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Gastroenterology > MTB > Flashcards

MTB Flashcards

1
Q

Alarm symptoms that prompt endoscopy

A

Weight Loss
Blood in stool
Anemia

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2
Q

Achalasia Pathophys

A

Inability of LES to relax

loss of nerve plexus

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3
Q

Presentation of Achalasia

Age group

A

Young (<50)

Progressive dysphagia to BOTH solids and liquids conurrently

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4
Q

Is Achalasia related to alcohol and tobacco use?

A

NO

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5
Q

Best initial test for achalasia

A

Barium esophagram

- Bird’s beak

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6
Q

Most accurate test for achalasia

A

Manometry

- failure of LES to relax

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7
Q

What does CXR show for achalasia?

A

Widening of esophagus

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8
Q

What does endoscopy look like for achalasia?

A

Normal mucosa in Upper endoscopy

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9
Q

In esophageal patients, what test is acceptable to do first in MOST patients?

A

Barium studies

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10
Q

What is diagnosed by Bx in esophagus?

A

Cancer

Barrett esophagus

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11
Q

What is the tx for achalasia?

A

Simple mechanical dilation

  • Pneumatic dilation
  • Botulinum injection
  • Myotomy
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12
Q

What is Pneumatic dilation?

A

Place endoscope that can inflate a device to enlarge esophagus.
Works in 80-85% of pts

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13
Q

What risk occurs with pneumatic dilation?

A

Perforation in <3%

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14
Q

How long does botulinum work in pneumatic dilation?

A

3-6 months.

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15
Q

What is the MC AE of Myotomy?

A

Reflux dz

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16
Q

Presentation of esophageal cancer

A

Progressive dysphagia from solids to liquids
Ass’d with alcohol and tobacco use
>5 yrs GERD sx’s

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17
Q

Best initial test for esophageal cancer?

A

Barium possibly. NEED Bx for DX.

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18
Q

What is the role of CT/MRI in esophageal cancer?

A

Assess extent of spread

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19
Q

Tx for esophageal cancer?

A

Surgical resection

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20
Q

Chemo drug used in esophageal cancer?

A

5-FU

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21
Q

What cancers are treated with 5-FU?

A

Stomach
Esophagus
Colon

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22
Q

When is stent placement used in esophageal cancer?

A

Non resectable lesions

Palliative to improve dysphagia

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23
Q

Presentation of DES and nutcracker?

A

Sudden onset of chest pain NOT related to exertion

Precipitated by cold drinks

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24
Q

Pt w/ sudden, severe chest pain and normal EKG and stress test?

A

DES

Nutcracker

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25
Q

What is the most accurate test for DES and nutracker?

A

Manometry

Differentiates

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26
Q

Patient presents w/atypical chest pain - what is the initial workup?

A
  1. EKG

2. NST if old or risk factors

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27
Q

Tx for DES/Nutcracker?

A

DHP CCB’s - work on vascular smooth muscle to vasodilate arteries
- Nifedipine
- Amlodipine
Nitrates

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28
Q

CMV Esophagitis presentation of cells? What CD4 count?

A

Owl eye inclusions

CD4 < 50

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29
Q

Tx for CMV Esophagitis

A

Gancicyclovir

Resistant HSV:
Foscarnet
Cidofovir

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30
Q

Gancicyclovir AE’s

A

Agranulocytosis

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31
Q

AE’s of Cidofovir

A

ATN

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32
Q

Infectious esophagitis in AIDS pts?

A

Esophageal candidiasis

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33
Q

Esophageal candidiasis Tx?

A

Fluconazole - response to tx is the Dx
If not effecitive -> Endosocpy
IV Ampho if confirmed

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34
Q

When to stop fluconazole in AIDS pt?

A

Lifelong or until T cell count increases.

Opportunisitic infxn all treated until T cell count rises

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35
Q

Pill Esophagitis presentation?

A

Pain on swallowing w use of pills - pt drinks water and sits up
MC - Hx of HIV

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36
Q

What pills cause esophagitis?

A

Oledronate, Risondronate
Iron pills
Vit C pills
Potassium pills

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37
Q

AE of “azoles”

A

Hepatotoxic

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38
Q

What causes Schatzki ring?
Presentation?
Ass’d with?

