GI Flashcards
(150 cards)
1
Q
mgmt rectovaginal fistual
A
IBD related:
- asx: observe
- mild: cipro/flagyl
- mod to severe: Infliximab first! (any anti-tnf)…only if persistent dz then surgery
Non-IBD: surgery
20-30% crohns pt will develop anorectal fistula
2
Q
Mgmt post corrosive ingestion
A
- CXR and abdominal xray will identify perforation
- if no perf on xrays, early EGD w/in first 24 hours to assess and grade esophageal involvement
acute mgmt does not have role for barium swallow (can ID strictures later)
No NG insertion b/c can induce perforation
3
Q
common complications of Roux-en-y
A
- Stomal Stenosis (20%): n/v/abdominal pain/early satiety. Dx EGD. Tx endoscopic balloon dilation
- Cholelithiasis (40%): give prophy URSDA for up to 6 mo post op
- Dumping syndrome (50%): abdominal pain, n, hypotension, reflex tachycardia. Avoid by replacing simple carbs for complex carbs
- SIBO: abdominal distention, flatulence, diarrhea. macrocytic anemia. fat malabsorption (D, A, B1, b12).
4
Q
SIBO
A
Cause: strictures/surgery (anatomical) or motility (DM, scleroderma)
Dx: jejunal aspirate or positive hydrogen breath test
Tx: abx (rifaximin, augmentin), avoid opiates, increase fat and reduce carbs in diet, promotility agents
5
Q
Anemia in celiac disease
A
microcytic from iron deficiency
6
Q
T/F: All patients with UGI found to have ulcer should be admitted
A
False, if clean base ulcer and stable its low risk and give regular diet and DC on once-daily PPI
high risk features = active bleeding, visible vessel, adherent clot
7
Q
Tx of recurrent c dif
A
First recurrence: Vanc PO in a prolonged taper
Multiple recurrence: Vanc PO followed by rifaximin
can use fidaxomicin instead of vanc. recurrence due to spores, not resistance to meds
8
Q
fatigue and pruritis with cholestatic labs in a middle age female
A
Primary biliary cholangitis
9
Q
Tx for PBC
A
URSDA (delays progression)
Risk of osteoporosis/osteomalacia so give Ca and Vit D supp
10
Q
Anti-HBs ( Hepatits B surface antibody)
A
If + Hepatitis B core antibody, IgG (anti-HBc): Resolved Previous Infection
If - anti-HBc: immunity from previous vaccination
11
Q
HBsAg (surface antigen)
A
if + anti-HBc, IgM (core antibody IgM): acute HBV
if + anti-HBc, IgG: chronic inactive carrier state
Anti-HBs is negative in acute and chronic infection
12
Q
how to tell acute/chronic HBV versus resolved
A
HBsAG: positive in acute and chronic infections
Anti-HBs: positive in resolved previous infection (and those with immunity from prior vaccine)
These are not positive together ever
13
Q
Hep B serologies
A
HBcAb: Exposure
HBsAg: Infection
HBsAb (Anti-HBs): Immunity
14
Q
T/F: Lipase levels remain elevated in chronic pancreatitis
A
False, usually normal. Presents with abdominal pain and pancreatic insufficiency (steatorrhea, malabsorption, diabetes)
15
Q
Failure of initial standard triple therapy for H Pylori
A
Occurs in 20%
Step 1: Eradication testing (urea breath test, fecal Ag test or repeat EGD)
- if positive: quadruple therapy or different triple therapy
- note: PPIs reduce sensitivity of these tests (so if + on PPI, highly likely positive)
16
Q
Treatment reg for H Pylori
A
Triple Therapy:
PPI + Clarithromycin + Amoxicillin
or
(alt)PPI + Clarithromycin + Metronidazole
Quadruple Therapy: PPI + Bismuth + Metronidazole + Tetracycline
all regimens 10-14 days
17
Q
T/F: In absence of alarm features for GERD, EGD is not indicated prior to failure of 4-8 weeks of bid PPI therapy
A
TRUE. ALarm sxs i.e. wt loss, GI bleed, dysphagia, odynophagia.
18
Q
Presentation and mgmt of the most common cause of esophagitis in AIDs patient
A
Candida
- mild to mod odynophagia (pain mild compared to CMV, HSV)
- oral thrush (not always present)
- dysphagia
Tx with empiric trial of oral fluconazole (Nystatin doesn’t work in HIV patients) aka don’t need EGD if high clinical suspicion. unless red flag sxs
19
Q
Peritoneal dialysis associated peritonitis
A
wbc>100 or neutrophil >50%. may not have fever or leukocytosis. Tx with intraperitoneal vanc and ceftriaxone/cefepime
20
Q
Liver disease + neuropsychiatric dz in young patient
A
Wilson dz. All get slit lamp. Dx by increased serum/urine Copper and low ceruloplasmin. Tx with pencillamine or trientine to prevent permanent sequelae.
