GI Flashcards
1
Q
can you get pleural effusion in Boerrhave?
A
yes you can get pleural effusion in boeerhave
2
Q
dx of Boeerhave?
A
Gastrografin water soluble gram or CT
3
Q
Dx of esophagitis in HIV for CMV versus HIV versus candida?
A
Candida will have thrush and no odynophagia and just treat with PO fluconazole, versus CMV and HSV will have NO thrusth and will have odynophagia and NEED EGD to diagnose
4
Q
Tx of CMV vs HSV esophagitis
A
Acyclovir (HSV) and gangciclovir (CMV)
5
Q
Initial study for motility disorders?
A
Suggested when solid/liquids at same time are troublesome, not progressive, do a barium swallow and follow with manometry as definitive diagnosis. In achalasia, it mimics CA and EGD is needed after swallow to r/o cancer.
6
Q
Other causes of Boeerhave other than vomiting?
A
Iatrogenic from instrumentation and procedures. Suspect with with acute chest pain, crepitus and emphysema and left pelrual effusion. Dx with contrast water-sol esophagram
7
Q
What does a pill-induced esophagitis look like?
A
Circumferental ulceration that is sudden onset with pain and odynophagia + dysphagia. Commonly due to bisphosphonates, NSAID, KCl and tetracyclines
8
Q
When do you see a cork-screw esophagus?
A
Diffuse esophageal spasm
9
Q
What else is a concern in diffuse esophageal spasm?
A
Need to do a cario work-up.
10
Q
Definitive test for diffuse esophageal spasm?
A
EKG/Cardio workup – barium swallow – manometry (Definitive) with simultaneous contractions
11
Q
tx of diffuse esophageal spasm?
A
CCb, nitrates
12
Q
What does barium swallow show for achalasia
A
LES tone is increased, birds-beak, Need EGD after then need to do manometry to make definitive diagnosis and remember the LES will not relax
13
Q
tx of achalasia short term
A
NO2 and CCB or botulinum toxin
14
Q
long term tx of achalasia
A
pneumatic balloon dilation, myotomy (Heller)
15
Q
How is Zenker dx?
A
Dx Zenker with barium swallow showing outpouchings (false) diverticuli in the posterior UES of the cricopharyngeal muscle. Remember it can present as a mass
16
Q
Tx of Zenker?
A
Surgery and removal of the false diverticuli is the treatment for Zenker
17
Q
Dx of esophageal cancer
A
With alarm syx you go right to EGD (weight loss, pain, dysphagia, smoker) then stage it with CT
18
Q
What causes stricture of esophagus?
A
GERD, radiation, sclerosis; it is circumferential narrowing. Dysphagia for solids not liquids more common
19
Q
If someone has dysphagia progressive from solids to liquids, but has a history of radiation or esophageal surgery, how do you diagnose?
A
Suspect stricture, do barium swallow; if not, do EGD and suspect cancer. Alg 2212. These patients have increased risk of perforation from lesser diameter and can have barium swallow first to rule out stricture.
20
Q
Dysphagia of solids AND liquids? Dx?
A
Means motility. Barium swallow. Progressive = mechanical obstruction = EGD and suspect CA
21
Q
What is an odd, but common sign of perforation of esophagus?
A
Pleural effusion and look for wide mediastinum if quick XR done or Hamman sign with crunching on auscultation of the chest
22
Q
Pill-induced esophagitis
A
CIRCUMFERENTIAL (viral would not cause this, does not contact whole mucsoa) ulcerations with normal surrounding mucosa on EGD
23
Q
First line in diffuse esophageal spasms?
A
Calcium channel blockers
24
Q
how does Diffuse eso spasm look on mano?
A
Multiple, simultaneous contraction
25
what is definitive dx for diffuse eso spasm?
like other motility disorders, manometry is definitive
26
achalasia tx short term
CCB and nitrates or botulinum
27
long term tx of achalasia
dilation and heller myotomy
28
how is zenker diagnosed?
