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Step 2 High Yield > GI Test And Treatments > Flashcards

GI Test And Treatments Flashcards

0
Q

How do you diagnose esophageal dysphagia?

A 
Barium swallow (esophagram)
Followed by: endoscopy
Manometry
Ph monitoring
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1
Q

How do you diagnose oropharyngeal dysphagia?

A

Video fluoroscopy

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2
Q

How do you diagnose an esophageal obstruction?

A

Endoscopy with bx

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3
Q

How do you diagnose odynophagia?

A

Upper endoscopy

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4
Q

How do you diagnose diffuse esophageal spasm?

A

Barium swallow followed by manometry which will show a corkscrew esophagus and high amplitude simultaneous contractions

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5
Q

What is the treatment for diffuse esophageal spasm?

A

Nitrates and CCBs for symptoms

Surgery if debilitating

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6
Q

What are the diagnostic tests for achalasia?

A

Barium swallow : shows bird’s beak
Manometry: shows increased resting LES pressure, incomplete LES relaxation, decreased peristalsis
Endoscopy: to r/o obstruction

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7
Q

What is are the treatments for achalasia?

A

Nitrates
CCB
Botox in the LES

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8
Q

What are the definitive treatments of achalasia?

A

Pneumatic balloon dilation

Surgical Heller myotomy

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9
Q

How do you diagnose Zenker’s diverticulum?

A

Barium swallow

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10
Q

How do you treat diverticulum?

A

Surgical excision

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11
Q

How do you treat zenker’s?

A

Myotomy of cricopharyngeus muscle

Excision of diverticulum

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12
Q

How do you diagnose esophageal cancer?

A

Barium swallow: will show narrowing of esophagus with an irregular border protruding into the lumen

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13
Q

How do you confirm the diagnosis of esophageal cancer?

A

EGD with bx

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14
Q

What tests are used for staging of esophageal cancer?

A

CT and endoscopic US

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15
Q

What is the treatment for esophageal cancer?

A

Chemoradiation and surgical resection

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16
Q

What is the treatment for high grade Barrett’s dysplasia?

A

Surgical resection

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17
Q

When should someone with GERD undergo EGD with bx?

A

When they don’t respond to empiric medical tx
They’ve had it for a long time
They have alarm sx

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18
Q

What are the lifestyle modifications for GERD?

A

Weight loss
Elevation of head of bed
Small but frequent meals
Avoid nocturnal meals

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19
Q

What are the medications for GERD?

A

Antacids
H2 receptor antagonists
PPIS

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20
Q

What is the surgical treatment for GERD?

A

Nissen fundoplication

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21
Q

How do you diagnose hiatal hernia?

A

Incidental finding on CXR
Barium swallow
EGD

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22
Q

What is the treatment for a sliding hiatal hernia?

A

Same as GERD

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23
Q

What is the treatment for a paraesophageal hernia?

A

Surgical gastropexy to prevent gastric volvulus

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24
Q

What can be used to look for mets in esophageal cancer?

A

MRI with contrast

PET scan

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25
Q

What is the diagnostic test of choice for gastritis?

A

EGD

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26
Q

What test demonstrates exposure to H. Pylori?

A

IgG Ab

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27
Q

What tests can be done to determine infection with H. Pylori?

A

Stool antigen
Urease breath test
EGD bx

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28
Q

What is the treatment of gastritis?

A

Same as GERD

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29
Q

What is the treatment for h. Pylori?

A

Amoxicillin + omeprazole + clarithromycin

Metro is patient is penicillin allergic

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30
Q

How do you diagnose gastric cancer?

A

Upper endoscopy with bx

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31
Q

What is the treatment of gastric cancer?

A

Resection if early

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32
Q

How do you rule out perforation from a gastric ulcer?

A

Ab XR: look for free air under diaphragm

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33
Q

How do you rule out perforation from a duodenal ulcer?

A

CT with contrast - will show air in retroperitoneal space

Order CBC to detect GI bleeding

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34
Q

How do you confirm/rule out gastric bleeding?

A

Upper EGD with bx

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35
Q

How do you diagnose PUD?

