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Online Med Ed > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

cholelithiasis path

A

cholesterol: Fat, Female, Forty, Fertile, and Native Americans
pigmented: hemolysis, African Americans

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2
Q

cholelithiasis pt

A

colicky RUQ pain, radiates to the shoulder, worse with fatty foods

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3
Q

cholelithiasis dx

A

RUQ US = gallstones

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4
Q

cholelithiasis tx

A 
cholecystectomy (elective)
ursodeoxycholic acid (nonsurgical)
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5
Q

cholecystitis path

A

gallstones in cystic ducts

  • pericholecystic fluid
  • thickened wall
  • gallstones
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6
Q

cholecystitis pt

A

constant RUQ pain
+ Murphy’s sign
+ inflammation (fever, increase wbc)

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7
Q

cholecystitis dx

A

RUQ U/S = cholecystitis

HIDA scan if equivocal

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8
Q

cholecystitis tx

A

NPO, IVF
cholecystectomy (urgent)
Cholecystostomy (poor surgical candidate)

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9
Q

Choledocolithiasis path

A

gall stones in common bile duct
+/- pancreatitis
+/- hepatitis
+ painful jaundice

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10
Q

Choledocolithiasis pt

A

constant RUQ pain AND jaundice
+ Murphy’s sign
+ inflammation (fever, increase wbc)

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11
Q

Choledocolithiasis dx

A

RUQ U/S = dilated CBD

MRCP if uncertain

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12
Q

Choledocolithiasis tx

A

NPO, IVF
ERCP urgently … OR
cholecystectomy with intraoperative cholangiogram

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13
Q

cholangitis path

A

gallstone in CBD + infection - GNR, anaerobes

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14
Q

cholangitis pt

A

Charcot’s triad = RUQ pain, jaundice, fever

Reynold’s pentad = Charcot’s triad + hypotension, AMS

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15
Q

cholangitis dx

A

RUQ U/S = dilated biliary duct

no time for MRCP or HIDA

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16
Q

cholangitis tx

A

NPO, IVF, + IV abx (ciprofloxacin + metronidazole)

ERCP emergently

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17
Q

esophagitis path

A 
Pill-induced
Infectious
Eosinophilic
Caustic
GERD
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18
Q

esophagitis pt

A

odynophagia, dysphagia

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19
Q

esophagitis dx

A

EGD with bx

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20
Q

esophagitis tx

A

dz-specific

antiacid (PPI, H2)

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21
Q

pill-induced esophagitis path

A

pill gets stuck

NSAIDs, abx, bisphosphonates, HIV

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22
Q

pill-induced esophagitis pt

A

esophagitis

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23
Q

pill-induced esophagitis dx

A

EGD w bx

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24
Q

pill-induced esophagitis tx

A

EGD -> remove pill
remove offending agent
time and PPI

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25
Q

pill-induced esophagitis f/u

A

no recumbency, water with pills

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26
Q

infectious causes of esophagitis

A

candida
HSV
CMF
HIV

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27
Q

candida esophagitis

A

oral thrush

tx: fluconazole

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28
Q

HSV esophagitis

A

oral lesions

tx: valacyclovir

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29
Q

CMV esophagitis

A

tx: valagancyclovir

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30
Q

HIV esophagitis

A

opportunistic infections

tx: HAART

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31
Q

eosinophilic esophagitis path and pt

A

asthma, allergies, atopy

allergic reaction

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32
Q

eosinophilic esophagitis dx

A

EGD w bx >16 Eos/hpf

trial PPI x 6wks

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33
Q

eosinophilic esophagitis tx

A

oral aerosolized steroids

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34
Q

caustic esophagitis path

A

kid (accidental ingestion)
adult (suicide attempt)
alkaline&raquo_space;> acid

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35
Q

caustic esophagitis pt

A

larynx -> hoarse, stridor

esophagus -> drooling

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36
Q

caustic esophagitis dx

A

EGD w bx

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37
Q

caustic esophagitis tx

A

low severity … liquid diet

high severity … NPO x 72h EGD

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38
Q

caustic esophagitis f/u

A

NEVER neutralize

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39
Q

esophageal motility disorders

A

NOT progressive

foods AND liquids

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40
Q

esophageal motility disorders dx

A

barium, manometry, EGD

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41
Q

esophageal mechanical disorders

A

progressive

foods, THEN liquids

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42
Q

esophageal mechanical disorders dx

A

barium, EGD

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43
Q

achalasia path

A

motility
absent myenteric plexus
LES cannot relax

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44
Q

achalasia pt

A

knot/ball of food

stuck at GE junction

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45
Q

achalasia dx

A

barium = bird’s beak
manometry - LES high tone
EGD w bx r/o cancer (pseudoachalasia)