Zenker is diagnosed with barium swallow
29
is manometry needed in zenker?
zenker is not motility disorder, it is an outpouching so no confirmation with motility study is needed as it will likely be normal
30
how is zenker treated
zenker is treated with surgical excision of the diverticulum and myotomy
31
Is CT needed after EGD in eso or gastric cancer?
Yes, CT is always needed to stage after histologic diagnosis and determines prognosis and treatment
32
Duodenal ulcers are treated how?
Treat duodenal ulcers as if they are due to H/ pylori, as 90% are. Syx are better with food and wrose without food; need PPI + clarithro + amox (or gent if amox allergy)
33
ZE syndrome check for?
MEN1 parathyroid / PTH and pituitary dysfunction
34
Dxylose is absorbed when
When GI mucosa is normal, it does NOT need brush border to be absorbed (normal in lactose def), but it will be abnormal in Celiac, IBD, etc
35
Preferred diagnosis for Giardiasis?
Stool Ag (versus histolytica which is SERUM ag as it is systemic and no longer gut once RUQ syx start)
36
Tx for giardia
Dx with stool Ag then tx with metro
37
s/s of vit D deficiency?
May happen with chronic, malabsorptive diarrhea (DAKE) with low vit D, low Ca, HIGH PTH, and LOW PO4,3-
38
Tropical sprue s/s
endemic area for 1 month, most have malabsoprtion of the small gut
39
dx of tropical sprue
small gut biopsy, which is the reason they have malabsorption and megaloblastic anemia along with blunt villi and chronic inflammatory cells present
40
Dx for c. diff
stool studies + empiric metro
41
how is c. diff treated empirically?
metro and stool studies
42
unexplained leukocytosis in hospitalized patient on antibiotics (or not), think?
c. diff
43
Do you do I and D / aspiration of abscess from histolytica?
NO, DO NOT do I and D of histolytica in the RUQ as it is due to an abscess and not a cyst
44
how do you treat histolytic abscess?
Just use metro
45
How is histolytica dx?
Dx histolytica with BLOOD SERUM AG NOT STOOL AG (unlike giardia) because by the time there is RUQ pain it is an ascess and out of the gut
46
RUQ pain preceded by dysentary from a Mexican and mass seen on U/S, treat?
Get a serum Ag for histolytica (not stool) then do metro WITHOUT drainage of the ABSCESS and add praomycin or maromycin to get rid of larvae
47
Dx of EHEC?
Shiga-toxin stool assay
48
Cx of EHEC
Watch for microangiopathic hemolytic anemia and low PLT and rising Cr/BUN due to HUS
49
Do you treat EHEC?
NO! DO NOT TREAT EHEC it raises the risk for HUS
50
Abd pain and diarrhea without fever?
Abd pain and diarrhea without fever you suspect EHEC, versus C. diff which is healthcare associated and abd pain/diarrhea WITH fever
51
Salmonella associations (food and demographic?
Eggs and poultry + SCA osteomyelitis
52
Treat salmonella?
Yes with fluoroquinolones or TMPSMX
53
Tx shigella?
YES! treat shigella vs EHEC in which you do NOT treat
54
Whipple disease causes?
LAD, diarrhea (malab), fever, joint pain, heart block, weight loss, cough, dementia
55
Dx of Whipple
PAS + adn PCR, gram + bacillus
56
Small I overgrowth can cause?
malabsorption due to gut bacteria
57
what is diagnostic of bact small I overgrowth
Biopsy with 10^5 organisms or more; causes B12, calcium, iron def
58
Why is it a condition (small I overgrowth)
Usually not as many in small bowel due to higher acidity from gut
59
How do you treat small I overgrowth
Treat it with 7-10d of amox-clv and rifamixin and stimulate motility (metoclopramide and avoid narcotics as no movement allows bact to overgrow)
60
What nutrient def does Celiac commonly cause
Celiac commonly causes Iron Def as it is in the duodenum and early jejenum
61
Dx of Celiac?
