GI 2 (Exam #2) Flashcards
(258 cards)
1
Q
What portion of the GI tract is most affected with Diverticulosis, and why?
A
Sigmoid colon
- Highest intraluminal pressure
2
Q
How does Diverticulosis typically present? What is the diagnostic recommendation?
A
Often asxs (incidental finding) - NO labs or imaging
3
Q
What is the treatment for Diverticulosis?
A
High fiber diet
- Increase hydration
4
Q
How does Diverticulitis differ from Diverticulosis (2)?
A
Diverticulitis is sxs AND has inflammation
5
Q
What condition involves progressive/steady aching pain in LLQ, fever/chills +/- N/V?
A
Diverticulitis
6
Q
What is the gold standard dx test for Diverticulitis?
A
CT WITH contrast
7
Q
What is the recommended disposition and tx for uncomplicated Diverticulitis (2)?
A
HOME
- Abx
- F/U in 2 days
8
Q
What are the recommended abx choice for uncomplicated Diverticulitis (2, __+__ vs. __)
A
G- anaerobic coverage
- Metronidazole + Cipro/Bactrim
- Augmentin
9
Q
What is the recommended disposition and tx for complicated Diverticulitis (4)?
A
ADMIT
- NPO
- IVF
- IV abx
- Consult GI/Surgery
10
Q
For Diverticulitis, what diagnostic test should always be performed after resolution of acute sxs, and when?
A
Colonoscopy 6-8 weeks after sxs resolve
11
Q
What is the recommended diet for during and after Diverticulitis?
A
- During = clear liquid
- After (NON-acute) = high fiber
12
Q
What is a common cause of overt lower GI bleed?
A
Diverticular Bleeding
13
Q
What condition involves painless hematochezia +/- bloating/cramping, abnormal vital signs?
A
Diverticular Bleeding
14
Q
What is the tx for Diverticular Bleeding (__ vs. __)?
A
- Resolve spontaneously
vs. - Admit and resuscitate if severe
15
Q
What are the four classifications of Colon Polyps, and why are benign vs. pre-cancerous?
A
- Hyperplastic = benign
- “Pseudopolyps” = benign (inflammatory)
- Adenomas = pre-cancerous
- Sessile serrated polyps = pre-cancerous
16
Q
Are Adenoma Colon Polyps benign or pre-cancerous, and what is the most common type?
A
Pre-cancerous
- Tubular = most common
17
Q
What is the most common type of CRC?
A
Adenomas
- Early detection/removal vital
18
Q
What are the two types of CRC, and which is more common vs. increasing in incidence?
A
- Left-sided = more common
- Right-sided = increased incidence
19
Q
What are five important RF of CRC, and which is most important?
A
- Tobacco use = most important
- Personal/family hx (includes FAP, HNPCC)
- IBD hx
- 50+ years
- AA
20
Q
What positive test indicates recurrent CRC?
A
Carcinoembryonic Antigen (CEA)
21
Q
What is the test of choice for CRC, and what finding may be seen?
A
Colonoscopy
- “Apple core” lesion
22
Q
What is the recommended tx for CRC? What test should be done serially?
A
Partial colectomy
- Serial CEA levels
23
Q
What is the gold standard dx test for colon CA, and why (2)?
A
Colonoscopy
- Dx and therapeutic
- Can visualize ENTIRE colon
24
Q
What is the only test that can be used to prevent colon CA, and why?
A
Colonoscopy
- Evaluates entire colon and can remove polyps
25
Which colon CA screening test ONLY visualizes distal 1/3 of colon (does NOT show entire colon/right side)?
Flex Sigmoidoscopy
26
Which colon CA screening test is a “virtual colonoscopy”; reserved for those with comorbidities? What is a major con associated with this test?
CT Colonography
| - Can miss flat/small polyps
27
Why are visualization tests preferred over stool-based tests for colon CA screening?
MOST polyps do NOT bleed = low sensitivity
28
What is the preferred stool-based detection test for colon CA screening?
FIT (Fecal Immunochemical Test)
29
Which colon CA screening test is good for average risk patient? What should you caution with this test?
FIT-DNA (Cologuard)
| - Caution false +
30
If a patient is being screened for colon CA and is asxs/average-risk, what is the recommended start and end age?
- Begin at age 45/50 (45 if AA)
| - Discontinue at age 75
31
If a patient is being screened for colon CA and has a FH of colon CA, what is the recommendation (2)?
- Begin at age 40 years and every 5 years
| - 10 years younger than age at which 1st degree relative was diagnosed
32
If a patient is being screened for colon CA and has IBD, what is the recommendation?
Begin 8-10 years after onset of IBD sxs
33
What condition involves 100+ adenomatous polyps → increased risk for CRC?
Familial Adenomatous Polyposis (FAP)
34
What are the two hereditary colon CA syndromes? What are patients at increased risk for?
