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Awesome Review 2021 > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

Colonoscopy screening for ulcerative colitis

A

Every one to two years beginning 10 years after diagnosis for patients with disease extending beyond rectum

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2
Q

Irritable bowel syndrome workup with history of autoimmune disease

A

Check TTG rule out celiac disease - especially with type one diabetes and autoimmune thyroid disease

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3
Q

Acute fatty liver of pregnancy

A

Liver failure and coagulopathy

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4
Q

HELLP HEMOLYSIS, elevated liver enzymes, low plateletS

A

Microangiopathic hemolytic anemia

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5
Q

Resolved acute diverticulitis next step

A

After appropriate antibiotic therapy will require full colonoscopy to rule out other causes mimicking diverticulitis

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6
Q

Chest pain intermittent unrelated to exertion no reflux symptoms retrosternal pain seconds to minutes corkscrew on x-ray dysphasia to both liquids and solids

A

Diffuse esophageal spasm treat with calcium channel blockers/ppi - multiple simultaneous contractions on manometry

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7
Q

Many month history of dyspepsia looking like Gerd no alarm symptoms no physical exam abnormality what is treatment

A

Proton pump inhibitor

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8
Q

Hematochezia hypotension syncopal symptoms use of NSAIDs anemia what is next test to perform

A

Suspect upper G.I. source of bleeding needs upper endoscopy first - absence of blood or coffee ground material in NG tube does not rule out upper G.I. bleed - if negative then do colonoscopy

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9
Q

Treatment of new onset severely active Crohn’s disease

A

Antitumor necrosis factor therapy like infliximab is best and better than immunomodulators such as mesalamine because Crohn’s disease is transmural

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10
Q

Treatment of severe alcoholic hepatitis

A

Mandry discriminant function score of greater than 32 benefit from pentoxifylline if corticosteroids are contraindicated - like with kidney failure G.I. bleed active infections

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11
Q

How long to keep patient in hospital after high-risk peptic ulcer and a scopic treatment

A

72 hours - takes this long for high-risk peptic ulcer to become peptic ulcer

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12
Q

Patient with G.I. bleed due to angioectasias and aortic stenosis

A

replace aortic valve - heyde syndrome e - mechanical destruction of von Willebrand multimers during non-laminar flow through narrow aortic valve

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13
Q

Young patient history of several food impaction’s history of allergies and asthma egd with concentric rings

A

Eosinophilic esophagitis treat with PPI or budesonide

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14
Q

Food regurgitation barium swallow dilated esophagus tapering gastroesophageal junction manometry decreased peristalsis increased lower esophageal pressure

A

Achalasia then do a EGD to rule out lymphoma cancer then a surgical myotomy

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15
Q

Regurgitating food eaten several days ago with halitosis

A

Zenkers diverticulum pouch in hypopharynx

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16
Q

odynophasia for more than 10 days

A

Egd to rule out esophagitis consider pill induced, radiation, infections like Candida CMV herpes

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17
Q

HIV patient with oral thrush complaining of odynophasia

A

No need for EGD right away treat empirically then if no improvement EGD to rule out CMV and herpes

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18
Q

Progressive dysphasia two solids heartburn several years

A

Peptic stricture

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19
Q

Patient with CVA hemiparesis with coughing and choking sensation was regurgitation of fluids to knows best diagnostic test

A

Video fluoroscopic swallowing study or modified barium swallow

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20
Q

Heartburn not remove by antacid initial diagnostic step is

A

Ppi challenge - step down to H2 if better in 3 months

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21
Q

If patient doesn’t get better with PPI

A

EGD - if no esophagitis then ambulatory pH monitoring if little reflux than likely psychiatric give citalopram

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22
Q

Heartburn not respond – since with weight loss

A

Directly to EGD

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23
Q

Treatment of GERD with PPI’s or fundoplication surgery effect on existing Barrett’s

A

No effect

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24
Q

Barrett’s esophagus EGD guidelines

A

After diagnosis the EGD one year later
NO Dysplasia ON REPEAT EGD NEXT ONE THREE-YEARs
Low-grade dysplasia repeat Egdsix months if still low-grade repeat yearly
If changes back to metaplasia continually EGD every three years
HIGH-GRADE DYSPLASIA ENDOSCOPIC HIGH FREQUENCY ABLATION

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25
Q

Severe retrosternal chest pain worse with swallowing and breathing - chest x-ray with left plural effusion subcutaneous emphysema

A

Esophageal rupture diagnosed with Gastrografin study

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26
Q

Best H. pylori test if taking PPI

A

Antibody ie serology test - only for diagnosis

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27
Q

Best H pylori test if not taking PPI

A

Fecal antigen test used for diagnosis and follow up

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28
Q

Urease breath test for H. pylori

A

Diagnosis and follow up

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29
Q

H pylori treatment failure with triple therapy

A

Quadruple therapy tetracycline Flagyl bismuth ppi

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30
Q

NSAID induced PUD

A

Gastric ulcers higher with old age higher dose steroids with NSAIDs give worse risk bleeding