Anti-Endomysial IgA transglut (can be negative if IgA def ) to biopsy as definitive lesion
62
MCC of malabsorptoin?
Chronic pancreatitis due to alcohol
63
How is steatorrhea confirmed?
Fecal fat tests confrim steatorrhea with sudan stain on spot stool specimen
64
Person has foul smelling stools, loose and high volume, BMI19 with pain radiating to his back, what is the cause?
Alcohol most likely
65
Some fat-sol deficiencies in steatorrhea?
D, A, K, E
66
Why does Celiac affect Iron abs?
Earliest part of the gut is where it blunts villi in duod and jejenum where iron is absorbed
67
Lactose deficiency diagnosis?
Reducing substances in the stool with + Hydrogen breath test, low stool pH and osmotic diarrhea without steatorrhea (acidic due to fermentation products)
68
How is carcinoid diagnosed?
Carcinoid syndrome is due to serotonin which has breakdown product 5HIAA, diagnose it with 24 hour urine test of 5HIAA
69
s/s carcinoid
Wheeze, right valve issues, flushing, diarrhea and +5HIAA in urine
70
Carcinoid syndrome may cause what else?
Due to appendiceal and small bowerl 5HT3 secreting tumors, it uses up tryptophan to make it causing a niacin deficiency = pellagra
71
When is pellagra seen commonly
Malnutrition of niacin and serotonin syndrome
72
S/s of pellagra i/e in carcinoid syndrome?
The D's: Dermatitis, dementia, diarrhea (hyperpigmentation comon)
73
Consider what in carcinoid sydrome?
Consider echocardiogram
74
Full dx of carcinoid
5HIAA -- CT or MRI to locate -- Octreoscan to detect mets
75
Carcinoid Tx before surgery for syx?
Octerotide treats carcinoid
76
Common met of carcinoid tumor
To liver, then you get syx
77
Big tip off for laxative (factitious) diarrhea?
Nocturnal diarrhea
78
How to diagnose factitious diarrha?
Diagnose factitious diarrhea wiht melanosis coli by dark brown discoloration of colon withlymph follicles shining through as pale patches. Their diarrhea will also be an extreme number of times a day with multiple hospitalization and no definitive diagnosis (3593)
(laxatives pigment GI tract)
79
What does IBS mucosa look like?
NORMAL mucosa
80
What are things suggesting something isn;t IBS
IBS has normal mucosa and alternating constipation and diarrhea, pain relieved with defecation, labs will be normal; won't se rectal bleeding, noctunral diarrhea-- functional disorder of the GI tract and NO ALARM SYX
81
What is a succession splash indicative of?
Bowel obstruction as food sloshes around between gas that is obstructed as a hollow viscus with gas
82
Tx of gastric outlet obstruction
NG tube, IVF, endoscopy is definitive
83
Diff between ileus and bowel obstruction on XR?
Ileus is both small and large bowel dilation and obstruction is dilation proximal to an obstructed lesion
84
Diverticulitis versus osis syx
itis is pain with fever and ifnectious syx and without bleeding and osis has bleeding that is painless
85
When do you see colovesicular fistula?
You see it with diverticular disease and consider in Crohn's transmural inflammation; consider CRC as this may erode through bowel and follow-up with scope if high suspicion
86
dx colonovesicular fistula?
CT with oral/rectal contrast in bladder and thickened walls and get colonoscopy to excldue malignancy as these can erode too
87
Diagnosis of diverticulitis
AVOID SCOPE = perf; do CT
88
dx of diverticulosis
scope is definitive, do not scope in itits
89
Bright red blood per rectum in a young patient with pain and no alarm syx or family history?
Anoscopy in - office, if negative do a scope follow up
90
Do hyperplastic polyps need workup?