Increased risk of extracolonic malignancies
- Familial Adenomatous Polyposis (FAP)
- Hereditary Non-Polyposis Colon CA (HNPCC)
35
What is the recommended screening test for Familial Adenomatous Polyposis (FAP), and at what age? How often should is be repeated?
Colonoscopy/Flex Sigmoidoscopy by age 10-12 years
| - Repeat every 1-2 years
36
What general type of malignancies are patients with Familial Adenomatous Polyposis (FAP) and Hereditary Non-Polyposis Colon CA (HNPCC) at increased risk for? Which specific type is most common for each?
Extracolonic malignancies
- FAP = Gastric/Duodenal/Ampullary carcinoma
- HNPCC = Endometrial CA
37
What is the recommended tx for Familial Adenomatous Polyposis (FAP)?
Prophylactic colectomy
38
What age group is most affected by Familial Adenomatous Polyposis (FAP)? What about Hereditary Non-Polyposis Colon CA (HNPCC)?
- FAP = teens (16 years)
| - HNPCC = 45-60 years
39
What condition involves multiple family members affected and increased risk for CRC? What sxs is often seen?
Hereditary Non-Polyposis Colon CA (HNPCC)
| - Right-sided mass in age 45-60 years
40
What is the Amsterdam Criteria, and what condition is it associated with?
“3-2-1 rule” is 3 affected members, 2 generations, 1 under age 50 years
- Hereditary Non-Polyposis Colon CA (HNPCC)
41
What is the recommended screening test for Hereditary Non-Polyposis Colon CA (HNPCC), and at what age (2)?
- Annual Colonoscopy beginning age 20-25 years
| - Colonoscopy 2-5 years prior to earliest CRC diagnosis in family
42
What group of conditions should be considered if FH of CRC in 1+ members OR personal/FH of CRC at early age (<50 years) vs. multiple adenomas (10-20+) vs. multiple extracolonic malignances?
Hereditary Colon CA Syndromes
43
What is the most common obstruction, and what is the #1 RF?
Small Bowel Obstruction (SBO)
| - RF: adhesions (prior abdominal/pelvic surgery)
44
What condition involves abdominal pain (periumbilical, intermittent cramping → focal/constant); bloating/distention, N/V?
Small Bowel Obstruction (SBO)
45
What SXS is indicative of a serious Small Bowel Obstruction (SBO)? What DX FINDING is indicative of a serious SBO?
- Sxs: obstipation
| - Dx finding: perforation
46
What condition, if severe, presents as shock, motionless, hypoactive/absent BS, peritoneal signs (guarding, rigidity, rebound)?
Small Bowel Obstruction (SBO)
47
What condition involves dilated loops of bowel and air fluid levels on XR?
Small Bowel Obstruction (SBO)
48
What is the tx for Small Bowel Obstruction (SBO) (3)? When would surgery be considered (3)?
- Admit
- Consult surgery/GI
- Trial non-operative tx first (NPO, IVF, NG tube, antiemetics, abx)
Surgery if...
- Peritonitis (ischemia/necrosis/perf)
- Intestinal strangulation (necrosis)
- Non-surgical tx ineffective
49
What condition involves hypomotility of GI tract in absence of mechanical BO?
Ileus
50
What is the most common cause of Ileus? What is another possible cause?
Post-op abdominal surgery
| - Also, hypomotility meds
51
What condition involves dilated loops of bowel with air present in BOTH small and large bowel but NO air fluid levels on XR?
Ileus
52
How can you differentiate SBO from Ileus diagnostically?
- SBO = air-fluid levels
| - Ileus = NO air-fluid levels
53
What is the most common cause of Large Bowel Obstruction (LBO), and what two specific subtypes?
Adenocarcinoma
- Colon
- Rectum
54
What condition involves abdominal pain (cramping); bloating/distention, N/V, obstipation, hematochezia +/- fever/chills; diffuse tenderness,?
Large Bowel Obstruction (LBO)
55
What condition involves dilated bowel proximal to obstruction on XR?
Large Bowel Obstruction (LBO)
56
What condition involves abnormal twisting of portion of GI tract, and what is the most common type?
Volvulus
| - Sigmoid
57
In what age group is Sigmoid Volvulus more common? What about Cecal Volvulus?
- Sigmoid: 70 years
| - Cecal: 33-53 years
58
What is the tx for Sigmoid Volvulus?
Flex Sig to decompress/de-rotate then surgery to resect and prevent recurrence
59
What is the tx for Cecal Volvulus?
Surgery
60
What three sxs are most often seen with anorectal disease?
- Pain
- Bleeding
- Lump
61
How does Internal Hemorrhoid differ form External Hemorrhoid by location and sxs?
