Gastroenterology Flashcards

Question

diarrhea and recent ingestion of water from a stream

Answer 1

giardia lamblia | entamoeba histolytica

Answer 2

taenia solium

Answer 3

enterohemorrhagic e. coli

Answer 4

vibrio species

Answer 5

salmonella, campylobacter

Answer 6

adenovirus

Answer 7

entamoeba histolytica

Answer 8

cryptosporidium

Answer 9

metronidazole

Answer 10

metronidazole

Answer 11

fluoroquinolones only if pt is immunocompromised or very ill

Answer 12

fluoroquinolones, TMP-SMX

Answer 13

erythromycin, but this is usually self- limited

Answer 14

IV drug use alcoholism travel to developing countries poor sanitation

Answer 15

``` asymptomatic or malaise, arthralgias, fatigue nausea/vomiting RUQ pain jaundice, scleral icterus hepatomegaly, splenomegaly lymphadenopathy ``` ``` Labs: bilirubin increased AST increased ALT (roughly equally elevated) increased bilirubin increased alk phos ```

Answer 16

Anti-HAV IgM abs -present during illness Anti-HAV IgG abs - after illness has resolved - present with vaccination

Answer 17

active disease

Answer 18

history of active disease IgM rises early IgG rises late

Answer 19

active viral replication, high transmissibility HBeAb signifies low transmissibility

Answer 20

ssRNA spread by fecal- oral route food/shellfish treatment: self-limited, supportive care

Answer 21

dsDNA spread by blood, sexual contact Treatment: hep B vaccine, IFN-gamma Prevention: hep B vaccine Complications: chronic hepatitis, cirrhosis, hepatocellular carcinoma persistent carrier state fulminant hepatic failure Extrahepatic manifestations: polyarteritis nodosa (vasculitis of medium and small- sized arteries), glomerular disease

Answer 22

vasculitis of medium and small- sized arteries ``` fever weakness rash joint pain erythematous nodules ``` associated with hep B

Answer 23

membranous nephropathy rarely, membranoproliferative GN (hep B or hep C), proteinuria adults>children

Answer 24

ssRNA spread via blood treat: IFN-alpha, ribavirin there is no vaccine ``` complications: chronic hepatitis cirrhosis, hepatocellular carcinoma, persistent carrier state extrahepatic manifestations: membranoproliferative GN essential mixed cryoglobinemia lymphoma thyroiditis porphyria cutanea tarda lichen planus DM ```

Answer 25

disabled, requires co-existant hep B in order to be infectious Treatment: IFN-alpha prevention: Hep B vaccine

Answer 26

spread by facal-oral route, contaminated waters treatment: self- limited, supportive care complications: pregnant women

Answer 27

obstructed salivary gland by a stone swelling, pain with eating Tx: warm compresses, massage, sour candy, surgery (remove the stones) antibiotics if infection

Answer 28

inflammatory disorder that can affect the salivary glands. Dry mouth, dry eyes (sicca complex) diminished secretions

Answer 29

pleomorphic adenoma, benign

Answer 30

parotid gland, which can also be a site of extra-pulmonary sarcoidosis

Answer 31

difficulty or abnml swallowing (oropharyngeal/transfer disfunction= difficulty initiating swallo) (esophageal phase is the 2nd phase of the swallow) Causes: achalasia, scleroderma, food impaction peptid strictures, cancer, esophageal webs/rings, radiation- induced fibrosis, alkaline fluid-induced fibrosis

Answer 32

pain with swallowing

Answer 33

iron def dysphagia esoph web

Answer 34

Oropharyngeal dysfuntion

Answer 35

esophageal dysfunction

Answer 36

obstructive pathology

Answer 37

neuromuscular dysmotility

Answer 38

BARIUM SWALLOW esophagogastroduodenoscopy (EGD) manometry

Answer 39

esophagus, LES, stomach

Answer 40

stomach, pyloric sphincter, duodenum

Answer 41

stomach to terminal ileum

Answer 42

appendix to rectum

Answer 43

esophageal reflux | pressure necrosis

Answer 44

feeding tube directly into the stomach, can occur at the bedside with proper equipment open gastrostomy allows the same outcome but with a bigger incision, better for longterm

Answer 45

patient may yank the tube

Answer 46

``` nutrition into the veins. prefer to use the gut biostasis acalculous cholecystitis venous line is a potential site for infection ```

Answer 47

visualization of the peritoneal cavity using a laparoscope

Answer 48

surgical incision into the abdominal cavity

Answer 49

surgical removal or something

Answer 50

neuromuscular disorder of the esophagus impaired peristalsis decreased lower esophageal (LES) relaxation most commonly affects people 25-60 years old secondary causes: Chagas disease neoplasms scleroderma ``` H and P: gradually progressive dysphagia of solids and liquids regurgitation cough aspiration heartburn weightloss ``` Diagnostics: Manometry shows increased LES pressure Incomplete LES relaxation and decreased peristalsis Barium swallow shows "bird's beak" sign ``` Treatment goal is to lower LES pressure pneumatic dilation myotomy (open up the muscle) botulinum toxin injections nitrates dihydropyridine CCBs ``` Order an EGD to rule out malignancy

Answer 51

neuromuscular disorder non-peristaltic contractions of the lower esophagus H and P: chest pain dysphagia for liquids and solids diagnostic testing: "cork screw" pattern on barium swallow non-peristaltic contractions on manometry Treatment: CCBs, TCAs, nitrates relieve pain but worsen reflux

Answer 52

outpouching of upper posterior esophagus caused by smooth muscle weakness immediately above the UES ``` H and P: bad breath difficulty initiating swallowing regurgitation of food several days after eating occasional dysphagia feeling of aspiration ``` Radiology: barium swallow shows outpouching of the esophagys complications:aspiration squamous cell carcinoma perforation may occur with endoscopy Treatment: crichopharyngeal myotomy diverticulectomy via external neck incision

Answer 53

between UES and LES

Answer 54

above the LES

Answer 55

Caused by a lower esophageal sphincter that transiently and intermittently relaxes Stomach contents reflux back into the esophagus ``` Risk factors: obesity hiatal hernia pregnancy scleroderma ``` ``` H and P: burning chest pain 30-90 minutes after eating sour taste in mouth regurgitation dysphagia nausea cough ``` symptoms worsened by consumption of alcohol or fatty foods, or after lying down

Answer 56

upper endoscopy with biopsy to evaluate for reflux or other causes ambulatory pH monitoring to confirm acid reflux manometry can be used to monitor for dysphagia due to neuromuscular dysfunction CXR to assess for neoplasm barium swallow can show peptic stricture

