GI (Exam #1) Flashcards
(291 cards)
1
Q
What views are included on a 3-way view series, and what does each view evaluate for?
A
- Supine (KUB, plain film) = distended/dilated bowel
- Upright = air-fluid levels
- PA CXR = pneumoperitoneum
2
Q
What condition involves dilated bowel proximal to obstruction, collapsed bowel distally? What will also be seen?
A
Small Bowel Obstruction
+ air fluid levels
3
Q
What condition involves non-mechanical: dilated bowel, air present in both small bowel AND colon?
A
Ileus
4
Q
Differentiate Small Bowel Obstruction from Ileus…
A
SBO = dilated proximally and collapsed distally
+ air fluid levels
Ileus = small bowel AND colon
- air fluid levels
5
Q
What condition involves free air outside of bowel (air under both sides of diaphragm)?
A
Perforation
6
Q
What is the initial diagnostic test for cholelithiasis and cholecystitis?
A
Abdominal US
7
Q
What is the preferred diagnostic test for diverticulitis and pancreatitis?
A
CT Scan Abdomen/Pelvis
8
Q
What diagnostic test should be ordered to evaluate for renal stone?
A
CT Abdomen/Pelvis WITHOUT contrast
9
Q
What diagnostic test assesses bile excreting function?
A
HIDA Scan
10
Q
What is an abnormal finding on HIDA Scan?
A
GB does NOT visualize due to cystic duct obstruction
- Patent = normal
11
Q
If evaluating for Cholecystitis using HIDA Scan, what should also be included (2)?
A
CCK stimulation and ejection fraction
12
Q
What diagnostic test can assess luminal GI tract disorders, and what two aspects of the tract are focused on?
A
Barium Studies
- Mucosa
- Peristalsis
13
Q
What diagnostic test involves esophagus and gastroesophageal junction (GEJ) into proximal stomach?
A
Esophagram/Barium Swallow
14
Q
What diagnostic test involves esophagus, stomach and first part of duodenum? When is this indicated?
A
UGI Series
- PUD (ulcer mound)
15
Q
What two diagnostic tests have CI of suspected upper GI perforation?
A
- UGI Series
- Enema = Lower GI Series
16
Q
If there is a suspected upper GI perforation, what should NOT be used and what is used in its place?
A
NO Barium
- Use water-soluble Gastrografin
17
Q
What diagnostic test involves esophagus, stomach, duodenum, jejunum, ileum?
A
SBFT (UGI + Small Bowel Follow Through)
18
Q
What diagnostic test involves colon and distal small bowel?
A
Enema = Lower GI Series
19
Q
What diagnostic test may show an “apple core” lesion?
A
Enema = Lower GI Series
20
Q
What diagnostic test is a scope of upper GI tract, and involves conscious sedation? What condition should be shown caution regarding the conscious sedation?
A
EGD (Esophagogastroduodenoscopy)
- Caution with conscious sedation if cardiopulmonary disease
21
Q
What diagnostic test can be used to evaluate alarm symptoms, and what are these three sxs?
What other two conditions can be evaluated with this test?
A
EGD (Esophagogastroduodenoscopy)
- Dysphagia
- Weight loss
- Early satiety
Also, chronic GERD and hematemesis/melena
22
Q
What diagnostic test can be used to evaluate for esophagitis (reflux, candida, HSV, eosinophilic)?
A
EGD (Esophagogastroduodenoscopy)
23
Q
What diagnostic test can be used to evaluate for Barrett’s Esophagus; PUD; Celiac; CA?
A
EGD (Esophagogastroduodenoscopy)
24
Q
What diagnostic test is considered invasive?
A
ERCP (Endoscopic Retrograde Cholangiopancreatography)
25
What is an important complication of ERCP (Endoscopic Retrograde Cholangiopancreatography)?
Pancreatitis
26
Differentiate ERCP (Endoscopic Retrograde Cholangiopancreatography) from MRCP (Magnetic Resonance Cholangiopancreatography) (2)?
- ERCP = invasive but diagnostic AND therapeutic
| - MRCP = non-invasive but ONLY diagnostic
27
What diagnostic test is used to evaluate for assess for pancreatic/biliary conditions?
ERCP (Endoscopic Retrograde Cholangiopancreatography)
28
What diagnostic test is a scope of rectum, colon, and terminal ileum = entire colon?
Colonoscopy
29
What diagnostic test requires bowel prep?
Colonoscopy
30
What diagnostic test is the gold standard for colon CA screening? What are two other indications?
Colonoscopy
| - Also used for IBD (UC) and Diverticulosis
31
What is an important CI of Colonoscopy, and why?
Active diverticulitis
| - Risk for perforation
32
What diagnostic test involves rectum and sigmoid colon = distal colon ONLY?
Flexible Sigmoidoscopy
33
Differentiate Colonoscopy from Flexible Sigmoidoscopy...
- Colonoscopy = ENTIRE colon (rectum, colon, and terminal ileum)
- Flexible Sigmoidoscopy: distal colon ONLY
34
What condition is a common cause of GERD, and what subtype is most common?
Hiatal Hernia
| - Sliding hernia = most common
35
What condition involves LES transiently relaxes → reflux of stomach contents = backflow?
GERD
36
What is the Montreal Classification, and what condition is it associated with?
