GI Portion Flashcards

Question

esophageal varices ## Footnote 6 sxs 3 dx

Answer 1

sxs: **_1. hematemesis!!! over 50% stop bleeding spontaneously_** 2. melena 3. tachycardia 4. hypotension 5. syncope 6. jaundice DX: **1. emergent endoscopy** CBC BUN/creatine type and cross

Answer 2

1. immediate tx-stop bleeding because mortaltiy approaches 75% 2. visceral ligation- rubber band 3. sclerotherapy 4. balllon tamponade

Answer 3

linear mucosal tear in the distal esophagus or gastric cardia from forceful _vomiting_ or retching, causing _hematemesis_ commonly seen in _alcoholics_ ## Footnote **most common location: gastroesophageal junction** **RF:** **alcholic** **hiatial hernia** **eating disorder BULEMIA** **SXS:** 1. multiple bouts of vomiting and retching followed by **_PAINLESS HEMATEMESIS_** 2. abdominal pain \*\*\*keep in mind the bleeding usually stops spointaneously as teh condition is usually benign\*\*

Answer 4

DX: ENDOSCOPY TX: 1. **stabliazation** - transfusion/gastric lavage if needed 2. **control bleeding via endoscopy** \*\*keep in mind most bleeding stops spontaneously and condition is usually benign\*\*

Answer 5

ring of tissue located at the _gastroesophageal_ junction called **_schatzkis ring_** sxs: 1. dysphagia with **_foods, but not typically liquds_** DX: barium esophagram TX: mechanical dilation with balloon

Answer 6

obtain occult negative stool to insure not bleeding still or hemmoraging

Answer 7

thickening and harderning of the skin **via collagen deposition** 1. raynauds (75%) 2. vascular changes in nail bed 3. GI dysmotility "watermelon stomache" 4. puffy hands 5. fixed face \*\*\*\*\*WORRY ABOUT PULMONARY FIBROSIS AND ACUTE RENAL FAILURE\*\*\*\*\*\*\* DX: ANA-SPECKLED Tx: treat system effected renal-ACE inhibitors raynauds-calcium channel blockers Gi: promotility lungs: cyclophosphamide

Answer 8

LIMITED SCLERODERMA **C- calcinosis** of joints leading to puffy hands **R- raynauds** **E-Esophageal dysmotility** **S-sclerodactyly** of _MCPs_ **T: telangiectasis** \*\*complication=pulmonary hypertension so need to get _annual PFT/DLCO to make sure no lung fibrosis_\*\* Tx: symptoms

Answer 9

occur in antrum, MC in lesser curvature **_bulky, irregularly shaped_** **_firm, jagged edges_** usually asymptomatic till late disease early detection is therefore difficult DX: 1. barium swallow xray 2. endoscopic studies with bx 3. cytologic (screening in atrophic gastritis/polyps) TX: **_surgery-radical subtotal gastrectomy TOC_**

Answer 10

1. genetic predisposition 2. carcinogenic diet _smoked food/perserved food_ 3. autoimmune gastritis _increased inflammation_ 4. gastric adenomas 5. polyps 6. h. pylori, cofactor for some

Answer 11

**break in the gastric or duodenal mucosa that _extends through the muscularis mucosa_ that comes from** **1. _impaired normal mucosal defense factors_** NSAIDS **_2. defense factors overwhelmed by aggressive luminal factors_** acid pepsin infection greater than 5 mm in diameter

Answer 12

1. NSAIDS 2. H. pylori 3. idiopathic 4. hypersecretory states 5. smoking

Answer 13

1. duodenal ## Footnote a. **_MOST COMMON LOCATION!!_** b. 90% heal in 4 weeks 2. pylorus 3. gastric \*\*CAN BE MALIGNANT\*\* \*\*must get bx at endoscopy time\*\* a. take longer to heal 8 weeks! b. increased length of tx

Answer 14

caused by long term NSAID use esp nonselective COX1 and COX2 blockers _COX1 decreases prostaglandins_ which have a _protective effect on gastric mucosa_, it the lack of this **_impairs gastric mucous and HCO3 secretion_** \*\*this is why COX2 selective are better option since decrease risk of bleeding\*\* RF: 1. ASA 2. corticosteroids 3. over 60 TX: **_1. PPI_** or H2 \*\*\*4 weeks duodenal\*\*\* \*\*\*8 weeks gastric\*\*\* **_2. D/C NSAID_**

