ACG CxA flashcards

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

Celiac screening serology

Tissue transglutaminase IgA is the preferred initial test; total IgA must be checked because IgA deficiency can cause a false-negative result. Confirm with duodenal biopsy while the patient is on gluten.

Hepatitis B core antibody

Isolated anti-HBc IgG with negative HBsAg indicates prior resolved infection or occult carriage; it can reactivate with immunosuppression and warrants monitoring or prophylaxis.

Acute pancreatitis diagnostic criteria

Diagnosis requires two of three: characteristic epigastric pain radiating to the back, lipase or amylase greater than three times the upper limit of normal, and cross-sectional imaging findings.

Hereditary hemochromatosis screening

Transferrin saturation above 45% with elevated ferritin prompts HFE genotyping; C282Y homozygosity is the most common genotype associated with clinical iron overload.

Wilson disease features

Low ceruloplasmin, elevated 24-hour urinary copper, Kayser-Fleischer rings, and Coombs-negative hemolytic anemia are classic; liver biopsy copper quantification can confirm the diagnosis.

Adenoma detection rate benchmark

Adenoma detection rate of at least 25% is the benchmark quality indicator for screening colonoscopy; higher rates correlate with reduced interval colorectal cancer risk.

Split-dose bowel preparation

The second half of the preparation is completed within 4 to 6 hours of colonoscopy; split dosing improves colon cleanliness and is preferred over same-day preparation.

Cecal intubation rate

A cecal intubation rate of at least 90% for screening colonoscopy is a recognized quality benchmark reflecting technical competence and adequate mucosal visualization.

Post-ERCP pancreatitis prophylaxis

Rectal indomethacin and periprocedural hydration reduce post-ERCP pancreatitis risk, which is approximately 3% to 10% and higher in patients with sphincter of Oddi dysfunction.

PEG placement contraindications

Percutaneous endoscopic gastrostomy is generally avoided within 30 days of peritoneal dialysis catheter placement and in uncorrected coagulopathy or peritonitis.

Conscious sedation reversal agents

Flumazenil reverses benzodiazepines such as midazolam, and naloxone reverses opioids; both require continuous pulse oximetry and capnography monitoring during and after endoscopy.

Ulcerative colitis distribution

Ulcerative colitis begins in the rectum and extends proximally in a continuous pattern limited to the colon; Crohn disease can involve any GI segment with skip lesions.

Fecal calprotectin interpretation

Values below 50 mcg/g generally indicate remission, while values above 250 mcg/g suggest active intestinal inflammation; intermediate values require clinical correlation.

Truelove and Witts criteria

Acute severe ulcerative colitis is defined by six or more bloody stools per day plus systemic toxicity such as fever, tachycardia, anemia, or elevated erythrocyte sedimentation rate.

Anti-TNF pretreatment screening

Latent tuberculosis and hepatitis B screening are required before starting anti-TNF therapy because of the risk of reactivation of these infections.

Toxic megacolon

Colonic dilation greater than 6 cm with systemic toxicity is a medical emergency; antimotility agents and colonoscopy are contraindicated and surgical consultation is required.

Colitis cancer surveillance timing

Colorectal cancer surveillance in inflammatory bowel disease begins 8 to 10 years after diagnosis, using dye-spray chromoendoscopy or high-definition white-light with targeted biopsies.

MELD score components

MELD uses bilirubin, INR, creatinine, and sodium; higher scores predict 90-day mortality and determine priority for liver transplant allocation.

Child-Pugh classification

Child-Pugh uses bilirubin, albumin, INR, ascites, and encephalopathy to stratify cirrhosis into classes A, B, and C, predicting survival and surgical risk.

Serum-ascites albumin gradient

A gradient of 1.1 g/dL or greater indicates portal hypertension; a lower gradient suggests peritoneal carcinomatosis, tuberculosis, or pancreatic ascites.

Spontaneous bacterial peritonitis diagnosis

Ascitic fluid polymorphonuclear cell count above 250 cells/mm3 establishes the diagnosis; empiric therapy is a third-generation cephalosporin such as cefotaxime.

Hepatorenal syndrome type 1

Rapid creatinine rise in cirrhosis unresponsive to volume expansion defines type 1; treatment includes albumin plus a vasoconstrictor such as terlipressin or norepinephrine.

Sustained virologic response

Undetectable hepatitis C RNA 12 weeks after completing direct-acting antiviral therapy defines cure and is achieved in the vast majority of treated patients.

HCC surveillance interval

Ultrasound with or without alpha-fetoprotein every 6 months is recommended for hepatocellular carcinoma surveillance in patients with cirrhosis.

Rome IV IBS criteria

Recurrent abdominal pain at least 1 day per week in the last 3 months, associated with defecation or change in stool form or frequency, defines irritable bowel syndrome.

Gastroparesis scintigraphy threshold

Delayed gastric emptying on 4-hour scintigraphy, with retained radiotracer greater than 10% at 4 hours, supports a diagnosis of gastroparesis in the appropriate clinical setting.

Achalasia manometry findings

Absent or impaired lower esophageal sphincter relaxation with absent peristalsis on high-resolution manometry defines achalasia; treatment includes pneumatic dilation, Heller myotomy, or POEM.

Functional dyspepsia definition

Bothersome postprandial fullness, early satiation, epigastric pain, or burning for at least 3 months with onset at least 6 months prior defines functional dyspepsia.

GERD alarm features

Dysphagia, weight loss, anemia, or GI bleeding in a patient with reflux symptoms warrants prompt upper endoscopy rather than empiric acid suppression.

Rumination syndrome

Regurgitation within minutes of eating without retching characterizes rumination syndrome; diaphragmatic breathing and behavioral therapy are effective treatments.

Interpreter services requirement

Title VI of the Civil Rights Act requires interpreter services for limited-English-proficiency patients; professional interpretation improves informed consent comprehension and reduces errors.

Endoscope high-level disinfection

Reusable endoscopes require high-level disinfection following manufacturer reprocessing protocols; deviations increase infection transmission risk and are a common quality audit finding.