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GI Boards November 20th 2024 > GI Mucosal Disease > Flashcards

GI Mucosal Disease Flashcards

1
Q

WHEN should you RE-TEST for H.pylori after completion of treatment?

A

4 WEEKS after treatment
MUST be 2 WEEKS off a PPI (H2 OK)

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2
Q

Should you use SEROLOGIC testing after H.pylori treatment?

A

NO!! (once expposed and Ab exists, it will ALWAYS exist)

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3
Q

In a patient with IRON DEFFICIENCY ANEMIA with no identifiable cause on EGD/Colonoscopy, what should be TESTED for next?

A

NON-INVASIVE H.ylori testing

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4
Q

In a patient with TREATMENT FAILURE of H.pylori when CLARITHROMYCIN or LEVOFLOXACIN are used, what should be done?

A

Chanage antibiotics, they are likely RESITENT to those due to PRIOR exposure
NO PATIENT should be treated TWICE with a regimen containing clarithromycin or levfloxacin

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5
Q

What is the BEST treatment for H.pylori?

A

PPI + BISMUTH + TETRACYCLINE + METRONIDAZOLE for 14 DAYS (quad therapy)

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6
Q

In treating H.pylori, if the patient has had ANY MACROLIDE exposure, what med should you NOT USE in treatment?

A

CLARITHROMYCIN

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7
Q

Which H.pylori patients should be TESTED for eradication after treatment?

A

ALL

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8
Q

In a patient with FAILED H.pylori treatment, what is a tripple therapy ALTERNATIVE with NO reported RESISTENCE?

A

Omeprazole + Amoxicillin + RIFABUTIN

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9
Q

What are the TWO regimens using the NEW Potassium-Competitive Acid Blocker VANOPRAZAN?

A

Vanoprazan BID + Amoxicillin TID
or
Vanoprazan BID + Clarithromycin BID + Amoxicillin BID

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10
Q

Do you need to perform ANTIBIOTIC SUSCEPTIBILITY testing whe using BISMUTH QUADRUPLE (Bismuth+PPI+Tetracycline+Metronidazole) terapy or RIFABUTIN therapy (PPI+Amoxicillin+Rifabutin)?

A

NO

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11
Q

For WHICH antibiotics used to treat H.pylori do you need to perform SUSCEPTIBILITY testing?

A

Clarithromycin, Metronidazole, Levofloxacin (if NOT susceptible to any of these, use RIFABUTIN based therapy)

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12
Q

What is PBMT H.pylori therapy?

A

QUADRUPLE therapy with PPI+BISMUTH+Metronidazole+Tetracycline

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13
Q

What do you do NEXT if quadruple therapy for H.pylori (PBMT) fails?

A

Assess if TRULY PCN allergic, if NOT then PAR (PPI+Amoxicillin+Rifabutin) or PAL (PPI+Amoxicillin+Levofloxacin) or PBLA (PPI+Bismuth+Levofloxacin+Amoxicillin) if YES then PBLT/PBLM/PBMT/PCBT

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14
Q

If ALL treatments FAIL for H.pylori, what do you do?

A

SUSCEPTIBILITY TESTING

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15
Q

< 10% of CHRONIC gastritis, with LOW acid to NO acid, HIGH GASTRIN levels (tries to stimulate acid production) and AFFECTS BODY, SPARING ANTRUM?

A

AUTOIMMUNE GASTRITIS

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16
Q

In WHICH CHRONIC gastritis do you see PARIETAL CELL Ab’s and Vit B12 DEFFICIENCY?

A

AUTOIMMUNE GASTRITIS (LOW acid, HIGH gastrin)

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17
Q

Which TYPE of GASTRITIS carries a RISK of ADENOCARCINOMA?

A

AUTOIMMUNE GASTRITIS

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18
Q

In a patient with HIGH CV risk (where ASA is REQUIRED) and HIGH GI risk (prior PUD), what NSAIDs/COX-2 are recommended?

A

NONE

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19
Q

In a patient with LOW CV risk (no ASA required) and LOW GI risk (no h/o PUD), what do you recommend for NSAIDs?

A

NSAIDs alone, WITHOUT PPI

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20
Q

In a patient with HIGH CV risk (ASA required) and LOW or MODERATE GI risk (no h/o PUD), what NSAIDs are recommended?

A

NAPROXEN+PPI/misoprostol

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21
Q

In a patient with LOW CV risk and HIGH GI risk what NSAIDs are recommended?

A

ALTERNATIVE or COX-2+PPI/misoprostol

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22
Q

Which gastric POLYP is associated with NEGATIVE H.pylori, PPI use and FAP?