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46
Q

achalasia tx

A

botulinum (poor surgical candidate)
dilation (perforates)
myotomy (best)

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47
Q

achalasia f/u

A

GERD (if you take too much)

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48
Q

scleroderma path

A

motility
collagen deposition
LES cannot contract

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49
Q

scleroderma pt

A

CREST anti-centromere
SS - Anti-Scl-70
Relentless GERD

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50
Q

scleroderma dx

A

barium = normal
manometry = LES low tone
EGD w bx = collagen

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51
Q

scleroderma tx

A

PPI

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52
Q

scleroderma f/u

A

serology

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53
Q

diffuse esophageal spasm path

A

motility

random sustained contractions

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54
Q

diffuse esophageal spasm pt

A

‘heart attack’ // better with nitro

exacerbated by cold liquids

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55
Q

diffuse esophageal spasm dx

A

r/o ACS first (trops, ekg)
barium = corkscrew esophagus
manometry = random contractions
no EGD

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56
Q

diffuse esophageal spasm tx

A

CCB, nitro

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57
Q

Schatzki ring path

A

mechanica

ring @ GE junction

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58
Q

schatzki ring pt

A

‘steak house dysphagia’ = infrequent, large caliber foods get stuck

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59
Q

Schatzki ring dx

A

barium = narrowed lumen/ring

EGD w bx = ring

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60
Q

Schatzki ring tx

A

lysis during EGD

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61
Q

esophageal webs path

A

mechanical

Plummer-Vinson syndrome

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62
Q

esophageal webs pt

A

woman with dysphagia, iron deficiency anemia, webs and eventually
esophageal cancer

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63
Q

esophageal webs dx

A

barium = webs

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64
Q

esophageal webs tx

A

EGD to screen for cancer only

iron for iron deficiency anemia

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65
Q

esophageal webs f/u

A

do not do esophagectomy

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66
Q

zenker’s diverticulum path

A

mechanica

diverticulum

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67
Q

zenker’s diverticulum pt

A

old guy with halitosis … chokes while eating and regurgitates undigested food

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68
Q

zenker’s diverticulum dx

A

barium = pouch

EGD w bx = visualization

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69
Q

zenker’s tx

A

surgical resection (endoscopic or open)

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70
Q

esophageal stricture path

A

GERD grade IV

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71
Q

esophageal stricture pt

A

GERd, dysphagia, weight loss

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72
Q

esophageal stricture dx

A

barium = symmetric

EGD bx = no cancer

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73
Q

esophageal stricture tx

A

PPI, dilation

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74
Q

esophageal cancer path

A 
Adeno = bottom 1/3 esophagus = GERD
SCC = upper 1/3 esophagus = smoking, EtOH
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75
Q

esophageal cancer pt

A

GERD, dysphagia, weight loss

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76
Q

esophageal cancer dx

A

Barium = asymmetric

EGD w bx = cancer

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77
Q

esophageal cancer tx

A

chemo/radiation, surgery

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78
Q

peptic ulcer disease path

A 
2 locations: gastric, duodenal
5 etiologies:
- H. pylori: single
- NSAIDs: multiple shallow
- Malignancy: heaped, necrotic
- Curling's: burns
- Cushing's: steroids
- gastrinoma
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79
Q

PUD pt

A

asymptomatic (20%)
gnawing epigastric pain
pain increase w food (gastric)
pain decrease w food (duodenal)

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80
Q

PUD dx

A

EGD w bx

  • r/o malignancy
  • r/o H. pylori
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81
Q

PUD tx

A

PPI
stop EtOH
stop NSAIDs
stop smoking

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82
Q

H. pylori path

A

infection

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83
Q

H. pylori pt

A

Asymptomatic (85%)
PUD + dyspepsia (15%)
MALToma (~1%)

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84
Q

H. pylori dx

A

serology = test and treat (once)
urea breath test = initial test
stool antigen = eradication
EGD w bx = best (histology)