No
91
risks for polyp to cancer?
>2.5cm, villous/sessile adenoma
92
Most malignant polyp?
Villous >2.5cm
93
Person has FP, can you follow closely?
NO. IN FAP you DO NOT FOLLOW CLOSE -- your recommended a proctocolectomy
94
What cancer is most common in HPNCC (lynch) other than bowel?
Endometrial, all women need endometrial collow up
95
C. diff high risk patient with negative PCR for stool toxins do what?
Do a scope to document pseudomembranous colitis
96
thumb printing on XR following procedure where BP drops in a patient with ASCVD and now abdominal pain and bloody stool?
Thumb printing on XR with the aforementioned think ischemic colitis
97
What marker for CRC?
CEA
98
How is Mesenteric ischemic detected
Start with an U/S or a CT angiography
99
In lower GI bleeds, what happens if scope doesn't locate source of bleeding
Lower Gi bleed --NG tube-- scope done -- nothing found -- Tn99 localization -- then CT
100
In the case of a GI bleed, first step?
In a GI bleed, do an NG tube then some sort of a scope either upper or lower
101
IN a GI bleed that cannot be found with scope, then what?
Do a Tn99 scan after and THEN a CT to localize definitively
102
In ISCHEMIC COLITIS, what do you start with
ischemic colitis you can start with SMA u/s and then do a CT
103
Ischemic colitis, MC place and artery
Use u/s of splenic flexure for SMA and then consider IMA afterward
104
Mallory weiss tears are due to what vasculature?
MW are due to submucosal arteries and sotp on their own 90% of time
105
What type of rupture are varices?
Varices are GE junction veins due to portan HTN
106
MW is vein or artery?
MW is artery
107
Variceal is vein or artery?
Vein is variceal at GE junction
108
Why is angiodysplasia *Heyde* associated with ESRD and aortic stenosis
Bleeding is more likley due to uremia consuming platelets and due to aortic stenosis turbulence causing microangiopathic anemia
109
Urine bilirubin is what kind?
Only conjugated bilirubin is water soluble so only that can be found in the urine
110
Someone has solely elevated Alk-phos, what needs to be ordered?
You need to image the liver with U/S
111
What do you suspect with conj, bili elevated in the urine and no other lab findings?
Suspect DJ and rotor syndrome
112
Gilbert is a defect in?
UDP conj and causes mild jaundice do to unconj bili
113
Criggler is a defect in?
UDP conj bilir and more severe with kernicterus, pheno barb treats type II
114
Dubin Johnson is a defect in ?
Conjugation excretion (it cannot be excreted) = jaundice and black liver
115
Rotor is?
Same as DJ, cannot excrete bili, even milder no black liver
116
Screening of CRC?
q10 with a scope, q5 sigmoid, at age 040 with cancer or 10 years beofre, less tan 5 years if polyp found that is precancerous
117
What can TPN due to gallbladder?
TPN = less CKK = stasis = gallstones
118
Person has high alk phospatase, what is next and how is it interpreted?
Do a U/S for intra vs extrahepatic cholestasis (intra is no CBD dilation)
119
Why do UC get megacolon
UC get megacolon because the plexus is damaged and it distends and cannot maintain normal tone
120
Biopsy of Crohns, classic lesion?
Non caseating granuloma in Crohn's
121
Biopsy of UC classic lesion?
Crypt abscess MORE COMMON in UC, non-caseating granuloma in Crohn's
122
Are fistulas in Crohn or UC
Fistula and tags and mouth to anus ulcers are in Crohn's
123
what IBD is skip lesions?
SKip lesions, fat creeping, cobblestoning, fistula, tags, oral ulcers are Crohn's with non-caseating granuloma
124
Dx of toxic megacolon in UC patient suspected?
DO an XR DO NOT do scope you will perf it
125
Difference between acute cholecystis and biliary colic?