Internal = proximal to denate line
- Painless
External = distal to denate line
- Painful
62
What condition involves bleeding with BM +/- prolapse, pruritus, fecal incontinence, mucoid discharge?
Hemorrhoids
63
What is the 1st line tx for Hemorrhoids?
Dietary/lifestable changes for ALL patients
64
What two procedures/surgeries may be considered for Internal Hemorrhoids?
- Rubber band ligation/banding
| - Hemorrhoidectomy
65
What three medications can be considered for Hemorrhoids?
- Stool softeners
- SHORT-course steroids
- Antispasmodics
66
What condition involves outgrowth of normal skin/loose and flesh-colored? What is the recommended tx?
Perianal Skin Tags
| - NO tx unless discomfort
67
What condition involves intense itching, burning; circumferential redness and irritation of perianal skin?
Pruritus Ani
68
What condition is the most common cause of severe anorectal pain?
Anal Fissure
69
What is the most common area affected with Anal Fissure?
Posterior midline tear
70
What condition involves severe pain during/after defecation (“passing glass” or “sitting on a knife”)?
Anal Fissure
71
What three anorectal disorders may be associated with Crohn Disease?
- Anal Fissure
- Perianal Abscess
- Anorectal Fistula
72
What condition involves obstructed/infected anal crypt gland? What can it progress to?
Anal Fissure
| - Can progress to fistula
73
What condition involves chronic drainage of blood/pus +/- excoriated/inflamed perianal skin, palpable cord?
Anorectal Fistula
74
What condition is a chronic perianal abscess; can be associated with Crohn Disease?
Anorectal Fistula
75
What dx test can be used for Fistula if there is concern for IBD?
Colonoscopy
76
What is the mainstay treatment for Anorectal Fistula?
Surgery (fistulotomy)
77
What is the recommended tx for Anal Fissure?
Supportive (increase fiber/fluids, proper hygiene, Sitz baths, stool softeners, topical analgesics or vasodilators)
78
What anorectal condition is caused by HPV?
Anal Condyloma
79
What condition is often asxs +/- pruritus; cauliflower-like appearance in clusters or single entities?
Anal Condyloma
80
What is the most common type of Anal CA?
Squamous Cell CA
81
What is the recommended tx for Anal Condyloma (2)?
- Removal/destruction of lesions
| - Topical Podofilox or Imiquimod cream
82
What condition involves fecal incontinence, incomplete bowel evacuation; protruding circumferential tissue?
Rectal Prolapse
83
What is the recommended tx for Rectal Prolapse?
Surgery
84
What condition involves fascia weakens and allows rectum to bulge into vagina?
Rectocele
85
What condition involves pelvic pressure, constipation, fecal incontinence, sexual dysfunction?
Rectocele
86
How are Rectal Prolapse and Rectocele dx?
Defecography
87
What is the recommended tx for Rectocele?
- Pelvic floor muscle training
| - Pessary
88
What are the four RF of Cholelithiasis?
Four F's
- Female
- Fluffy (obese)
- Forty
- Fertile (pregnant)
89
What is the most common type of Cholelithiasis?
Cholesterol
90
What is the initial test for Cholelithiasis?
US
91
What condition involves intense RUQ pain with radiation to R shoulder blade?
Biliary Colic (Uncomplicated Cholelithiasis)
92
What condition involves constant/steady pain (NOT colicky unlike name); typically lasts 30-60 minutes (<6 hours)?
Biliary Colic (Uncomplicated Cholelithiasis)
93
What does PE look like for a patient with Biliary Colic (Uncomplicated Cholelithiasis)?
NORMAL
- No jaundice
- Negative Murphy's sign
94
What does dx look like for a patient with Biliary Colic (Uncomplicated Cholelithiasis)?
NORMAL labs
| - Gallstones +/- GB sludge on US
95
What is the recommended tx for Biliary Colic (Uncomplicated Cholelithiasis)?
Cholecystectomy
96
What condition presents similar to Biliary Colic but NO gallstones, sludge or micro disease?
Functional Gallbladder Disorder
97
What condition is possible due to gallbladder dysmotility, and how do you dx?
Functional Gallbladder Disorder
98
How do you dx Functional Gallbladder Disorder? What test can be ordered to evaluate, and what is a positive finding?
Dx of exclusion
| - HIDA Scan with CCK and if GBEF <40% = low = FGD
99
What Rome IV Criteria are used in dx of Functional Gallbladder Disorder (3)?
- Biliary pain
- Absence of gallstones
- Supported by low GBEF, normal labs
100
What is the recommended tx for Functional Gallbladder Disorder?
- Educate/reassure
| - Cholecystectomy if biliary-like pain + low GBEF
101
What condition involves inflammation of GB WITH gallstones (cystic duct obstruction)?
Acute Calculous Cholecystitis
102
What condition involves persistent biliary pain (RUQ) lasts 6+ hours?