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31
Q

ZE syndrome

A

Duodenal bulb, Gastrinoma’s, present with PUD or diarrhea steatorrhea - inactivated pancreatic lipase
Diagnosis IV secretin increase gastric greater than 1000
CT scan or somatostatin receptor scan localized tumor
PPI and resection of Tumor
MEN1

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32
Q

G.I. bleeding monitor period

A

72 hours

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33
Q

Ppi related issues

A

C diff colitis, hospital acquired pneumonia, osteoporosis, hypomagnesemia, microscopic colitis

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34
Q

Esophageal varices

A

Not selective beta blockers such as propranolol carvedilol nadolol - if asthma then band ligation

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35
Q

Patient with cirrhosis and variceal bleed and spider angiomata

A

Nonselective beta blocker and antibiotics

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36
Q

Gastric malignancies

A

Adenocarcinoma 80% caused by h pylori

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37
Q

MALToma

A

Treat for H. pylori will regress

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38
Q

Post gastrectomy abdominal bloating postprandial symptoms relieved by vomiting

A

Afferent loop syndrome

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39
Q

Post gastrectomy fat and vitamin B12 malabsorption

A

Blinds loop syndrome bacterial overgrowth the conjugation of bike salts

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40
Q

Prognostic factor in acute pancreatitis

A

BUN - despite temperature elevated lactate white count no antibiotics

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41
Q

Congenital failure to fuse pancreatic ducts resulting in frequent pancreatitis

A

Pancreas divisum

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42
Q

Way to feed severe acute pancreatitis

A

Enterojejunal tube

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43
Q

Pancreatitis with muscle spasm in weakness

A

Hypocalcemia

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44
Q

18 Year old pancreatitis of unknown etiology

A

Sweat chloride test rule out cystic fibrosis - can be associated with pancreatitis

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45
Q

Lab values suggesting biliary ideology of pancreatitis

A

ALT greater than two times normal then increased alk phos

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46
Q

Severe pancreatitis elevated AST and LFT dilated common bile duct next

A

ERCP, remove stone, eventual cholecystectomy

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47
Q

Mild pancreatitis ultrasound gallstones no CBD dilation

A

Elective cholecystectomy

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48
Q

Post cholecystectomy patient with nausea vomiting pain chills with elevated bilirubin liver enzyme tests amylase

A

Retain common bile duct stone

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49
Q

Post hip replacements pain fever elevated liver enzymes elevated amylase ultrasound but thinking gallbladder wall

A

Acalculus cholecystitis requires cholecystectomy

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50
Q

Complications of pancreatitis

A
  1. fluid collections pleural effusion’s two days
  2. Pancreatic necrosis less than two weeks
  3. Pseudocyst wonder four weeks can hemorrhage rupture fistula
  4. Abscess 4-6 weeks soap bubble sign Gram stain
  5. Splenic vein thrombosis can occur anytime digastric CT abd
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51
Q

Ulcerative colitis

A

Rectal ulcer spreads proximately erythema friable mucosa very superficial ulcer crypto just toxic like a cool with erythema nodosum Rh negative arthritis pyoderma gangrenosum ankylosing spondylitis sclerosing cholangitis associated with cancer colonoscopy every after 8 years then q1-3

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52
Q

Crohn’s disease

A

Rectal sparing perirectal fistulas anyone G.I. tract mainly in the terminal ileum skip lesions
Diarrhea deep ulcers with granulomas toxic Megacolon
String sign

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53
Q

Best treatment for stricture

A

Surgery

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54
Q

Ulcerative colitis with extraintestinal symptoms pain in joints of hands with early morning stiffness

A

Rheum neg arthritis - sulfasalazine

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55
Q

Diarrhea right lower quadrant mass temperature ulcer in mouth

A

Crohn’s disease

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56
Q

Bloody diarrhea last 2 years, wks ago went to mexco, colonoscopy with erythematous friable mucosa

A

UC

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57
Q

Pt h/o UC with diarrhea/leukocytosis

A

r/o c diff

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58
Q

Young woman with chronic diarrhea wakes up at night for bathroom

A

Inflamm bowel dz

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59
Q

UC in remission - p/w LFTs bili, US shows focal dilations

A

ERCP/MRCP dx primary sclerosing cholangitis (beaded appearance) - brush bx prodominant stricture, need annual US gallbladder for polyps - if pos - cholecystectomy - if enzymes worsen then refer for liver tx

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60
Q

UC/Crohns maintenance medication

A

5ASA (Mesalamine +- flagyl, antiTNF alpha - DO NOT USE STEROIDS

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61
Q

Young man UC p/w abd pain, distension of colon to 7cm not improving with thumb printing on xray

A

subtotal colectomy

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62
Q

Pt with proctocolectomy and ileal anal anastamosis pouch p/w diarrhea with blood, temp -> endoscopy with diffuse superficial ulceration in pouch

A

Pouchitis -> tx with flagyl

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63
Q

Pt with Crohns rectovaginal fistula not responding to 6MP and flagyl

A

anti-TNF alpha (infliximab) - watch out for TB reactiv, PNA, crypto, histo

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64
Q

24 yo UC 4 years with jaundic and fever, hepatomegaly, elev bili, elev alk phos, AST, ALT p-ANCA +

