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146 Cards in this Set
- Front
- Back
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Soes smoking increase the risk of crohn's disease or colitis?
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Crohn's
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Which is more common in former smokers or current smokers - crohn's or colitis?
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colitis
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What do most patients with gastric and duodenal ulcers have?
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Helicobacter pylori
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What should you think of when you see a patient with Hep C and new hepatic mass with vascular enhancement?
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hepatocellular carcinoma
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What kind of diet should patients with gastroparesis be started on?
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small, frequent feedings of a diet low in fiber, fat, and refined sugar
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What disease should be suspected in a patient with malabsorption, autoimmune disease (thyroid) and anemia with an increased red cell distribution width?
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Celiac sprue (macrocytosis and microcytosis seen with folate and iron deficiency, respectively)
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What is is the definitive test to confirm or exclude a diagnosis of celiac sprue?
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Upper endoscopy with small bowel biopsies
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What type of immunoglobin deficiency do patients with celiac sprue have?
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IgA deficiency
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Patient presents with fatigue, xanthomas and elevated serum alkaline phosphatase. What is the suspect diagnosis?
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primary biliary cirrhosis
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What should be tested if you suspect primary biliary cirrhosis?
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antimitochondrial antibody assay (titers 1:40 or more)
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What are poor prognostic infindings in patients with pancreatitis?
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- marked volume depletion
- elevated glucose - Elevated aspartate aminotransferase - Elevated lactate dehydrogenase levels |
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How often should patients with pancolitis for 10 or more years receive a colonoscopy ?
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every 1 to 2 years
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60 yo complains of difficulty swallowing solids & liquids and chokes when eating and has nasal regurgitation. What is the diagnosis? What diagnostic study should be performed?
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- oropharyngeal dysphagia
- Videofluoroscopy swallow |
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What diagnosis should be considered in a patient with gastrointestinal bleeding, fever, abdominal pain, and leukocytosis if they have a history of abdominal prosthetic vascular graft?
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aortoenteric fistula
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What is the initial diagnostic study for evaluation of a possible aortoenteric fistula? and what would be done next if normal?
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- Upper endoscopy
- CT scan of abdomen |
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How do patients with cholangitis present?
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- Fever
- Jaundice, and - Altered mental status ** Don't always have abdominal pain** |
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How should cholangitis be treated?
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ERCP (to document choledocholiithiasis & perform therapy if needed) & antibiotics
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What is the most sensitive test for diagnosing an insulinoma of the pancreas?
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Endoscopic ultrasound (especially after a negative CT scan)
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How should patients with chronic ulcerative colitis and dysplasia of any grade be managed?
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- Referred for colectomy
There is usually concurrent adenocarcinoma or progression to high-grade dysplasia and cancer in up to 24% of patients |
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Which patients with nonaclcoholic fatty liver disease should undergo liver biopsy?
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- age > 45
- diabetic - obese - AS: ALT > 1 |
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What will liver biopsy help determine in patients with nonalcoholic fatty liver?
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NASH or fibrosis.
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Besides DM, obesity, glucose intolerance, what else is associated with NASH?
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- extensive resection or bypass of the small intestines
- medications: tamoxifen, estrogen, amiodraone & corticosteroids |
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Which hypoglycemic agents should be considered for patients with NASH and features of the metabolic syndrome?
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pioglitazone and rosiglitazone
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What type of nutrition will patients with short bowel syndrome associated with <115 cm of small intestine in the absence of a colon most likely require?
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total parenteral nutrition
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What should be given to patients with short bowel syndrome and high stomal output?
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proton pump inhibitor or an H2-receptor antagonist to decrease gastric secretions and output
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Can oral contraceptive agents cause cholestasis and conjugated (direct) hyperbilirubinemia?
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YES
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What is tenesmus? What does it's presence indicate?
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- a sensation of incomplete evacuation of the bowels
- indicates the presence of proctitis |
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What organism should be considered a cause of proctitis in sexually active patients?