Answer 57

elevation of the head of the bed weight loss- avoid carbonated bevereges dietary modifications ``` Antacids: calcium carbonate aluminum hydroxide milk of magnesia these neutralize stomach acid quickly ```

Answer 58

Famotidine, ranitidine, cimetidine These should be used on select occasions in patients who do not respond to antacids. They should be used in anticipation of reflux (delayed onset of action, longer duration of action). Reversibly block H2 receptors to inhibit gastric acid secretion ``` Side effects: headache diarrhea thrombocytopenia gynecomastia and impotence (cimetidine) ```

Answer 59

omeprazole, lansoprazole given to patients who don't response well to H2 blockers well-tolerated, but block CYP450 enzymes irreversibly inhibit the parietal cell proton pump (H/K ATPase) to block gastric acid secretion

Answer 60

metoclopramide is an example, no longer recommended for GERD

Answer 61

antacids, PPIs, H2 blockers

Answer 62

Nissen fundoplification

Answer 63

``` Esophageal ulceration Esophageal stricture Barrett esophagus Adenocarcinoma Reflux- induced asthma Laryngeal disorders ```

Answer 64

Squamous cell carcinoma (more common worldwide) | Adenocarcinoma (more common in the US, less common worldwide)

Answer 65

intestinal metaplasia of the distal esophagus secondary to chronic GERD increases risk of adenocarcinoma

Answer 66

``` alcohol tobacco chronic GERD obesity (adenocarcinoma) nitrates preserved meats ```

Answer 67

``` progressive dysphagia weight loss odynophagia reflux GI bleeding vomiting weakness cough, hoarseness ```

Answer 68

barium swallow EGD (biopsy is what makes the diagnosis) MRI, CT, PET scan

Answer 69

surgical resection radiation and chemotherapy (non-operative and advanced cases) neoadjuvant therapy to surgery poor prognosis because it has often extended by the time it is diagnosed

Answer 70

longitudinal mucosal laceration in the distal esophagus and proximal stomach, minor injury

Answer 71

perforation or rupture in the distal esophagus, tears all layers of the esophagus; life-threatening

Answer 72

diffuse esophageal spasm

Answer 73

Zenker diverticulum

Answer 74

persistent cough | heartburn

Answer 75

paraesophageal hiatal hernia

Answer 76

inflammation of the gastric mucosa, acute (erosive) or chronic (non-erosive), related to NSAIDs, alcohol, corrosive materials, h. pylori, stress

Answer 77

terminal ileum

Answer 78

urea breath test antral biopsy serum h.pylori antibodies

Answer 79

stop alcohol or offending medications H2 blocker or PPI Vit B12 (type A) Treat h. pylori (type B): PPI, clarythromycin, amoxicillin or metronidazole for 7-14 days

Answer 80

Patients tend to be older, H. pylori + chronic NSAID users 25% if ulcers pain occurs soon after eating due to acid produced to process food; eating worsens the pain and leads to n/v normal or low gastric acid level +/- high gastrin level eating may cause n/v as well

Answer 81

Patients: younger +H.Pylori 75% of ulcers pain occurs 2-4 hours after eating eating improves pain initially, but the pain then worsens normal or low gastrin level there may be nausea or vomiting patient tends to be thinner than patients with other types of ulcers

Answer 82

Curling's ulcer

Answer 83

Cushing's ulcers

Answer 84

increased gastrin

Answer 85

abnormal appearing mucosal folds in the region near the ulcer Mass near ulcer Irregular filling defects in ulcer base Biopsy 4 quadrants around the ulcer

Answer 86

1. rule out active bleeding: CBC, EGD, Stool guiac 2. decrease gastric acid levels PPI H2 antagonist 3. protect mucosa Sucralfate Bismuth subsalicylate Misoprostol 4. Treat H. Pylori: PPI, Amoxicilin or metronidazole, clarithromycin 5. Surgery -perforation repair -parietal cell vagotomy -antrectomy 6. COX2 inhibitors (still have some gastric side effects)

Answer 87

hemorrhage perforation lymphoproliferative disease

Answer 88

gastrin- producing tumor in the duodenum or pancreas ``` refractory PUD abdominal pain n/v indigestion diarrhea steatorrhea other endocrine abnormalities ``` 1. Labs: fasting gastrin level (>1000) secretin stimulation test (secretin induces a steep rise in gastrin levels in patients who do have ZE) 2. Radiology CT or MRI to look for the tumor Endoscopic ultrasound to look for small pancreatic tumors Somatostatin receptor scintigraphy can localize tumors Angiography can be used to look for the tumor if it is hypervascular 3. Treatment: Surgical resection PPI (stop before gastrin testing to get an accurate reading) H2 antagonist Octreotide If you must pick between PPI and octreotide, then pick PPI

Answer 89

1. ulcerating (this is why we biopsy the area around all gastric ulcers) 2. polypoid 3. superficial spreading 4. linitis plastica, involving all layers of the stomach

Answer 90

``` H. Pylori Family history Japanese person living in Japan Tobacco use Alcohol use Vit C deficiency Preserved foods (nitrosamines) Males>females ```

Answer 91

weight loss, anorexia, early satiety vomiting, dysphagia, epigastric pain left supraclavicular node: Virchow's node periumbilcal node (Sister Mary Joseph node) Labs: increased CEA Radiology: barium swallow EGD to visualize ulcers Treatment: subtotal gastrectomy in the distal third Total gastrectomy for lesions in the middle or upper part of the stomach Adjuvant chemotherapy and radiation Prognosis >70% if early detection

Answer 92

malabsorption and restriction sustained weightloss- 30-50% reduction or cure of DM, HTN, OSA, mortality overall depression and suicide increase in the first year after surgery, so pre-opping is extensive

