UWORLD GI

Question 1

Tx pregnancy and gallstones

Answer 1

Asymptomatic: no treatment.
pregnancy-related gallstones resolve spontaneously within 2 months of delivery.

Symptomatic treated with IV fluids and pain control. if persistent: cholecystectomy during the second trimester.

Question 2

Anal Abscess Sxs

Answer 2

severe, constant pain
fever or malaise.

PE: Erythematous, indurated skin or a fluctuant mass over the perianal or ischiorectal space.possibly Purulent drainage

Question 3

Anal Abscess Tx

Answer 3

Most important: prompt incision and drainage (I&D) of the abscess

Oral antibiotics for pt with DMs, immunosuppression, extensive cellulitis, or valvular heart disease. Abx after I&D

Admit not necessary for localized infection

Question 4

Anal abscess vs fistula

Answer 4

Anal abscess is an infection within one or more of the anal spaces

Anal fistula is a tunneling between the anus or rectum and another epithelial lined space (eg, the skin overlying the drainage site).

Question 5

Anal fistula SXS and Tx

Answer 5

Typically present with an anal abscess that persists or with a pustule-like lesion in the perianal or ischiorectal area that continually drains.

Surgical repair is usually necessary to eliminate the fistula while preserving fecal continence.

Question 6

GERD vs H. Pylori infection

Answer 6

Helicobacter pylori presentas as dyspepsia ( epigastric burning and symptoms of bloating, nausea, or early satiety)

GERD- substernal burning and regurgitation, sour taste

Question 7

Drug induced pancreatitis

“Daily” drugs

Answer 7

Antihypertensive: thiazides, furosemide, enalapril, losartan

Antiepileptic: valproate acids, carbamazepine

Immunosuppressants: azathioprine, mercaptopurine, corticosteroids

Question 8

Drug Induced Pancreatitis

“Occasional/ event” drugs

Answer 8

Antibiotics: Isoniazid, Tetracyclins, metronidazole, TMP-SMX

Antivirals: lamivudine, didanosine

Analgesics: NSAID, Acetaminophen, Pilates, mesalamine, sulfasalazine

Question 9

Mechanism of Drug induced pancreatitis

Answer 9

-Hypersensitivity sulfonamide
-Ischemia due to decreases intravascular volume
-Increased viscosity of pancreatic secretions

Question 10

White by baccal lesions that can be scrapped of leaving hyperremic spots

Answer 10

Oral thrush.

Plaques can be removed (even if difficult)

Residual area of inflammation normal after plaque removal

Question 11

Small Flat Cherry-red Lesions in the colon

Answer 11

Angiodysplasia (vascular ecstasies or AV malformations)

Vascular anomalies composed of multiple aberrant blood located in GI tract. Frequent cause of occult bleeding.

Pathogenesis: chronic occlusion of submucosal veins- congestions- AV collaterals

Question 12

Bleeding GI angiodysplasia associated with?

Answer 12

Small percent bleed. ^ bleeding associated with:
-ESRD
-Aortic stenosis
- Von Willebrand

Question 13

Chronic Diarrhea MCC

Answer 13

IBS, IBD
Chronic Infection
Malabsorption Syndrome

Question 14

Evaluation of Chronic Diarrhea

Answer 14

Complete Hx of Sxs

Routine Lab Tests
Electrolytes
Stool Analysis
Microscopic Stool examination (leukocytes, parasites, occult blood,pH, fat)
Stool Osmotic gap

Question 15

Stool findings in celiacs

Answer 15

Increased stool osmotic gap
Micro cystic anemia, iron deficiency
Villous atrophy

Question 16

Lactose intolerance stool findings

Answer 16

Diarrhea after lactose

Increased stool osmotic gap
Decreased stool pH
+ lactose hydrogen breath test

Question 17

Collagenous Colitis

Answer 17

Chronic watery diarrhea associated with fecal urgency and nocturnal diarrhea

Secretory diarrhea (decreased stool osmotic gap)

Thick subepithelial collagen band

Question 18

Further Management of celiacs (in addition initial tx: diet)

Answer 18

Monitor: iron, folate, calcium, and other vitamins (A, D, E, B12) monitored.

DXA scan to evaluate for bone loss (due to vitamin D deficiency)

pneumococcal vaccine due to associated hyposplenism.

Question 19

Eosinophilia Esophagitis
pathogenesis

Answer 19

Th2- mediated inflammatory response triggered by food antigen exposure

Conor bid atopic disease (asthma, eczema, food allergies)

Question 20

Eosinophilia esophagitis Sxs and Dx

Answer 20

Dysphasia
Heartburn & epigastric pain
Regurgitation
Food impaction

Dx: endoscopy and biopsy (eosinophils >15)

Question 21

Eosinophilic esophagitis Tx

Answer 21

Elimination diet (primary)
PPI
Topical glucocorticoids

Question 22

Risk factors infantile hypertrophic pyloric stenosis

Answer 22

Firstborn Male
Macrolide antibiotic exposure (< 2 weeks age)

Question 23

Infantile hypertrophic pyloric stenosis Tx

Answer 23

IV Fluids
Surgical Pyloromyotomy

Question 24

Infantile hypertrophic pyloric stenosis Sxs

Answer 24

Age 3-6 weeks

Projectile nonbilious emesis (immediate)
Hungry VOmiter
Visible peristalsis
Dehydration

Hypochloremic Hypokalemic metabolic alkalosis
Indirect hyperbilirubinemia

Question 25

Initial studies of suspected esophageal mural injury

Answer 25

Malloy Weiss: UpperGI endoscopy

Boerhaave: CXR (pneumothorax, pneumomediastinum, pleural effusion). CT water soluble contrast

Question 26

Mallory Weiss vs Boerhaave

Answer 26

bothe present with hematemisis.

Boerhaave: fever, chest pain, mediastinitis, pleural effusion, hemodynamic instability

Question 27

Complications of untreated celiac disease

Answer 27

At risk for Entropy they associated T cell Lymphoma.

Poor prognosis due to late presentation: 10 months

Question 28

Sxs of Enteropathy associciated T-cell Lymphoma

Answer 28

(Aggressive hematologist malignancy that affects the jejunum)

And Pain
B Symptoms
Bowel obstruction/ perforation
GI bleed

Question 29

pathogenesis of intussuscption

Answer 29

MCC: involves hyperplasia of intestinal lymphoid follicles (Peyer patches) in the ileocecal region following viral infection in children age 6 months to 3 years;

intussusception due to a pathologic lead point (eg, Meckel diverticulum)

Question 30

clinical findings in intussusception

Answer 30

1. Sudden, intermittent abdominal pain & vomiting
2. Sausage-shaped mass in right abdomen
3. Currant jelly stools
4. Lethargy or altered mental status

Question 31

next step in management of intussusception

Answer 31

1. Classic presentation: Air or water-soluble both diagnostic and therapeutic.
2. Atypical presentation (eg, lethargy alone): Ultrasonography is the diagnostic reveals a target sign. An enema can be performed once the diagnosis is confirmed.

Question 32

colon cancer screening with family

Answer 32

Colonoscopy at age 40 (or 10 years prior to age of diagnosis in FDR, whichever comes first)Repeat every 5 years (every 10 years if FDR diagnosed at age >60)