GERD
| - Reflux causes troublesome sxs/complications
37
What symptom is most commonly associated with GERD?
Heartburn/pyrosis (post-prandial)
38
What condition involves angina-like chest pain (R/O cardiac causes), dysphagia, hypersalivation, odynophagia?
GERD
39
What are the two ways by which medications increase GERD sxs, and what are three examples of each?
Decrease LES pressure:
- Anticholinergics
- TCAs
- CCBs
Injure mucosa:
- Bisphosphonates
- Iron supplements
- NSAIDs/ASA
40
How is GERD often diagnosed?
CLINICALLY
| - If classic sxs and NO alarm features
41
What are the seven alarm sxs associated with GERD?
- Dysphagia
- Odynophagia
- IDA or GI bleed
- Unexplained weight loss
- New onset dyspepsia in patient 60+ years
- Prior anti-reflux surgery
- Hx of CA
42
What is the best diagnostic test to evaluate for mucosal injury in GERD?
What other three tests might be utilized?
EGD
Also...
- Esophageal Manometry
- Esophageal pH Monitoring
- Esophageal Impedance Testing
43
What diagnostic test is used to evaluate the function of LES and esophageal muscles (peristalsis) via pressure?
Esophageal Manometry
44
With mild or intermittent GERD sxs, what is the recommended treatment approach? What does this involve (3)?
STEP UP therapy
| - Lifestyle modifications, H2 blockers +/- Antacids
45
With severe GERD sxs, what is the recommended treatment approach? What does this involve (2)?
STEP DOWN therapy
| - Lifestyle modifications + PPI daily for 8 weeks
46
If severe esophagitis or Barrett’s are present, what type of treatment is necessary to avoid recurrent sxs or complications?
Maintenance PPI
47
What pharm treatment for GERD involves temporarily neutralize gastric pH? What is an example of this?
Antacids
| - TUMS
48
What pharm treatment for GERD involves decreased secretion of stomach acid? What are two examples of this?
H2 Blockers/H2 Antagonists
- Ranitidine
- Zantac
49
What pharm treatment for GERD involves decreased production of stomach acid? What are three examples of this?
PPIs
- Prilosec
- Prevacid
- Nexium
50
When should PPIs be taken for the treatment of GERD (time of day)?
Take 30 minutes before 1st meal of day
51
What are two things you are at increased risk for with use of PPIs in the treatment of GERD?
- Infection (C. diff)
| - Malabsorption (especially Magnesium)
52
If medications are indicated, what class should be tried first? If this does not work, what is often the second option? If this is then refractory, what are the next two options (hint: not necessarily meds...)?
1. H2 Blocker
2. PPI
3. Make PPI BID and/or order an Endoscopy
53
What is the preferred method for anti-reflux surgery, and under what three conditions should surgery be considered?
Nissen
- Failed tx
- GERD complications
- Noncompliance
54
What condition involves columnar epithelium replaces squamous epithelium in distal esophagus?
Barrett’s Esophagus
55
With Barrett’s Esophagus, what epithelium is replaced, and by what?
Columnar epithelium replaces squamous epithelium
56
Patients with Barrett’s Esophagus are predisposed to what condition? How does this progress (5 steps)?
Adenocarcinoma
| - GERD → Barrett’s Esophagus → Low Grade Dysphagia → High Grade Dysphagia → Adenocarcinoma
57
What diagnostic test should be utilized to monitor for evidence of dysplasia, and what condition are you ultimately trying to avoid progression to?
Adenocarcinoma
| - Surveillance with EGD
58
What is the recommended treatment for Barrett’s Esophagus?
PPI indefinitely
| - Can prevent CA
59
What two esophageal conditions are more common in white males? Which condition is more common in African American males?
- Barrett’s Esophagus
- Adenocarcinoma (Esophageal CA)
AA males = Squamous Cell Carcinoma (Esophageal CA)
60
What are the two subtypes of Esophageal CA, and which is increasing in incidence?
- Adenocarcinoma = increasing incidence
| - Squamous Cell Carcinoma
61
What is the primary RF associated with Adenocarcinoma? What are the two primary RF associated with Squamous Cell Carcinoma?
- Adenocarcinoma = Barrett’s Esophagus
| - Squamous Cell Carcinoma = smoking, alcohol
62
If a patient has dysphagia, what diagnostic test should be ordered?
Endoscopy
63
What is the most common cause of Esophagitis?
GERD (reflux esophagitis)
64
What are the four etiologies of Esophagitis?
- Infectious
- Medication-induced
- Eosinophilic
- Radiation
65
What specific symptom is associated with Eosinophilic Esophagitis?
Dysphagia
66
What esophageal condition has a strong connection with other allergic diseases, and what are four examples of these allergic diseases?
Eosinophilic Esophagitis
- Asthma
- Rhinitis
- Food allergies
- Chronic eczema
67
What are the three recommended treatments for Eosinophilic Esophagitis?
- Diet (avoid allergens)
- PPIs
- ICS (spray and swallow, NOT inhaled)
68
What three symptoms should prompt consideration of an Esophageal Motility Disorder?
- Dysphagia
- Noncardiac CP
- Refractory GERD sxs
69
What two medications are recommended for treatment of Hypercontractile (Jackhammer) Esophagus
and Distal Esophageal Spasm (DES) (__ + __ or __)?