Answer 93

``` nutritional deficiencies iron b12 folate thiamine vit D GERD Dumping syndrome: bloating, swelling, steatorrhea, diarrhea ```

Answer 94

H. Pylori triple therapy PPI Amoxicillin Clarithromycin (metronidazole if pt allergic to clarithromycin)

Answer 95

subtotal if cancer in the distal 1/3 of the stomach: subtotal gastrectomy Total gastrectomy if cancer in the middle or upper stomach add on adjuvant chemo and radiation as needed

Answer 96

actinomyces israelii

Answer 97

weight loss, bloating, diarrhea, steatorrhea, glossitis, dermatitis (zinc deficiency), edema (protein malabsorption)

Answer 98

reduced absorptive capacity from duodenum and jejunum Labs:anti-tissue transglutaminase antibody antiendomysial antibody antigliadin ab no longer considered reliable definitive diagnosis via biopsy of duodenum +/- jejunum looking for blunting of the villi H and P: FTT, bloating, abnormal stools diarrhea, steatorrhea, weight loss 5% of Down syndrome patients have this Associated with dermatitis herpetiformis Treatment: removal of gluten (wheat, barley, rye) from the diet Refractory disease may require corticosteroids

Answer 99

similar presentation to celiac sprue, but the autoantibody tests would be negative and removing gluten from the diet will not have any benefits occurs in patients who have spent time in the tropics, may present years after leaving the tropics Megaloblastic anemia Treatment: folic acid replacement tetracycline, sulfa drugs

Answer 100

lactase deficiency lactose goes straight to the colon when it is not metabolized, drawing water into the colon, causing osmotic diarrhea flatulence, bloating, abdominal pain, diarrhea Treatment: remove lactose from the diet and supplement calcium

Answer 101

bacterial infection with tropheryma whipplei RF:white, european ancestry ``` H and P: abdominal pain diarrhea weight loss arthralgia wasting endocarditis pleural effusions abdominal distention from ascites or adenopathy vision abnormalities dementia ``` Labs: jejunal biopsy- foamy macrophages on PAS stain, villous atrophy PCR Treatment: 1. IV ceftriaxone 2. TMP-SMX continue treatment for 12 months to prevent relapse

Answer 102

if you suspect fat malabsorption bacterial overgrowth pancreatic insufficiency

Answer 103

if you suspect carbohydrate malabsorption PO radiolabelled D-xylose, then blood and urine are tested. Low levels suggest impaired carb absorption (poor absorption) Pancreatic insufficiency would be expected to show normal levels of D-xylose Meanwhile, normal sudan stain but high D-xylose might indicate lactase deficiency

Answer 104

B12 malabsorption Stage 1: give radiolabeled B12 by itself and see if it is absorbed by detecting it in the urine or the serum If it is present in high amounts, malabsorption may be due to absent IF or diminished terminal ileum absorption Stage 2: B12 is administered with intrinsic factor If B12 is absorbed in the second stage, then IF is probably the problem If B12 is not absorbed in the second stage, then the problem is likely the terminal ileum, or maybe the problem is bacterial overgrowth antibiotics or pancreatic enzymes are given in some versions of the Schilling test to further characterize the cause of malabsorption

Answer 105

1. inflammatory - autoimmune disorders - Crohn disease - Ulcerative colitis - Chronic infection 2. fatty - pancreatic insufficiency - Whipple disease 3. watery -osmotic celiac sprue tropical sprue lactose intolerance excess sorbitol lactulose milk of magnesia ``` -secretory irritable bowel syndrome laxative abuse enterotoxic bacteria hormone-mediated (VIPomas, gastrinomas, medullary thyroid cancer, carcinoid tumors) ``` treatment:ileum resection history and physical: FOBT, CBC, metabolic panel, lactose- restricted diet sudan stain, D-xylose test, stool electrolytes osmotic gap125= osmotic colonoscopy with possible biopsy (malignancy, inflammatory bowel disease?)

Answer 106

290-2(Na+K)= stool osmotic gap

Answer 107

infection - rotavirus (winter) - adenovirus (plus conjunctivitis) antibiotic use -macrolides immunosuppression

Answer 108

carcinoid tumor VIPoma gastrinoma medullary thyroid cancer

Answer 109

campylobacter | salmonella

Answer 110

idiopathic, women more than men, related to stress ``` abdominal pain diarrhea constipation bloating nausea mild abdominal tenderness urinary frequency urinary urgency symptoms of fibromyalgia ```

Answer 111

recurrent abdominal pain/discomfort at least 3 days per month in the last 3 months associated with at least 2 of the following: 1. relief with defecation 2. onset associated with a change in frequency of stool 3. onset associated with a change in form of stool important to rule out other causes

Answer 112

IBS with diarrhea IBS with constipation Mixed IBS IBS unsubtyped

Answer 113

``` anorexia weight loss malnutrition progressively worsening pain pain that prevents sleep rectal bleeding ```

Answer 114

electrolyte disturbances anemia increased inflammatory markers

Answer 115

abdominal x-ray abdominal CT barium studies

Answer 116

``` physician assurance no higher rate of malignancy goal is to improve symptoms eat a high-fiber diet avoid gas-producing foods avoid lactose and gluten ``` possible psychotherapy Constipation predominant: fiber and hydration, polyethylene glycol Diarrhea predominant: anti-diarrheals TCAs SSRIs Treat abd pain and bloating with antispasmodics antidepressants funtional disorder

Answer 117

inflammatory disease Crohn Ulcerative colitis

Answer 118

fatigue abdominal pain weight loss watery diarrhea ``` PE: fever RLQ abdominal mass Abdominal tenderness Perianal fissures and fistulas Oral ulcers ``` ``` Features: transmural inflammation skip lesions most commonly affects the distal ileum "gum to bum" ``` Imaging: Transmural inflammation and strictures String sign (not much lumen in some areas) Skipped areas of bowel 1. Barium study with small bowel follow-through 2. Colonoscopy: granulomas, colonic ulcers ``` Complications: malabsorption fissures fistulas strictures obstruction abscess formation ``` Treatment for Crohn disease: 1. steroids +/- abx for acute exacerbations 2. azathioprine or mercaptopurine> methotrexate 3. anti-TNF-alpha agents (infliximab, adalimumab) Medical management preferred over surgical resection, as surgery is not curative distal ileum classically involved mouth to anus with multiple skip areas in between entire thickness of bowel wall is affected

Answer 119

distal ileum classically involved mouth to anus with multiple skip areas in between entire thickness of bowel wall is affected ``` Granulomas Ileum Fistula and fissures Transmural Skip lesions ```

Answer 120

``` fatigue abdominal pain diarrhea weight loss fecal urgency tenesmus incontinence bloody diarrhea ``` ``` PE: fever abdominal tenderness gross blood on rectal exam orthostatic hypotension tachycardia ``` continuous disease of the colon perianal inflammation Colonoscopy would show continuous involvement, pseudopolyps, friable mucosa barium enema would show lead pipe colon, colonic shortening Complications: hemorrhage, toxic megacolon, perforation Longterm complications: strictures leading to obstruction and dysplasia leading to colon cancer Treatment: topical treatment with suppositories and enema preferred to oral treatment start with aminosalicylate (mesalamine), then move on to oral glucocorticoids, immunosuppressive agents, supplemental iron Total colectomy is curative as long as there is no dysplasia