A

Primary Sclerosing Cholangitis - beading/focal dilation biliary tree - P-ANCA +, a/w UC - if LFT/bili worsens - refer for liver tx

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65
Q

Review Chart GI page 453

A

Green book - GI

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66
Q

20 yo rectal bleed tenesmus - anal fissue - 6x6cm ulcer on leg

A

r/o UC with sigmoidoscopy/anoscopy - tx with 5asa suppostory

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67
Q

External hemorrhoid

A

topical NTG

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68
Q

Stool osmotic gap equation

A

290-2(stool Na+K)

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69
Q

Secretory diarrhea

A

> 1L/day, doesn’t stop with fasting, stool osm=290, osm gap <50

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70
Q

Osmotic diarrhea

A

50

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71
Q

longstanding diarrhea x years, stool osm 290, stool Na=50, K=25

A

lactose intolerance (stool gap >50)

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72
Q

diarrhea while vacation mexico - no blood, no fever

A

entertoxogenic e coli - tx with loperamide +- azithro x 3 days

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73
Q

Diarrhea +-fever +-blood with abd pain 2 days after undercooked poultry, mountain stream water, contact with dogs/cats - +fecal WBCs

A

C.Jejunum (can cause Guillion barre)

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74
Q

Diarrhea with abd cramping +- fever - had chicken, raw eggs or ice cream

A

salmonella

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75
Q

bloody diarrhea - hamburgers at fair 36hrs ago or unpasteurized mild - dec platelets

A

O157:H7 E.Coli - Mcorrey sorbitol agar - SX treatment only DO NOT GIVE ABX - will cause HUS - if RF then HD (TTP)

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76
Q

Bloody diarrhea

A

Shigella, C.jejuni, salmonella, c.diff

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77
Q

Diarrhea after camping, skiing with bloating, flatus, frothy stool

A

Giardiasis - check elisa for Giardia ag -> flagyl - post tx elisa should be negative

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78
Q

Canned Precooked foods beef/turkey - 12 hrs later diarrhea/vomitting no blood

A

C.perfringen - supportive tx

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79
Q

Diarrhea 4 hours after asian restaurant - fried rice - vomiting no blood

A

Bacilius cereus - supportive tx

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80
Q

Diarrhea after sea food dinner - g neg comma shaped bug

A

vibrio parhemolyticus -> cipro

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81
Q

Diarrhea, nausea vomiting, abd pain after eating fish (2hrs) with perioral paresthesias - reversal hot/cold sensation

A

ciguatera toxin from large reef fish (fish that eat other fish)

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82
Q

Flushing, utricaria, paresthesias minutes after eating fish

A

scromboid - histamine in fish

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83
Q

eats fish and minutes later parestehesias, weakness, ascendign paralysis and SOB

A

tetrodotoxin from puffer fish

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84
Q

Chronic diarrhea, hx travel to mexico last year - or presentation with acute dysntery - colonscopy with flask shaped ulcers

A

amoebic colitis

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85
Q

RUQ pain, fever, elev wbc after third world country - bloody diarrhea inc LFTs

A

amobic liver cyst - check stool for ova/cyts - elisa - if CT abd + then aspirate and tx with flagyl

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86
Q

HIV CD4<200 chronic diarrhea/wt loss no fever no blood

A

cryptosporidium - stool afb small round organisms - if stable just hydration, if not imporoving nitazoxanide

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87
Q

woman chronic diarrhea years, frequent small stools with mucous and constipation pain relieved with BM, no night waking no fever, wt loss anemia, stool studies neg, emotional stress - flex sig neg

A

irritable bowel syndrome (rome III criteria) - reassurance - rifaxinin, antispasmotics, anticholinergics - TCA, fiber

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88
Q

chronic diarrhea stool osm 300, stool Na 40, K 30 on adding naOH turns red

A

laxative abuse - stool gap 160 (>50)

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89
Q

diarrhea, RLQ pain, fever, rash fecal WBC no h/o diarrhea

A

yersinia enterocolitica

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90
Q

diarrhea WBC 12K Cdiff +

A

flagyl PO

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91
Q

recurred (x1) cdiff + diarrhea WBC 13

A

restart flagyl (leftover cdiff spores now matured)

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92
Q

recurred (x2) cdiff

A

vanco PO pulse therapy - 125mg 4x daily x 7 days, then taper

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93
Q

diarrhea, cdiff + WBC 18

A

po vanc (>15k don’t use flagyl)

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94
Q

which abx induced B1/NAP1 cdiff which causes toxic megacolon

A

cephalosporin or quinalones

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95
Q

77yo M a/w PONA started on abx - what do prevent cdiff

A

probiotics (lactobacillus)

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96
Q

74yo known diabetic p/w diarrhea with c.diff WBC 12 better with flagyl returns with WBC 24 with hypotension, fever, tachycardia ele lacatate

A

po vanc, recta vanc, iv flagyl and surgery c/s

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97
Q

prevent spread of cdiff

A

wash hands with soap and water (no etoh sanitizer)

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98
Q

65yo M fatigue, chronic diarrhea, itching with pallor, bullous skin lesions, Hg low, MCV low, TIBC inc, ferritin low, occult neg - blood smear howel jowell body, colonscopy neg for bleed - no change with iron therapy

A

TTG ab r/o celiac sprue

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99
Q

If celiac sprue neg tx?

