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Flashcards in Gastroenterology Deck (290):
1

esophageal disorders leading to narrowing will result in

dysphagia and weight loss

2

name the causes of dysphagia (7)

1. achalasia
2. cancer
3. rings/webs
4. Zenker's diverticulum
5. spastic d/o's
6. scleroderma
7. eosinophilic esophagitis

3

- YOUNG nonsmoker
- dysphagia to solids AND liquids at the same time
- REGURGITATION of food
- ASPIRATION of previously eaten food

achalasia

4

best INITIAL test for achalasia

barium swallow

5

MOST ACCURATE test for achalasia

esophageal manometry

6

endoscopy in achalasia is done for what purpose?

to EXCLUDE cancer

7

best INITIAL treatment for achalasia

pneumatic dilation, or surgical myotomy

8

pneumatic dilation for achalasia is done when?

surgical myotomy is UNSUCCESSFUL

9

treatment for achalasia if pt refuses pneumatic dilation/surgical myotomy

botulinum toxin injection

10

- dysphagia to solids THEN liquids
- +/- heme-positive stool, or ANEMIA
- often pts > 50 yoa
- smoker/drink alcohol

esophageal cancer

11

best INITIAL test for esophageal cancer

endoscopy

(barium swallow if endoscopy isn't a choice)

12

best INITIAL treatment for esophageal cancer

RESECTION

13

surgical resection of esophageal cancer should be followed by

5-fluorouracil (5-FU)

14

name the causes of rings/webs causing dysphagia (3)

1. Plummer-Vinson syndrome
2. Schatzki's ring
3. peptic stricture

15

best INITIAL test for rings/webs

barium swallow

16

- PROXIMAL stricture
- IDA
- middle-aged females

Plummer-Vinson syndrome

17

best INITIAL treatment for Plummer-Vinson syndrome

iron

18

- DISTAL ring
- INTERMITTENT symptoms of dysphagia

Schatzki's ring

19

best INITIAL treatment for Schatzki's ring

pneumatic dilation

20

- dysphagia
- longstanding acid reflux

peptic stricture

21

treatment for peptic stricture

pneumatic dilation

22

- horrible bad breath from rotting food in back of esophagus
- dilation of posterior pharyngeal constrictor muscles

Zenker's diverticulum

23

best INITIAL test for Zenker's diverticulum

barium swallow

24

best INITIAL treatment for Zenker's diverticulum

surgical resection

25

- dysphagia
- h/o allergies
- mean of 5 years before diagnosis is made

eosinophilic esophagitis

26

test for eosinophilic esophagitis

endoscopy w/ biopsy

27

treatment for eosinophilic esophagitis

PPT and budesonide

28

- severe chest pain w/o risk factors for ischemic heart disease
- pain after drinking cold beverage
- normal EKG/stress test/coronary angiography

diffuse esophageal spasm

29

MOST ACCURATE test for diffuse esophageal spasm

manometry

30

barium swallow may show what during an episode of spasm in diffuse esophageal spasm

corkscrew pattern

31

treatment for diffuse esophageal spasm

- CCB
- nitrate

32

difference between diffuse esophageal spasm and Prinzmetal's variant angina

ST segment elevation

33

- diffuse disease
- reflux symptoms

scleroderma

34

- odynophagia
- HIV-NEGATIVE

what is the next step in management?

endoscopy

35

- odynophagia
- HIV-POSITIVE w/ CD4 count

fluconazole

36

- odynophagia
- HIV-POSITIVE w/ CD4 count

endoscopy

37

> 90% of esophagitis in HIV-positive pts are caused by?

Candida

38

treatment for pill esophagitis

- sit up
- drink a lot of water
- remain upright for 30 minutes after

39

- SUDDEN UGIB
- violent retching/vomiting
- there may be hematemesis or melena

Mallory-Weiss tear

40

test for Mallory-Weiss tear

endoscopy

41

treatment for Mallory-Weiss tear

most spontaneously resolve

42

treatment for Mallory-Weiss tear if bleeding does NOT resolve

endoscopic epinephrine injection

43

- epigastric pain/substernal chest pain
- sore throat
- metallic or bitter taste
- hoarseness
- chronic cough
- wheezing
- nausea

GERD!!

