GI Disease Part 2

Question 1

What medication treatment should start with GERD?

Answer 1

PPI, not pepcid

Question 2

Functional Dyspepsia is what?

Answer 2

Postprandial fullness, early satiety, epigastric pain or epigastric vomiting

Question 3

Achlasia, what is it?

What is the treatment?

Answer 3

Achlasia is defined by inadequate relaxation of the LES and aperistalsis

Tx: Calcium Channel Blockers, botulism toxin, pneumonic dilation, and surgical myotomy

Question 4

Gastroparesis, what the test of choice?

Answer 4

Scintigraphy (Gastric Emptying Study)

Question 5

Entoembia Histolytica, if liver abscess seen, think what?

Answer 5

Flagyl

Question 6

Duodenal Ulcer is what with food?

Answer 6

Better with food

Question 7

Gastric Ulcer is what with food?

Answer 7

Worse with food

Question 8

Gastric Polyps have what characteristics that make them concerning for cancer?

Answer 8

Hyperplastic Polyps greater than 1cm and pedunculated morphology

Question 9

Do fundic gland polyps (in the stomach) require routine follow up?

Answer 9

No

Question 10

Lynch Syndrome and Familial adenomatous polyposis may have gastric polyps. If they are found, when should a repeat EGD be done?

Answer 10

1 year after resection and then 3-5 years after resection

Question 11

Entecavir and Tenofivir are the first line treatments for what disease?

Answer 11

Hepatitis B infection, usually wait 6 months to clear on its own

Question 12

Achalasia, what type of food problem will the patient have?

Answer 12

Solid and Liquid Problem

Question 13

Solid food dysphagia episodically for years suggests what?

Answer 13

Schatzki Ring

Question 14

Progressively increasing solid-food dysphagia for several months suggests what?

Answer 14

Peptic Stricture or Carcinoma

Question 15

If patient states that their 1st bite is difficult to swallow, but the repeat bites are ok, what is this?

Answer 15

Schatzki Ring

This is seen on GI imaging

Question 16

A patient has abdominal cramps, nausea, and loose stools 15 minutes after eating. 90 minutes later, the patient has lightheadedness, diaphoresis, and tachycardia. The patient had gastric bypass surgery, what is this?

Answer 16

Dumping Syndrome

Treatment is small frequent meals and low carb meals, followed by liquids

Question 17

If a patient is diagnosed with Hepatitis A, what should be done in 2 weeks from disease onset?

If a patient is over 40 years old with a Hepatitis A infection, what else can be given besides a vaccine?

Answer 17

Hepatitis A vaccine

Immunoglobulin Administration

Question 18

When are colonoscopies started and stopped?

The normal person age range

Answer 18

45-75 years old

Question 19

What is the treatment for the following?

Mild to moderate ulcerative colitis

Answer 19

5-ASA oral and topical treatments

If fails, think oral budesonide

Question 20

What medication should not be used in Ulcerative Colitis?

Answer 20

Methotrexate

Can be used with Crohn’s Disease

Question 21

Azaithroprine and 6-MP are effective in maintaining remission in what GI disease?

Answer 21

Ulcerative Colitis

Question 22

What autoimmune disease has architectural crypt distortions and diffuse lymphocytic infiltrate expanding into the lamina propria, is what?

Answer 22

Ulcerative Colitis

Question 23

What autoimmune disease has transmural inflammation, non-caseating granulomas, cobblestone appearance, skip lesions, patchy pattern of inflammation, is what?

Answer 23

Crohn’s Disease

Question 24

How do we treat the following?

Mild to moderate Ulcerative Colitis Flare

Answer 24

5-ASA Suppossitories

Question 25

# A patient has the following: Abdominal pain that has worsened despite increased opiod doses, scans/imaging is negative, what is this? What should be done?

Answer 25

Centrally Mediate Abdominal Pain Syndrome Wean off opiods, therapy/psychotherapy

Question 26

# When should a colonoscopy be done? Colon Cancer diagnosed in a first degree relative less than 60 years old or 2 first degree relatives of any age

Answer 26

Begin at age 40 or 10 years earlier than the youngest family member colon cancer diagnosis, whichever comes first Repeat Colonoscopy every 5 years

Question 27

# When should a colonoscopy be done? Colon Cancer diagnosed in a first degree relative greater than 60 years old

Answer 27

Begin at age 40, repeat every 10 years

Question 28

# When should a colonoscopy be done? Personal history of colon cancer

Answer 28

Time of diagnosis then 1 year and 3 years If negative, for both, then every 5 years

Question 29

# When should a colonoscopy be done? Adult patients with cystic fibrosis

Answer 29

At 40 years old, every 5 years afterward

Question 30

# When should a colonoscopy be done? Familial Adenomatous Polyposis

Answer 30

Begin at age 10-12 years, flexible sigmoidoscopy/colonoscopy, repeat every 1-2 years until colectomy

Question 31

# When should a colonoscopy be done? Lynch Syndrome

Answer 31

Begin at age 20-25 years old or 10 years earlier from youngest family member cancer detection, repeat every 1-2 years

Question 32

# When should a colonoscopy be done? Crohn's Disease or Ulcerative Colitis

Answer 32

8 years after diagnosis, colonoscopy with biopsies, repeat every 1-3 years

Question 33

What is primary biliary cholangitis? What is the treatment?