- PPI
AND
- CCB (Diltiazem) or TCA (Imipramine)
70
What two symptoms often present with Hypercontractile (Jackhammer) Esophagus
and Distal Esophageal Spasm (DES)?
- Dysphagia
| - CP
71
What two symptoms are often present with Achalasia?
- Dysphagia
| - Regurgitation
72
What diagnostic test is REQUIRED for Achalasia, and what does this show? What other test may be used, and what is seen with this?
Esophageal Manometry = required
- Shows aperistalsis (NO contraction)
Can also use barium swallow - Shows “bird’s beak”
73
What condition presents with aperistalsis and “bird’s beak” diagnostically?
Achalasia
74
What two conditions presents with high pressure contractions (with normal relaxation at junction) diagnostically, and what diagnostic test is used for this?
Esophageal Manometry
- Hypercontractile (Jackhammer) Esophagus
- Distal Esophageal Spasm (DES)
75
With Achalasia, what diagnostic test is NECESSARY to R/O malignancy?
EGD
76
What is the preferred treatment for Achalasia? What other three biochemical reduction in LES pressure can be tried?
SURGERY = mechanical (pneumatic dilation vs. Heller myotomy)
| - Can also try Botulinum toxin, Nitrates or CCBs
77
What condition presents with retching, repetitive vomiting (hematemesis)?
Mallory Weiss Syndrome
78
What condition involves mucosal laceration in distal esophagus and proximal stomach?
Mallory Weiss Syndrome
79
What two symptoms present with Mallory Weiss Syndrome?
- Retching
| - Repetitive vomiting (hematemesis)
80
What are two important RFs associated with Mallory Weiss Syndrome?
- Heavy alcohol use
| - Hiatal hernia
81
What condition involves esophageal rupture similar to MWS but does NOT improve with time?
Boerhaave’s Syndrome
82
What condition involves progressive inflammation and degeneration of neurons → LES fails to relax?
Achalasia
83
What are the three primary functions of Macronutrients?
- Provide energy
- Promote muscle growth/repair
- Support cell function
84
What are the five primary functions of Micronutrients?
- Cell metabolism
- Biochemical reaction
- Hormone function
- Nerve impulse propagation
- Muscle function
85
What are the three Macronutrients, and which is the primary fuel source? What is the primary digestive enzyme for each?
- Carbs = primary fuel source: amylase
- Proteins: protease
- Fats: lipase
86
What are the three important fat-soluble vitamins and what is an important aspect of each? What is the fourth fat-soluble vitamin?
- Vitamin A = vision
- Vitamin D = calcium absorption
- Vitamin K = clotting
Also, Vitamin E
87
Which vitamin is associated with vision, and is this fat or water soluble?
Vitamin A
| - FAT-soluble
88
Which vitamin is associated with calcium absorption, and is this fat or water soluble?
Vitamin D
| - FAT-soluble
89
Which vitamin is associated with clotting, and is this fat or water soluble?
Vitamin K
| - FAT-soluble
90
Which vitamin binds to IF, and is this fat or water soluble?
Cyanocobalamin/B12
| - WATER-soluble
91
Which vitamin aids in iron absorption, and is this fat or water soluble?
Ascorbic Acid/Vitamin C
| - WATER-soluble
92
What two conditions are associated with Thiamine/B1 deficiency?
- Beriberi (peripheral neuropathy, edema)
| - Wernicke-Korsakoff Syndrome (neuro sequela)
93
Which vitamin deficiency is associated with Beriberi (peripheral neuropathy, edema) and Wernicke-Korsakoff Syndrome (neuro sequela)?
Thiamine/B1 deficiency
94
What three symptoms are associated with Riboflavin/B2, Niacin/B3 and Pyridoxine/B6 deficiencies?
- Cheilitis
- Angular stomatitis
- Glossitis
95
Which three vitamin deficiencies are associated with cheilitis, angular stomatitis, glossitis?
- Riboflavin/B2
- Niacin/B3
- Pyridoxine/B6
96
What condition is associated with Niacin/B3 deficiency? What are the three symptoms associated with this disorder?
Pellagra
- Diarrhea
- Dermatitis
- Dementia
97
What two conditions are associated with Cyanocobalamin/B12 deficiency?
- Peripheral neuropathy
| - Macrocytic anemia
98
What primary condition is associated with Vitamin A deficiency?
Night blindness
99
Which vitamin deficiency is associated with night blindness, bitot’s spots, poor wound healing, dry skin?
Vitamin A deficiency
100
Which mineral deficiency is associated with confusion, hypotension, tachycardia?
Sodium deficiency
101
What three symptoms are associated with Sodium deficiency?
- Confusion
- Hypotension
- Tachycardia
102
Which mineral deficiency is associated with taste disturbance, poor wound healing?
Zinc deficiency
103
What primary symptom is associated with Zinc deficiency?
Taste disturbance
104
What two symptoms are associated with Calcium deficiency?
- Tetany
| - Fractures
105
Which mineral deficiency is associated with fractures, tetany?
Calcium deficiency
106
What three symptoms are associated with Potassium deficiency?
- Muscle cramping
- Fatigue
- U waves on EKG
107
Which mineral deficiency is associated with muscle cramping, fatigue, U waves on EKG?
Potassium deficiency
108
What five symptoms are associated with Iron deficiency?