44

diagnosis and treatment for GERD

PPI

45

if no response to PPI for GERD symptoms, next step in management

endoscopy

46

if GERD symptoms persist and EGD is normal, next step in management

24-hour pH monitoring

47

alarm symptoms in pt w/ GERD indicating endoscopy

- weight loss
- anemia
- blood in stool
- dysphagia
- reflux for more than 5-10 years

48

- PREcancerous lesion of lower esophagus
- 0.5%/year transform into cancer

Barrett esophagus

49

test for Barrett esophagus

endoscopy

50

endoscopic finding: Barrett esophagus (metaplasia)

next step in management

PPI and repeat EGD every 2-3 years

51

endoscopic finding: low-grade dysplasia

next step in management

PPI and repeat EGD in 3-6 months

52

endoscopic finding: high-grade dysplasia

next step in management

- endoscopic mucosal resection
- endoscopic ablation
- distal esophagectomy

53

MCC of epigastric discomfort

non-ulcer dyspepsia (diagnosis of exclusion)

54

test for non-ulcer dyspepsia

endoscopy

55

treatment for non-ulcer dyspepsia

- H2 blocker
- liquid antacid
- PPI

56

treatment for REFRACTORY non-ulcer dyspepsia

treat for Helicobacter pylori

57

MCC of peptic ulcer disease (duodenal/gastric)

H. pylori

58

after H. pylori, MCC of PUD

- NSAIDs
- head trauma
- burns
- intubation
- Crohn's disease
- Zollinger-Ellison syndrome

59

what % of GU pts develop gastric cancer?

4%

60

gastritis can be associated w/

H. pylori

61

treatment for H. pylori

- omeprazole
- clarithromycin
- amoxicillin

62

MOST ACCURATE test for gastritis

endoscopy w/ biopsy

63

treatment if initial H. pylori treatment fails

repeat triple therapy w/ 2 new abx

- PPI
- metronidazole
- tetracycline

64

if H. pylori treatment fails twice

evaluate for ZES (gastrinoma)

65

stress ulcer prophylaxis should be given to the following:

- head trauma
- intubation and mechanical ventilation
- burns
- coagulopathy AND steroid use in combination

66

- epigastric pain
- H. pylori positive
- NO ulcer or gastritis

non-ulcer dyspepsia

67

EVERYONE on an H2 blocker or PPI has an

ELEVATED GASTRIN LEVEL

68

diagnostic test ZES

gastrin level and gastric acid output

69

test the gastrin level and gastric acid output for ZES when the following is present:

- large ulcer (> 1cm)
- multiple ulcers
- ulcer distal to ligament of Treitz
- recurrent/persistent ulcer despite H. pylori treatment

70

if gastrin level and acid output are elevated in ZES, next step

localize the gastrinoma

71

MOST ACCURATE test for ZES

secretin suppression test

72

treatment of ZES for LOCAL disease

surgical resection

73

treatment of ZES for metastatic disease

lifelong PPI

74

clue about the presence of a parathyroid problem w/ ZES, and multiple endocrine neoplasia (MEN) syndrome

hypERcalcemia

75

both CD and UC can present w/

- fever
- abdominal pain
- diarrhea
- bloody stools
- weight loss

76

extraintestinal manifestations of IBD

- joint pain
- iritis/uveitis
- pyoderma gangrenosum/erythema nodosum
- sclerosing cholangitis

77

features more common to CD

- masses
- skip lesion
- upper GI tract
- perianal disease
- transmural granulomas
- fistulae
- hypocalcemia from fat malabsorption
- obstruction
- calcium oxalate kidney stones
- cholesterol gallstones
- vitamin B12 malabsorption from terminal ileum involvement

78

diagnosis for CD and UC

barium swallow or endoscopy

79

when diagnosis of CD or UC, what can be helpful

blood tests

80

ASCA and ANCA in CD

ASCA POSITIVE

81

ASCA and ANCA in UC

ANCA POSITIVE

82

best INITIAL treatment for both CD and UC

mesalamine

83

adverse effects of sulfasalazine

- rash
- hemolytic anemia
- interstitial nephritis

84

treatment for acute exacerbation of CD and UC

budesonide

85

treatment for severe CD and UC w/ recurrent symptoms when steroids are STOPPED

azathioprine, or 6-mercaptopurine

86

most useful treatment for CD associated w/ FISTULA formation

infliximab

87

treatment for perianal involvement in CD

metronidazole and ciprofloxacin

88

curative treatment for UC

surgical resection of colon

89

most important feature of infectious diarrhea

presence of blood indicating invasive bacterial pathogen

90

infectious diarrhea +/- blood may be d/t which pathogens?

