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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
Depending on stage at initial diagnosis, what's the range of overall 5 year survival in patients with esophageal cancer?
15-25%
26
MC clinical manifestation of esophageal cancer?
Solid food dysphagia
27
Preferred initial test for esophageal CA?
Upper endoscopy w/ Bx
28
Gold standard for Dx of PUD?
Upper endoscopy
29
How do you diagnose PUD?
Upper endoscopy showing mucosal break 5 mm or greater in the stomach or duodenum
30
4 major Cpx of PUD?
1. Obstruction 2. Bleeding 3. Perforation 4. Penetration
31
2 primary goals of management of uncomplicated PUD?
ID the cause | Correct modifiable RFs for ulcer Cpx and recurrences
32
Which 2 broad groups of PUD patients don't usually require endoscopic follow-up?
1. Duodenal PUD | 2. Low-risk gastric PUD
33
Describe the diagnostic criteria for functional dyspepsia
``` 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 ```
34
In patients younger than 50-55 who p/w dyspepsia w/o alarm features, what should you do next (2 options)?
Trial of PPI or test/treat for H pylori
35
4 components of Tx of functional dyspepsia?
1. Dietary and lifestyle mods 2. OTC/script meds 3. Psychological Tx 4. CAM therapies
36
5 clearly established indications for H pylori testing?
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!
37
Describe general treatment plan for H pylori (classes of agents and timeframe)
Min of 3 agents: 1 antisecretory + 2 antimicrobials. Duration of 10-14 days.
38
What's the rate of treatment failure for H pylori?
25%
39
What are the two main options for testing to confirm eradication of H pylori?
Urea breath test | Fecal antigen test
40
Why shouldn't you use antibody testing to confirm eradication of H pylori?
Abs remain in serum for a long time after H pylori has been eradicated
41
6 RF for NSAID-related GI complications?
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
Preferred drug for Tx and Ppx of NSAID and ASA-related GI injury?
PPI
43
6 commonly reported Sx of gastroparesis?
``` Early satiety Postprandial fullness N/V Upper abdominal pain Bloating Wt loss ```
44
Describe sequence of testing for gastroparesis
Initial upper endoscopy to r/o mechanical obstruction, followed by gastric emptying study
45
What test should you do in patients younger than 40 w. dysplastic or numerous fundic gland polyps? Why?
Colonoscopy to r/p FAP or MYH-associated polyposis
46
Imaging of choice to eval for gastric subepithelial lesions?
Endoscopic ultrasound
47
Describe screening for gastric cancer
Not for average risk people. Pts w/ genetic gastric cancer predisposition undergo syndrome-specific surveillance
48
Dx test of choice for gastric cancer?
Upper endoscopy w/ Bx
49
2 MCCs of acute pancreatitis? Together, what % of cases do they account for in the US?
EtOH + gallstones | 80%
50
Dx of acute pancreatitis?
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
What imaging should all patients w/ acute pancreatitis get unless there's an obvious etiology?
Transabdominal US (to check for stones)
52
3 lab values that are poor prognostic indicators in acute pancreatitis? (discrete values, not trends)
BUN greater than 20 HCT geater than 44 Elevated serum creatinine
53
What intervention should you perform prior to discharge in patients w/ acute pancreatitis 2/2 gallstones?
Cholecystectomy
54
MCC of chronic pancreatitis?
EtOH
55
Hallmark Sx of chronic pancreatitis?
Abdominal pain, often radiating to the back
56
Common diagnostic criteria for chronic pancreatitis are lumped into what two groups (ideally with findings from each)?
Clinical features (pain, recurrent attacks of pancreatitis, wt loss) + objective findings
57
Name 5 possible "objective findings" that would suggest a diagnosis of chronic pancreatitis (when coupled with appropriate clinical features)
``` Calcifications Imaging features of ductal dilatation or inflammatory masses Exocrine pancreatic insufficiency DM Histologic findings ```
58
2 major counseling points for patients w/ chronic pancreatitis?
