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MKSAP: Key Points > GI/hepatology key points > Flashcards

GI/hepatology key points Flashcards

1
Q

Initial test of choice for eval of oropharylgeal dysphagia?

A

MBS (aka videofluoroscopy)

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2
Q

Esophageal dysphagia to solids suggests what sort of issue?

A

Mechanical obstruction

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3
Q

Esophageal dysphagia to liquids only or both solids and liquids suggests what sort of issue?

A

Motility disorder

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4
Q

What’s the most appropriate test for esophageal dysphagia? Why?

A

Upper endoscopy; it alloes for Dx (Bx + inspection) and Tx (dilation)

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5
Q

What key group of things must you rule out before attributing chest pain to an esophageal caues?

A

Cardiac causes

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6
Q

Name 5 major s/s of achalasia. 1 and 2 are most important, but 3-5 may be present as well.

A
  1. Dyspahgia to both solids and liq
  2. Regurg of undigested bland food and saliva
  3. Wt loss
  4. Chest pain
  5. Heartburn
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7
Q

Initial test for suspected achalasia? What does it show?

A

Barium esophogram; dilation of the esophagus and narrowing @ GEJ (bird beak)

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8
Q

What are the two primary options for Tx of achalasia? How do you choose btwn them?

A

Endoscopic pneumatic dilation and laproscopic surgical myotomy. They have comparable success rates, so choose based on local expertise

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9
Q

MCC of infectious esophagitis?

A

Candida albicans

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10
Q

Tx of candidal esophagitis?

A

PO fluconazole

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11
Q

2 main Ppx strategies to avoid pill-induced esophagitis?

A

Drink lots of water with the med

Avoid lying down for 30 min s/p ingestion

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12
Q

Classic presentation of eosinophilic esophagitis?

A

Atopic man in his 20s w/ Sx of solid-food dysphagia and food impactions requiring removal by endoscopy

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13
Q

4 major Cpx of GERD?

A
  1. Erosive esophagitis
  2. Stricture
  3. Barrett esophagitis
  4. Esophageal cancer
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14
Q

What are the 4 major alarm Sx in suspected GERD?

A

Melena
Unintectional wt loss
Hematemesis
Dysphagia

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15
Q

Mx of suspected GERD w/o alarm Sx?

A

Trial of PPIs- responsiveness confirms Dx

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16
Q

Which patients with suspected GERD get an upper endoscopy (2)?

A

Those with alarm Sx

Those w/ Sx unresponsive to PPIs

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17
Q

DOC for GERD?

A

PPIs- superior to H2 blockers

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18
Q

4 major indications for antireflux surgery in GERD?

A
  1. Patient preference to stop taking meds
  2. Med ADEs
  3. Large hiatal hernia
  4. Refractory Sx despite max medical therapy
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19
Q

Describe long-term efficacy of endoscopic therapies for GERD

A

Haven’t been shown to be effective in long-term

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20
Q

What’s Barrett esophagus?

A

Premalignant condition that could progress to esophageal cancer

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21
Q

Describe initiation of screening for Barrett esophagus in patients with GERD

A

No routine screening based on Sx!
Screening may be appropriate for patients older than 50 w/ chronic GERD (more than 5 yr) and additional risk factors (nocturnal reflux S, hiatal hernia, elevated BMI, tobacco use, intra-abdominal fat distribution)

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22
Q

In patients with Barrett esophagus, have meds (ASA, PPI, NSAID) or antireflux surgery been shown to decrease progression of dysplasia or development of adenoCA?

A

Nope (at least not definitively)

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23
Q

Which subgroup of patients with Barrett esophagus should have treatment to remove the lesion?

A

Those with high-grade BE

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24
Q

3 options for management of high grade Barrett esophagus?

A

Endoscopic ablation
Photodynamic therapy
Endoscopic mucosal resection

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25
Q

Depending on stage at initial diagnosis, what’s the range of overall 5 year survival in patients with esophageal cancer?

A

15-25%

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26
Q

MC clinical manifestation of esophageal cancer?

A

Solid food dysphagia

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27
Q

Preferred initial test for esophageal CA?

A

Upper endoscopy w/ Bx

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28
Q

Gold standard for Dx of PUD?

A

Upper endoscopy

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29
Q

How do you diagnose PUD?

A

Upper endoscopy showing mucosal break 5 mm or greater in the stomach or duodenum

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30
Q

4 major Cpx of PUD?

A
  1. Obstruction
  2. Bleeding
  3. Perforation
  4. Penetration
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31
Q

2 primary goals of management of uncomplicated PUD?

A

ID the cause

Correct modifiable RFs for ulcer Cpx and recurrences

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32
Q

Which 2 broad groups of PUD patients don’t usually require endoscopic follow-up?