- Fatigue
- Pallor
- Pale conjunctiva
- Pica
- Koilonychia
109
Which mineral deficiency is associated with fatigue, pallor, pale conjunctiva, pica, koilonychia?
Iron deficiency
110
What four symptoms are associated with Vitamin C AND Vitamin K deficiencies?
- Bleeding gums
- Easy bruising
- Poor wound healing
- Petechiae/purpura
111
Which two mineral deficiencies are associated with bleeding gums, easy bruising, poor wound healing, petechiae/purpura?
- Vitamin C deficiency
| - Vitamin K deficiency
112
Which mineral deficiency is associated with sensory and motor neuropathy?
Vitamin E
113
Which mineral deficiency is associated with tooth decay?
Fluoride
114
Which vitamin toxicity is associated with flushing?
Niacin/B3
115
What symptom is associated with Niacin/B3 toxicity?
Flushing
116
Which mineral toxicity is associated with edema?
Sodium
117
What symptom is associated with Sodium toxicity?
Edema
118
Which mineral toxicity is associated with weakness, vomiting, peaked T waves on EKG?
Potassium toxicity
119
What three symptoms are associated with Potassium toxicity?
- Weakness
- Vomiting
- Peaked T waves on EKG
120
What symptom is associated with Fluoride toxicity?
Tooth discoloration
121
What symptom is associated with Copper toxicity?
Golden-brown discoloration of iris
122
What nutrient is necessary to decrease risk of neural tube defects in pregnant women?
Folic acid
123
What supplement should be given to infants if they are exclusively breastfed?
VItamin D supplements
124
What three nutritional modifications should be made for the elderly?
- Liberalize diet
- Incorporate high calorie foods
- Add oral nutrition supplements (if needed)
125
What is the recommended daily fiber intake?
25-35 grams per day
126
Which diet regimen involves well-balanced of complex carbs, protein, healthy fats?
Macronutrient Balance Glycemic Control
127
What are the two Low-Fat diet regimens?
- Mediterranean
| - DASH
128
What four concerns are associated with the Very Low-Calorie diet regimen?
- Loss of lean muscle
- Electrolyte abnormalities
- Bile stasis
- Constipation
129
What three concerns are associated with the Ketogenic diet regimen?
- Nutrient deficiencies
- Poor sustainability
- Bad if heart disease/chronic disease
130
Which diet regimen can be used as tx for refractory epilepsy cases?
Ketogenic diet
131
Which diet regimen involves a concern for B12 deficiency?
Veganism
132
What is a brief preliminary screen used to identify individuals at nutritional risk, and if it is +, who should the patient be referred to?
Nutrition Screen
| - If +, refer to Dietician for a complete Nutrition Assessment
133
What can increase risk for Thiamine/B1 deficiency?
Alcohol use
134
What BMI is considered underweight? What is obese?
- Underweight = <18.5%
| - Obese = 30+%
135
What are the two types of nutrition support, and which is preferred? Which should be used for a NON-functional GI tract?
- Enteral Nutrition (EN) = preferred/physiologic
| - Parenteral Nutrition (PN): used for NON-functional GI tract
136
What are two primary nutrition support complications, and what are two examples of each?
- Mechanical issues: tube malfunction, catheter-related issues
- Metabolic/electrolyte abnormalities: hyperglycemia, unstable fluid/electrolyte status
137
What potentially fatal condition should always be monitored for when providing nutrition support?
Refeeding syndrome
| - Intracellular shift of electrolytes
138
Which two diets are recommended for those with CVD?
- Mediterranean
| - DASH
139
Which diet is recommended for those with HTN?
DASH
140
Which two diets are recommended for those with CHF?
- Low-sodium
| - Fluid restriction
141
Which three diets are recommended for those with DM? What is the primary goal with these diets?
- Mediterranean
- DASH
- Carb-counting
Goal: optimize ABCs (A1c, BP, Cholesterol)
142
Which three metabolites are recommended to be restricted in those with renal disease? What medication could also be considered?
- Na+
- K+
- PO4
Can also consider phosphorous binders
143
What vitamin deficiency should be considered for those on INH?
Vitamin B6 deficiency
144
What is the most important protective feature of the stomach, and in what four ways does it provide protection?
Mucosal barrier
- Bicarbonate-rich mucous = neutralizes acid
- Tight junctions = block gastric juice from penetrating tissue
- Stem cells = replace damaged mucosal cells
- Produces PGs
145
What are five important RFs associated with Peptic Ulcer Disease (PUD)?
- Smoking
- Alcohol use
- Genetic factors
- Diet
- Psychological factors (stress, depression)
146
What are the two most common etiologies of Peptic Ulcer Disease (PUD)?
- H. pylori
| - NSAIDs
147
What is the most common cause of PUD worldwide?
H. pylori
148
What can predispose PUD patient's to gastric CA?
H. pylori
149
What three virulence factors of H. pylori contribute to PUD?
- Motile flagella
- Urease
- Adhesins
150
What condition is often asxs, but if symptoms do present, the most common is upper abdominal pain? What other symptom may present?
Peptic Ulcer Disease (PUD)
| - May see dyspepsia
151
What role do NSAIDs play in causing PUD?
Decrease PG synthesis (PGE2)
152
What are the two types of ulcers seen with PUD?
- Gastric
| - Duodenal
153
Which PUD ulcer is associated with weight loss/anorexia? Which is associated with weight gain?