Cholecystitis is obstruction that isn't moving with inflammation and colic is temporary obstruction that clears and does not cause inflammation (no fever, tenderness, pain resolves, WBC and liver counts normal)
126
How is gallbladder emphysema treated?
Emergent chole and amp-sulbactam
127
Best step for RUQ pain or odd LFTs?
U/S; after U/S do HIDA if equivocal and high suspicion
128
Poor candidate for gall surgery?
Do ursodeoxycholic acid (but recur)
129
Pain after chole "similar" to before? do what and fix how?
Do U/S and follow with ERCP/MCRP likely due to a stuck stone
130
elevated alk phos and bilirubin levels do what?
Do a US of the gallbladder and suspect obstruction in CBD as high alk phos and leaking of bile suggests choledocholithisiasis and follow with ERCP
131
Pancreatitis suspected, first test?
need to detect gallstones as it is a common cause of pancreatitis, so do a U/S in a person with acute pancreatitis and follow with ERCP if positive or unsure
132
Calcified gallbladder
Porcelain gallbladder has high risk of adenocarcinoma, remove it even without syx.
133
Risk of porcelain gallbladder?
Chronic cholecystitis
134
If you see AST and ALT in the thousands, what is the cause
Think acute liver failure, which presents with AST ALT in the thousands and high INR, PT/PTT, bilirubin
135
What is the antibody that distinguished infection from vaccination in asyx individual?
The antibody is the antiHBc which is the window AB in infected, but not in immunized
136
First marker in HBV infection
HBsAg
137
Window marker in HBV
HBcAg which is NOT in the vaccination and is unique to infected individuals (or antibodies against it)
138
Hep a weird syx
aversion to cigarettes
139
how is hep A treated
in hep A it self resolves IgA to close contacts
140
Going abroad? MC travel acquired illness?
Hep A
141
What is mixed cryoglobulinemia associated with
Mixed cryo = HCV screen and vice versa
142
What other two things beside cyroglob are associated with HCV?
HCV is associated with membranoproliferative GN and porphoryia cutanea tarde
143
If you see vesicles on the dorsum onf someones hands, IC deposits and purpura and low serum complement + membranoproliferative GN, think what?
HCV due to porphyria cutaneua tarda and cryoglobulinemia
144
What vasculitis is associated with HBV
HBV has a PAN association (lungs spared)
145
Autoimmune hep diagnosis?
ANA first then anti-SMC antibodies
146
Chronic liver disease patients need what vaccination?
HAV and HBV in chronic liver disease. Infection of new virus and at high risk for fulminant liver failure
147
What drugs are used to treat HBV
Treat HBV with entecarvir and tenofovir lowest resistance against them
148
What do ALL HCV patients need before tx?
HCV patients need a liver biopsy to rule out other causes and types of liver disease and is the best way to assess response to treatment, weird time you jump right to the procedure and treat with IFN and ribavirin
149
Why do you get liver biopsy in HCV
many have alternating levels of LFTs that do not correlate with severity and biopsy is best way to see severity
150
Why do cirrhotic patients need U/S q6 months?
Cirrhotic patients get U/S q6 months because they are at risk of developing HCC
151
A1 diagnosis and biopsy shows
Diastase resistance and PAS + along with elevated LFTs and early-onset emphysema
152
Dx of a1 antitryp
GEnetic test
153
Cirrhosis does what to HPA axis
Cirrhosis causes hypogonadism
154
All new onset ascites needs?
TAP ALL NEW ONSET ASCITES just like all unknown pleural effusions
155
Cause of the low libido, body hair, palmar erythema, small testes, ED in cirrhosis?
There is hyperestrogenism
156
Cr >1.5 and Na in urine
Hepatorenal sydrome is due to renal hypoperfusion from splanchnic vasodilation and fluid shifts resulting in kidney damage that does not respond to IV bolus with high mortality rate, only transplant is curative
157
How is hepatorenal treated?
