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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
What can be used to look for mets in esophageal cancer?
MRI with contrast | PET scan
25
What is the diagnostic test of choice for gastritis?
EGD
26
What test demonstrates exposure to H. Pylori?
IgG Ab
27
What tests can be done to determine infection with H. Pylori?
Stool antigen Urease breath test EGD bx
28
What is the treatment of gastritis?
Same as GERD
29
What is the treatment for h. Pylori?
Amoxicillin + omeprazole + clarithromycin | Metro is patient is penicillin allergic
30
How do you diagnose gastric cancer?
Upper endoscopy with bx
31
What is the treatment of gastric cancer?
Resection if early
32
How do you rule out perforation from a gastric ulcer?
Ab XR: look for free air under diaphragm
33
How do you rule out perforation from a duodenal ulcer?
CT with contrast - will show air in retroperitoneal space | Order CBC to detect GI bleeding
34
How do you confirm/rule out gastric bleeding?
Upper EGD with bx
35
How do you diagnose PUD?
H. Pylori testing
36
What should you order if patient is refractory or recurrent PUD.
Serum gastrin level to check for ZES
37
What should you do if you suspect perforation?
CT with IV contrast
38
What should you do if there is a perforation?
Surgical laparotomy Bp check Blood transfusions IV PPIs
39
How do you rule out active bleeding?
Rectal vault exam NG lavage Serial hematocrits
40
How do you manage acute PUD?
``` Rule out active bleeding IV PPI Blood transfusions IVF urgent EGD for an suspected bleeding ```
41
When is a EGD with targeted bx indicated?
In patients with refractory sx to rule out cancer
42
How do you diagnose ZES?
Increased fasting gastrin levels | Increased gastrin levels with administration of secretin
43
What is indicated after diagnosing ZES.
CT to characterize and stage
44
What is the treatment of ZES?
PPI | Surgical resection
45
How do you localize a ZES tumor?
CT or octreotide scan
46
What is the treatment for Campylobacter ?
Erythromycin
47
What is the treatment for C. Difficile?
Po metronidazole or vanc
48
How do you treat entamoeba histolytica?
Metronidazole
49
What can lead to fatal perforation with entamoeba histolytica?
Steroids
50
What is the treatment for E. coli O157:H7?
Nothing | Do not give antibiotics because it increases the risk of HUS
51
What is the treatment for salmonella?
Oral quinolones or Bactrim only if sickle cell patient because otherwise this prolongs the carrier state
52
What can be given to decrease the spread of shigella?
Bactrim to decrease person to person spread
53
What is the diagnostic test for lactose intolerance?
Hydrogen breath test (increased hydrogen after milk ingestion)
54
What is the treatment of carcinoid syndrome?
Octreotide | Surgical resection
55
What is the diagnostic criteria for IBS.
At least 3 months of episodic abdominal discomfort that is relieved by defecation and associated with a change in stool frequency or consistency
56
How do you diagnose SBO?
Ab XR : step ladder pattern of dilated small bowel loops, air fluid levels, no gas in the colon
57
What acid base abnormality would you see with SBO?
Metabolic alkalosis due to contraction
58
What is the treatment of SBO?
``` IVF NPO NG tube Foley Correct electrolytes ```
59
When is an exploratory lap indicated for an SBO?
Partial SBO after 3 days Complete SBO Ischemic necrosis
60
What is required in an elderly patient if ileus is suspected?
A rectal exam to rule out fecal impaction
61
How do you diagnose ileus?
Abdominal films show distend loops of small and large bowel with air seen throughout the colon and rectum
62
What is the treatment of ileus?
``` Discontinue offending meds Temporary NPO NG tube Replete electrolytes IVF ```
63
What do labs show with mesenteric ischemia?
Leukocytosis Metabolic acidosis Increased LDH, amylase, lactate, CK
64
What is seen on Ab XR and CT with mesenteric ischemia?
Bowel wall edema | Air in the bowel wall (pneumatosis intestinal is)
65
What is the gold standard for diagnosing mesenteric ischemia/arterial occlusive disease?
Mesenteric angiography
66
What is the treatment of mesenteric ischemia?
IVF | Broad spectrum antibiotics
67
How do you definitively diagnose diverticulum disease?
Colonoscopy
68
What should be avoided in patients with early diverticulitis and why?
Sigmoidoscopy or colonoscopy because of the risk of perforation
69
What is the treatment for uncomplicated diverticulosis?
High fiber diet or fiber supplements
70
What is the treatment for bleeding that doesn't stop in diverticulosis ?