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85
Q

H. pylori tx

A

triple therapy

  • clarithromycin
  • amoxicillin (MTZ backup)
  • PPI
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86
Q

H. pylori f/u

A

MALToma … treat H. pylori, tx the cancer

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87
Q

Zollinger-Ellison (gastrinoma) path

A

gastrinoma -> decrease gastric pH

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88
Q

gastrinoma pt

A

big, virulent, refractory ulcers …

and diarrhea

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89
Q

gastrinoma dx

A 
gastrin
< 250 = normal
between = secretin stim
> 1600 = gastrinoma
*** SRS ***
CT scan
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90
Q

gastrinoma tx

A

resection

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91
Q

GERD path

A

acid burns esophagus
LES weakened
esophagitis

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92
Q

GERD pt

A

typical:
- burning CP
- worse with recumbency, spicy food
- better with antacid, sitting up
atypical:
- hoarseness, coughing, stridor
- nocturnal asthma

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93
Q

GERD dx

A

PPI + lifestyle x6wks
EGD w bx (start here with alarm sxs)
24-hr pH monitoring

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94
Q

GERD tx

A

GERD: PPI

metaplasia: increase PPI
dysplasia: local ablation
adenocarcinoma: resection

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95
Q

GERD f/u

A

surveillance EGDs

Nissen … more lifestyle than treatment

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96
Q

gastroparesis path

A

emptying problem

idiopathic/diabetes

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97
Q

gastroparesis pt

A

chronic n/v
abdominal pain with eating
peripheral neuropathy

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98
Q

gastroparesis dx

A

EGD = r/o other disease
nuclear emptying study
>60% at 2hrs, >10% at 4hrs

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99
Q

gastroparesis tx

A

avoid opiates
blood glucose control
pro kinetic agents (metoclopramide, erythromycin, domperidone)
low-fiber, small volume diet

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100
Q

cyclic vomiting syndrome path

A

+ THC

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101
Q

cyclic vomiting syndrome pt

A

habitual marijuana

n/v in cycles (weeks)

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102
Q

cyclic vomiting syndrome dx

A

clx -> EGD -> emptying

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103
Q

cyclic vomiting syndrome tx

A

stop THC

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104
Q

gastric adenocarcinoma path

A

East Asian cuisine

nitrites

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105
Q

gastric adenocarcinoma pt

A

early satiety, weight loss, obstruction

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106
Q

gastric adenocarcinoma dx

A

EGD w bx = signet

PETCT +/- Pan CT

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107
Q

gastric adenocarcinoma tx

A

resection and chemo

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108
Q

evaluation of diarrhea: severe

A

severe: fever >/= 104, blood/pus, electrolytes, abx use, duration >3 d, immuno decrease

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109
Q

evaluation of diarrhea steps

A

step 1: c diff
step 2: stool wbc and rbc
step 3: no wbc, no rbc -> ova + parasites; + wbc, +rbc -> colonoscopy
step 4: c. diff -> tx

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110
Q

c. diff path

A

overgrowth after recent abx use

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111
Q

c. diff pt

A

watery diarrhea, smell

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112
Q

c. diff dx

A

c. diff NAAT

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113
Q

c. diff tx

A

1st: PO MTZ = po vanc
2nd: PO MTZ = po vanc
3rd: fidaxomicin

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114
Q

c. diff f/u

A

refractory: fecal transplant

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115
Q

diarrhea etiology to risk factor: entero

A

c. diff - antibiotic use

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116
Q

diarrhea etiology to risk factor: toxic

A 
ETEC - travelers, central america
vibrio cholera - 3rd world, no boiling
s. aureus - proteinaceous foods
b. cereus - reheated rice
giardia - camping, fresh water
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117
Q

HUS/TTP path

A

EHEC 0157:H7

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118
Q

HUS/TTP pt

A

blood, diarrhea after meat
increase BUN/Cr
anemia

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119
Q

HUS/TTP dx

A

smear = MAHA = schistocytes

shiga-like toxin

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120
Q

HUS/TTP tx

A

supportive care

plasma exchange transfusion

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121
Q

secretory diarrhea

A 
stool osm gap ---
fecal wbc ---
fecal rbc ---
mucous ---
change NPO no
nocturnal symptoms +
fecal fat ----
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122
Q

osmotic diarrhea

A 
stool osm gap
fecal wbc ---
fecal rbc ---
mucous ---
change NPO +
nocturnal symptoms no
fecal fat *** FAT ***
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123
Q

inflammatory diarrhea

A 
stool osm gap
fecal wbc +
fecal rbc +
mucous +
change NPO ---
nocturnal symptoms ---
fecal fat ---
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124
Q