A

From acid reflux
Scarring/tightening (peptic stricture) of distal esophagus
Non painful, intermittent dysphagia
Ass’d with hiatal hernia

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39
Q

Plummer-Vinson syndrome?
Age group
Ass’n with cancer?

A

Ass’d with IDA
Rarely transforms to SQCC
Middle aged woman

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40
Q

Location of Schatzki ring?

A

Distal, @ Sq/columnar Jnc, proximal to LES

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41
Q

Location of Plummer-Vinson syndrome?

A

Proximal, @ Hypopharynx

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42
Q

Which ring/web ass’d with intermittent dysphagia?

A

Schatzki ring

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43
Q

Ass’d with dysphagia with solid food/”steakhouse syndrome”?

A

Schatzki ring

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44
Q

Tx for Schatzki ring?

A

Pneumatic dilation

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45
Q

Tx for Plummer-Vinson?

A

Iron replacement

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46
Q

What is Zenker Diverticulum?

A

Outpouching of posterior pharyngeal constrictor muscles

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47
Q

How does Zenker present?

A

Dysphagia
Halitosis
Food particle regurgitation
Aspiration Pneumonia

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48
Q

Dx test for Zenker?

A

Barium study

Confirm with contrast esphagram

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49
Q

Tx for Zenker?

A

Surgery

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50
Q

What studies are CI in Zenker pts?

A

Nasogastric tube
Upper Endoscopy
Cause Perforation!

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51
Q

What is scleroderma?

A

Decreased LES pressure from inability to close LES
Progressive systemic sclerosis = From atrophy and fibrosis of esophageal smooth m.
Diminished esophageal peristalsis

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52
Q

Scleroderma Dx test?

A

Manometry

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53
Q

Tx for scleroderma?

A

PPI’s

  1. Omeprazole
  2. Metoclopromide - cost efficient
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54
Q

When is manometry the answer for esophageal disorders?

A

ASS
Achalasia
Spasm
Scleroderma

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55
Q

What is Boerhaave’s?

A

Esophageal Rupture resulting in full thickness tear of wall

Sudden increase intraesophageal pressure

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56
Q

Where is boerhaave’s located?

A

Few cm’s above GE Jnc

Postero-lateral distal esophagus

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57
Q

Boerhaave’s presentation?

What sign is seen on auscultation?

A

Retrosternal pain
Hamman’s sign: crunching sound on auscultation of heart due to pneumomediastinum
Subcutaneous emphysema

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58
Q

Causes of Boerhaave?

A

Vomiting - Mallory-Weiss, repeated

Protracted vomiting

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59
Q

Mallory-Weiss Tear pathophysiology?

A

Non penetrating tear of mucosa ONLY

Submucosal arteries of distal esophagus and proximal stomach

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60
Q

Mallory-Weiss presentation?

A

Upper GI bleeding after prolonged/severe vomiting/retching

Repeat retching = hematemesis of bright red blood, black stool

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61
Q

Is there dysphagia with Mallory-Weiss?

A

No.

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62
Q

Tx of Mallory-Weiss?

A

Resolves spontaneously

Severe - epinephrine injection/electrocautery

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63
Q

What are esophageal varices? How are they different from Mallory-Weiss?

A

Submucosal VEINS that are dilated with portal HTN in lower third of esophagus

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64
Q

Non-Ulcer Dyspepsia Presentation?

A

MCC epigastric pain esp with no identified etiology

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65
Q

Epigastric pain, DM and bloating?

A

Gastroparesis

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66
Q

Best test for epigastric pain?

A

Endoscopy
Unless: s
Stomach - barium poor

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67
Q

Best initial tx for epigastric pain?

A
  1. PPIs

2. H2 Blockers - less effective, work 70%

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68
Q

AE’s of PPI’s?

A

Osteoporosis
C. Diff
Aspiration Pneumonia (hospitalized, elderly pts)

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69
Q

What worsens GERD?

A 
Nicotine
Alcohol
Caffeine
Peppermint
Chocolate 
Late night meals
Obesity
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70
Q

GERD sx’s?