Acute Calculous Cholecystitis
103
What four signs/sxs are indicative of Acute Calculous Cholecystitis?
- Fever
- Tachycardia
- Ill-appearing
- + Murphy's sign
104
What lab finding is indicative of Acute Calculous Cholecystitis? What is seen on US?
Leukocytosis with left shift
| - Gallstones, wall thickening/edema on US
105
What is the recommended tx for Acute Calculous Cholecystitis (3)?
ADMIT
- IV (fluids, pain control, abx)
- Cholecystectomy
106
What is the most common complication associated with Acute Calculous Cholecystitis?
Gangrene
107
What condition involves chronic inflammation of GB almost ALWAYS associated with gallstones?
Chronic Cholecystitis
108
What condition involves inflammation of GB WITHOUT gallstones?
Acute Acalculous Cholecystitis
109
What condition should be considered in a critically ill patient with sepsis, without a clear source or jaundice present?
Acute Acalculous Cholecystitis
110
What is the recommended tx for Acute Acalculous Cholecystitis (3)?
- Obtain cultures
- Start abx
- Cholecystectomy vs. GB drainage
111
What condition involves stones in common bile duct (CBD)?
Choledocholithiasis
112
What condition involves asxs or biliary-type pain; jaundice, normal VS, Courvoisier sign?
Choledocholithiasis
113
What condition involves elevated LFTs, early = ALT/AST (later = cholestatic pattern: Bili, ALP exceed ALT/AST)?
Choledocholithiasis
114
What is the recommended tx for Choledocholithiasis?
ERCP
| - Dx and tx to remove stones
115
What condition involves inflammation of biliary duct due to ascending bacterial inf. in patient with biliary obstruction?
Acute Cholangitis
116
What condition involves Charcot’s Triad, and what are the three components?
Acute Cholangitis
- Fever
- Abdominal pain
- Jaundice
117
What triad involves fever, abdominal pain, jaundice? And what condition does it present with?
Charcot’s Triad
| - Acute Cholangitis
118
What condition involves Reynolds Pentad, and what are the five components?
Acute Cholangitis
- Charcot's Triad (fever, abdominal pain, jaundice)
- AMS
- Hypotension
119
What condition involves leukocytosis; LFTs show cholestatic pattern (elevated Bili, ALP, GGT)?
Acute Cholangitis
120
What is the recommended tx for Acute Cholangitis (4)?
ADMIT
- Empirical abx
- Emergent consult with GI/surgery
- ERCP: relieves biliary obstruction via drainage
121
What condition involves mostly women; autoimmune destruction of bile ducts → cholestasis?
Primary Biliary Cholangitis (PBC)
122
What two conditions often present with fatigue, pruritus, jaundice, and what sxs is most common?
- Primary Biliary Cholangitis (PBC)
- Primary Sclerosing Cholangitis (PSC)
Pruritus = most common
123
What condition presents with cholestatic pattern, specifically elevated ALP; +AMA?
Primary Biliary Cholangitis (PBC)
124
What two lab findings are seen with Primary Biliary Cholangitis (PBC)?
- Elevated ALP (cholestatic pattern)
| - +AMA
125
What are the three Inherited/Autoimmune Biliary Conditions, and what is the tx for all?
What gender does each present in?
- Primary Biliary Cholangitis (PBC) = women
- Primary Sclerosing Cholangitis (PSC) = men
- Gilbert Syndrome = men (post-puberty)
Tx = refer to GI
126
What condition involves mostly men; strong association w/ IBD (UC > CD) → cholestasis, ES liver disease?
Primary Sclerosing Cholangitis (PSC)
127
What two lab findings are seen with Primary Sclerosing Cholangitis (PSC)?
- Cholestatic pattern
| - -AMA
128
What three complications can present with Primary Sclerosing Cholangitis (PSC)?
- End-stage liver disease
- Hepatobiliary CA
- Colon CA
129
What condition involves unconjugated hyperbilirubinemia in absence of hemolysis?
Gilbert Syndrome
130
What condition involves inherited; deficiency in enzyme for glucuronidation (conjugates bili)?
Gilbert Syndrome
131
What condition involves asxs with normal PE: mild intermittent episodes of jaundice triggered by dehydration, fasting, period?
Gilbert Syndrome
132
What is the most common Biliary Neoplasm? What is the prognosis for this CA?
Gallbladder CA
| - HIGHLY fatal
133
What is a major RF associated with Gallbladder CA?
Porcelain GB
134
What type of Biliary Neoplasm arises from epithelial cells of bile ducts?
Cholangiocarcinoma
135
What condition is often associated with Cholangiocarcinoma? What two sxs are often seen?
PSC
- Jaundice
- Pruritus
136
What two conditions are often associated with Ampullary CA?
