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PANCE review > GI > Flashcards

GI Flashcards

1
Q

Odynophagia =

Dysphagia =

A

painful swallowing

difficulty swallowing

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2
Q

Causes of esophagitis

A
  • infections related to immunocomp’d patient: Candida, Herpes, CMV
  • GERD
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3
Q

How does endoscopy with biopsy for esophagitis patient differentiate the infectious causes?

A

Herpes – Multiple shallow ulcers throughout the esophagus
CMV – Large solitary deep ulcers
Candida – Raised white plaques which can be removed

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4
Q

How is esophagitis caused by Candida treated?

A

Fluconazole x 3 weeks

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5
Q

Diagnostic test of choice for most esophageal and gastric issues

A

Barium swallow

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6
Q

Why is there concern for doing an endoscopy with diverticula?

A

possible perforation

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7
Q

What is diverticula within the esophagus called?

A

Zenker’s Diverticula

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8
Q

Zenker’s Diverticula treatment

A

Hydration after meals
Thorough chewing
Surgical repair of diverticula

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9
Q

Decreased peristalsis of the esophagus along with increased muscle tone of the lower esophagus

A

Achalasia

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10
Q

Barium swallow of achalasia

A

bird’s beak (clear tapering at LES)

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11
Q

I came in to see my physician assistant because of…

  • Regurgitating undigested food hours after a meal
  • Bad breath
  • Neck pain
  • Odynophagia
  • Dysphagia
A

Zenker’s Diverticula

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12
Q

I came in to see my physician assistant because of…

  • Dysphagia with both fluids and solids and will continue to get progressively worse
  • Regurgitation of undigested foods
  • Non-cardiac chest pain
A

Achalasia

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13
Q

Achalasia treatment

A

CCBs – Nifedipine

Try to dilate LES: Nitrates, Botox injections, Pneumatic dilation

Surgical myotomy

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14
Q

Patient c/o forced retching vomiting and is now vomiting blood. Also has epigastric pain. Likely dx?

A

Mallory-Weiss tears (longitudinal lacerations of esophagus)

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15
Q

Mallory-Weiss tear treatment

A

Usually self limiting
Transfusion if high loss of blood
Endoscopy with epinephrine injection or thermal coagulation

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16
Q

Treatment of esophageal strictures

A

Treat for GERD since most likely cause
PPIs - omeprazole
H2 Blockers - Zantac

Surgical correction

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17
Q

DDX of hematemesis (vomiting blood)

A

Mallory-Weiss tears, esophageal varices, PUD, cirrhosis…

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18
Q

I came in to see my physician assistant because of…

  • Substernal chest pain
  • Pain typically postprandial
  • Dysphagia
  • Chronic dry cough and laryngitis
A

GERD

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19
Q

I came in to see my physician assistant because of…

Hematemesis (vomiting blood)
Black, tarry or bloody stool
Signs and symptoms of GI bleed (lightheaded etc)

A

Esophageal varices

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20
Q

Pathophysiology of esophageal varices

A

dilated veins of esophagus secondary to alcoholism, cirrhosis, and/or portal HTN

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21
Q

What is diagnostic and therapeutic for esophageal varices?

A

Endoscopy

  • Variceal ligation or banding
  • Sclerotherapy
  • Balloon tamponade
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22
Q

Behavior modifications to relieve GERD?

A 
Smaller portion sizes
Not laying down after meals
Weight reduction
Avoid acidic foods
Avoid things that relax the lower esophageal sphincter - fatty foods, mint, chocolate, alcohol, smoking
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23
Q

Medical treatment for GERD

A

OTC antacids - rolaids, TUMS, Pepto-Bismol, Milk of Magnesia
H2 blockers - rantidine (Zantac), famotidine (Pepcid)
PPIs - omeprazole

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24
Q

Possible complications of GERD

A

Increased risk for esophageal strictures
Barrett’s esophagus (pre-malignancy)
Peptic ulcers

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25
Q

I came in because of…

  • Unexplained weight loss
  • Abdominal discomfort
  • Dysphagia
  • Anorexia
  • Enlarged left supraclavicular lymph node (virchow’s node)

Must not miss dx?

