Gastroenterology Block Flashcards
(80 cards)
1
Q
What is Charcot’s Triad?
A
The combination of jaundice, RUQ pain, and fever = ascending cholangitis
- Infection of the bile duct in the liver
- E. coli is typically the causative organism of ascending cholangitis
2
Q
What antispasmodic is typically used in gallstones?
A
Buscopan
- Should avoid NSAIDs
3
Q
What condition is a risk factor for gallbladder cancer?
A
Chronic cholecystitis
4
Q
What is a complication of acute cholecystitis?
A
Gallbladder empyema/mucosele
5
Q
What is Sepsis 6?
A
Remember “3 in, 3 out”
3 in:
- Oxygen
- Fluids
- IV antibiotics
3 out:
- Blood cultures
- Lactate
- Urine output
6
Q
What findings on ultrasound are consistent with gallstones?
A
Thick-walled gallbladder with pericholecystic fluid
7
Q
What is the treatment for peptic ulcers?
A
- Antibiotics to kill H. Pylori -> i.e. amoxicillin, clarithromycin
- Block acid production (PPI)-> i.e. omeprazole, lansoprazole
- Reduce acid production (H2 antagonists) -> i.e. ranitidine, nizatidine
- Antacids to neutralise stomach acid
- Protect lining of stomach + small intestine -> i.e. misoprostol
8
Q
What hematological values would be indicative of an upper GI bleed?
A
High urea with a normal creatinine
- Increased protein
9
Q
What 3 things would you look for when investigating a DKA?
A
- Acidosis on ABG
- Raised glucose on ABG
- Raised ketones in urine/blood
10
Q
What are the 3 main risk factors for kidney stones?
A
- Smoking
- High calcium
- Dehydration
11
Q
What is the striking differential in a patient presenting with LIF pain?
A
Diverticulitis
12
Q
What is the difference between diverticulosis, diverticular disease, and diverticulitis?
A
Diverticulosis = multiple out-pouching of the bowel without symptoms
Diverticular disease = symptoms associated after eating
Diverticulitis = pain, fever, and PR bleeding
13
Q
What are the causes of epigastric pain?
A
- Pancreatitis
- Gastritis/duodenitis
- Peptic ulcer
- Gallbladder disease
- Aortic aneurysm
14
Q
What blood test would be elevated in pancreatitis?
A
Lipase (more sensitive than amylase) + amylase
15
Q
What are the causes of pancreatitis?
A
GET SMASHED
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Scorpion sting
Hypercalcemia/high cholesterol
ERCP (endoscopic retrograde cholangiopancreatography)
Drugs (i.e. sodium valproate, thiazide diuretics, amiodarone)
16
Q
What is messenteric adenitis?
A
A mild condition that causes temporary pain in the abdomen, mainly in children. It usually clears on its own or requires antibiotics + painkillers.
Inflamed lymph glands in the abdomen
17
Q
How can you differentiate small and large bowel obstruction?
A
Ask the patient if vomit or pain came first.
If pain = large bowel obstruction
If vomit = small bowel obstruction
Important to also ask when they last passed stool, diarrhoea, family history, weight loss, PR bleeding
Remember previous abdominal surgery is a risk factor for GI adhesions!
18
Q
What is the 3-6-9 rule?
A
The diameter of the small intestine, large intestine, and cecum cannot be greater than 3cm, 6cm, and 9cm respectively. If so, then the bowel is dilated and is likely caused by an obstruction.
19
Q
What is “drip and suck”?
A
In a patient with a GI adhesion, insert a nasogastric tube and cannula to try and get rid of stomach contents. If no change, then surgery is required to operate on adhesions.
20
Q
What is permissive hypotension?
A
In the scenario of a gross haemorrhage, it has been found to be beneficial in some patients who are hypotensive to avoid giving IV fluids to the extent that reverses their hypotension.
Instead management is given so their SBP ≤ 80mmHg. This is to prevent thrombus dislodgement and help the body to stop the bleeding on its own without causing further fluid loss.
21
Q
What is a cause of increased ADH secretion and decreased ADH secretion?
A
Increased ADH = SIADH (I.e. cancer)
Decreased ADH = Diabetes Insipidus
22
Q
What’s the difference between transudate and exudate?