VIPoma path

A

VIP

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125
Q

VIPoma pt

A

chronic diarrhea

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126
Q

VIPoma dx

A

VIP

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127
Q

VIPoma tx

A

resection

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128
Q

VIPoma f/u

A

don’t pick VIPoma

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129
Q

ZE (gastrinoma) path

A

gastrinoma

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130
Q

ZE pt

A

virulent and refractory PUD

diarrhea

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131
Q

ZE dx

A 
gastrin
<250 = ruled out
between = secretin stimulations
>1600 = ruled in
SRS vs CT
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132
Q

ZE tx

A

resection

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133
Q

carcinoid path

A

serotonin

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134
Q

carcinoid pt

A

right sided heart fibrosis

flushing + diarrhea

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135
Q

carcinoid dx

A

5-HIAA urine

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136
Q

carcinoid tx

A

resection

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137
Q

celiac disease path

A

gluten allergy

autoimmune - IgA

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138
Q

celiac disease pt

A

diarrhea, bloating, weight loss

dermatitis herpetiformis

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139
Q

celiac disease dx

A

1st: antibodies
- Ttg
- Endomysial
EGD w bx = blunted villi

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140
Q

celiac dz tx

A

avoid gluten 3-4mo

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141
Q

celiac dz f/u

A

avoid gluten is the wrong answer for diagnosis

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142
Q

lactose intolerance path

A

age, asians

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143
Q

lactose intolerance pt

A

carb malabsorption

144
Q

lactose intolerance dx

A

avoiding dairy

145
Q

lactose intolerance tx

A

lactose enzyme

146
Q

Whipple’s disease path

A

T. whipplei

147
Q

Whipple’s disease pt

A

malabsorption + brain + joint + lymph

148
Q

whipple’s disease dx

A

EGD w bx

  • PAS +
  • organisms
149
Q

whipple’s disease tx

A

TMP-SMX

doxycycline

150
Q

absorption in general: pancreas

A

Pancreas = protein

151
Q

absorption in general: fat

A

A - night blind
D - osteoporosis
E - nystagmus
K - bleeding

152
Q

absorption in general: duodenum

A

Folate
Iron
Calcium
+ carbs

153
Q

absorption in general: TI

A

bile salts and B12

154
Q

diverticulosis path

A

increase intraluminal pressures, false pouches

155
Q

diverticulosis pt

A

> 50yo, decrease fiber/vegetables
increase red meat
asx screening

156
Q

diverticulosis dx

A

colonoscopy

157
Q

diverticulosis tx

A

no treatment

high fiber

158
Q

diverticulosis f/u

A

+ fruits/vegetables, fiber diet

159
Q

diverticular spasm path

A

contractions of diverticula

160
Q

diverticular spasm pt

A

post-prandial LLQ abdominal pain relieved with BM (sounds like IBS)

161
Q

diverticular spasm dx

A

clx vs IBD

162
Q

diverticular spasm tx

A

high-fiber diet

163
Q

diverticular hemorrhage path

A

arteriole ruptures in dome

164
Q

diverticular hemorrhage pt

A

painless hematochezia, can be fatal or self-limiting

165
Q

diverticular hemorrhage dx

A

colonoscopy (for diverticulosis)

angiogram (for embolization)

166
Q

diverticular hemorrhage tx

A

embolize (severe)

self-limiting (often)

167
Q

diverticulitis path

A

fecalith blocks diverticula and infection grows

microperforation to abscess

168
Q

diverticulitis pt

A

left sided appendicitis
constant LLQ pain
fever/leukocytosis
local peritoneal signs

169
Q

diverticulitis dx

A

KUB to r/o frank perforation

CT w IV and PO contrast

170
Q

diverticulitis tx

A

mild: liquid diet … po abx
severe: NPO … IV abx
abscess: NPO … IV abx + drainage
perforation: exlap w IV abx
refractory: hemicolectomy