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Neisseria gonorrhoeae, transmitted via anal sex
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What affects the accuracy of the amylase assay and may cause false-negative results in patients with pancreatitis?
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hypertriglyceridemia
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Who is at increased risk for development of small bowel bacterial overgrowth?
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diabetic patients with peripheral neuropathy
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Secondary lactose intolerance is seen in which other condition?
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small bowel bacterial overgrowth
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Is empiric trial of a gluten-free diet justified in the absence of a definitive diagnosis of celiac sprue?
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NEVER
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When is ERCP indicated preoperatively?
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- When a patient is likely to have common bile duct stones that can be removed by therapeutic ERCP.
- when liver chemistry values greater than twice the upper limit of normal (including serum total bilirubin >3 mg/dL) associated with common bile duct dilatation or jaundice |
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Which antidepressants are effective against noncardiac chest pain (visceral hypersensitivity)?
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amitriptyline and trazodone
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What should be tested in patinets with possible autoimmune hepatitis?
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Antinuclear antibody and anti–smooth muscle antibody
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What is a reasonable first test for searching for a gastrinoma?
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Helical CT
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When should patients with diverticulosis be referred for surgical resection?
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When they have had two or more episodes of diverticulitis
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How should a young patient with a first episode of nonulcer dyspepsia and a negative serologic test for Helicobacter pylori be treated?
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empiric trial of acid-suppressive therapy with a proton pump inhibitor
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What could cause chronic intestinal pseudo-obstruction?
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- neuropathic disorder (paraneoplastic syndrome) or
- a myopathic condition secondary to smooth muscle disease (e.g., amyloidosis or systemic sclerosis |
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How is the diagnosis of sclerosing cholangitis confirmed?
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ERCP
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A patient with longstanding ulcerative colitis and abnormal liver chemistry tests is at risk for developing what disease?
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primary sclerosing cholangitis
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What is the initial management of cholecystitis?
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pain control and broad-spectrum antibiotics plus surgical consultation for elective cholecystectomy
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What generally cause rectal outlet bleeding and pain with defecation?
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anal fissure
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What type of bleeding do you see with diverticula?
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significant acute hematochezia that often stops spontaneously
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Which is hemorrhoidal bleeding is most often associated with - painful or painless defecation?
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painless
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How is Nutcracker esophagus characterized?
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high-amplitude peristaltic waves on esophageal manometry
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What condition is nutcracker esophagus associated with?
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GERD - test with pH monitoring or upper endoscopy
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When should a person who has a first-degree relative with colorectal cancer initially undergo colorectal cancer screening?
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10 years before the age of diagnosis of the affected relative or at age 40 years, whichever comes first.
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How should patients with pain from chronic pancreatic be treated?
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With narcotics
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During pregnancy, what GI clincial findings can be seen?
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- spider angiomata
- palmar erythema - elevated alk phos |
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What should be the initial treatment for patients with ulcerative proctosigmoiditis?
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mesalamine enema
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What signs and symptoms can be seen with peptic ulcer disease?
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- weight loss
- nausea - mild anemia - gnawing epigastric pain - improvement after meals and antacids |
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What are pulmonary infiltrates, hepatomegaly, and a high alkaline phosphatase value highly indicative of?
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hepatic sarcoidosis
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Patient presents with hepatomegaly, cholestasis and nephrotic syndrome or neuropathy. What is the diagnosis?
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amyloidosis
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Recurrent attacks of pancreatitis in a postcholecystectomy patient are most often caused by what?
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sphincter of Oddi dysfunction or pancreas divisum
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What is a frequent cause of self-limited, relatively painless hematochezia in elderly patients?
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Ischemic colitis - only endoscopic evaluation needed
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Which patients with Hepatitis C may not be candidates for treatment?
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elderly with other comorbid conditions
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A young person presents with hematochezia with previously negative workup. What diagnostic study should be done next?