Hepatorenal is treated with midodrine and octreotide + norpeinpehrine to constrict the splanichic circulation, otherwise liver must be trasnplanted. IV bolud will still show decreaseing urine output.
158
What is a way to treat hepatic hydrothorax
hepatic hydrothorax is transudative and can be treated with fluid restriction and diuretics, but TIPS is curative
159
Everytime you see ascites you need a tap, but how do you evaluate the cause?
You do serum alb - ascitic alb and >1.1 =portal HTN and
160
SAAG > 1.1
Portal HTN
161
SAAG
Not portal related
162
What is the stepwise approach for ascites tx?
Tx ascites with water and salt restriction, then add spironolactone because it decreases antiandrogen syx and blocks Na reabsorption, then add furosemide, then tap ascitic fluid 2-4x daily
163
How come you have to be careful with diuresis in ascites?
There is transudate and hydrostatic edema in ascites and the patients are volume deplete, ease into diuresis as this prevents hepatorenal syndrome which is why the last step of tx is tapping it rather than more diuresis
164
When do you suspect SBP?
In ascites when a patient has fever, any abd pain or altered mentorium
165
How is SBP diagnose
PMN >250
166
HOw is SBP treated
Treat empirically with third generation cephalosporins (e.coli and klebsiella)
167
How does heptarenal present?
It is due to lack of perfusion to kidneys from splanchinic VASODILATION and storage of blood from portal hypertension resulting in decreased urine output and rising Cr and down GFR in the absence of proteinuria/extreme acute hypoperfusion event
168
Tx o hepatorenal syndrome
Will not respond to IVF and urine output will be still low, they will third space. Octreotide and Epi and midodrine can constrict splanchnic and improve flow to kidneys, but only cure that reduces mortality is liver transplant
169
Urine lab indicating hepatorenal syndrome?
They have very very low urine sodium (
170
Body labs for hepatorenal sydrome/cirrhosis
They have very dilute sodium and low potassium. There is decreased perfusion to kidneys activating RAA and increasing sodium reabsorption and K+ excretion along with HCO3 absorption
171
First step in Tx of bleeding varices?
Control blood as surgery is prepped with IVF + OCTREOTIDE
172
After IVF and octreotide as first step for varcies then what?
IVF and octreotide for variceal bleed -- then sclerotherapy;
173
Tx of varices is IVF + octreotide then EGD with sclerotherapy, what if that doesn't work?
Then do a balloon tamponade and follow with TIPS. If it works, initiate BB and follow up for band ligation in 1-2 weeks. If they have a rebleed to EGD again and follow up with TIPs
174
Who gets primary sclerosing cholangitis?
Primary sclerosing cholangitis = UC patients
175
What is the defect in primary sclerosing cholangitis?
The defect in primary sclerosing cholangitis si fibrosis and stricturing intra and extra hepatically
176
What is the histologic sign of primary sclerosing cholangitis
Onion skinning
177
What is definitive tx for PSC
PSC is treated definitively with liver transplantation
178
How is PSC diagnosed?
U/S does NOT diagnose it usually, requires a cholangiogram with ERCP, MRCP to see the beading
179
Diagnosis of PSC after a U/S in a UC patient with high alk phosphatase is negative?
YOU NEED To diagnose PSC in a UC patient with cholangiogram ERCP/MCRP because U/S cannot detect it.
180
A patient has primary biliary cirrhosis confirmed with anti-mitochondrial Ab, what treatment without s/s of cirrhosis?
Ursodeoxycholic acid slows progression, if cirrhotic syx/ they need a liver transplant
181
Where is the defect in PBC
PBC is in middle aged women and intrahepatic
182
Why does it matter that PBC is intraheptic
U/S will not detect intrahepatic duct changes, similar to PSC in US which is intra and extra, but U/S cannot detect it. Diagnose with anti-mito Ab here and in PSC you need cholangiogram with ERCP and MRCP
183
What is NAFLD
It is mild liver elevations due to fatty steatosis not form alcohol in obese, DM patients
184
how is NAFLD treated?
