GI/Hepatology Flashcards
Initial treatment for type 1 autoimmune pancreatitis
High-dose PO prednisone
Treatment for severe alcoholic hepatitis, defined as Maddrey score > 32 or the presence of hepatic encephalopathy
Prednisolone
Appropriate colon cancer surveillance with colonoscopy for patients with 1 or 2 sessile serrated polyps < 10 mm without dysplasia
Every 5 to 10 years
Diagnostic study for Budd-Chiari syndrome
US with doppler
Post exposure prophylaxis for hepatitis A virus in nonimmune person
Hepatitis A virus vaccine
+ HAV immune globulin if > 40 y/o
Diagnosis associated with insulinoma in patients <40 years old
MEN type 1
Management for localized Ulcerative proctitis
Topical/suppository 5-ASA
Elevated serum ferritin level and transferring saturation
Hereditary hemochromatosis
Study of choice for active lower GI bleeding with associated hemodynamic instability
CT angiography
Treatment of choice for familiar adenomatous polyposis
Colectomy
Recommend surveillance for cervical cancer screening in patients with IBD receiving immuno suppressive therapy
Pap testing annually
Dysphasia and food bolus obstruction usually found in younger men with a topic conditions
Eosinophilic esophagitis
Recommend surveillance for patients with cirrhosis who have undergone virologic cure for Hepatitis C virus infection
US every 6 months for evaluation of HCC
Recommended imaging modality for the diagnosis of acute mesenteric ischemia
CT angiography
Equation for fecal osmotic gap
290 - (2 x [stool Na + stool K])
Evaluation for suspected oropharyngeal dysphasia
Videofluoscopy with liquid and solid phases
Degeneration of the myenteric plexus with failure of the lower esophageal sphincter to relax in response to swallowing and absent peristalsis
Achalasia
Diagnostic evaluation for Achalasia in the following order
1) barium swallow
2) Esophageal manometry
3) Upper endoscopy
First line therapies for achalasia
Laparoscopic surgical myotomy of the LES and endoscopic pneumatic dilation of the esophagus
Appropriate evaluation for GERD refractory to empiric therapy with PPI
Upper endoscopy
If normal, ambulatory esophageal pH monitoring or impedance pH testing
Surveillance for Barret esophagus and no dysplasia
Every 3 to 5 years
Surveillance for Barret esophagus with low-grade dysplasia in those that do not choose endoscopic ablation
Every 6 to 12 months
Evaluation for eosinophilic esophagitis
8 week trial of PPI
If symptoms refractory, this confirms diagnosis
If symptoms resolved, this indicates GERD-associate eosinophilia
Timing of follow-up H. pylori testing After completion of therapy
4 weeks
First line therapy for dumping syndrome
Smaller, more frequent meals
Most common cause of recurrent celiac disease symptoms
Gluten exposure
Management for esophageal hypomotility disorder
Lifestyle changes + PPI
Painless obstructive jaundice with cross-sectional imaging revealing sausage-shaped pancreatic enlargement with and without elevated IgG4 levels
Type 1 Autoimmune pancreatitis (elevated IgG4)
Type 2 AIP (normal IgG4)
1) Osmotic gap > 100 mOsm/kg H2O
2) Osmotic gap < 50 mOsm/kg H2O
1) osmotic diarrhea
2) secretory diarrhea
Appropriate surveillance for patients with larger adenomas (>10 mm), 5-10 tubular adenomas <10 mm, Adenomas with tubulovillous histology, or other adenomas with high-grade dysplasia
Colonoscopy every 3 years
Diagnosis of Puetz Jeghers syndrome requires 2 of the following 3 criteria:
1) >2 PJS-type hamartomatous polyps in the G.I. tract
2) Multiple melanogic macules in the mouth, bucc mucosa, nose, Eyes, fingers, genitalia
3) Family history of PJS
Age at which patients with Lynch syndrome should be screened for colon and stomach/small bowel cancer
Colon: colonoscopy beginning at ages 20 to 25 years (or 2-5 years before the earliest cancer diagnosis in family)
Stomach/small bowel: Upper endoscopy beginning at age 30 to 35 years
Surveillance for ulcerative pancolitis or Crohn disease
Colonoscopy beginning 8 years after diagnosis then performed every 1 to 2 years after
Proctocolectomy if dysplasia is found
Poorly localized severe abdominal pain, often out of proportion to physical findings; peritoneal signs signify infarction
Diagnostic evaluation
Treatment
Acute mesenteric ischemia
CTA or selective mesenteric angiography
Peritoneal: urgent laparotomy
Not peritoneal: angiography
Postprandial abdominal pain, Fear of eating, and weight loss; often signs and symptoms of atherosclerosis in other vascular beds
Diagnostic evaluation
Treatment
Chronic mesenteric ischemia
CTA, selective angiography, or MRA
Surgical reconstruction or angioplasty with stenting
LLQ abdominal pain and self-limited bloody diarrhea
Diagnostic evaluation
Treatment
Ischemic colitis
Colonoscopy: patchy segmental ulcerations
Supportive care with IV fluids and bowel rest
Management for gallbladder polyps > 1cm
Cholecystectomy
Treatment for functional dyspepsia refractory to PPI
Tricyclic antidepressant
Management for Canada esophagitis
PO fluconazole
Appropriate management for dermatitis herpetiformis after resolution of celiac symptoms
Testing for G6PD deficiency prior to initiating dapsone
Hepatitis A prophylaxis in
1) healthy persons <40 years old
2) Older adults and those who are immune compromised or half chronic liver disease
1) hepatitis A vaccine
2) Vaccine + immunoglobulin
Hepatitis B prevention for postexposure prophylaxis after needlestick injury and for sexual and household contacts of patients with HBV
Hepatitis B vaccine + HBIG
Recommended indications for treatment in patients with hepatitis B infection
1) acute liver failure or cirrhosis
2) Infection in the immune active phase
3) Infection in the reactivation phase (immune escape)
4) Immunosuppression or planned immunosuppression
Treatment for hepatitis B virus
entecavir or tenofovir
Indications for US Surveillance every 6 months in patients with HBC anD increased risk for HCC
1) cirrhosis
2) Asian men > 40 years and Asian women >50 years
3) Black patients > 20 years
4) Elevated ALT level and HBV DNA levels > 10,000 U/mL
5) Family history of HCC
Initial diagnostic study for hepatitis C infection
Anti-HCV antibody
If positive, test for HCV RNA
Patients with HCV who are candidates for liver transplantation
HCV + decompensated disease
Localized HCC
HCC Ultrasound surveillance for patients with HCV cirrhosis
Every 6 months
Indication for initiation and discontinuation of prednisolone in alcoholic hepatitis
Inititation: MDF > 32, MELD > 18, or encephalopathy and ascites
Discontinuation: If bilirubin level does not improve by day 7
Most appropriate screening test for Hemochromatosis
Fasting serum transferrin saturation
Diagnostic studies of Hemochromatosis
C282Y homozygous or C282Y/H63D compoubd heterozygous
The diagnosis of Peutz-Jeghers syndrome is based on the presence of 2 of the following 3 criteria:
1) 2 or more PJS type hamartomatous polyps in G.I. tract
2) Multiple melanotic macules in the mouth, buccal mucosa, nose, eyes, genitalia, or fingers
3) Family history of PJS