- Campylobacter
- Salmonella
- Vibrio parahaemolyticus
- Vibrio vulnificus
- E. coli (including E. coli O157:H7)
- Shigella
- Yersinia
- amoeba

91

- diarrhea
- MCC of food poisoning

Campylobacter

92

Campylobacter can be associated w/

- Guillain-Barre syndrome
- reactive arthritis

93

- diarrhea
- transmitted by chickens and eggs

Salmonella

94

- diarrhea
- associated w/ seafood

Vibrio parahaemolyticus

95

- diarrhea
- most commonly associated w/ HUS (effects of verotoxin)
- h/o undercooked beef

E. coli O157:H7

96

which treatments should be AVOIDED in HUS

platelet transfusion and antibiotics

97

- diarrhea
- associated w/ shellfish
- septicemia is MUCH more likely in pt w/ liver disease - - necrotizing wound infections can occur in skin lesions

Vibrio vulnificus

98

- diarrhea
- secretes Shiga toxin
- also, associated w/ reactive arthritis
- 2nd MCC of HUS

Shigella

99

- diarrhea
- rodents are natural reservoir
- transmission is through food contaminated w/ infected urine/feces

Yersinia

100

diarrhea, which may be associated w/ liver abscesses

amoeba

101

best INITIAL test for infectious diarrhea

fecal leukocytes

102

MOST ACCURATE test for infectious diarrhea

stool culture

103

treatment for infectious diarrhea: mild disease

none; will resolve on its own

104

best INITIAL treatment for infectious diarrhea: severe disease

fluoroquinolones

105

severe infectious diarrhea is defined as having the following

- blood
- fever
- abdominal pain
- hypotension and tachycardia

106

infectious diarrhea (which NEVER presents w/ blood) may be d/t which pathogens?

- viruses
- Giardia
- Staphylococcus aureus
- Bacillus cereus
- Cryptosporidium
- Scombroid

107

- diarrhea
- camping/hiking
- men who have sex w/ men
- bloating, flatus, signs of steatorrhea

Giardia

108

more accurate test for Giardia

stool ELISA Ag

109

treatment for Giardia

metronidazole or tinidazole

110

- diarrhea
- associated with mayonnaise and vomiting

Staphylococcus aureus

111

- diarrhea
- associated w/ refried Chinese rice and vomiting

Bacillus cereus

112

- diarrhea
- HIV-positive pt w/ CD4 cells

Cryptosporidium

113

test for Cryptosporidium

modified acid-fast stain

114

treatment for Cryptosporidium

HAART and nitazoxanide

115

- diarrhea
- histamine fish poisoning
- FASTEST onset diarrhea, w/i 10 MINUTES
- vomiting, wheezing, flushing

Scombroid

116

treatment for Scombroid

diphenhydramine

117

- antibiotic-associated diarrhea
- develops several days to weeks after abx use

Clostridium difficile

118

best INITIAL test Clostridium difficile diarrhea

stool toxin assay

119

initial treatment for mild/moderate CDI

PO metronidazole or PO vancomycin

120

treatment for severe CDI

PO vancomycin +/- IV metronidazole

121

definition of severe CDI

- WBCs > 15,000
- serum albumin

122

treatment for complicated CDI

- PO vancomycin and IV metronidazole
- surgery consult

123

definition of complicated CDI

- toxic megacolon
- peritonitis
- respiratory distress
- hemodynamic instability

124

alternate treatment for severe and recurrent CDI

fidaxomicin

125

chronic diarrhea (> 4 weeks) causes

- lactose intolerance
- carcinoid syndrome
- IBD

126

MCC of chronic diarrhea and flatulence

lactose intolerance

127

chronic diarrhea associated w/ flushing and episodes of hypotension

carcinoid syndrome

128

test for carcinoid syndrome

urinary 5-HIAA level

129

treatment for carcinoid syndrome

octreotide (somatostatin analog)

130

chronic diarrhea w/ blood in stools, fever, and weight loss

IBD

131

- chronic diarrhea ALWAYS associated w/ weight loss

malabsorption

132

name the causes of malabsorption (4)

1. celiac disease (gluten sensitive enteropathy)
2. tropical sprue
3. chronic pancreatitis
4. Whipple's disease