Answer 15

**_nesscary cofactor for 75-90% of duodenal/gastric ulcers_** characteristics: PRODUCE UREASE ACUTE: a. infectious "gastroenteritis" CHRONIC: a. **_ASYMPTOMATIC_** b. DIFFUSE SUPERFICIAL MUCOSAL INFLMMATION WITH POLYPS \*\*ERRADIACATION IS ESSENTIAL OTHERWISE _85% WILL RECURR!!!!!\*\*_

Answer 16

1. infection in body 2. causes **gastritis and chronic inflamation that overwhelms immune system** 3. causes **mucosal breakdown** 4. creates gastric ulcer

Answer 17

SXS 1. _epigastric like pain "hunger like" in 80-90%_ 2. _50% have relief by eating antacids within 2-4 hours_ \*\*physical exam is often unremarkable so need to watch for changes in pattern, indicating perforation or penetration\*\* DX: 1. endoscopy EDG TOC! allow so for visulaization and also bx!! 2. fecal antigen test (noninvasive) 3. c-urear breath test (noninvasive) \*\*\*\*OPTIONS 2 AND THREE AT THE TOC FOR ACTIVE PUD AND PROOF OF ERADICATION\*\*\* _MUST D/C PPI 7-14 DAYS PRIOR OR MAY GET FALSE POSITIVIVE!_

Answer 18

2/3 abx, PPI, +/- bismuth ## Footnote **_1. amoxicillin_** 1 g BID **_2. clarithromycin_** 500 mg BID **_3. HIGH DOSE 40 mg PPI_** BID \*\*\*no reason shouldn't use quadrople therapy see in this pic\*\* KNOW BOTH \*\*must confirm eradication with C-urea breath test or fecal antigen test 4 weeks post abx 2 weeks post PPI\*\*\*

Answer 19

1. _antisecretory agents_ A.**_PPIs_** 1st DOC-inhibit 90% acid secretion **_ompreazole_** **_lansoprazole_** B. H2-inhibit histamine mediated secertion C. OTC anti-secretory 2. _mucosal defense agents_ 2nd line can be used as adjunct for _symptom relief_ **sacralfate, busmuth**

Answer 20

**DUODENAL f still large or bleeding post tx:** _continue PPI for 2-4 weeks_ **GASTRIC if large ot blleding post tx:** _continue PPI for 4-6 weeks_

Answer 21

rule out H. pylori and NSAID use

Answer 22

results in chemical peritonitis a. severe generalized abdominal pain b. _rigid abdominal rebound_ _TX:_ _1. laproscopic perforation closure_ _2. increased RX TX_

Answer 23

uncommon, contributed to non compliance with medication Contirbutory factors: 1. cigs 2. NSAIDS 3. failutre to eradicate H. pylori! MUST DO THIS

Answer 24

1. inflammation of the pancreas causes damage to the **_acrinar cells_** 2. the inactive proenzymes like _trysinogen_ are activated early while still in the pancreas 3. early activated _lipases_ disolve the fat 4. so the _pancreatic enzymes_ start to DIGEST THE PANCREASE "EATS ITSELF" theories: 1. obstruction of the pancreatic duct due to stones 2. failure of the two parts of the pacreas to fully join during development _pancreatic divism_

Answer 25

causes: 1. gallstones 45%-**MC** 2. alcohol 35% \*\*these two are most common and make up 80% of cases\*\* other causes: trauma drugs (iatrogenic) obstruction (tumors) infections (mumps) metabolic (hyperlipidemia) toxins (methyl alcohol, scorpion stings) \*\*MOST RECOVER AND HAVE NORMAL FUNCTING PANCREASE\*\*

Answer 26

lipase (this is better than amylase)

Answer 27

LAB TESTS: **_elevated cbc_** (infection) **_elevated lipase_** (pancreas) **_elevated LFT_** **_elevated glucose_** **_decreased calcium_** TEST OF CHOICE FOR DX: **_CT SCAN!!!_** scored A-E, A is good, E is bad

