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54 Cards in this Set
- Front
- Back
When is further evaluation with endoscopy required or GERD warning signs?
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Symptoms of weight loss, dysphagia, odynophagia, bleeding, or anemia and in men with long-standing symptoms (>5 years) or refractory to acid-suppression therapy.
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Bleeding rate required for angiography. |
>1 mL/min |
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Bleeding rate detected by nuclear scintigraphy. |
0.1 to 0.5 mL/min
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Endoscopy should not be delayed for anticoagulation reversal unless the INR is: |
>3.0
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Surveillance endoscopy if Barrett's is identified: |
-Endoscopy with multiple biopsies at diagnosis and at 1 year; if no dysplasia found, defer next surveillance for 3 years |
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Most common cause of acute mesenteric ischemia? |
Embolus to superior mesenteric artery from left atrium or ventricular mural thrombus. |
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Second most common cause of acute mesenteric ischemia: |
nonocclusive mesenteric ischemia due to cardiovascular event (s.a. hypotension post MI) |
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When to repeat colonoscopy in patients with 3-10 adenomas on initial colonoscopy? |
in 3 years
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When to repeat colonoscopy in patients with 1 or 2 small (<1cm) tubular adenomas, with low-grade dysplasia? |
in 5 years
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When to repeat colonoscopy in patients with small rectal hyperplastic polyps? |
in 10 years
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Treatment of eosinophilic esophagitis: |
The first step in treatment of suspected eosinophilic esophagitis is exclusion of GERD by an ambulatory pH study (to detect excessive esophageal acid exposure) or a 6-week therapeutic trial of a high-dose PPI |
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Medications that cause pill-induced esophagitis |
-Tetracycline -Iron sulfate -Bisphosphonates -Potassium -NSAIDs -Quinidine |
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What is lubiprostone? |
C2 chloride channel activator that causes secretion of salt water into the intestine and may improve colonic motility - for constipation-predominant IBS |
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NOTE: If CT and MRI radiologic criteria are typical of hepatocellular cellular carcinoma, a |
Biopsy is NOT necessary and the lesion should be treated as HCC. |
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Clinical features of thiamine deficiency manifesting as Wernicke encephalopathy |
-Nystagmus -Ophthalmoplegia -Ataxia -Confusion |
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Formula for stool osmotic gap |
290 - 2(stool Na + stool K): >100 indicates osmotic diarrhea, most commonly lactose intolerance |
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Preferred diagnostic test for acute cholangitis |
ERCP |
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Indications for ERCP: |
ERCP should be performed ONLY if a patient with gallstone pancreatitis has worsening liver chemistry tests in the setting of clinical instability or has documented ascending cholangitis. |
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Maddrey Score for severe alcoholic hepatitis |
>/= 32 |
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Drug of choice in severe ETOH hepatitis with contraindications to steroids (s.a. bleeding) |
pentoxyfilline
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Definitive therapy for acute acalculous cholecystitis? |
cholecystectomy OR percutaneous drainage if surgery not possible |
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Fusiform dilatation of the common bile duct in the absence of obstruction or stones |
Type 1 biliary cyst |
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Octreotide inhibits the hormone secretion of these tumors by binding to somatostatin receptors: |
1. Carcinoid 2. Insulinomas 3. Gastrinomas |
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Most reliable routine laboratory test to predict mortality in acute pancreatitis? |
Serial BUN measurements |
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Causes of erythema nodosum (EN) fall into 3 broad categories |
-Infections -Drugs, and -Systemic diseases (ulcerative colitis or sarcoidosis). |
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Treatment of large varices |
offer beta blocker vs ligation (if BB contraindicated) |
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What is chronic HBV infection in the immune-tolerant state? |
High circulating viral level in the absence of markers of liver inflammation - no pharmacologic treatment, just monitor LFTs |
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Rome III criteria for IBS: |
Recurrent abdominal pain or discomfort 3 days/month in last 3 months associated with 2 or more of: -(1) improvement with defecation, -(2) onset associated with a change in frequency of stool, and -(3) onset associated with a change in form of stool |