171
Q

colon cancer path

A 
premalignant lesions = polyps
>50 y/o, ETOH
smoking, increase BMI
processed red meat
inflammation (UC, Crohn's, PSC)
172
Q

colon cancer pt

A

1 - asymptomatic screen
2 - iron deficiency anemia >50, man
3 - change caliber of stool with alternating bowel habits

173
Q

colon cancer dx

A

colonoscopy w bx

- age 50 q10y

174
Q

colon cancer tx

A

polyp - polypectomy
stage I/II - colectomy
stage III/IV - chemo (FOLFOX, FOLFIRI)

175
Q

colon cancer ppx

A

screening 50-75 (+/- 85)

  • colonoscopy q10y
  • flex sig q5y + FOBT q3y
  • FOBT q1y
  • FIT q1y
176
Q

familial adenomatous polyposis path

A

APC gene

177
Q

familial adenomatosis polyposis pt

A

1000s of polyps by 20
cancer by 40
dead by 50

178
Q

familial adenomatosis polyposis dx

A

colonoscopy before 20

179
Q

familial adenomatosis polyposis tx

A

prophylactic colectomy

180
Q

HNPCC/Lynch path

A

DNA mismatch repair
3 family members
2 generations
1 premature cancer

181
Q

HNPCC/Lynch pt

A

colon cancer

182
Q

HNPCC/Lynch dx

A

biopsy

183
Q

HNPCC/Lynch tx

A

resection

184
Q

HNPCC/Lynch f/u

A

colorectal
endometrial
ovarian

185
Q

turcot

A

brain tumors and colon cancer

Turcot …. Turban on your head

186
Q

gardner

A

jaw tumors and colon cancer

187
Q

Peutz-Jeghers

A

spots on the mouth, small intestinal tumors, colonic hamartomas

188
Q

upper GI bleed

A

hematemesis, melena, hematochezia

189
Q

lower GI bleed

A

melena, hematochezia

190
Q

handling a GI bleed

A 
2 large bore IVs
IVF bolus
type and cross, transfuse as needed
IV PPI
call GI for EGD
---------------------
octreotide (cirrhosis)
ceftriaxone (cirrhosis)
191
Q

varices path

A

portal HTN

192
Q

varices pt

A

cirrhotic with GI bleed

193
Q

varices tx

A

stabilize….
1st: octreotide
then: balloon
EGD: banding
refractory: TIPS
transplant

194
Q

varices f/u

A

ceftriaxone for SBP ppx

195
Q

PUD path

A

H. pylori; NSAIDs, Ca, others

196
Q

PUD pt

A

dyspepsia, GI bleed

197
Q

PUD dx

A

EGD w bx

198
Q

PUD tx

A

PPI

199
Q

mallory-weiss path

A

superficial tear in mucosa

200
Q

mallory-weiss pt

A

weekend warriors, self-limiting

201
Q

mallory-weiss dx

A

EGD

202
Q

mallory-weiss tx

A

supportive

203
Q

boerhaave’s path

A

transmural tear in mucosa

204
Q

boerhaave’s pt

A

ETOH/bulimics, retching
fever, dyspnea
air in mediastinum

205
Q

boerhaave’s dx

A

1st: gastrograffin
then: barium
best: EGD
EGD w bx

206
Q

boerhaave’s tx

A

surgery

207
Q

dieulafoy’s lesion path

A

normal variant

208
Q

dieulafoy’s lesion pt

A

painless abrupt bleed

209
Q

dieulafoy’s lesion dx

A

EGD

210
Q

dieulafoy’s lesion tx

A

subtotal gastrectomy

211
Q

hemorrhoids path

A

internal: bleed but do not hurt
external: no bleed, but do hurt

212
Q

hemorrhoids pt

A

blood on toilet paper

213
Q

hemorrhoids dx

A

clx

214
Q

hemorrhoids tx

A

sitz baths -> banding

215
Q

diverticular hemorrhage path

A

arteriole in dome of diverticula

216
Q

diverticular hemorrhage pt

A

> 50yo

painless BRBPR

217
Q

diverticular hemorrhage dx

A

colonscopy

218
Q

diverticular hemorrhage tx

A

hemicolectomy

219
Q

mesenteric ischemia path

A

‘gut attack’

220
Q

mesenteric ischemia pt

A

vasculopath, AFib
pain out of proportion to exam (acute)
h/o pain while eating, weight loss (chronic)

