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My Step 2 CK > GI > Flashcards

GI Flashcards

1
Q

A pt presenting with progressive dysphasia to both liquids and solids at same time and regurgitation several hours after meals suffers from …

A

Achalasia (inability to relax LES)

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2
Q

What is the best initial test for Achalasia?

A

barium swallow (bird’s peak)

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3
Q

What is the most accurate test for Achalasia?

A

manometry (increased LES pressure; decreased LES tone)

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4
Q

What is the best initial treatment for Achalasia?

A 
pneumatic dilation
(followed by Botox, myometry)
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5
Q

An older pt who drinks and smokes presents with progressive dysphasia that starts as just to solids and progresses to liquids and weight loss most likey suffers from …

A 
Esophageal cancer (Squamous cell)
(associated with long standing GERD)
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6
Q

What type of cancer occurs in proximal 2/3 of esophagus?

A

Squamous cell carcinoma

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7
Q

What type of cancer occurs in distal 1/3 of esophagus?

A

Adenocarcinoma

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8
Q

What is the best test for esophageal carcinoma?

A

Endoscopy w/ biopsy

do CT scan for local spread; endoscopic U/S for staging

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9
Q

What is the most accurate test for esophageal dysphagia in scleroderma patients?

A

motility study

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10
Q

What is the best treatment for pts with esophageal dysphagia and scleroderma?

A

PPI (can add metoclopramide)

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11
Q

A pt with intermittent chest pain along with dysphasia, usually precipitated by cold liquids most likely suffers from …

A

diffuse esophageal spasm/ Nutcracker esophagus

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12
Q

What is the finding on barium swallow for Nutcracker esophagus/ diffuse esophageal spasm?

A

corkscrew appearance (at time of spasm)

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13
Q

What is the most accurate test for Nutcracker esophagus/ diffuse esophageal spasm?

A

manometry (high intensity, disorganized contractions)

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14
Q

What is the treatment for Nutcracker esophagus/ diffuse esophageal spasm?

A
  1. calcium channel blockers (nifedipine)

2. nitrates

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15
Q

A patient with history of regurgiting undigested food, especially at night, and can express food via pushing on their throat most likely suffers from ….

A

Zenker’s Diverticulum

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16
Q

What is the best initial test for Zenker’s diverticulum?

A

Barium studies

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17
Q

What is the treatment for Zenker’s diverticulum?

A

surgery (avoid endoscopy, NG tubes)

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18
Q

…. is thin epithelial membranes made from squamous cells located at squamocolumnar junction proximal to LES that causes intermittent dysphagia

A

Scatzki’s rings

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19
Q

… are epithelial membranes made of squamous cells loacted in hypopharynx, causes intermittent dysphagia, associated with iron deficiency and squamous cell cancer

A

Plummer-Vinson syndrome

tx w/ dilation and iron

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20
Q

An HIV pt with CD4 count less than 200 presenting with odynophagia (pain with swallowing) most likely presents with ….

A

Candida esophagitis

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21
Q

What is the treatment for Candida esophagitis?

A

fluconazole

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22
Q

A patient on bisphosphonates or acne meds presenting with odynophagia most likely suffers from …

A

Esophagitis (due to pill)

treat with swallow pill in upright position with lots of water

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23
Q

A pt presents with painless upper GI bleed after repeated episodes of retching and vomiting most likely presents with …

A

Mallory-Weiss syndrome

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24
Q

What is the diagnostic tool of choice for Mallory-Weiss syndrome?

A

endoscopy

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25
Q

What treament is used for Mallory Weiss syndrome?

A
  1. nothing

2. can inject epi or cauterize if necessary

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26
Q

What test for H. pylori is not affected by PPI use?

A

H. pylori ELISA

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27
Q

When should a pt with epigastric pain undergo endoscopy?

A
  1. older than 55 y/o
  2. alarm symptoms (bleeding, weight loss, dysphagia)
  3. if symptoms not resolved with PPI
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28
Q

What is the most accurate test for GERD?

A

24 hour pH monitoring

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29
Q

A pt presents with epigastric pain, sore throat, metallic taste, hoarseness and cough most likely suffers from…

A

GERD

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30
Q

What is the next best step in a patient presenting with GERD or signs of peptic ulcer disease (<45 y/o) without alarming symptoms?