21
Q
Most common cause of acute liver failure in US
A
Acetaminophen toxicity
22
Q
T/F: Cholecystectomy should be performed after recovery from gallstone pancreatitis
A
True!! Reduce risk of recurrence. do it BEFORE discharge
23
Q
Features suggestive of celiac disease but negative serology
A
Measure serum IgA levels, high prevalence of deficiency in celiac patients (only test if serology neg).
Patient with + serology or highly suggestive need endoscopy with biopsy (“small bowel enteroscopy”) to confirm dx PRIOR to starting gluten-free diet (reduces biopsy sensitivity). A cutaneous bx showing dermatitis herpetiformis is also diagnostic.
24
Q
Differentiate eosinophilic esophgitis from pill-induced esophagitis
A
EE: Dysphagia (difficulty swallowing) and chest pain and heartburn. Usually in young man with history of atopy (asthma, allergies) i.e. Roshee
PIE: Odynophagia (painful)…and retrosternal CP
PIE is PAINFUL IF EATING
Neither need EGD routinely.
For EE: dietary modifications, swallowed fluticasone/budesonide (topical glucocorticoid). Eval includes 8 week trial of a PPI
for PIE: DC offending agent and supportive, will self-resolve
25
Barium esophagram is used for:
diagnosing anatomical abnormalities and neuromuscular disorders (achalasia)
26
EGD findings in EE
longitudinal furrows, multiple esophageal (concentric) rings, white specks and mucosal friability
27
first step in any patient with impaired gastric motility
EGD to exclude gastric outlet obstruction from mechanical/mucosal etiology. even if highly suspicious for gastroparesis
28
marked colonic dilation without mechanical obstruction (no TP) in a hospitalized/institutionalized man >60
Ogilvie syndrome: acute colonic pseudo-obstruction.
Treat conservatively, serial abdominal exam and xray to eval perforamtion. NG/rectal tube decompression. Consider Neostigmine for those who fail conservative management, though theres many CI
29
Chronic diarrhea in middle aged female with normal appearing mucosa
Likely microscopic colitis (r/o celiac). biopsy shows lymphocytic infiltration. Remove triggers (nsaids), try antidiarrheal agents (loperamide, bismuth) and can use oral budesonide . No increased risk for malignancy
30
Chest pain and respiratory distress after forceful vomiting
Booerhaave syndrome.
Clues:
- rapid development of pleural effusion (usually left-sided)
- subcutaenous emphysema (mediastinal air/retrocardiac air shadow)
31
UC patient with elevated alk phos
PSC
32
Antibodies positive in Autoimmune Hepatitis (young/middle aged females with range from asx LFT elevation to acute liver failure)
Anti-smooth muscle
Anti-liver/kidney microsomal antibody (LKM-1)
ANA
false positive HCV AB
33
Diagnosing hepatopulmonary syndrome
Need contrast echo (bubble study), will show intrapulmonary vascular dilations (IVPD). this causes R->L shunting and manifests in platypnea (dyspnea when sitting upright relieved supine) and orthodeoxia (opposite of orthopnia)
no good tx other than liver transplant
34
If you suspect spontaneous esophageal rupture (Booerhave):
Contrast esophogram is the study of choice. A CXR may show mediastinal or free peritoneal air, f/u with the contrast esophgram or CT.
Pleural fluid analysis would show very high amylase.
35
Interpret SAAG
SAAG>1.1 = portal hypertension from cirrhosis or HF
Look at ascitic fluid protein
<2.5 = cirrhosis
>2.5 = HF, budd-chiari
SAAG <1.1 "are you KIDding me?"
