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91 Cards in this Set

  • Front
  • Back
What test(s) diagnose small bowel obstruction?
There are multiple air-fluid levels seen throughout the bowel.
When do you use abdominal X-ray?
What does a barium enima do?
When is BE contraindicated?
What is Capsule Endoscopy?
When do you use Capsule Endoscoopy?
What are Amylase/Lipase levels?
When do you answer amylase and lipase levels?
What is the most accurate test for acute pancreatitis?
What is Antiendomysial/ Antigliadin Antibodies?
When are Antiendomysial/ Antigliadin Antibodies the answer?
What is the most accurate test for celiac disease?
What is the Antimitochondrial Antibodies (AMA) test for?
When do you answer AMA?
What is the most accurate test for PBC?
Liver biopsy.
What is anti-Smooth Muscle Antibodies?
When do you answer ASMA?
What other immune markers are associates with autoimmune hepatitis?
What is the most accurate test for autoimmune hepatitis?
For which clinical condition is Barium Esophagram the best initial test?
For which conditions is Barium Esophagram the most accurate test?
What is a Bernstein Test?
The Bernstein test is to diagnose gastroesophageal reflux disease.
How is a Bernstein Test done?
When is a Bernstein Test the right answer?
What is a Bleeding Scan?
When do you answer bleeding scan?
What is Ceruloplasmin?
When do you answer ceruloplasmin?
Is a high or low value abnormal?
What additional tests would confirm the diagnosis?
When do we use colonoscopy as a screen?


What is D-Xylose Test?
When do you answer D-xylose testing?
What is the most accurate test for malabsorption syndromes?
What disease will make D-xylose abnormal?
What is an endoscopic Retrograde Cholangiopancreatography (ERCP)?
ERCP is a direct visualization of hte biliary tract.
For which condition is an ERCP most accurate?
What are the characteristics lesion of sclerosing cholangitis?
In sclerosing cholangitis there are multiple intrahepatic and / or extrahepatic strictures of the biliary tract on cholangiography This gives the biliarry radicles a "beaded" appearance.
When do I answer ERCP?

What is Esophageal manometry used for?
How is Esophageal manometry done?
When do you answer esoophageal manometry?

If the stem of the question clearly describes a motility problem, you do not have to do either endoscopy or barium prior to doing the manometry; for example, achalasia, diffuse esophageal spasm, or nutcracker esophagus.
What is fecal occult blood testing?
Fecal occult blood testing (FOBT) is the screening of normal brown stool for microscopic amounts of blood not grossly visible. Gross blood or dark stool, such as melena, does not occur until >100ml of blood has been lost in the bowel. The FOBT will detect as lettle as 5-10ml of blood.
When is fecal occult blood testing the right answer?
FOBT is a screening test for occult blood in the stool. FOBT is an option for screening for colon cancer in those above the age of 50. In colon cancer screening the three methods of screening, are: colonoscopy every 10 years, sigmoidoscopy every 3-5 years, FOBT every year after age 50.
What do you do for a positive fecal occult blood test?
A positive FOBT should be investigated with a colonoscopy.
What is Fecal Leukocytes a test for?
Fecal leukocytes are used to assess the etiology of acute diarrhea.
What diseases is Fecal Leukocytes associated with?
Invasive and inflammatory causes of iarrhea can give both blood as well as fecal leukocytes. Diseases such as Salmonella, Shigella, Campylobacter, etc., can give both blood as well as white cells in the stool.
When do you answer fecal leukocytes?
Look for a patient with diarrhea with no blood in whom you are trying to see if there is an invasive form of diarrhea. Fecal leukocytes are not found with diarrhea secondary to viruses, most protozoans, or pre-formed toxins such as Bacillus cereus or staph.
What is the Gastrin level?
Serum gastrin levels should be measured when you suspect Zollinger-Ellison syndrome (ZES).
When do you answer gastrin level as the best initial test?
Look for ulcers that are large (>1cm), rcurrent, distal, and multiple. A gastrin level greater than 1,000 pg/ml is diagnostic.