Diet and exercise
185
Are statins ok in NAFLD?
YES! Statins are ok in NAFLD, tell them to lose weight
186
What is NAFLD related to?
NAFLD is related to insulin resistance
187
Is NAFLD related to alchol
NO, NAFLD is NON ALCOHOLIC
188
Why is NAFLD related to insulin resistance?
More insulin resistance, more release of FFA which are taken up by the liver
189
Do you biopsy hepatic adenoma?
do not biopsy hepatic adenoma, follow with AFP and U/S to make sure no transformation
190
What is the marker to follow benign adenoma with?
AFP and U/S
191
Hepatic adenoma, who gets it and how is it treated and what is C/I?
hepatic adenoma in OCP and anabolic steroid use and is followed with AFP and U/S to make sure it does not transform, DO NOT biopsy it due to hemorrhage, just complete resection if becomes worrisome
192
Main risk for cholangiocarcinoma (cancer of biliary tress)
main risk of cholangiocarcinoma is primary sclerosing cholangitis as found in UC patients
193
Multiple liver lesions (mets) where do you look first to find primary tumor?
Colon.
194
AFP and RUQ pain think?
Liver cancer. AFP is associated with liver cancers
195
Biggest risk for Hemochromatosis
Risk of HCC
196
HCC is associated with hemochromatosis true of false
TRue! HCC has 20-200x increase risk in hemochromatosis
197
Syx of hemochromatosis
bronze skin, hepatic LFT elevation, small testes, DM evidence, herat failure and arthropathy with hepatomegaly
198
What weird syx do hemochromatosis patients get
They get chondrocalcinosis of joints confused with pseudogout, along with small testes and bronze skin and high risk of HCC
199
What genes are associated in hemochromatosis
HFT and H63D
200
Dx of hemochromatosis
First do iron studies (otherwise wasted gene test) then test for HFE and H63D and if negative, but suspicion high, then you do liver biopsy
201
What is another name for Wilson disease?
Hepatolenticular degeneration
202
How is Wilson diagnosed?
Dx with low ceruloplasmin, high copper (or high copper excretion) and Kayser Fleisher rings with slit lamp, biopsy liver only if unceratin
203
How is Wilson treated
Wilson is treated with trienterene or penicilaamine vs hemochromatosis with phlebotomy and deferoxamine
204
Gastrinoma is diagnosed after EGD with multiple ulcers and gastrin level >1000, what if gastrin is less/equivocal? (between 110 and 1000)? Note: if gastrin >1000 and stomach pH
Then do secretin stimulation test to see if the levels drop, if they do not, check stomach pH
205
For beta cell tumor, what do you need to order?
Order insulin levels, blood sugar, C peptide and sulfonylurea levels (remember sulfonylureas cause incresaed C peptide it is endogenous as well)
206
How is bleeding treated in someone with cirrhosis?
Cirrhotic patients cannot make their clotting factors so you treat it with FFP which replaces all those factors
207
Most significant risk of pancreatic CA?
Smoking most consistent reversible factor
208
What drug is a common cause of pancreatitis
Alc and stones are mCC (Get U/S) but anti-seizure meds like valproic acid cause pancreatitis
209
MCC of chronic pancreatitis?
MCC is alcohol abuse of CHRONIC pancreatitis, mCC reversible for pancreatic cancer is cigarettes
210
Is imaging needed to diagnose pancreatitis?
NO IMAGING IS NOT NEEDED TO DIAGNOSE PANCREATITIS. Just n/v with radiating pain and get a lipase level. Consider U/S d/t high risk of stones causing it.
211
How is pancreatitis diagnosed?