- Gastric = weight loss/anorexia
| - Duodenal = weight gain
154
Which PUD ulcer is worse with meals? Which is relieved with meals?
- Gastric = worse
| - Duodenal = relieved
155
Which PUD ulcer is more likely to hemorrhage, and what symptom may be seen? If the other type does hemorrhage, what symptom is seen?
Gastric Ulcer
- Hematemesis
If duodenal = melena
156
Which PUD ulcer is more associated with vomiting?
Gastric Ulcer
157
What complication is most common with PUD? What three symptoms may be seen, and how do you diagnose this?
Bleeding
- Hematemesis
- Melena
- Hematochezia
EGD = gold standard
158
Besides bleeding (most common), what other three complications may be seen with PUD?
- Perforation
- Penetration
- Gastric outlet obstruction
159
With the complication of perforation and PUD, what symptom may be seen? How do you dx and tx perforation?
Severe/diffuse abdominal pain
- Dx: upright chest/abdominal XR
- Tx: surgery
160
With the complication of Gastric Outlet Obstruction and PUD, what three symptoms may be seen?
- Vomiting
- Dilated stomach
- Succession splash
161
If a perforation is ever suspected, which diagnostic study is always CI?
NO UGI with Barium
162
With the complication of penetration and PUD, what other organ is most commonly affected?
Pancreas
163
What specialized abdominal test can be performed to diagnose PUD, and what is a positive result?
Succession splash
| - Retained gastric material 3+ hours post-meal will make a splashing sound
164
What diagnostic test is the most sensitive AND most specific in diagnosis of H. pylori induced PUD? What two other tests may be used, and what can they determine (2)?
Biopsy for histology during EGD
Also, urea breath test and stool antigen test
- Can determine if active infection and determine H. pylori eradication
165
Prior to performing a urea breath test or stool antigen test, what medication should be discontinued?
STOP PPI 1-2 weeks before tests
166
What diagnostic test is associated with a high false positive rate in H. pylori induced PUD?
Serology
167
In treatment of PUD, if H. pylori is +, you can treat with which two therapy regimens (3 vs. 4)?
- Clarithromycin Triple Therapy: PPI + Clarithromycin + Amoxicillin
- Bismuth Quadruple Therapy: PPI + Bismuth subsalicylate + Metronidazole + Tetracycline
168
What four medications are included in the Bismuth Quadruple Therapy, and what condition is it used to treat?
H. pylori induced PUD
- PPI
- Bismuth subsalicylate
- Metronidazole
- Tetracycline
169
What three medications are included in the Clarithromycin Triple Therapy, and what condition is it used to treat?
H. pylori induced PUD
- PPI
- Clarithromycin
- Amoxicillin
170
In treatment of PUD, if H. pylori is - AND secondary to NSAID/ASA use, you can treat with (2)?
- PPI for 6-8 weeks
| - STOP NSAID/ASA use
171
In treatment of PUD, if H. pylori is - and NOT due to NSAID/ASA use, you can treat with?
PPI for 4-8 weeks
| - Be sure to evaluate for other etiologies
172
What symptomatology is often seen with Zollinger-Ellison Syndrome (ZES)?
Recurrent PUD sxs
173
What condition involves gastrinomas from duodenum or pancreas?
Zollinger-Ellison Syndrome (ZES)
174
What two diagnostic findings are sufficient to diagnose Zollinger-Ellison Syndrome (ZES)?
- Fasting serum Gastrin of 1000+ pg/mL
| - Gastric pH <2
175
What is the recommended treatment for Zollinger-Ellison Syndrome (ZES)?
PPIs
176
What is the most common type of Gastric CA?
Adenocarcinomas
177
What are the two most common etiologies associated with Gastric CA?
- H. pylori
| - Gastric ulcers
178
What condition involves weight loss, persistent abdominal pain, hx of gastric ulcers?
Gastric CA
179
What three symptoms are often associated with Gastric CA?
- Weight loss
- Persistent abdominal pain
- Hx of gastric ulcers
180
The involvement of what lymph node is often indicative of Gastric CA? Where is this lymph node located?
Virchow’s Node
| - Left supraclavicular lymph node
181
What is the gold standard diagnostic test used to evaluate for Gastric CA? What is an alternative test?
EGD
| - Can also use UGI series
182
What treatment is recommended for Gastric CA?
Total or partial gastrectomy
| +/- chemotherapy
183
An EGD should be ordered on ANY patient that is over what age, and with what symptom?
60+ years with dyspepsia
184
If a patient is <60 years with dyspepsia, under what conditions would you order an EGD (3)?
If any of the following are seen...
- Significant weight loss
- GI bleeding
- 2+ alarm features and rapid prog. (unintentional weight loss, progressive dysphagia, odynophagia, unexplained IDA, persistent vomiting, palpable mass/LAD, family hx of upper GI CA)
185
What condition is a functional bowel disorder that is often multifactorial in etiology?
Irritable Bowel Syndrome (IBS)
186
What condition involves chronic/recurrent abdominal pain AND altered bowel habits?
Irritable Bowel Syndrome (IBS)
187
What two sxs must be present to classify as Irritable Bowel Syndrome (IBS)?
- Chronic/recurrent abdominal pain
AND
- Altered bowel habits
188
What is the Rome IV Criteria (__ AND 2+ of... (3)), and what condition is it associated with?