REMEMBER: Everyone on a PPI has a high gastrin level.
What additional test would you like if this is not diagnostic?
The secretin stimulation test can confirm ZES when serum gastrin concentration testing is nondiagnostic. In ZES, gastrin levels do not go down with secretin.
What disease is the syndrome part of?
ZES is associated with MEN I:

Pituitary adenomas
Pancreatic islet cell/gastrointestinal adenomas
What is gastrograffin?
Gastrograffin is a water-soluble form of radio-opaque constrast material that is used when there is the possibility that there has been organ perforation and the material may leak through into the peritoneum. Gasrograffin is used as the diagnostic test of choice for Boerhaave's syndrome, or esophageal perforation, because barium going through a perforation causes inflammation.
When do you answer gastrograffin?
Look for a patient presenting with a recent history of severe retching followerd by severe chest pain, dyspnea, shock, and possible crepitation. Initial chest X-ray would show free air in teh mediastinum or peritoneum.
What is the most accurate test for Boerhaave's syndrome?
The most accurate test is a CT scan.
What is HFE gene, and C282Y mutation?
The HFE gene and C282Y mutation both lead to the overabsorption of iron in teh duodenum. They are confirmatory tests for hemochromatosis. These genetic tests and an MRI can eliminate the need for liver biopsy to diagnose hemochromatosis.
When do you answer HFE gene, or C282Y mutation?
Answer HFE gene and C282Y mutation when you are shown a patient with the characteristics of hemochromatosis and abnormal iron studies consistent with hemochromatosis. The patient will have liver disease, skin hyperpigmentation, joint pain, diabetes, and infertility. The iron and ferritin levels will be elevated and the iron-binding capacity will be markedly dimished.
What is HIDA Scanning?
HIDA scan is used when you suspect acute cholecystitis with a nondiagnostic ultrasonography.
When do you answer HIDA scan?
Answer HIDA scan when you see either:

Gallstones without gallbladder edema and ultrasound Murphy's sign, or

Gallbladder edema and ultrasound Murphy's sign without gallstones.
How does HIDA scan work?
HIDA is taken up by hepatocytes and excreted into bile and concentrated in teh gallbladder. If the gallbladder does not opacify, it means that there is an obstruction of the cystic duct. Leakage into the pericholecystic space suggests perforation. On a normal scan the gallbladder should opacify.
When is the HIDA scan the most common wrong answer?
The HIDA is not recommended in critically ill patients who should be taken to the operating room. If the diagnosis is obvious, the HIDA scan is not necessary, surgery is necessary.
What is PAS staining used for?
PAS staining on a small bowel biopsy specimen is the most accurate test for Whipple's disease.
When do you answer PAS staining?
Look for chronic multisystem illness, initially rheumatological (80%), then with fat malabsorption (75%), fever (50%), and ocular and neurological complaints..
How do you treat Whipple disease?
Initial course of Ceftriaxone followed by trimethoprim-sulfamethoxazole for 1 year.
What is 24-Hour pH monitoring used for?
Twenty-four -hour esophageal pH recording is indicated to document abnormal esophageal acid exposure.
When do you answer 24-Hour pH monitoring?
It is the appropriate test in the following scenarios:

1) Persistent symptoms of gastroesophageal reflux disease (GERD) after at least 4 weeks of treatment with a PPI.
2) To exclude GERD in a patient with unexplained chest pain
3) GERD sysptoms wit a negative upper endoscopy wen you are considering antireflux surgical repair.
4) To assess the efficacy of antireflux surgery
5) To evaluate patients with laryngitis, pharyngitis, chronic cough, nonallergic asthma (reflux-induced asthma)
For what diseases do you answer secretin stimulation testing?
Secretin stiulation is a rarely used test for two completely separate diseases:

Zollinger-Ellison syndrome (ZES) and chronic pancreatitis.
What is secretin stimulation testing?
ZES: You inject secretin intravenously and measure the level of gastrin in blood. Secretin should inhibit gastrin and lower the levels of gastrin in a normal person. In ZES, there is a failure to suppress gastrin levels.

Chronic pancreatitis: Normally, secretin should induce a large release of bicarbonate from the pancreas into the duodenum and measure the release of bicarbonate from the sphincter of Oddi. With chronic pancreatitis, the pancreas is too burned out and tired to do anything.
When do you answer secretin stimulation test?
Answer secretin stimulation testing in ZES when the patient has large, recurrent, and multiple ulcers, but has a nondiagnostic fasting serum gastrin concentration.