- FAP
| - HNPCC
137
Which Biliary Neoplasm is associated with PSC? Which Biliary Neoplasm is associated with FAP and HNPCC?
- PSC = Cholangiocarcinoma
| - FAP and HNPCC = Ampullary CA
138
What sxs is most commonly seen with Ampullary CA?
Obstructive jaundice
139
What condition presents with an AST:ALT ratio >1.5? AST:ALT ratio <1?
- AST:ALT ratio >1.5 = EtOH (alcoholic liver disease)
| - AST:ALT ratio <1 = NASH or acute/chronic viral Hepatitis
140
What are the two types of NAFLD (Non-Alcoholic Fatty Liver Disease)?
- Isolated Steatosis (NAFL)
| - Non-Alcoholic Steatohepatitis (NASH)
141
What is the strongest predictor associated with NAFLD (Non-Alcoholic Fatty Liver Disease)?
Metabolic Syndrome
142
What finding is seen on VCTE/US with NAFLD (Non-Alcoholic Fatty Liver Disease)?
Hepatic steatosis
- 5+% liver fat on VCTE
- US shows fat present
143
What is the first line tx of NAFLD (Non-Alcoholic Fatty Liver Disease)? What med should be started?
1st Line = Exercise/weight loss
| - Start Statin
144
What hereditary liver disorder is a disorder of iron metabolism (iron accumulation)?
Hereditary Hemochromatosis
145
What hereditary liver disorder is a disorder of copper metabolism (copper accumulation)?
Wilson’s Disease
146
What condition involves Bronze Diabetes, and what are the three components?
Hereditary Hemochromatosis
- DM
- Bronze pigmentation of skin
- Cirrhosis
147
What condition involves triad of DM, bronze pigmentation of skin, cirrhosis? What is this called?
Bronze Diabetes
| - Seen with Hereditary Hemochromatosis
148
What is the tx goal with Hereditary Hemochromatosis?
Goal = prevent cirrhosis from iron overload
| - Avoid Vit C/iron, uncooked shellfish, EtOH
149
What condition can present as acute hepatitis, chronic liver disease/failure; also, neuro/psych = confusion, dysarthria, incoordination, seizures?
Wilson’s Disease
150
What condition presents with Kayser-Fleischer ring + neuro manifestations?
Wilson’s Disease
151
What two sxs/signs may present with Wilson’s Disease?
- Kayser-Fleischer ring
| - Neuro manifestations
152
What lab finding is seen with Wilson’s Disease?
LOW serum ceruloplasmin
153
What is the recommended tx for Wilson’s Disease?
Chelating agents
154
What condition should you suspect in a non-smoker with early onset emphysema (<45)?
Alpha-1 Antitrypsin Deficiency
155
What condition should you suspect if neonatal cholestasis OR childhood cirrhosis?
Alpha-1 Antitrypsin Deficiency
156
What lab finding is seen with Alpha-1 Antitrypsin Deficiency (2)?
- LOW serum alpha-1 antitrypsin
| - Alpha-1 antitrypsin phenotype
157
What three lab findings are seen with Autoimmune Hepatitis (AIH)? What is also seen in peds?
- +ANA
- +SMA
- +IgG
In peds, +LKMA-1
158
What is the recommended tx for Autoimmune Hepatitis (AIH) (2)?
For 2+ years or lifelong:
- Prednisone
- Azathioprine
159
Which two Viral Hepatitis are acute ONLY? Which type is chronic only? Which two Viral Hepatitis have a vaccine available? Which type can be fatal in pregnancy?
- Acute ONLY = A, E
- Chronic = D
- Vaccine = A, B
- Fatal in pregnancy = E
160
Which Viral Hepatitis is more common in Asia, Africa, US (homeless); areas with inadequate sanitation (fecal-oral)?
Hepatitis A
161
How does presentation differ between peds and adults?
- Peds = asxs
| - Adults = sxs
162
What are the three phases of Hepatitis A? What sxs are seen with the Icteric phase (4)?
1. Incubation
2. Prodrome (“flu-like” sxs)
3. Icteric = jaundice (1-week post-sxs onset), dark urine, pruritus, light-colored stool
163
What two populations are at increased risk of becoming chronic if they have Hepatitis B?
- IC adult
| - Infant/child <5 years
164
What is the leading cause of cirrhosis and hepatocellular carcinoma?
Hepatitis B
165
What type of Viral Hepatitis involves DNA? Which involves RNA?
- Hepatitis B = DNA
| - Hepatitis C = RNA
166
Which Viral Hepatitis involves 5% of adults become chronic; 80-90% of infants become chronic?
Hepatitis B
167
What does +IgM anti-HAV imply? +IgG anti-HAV?
Hepatitis A
- +IgM anti-HAV = acute infection
- +IgG anti-HAV = implies immune
168
What does +HbsAg imply? +IgM anti-HBc? +IgG anti-HBc?