221
Q

mesenteric ischemia dx

A

angiogram

colonscopy

222
Q

mesenteric ischemia tx

A

revascularize

resect

223
Q

ischemic colitis path

A

watershed areas

224
Q

ischemic colitis pt

A

hypotension first, then GI bleed

painful BRBPR

225
Q

ischemic colitis dx

A

colonoscopy

226
Q

ischemic colitis tx

A

supportive

227
Q

hemolysis/hematoma path

A

excess bilirubin from rbc turnover

228
Q

hemolysis/hematoma pt

A

hemolysis

resolving hematoma

229
Q

hemolysis/hematoma dx

A

increase bilirubin, indirect

230
Q

hemolysis/hematoma tx

A

monitor for resolution

diagnose hemolytic disease

231
Q

painless obstructive jaundice path

A

cancer and stricture

232
Q

painless obstructive jaundice pt

A

weight loss, clay colored stools, jaundice

233
Q

painless obstructive jaundice dx

A

dramatic increase in bilirubin, direct
RUQ U/S = dilation
MRCP = lesion
EUS (pancreas) ERCP (biliary)

234
Q

painless obstructive jaundice tx

A

resection

235
Q

painful jaundice path

A

gallstones

236
Q

painful jaundice pt

A

RUQ pain, tenderness
Murphy’s sign
worse on eating

237
Q

painful jaundice dx

A

RUQ U/S shows gallstones, dilated ducts
MRCP for dx
ERCP for intervention

238
Q

painful jaundice tx

A

ERCP or intraop cholangiogram

239
Q

viral hepatitis path

A 
Hep B (both) -- immuno decrease
Hep C (chronic)
240
Q

viral hepatitis pt

A 
IVDA = HepC
Sex = HepB
241
Q

viral hepatitis dx

A

Hep C Ab

Hep B Ab

242
Q

viral hepatitis tx

A

direct acting agonists

ribavirin + IFN

243
Q

Wilson’s disease path

A

copper depositions in basal ganglia, eyes, and liver

244
Q

Wilson’s disease pt

A

basal ganglia = chorea
liver = cirrhosis
eyes = Kayser-Fleischer rings; ceruloplasmin

245
Q

Wilson’s disease dx

A

1st: slit lamp
then: ceruloplasm, urine Cu
best = bx = increase Cu liver

246
Q

Wilson’s disease tx

A

penicillamine

transplant

247
Q

Wilson’s disease r/u

A

cirrhosis + picture of eye = wilson

248
Q

hemochromatosis path

A

iron absorption, iron overload

249
Q

hemochromatosis pt

A

bronze diabetes = DM, cirrhosis, and hyperpigmentation

250
Q

hemochromatosis dx

A

1st: iron studies
- ferritin >1000
- transferrin >50%
best: biopsy = increase Fe

251
Q

hemochromatosis tx

A

phlebotomy, deferoxamine

252
Q

alpha1 antitrypsin deficiency path

A

above

253
Q

alpha1 antitrypsin deficiency pt

A

COPD + cirrhosis

254
Q

alpha1 antitrypsin deficiency dx

A

bx = PAS + macrophages

255
Q

alpha1 antitrypsin deficiency tx

A

transplant

256
Q

primary sclerosing cholangitis path

A

extra hepatic, goes with UC, IBD

257
Q

primary sclerosing cholangitis pt

A

men present with pruritus and jaundice, age 30-50

258
Q

primary sclerosing cholangitis dx

A 
MRCP = beads on a string
ERCP = bx = onion skin fibrosis
259
Q

primary biliary cirrhosis path

A

intrahepatic NO association with UC, IBD

260
Q

primary biliary cirrhosis pt

A

women with pruritus and jaundice

30-50y/o

261
Q

primary biliary cirrhosis dx

A

AMA
imaging = normal
best = biopsy

262
Q

primary biliary cirrhosis tx

A

transplant

263
Q

ETOH path

A

ETOH

264
Q

ETOH pt

A

ETOH

265
Q

ETOH dx

A

ETOH

266
Q

ETOH tx

A

stop ETOH

transplant

267
Q

NASH/NAFL path

A

fatty liver disease

268
Q

NASH/NAFL pt

A

cirrhotic changes and there isn’t another cause you can find

obese people with ‘obese’ limits

269
Q

NASH/NAFL dx

A

1st: ultrasound
best: bx

270
Q

NASH/NAFL tx

A

transplant

271
Q

cirrhosis path

A

bridging fibrosis in regenerating islands of good liver

272
Q

cirrhosis pt

A 
asx until advanced then...
increase bilirubin = jaundice
increase bile salts = pruritus 
decrease factor II, VII, IX, X = bleeding, increase INR
decrease albumin = 3rd spacing fluid
portal HTN = ascites
estrogen = palmar erythema, spider angiomata, gynecomastia
splenomegaly = decrease platelets
273
Q