A

Gastric adenocarcinoma

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26
Q

Risk factors for gastric adenocarcinoma

A

Smoking
H. Pylori
Male (3:1)

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27
Q

Gastrin secreting tumor of pancreas resulting in GERD symptoms, diarrhea, and unexplained weight loss?

A

Zollinger Ellison Syndrome (gastrinoma)

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28
Q

Patient c/o achy stomach pain, nausea, hematemesis, and anorexia. Urea breath test positive for H. pylori. Likely dx?

A

Peptic ulcer disease

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29
Q

Where can peptic ulcer disease occur? Most likely spot?

A

mucosal lining of stomach or duodenum

ulcer 4-5x more likely to be found in duodenum

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30
Q

Risk factors for Peptic Ulcer Disease

A

H. Pylori (90% of cases)
NSAIDS
Smoking

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31
Q

How is H. Pylori detected?

A

urea breath test

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32
Q

Gold standard for PUD diagnosis

A

endoscopy with biopsy

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33
Q

Peptic Ulcer Disease treatment plan

A

1st line: triple therapy = PPI + 2 antibiotics x 2 weeks
(omeprazole + clarithromycin + amoxicillin)

Quadruple therapy = PPI + bismuth subsalicylate + 2 antibiotics x 2 weeks

PPIs long term

Surgical repair of ulcer if necessary

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34
Q

An 4 wk old infant comes in with projectile vomit and abd distention. Epigastric olive-like mass found on palpation. DX?

A

Pyloric stenosis

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35
Q

Barium swallow test results for Pyloric Stenosis

A

String sign

or railroad track sign

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36
Q

Treatment of Pyloric Stenosis

A

Fluids for dehydration

Pyloromyotomy (Ramstedt’s procedure)

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37
Q

Average age of Pyloric Stenosis

A

6 weeks old

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38
Q

corkscrew appearance on Barium swallow =

A

esophageal spasms

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39
Q

What is the best test to diagnose peptic ulcer disease?

A

endoscopy

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40
Q

A 65 year old male has had GERD for years. Over the past year he has noticed an increase in difficulty swallowing his food. What is the most likely diagnosis?

A

Esophageal strictures

achalasia and esophageal also possible, but strictures more likely with h/o GERD

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41
Q

________ is a direct cause of esophageal varices.

A

Portal HTN

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42
Q

________ is an infection of the gallbladder.

A

Cholecystitis

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43
Q

Explain pathophysiology behind the most common cause of Cholecystitis.

A

90% of cases are associated with gallstones (cholelithiasis)

Cholesterol builds up in gallbladder to form stones that can block cystic duct (choledocholithiasis)

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44
Q

Risk factors for Cholecystitis

A 
Native American
Females slightly higher rate
Obesity
Diabetes
Pregnancy
Crohn’s disease
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45
Q

What is Murphy sign? When is it positive?

A

Inhibited inspiration with pressure over RUQ secondary to pain

Cholecystitis

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46
Q

Woman comes in with pain in RUQ that worsens after fatty meals. She is jaundice and has elevated bilirubin. DDX?

A

Cholecystitis, Cholangitis

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47
Q

Cholecystitis treatment

A

Asymptomatic gallstones require no treatment

Initially antibiotics and NSAIDs are given to stabilize patient and bring down inflammation (2nd gen cephalosporin OR fluoroquinolone + Metronidazole)

Cholecystectomy is the definitive treatment for cholecystitis

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48
Q

Labs that indicate gallbladder infection

A

WBC
Bilirubin
Alk Phos and ATF

  • all will be elevated
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49
Q

Charcot’s triad includes symptoms for what disease? What are sx’s?

A

pain, fever, jaundice = Cholangitis

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50
Q

What is Reynold’s pentad?

A

Charcot’s triad + hypotension and altered mental status = EMERGENCY!!!