Answer 28

1. **_epigastric radiates to back_** 2. **_billiary colic PERSISTS DOESN"T GO AWAY_** 3. **_worse SUPINE, BETTER LEANING FORWARD_** 4. **_PAINFUL INSPIRATION, SHALLOW BREATHS_** 5. _TACHYCARDIA_ **_6. hemmoragic pancreatitis_** _cullens sign_: periumbical ecchymosis _grey tuner's sign:_ flank eccymosis

Answer 29

LAB TESTS: **_elevated cbc_** (infection) **_elevated lipase_** (pancreas) **_elevated LFT_** **_elevated glucose_** **_decreased calcium_** TEST OF CHOICE FOR DX: **_CT SCAN!!!_** scored A-E, A is good, E is bad

Answer 30

inflammatory disease of the pancreas **_irreversible**_ _**changes occur_** **_can lead to permanent loss of function_** HINT: think necrosis fibrosis theory of alcoholic pancreatitis alcohol to tissue damage to fibrosis to partial obstruction

Answer 31

1. alcohol cause #1!! \*\*\*THIS IS **_NOT_** CAUSED BY GALLSTONES LIKE ACUTE\*\* 2. **_obstructive causes of spincter of oddi by neoplasms_** 3. **_malnuitirion_** 4. metabolic chronic pain leads to opoid addiction! keep this in mind

Answer 32

sxs: 1. **_epigastric abdominal pain_** that radiates to the **_LEFT_** 2. insufficiency of pancreatic function leads to **_a. steatorhhea_** damages decreases lipase **_b. diabetes_** once islets damaged **3. asymptomatic and found incidently**

Answer 33

1. _stop the alcoho_l!! 2. controls sxs a. **pain control** **b. prancreatic enzyme supplements _viokase and pancrease_** 3. endoscopic duct decompression 4. surgical draingage of duct 5. celiac plexsus nerve block

Answer 34

mostly supportive ## Footnote a. NPO 48-72 hours **_NO ALCOHOL_** **_b. ERCP if presense of stone**_ _**on CT scan_** b. maintain hydration c. pain control d. NG tube in extreme e. abx if infectious f. incision and drainage if infected/necrosis

Answer 35

1. amylase/lipase **_NORMAL_** ## Footnote body gets used to working under these circumstances 2. _secretin stimulation test "gold standard" for **early** chronic pancreatitis dx_ 3. plain xray films QUICK AND CHEAP-see calcifications 4. CT SCAN-better at seeing calcifications but $$/rad _"arrowhead and fat stranding"_

Answer 36

1. Ranson's criteria ## Footnote _Take home: higher numbers means more severe disease and increased risk of death_ -measured at time of admission and during first 48 hours **6+=50% mortality** 2. APACHE II score \*\*typically impatient ICU use\*\* over **_8_** is severe!!!

Answer 37

tumor markers: 1. CA19-9 85% 2. CEA 40-45% 5 year survival is only 4% _really bad_ only RF: _chronic pancreatitis_

Answer 38

LABS: **_1. elevated direct bilirubin_** **_2. elevated alkaline phosphatase_** (significantly elevated in cancer) **_TX:_** **_1. chemo_**-poor respinse only reduces size to buy little time 2. _whipple surgery_-only at cancer specialties 3. **_pallaitive care_**

Answer 39

TOC #1: **_US_** ## Footnote find gallstones and _wall thickening over **3 mm**_ TOC #2: **_HIDA nuclear med scan_** (cholescintigraphy) GOLD STANDARD and _BEST TEST_ \*\*\*\*not usually used since it is $$$$$$$, so US becomes TOC\*\*\*\*\*\* Two elevated labs: **_elevated gamma-glutamyl transpeptidase_** **_elevated bilirubin_**

Answer 40

1. over 40 2. obesity (or rapid weight loss) 3. female/pregnant 4. native american **"FEMALE, FAT, FORTY, FERTIL" 4, F's**

Answer 41

stone in the **_COMMON BILE DUCT_** usually migrate from the gallbladder patient very sick and likely in ICU!! compared to cholelithiasis sxs: asymptomatic in 30-40% **_BILLARY COLIC_** **_jaundice, pancreatitis_**