A
Transudate -> dealing with hydrostatic P
Exudate -> dealing with inflammation
Transudate:
- Fluid shifts out b/c of low protein (increased hydrostatic P = leakage between endothelial cells)
- Causes: CHF, Liver failure, Kidney failure, SVC obstruction, PE
Exudate:
- Vessel dilates + stasis of fluid + proteins
- Endothelial spaces are larger thus fluid + protein leaks out of the vessel
- Causes: pleural effusion, pneumonia/infections, SLE, Cancer, PE, Pancreatic disease, Drug reactions
Test for transudate or exudate with Thoracentesis -> “Light’s criteria”:
- Presence of cholesterol (LDH) + protein = exudate
- No cholesterol/proteins = transudate
23
Q
What are the BMI categories?
A
< 18.5 = underweight 18.5-25 = on target 25-30 = overweight 30-40 = obesity > 40 = morbidly obese
24
Q
Name 9 conditions affecting the mouth?
A
- Leukoplakia = white patch on oral mucosa. Oral hairy leukoplakia is associated with HIV caused by EBV.
- Aphthous Ulcers = causes can be Celiac or Crohn’s Disease
- Candidiasis = risk factor is steroids (fluconazole for oropharyngeal thrush)
- Angular Stomatitis = denture problems, candidiasis, def of iron/vitamin B2
- Gingivitis = poor oral hygiene, pregnancy, drugs (phenytoin, cyclosporine, nifedipine), vitamin C deficiency, acute myeloid leukaemia, Vincent’s angina
- Microstomia = mouth is too small from thickening and tightening of perioral skin after burns or in epidermolysis bullosa
- Oral Pigmentation = Perutz-Jegher’s; Addison’s disease, drugs (antimalarials), malignant melanoma
- Teeth = blue line at gum-tooth margin is lead poisoning
- Tongue = Glossitis (B12/iron/folate deficiency), macroglossia (myxoedema, acromegaly, amyloid), tongue cancer (raised ulcer with firm edges. Smoking + alcohol are risk factors)
25
List causes of white intra-oral lesions in the mouth?
- Idiopathic keratosis
- Leukoplakia
- Lichen plants
- Poor dental hygiene
- Candidiasis
- Squamous papilloma
- Carcinoma
- Hairy oral leukoplakia
- Lupus erythematosus
- Smoking
- Aphthous stomatitis
- Secondary syphilis
26
List diagnostic and therapeutic indications for upper GI endoscopy
Diagnostic:
- Hematemesis/melena
- Dysphagia
- Dyspepsia
- Duodenal biopsy
- Persistent vomiting
- Iron deficiency (cancer)
Therapeutic:
- Treatment for bleeding lesions
- Variceal banding and sclerotherapy
- Argon plasma coagulation for suspected vascular abnormality
- Stent insertion, laser therapy
- Stricture dilatation, polyp resection
27
What are the diagnostic and therapeutic indications for colonoscopy?
Diagnostic:
- Rectal bleeding
- Iron-deficiency anemia (bleeding cancer)
- Persistent diarrhoea
- Positive fecal occult blood test
- Assessment or suspicion of IBD
- Colon cancer surveillance
Therapeutic:
- Hemostasis
- Bleeding Anglo dysplasia lesion
- Colonic stent deployment
- Volvulus decompression
- Pseudo-obstruction (polypectomy)
28
What are the causes of dysphagia?
Dysphagia is difficulty swallowing -> exclude malignancy!
Causes:
- Oral, pharyngeal, or esophageal?
- Mechanical or motility related?
Key questions to ask:
1. Was there difficulty swallowing solids + liquids from the start?
Yes = motility disorder (I.e. Achalasia - coordinated peristalsis lost, CNS, or pharyngeal causes)
No = solids then liquids suspect a stricture (benign or malignant)
2. Is it difficult to initiate a swallowing movement?
Yes = suspect bulbar palsy, especially if patient coughs on swallowing
3. Is swallowing painful (odynophagia)?
Yes = suspect ulceration (malignancy, esophagitis, viral infection, candida in immunocompromised, poor steroid inhaler technique) or spasm
4. Is the dysphagia intermittent or constant and getting worse?
Intermittent = suspect esophageal spasm
Constant and worsening = malignant stricture
5. Does the neck bulge or gurgle on drinking?
Yes = suspect a pharyngeal pouch
29
What are risk factors for esophageal cancer?
- Male
- GORD
- Tobacco
- Alcohol
- Barrett’s esophagus
- Tylosis (palmar hyperkeratosis)
- Plummer-Vinson syndrome (post-cricoid dysphagia, upper esophageal web + iron-deficiency)
30
What are the possible different appearances of vomit and what do they indicate?