A

treat with PPI

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31
Q

What things should people avoid if they have GERD?

A
  1. nicotine
  2. alcohol
  3. chocolate
  4. caffeine
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32
Q

What is the surgical treatment for GERD and when is it indicated?

A

Nissen fundoplication

  1. refactory side effects of PPI (headaches, diarrhea)
  2. no response to PPI
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33
Q

…. is a complication of long standing reflux in which epithelium of lower esophagus changes from squamous to columnar

A

Barrett’s esophagus

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34
Q

How often should endoscopy be repeated in pts with Barrett’s esophagus?

A

every 2-3 years

every 3-6 months if low grade dysplasia

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35
Q

What is the best treatment for Barrett’s esophagus?

A

PPI

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36
Q

A patient with midepigastric pain that is relieved by eating and not associated with weight loss is most likely …

A

Dudodenal ulcer

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37
Q

A patient presenting with epigastric pain that is worsened by food and associated with weight loss is most likely …

A

Gastric ulcer

always biopsy to exclude cancer

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38
Q

What tests are used to assess whether H. pylori treatment was successful or if recurred after remission?

A
  1. urea breath test

2. stool antigen

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39
Q

What are the two most common causes of peptic ulcer disease?

A
  1. H. pylori

2. NSAIDs use

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40
Q

What is the treatment for H. pylori associated peptic ulcers?

A
  1. clarithromycin
  2. amoxicillin
  3. PPI
    (for 10-14 days)
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41
Q

What are the indications for stress ulcer prophylaxis?

A
  1. mechanical ventilation
  2. burns
  3. head trauma
  4. severe coagulopathy with sepsis
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42
Q

A patient presents with peptic ulcer disease despite max dose of PPI and H2 blocker and associated diarrhea most likely suffers from …

A

Zollinger-Ellison syndrome

diarrhea due to lipase inactivation by acids

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43
Q

What are the diagnositic for Zollinger-Ellison syndrome?

A
  1. elevated gastrin level with pt off PPI/H2 blocker for few days
  2. secretin stimulation (positive if elevated gastrin)
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44
Q

What diagnostic tools are used to assess whether gastrinoma is metastasized?

A
  1. Somatostatin-recpetor scintigraphy

2. endoscopic ultrasound (most sensitive)

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45
Q

A poorly controlled diabetic presents with early satiety, post-prandial nausea, abdominal fullness and bloating most likely suffers from …

A

gastroparesis

b/c can’t feel stretch so no gastrin release

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46
Q

What is the treatment for gastroparesis?

A
  1. erythromycin

2. metoclopramide

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47
Q

What disease can occur in a pt with history of vagotomy and gastric resection for severe peptic ulcer disease?

A

Dumping syndrome

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48
Q

What is the sequence of events involved in dumping syndrome?

A
  1. rapid release of chyme in duodenum –> osmotic draw –> intravascular volume depletion
  2. rapid release of chyme in duodenum –> peak of glucose –> rapid release of insulin –> hypoglycemia
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49
Q

A pt presents with sweating, shakiness, palpitations and lightheadedness shortly after a meal most likely suffers from ..

A

Dumping syndrome

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50
Q

What is the treatment for Dumping syndrome?

A

eat multiple, small meals

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51
Q

A pt who has epigastric pain but all other causes have been excluded most likely suffers from ..

A

Non-ulcer dyspepsia

treat via symptomatic relief

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52
Q

What are the findings on endoscopic exam for Crohn’s disease?

A

skip lesions with transmural inflammation throughout bowels

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53
Q

What are findings in barium studies for Crohn’s disease?

A

string sign

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54
Q

What is the difference between Crohn’s disease and Ulcerative colitis?

A

Crohn: skip lesions, trasmural, fistula formation, granulomas forming abdominal masses, through GI tract
UC: no skip lesions, mucosal, no fistulas,no granulomas, only in colon, bloody diarrhea

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55
Q

A pt presenting with fever, diarrhea, weight loss, and abdominal pain that has positive for Anti-Saccharomyces cerevisiae antibodies most likely suffers from …

A

Crohn’s disease

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56
Q

A pt presenting with fever, diarrhea, weight loss, and abdominal that has positive ANCA (anti-neutrophil cytoplasmic antibody) most likely suffers from …

A

Ulcerative colitis

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57
Q

What are treatments for chronic treatment of Crohn’s disease?