Answer 42

1. cholecystectomy-MOST COMMON "it hurts ## Footnote 2. leave in if doesn't hurt _UNLESS_ high risk to keep in a. diabetics b. sickle cell c. Native americans with _calfieiced "porcelain" stone_ 3. dissolve cholesterol stones with _actigal, urodeoxycholic acid_ but $$$

Answer 43

sxs: 1. _painless **jaundice** is PC until prove otherwise_ 2. **_virchows node_-**supraclavicular node 3. **_trouseaus signs- recurring superficial thrombophlebitis_**can be anywhere 4. weight loss TOC: _CT scan dual phase helical_

Answer 44

the **_cystic duct**_ becomes blocked _**most commonly from gallstone!_** less common: cancer, sludge, infection blockage causes distention and edema that cauess _ischemia, necrosis, perforation_ and possible _generalized sepsis_ SXS 1. RUQ/epigastric pain _radiate to shoulder/scapula_ 2. _murphys sign_ (tenderness and pt stops inspiration on palpation)

Answer 45

TreatOT: TAKE IT OUT!! MOST COMMON!! via _laproscopic cholecystectomy_ 2. leave in if very mild 3. drain it if patient too sick 4. abx if elevated WBC

Answer 46

**1. cholesterol stones** MC-75% of stones!! don't show up on xray 2. **calcium bilirubinate/ca salts** 25% of stones pigmented black/brown sludge stones

Answer 47

_asymptomatic in 50-60%_ ## Footnote symptomatic patients: **biliary collic with _RUQ pain/epigastric areas_** **_refers to back, scapula or R shoulder_** DX: TOC: transabdominal US **_shows stone without wall thickening_** \*\*_keep in mind not great for stones in common bile duct\*\*_

Answer 48

1. MRCP magnetic resonance cholangiopacreatogprahy ONLY DX ## Footnote 2. ERCP-endoscopic retrograde cholangioancreatography DX **_AND TX so GOLD STANDARD!!_** \*\*\*\*keep in mind contraindicated in pancreatitis/cholecystomy\*\*\*

Answer 49

autoimmune dx of _SI_ ## Footnote introlerance to **_gluten and the alpha-gliadin_** gluten triggers immune response in turn causing damage to the small intestine causes _nuitritional deficits secondary to absorption issues_ "celiac sprue"

Answer 50

1. unintended weight loss ## Footnote 2. persistently underweight 3. sxs of poor nuitrition 4. "failure to thrive in child" 5. diarreah 6. _dermatitis herpetiformis_ a. ***intense itching*** ***b. blisterning rashes*** ***c. 10-15% of patients***

Answer 51

1. anti-tissue transglutaminase antibodies OR anti-endomysium IgA antibodies ## Footnote 2. _bx if small intestine_ and blood + for antibody \*\*\*\*if they have dermatitis herpetiform with + antibody skin bx, THEN NO NEED FOR INTESTINAL BX\*\*\*

Answer 52

1. gluten free diet ## Footnote - wheat - rye - barley 2. abx for dermatitis herpetiformis \*\*\*make sure to screen if family hx using blood test for autoantibodies\*\*

Answer 53

sac-like protrusions in the colonic wall **blood vessels penetrate the mucosal wall** **internal layers penetrate through weak areas creating diverticula**

Answer 54

condition of having divericula typically asymptomatic MC in SIGMOID COLON, _account for 50% of all lower GI bleeds, bright red blood in rectum earliest finding MOST COMMON_ diet restricted in seeds, strawberries

Answer 55

inflammation of the pocuhes 1. severe **_LLQ_** pain 2. change in bowel habit 3. constapation Tests: 1. **_CT TOC with IV and oral contrast_** 2. WBCs 3. barium enema 4. colonoscopy

Answer 56

western/industerialized societies ## Footnote 30% by 60 65% have by age 85

Answer 57

1. connective tissue disorders 2. low fiber diet 3. too little exercise

Answer 58

1. legions mouth to anus; spread out with healthy tissue between _2. transmural_ **_3. RLQ pain MC_** 4. fistulas, abscesses, fibrotic stricutres 5. bleeding common 6. weight loss common 7. obstruction common 8. perianal disease common 8. can effect skin eyes joints liver 9. _large volume_ diarreah and mucous (trash bag)