Stop smoking | Stop drinking
59
5 year survival for pancreatic adenoCA?
5%
60
7 strong RFs for pancreatic CA
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
3 MC presenting Sx of pancreatic cancer?
Wt loss, abdominal pain, jaundice
62
What's the sensitivity of contrast-enhanced multidetector CT in detection of pancreatic cancer?
90%
63
Classic presentation of autoimmune pancreatitis?
Painless obstructive jaundice
64
Classic imaging characteristic of autoimmune pancreatitis?
X-sectional imaiging evidence of focal or diffuse sausage-shaped pancreatic enlargement w/ a featureless border
65
Initial Tx of autoimmune pancreatitis? Describe response?
Steroids | Almost all will enter clinical remission, but relapse is common
66
2 MC pancreatic cystic neoplasms? Which ducts do they involve?
Mucinous cystic neoplasms Intraductal papillary mucinous neoplasms Main duct, branch ducts or both
67
What percent of PNETs are functional vs non-functional?
75-90% nonfunctional, 10-25% are functional
68
Of the functional PNETs, what are the 2 MC secreted hormones?
Insulin and gastrin
69
Why should you resect localized PNETs?
Risk of mets
70
What are the 2 major causes of acute diarrhea in developed countries? What impact does this have on your work-up?
Viral AGE and foodborne illness. Since both are self-limited, it's not worth it to perform diagnostic testing.
71
What testing should you do in patients older than 50 (but not always in those younger than that) who p/w chronic diarrhea?
Colonoscopy to screen for CRC
72
What two things are required for Dx of celiac dz?
1. positive serologic markers (anti-tTG IgA or anti-endomysial Abs) 2. Compatible small bowel Bx
73
Tx of celiac dz?
Strict gluten-free diet
74
Name 4 symptoms and 2 labs characterizing small intestinal bacterial overgrowth
Diarrhea, bloating, weight loss, flatulence | B12 deficiency and elevated serum folate
75
Short-bowel usually won't occur until how much healthy small bowel is left?
Less than 200 cm
76
What's the MC malabsorbed carb?
Lactose
77
Malabsorption of what carb is commonly overlooked bc people forget its presence in many processed foods?
Fructose (remember how prevalent high frc corn syrup is)
78
6 common presenting Sx of UC?
``` Bloody diarrhea Abdominal discomfort Tenesmus Urgency Rectal pain Fecal incontenence ```
79
3 common Sx of Crohn dz?
Abdominal pain Diarrhea Wt loss
80
5 common extra-intestinal manifestations of IBD?
``` Oral apathous ulcers Arthralgias Back pain Eye Sx Skin Sx ```
81
How do you diagnose IBD?
Visualization of GI tract- MC w/ colonoscopy and Bx of colon and ileum
82
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?
1. Only image with results will affect Mx | 2. Use MRI or US in place of CT whenever possible
83
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?
Start after 8-10 years of disease, and repeat every 1-2 years
84
Suspect microscopic colitis in patients with what type of diarrhea? What percent of these patients have microscopic colitis?
Chronic, watery diarrhea | 10-15%
85
How does microscopic colitis differ from IBD in terms of demographics and endoscopic findings
It's MC in older people and doesn't cause endoscopically visible inflammation
86
How do the Rome III criteria define constipation?
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
2 initial lifestyle measures to improve constipation?
1. Increased physical activity | 2. Increased dietary fiber
88
How do you Dx IBS (general)
Fulfillment of diagnostic criteria in absence of alarm features
89
3 major alarm features to consider when diagnosing IBS?
1. Unintentional weight loss 2. Anemia 3, FHx of CRC, IBD, or celiac
90
Essential diagnostic step in management of IBS?
Clear establishment of the Dx with explanation of and reassurance regarding the patient's Sx
91
What percent of patients w/ diverticula have an episode of diverticulitis?
20%
92
3 main Sx of diverticulitis?
Abdominal pain, fever, altered bowel habits

MKSAP: Key Points (6 decks)

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