A
  1. pentasa (mesalamine derivative)
  2. azathioprine
  3. 6-MP
  4. Infliximab (if fistula or refractory to others; test for TB first)
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58
Q

What is use for acute exacerbations of Ulcerative colitis and Crohn’s?

A

Budesonide (steroids)

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59
Q

What treatments are used for chronic treatment of Ulcerative colitis?

A
  1. asacol, rowasa, sulfasalazine (mesalamine derivatives in colon)
  2. azathioprine
  3. 6-MP
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60
Q

What are common side effects of sulfasalazine?

A
  1. reversible infertility in men
  2. leukopenia
  3. sulfa effects (rash, hemolysis, allergic interstitial nephritis)
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61
Q

What is a side effect that can occur with the use of azathioprine and with the use of 6-MP?

A

drug-induced pancreatitis

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62
Q

What is the most important thing to do before starting treatment with infliximab?

A

test for latent TB with PPD

can induce re-activation of TB

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63
Q

What is the first thing to do in a patient with diarrhea?

A

assess for hypovolemia (hypotensive or orthostatic hypotension; tachycardia)

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64
Q

What tests should be done to exclude infectious diarrhea?

A
  1. fecal leukocytes
  2. stool culture
  3. ova and parasite exam
  4. C. difficile toxin (if clues in hx)
  5. Giardia-ELISA antigen testing (if clues in hx)
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65
Q

What are the two most common causes of infectious diarrhea?

A
  1. Campylobacter

2. Salmonella

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66
Q

A pt develops diarrhea and vomiting shortly after eating Chinese food most likely suffers from …

A

Bacillus cereus infection (pre-formed toxins)

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67
Q

A pt has history of diarrhea and develops Guillian Barre syndrome or reactive arthritis most likely had diarrhea due to …

A

Campylobacter

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68
Q

What are the most likely causes of diarrhea in an HIV pt with CD4 count less than 100?

A
  1. Cryptosporidia

2. isopora

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69
Q

A pt develops diarrhea (bloody) after eating a hamburger most likely is infected with …

A

E.Coli 0157:H7

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70
Q

What is a common complication of infection with E. Coli 0157:H7?

A

HUS (hemolytic uremic syndrome)

  • avoid abx b/c organism already dead at this point
  • avoid platelet tranfusion b/c make it worse
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71
Q

A camper or mountain hiker develops diarrhea with abdominal fullness, bloating and gas most likely suffers from ….

A

Giardia

associated with fat and vitamin malabsorption

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72
Q

A pt develops diarrhea after ingesting chicken, eggs, and dairy products most likely suffers from …

A

Salmonella

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73
Q

A pt develops diarrhea, flushing, wheezing, and vomiting within minutes of eating fish most likely suffers from …

A

Scombroid infection (release histamine into fish)

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74
Q

What are the most common causes of diarrhea in an iron overloaded patient (hemochromatosis)?

A
  1. Yersinia
  2. Shigella
  3. Vibrio vulnificus
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75
Q

What infectious diarrheal organism can mimic appendicitis?

A

Yersinia

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76
Q

A pt presents with hx of chronic liver disease and diarrhea after eating raw shellfish (muscles, oysters, clams) most likely suffers from …

A

Vibrio (vulnificus and parahaemolyticus)

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77
Q

What is the difference between infection with vibrio vulnificus and vibrio parahaemolyticus>

A

vulnificus: iron loaded pt (hemochromatosis); skin bullae
parahaemolyticus: not above

78
Q

What is the most common cause of diarrhea in children at day-care?

A

viral (rotavirus)

79
Q

A pt develops nausea and vomiting (with mild diarrhea) shortly after eating dairy products, eggs, salads most likely suffers from …

A

S. aureus (pre-formed toxins)

80
Q

A pt develops diarrhea along with neuro symptoms (paresthesia, weakness, reversal of heat/cold) after eating large reef fish (grouper, red snapper, barracuda) most likely suffers from …

A

Ciguatera -toxin

81
Q

What is the diagnostic test for Cryptosporidiosis?