A
  1. Duodenal PUD

2. Low-risk gastric PUD

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33
Q

Describe the diagnostic criteria for functional dyspepsia

A 
One of more of the following:
1. Bothersome postprandial fullness
2. Early satiety
3. Epigastic pain
4. Epigastric burning
Must have met criteria for last 3 months, w/ Sx onset at least 6 mo prior to Dx and w/ no evidence of structural disease to explain symptoms
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34
Q

In patients younger than 50-55 who p/w dyspepsia w/o alarm features, what should you do next (2 options)?

A

Trial of PPI or test/treat for H pylori

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35
Q

4 components of Tx of functional dyspepsia?

A
  1. Dietary and lifestyle mods
  2. OTC/script meds
  3. Psychological Tx
  4. CAM therapies
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36
Q

5 clearly established indications for H pylori testing?

A
  1. Active PUD
  2. Confirmed history of PUD
  3. Gastric MALT lymphoma
  4. Uninvestigated dyspepsia
  5. After endoscopic resection of early gastric cancer

*Note that GERD is NOT an indication!

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37
Q

Describe general treatment plan for H pylori (classes of agents and timeframe)

A

Min of 3 agents: 1 antisecretory + 2 antimicrobials. Duration of 10-14 days.

38
Q

What’s the rate of treatment failure for H pylori?

A

25%

39
Q

What are the two main options for testing to confirm eradication of H pylori?

A

Urea breath test

Fecal antigen test

40
Q

Why shouldn’t you use antibody testing to confirm eradication of H pylori?

A

Abs remain in serum for a long time after H pylori has been eradicated

41
Q

6 RF for NSAID-related GI complications?

A
  1. Hx of PUD or other GI bleeding event
  2. H pylori infection
  3. 65 or older
  4. Concomitant use of ASA (any dose), anticoagulants, other NSAIDs, or steroids
  5. High-dose NSAID use
  6. Chronic comorbid illness
42
Q

Preferred drug for Tx and Ppx of NSAID and ASA-related GI injury?

A

PPI

43
Q

6 commonly reported Sx of gastroparesis?

A 
Early satiety
Postprandial fullness
N/V
Upper abdominal pain
Bloating
Wt loss
44
Q

Describe sequence of testing for gastroparesis

A

Initial upper endoscopy to r/o mechanical obstruction, followed by gastric emptying study

45
Q

What test should you do in patients younger than 40 w. dysplastic or numerous fundic gland polyps? Why?

A

Colonoscopy to r/p FAP or MYH-associated polyposis

46
Q

Imaging of choice to eval for gastric subepithelial lesions?

A

Endoscopic ultrasound

47
Q

Describe screening for gastric cancer

A

Not for average risk people. Pts w/ genetic gastric cancer predisposition undergo syndrome-specific surveillance

48
Q

Dx test of choice for gastric cancer?

A

Upper endoscopy w/ Bx

49
Q

2 MCCs of acute pancreatitis? Together, what % of cases do they account for in the US?

A

EtOH + gallstones

80%

50
Q

Dx of acute pancreatitis?

A

Requires 2 of the following 3:

  1. Acute onset upper abdominal pain
  2. Serum amylase or lipase increased by at least 3x ULN
  3. Characteristic findings on X-sectional imaging
51
Q

What imaging should all patients w/ acute pancreatitis get unless there’s an obvious etiology?

A

Transabdominal US (to check for stones)

52
Q

3 lab values that are poor prognostic indicators in acute pancreatitis? (discrete values, not trends)

A

BUN greater than 20
HCT geater than 44
Elevated serum creatinine

53
Q

What intervention should you perform prior to discharge in patients w/ acute pancreatitis 2/2 gallstones?

A

Cholecystectomy

54
Q

MCC of chronic pancreatitis?

A

EtOH

55
Q

Hallmark Sx of chronic pancreatitis?

A

Abdominal pain, often radiating to the back

56
Q

Common diagnostic criteria for chronic pancreatitis are lumped into what two groups (ideally with findings from each)?

A

Clinical features (pain, recurrent attacks of pancreatitis, wt loss) + objective findings

57
Q

Name 5 possible “objective findings” that would suggest a diagnosis of chronic pancreatitis (when coupled with appropriate clinical features)

A 
Calcifications
Imaging features of ductal dilatation or inflammatory masses
Exocrine pancreatic insufficiency
DM
Histologic findings
58
Q

2 major counseling points for patients w/ chronic pancreatitis?

A

Stop smoking

Stop drinking

59
Q

5 year survival for pancreatic adenoCA?

A

5%

60
Q

7 strong RFs for pancreatic CA

A
  1. Older than 50 yo
  2. FHx of pancreatic CA
  3. Smoker
  4. Chronic pancreatitis
  5. Obesity
  6. DM
  7. Intraductal papillary mucinous neoplasms
61
Q

3 MC presenting Sx of pancreatic cancer?

A

Wt loss, abdominal pain, jaundice

62
Q

What’s the sensitivity of contrast-enhanced multidetector CT in detection of pancreatic cancer?