Answer 121

``` arthritis ankylosing spondylitis erythema nodosum pyoderma gangernosum uveitis primary sclerosing cholangitis ```

Answer 122

ASCA:anti-saccharomyces cerevisiae abs often positive in Crohn pANCA- perinuclear anti-neutrophil cytoplasmic antibodies, often positive with UC

Answer 123

Adhesions (from previous surgeries ~75% of cases) Bulge- incarcerated hernia (second most common cause) Cancer (most commonly metastatic colorectal cancer) Other less common causes: volvulus, intussusception, Crohn disease, gallstone ileus, bezoar (organic sediment gets impacted in the small bowel), bowel wall hematoma from trauma, inflammatory stricture, congenital malformation, radiation enteritis

Answer 124

abdominal pain and tenderness n/v +/- recent flatus/ small BM hyperactive high- pitched bowel sounds diagnosis: dilated loops of small bowel proximal to the obstruction seen on plain film abdominal series or CT scan of the abdomen

Answer 125

NPO, IV fluids, monitor electrolytes, Foley catheter to monitor urine output NG tube to low intermittent wall suction (LIWS) especially if the patient has severe intermittent nausea and vomiting Partial obstruction might just need bowel rest Complete might need surgery Hospital observation with frequent reassessments +/- repeat CT scan Avoid pain medication if possible, which may interfere with identification of disease worsening, but treat pain Surgery (laparotomy and lysis of adhesions) if: no improvement in 12-24 hours complete SBO suspected, impending, or ongoing strangulation

Answer 126

neoplasm adhesions volvulus diverticulitis radiology: bowel distention proximal to the obstruction treatment: NPO, maintain hydration, colonoscopy, surgery if necessary

Answer 127

ischemia of the colon secondary to vascular compromise ``` embolus bowel obstruction hypotension medication surgery ``` RF: diabetes, atherosclerosis, PVD, lupus ``` presents with acute abdominal pain bloody diarrhea vomiting mild abdominal tenderness pain out of proportion to exam ``` Barium enema- thumbprint sign 2/2 diffuse submucosal changes from localized bleeding Sigmoidoscopy- bloody and edematous mucosa CT- air within the bowel wall- pneumotosis coli, maybe bowel- wall thickening Treatment: IV fluids, bowel rest, antibiotics, surgical resection of necrotic bowel Complications: high mortality rate if irreversible damage

Answer 128

inflammation with possible perforation of appendix common clinically lymphoid hyperplasia, more often seen in children fibroid bands, fecalith H and P: dull periumbilical pain that migrates to the RLQ n/v/anorexia Tenderness at McBurney's Point (2/3 of the way between umbilicus and ASIS) Rebound tenderness due to peritoneal irritation Psoas sign- pain on passive extension Rovsing sign- RLQ pain with LLQ palpation Obturator sign- RLQ pain on passive internal rotation Severe pain, distention, rebound tenderness, rigidity, guarding, high fever, hypotension, shock Labs: CBC with left-shift UA- increased WBC, cystitis, UTI

Answer 129

CT scan with oral contrast CT scan with rectal contrast +/- IV contrast CT scan without contrast (fast, higher rate of false neg, but better than no CT scan) Plain radiograph for fecolith Ultrasound for pelvic pathology in women Don't wait so long for imaging that the appendix perforates

Answer 130

Pain control: Morphine or meperidine PCA Antibiotic administration for mild to moderate inpatient: - Ampicillin/sulbactam (Unasyn) - Piperacillin/tazobactam (Zosyn) - Ticarcillin/clavulanate (Timentin) - Levofloxacin + metronidazole - Ciprofloxacin + metronidazole Antibiotic administration for severe ICU patient: - Ampicillin + levofloxacin + metronidazole - Imipenem/cilastatin (Primaxin) - Meropenem If presentation within 24-72 hours of symptom onset, then proceed with surgical removal of appendix by laparoscopy or open appendectomy If symptoms present for more than 5 days and pain is specifically in the RLQ, then antibiotics, IVF, bowel rest--> interval appendectomy about 8 weeks later If abscess on CT scan, then percutaneous drainage (interventional radiology)

Answer 131

paralytic obstruction of small bowel secondary to decreased peristalsis infection, ischemia, recent surgery, DM typically less than 5 days. small bowel recovers first (

Answer 132

gallstone impacted in ileum after passing through biliary-enteric fistula subacute, episodic obstruction in elderly woman with vague, recurrent abdominal pain and vomiting that recurs as the stone repeatedly lodges and dislodges Average time from symptom onset to hospitalization- 5 days

Answer 133

abnormal rotation of bowel obstruction, ischemia double bubble sign on xray due to air trapped both distal and proximal to the volvulus barium enema may show bird's beak at distal volvulus as well Treatment: sigmoidoscopy, colonoscopy for decompression, contra-indicated if gangrene due to risk of perforation If the bowel is gangrenous or sigmoid/colonoscopy is unsuccessful, then laparoscopic resection of the affected colon and colostomy Once corrected, the recurrence in 40-60% of patients can be prevented with one of the following: - mesosigmoidopexy - resection with primary anastomosis - Hartmann's procedure (proximal colostomy + stapling but not removal of the distal segment)

Answer 134

outpouchings, may erode and cause bleeding, may become inflammed and infected RF: low- fiber, high fat diet being older ``` H and P: occasional cramping bloating flatulence irregular defecation painless rectal bleeding ``` MCC lower GI bleed in patients > 40 yo Mild LLQ pain relieved with defecation Radiology: irregular outpouchings Colonoscopy can also visualize diverticulosis Treatment: do not limit seeds, nuts, popcorn Complications: diverticulitis, GI bleeds

Answer 135

infection of diverticulum that can lead to necrosis or perforation H and P: LLQ pain older patient fever Labs: increased WBC count with or without left shift CT scan: increased soft- tissue density in the affected area due to inflammation. You will see bowel wall thickening, and possible abscess formation Treatment: outpatient bowel rest fluoroquinolone + metronidazole TMP-SMX + metronidazole Amoxicillin- clavulanic acid

Answer 136

``` elderly immunocompromised significant comorbidities high fever with significant leukocytosis unable to tolerate oral intake ```