A

modified acid fast test

82
Q

What is the best empiric therapy for infectious diarrhea?

A
  1. ciprofloxacin
  2. other fluroquinolone with metronidazole
    (if pain, fever, blood, tender)
83
Q

What is the best treatment for Scombroid?

A

antihistamines (diphenhydramine)

84
Q

What is the best treatment for Giardia?

A

metronidazole (can also use single dose tinidazole)

85
Q

What is the best treatment for cryptosporidiosis?

A
  1. raise CD4 count (anti-retrovirals)
  2. paromomycin
  3. nitazoxanide
86
Q

What is the best treatment for diarrhea caused by Isopora?

A

Bactrim

87
Q

What is the best treatment for Vibrio vulnificus?

A

Doxycyline

88
Q

What is the best treatment for traveller’s diarrhea (E. Coli)?

A

Rifaximin

never prophylactic antibiotics

89
Q

A pt presents with profuse watery diarrhea and a history of recent antibiotic treatment most likely suffers from …

A

C. difficile

90
Q

What is the best diagnostic test for C. difficile?

A

stool toxin for C. difficile

91
Q

What is the best treatment for C. difficile associated colitis?

A

Metronidazole (oral or IV)

second line is oral vancomycin if persisted despite metronidazole

92
Q

What medication can be used to decreased the frequency of recurrent episodes of C. difficile colitis?

A

Fidaxomicin

93
Q

A pt presenting with gas, bloating and diarrhea associated with ingestion of dairy products most likely suffers from …

A

Lactose Intolerance (usually starts around 12 y/o)

94
Q

What diagnostic tests can be used to diagnosis lacotse intolerance?

A
  1. increased stool osmolality

2. increased osmolar gap (difference btw stool osmolality is greater than expected with level of Na and K; >50)

95
Q

What is the best initial test for lactose intolerance?

A

remove milk, cheese, ice cream and other dairy products from diet
(symptoms resolve within 24-36 hours)

96
Q

A pt presenting with abdominal pain that is relieved by bowel movements, diarrhea and/or constipation most likely suffers from …

A

irritable bowel syndrome

97
Q

What is Rome criteria and what disease is it used for?

A

following symptoms for at least 3 months
1. pain relieved by bowel movement/ change in bowel habits
2.fewer symptoms at night
3. diarrhea alternating with constipation
used for irritable bowel syndrome

98
Q

What are treatments used in irritable bowel syndrome? (5)

A
  1. high fiber diet
  2. anti-diarrheal (loperamide, diphenoxylate)
  3. antispasmodics (hyoscyamine, dicyclomine, belladonna alkaloids)
  4. TCAs (have anticholinergic effect)
  5. tegaserod (for constipation predominant)
  6. alosetron (for diarrhea predominant)
99
Q

What antibiotics can be used for the peri-rectal/ peri-anal disease associated with Crohn’s disease?

A

Ciprofloxacin with Metronidazole

100
Q

What are the side effects associated with sulfa drugs (i.e. sulfasalazine)? (3)

A
  1. drug induced hemolysis
  2. rash
  3. renal (allergic interstitial nepritis)
101
Q

What medication is used for fistula formation associated with Crohn’s disease?

A

Infliximab

102
Q

If patient has crohn’s disease of colon or ulcerative colitis for more than 8 years, have an increased risk of …..

A

colon cancer

scope after 10 years of IBD

103
Q

What is the liver disease associated with ulcerative colitis and crohn’s disease?

A

Primary Sclerosis Cholangitis

104
Q

What is a curative treatment for ulcerative colitis?

A

Colectomy (surgical removal of colon)

105
Q

What is the complication of surgery for Crohn’s disease?

A

recurrence at site of surgery

106
Q

If have positive fecal leukocytes or fecal blood in the setting of diarrhea, what are likely infectious causes?

A 
Invasive disease (Salmonella, Yersinia, Shigella: white cells)
(Campylobacter, E.Coli, Vibrio parahemolyticus: red cells)
107
Q

What should you avoid in the treatment of a pt with E.Coli 0157:H7 associated HUS?

A
  1. avoid antibiotics (killing bacteria release more toxin)

2. avoid platelet transfusion (makes it worse)

108
Q

An elderly pt presents with colicky LLQ pain with painless bleeding most likely suffers from..