A

FUNDIC gland polyp

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23
Q

Which gastric POLYP is generally found in patients with GASTRITIS, ATROPHY and HIGH gastrin levels?

A

HYPERPLASTIC polyp - REMOVE

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24
Q

Which gastric POLYP is associated with GASTRITIS, H.pylori and FAP?

A

ADENOMATOUS (pre-malignant) polyp - REMOVE

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25
What is the **EGD RECOMMENDATION** for **FUNDIC GLAND POLYPS** (associated with NEGATIVE H.pylori, PPIs and FAP)?
**REMOVE >1 cm**, otherwise observe
26
What is the **EGD RECOMMENDATION** for **HYPERPLASTIC POLYPS**?
**REMOVE >0.5 cm**
27
Which is the **ONLY** polyp type for which **SURVEILLANCE** is recommended after **1 YEAR?**
**ADENOMATOUS**
28
What is the **EGD RECOMMENDATION** for **ADENOMATOUS** polyps (associated with H.pylori and FAP)?
**REMOVE ALL**, **SURVEILLANCE in 1 YEAR**
29
**H.pylori**, **Autoimmune/ATROPHIC** gastritis with Pernicious Anemia (low Vit B12) and **E-CADHERIN** mutations are all associated with what?
**GASTRIC ADENOCARCINOMA**
30
What are the **RISK FACTORS** for **GASTRIC ADENICARCINOMA**?
Smoking, H.pylori, Atrophic gastritis, **Gastric Metaplasia**, **FIRST DEGREE RELATIVE** with gastric adednocarcinoma
31
What **FEATURES** of gastric **INTESTINAL METAPLASIA** carry the **HIGHEST** risk of developing into gastric **ADENOCARCINOMA**?
**INCOMPLETE** (small intestine & colon tissue) & **EXTENSIVE**
32
What is the **ONLY RECOMMENDATION** if gastric **INTESTINAL METAPLASIA** is found?
Test for **H.pylori**
33
If a patient is found to have gastric **INTESTINAL METAPLASIA** and is **HIGH-RISK** for gastric **ADENICARCINOMA** (family history, minorities, immigrants, incomplete/extensive features) and **WANTS** surveillance, is this **OK**?
**YES** (otherwise NO routine surveillance for the finding of gastric intestinal metaplasia)
34
If a patient is diagnosed with **PERNICIOUS ANEMIA** (low Vit B12), when should you perform an **EGD**?
Within **6 MONTHS** of diagnosis or NEW SYMPTONS
35
When does the **RISK** of gastric **ADENOCARCINOMA** increase post **PARTIAL GASTRECTOM**Y?
**15-20 years**
36
Which **IMMUNOLOGIC DISEASE** carries a **HIGH-RISK** of gastric **ADENOCARCINOMA**?
**C**ombined **V**ariable **I**mmuno-**D**eficiency (**CVID**)
37
Submucosal GI tumor from **INTERSTITIAL CELLS** of **CAJAL**, positive for **C-KIT** mutation?
GIST (CD117) - tyrosine kinase receptor
38
Besides **SIZE** (**>2 cm**) and **HIGH MITOTIC RAT**E, what features on **EUS** predict risk of malignancy (local vs liver mets) of a **GIST**?
**IRREGULAR** BORDERS, **HETEROGENEITY**
39
When should **GISTs** be recommended for **RESECTION**?
**>2 cm**
40
What is the **BEST** treatment for **METASTATIC GISTs**?
Tyrosine Kinase **INHIBITORS** (**imatinib**, **sunitinib**)
41
What is the **HIGHEST** risk **NeuroEndocrine Tumor** (**NET**) **TYPE** because it is **SPORADIC** (not associated with any condition) with **NORMAL GASTRIN** and **ACID** levles and **METASTASIZES**?
**Type III** NET Type I - associated with atrophic gastritis, high gastrin, low acid (atrophy) Type II - associated with ZES/MEN-I high gastrin, high acid (gastrinoma)
42
What is the **GASTRIN** level of a **SPORDIC**, **TYPE III** **NeuroEndocrine Tumor** (**NET**)?
**NORMAL**
43
In a patient **POSITIVE** for **H.pylori** who has a **QUESTIONALBLE PCN** allergy, what do you do **BEFORE** starting therapy?
**TEST** for **PCN** **ALLERGY IF** there is **DOUBT**
44
