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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
Q

What is the EGD RECOMMENDATION for FUNDIC GLAND POLYPS (associated with NEGATIVE H.pylori, PPIs and FAP)?

A

REMOVE >1 cm, otherwise observe

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26
Q

What is the EGD RECOMMENDATION for HYPERPLASTIC POLYPS?

A

REMOVE >0.5 cm

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27
Q

Which is the ONLY polyp type for which SURVEILLANCE is recommended after 1 YEAR?

A

ADENOMATOUS

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28
Q

What is the EGD RECOMMENDATION for ADENOMATOUS polyps (associated with H.pylori and FAP)?

A

REMOVE ALL, SURVEILLANCE in 1 YEAR

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29
Q

H.pylori, Autoimmune/ATROPHIC gastritis with Pernicious Anemia (low Vit B12) and E-CADHERIN mutations are all associated with what?

A

GASTRIC ADENOCARCINOMA

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30
Q

What are the RISK FACTORS for GASTRIC ADENICARCINOMA?

A

Smoking, H.pylori, Atrophic gastritis, Gastric Metaplasia, FIRST DEGREE RELATIVE with gastric adednocarcinoma

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31
Q

What FEATURES of gastric INTESTINAL METAPLASIA carry the HIGHEST risk of developing into gastric ADENOCARCINOMA?

A

INCOMPLETE (small intestine & colon tissue) & EXTENSIVE

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32
Q

What is the ONLY RECOMMENDATION if gastric INTESTINAL METAPLASIA is found?

A

Test for H.pylori

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33
Q

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?

A

YES (otherwise NO routine surveillance for the finding of gastric intestinal metaplasia)

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34
Q

If a patient is diagnosed with PERNICIOUS ANEMIA (low Vit B12), when should you perform an EGD?

A

Within 6 MONTHS of diagnosis or NEW SYMPTONS

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35
Q

When does the RISK of gastric ADENOCARCINOMA increase post PARTIAL GASTRECTOMY?

A

15-20 years

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36
Q

Which IMMUNOLOGIC DISEASE carries a HIGH-RISK of gastric ADENOCARCINOMA?

A

Combined Variable Immuno-Deficiency (CVID)

37
Q

Submucosal GI tumor from INTERSTITIAL CELLS of CAJAL, positive for C-KIT mutation?

A

GIST (CD117) - tyrosine kinase receptor

38
Q

Besides SIZE (>2 cm) and HIGH MITOTIC RATE, what features on EUS predict risk of malignancy (local vs liver mets) of a GIST?

A

IRREGULAR BORDERS, HETEROGENEITY

39
Q

When should GISTs be recommended for RESECTION?

A

>2 cm

40
Q

What is the BEST treatment for METASTATIC GISTs?

A

Tyrosine Kinase INHIBITORS (imatinib, sunitinib)

41
Q

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?

A

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
Q

What is the GASTRIN level of a SPORDIC, TYPE III NeuroEndocrine Tumor (NET)?

A

NORMAL

43
Q

In a patient POSITIVE for H.pylori who has a QUESTIONALBLE PCN allergy, what do you do BEFORE starting therapy?

A

TEST for PCN ALLERGY IF there is DOUBT

44
Q

If a patient has a HISTORY of PUD and or ULCER BLEEDING and requires NSAID use, what do you RECOMMEND?

A

COX-2 + PPI
NO NSAID

45
Q

If there are RISK factors to NSAID use (CV or GI), do you recommend PPI prophylaxis?

A

YES!!

46
Q

If in a patient, on EGD you find INTESTINAL METAPLASIA, what do you do NEXT?

A

Test for H.pylori

47
Q

To which ANTIBIOTIC is H.pylori the LEAST likely to be RESISTENT?

A

AMOXICILLIN

48
Q

If a patient is tested for H.pylori while ON PPIs and is NEGATIVE, is this reliable?

A

NO, can be a FALSE NEGATIVE

49
Q

What TREATMENT may REDUCE EGD hemostatic therapy in a patient with an UGIB?

A

Pre-EGD PPI therapy

50
Q

Should you DELAY EGD for a patient with a suspected UGIB if they are on ANTICOAGULATION?

A

NO!

51
Q

If a patient with WHAT GLASGOW score for GIB can be safely discharged HOME WITHOUT HOSPITALIZATION or EGD?

A

GLASGOW 0-1

52
Q

If a patient with WHAT GLASGOW score for GIB requires EGD intervention?

A

GLASGOW >6

53
Q

Does PRE-EGD PPI therapy for an UGIB reduce MORTALITY or RISK of RE-BLEED?

A

NO (just reduces stigmata of bleed)

54
Q

In a patient on WARFARIN with LIFE-THREATENING BLEEDING, VERY HIGH INR, and in whom a LARGE TRANSFUSION is contra-indicared, what is RECOMMENDED?

A

PCC (prothrombin complex concentrate) or FFP

55
Q

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?

A

NO (PCC-prothrombin complex concentrate or FFP)

56
Q

When is the ONLY time ORAL ANTICOAGULATION REVERSAL AGENTS (idarucizumab for dabigatran & adnexanet alfa for rivaroxaban or apixaban) or PCC (prothrombin complex concentrate) RECOMMENDED?

A

LIFE-THREATENING BLEED with use of these agents WITHIN 24 HOURS

57
Q

Sould ASA be held when treating a patient with UGIB if theyre using the ASA for SECONDARY CV PROPHYLAXIS?

A

NO

58
Q

In a patient with UGIB caused by antiplatelet agets such as CLOPIDOGREL or ASA, should you TRANSFUSE PLATELETS?

A

NO

59
Q

WHEN should an EGD be performed for an ACUTE UGIB?