2/3: Acute pain radiating to back, high lipase, or imaging with U/s -- imaging is NOT required
212
Pancreatic CA marker
Pancreatic CA marker is CA19-1
213
How is pancreatic pseudocyst diagnosed
it is a non-epithelial fibrous capsule that may present with pain and a mass, observe for 6 weeks then drain if no resolution. Diagnosis with US, a CT iS NOT NEEDED
214
Pancreatic pseudocyst dx with CT or U/s
U/S if possible
215
Is screening recommended in pancreatic CA
NO SCREENING RECOMMENDED FOR PANCREATIC CA
216
what screening is rx for pancreatic ca
NO SCREENING FOR PANCREATIC CA REGARDLESS OF HISTORY IN ASYX PATIENT
217
When do you suspect zinc def
Suspect in TPN/bowel resection/Crohn/IBD patients with hair loss, skin lesions, foot tastes bad, and pustular bullae on the skin
218
What causes pellagra
Niacin def
219
when does niacin cause a disease
niacin causes pellagra and shares a precursor with serotonin so high serotonin means less tryptophan and less niacin synthesis
220
s/s of niacin def (pellagra)
pellagra is niacin deff and presents with dermatitis, dementia and diarrhea in setting of serotonin syndrome
221
What drug causes pellagra
INH causes pellagra
222
INH causes what nutritional deficiency
prolonged INH can cause pellagra
223
What disease is associated with vanishing ducts in the hepatic system
ductopenia intrahepatic is due to primary biliary cirrhosis
224
what disease is associated with ductopenia
vanishing ducts is associated with primary biliary cirrhosis
225
When else does ductopenia happen
ductopenia is due to an immune response and happens after bone marrow transplant, liver transplant or in patients with primary biliary cirrhosis
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Pallor in an old person first guess?
NSAIDs/ASA or iron deficiency anemia from bleeding get CBC and iron studies and scope if no NSAIDs and deficient
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Duodenal ulcer treatment?
Better with eating, suspect H. pylori, as they are involved in 90% of cases. Treat with triple therapy, not just PPI
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A patient has elevated alkaline phosphatase with normal LFTs and high bilirubin, what is considered as a next diagnostic step?
This reflects cholestasis and obstruction and RUQ U/S needs consideration (especially with s/s of jaundice/iceterus or elevated bilirubin, don't forget Paget's as well). If Alk phosph was high and AST and ALT were high, you would consider hepatitis, hemochromatosis, toxins, alc, ischemia, etc
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DJ syndrome and treatment?
Benign, conjugated hyperbilirubinemia with grossly black liver (Rotor is less intense form) and look at urine uroporphyinogen levels to confirm, no tx needed.
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How is Zenker treated?
Zenker is treated with surgical excision, commonly they have a mass and regurgitation -- barium swallow first and confirm with mano.
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Who gets Zn def?
TPN patients
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what are s/s of Zn def?
Periorbital rash, hair loss, food/taste aversion, TPN, skin lesions and impaired wound healing
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Does NAFLD cause fibrosis?
Yes, up to 40%
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How is NAFLD treated?
Exercise and statins are ok too
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What are NAFLD labs like
Exclude alc and mild elevation in AST and ALT and ratio~1
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Urine is dark and dipstick shows bilirubin, interpret as what?
CONJUGATED BILIRUBIN can be renally excreted, not unconjugated
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PBC treatment as soon as diagnosed?
As soon as PBC diagnosed start ursodeoxycholid acid
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if someone has high alk phosphatase and nos/s of jaundice, first step?
yGGT, then if high you know its liver, if not = Paget. After you find it is liver = RUQ U/S
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hemochromatosis genes?
HFE
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How is cholangitis treated?
Treated wtih ERCP and broad-spec antibiotics
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s/s of cholangitis
RUQ pain, jaundice, fever, hypotension, mental status changes
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Pancreatic cancer is associated with what antigen?
CA19-9 = pancreatic CA