Answer 59

1. crohns disease 2. ulcerative colitis

Answer 60

1. anti-saccharomyces cervisial (ASCA)- 44% of crohns are pos ## Footnote 2. _colonoscopy TOC_

Answer 61

1. 5-aminosalcyclics (5-ASA) ## Footnote **-mesalamine** **-sulfasalazine** 2. corticosteroids 3. cimzia-certolizumab 4. humira-adalmumab \*\*surgery doesn't work since it involves the entire GI tract\*\*

Answer 62

ulcerative colits 3x more likely

Answer 63

1. primarily localized in _colon_ **_2. LLQ_** 3**_. bleeding from rectum_** **_is most common_** 3. _urgency need of BM_ _4. potenital anemia due to blood loss_ 4. lesions are continuous starting at the rectum and in mucosa only 5. _colon wall thin with continuous inflammation_ 6. no granulomas (weight loss/obstruction very rare with this)

Answer 64

colonoscopy

Answer 65

1. 5-ASA - sulfasalzine - mesalamine 2. corticosteroids 3. **_colonectomy CURE best choice_** removal of colon

Answer 66

**_dx of exclusion, no other cause_** FUNCTIONAL BOWEL WITH MUCOSAL INFLAMMATION women more than men presents before age **_45_** **_1. abnormal motiltiy_** _2. **visceral hypersensitivity**_ lower visceral pain threshold **_3. psychosocial interaction_**-emotional stress

Answer 67

1. pt education and behavior/ emotional support ## Footnote 2. dietary therapy 3. pharm a. antispasmotics b. antidiarreals c. psychotropic d. serotonin receptor agonists

Answer 68

1. genetic predisposition 2. presence of _adenomatous polyps)_ _3. diets high in fats and refined carbs that are low in plant fiber \*industerialized world\*_

Answer 69

sxs: 1. **_colic type pain_** **_2. anorexia_** **_3. thin appeareance_** **_4. pallior/anemia_** dx: 1. xray: _classic apple core/npaking ring appearance_ 2. endoscopy with bx 3. iron deficient anemia 4. hypoalbuminemia 5. occult blood in stool

Answer 70

small outcropping that grows in the rectum or colon \*\*need to deterine the type since some are associated with carcinoma\*\* _adenomas_ **_PREMALIGNANT POLYP_** **_PRECURSOR TO COLORECTAL CANCER_** **_sessile_**: flat and intimately attacted to mucosa **_peduclated_**: round and attached be stalk

Answer 71

the progression of adenomatous polyp into malgnancy

Answer 72

1. tubular adenoma ## Footnote **_MOST COMMON TYPE 65-80%_** pedunculated, little cancer risk 2. tubulovillous adenoma 10-25% of adenomas 22% risk of cancer 3. **_vilous adenomas_** **_40% RISK OF CANCER_** only 5-10% so least common but most deadly

Answer 73

vilous adenoma \*think vilian=evil\*

Answer 74

1. guiac fecal occult blood test (gFOBT) ## Footnote 2. immunochemical-based fecal occult blood test (iFBT)

Answer 75

age 50 to less than 10 years life expectancy ## Footnote 1. **_optical colonscopy_**-10 years 2. flexible sigmoidoscopy-5 years 3. CT colonography-10 years

Answer 76

**_difficulty digesting lactose from lack of lactulase_** MOST COMMON IN: 1. AFRICAN AMERICANS 2. HISPANIC/LATINO 3. ASIAN AMERICANS 4. NATIVE AMERICANS SXS: 1. bloating 2. pain 3. increase passage of gas 4. diarrhea and nausea **_5. 2 hours post consumption of milk or dairy_**

Answer 77

dx: ## Footnote hydrogen breath test tx: dietary avoidance

Answer 78

divides the rectal mucosa from the squamous epithelium in the canal ## Footnote above in anorectal canal: INSENSATE (no pain) below in _andoderm_: _SENSATE AND PAINFUL!!_

Answer 79

**Tear in the andoderm of rectal canal** 90% are posterior along midline **_most common cause of painful rectal bleeding_** causes: 1. passage or hard stool 2. prolonged diarreah

Answer 80

ANAL FISSURE!!