A

H. Pylori testing

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36
Q

What should you order if patient is refractory or recurrent PUD.

A

Serum gastrin level to check for ZES

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37
Q

What should you do if you suspect perforation?

A

CT with IV contrast

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38
Q

What should you do if there is a perforation?

A

Surgical laparotomy
Bp check
Blood transfusions
IV PPIs

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39
Q

How do you rule out active bleeding?

A

Rectal vault exam
NG lavage
Serial hematocrits

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40
Q

How do you manage acute PUD?

A 
Rule out active bleeding
IV PPI
Blood transfusions
IVF 
urgent EGD for an suspected bleeding
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41
Q

When is a EGD with targeted bx indicated?

A

In patients with refractory sx to rule out cancer

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42
Q

How do you diagnose ZES?

A

Increased fasting gastrin levels

Increased gastrin levels with administration of secretin

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43
Q

What is indicated after diagnosing ZES.

A

CT to characterize and stage

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44
Q

What is the treatment of ZES?

A

PPI

Surgical resection

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45
Q

How do you localize a ZES tumor?

A

CT or octreotide scan

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46
Q

What is the treatment for Campylobacter ?

A

Erythromycin

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47
Q

What is the treatment for C. Difficile?

A

Po metronidazole or vanc

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48
Q

How do you treat entamoeba histolytica?

A

Metronidazole

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49
Q

What can lead to fatal perforation with entamoeba histolytica?

A

Steroids

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50
Q

What is the treatment for E. coli O157:H7?

A

Nothing

Do not give antibiotics because it increases the risk of HUS

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51
Q

What is the treatment for salmonella?

A

Oral quinolones or Bactrim only if sickle cell patient because otherwise this prolongs the carrier state

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52
Q

What can be given to decrease the spread of shigella?

A

Bactrim to decrease person to person spread

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53
Q

What is the diagnostic test for lactose intolerance?

A

Hydrogen breath test (increased hydrogen after milk ingestion)

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54
Q

What is the treatment of carcinoid syndrome?

A

Octreotide

Surgical resection

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55
Q

What is the diagnostic criteria for IBS.

A

At least 3 months of episodic abdominal discomfort that is relieved by defecation and associated with a change in stool frequency or consistency

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56
Q

How do you diagnose SBO?

A

Ab XR : step ladder pattern of dilated small bowel loops, air fluid levels, no gas in the colon

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57
Q

What acid base abnormality would you see with SBO?

A

Metabolic alkalosis due to contraction

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58
Q

What is the treatment of SBO?

A 
IVF
NPO
NG tube 
Foley 
Correct electrolytes
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59
Q

When is an exploratory lap indicated for an SBO?

A

Partial SBO after 3 days
Complete SBO
Ischemic necrosis

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60
Q

What is required in an elderly patient if ileus is suspected?

A

A rectal exam to rule out fecal impaction

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61
Q

How do you diagnose ileus?

A

Abdominal films show distend loops of small and large bowel with air seen throughout the colon and rectum

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62
Q

What is the treatment of ileus?

A 
Discontinue offending meds
Temporary NPO
NG tube
Replete electrolytes
IVF
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63
Q

What do labs show with mesenteric ischemia?

A

Leukocytosis
Metabolic acidosis
Increased LDH, amylase, lactate, CK

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64
Q

What is seen on Ab XR and CT with mesenteric ischemia?

A

Bowel wall edema

Air in the bowel wall (pneumatosis intestinal is)

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65
Q

What is the gold standard for diagnosing mesenteric ischemia/arterial occlusive disease?

A

Mesenteric angiography

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66
Q

What is the treatment of mesenteric ischemia?

A

IVF

Broad spectrum antibiotics

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67
Q

How do you definitively diagnose diverticulum disease?

A

Colonoscopy

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68
Q

What should be avoided in patients with early diverticulitis and why?

A

Sigmoidoscopy or colonoscopy because of the risk of perforation

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69
Q

What is the treatment for uncomplicated diverticulosis?

A

High fiber diet or fiber supplements

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70
Q

What is the treatment for bleeding that doesn’t stop in diverticulosis ?

