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Step III
Step III - GI 4
| Question | Answer |
|---|---|
| Pt >45yo c/o persistent epigastric pain. Next best step | Upper endo (must for pts >45yo to r/o gastric cancer |
| Pt >45yo c/o persistent epigastric pain. Initial management done w/ upper endo which shows non ulcer dyspepsia. Tx | H2(-)/liquid antacid/PPI (dx of exclusion must r/o ulcer, gastric CA, gastritis first via endo) |
| What are the other common causes of PUD after H. pylori | NSAIDs/head trauma/ZE/burns/intubation/Crohns |
| Most accurate test for gastritis caused by H. pylori | Endoscopy + biopsy |
| Tx for gastritis caused by H. pylori | PPI + 2 Antibx (clarithro + amox) |
| What test for H. pylori is very sensitive but not specific | Serology |
| Pt tx for H. pylori gastritis and continues to have symptoms. Next step | Test for H. pylori again |
| Pt tx for H. pylori gastritis and ulcer still present. Next step | Test for H. pylori again |
| When are the only times you should tx H. pylori infection | Gastritis OR peptic ulcer |
| Pt tx for H. pylori gastritis and Rx fails. Repeat testing H. pylori is (+). Next step | PPI + 2 new Antibx (metro + tetra) |
| Under what circumstances would you need to look for ZES (gastrinoma) | Ulcer >1cm, multiple ulcers, recurrent OR persistent despite H. pylori tx, located distally near Ligament of Treitz |
| Evaluation for ZES involves what kind of testing | Gastrin level and gastric acid output |
| What are the two most accurate tests for ZES and which is MOST sensitive | somatostatin scan >> Endoscopic U/S (similar to TEE) |
| Infusing secretin to nL pts has what effect | Gastrin level and gastric acid output decreases |
| Infusing secretin to ZES pts has what effect | Gastrin level shows no change/increase and gastric acid output stays same |
| What is the tx for local ZES | Surgical resection |
| What is the tx for metx ZES | PPIs lifelong |
| If pt has ZES + elevated Ca2+ then dx | MEN |
| How does IBD usually present | fever, ab pain, diarrhea, bloody stool, weight loss |
| What are the extra-intestinal manifestation of IBD | Joint pain, uveitis, sclerosing cholangitis, erythema nodosum, pyoderma gangrenosum |
| Perianal dz, fistula formation, VB12 defx, obstruction, masses and involvement of upper GI is commonly found in which type of IBD | Crohns |
| What type of kidney stone is found in Crohn’s | calcium oxalate |
| What type of gallstones are found in Crohn’s | cholesterol |
| What are calcium levels like in Crohn’s and why | HYPO d/t malabsorption of fat (VitaD) |
| When should screening colonoscopy be done for IBD pts | 8-10 yrs after dx q1-2yrs |
| What are the two diagnostic studies for IBD | Endo + barium |
| If endo and barium are non conclusive for IBD then what else can help | Blood tests |
| Best initial tx for IBD | Mesalamine aka 5-ASA |
| Limitation to 5-ASA | Effective for small bowel only |
| If IBD affects colon then what is the Best initial tx | Sulfasalazine |
| What drug is used to tx acute exacerbations of IBD | Budesonide (steroid) |
| What drug is reserved for severe IBD pts who have recurrence after steroids are stopped | Azathioprine + 6-mercaptopurine |
| What drug is used for Crohn’s dz w/ fistula formation | Infliximab |
| Before giving a pt Infliximab what must be done and why | Test for PPD, if (+) give INH prior to tx w/ infliximab; Infliximab can re-activate dormant TB from granulomas |
| What drug is used for Crohn’s dz w/ perianal involvement | Metro + cipro |
Created by:
DrINFJ
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