Answer 81

sxs: 1. "tearing" pain with BM since below dentate line 2. hematochezia during BM 3. SPREAD BUTTOCKS to examine \*\*NEVER DO RECTAL EXAM, TOO PAINFUL!..and cruel\*\*

Answer 82

1. 90% heal without tx ## Footnote a. bulk agents b. stool softeners c. sitz baths d. hydrocortizone ointment Anusol 2. _surgical-lateral internal anal spincterotomy GOLD STANDARD if failure conservative_ \*\*can't do if patient incontinent\*\*

Answer 83

above the denate line!! veins surrounded by mucosa 1. **_PAINLESS, above denate_** **_2. bright red bleeding with defecation_** **_3. may prolapse and be palpable on DRE_** **_4. bleed_**

Answer 84

**_first_**-bleed **_second-_**bleed and prolapsed, spontanously reduce **_third_**-bleed, prolapse, and require manual reduction **_fourth degree_**-bleed/incarcerate

Answer 85

1. anal canal is lined with "cushions" that are **_vascualr and connective tissue and make the hemmorrhoidal plexsus_** 2. exist in 3 columns 3. **_cushions encorge during defecation_** to profect the anal canal from abrasion 4. when venous engorgement is increased with conditions like pregnancy, straining, and increased abdominal pressure it **prompts production of abnormal hemorrhoidal tissue** which can be symptomatic

Answer 86

below the dentate line and covered with andoderm 1. usually don't **_bleed_** 2. may **_thrombose_** which is VERY painful 3. cause **_pain, discomfort and most severe at time of defecation_** dx "either present or not" tx: 1. excision of outside of the mucotaneous junction leaving wound open **_hemroidectomy_**

Answer 87

constapation straining at stool pregnancy obesity chronic liver disease portal HTN

Answer 88

1-2 degree: ## Footnote a. fiber b. water c. stool softner d. anusol hydrocortisone e. numbing agent nupercainal ointment 3-4 degree: a. SURGICAL b. EXCESIONALHEMMOIROIDECTOMY

Answer 89

**mortality 40-80%** sudden onset deterioration of hepatocyte function causing coagulopathy 1. tylenol 45% of cases 2. alcohol and drugs 3. heptitis A and B sxs: **_1. jaundice_** **_2. elevated transmidates AST/ALT_** **_3. coagulopathy INR over 1.5_** **_4. encepalopathy-alteration in mental status due to evelated ammonia_**

Answer 90

50% of all cases hep a b c d e account for 95% of thse

Answer 91

**65% of all cases** **RNA**occurs exclusively in liver cells **incubates 2-6 wks** transmission **_FECAL ORAL_** 1. travel 2. contanimated food and water 3. close contact with infected individuals

Answer 92

SXS 1. prodrome, flu like _most infectious here 12-21 days_ _2. icteric phase_ **1. dark urine appeares first (bilrubinuria)** **2. pale stool follows** **3. jaundice 70-85%** **4. abdominal RUQ pain 40%** **5. _prurits, indicates bilirubin_** 6. arthralgias 7. hepatomegally

Answer 93

DX: 1. anti-hep A IGM and IGG 2. LFTS - increase AST/ALT over 1000 - increased bilirubin 5-10 x TX: selflimiting supportive

Answer 94

improvement in hygiene and sanitation cooking food avoidance of water foods and endemic areas avoidance of raw shellfish immunization

Answer 95

Harvix **travelers** **miliary personnel** **lab workers** **immunocomprimised**

Answer 96

DNA virus 1/3 of population infected, majority immigrants or 1st gen transmission: 1. perianatal 2. sexual 3. blood containing med equiment **_\*\*\*\*\*\*\*causes 80% of hepatocellular carcinoma=fatal!!!!\*\*\*\*\*_**

Answer 97

HEPATITIS B!! vaccines for this mandated

Answer 98

**immunity** - vaccination - natural infection **actue infection** **chronic infection** - active - chronic

Answer 99

**_hepatitis B surface antibody (HBsAB)=_**IMMUNITY--ONLY PRESENT IN VACCINATED PEOPLE ## Footnote **_hepatitis B envelope antigen (HBeAg)_**: NEEDS TREATMENT, current infection