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51
Q

DDX of RUQ pain

A 
Cholecystitis
Cholangitis
Choledocholithiasis
Hepatitis A, B
...
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52
Q

Most common cause of Cholangitis?

A

choledocholithiasis

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53
Q

Test of choice for Cholangitis

A

ERCP (Endoscopic retrograde cholangiopancreatography) because it can both diagnose and treat with stone extraction and sphincterotomy

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54
Q

infection of common bile duct is

A

cholangitis

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55
Q

Hepatits A treatment

A

Supportive care as illness is self limiting with full recovery in about 9 weeks

Vaccine available

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56
Q

How is Hepatitis A differentiated from other RUQ pains?

A

hepatomegaly

anti-HAV

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57
Q

Hepatitis A, B, and C transmission

A

A: fecal-oral

B, C: blood, needles, sex, across placenta

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58
Q

Incubation period of Hep B

A

6 wks - 6 months

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59
Q

Acute and chronic Hep B treatment

A

Vaccination available; given to all infants

Acute - usually self limiting with sx’s improvement in 2-3 weeks and full recovery in 16 weeks; however some become chronic

Chronic - Antiviral therapy

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60
Q

What do HBsAG, Anti-HBs, and Anti-HBc indicate on serum testing for Hep B?

A

HBsAG (surface antigen) = disease; either acute or chronic

Anti-HBs (Antibody to surface antigen) = immunity; vaccine or recovery from previous infection

Anti-HBc (Antibody to core antigen) = has infection or h/o infection

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61
Q

30% of ____ patients are found to also have Hep C.

A

HIV

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62
Q

How will untreated Hep B and C progress?

A

chronic hepatitis -> cirrhosis -> hepatoellular carcinoma or liver faliure

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63
Q

Hep C treatment

A

Self limiting and recovery is complete in 3-6 months

Meds if doesn’t resolve in 3 months and becomes chronic: Interferon alpha, Pegylated interferon, Ribavirin

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64
Q

Labs to help dx Hep C

A

screen for anti-HCV antibody

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65
Q

Which hepatitis most likely to become chronic?

A

Hep C

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66
Q

Patient must have _____ in order to contract Hep D.

A

Hep B

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67
Q

Risk factors for cirrhosis

A 
Chronic hepatitis
Chronic alcohol abuse
Drug toxicity
Age > 55
Diabetes
Obesity
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68
Q

Symptoms associated with decreased liver function?

A 
jaundice
hepatomegaly
ascites
peripheral edema
asterixis
caput medusa
spider angioma
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69
Q

Labs results associated with decreased liver function?

A

Elevated bilirubin (mostly conjugated)
Increased prothrombin time
Decreased serum albumin

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70
Q

Diagnostic imaging for cirrhosis

A

U/S to determine liver size and hepatic blood flow

CT/MRI with contrast to find hepatic nodules

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71
Q

How to manage/treat cirrhosis?

A

STOP DRINKING ALCOHOL!!!

Treat symptoms:

  • restrict fluids and Na+ for edema and ascites
  • daily folate, iron for anemia
  • fresh frozen plasma for increased bleeding time

ultimately need liver transplant

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72
Q

Most cases of cirrhosis will progress to _______.

A

hepatocellular carcinoma

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73
Q

What lab value can differentiate liver cancer from cirrhosis?

A

hepatocellular carcinoma will have elevated WBC and cirrhosis will not

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74
Q

How can hepatocellular carcinoma be prevented?

A

Hep B vaccines

Monitor patients with cirrhosis or chronic hepatitis with alpha fetoprotein and U/S

75
Q

Test of choice for dx of pancreatitis

A

CT

76
Q

What are Cullen and Turner signs? What pathology do they suggest?

A

Cullen sign – ecchymosis in periumbilical region
Turner sign – ecchymosis in the flanks

Both positive in pancreatitis

77
Q

What is included in liver function panel?

A

bilirubin, Alk phos, ALT/AST, ATF

78
Q

Patient with acute epigastric pain that is alleviated by sitting or leaning forward. Bruising is seen around umbilicus. Likely dx?