A

gluten free diet - can have dermatitis herpetiformis

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100
Q

Dermatitis herpetiformis tx

A

gluten free diet and dapsone

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101
Q

asx brother of pt with celiac sprue - what to check

A

HLA DQ2 or 8 (not TTG)

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102
Q

vitamin supplement needed in celiac sprue

A

Vit D

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103
Q

Diarrheal dz a/w celiac sprue

A

microscopic colitis

104
Q

Pt with celiac sprue confirmed with TTG put on gluten free diet improves then worsens after few months

A

likely non-adherance

105
Q

Pt with celiac sprue responds well to gluten free diet for 10 year now with diarrhea/abd pain/wt loss

A

r/o lymphoma

106
Q

pt returns from 3rd world with diarrhea, foul oily stools, +steatorrhea, Hg low, MCV high D-xylose test abn, folic acid decreased

A

Small bowel bx - falttened villi with lymphotcitis and plasma cell infilitration - tropical sprue from klebsiella or ecoli -> treat with tetracycline and folic acid

107
Q

25yo diarrhea, bloating, flatulance wt loss from dominican republic - low hg, high mcv low normal b12 +steatorrhea

A

tropical sprue - carribean folate N, B12 low, Asia folate low B12 N, Bact overgrowth folate high b12 low

108
Q

Pt with diarrhea few months with greasy stools, fecal fat 15g/day, low d-xylose

A

check small bowel bx

109
Q

pt with h/o arthritis>2yrs, diarrhea >3/day, oily stools, foul smelling, wt loss, adenopathy, SKIN PIGMENTATION, posterior uveitis with blurry vision - foamy macorphages and PAS+ on small bowel bx

A

Whipple’s dz, t.whilli -> bactrim tetracycline

110
Q

55yo with recurrent pain/swelling shoulers for years with wt loss, LAD and asp of knee with WBC 13K

A

PCR synovial fluid for t. whipplei (whipple’s dz)

111
Q

diarrhea with food intolerance, n/v/abd pain, steatorreha, ova/cysts/parasites neg -> peripheral eosinophilia

A

eosinophillic gastroenteritis - r/o parasitic infection then start steroids

112
Q

35yo n/v epigastric pain for months - n/v in morning better with shower - wt loss but no dysphagia

A

marijuana induced

113
Q

30yo F early satiety even with tiny amoutn of food for months - gastric emptying normal

A

tx with buspiron

114
Q

chronic diarreha, fecal fat 14g/day, dxylose normal - B12 190, folate 18, small bowel shows diverticula

A

Bacterial overgrowth - check hydrogen breath test or xylose 14C breath test - tx with cipro+flagyl

115
Q

Pt steatorrhea 40g/day, dxylose 8g/5hrs - colonoscopy normal, h/o lactose intolerance

A

xray abd check for Calcification of pancrease - chronic pancreatitis

116
Q

Short bowel syndrome

A

calcium oxalate stones, replace ADEK, B12, Ca, Mg, Zn - replace long chain with med chain Fatty acids

117
Q

Intestinal lymphangietctasia - dilated lymphatic vessels

A

replace long chain FA with med Chain FA

118
Q

Abetalipoproteinemia

A

normal villi - impaired B globulin synthesis->imopaired chylomicron formation

119
Q

pt s/p extensive small bowel resection with lots of diarrhea 3 days post op

A

PPI - acid induced diarrhea

120
Q

small bowel resection of 50cm after GSW - diarrhea

A

mechanism is bile acid malabsorption

121
Q

GSW with bowel resection - couple months later with greasy stools and wt loss - fecal fat 20g/day INR 1.2 dxylose nl,

A

etiology=decreased bile acids

122
Q

severe ischemic colitis s/p small bowel resection - greasy stools wt loss, stool fat 20g/day, low alb/calcium

A

tx with med chain TG/FA

123
Q

52yo F chronic watery diarrhea 5x daily no constip, blood, fever - neg stool studies, neg giardia, neg scopes

A

flex sig with bx - r/o microscopic colitis (collagenous) vs lymphcytic colitis (lymphocytes) - inflammation of laina propria (NSAIDs, PPI, setraline, DM can cause) - D/C offending agent - start budesonide - check TTG

124
Q

Causes of osteomalacia

A

post gastrectomy, celiac sprue, biliary cirrhosis, pancreatic insufficiency, crohn’s dz

125
Q

60yo pt with fever, inc WBC, abd pain in LLQ

A

r/o diverticultis - CT scan - avoid colonoscopy/barium enema, cipro +flagyl - clear fluids then high fiber
4 weeks later do colonoscopy r/o cancer, crohns etc

126
Q

treated diverticulitis 3 months later still wtih LLQ pain with no fever or WBC - left segmental diverticulosis - DX?