Answer 100

surface=**immunity (vaccine or exposure)** core=**exposed to virus** envelope=**present infection with active replication**

Answer 101

70% are subclinical (no jaundice or aniteric) 30% get icteric hepatitis dx **_1. HBcIGM for dx_** 2. elevated AST/ALT 3. elevated bilirubin TX: 1. supportive \*\*many will seroconvert to HBsAB and HBeAB meaning they develop immunity on their own!!\*\* 2. high calorie diet

Answer 102

initial phase: **positive HBeAG** immune clearance phase **HBsAg, HBeAG** **elevated ALT** **inflammation on liver bx** inactive carrier tx: 1. tenofovir DOC 2. entecavir DOC \*\*\*both of these are lifelong drugs!!!\*\*\* 3. interferone alpha 6 months

Answer 103

1. recombinant hepatitis vaccine 2. hep B immune globulin (exposued)

Answer 104

RNA coinfection with **_HEP BE IS REQUIRED!!!_** **_HBsAg_** transmission: sexual contact

Answer 105

**_most common chronic blood borne infection in the US_** ## Footnote 1. injection drug use/cocaine 2. sexual contact 3. transfusion RNA virus, 30-49 y/o

Answer 106

**_test everyone born between 1945 to 1965_**

Answer 107

80% proceed to the chronic state HIGH RISK OF CIRRHOSIS AND HEPATOCELLULAR CARCINOMA

Answer 108

1. supportive first since can clear on their own 2. avoid hepatotoxic drugs 3. \*\*most wait **_6 months_** for posisble clearance before starting antiviral therapy\*\* - harvoni (sofosbuvir/ledipasvir) - daklinza (daclatasvir) \*\*12-24 weeks tx depending tx naive and if cirrhosis\*\* \*\*some regimens still include ribaviran, but not all of them\*\* NO INTERFERON

Answer 109

viral load after **_12 weeks_** to confirm cure

Answer 110

IT IS CURABLE!!! nearly 100!!!!! there is no vaccine and no post exposure immunoglobulin **_THEREFORE YOU WANT TO SCREEEN!!!_**

Answer 111

if coinfected with HIV, helps reduce the HIV replication

Answer 112

**chronic end stage dxs of the liver marked by _degeneration of cells_ from inflammation resulting in _fibrous thickening of tissue_** 4 stages of fibrosis and cirrhosis is the last **_compensated_**: although fibrotic can still preform functions **_decompensated_**: fibrotic with loss of essential function

Answer 113

North Africa South Asian fecal oral self-limiting ***issues in pregnacy!!! EXTREMELY SEVERE!!!! esp in third trimester 20% mortality!!!!!! KEY***

Answer 114

_compensated sxs:_ ammenorreah impotence gynecomastica **_hematemesis as present features in 15-25% (esophageal varices)_** _decompenstated_: **1. spider angiomas** **2. muscle wasting** **3. palmar erythema** **4. dilated superficial veins of abdomen** **5. ascities** **6. portal HTN** **7. encepalopathy**

Answer 115

LABS: low platelets **_prolonged PT_** moderate elevations enzymes **_elevated bilirubin_** **_low serum albumin_** **_1. abdominal US WITH DOPPLER_** - nodular appearing liver +/- hepatosplenomegaly 2. LIVER BX! TOC to confirm, determine staging

Answer 116

1. alcohol abstinence 2. vitamin supp 3. nuitrional supp 4. BB for portal HTN 5. _CURE IS TRANSPLANT_!!!

Answer 117

_**\*\*\*\*\*must screen for alpha fetal protein and imaging ever 6 months\*\*\***_

Answer 118

associated with **_cirrhosis_** ## Footnote 4-6 months from time of dx 5 year survival is 25% SXS: 1. _painless jaundice_ 2. weight loss 3. hepatomegaly dx 1. triple phase CT or MRI 2. **_percutaneous bx of lesions!!! TOC_** **_3. Alpha fetoprotein tumor marker is PATHOPNEUMONIC_**

Answer 119

1. surgical ressection 2. chemo 3. portal vein embolizations 4. _transplant_ if small and localized

GI Portion Flashcards

(145 cards)