133

ALL forms of fat malabsorption are associated w/

- hypocalcemia (vitamin D deficiency)
- oxalate kidney stones
- easy bruising and elevated PT/INR (vitamin K malabsorption)
- vitamin B12 malabsorption

134

best INITIAL test for malabsorption

Sudan black stain for stool

135

MOST SENSITIVE test for malabsorption

72-hour fecal fat

136

- iron malabsorption and microcytic anemia
- folate malabsorption
- dermatitis herpetiformis

celiac disease

137

best INITIAL tests for celiac disease

- anti-gliadin Ab
- anti-endomysial Ab
- anti-tissue transglutaminase Ab

138

MOST ACCURATE test for celiac disease

small bowel biopsy

139

D-xylose test result in celiac disease, Whipple's disease, and tropical sprue

ABNORMAL (villous lining is destroyed)

140

what test should be done even if diagnosis of celiac disease has been confirmed?

small bowel biopsy to EXCLUDE bowel wall lymphoma

141

treatment for celiac disease

gluten free diet

142

MOST ACCURATE test for tropical sprue

small bowel biopsy showing microorganisms

143

treatment for tropical sprue

doxycycline, or TMP/SMX for 3-6 MONTHS

144

- malabsorption
- arthralgia (MCC presenting symptom)
- neurological abnormalities
- ocular findings

Whipple's disease

145

MOST ACCURATE test for Whipple's disease

small bowel biopsy showing PAS POSITIVE organisms

146

treatment for Whipple's disease

tetracycline, or TMP/SMX for 12 MONTHS

147

- malabsorption
- h/o alcoholism
- h/o multiple episodes of pancreatitis
- amylase/lipase will most likely be normal

chronic pancreatitis

148

best INITIAL tests for chronic pancreatitis

- abdominal XR (pancreatic calcifications)
- CT scan of abdomen

149

MOST ACCURATE test for chronic pancreatitis

secretin stimulation testing

150

D-xylose test in chronic pancreatitis will be

NORMAL

151

treatment for chronic pancreatitis

pancreatic enzymes

152

- abdominal pain relieved by BM
- abdominal pain that's less at night
- abdominal pain w/ diarrhea alternating w/ constipation

irritable bowel syndrome (IBS)

153

all diagnostic tests for IBS will be?

normal

154

best INITIAL treatment for IBS

fiber

155

if fiber does not relieve pain in IBS, next treatment

- dicyclomine
- hyoscyamine

156

if fiber, and dicyclomine don't work for IBS, last resort treatment

TCA

157

colonoscopy screening: general population

- begin at 50 yoa
- repeat every 10 years

158

colonoscopy screening: 1 family member w/ colon cancer

- begin at 40 yoa, OR 10 years before age of family member who had cancer

159

colonoscopy screening: 3 family members, 2 generations, or 1 premature (

- begin at 25 yoa
- repeat every 1-2 years

160

colonoscopy screening: FAP

- begin sigmoidoscopies at 12 yoa
- COLECTOMY once polyps are found

161

- colon polyps
- osteomas (benign bone tumors)

Gardner's syndrome

162

- hamartomatous polyps throughout small bowel and colon
- melanotic spots on lips

Peutz-Jeghers syndrome

163

- multiple extra hamartomas in bowel
- no significant increase in cancer risk

juvenile polyposis

164

colonoscopy screening: DYSplastic polyp found

repeat colonoscopy every 3-5 years after polyp was found

165

- LLQ abdominal pain
- LGIB

diverticulosis

166

MOST ACCURATE test for diverticulosis

barium enema

167

- complication of diverticulosis
- LLQ abdominal pain
- TENDERNESS
- FEVER
- ELEVATED WBC COUNT

diverticulitis

168

best test for diverticulitis

CT scan of abd/pelvis

169

is CI in diverticulitis d/t increased risk of perforation

colonoscopy

170

treatment for diverticulosis

high-fiber diet

171

treatment for diverticulitis

antibiotics against GNR and anaerobes

metronidazole and ciprofloxacin

172

GI bleed: red blood

LGIB

173

GI bleed: black stool

UGIB (when proximal to ligament of Treitz (duodenum/jejunum))

174

MOST important step in managing an acute GI bleed

determine if pt is hemodynamically unstable

175

GI bleed management:

when do I transfuse PRBCs?

- Hct

176

GI bleed management:

when do I transfuse FFP?

elevated PT/INR and vitamin K is too slow

177

GI bleed management:

when do I transfuse platelets?