For chronic pancreatitis, look for a patient with fat malabsorbtion with no evidence of celiac disease and a normal D-xylose test.
Who should upper endoscopy screening be offered to?
Screening upper endoscopy should be performed in patients with gastroesophageal reflux disease (GERD) in whom the symptoms have been present for more than 5 years. You are screening to see if there is Barrett's esophagus, which is when the lower esophagus is transforming form squamous to columnar epithelium. Screening for the presence of esophageal varices should be done in those with cirrhosis.
What is the treatment for an abnormal upper endoscopy?
Barrett's esophagus is treated with proton pump inhibitors with a repeat upper endoscopy every 2-3 years. Low-grade esophageal dysplasia is treated with PPIs with a repeat upper endoscopy in 6 months. Those with varices should receive propranolol to decrease the risk of bleeding.
What is a 72-Hour Fecal Fat test used for?
The 72-hour fecal fat collection is an old test for intestinal malabsorption. As the name implies, you are supposed to collect 3 days' worth of stool in order to have a very sensitive test for fat malabsorption. A single test of a Sudan black stain of the stool for the presence of fat is usually sufficient.
When do you answer 72 -hour fecal fat test?
The 72-hour fecal fat collection is the single most accurate test for fat malabsorption; however, it is virtually never done and is most often a WRONG answer on your test. The 72-hour fecal fat is the answer if you strongly suspect fat malabsorption and the Sudan black stain is negative.
What is a string test?
The string test is an old test for giardiasis. The string test samples the duodenal mucosa without the need of endoscopy. A string is swallowed and left in place with one end in the duodenum and the other end hanging out through the patient's mouth.
When is a string test the answer?
String test is always the WRONG answer. Stool ova and parasite testing is sufficiently sensitive and less invasive. Stool Giardia antigen testing by ELISA is the single most accurate test for Giardia and is considerably less invasive.
What is a Sudan Black Stain?
Stool staining with Sudan black is used to detect steatorrhea as a sign of fat malabsorption.
What is the most accurate test for fat malabsorption.
Seventy-two-hour quantitative estimation of stool fat is the most accurate test because of increased sensitivity. The 72-hour estimation is almost always the wrong answer.
When do I answer Sudan black stain?
Answer Sudan black stain when you see a patient with chronic pale, greasy, malodorous diarrhea, and no evidence of infection.
What is Fasting Transferrin saturation?
Serum measurement of fasting transferrin saturation is the best initial test to diagnose hereditary hemochromatosis (HH) as well as the screening test for asymptomatic family members. Fasting transferrin saturation = (serum iron/TIBC)
When do you answer fasting transferrin saturation?
Answer fasting transferrin satruation when you see a ase of liver disease with oint pain, diabetes, cardiomyopathy, skin hyperpigmentation, and infertility.
How would you confirm an abnormal test of fasting transferrin saturation?
Liver biopsy is the most accurate test.
What is the pathogenesis of hereditary hemochromatosis (HH)?
The pathogenesis is genetically determined abnormal increase in intestinal absorption of iron.
When is the optimal timing of screening for HH?
The optimal timing for screening family members is between the ages of 18 and 30, before organ damage (e.g., cirrhosis) has occurred.
What is serum trypsinogen concentration used for?
Serum assay of trypsinogen is used when you suspect chronic pancreatitis in a patient with steatorrhea. This is the only test that is specific for steatorrhea of pancreatic origin. Trypsinogen levels are low if the fat malabsorption is form a burned-out pancreas.
When is serum trypsinogen concentration the answer?
Answer trypsinogen level only after Sudan black stin has confirmed a fat malabsorption.

Antigliadin and anti-endomysial antibodies should be normal. Low trypsinogen levels are specific but not sensitive for chronic pancretitis.
What is the urea breath test?
Urea breath testing is the measurement of radiolabled carbon dioxide after the oral ingestion of labeled urea. H. pylori splits urea wuth urease. The labeled carbon is in the urea and is released as labeled carbon dioxide.
When is the urea breath test used?
Urea breth testing is best used to confirm the eradication of H. pylori immediately after treatment. Serology does not rapidly improve after treatment. If an ulcer is found at endoscopy, the test of choice will be biopsy, not the urea breth test.
When do you answer urea breath test?
Answer urea breath test with a patient with epigastric pain that does not improve or that recurs after a proton pump inhibitor and antibiotics have been given. There is no routine test of cure for H. pylori. You do not do the test if the patient feels better after treatment.