cirrhosis dx

A 
multiple testing
1st: U/S = fatty liver, small
monitor: LFTs, Cr, INR
then = triple phase CT (HCC)
best: transjugular biopsy
274
Q

cirrhosis tx

A

irreversible once cirrhotic
stop drinking ETOH
vaccinate HepA + HepB
transplant

275
Q

cirrhosis f/u

A

screen AFP + RUQ U/S q6mo (HCC)

276
Q

hepatic encephalopathy path

A

ammonium

277
Q

hepatic encephalopathy pt

A

altered with asterixis

278
Q

hepatic encephalopathy dx

A

clx

279
Q

hepatic encephalopathy tx

A

lactulose, rifaximin, zinc

280
Q

varices path

A

porto-caval shunt in esophagus

portal HTN

281
Q

varices pt

A

asx screen vs. vigorous GI bleed

282
Q

varices dx

A

EGD

283
Q

varices tx

A

bleeding = banding
(ceftriaxone, octreotide)
not bleeding = nadolol, propranolol
refractory = TIPS

284
Q

ascites path

A

fluid in belly

SAAG = serum alb - fluid alb

285
Q

ascites pt

A 
>/= 1.1 portal HTN
- cirrhosis
- right CHF
non <1.1
- TB
- Ca
286
Q

ascites dx

A

paracentesis = bx = SAAG

287
Q

ascites tx

A 
furosemide
spironolactone
therapeutic tap
<2g Na
<2L H2O
288
Q

SBP path

A

spontaneous = strep, GNR

289
Q

SBP pt

A

asx

fever and abdominal pain

290
Q

SBP dx

A

paracentesis >250 polys

culture is done, but not needed

291
Q

SBP tx

A

ceftriaxone

292
Q

SBP f/u

A

TP <1.0 = FQ

293
Q

secondary bacterial peritonitis path

A

perforation of hollow viscous

294
Q

secondary bacterial peritonitis pt

A

abdominal pain, fever, cirrhosis

295
Q

secondary bacterial peritonitis dx

A

paracentesis >250 polys

>/= 2 organisms seen

296
Q

secondary bacterial peritonitis tx

A

stop ETOH

transplant

297
Q

hepatocellular carcinoma path

A

cirrhosis

Hep B, HIV

298
Q

HCC pt

A

asx screen

299
Q

HCC dx

A

screen = RUQ U/S + AFP

triple phase CT

300
Q

HCC tx

A

resect
transplant
RFA, TACE

301
Q

primary biliary cirrhosis path

A

intrahepatic NO association with UC, IBD

302
Q

primary biliary cirrhosis pt

A

women with pruritus and jaundice 30-50

303
Q

primary biliary cirrhosis dx

A

AMA
imaging = normal
best = biopsy

304
Q

primary biliary cirrhosis tx

A

transplant

305
Q

pancreatitis path

A

ETOH (#1), gallstones (#2)

…. TGs, drugs, ERCP

306
Q

pancreatitis pt

A

boring epigastric pain that radiates to the back, relief leaning forward, pain leaning back
anorexia, n/v
Cullen (umbilical hematoma)
Turner (flank hematoma)

307
Q

pancreatitis dx

A

lipase >3x ULN
amylase p
CT scan only if equivocal
U/S or MRCP (etiology only)

308
Q

pancreatitis tx

A

NPO, IVF, analgesia

reseed on demand

309
Q

pancreatitis f/u

A

RUQ U/S r/o gallstones
BUN is single best mortality lab
Apache II&raquo_space; Ranson’s criteria