A

Hemostasis by colonoscopy, angiography with embolization or surgery

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71
Q

What is the treatment of diverticulitis?

A

NPO
NG tube placement
Broad spectrum antibiotics (metro + quinolones or 2/3 gen ceph)

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72
Q

How do you treat a LBO?

A

Gastrogaffin enema
Rectal tube
Colonoscopy
Surgery

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73
Q

How do you diagnose colon cancer?

A

Colonoscopy with bx

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74
Q

What should you order to evaluate for mets of colon CA?

A

CXR
LFTs
Abdominal/pelvic CT

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75
Q

What is the treatment for colon cancer with positive nodes?

A

Adjuvant chemo with surgery

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76
Q

What is the treatment for ischemic colitis?

A

NPO, IVF, antibiotics

Bowel resection is infarct, fulminant colitis, or obstruction

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77
Q

What is the diagnostic test for ischemic bowel?

A

CT

Colonoscopy : pale mucosa with petechia

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78
Q

How do you diagnose upper GI bleed?

A

NG tube and lavage

Endoscopy (if stable)

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79
Q

What is the treatment of UGI?

A

Endoscopy with treatment

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80
Q

What is the diagnostic test of choice for LGI?

A

Anoscopy/sigmoidoscopy for patients greater than 45 with small volume of bleeding
Colonoscopy

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81
Q

What is the diagnostic test of choice if patient is unstable?

A

Arteriography

Exploratory laparotomy

82
Q

What is the treatment for diverticulosis causing lower GI bleed?

A

Epi injection
Intra arterial vasopressin or embolization
Surgery

83
Q

What is the test of choice for gallstones?

A

RUQ US

84
Q

How do you diagnose cholecystitis?

A

US

If US is equivocal do HIDA scan

85
Q

What is the treatment of cholecystitis?

A

IV antibiotics and IVF

Surgical cholecystectomy

86
Q

How can definitive diagnosis of UC and Crohn’s be made?

A

Colonoscopy with bx

87
Q

What are the treatments for UC and crohn’s ?

A

5-ASA agents
Azathioprine
Corticosteroids

88
Q

What treatment can be curative of UC?

A

Total proctolectomy

89
Q

What is the hallmark of choledocholithiasis?

A

Increased alk phos and total and direct bilirubin

90
Q

What is the treatment of choledocholithiasis?

A

ERCP with sphincterotomy and cholecystectomy

91
Q

What is diagnostic of ascending cholangitis?

A

ERCP

92
Q

What is the treatment for ascending cholangitis?

A

ICU admission
IV antibiotics
emergent bile duct decompression!!! –>. ERCP

93
Q

How do you diagnose gallstone ileus?

A

Ab XR that shows characteristics of SBO

94
Q

What is the treatment of gallstone ileus?

A

Laparotomy with stone extraction and closure of the fistula + cholecystectomy

95
Q

How do you diagnose PSC?

A

MRCP/ERCP: shows beading from multiple duct stricture/dilation
Liver bx: shows onion skinning of periductal stenosis

96
Q

What is the treatment for PSC.

A 
High dose ursodiol
ERCP with dilation and stenting of strictures
Liver transplant (definitive)
97
Q

What is the marker for autoimmune hepatitis?

A

Anti-smooth muscle antibodies

98
Q

What is the treatment for chronic HBV infection?

A

INF And Lamivudine

Or adefovir

99
Q

What is the treatment for INF and ribavirin for?

A

Chronic Hep C

100
Q

How is SBP diagnosed?

A

Paracentesis

With greater than 250 PMNs/ml in the ascitic fluid and positive gram stain

101
Q

What does an SAAG less than 1.1 mean?

A

The ascites is not related to portal HTN

Due to TB, malignancy or nephrotic syndrome

102
Q

What is the treatment of SBP.

A 
IV antibiotics (ceftriaxone)
IV albumin
103
Q

What should be given to prevent recurrence of SBP?

A

Fluoroquinolone

104
Q

What is the treatment of ascites?

