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GI Flashcards

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1
Q

How do you treat autoimmune pancreatitis with biliary obstruction?

A

not with stent. do steroids.

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2
Q

What antibody do PSC, PBC, and autoimmune hepatitis share?

A

anti-smooth muscle

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3
Q

Which antibody is positive in PBC? anti-smooth muscle or anti-mitochondrial antibody?

A

anti-mitochondrial antibody

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4
Q

What condition is associated with alk phos elevated to 1.5 x ULN + positive anti-mitochondrial antibody?

A

PBC

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5
Q

What is the clinical presentation of PBC?

A

usually asymptomatic but may have pruritis and fatigue, elevated alk phos, then elevated anti-mitochondrial antibody

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6
Q

what is the treatment for PBC?

A

ursodeoxycholic acid

*hydrophilic bile salt, which stabilizes hepatocyte membranes against toxic bile salts and inhibits apoptosis and fibrosis.

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7
Q

Why is the reason to avoid ACE/ARBs in certain people with cirrhosis?

A

can worsen ascites if present

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8
Q

Why avoid NSAIDs in cirrhosis?

A

can worsen azotemia and Na retention

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9
Q

what are the 4 phases of Chronic Hep C?

A

immune tolerant/active/control and reactivation

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10
Q

Of the 4 phases of chronic Hep B, which involves seroconversion of HBsAg from neg to pos and rising viral DNA levels?
1) Immune tolerant
2) Immune active
3) Immune control
4) Reactivation

A

Reactivation

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11
Q

Of the 4 phases of chronic Hep B, which involves vertical transmission, +HBeAg without e Ab, DVA >1 million, and normal ALT?
1) Immune tolerant
2) Immune active
3) Immune control
4) Reactivation

A

Immune tolerant (hep c is going crazy but liver is okay)

*no treatment needed in this phase

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12
Q

Of the 4 phases of chronic Hep B, which has moderate levels of viral DNA with high ALT?
1) Immune tolerant
2) Immune active
3) Immune control
4) Reactivation

A

Immune active

*treatment is needed here because liver is actually being damaged

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13
Q

What is treatment for alcoholic hepatitis with MELD >20?

A

NAC + (prednisolone at least 4-7 days)

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14
Q

What MELD score in alcoholic hepatitis could benefit from steroids?

A

> 20

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15
Q

What would you do in someone you think has celiac but also has IgA deficiency?

A

can use IgG serologies for deaminated gliadin peptide or ttg

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16
Q

what is postexposure prophylaxis for HAV?

A

within two weeks if possible

if nonimmune –> HAV vaccine

if nonimmune and >40 yo (could consider), or high risk complication (immunosuppression or chronic liver disease) –> HAV vaccine + immune globulin

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17
Q

what screenings are needed for women with IBD on immunosuppression?

A

annual Pap and yearly skin exam

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18
Q

What screening is done for PSC?

A

at diagnosis, colonoscopy because 85% chance associated with IBD.

Annual or biannual MRCP and CA 19-9 for cholangio screening.

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19
Q

why might a patient with autoimmune hepatitis need liver biopsy before stopping therapy?

A

ensure no ongoing inflammation, high risk relapse.

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20
Q

what does an iron profile look like in hereditary hemochromatosis?

A

increased ferritin and transferrin saturation

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21
Q

What diseases does porphyria cutanea tarda have strong association?

A

Hepatitis C and iron overload

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22
Q

is CTA or angiography more sensitive in identifying a GI bleed?

A

CTA, can find at lower rate of bleeding. angiography associated with higher rate AKI.

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23
Q

What should you think of when you see gastric fundal varices?

A

more common in venous thrombosis so will need CT w contrast.

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24
Q

How would you treat gastric fundal varices?

A

can’t band (only esophageal or gastric cardia)! depending on vessel patency could do splenectomy, TIPS. or transvenous obliteration.

