Colon and Liver

Question 1

Treatment for hepatic encephalopathy

Answer 1

Lactulose: prevents ammonia absorption by stimulating NH4+ formation
Neomycin: kills bacteria that produce ammonia in GI tract

Question 2

Medicine given to treat bleeding esophageal varices.

Answer 2

Octreotide: vasoconstrictor to prevent bleeding

Question 3

Way to classify liver cirrhosis.

Answer 3

Childs Classification

-based on ascites, nutrition, albumin, bilirubin, and encephalopathy

Question 4

Dx mode of choice for cirrhosis

Answer 4

Liver biopsy

Question 5

Most sensitive and specific test for colon cancer

Answer 5

Colonoscopy

Question 6

Riskiest type of colonic polyp

Answer 6

Villous type
(tubular lesions don't turn into cancer as often)

Question 7

What is FAP?

Answer 7

Familial Adenomatous Polyposis: autosomal dominant condition with lots of polyps in the colon and sometimes duodenum.
Colon cancer is 100% in 4th decade, colectomy recommended

Question 8

What is Peutz-Jeghers Syndrome?

Answer 8

Hamartomas scattered throughout the GI tract, pigmented spots seen on the lips.

Question 9

What are the Lynch Syndromes?

Answer 9

Hereditary Nonpolyposis CRC
Lynch 1: only one site
Lynch 2: multiple sites with other types of cancers

Question 10

Test of choice for diverticulosis

Answer 10

Barium Enema

Question 11

Test of choice for diverticulitis

Answer 11

CT scan

a barium enema would increase pressure too much and risk perforation

Question 12

What is Ogilvie Syndrome

Answer 12

Symptoms of a bowel obstruction without actual mechanical obstruction. Usually post trauma, surgery or some drug use.

Question 13

Treatment for pseudomembranous colitis.

Answer 13

Also called C. diff colitis, stop antibiotic and give metronidazole

Question 14

Treatment for hepatorenal failure and cirrhosis

Answer 14

Liver Transplant

Question 15

Treatment for Wilsons Disease

Answer 15

D-penicillamine

Question 16

Primary organ affected by hemochromatosis.

Answer 16

Liver
-cirrhosis is a common complication
(autosomal recessive disease)

Question 17

Requirement for diagnosis of hemochromatosis

Answer 17

Liver Biopsy to determine hepatic cellular iron concentration

Question 18

Board buzz word for hemochromatosis

Answer 18

Bronze Diabetic

• iron deposits in the pancreas inhibiting insulin release causing diabetes
• iron deposits in the skin causing a hyper-pigmentation appearance

Question 19

Treatment for hemochromatosis

Answer 19

Repeated phlebotomies

Question 20

Most common population to get hepatocellular adenomas and why?

Answer 20

Women age 15-40 because of oral contraceptive use

Question 21

Most common benign tumor of the liver and which population most commonly gets them?

Answer 21

Cavernous Hemangioma

• vascular tumor in the liver vessels
• oral contraceptive use causes them in menstruating women

Question 22

Two types of hepatocellular carcinoma and which is associated with Hep B and Hep C and cirrhosis?

Answer 22

Nonfibrolamellar: associated with cirrhosis and viruses
Fibrolamellar: not associated (better outcome because usually resectable)

Question 23

Biggest risk factor for hepatocellular carcinoma

Answer 23

Cirrhosis: especially due to Hep B, Hep C, or alcohol

Question 24

What is required for diagnosis of hepatocellular carcinoma?

Answer 24

Liver Biopsy

Question 25

Defect in Gilbert Syndrome

Answer 25

Autosomal dominant deficiency of diphosphate glucoronyl transferase. Elevation of unconjugated bilirubin

Question 26

Cause of hydatid cyst liver disease

Answer 26

Echinococcus granulosus

Question 27

Most common cause of pyogenic liver abscesses

Answer 27

Biliary duct obstruction, causes backup of bile flow allowing bacterial proliferation

Question 28

Main cause and prominent population to get amebic liver abscesses

Answer 28

Homosexual men, due to fecal oral route | Caused by Entamoeba histolytica

Question 29

What is Budd Chiari Syndrome?

Answer 29

Liver disease occludes hepatic venous flow causing portal congestion leading to ascites, RUQ pain, vatical bleeding, jaundice.

Question 30

When does jaundice clinically present?

Answer 30

When bilirubin levels are above 2mg/dl.

Question 31

Which bilirubin makes urine darker?

Answer 31

Conjugated (direct) because it is loosely bound to albumin and therefore more water soluble. Can be excreted easily by kidneys

Question 32

Name the two major inherited disorders that can cause direct hyperbilirubinemia

Answer 32

Dubin Johnson and Rotors

Question 33

What clinical signs on PE differentiate direct from indirect hyperbilirubinemia?

Answer 33

Direct: dark urine and pale stool Indirect: neither of these

Question 34

Which aminotransferase is more specific for the liver?

Answer 34

ALT ALT (a liver test) AST (a systemic test)

Question 35

What change in LFT is expected with alcoholic liver disease

Answer 35

AST>ALT by about 2:1

Question 36

What is suspected with LFT where the AST and ALT are: 1. Mildly elevated (low hundreds) 2. Moderately elevated (high hundreds to thousands) 3. Severely elevated (>10,000)

Answer 36

Mild: chronic viral hepatitis, acute alcoholic hepatitis Moderate: acute viral hepatitis Severe: ischemia, shock, bad viral hepatitis, acetaminophen toxicity (Normal ALT: 10-35) (Normal AST: less than 35)

Question 37

What does an elected alkaline phosphatase mean in regard to liver disease?

Answer 37

Cholestasis, if its very high (10x increase) think extra hepatic biliary tract obstruction.

Question 38

What can be measured to determine if an elevated alk phos is related to a hepatic disease?

Answer 38

Gamma-glutamyl-transferase activity. If it is also elevated it is probably a liver disease

Question 39

What is suspected if Alk phos is elevated but GGT is not?

Answer 39

Biliary obstruction, pregnancy, or bone disease