Answer 137

1. IV fluids 2. broad- spectrum empiric antibiotics (similar to appendicitis) 3. If there are signs of peritonitis (guarding, tenderness), then sent the patient for emergency exploration through midline incision

Answer 138

Colonic abscesses fistulas sepsis

Answer 139

dilated veins internal- superior rectal veins, above the pectinate line, painless external- inferior rectal veins, painful if thrombosed sigmoidoscopy colonoscopy anoscopy Anal exam for fistulas, lesions Treatment: warm baths, high fiber diet, avoid prolonged straining, sclerotherapy, ligation, surgical excision

Answer 140

spasm of rectal sphincter may result treatment: 1. stool softeners + hydration 2. topical nitroglycerin 3. diltiazem, nifedipine, bethanechol 4. botulinum toxin injection 5. sphincterotomy, which carries 10-30% risk of incontinence

Answer 141

infection of anal crypts, hair follicles H and P: throbbing rectal pain, fever, tenderness on DRE Treatment: Antibiotics I and D

Answer 142

A tract between rectum and adjacent structures from unknown cause or 2/2 ischemic bowel H an P: mild pain during defecation visible site draining pus Treatment: fistulotomy

Answer 143

1 or more curaneous tracts in the midline gluteal cleft H and P: asymptomatic painful cysts abscesses Treatment: I and D Sterile packing with changing Surgical closure of sinus tract

Answer 144

serotonin-secreting tumor, mc arising from ileum, bronchopulmonary tree, appendix, rectum MC GI site is the small i (ileum) H and P: asymptomatic, because the serotonin gets processed in the liver abdominal pain ``` Be FDR Bronchospasm (10-20%) Flushing (85%) Diarrhea (80%) Right- sided valvular disease/murmurs ``` Treatment: Somatostatin analog octreotide helps shut down serotonin Other drugs that can be used for symptom relief: cyproheptadine for diarrhea and/or anorexia Albuterol and/or theophylline for asthma symptoms Codeine and/or cholestyramine for diarrhea If symptoms are refractory to octreotide, give IFN-alpha combined with ocretotide Surgical resection in certain circumstances of isolated tumors Valvular surgery for symptomatic carcinoid heart disease Labs: you might see an increase in urine 5-HIAA increased serum serotonin

Answer 145

presence of colon polyps, especially the adenomatous ones

Answer 146

``` adenomatous colon polyps hereditary polyposis syndromes family history previous colon cancer ulcerative colitis and Crohn's disease low fiber/ high-fat diet alcohol smoking diabetes ```

Answer 147

hundreds of polyps in the colon due to mutated APC gene Treatment: prophylactic subtotal colectomy (this requires a colostomy bag, so wait until after high school) If a patient has an APC gene mutation, you can start doing colonoscopies at a young age

Answer 148

APC mutation colon polyps osteomas soft tissue tumors

Answer 149

APC gene mutation colonic adenomas CNS tumors

Answer 150

polyps in colon, small bowel, stomach Hamartoma, which is an excess amount of normal tissue (not adenomas, so the polyps don't become tumors, but they can be a source of GI bleeding)

Answer 151

Hamartomas in the GI tract | pigmented lesions on lips and oral mucosa

Answer 152

Colon cancer arising from normal- appearing mucosa without forming polyps Neoplasms form in the proximal colon (distal is more common)

Answer 153

distal colon leads to change in bowel habits left colon changes leads to thinned stool caliber There may be hematochezia or melena Iron deficiency anemia (right- sided cancer) Weakness, fatigue Weightloss Labs: positive stool guaiac test anemia increased CEA *not specific but can be used to monitor response to therapy/ recurrence ``` Radiology: apple-core lesion seen on barium enema colonoscopy CT PET ``` Treatment: take out the cancer and at least 12 nodes

Answer 154

node involvement: stage III, involves chemotherapy met's beyond nodes: stage IV

Answer 155

CEA every 3 months for 3 years CT chest/abdomen/pelvis every year Colonoscpoy at 1, 3, 5, years

Answer 156

For the average patient, after age 50 - fecal occult blood test annually with guiac (samples from 3 consecutive stools is ideal) - Colonoscopy every 10 years - or, flex sig, which goes up to the splenic flexure, with double- contrast barium enema to see proximal to the splenic flexure BOTH every 5 yrs - CT colonography is not currently used for screening because it does not have adequate sensitivity and specifiticy, followed by colonoscopy if anything is seen - screening should stop when a patient's life expectancy is less than 5 years (or at age 75, whichever comes first) Screen more frequently if you find polyps

Answer 157

contrast enema requires that the patient take in contrast from above and below, and also tolerate air in the colon Flex sig done without conscious sedation Better visualization with colonoscopy than with flex sig

Answer 158

lower GI bleed rapid or heavy bleed could be an upper GI bleed if it is a severe upper GI bleed

Answer 159

upper GI or proximal small bowel blood

Answer 160

blood that has been sitting in the stomach for some time

Answer 161

``` peptic ulcer disease Mallory- Weiss tears esophagitis esophageal varices gastritis ```

Answer 162

Diverticular disease (most common cause of lower GI bleed in anyone over 40yo) Neoplasms Ulcerative colitis Mesenteric ischemia AV malformations Hemorrhoids Meckel diverticulum (bleeding 2/2 acid secretion into the ileum)

Answer 163

colonoscopy

Answer 164

terminal ileum

Answer 165

capsule endoscopy, which sends pictures to a received

Answer 166

tagged technetium helps localize bowel bleed to quadrant, helpful for intermittent bleeds

Answer 167

EGD- upper GI bleeds Colonoscopy- lower GI bleeds Capsule endoscopy Tagged RBC scan Angiography- would miss an intermittent bleed Meckel scan- just for Meckel diverticulum

Answer 168

1. H and P 2. Continuous monitoring of vital signs 3. obtain IV access with 2 large bore IVs (18 gauge in both arms) or central line 4, Volume and rescuscitation with NS or LR as needed 5. type and cross 2 U PRBC 6. Labs:CBC, coags (guaiac stool if necessary, to confirm blood) Treat and determine the cause 7. NG tube to rule out massive upper GI bleed 8. If colonoscopy is nondiagnostic and not feasible (too much active bleeding may obscure visualization), and bleeding persists, then radionucleotide scan and/or angiogram

Answer 169

Start at 40 years of age, or 10 years before the age the relative was diagnosed- whichever comes first