A

acute pancreatitis

79
Q

What is included in a BMP lab order?

A

BUN, creatinine, glucose, Na, K, Ca

80
Q

Median survival for cases of pancreatic cancer?

A

less than 1 year

81
Q

Risk factors for pancreatic cancer

A 
Age > 60
FHX
Diet - Low in fruits and veggies, high in red meat and sugar
Smoking
Obesity
82
Q

Pancreatitis treatment

A 
IV fluids
Monitoring of vitals
Pain medication
NPO
Treat abnormal labs -blood transfusion, calcium, albumin
83
Q

What lab value is 3x normal level in pancreatitis?

A

serum amylase

lipase

84
Q

What is the Trousseau sign?

A

tender nodules within veins which are small venous thrombi

Hallmark of hypercoagulable state associated with some cancers (pancreatic)

85
Q

Surgical treatment for Pancreatic Cancer

A

Whipple procedure
major surgery involving a pancreaticoduodenectomy, a gastro-jejunostomy and a cholecystojejunostomy. A successful procedure results in 5 year survival rate of about 20%

86
Q

Abdominal pain beginning periumbilical and moving toward the RLQ

A

appendicitis

87
Q

Positive tests for appendicitis on PE

A

Rebound tenderness

Tenderness over McBurney’s point – located on the right side of the abdomen one third of the way from the anterior superior iliac spine to the umbilicus

Obturator sign – pain with flexion and internal rotation of the right hip

Psoas sign – pain with either passive right hip extension or active right hip flexion

88
Q

What are specific managements of appendectomy pre-op?

A

Keep patient NPO

IV antibiotics

89
Q

Pathophysiology of Celiac disease

A

Autoimmune disease which is an inflammatory reaction to the protein gluten

Damages villi of small intestine causing poor absorption of nutrients

90
Q

Treatment of Celiac Disease

A

gluten free diet (avoid wheat) and intestinal villi should heal within weeks

91
Q

What is clinical definition of constipation?

A

less than 2 bowel movements per week

92
Q

Constipation treatment

A 
Fiber supplements
Mineral oil
Osmotic or stimulant laxatives
Digital disimpaction
Enema
93
Q

Diverticulosis vs Diverticulitis

A

Diverticulosis is out-pouching of diverticula due to weakened intestinal walls

Diverticulitis if diverticula become inflamed

94
Q

What tests are contraindicated in acute diverticulitis due to risk of perforation?

A

endoscopy and colonoscopy

95
Q

Typical location of diverticulitis pain

A

descending colon in LLQ

96
Q

Treatment of mild/moderate and severe diverticulitis

A

Mild/mod treated conservatively:
Clear liquid diet
Oral antibiotics (metronidazole, cipro, Augmentin)

Severe:
NPO
IV fluids and abx
Surgery - Removal of diseased colon with temporary colostomy

97
Q

DDX LLQ pain

A

diverticulitis
diverticulosis
Crohn’s Disease
Ulcerative Colitis

98
Q

Labs to look for malnutrition

A

B12, folate, iron, albumin

99
Q

Disease with cobblestone appearance and skip lesions on colonscopy?

A

Crohn’s Disease

100
Q

Common effects of Crohn’s Disease on GI tract

A

strictures, fistulas, abscesses

B12 deficiency anemia in small intestines

101
Q

Management of Crohn’s Disease

A 
Smoking cessation
Encourage fluids
Treat malnutrition
Anti-diarrheals
ABX prn
Prednisone for inflammation
Surgery if abscess, stricture, or fistula
102
Q

Patient with bloody diarrhea and abd pain localized to LLQ. Blood is found on DRE but stool cultures are negative. Likely dx?

A

Ulcerative colitis

103
Q

Difference in sx’s and location of Crohn’s and Ulcerative colitis

A

Crohn’s: non-bloody diarrhea, can occur anywhere along GI tract (usually intestines)

UC: bloody diarrhea, restricted to colon

104
Q

Ulcerative colitis treatment

A

NPO only in severe colitis
Topical or oral aminosalicylate agents – 5 ASA (mesalamine)
Topical or oral corticosteroids
Surgical removal of the colon

105
Q

Massive dilation of the colon in acute colitis that makes patient extremely sick.