Answer 33

Fibrosis of the intrahepatic ducts Tx: Ursodeoxycholic Acid

Question 34

# What are the following diseases assoicated with? Primary Biliary Cholangitis ->? Primary Sclerosing Cholangitis ->?

Answer 34

PBC -> Sjogren's Syndrome PSC -> Ulcervative Colitis

Question 35

# What disease is seen from the following picture? Patient may have ulcerative colitis as well

Answer 35

Primary Sclerosing Cholangitis Intrahepatic and Extrahepatic fibrosis, will need a Liver transplant long term

Question 36

# When should a colonoscopy be done? 1-2 tubular adenoma polyps that are less than 10mm

Answer 36

5-10 years

Question 37

# When should a colonoscopy be done? 3-10 adenomas, greater than 10 mm, villous histology, or high grade dysplasia

Answer 37

3 years

Question 38

# When should a colonoscopy be done? More than 10 adenomas on a single exam

Answer 38

less than 3 years, find a genetic cause

Question 39

# What GI disease could this be? Arthralgia Fever Neurologic Disease Ocular or Cardiac Disease

Answer 39

Whipple Disease | Nedd a small bowel biopsy and Trop. whippelli PCR

Question 40

# What GI disease is the following? India or Puerto Rico travel, malabsorption, weight loss, malaise, and steatorrhea

Answer 40

Tropical Spure | Small Bowel biopsy

Question 41

# What disease has the following antibodies? IgA anti-tTg or IgA anti-endomysial antibody assay

Answer 41

Celiac's Disease

Question 42

What two electrolytes should be tested when doing a diarrhea evaluation?

Answer 42

Sodium and Potassium (Stool Levels)

Question 43

# What types of diarrhea, most likely cause the following: Secretory Diarrhea -> ? Osmotic Diarrhea -> ?

Answer 43

Secretory Diarrhea -> Celiac's Disease (unchanged by eating, nocturnal, does not improve with fasting) Osmotic Diarrhea -> Lactase Deficiency (follows eating, improves with fasting, not nocturnal)

Question 44

Nocturnal diarrhea and DM or Scleroderma cause what disease?

Answer 44

Small Bowel Bacterial Overgrowth

Question 45

What chronic medication use can lead to benign pigmentation of the colon (melanosis coli)?

Answer 45

Chronic Senna

Question 46

What disease has the following picture?

Answer 46

Ischemic Colitis (Thumbprint Sign)

Question 47

# These treatment regimens are for what disease? Glecaprevir/pibrentasvir, 8 weeks Sofosbuvir/velpatasvir, 12 weeks

Answer 47

Hepatitis C

Question 48

Upper GI bleed, impending EGD, unsure if varicies exist, what should be given? | Patient has a liver cirrhosis background

Answer 48

IV abx

Question 49

# What Liver Cirrhosis Algorithm has the following? Total Bilirubin Albumin INR Ascites Encephalopathy

Answer 49

Child-Pugh Score ## Footnote This Algorithm looks at mortality and pre-surgery benefit

Question 50

# What Liver Cirrhosis Algorithim has the following? Dialysis Creatitine Bilirubin INR Sodium

Answer 50

MELD-Na Score higher than 15, should discuss a liver transplant

Question 51

# What Alcoholic Hepatitis algorithim has the following? PT INR Total Bilirubin

Answer 51

> 32 points, may benefit from glucorticoid therapy | Maddrey's Discriminant Function for Alcoholic Hepatitis

Question 52

# Gastroparesis has what treatment choices? 1st line: Metocloparamide 2nd line, short term

Answer 52

1) Metocloparamide 2) Erythromycin (short term)

Question 53

What disease is associated with superficial thrombophlebitis, hypercoagulable, fever, and weight loss?

Answer 53

Pancreatic Cancer

Question 54

A patient has chronic Knee pain, refused surgery, what should be done to make her medications?

Answer 54

NSAID to COX2 inhibitor with PPI

Question 55

What other test should be done with Celiac patients to insure appropriate health?

Answer 55

DEXA scan