does lubiprostone do?
Prostaglandin E analogue, Activates Bowel Chloride Channel, increase chloride into the bowel, increases fluid in bowel
Irritable Bowel Syndrome with constipation (IBS-C), can be treated with linaclotide, what does linaclotide do?
Linaclotide (Linzness), activates guanylate cyclase C receptors in the small intestine, increases fluid in the small intestine
Irritable Bowel Syndrome with constipation (IBS-C), can be treated with plecanatide, what does plecanatide do?
Activates Guanylate cyclase C receptors in the small intestine, increases fluid in the small intestine (very similar to Linzness)
Irritable Bowel Syndrome with constipation (IBS-C), can be treated with tenapanor, what does tenapanor do?
Blocks Sodium/Hydrogen Exchanger in the small intestine and colon, more fluid is kept in the intestines, will help move the bowels
Irritable Bowel Syndrome with diarrhea (IBS-D), can be treated with Eluxadoline, what does Eluxadoline do?
Kappa agonist, mu agonist, and opiod receptor antagonist. This relieves diarrhea and abdominal pain.
What IBS drug has to be held with the following underlying conditions:
1) No Gallbladder, Sphincter of Odi dysfunction
2) 3 or more ETOH beverages a day
3) Pancreatic Disease
4) Severe Liver Disease
5) Severe Constipation
Eluxadoline
What routine anti-diarrhea medication is anti-spasmodic that decreases abdominal pain and global abdominal symptoms?
Dicyclomine (Bentyl)
What anti-depression medication can work in the brain to decrease abdominal pain?
TCA medications
Alosetron (a selective 5 HT3 antagonist) is recommended for women with refractory what?
Refractory IBS-D, alleviates abdominal pain and global symptoms
Alosetron has what side effects, requires a lot of oversight?
Colonic Ischemia and Severe Constipation
IBS-D patient have difficulty reabsorbing bile, what medication should be recommended if symptommatic?
Bile Acid Binder, Colesevelam, reduces stool frequency and improves stool consistency
Crohn’s Disease patients with increased anorectal disease, are at an increased risk of what?
Anal Cancer
IBS-D patients can receive what antibiotic? This antibiotic is non-reabsorbale. This relieves global symptoms, bloating, and loose stools.
Rifaximin
A 14 day course can provide up to 10 weeks of relief
Fecal Calprotectin and fecal lactoferrin are normal, what is unlikely?
An IBD diagnosis
What does cholestyramine do?
Bile Acid binder, cannot reabsorb bile, usually after ileal resection, abdominal radiation therapy or post-cholecystecomy diarrhea
This is a powder medication form
What is Colestipol?
A bile acid diarrhea treatment, this medication binds bile acid, a pill form of cholestyramine
Men with hepatic adenomas of any size should have what done?
Resection is recommended
Women with hepatic adenomas (less than 5cm) should stop taking what medication?
OCPS/Hormone Devices, men should stop any anabolic steroids
Women with hepatic adenomas (less than 5 cm), what is the imaging game plan?
Imaging Every 6 months for 2 years, then annually there after
Women with hepatic adenomas (greater than 5 cm), what is the imaging game plan?
Imaging at 6 months and 12 months, then serial MRI
Women with hepatic adenomas (greater than 5 cm), what is the game plan if the adenoma has increased in size or not shrinking?
Consider Surgical Resection
Chronic Hep B Infection, what is this?
Hep B Surface Antigen +
Anti Hep B Core + (IgG)
Hep B Envelope Antigen +
HBV DNA viral load > 1 million
ALT is normal/mildly elevated
Immune tolerant chronic HBV infection
Chronic Hep B infection, what is this?
Hep B Surface Antigen +
Anti Hep B Core + (IgG)
Hep B Envelope Antigen +
HBV DNA viral load > 20,000
ALT is increased
Immune active tolerant chronic HBV infection
Chronic Hep B infection, what is this?
Hep B Surface Antigen +
Anti Hep B Core + (IgG)
Hep B Envelope Antigen +
HBV DNA viral load = 2,000
ALT is normal/mildly elevated
Inactive chronic HBV infection
Hepatic Cellular Carcinoma screening should be done again in 3-6 months if a liver lesion less than 1cm and AFP elevation is found? Yes or no
Yes
A liver lesion that is 1cm, AFP greater than 20, what should be done next?
MRI/CT scan of liver
HCC with 5cm or smaller should have what done?
Can do ablative therapies, if refusing surgery
HCC with 3cm or smaller can have what?
HCC with 3cm or larger can have what done?
Radiofrequency or Microwave therapy for < 3cm
Targeted radioembolization therapy for > 3cm
PBC treatment is what?
Urosodeoxycholic acid
If this does not work, think fibrates (off label) or obeticholic acid
PBC diagnosis, what primary care things should be checked?
Thyroid level (TSH)
EGD ordered -> esophageal varices rule out
1st degree relatives with PBC should be screened for this disease annually with what lab test?
ALP level
PSC (Primary Sclerosing Cholangitis) is more common in men than women, what is it?
Intrahepatic and Extrahepatic fibrosis
PSC should have what annual tests done?
Annual MRCP and CA 19-9 (high risk of cholangiocarcinoma)
PSC, what is the colonoscopy screening recommendation?
Colonoscopy at time of diagnosis, then every 1-2 years
Patients that get a transplant have a high chance of a long life
ALP is produced where besides the liver?
Bone, Red Blood cells, and placenta
ALP fractionation can help discern elevation, location
Hepatic Cellular Carcinoma, that are not transplant candidates, what are best treatment choices?
1) Atezolizumab (immune checkpoint inhibitor) and Bevacizumab (Anti-angiogenic agent)
2) Lenvatinib or Sorafenib (multikinase inhibitors), if patient does not tolerate the first round, as above
What gallbladder size should be removed, even if asymptommatic?
Gallstones > 3 cm
During gallbladder imaging, if the patient has an EF less than what number, should gallbladder removal be considered?
Less than 40%
What disease is angiodysplasia and aortic stenosis? A low hemoglobin is seen sometimes
Heyde Syndrome
If this image is seen on endoscopy, what is this?
Dieulafoy lesion, an aberrant blood vessel that can cause bleeding
If this image is seen on a colonoscopy, what could this be?
Angiodysplasia, sometimes seen with aortic stenosis in Hyde Syndrome, some pathology slides note a “fernlike pattern”
What disease has high urine copper levels, low levels of ceruplasmin/ALP? What is in the eye?
Wilson’s Disease
Kayser Fleischer Rings
What is odynophagia?
Pain while swallowing
A young patient has asthma and difficulty swallowing, what could this be?
Eosinophilic Esophagitis
A patient has difficulty swallowing, barium swallow shows the following, what is this?
What is a treatment?
Diffuse Esophageal Spasm or Jackhammer esophagus, this is a “rosary bead” appearance
Treatment: Nitroglycerin (Start)