Ascitic protein
<2.5 = nephrotic syndrome
>2.5 = malignancy, TB
36
Acetaminophen overdose
acute liver failure with LFTs in thousandssss
37
middle aged female with fatigue, pruritis, elevated alk phos
Primary biliary cholangitis
38
T/F: IDA is typically seen in celiac dz
true
39
Pseudoachalasia
older patient with achalasia sxs. Screen for malignancy (obstructive) with EUS or CT
40
Tx for achalasia
- Pneumatic dilation or surgical myotomy
| - if they're old and would not be a good candidate for procedure, botox injection
41
intermittent dysphagia to solids/liquids (especially cold liquids)
DES. Barium swallow with corkscrew appearance
42
Tx for DES
CCB
43
Young patient with intermittent solid food dysphagia
Schatzki ring (intermittently catches on it)
vs peptic stricture in older patient
44
esophageal cancer
Upper 2/3: Squamous cell (smoking, drinking)
Lower 1/3: adenocarcinoma (reflux, barretts)
45
IDA + dysphagia in elderly women
plummer vinson syndrome (web in upper esophagus)
46
EoE EGD
stacked circular rings,trachEEEEEEalization, friability.
47
Food impaction and dysphagia in young adult with hx of asthma/eczema/allergic rhinitis
Eosinophilic esophagitis
Dx with EGD w/biopsy
Tx with PPI or swallowed fluticasone/budesonide
48
common meds for pill induced esophagitis
doxycycline, nsaids, KCl, iron, alendronate
49
Initial approach to dyspepsia
<60: H pylori test and treat. If + H pylori, tx. Persistent sxs then 8 weeks PPI. + sx still low-dose TCA.
>60: EGD
50
Meds to stop before H pylori testing
Stop PPI for 2 weeks
| Stop Abx for 4 weeks
51
H pylori tx
```
Triple Therapy: OCLAM
Omeprazole + CLarithromycin +
Amoxicillin.
**If pencillin allergy -->
Metronidazole instead of amox
```
If they hav e received macrolide (i..e had Zpak a few months ago), then quadruple therapy OBMT:
Omprezole + Bismuth + Metronidazole + Tetracycline
52
T/F: Low cancer risk in duodenal ulcer
True, don't need post-surveillance really
53
Zollinger-Ellison syndrome
diarrhea, erosive esophagitis, DISTAL ulcers, high gastrin level. Secretin stim test will have same or higher gastrin. can do octreotide scan to localize the gastrinoma. surgical resection, high dose PPI
54
Presentation and dx of oropharyngeal dysphagia
Choking/coughing in a patient with neuro or muscular disorder i.e. stroke patient. Includes Zenker diverticulum fyi.
Dx: Modified barium swallow/videofluoroscopy
55
T/F: Celiac patients are at risk for intestinal lymphoma
true, dietary compliance helps reduce risk
56
SIBO
Dx: carb breath testing (lactulose, glucose) or jejunal aspirate/culture
Tx: - abx (rifaximin, augmentin)
-high fat, low carb diet
57
T/F: Young patient with dyspepsia, no red flag sxs and normal labs should be treated with PPI trial
False, H pylori test and treat first. If negative then PPI trial
58
screening in IBD patient with PSC
annual colonoscopy, inc risk colorectal ca
59
liver nodule mgmt
<1cm: US f/u 3 mo
>1cm: Liver MRI (or multiphase CT)
percutaneous biopsy not usually recommended
60
colon ca screening in IBD patients
8-10 years after dx, then q 1-3 years
61
colon ca screening in patient with first degree relative +
age 40 or 10 years prior to age of dx, whichever is earlier
62
EGD in Z-E syndrome
thickened gastric folds, multiple stomach ulcers, ulcers distal to the duodenum (i.e. jejunum). Check gastrin level, then pH. associated with MEN-1 syndrome...usually responds to PPI
63
Mgmt celiac dz
Gluten-free diet
Obtain DEXA @ dx, increased risk osteopenia/osteoporosis
Pneumococcal vaccination (at risk for hyposplenism)
Vit def: iron, calcium, vit d, folic acid
no need for colonoscopy
64
Medication for dermatitis herpetiformis
dapsone + gluten free diet
65
T/F: always think about c diff when IBD patient has a flare up
true
66
UC patient with elevated alk phos or elevated LFTs
PSC
67
screening in PSC
colonoscopy @ dx and EVERY SINGLE YEAR BRO
68
SIBO is associated with
Dysmotility: DM or Systemic Sclerosis
Terminal ileum resection
Pernicious anemia
will see high folate and low b12
Dx: lactulose/glucose/ hydrogen breath test
Tx: antibiotics (Rifaximin, augmentin)
69
Amount of terminal ileum resection for malabsorption
<100cm TI resected: bile acid diarrhea. tx with cholestyramine.
>100cm: fatty acid diarrhea. don''t use cholestyramine (liver cant keep up when this much is lost and so youre already bile acid deficient).