A

Toxic megacolon

106
Q

Child laying on exam table holding his knees to chest. Palpable sausage-shaped abdominal mass

A

Intussusception

107
Q

Pathophysiology of intussusception vs volvulus

A

intussusception: portion of bowel telescopes into another portion of bowel
volvulus: twisting of bowel on itself
* both cause bowel ischemia

108
Q

Typical age range of intussusception

A

3 mon to 6 yrs

109
Q

Dx and Tx of intussusception

A

air contrast enema

110
Q

Patient comes in with diffuse acute abd pain and distention. There are signs of shock and patient has started vomiting. XR shows air fluid levels. Likely dx and tx?

A

Volvulus

MEDICAL EMERGENCY!
Need surgery

111
Q

Risk factors for ischemia bowel disease

A 
> 60 yo
History of a-fib
Vasculitis
Hypercoagulable states
Uses of vasoconstrictors - vasopressins, cocaine, etc.
112
Q

currant jelly stool =

A

intussusception; secondary to bowel ischemia (later finding)

113
Q

Likely dx of patient with severe abdominal pain that is out of proportion to your exam. Has sx’s of bloody diarrhea, fever, and shock.

A

Ischemic bowel disease

114
Q

Treatment of ischemic colitis and mesenteric ischemia

A

Ischemic colitis
- Supportive care including NPO and IV fluids

Mesenteric Ischemia

  • Surgical removal of ischemic bowel
  • Patients have 50% survival rate if dx’d within 24 hrs
115
Q

1 cause of small bowel obstruction

A

adhesions following abdominal surgery

116
Q

1 cause of large bowel obstruction

A

carcinoma

117
Q

Early and late PE findings of bowel obstruction

A

Early obstruction

  • Peristaltic waves
  • High pitched bowel sounds

Late obstruction

  • Peristaltic waves stop
  • Bowel sounds quiet down and stop
118
Q

Abdominal XR findings of bowel obstruction

A

Dilated loops of bowel
Air fluid levels – step ladder appearance
Free air

119
Q

Condition defined by…

  • Abd pain relieved with defecation
  • Change in freq, form, or appearance of stool
  • Sx’s for +6 months
  • Normal PE
A

Irritable bowel syndrome

120
Q

Possible treatments of Irritable Bowel?

A 
Modified diet - fiber, probiotics, avoiding aggravators
Increase exercise
Anti-spasmodics
Laxatives
SSRIs or TCAs
121
Q

Recommendations for colorectal cancer screening - tests and how often?

A

Colonoscopy: every 10 years starting at age 50 (more often if h/o polyps)

Fecal occult blood test: annually starting at age 50

122
Q

95% of adenocarcinoma of the colon come from _____ found on colonoscopy.

A

polyps

123
Q

When is colon polypectomy indicated?

A

polyps > 2-3 cm

124
Q

Air fluid levels or step ladder appearance on abdominal XR =

A

perforated bowel

125
Q

Who is at higher risk for colorectal cancer?

A

H/O of colon polyps, Crohn’s disease, or ulcerative colitis
Increasing age
FHX
African Americans

126
Q

Symptoms if neoplasm in rectum

A

tenesmus

hematochezia = bright red blood in stool

127
Q

List all 5 of Ranson’s Criteria

A 
Age > 55 years old
WBC > 16,000
Glucose > 200
Lactate dehydrogenase (LDH) > 350
Aspartate aminotransferase (AST) > 250

used to assess severity of pancreatitis upon admission

mneumonic: “GA LAW”

128
Q

What are the first 3 steps in managing pancreatitis?

A

NPO, IV fluids, pain medication

** Abx currently not recommended. A surgical consult is unnecessary for pancreatitis.

129
Q

A 45 yo male presents with a low grade fever and abdominal pain. He has had non bloody diarrhea x 2 weeks. You decide to have the patient undergo a colonoscopy. On the report it mentions a cobblestone appearance. What is the most likely diagnosis?