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25
what are treatment options for HCC?
-surgical resection -if pHTN or decompensated cirrhosis --> liver transplant -if no chance of surgery or transplant --> cytoreductive therapy
26
why not give lactulose in acute liver failure (no chronic component?)
not well studied and may be harmful. should use other methods to lower ICP.
27
what is done for the patient with low risk on Fib-4 score (<1.3)?
lifestyle modification
28
what is done for the patient with moderate risk on Fib-4 score (>1.3)?
transient elastography and if indeterminate or high risk stiffness refer to hepatology
29
what components does Fib-4 include?
age, AST, ALT, plt count
30
what disease should you think about in female in early stages pregnancy with pruritis? what are the risks of this condition?
intrahepatic cholestasis of pregnancy. risk of premature labor and fetal death.
31
treatment for intrahepatic cholestasis of pregnancy
ursodeoxycholic acid
32
what should be discontinued in cirrhosis with refractory ascites or HRS?
beta blocker
33
How do you calculate the fecal osmotic gap?
290 - 2(Na + K). should also get stool osmoles. >100 gap suggests osmotic diarrhea (fructose, sorbitol, lactose) and should try low FODMAP diet or lactose free
34
what kind of diarrhea does bile salt excess cause? tx?
low osmotic gap i.e. secretory diarrhea. treat with cholestyramine.
35
if you get results back for patient with chronic diarrhea and fecal osmotic gap is 150 what does this suggest?
osmotic diarrhea
36
if you have a patient with chronic diarrhea and fecal osmotic gap is 40 what does this suggest?
secretory diarrhea
37
what is the fecal osmotic gap for a person with stool measurements of Na - 130 and K - 12?
290 - 2(130 + 12) = 290 - 284 = 6
38
what stool tests do you need to calculate the fecal osmotic gap?
stool sodium and potassium.
39
what might protease inhibitor do in a person with decompensated cirrhosis?
may induce worsening liver failure
40
hepatic adenoma
need MRI abdomen w/ gadoxetate sodium to ensure not biliary, if >5cm or male more worrisome for bleeding or harmful.
41
what are causes of granulomas in the liver?
TB, fungal, brucellosis, Q fever, Hodgkin lymphoma, sarcoidosis, drug toxicity
42
is ibuprofen a possible cause of chronic diarrhea?
yes
43
what is the thing about diet when testing someone for celiac?
have to be on gluten to avoid false negative tTG IgA
44
what are the most common drugs at fault for DILI?
NSAIDs, Abx (augmentin, isoniazid) and AED (phenytoin, valproate). Can happen up to 6 months after exposure.
45
what is the ascites total protein cut off for considering cirrhotic vs cardiac cause of portal hypertension?
2.5 (cirrhosis is less)
46
what are complications of using andexanet alfa to reverse Xa inhibitor?
associated with MI, stroke, cardiac arrest
47
would you use red cell scintigraphy before or after CTA?
After, sensitivity is low so could consider if CTA or colonoscopy are negative
48
would you worry more about a serous cystadenoma, an IPMN, or a mucinous cystic neoplasm?
IPMN and mucinous cystic neoplasm Serous cystadenoma has no malignant potential.
49
what syndrome should you think about in young person with rectal bleeding with family history of cancer?
Peutz-Jeghers syndrome
50
what can happen to the GI tract of someone with Peutz-Jeghers syndrome?
hamartomas in small bowel, stomach, and or colon. melanotic lip macules
51
are fundic gastric polyps better or worse than gastric cardia polyps?
fundic are better, don't need endo follow up if no dysplasia
52
what is the difference between portopulmonary hypertension and hepatopulmonary syndrome?
PoPHTN - dyspnea, type of group 1 PAH which is seen with echo HPS - caused by vasodilation of pulmonary veins, AV shunting. symptoms: dyspnea but also very specific symptoms of orthodoxia (hypoxia while upright) (pulmonary dilation most significant in lung bases) dx: reduced PaO2 and or increased A-a ratio, echo with contrast - will see bubbles make it past pulmonary circulation due to dilation/shunt
53
why do people with hepatopulmonary syndrome get orthodoxia?
pulmonary vasodilation and AV shunting are most significant in the lung bases and upon moving from supine to standing blood is shunted more to the lower lobes
54
which mood medication should you avoid in hepatic dysfunction
duloxetine (there may be others) - can worsen dysfunction
55
what size of gallbladder polyp is worrisome?
> 1cm is high risk for malignancy and should be removed, also worrisome if associated with stones
56
what test should be done before you can diagnose gastroparesis?
EGD to ensure no ulcer or tumor obstructing.
57
what drugs have been associated with development of microscopic colitis (lymphocytic and collagenous colitis)
NSAIDs, PPI, SSRIs
58
what is the treatment for dermatitis herpetiformis?
Dapsone
59
is anti-smooth antibody specific to autoimmune hepatitis?
No. low titers are not impressive but if you have high titers and increased IgG, then this is more likely autoimmune hepatitis.
60
what is the sensitivity of gastric biopsy in diagnosis of H pylori in gastric PUD?
not perfect, can miss due to bleeding or PPI. should retest outpatient after can safely stop PPI for 1-2 weeks with urea breath test or stool antigen test.
61
If concern for biliary source elevated alk phos, what are your first tests?
RUQ US and AMA If normal but alk phos is >50% elevated above normal, would be worth liver bx/MRCP/ERCP
62
How is celiac disease diagnosed?
serologic studies (anti-transglutaminase IgA or anti-endomysial IgA antibodies) and if positive screen or highly suggestive symptoms despite negative serologies (also check IgA levels +/- IgG studies) then needs endoscopy with biopsy. Initiate gluten free diet AFTER biopsy. also can diagnose based on cutaneous biopsy showing dermatitis herpetiformis.
63
What disease should you think of in a 40 year old person with fatigue, arthralgias, diabetes, elevated LFTs, sick sinus syndrome, and secondary hypogonadism?
Hereditary hemochromatosis

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