Hemostasis by colonoscopy, angiography with embolization or surgery
71
What is the treatment of diverticulitis?
NPO NG tube placement Broad spectrum antibiotics (metro + quinolones or 2/3 gen ceph)
72
How do you treat a LBO?
Gastrogaffin enema Rectal tube Colonoscopy Surgery
73
How do you diagnose colon cancer?
Colonoscopy with bx
74
What should you order to evaluate for mets of colon CA?
CXR LFTs Abdominal/pelvic CT
75
What is the treatment for colon cancer with positive nodes?
Adjuvant chemo with surgery
76
What is the treatment for ischemic colitis?
NPO, IVF, antibiotics | Bowel resection is infarct, fulminant colitis, or obstruction
77
What is the diagnostic test for ischemic bowel?
CT | Colonoscopy : pale mucosa with petechia
78
How do you diagnose upper GI bleed?
NG tube and lavage | Endoscopy (if stable)
79
What is the treatment of UGI?
Endoscopy with treatment
80
What is the diagnostic test of choice for LGI?
Anoscopy/sigmoidoscopy for patients greater than 45 with small volume of bleeding Colonoscopy
81
What is the diagnostic test of choice if patient is unstable?
Arteriography | Exploratory laparotomy
82
What is the treatment for diverticulosis causing lower GI bleed?
Epi injection Intra arterial vasopressin or embolization Surgery
83
What is the test of choice for gallstones?
RUQ US
84
How do you diagnose cholecystitis?
US | If US is equivocal do HIDA scan
85
What is the treatment of cholecystitis?
IV antibiotics and IVF | Surgical cholecystectomy
86
How can definitive diagnosis of UC and Crohn's be made?
Colonoscopy with bx
87
What are the treatments for UC and crohn's ?
5-ASA agents Azathioprine Corticosteroids
88
What treatment can be curative of UC?
Total proctolectomy
89
What is the hallmark of choledocholithiasis?
Increased alk phos and total and direct bilirubin
90
What is the treatment of choledocholithiasis?
ERCP with sphincterotomy and cholecystectomy
91
What is diagnostic of ascending cholangitis?
ERCP
92
What is the treatment for ascending cholangitis?
ICU admission IV antibiotics emergent bile duct decompression!!! -->. ERCP
93
How do you diagnose gallstone ileus?
Ab XR that shows characteristics of SBO
94
What is the treatment of gallstone ileus?
Laparotomy with stone extraction and closure of the fistula + cholecystectomy
95
How do you diagnose PSC?
MRCP/ERCP: shows beading from multiple duct stricture/dilation Liver bx: shows onion skinning of periductal stenosis
96
What is the treatment for PSC.
``` High dose ursodiol ERCP with dilation and stenting of strictures Liver transplant (definitive) ```
97
What is the marker for autoimmune hepatitis?
Anti-smooth muscle antibodies
98
What is the treatment for chronic HBV infection?
INF And Lamivudine | Or adefovir
99
What is the treatment for INF and ribavirin for?
Chronic Hep C
100
How is SBP diagnosed?
Paracentesis | With greater than 250 PMNs/ml in the ascitic fluid and positive gram stain
101
What does an SAAG less than 1.1 mean?
The ascites is not related to portal HTN Due to TB, malignancy or nephrotic syndrome
102
What is the treatment of SBP.
``` IV antibiotics (ceftriaxone) IV albumin ```
103
What should be given to prevent recurrence of SBP?
Fluoroquinolone
104
What is the treatment of ascites?
Sodium restriction Diuretics (furosemide and spironolactone) Large volume paracentesis
105
What is hepatorenal syndrome?
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
What is the cure for hepatorenal syndrome?
Liver transplant
107
What is the treatment for hepatic encephalopathy?
Protein restriction Lactulose And/or rifampin
108
What is the medical prophylaxis for esophageal varices?
Bb
109
What is the treatment for esophageal varices?
Endoscopy with band ligation or sclerotherapy
110
What is the treatment for coagulopathy associated with liver cirrhosis?
FFP
111
What are the treatments for PBC?
Ursodeoxycholic acid for slowing disease progression Cholestyramine for pruritis Liver transplant
112
When is a partial hepatectomy ok to do for HCC?
For single lesions less than 5 cm and no cirrhosis
113
What is the surgical treatment for patients with HCC and cirrhosis?
Ortho topic liver transplant
114
What is the non surgical treatment for advanced disease?
Transarterial chemoembolization and/or sorafenib
115
What should be monitored for recurrence of HCC?