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Meckel's scan (radionuclide scan)
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In elderly patients that likely have angiectasias, what diagnostic study is sometimes helpful?
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externder upper endoscopy
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What is the most common benign liver tumor that causes bleeding?
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hepatic adenoma
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What is the recommended treatment for hepatic adenomas and why?
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resection because of their potential to become malignant and their risk of bleeding
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Where are Cameron's erosions usually found?
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in patients with large hiatal hernias and iron deficiency anemia
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In patients with Barrett's esophagus, what are the recommendations for monitoring?
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- Repeat endoscopy with biopsies to exclude dysplasia followed by surveillance endoscopy with esophageal biopsies every 3 years
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What value will you get for stool osmotic gap if caused by osmotic diarrhea?
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> 125 (stool osm - 2 (Na + K))
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What causes abnormally low stool osmolality (< 250 osm/kg)?
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tampering with stool sample by adding water or urine
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How is secretory diarrhea caused by carcinoid diagnosed?
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24-hour urine collection for 5-hydroxyindoleacetic acid (5-HIAA
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What are the only liver lesions that are estrogen-dependent?
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hepatic adenomas
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What should patients who have diarrhea associated with fever, abdominal pain, and leukocytosis be evaluated for?
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the presence of an invasive or inflammatory bowel disease.
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What are the definitive studies for diagnosing the cause of invasive or inflammatory diarrhea?
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flexible sigmoidoscopy or colonoscopy to visualize and biospy the mucosa
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What laboratory abnormalities can be seen with muscle injury?
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Marked elevations in serum aspartate aminotransferase and alanine aminotransferase (AST normalizes more quickly)
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What is the most common cause of liver abscesses?
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cholangitis
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How long do patients with liver abscesses usually require antibiotics for?
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2-4 weeks
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How do patients with GI amyloidosis present?
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diarrhea and bleeding
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What are some of the clinical features of amyloidosis?
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- Orthostatic hypotension
- Ecchymoses - Macroglossia - A history of monoclonal gammopathy of undetermined significance |
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Patients with primary sclerosing cholangitis are at increased risk for developing which malignancy?
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Cholangiocarcinoma (10-30% lifetime risk)
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How is eosinophilic esophagitis treated?
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- elemental diet and
- either oral or topical corticosteroids |
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What is disorder is eosinophilic esophagitis associated with?
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atopic disorders
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How do patients with eosinophilic esophagitis usually present?
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solid-food dysphagia and a history of food impactions
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How should a patient with AIDS cholangiopathy associated with extrahepatic bile duct obstruction be treated?
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ERCP
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What infections is AIDS cholongiopathy usually associated with?
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Cryptosporidium or cytomegalovirus
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What should be a patient with recurrent gastrointestinal infections (especially giardiasis) and respiratory infections?
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Common variable immunodeficiency
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How do you establish the diagnosis of common variable immunodeficiency?
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low levels of IgG
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What is the initial treatment for patients with achalasia?
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pneumatic dilation of the distal esophagus
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What may patients with achalasia who do not respond to pneumatic dilation require?
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myotomy
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Who should receive a nonselective β-blocker for prophylaxis against variceal bleeding?
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patients with large esophageal varices
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How do you treat H. pylori?
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Triple therapy including a proton pump inhibitor with clarithromycin and either amoxicillin or metronidazole for 10-14 days
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How do patients with hereditary hemochromatosis present?
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arthropathy (2nd & 3rd MCP), fatigue, impotence, and liver test abnormalities.
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What is the most appropriate initial diagnostic study for a patient with suspected hereditary hemochromatosis?
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determination of transferrin saturation. If > 45%, should do additional testing
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What may be effective for treating patients with nonulcer dyspepsia?
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antidepressant (ex. trazadone). Esp if no regurgitation, normal EGD
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What is the most appropriate study for a patient with possible Crohn's disease but with a normal colonoscopic examination?
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CT enterography
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When should followup colonoscopy be performed in a patient with one or two small (< 1cm) polyps & low-risk features?