A 
Epigastric pain radiating into chest
Sore throat
Bad taste (metallic) in mouth, "brackish"
Hoarseness
Cough
Wheezing
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71
Q

Confirmation and most accurate test for GERD?

A

24-hr pH monitoring: electrode placed several cm’s above GE Jnc and average pH determined
Done if PPI’s fail to work

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72
Q

When to do endoscopy for GERD?

A

Signs of obstruction - dysphagia or odynophagia
Alarm sx’s (Wt loss, Anemia, Blood in stool)
6mo’s -> Persistent sx’s

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73
Q

What is seen on endoscopy in GERD?

A 
Redness
Erosions
Ulcerations
Strictures
Barrett
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74
Q

GERD Tx - non-medical

A

Wt loss
Avoid irritants to decrease sphincter pressure (good for digestion, bad for reflux)
Avoid eating before bed
Elevate head 6-8 inches

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75
Q

GERD Tx mild/Intermittent

A

Liquid antacids

H2 blockers

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76
Q

GERD Tx Persistent sx’s/Erosive esophagitis/Moderate

A

PPIs

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77
Q

GERD Tx not responsive to Meds

A

Tighten LES:

  1. Nissen fundoplication - wrap stomatch around LES laparasocopically
  2. Endocinch - suture around LES
  3. Local heat/radiation of LES = scarring
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78
Q

What is a hiatal hernia?

A

Type I - Sliding. MC type. Jnc of stomach and GE slides into mediastinum
Type II - Paraesophageal; stomach fundus through diaphragm; GE Jnc below diaphragm

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79
Q

Si/Sx’s of hiatal hernia?

A 
Incidental finding
Asymptomatic 
Chest pain
Heart burn
GERD
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80
Q

Test for Hiatal hernia?

A

Barium swallow

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81
Q

Tx for hiatal hernia?

A

Sx management

Surgery for type II b/c risk of strangulation

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82
Q

What is Barrett esophagus?

A

> 5 years of GERD causes LE columnar metaplasia

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83
Q

Dx test for Barrett and what do we see?

A

Bx.

Columnar metaplasia w/intestinal features - greatest risk of transforming into esophageal cancer

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84
Q

What is Tx for Barrett alone?

How often do we scope?

A

PPIs

Endoscopy every 2-3 yrs

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85
Q

Tx for low-grade dysplasia?

How often do we scope?

A

PPIs

Endoscopy every 6-12 months (some sources say every 3-6)

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86
Q

Tx for high-grade dysplasia?

How often do we scope?

A

Ablation with Endoscopy
Distal esophagectomy or endoscopic mucosal secretion
Photodynamic therapy

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87
Q

Which Barrett patients get PPIs?

A

All = PPIs BID

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88
Q

What is gastritis? Causes of gastritis?

A 
Inflammation/Erosion of gastric lining
Alcohol
NSAIDs
H.Pylori
Portal HTN
Stress: burns, trauma, sepsis, uremia
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89
Q

What is type A gastritis?

A

Atrophic gastritis
Ass’d with:
Achloridya - decreased gastric acid production -> increased gastrin b/c acid inhibits gastrin release from G cells
B12 Deficiency (AI),

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90
Q

What does Gastrin do?

A

Stimulates gastric acid (HCl) release by parietal cells (stomach) and gastric motility
G cells found in pyloric antrum, duodenum, pancreas

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91
Q

Presentation of gastritis?

A

GI bleeding w/out pain
Severe, erosive can be epigastric pain
Bleeding varies: mild “coffee-ground” emesis to large -volume red blood to melena (black stool)

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92
Q

5-10 mL bleeding is?

A

Coffee-ground emesis

Heme (guaiac) positive stool

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93
Q

50-100 mL bleeding is?

A

Melena

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94
Q

Dx test for gastritis?

A

Upper endoscopy

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95
Q

Most accurate test for H.Pylori?

A

Endoscopic Bx - but invasive

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96
Q

What H.pylori tests are only positive in active infxn?

A
  1. Urea breath test

2. H.Pylori stool Ag

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97
Q

Tx for gastritis?

98
Q

H.Pylori tx?