Answer 170

gallstones chronic alcohol use idiopathic

Answer 171

``` hyperParathyroidism Alcohol Neoplasm (backed up enzymes) Cholelithiasis Rx (drugs- HIV drugs and sulfa drugs) ERCP (backflow) Abdominal surgery hyerTriglyceridemia Infection (mumps) Trauma Idiopathic Scorpion sting ``` pathophysiology:leakage of pancreatic enzymes into surrounding tissue increased serum lipase and amylase on labs, though these are not prognostic indicators. Lipase is more specific than amylase

Answer 172

``` total 11 values 5, assessed at admission at GA LAW Glucose >200mg/dK AST>250 IU/L LDH> 350 IU/L Age>55 yo WBC> 16,000/mL ``` 6 assessed after 48 hours: CALvin and HOBBeS Calcium10% pO2 4mg/dL BUN increase >5mg/dL Sequestration of fluid > 6L 0-2: 0-3% mortality 3-5: 11-15% mortality 6-11: > 40% mortality

Answer 173

``` acute epigastric pain n/v Cullen sign: periumbilical ecchymosis Grey Turner sign: ecchymosis of flank Tachycardia Hypotension Shock- the pt may need fluids ``` Check labs for Ranson criteria and for elevated amylase Upright AXR may show Sentinel loop (dilated loop of bowel) - elevated hemidiaphragm - the right colon may be distended until you get to the pancreas "colon cut-off" sign - pleural effusion CT scan is most sensitive: -enlarged, inflamed pancreas -pseudocyst US-gallstone

Answer 174

aggressive hydration NPO NGT to suction correct electrolytes opioids for pain control morphine causes sphincter of Odi to spasm (meperidine is therefore preferred) NJ tube for feeding (nasojejunum, so as not to stim the stomach) TPN prophylactic abx debridement cholecystectomy if they have gallstones causes pancreatitis ERCP (remove the stones, or this can cause pain, so weight risk and benefits)

Answer 175

``` pancreatic abscess pseudocyst pancreatic necrosis fistulas renal failure chronic pancreatitis hemorrhage shock DIC sepsis respiratory failure ``` treat patients before they get quick

Answer 176

almost always due to alcoholism | recurrent

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``` recurrent epigastric pain steatorrhea weight loss nausea constipation ``` Labs: mildly increased amylase and lipase low fecal elastase (most specific and sensitive test for chronic pancreatitis) ``` Xrays and CTs: pancreatic calcifications enlarged pancreas pseudocyst MR-CP pancreatic duct ```

Answer 178

``` stop alcohol use stop smoking opioids pancreatic enzymes vitamin supplements small, low-fat meals surgical repair of ductal damage ```

Answer 179

``` ductal obstruction pseudocyst malnutrition glucose intolerance pancreatic cancer ```

Answer 180

enzyme-rich fluids contained in a sac of inflamed membranous tissue lined with granulation tissue and fibrous tissue, filled with pancreatic juice usually asymptomatic incidental finding epigastric pain fever Labs: elevated WBC and amylase On aspiration, the cyst contents also hold a lot of amylase

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often resolves on its own drain for diagnosis debridement or percutaneous drainage if the cyst persists over 4 weeks

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rupture abscess hemorrhage pseudoaneurysm (digests vessels so that they bleed into the cyst)

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The most common kind adenocarcinoma usually in the head of the pancreas, where the bulk of pancreatic tissues lies ``` Risk factors: chronic pancreaitis diabetes family history tobacco use high- fat diet male>female obesity sedentary lifestyle abdominal pain with radiation to the back anorexia nausea/vomiting weight loss jaundice ``` ``` Signs and symtoms: palpable, nontender gallbladder -courvoisier sign -splenomegaly -palpable deep abdominal mass ``` Pancreatic adenocarcinoma tumor markers CEA CA 19-9 increased bilirubin and increased phosphatase with biliary obstruction CT abdomen: mass at the head of the pancreas will be visible ERCP to locate Endoscopic ultrasound Treatment: 1. resection (whipple procedure) 2. adjuvant chemotherapy 3. pancreatic enzymes 4. stenting (this would be a palliative measure) Pancreatic adenocarcinoma- complications: death, with 1 yr survival less than 2% Trousseau syndrome: migratory thrombophlebitis classically associated with pancreatic adenocarcinoma

Answer 184

migratory thrombophlebitis classically associated with pancreatic adenocarcinoma

Answer 185

Gastrin- secreting glandular tumors that cause Zollinger- Ellison syndrome

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insulin-secreting beta-cell tumor that causes hypoglycemia Labs: increased fasting insulin elevated C-peptide (produced when the insulin is made) CT or US can help, but these tumors are often difficult to locate Treatment: surgical resection Diazoxide, which reduces insulin release Octreotide

Answer 187

glucagon- secreting alpha-cell tumor that causes hyperglycemia Elevated glucagon, presents with refractory diabetes may present with necrolytic migratory erythemarash, erythematous plaques on the face, perineum, extremities Treatment: surgical resection if you can localize the tumor - surgical resection - octreotide - IFNalpha - embolization Frequently malignant

Answer 188

uncommon presentation of glucagonoma | rash, erythematous plaques on the face, perineum, extremities

Answer 189

tumor that produces vaso-active intestinal peptide, which leads to watery diarrhea usually non-beta islet cells labs: increased serum VIP high stool osmolality ``` Treatment: hydration and electrolyte replacement surgical resection steroids chemotherapy octreotide embolization ```

Answer 190

``` fat fertile female forty family history Also, OCP use TPN rapid weightloss ``` most gallstones are made of cholesterol, calcium, and bilirubin ``` H and P: pain worse after fatty meals, which cause the gallbladder to contract n/v indigestion flatulence RUQ tenderness to palpation ``` Dx: see gallstones on ultrasound cholesterol stones don't show up on xray or CT; bile stones might ``` Tx: low-fat diet bile salts lithotripsy cholecystectomy ``` complications: more stones cholecytitis pancreatitis

Answer 191

inflammation of the gallbladder | Usually, a gallstone obstructs the cystic duct, leading to infection and inflammation behind the obstruction

Answer 192

patients on TPN critically ill patients inflammation, without obstruction

Answer 193

inspiration stopped by pain when you put your hand over the RUQ positive test consistent with cholecystitis

Answer 194

``` RUQ radiating to back n/v fever palpable gallbladder +Murphy sign ``` Labs: increased WBC increased bilirubin and alk phos Radiology Ultrasound: gallstones, thickened gallbladder wall, sludge in the gallbladder, sonographic Murphy sign (Murphy sign elicited with an ultrasound probe), HIDA scan (detects obstruction of the cystic duct)

