GI Flashcards
(14 cards)
Dx requirements of acute liver failure
1) Severe acute liver injury (AST and ALT often > 1000 U/L)
2) Signs of HE
3) Synthetic liver dysfunction (INR greater than or equal to 1.5)
Should have EARLY CONSIDERATIONS FOR TRANSPLANT–survival w/o transplant is low.
Conditions where LFTs can potentially reach 10,000?
Severe hepatic injury leading to severe necrosis:
1) Shock liver/ischemia
2) Acetominophen toxicity
3) Viral hepatitis
LFTs usually go back to normal if patient survives underlying illness/condition.
Eosinophilic esophagitis
Path: Chronic, immune-mediated esophageal inflammation; no treatment can lead to stricture formation
Clinical features:
1) Dysphagia - solid foods
2) Chest/epigastric pain
3) Reflux/vomiting, reflux refractory to PPIs
4) Food impaction from esophageal narrowing
5) Drooling, hypersalivation, inability to tolerate liquids
6) A/w atopy
Dx: Endoscopy and esophageal bx (>= eos/hpf)
Tx: dietary modification, +/- topical glucocorticoids (fluticasone, budenoside)
Food impaction can lead to esophageal perforation and requires urgent upper endoscopy to remove food bolus
Osler Weber Rendu Syndrome (aka hereditary hemorrhagic telangiectasia)
AD d/o characterized by diffuse telangiectasias (ruby colored papules that blanch with pressure), recurrent epistaxis, and widespread AVMs.
AVMs tend to occur in mucous membranes, skin, GI tract, but may also present in liver, brain, and lungs. AVMs in lungs can shunt blood from right to left side of the heart, cause chronic hypoxemia, digital clubbing, and reactive polycythemia.
Treatment for Wilson Disease
Chelators: D-penicillamine, trientine
Zinc: interferes with copper absorption
Transplant is definitive
Recommended screening for UC?
CRC screening 8-10 years after dx, even in the absence of symptoms
Dx pancreatic adenocarcinoma
Jaundice + radiating epigastric pain = head of pancreas (biliary obstruction, steatorrhea) –> abd US
No obstructive jaundice = tail and body –> abd CT w/ contrast (more sensitive and specific) that can delineate necrosis within pancreas and ID distant metastases; can exclude other conditions
CA 19-9 not recommended for screening due to variable sensitivity and low specificity. Normal levels do not r/o pancreatic cancer.
ASA/NSAIDS and colon cancer
Have been a/w reduced risk of colon cancer in average risk.
HOWEVER, have no studies showing decrease risk of FAP.
SAAG score
Serum to ascites albumin gradient can help differentiate portal hypertension vs. non-portal hypertensive causes of ascites
SAAG = serum albumin - peritoneal fluid albumin
=>1.1 portal HTN
<1.1 suggests other causes
IBS
Functional d/o characterized by recurrent abdominal pain and altered bowel habits with symptoms that improve or worsen with bowel movements.
DOE with following Rome IV dx criteria: recurrent abdominal pain/discomfort => 1 day/wk x 3 months and => following:
1) Related to defecation (worsens or improves)
2) Change in frequency
3) Change in form
Most commonly in younger women (<50) a/w fibromyalgia, depression, anxiety.
Associated conditions with primary biliary cholangitis?
anti-mitochondrial Ab, destruction of intrahepatic biliary duct
Severe hyperlipidemia leading to xanthelasmas, malabsorption, metabolic bone disease (osteoporosis, osteomalacia), HCC.
Acute bacterial cholangitis–charcot triad
Fever, RUQ pain, jaundice
Acute erosive gastropathy
Development of hemorrhagic lesions after ischemia or exposure of gastric mucosa to various injurious agents:
1) ETOH: direct mucosal injury –> decreases normal barriers like mucin and bicarb
2) ASA: “
3) Cocaine: vasoconstriction –> reduces blood flow
Ursodeoxycholic acid
Treatment for symptomatic hepatobiliary d/o like PBC (eg fatigue, pruritus) or gallstone disease (eg RUQ pain)