- +HbsAg = active infection (acute/chronic)
- +IgM anti-HBc = acute infection
- +IgG anti-HBc = implies immune
169
Which Viral Hepatitis involves OFTEN chronic; transmit via blood (IVDU, tattoos/piercings)?
Hepatitis C
170
Which Viral Hepatitis involves lower LFTs than with HAV/HBV (~100 or less)?
Hepatitis C
171
Which Viral Hepatitis involves new cases mostly IVDU in 20’s? What is the recommended screening?
Hepatitis C
| - One-time screen for ALL 18+ years
172
Which Viral Hepatitis is seen ONLY in co-infection with HBV?
Hepatitis D
173
Which Viral Hepatitis is ONLY acute; fecal-oral; can be FATAL in pregnant women?
Hepatitis E
174
Which Viral Hepatitis is often asxs; + test for 6+ months; comp. = HCC +/- cirrhosis?
CHRONIC Hepatitis B
175
What are the three main patterns of injury seen with Alcohol-Related Liver Disease (ALD)?
- Fatty liver
- Chronic hepatitis with fibrosis/cirrhosis
- Alcoholic hepatitis
176
What are the four primary modifiable RF associated with Alcohol-Related Liver Disease (ALD)?
- Daily drinking above threshold of 1/day (F) vs. 2/day (M)
- F
- Pattern of consumption (daily, with fasting, binge)
- Increased BMI
177
What are the three primary NON-modifiable RF associated with Alcohol-Related Liver Disease (ALD)?
- Genetics
- Co-existing chronic liver disease (CLD)
- Smoking
178
What type of Alcohol-Related Liver Disease (ALD) can be reversed after 4-6 weeks of abstinence?
Fatty Liver (Hepatic Steatosis)
179
What is the recommended tx for Fatty Liver (Hepatic Steatosis) (2)?
- Lifestyle modifications (weight loss, exercise)
| - Alcohol cessation
180
What condition involves liver inflammation, necrosis, fibrotic scaring; more likely if chronic/current heavy EtOH use?
Alcoholic Hepatitis (AH)
181
What is associated with an increased likelihood that alcoholic hepatitis will progress to permanent damage?
Continued EtOH use
182
What condition involves leukocytosis with L shift, macrocytosis, thrombocytopenia, AST/ALT of 1.5+?
Alcoholic Hepatitis (AH)
183
What condition involves neutrophilic lobular inflammation; Mallory-Denk bodies?
Alcoholic Hepatitis (AH)
184
What six conditions are used for the CLINICAL dx of Alcoholic Hepatitis (AH)?
- 40+ g/day for F or 60+ g/day for M for 6+ months
- Jaundice in prior 8 weeks
- Total Bili 3.0+ mg/dL
- AST/ALT 1.5+ IU/L
- AST 50+ IU/L
- <60 days abstinence of alcohol before jaundice onset
185
What is the most important factor in tx of Alcoholic Hepatitis (AH)? If severe AH, is present, what medication may be recommended?
DISCONTINUE ETOH USE
| - If severe, steroids (D/C after 7 days if ineffective)
186
What condition involves positive asterixis = tremor; Stroop Test?
Hepatic Encephalopathy
187
What condition involves neurotoxins accumulate bc not detoxified by liver, and what is the most common neurotoxin?
Hepatic Encephalopathy
| - Ammonia
188
What condition involves widespread destruction/regeneration of liver tissue with nodules and altered structure?
What are the two subtypes, and what is the survival rate for each?
Cirrhosis
- Compensated Cirrhosis = 12 years
- Decompensated Cirrhosis = <2 years
189
What two medications can be used to treat Ascites seen with Cirrhosis? What other tx may be considered?
- Lasix
- Spironolactone
May consider paracentesis vs. shunt (TIPS) if refractory
190
What sign/sxs is often seen with Compensated Cirrhosis? What four lab findings may be seen?
Splenomegaly
- Thrombocytopenia
- Leukopenia
- Anemia
- High AST
191
What two signs/sxs are often seen with Decompensated Cirrhosis?
- Portal HTN
| - Port-systemic shunting
192
What condition involves renal failure in setting of decompensated cirrhosis?
What is the prognosis?
```
Hepatorenal Syndrome (HRS)
- Poor prognosis
```
193
What are the two types of Hepatorenal Syndrome (HRS), and what is the prognosis for each?
- Type 1 = rapid/progressive: 4 weeks survival
| - Type 2 = a/w refractory ascites: 6 months survival
194
What condition presents with azotemia (increased BUN); progressive rise in serum Cr?
Hepatorenal Syndrome (HRS)
195
What are the three types of Alcohol-Related Liver Disease (ALD), and what is the general prognosis for each?
