Medicine GI

Question 1

if person has cholelithiasis, what MEDICINE can you give them?

Answer 1

ursodeoxycholic acid. for nonsurgical candidates (cholecystectomy)

note: if they have acute cholecystitis don’t give them the med, either have to do cholecystectomy or cholecystostomy

Question 2

medical management for cholecystitis prior to cholecystectomy (3)

Answer 2

NPO
IV fluids
IV antibiotics

Question 3

if you suspect achalasia, you do barium swallow -> manometry to confirm dx. however what study do you have to order to rule out something important?

Answer 3

EGD with biopsy to rule out cancer (pseudoachalasia). it also reveals the absent myenteric plexus.

Question 4

pt has relentless GERD. manometry shows relaxed esophagus, lack of tone, and decreased pressure in LES. what is dx? what is tx?

Answer 4

scleroderma (autoimmune disorder of collagen deposition)

treat symptomatically with PPIs.

Question 5

patient has crushing retrsoternal chest pain relieved with nitrates but it’s not an MI (ruled out with ECG and troponin) what is next step? what is tx?

Answer 5

suspect esophageal spasm. order manometry to confirm

tx: calcium channel blockers or nitroglycerin

Question 6

corkscrew esophagus on barium swallow. what is dx, how to treat?

Answer 6

esophageal spasm

tx: calcium channel blockers or nitroglycerin

Question 7

episodic dysphagia, months in between each episode. barium swallow shows narrowed lumen. what is next step for dx?

Answer 7

EGD confirms dx of fibrous ring at the LES

Question 8

Plummer vinson syndrome - esophageal rings in upper esophagus + esophageal webs + iron deficient anemia.

these patients are at increased risk for what, and thus must get screening for it? (and what’s the screening tool?)

Answer 8

SCC of esophagus

screen with EGD

Question 9

pt with GERD = retrosternal burning chest pain.

what are warning sx? in which case you have to do an endoscopy with biopsy. otherwise you do PPI trial

Answer 9

epigastric pain, dysphagia/odynophagia, vomiting, hematemesis, anemia, or weight loss

Question 10

tx for the following esophageal stuff:
GERD
Barrett's
Dysplasia
Adenocarcinoma

Answer 10

GERD - minimum effective dose of PPIs + lifestyle
Barrett’s - high dose PPI’s
Dysplasia - ablation
Adenocarcinoma - resection

Question 11

triple therapy for H pylori

Answer 11

PPI
clarithromycin
amoxicillin

Question 12

endoscopy with biopsy is gold standard for establishing presence of h pylori in setting of peptic ulcers. what other 2 studies can you use to confirm h pylori?

Answer 12

rapid urease test

histology

Question 13

what imaging will localize a gastrinoma tumor? hint, it’s special

Answer 13

somatostatin receptor scintigraphy (SRS) scan.

CT scans aren’t sensitive enough for this

Question 14

a long time diabetic (poorly controlled) with peripheral neuropathy presents with chronic nausea vomiting and early satiety. what do you think they have? what study confirms it? (hint: it’s NOT EGD!)

Answer 14

gastroparesis. from diabetic neuropathy.

dx study: gastric emptying study. also endoscopy to rule out cancer and gastric outlet obstruction.

Question 15

meds for gastroparesis:
chronic management ________
acute exacerbations ________
avoid _____ and ______

Answer 15

chronic management - metoclopramide
acute exacerbations IV erythromycin

avoid opiates and anticholinergics

Question 16

specific med for recurrent c. diff infection. if this doesn’t work, can try fecal transplant also

Answer 16

fidaxomicin