GI and Hepatology Flashcards
(184 cards)
1
Q
Laxative abuse presentation
A
Very frequent, watery, nocturnal diarrhea. Melanosis coli.
2
Q
Melanosis coli looks like
A
Dark brown colon with light patches which are the lymph follicles
3
Q
Iron deficiency anemia DDx important
A
Always include colon cancer, colonoscopy is high on list of things to do
4
Q
Most common cause of iron deficiency anemia in elderly
A
GI blood loss
5
Q
Toxic megacolon most common cause
A
UC
6
Q
Toxic megacolon tx
A
IV steroids, nasogastric decompression, and fluid management
7
Q
BRBPR workup
A
In patients <50 with no risk factors for colon CA, do anoscopy/proctoscopy
8
Q
Esophageal cancer vs. achalasia
A
CA can mimic achalasia very closely. Think of CA in old age, short history, rapid weight loss, and inability to pass endoscope through sphincter
9
Q
Peptic strictures presentation
A
Pain with swallowing solids, but NO WEIGHT LOSS
10
Q
What causes peptic strictures
A
GERD!!!, radiation, scleroderma, and caustic ingestions
11
Q
Painless jaundice in old person is
A
Pancreatic head CA
12
Q
How to treat ALL anal fissures
A
High fiber diet, large amount of fluids, stool softeners, local anesthetics
13
Q
Multiple myeloma presentation
A
Back pain, anemia, renal dysfunction, elevated ESR, and hyperCa
14
Q
Metastatic cancers to bone
A
Lung, breast, renal thyroid, prostate,
15
Q
Constipation ddx
A
Always include hyperCa from myeloma or metastases to bone
16
Q
Diagnosis of UC
A
Proctosigmoidoscopy with biopsy
17
Q
Most commonly affected part of colon by ischemia
A
Splenic flexure
18
Q
Most common abx cause of c.diff
A
Clindamycin
19
Q
How to treat c.diff
A
Stop Abx and start flagyl
20
Q
Scleroderma esophageal dismotility
A
Decreased LES tone
21
Q
Any tests or signs of IBS
A
Nope, no lab tests or pathologic hallmark
22
Q
Tx for asymptomatic diverticulosis
A
high fiber intake
23
Q
H pylori diagnosis in patients <45
A
Noninvasive tests
24
Q
Anti-endomysial antibodies
A
Celiac disease
25
Anti-scl 70 antibodies
Scleroderma
26
Anti-centromeric antibodies
CREST syndrome
27
Antimitochondrial antibodies
PBC
28
Gastrin in ZE syndrome for diagnosis
>1000 pg/mL is diagnostic, if not this high, do secretin stimulation test
29
Causes of zinc deficiency
TPN or malnutrition.
30
Zinc def. signs
ALopecia, skin lesions, abnormal taste, and impaired wound healing
31
Endoscopy in achalasia?
Always, to rule out cancer
32
Most common complication of PUD
hemorrhage
33
Tx for ascites
1. Sodium and water restriction 2. Spironolactone 3. Loop diuretic (not >1L/day) 4. Frequent abdominal paracentesis (2-4L/day, as long as renal function okay)
34
TPN RUQ complication
Gallstones due to sludging and decreased GB peristalsis. can lead to cholecystitis
35
chronic DIC
FOund in malignancy, can cause migratory thrombophlebitis and atypical venous thromboses
36
How to test for chronic pancreatitis
Fecal elastase to test for exocrine failure
37
VIPoma sxs
Pancreatic cholera
38
Unexplained chornic abd. pain, weight loss, and food aversion
Chronic mesenteric ischemia
39
Chronic mesenteric ischemia supporting signs
Atherosclerosis, psosible abdominal bruit
40
Lactose intolerance test
Positive hydrogen breath test, positive stool test for reducing substances, low stool pH, and increased stool osmotic gap. No steatorrhea
41
Antibiotic associated idarrhea is always
cdiff. use cytotoxin assay
42
most common causes of painless GI bleeding in >65
Diverticulosis and angiodysplasia
43
Angiodysplasia associated with
aortic stenosis
44
D-xylose absorption test
Abnormal in bacterial overgrowth and celiac sprue. With bacterial overgrowth, it normalizes with abx
45
Iron defieincy anemia and celiacs?