A

PPI + Clarithromycin + Amoxicillin

IF unresponsive, change to Metronidazole + Tetracycline

99
Q

When do we do stress ulcer PPX?

A 
Mechanical ventilation (ventilators)
Burns
Head trauma
Coagulopathy
Sepsis
100
Q

PUD causes?

A 
H.Pylori
NSAIDs = inhibit PG's that produce mucus
Burns
Head trauma
Crohn dz
Gastric cancer
Gastrinoma (Z-E syndrome)
101
Q

Why peptic ulcers in burns and head trauma?

A

Intense vasoconstriction of vasculature that supplies gastric mucosa -> cells slough off and ulcer

102
Q

Do Alcohol and tobacco cause ulcers?

A

Do NOT cause. Delay healing.

103
Q

Complications of PUD?

A

MC = Hemorrhage
Perforation
Penetration
Obstruction

104
Q

PUD presentation?

A

Recurrent episodes epigastric pain - dull, sore, gnawing

Most ulcers don’t bleed

105
Q

MCC of upper GI bleed?

106
Q

Most accurate test for PUD?

A

Upper Endoscopy

107
Q

Is cancer ass’d with both gastric and duodenal ulcer?

A

No. Gastric only in 4%

108
Q

Tx for PUD?

109
Q

What is confirmatory test for PUD?

A

CLO test - rapid urease test.

Done on Bx.

110
Q

GU or DU ass’d with H.Pylori more often?

111
Q

Tx for PUD?

A

PPI + Clarithromycin + Amoxicillin for 10-14 days
IF unresponsive, change to Metronidazole + Tetracycline
Repeat endoscopy after GU to R/O cancer

112
Q

No response to tx in DU with PPI/Clar/Amox, what is the most appropriate next step in management?

A

Urea breath test, stool Ag, Repeat endoscopy for BX
Think Antibiotic resistance!
Then change to Metronidazole + Tetracycline

113
Q

Tx for refractory ulcers?

A

Detection of H.Pylori, Then change to Metronidazole + Tetracycline
GU - Repeat endoscopy to r/o cancer

114
Q

Common causes of Tx failure in PUD?

A

Nonadherence
Alcohol
Tobacco
NSAIDs

115
Q

Complications post partial gastrectomy?

A

Antrum removed -> Dumping = post-prandial GI discomfort, i.e. N/V/D, cramps
Alkaline Reflux Gastritis - burning epigastric pain
Vitamin Deficiency - B12, Iron, Calcium

116
Q

Why do H2 blockers and PPIs increase risk of osteoporosis?

A

Calcium needs acid to be absorbed

117
Q

What is MALT?

A

Low grade lymphoma
Tx w/ H.pylori Abx - PPI/C/A
If no mets, next step chemo with CHOP

118
Q

What is CHOP chemo?

A

Cyclophosphamide
Hydroxydanarubicin = Adriamycin
Oncovin = Vincristine
Prednisone

119
Q

Non-ulcer Dyspepsia tx?

A

55 yoa - Endoscopy

120
Q

Which patients with dyspepsia get endoscopY?

A

Pt over 45-55 yoa

Alarm sx’s

121
Q

Best initial tx for NUD?

122
Q

What is a gastrinoma?

A 
Aka Zollinger-Ellison syndrome
Ulcers that are:
- Large ( >1-2 cm)
- Recurrent after H.Pylori eradicated
- Distal duodenum (1/2), Pancreas (1/4)
- Multiple
Diarrhea - acid inactivates lipase
123
Q

What does Lipase do?

A

Catalyzes hydrolysis of fats/lipids = digest, transport, process lipids

124
Q

Most accurate test for gastrinoma?

A

Functional test assessing response to secretion:

  1. High gastrin levels off anti-secretory tx (PPIs or H2 blockers) w/gastric acidity
  2. High gastrin levels despite high gastric acid output
  3. Persistent high gastrin after secretin injection
125
Q

Best initial test gastrinoma?

A

Endoscopy to confirm

126
Q

What does secretin do?

A

Stimulates release of gastrin by gastrinoma cells

127
Q

If Dx gastrinoma, next test?

A

Somatostatin receptor scintigraphy with endoscopic US to r/o metastatic dz

128
Q

What is seen on Endoscopic US in gastrinoma?