- Fatty Liver/Alcoholic Fatty Liver: complete resolution if EtOH stopped in 4-6 weeks
- Alcoholic Hepatitis (AH): depends on severity (mild often reversible); NEED to D/C EtOH use
- Chronic Hepatitis (Alcoholic Cirrhosis) = WORSE: if continue to drink, 4-year survival rate is <20% if patient has major complication
196
What dx criteria can be used to evaluate Hepatorenal Syndrome (HRS) - besides signs of decompensated liver disease and renal impairment (3)?
- NO shock
- No improvement with correction of volume status/Albumin in 2+ days
- Absence of other AKI causes
197
When is Hepatocellular CA (HCC) surveillance recommended?
ANY patient at high-risk for liver CA
198
What type of CA is a majority of all primary liver CA?
Hepatocellular CA (HCC)
199
When should Hepatocellular CA (HCC) be suspected in a patient (2)?
- Cirrhosis
| - Non-cirrhosis chronic HBV
200
If a patient has non-cirrhosis chronic HBV, what two tests can be used as screening tools, and what are you screening for? How often should screening be done?
Screen for Hepatocellular CA (HCC) every 6 months with...
- AFP
- US
201
What lab test will be elevated with Hepatocellular CA (HCC)?
What imaging test should be performed first?
```
Elevated AFP (alpha-fetoprotein)
- Tri-phasic CT
```
202
What condition involves high levels of activated trypsin → organ auto-digestion = injury/inflammation?
Acute Pancreatitis
203
What condition involves inflammation of parenchyma/peripancreatic WITHOUT necrosis?
Interstitial Edematous Acute Pancreatitis
204
What condition involves inflammation + parenchymal necrosis +/- peripancreatic necrosis?
Necrotizing Acute Pancreatitis
205
What condition involves possible etiologies of ‘I GET SMASHED’? Which two are more common, and which of these two is MOST common?
Acute Pancreatitis
- Gallstones = most common
- Chronic alcohol abuse
206
What condition involves acute/constant, boring, severe, epigastric radiates to back?
Acute Pancreatitis
207
What positions/things make Acute Pancreatitis worse (2)? Better (3)?
- Worse with food or supine
| - Better sitting, leaning forward, knees flex
208
If a patient has severe Necrotizing Acute Pancreatitis, what two signs may be positive?
- +Cullen sign
- +Grey-Turner sign
- Panniculitis
209
What is the diagnostic criteria for Acute Pancreatitis (2 out of 3...)?
- Clinical presentation (acute/constant, boring, severe abd. pain)
- High serum lipase/amylase (3x normal)
- Consistent imaging findings
210
What is the recommended initial imaging test for Acute Pancreatitis? What other two tests may need to be performed?
Abdominal US
| - EUS → MRCP
211
What is the recommended tx for Acute Pancreatitis (3)?
ADMIT
- IVF
- Meds (analgesics, abx)
212
What complication of Acute Pancreatitis should you be concerned for?
Pancreatic pseudocyst
213
What condition involves localized fluid collection with palpable mass in mid-epigastric area; can be resolve spontaneously or need surgery vs. drainage if sxs/infected?
What is it a complication of?
Pancreatic pseudocyst
| - Comp. of Acute Pancreatitis
214
What condition involves possible exocrine dysfunction (steatorrhea, weight loss) or endocrine dysfunction (DM)?
Chronic Pancreatitis
215
What condition involves epigastric pain worse with alcohol/high-fat meals; N/V; weight loss?
Chronic Pancreatitis
216
What are the three components of the "classic" triad associated with Chronic Pancreatitis?
- DM
- Steatorrhea
- Calcifications
217
What is the gold standard test for Chronic Pancreatitis? What test should be considered if steatorrhea is present?
72-Hour Quantitative Fecal Fat
| - Fecal Elastase if steatorrhea
218
What gender and age if most affected by Pancreatic CA?
- M
| - 45+ years
219
What is the most common type of Pancreatic CA?
Ductal adenocarcinoma
220
What three sxs are often associated with Pancreatic CA?
- Epigastric pain
- Jaundice
- Weight loss
221
What is the tumor marker test associated with Pancreatic CA?
CA 19-9
222
If jaundice is present with Pancreatic CA, what imaging test is preferred? What if epigastric pain or weight loss?
- Jaundice = US (CT if mass)
| - Epi pain/weight loss = triple phase thin sliced enhanced helical CT, 3D reconstruction
223
What condition involves dx test of triple phase thin sliced enhanced helical CT, 3D reconstruction?
Pancreatic CA (epigastric pain or weight loss sxs)
224
What is the only CURATIVE tx for Pancreatic CA?
Resection via Whipple
225
What is the prognosis for Pancreatic CA, and why is this?
```
Poor prognosis (5-year survival is <5%)
- Patients often present with advanced disease or metastasis
```
226
What condition involves increased risk if men, 20-29 years, AA/Hispanics; higher risk if MSM?