Yes, one of th emost common presentations
46
Chronic pancreatitis can lead to
Pancreatic cancer
47
HIV chronic diarrhea CD4<180
cryptosporidium parvum
48
Carcinoid syndrome triad
Flushing, wheezing, diarrhea
49
Alarm signals of GERD
N/V, weight loss, anemia, melena/hematochezia, long duration of symptoms especially when white male>45, failure to respond to PPIs
50
Rocky mountain or foreign country diarrhea
Giardiasis, causes adhesive disks and malabsorption
51
Abd. surgery complication leading to malabsorption
Bacterial overgrowth
52
ZE syndrome can cause malabsorption how
Inactivation of pancreatic enzymes
53
Best dx and evaluation for diverticulitis
CT
54
Carcinoid syndrome nutrient deficiency
Niacin from 5HT production
55
MENI tumors
Primary hyperPTH, pituitary tumors, and enteropancreatic tumors (GASTRINOMA)
56
When to do esophagoscopy for GERD
When patient fails to respond to PPI tehrapy or the scary signs pop up
57
Initial test for all dysphagia
Barium swallow
58
Young person with chronic diarrhea, abd. pain, and weight loss
Crohn's
59
Digoxin toxicity can be caused by this
Verapamil
60
Digoxin toxicity sxs
GI, anorexia, N/V
61
Tx for zenker's
Cricopharyngeal myotomy.
62
BUN>40 in presence of normal Cr
Upper GI bleed. or steroids
63
Whipple's disease presentation
Arthralgias, weight loss, fever, diarrhea, and abd. pain. PAS positive stain
64
Tropical sprue biopsy
blunting of villi with infiltration of chronic inflammatory cells, including lymphocytes, plasma cells, and eosinophils
65
How to dx zenker's
Barium swallow
66
Dx of steatorrhea
quantitative estimatino of stool fat
67
Corkscrew esophagus on barium swallow
Diffuse esophageal spasm
68
When to think of diffuse esophageal spasm
Young female with intermittent chest pain and dysphagia
69
Diffuse esophageal spasm tx
Supportive, nitrates and CCBs?
70
WHen to tx Hep B
Persistently elevated ALT levels, detectable HBsAg, HBeAg, and HBV DNA should be treated with interferon and lamivudine
71
Recurrent pancreatitis with no clear cause w/u
ERCP
72
Most common cause of pancreatitis in men and women
Men: alcoholism, Women: gallstones
73
Liver metastases most commonly caused by
GI tract tumors, lung, breast
74
Post-cholecystectomy pain
Common bile duct stone, sphincter of Oddi dysfunction, or functional causes
75
Chronic hep c vaccinations
Hep A and B
76
Isoniazid and liver function
Causes idiosyncratic liver injury like viral hepatitis
77
Hydatid cysts are
Due to infection with echinococcus granulosus
78
Pancreatic pseudocyst effects
Causes an inflammatory response, but tends to respond spontaneously
79
aminotransferases in alcoholic liver disease
Always lower than 500 IU/L
80
Wilsons dz presentation
Low serum ceruloplasmin, increased Cu urine, kaiser fleischer rings
81
Risk factors for cholangiocarinoma
Smoking and UC
82
When to do TIPS
Refractory ascites, refractory hydrothorax, and surgical management of acute recurrent variceal bleeding
83
Risk factors for pancreatic cancer
FH, chornic pancreatitis, smoking, DM, obesity, high fat diet. Alcohlism is not a risk FACTOR!
84
How to tx symptomatic gallstones
With surgery, if they aren't good surgical candidates, then just do medical management
85
Dubin-Johnson liver appearnce
BLACK
86
Which cholestatic liver disease are fine
Dubin-Johnson, Rotor, Gilbert's, Crigler-Najjar type 2
87
Dx of dubin-johnson
Conjugated hyperbilirubinemia with a direct bilirubin fraction of at least 50% and otherwise normal liver function profile must be present
88
Which cholestatic liver disease is bad
Crigler-Najjar type 1 Can result in kernicterus and death
89
Causes of acute acalculous cholecystitis
Extensive burns, severe trauma, prolonged TPN, prolonged fasting, mechanical ventilation
90
What is fulminant hepatic failure
If you get hepatic encephalopathy within 8 weeks and liver failure.