If a patient has a **HISTORY** of **PUD** and or **ULCER BLEEDING** and requires **NSAID** use, what do you **RECOMMEND**?
**COX-2 + PPI** **NO NSAID**
45
If there are **RISK** factors to **NSAID** use (CV or GI), do you recommend **PPI** prophylaxis?
**YES!!**
46
If in a patient, on **EGD** you find **INTESTINAL METAPLASI**A, what do you do **NEXT**?
Test for **H.pylori**
47
To which **ANTIBIOTIC** is **H.pylori** the **LEAST** likely to be **RESISTENT**?
**AMOXICILLIN**
48
If a patient is tested for **H.pylori** while **ON PPIs** and is **NEGATIVE**, is this reliable?
**NO**, can be a **FALSE NEGATIVE**
49
What **TREATMENT** may **REDUCE EGD** hemostatic therapy in a patient with an **UGIB**?
**Pre-EGD PPI** therapy
50
Should you **DELAY EGD** for a patient with a suspected **UGIB** if they are on **ANTICOAGULATION**?
**NO!**
51
If a patient with **WHAT GLASGOW** score for **GIB** can be safely discharged **HOME WITHOUT HOSPITALIZATION** or **EGD**?
GLASGOW **0-1**
52
If a patient with **WHAT GLASGOW** score for **GIB** requires **EGD** intervention?
GLASGOW **>6**
53
Does **PRE-EGD PPI** therapy for an **UGIB** reduce **MORTALITY** or **RISK** of **RE-BLEED**?
**NO** (just reduces stigmata of bleed)
54
In a patient on **WARFARIN** with **LIFE-THREATENING BLEEDING**, **VERY HIGH INR**, and in whom a **LARGE TRANSFUSION** is contra-indicared, what is **RECOMMENDED**?
**PCC** (prothrombin complex concentrate) or **FFP**
55
In a patient on **WARFARIN** with **LIFE-THREATENING BLEEDING**, **VERY HIGH INR**, and in whom a **LARGE TRANSFUSION** is the use of VITAMIN K **RECOMMENDED**?
**NO** (PCC-prothrombin complex concentrate or FFP)
56
When is the **ONLY** time **ORAL ANTICOAGULATION REVERSAL AGENTS** (**idarucizumab** for **dabigatran** & **adnexanet** alfa for **rivaroxaban** or **apixaban**) or **PCC** (prothrombin complex concentrate) **RECOMMENDED**?
**LIFE-THREATENING BLEED** with use of these agents **WITHIN 24 HOURS**
57
Sould **ASA** be held when treating a patient with **UGIB** if theyre using the **ASA** for **SECONDARY CV PROPHYLAXIS**?
**NO**
58
In a patient with **UGIB** caused by antiplatelet agets such as **CLOPIDOGREL** or **ASA**, should you **TRANSFUSE PLATELETS**?
**NO**
59
**WHEN** should an **EGD** be performed for an **ACUTE UGIB**?
WITHIN **24 HOURS**
60
In a patient with **UGIB**, if the **EGD** finding is **CLEAN BASED** ulcer, or **NON-PROTUBERANT PIGMENTED SPOT** is **INTERVENTION RECOMMENDED**?
**NO**
61
In a patient with an **UGIB**, who on **EGD** was found to have an **ACTIVELY BLEEDING** ulcer or an ucer with a **RAISED PIGMENTED SPOT** (non-bleeding visible vessel), what is recommended?
**EGD** with **INTERVENTION**
62
What should be done for a patient with UGIB who was found on **EGD** to have an ulcer with a **VISIBLE CLOT**?
**ATTEMPT** to **DISLODGE** clot with **WATER JET**, if **DOESN**'T dislodge, treat with **PPI**
63
When should endoscopic **HEMOSTATIC POWDER** be used to control ulcer bleed?
When **CONVENTIONAL** thearpy **FAILS** (rescue therapy) or an **ACTIVELY BLEEDING ULCER** (massive bleed, poor visualization)
64
Should **EPINEPHRINE MONOTHERAPY** be used as hemostatic therapy following an ulcer bleed?
**NO**
65
What is **RECOMMENDED** for **UGIB** that is **REFRACTORY** to **EGD**?
**EMBOLIZATION** or **SURGERY**
66
Patient comes in for an **UGIB**, **EGD** shows ulcer with **FLAT**, **CLEAN BASE**, how do you **TREAT**?
**NO INTERVENTION**, ONLY **STANDARD DOSE PPI**
67
Patient comes in for an **UGIB**, **EGD** shows ulcer with **ADHERENT CLOT**, how do you **TREAT**?