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5 years
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When should follow-up colonoscopy be performed in patients with three or more adenomatous polyps, large polyps (>1 cm), or polyps with villous histologic findings (including tubulovillous polyps)?
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3 yrs
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How should patients with chronic hepatitis B with cirrhosis be treated?
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entecavir or lamivudine or adefovir
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Who should receive prophylaxis against spontaneous bacterial peritonitis? What should they receive?
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Patients with cirrhosis and gastrointestinal bleeding, a history of spontaneous bacterial peritonitis; and an ascitic fluid protein concentration <1 g/dL (<10 g/L).
- Norfloxacin for 7 days |
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What is the most common type of non-neoplastic polyp found in the stomach?
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fundic gland polyp
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Is endoscopic surveillance required for fundic gland polyp?
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NO
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How much pancreatic enzyme supplements should be taken for chronic pancreatitis and how should they be spaced out?
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- 30,000 units of lipase with each meal
- before, during and after meals |
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What medications provide effective maintenance therapy following a corticosteroid-induced remission in patients with ulcerative colitis?
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azathioprine or 6-mercaptopurine
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What provides the only chance for cure in a patient with gastric cancer?
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early detection and surgical resection
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What is new-onset obstructive jaundice in an elderly patient most often due to? How should it be managed?
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- pancreatic or biliary tract carcinoma
- Begin with ERCP |
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With cirrhosis, what do you expect to see in regards to ascitic fluid protein and SAAG?
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Ascitic fluid protein of <2.5 g/dL (<25 g/L) and a SAAG of >1.1 g/dL (>11 g/L)
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With peritoneal carcinomatosis, what do you expect to see in regards to ascitic fluid protein and SAAG?
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low gradient < 1.1 g/dL and high protein ascitic fluid > 2.5 g/dL
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With Budd-Chiari syndrome & cardiomyopathy, what do you expect to see in regards to ascitic fluid protein and SAAG?
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high-gradient (> 1.1 g/dL and high-protein ascitic fluid >2.5 g/dL
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Elderly patients with achalasia should undergo what type of study? Why?
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upper endoscopy to rule out pseudoachalasia (caused by tumor or paraneoplastic disorder)
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What should you suspect if a pregnant or immunosuppressed patient presents with , serum aminotransferase values >5000 U/L, +/- skin lesions?
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herpes hepatitis, treat with acyclovir
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When does radiation colitis usually occur and how does it present? What is usually seen on endoscopy?
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- 9 mo - 4 yrs after radiation
- tenesmus, diarrhea, and hematochezia - friable colonic mucosa and telangiectasias |
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What is the drug of choice for treating a Crohn's disease flare that is limited to the ileum?
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budesonide
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What should you think of when you see “string of beads” pattern in the biliary tree on ERCP or MRCP?
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Primary sclerosing cholangitis
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What other disease is primary sclerosing cholangitis associated with?
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ulcerative colitis
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Patient found to have elevated serum alkaline phosphatase value on routine testing. What should you suspect & how can you confirm diagnosis?
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- Primary sclerosing cholangitis
- ERCP |
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How should patients with collagenous colitis be treated?
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- Loperamide, diphenoxylate and bismuth subsalicylate initially
-choestyramine or 5-ASA - or budesonide (high recurrence rates when DC'd) |
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What should be considered in patients with microscopic colitis that is refractory to therapy?
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coexisting celiac sprue
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What is the most sensitive and specific noninvasive study for documenting active Helicobacter pylori infection?
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14C-urea breath test
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When is a hydrogen breath test used?
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To document bacterial overgrowth
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What is he first step in evaluating a patient with recurrent nausea?
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rule out common systemic disorders such as thyroid disease, diabetes mellitus, and electrolyte abnormalities
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Patient presents with recurrent nausea and vomiting after recent viral illness. What should be suspected and how do you treat?