- if pt is bleeding/undergo surgery w/ platelets

178

MCC of death in GI bleeding

myocardial ischemia

179

what should be ordered on an older pt w/ GI bleeding?

EKG to r/o ischemia

180

most important treatment for acute GI bleeding

fluid resuscitation

181

most important measure of severity of GI bleeding

pulse and BP

182

what if pulse is still elevated, or BP is still low in pt w/ GI bleeding and is becoming hypotensive?

oxygenate (intubate if needed) and c/w IVF

183

more important in GI bleed than endoscopy

correcting anemia, thrombocytopenia, or coagulopathy

184

with adequate fluid resuscitation, even w/o endoscopy 80% of GI bleeds

stop bleeding

185

should be added to initial fluid resuscitation if GI bleed is d/t ulcer disease

PPI

186

unnecessary stress ulcer ppx w/ PPIs increases risk of

pneumonia and Clostridium difficile colitis

187

- alcoholic and/or cirrhosis w/ hematemesis
- splenomegaly
- thrombocytopenia
- spider angiomata
- gynecomastia

variceal bleeding

188

should be added to initial fluid resuscitation if GI bleed is d/t variceal bleeding

octreotide (somatostatin analog)

(decreases portal hypertension)

189

treatment for variceal bleeding aside from fluid resuscitation and octreotide

EGD to do banding

190

if variceal bleeding PERSISTS, next step in management

transjugular intrahepatic portosystemic shunt (TIPS)

(shunt between PORTAL vein and HEPATIC vein)

191

MC complication of transjugular intrahepatic portosystemic shunt (TIPS) procedure

hepatic encephalopathy

192

prevents future episodes of variceal bleeding

propranolol

193

temporary measure to stop variceal bleeding to allow time for a shunt to be placed

Blakemore gastric tamponade balloon

194

UPPER GIB can have the following causes: (6)

1. PUD
2. esophagitis
3. gastritis
4. duodenitis
5. varices
6. cancer

195

LOWER GIB can have the following causes: (6)

1. angiodysplasia
2. diverticular disease
3. polyps
4. ischemic colitis
5. inflammatory bowel disease
6. cancer

196

- test performed to detect site of bleeding IF endoscopy cannot
- gives you location, but not exact cause

tagged red cell scan

(technetium bleeding scan)

197

- tells you precise vessel that is bleeding
- may be done PREOPERATIVELY in massive GI bleeding to let you know which part of the colon to resect

angiography

198

can detect location of GIB from SMALL BOWEL, IF upper and lower endoscopies cannot

capsule endoscopy

199

- embolus from heart resulting in infarction of bowel
- SUDDEN onset of extremely severe abdominal pain
- +/- bleeding
- PE is relatively benign
- older pt w/ h/o valvular heart disease

acute mesenteric ischemia

200

look for what on blood tests of acute mesenteric ischemia

- metabolic acidosis (elevated lactic acid d/t ischemia)
- elevated amylase level

201

MOST ACCURATE test for acute mesenteric ischemia

angiography

202

treatment for acute mesenteric ischemia

surgical resection of bowel

(surgical emergency)

203

treatment in mesenteric ischemia NOT caused by emboli

treat underlying flow state

204

management of constipation

correct underlying cause

205

possible causes of constipation: (7)

1. dehydration (decreased skin turgor in elderly pt w/ BUN:Cr ratio > 20:1)
2. CCB
3. opioids
4. hypothyroidism
5. DM (loss of sensation in bowels)
6. ferrous sulfate iron replacement
7. anticholinergics (including TCAs)

206

differentiating between UGIB and black stool d/t ferrous sulfate iron replacement

blood is cathartic causing RAPID BM

207

treatment of constipation

hydration and increased fiber

208

- prior gastric surgery
- SHAKING, SWEATING, WEAKNESS
- +/- hypotension

dumping syndrome

209

mechanism of hypotension in dumping syndrome (2 possible mechanisms)

1. rapid release of gastric contents in duodenum --> osmotic draw into bowel
2. rapid rise in blood glucose --> reactive hypoglycemia

210

management of dumping syndrome

frequent small meals

211

- longstanding diabetes
- bloating
- constipation
- diarrhea

gastroparesis

212

mechanism of gastroparesis

- main stimulant to gastric motility is DISTENSION
- DM damages sensory nerves

213

treatment for gastroparesis

- erythromycin
- metoclopramide

214

mechanism of erythromycin in gastroparesis

increases motilin in gut (hormone that stimulates gastric motility)

