ITE - GI

Question 1

Autoimmune hepatitis: Dx, Tx.

Answer 1

Dx: exclude other causes, elevated aminotransferase levels, positive antinuclear antibody and smooth-muscle antibody, elevated levels of IgG, and compatible findings on liver biopsy
Tx: 2-3 yrs min of azatioprine and Prednisone (or budesonide)

Question 2

Differential for autoimmune hepatitis

Answer 2

Wilson disease
Viral hepatitis
drug-induced injury

Question 3

Azathioprine: monitoring.

Answer 3

cytopenia

Question 4

Celiac disease: Initial test, Dx, Tx.

Answer 4

Initial test: IgA tTG (tissue transglutaminase) Ab
Dx: Bx with intraepithelial lymphocytosis and blunting/atrophy of duod villi
Tx: no gluten

Question 5

Nausea (90%), vomiting (84%), upper abdominal pain (72%), and early satiety (60%), and maybe fullness/bloating

Answer 5

Gastroparesis, clues

Question 6

Gastroparesis: Dx, Tx.

Answer 6

Dx: Sxs, no mechanical obstruction, and delayed gastric emptying
Tx: Lifestyle (Small frequent meals, low fat/fiber, glucose control if DM), then metoclopramide

Question 7

Metoclopramide: MOA, monitoring.

Answer 7

MOA: prokinetic
Monitoring: movement DO’s (e.g., dystonia, TD, PD)

Question 8

Gilbert syndrome: Dx, Tx.

Answer 8

Dx: elevated bilirubin with a high unconjugated to conjugated ratio. Confirm with PCR or DNA sequencing for mutations of UGT1A1
Tx: if jaundiced –> phenobarbital

Question 9

chronic diarrhea, bloating, and weight loss, but may also include atypical symptoms, such as constipation and dyspepsia, iron deficiency anemia, bone loss, abnormal liver aminotransferase levels, neurologic symptoms, and dermatitis herpetiformis

Answer 9

celiac disease, clues

Question 10

MCC of refractory celiac disease symptoms.

Answer 10

Gluten exposure

Question 11

Usually asymptomatic. 18mo old with painless rectal bleeding such as melaena-like black offensive stools, followed by intestinal obstruction, volvulus and intussusception

Answer 11

Meckel Diverticulum, clues

Question 12

Meckel Diverticulum: Dx, Tx.

Answer 12

Dx: Meckel scan or technetium-99m pertechnetate scan shows ectopic gastric/pancreatic cells.
Tx: Laparoscopic resection

Question 13

Affects middle-aged women and is associated with other autoimmune conditions, particularly celiac disease. It presents with abrupt or gradual onset of watery diarrhea that has a relapsing and remitting course over months to years, sometimes accompanied by mild weight loss. Sometimes caused by: NSAIDs, SSRIs, PPIs.

Answer 13

Microscopic Colitis, clues.

Question 14

Microscopic Colitis: Dx, Tx.

Answer 14

Dx: histopathology with inflammatory changes; lymphocytic or collagenous (macroscopically normal)
Tx: DC causative meds (NSAIDs, SSRIs, PPIs), then supportive care, then budesonide.

Question 15

Acute pancreatitis: Risk factors for severe disease

Answer 15

> 55yo, comorbs, obese, SIRS, hypovolemia, pleural effusions/infiltrates, AMS.

Question 16

Ranson criteria: Defn, use.

Answer 16

Defn (a point for each):
On admission - WBC>16k, Age>55, Glucose>200, AST>250, LDH>350
At 48hrs - Hct drop > 10%, BUN increase >5, Ca < 8, A pO2 < 60, Base deficit > 4, fluids >6L
Use: prognosis of severity of Acute pancreatitis

Question 17

APACHE II score: Use.

Answer 17

Use: mortality prediction in ICU

Question 18

Small nodules or polypoid lesions. They are typically located in the rectosigmoid and are less than 5 mm in size. do not exhibit dysplasia, and have a characteristic serrated (“saw tooth”) pattern. Proliferation is mainly in the basal portion of the crypt of hyperplastic polyps.

Answer 18

Hyperplastic colonic polyp, clues.

Question 19

Abdominal pain with: Unremarkable imaging, positive Carnett test, no constitutional symptoms, no GI/GU symptoms, unremarkable labs, point tenderness, pain nonperistaltic and unrelated to meals or BMs

Answer 19

Abdominal wall pain, clues

Question 20

Abdominal wall pain: Dx, Tx.

Answer 20

Dx:
Tx: Analgesia (NSAIDs), if chronic or persistent: trigger point injection

Question 21

severe right-upper-quadrant or epigastric pain lasting longer than 6 hours, accompanied by fever and localized peritoneal signs in the right upper quadrant

Answer 21

Acute cholecystitis, clues

Question 22

Acute cholecystitis: Dx, Tx.

Answer 22

Dx: Abdominal ultrasound with inflammatory gallbladder and Murphy sign
Tx:
initial - antibiotics for enteric bugs
definitive- cholecystectomy

Question 23

RUQ pain, leukocytosis, jaundice, and sepsis in patient with CVT surgery, sepsis, burns, or vasculitis.

Answer 23

Acalculous cholecystitis, clues

Question 24

Acalculous cholecystitis: Dx, Tx.

Answer 24

Dx: ultrasound with gallbladder that is inflamed, distended, shows wall pneumatosis, and no stones. Also Murphy sign
Tx:
initial - antibiotics for enteric bugs
definitive- cholecystectomy

Question 25

Gallstone disease, pregnancy: Tx

Answer 25

Tx: supportive care

if infected - abx w/ enteric coverage, then lap choley (OK during any trimester)

Question 26

Hepatic encephalopathy: Dx, Tx.

Answer 26

Dx: cognitive dysfunction, asterixis in cirrhotic patient
Tx: Treat precipitating cause, lactulose, then add rifaximin