GI #2

Question 1

What is the MC type of colon polyp

Answer 1

-Adenomatous

Question 2

What type of adenomatous polyp has the highest risk of becoming malignant

Answer 2

Villous adenoma

Question 3

What type has the LOWEST risk for becoming malignant?

Answer 3

Tubular adenoma

Question 4

Risk Factors for colorectal cancer

Answer 4

• Age > 50
• AA
• family history
• UC
• Diet (Low fiber, high in red or processed meat)
• Obesity, Smoking, ETOH

Question 5

What is Familial Adenomatous Polyposis?

Answer 5

Genetic mutation of the APC gene. Adenomas begin in childhood and almost all develop cancer by age 45. Prophylactic colectomy best for survival.

Question 6

Protective factors for Colorectal Cancer

Answer 6

• Physical activity

- Regular use of Aspirin, NSAIDs

Question 7

Symptoms of colorectal cancer

Answer 7

• Iron deficiency anemia (fatigue, weakness)
• Rectal bleeding
• Change in bowel habits
• Abdominal pain

Question 8

Right sided (proximal) vs left sided (distal) symptoms

Answer 8

• Right side: chronic occult bleeding, iron deficiency anemia
• Left side: bowel obstruction, changes in stool diameter

Question 9

Diagnostic test of choice for colon cancer

Answer 9

Colonoscopy with biopsy

Question 10

On Barium enema, what is seen with colon cancer?

Answer 10

Apple core lesion

Question 11

What Tumor Marker is monitored with Colon Cancer?

Answer 11

CEA

Question 12

Regarding colonoscopies and fecal occult blood tests, what are the current recommendations?

Answer 12

• Fecal occult blood test annually starting at 50
• Colonoscopy every 10 years from 50-75
• Flexible sigmoidoscopy every 5 years, along with occult blood test every 3 years

If patient has FAP, the colonoscopies start at age 10-12 and they have flexible sigmoidoscopy yearly.

Question 13

MCC of esophagitis

Answer 13

-GERD

Question 14

Symptoms of esophagitis

Answer 14

• Odynophagia (painful swallowing)
• Dysphagia (difficulty swallowing)
• Retrosternal Chest Pain

Question 15

Diagnostic for esophagitis

Answer 15

Upper endoscopy

Question 16

What is the Rome IV Criteria for Irritable Bowel Syndrome

Answer 16

Recurrent abdominal pain on average at least 1 day/week in the last 3 months associated with 2 of the 3 following things:

• 1) Pain with defecation
  2) change in stool frequency
  3) change in stool form/appearance

Question 17

Treatment for IBS

Answer 17

• Lifestyle and dietary changes are first line (low fat, high fiber, and unprocessed food diet)
• Sleep hygiene
• Smoking cessation

Question 18

What can be given for diarrhea?

What can be given for constipation?

Answer 18

Loperamide, Dicyclomine

Psyllium, Polyethylene Glycol

Question 19

MCC of infectious esophagitis

Answer 19

Candida, in immunocompromised patients

Question 20

Treatment for Candida Esophagitis

Answer 20

-PO Fluconazole

Question 21

What is seen on exam of a patient with candida esophagitis?

Answer 21

Linear, white yellow plaques on endoscopy

Question 22

On endoscopy for eosinophilic esophagitis, what is usually seen?

Answer 22

Multiple corrugated rings, white exudates

Question 23

However, for eosinophilic esophagitis, what is the definitive diagnostic?

Answer 23

Biopsy: presence of abundance of eosinophils

Question 24

What medications are usual causes of pill esophagitis?

Answer 24

NSAIDs, bisphosphonates, BB, CCB, Vitamin C

Question 25

How to manage symptoms of pill esophagitis

Answer 25

- Take pills with at least 4 ounces of water | - Avoid recumbency for at least 30-60 minutes after pill ingestion

Question 26

A sliding hiatal hernia is the MC type. Explain what happens in this type of hernia

Answer 26

-GE junction slides into mediastinum

Question 27

Treatment for hiatal hernia

Answer 27

- PPI | - Weight loss

Question 28

Pathophysiology of GERD

Answer 28

- Incompetent lower esophageal sphincter | - Transient relaxation of LES

Question 29

Symptoms of GERD

Answer 29

- Heartburn (pyrosis) - Sour taste in mouth, cough, sore throat - Wheezing, chest pain, hoarseness (atypical symptoms)