Coffee grounds = upper GI bleed
Recognisable food = gastric stasis
Feculent = small bowel obstruction
31
What does the timing of the vomiting tell you about the condition?
Morning = pregnancy or increased ICP
1h post food = gastric stasis/gastroparesis (DM)
Vomiting that relieves pain = peptic ulcer
Preceded by loud gurgling = GI obstruction
32
Name an anti-emetic from each class
H1 - cyclizine
D2 - Metoclopramide
5HT3 - ONdansetron
Others - Hyoscine Hydrobromide
33
What are the symptoms of indigestion + peptic ulcer disease?
Epigastric pain often related to hunger, specific foods, or time of day, fullness after meals, heartburn (retrosternal pain), tender epigastrium
```
Beware of ALARM Symptoms:
Anemia (iron deficiency)
Loss of weight
Anorexia
Recent onset/progressive symptoms
Melena/hematemesis
Swallowing difficulty
```
34
How do you treat H. Pylori?
Give appropriate PPI and 2 antibiotic combination
I.e. Lnassoprazole 30mg/12h PO, clarithromycin 250mg/12h PO, and amoxicillin 1g/12h PO for 1 week
35
What are risk factors for gastric ulcers?
```
H. Pylori (~80%)
Smoking
NSAIDs
Reflux of duodenal contents
Delayed gastric emptying
Stress
```
36
List 6 differentials for dyspepsia
1. Non-ulcer dyspepsia
2. Oesophagitis/GORD
3. Duodenal/gastric ulcer
4. Gastric malignancy
5. Duodenitis
6. Gastritis
37
What are the causes of GORD?
- Lower esophageal sphincter hypotension
- Hiatus hernia
- Oesophageal dysmotility
- Obesity
- Gastric acid hypersecretion
- Delayed gastric emptying
- Smoking
- Alcohol
- Pregnancy
- Drugs (tricyclics, anticholinergics, nitrates)
- H. Pylori
38
What are the symptoms of GORD?
- Heartburn
- Belching
- Acid brash
- Waterbrash
- Odynophagia
- Nocturnal asthma
- Chronic cough
- Laryngitis
- Sinusitis
39
What’s the difference between a sliding hernia and rolling hiatus hernia?
Sliding (80%):
- Gastroesophageal junction slides up into the chest. Acid reflux often happens as the lower oesophageal sphincter becomes less competent in many cases
Rolling (20%):
- Gastroesophageal junction remains in the abdomen but a bulge of stomach herniated up into the chest alongside the esophagus. As the GE junction remains intact, GORD is less common
40
What are common causes of upper GI bleeds?
- Peptic ulcers
- Mallory-Weiss tear
- Oesophageal varies
- Gastritis/gastric erosions
- Drugs (NSAIDs, aspirin, steroids, trombolytics, anticoagulants)
- Esophagitis
- Duodenitis
- Malignancy
- No obvious cause
41
What are the pre-hepatic, intra-hepatic and post-hepatic causes of portal hypertension?
Pre-hepatic:
- Thrombosis (portal or splenic vein)
Intra-hepatic:
- Cirrhosis (80% in UK)
- Schistosomiasis (commonest worldwide)
- Sarcoid
- Myeloproliferative disease
- Congenital hepatic fibrosis
Post-Hepatic:
- Budd-Chiari syndrome
- R heart failure
- Constrictive pericarditis
- Veno-occlusive disease
42
What characteristics of diarrhoea indicate certain conditions?
Bloody diarrhoea: campylobacter, shigella/salmonella, E.coli, UC, Crohn’s Disease, Colorectal cancer, Colonic polyps, pseudomembranous colitis, ischemic colitis
Mucus: IBS, colorectal cancer, polyps
Frank pus: IBD, diverticulitis, fistula/abscess
Explosive: Cholera, Giardiasis, Yersinia, Rotavirus
Steatorrhoea: increased gas, offensive smell, floating/hard-to-flush stools (consider pancreatic insufficiency or biliary obstruction)
43
What are common causes of diarrhoea?