A

90%

63
Q

Classic presentation of autoimmune pancreatitis?

A

Painless obstructive jaundice

64
Q

Classic imaging characteristic of autoimmune pancreatitis?

A

X-sectional imaiging evidence of focal or diffuse sausage-shaped pancreatic enlargement w/ a featureless border

65
Q

Initial Tx of autoimmune pancreatitis? Describe response?

A

Steroids

Almost all will enter clinical remission, but relapse is common

66
Q

2 MC pancreatic cystic neoplasms? Which ducts do they involve?

A

Mucinous cystic neoplasms
Intraductal papillary mucinous neoplasms
Main duct, branch ducts or both

67
Q

What percent of PNETs are functional vs non-functional?

A

75-90% nonfunctional, 10-25% are functional

68
Q

Of the functional PNETs, what are the 2 MC secreted hormones?

A

Insulin and gastrin

69
Q

Why should you resect localized PNETs?

A

Risk of mets

70
Q

What are the 2 major causes of acute diarrhea in developed countries? What impact does this have on your work-up?

A

Viral AGE and foodborne illness. Since both are self-limited, it’s not worth it to perform diagnostic testing.

71
Q

What testing should you do in patients older than 50 (but not always in those younger than that) who p/w chronic diarrhea?

A

Colonoscopy to screen for CRC

72
Q

What two things are required for Dx of celiac dz?

A
  1. positive serologic markers (anti-tTG IgA or anti-endomysial Abs)
  2. Compatible small bowel Bx
73
Q

Tx of celiac dz?

A

Strict gluten-free diet

74
Q

Name 4 symptoms and 2 labs characterizing small intestinal bacterial overgrowth

A

Diarrhea, bloating, weight loss, flatulence

B12 deficiency and elevated serum folate

75
Q

Short-bowel usually won’t occur until how much healthy small bowel is left?

A

Less than 200 cm

76
Q

What’s the MC malabsorbed carb?

A

Lactose

77
Q

Malabsorption of what carb is commonly overlooked bc people forget its presence in many processed foods?

A

Fructose (remember how prevalent high frc corn syrup is)

78
Q

6 common presenting Sx of UC?

A 
Bloody diarrhea
Abdominal discomfort
Tenesmus
Urgency
Rectal pain
Fecal incontenence
79
Q

3 common Sx of Crohn dz?

A

Abdominal pain
Diarrhea
Wt loss

80
Q

5 common extra-intestinal manifestations of IBD?

A 
Oral apathous ulcers
Arthralgias
Back pain
Eye Sx
Skin Sx
81
Q

How do you diagnose IBD?

A

Visualization of GI tract- MC w/ colonoscopy and Bx of colon and ileum

82
Q

Since patients with Crohn dz commonly require repeat imaging, which can be end up exposing them to large amounts of radiation, what are 2 ways you can decrease this exposure?

A
  1. Only image with results will affect Mx

2. Use MRI or US in place of CT whenever possible

83
Q

Patients w/ long-standing colitis a/w IBD are at increased risk for colon cancer. When do you start surveillance colonoscopy, and how often should you repeat it?

A

Start after 8-10 years of disease, and repeat every 1-2 years

84
Q

Suspect microscopic colitis in patients with what type of diarrhea? What percent of these patients have microscopic colitis?

A

Chronic, watery diarrhea

10-15%

85
Q

How does microscopic colitis differ from IBD in terms of demographics and endoscopic findings

A

It’s MC in older people and doesn’t cause endoscopically visible inflammation

86
Q

How do the Rome III criteria define constipation?

A

As a symptom complex that includes at least 2 of the following:

  1. Straining during defecation
  2. Passage of lumpy or hard stool
  3. Sensation of incomplete defecation
  4. Use of manual maneuvers to facilitate a BM
  5. Fewer than 3 BM per week
87
Q

2 initial lifestyle measures to improve constipation?

A
  1. Increased physical activity

2. Increased dietary fiber

88
Q

How do you Dx IBS (general)

A

Fulfillment of diagnostic criteria in absence of alarm features

89
Q

3 major alarm features to consider when diagnosing IBS?

A
  1. Unintentional weight loss
  2. Anemia
    3, FHx of CRC, IBD, or celiac
90
Q

Essential diagnostic step in management of IBS?

A

Clear establishment of the Dx with explanation of and reassurance regarding the patient’s Sx

91
Q

What percent of patients w/ diverticula have an episode of diverticulitis?

A

20%

92
Q

3 main Sx of diverticulitis?

A

Abdominal pain, fever, altered bowel habits

MKSAP: Key Points (6 decks)

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