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- Idiopathic gastroparesis
- empiric trial of metoclopramide |
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What are the most common symptoms of paraesophageal hernia?
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fullness, pain, and vomiting
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What is the recommended treatment for a symptomatic paraesophageal hernia?
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urgent repair of the hernia
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What may patients with long-term H. pylori infection develop?
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chronic antral gastritis, atrophic gastritis, and intestinal metaplasia, which in turn can lead to the development of gastric cancer of the “intestinal type”
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What must be monitored in patients with celiac sprue?
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Vitamin D and calcium levels because of their increased risk for osteoporosis or osteomalacia
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What are patients with longstanding celiac sprue at risk for?
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small bowel lymphoma
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What is the most appropriate treatment for primary biliary cirrhosis?
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ursodeoxycholic acid
(improves pruritis, abnormal liver chemistry and decreases progression to cirrhosis) |
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What findings favor the diagnosis of primary biliary cirrhosis?
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- Pruritis
- Hypercholesterolemia - Positive antimitochondrial antibody - Liver chemistry studies indicating cholestatic liver disease |
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What is used to treat autoimmune hepatitis?
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Prednisone (for antinuclear antibody titer ≥1:80 and a γ-globulin level ≥1.5 times the upper limit of normal)
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What is the overall risk of maternal–fetal transmission of hepatitis C?
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5%
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What should be done to determine the occurrence of maternal–fetal transmission of hepatitis C?
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Check the newborn for HCV RNA at 2 to 6 months of age.
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Should pegylated interferon and ribavirin be given to a pregnant patient?
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No, it is teratogenic
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How is bile leak diagnosed and treated?
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- ERCP
- stent |
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What should be suspected in a patient with a hypervascular hepatic mass, cirrhosis and a high serum α-fetoprotein level?
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hepatocellular carcinoma
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When is the evaluation for liver transplantation indicated in a patient with advanced liver disease?
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When there is one lesion of hepatocellular carcinoma measuring <5 cm or up to three lesions with the largest measuring <3 cm
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What is the preferred initial test in a patient with possible gastric outlet obstruction?
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upper endoscopy
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What should be considered in a patient with severe iron deficiency anemia associated with Cameron's erosions who cannot tolerate oral iron therapy?
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Fundoplication
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When should a patient who has undergone resection for colorectal cancer undergo surveillance colonoscopy?
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3 years post op (majority of recurrent colorectal cancers occur within the first 2 years postoperatively)
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What should be considered in a young patient with abnormal liver chemistry studies, cognitive changes, and hemolysis?
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Wilson's disease
(usually have normal alkaline phosphatase) |
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What is indicative of Wilson's disease?
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A low serum ceruloplasmin value (<20 mg/dL)
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Why do patients with Wilson's disease have congnitive changes?
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Copper deposition in the basal ganglia
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What is helpful in the diagnosis of autoimmune hepatitis?
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Measurement of antinuclear antibody and serum γ-globulin
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How is diverticulitis treated?
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fluoroquinolone plus either metronidazole or amoxicillin/clavulanate
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When should erythromycin be considered in patients with gastroparesis?
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when they cannot tolerate metoclopramide
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What are the side effects of metoclopramide?
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confusion, lethargy, and extrapyramidal side effects
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What is the most common pancreatic cystic neoplasm?
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Mucinous cystadenoma/carcinoma
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How should pancreatic cysts in a patient with no history of pancreatitis be treated?
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surgical resection because of high malignancy potential
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How is dumping syndrome characterized?
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- nausea
- abdominal pain and distention - lightheadedness - diaphoresis. |
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How should patients with dumping syndrome be treated?
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diet consisting of six small meals daily
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Patient comes in with GI bleed and upper endoscopy shows a pigmented spot in the gastric cardia. What is the diagnosis?
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Dieulafoy's lesion
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What may patients with with chronic hemolysis develop?
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iron overload (evidenced by splenomegaly, anemia, and disproportionate elevation of the serum total to direct bilirubin level)
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