Answer 195

technectium- labeled hepatic iminodiacetic acid given IV, taken up by hepatocytes, excreted into bile for visualization of gallbladder Inability to visualize the gallbladder with this test indicates cystic duct obstruction, usually from acute cholecystitis or an obstructing stone

Answer 196

hydration antibiotics wait 24-48 hours, then proceed to cholecystectomy Use ERCP to inject solvent if you can't stabilize the patient for surgery

Answer 197

infection of the bile duct, usually due to bile duct obstruction RUQ pain, chills, jaundice, fever (Charcot triad) ``` Labs: biliary obstruction increase AST, ALD, amyplase increased WBC count increased bilirubin increased alk phos ``` Radiology: ultrasound ok, HIDA scan is preferred test (HIDA accumulates in the liver, and then depending on where the obstruction is, it might fill the gallbladder, or fill the gallbladder and not be able to empty) ``` Treatment: hydration IV antibiotics endoscopic biliary drainage delayed cholecystectomy ```

Answer 198

RUQ pain jaundice fever cholangitis until proven otherwise

Answer 199

Charcot triad (RUQ pain, fever, jaundice) + AMS and hypotension or shock

Answer 200

Adenocarcinoma of the gallbladder a/w cholilithiasis, biliary tract disease, chronic infection ``` poor prognosis Symptoms: pain jaundice palpable gallbladder ``` Labs: elevated bilirubin elevated alk phos Porcelain (calcified) gallbladder, while more suggestive of chronic cholecystitis, is cancer 10-30% of the time. ``` Treatment: cholecystecomy lynph node dissection removal of adjacent hepatic tissue radiation and chemo ```

Answer 201

Porcelain (calcified) gallbladder, while more suggestive of chronic cholecystitis, is cancer 10-30% of the time.

Answer 202

- autoimmune disease that destroys the intrahepatic bile ducts (cholesterol, bile acids) - more common in women - associated with autoimmune diseases

Answer 203

Usually women (95% of patients) between ages 30-65 Fatigue and pruritis are the most common presenting symptoms - excessive daytime somnolence - pruritis often starts during pregnancy and then not relieved postpartum - patients are often initially referred to a dermatologist for pruritis and excoriations are common Skin changes: - hyperpigmentation due to melanin deposition, xerosis, dermatographism (wheal where you write on them) - xanthelasma (cholesterol- filled plaques on the medial aspects of the eyelids bilaterally and/or xanthomata Hepatomegaly that progressively worsens +/- splenomegaly Malabsorption and steatorrhea from less bile acid secretion In late stages, cirrhosis, jaundice, ascites, edema, portal hypertension Labs: Elevated alk phos, elevated GGT, elevated direct and indirect bilirubin (in late disease), elevated cholesterol Elevated serum antimitochondrial antibodies (AMA), in >95% of patients: qhallmark finding of PBC Elevated antinuclear antibodies (ANA) in 70% Associated conditions: osteoporosis, osteomalacia, other autoimmune disorders (thyroiditis/hypothyroid, sicca syndrome, scleroderma, Sjogren syndrome, arthritis, Raynaud) ``` Treatment: Ursodeoxycholic acid (UDCA), delays disease progression and enhances survival. The only approved therapy for PBC ``` Definitive treatment is liver transplantation

Answer 204

Elevated serum antimitochondrial antibodies (AMA)

Answer 205

progressive destruction of intrahepatic and extrahepatic bile ducts, leading to fibrosis and cirrhosis. Presents with fatigue, pruritis, hepatomegaly, xanthomas, maybe jaundice if severe UNLIKE PBC PSC is more common in men Associated with ulcerative colitis Labs: negative ANA often with + p-ANCA ERCP shows "beads on a string" Treatment: transplant Associated with increased risk of cholangiocarcinoma

Answer 206

primary sclerosing cholangitis is associated with cholangiocarcinoma, which is cancer of the bile duct

Answer 207

- intraductal biliary stones - surgical trauma or blunt abdominal trauma to the biliary tree - drugs (IV chemotherapy) - recurrent pancreaitis - autoimmune pancreatitis - AIDs cholangiopathy

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- mild deficiency of UDPGT - mild jaundice following fasting, exercise, stress - increased indirect bilirubin (

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``` autosomal recessive -severe deficiency of UDPGT present in infancy -persistent jaundice -kernicterus ``` Icreased indirect bilirubin (>5mg/dL) fatal if untreated - phototherapy - plasmapheresis - liver transplantation

Answer 210

Mildly decreased UDPGT Mildly elevated indirect bilirubin Treatment- phenobarbital, Note, phenobarbital will induce cytochrome p450 as well as production of UDPGT

Answer 211

Murphy sign | Cholecystitis

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Reynold's pentad | Cholangitis

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psoas sign | appendicitis

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obturator sign | appendicitis

Answer 215

Kehr's sign splenic rupture

Answer 216

acute pancreatitis

Answer 217

Cullen sign | acute pancreaitis

Answer 218

1. hepatic steatosis (Reversible early on) 2. steatohepatitis (fat and inflammation) 3. cirrhosis

Answer 219

mcc: obesity, DM hyperlipidemia, insulin resistance insulin resistance leads to excess lipid accumulation in the liver can progress to cirrhosis, lead to hcc, or worsen hep C progression suspect NASH if chronically elevated LFTs Diagnose NASH with liver US, CT scan, or MRI Magnetic resonance spectroscopy (MRS) is the gold standard liver biopsy can also make the diagnosis, and can be used to identify those at risk for disease progression Treatment: 1. avoid all alcohol 2. weight loss: most likely beneficial, but no proven benefit 3. Control any diabetes aggressively to keep HbA1C

Answer 220

``` anorexia n/v abd tenderness ascites splenomegaly ``` lab: elevated ALT, AST, GGT unless the liver is so far gone that it doesn't make enzymes anymore look for AST>ALT by 2:1 or more Also, elevated alk phos and bilirubin Low albumin, prolonged PT and PTT, low triglycerides, LDL, HDL increased WBC

Answer 221

``` stop alcohol use thiamine folate high caloric intake liver transplant (eligible after sober 6 months) ```

