Gih Week 1: Lab Tests In Upper Gi Disorders

Front 1

List 3 essential lab tests for Gastrointestinal hemorrhage.

Back 1

1. CBC
2. Comprehensive metabolic profile (CMP)
3. Prothrombin time

Front 2

List 3 clinical scoring systems used to gauge gastrointestinal hemorrhages.

Back 2

1. Glasgow-Blatchford Score
2. AIMS-65
3. Rockall score

Front 3

Which scoring system is best for assessing need for intervention of gastrointestinal hemorrhages?

Back 3

Glasgow-Blatchford score

Front 4

Which scoring system is best for outcome prediction of gastrointestinal hemorrhages?

Back 4

Rockall Score

Front 5

What does AIMS-65 measure and which GI disorder is it used for?

Back 5

Albumin
INR (Prothrombin time)
Mental status change
Systolic blood pressure
65 years or older

*Used for GI hemorrhages to evaluate need for intervention and likelihood of outcome

Scored w/ 1 point for each present factor
(0-1 = low risk of need for intervention and likelihood of good outcome)

Front 6

What Rockall score indicates a good prognosis of GI hemorrhage?

What score indicates a high risk of mortality?

Back 6

< 3 = good prognosis

>8 = high risk mortality

Front 7

What scoring system is used to measure severity of disease in adult patients in the ICU?

Back 7

APACHE II Score
(Acute Physiology and Chronic Health Evaluation Score)

Front 8

What must be done if a patient is tested positively for H.pylori?

Back 8

Must treat and demonstrate eradication

Front 9

What should be the initial approach to diagnosing H.pylori?

Back 9

Serology (ELISA, C13 bicarbonate assay)

*Most cost-effective approach

(Then confirm positive result with a different method)

Front 10

What is the best testing choice to demonstrate eradication of H.pylori?

Back 10

Urea breath test
(alternative = stool antigen assay, but less accurate than UBT)

Front 11

Does a urea breath test (UBT) have a high or low sensitivity and specificity?

Back 11

High sensitivity
High specificity

Front 12

Which test is only done in clinical context to demonstrate acid production in patients with elevated serum gastrin levels?

This test helps differentiate between which two conditions?

Back 12

Clinical gastric function test
*Differentiates between achlorhydria (absence of gastric acid) from Zollinger-Ellison syndrome

Front 13

Is pancreatic function testing primary used to test endocrine or exocrine function?

What patients is this test most useful for?

Back 13

Exocrine function

Used in children with cystic fibrosis and other congenital disease

(sparingly used in adult clinical practice)

Front 14

What test can be useful as a tool to evaluate the etiology of steatorrhea?

Back 14

Fecal fat concentrations

Concentrations are higher in patients w/ fat maldigestion problems than those with malabsorption problems

>9.5% = fat maldigestion
<9.5% = fat malabsorption

Front 15

Which enzyme is determined in endoscopic fluid collections taken for a pancreatic function test?

Back 15

Lipase

Front 16

Which enzymes can be measured indirectly (in serum or fecal matter) to test pancreatic function?

Back 16

Serum trypsinogen
Fecal elastase-1
Fecal chymotrypsin

Front 17

Is pancreatic function testing sensitive in mild disease?

Back 17

No.

Front 18

Are amylase and lipase levels useful for predicting the outcome or severity of acute pancreatitis?

Back 18

No.

Front 19

What labs should be run to predict severity of acute pancreatitis?

Back 19

1. Hematocrit
2. C-reactive protein
3. BUN (blood urea nitrogen) increase
4. Creatinine

Front 20

What criteria can be used to predict risk of mortality in acute pancreatitis?

Back 20

Ransom criteria

1-3 = mild pancreatitis
>4 = high risk of mortality

Front 21

Is high serum amylase a specific finding for acute pancreatitis?

Back 21

No, high serum amylase levels are present in many other disorders/diseases

Front 22

Is high serum lipase a fairly specific finding for acute pancreatitis?

Back 22

Yes
(more specific than amylase)

It is also fairly sensitive -- 85-100% sensitivity

Front 23

Does combining serum amylase and lipase findings improve diagnostic accuracy of acute pancreatitis?

Back 23

NO.

Front 24

List 3 antibodies associated with Celiac disease.

Back 24

1. Anti-EMA (anti-endomysial antibodies)
2. Anti-gliadin antibodies
3. Anti-tTG/ Anti-tTG-gliadin antibodies

Front 25

Which antibody has the highest sensitivity and specificity for Celiac diease?

Back 25

anti-tTG-IgA

Front 26

How are tumor markers measured?

Is this a good screening tool for GI tumors?

Back 26

Markers are measured in the serum
(markers are proteins that are found at greater concentrations in tumor cells than in normal cells)

*Not a good screening tool, but useful in diagnosis and therapy

Front 27

CEA (Carcinoembryonic antigen) is associated with what type of cancer?

What is the best use of measuring CEA?

Back 27

Colon cancer
(CEA is a tumor marker, but not all cancers produce CEA so it is not useful for screening)

*Best used for monitoring therapy and detecting recurrence in patients with pre-treatment elevations.

Front 28

Is CEA (Carcinoembryonic antigen) better for detecting distant metastases or local recurrences of colon cancer?

Back 28

Distant metastases

Front 29

What tumor marker is elevated in pancreatico-biliary malignancies?

Is this marker highly specific or sensitive?

Back 29

CA 19-9

Highly specific
Variable sensitivity

*Used to monitor therapy and recurrence

Front 30

What tumor marker is sometimes used in gastric cancer?

Back 30

CA 67-4

Front 31

What tumor marker is sometimes measured in ovarian cancer?

Back 31

CA 125

Front 32

What tumor marker is sometimes measured in hepatoma?

Back 32

Alpha fetoprotein