A

Sodium restriction
Diuretics (furosemide and spironolactone)
Large volume paracentesis

105
Q

What is hepatorenal syndrome?

A

Acute preferably failure (decreased GFR, urine osmolality great than 500, urine sodium less than 10, FeNa less than 1%, bun/cr greater than 20) + cirrhosis

106
Q

What is the cure for hepatorenal syndrome?

A

Liver transplant

107
Q

What is the treatment for hepatic encephalopathy?

A

Protein restriction
Lactulose
And/or rifampin

108
Q

What is the medical prophylaxis for esophageal varices?

A

Bb

109
Q

What is the treatment for esophageal varices?

A

Endoscopy with band ligation or sclerotherapy

110
Q

What is the treatment for coagulopathy associated with liver cirrhosis?

A

FFP

111
Q

What are the treatments for PBC?

A

Ursodeoxycholic acid for slowing disease progression
Cholestyramine for pruritis
Liver transplant

112
Q

When is a partial hepatectomy ok to do for HCC?

A

For single lesions less than 5 cm and no cirrhosis

113
Q

What is the surgical treatment for patients with HCC and cirrhosis?

A

Ortho topic liver transplant

114
Q

What is the non surgical treatment for advanced disease?

A

Transarterial chemoembolization and/or sorafenib

115
Q

What should be monitored for recurrence of HCC?

A

AFP levels

116
Q

How is HCC diagnosed?

A

Mass on US or CT
Abnormal LFTs
Elevated AFP

117
Q

How is hemochromatosis diagnosed?

A

Increased serum iron, percent saturation of iron and ferritin
Transferrin saturation over 45%

118
Q

What should you do if you suspect hemochromatosis?

A

Liver bx

MRI or HFE mutation screen

119
Q

What is the treatment of hemochromatosis?

A

Weekly phlebotomy then maintenance

Deferoxamine for maintenance

120
Q

How do you diagnose Wilson’s disease?

A

Decreased serum ceruloplasmin
Increased urinary excretion of copper
Liver bx
Rhodamine or orceine stain

121
Q

What are the diagnostic tests for acute pancreatitis?

A

Amylase, lipase, calcium

Ab US or CT- show sentinel loop or colon cut-off sign

122
Q

What is the treatment of acute pancreatitis?

A 
Same as SBO
IVF
NPO
NG tube
Nutritional support
123
Q

What is the diagnostic sign on AXR and CT for chronic pancreatitis?

A

“Chains of lakes”

Calcification

124
Q

What is decreased in chronic pancreatitis?

A

Stool elastase

125
Q

What is the treatment for chronic pancreatitis?

A

Analgesia
Celiac nerve block
Pancreatic enzyme replacement

126
Q

What is used for diagnosis of pancreatic cancer?

A

CT with contrast

127
Q

What can be used to assess extent of pancreatic cancer

A

Ct with contrast

128
Q

What can be used if cant see mass on CT?

A

Endoscopy

ERCP with bx

129
Q

What is often elevated in pancreatic cancer?

A

CA-19-9

130
Q

What is the treatment?

A

Chemo with 5-FU and gemcitabine

131
Q

When can a whipped procedure be done?

A

If tumor is small in the head of the pancreas with no mets

132
Q

What Hep B drug is reserved for younger patients with compensated liver disease?

A

INF

133
Q

What are the preferred drugs for hep b?

A

Entecavir

Tenofovir

134
Q

What med is added to INF and ribavirin for patients who have genotype 1 hep c?

A

Telepravir

135
Q

What is the treatment for severe C dif. With WBC over 15 or Creatinine over 1.5?

A

Oral vanc

136
Q

What if the patient has severe c.dif and has an ileus being treated with oral vanc?

A

Add IV metro

Or switch or rectal vanc

137
Q

What is the treatment for C.dif when WBC is above 20K, lactic acid is greater than 2.2, if they have toxic megacolon or severe ileus?

A

Subtotal colectomy

Diverting loop ileostomy

138
Q

What is the treatment for mild C.dif?

A

Oral metro

139
Q

How do you diagnose C.dif?