1. Gastroenteritis
2. Traveller’s diarrhea
3. C. Difficult
4. IBS
5. Colorectal cancer
6. Crohn’s, UC, Celiac
7. Thyrotoxicosis
8. Autonomic neuropathy
9. Addison’s Disease
10. Drugs (antibiotics, propranolol, cytotoxic, laxatives, PPI, NSAIDs, Digoxin, Alcohol)
44
Name an example of a constipation agent from each drug class
Bulking agents - Ispaghula husk, Methylcellulose
Stimulant Laxatives - Bisacodyl tablets, suppositories, senna, Docusate, Sodium picosulfate
Stool Softeners - Arachis oil enemas
Osmotic Laxatives - Lactulose, Macrogol/Movicol, Magnesium salts, Phosphate enemas (rapid evacuation)
If these don’t help...Prucalopride (5HT4 agonist)
45
What are the symptoms of UC?
- Episodic/chronic diarrhea
- Crampy abdominal discomfort
- Bowel frequency relates to severity
- Urgency/tenesmus = proctitis
- Systemic symptoms in attacks: fever, malaise, anorexia
46
What is UC and what are the signs?
UC is a relapsing and remitting inflammatory disorder of the colonic mucosa.
Signs:
- Clubbing
- Aphthous oral ulcers
- Erythema nodosum
- Nutritional deficits
47
What is the treatment for UC and Crohn’s?
Steroids
48
What is Crohn’s disease? It’s symptoms and signs?
A chronic inflammatory disease characterised by transmutation granulomatous inflammation affecting any part of the gut from mouth to anus.
Unlike UC there is unaffected bowel between areas of active disease (skip lesions)
Symptoms:
- Diarrhea
- Abdo pain
- Weight loss
- Fever, malaise, anorexia
Signs:
- Bowel ulceration
- Abdo tenderness/mass
- Perianal abscess/fistula/skin tags
- Anal stricture
- Clubbing, skin/joint/eye problems
49
What type of anemia is present in Celiac disease?
B12 or iron deficiency
50
List 4 nutritional disorders
Scurvy: Lack of vitamin C
- Signs = listlessness, anorexia, cachexia, gingivitis, bleeding from gums/nose/hair follicles/into joints/bladder, muscle pain/weakness, oedema
BeriBeri: Deficiency of B1 (thiamine)
- Heart failure with general oedema = wet Beriberi
- Neuropathy = dry Beriberi
Pellagra: Lack of nicotinic acid
- Classical triad: Diarrhoea, Dermatitis, Dementia
Xerophthalmia: Vitamin A Deficiency
- Cause of blindness in the tropics (Bitôt’s Spots)
51
What are causes of chronic pancreatitis?
```
Alcohol
Smoking
Autoimmune
familial,
cystic fibrosis
Hemochromatosis
Pancreatic duct obstruction (tumour/stones)
Congenital (pancreas divisum)
```
52
What is the drug treatment for chronic pancreatitis?
1. Analgesia (celiac-plexus block may give brief relief)
2. Lipase (I.e. Creon)
3. Fat-soluble vitamins
4. Insulin
53
Name risk factors for pancreatic carcinoma
- Smoking
- Alcohol
- Carcinogens
- Diabetes
- Chronic pancreatitis
- Obesity
- Genetics (95% have mutations in the KRAS2 gene)
54
How does pancreatic cancer present?
Tumours in the head of the pancreas = painless obstructive jaundice
Tumours in body + tail of pancreas = epigastric pain
Either may cause:
- Anorexia
- Weight loss
- Diabetes
- Acute pancreatitis
Mean survival < 6mo
55
What is jaundice and what causes it?
Yellowing of the skin, sclera, and mucosae from increased plasma bilirubin (visible at ≥60umol/L).