A

Crohn’s Disease

130
Q

What are some tests to eval Celiac Disease? What is the definitive test?

A

Serum antibodies
Gluten challenge
Anti tTG assay
Endoscopic biopsy (definitive)

131
Q

Patient has extreme rectal pain especially during bowel movements. Ulcers are visualized on posterior midline of rectum. DX?

A

anal fissure

132
Q

Anal fissure treatment

A 
Increase fiber
Stool softeners
Sitz baths
Topical nitroglycerin
Botox injection into the anasl sphincter
Sphincterotomy
133
Q

An abscess can form if anal gland gets blocked. A ______ is the tract that forms from abscessed gland to skin.

A

fistula

134
Q

Patient has severe rectal pain with opening of skin near anus. There is purulent discharge and area is tender, red, and swollen. Dx and tx?

A

anal fistula

tx: surgical drainage and/or repair

135
Q

How is fecal impaction treated and prevented?

A

Laxatives, water or oil enema
Manual disimpaction

Prevention: reduce occurrence of constipation

136
Q

Ways to prevent constipation

A 
increase fiber
increase fluids
daily exercise
regular bowel habits
avoid opiates
137
Q

What differentiates internal from external hemorrhoids?

A
  • dentate line divides them
  • internal are painless and external are painful
  • both have bright red blood per stool
138
Q

What diagnostic imaging is used to assess hemorrhoids?

A

anoscopy

139
Q

How are hemorrhoids treated and when can they be manually reduced?

A

Grade I-III (may be manually reduced)

  • Sclerotherapy
  • Rubber band ligation
  • Electrocoagulation

Grade IV or thrombosed (can’t be reduced)
- Surgical excision

Symptomatic - Sitz bath, increased fluids and fiber

140
Q

movement of an organ through the wall which normally contains it is called a ________.

A

hernia

141
Q

Strangulated hernia

A

a hernia whose blood supply has been cut off; ischemic bowel

142
Q

Most common type of hernia

A

inguinal hernia

143
Q

indirect vs direct inguinal hernias

A

Indirect: hernia sac enters inguinal ring through a congential defect

Direct: protrude through weakening in fascia of Hesselbach’s triangle

144
Q

Boundaries of Hesselbach’s triangle

A

rectus abdominalis, inguinal ligament, and inferior epigastric artery

145
Q

2 types of groin hernia? Which is more complicated?

A

Inguinal - more common

Femoral - rare but more likely to strangulate

146
Q

Diagnostic imaging for hernias

A

U/S with doppler

CT (study of choice)

147
Q

How are hernias managed?

A

Unincarcerated

  • monitor
  • reduce if possible

Incarcerated

  • NPO
  • Narcotics
  • Reduce if possible
  • Surgical repair

Strangulated
- Surgical emergency!

148
Q

Clinical definition of diarrhea

A

3 or more watery bowel movements per day OR increase in freq

149
Q

Non-infectious pathologies that cause diarrhea

A

Inflammatory bowel disease
Irritable bowel disease
Celiac disease
Lactose intolerance

150
Q

Which part of nervous system allows for LES to relax and let food into stomach?

A

parasympathetic

** nerve branches damaged in achalasia

151
Q

What chemicals stimulates acid release in stomach?

A

Histamine
Gastrin
Acetylcholine (parasympathetic)

152
Q

H+ release into stomach is inhibited by what?

A

Somatostatin
Prostaglandins
Secretin

153
Q

Why do NSAIDs cause decreased mucosal protection in the stomach? Which NSAIDs are least damaging?

A

inhibit prostaglandins which increase mucus secretion

COX-2 inhibitors have fewer GI side effects (Celebrex)

154
Q

Function of the following cells in the stomach: G cells, parietal cells, mucus cells

A

G cells -> gastrin
parietal cells -> H+ and intrinsic factor
mucus cells -> mucus

155
Q

When and where is secretin secreted? What is its function?