Can intervene, up to endoscopist, **HIGH-DOSE PPI**
68
Patient comes in for an **UGIB**, **EGD** shows ulcer with **ACTIVE BLEEDING or VISIBLE VESSEL**, how do you **TREAT**?
**EGD HEMOSTASIS + HIGH-DOSE PPI x 72 HOURS**
69
Patient comes in for an **UGIB**, **EGD** shows ulcer of **ANY KIND**, pt needs **NSAIDs**, what do you **RECOMMEND**?
**COX-2 + PPI**
70
Patient comes in for an **UGIB**, **EGD** shows ulcer of **ANY KIND**, pt needs **ASA RESTARTED for SECONDARY CV PROPHYLAXIS**, what do you **RECOMMEND**?
**RESTART ASA + PPI**
71
Patient comes in for an **UGIB**, **EGD** shows ulcer of **ANY KIND**, pt needs **ANTIPLATELET AGENT**, what do you **RECOMMEND**?
**RESTART + PPI**
72
Patient comes in for an **UGIB**, **EGD** shows ulcer of **ANY KIND**, pt needs **ANTICOAGULATION**, what do you **RECOMMEND**?
**RESTART + PPI**
73
Patient comes in for an **UGIB**, **EGD** shows ulcer of **ANY KIND**, **Pt's H.pylori test is NEGATIVE**, what do you **RECOMMEND**?
**REPEAT ANY NEGATIVE TEST after a GIB**
74
Patient comes in for an **UGIB**, **EGD** shows ulcer of **ANY KIND**, pt needs **ASA for PRIMARY CV PROPHYLAXIS**, what do you **RECOMMEND**?
DO **NOT** RESTART
75
**CREST** syndrome, **RADIATION** therapy and **HHT** (lips and nose - epistaxis) can cause **GIB** how?
**ANGIOECTASIA**
76
What is the **BEST** treatment thus far for **SLOW**, **RECURRENT** bleeding from **GI AVMs**?
MAINTENANCE **IRON** therapy
77
This **GIB** condition is associated with **autoimmune** disorders (**thyroid**), **cirrhosis** and is treated with **APC** or Endoscopic Band Ligation (**EBL**)?
**GAVE** (watermellon or punctate)
78
What is the **TREATMENT** of **GIB** from Portal Hypertensive Gastropathy (**PHG**) which is found in the **PROXIMAL** stomach unlike GAVE?
Non-selective **β-Blocker** or **SHUNT** (TIPS)
79
**Acute** or **SLOW** bleeding from **CAMERON LESIONS** is best treated how?
**IRON + PPI**
80
Besides the **CARDIA** of the stomach, where can **DIEULAFOY** lesions occur?
**ANYWHERE** in the **GIT** (treat on EGD)
81
Besides due to an **AORTIC GRAFT**, when else can an **AORTO-ENTERIC** fistula form and cause **UGIB**?
Due to **SEVERE ATHEROSCLEROSIS**
82
A **SIGNIFICANT GIB** that **SPONTANEOUSLY** stops followed by a **MUCH GREATER LIFE-THREATENING BLEED** is typically caused by what?
**AORTO-ENTERIC FISTULA**
83
What is the **ONLY** role for **EGD** in an **UGIB** potentially caused by an **AORTO-ENTERIC** fistula?
To **RULE-OUT OTHER** causes, it **CANNOT** be used to rule-in/out an aorto-enteric fistula **EGD NOT** used as **INTERVENTION**
84
This **UGIB** condition is usually found in the **DISTAL DUODENUM** or **JEJUNUM**, it is **DIAGNOSED** by **EMERGENT CT-ANGIOGRAPHY** and treated **SURGICALLY**?
**AORTO-ENTERIC FISTULA**
85
What are the **TWO** main **RISK** factors for **STRESS** (**ICU**) ralated **UGIB**?
**ANTICOAGULATION** & **RESPIRATORY FAILURE** (intubated ≥72 HOURS)
86
What is meant by **OBSCURE GIB**?
Either **OVER** or **OCCULT GIB** with no **IDENTIFIABLE** cause
87
In an **OBSCURE-OCCULT GIB**, push **SB** enteroscopy, **EGD** and **colonoscopy** are **negative**, Video Capsule Endoscopy (**VCE**) is **EQUIVOCAL**, whats the **NEXT STEP**?
CT Enterography (**CTE**) or MR Enterography (**MRE**)
88
What are the **TWO** recommendations for **Endoscopic Hemostatic Therapy** therapy for **UGIB**?
**ACTIVELY** bleeding vessel or **VISSIBLE** vessel **NEVER** with **epinephrine ALONE**

GI Boards November 20th 2024 (11 decks)

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