A

Prominent gastric folds

ulcer below duodenal bubl

129
Q

Assn b/t gastrinoma and somatostatin?

A

Massive increase in somatostatin receptors in abdomen

130
Q

What is the tx for gastrinoma?

A

Local dz - surgical resection

Mets cannot be resected - lifelong PPIs - high dose BID to block acid production

131
Q

What is dumping syndrome?

A

Surgery for Ulcer dz - cut vagus Nerve
Rapid release of gastric contents from stomach to duodenum = rapid release of glucose into duodenum increases insulin -> Reactive Hypoglycemia
Hypertonicity of gastric contents get dumped into duodenum, sucking volume/fluid into intestine. Causes large osmotic shift out of vasculature into duodenum
Intravascular Volume depletion

132
Q

Tx for Dumping syndrome?

A

Eat small portions

133
Q

What is diabetic gastroparesis?

A

Autonomic neuropathy -> dysmotility from inability to sense stretch

134
Q

Diabetic pt w/abdominal discomfort, bloating, constipation?

A

Diabetic Gastroparesis

135
Q

Next best step in management pt presents w/gastric paresis?

A

If Dx clear -> Tx with Erythromycin, Metoclopromide

136
Q

Most accurate test gastric paresis?

A

Nuclear gastric emptying study

- Rarely needed

137
Q

What is the MCC of lower GI bleeding?

A

Diverticulosis

138
Q

Upper GI bleeding causes?

A 
Ulcer Dz
Gastritis
Esophagitis
Duodenitis
Cancer
Varices
139
Q

Lower GI bleeding causes?

A 
Diverticulosis 
Angiodysplasia
Polyps
Cancer
Hemorrhoids
IBD
Upper GI bleeding w/rapid transit (hi volume)
140
Q

Most important initial management for GI Bleed?

A 
Assess BP
Orthostasis
> 10 point rise in pulse from lying to standing
OR
BP drop of  > 20 pts when sitting up
141
Q

Si/Sx with Variceal bleeding?

A 
Vomiting blood +/- black stool
Spider Angiomata
Caput Meduse
Splenomegaly
Palmer Erythema
Asterixis
142
Q

GI bleeding - what to check?

A

Fluids - replace PRN
Hct
Platelet count
Coag profile - Pt/INR

143
Q

Why is Nasogastric tube (NG) used in variceal bleeding?

A

Decompresses stomach by clearing out blood to help visualization in endoscopy

144
Q

Black stool, no hematemesis, NG tube shows red blood?

A

Octreotide

Arrange urgent endoscopy for banding

145
Q

Massive, nonresponsive bleeding?

A

Angiography to localize vessel bleed

146
Q

EKG in GI bleeding?

A

Shows ischemia in severe bleeding

147
Q

Tx for GI bleed

A
  1. Fluid replacement (1-2 L/hr) saline or Ringer lactate (acute, severe)
  2. PRBCs if Hct <50,000 AND bleeding
  3. Octreotide for variceal bleed
  4. Endoscopy for Dx/Tx
  5. IV PPI for Upper GI bleeding
  6. Surgery
148
Q

When do we transfuse platelets?

A

Platelets if <10-20,000

149
Q

Tx for esophageal and gastric varices?

A
  1. Octreotide decrease portal pressure
  2. Banding - by endoscopy
  3. TIPS - decrease portal pressure if 1 and 2 fails
  4. Propranolol - prevention
150
Q

If suspect C.diff diarrhea: best initial test and tx?

A

Stool C.diff toxin test
Metronidazole
If no response - switch to oral vancomycin

151
Q

Recurrent C.diff tx?

A

1st episode: Metronidazole oral 10 days
IV only w/pts that can’t tolerate, i.e. adynamic ileus
2nd epi: Vanco oral (taper hi to low) +/- probiotics
3rd epi: Fidoxamycin (Macrolide)
4th epi: Fecal transplant

152
Q

When do we use IV Vancomycin in antibiotic resistant diarrhea?

A

Never. It will not pass bowel wall.

153
Q

How is severe C.diff treated?