Irritable Bowel Syndrome (IBS)
- Recurrent abdominal pain 1+ day/week in last 3 months AND
- 2+ of following criteria... Related to defection, associated with change in stool frequency, associated with change in stool form
189
If a patient presents with typical IBS hx with NO alarm features, what is the diagnostic recommendation?
Basic labs ONLY
| - CBC, CMP, TSH, Celiac serologies
190
If a patient presents with atypical IBS sxs, alarm features OR refractory to tx, what is the diagnostic recommendation (3)?
- Basic labs
- Stool studies
- Imaging + scopes
191
What three aspects should be considered in treatment Irritable Bowel Syndrome (IBS), and which is initial?
- Diet/lifestyle/behavior modifications = INITIAL
- Psychotherapy
- Pharm
192
What is an important step of the diet/lifestyle/behavior modification treatment of Irritable Bowel Syndrome (IBS), especially IBS-C?
RECONCILE offending meds
193
What diet may be considered in treatment of Irritable Bowel Syndrome (IBS), and what does this involve?
FODMAP
| - Eliminate foods that contain sugar or fiber
194
What two classes of drugs are used to treat abdominal pain/discomfort associated with Irritable Bowel Syndrome (IBS)?
- Antispasmodics
| - Antidepressants (TCAs, SSRIs)
195
What five groups of drugs are used to treat constipation associated with Irritable Bowel Syndrome (IBS)?
- FIber
- Stool softeners
- Laxatives
- Prosecretory agents
- 5-HT4 Agonists
196
What five groups of drugs are used to treat diarrhea associated with Irritable Bowel Syndrome (IBS)?
- Anti-diarrheal
- Bile acid sequestrants
- Rifaximin
- Eluxadoline
- 5-HT3 Antagonists
197
What is the most common digestive complaint?
Constipation
198
What three drugs can contribute to constipation?
- Antipsychotics
- Iron
- Opioids
199
What are the two most common etiologies of constipation?
- Chronic idiopathic constipation
| - IBS-C
200
What is the diagnostic criteria associated with constipation?
25% of BMs involve…
- <3 BMs/week
- Lumpy/hard stools
- Straining
- Manual maneuvers needed
- Sensation of anorectal obstruction/blockage
- Sense of incomplete evacuation
201
What four classes of drugs can be used in the treatment of constipation?
- Fiber supplements
- Stool softeners
- Osmotic laxatives
- Stimulant laxatives
202
What are the three AEs associated with fiber supplements, and what condition are these meds used to treat?
CONSTIPATION
- Flatulence
- Bloating
- Distention
203
What group of medications involves AEs of flatulence, bloating, distention?
Fiber supplements
FYI:
- Metamucil
- Citrucel
- Fiber Con
- Benefiber
204
What primary AE is associated with osmotic laxatives, and what condition are these meds used to treat?
CONSTIPATION
| - Hypermagnesemia in renal insufficiency patients
205
What group of medications involves AE of hypermagnesemia in renal insufficiency patients?
Osmotic Laxatives
FYI:
- MiraLAX
- Milk of magnesia
- Mag citrate
- Lactulose
206
What three complications are associated with constipation?
- Hemorrhoids/anal fissures
- Fluid/electrolytes abnormalities with laxative abuse
- Fecal impaction → Bowel Obstruction
207
How can you differentiate acute diarrhea from chronic diarrhea?
- Acute = <14 days
| - Chronic = 30+ days
208
What is the most common etiology of diarrhea, and what specific pathogen causes it?
VIRAL (infectious)
| - Norovirus
209
What condition involves watery, non-bloody diarrhea; N/V; mild abdominal pain +/- low grade fever?
NON-inflammatory diarrhea
210
What condition involves bloody diarrhea; severe abdominal pain; fever?
Inflammatory diarrhea
211
What three symptoms are seen with inflammatory diarrhea?
- Bloody diarrhea
- Severe abdominal pain
- Fever
212
What are the two most common etiologies of NON-inflammatory diarrhea?
- Norovirus (viral)
| - Giardia (protozoal)
213
What is the most common etiology of inflammatory diarrhea, and what five pathogens specifically?
BACTERIAL
- Salmonella
- Campylobacter
- Shigella
- EHEC
- C. diff
214
What side effect may be seen with Pepto Bismol, and what condition would you use this to treat?
Black stools
| - Used to treat diarrhea
215
What symptom is associated with chronic Giardia lamblia? Does this cause NON-inflammatory diarrhea or inflammatory diarrhea?
Profound weight loss
| - NON-inflammatory diarrhea
216
What are the two most common viral etiologies NON-inflammatory diarrhea, and what is an important aspect of each?
- Norovirus: cruise ship, restaurants
| - Rotavirus: 6 months to 2 years
217
Which pathogen involves "rice water diarrhea"? Does this cause NON-inflammatory diarrhea or inflammatory diarrhea?
Vibrio cholerae
| - NON-inflammatory diarrhea
218
Which pathogen involves creamy foods, potato salad? Does this cause NON-inflammatory diarrhea or inflammatory diarrhea?
Staph aureus
| - NON-inflammatory diarrhea
219
Which three pathogens are considered endotoxins? Do these cause NON-inflammatory diarrhea or inflammatory diarrhea?