91
What is acute hepatic failure
If you get liver failure within 8 wweeks
92
Most common cause of acute liver injury and fulminant hepatitis
acetaminophen toxicity
93
High serum AFP (>500 ng/mL) in an adult with liver disease and no obvious GI malignancy
is strongly suggestive of Hepatocellular cancer
94
Hyperestrogenism signs
Gynecomastia, testicular atorphy, decreased body hair, spider angiomas, and palmar erythema
95
Cause of hyperestrogneism in liver disease
Liver cant metabolize the estrogen that is present
96
Screen people for HCVc and b in what blood transfusions
For B if before 1986, for C if before 1992
97
In patients with oliguria and abd./pelvic surgeries
Do a foley catherization because they might have post-renal obstructive failure
98
Patients with first episode of acute pancreatitis should always get this test to rule it out as ac ause
an Abd u/s to rule out gallstones as a cause
99
Risk factors for nonalcoholic steatohepatitis
Obesity, DM, HLD, TPN, and using certain meds
100
ABO mismatch signs
Fever, hemolysis, shock, and DIC
101
Ursodeoxycholic acid uses
Used in PBC to relieve symptoms and lengthen transplant-free survival time
102
Risk factors for cirrhosis in Hep C patients
Male, acquiring infection after age 40, longer duration of infection, coinfeciton with HBV or HIV, immunosuppresion, liver comorbidities like alcoholic liver disease, hemochromatosis, alpha-1 antitrypsin deficiency, alcohol intake
103
postexposure ppx for HBV
HBIG and three shots of HBV vaccine at set intervals
104
SAAG levels
High SAAG >1.1 is going to transudative like CHF and cirrhosis due to high portal HTN. Low SAAG is going to be exudative like malignancy,
105
Postoperative cholestasis
Especially in surgeries with hypotension, extensive blood loss into tissues, and massive blood replacement
106
Hepatic adenoma
Young women with OCPs
107
Most commonc ause of cirrhosis in the US, then second
Alcohlism, HCV is second
108
Best testing for Acute HBV infection
HBsAg and anti-HBc
109
Isoniazid and liver
Mild aminotransferase elevations within first few weeks and will resolve without intervention
110
When to treat Hep C
If persistently normal liver enzymes, there is minimal histological abnormalities, therefore no tx with interferon or antiviral drugs needed
111
30% of patients with hemochromatosis die from this dz
HCC
112
Pseudocyst occurs when
>5 wks s/p acute pancreatitis
113
When to drain pseudocyst
If >5 cm or doesnt go away in 6 wks
114
All pancreatic pathology diagnostic test
CT scan
115
How does pancreatic pseudocyst present
Early satiety and abd. pain
116
When does pancreatic abscess occur
2 weeks s/p (pseudocyst is 5 weeks), abd. pain and early satiety
117
Tx pancreatic abscess
Perc drainage and IV Abx
118
Chronic pancreatitis presentation
Chronic abd. pain, steatorrhea, DM
119
Treating Chronic pancreatitis
Insulin, enzyme packets, for acute attacks: IVFs, NPO, pain meds
120
Most common causes of chronic pancreatitis
Alcoholism in adults, Cystic fibrosis in young
121
Grey-Turner sign
Flank ecchymoses
122
Cullen's sign
Periumbilical ecchymoses
123
Fox sign
Ecchymosis along inguinal ligament
124
How to diagnose pancreatic Ca
CT scan
125
How to treat pancreatic Ca
Head: whipple, Tail/body: distal pancreatectomy, mets or local invasion, palliation
126
Tumor markers for pancreatic Ca
CA 19-9 and CEA
127
Causes of Pancreatitis
I GET SMASHED. Idiopathic. Gallstones (#1), Ethanol (#2), Trauma, Steroids, Mumps, autoimmune, scorpion sting, Hypertriglyceridemia (#3), hyperCa, ERCP, drugs
128
I GET SMASHED
Idiopathic, gallstones, etoh, trauma, steroids, mumps, autoimmune, scorpion sting, hyperTGs, hyperCa, ERCP, Drugs
129
Trousseau syndrome
Migratory thrombophlebitis, think of Pancreatic cancer. It is a superficial venous thromboembolism
130
Courvosier's sign
Palpable GB w/o pain in pancreatic cancer in 30%
131
Chronic viral Hepatitis LFTs
ALT>AST, moderately elevated
132
Acurte viral hepatitis LFTs
ALT>AST, in the thousands
133
Alcohlic hepatitis LFTs
AST>ALT 2
134
LFTs in the 10,000s
Severe hepatic necrosis
135
Elevated alk phos w/o elevated GGT
Pregnancy or Paget's dz
136
Elevated alk phos with elevated GGT
Obstructive process
137
Conjugated bilirubin >50%
Dubin-Johnson, Rotor?, cancer, choledocholithiasis
138
Conjugated bilirubin <20%
Hemolytic jaundice
139
Conjugated bilirubin 20-50%
Hepatocellular jaundice (viral or alcoholic)
140
When to do HIDA scan
If RUQ u/s is inconclusive
141
When to do ERCP
Choledocholithiasis and acute cholangitis
142
Charcot triad
RUQ pain, jaundice, fever
143
Reynold's Pentad
RUQ pain, jaundice, fever, AMS, hypotension
144
Boas sign
Referred right scapular pain of biliary colic
145
Cause of SBO in patient with gallbaldder dsiease
Gallstone ileus in distal ileum caused by a cholecystenteric fistula
146
N/V in normal biliary colic
yes, can happen, not automatically a warning sign
147
Tx for symptomatic gallstones
Elective! cholecystectomy
148
Acute cholecystitis treatment
Cholecystectomy w/i 24 hrs
149
Gallstone pancreatitis tx
If amylase goes down, lap chole. If amylase remains elevated, ERCP to remove stone.