A

Severe C.diff =
- WBC >15,000
- Creatinine > 1.5 (Dehydration)
Tx: Oral Vancomycin

154
Q

Malabsorption ass’d with which vitamin deficiencies ? How do they present?

A 
ADEK, B12, B6
D: Hypocalcemia, osteoporosis
E: Hemolytic Anemia
K: Bleeding, easy bruising, elevated PT
B12: Anemia, hypersegmented neutrophils, neuropathy
B6: Sideroblastic Anemia
155
Q

What is celiac dz and how does it present?

A

Gluten insensitivity - malabsorption
Anti-tissue transglutaminase
IgA antigliadin Ab
Antiendomysial Ab

156
Q

What is the best initial test for celiac dz?

A

Anti-tissue transglutaminase - pts w selective IgA deficiency will inhibit the Ab tests

157
Q

How can one differentiate chronic pancreatitis and gluten insensitivity?

A

Celiac = Iron deficiency

Iron needs in tact bowel wall to absorb iron, not pancreatic enzymes

158
Q

What skin disorder ass’d with Celiac?

A

Dermatitis herpetiformis

  • pruritic papules and vesicles on elbows, knees, buttocks, neck, scalp
  • Granular IgA seen on dermal papillae
  • Tx: Dapsone
159
Q

Most accurate test for Celiac?

A

Small Bowel Bx shows flattening of villi

160
Q

What does Whipple Dz present with?

A 
Arthralgias
Ocular findings - opthalmoplegia
Neuro sx's - dementia, seizures
Fever
LA
161
Q

Most accurate test for Whipple dz?

A

Small Bowel Bx shows organism

- also for tropic sprue

162
Q

Most accurate test for chronic pancreatitis?

A

Secretin stimulation test
Place NG tube - unaffected pancreas releases large volume HCO3-rich fluids after IV secretin injection
Pancreatitis - pancreas will not release into duodenum

163
Q

What drugs cause acute pancreatitis?

A 
Valproic acid
Diuretics: loops, HCTZ
IBD: Sulfalazine, 5-ASA
Azothioprine
Didanosine, Pentamidine
Metronidazole, Tetracycline
164
Q

What is the tx for Celiac Dz?

A

Gluten free diet

Avoid wheat, oats, rye, barley

165
Q

What is the tx for Whipple dz?

A

Ceftriaxone, TMP/SMX

Doxycycline

166
Q

Tx for Chronic Pancreatitis?

A

Enzyme replacement

amylase and lipase - 1 pill

167
Q

What is the Tx for tropic Sprue?

A

TMP/SMX

Doxycyline

168
Q

What are the sx’s of carcinoid syndrome?

A 
BFDR
Bronchoconstriction/wheezing
Flushing
Diarrhea
Right sided heart dz - Tricuspid insufficiency, Pulmonary stenosis
Follow eating, exertion, excitement
169
Q

Why do we see flushing in Carcinoid syndrome?

A

Increased serotonin -> Decreased tryptophan -> Decreased Niacin ->

170
Q

What is the best initial test for carcinoid syndrome?

A

Urinary 5-HIAA test

171
Q

What is the tx for carcinoid syndrome?

A

Octreotide

172
Q

What causes carcinoid syndrome? Where are they most often found?

A

Liver mets of carcinoid tumors (hormone producing enterochromaffin cells)
Appendix
Ileum

173
Q

What is tx if carcinoid syndrome is localized tumor?

174
Q

How does lactose Intolerance present?

A

No weight loss
Increased stool osmolality
Oral lactase replacement

175
Q

What are the sx’s of IBS?

A

Pain syndrome
Diarrhea, constipation, or both
No weight loss
Pain relieved w/BM, less at night, relieved by change in bowel habits

176
Q

What is the Tx for IBS?

A
  1. Increase fiber
  2. Antispasmodic agents - Hyosyamine, Dicyclomine
  3. TCAs - anticholingeric = antispasmodic/relaxing bowels
  4. Antimotility agents - Loperamide for diarrhea
  5. Lubiprostone -increases BM frequency
177
Q

How does IBD present?

A 
Diarrhea
Bloody stool
Weight loss
fever
Arthralgias
Uveitis, Iritis
Skin involvement
178
Q

What skin lesions seen in IBD?