A

uncomplicated symptomatic diverticular disease - tx with mealamine, rifampin

127
Q

Pt with divertiulitis with >4cm abscess

A

CT guided drainage first then elective surgery

128
Q

pt with acute diverticulits and 9cm dilation with 5cm abscess

A

surgical intervention

129
Q

what medication can cause divertiulitis with perforation

A

Tocilizumab - IL-6 inhibitor (also causes OCP failure)

130
Q

75yo M with ER c/o painless brbpr, no pmhx - BP ok HR ok, BRB in rectal vault

A

dx - diverticulosis (painless)

131
Q

55yo F with long rheum arthritis controled with ASA and naproxen x 14 years with abd pain for last 4 months - EGD/colonsocpy neg - small bowel barium enema with multiple concentric constricting lesions - dx?

A

small bowel diaphragm disease

132
Q

Chronic mesenteric ischemic

A

post prandial, abd pain, fear of eating, wt loss - dec blodo from from PAD - dx with doppler us/angio, - tx with revascularization

133
Q

Acute mesenteric ischemic

A

sudden onset sev abd pain, n/v/elev WBC, ileus - emboism in celiac, S mesenteric with valvular heart dz, afib, low flow state - dx with angio, tx with thrombolysis or surgery

134
Q

Ischemic colitis

A

hematochezia, diarrhea, abd pain - low flow state (CHF, hypercoag state, hypotension) - dx with thumbprinting colon on xray, pausity of vessesl - rehydration and antibiotics

135
Q

Angiodysplasia

A

AVM - cause lower GIB - common in elderly - osler weber rendu syndrome -> tx with laser photocaog, sclerotherapy or cautery

136
Q

65yo M pmhx severe AS with recurrent melena - colonscopy with angiodysplasia

A

Aortic valve replacement

137
Q

Post radiation tx in pelivs 2 years later with rectal bleeds - colonscopy with friable mucosa, atrophy and fibrosis - dx?

A

radiation prococolitis

138
Q

70yo M with severe abd pain x 1 day, last BM normal - tender abdomen, h/o DM, CHF, HTN, JVD+, S3+ rectal normal , FOBT neg, amylase elevated - abd xray normal, CT abd with small bowel wall thickenss and intestinal pneumoatosis

A

check mesenteric angiography

139
Q

MCC GIB in kids

A

meckels divertiulum

140
Q

Constipation

A

BM<3x/wk, hyperCa+, hypothyroid, slow transic - pelvic floor dysfxn, CCB, HCTZ, anticholing, antipsych, opiates+stim laxative

141
Q

Tx for constipation

A

tx underlying cuase and inc fiber

142
Q

Opioid induced constipation

A

start laxative with opioid rx

143
Q

elderly pt with chronic constip not responding to fiber

A

polyethylene glycol

144
Q

Pt with stage IV lung Ca not responding to stimulant laxative, polyethylene glycol

A

SQ methylnaltrexone

145
Q

elderly woman with constipation and diarrhea - hard stool in LQ

A

enema

146
Q

65yo M s/p ortho surgery on abx and morphine - with abd pain adn distension - abd xray with 6cm distenstion of cecum with no WBC, hypokalemia

A

dx: acute pseduo colonic obstruction (ogilvie’s syndorme) - CT scan or gentle hypaque (water soluble) enema to dx -> remove precip cause, correct electrolyties, d/c opiates, d/c aticholinergics, rectal tube, neostigmine

147
Q

75yo F with LLQ pain x 2 days, last BM 1 wk ago, BS+, xray with colonic dilation, CT with partial obst of signmoid

A

Dx Sigmoid volvulus - flex sig (analgesia for pain won’t affect dx accuracy)

148
Q

Woman sharp RUQ pain x 1 year - severe - US/CT normla - pain with raising legs

A

FXN abd wall pain

149
Q

Hepatitis A

A

RNA virus, incubation15-50 dyas, p/w jaundice, feco-oral/sexual, no carrier state, can worssen underlying liver dz (vacc HCV pts for HAV) - vaccinate high risk groups (travellors, gays, liver dz) - IVIG for high risk exposure -

150
Q

Anti HAV IgM

A

Acute hep A -> treat!!

151
Q

anti-HAV igG

A

post infection - Do not treat

152
Q

Preg woman - how to determine past infection HAV

A

HAV IgG+, IgM-

153
Q

Pt going to mexico for 2 weeks

A

hep A vaccine

154
Q

Hep A vaccine in….

A

Hep C, chronic liver dz, high risk country travelor, gay men (NOT PT WITH PNA)

155
Q

Pt returns from beize with contact with prostitutes - now with n/v/malaise, anorexia - HBV ab+, HBV cAb+ ->dx?

