GI/Liver

Question 1

GERD risk factors

Answer 1

drugs that lower esophageal sphincter (estrogen, CCB)

caffeine/carbonated/etoh/fatty food/smoking/obesity

Question 2

Red flags for GERD complication

Answer 2

ALARMS
Anemia (iron deficiency)
Loss of weight (involuntary)
Anorexia (persistent)
Recent onset of progressive sx
Melena (tarry/bloody stools) or hematemesis (vomiting bright red blood)
Swallowing difficulty or painful (odynophagia)

Question 3

1st line GERD tx

Answer 3

PPI only 2 months

if failed PPI BID refer to GI with upper endoscopy

Question 4

PPI adverse effects

Answer 4

if taken >2 months/8 weeks
malabsorption (vit B12, calcium, mg, iron)
increased fracture
PNA
Cdiff risk

Question 5

Chronic etoh use can lead to this microcyctic hypochemic anemia with elevated RDW

Answer 5

iron deficiency

Question 6

ddx of partial esophageal obstruction

Answer 6

esophageal cancer
esophageal stricture
esophagitis

Question 7

Acute appendicitis findings

Answer 7

• leukocytosis with neutrophilia and bandemia
• positive obturator and psoas signs
• 12 hr hx of epigastric discomfort
• CT with contrast

Question 8

Acute pancreatitis

Answer 8

• heavy etoh use
• 12 hr hx of acute onset epigastric pain radiating to the back
• bloating, N/V
• epigastric tenderness, hypoactive BS, abd distended/hypertympanic
• elevated lipase and amylase
• manage fluids inpatient

Question 9

Diverticulitis

Answer 9

• intermittent LLQ pain + fever, cramping, nausea
• 4-5 loose stools/day
• +BS, tender LLQ, negative Blumberg’s sx
• leukocytosis with neutrophilia
• CT with contrast
• outpatient if able to take po meds/fluids
• maybe Augmentin if mild, or Bactrim if penicillin allergy

Question 10

Duodenal ulcer

Answer 10

• epigastric burning, gnawing pain 2-3 hrs after eating
• relief w/antacids, nighttime awakening
• tender epigastrum/LUQ
• stool h.pylori or urea breath test; cbc
• antimicrobial therapy

Question 11

Cholescysitis

Answer 11

• RUQ pain + N/V, intermittent fever
• +Murphys sx
• elevated AST, ALT, ALP**
• ultrasound
• refer to surgery, gut rest, low fat diet

Question 12

HBsAG positive

Answer 12

stays / always growing HBV
ALT/AST
5x ULN = acute, RUQ, jaundice
modest elevation/asymptomatic = chronic

Question 13

Anti-HAV positive

Answer 13

person is immune to HAV by disease or vaccine

Question 14

Anti-HCV negative

Answer 14

no past HCV ifxn

Question 15

HCV RNA positive

Answer 15

current HCV infection

Question 16

Anti-HBs/HBSab positive

Answer 16

HBV immunity

“B as in Bye” HBV

Question 17

Anti-HAV negative

Answer 17

never had HAV

get Hep A vaccine

Question 18

Hep A next steps if positive

Answer 18

vaccinate HAV to pt and close contacts
post-exposure prophylaxis with Gamma-gard
ALT, AST, bilirubin, NOTIFY public health authorities
elevated IgM (miserable)= acute

Question 19

Hep B post exposure prophylaxis

Answer 19

HBIG (hep B immune globulin)

- HBV vaccine for pt and contacts

Question 20

Tests for Heb B positive pt

Answer 20

LFTs
coinfection: hep A, C, HIV, other STI
required to immunize against Hep A

Question 21

susceptible to HBV infection results

Answer 21

HBsAG negative
Anti-HBc negative
HBsAb negative

Question 22

IBD types and sx

Answer 22

UC: colon only
Crohn's: mouth-anus
- rectal bleeding
- diarrhea
- fever, wgt loss
- high CRP/ESR, leukocytosis
- steroids if indicated, refer out

Question 23

H pylori testing

Answer 23

urea breath test (need to d/c antibiotics or PPI 2 weeks before test)

fecal antigent test

Question 24

first-line tx for h pylori

Answer 24

PPI
amoxicillin
clarithromycin
tinidazole

if penicillin allergy: bismuth, metronidzaole, tetracylcine, PPO/ranitidine