215

- severe midepigastric abdominal pain and tenderness
- MCC are alcohol and gallstones
- vomiting w/o blood
- anorexia

acute pancreatitis

216

other causes of acute pancreatitis

- hypertriglyceridemia
- trauma
- infection
- ERCP
- medications (thiazides, didanosine, stavudine, azathioprine)

217

severe acute pancreatitis signs and lab findings

- hypotension
- metabolic acidosis
- leukocytosis
- hemoconcentration
- hyperglycemia
- hypocalcemia
- hypoxia

218

best INITIAL test for acute pancreatitis

amylase and lipase

219

MOST ACCURATE test for acute pancreatitis

CT scan of abdomen

220

detects causes of biliary and pancreatic duct obstruction not found on CT scan

MRCP

221

- consider if there is dilation of CBD WITHOUT pancreatic head mass
- detects presence of stones/strictures
- can REMOVE stones and DILATE strictures

ERCP

222

urinary test used to determine severity of pancreatitis

trypsinogen activation peptide

223

treatment for acute pancreatitis

- no feeding (bowel rest)
- hydration
- pain medications

224

most precise method of determining pancreatitis severity

CT scan

225

Ranson's criteria and CT scan are methods to determine which patients require

pancreatic debridement

226

when the CT scan shows > 30% NECROSIS of pancreas, the pt should:

- receive abx such as imipenem, and
- undergo CT-guided biopsy

227

if biopsy shows INFECTED, NECROTIC pancreatitis, pt should undergo

surgical debridement

228

hepatitis B is associated w/ what in 30% of cases

polyarteritis nodosa (PAN)

229

hepatitis C is associated w/

cryoglobulinemia

230

- jaundice
- fatigue
- weight loss
- dark urine (bilirubin)

acute hepatitis

231

- jaundice
- fatigue
- weight loss
- dark urine (bilirubin)
- present w/ serum sickness-phenomena (joint pain, urticaria, and fever)

hepatitis B and C

232

hepatitis E is most severe in

pregnant females (can be fatal)

233

ALL patients w/ acute hepatitis will have an ELEVATED?

conjugated (direct) bilirubin

234

viraL hepatitis gives an ELEVATED

aLt

235

hepatitis from drugS gives and ELEVATED

aSt

236

MOST ACCURATE tests for hepatitis A, C, D, and E

serology

237

MOST ACCURATE tests for hepatitis B

- surface Ag
- core Ab
- e-Ag
- surface Ab

238

FIRST test to become abnormal in ACUTE hepatitis B infection

SURFACE Ag

239

ALT elevation, e-Ag, and symptoms all occur AFTER

SURFACE Ag

240

CHRONIC hepatitis B gives same serologic pattern as acute hepatitis B, but has

PERSISTENCE OF SURFACE AG > 6 MONTHS

241

ONLY acute hepatitis that CAN be treated

hepatitis C

242

best INITIAL test for acute hepatitis C

hepatitis C Ab

243

MOST ACCURATE tests for acute hepatitis C

- hepatitis C PCR
- liver biopsy

244

MOST ACCURATE way of determining response to treatment for acute hepatitis C, which is based on GENOTYPE

hepatitis C PCR

245

MOST ACCURATE way to determine extent of liver damage in acute hepatitis C

liver biopsy

246

treatment for acute hepatitis C

interferon, ribavirin, and PI (ledipasvir, simeprevir, or sofosbuvir)

247

treatment for chronic hepatitis B

single agent!

- lamivudine
- adefovir
- entecavir
- telbivudine
- tenofovir
- interferon

248

MC adverse effect of ribavirin

anemia

249

treatment of chronic hepatitis C genotype 1

ledipasvir and sofosbuvir

250

treatment of chronic hepatitis C all other genotypes

- simeprevir
- boceprevir

251

MC reason to need liver transplantation in USA

chronic hepatitis C

252

strongest indications for hepatitis A and B vaccination in ADULTS

- chronic liver disease
- household contacts w/ hepatitis A or B
- men who have sex w/ men
- chronic blood product recipients
- IVDA

253

specific indication for hepatitis A vaccination

travelers

254

specific indications for hepatitis B vaccination

- health care workers
- dialysis pts
- DM pts

255

- edema from low oncotic pressure
- gynecomastia
- palmar erythema
- splenomegaly
- thrombocytopenia from splenic sequestration
- encephalopathy
- ascites
- esophageal varices

cirrhosis

256

treatment for edema from low oncotic pressure in cirrhosis pts

spironolactone and diuretics

257

treatment for encephalopathy in cirrhosis pts

lactulose

258

treatment for ascites in cirrhosis pts

spironolactone

259

treatment for esophageal varices in cirrhosis pts

- propranolol to prevent bleeding
- banding to stop acute bleeding

260

what should be done in the following?

