Internal Medicine Essentials Questions: Gastroenterology and Hepatology Flashcards
Give the criteria for diagnosing IBS.
The Rome criteria:
•At least three days of abdominal pain each month for the last three months
•At least two of the following:
- Improvement with defecation
- Onset of pain associated with change in the consistency or frequency of stool
Also, they must not have any alarm symptoms: fever, onset after age 50, hematochezia, melena, family history of colon cancer, weight loss, and recent antibiotic use.
Acute mesenteric ischemia can be caused by systemic hypotension or ______________.
thrombosis to either mesenteric artery
A 50-year-old has acute lower-left quadrant abdominal pain and transmural inflammation of the colon on CT. What is this?
Diverticulitis! Don’t be tricked.
Treat with ciprofloxacin and metronidazole.
Describe the features of dyspepsia and symptoms that warrant further workup.
- Early satiety
- Postprandial epigastric burning
- Lack of features on endoscopy (if done)
- Duration of symptoms lasting at least 3 months
Alarm symptoms:
- Onset after age 50
- Vomiting
- Weight loss
- Odynophagia
- Dysphagia
- History of PUD or gastric surgery
- FMH of gastric malignancy
- Lymphadenopathy or abdominal masses on exam
GERD with dyspeptic features (early satiety, bloating, etc.) should be managed with ________________.
a PPI
Describe the treatment and follow-up of H. pylori ulcer.
- Triple therapy for 14 days (omeprazole, amoxicillin, and clarithromycin)
- Omeprazole for another 14 days
- Follow-up with fecal antigen testing after completion of therapy
Which ulcers need to be biopsied?
All of them
Even small, benign-appearing ulcers can harbor malignancy.
A patient has painless jaundice and a cholestatic liver pattern. What is the proper initial diagnostic?
Abdominal ultrasound
If the US shows a dilated bile duct, then an ERCP should be done for removal of presumed gallstone.
Give the criteria for metabolic syndrome.
Any three of the following:
•Triglycerides greater than 150
•HDL less than 50 in men and 40 in women
•Fasting glucose greater than 110
•BP greater than 130/85
•Waist greater than 40 inches in men and 35 in women
NAFLD should be treated with ________________.
lifestyle interventions: diet and exercise
Alcoholic hepatitis causes what vital sign abnormality?
Fever
When is HCV treatment indicated?
When the patient has a detectable viral load and some kind of consequence of HCV infection (e.g., cirrhosis, transaminitis, liver inflammation on US)
A patient from SE Asia has chronic HBV infection (indicated by HbSAg positivity and lack of HbSAg antibody). Describe how you should approach management.
•Draw LFTs.
- If the liver function is normal and there is no elevation of transaminases, then this person likely has immune-tolerant HBV. This is a classic pattern of perinatally-acquired HBV. In this case, monitor with serial transaminases.
- If the liver function labs are abnormal, biopsy the liver and start treatment with IFN-alpha and tenofovir.
Describe how to calculate SAAG.
Serum albumin - ascites albumin
A value greater than 1.1 is suggestive of ascites.
What is the recommended management of asymptomatic gallstones (that is, gallstones discovered incidentally)?
Observation
50% remain asymptomatic
Those with ulcerative colitis and PSC are at increased risk of colorectal cancer and which other type of cancer?
Cholangiocarcinoma
Think of this if a patient with PSC presents with worsening jaundice.
True or false: elevated bilirubin in a patient with gallstones is likely choledocholithiasis.
True, but cholecystitis can also cause mild elevations in bilirubin.
List the two treatment strategies for cholangitis.
- ERCP (to remove the stone, if present)
* Antibiotics
Describe the management of acute pancreatitis.
•Morphine
•IVF
•NPO
•Resume oral intake when symptoms improve
- If they can’t eat in 96 hours then consider NJ tube feeding.
Which lab finding is suggestive of poor prognosis in pancreatitis?
Elevated BUN
Severe C. diff infection should be treated with ____________.
oral vancomycin and intravenous metronidazole
Malabsorption, diarrhea, and bloating after a Roux-en-Y bypass are suggestive of ________________.
small intestinal bacterial overgrowth (SIBO)
Decreasing the amount of time that food spends in the gastric acid (which a bypass does) leads to increased risk of SIBO.
Explain the screening guidelines for colonoscopy in those with ulcerative colitis.
Starting 10 years after diagnosis, screen every 1 to 2 years.
The rate of colon cancer in those with UC for 10 years or more is 1% per year.
One cause of mid-gut GI bleed –meaning not detected on colonoscopy or endoscopy –is _____________, particularly common in the elderly.
small bowel angiectasia
Most experts agree that those older than _________ with rectal bleeding should be screened with colonoscopy for colon cancer.
40