A

Erythema nodosum
Pyoderma gangrenosum
- Painful skin lesions; MC lower leg, neutrophilic dermatitis

179
Q

What are sx’s seen in Crohn DZ?

A 
Rectal sparing
Skip lesions
Transmural granulomas (non-caseating) = palpable abd mass
Fistulas
Abscesses 
Masses
Obstruction
Perianal dz
180
Q

What is the MC location of perianal dz in Crohn?

A

Terminal Ileum

Cobblestone colon

181
Q

What oral lesion is seen with Crohn Dz?

A

Apthous Ulcer - painful, shallow ulcers on buccal mucosa

182
Q

What are sx’s seen in Ulcerative Colitis?

A 
Rectal involvement
Entirely mucosal and submucosal
No fistulas, abscesses, obstruction
Crypt Abscesses
Limited to colon
Bloody diarrhea MC than in Crohn's
Pseudopolyps
183
Q

What is primary sclerosing cholangitis ass’d with?

184
Q

When does screening occur with IBD?

A

After 8-10 years of colonic involvement -> colonoscopy every 1-2 years

185
Q

What is the most accurate test for IBD?

186
Q

Where do we see positive P-ANCA?

A 
UC
Primary Sclerosing Cholangitis
Pauci Immune GN
Microscopic Polyangitis
Churg-Strauss
187
Q

Where do we see + ASCA (Antisaccharomyces cerevesiae Ab)?

188
Q

What is the Tx for Crohn’s?

A

Acute exacerbation: Steroids - Budesonide
Chronic: 5-ASA agents: Mesalamine
Pentasa - released in both Upper and lower bowel

189
Q

What is the Tx for UC?

A

Acute exacerbation: Steroids - Budesonide
Chronic: 5-ASA agents: Mesalamine
Asacol
Rowasa

190
Q

What is the Tx for perianal Crohn’s?

A

Cirpo and Metronidazole

191
Q

What is tx for fistulae in Crohn’s?

A

Infliximab

192
Q

When is azathioprine and 6-mercaptopurine used in IBD?

A

To wean pts off steroids

193
Q

What side of colon is bleeding more common?

A

Right - bc of thinner mucosa and more fragile blood vessels

194
Q

What is diverticulosis?

A

Outpocketings of colon

195
Q

Presentation of diverticulosis?

A 
Meat filled diet
>65-70 yoa
Asymptomatic most of the time
LLQ Abdominal pain
Constipation
Bleeding
196
Q

Most accurate test for diverticulosis?

A

Colonosocpy

197
Q

Tx for diverticulosis?

A

Increase dietary fiber = increases radius of colon and decreased intracolonic pressure
Bran, psyllium, methylcellulose

198
Q

What is presentation of diverticulitis?

A

LLQ pain and tenderness
Fever
Leukocytosis

199
Q

Best initial test for diverticulitis?

200
Q

What tests are CI in diverticulitis and why?

A

Colonosocpy
Barium enema
Risk of perforation

201
Q

Tx for diverticulitis?

A 
Abx to cover E.coli and Anaerobes
Cipro and Metronidazole
Amoxicillin/clavulanate
Ticarcillin/clauvulanate
Piperacillin/Tazobactam
202
Q

When is surgery done for diverticulitis?

A

No response to meds
Frequent recurrences
Perforation, fistula, abscess, strictures, obstruction

203
Q

What does free air under diaphragm on upright xray indicate?

A

perforation of colon

204
Q

What are some constipating drugs?

A

Opiates
Anti-cholinergics (TCAs)
CCBs
Iron pills

205
Q

When is capsule endoscopy done?

A

Detect sources of bleeding in small bowel not reachable by endoscopy

206
Q

Who gets colon cancer screening?

A

All patients at age 50, every 10 years = colonoscopy

207
Q

Colon cancer screening with 1 family member?

A

10 years earlier than age family member developed cancer
OR
age 40
whichever is younger

208
Q

HNPCC (Lynch syndrome) is what and when to screen?

A

3 family members
2 generations
1 premature (before 50 yoa)
Screening at 25 with colonoscopy, every 1-2 years

209
Q

Which cancer is ass’d with Lynch syndrome?