A

Hep A - check hep A serology in 2 weeks

156
Q

Hepatitis B

A

only DNA virus in hepatitis - sexual or IVDA, 30% chance after needle stick - most pt clear infxn - lose HBsAg and get HBV Ab - 5% with chronic - 1% fulminant hepatitis
Causes cirrhosis - hepatoma 2-4%/year -> carrier status highest in infants

157
Q

Heb B -> HBe Ag

A

denotes viral replication, active infxn

158
Q

HBV Vacc

A

high risk groups

159
Q

HBV IVIV (HBIG)

A

high risk exposure

160
Q

HBV tx

A

interferon, tenofovir, entecavir, adefovir, lamivudine can suppress

161
Q

HB S Ag

A

acute hep B, chronic hep B, Carrier Hep B

162
Q

anti-HB cIgM

A

acute hep B

163
Q

anti-HB c IgG

A

chronic, carrier, past infection

164
Q

HB e Ag

A

active replication

165
Q

Anti-HB IgG

A

post vacc, cleared infection

166
Q

anti Hbc IgG Ab +, HBsAg neg Anti HBsAb neg

A

chrnoic hepatitis or past infection - HBsAg or Anti-HBs could be below threshold

167
Q

pt low endemic area, no risk factors for Hep B has anti-HBc Ab only - wtd?

A

Hep B vacc

168
Q

Nurse with HBV vacc with needle stick pt with HBV

A

check anti HBs Ab titer - if >10 - reassure, if <10 HBIG+booster HBV vacc

169
Q

Pt with Hep B vacc series

A

+anti-HBs Ab

170
Q

HBV DNA >20K, ALT normal - treatment?

A

none

171
Q

HBV DNA >20K, ALT 1-2x normal - treatment?

A

Bx

172
Q

HBV DNA >20K, ALT >2x normal - treatment?

A

Yes

173
Q

HBV DNA >10IU - cirrhosis compensated

A

treat HBV

174
Q

HBV DNA >10IU - cirrhosis decompensated

A

liver tx

175
Q

HBV treatment

A

tenofovir, entecavir, telbivudine, adefovir, lamiudine or alpha interferon

176
Q

HIV/HBV pt coinfected

A

if treating HIV also - tenofovir, otherwise alpha interferon

177
Q

prior to starting rituximab or chemo with steroids or anti-TNF what to check

A

Hep B cIgG and HBsAg

178
Q

Asian american woman with HBV in 3rd trimester - prevent HBV in child

A

telbivudine for mother and hep B vaccine/HBIG in baby

179
Q

Hepatitis C

A

SSRNA - 90% tranfusion associated before 1992 - MCC of liver transplant in US, presentation with fatigue and elevated LFTs

180
Q

Hep C high risk groups

A

IVDU/prisoners, blood tx before 1992, tattoos, snorting cocaine, most patients DO NOT CLEAR - NO VACCINE, NO IGG, no post exposure PPX available

181
Q

Woman with hep C - precautions with husband

A

sex ok - DO NOT SHARE TOOTHBRUSH

182
Q

60yo pt born 1945 to 1965 - what to check

A

hep C abs

183
Q

Risk factors progression to cirrohisis from HCV

A

age>40, etoh, man, coinfection with Hep B or HIV

184
Q

Treatment HCV

A

Boceprevir, interferon, ribavirin, d/c therapy if VLsuppressed

185
Q

53yo M received multple blood tx in 1990 after MVA p/w fatigue, elev LFTs, Hep C Ab + and liver bx with mod bridging fibrosis - hep C viral load 250K - 2 months alater AST/ALT lower - VL 210K

A

Start IFN/ribavirin

186
Q

Nurse gets stuck with needle HCV patient - Hep C ab neg

A

repeat HC Ab/RNA in 4 weeks (no ribavirin/IFN)

187
Q

Nurse stuck with HCV 4 weeks ago with VL 45K - wtd?

A

reassess HCV RNA at 12 weeks if + start PI, ribavirin and IFN

188
Q

Pt with IV exp to HCV 6 weeks later with malaise and fatigue - all Hep Ab neg - wtd?

A

check HCV RNA

189
Q

55yo pt with fatigue, no history - ALT 2x, AST 1.5x, takes tylenol

A

Dx HCV (tylenol would be AST in 1000s) - if HCV Ab + check HCV RNA - if viral load high liver bx - if +fibrosis treat HCV (ribavirin+IFN)

190
Q

Pt with hep C, genotype 1 on IFN, ribavirin p/w fatigue

A

check Hg (ribavirin causes hemolytic anemia) - if retic + then start erythropoietin, d/c ribavirin

191
Q

If pt on IFN get depressed

A

start SSRI (Paroxetine)

192
Q

Pt with HCV with briding fibrosis and inc’d HCV RNA started on Ribavirin and IFN - advice for pt

A

NO ETOH, if seroneg for HAV, HBV give vaccines for HAV/HBV

193
Q

Extrahepatic manifestations of HCV

A

small vessel vasculitis, glomerulonephritis, neruopathy, mixed cryoglobulinemia dec C4>dec C3, porphyria cutanea tarda

194
Q

HCV pt on ribavirin/IFN - what to monitor

A

hypothyroid, hyperthyroid

195
Q

HDV

A

incomplete RNA virus needs HBV to survive

196
Q

HBc IgM + HDV

A

Acute co-infection - doesn’t make hepatitis worse

197
Q

HBc IgG + HDV

A

Acute superinfection - can cause fulminant hepatitis

198
Q

HEV

A

fecooral transmission like HAV, Fulminant hepatitis in 3rd trimester of preg, ALL hepatitis seriology NEGATIVE,