It’s classified by the site of the problem or by the type of circulating bilirubin
UNCONJUGATED HYPERBILIRUBINEMIA:
- Unconjugated bilirubin is water-insoluble, it doesn’t enter urine resulting in unconjugated hyperbilirubinemia
1. Overproduction = hemolysis (I.e. malaria, DIC), ineffective erythropoiesis
2. Impaired Hepatic Uptake = Drugs (paracetamol, rifampicin), ischemic hepatitis
3. Impaired Conjugation = Eponymous syndromes: Gilbert’s, Crigler-Najjar
4. Physiological Neonatal Jaundice = Caused by a combo of the above
CONJUGATED HYPERBILIRUBINEMIA:
- Conjugated bilirubin is water-soluble, it’s excreted in urine, making it dark. Less conjugated bilirubin enters the gut and the feces become pale. When severe, it can be associated with an intractable prurititus which is best treated by relief of the obstruction
1. Hepatocellular Dysfunction: Viruses (Hepatitis, CMV, EBV), Drugs, Alcohol, Cirrhosis, Liver mets/abscess, hemachromatosis, autoimmune hepatitis, septicaemia, leptospirosis, syphilis, a1-antitrypsin deficiency, Budd-Chiari, Wilson’s disease, R heart failure, toxins (carbon tetrachloride, fungi)
2. Impaired Hepatic Excretion (Cholestasis): Primary biliary cholangitis, primary sclerosis growth cholangitis, drugs, common bile duct gallstones, pancreatic cancer, compression of the bile duct, cholangiocarcinoma, Mirrizi’s syndrome (compression by a gallstone in the cystic duct on the common bile duct)
56
Name examples of drugs that cause jaundice
Antimalarials -> Hemolysis
Paracetamol OD, TB treatment, Statins, Sodium valproate -> Hepatitis
Flucloxacillin, Steroids, Sulfonylureas -> Cholestasis
57
What are the 5 broad causes of liver failure?
Infections: Viral hepatitis, yellow fever, leptospirosis
Drugs: paracetamol OD, halothane, isoniazid
Toxins
Vascular: Budd-Chiari syndrome, veno-occulusive disease
Others: Alcohol, fatty liver disease, primary biliary cholangitis, a1-antitrypsin deficiency
58
What is primary biliary cholangitis?
Interlobular bile ducts are damaged by chronic autoimmune granulomatous inflammation causing Cholestasis which may lead to fibrosis, cirrhosis, and portal HTN.
Patient is often asymptomatic and diagnosed after incidental finding of increased ALP (increased yGT, mildly increased AST + ALT). Lethargy, sleepiness, and pruritis may preced jaundice by years.
Signs:
- Jaundice
- Skin pigmentation
- Xanthelasma
- Xanthomata
- Hepatosplenomegaly
Treatment:
- Pruritis -> colestyramine; naltrexone + rifampicin may also help
- Diarrhoea -> codeine phosphate
- Osteoporosis prevention
- Vitamin prophylaxis -> Vitamin A, D, K
- High-dose ursodeoxycholic acid (UDCA) may improve survival + delay transplantation
59
What is primary sclerosis cholangitis?
Progressive Cholestasis with bile duct inflammation and strictures
Symptoms/Signs:
- Pruritis + fatigue
- Ascending cholangitis, cirrhosis, and hepatic failure if severe
- Associated with male sex and increased risk of colorectal malignancy
Also use Ursodeoxycholic Acid as it may improve LFT
60
What diseases are associated with autoimmune hepatitis?
1. Pernicious anemia
2. Ulcerative colitis
3. Glomerulonephritis
4. Autoimmune thyroiditis
5. Autoimmune hemolysis
6. Diabetes
61
Discuss the different LFTs
1. TESTS OF HEPATOCELLULAR INJURY OR CHOLESTASIS
Aminotransferases (AST, ALT):
- Released in the bloodstream after HEPATOCELLULAR injury
- ALT is more specific to hepatocellular injury (also in kidney + muscle)
- AST also expressed in the heart, skeletal muscle, and RBCs
```
Alkaline Phosphatase (ALP):
- May originate from liver, bone (so raised in growing child), or placenta
```
yGT:
- Present in liver, pancreas, renal tubules, and intestine - but not bone so it helps if a raised ALP is from bone (b/c yGT will be normal) or liver (yGT elevated)
- It’s not specific to alcohol damage in the liver
2. TESTS OF HEPATIC FUNCTION
- Serum albumin
- Serum bilirubin
- PT (INR)
HEPATOCELLULAR PREDOMINANT LIVER INJURY
- Increased AST + ALT
CHOLESTASIS/OBSTRUCTION PREDOMINANT LIVER INJURY
- ALP + yGT are elevated, AST + ALT mildly elevated
62
Discuss ALP, GGT, AST, ALT, Albumin, PT/INR
ALP:
- Low specificity for cholestasis, increased in:
1. Cholestasis
2. Preganncy
3. Bone growth (ie. Paget's disease, prostate + breast cancer - blastic cancers)
GGT:
- Cholestasis
- Alcohol
* * Not raised in bone disease! Used to distinguish if ALP is increased.
