ABIM GI flashcards

36 cards. Read the term and the definition here. The deck at the top of this page is optional.

Achalasia manometry

Absent esophageal peristalsis and failure of lower esophageal sphincter relaxation; gold standard for diagnosis; treated with pneumatic dilation, botulinum toxin, or Heller myotomy.

Barrett's esophagus surveillance

Intestinal metaplasia with goblet cells; surveillance intervals depend on dysplasia grade: none 3-5 years, low-grade 6-12 months, high-grade endoscopic eradication.

H. pylori test-and-treat

For dyspepsia without alarm features, use urea breath test or stool antigen to diagnose active infection; serology not recommended for confirmation of eradication.

Zollinger-Ellison syndrome

Gastrinoma causing multiple refractory ulcers and diarrhea; diagnosed with elevated fasting gastrin and positive secretin stimulation test.

Celiac disease serology

IgA tissue transglutaminase antibody with total IgA level; duodenal biopsy shows villous atrophy, crypt hyperplasia, and intraepithelial lymphocytosis; treatment is gluten-free diet.

Small bowel bacterial overgrowth

Diagnosed with glucose or lactulose breath testing or small bowel aspirate culture >10^5 CFU/mL; treat with rifaximin or other antibiotics.

Acute mesenteric ischemia

Pain out of proportion to exam; CT angiography is diagnostic; requires early revascularization and resection of necrotic bowel.

Colorectal cancer screening

Average risk start at age 45; options include colonoscopy every 10 years, FIT annually, or CT colonography every 5 years.

Acute pancreatitis diagnosis

Requires 2 of 3: characteristic pain, lipase/amylase >3x upper limit, or imaging findings; gallstones and alcohol are most common causes.

Chronic pancreatitis

Calcifications on CT and pancreatic insufficiency with steatorrhea; fecal elastase <200 μg/g suggests exocrine insufficiency; treat with pancreatic enzyme replacement.

Autoimmune pancreatitis type 1

IgG4-related disease; elevated serum IgG4, diffuse enlargement (sausage pancreas), responds to steroids.

Primary sclerosing cholangitis

Beaded strictures on MRCP; associated with IBD (especially ulcerative colitis); increased risk of cholangiocarcinoma and colorectal cancer.

Child-Pugh score

Uses bilirubin, albumin, INR, ascites, and encephalopathy to classify cirrhosis severity (A/B/C); MELD-Na used for transplant allocation.

HCC surveillance

Ultrasound with or without AFP every 6 months in cirrhosis; diagnosis can be made with multiphasic CT/MRI showing arterial enhancement and venous washout.

Spontaneous bacterial peritonitis

Ascitic fluid PMN ≥250/mm³; treat with third-generation cephalosporin; secondary prophylaxis with norfloxacin or ciprofloxacin.

Acute liver failure

Coagulopathy (INR ≥1.5) and encephalopathy in patient without preexisting cirrhosis; most common causes are acetaminophen, viral hepatitis, and idiosyncratic drug reactions.

Ulcerative colitis

Continuous mucosal inflammation from rectum proximally; treat with 5-ASA, corticosteroids, immunomodulators, or biologics; surgery curative (proctocolectomy).

Crohn's disease

Skip lesions, transmural inflammation, fistulas, strictures; small bowel most common; treat with steroids, immunomodulators, biologics; surgery not curative.

Irritable bowel syndrome

Rome IV criteria: recurrent abdominal pain ≥1 day/week in last 3 months with defecation or change in stool form; treatment is symptom-based (fiber, antispasmodics, low FODMAP diet, neuromodulators).

Toxic megacolon

Colonic dilation >6 cm with systemic toxicity; risk with IBD, infectious colitis; avoid colonoscopy; treat with IV steroids, antibiotics, and surgery if no improvement.

Lynch syndrome

Mismatch repair gene mutations (MLH1, MSH2, MSH6, PMS2); Amsterdam criteria and Bethesda guidelines; colonoscopy every 1-2 years starting at age 20-25.

Familial adenomatous polyposis

APC mutation; hundreds of adenomas; prophylactic colectomy recommended; screen for duodenal adenomas with EGD.

Hereditary diffuse gastric cancer

CDH1 mutation; prophylactic gastrectomy recommended; also increased risk of lobular breast cancer.

Colorectal cancer staging

TNM; stage I-II potentially curable with surgery; stage III requires adjuvant chemotherapy; stage IV often treated with palliative chemotherapy and biologics.

Body mass index

BMI = weight (kg) / height (m)^2; obesity defined as BMI ≥30; class I 30-34.9, class II 35-39.9, class III ≥40.

Malabsorption testing

Fecal fat >7 g/day on 72-hour collection; steatorrhea suggests pancreatic insufficiency, celiac disease, or small bowel bacterial overgrowth.

Refeeding syndrome

Hypophosphatemia, hypokalemia, hypomagnesemia after rapid reintroduction of nutrition in malnourished patients; start low and go slow with thiamine supplementation.

Obesity pharmacotherapy

BMI ≥30 or ≥27 with comorbidities; options include GLP-1 receptor agonists (semaglutide, tirzepatide), orlistat, phentermine/topiramate.

Bariatric surgery indications

BMI ≥40 or ≥35 with comorbidities; most effective treatment for sustained weight loss and diabetes remission; monitor for nutritional deficiencies postoperatively.

Colonoscopy preparation

Split-dose PEG solution; clear liquid diet day before; adjust for renal failure (use PEG-3350 without electrolytes).

Percutaneous endoscopic gastrostomy

For long-term enteral feeding; contraindicated in ascites, coagulopathy, or gastric outlet obstruction.

Post-ERCP pancreatitis prophylaxis

Rectal NSAIDs and hydration reduce risk; ERCP is therapeutic for stone removal and stent placement.

E. coli O157:H7

Shiga toxin-producing; can cause hemolytic-uremic syndrome; avoid antibiotics as they may increase toxin release.

Giardiasis

Protozoan causing bloating, diarrhea, malabsorption; diagnose with stool antigen or PCR; treat with metronidazole or tinidazole.

Whipple's disease

Tropheryma whipplei; weight loss, diarrhea, arthralgias; duodenal biopsy with PAS-positive macrophages; treat with prolonged antibiotics (ceftriaxone then TMP-SMX).

Amebiasis

Entamoeba histolytica causes bloody diarrhea and liver abscess; diagnose with stool antigen or serology; treat with metronidazole followed by paromomycin or diloxanide furoate.