HIV
227
What condition requires infectious body fluid AND port of entry for transmission?
HIV
228
What are the four stages of HIV?
1. Primary infection
2. Clinical latency
3. Symptomatic HIV
4. AIDS
229
In what stage of HIV does a patient seroconvert, and what does this mean?
```
Clinical latency (2)
- Seroconversion = +Ab test
```
Ab test negative in primary infection
230
What stage of HIV presents with leukopenia, thrombocytopenia; rash, fever, LAD, sore throat, diarrhea?
Which stage is often asxs?
Primary infection
| - Clinical latency = asxs
231
What HIV stage may present as fever, weight loss, night sweats, LAD?
What other three sxs may presents?
Symptomatic HIV (3)
- Oral hairy leukoplakia
- Thrush
- Karposi's Sarcoma
232
What conditions (__ OR __) can indicate progression to AIDS?
- CD4 T cell count <200
OR
- HIV+ AND 1 of 27 AIDS defining conditions
233
With a CD4 count <200, what AIDS-defining condition should you consider?
PCP (Pneumocystis jirovecii PNA)
234
With a CD4 count <100, what AIDS-defining condition should you consider?
Encephalitis
235
With a CD4 count <50, what two AIDS-defining conditions should you consider?
- MAC (Mycobacterium avium complex)
| - Cytomegalovirus (CMV) Retinitis
236
What condition is the most common intracranial lesion in HIV patients; caused by Toxoplasma gondii via cat feces?
What is the tx (2)?
Encephalitis
| - Sulfadiazine + Pyrimethamine
237
What is the tx for PCP (Pneumocystis jirovecii PNA)?
Bactrim DS
238
What is the tx for MAC (Mycobacterium avium complex) (2)?
Macrolide + Ethambutol
239
What is the most common retinal infection in AIDS patients? What sxs may be seen (2)?
What is the tx for this?
Cytomegalovirus (CMV) Retinitis
- Sxs: hemorrhage, white fluffy exudates
- Tx: IV Ganciclovir
240
When prescribing HIV meds, what two things should generally be considered?
- Significant AEs
| - Many drug interactions
241
What should ALL HIV patients be screened for?
TB
242
For HIV, what is the prophylactic tx for Valley Fever? PCP? Encephalitis?
- Valley Fever = Diflucan
- PCP = Bactrim DS
- Encephalitis = Bactrim DS
243
What is the recommended screening for general patients?What four populations/situations should screening be considered MORE?
Everyone 13 to 64 years can voluntarily opt-out of testing
Consider more if...
- Initiating TB tx
- Presenting with an STD
- Annually for at-risk patients (MSM)
- Pregnant women
244
What is the test of choice for HIV?
Combination HIV antibody AND antigen test
245
What condition is called the “Great Imitator”; caused by Treponema pallidum?
Syphilis
246
What are the four stages of Syphilis, and what sxs are seen in each (1, 3, 1, 4)
1. Primary: painless chancre
2. Secondary: rash, condyloma lata, mucous patches
3. Latent: asxs
4. Tertiary: damage to heart, blood vessels, brain, nervous system
247
What condition involves a painless chancre, and at what stage?
Syphilis (primary stage)
248
What two complications of Syphilis can be seen in ANY Stage?
- Neurosyphilis
| - Ocular Syphilis
249
What is the recommended dx test for Syphilis (2)?
Serology
- RPR
- VDRL
250
What is the recommended tx for Syphilis? What other two considerations must also be met with tx?
Benzathine Pen G
- TREAT EVERYBODY (partners too)
- REPORT to County Health Department
251
With Syphilis, what must be done post-tx?
Test for cure = recheck RPR titer
| - At 6, 12, 24 months
252
What Syphilis complication should be considered in pregnant women, and what is the recommended screening to avoid this?
Congenital Syphilis = can lead to stillbirth, death or infant disorders
- Screen ALL at first prenatal visit
253
What condition is caused by Chlamydia trachomatis; rare in U.S.?
Lymphogranuloma Venereum (LGV)
254
What is the most common sxs associated with Lymphogranuloma Venereum (LGV)?
Unilateral inguinal bubo (swollen lymph node)
255
What is the recommended dx test for Lymphogranuloma Venereum (LGV)?
Tx for LGV?
- Dx = NONE (R/O Syphilis)
| - Tx = Doxycycline
256
What condition is caused by Haemophilus ducreyi; rare in U.S.?
Chancroid
257
What is the most common sxs associated with Chancroid? What other sxs may present?
Painful/tender genital ulcer
| - Contagious foul-smelling discharge
258
What is the recommended tx for Chancroid (__ OR __ OR __)?
```
- Azithromycin
OR
- Ceftriaxone
OR
- Ciprofloxacin
```