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GI antispasmodic agents: |
-Dicyclomine (Bentyl) -Hyoscyamine (Levsin) -Possibly peppermint oil |
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Extrahepatic manifestations of chronic HCV infection: |
-Hematologic conditions (mixed cryoglobulinemia, lymphoma) -Skin diseases -Autoimmune diseases (thyroiditis) -Kidney disease |
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How to interpret SAAG? |
SAAG: >1.1 indicates portal hypertension; <1.1 other causes;
Heart failure causes SAAG >1.1 and total ascitic protein >2.5 |
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Post colorectal cancer surveillance with colonoscopy |
1 year |
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Treatment of primary billiary cirrhosis (PBC) |
Ursodeoxycholic acid (Actigall) |
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Diagnosis of primary billiary cirrhosis is confirmed by: |
-Cholestatic profile (alkaline phosphatase >1.5x upper limits of normal; -Increases in ALT AST < 5 x upper limits of normal -Positive serum antimitochondrial antibody titer >1:40 |
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Condition characterized by effortless regurgitation of undigested food and reswallowing of the contents? |
Rumination syndrome |
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Treatment for rumination syndrome? |
Postprandial diaphragmatic breathing exercises |
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Initial diagnostic test for Budd Chiari syndrome |
Ultrasound |
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Initial treatment of mod to severe Crohn's disease: |
anti-TNF infliximab (Remicade) |
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The syndrom with arterial hypoxemia from pulmonary vascular dilatation in the setting of portal hypertension? |
Hepatopulmonary syndrome |
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Most efficient method to detect hepatopulmonary syndrome? |
-Contrast-enhanced transthoracic echocardiography with agitated saline -> microbubbles in the left atrium within three to six cardiac cycles indicate the presence of an abnormally dilated vascular bed. |
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Development of pulmonary arterial hypertension in patients with portal hypertension |
Portopulmonary hypertension (POPH) |
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Define fulminant hepatic failure |
Hepatic encephalopathy in the setting of jaundice without preexisting liver disease |
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Classification of liver failure based on time of onset of encephalopathy after onset of jaundice |
-Hyperacute liver failure: within 1 week
-Acute liver failure is between 1 and 4 weeks
-Subacute liver failure is between 4 and 12 weeks |
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The two types of hepatorenal syndromes? |
- Type 1 HRS: is typically defined by at least a doubling of the initial serum creatinine to greater than 2.5 mg/dL (221 micromoles/L) in less than 2 weeks.
-Type 2 HRS: is not as rapidly progressive but is a common cause of death in patients with refractory ascites. |
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Major criteria for diagnosis of HRS |
cirrhosis with ascites, crea >1.5 mg/dL (133 micromoles/L); no improvement of serum creatinine (improvement is defined by a decrease to ≤1.5 mg/dL [133 micromoles/L]) after at least 2 days of diuretic withdrawal and volume expansion with 1.5 L or more of albumin; absence of shock or hypotension; no current or recent treatment with nephrotoxic drugs; and the absence of parenchymal kidney disease (no significant proteinuria [<500 mg/d], hematuria, findings of acute tubular necrosis [pigmented granular casts on urinalysis], or evidence of obstruction on ultrasound) |
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The most promising agent that reverses type 1 hepatorenal syndrome? |
Terlipressin |
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Recommended for the initial treatment of type 1 HRS? |
vasopressor agents |
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Second most promising treatment for HRS? |
albumin
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The most effective medical treatment for fistulizing Crohn disease? |
Infliximab (Remicade) |
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Most appropriate management for achalasia? |
Laparoscopic myotomy |
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Micro-opioid-receptor antagonist, has been found to help with opioid-induced constipation without negating the beneficial effects of the analgesia? |
Methylnaltrexone |
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Treatment for diffuse esophageal spasm |
calcium channel blockers
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Options for the management of high-grade dysplasia in patients with Barrett esophagus (BE) |
esophagectomy or endoscopic therapy (ablation)
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Size of bile ducts affected in primary biliary cirrhosis? |
-Microscopic bile ducts. -Extrahepatic bile ducts are not dilated in PBC |