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  1. when do you scope a pt with epigastric pain?
    • if age more than 45
    • or if less than 45 with alarming symptoms
  2. mngt with epigastric pain and less than 45?
    • h2 blocker
    • ppi
  3. which h2 blocker has the most adverse effects?
    • cimetidine
    • - inhibits cytp450
    • -anti-androgenic effects
    • -decreases cr clearance in kidney
  4. H pylori testing?
    • serology
    • stool antigen
    • urea breath test
  5. mngt when faced with gerd symptoms?
    • Rx
    • mild and intermittent--h2 blocker
    • moderate or persistent---ppi
  6. most accurate test for gerd?
    24 hr ph monitoring
  7. if meds dont work for gerd, next step?
  8. is bernstein test done?
  9. most accurate test for barrets?
  10. scope for barrets?
    low grade dysplasia
    • 2 years
    • low grade dysplasia --every 2 months
  11. what tests for h pylori change iwth therapy?
    when should you retest after therapy ends?
    • breath test
    • stool antigen

    if symptoms persists
  12. Rx for hpylori?
    • ppi
    • clarithromycin
    • amoxicillin
  13. most accurate test for h pylori?
  14. what effect do alcohol have on ulcers?
    delay it
  15. what causes gastritis and ulcers?
  16. what stimulates gastrin, and mucus secretion int he stomach?
    • ach
    • h2
    • stretch
    • vagus nerve
  17. stress ulcer prophylaxis?
    • intubation
    • head trauma
    • burns
    • sepsis and coagulopathy
  18. how are GU/DU treated?
    same as h pylori
  19. how is zollinger ellsion diagnosed?
    high gastrin and high acid output
  20. what effect does h2 and ppi have on gastrin/?
    gastrin is increased
  21. rx for local zollinger ellsion
    rx for metastatic?
    • surgery
    • life long ppi
  22. most accurate test for zollinger ellsion?
    2nd most accurate..
    • endoscopic ultrasound
    • nuclear somatostatin scintigropahy
  23. when do u suspect ze syndrome?
    • large
    • distal
    • multiple
    • recurrent
  24. rx for gastroparesis?
    • erythromycin
    • metoclopramide
  25. dumping syndrome?
    due to gastrectomy resulting in hypoglycemia and diarrhea
  26. rx for non ulcer dyspepsia?
    • h2
    • sucrulfate/bismuth
    • ppi
  27. panca is specific for what IBD?
    asca is specific for what IBD?
    • UC
    • CD
  28. what 3  adverse things do sulfa drugs cause?
    • rash
    • hemolysis
    • ain
  29. steroid for CD and UC?
  30. drugs to keep pts off steroids but still immunomodulate?
    • 6mp
    • azathioprine
  31. antibiotic for diverticulitis?
    cipro and metro
  32. cd and uc exacerbation rx?
  33. what drug is used for fistulas in cd?
    anti tnf
  34. when should you scope in cd and uc?
    20 years after diagnosis
  35. psc and colecrectal cancer is caused by which ibd?
    both cause it
  36. which ibd is curable with surgery?
  37. most accurate test for giardia?
    stool antigen
  38. most accurate test for cryptosporidium?
    modified acid fast stain
  39. rx for cryptosporidium?
  40. Rx for infectous diarrhea with fever, pain and bloody diarrhea?
  41. rx for isospora?
  42. which bacteria cause diarrhea in hemochromatosis
    • vibrio
    • yersinia
  43. c. deficile diarrhea reoccurs afer best step?
    when do you give vanco?
    • metro
    • if diarrhea persists despite metro
  44. irritable bowel syndrome is primarily what complaing?
    pain relieved with diarrhea or consitpation
  45. rx for IBS?
    • diarrhea--olansetron
    • constipation--tegaserod 5ht4 agonist but withdrawn bc of increased cv toxicity

  46. antispasmadics for ibs?
    hyo and diaciamino
  47. sym[ptoms of carcinoid syndrome?
    • flushing
    • wheezing
    • diarrhea
    • tricuspid valve abnormalities
  48. 3 diseases with steatorhea?
    • celiac
    • chronic pancreatitis
    • tropical sprue
  49. most accurate diagnosis for tropical sprue?
  50. most accurate test for celiac?
    biopsy--flattening for the vili
  51. best initial test
    most accurate test for chronic pancreatitis
    • x ray with calcifications and the history of malabsorption and weightloss
    • secretin stimulation
  52. test for fat absorptions?
    sudan black
  53. difference in malabsorption between chronic pancreatitis and celiac dz?
    • celiac dz has iron and folate malabsorption bc the ileum is not function
    • ileum is funcitonal in chronic pancreatitis
  54. when do you transfuse platelets?
    less than 50,000
  55. what is orthostasis?
    • >10 in pulse
    • >20 in systolic blood pressure
  56. when do u test orthostasis?
    normal blood pressure on laying down
  57. what decreaes esophageal variceal bleeding?
  58. UGI bleeding that has highest mortLITY?
  59. MNGTM of acute bleeding?
    • fluids
    • cbc and pt and transfuse ffp or prbc if needed
  60. how u treat e.varices?
    • octeotride
    • banding
    • tips
  61. adverse side effect of tips?
    hepatic encephalopathy
  62. when do u use bb for esophageal varices?
    after stabilization
  63. what responses are present in the body with 
    10% blood loss?
    • tachy
    • orthostasis
    • shock
  64. when do you treat h pylori?
    iff gastritis or pud are present not when gerd are presetn
  65. if ct shows severe necrosis is pancreatitis what do i do?
    severe >30%
    • antibiotics--imipenem
    • biopsy to see if there is infection
  66. prophylaxis against esophageal varices?
  67. primary biliary cirhosis has what antibodies?
    anti-mitochondrial antibodies
  68. most accurate test for primary scleroising cholangitis?
  69. chronic hepatits?
    >6 months of surface antigen
  70. Rx for alpha 1 antitrypsin?
    replace the enzyme
  71. When do you use deferoxamine vs phlebotomy?
    • deferoxamine--overtransfusion for whatever reason
    • phlebotomy-- hemochromatosis
  72. Rx for Hep B?
    Rx for Hep C?
    • tenofovir
    • entecavir
    • interferon

    • Hep C--
    • Interferon + ribavirin
  73. what is the routine serology done in cirhosis?
    • hep B 
    • Hep B
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