A

Diverticulosis (outpouching of colon)

109
Q

What is the diagnostic test of choice for Diverticulosis?

A

Colonscopy

110
Q

What is the treatment for Diverticulosis?

A

increase fiber (bran, metamucil, bulking agents, psyllium husks)

111
Q

A pt presents with intermittent flushing, wheezes, diarrhea, tachycardia and hypotension most likely suffers from …

A

Carcinoid syndrome (serotonin release- lung or appendix)

112
Q

What are the cardiac complications associated with Carcinoid syndrome?

A
  1. tricuspid insufficiency

2. pulmonic stenosis

113
Q

What is the treatment for diarrhea for carcinoid syndrome?

A

octreotide

114
Q

What is the diagnostic test of choice for carcinoid syndrome?

A

urinary 5HIAA

115
Q

A patient presents with greasy, oily, floating and fatty stools that are particularly foul smelling and weight loss most likely suffer from …

A

fat malabsorption syndromes (celiac disease, chronic pancreatitis, tropical sprue, whipple disease)

116
Q

What is the best treatment for tropical sprue?

A
  1. Bactrim

2. doxycycline

117
Q

What is the best inital diagnostic test for Celiac disease?

A
  1. anti-gliadin antibodies

2. anti-endomysial antibodies

118
Q

What is the most accurate diagnostic test for Celiac disease?

A

Small bowel biopsy (flattening of villi)

119
Q

What is the best treatment for Whipple’s disease?

A
  1. bactrim or doxycyline

2. ceftriaxone

120
Q

A pt presents with fat malabsorption after visiting a tropical country most likely suffers from …

A

tropical sprue

121
Q

What is d-xylose testing used for?

A

distinguish btw normal bowel wall versus abnormal bowel wall for fat malabsorption syndromes

122
Q

A pt presents with fat malabsorption with dementia, arthalgias, and ophthalmoplegia most likely suffers from …

A

Whipple’s disease

123
Q

What is the most sensitive test for Whipple’s disease?

A

PCR of bowel biopsy

124
Q

What findings on bowel-wall biopsy in patients with Whipple disease?

A

foamy macrophages that are PAS positive

125
Q

What is the most accurate test for chronic pancreatitis?

A

secretin testing (no bicarb release with secretin injection via NG tube)

126
Q

A pt presenting with fever, tenderness, leukocytosis, and intense LLQ pain most likely suffers from…

A

Diverticulitis (inflammation of outpouching)

127
Q

What is the best diagnostic test for diverticulitis?

A

CT scan (avoid barium swallow and endoscopy b/c increases perforation)

128
Q

What is the Sudan Black test?

A

detects fat in stool (used to detect fat malabsorption)

129
Q

What is the best treatment for diverticulitis?

A

Ciprofloxacin with metronidazole

130
Q

What vitamin deficiencies are associated with fat malabsorption?

A
  1. vitamin D (decrease calcium)
  2. vitamin A
  3. vitamin K (increased PT; easy brusing)
  4. vitamin E
131
Q

What are unique findings in Celiac disease compared to other fat malabsorption syndromes?

A
  1. iron deficiency
  2. folate deficiency
  3. dermatitis herpetiformis
132
Q

….. is vesicular skin rash on extensor surfaces of the body seen in Celiac disease

A

Dematitis herpetiformis

133
Q

What are common causes of constipation? (6)

A
  1. calcium channel blockers
  2. iron supplement (not absorbed so stuck in stool)
  3. hypothyroidism
  4. opioids
  5. anticholinergics (TCAs)
  6. diabetes
134
Q

If polyps are detected on colonoscopy, when should repeat colonscopy?

A

3-5 years

135
Q

In general population, when should colon cancer screening start and how often if normal?

A

at age 50 y/o, every 10 years

136
Q

Endocarditis due to what organism is associated with increased likelihood of colon cancer?

A

Strep bovis (colonoscopy screening immediately)

137
Q

A pt with 3 family members in at least 2 generations that were found to have colon cancer (1 prior to 50 y/o) most likely suffers from..

A

Hereditary Nonpolyposis Syndrome (lynch syndrome)

138
Q

What is the colon cancer screening recommendations for pt with Hereditary Nonpolyposis Syndrome?