AFP levels
116
How is HCC diagnosed?
Mass on US or CT Abnormal LFTs Elevated AFP
117
How is hemochromatosis diagnosed?
Increased serum iron, percent saturation of iron and ferritin Transferrin saturation over 45%
118
What should you do if you suspect hemochromatosis?
Liver bx | MRI or HFE mutation screen
119
What is the treatment of hemochromatosis?
Weekly phlebotomy then maintenance | Deferoxamine for maintenance
120
How do you diagnose Wilson's disease?
Decreased serum ceruloplasmin Increased urinary excretion of copper Liver bx Rhodamine or orceine stain
121
What are the diagnostic tests for acute pancreatitis?
Amylase, lipase, calcium | Ab US or CT- show sentinel loop or colon cut-off sign
122
What is the treatment of acute pancreatitis?
``` Same as SBO IVF NPO NG tube Nutritional support ```
123
What is the diagnostic sign on AXR and CT for chronic pancreatitis?
"Chains of lakes" | Calcification
124
What is decreased in chronic pancreatitis?
Stool elastase
125
What is the treatment for chronic pancreatitis?
Analgesia Celiac nerve block Pancreatic enzyme replacement
126
What is used for diagnosis of pancreatic cancer?
CT with contrast
127
What can be used to assess extent of pancreatic cancer
Ct with contrast
128
What can be used if cant see mass on CT?
Endoscopy | ERCP with bx
129
What is often elevated in pancreatic cancer?
CA-19-9
130
What is the treatment?
Chemo with 5-FU and gemcitabine
131
When can a whipped procedure be done?
If tumor is small in the head of the pancreas with no mets
132
What Hep B drug is reserved for younger patients with compensated liver disease?
INF
133
What are the preferred drugs for hep b?
Entecavir | Tenofovir
134
What med is added to INF and ribavirin for patients who have genotype 1 hep c?
Telepravir
135
What is the treatment for severe C dif. With WBC over 15 or Creatinine over 1.5?
Oral vanc
136
What if the patient has severe c.dif and has an ileus being treated with oral vanc?
Add IV metro | Or switch or rectal vanc
137
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?
Subtotal colectomy | Diverting loop ileostomy
138
What is the treatment for mild C.dif?
Oral metro
139
How do you diagnose C.dif?
Stool studies for c. Dif toxin
140
What drug can be used for recurrent colitis or in patients who can't tolerate oral vanc?
Fidaxomicin
141
What is IV vanc commonly used for?
Bacteremia secondary to an skin source (central line)
142
What is the D-xylose test used for?
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
What is the treatment of hepatic hydrothorax?
Salt restriction and furosemide Therapeutic thoracentesis TIPS
144
What is part of the management of Hep A?
Giving immunoglobulin to contacts | Giving vaccine to those at high risk
145
What is the treatment of NEC?
``` IV antibiotics NPO TPN IVF Surgery ```
146
What is the test of choice for intussception?
US - shows target sign
147
What should you do for breast feeding failure jaundice?
Increase feeds to every 2-3 hours for 10-20 minutes
148
When does a baby need an exchange transfusion?
When unconjugated bilirubin is over 25 or 20 for preterm infants
149
When should the bilirubin level be rechecked if baby has jaundice?
In 2 days
150
What is the treatment for galactosemia?
Soy based formula | No cow based or breast milk
151
What is the first step after BRBPR if under 50 with no other risk factors
Anoscopy or proctoscopy
152
What if a patient over 50 has BRBPR.
Do a colonoscopy or sigmoidoscopy
153
What is the diagnostic test for retroperitoneal abscess?
CT
154
What is the treatment of a retroperitoneal abscess?
Immediate placement of percutaneous Catheter for drainage Cultures Surgical debridement
155
What should management of cirrhosis entail?
Periodic LFTs, albumin, INR, bilirubin
156
What should management of compensated cirrhosis include?
US for surveillance of HCC +/- AFP q 6 months | EGD for varices
157
What should management of uncompensated cirrhosis include?
Bb for varices + EGD annually Sodium restriction, diuretics and paracentesis for ascites, abstinence from EtOH Hepatic enceph ? Lactulose, fix etiology
158
What is the gold standard for diagnosing small bowel bacterial overgrowth?
EGD with jejunum aspirate showing greater than 10^5 organisms
159
What is the treatment for bacterial overgrowth?
7-10 days of antibiotics (rifamixin, augmentin) Avoid anti-motility drugs Try promotility drugs Change diet
160
What is the treatment of hepatorenal syndrome?