70
When you see a patient for f/u of diverticulitis...
check to see if they are up to date on colonoscopy. if not they should get one in about 8 weeks (when no more inflam)
71
tx of diverticulitis
Mild: PO abx and CLD @ home for 7-10 days, usually cipro flagyl
If can't do oral intake, admit for IV ceftriaxone and fluids
72
T/F: Patient with suspected diverticulitis should get colonoscopy now
False, risk of perforation from air insufflation. They do need to get a f/u colonoscopy once resolved if not up to date
73
isolated right-sided ischemic colitis
suggestive of SMA thrombus, will need CTa
74
sigmoid volvulus, which patient
elderly in institution or neuropsych dz/dementia
75
classic triad for chronic pancreatitis
Pancreatic calcification
Diabetes
Steatorrhea
76
double duct sign
Both pancreatic duct and common bile duct dilated: consider pancreatic head mass
77
T/F: Patient with symptomatic cholelithiasis should have elective cholecystectomy
TRUE
78
gallstone associated with hemolysis
pigmented stone
79
acalculous cholecystitis
sick ICU patient, needs chole tube
80
Which patients with HBV need US q6 months?
those for HCC screening:
- cirrhosis
- asian men>40 and asian women>50
- black patients>20
81
tx for autoimmune hepatitis
glucocorticoids + azothioprine
82
treatment for hepatorenal
Albumin (volume mgmt)
Octreotide (inc SVR, MAP)
Midodrine (inc SVR)
83
tx for wilson's
penicillamine (chelates the copper) with pyridoxine supplementation
84
Dermatitis, Diarrhea, Dementia
Pellagra = Niacin (vit b3) deficiency
85
Thiamine def
Wet beri beri: HF
Dry: neuropathy
Wernicke and Korsakoff
86
T/F: Hydroxyurea is helpful to decrease frequency of pain crisis and acute chest syndrome but not useful in acute sick cell mgmt
true. need blood or exchange transfusions for acute chest syndrome
87
most common side effect external beam radiation for prostate cancer
sexual dysfunction
88
stroke mgmt in sickle cell patient
Acute ischemic stroke: exchange transfusion
Recurrent stroke prophylaxis: simle transfusion
note: monitor for iron overload in patients getting chronic transfusions, they need periodic chelation therapy to prevent cirrhosis
89
Tx for Essential thrombocythemia
low risk for clot: aspirin
higher risk: hydroxyurea
20% will develop acquired vWB dz: cytoreduction
90
Philadelphia chromosome
t9:22, associated with CML
Philadelphia CreaMcheese Lite @ 9:22am
91
JAK2 mutation
JACK mutated 2 JAK because he didn't wear PPE
Polycythemia Vera
Primary Myelofibrosis (MF)
Essential Thrombocythemia
92
associations with polycythemia vera
- low epo, high rbc and hgb (its EPO independent due to JAK2 mutation)
- pruritis in hot shower
- check for PV In patient with PVT or budd-chiari (hepatic vein thrombus)
93
low hgb
high wbc
high plt
abdominal pain/splenomegaly
usually CML
94
direct coombs (antiglobulin) test
to evaluate for autoimmune hemolytic anemia (differentiate from hereditary spherocytosis which would be neg)
95
tx for acute intermittent porphyria
(abdominal pain, autonomic dysfunction i.e. ileus, DARK/REDDISH urine, peripheral neuropathy (painful flaccid paralysis), neuropsych
glucose loading and IV hemin
96
vitamin K related clotted factors
2, 7, 9, 10
Will see mainly PT prolongation with mild PTT in severe vit k def
97
severe anemia in sickle cell
1. Splenic sequestration (low hgb, inc reticulocytosis, rapidly enlarging spleen)
Tx: splenectomy
2. Aplastic crisis
(markedly low reticulocytosis, usually from infection)
Tx: supportive (including transfusions, oxygenation, hydration)
3. Hyperhemolytic crisis
(sudden worsening of anemia, but increased reticulocytosis. usually after acute sickling events)
98
extra testing if suspecting ITP other than CBC and peripheral smear
r/o HIV, HCV (if risk factors)
if >60, bone marrow aspiration recommended to r/u MDS
if plt <30k, high dose oral steroids (1 mg/kg) even if asx
99
Leukocytosis
Lack of symptoms
Lymphadenopathy
Hepatosplenomegaly
CLL (most common leukemia)
Dx: peripheral blood smear and flow cytometry of the peripheral blood
don't really need imaging or LN/bone marrow bx
100
T/F: Primary polycythemia is EPO independent
True, usually PV from JAK 2 mutation (so serum EPO would be low).