A

colonoscopy q 1-2 years starting at 25 y/o

139
Q

A pt with multiple polyps associated with defect in APC gene most likely suffers from …

A

Familial adenomatous polyposis

140
Q

What is the screening recommendations for familial adenomatous polyposis?

A

flexible sigmoidoscopy every 1-2 years at 12 y/o

141
Q

If have familial adenomatous polyposis and start to have polyps on colon cancer screening, what is next best step?

A

colectomy (with new rectum from terminal ileum) b/c adenomas –> cancer all the time by 50 y/o

142
Q

A pt with hamartomous polyps and melanotic spots (hyperpigmentation of lips, skin, mucosa) presenting with abdominal pain due to intussusception/ bowel obstruction most likely suffers from …

A

Peutz-Jegher’s syndrome

143
Q

A pt with CNS tumors and colon cancer most likely suffers from …

A

Turcot syndrome

144
Q

A patient with multiple soft tissue tumors (osteomas of mandible, lipomas, fibrosarcomas) and colon cancer most likely suffers from …

A

Gardner syndrome

145
Q

What are the most common causes of acute pancreatitis?

A
  1. alcoholism
  2. gallstones
    (pentamidine, 6MP, sulf drugs, azathioprine, hypertriglyceridemia)
146
Q

What is the initial step in management of severe GI bleed (hypotensive & tachycardiac)?

A

fluid resuscitation w/ normal saline or lactated ringers

followed by CBC- hct & plt; PT; type & crossmatch

147
Q

When should you transfuse packed RBCs in pt with severe GI bleed?

A

Hct < 30% if older, heart disease

Hct <25% if younger, healthy

148
Q

When should you transfuse platelets?

A

platelets < 50,000 (if surgery or already bleeding)

149
Q

What is the next best step in management if the PT is elevated in pt with GI bleed?

A

fresh frozen plasma (immediate)

150
Q

What are the common causes of lower GI bleed?

A
  1. diverticulosis
  2. AVMs (angiodysplasia/ vascular ectasia)
  3. hemorrhoids
  4. cancer
151
Q

What are diagnostic criteria for orthostatic hypotension?

A
  1. HR >10 or more
  2. SBP > 20 or more
    (occurs once 15-20% blood loss; used if pt normal when lying down)
152
Q

If SBP < 100 or HR >100, suggests what amount of blood loss?

A

30% blood loss

153
Q

If a pt has hx of liver disease or alcoholism presenting with acute GI bleed, what treatment should be used if vomiting blood?

A

Octreotide (decreases portal hypertension to help with varices)

154
Q

If octreotide does not stop bleeding of esophageal varices, what is the next best step of management?

A

Emergency endoscopy for banding then TIPS (transjugular intrahepatic portosystemic shunting)

155
Q

What is a common complication of TIPS for varcieal bleeding?

A

encephalopathy (blood not detoxified by liver)

156
Q

What is the treatment used for pt who presented with variceal bleeding secondary to portal hypertension but now stable (no active bleed)?

A

Propanolol (nadolol; beta blocker prevents recurrent bleeding)

157
Q

A pt with an upper GI bleed with hx of abdominal aortic aneurysm repair in last 6 months most likely suffers from …

A

aortoenteric fistula

158
Q

A pt presents with mid-epigastric pain that radiates to the back with tenderness, nausea, vomiting most likely suffers from …

A

acute pancreatitis

159
Q

What is the initial best test for suspected pancreatitis?

A

amylase and lipase

160
Q

What is the most accurate test for severity pancreatitis?

A

CT scan (better than ranson criteria- leukocytosis, LDH, AST, BUN, glucose, hypoxia, hypocalcemia; to determine if surgery)

161
Q

If CT scan shows severe necrosis of pancreas in pancreatitis, what is the next best step in management?

A
  1. give antibiotics (imipenem)

2. percutaneous needle biopsy

162
Q

… is blue discoloration around umbilicus due to hemoperitoneum and is a sign of ….

A

Cullen sign; severe necrotizing pancreatitis

163
Q

… is bluish purple discoloration of the flanks due to tissue catabolism of hemoglobin and is a sign of ….