150
Acute cholangitis tx
Immediate ERCP.
151
Tx for acalculous cholecystitis
Usually ICU patients, lap chole, or med management if poor surgical candidate
152
Porcelain GB
GB cancer! take it out 50% chance of adenocarcinoma
153
PSC natural history
Intra and extrahepatic biliary ducts. liver failure, cirrhosis, portan HTN
154
PSC dx
ERCP beading of bile ducts
155
PSC tx
cholestyramine, liver txp
156
PBC presentation
Antimitochondrial antibody (AMA) leads to destruciton of intrahepatic ducts, gradual juandice and pruritus, liver failure, cirrhosis, portal htn
157
PBC dx
AMA and liver bx
158
PBC tx
Ursodeoxycholic acid, liver txp eventaully
159
Secondary biliary cirrhosis
Cirrhosis due to obstruction from any cause
160
Cholangiocarcinoma presentaiton
tumor of bile ducts, obstructive jaundice
161
Cholangiocarcinoma dx and tx
ERCP and Whipple
162
Cholangiocarcinoma most common cause in USA and China
USA: PSC from UC. China: Liver fluke (chlonorchis sinensis)
163
Klatskin tumor
tumor of proximal 1/3 of CBD, unresectable
164
Choledochal cysts
Cystic dilation of biliary tree causing RUQ pain/mass, jaundice, fever. Dx ERCP and Tx Resection
165
Biliary dyskinesia presntation
Motor dysfxn of sphincter of Oddi, recurrent biliary colic without stones
166
Biliary dyskinesia dx and tx
HIDA scan and give CCK to determine ejection fraction. Lap chole for tx.
167
Wilson disease is what degeneration
Hepatolenticular degeneration
168
Wilson disease inheritance
Autosomal Recessive
169
Wilson disease presentation
Cirrhosis, kaiser fleisher, movement disorders, Schistocytes
170
WIlson disease dx and tx
Dx with decreased serum ceruloplasmin, increased ceruloplasmin urine, increased AST/ALT, liver bx. Tx with d-penicillamine (copper chelating agent) + zinc (copper uptake competition)
171
Hemochromatosis synonym
Bronze Diabeetus
172
Hemochromatosis presentation
Cirrhosis, restrictive CM, arthritis, bronze suntan, DM from incresaed Iron absorption in GI tract
173
Hemochromatosis dx and tx
Increased ferritin, decreased TIBC (because transferrin saturation is high!??), liver bx. Tx with repeated phlebotomies
174
Secondary hemochromatosis
Iron overlaod secondary to multiple transfusions or chornic hemolytic anemia
175
Hepatic adenoma dx and tx
CT or u/s. stop OCP and resect if it doesnt disappear. can cause shock and distended abdomen. ALso seen in anabolic STEROIDS!
176
MC benign liver tumor
Cavernous hemangioma, usually asymptomatic
177
Cavernous hemangioma causes
VAT: vinyl chloride, aflatoxin, thorotrast
178
HCC dx and tx
Elevated AFP and CT scan. tx with resection
179
HCC causes
MCC is cirrhosis, A1AT deficiency, hemochromatosis, wilsons, smoking, chemical carcinogens
180
Polycystic liver due to what
ADPKD simple cyst in liver and kidneys. tx with reassurance
181
Hydatid cyst cause and tx
Echinococcus granulosus (dog tapeworm) causes multilocular cyst with calcified walls. Tx inject cyst with Hypertonic saline and excise, post-op with Mabendazole
182
how to tx amebic abscess
In mexicans, use flagyl, NO DRAINAGE
183
Liver abscess txs
Multiple/small bacterial tx IV Abx. Single/large tx perc drainB
184
Budd-Chiari syndrome most common cause, tx, and dx
Polycythemia vera (MCC), OCPs (#2), causes portal HTN, ascites, jaundice. tx TIPS in bridge to liver txp