Secondary polycythemia from hypoxia = increased EPO
101
testing order for suspected achalasia
1. barium swallow (preferred screening test), will show bird beak narrowing
2. Esophgeal manometry (incomplete LES relaxation, absence of peristalsis)
3. EGD: r/o adenocarcinoma (pseudoachalasia) at GE j(x)
102
tx for achalasia
Pneumatic dilation (endoscopic) and laparoscopic surgical myotomy
103
when could you use ambulatory esophageal pH monitoring or imedeance pH testing
GERD sxs refractory to empiric PPI therapy. can get sx and reflux correlation
104
tx for infectious esophagitis
Candida: Fluconazole or Itraconazole
CMV: Ganciclovir or foscarnet
HSV: Acyclovir, famciclovir or valacyclovir
*EE: swallowed fluticasone or budesonide
105
T/F: F/u testing to document H pylori eradication should be performed at least 4 weeks after completion of therapy in any patient with positive H pylori
TRUE. don't use serology i.e. elisa for IgG b/c this stays positive for a bit
106
Tx for gastroparesis
- small low fat meals 4-5x/day
- acute gastroparesis: IV erythromycin
- chronic: Metoclopramide
**Dystonia and parkinsonian-like tardive dyskinesia can happen from metoclopramide, must be stopped
107
T/F: SIBO occurs most commonly with Roux en y
true
108
crampy abdominal pain and loose stools 15 minutes after eating, then lightheadedness/tachycardia within 90 minutes. patient had a roux en y
Dumping syndrome (tx with small freq feedings and low carb meals)
109
loose stools and malabsorption following gastric bypass surgery
Blind loop syndrome (SIBO)
| tx with abx and nutritional supp
110
When do you get CT in pancreatitis patient?
NOt always. only if it is severe, lasts longer than 48 hours or complications are suspected
111
When do you do ERCP in gallstone pancreatitis?
if suspected ascending cholangitis. otherwise MRCP for dx (can see the stone size, it might pass on its own)
112
autoimmune pancreatitis
-huge edematous pancreas (sausage-shaped)
-painless obstructive jaundice usually
Type 1: Increased IgG4. older men. dz like Sjogren, PSC, interstitial nephritis
Type 2: normal IgG, its IBD and chronic pancreatitis related
Tx steroids
113
Yersinia enterocolitica colitis can mimic:
appendicitis and Crohns
114
Giardia lamblia and Entamoeba histolytica is diarrhea caused by parasites and requires:
metronidazole
115
chronic diarrhea workup
- colonoscopy. view terminal ileum for crohns and take random biopsies of colonic mucosa to assess for microscopic colitis
- if nondx, 48-72 hour stool collection with analysis of fat content. >14g/day = steatorrhea (eval celiac, SIBO, pancreatic insuff)
116
how do you determine osmotic vs secretory diarrhea
Stool osmotic gap.
290 - (2x (Na +K))
```
>100 = osmotic (concentrated). usually lactase def. Its associated with EATING, improves with fasting and not nocturnal
<50 = secretory (dilute). Large volume, NOCTURNAL BM, unchanged by fasting. things like VIPoma, gastrinoma (Z-E syndrome), carcinoid
```
117
Diarrhea in female 45-60, unrelated to food (nocturnal sxs), normal colonoscopy
Likely microscopic colitis. Stop nsaids/PPI and bx
118
nocturnal diarrhea and hx of SSc or DM (aka dysmotility)
SIBO. can do hydrogen breath test or empiric abx.
can also be seen in terminal ileum resection. may see combo of elevated folate and def of b12
119
recurrent Giardia infections
CVID or selective IgA deficiency. check immunoglobulins. may have coexisting pulmonary disease
120
diarrhea in AIDS
cryptosporidium
121
Infection with _____ should be considered in patients with diarrhea after exposure to young children or contaminated water (lakes/streams)
Giardia lamblia
122
tropical sprue
travel to india or puerto rico
malabsorption, folate or b12 def, steatorrhea
Dx small bowel biopsy
Tx: Doxy and folic acid for 6 months
123
prolonged travelers diarrhea after camping/day care
Giardiasis. TX with metronidazole.
124
Vasculitis + HBV and neg HCV
PAN
125
Treatment of Hep B
Main drugs (pick one):
- Entecavir
- Tenofivir
* PEG Interferon is an option with limitations (ok if pregnant, CI if cirrhosis, major depression, autoimmune disorders, severe cytopenias)
* If HIV also: Emtricabine-Tenofivir
* Don't treat in immune tolerant phase (AKA normal LFTs despite high DNA level)
126
How do you differentiate phases of Hep B?
