GI Stepup Flashcards
1
Q
causes of viral gastroenteritis
A
Norwalk, Coxsackie virus A1, echovirus and adenovirus
rota in kids
2
Q
labs in viral gastroenteritis
A
no fecal WBC
3
Q
fried rice and vomiting within a few hours of eating it
A
bacillus cereus
4
Q
bloody diarrhea and abdominal pain after eating chicken
A
campylobacter jejuni
5
Q
which pathogen is assoc with bacterial GI upset and guillain barre
A
campylobacter jejuni
6
Q
flaccid paralysis from honey
A
clostridium botulinum
7
Q
Tx for adult botulism toxin from canned foods
A
botulism antitoxin
8
Q
watery or bloody diarrhea post antibiotics
A
clostridium difficile
9
Q
Tx C diff
A
metro or vanco
10
Q
what is travelers diarrhea from
A
enterotoxigenic E coli
11
Q
bloody diarrhea, abdominal pain, renal failure
A
E coli O157:H7
12
Q
vomiting several hours after eating past salad
A
staph aureus
13
Q
bloody diearrha, fever vomiting after eggs
A
salmonella
14
Q
whats the most common foodbourne bacterial GI infection
A
salmonella from fresh produce
15
Q
severe bloody diarrhea after eating
A
shigella
16
Q
Tx for sigella bloody diarrrhea
A
hydration
can use cipro
if severe use tMP SMX
17
Q
copious watery diarrhea after eating shellfood
A
vibrio cholera
18
Q
Tx for vibrio cholera
A
tetracycline or doxy decrease length
19
Q
watery diarrhea after oysters
A
vibrio parahaemolyticus
20
Q
Bloody diarrhea and right lower pain after eating pork and fresh produce
A
yersinia
21
Q
greasy foul smelling diarrhea with abdominal pain
A
giardia
22
Q
Tx giardia
A
metro and hydration
23
Q
mild to severe bloody diarrhea abdominal pain
after drinking water in poor area
A
entamoeba histolytics
24
Q
Tx entamoeba histolytica
A
metro and paromomycin
25
watery diarrhea, abdominal pain, in immunocompromised patient
cryptosporidium
26
fever with myalgias and periorbital edema after eating undercooked pork
trichinella spiralis
27
Tx trichinella spiralis
albendazole, mebendazole
28
what causes neurocystercosis
taenia solium
| fecal oral transmission
29
cysts in muscles, subcut tissues and brain
taenia solium neurocysticercosis
30
Tx for neurocysticercosis
albendazole and corticosteroid
31
Sx hepattis
malaise, arthralgias, fatigue, nausea, vomiting, RUQ pain, jaundice, scleral icterus, tender hepatomegaly, splenomegaly and lymphadenopathy
32
labs in hepatitis
bilirubinuria
increased AST and ALT!!!
increased alkaline phos
33
anti HAV IgM Ab
during acute illness
34
anti HAV IgG Ab
after resolution
35
how to test for HCV
Ab and PCR for HCV
36
Tx HCV
IFN alpha and can add ribavirin
37
Tx HBV
IFN-a or antivirals
38
what is the double stranded DNA hepatitis virus
HEPB
39
how does Hep A spread
fecal-oral
| food (shellfish)
40
how is Hep B spread
sexual contact, blood and bodily fluids
41
prevention Hep B
vaccine
42
complications of Hep B
hepatocellular carcinoma
43
how does Hep C spread
blood, possible sexually
44
how does Hep D spread
blood, need Hep B to have infection
45
how does Hep E spread
water
| fecal-oral
46
complications Hep E
high maternal mortality in pregnant women
47
Hep B markers for acute illness
HBsAg
HBeAg
anti-HBc IgM
DNA
48
Hep B markers for window period post exposure
anti-HBc IgM
49
Hep B markers for chronic infection with active viral repilication
+HBsAg
+HBeAg
+ antiHBc IgG
50
Hep B marker chronic infection low infectivitY
+HBSAG
| + ANTI-HBc IgG
51
Hep B marker for previoud infection
+ anti-HBs
| +anti-HBc IgG
52
Hep B markers if had vaccination
only +antiHBs
53
what limits only solid foods
obstruction
54
what limits solids and liquids
neuromuscular pathology
55
patient has dysphagia, first step
barium swallow before EGD
56
Achalsia
impaired neuromuscular disorder
| impaired peristalsis with decreased LES relaxation
57
what causes achalsia
intramural neuron dysfunction
58
signs achalsia
