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Step III

Step III - GI 4

QuestionAnswer
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