A

Stool studies for c. Dif toxin

140
Q

What drug can be used for recurrent colitis or in patients who can’t tolerate oral vanc?

A

Fidaxomicin

141
Q

What is IV vanc commonly used for?

A

Bacteremia secondary to an skin source (central line)

142
Q

What is the D-xylose test used for?

A

Celiac disease because it is a monosaccharide so it doesn’t need enzymatic breakdown, just an intact mucosa
Positive test = low D-xylose in urine because it gets excreted in the feces instead

143
Q

What is the treatment of hepatic hydrothorax?

A

Salt restriction and furosemide
Therapeutic thoracentesis
TIPS

144
Q

What is part of the management of Hep A?

A

Giving immunoglobulin to contacts

Giving vaccine to those at high risk

145
Q

What is the treatment of NEC?

A 
IV antibiotics
NPO
TPN
IVF
Surgery
146
Q

What is the test of choice for intussception?

A

US - shows target sign

147
Q

What should you do for breast feeding failure jaundice?

A

Increase feeds to every 2-3 hours for 10-20 minutes

148
Q

When does a baby need an exchange transfusion?

A

When unconjugated bilirubin is over 25 or 20 for preterm infants

149
Q

When should the bilirubin level be rechecked if baby has jaundice?

A

In 2 days

150
Q

What is the treatment for galactosemia?

A

Soy based formula

No cow based or breast milk

151
Q

What is the first step after BRBPR if under 50 with no other risk factors

A

Anoscopy or proctoscopy

152
Q

What if a patient over 50 has BRBPR.

A

Do a colonoscopy or sigmoidoscopy

153
Q

What is the diagnostic test for retroperitoneal abscess?

A

CT

154
Q

What is the treatment of a retroperitoneal abscess?

A

Immediate placement of percutaneous Catheter for drainage
Cultures
Surgical debridement

155
Q

What should management of cirrhosis entail?

A

Periodic LFTs, albumin, INR, bilirubin

156
Q

What should management of compensated cirrhosis include?

A

US for surveillance of HCC +/- AFP q 6 months

EGD for varices

157
Q

What should management of uncompensated cirrhosis include?

A

Bb for varices + EGD annually
Sodium restriction, diuretics and paracentesis for ascites, abstinence from EtOH
Hepatic enceph ? Lactulose, fix etiology

158
Q

What is the gold standard for diagnosing small bowel bacterial overgrowth?

A

EGD with jejunum aspirate showing greater than 10^5 organisms

159
Q

What is the treatment for bacterial overgrowth?

A

7-10 days of antibiotics (rifamixin, augmentin)
Avoid anti-motility drugs
Try promotility drugs
Change diet

160
Q

What is the treatment of hepatorenal syndrome?

A

Midodrine
Octreotide
Dialysis

161
Q

What is done for diagnosis of tropical sprue?

A

Mucosal bx : shows blunting of villi with infiltration of inflammatory cells

162
Q

When do you diagnose SBP?

A

When neutrophil count is greater than 250

163
Q

What is the tx for SBP?

A

IV antibiotics : ceftriaxone, Fluoroquinolones, or extended spectrum penicillin

164
Q

How do you confirm esophageal rupture?

A

CT chest

Contrast esophagram

165
Q

What is recommended after gastric bypass surgery to prevent gallstones?

A

Ursodeoxycholic acid for 6 months

166
Q

What is the tx of pruritis due to pancreatic cancer?

A

Endoscopic stent placement in th common bie duct via ERCP

167
Q

Which chemo therapeutic agent is used to treat unresectable metastatic pancreatic cancer?

A

5-FU with radiotherapy

168
Q

How do you diagnose a midgut volvulus?

A

Upper GI series

169
Q

What is the tx of a midgut volvulus?

A

NG tube
ICF
Emergent surgical repair

170
Q

How do you assess for cardiac iron overload in hemochromatosis?

A

Cardiac MRI

171
Q

What is the tx for fluid collection less than 3 cm in complicated diverticulitis?

A

IV antibiotics and observation

172
Q

What is the tx for uncomplicated diverticulitis?