NON-inflammatory diarrhea
- Clostridium
- S. aureus
- Bacillus
220
Which pathogen is associated with camp, lakes, streams, ponds, daycares, pools? Does this cause NON-inflammatory diarrhea or inflammatory diarrhea?
```
Giardia lamblia (protozoa)
- NON-inflammatory diarrhea
```
221
How do you treat a NON-inflammatory diarrhea caused by Vibrio cholerae?
ABX
222
Which pathogen is associated with poultry/livestock, reptiles? Does this cause NON-inflammatory diarrhea or inflammatory diarrhea?
Salmonella
| - Inflammatory diarrhea
223
Which pathogen is linked to Guillain-Barré Syndrome? Does this cause NON-inflammatory diarrhea or inflammatory diarrhea?
C. jejuni
| - Inflammatory diarrhea
224
Which pathogen is associated with severe afebrile bloody diarrhea? Does this cause NON-inflammatory diarrhea or inflammatory diarrhea?
EHEC
| - Inflammatory diarrhea
225
Which pathogen is associated with recent hospitalization/abx use? What three abx should you avoid use of?
Does this cause NON-inflammatory diarrhea or inflammatory diarrhea?
C. diff
- Inflammatory diarrhea
AVOID:
- Vancomycin
- Fidaxomicin
- Metronidazole
226
Which pathogen is associated with raw seafood? Does this cause NON-inflammatory diarrhea or inflammatory diarrhea?
Vibrio parahaemolyticus
| - Inflammatory diarrhea
227
Which pathogen mimics appendicitis? Does this cause NON-inflammatory diarrhea or inflammatory diarrhea?
Yersinia enterocolitica
| - Inflammatory diarrhea
228
Which pathogen is also known as “classic dysentery”? Does this cause NON-inflammatory diarrhea or inflammatory diarrhea?
Shigella
| - Inflammatory diarrhea
229
What protozoa can cause inflammatory diarrhea?
E. histolytica
230
What two conditions involve chronic relapsing/remitting inflammatory conditions of GI tract?
IBD
- Crohn Disease (CD)
- Ulcerative Colitis (UC)
231
What is the age distribution of IBD?
BIMODAL
- 15-35 years
- 50-80 years
232
What condition involves GI tract from mouth to anus?
Crohn Disease (CD)
233
What condition involves skip lesions?
Crohn Disease (CD)
234
What condition involves transmural inflammation (more layers)?
Crohn Disease (CD)
235
What area of the GI tract is most affected by Crohn Disease (CD), and what is this called?
Ileus
| - Ileitis
236
What condition involves penetrating disease (ulcers, strictures, fistula, abscess)?
Crohn Disease (CD)
237
What are the four types of fistulas associated with Crohn Disease (CD)?
- Enteroenteric (bowel to bowel)
- Enterovesical (bowel to bladder)
- Enterovaginal
- Enterocutaneous
238
What is the primary symptom associated with Crohn Disease (CD)?
Abdominal pain (RLQ)
239
What is the most common extra-intestinal symptom associated with IBD (CD and UC)? What additional sxs can be seen with UC?
Arthralgias
| - Also, sclerosing cholangitis with UC
240
What diagnostic test is recommended for Crohn Disease (CD)? What other test may be added on?
Colonoscopy with TI intubation
| +/- EGD
241
What finding would be seen if a UGI is performed on a Crohn Disease (CD) patient?
“String sign”
242
What condition involves ulcerations, cobblestoning, granulomas (on biopsy)?
Crohn Disease (CD)
243
What four findings would be seen with Crohn Disease (CD) diagnostically?
- Skip lesions
- Ulcerations
- Cobblestonning
- Granulomas
244
What area of the GI tract is spared with Crohn Disease (CD)?
RECTUM
245
What are three possible complications of Crohn Disease (CD)?
- Colon CA
- Malabsorption (iron, B12)
- Possible SBO/perforation
246
What condition involves the mucosal surface of colon ONLY?
Ulcerative Colitis (UC)
247
What two conditions are of slow onset; intermittent (alternate between exacerbations and remission)?
- Crohn Disease (CD)
| - Ulcerative Colitis (UC)
248
What two diagnostic tests can be used to diagnose Ulcerative Colitis (UC)?
- Flex sigmoidoscopy
| - Colonoscopy
249
How does the spread of inflammation occur with Ulcerative Colitis (UC), and in what pattern?
Distal to proximal
- Continuous
- Circumferential
250
What condition involves erythema, exudate, friability, erosions superficially?
Ulcerative Colitis (UC)
251
What condition involves crypt abscesses on biopsy?
Ulcerative Colitis (UC)
252
What finding is seen on biopsy with Crohn Disease (CD)? What about with Ulcerative Colitis (UC)?
- CD = granulomas
| - UC = crypt abscesses
253
What are two possible complications of Ulcerative Colitis (UC)?
- Colon CA
| - Toxic megacolon
254
5-ASA are primarily effective in treating what condition? What are the two side effects of these medications?
UC
- Diarrhea
- Kidney injury
255
What medication is used to treat flares of CD or UC?
Corticosteroids
256
Should Corticosteroids be used short-term or maintenance for the treatment of IBD? What two considerations should be made?
SHORT-TERM
- Slow taper
- Have exit strategy
257
For treatment of IBD, which Corticosteroid is associated with systemic sxs, and what are these eight sxs?