A

Turner’s sign; severe necrotizing pancreatitis

164
Q

What is the best treatment for acute pancreatitis that is not necrotizing?

A

NPO (bowel rest) and IV fluids

165
Q

What is a common complication of pancreatitis that occurs withing 2-4 weeks of acute episode?

A

pseudocyst

drain if enlarging, rupture, pain, fistula formation

166
Q

What are signs/symptoms of cirrhosis? (6)

A
  1. hypoalbuminemia (ascites, edema)
  2. elevated PT (decrease in clotting factors)
  3. spider angiomata, palmar erythema
  4. asterixis
  5. portal hypertension (causes varices)
  6. encephalopathy
  7. splenomegaly (thrombocytopenia)
167
Q

What is the treatment for the ascites and edema associated with cirrhosis?

A

spironolactone (decrease aldosterone effects from intravascular volume depletion)

168
Q

What is the treatment for the encephalopathy associated with cirrhosis?

A

lactulose (binds uremic acid and eliminates)

169
Q

What clotting factors are not made in the liver?

A
  1. factor 8

2. von willebrand factor

170
Q

What is the treatment for prolonged PT in the setting of active bleeding?

A

fresh frozen plasma

171
Q

What SAAG?

A

difference between serum-ascites albumin gradient

high in portal hypertension- low albumin in ascites

172
Q

What happens to SAAG in portal hypertension?

A

high b/c albumin in ascites is low

173
Q

What happens to SAAG in spontaneous bacterial peritonitis?

A

high

174
Q

What is the diagnostic criteria for spontaneous bacterial peritonitis (SBP)?

A
  1. WBC >500 in ascitic fluid

2. neutrophils >250 in ascitic fluid

175
Q

What is the treatment of spontaneous bacterial peritonitis (SBP)?

A
  1. cefotaxime (renal metabolized)
  2. ceftriaxone (liver metabolized)
    (w/ albumin transfusion)
176
Q

What liver disease is associated with inflammatory bowel disease?

A

Primary sclerosing cholangitis

177
Q

A middle-age female presents with pruritis and elevated alkaline phosphatase most likely suffers from …

A

primary biliary cirrhosis

178
Q

What antibodies are associated with primary biliary cirrhosis?

A

anti-mitochondrial antibodies

179
Q

A pt presents with pruritis and elevated alkaline phosphatase and a hx of inflammatory bowel disease most likely suffers from …

A

primary sclerosing cholangitis

180
Q

What is the most accurate test for primary sclerosing cholangits?

A

ERCP (tortusity and beading of biliary system)

181
Q

What is the treatment for primary sclerosing cholangitis and primary biliary cirrhosis?

A
  1. cholestyramine

2. urosdeoxycholic acid

182
Q

What is the initial diagnostic test for chronic hep C?

A

anti-hep C antibodies

PCR hep C viral load

183
Q

What is the initial diagnostic test for Wilson’s disease?

A
  1. ceruloplasmin (low)
    (high urinary copper level)
  2. slit lamp exam for kayser fleischer rings
184
Q

What is the initial diagnostic test for Hemochromatosis?

A

Iron studies (elevated iron, decreased TIBC, increased ferritin)

185
Q

A pt with a young non-smoker with emphysema and liver diease most likely suffers from …

A

Alpha-1 antitrypsin deficiency

186
Q

What is the treatment for alpha-1 antitrypsin deficiency?

A

replace enzyme

187
Q

A pt presenting with liver disease, skin hyperpigmentation, insulin intolerance/ diabetes, and restrictive cardiomyopathy most likely suffers from ….

A

Hemochromatosis

liver, heart, pancreas, skin, joints, infertility

188
Q

What infections are common in patient with Hemochromatosis?

A
  1. Vibro vulnificus

2. Yersinia

189
Q

A pt presents with liver disease, movement disorder and eye problems most likely suffers from …

A

Wilson’s Disease

liver, movement due to basal ganglia, Kayser Fleischer rings

190
Q

What is the treatment for Hemochromatosis?

A

phlebotomy

191
Q

What is the treatment for Wilson’s disease?

A

copper chelators (penicillamine, trientine)

192
Q

What is the diagnostic criteria for chronic hep B infection?

A

hep B surface antigen for more than 6 months

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