Midodrine Octreotide Dialysis
161
What is done for diagnosis of tropical sprue?
Mucosal bx : shows blunting of villi with infiltration of inflammatory cells
162
When do you diagnose SBP?
When neutrophil count is greater than 250
163
What is the tx for SBP?
IV antibiotics : ceftriaxone, Fluoroquinolones, or extended spectrum penicillin
164
How do you confirm esophageal rupture?
CT chest | Contrast esophagram
165
What is recommended after gastric bypass surgery to prevent gallstones?
Ursodeoxycholic acid for 6 months
166
What is the tx of pruritis due to pancreatic cancer?
Endoscopic stent placement in th common bie duct via ERCP
167
Which chemo therapeutic agent is used to treat unresectable metastatic pancreatic cancer?
5-FU with radiotherapy
168
How do you diagnose a midgut volvulus?
Upper GI series
169
What is the tx of a midgut volvulus?
NG tube ICF Emergent surgical repair
170
How do you assess for cardiac iron overload in hemochromatosis?
Cardiac MRI
171
What is the tx for fluid collection less than 3 cm in complicated diverticulitis?
IV antibiotics and observation
172
What is the tx for uncomplicated diverticulitis?
Bowel rest Antibiotics Obs
173
What is the next step if CT drainage of fluid collection in diverticulitis does not improve sx within 5 days?
Surgical debridement
174
What is the tx for ascites in patients who are maxed out on furosemide and spironolactone?
Therapeutic daily tap of ascitic fluid
175
What are the steps in the management of ascites?
1. Salt and water restriction 2. Spironolactone 3. Furosemide 4. Tapping
176
How do you diagnose toxic megacolon?
Plain Ab XR | Fever over 100.4, WBC over 10,500, and anemia
177
What is the tx for toxic megacolon?
``` IVF Broad spectrum antibiotics Bowel rest IV corticosteroids if due to IBD Emergency surgery if it doesn't resolve ```
178
What test is used for diagnosing chronic pancreatitis?
Secretin test which directly measures the ability of the pancreatic ducts to make bicarb
179
How do you diagnose splenic abscess?
CT abdomen
180
What is the tx for splenic abscess?
Splenectomy
181
When is ERCP indicated?
Chronic pancreatitis Ampullary cancers Bile duct exploration Tissue bx
182
What is the diagnostic test for appendiceal abscess?
CT
183
What can be used to tx severe alcoholic hepatitis?
Prednisone
184
What should be done after confirming achalasia?
Endoscopy to rule out malignancy
185
What is the criteria for diagnosing toxic megacolon?
``` 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
What is the initial test of choice when suspecting toxic megacolon?
AbXR to confirm dilation of colon over 6 cm
187
What is the best test to evaluate for complications of diverticulitis.
CT scan
188
When should a patient have the secretin stimulation test?
When suspected of having ZES but serum gastrin levels are non diagnostic
189
What level of gastrin is diagnostic of ZES?
Over 1000
190
What is important to check for when suspecting ZES?
Gastric ph levels to r/o achlorhydria causing secondary hypergastrinemia
191
When is the calcium infusion test used?
In patients suspected of ZES with a negative secretin stimulation test
192
How do you diagnose a pancreatic pseudo cyst?
US
193
What are the criteria for treating chronic Hep C?
``` Age over 18 Detectable HCV RNA in serum Liver bx with bridging fibrosis and chronic hep Compensate liver disease Stable labs ```
194
What are the contraindications for treating chronic hep C?
Ongoing alcohol or drug abuse | Major uncontrolled depression
195
What should be done when considering treatment for chronic hep C?
Liver bx - the degree of inflammation and fibrosis predicts the response to treatment, stage of disease and surveillance guidelines
196
How often is HCC checked for in cirrhosis patients?
Every 6 months by US
197
How do you diagnose someone with hep B?
HbsAg and Anti-Hbc IgM
198
What is the tx of an amebic liver abscess?
Metronidazole | And paromomycin, or iodoquinol, or diloxanide
199
How do you diagnose Dubin Johnson syndrome?
Conjugated hyperbilirubinemia with a direct bilirubin fraction over 50% and an otherwise normal LFT
200
What is the confirmatory test of Dubin Johnson?
Urinary coproporhyrin - look for unusually high levels of coproporhyrin I
201
What are the short term tx for Crigler Najjar?
Phototherapy | Plasmapheresis
202
What is the tx for cryoglobulinemia?
Plasmapheresis | Immunosuppressants
203
How do you diagnose mixed cryoglobulinemia?
Serology | Kidney or skin bx

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