A

produced by small intestines when food arrives from stomach

stimulates pancreas to secrete bicarbonate to neutralize duodenal contents

inhibits gastrin secretion and thus stomach acid

156
Q

MOA of H2 blockers in peptic ulcer treatment

A

block histamines that help stimulate parietal cell secretion of H+

157
Q

When food exits stomach, the duodenum, pancreas, and gall bladder release what?

A

duodenum - CCK and secretin
pancreas - bicarbonate and digestive enzymes
gall bladder - bile

158
Q

Typical virus that causes diarrhea

A

Rotavirus

159
Q

Define Inflammatory Bowel Disesae (IBD)

A

chronic inflammation of all or part of GI tract

Crohn’s Disease and Ulcerative Colitis

160
Q

Significance of “coffee grounds” vomit

A

indicates bleeding after the gastro-esophageal junction
blood has been digested
gastric or duodenal ulcer

161
Q

What is hematochezia?

A

bright red blood in stool

162
Q

DDX of hematochezia

A

hemorrhoid
colon cancer
diverticula

163
Q

Where do all the absorbed nutrients from the gut go? via what?

A

nutrients in gut’s venous system go to the liver via the hepatic portal vein

164
Q

_______ occurs due to an increase in conjugated or unconjugated bilirubin.

A

jaundice

165
Q

Elevation in specifically conjugated bilirubin indicates what?

A

liver is not secreting bile OR bile cannot be released due to biliary tree obstruction

166
Q

Signs of elevated bilirubin

A

jaundice (yellowing of skin and sclera)
clay-colored stools
tea-colored urine
itchy skin (bile salt deposits)

167
Q

Elevated AST and ALT =

A

liver injury

168
Q

Labs that measure liver function? What function specifically?

A

bilirubin - conjugation
albumin - protein synthesis
PT - clotting factor synthesis

169
Q

Elevated _____ associated with acute liver disease, while a decrease in _____ is generally chronic liver disease.

A

PT

albumin

170
Q

Elevated Alkaline Phosphate =

A

biliary obstruction

171
Q

Serology result that indicates patient has new infection of Hep B? chronic infection?

A

IgM anti-HBcAg = new infection

IgG anti-HBcAg = old infection

172
Q

Which hepatitis does not become chronic?

A

A and E

173
Q

What does positive HBeAg indicate?

A

highly infectious Hep B

174
Q

Autosomal recessive disease that causes bronze skin, cirrhosis, diabetes, and restrictive cardiomyopathy

A

Hemochromatosis - high iron in blood

175
Q

Autosomal recessive disease that causes cirrhosis, Kayser-Fleischer rings in eyes, and increased urinary copper.

A

Wilson’s Disease

176
Q

Alcoholic comes to the ER vomiting blood. Classic scenario of what condition?

A

esophageal or gastric varices

177
Q

pathophysiology of hepatic encephalopathy

A

liver failure -> decreased detoxification reactions -> toxic chemicals get to brain -> delirium

178
Q

Trace pathway of biliary tree from liver to gall bladder and duodenum

A

R and L hepatic ducts -> common hepatic duct -> common bile duct -> ampulla of Vater (converges with pancreatic duct) -> duodenum

common hepatic duct -> cystic duct -> gall bladder

179
Q

_____ stimulates contraction of gall bladder and release of bile.

A

CCK from duodenum

180
Q

_______ is inflammation and obliteration of extrahepatic biliary system in neonates. Have jaundice which leads to severe cirrhosis.

A

Biliary atresia

181
Q

Two most common causes of pancreatitis

A

alcoholism and gallstone that obstructs pancreatic duct

182
Q

“Female, fat, forty, and fertile” describes at-risk patient for what pathology?

A

cholesterol gallstones

183
Q

PE findings of peritonitis

A

rebound abd pain
guarding

  • PID, appendicitis, ruptured bowel???
184
Q

Some conditions that predispose a patient to development of GERD

A

hiatal hernia, pregnancy, scleroderma, incompetent esophageal sphincter, obesity

PANCE review (18 decks)

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