A

WITHIN 24 HOURS

60
Q

In a patient with UGIB, if the EGD finding is CLEAN BASED ulcer, or NON-PROTUBERANT PIGMENTED SPOT is INTERVENTION RECOMMENDED?

A

NO

61
Q

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?

A

EGD with INTERVENTION

62
Q

What should be done for a patient with UGIB who was found on EGD to have an ulcer with a VISIBLE CLOT?

A

ATTEMPT to DISLODGE clot with WATER JET, if DOESN‘T dislodge, treat with PPI

63
Q

When should endoscopic HEMOSTATIC POWDER be used to control ulcer bleed?

A

When CONVENTIONAL thearpy FAILS (rescue therapy) or an ACTIVELY BLEEDING ULCER (massive bleed, poor visualization)

64
Q

Should EPINEPHRINE MONOTHERAPY be used as hemostatic therapy following an ulcer bleed?

A

NO

65
Q

What is RECOMMENDED for UGIB that is REFRACTORY to EGD?

A

EMBOLIZATION or SURGERY

66
Q

Patient comes in for an UGIB, EGD shows ulcer with FLAT, CLEAN BASE, how do you TREAT?

A

NO INTERVENTION, ONLY STANDARD DOSE PPI

67
Q

Patient comes in for an UGIB, EGD shows ulcer with ADHERENT CLOT, how do you TREAT?

A

Can intervene, up to endoscopist, HIGH-DOSE PPI

68
Q

Patient comes in for an UGIB, EGD shows ulcer with ACTIVE BLEEDING or VISIBLE VESSEL, how do you TREAT?

A

EGD HEMOSTASIS + HIGH-DOSE PPI x 72 HOURS

69
Q

Patient comes in for an UGIB, EGD shows ulcer of ANY KIND, pt needs NSAIDs, what do you RECOMMEND?

A

COX-2 + PPI

70
Q

Patient comes in for an UGIB, EGD shows ulcer of ANY KIND, pt needs ASA RESTARTED for SECONDARY CV PROPHYLAXIS, what do you RECOMMEND?

A

RESTART ASA + PPI

71
Q

Patient comes in for an UGIB, EGD shows ulcer of ANY KIND, pt needs ANTIPLATELET AGENT, what do you RECOMMEND?

A

RESTART + PPI

72
Q

Patient comes in for an UGIB, EGD shows ulcer of ANY KIND, pt needs ANTICOAGULATION, what do you RECOMMEND?

A

RESTART + PPI

73
Q

Patient comes in for an UGIB, EGD shows ulcer of ANY KIND, Pt’s H.pylori test is NEGATIVE, what do you RECOMMEND?

A

REPEAT ANY NEGATIVE TEST after a GIB

74
Q

Patient comes in for an UGIB, EGD shows ulcer of ANY KIND, pt needs ASA for PRIMARY CV PROPHYLAXIS, what do you RECOMMEND?

A

DO NOT RESTART

75
Q

CREST syndrome, RADIATION therapy and HHT (lips and nose - epistaxis) can cause GIB how?

A

ANGIOECTASIA

76
Q

What is the BEST treatment thus far for SLOW, RECURRENT bleeding from GI AVMs?

A

MAINTENANCE IRON therapy

77
Q

This GIB condition is associated with autoimmune disorders (thyroid), cirrhosis and is treated with APC or Endoscopic Band Ligation (EBL)?

A

GAVE (watermellon or punctate)

78
Q

What is the TREATMENT of GIB from Portal Hypertensive Gastropathy (PHG) which is found in the PROXIMAL stomach unlike GAVE?

A

Non-selective β-Blocker or SHUNT (TIPS)

79
Q

Acute or SLOW bleeding from CAMERON LESIONS is best treated how?

A

IRON + PPI

80
Q

Besides the CARDIA of the stomach, where can DIEULAFOY lesions occur?

A

ANYWHERE in the GIT (treat on EGD)

81
Q

Besides due to an AORTIC GRAFT, when else can an AORTO-ENTERIC fistula form and cause UGIB?

A

Due to SEVERE ATHEROSCLEROSIS

82
Q

A SIGNIFICANT GIB that SPONTANEOUSLY stops followed by a MUCH GREATER LIFE-THREATENING BLEED is typically caused by what?

A

AORTO-ENTERIC FISTULA

83
Q

What is the ONLY role for EGD in an UGIB potentially caused by an AORTO-ENTERIC fistula?

A

To RULE-OUT OTHER causes, it CANNOT be used to rule-in/out an aorto-enteric fistula
EGD NOT used as INTERVENTION

84
Q

This UGIB condition is usually found in the DISTAL DUODENUM or JEJUNUM, it is DIAGNOSED by EMERGENT CT-ANGIOGRAPHY and treated SURGICALLY?

A

AORTO-ENTERIC FISTULA

85
Q

What are the TWO main RISK factors for STRESS (ICU) ralated UGIB?

A

ANTICOAGULATION & RESPIRATORY FAILURE (intubated ≥72 HOURS)

86
Q

What is meant by OBSCURE GIB?

A

Either OVER or OCCULT GIB with no IDENTIFIABLE cause

87
Q

In an OBSCURE-OCCULT GIB, push SB enteroscopy, EGD and colonoscopy are negative, Video Capsule Endoscopy (VCE) is EQUIVOCAL, whats the NEXT STEP?

A

CT Enterography (CTE) or MR Enterography (MRE)

88
Q

What are the TWO recommendations for Endoscopic Hemostatic Therapy therapy for UGIB?

A

ACTIVELY bleeding vessel or VISSIBLE vessel
NEVER with epinephrine ALONE

GI Boards November 20th 2024 (11 decks)

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