THIS CARD SUCKS IM SORRY
Prednisone
- Mood changes
- Insomnia
- Weight gain
- Worsening DM
- Increased infection risk
- Osteoporosis
- Cataracts
- Psychosis
258
For treatment of IBD, which Immunomodulator is associated with systemic sxs, and what are these seven sxs?
THIS CARD SUCKS IM SORRY
Thiopurines (6MP, Azathioprine)
- Bone marrow suppression
- 2º infection
- Pancreatitis
- Hepatotoxicity
- Non-Hodgkin Lymphoma
- Cervical CA
- Skin CA
259
What class of medications are steroid-sparing agent, prevent immunogenicity, and what do they treat?
Immunomodulators
| - Treat moderate/severe CD or UC
260
What two classes of drugs are used to treat moderate/severe CD or UC?
- Immunomodulators
- Biologics (Anti-TNFs)
Monotherapy or in combination
261
What two considerations should be made in the use of Methotrexate to treat IBD?
- Folate supplementation
| - Teratogenic
262
What labs should be used for monitoring when using Immunomodulators to treat IBD?
- CBC
| - LFTs scan
263
What are you at risk of with use of Biologics (Anti-TNFs) to treat IBD?
Infusion reaction
264
For treatment of IBD, Biologics (Anti-TNFs) are associated with systemic sxs - what are these four sxs?
THIS CARD SUCKS IM SORRY
- 2º infection
- Reactivation of TB or HBV
- Non-Hodgkin Lymphoma
- Skin CA
265
Under what three conditions are the use of Biologics (Anti-TNFs) CI in treatment of IBD?
- Active infection
- CHF hx
- MS/optic neuritis
266
What three drugs/classes of drugs to treat IBD are associated with systemic sxs?
- Prednisone
- Thiopurines (6MP, Azathioprine)
- Biologics (Anti-TNFs)
267
What medication is used to treat acute CD due to perianal disease?
Antibiotics
268
What three AEs are associated with Cipro, and what specific IBD condition is it used to treat?
Acute CD due to perianal disease
- Tendon rupture
- Photosensitivity
- Prolonged QT
269
What three AEs are associated with Flagyl/Metronidazole, and what specific IBD condition is it used to treat?
Acute CD due to perianal disease
- Peripheral neuropathy
- Metallic taste
- Disulfiram rxn
270
What is the first line treatment for mild/moderate UC?
Oral/topical 5-ASA
271
In patients with IBD, what diagnostic test should always be performed if diarrhea develops
Stool samples
272
What medication should be avoided in treatment of IBD, and why?
NSAIDs = worsen disease
273
What population is most affected by Celiac Disease?
Whites of Northern European ancestry
274
What condition involves immune-mediated disease causing inflammation, crypt hyperplasia, and villous atrophy?
Celiac Disease
275
What condition involves villous atrophy of small intestine?
Celiac Disease
276
What condition involves loss of absorptive surface capacity and small bowel malabsorption?
Celiac Disease
277
What three things/conditions are associated with Celiac Disease?
- Genetic predisposition
- Autoimmune disorders (DM, thyroid)
- Down Syndrome
278
What group of symptoms are considered "classic" for Celiac Disease, and what are four example symptoms?
Malabsorptive sxs
- Diarrhea
- Steatorrhea
- Flatulence/bloating
- Weight loss
279
What are the three possible presentations of Celiac Disease?
- Classic = malabsorptive sxs
- Atypical
- Silent
280
What three symptoms are considered "atypical" for Celiac Disease?
- Abdominal pain
- Constipation
- Dyspepsia
281
What type of symptoms are often seen with "silent" Celiac Disease, and what condition is an example of this?
Extra-intestinal sxs
| - Dermatitis Herpetiformis
282
What is the diagnostic plan (3 steps) associated with Celiac Disease?
1. Clinical suspicion
2. Serologic testing
3. Endoscopic findings
283
If performing serologic testing for Celiac Disease, what condition must a patient follow?
MUST be on a gluten diet
284
What Ab will be elevated with Celiac Disease on serology? What other two Ab may be elevated?
What finding should be normal?
tTG Ab
- EMA Ab titer
- DGP
IgA = NORMAL
285
What is the gold standard diagnostic test used for evaluate for Celiac Disease?
EGD with duodenal biopsy
286
What condition involves villous atrophy, crypt hyperplasia, intraepithelial lymphocytes? What diagnostic test would show these findings?
Celiac Disease
| - EGD with duodenal biopsy
287
What is the primary complication associated with Celiac Disease? As a result, what diagnostic test should be ordered often to evaluate?
Malabsorption (IDA, B12 deficiency)
| - Osteoporosis = DEXA scan
288
For what time frame would you begin TPN (rather than consider PPN)?
More than 7 days = TPN
289
What three accesses are used for short-term EN? What time frame is considered "short-term"?
SHORT = <4-6 weeks
- NG (nasogastric)
- ND (nasoduodenal)
- NJ (nasojejunal)
290
What two accesses are used for long-term EN? What time frame is considered "long-term"?
LONG = >4-6 weeks
- G-tube (gastrostomy)
- J-tube (jejunostomy)
291
For gastric vs. small bowel route of EN, under what two conditions should gastric be avoided?
AVOID gastric if:
- Risk of aspiration
- Gastroparesis