- new ascites
- pt w/ ascites develops pain, fever, or tenderness

paracentesis

261

if serum-to-ascites albumin GRADIENT (SAAG) is > 1.1

- portal hypertension from cirrhosis
- CHF

262

neutrophils > 250 on paracentesis

spontaneous bacterial peritonitis (SBP)

263

treatment for spontaneous bacterial peritonitis (SBP)

cefotaxime

264

causes of chronic liver disease (cirrhosis): (7)

1. alcoholic cirrhosis
2. primary biliary cholangitis
3. primary sclerosing cholangitis
4. Wilson's disease
5. hemochromatosis
6. autoimmune hepatitis
7. nonalcoholic steatohepatitis (NASH)

265

- diagnosis of exclusion
- longstanding h/o alcohol abuse

alcoholic cirrhosis

266

- middle-aged FEMALE c/o itching
- +/- xanthelasma (cholesterol deposit)
- may have h/o AI d/o's

primary biliary cholangitis

267

best INITIAL test for primary biliary cholangitis

elevated alkaline phosphatase w/ a NORMAL bilirubin level

268

MOST ACCURATE tests for primary biliary cholangitis

- anti-mitochondrial Ab (AMA)
- liver biopsy

269

treatment for primary biliary cholangitis

ursodeoxycholic acid

270

- associated w/ 80% of IBD cases
- also presents w/ itching
- elevated alkaline phosphatase
- ELEVATED BILIRUBIN level

primary sclerosing cholangitis

271

MOST ACCURATE tests for primary sclerosing cholangitis

- ERCP (shows "beading" of biliary system)
- anti-smooth muscle Ab (ASMA)
- ANCA positive

272

treatment for primary sclerosing cholangitis

ursodeoxycholic acid

273

- liver disease
- choreiform movement d/o
- neuropsychiatric abnormalities
- hemolysis

Wilson's disease

274

best INITIAL test for Wilson's disease

slit lamp looking for Kayser Fleischer rings

(on CCS check for low ceruloplasmin level as well)

275

MOST ACCURATE test for Wilson's disease

liver biopsy

276

treatment for Wilson's disease

penicillamine, or trientine

277

most often caused by a genetic d/o causing overabsorption of iron

hemochromatosis

278

aside from liver disease, other manifestations of hemochromatosis:

- restrictive cardiomyopathy
- skin darkening
- join pain
- damage to pancreas (leads to DM)
- pituitary accumulation w/ panhypopituitarism
- infertility
- hepatoma

279

best INITIAL test for hemochromatosis

- ELEVATED SERUM IRON
- ELEVATED FERRITIN
- LOW TIBC
- EXTREMELY ELEVATED IRON SATURATION (> 45%)

280

MOST ACCURATE test for hemochromatosis

liver biopsy

281

what, in combination, are sufficient for diagnosis of hemochromatosis?

MRI of liver, AND HFe gene mutation

282

treatment for hemochromatosis

phlebotomy

283

- young female w/ other AI diseases
- liver disease

autoimmune hepatitis

284

best INITIAL tests for autoimmune hepatitis

- ANA
- anti-smooth muscle Ab (ASMA)
- SPEP

285

MOST ACCURATE test for autoimmune hepatitis

liver biopsy

286

treatment for autoimmune hepatitis

- prednisone
- azathioprine for steroid-sparing medication

287

- strongly associated w/ obesity, DM, hyperlipidemia
- hepatomegaly

nonalcoholic steatohepatitis (NASH)

288

best INITIAL test for nonalcoholic steatohepatitis (NASH)

ALT > AST

289

MOST ACCURATE test for nonalcoholic steatohepatitis (NASH)

liver biopsy showing fatty infiltration

(looks just like alcoholic liver disease)

290

treatment for nonalcoholic steatohepatitis (NASH)

control underlying causes (weight loss, DM control, DLD management)