310
Q

necrotizing pancreatitis path

A

severe pancreatitis

infected pancreatitis

311
Q

necrotizing pancreatitis pt

A

acute pancreatitis + worsening outcome

312
Q

necrotizing pancreatitis dx

A

CT scan shows necrosis

FNA = bx required before abx

313
Q

necrotizing pancreatitis tx

A

IV meropenem if + FNA

314
Q

pancreatic pseudocyst path

A

epithelial lined pseudocyst

after pancreatitis

315
Q

pancreatic pseudocyst pt

A

3-7wks
early satiety, abdominal pain
bloated belly

316
Q

pancreatic pseudocyst tx

A

<6cm and <6wks = wait

>6cm OR >6wks = drain

317
Q

chronic pancreatitis path

A

recurrent acute pancreatitis

318
Q

chronic pancreatitis pt

A

chronic pain

exacerbations without increase lipase

319
Q

chronic pancreatitis dx

A

CT scan = calcifications

320
Q

chronic pancreatitis tx

A

pain control

NO SURGERY

321
Q

Hep A path

A

fecal-oral, RNA

Acute only

322
Q

Hep A pt

A

non-immunized
acute inflammation
⇈ AST, ⇈ ALT
diarrhea

323
Q

Hep A dx

A 
IgM = acute
IgG = immune
324
Q

Hep A tx

A

vaccinate

325
Q

Hep B path

A

sex > drugs (needles) and blood

DNA

326
Q

Hep B pt

A

good immune = acute, fulminant

bad immune = chronic, cancer

327
Q

Hep B dx

A 
Hep B s Ag = infection
Hep B e Ag = infectivity
Hep B s Ab IgM = early infection
Hep B s Ab IgG = immune
Hep B c Ab = immune, exposed
328
Q

Hep B tx

A

vaccinate

329
Q

Hep B f/u

A

HCC
focus on dx
Hep D (RNA) needs B, makes B worse

330
Q

Hep C path

A

blood (needles), RNA

sex not a risk factor on its own

331
Q

Hep C pt

A

chronic carrier

Hep C viral load

332
Q

Hep C dx

A

Hep C ab

333
Q

Hep C tx

A

direct acting antagonist

334
Q

Hep C f/u

A

HCC

focus on dx

335
Q

Hep C diagnosis

A

Ab -, HCV RNA + => infection
Ab +, HCV RNA + => infection
AB +, HCV RNA - => immune
AB -, HCV RNA - => unexposed

336
Q

Crohn’s disease pop

A

20-30 and again 50-75

337
Q

Crohn’s disease bx

A

transmural + noncaseating granulomas

338
Q

Crohn’s disease pt

A

watery diarrhea and weight loss

339
Q

Crohn’s disease Ca

A

no risk for cancer

340
Q

Crohn’s disease extra

A

fistulas
TI: decrease B12, decrease fats
Duod: decrease Fe, decrease Ca = osteoporosis

341
Q

Crohn’s disease surg

A

fistulotomy

drain abscess

342
Q

Crohn’s disease tx

A 
mild: 5-ASA compounds don't work
Mod: 6-MP, AZA ... MTX
Severe: TNF-1 = infliximab
flare: 
- r/o infection with c diff
- steroids, cipro, metronidazole
- perianal disease, drain abscess
343
Q

UC pop

A

20-30

344
Q

UC endo

A

continuous

rectum but stays within colon

345
Q

Crohn’s disease endo

A

skip lesions

anywhere in GI tract

346
Q

UC bx

A

superficial inflammation

crypt abscesses

347
Q

UC pt

A

bloody diarrhea

348
Q

UC ca

A

increase risk of CRC

screening colonoscopy @8y q1y

349
Q

UC extra

A

PSC, pANCA

350
Q

UC surgery

A

colectomy is curative

351
Q

UC tx

A

mild: 5-ASA, mesalamine
mod: 6-MP, AZA …. MTX
severe: surgical resection
flares: none

352
Q

UC vs. Crohn’s: diarrhea

A

UC: bloody diarrhea that should have the colon cut out as cure
Crohn’s: watery diarrhea that can’t have surgery unless there is a fistula

353
Q

UC vs. Crohn’s: predominating feature

A

UC: bloody diarrhea and pain predominates

Crohn’s: weight loss and malabsorption predominate

354
Q

UC vs. Crohn’s: cancer

A

UC: cancer and needs surveillance, colectomy

Crohn’s: no cancer and does not need surveillance or colectomy

355
Q

UC vs. Crohn’s: treatment

A

UC: surgery over DMARDs and biologics

Crohn’s: DMARDs and biologics win the day

Online Med Ed (18 decks)

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