Check total bilirubin: TB - DB = IB (indirect bilirubin to determine the location/cause of increased LFTs)
- DB > 50% = inrahepatic or extra hepatic cause
Gilbert's Disease = low glucoronic transferase enzyme which converts IB to DB
AST: Enzyme made in liver. Low specificity for liver. Also raised in muscle breakdown
ALT: Enzyme made in liver. Increased specificity for liver.
Both AST + ALT are released when hepatocytes die
Albumin: Low in chronic liver disease. 1/2 life = 20 days
PT/INR: Most sensitive liver function test
Factor 2, 7, 9, 10, 1, 5 = related to Vitamin K/PT
- Warfarin or hemophilia will increase PT
ALT, AST, ALP, GGT = distinguish between hepatocellular damage and cholestasis
Albumin, Bilirubin, PT = assess liver synthetic function
63
What are the steps to determine what the damage in the liver is coming from?
1. Is ALT raised 10x or less? (hepatocyte damage)
2. Is AST raised 3x or less? (cholestasis)
- If both are raised = mixed picture
3. Check GGT if AST is raised 3x b/c its more specific for cholestasis:
- if raised = cholestasis
- if normal = bone growth/pregnancy
4. Normal ALT + AST? Check bilirubin levels = pre-hepatic cause of jaundice
- Gilbert's Syndrome
- Hemolysis
Normal urine + normal stool = pre-hepatic cause
Dark urine + normal stool = hepatic cause
Dark urine + pale stool = post-hepatic cause (i.e. obstruction)
64
What are causes of unconjugated hyperbilirubinemia?
1. Hemolysis
2. Impaired hepatic uptake (drugs, CHF)
3. Impaired conjugation (Gilbert's syndrome)
65
What are causes of conjugated hyperbilirubinemia?
1. Hepatocellular injury
| 2. Cholestasis
66
What does the ALT/AST ratio tell you?
ALT > AST = chronic liver disease
| AST > ALT (2:1) = cirrhosis/acute alcoholic hepatitis
67
What are causes of acute hepatocellular injury?
1. Paracetamol OD
2. Infection (Hepatitis A + B)
3. Liver ischemia
68
What are causes of chronic hepatocellular injury?
1. Alcoholic fatty liver disease
2. Non-alcoholic fatty liver disease
3. Chronic infection (Hepatitis B + C)
4. Primary biliary cirrhosis
5. A1 antitrypsin deficiency
6. Wilson's disease
7. Hemachromatosis
69
What tests are included in a liver screen?
1. LFTs
2. Coagulation screen
3. Hepatitis serology (ABC)
4. EBV
5. CMV
6. Anti-mitochondrial antibody (AMA)
7. Anti-smooth muscle antibody (ASMA)
8. Anti-liver/kidney microsomal antibody (anti-LKM)
9. Anti-nuclear antibody (ANA)
10. p-ANCA
11. Immunoglobulins - IgM/IgG
12. A1-antitrypsin
13. Serum copper (for Wilson's Disease)
14. Ceruloplasmin (for Wilson's Disease)
15. Ferritin (for hemochromatosis)
70
What bacteria causes stool to float?
Giardia Lamblia
- fat malabsorption thus greasy stool floats in H2O
- Resistant to chlorination -> risk of transfer in swimming pools
71
When is ulcerative colitis severe?
1. Blood in stool
2. Stools > 7x/day
3. > 37.8ºC temperature, HR > 90bpm, anemia, or ESR > 30mm/hr
72
What is the most common organism found on ascetic fluid culture in spontaneous bacterial peritonitis?
E. coli
73
What is the triad of symptoms/signs in mesenteric ischemia?
1. CVD
2. High lactate
3. Soft + tender abdomen
74
What tumours can cause Cushingoid features? Why?
Carcinoid tumours
- Secrete ACTH
75
What condition has a 3-5% annual incidence of hepatocellular carcinoma?
Liver cirrhosis 2º to hepatitis C
76
What antibiotics have an increased risk of C. Diff infection and resulting diarrhea?
Clindamycin + cephalosporins
77
What is the treatment for patients with ascites ([protein] ≤ 15g/l)?
Oral ciprofloxacin or norfloxacin to protect against spontaneous bacterial peritonitis
78
What is the typical presentation of duodenal ulcers?
Pain when hungry + relieved by eating
79
What is the treatment of acute severe alcoholic hepatitis?
Corticosteroids
80
What should be prescribed first-line to those with suspected hepatic encephalopathy?
Lactulose