199
Q

Tylenol liver damage

A

> 7g tylenol can cause liver damage, in etoh 4gm tylenol causes liver damage - N-acetylcystein antidote

200
Q

20yo took 30 gm pain pill - ER denies sx - tylenol level Pending - wtd

A

give oral n-acetylcysteine without waiting for labs - if within 1hr then gastric lavage, activae charcoal and syrup of ipepac

201
Q

heavy etoh with myalgias and ha took tylenol q4h for past couple days now with n/v/abd pain AST 11,000, ALT 9000 INR 3 - dx?

A

acetaminophen toxicity

202
Q

INH Hepatitis

A

Dose related, age related tox with inc AST/ALT, ANA+

203
Q

Hepatitis with cholestasis

A

amox-clavu, bactrim, erythromycin

204
Q

Hepatitis with macrovascular fatty change

A

etoh hepatitis, amiodarone, steroids

205
Q

Hepatitis with microvasicular fatty change

A

tetracycline, reye’s syndorme with ASA+flu

206
Q

Chronic drug hepatitis

A

methyldopa, trazadone, nitrofurantoin, phenytoin

207
Q

Direct liver toxicity

A

tylenol

208
Q

Dysphagia

A

Solids -> pogressive Age>50 -> carcinoma
Solids -> progressive -> heart burn -> peptic stricture -> EGD/bx r/o CA ->dilation/PPI
Solids-> intermittent -> esosinophilic esophagitis -> esoph rings (steakhouse syndrome)
Solids or liquids ->progressive->cough/regurg ->achalasia->dx with barium swallow (autoimmune)
Solids or liquids->progressive->heart burn->scleroderma (scl70)
Solids or liquids->intermittent->chest pain -> diffuse esophageal spasm -> corkscrew esophagus->PPI trial->confirm with manometry

209
Q

Pt with intermittent syphagia to solids and liquds w/ CP

A

DES -> barium swallow (cordscrew esophagus)-> confirm with manometry-> PPI if no response-> CCB

210
Q

Young pt with steak dysphagia -> first bite ->

A

esophageal rings/schatzky ring-> pneumatic dilation

211
Q

food regurg several hours after eating, no heartburn, dyphagia to solids and liquids - dilated esophagus with tapering (bird beak) - manometyr decreased peristallsis increased Lower esoph pressure

A

Achalasia -> surgical myotomy (EGD r/o lymphoma or cancer

212
Q

GERD

A

Acid reflux sx - CP, heartburn, nocturnal cough, asthma, dental erosion

213
Q

GERD complications

A

Barrett’s-> AdenoCA

214
Q

GERD Tx

A

wt lossw, head elevation, tob cessation, early dinner, PPI>H2, fundoplication

215
Q

GERD EGD indication

A

heart burn not relieved with PPI x 8 wks, heartburn >5years, heartburn with wt loss, melena, anemia, dysphagia/odynophagia

216
Q

Hearburn partial response to PPI but EGD with severe GERD

A

lap fundoplication - prior to procedure manometry to confirm esophageal motility - (otherwise iatrogenic achalasia cuased)

217
Q

elderly pt with GERD not responsing to H2 - EGD with stricture dilated - bx neg, prox gastritis - further managment

A

lifelong PPI

218
Q

Barretts

A

normal Gastro-esoph jnc squamous epithelium - changes to columnar epithelium (like stomach) -> strictures/adenoCA

219
Q

gastritis

A

Erosive - NSAIDS, etoh, burns, surgery, vent, - tx with H2, PPI
Chronic type A - fundus/body less common - atrophic gastritis - inc gastrin
Chronic type B - antrum more common - cause by h pylori, tx H pylori only with sx

220
Q

PUD causes

A

H. pylori, NSAIDS, ZE

221
Q

H. Pylori

A

gram neg urease producing, inc’d in 3rd world, PUD, type B gastritis, gastic CA, maltoma,

222
Q

45yo Fp/w itching esp at night +xanthomas, alk phos 1400, +AMA, -ANA, liver bx granulomas/lymphocytic destruction of bile ducts (dec ADEK, osteomalacia, HLD with high HDL)

A

Primary biliary cirrhosis (PBC) - tx ursodeoxycholate (delays progression, doesn’t prevent –> liver transplant

223
Q

Autoimmune hepatitis

A

young woman with fatigue, wt loss, arthralgia, acneform rash, amenorrhea, +icterus, AST/ALT inc 5-10x, inc globulins, (a/w thyroititis, ITP, anemia, Coombs+) -> +ANA, +ANCA, +Anti DSDNA, +SMA (most specific)
Bx - piece meal necrosis of hepatocytes,
Tx - prednisone/azathioprine - NO IFN (makes worse)

224
Q

25yo F juandice, ALT 350, alkphos 115, +ANA, +ASMA, -AMA, IgG elev -> liver bx piecemeal necrosis of hepatocytes

