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GI
GI for the boards
43
Medical
Post-Graduate
06/14/2010

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Cards

Term
FAP CoCA screening
Definition
Annual flex sig at 10yo, Upper endoscopy at 25yo q 1-3 years, colectomy when polyposis is discovered.
Term
HNPCC CoCA screening
Definition
C-scope q1-2 years at age 20 OR 10 years before age of diagnosis of family member. Annual c-scope after 40. Pelvic exam or (prophylactic TAH BSO) with CA-125 and urine cytology q1-2 years at 30
Term
IBD CoCa Screening
Definition
C-scope 8 years after diagnosis with colectomy with dysplasia.
Term
HNPCC diagnostic rules
Definition
3-2-1. 3 relatives, 2 generations, 1 person diagnosed before 50.
Term
Regular CoCA screening
Definition
Start at 50, unless...
...first degree relative with CoCA <60, then 40 or 10 years before relatives diagnosis, repeat q3-5
...first degree relative with CoCA >60, then at 40 repeat q10 if normal
...first degree relative with adenomatous polyps < 60 then 40 or 10 years before relatives diagnosis, repeat q5
...first degree relative with adenomatous polyps > 60 then start at 40
Term
Post-polypectomy surveillence
Definition
More than 3-10 adenomas or any >1cm, villous features, high-grade dysplasia, cscope in 3 years. If f/u is normal, f/u 5 years after.

More than 10 should be examined more often.

Piecemeal removal indicates 2-6 month f/u c-scope
Term
Antimitochondrial AB are diagnostic of
Definition
Primary biliary cirrhosis
Term
Radiographic sign of PSC
Definition
Beads on a string
Term
Mass surveillance in a cirrhotic liver
Definition
<1cm, US. 1-2cm, two type of imaging, biopsy if only one is positive. >2cm only one image needed - if atypical, biopsy.
Term
Focal nodular hyperplasia
Definition
non-malignant, appears as central scar with large artery and small branches mimicking cirrhosis
Term
Hepatic adenoma
Definition
appears as sheets of hepatocytes with potential for CA and rupture. Hormone sensitive.
Term
CholangioCA diagnosis and treatment
Definition
MRCP is best for evaluation. CA19-9. Only treatment is surgery.
Term
AdenoCA at Ampula of Vader
Definition
Associated with FAP and HNPCC, CEA and / or CA19-9 positive. Whipple tx.
Term
Barrett screening
Definition
Endoscopy if GERD > 5 years. If negative, screen again in 1 year, if still negative, every 5 years.

With low grade dysplasia, re-screen every 6 months x2, then annually until 80 yo.

If high grade - to surgery, or x3mo surveillance if refused x 2 years, then x6 months.
Term
Barrett related CA
Definition
Esophageal adenoCA
Term
Esophageal carcinoma tx
Definition
Surgery, radiation +/- chemo.
Term
Symptoms of achalasia
Definition
Dysphagia, regurgitation, relieved by placing arms over the head
Term
Causes of pill esophagitis
Definition
Iron, K+, NSAIDs, bisphosphonates, tetracycline, quinidine.
Term
Alarm features in dyspepsia
Definition
> 55 yo w/new onset sx, FH of proximal GI CA, unintentional weight loss, progressive dysphagia, odynophagia, iron-deficiency, persistent vomiting, palpable mass, jaundice.
Term
CA associated with H. Pylori
Definition
MALT lymphoma (pan-gastritis, 80% early stage curable with PPI), gastric CA (corpus)
Term
H Pylori tx
Definition
Triple (PPI, Clarithro 500 BID, Amox 500 BID.) then if failure, Quadruple tx (PPI, Flagyl, Tetracycline, bismuth)
Term
Diagnosing GI stromal tumors
Definition
They express CD117
Term
Risks for GI adeno CA
Definition
salt, pickled or smoked foods, low veggie and citrus diets, tobacco, blood group A, chronic atrophic gastritis, H pylori, pernicious anemia, FAP, HNPCC, CDH1
Term
Nurtritional deficiencies s/p roux-en-y
Definition
Fe, B12, Ca++, Vitamin D
Term
Early vs late dumping syndrome
Definition
Early:30 minutes after a meal with diarrhea, bloating, nausea. Late: 1-3 hours after, with glycopenic symptoms
Term
Symptoms of pancreatic adenoCA
Definition
+/- Abdominal pain radiating to back, painless jaundice, new onset DM, cachexia, wt loss.
Term
VIPoma
Definition
Symptoms - diarrhea, dehydration, peptide hypokalemia, with 40-70% malignancy rate. Test with somatostatin receptor scintigraphy.
Term
Gastrinoma
Definition
Zollinger-Ellison syndrome. Ulcers, diarrhea, GERD with 60-90% malignancy rate. Test with somatostatin receptor scintigraphy.
Term
Stool osmotic gap
Definition
290 - 2 * (Na + K).
< 50 = secretory (abnormal ion transport)
> 125 = Osmotic
Osmolarity < 250 is factitious 2/2 laxative use.
Term
Acute vs chronic diarrhea
Definition
Acute < 2 weeks, chronic > 4 weeks.
Term
Predisposing factors for small-intestine bacterial overgrowth
Definition
Hypochlorhydria (PPIs H2 blockers, gastric atrophy), dysmotility, SI dilitation, surgical creations (blind loops, ileocecalectomy)

Tx with abx and carbohydrate restriction
Term
Crohns extra GI manifestations
Definition
rheumatoid arthritis, ankylosing spondilitis, erythema nodosum
Term
UC extra-colonic involvement
Definition
pyoderma gangrenosum, Primary sclerosing cholangitis
Term
IBD and colonic screening
Definition
every 1 to 2 years starting 8 years after diagnosis.
Term
Diagnosing Crohns
Definition
Sacchromyces cerevisiae ab (ASCA) (50%) but only 15-20% p-ANCA
Term
Diagnosing UC
Definition
2/3 with p-ANCA but <5% with ASCA
Term
Treating Crohns
Definition
5-ASA / mesalamine->topical steroids->Azathioprine / 6-MP (test for thiopurine activity) -> MTX (hepatotoxicity) -> anti-TNF-alpha (test for TB)
Term
Treating UC
Definition
5ASA -> steroids (short term) -> azathiaprine / 6-MP -> inflixamab / cyclosporine
Term
Alarm features in constipation
Definition
rectal bleeding, occult + stool, wt loss, FH of CoCA or IBD, anemia, acute onset
Term
Stimulant laxatives
Definition
senna, bisacodyl
Term
Anti smooth muscle antibody predicts...
Definition
Autoimmune hepatitis
Term
Rome III criteria for IBS
Definition
Recurrent abd. pain and change in bowel habits > 6 months, with symptoms at least 3 days / month x 3 months.  Pain is relieved by BM, onset of pain related to change in stool frequency or appearance of stool.
Term
Cholestasis is treated with
Definition
ursodeoxycholic acid
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