Question 30

Alarm symptoms of GERD

Answer 30

-Dysphagia, odynophagia, weight loss, bleeding

Question 31

Diagnostics for GERD

Answer 31

- 24 hour ambulatory pH: GOLD STANDARD - Manometry: decreased LES pressure - Endoscopy: first line diagnostic test if persistent or alarm symptoms

Question 32

Treatment for GERD

Answer 32

- Lifestyle modifications: elevated head of bed, avoid food in night, weight loss, no alcohol, smoking cessation - Antacids and H2 receptor antagonists (Famotidine, Cimetidine) - PPI in moderate-severe ( > 2 episodes/week) (Omeprazole) - Nissen fundoplication if refractory

Question 33

Pathophysiology of Barrett's Esophagus

Answer 33

- Esophageal squamous epithelium replaced by precancerous metaplastic columnar cells from cardia of the stomach - Complication of long-standing GERD

Question 34

MC type of esophageal carcinoma in the US MC type of esophageal carcinoma in the world

Answer 34

- Adenocarcinoma (distal esophagus) | - Squamous cell (mid-upper third of esophagus)

Question 35

Risk factors for Adenocarcinoma

Answer 35

- Caucasian males - Barrett's Esophagus - Smoking - Obesity

Question 36

Squamous Cell Carcinoma of the esophagus occurs ______ and is the MCC worldwide. What are the risk factors for this type of cancer?

Answer 36

Mid-upper third of the esophagus -African American Smoking -Alcohol

Question 37

Symptoms of esophageal cancer

Answer 37

Progressive dysphagia: solid food dysphagia progressing to include fluids, odynophagia -Weight loss, anorexia, iron deficiency anemia

Question 38

What is the diagnostic study of choice for esophageal cancer?

Answer 38

Upper endoscopy with biopsy

Question 39

What diagnostic is done to stage esophageal cancer?

Answer 39

Endoscopic US

Question 40

Pathophysiology of Achalasia

Answer 40

Loss of peristalsis and failure of relaxation of lower esophageal sphincter -Degeneration of Auerbach's Plexus

Question 41

Symptoms of Achalasia

Answer 41

Dysphagia to solids and liquids at same time | -Chest pain, cough, weight loss, dehydration

Question 42

Diagnostics for Achalasia

Answer 42

- Barium esophagram: bird's beak appearance of LES - Manometry: most accurate test (increased LES pressure) - Endoscopy: performed prior to starting treatment to rule out SCC

Question 43

Treatment for Achalasia

Answer 43

- Decrease LES pressure: Botox injection, Nitrates - Pneumatic dilation of LES - Esophagomyomectomy (definitive)

Question 44

Symptoms of a Zenker's Diverticulum Pathophysiology of Zenker's

Answer 44

- Dysphagia - Lump in neck - Choking Sensation - Halitosis (due to food retention in pouch) -Weakness at Killian's Triangle (between fibers of the cricopharyngeal muscle and lower inferior pharyngeal constrictor muscle)

Question 45

Diagnostic for Zenker Diverticulum

Answer 45

- Barium Esophagram | - Upper endoscopy for surgical evaluation

Question 46

Symptoms of Diffuse Esophageal Spasm

Answer 46

- Stabbing chest pain worse with hot or cold liquids or food - Not exertional pain (similar to angina though) - Dysphagia to both solids and liquids - Sensation of object stuck in throat

Question 47

Diagnostics for DES

Answer 47

- Esophagram: corkscrew esophagus | - Manometry: definitive (increased premature contractions)

Question 48

Treatment for DES

Answer 48

- Anti-spasmodics: CCB, Nitrates, TCA | - Botox injections, pneumatic dilation

Question 49

Pathophysiology of Mallory Weiss Tear

Answer 49

Sudden rise in intra-abdominal pressure due to persistent retching or vomiting after ETOH binge

Question 50

Symptoms of Mallory Weiss Tear

Answer 50

- Upper GI bleeding | - Abdominal pain, back pain, or hydrophobia

Question 51

Diagnostic of choice for Mallory Weiss Tear

Answer 51

-Upper endoscopy: shows longitudinal mucosal erosions

Question 52

Treatment for Mallory Weiss Tears

Answer 52

- Non-bleeding: supportive, PPIs | - Bleeding: Band ligation

Question 53

Diagnostic of choice for Esophageal Web or Esophageal Ring

Answer 53

Barium Swallow (Esophagram)

Question 54

Treatment for Esophageal Ring

Answer 54

Dilation