A

Bowel rest
Antibiotics
Obs

173
Q

What is the next step if CT drainage of fluid collection in diverticulitis does not improve sx within 5 days?

A

Surgical debridement

174
Q

What is the tx for ascites in patients who are maxed out on furosemide and spironolactone?

A

Therapeutic daily tap of ascitic fluid

175
Q

What are the steps in the management of ascites?

A
  1. Salt and water restriction
  2. Spironolactone
  3. Furosemide
  4. Tapping
176
Q

How do you diagnose toxic megacolon?

A

Plain Ab XR

Fever over 100.4, WBC over 10,500, and anemia

177
Q

What is the tx for toxic megacolon?

A 
IVF
Broad spectrum antibiotics 
Bowel rest
IV corticosteroids if due to IBD 
Emergency surgery if it doesn't resolve
178
Q

What test is used for diagnosing chronic pancreatitis?

A

Secretin test which directly measures the ability of the pancreatic ducts to make bicarb

179
Q

How do you diagnose splenic abscess?

A

CT abdomen

180
Q

What is the tx for splenic abscess?

A

Splenectomy

181
Q

When is ERCP indicated?

A

Chronic pancreatitis
Ampullary cancers
Bile duct exploration
Tissue bx

182
Q

What is the diagnostic test for appendiceal abscess?

A

CT

183
Q

What can be used to tx severe alcoholic hepatitis?

A

Prednisone

184
Q

What should be done after confirming achalasia?

A

Endoscopy to rule out malignancy

185
Q

What is the criteria for diagnosing toxic megacolon?

A 
Evidence of colonic distention + 3 of the following:
Fever over 38
HR over 120
Neutrophil of leukocytosis over 10,500
Anemia
Plus one of the following:
Volume depletion
Altered sensorium
Electrolyte imbalance
Hypotension
186
Q

What is the initial test of choice when suspecting toxic megacolon?

A

AbXR to confirm dilation of colon over 6 cm

187
Q

What is the best test to evaluate for complications of diverticulitis.

A

CT scan

188
Q

When should a patient have the secretin stimulation test?

A

When suspected of having ZES but serum gastrin levels are non diagnostic

189
Q

What level of gastrin is diagnostic of ZES?

A

Over 1000

190
Q

What is important to check for when suspecting ZES?

A

Gastric ph levels to r/o achlorhydria causing secondary hypergastrinemia

191
Q

When is the calcium infusion test used?

A

In patients suspected of ZES with a negative secretin stimulation test

192
Q

How do you diagnose a pancreatic pseudo cyst?

A

US

193
Q

What are the criteria for treating chronic Hep C?

A 
Age over 18 
Detectable HCV RNA in serum 
Liver bx with bridging fibrosis and chronic hep
Compensate liver disease 
Stable labs
194
Q

What are the contraindications for treating chronic hep C?

A

Ongoing alcohol or drug abuse

Major uncontrolled depression

195
Q

What should be done when considering treatment for chronic hep C?

A

Liver bx - the degree of inflammation and fibrosis predicts the response to treatment, stage of disease and surveillance guidelines

196
Q

How often is HCC checked for in cirrhosis patients?

A

Every 6 months by US

197
Q

How do you diagnose someone with hep B?

A

HbsAg and Anti-Hbc IgM

198
Q

What is the tx of an amebic liver abscess?

A

Metronidazole

And paromomycin, or iodoquinol, or diloxanide

199
Q

How do you diagnose Dubin Johnson syndrome?

A

Conjugated hyperbilirubinemia with a direct bilirubin fraction over 50% and an otherwise normal LFT

200
Q

What is the confirmatory test of Dubin Johnson?

A

Urinary coproporhyrin - look for unusually high levels of coproporhyrin I

201
Q

What are the short term tx for Crigler Najjar?

A

Phototherapy

Plasmapheresis

202
Q

What is the tx for cryoglobulinemia?

A

Plasmapheresis

Immunosuppressants

203
Q

How do you diagnose mixed cryoglobulinemia?

A

Serology

Kidney or skin bx

Step 2 High Yield (20 decks)

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