A

Autoimmune hepatitis

225
Q

26yo F jaundice, ALT 40, alk phos 290, -ANA, -ASMA -AMA, IgM/G normal - Liver bx mild inflamm with concentric fibrosis around bile ducts

A

Primary Sclerosing cholangitis (extrahep duct fibrosis) - urosdiol doesn’t help

226
Q

26yo F jaundice, ALT 100, alk phos 550, ANA neg, ASMA neg, AMA pos, IgM elev, IgG normal, liver bx - lymphocytic destruction of bile ducts

A

Primary Biliary cirrhosis (intrahep bile duct destruction, elev alk phos) - ursodiol helps

227
Q

Etoh Liver dz

A

Fatty liver-> etoh hepatits-> micronodular cirrhosis - hepatomeg, fat vaculoles on liver bx (reversible with stopping etoh)

228
Q

Etoh hepatitis

A

aorexia, n/v/abd pain/wt loss - AST:ALT 2>1, AST ALT up to 300, Hepatomegaly, liver bx - necrosis of hepatocytes with inflamm cells, inc WBC, enceph, elev PT

229
Q

35yo F jaundice, confusion, malaise, RUQ pain - icterus, mild ascities, hepatomegaly, AST 200/alt 100, INR 1.5, WBC 18, bili 15

A

acute etoh hepatitis -> steroids if no bleed

230
Q

If acute etoh hepatitis with bleed

A

pentoxyfyline

231
Q

Obese pt DM, HLD - non-etoh - mild elev of ALT/AST 2:1, Fasting suger 160, chol 280 - liver bx fatty changes with some fibrosis

A

NASH - dx wit liver bx - tx underinglying weight, DM, vit E, statin

232
Q

Causes of cirrhosis

A

Viral (B,C,D), Autoimmune hepatitis, etoh, PBC, PSC, Hemochormatosis, wilsons, CHF/Budd chiari (stasis)

233
Q

CA screening with cirrhosis

A

liver US/ alpha feto protein

234
Q

MELD

A

PT, INR, Ser Cr, Ser Bili

MELD24 - liver tx

235
Q

Indication for liver tx

A

viral hep, autoimmune hep, PBC, PSC, hepatoma, wilsons, Alpha 1 AT def, fulmianent hep failure

236
Q

Contraindications

A

untreated HIV, extrahep CA, active etoh/drug use, unresolved sepsis/fungemia, Hep B with eAg +

237
Q

When to refer for liver tx

A

cirrhotics with clinical or biochemical decompensation

238
Q

Pt with cirrhosis p/w hep enceph - quit drinking 2 years ago, ascitic fluid WBC 70 - wtd

A

refer for liver tx

239
Q

SAAG

A

figure this out

240
Q

Least likely to cause chylous ascites

A

cirrhosis/CHF

241
Q

management of cirrohsis with ascites

A

Na restriction to 1g/day, fluid restriction, diuresis witih aldactone/diurteics - large volume paracentesis or TIPS

242
Q

Cirrhotic p/w elev WBC, fever, ascities

A

paracentesis

243
Q

Pt with long cirrhosis brought in with lethargy, asterixis and asciteis - PT INR 3, plt 40 - WTF

A

paracentesis (plt>30 - ok)

244
Q

SBP

A

PMN >25 in asciteis or WBC >500 with >50%pmn

245
Q

SBP tx

A

cefotaxime (3rd gen cephalo) - usually single organism (ecoli, kleb, s pneumo) - give albumin if Ser Cr elev or bili >4

246
Q

Post surgery NPO OR pt on abx for bronchitis get icterus - AST/ALT normla, alk phos nromla - indirect bili elev 4.2, direct bili 0.3 - 2 days later total bili 2.5

A

Gibert’s syndrome - no tx

247
Q

Wilson’s dz

A

autosom recessive - chronic hepatitis with elev LFTs, nuero sx (tremors, rigidity, psych (personality/behavor), heolytic anemia - copper accumulation in liver/body tissues - urine copper high - KAYSER-FLEISCHER RING - liver bx with copper

248
Q

Tx wilson’s dz

A

chelation penicillamine/pyridoxine -> severe dz - liver tx

249
Q

UGIB causes

A

PUD, varices, mallory weiss tear, splenic vein thrombosis

250
Q

Pt with coffee ground emesis and dizzinesss - NGT with blodo tinged fluid - BP 90/60 HR 120

A

fluid resucitation

251
Q

Acute UGIB, continues bleeding confused, hypotensive/tachy

A

intubate then scope after volume resusitation

252
Q

Point to transfuse UGIB

A

<7gm Hg

253
Q

Tx of UGIB

A

bleeeding ulcer - electrocautery, visible vessel monitor/electrocautery, bleeding varices - octreotide infusion with banding -> monitor for 72hrs

254
Q

Clean based ulcer no bleed

A

early feeding

255
Q

PPI use

A

rel to cdiff, HAP, osteoporissis, low Mg, microscopic colitis

256
Q

prevent rebleed in PUD

A

PPI

Awesome Review 2021 (14 decks)

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