Answer 222

``` alcohol Hep B and C bile duct obstruction, chronic cholestasis- PBC, PSC hemochromatosis Wilson disease A1AT deficiency Non-alcoholic steatohepatitis autoimmune hepatitis ```

Answer 223

conjugate bilirubin synthesize proteins metabolize toxins

Answer 224

Dupuytren contracture

Answer 225

stop all alcohol even if it isn't the main problem lactulose to trap ammonia in the gut rifaximin to kill of ammonia- producing gut bacteria liver transplant

Answer 226

thrombosis and occlusion of the hepatic vein or intrahepatic/suprahepatic portion of the IVC presentation: ascites (84%) hepatomegaly (76%) jaundice acute presentation: acute RUQ pain and hepatomegaly rapid development of jaundice and ASCITES subacute or chronic presentation gradual development of ascietes, LE edema, cirrhosis, portal hypertension over a few months eventual development of liver failure and hepatic encephalopathy Best initial diagnostic test: US Gold standard test: hepatic venography

Answer 227

Best initial diagnostic test: US Gold standard test: hepatic venography

Answer 228

``` Thrombolytics to dissolve the clot) Diuretics Anticoagulation Angioplasty Shunting ```

Answer 229

These varices form due to the need for bypassing blood vessels, around the portal venous system (forming where portal venous system interfaces with the systemic circulation) 1. esophageal varices 2. hemorrhoids 3. caput medusae 4. renal varices 5. paravertebral varices

Answer 230

measure albumin in the ascites measure the albumin in the serum SAAG= serum alb- ascites albumin

Answer 231

``` portal hypertension (low albumin in the ascites) cirrhosis alcoholic hepatitis heart failure/ constrictive pericarditis massive hepatic metastases Budd- chiari syndrome ```

Answer 232

ascites not due to portal hypertension (high albumin in the ascietes, or low serum albumin) high albumin in the ascites -peritoneal carcinomatosis (ovarian cancer) -peritoneal tuberculosis -pancreatitis -serositis low serum albumin -nephrotic syndrome

Answer 233

consider cancer as a cause of ascites do a workup for cancer if this is the case

Answer 234

consider spontaneous bacterial peritonitis

Answer 235

1. Cefotaxime, ceftriazone, or other third- generation cephalosporin for at least 5 days to cover for gut bacteria (E. coli, klebsiella, and enterococcus), staph, and strep 2. Give IV albumin because it maintains plasma volume, preserves renal function, and reduces renal impairment and mortality

Answer 236

1. salt restriction and diuretics (spironolactone and furosemide combined each morning) 2. beta blockers to reduce risk of bleeding (propanolol, nadolol) 3. vasopressin or sclerotherapy 4. hepatic shunting 5. TIPs procedure (trans-jugular intra-hepatic port-caval shunt) which channels through liver to shunt blood from portal to systemic systems. This increases risk of hepatoencephalopathy while relieving varices

Answer 237

AR excess iron absorption, which then gets deposited in the liver, heart, pituitary ``` H and P: abdominal pain polydipsia polyuria arthralgias lethargy bronze hue of the skin hepatomegaly testicular atrophy/impotence related to infiltration of the pituitary dilated> restrictive cardiomyopathy ``` Labs: increased iron, increased ferritin, increased transferrin saturation, increased AST, ALT Bx will help determine extent of damage Tx: - phlebotomy weekly until iron levels normalize - avoid excess alcohol consumption - deferoxamine Complications: - cirrhosis - hcc - CHF - diabetes - hypopituitarism

Answer 238

impaired copper secretion Copper in the brain can yield depression, personality changes, loss of coordination, Parkinsonian-like symptoms like tremor dysphagia Copper in the liver: jaundice hepatomegaly cirrhosis Copper in the cornea: Kayser- Fleischer rings Labs: decreased serum ceruloplasmin (binds copper and transports it in the blood) UNlikely to be Wilson if pt >40 Labs: - decreased serum ceruloplasmin - increased urinary copper - increased AST and ALT - liver biopsy with increased copper deposits Treatment: trientine and penicillamine as copper chelators zinc supplements restrict dietary copper Vitamin B6 supplements Liver transplant complications: fulminant hepatic failure, cirrhosis

Answer 239

panacinar emphysema liver disease- mutated form of alpha1- antitrypsin, which polymerizes and accumulates in liver cells, toxic to hepatocytes Co-dominant disorder (homozygous confers early emphysema; heterozygotes might not get lung disease unless they smoke) labs: increased AST and ALT PFTs: obstructive disease emphysema Tx: liver transplant, lung transplant if severe

Answer 240

Autoimmune inflammation of the liver More common in women than men Often asymptomatic/subclinical, may result in cirrhosis ``` 2 clinically similar sybtypes: Type 1 (classic): associated with +ANA and anti-smooth muscle antibodies (ASMA) ``` Type 2- associated with antibodies against liver- kidney- microsomal (LKM) antibodies or liver cytosol antigens Treat with glucocorticoids or glucocorticoids + azathioprine (immunosuppressant)

Answer 241

Type 1 autoimmune hepatitis

Answer 242

type 2 autoimmune hepatitis

Answer 243

hepatic adenomas focal nodular hyperplasia hemangiomas hepatic cysts These benign liver growths are more common in women who use OCP Asx unless they get really big, usually found incidentally and don't need to be treated Can cause RUQ fullness

Answer 244

most often in women ages 20-44 (OCP years) risk factors: OCP use, anabolic steroids, glycogen storage diseases types I and III symptoms: +/- RUQ pain, usually asx 10% with malignant transformation Treatment: discontinue the OCP, serial imaging and AFP, +/- resection (especially if >5cm)

Answer 245

CT chest/abd/pelvis, since mets are much more common than primary liver tumors Consider colonoscopy if the patient is at risk or at screening age

Answer 246

malignant tumor of hepatic parenchyma ``` risk factors: hepatitis B hepatitis C cirrhosis aflatoxin (corn, nuts) ``` ``` History and physical: RUQ abdominal pain weight loss malaise anorexia diarrhea jaundice hepatomegaly bruit over the liver ascites ``` Labs: increased AST, ALT increased alk phos and bilirubin increased alpha-fetoprotein complications: hemorrhage, so biopsy is risky ``` Treatment: surgical resection chemotherapy transplant radiofrequency ablation and chemoembolization if the tumor is unresectable ``` Complications contd.. liver failure Budd-Chiari portal vein obstruction Paraneoplastic syndromes associated with hcc: 1. hypoglycemia 2. excessive RBC production -increased erythropoietin 3. refractory watery diarrhea 4. hypercalcemia 5. various skin lesions

Answer 247

Pheochromocytoma Renal Cell Carcinoma Hemangioblastoma HCC

Answer 248

Ferritin (high)

Answer 249

serum ceruloplasmin (low)

Gastroenterology Flashcards

(284 cards)