Immune tolerant: normal ALT despite +HBeAg and high HBV DNA. *No tx indicated
Inactive carrier stage: +HBeAg and HBV DNA <20,000. *No tx indicated
Chronic Phases:
Immune active: HBeAg +, elevated ALT and HBV DNA >10,000
or
Immune escape: HBeAg -, elevated ALT and HBV DNA>10,000
(Escape is without the E)
Reactivation phase: HBeAg negative, ALT up, HBV up
127
Chronic SBP prophylaxis
Use fluoroquinolone (cipro) in:
- any hx of SBP
- high risk: ascitic protein < 1.5 + any of Na <130, bili >3, Cr >1.2, BUN>25
- while hospitalized if ascitic protein <1
- for 7 days if active bleeding (variceal)
128
tx of cirrhotic ascites not responding to low sodium diet
Spironolactone +/- lasix
129
T/F: Stop ACE-i, ARB and NSAIDs in patient with ascites (cirrhotic)
true
130
how often do cirrhotics get US
every 6 months to screen for HCC
131
how is vertical transmission of HBV prevention?
Pregnant woman with HBV DNA >200,000 @ 24-28 weeks gestation: Tx with tenofovir, telbivudine or lamivudine
All babies born to chronic HBV mothers: active HBV vaccine + passive (HBV Immune globulin) immunization
132
gastroparesis testing
acute sxs: EGD to r/o obstruction
chronic or neg EGD: nuc med gastric emptying scan
*Glucose <275 needed if DM (impairs gastric emptying)
133
Chronic pancreatitis dx
most common cause is EtOH
young patient: consider sweat cl test for CF
old patient: eval for cancer and autoimmune pancreatitis
134
T/F: Stop nsaids and PPIs in microscopic colitis patient
true
135
T/F: Get DEXA and watch for bone health/osteoporosis/osteodystrophy in cirrhotics and celiacs
true
136
Back pain in IBD patient
think of Ankylosing Spondylitis or Sacroiliitis
137
T/F: Angiography or CTa plays role for acute mesenteric ischemia but NOT for suspected ischemic colitis
true
138
AMI vs Ischemic colitis
AMI: Usually from afib/ambolus. Acute severe pain. Need angiography. Likely need an intervention or surgery/embolectomy.
Ischemic colitis: usually mild to moderate, painless hematochezia will bring patients in. Low flow states or vasoconstricting meds. Don't need angiography, dx with colonoscopy. Tx with bowel rest and observation, usually no intervention.
139
T/F: All patients with Hep B need US q 6months to screen for HCC
No, but high risk people do:
- black >20 years old
- asian men >40, women >50
- cirrhotics
- have family hx
- ALT elevated, HBV DNA >10,000
*For HCV, just cirrhotics get US q 6 mo
140
T/F: Test for HBV before initiating tx for HCV
true, hep b can often be reactivating during HCV antiviral therapy
141
Tx of HCV
Sofosbuvir and ledipasvir (or other vir drugs).
142
T/F: Prednisolone can be useful in patients with alcoholic hepatitis
true
stop if bili doesn't improve by day 10
Dont use if GI bleed, infection, kidney dz or pancreatitis
143
best screening test for hemochromatosis
fasting serum transferrin saturation
| ferritin can be elevated in advanced liver disease but can have normal iron sat
144
surveillance in hemochromatosis patient
US q6 mo for HCC screen
First degree relatives should undergo screening for disease
145
HELLP vs Acute Fatty Liver of Pregnancy
HELLP: More MAHA
AFLP: More encephalopathy and coagulation abnormalities
both have features of preeclampsia, hemolysis, low platelets, normal bili possible and both require prompt delivery
146
RUQ pain
Pelvic adnexal tenderness
Leukocytosis
Cervical smear shows gonococci
Fitz-hugh-curtis syndrome (gonococcal or. chlamydial perihepatitis)
147
biliary colic/cholecystitis + air in biliary tree. may have small bowel obstruction
cholecystenteric fistula (gallstone ileus)
148
RUQ pain, diarrhea and obstructive jaundice in AIDS
Cryptosporidium induced AIDS cholangiopathy
149
painless hematochezia in a young patient and normal EGD/colonoscopy
meckels diverticulum
150
LGI bleed + mucocutaneous telangiectasias
Hereditary hemorrhagic telangietasia