A

Endometrial cancer

210
Q

Are hyperplastic polyps precancerous?

211
Q

What is Familial adenomatous polyposis (FAP) and when to screen for colon cancer?

A

Thousands of polyps w/ abnormal genetic test of APC

Start screening with sigmoidscopy at age 12 EVERY year

212
Q

Do we screen pts with a previous single adenomatous polyp?

A

Yes. Pts should have colonoscopy every 3-5 years

213
Q

Screening for pts with previous hx of colon cancer?

A

Colonoscopy at 1 year after resection, 3 years

Then every 5 years

214
Q

What is presentation of Peutz-Jeghers Syndrome?

A

Multiple hamartomatous polyps

Melanotic spots on lips and skin

215
Q

Which cancers are seen in Peutz-Jeghers Syndrome

A

Increased frequency of:
breast cancer
gonadal cancer
pancreatic cancer

216
Q

What is Gardner syndrome?

A

Colon cancer + osteomas
desmoid tumors
Other soft tissue tumors - mandible

217
Q

What is an osteoma?

A

new bone growth under existing bone

typically in skull

218
Q

What is next step in a patient with osteoma found in xray as incidental finding?

A

Colonoscopy

219
Q

What is screening with Peutz-jeghers, Gardner, Turcot, juvenile polyposis of colon cancer?

A

Same as healthy individual

220
Q

What are the most common causes of acute pancreatitis?

A 
Alcohol
Cholelithiasis
Trauma
Hypertriglyceridemia
Hypercalcemia
Infxn
Drugs - allergy, toxicity
221
Q

What is the pathophysiology of pancreatitis?

A

premature activation of trypsinogen into trypsin while in pancreas -> cleaves peptide binds (Lysine, Arginine) ->
Pancreatic self digestion

222
Q

Pt presents w/acute epigastric pain radiating straight to back + tenderness + N/V?

A

Pancreatitis

223
Q

Best initial test in acute pancreatitis?

A

Amylase and Lipase

224
Q

Most accurate test in acute pancreatitis?

225
Q

Epigastric pain that goes to back around the side?

A

Cholecystitis

226
Q

What is the best imaging for acute pancreatitis?

A

Abdominal CT with IV and oral contrast for better definition

227
Q

What does plain xray show with acute pancreatitis?

A

Sentinel loop of bowel

air filled piece of small bowel in LUQ

228
Q

Tx for Acute pancreatitis?

A
  1. NPO
  2. IVF
  3. Analgesia
  4. PPIs
229
Q

Why are PPIs used in acute pancreatitis?

A

To decrease pancreatic stimulation from acid entering duodenum

230
Q

When do we add abx in acute pancreatitis?

A

> 30% necrosis on CT

Imipenem added to decrease mortality

231
Q

What is management for pseudocyst?

A

CT guided percutaneous drainage

232
Q

When does a pseudocyst develop?

A

2-4 weeks post pancreatitis

233
Q

Why do we resect necrotic pancreatitis?

A

To prevent ARDS and death

234
Q

When is ERCP used?

A

Remove obstructing stones
Dilate strictures
Place stents

235
Q

When is imaging not needed in a pancreatitis?

A

When 2+ of following are present

  • Acute epigastric pain radiating to back
  • Elevated amylase/lipase 3X Normal
  • ?
236
Q

Ranson’s Criteria on admission

A 
GALAW
Glucose >200
Age > 55
LDH > 350
AST >250
WBC > 16,000
237
Q

Ransom’s criteria after 48 hours

A 
C HOBBS
Calcium < 8
Hct down by 10%
paO2  4meq/L
BUN up by >5 mg/dL
Sequestered fluid >6L
238
Q

What clotting factors are made in endothelial cells?

A

Factor VIII

VWF

239
Q

What tx for decreasing high TG levels fast?

A

IV Insulin drip b/c insulin inhibits HSL which hydrolyzes TG’s to FFAs
Then d/c pt home w/metformin, fibrates, omega-3

240
Q

When to do paracentesis in ascites patients?

A

New-onset ascites
Abd pain and tenderness
Fever

Gastroenterology (2 decks)

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