progressive dysphagia solids and liquids, regurg, cough, aspiration, heartburn, weight loss
59
birds beak
achalasia
60
Tx achalasia
nitrates and CCBs
pneumatic dilation
botulinum injections
myotomy
61
complications of achalasia
myotomy can cause GERD
62
Sx diffuse esophageal spasm
chest pain and dysphagia
63
corkscrew pattern on barium swallow
diffuse esophageal spasm
64
Tx diffuse esophgeal spasm
CCB
nitrates
TCA
65
secondary causes of achalasia
chagas, neoplasm, scleroderma
66
what relieves pain in diffuse esophgeal spasm but whats the trade off
nitrates help but worsen GERD
67
what causes zenker diverticulum
outpouching upper esophgaus by smooth mm weakness
68
Sx zenker
bad breath, regurg days after eating, dysphagia, feeling of aspiration, neck mass
69
Tx zenker diverticulum
cricopharyngeal myotomy or diverticulectomy
70
complications zenker
EGD can perforate
vocal cord paralysis
mediastinitis possible with surgery
71
labs to Dx GERD
esophageal pH monitoring
72
Tx for GERD
H2 antagonists and PPIs
73
complications GERD
esophageal ulceration, esophageal stricture, barrett esophagus, adenocarcinoma
74
most common esophageal CA in US
adenocarcinoma
75
most common esophageal CA in the world
squamous cell carcinoma
76
signs of esophageal cancer
```
progressive dysphagia solides then liquids too
weight loss
odynophagia
reflux
GI bleeding
vomiting
weakness
cough
hoarseness
```
77
how to Dx esophgeal CA
biopsy
78
Tx esophageal CA
resection
| radiation and chemo for nonoperative
79
complications esophageal CA
mets
80
what is a sliding hiatal hernia
GE junction and stomach through diaphragm
| most common
81
what is a paraesophageal hiatal hernia
stomach protrudes through diaphragm but GEJ at normal location
82
labs for hiatal hernia
barium swallow
| CXR
83
Tx sliding hernias
reflux control
84
Tx for paraesophageal hiatal hernias
gastropexy or nissen fundoplication
85
complications hiatal hernias
incarceration of stomach in herniation
86
acute gastritis
rapidly developing superficial lesions secondary to NSAID use, alcohol, ingestion corosive material, stress
87
signs Sx gastritis
epigastric pain, indigestion, nausea vomiting, hematemesis, melena
88
labs for gastritis
+ urea breath test (ammonia producing bacteria)
+ IgG Ab to H pylori
antral Bx
89
what cells are attacked in pernicious anemia
the parietal cells
90
chronic gastritis usually attacks what part of stomach
antrum
91
associated condiitions with chronic gastritis in antrum
peptic ulcer disease and gastric cancer
92
Tx H pylori
PPI, clarithromycin, amoxicillin or metro
93
curling ulcer
secondary to severe burn or intracranial injury
94
H pylori causes what
most gastric ulcers and almost all duodenal
95
refractory peptic ulcer disease, next step
measure gastrin to look for zollinger ellison
96
free air under diaphgram in CXR of someone with known PUD
perforated ulcer
97
complications of peptic ulcer disease
hemorrhage
perforation gastroduodenal artery
perforation from anterior ulcers
lymphoproliferative disease
98
where are the gastrinomas causing zollinger ellison found
duodenum or pancreas
99
eating helps Sx of epigastric pain
duodenal ulcer
100
eating worsens Sx of epigastric pain
gastric ulcer
101
what type of NSAID to those with PUD
Cox2 selective
102
labs to Dx zollinger ellison
increased fasting gastrin
| + secretin stimulation
103
imaging for zollinger ellison tumor
SPECT to localize tumor
104
Tx for zollinger ellison
surgical resection
PPI and H2 antagonists
octreotide to reduce Sx
105
complications zollinger ellison
MEN1
106
most common gastric CA
adenocarcinoma
107
types of gastric Ca
ulcerating
polypoid
superfiicial spreading
linitis plastica
108
risk factors for gastric CA
```
H pylori
FMH
japanese
tobacco
alcohol
Vit C def
high consumption preserved fod
```
109
Sx gastric CA
```
weight loss
anorexia
early satiety
n/v
dysphagia
epigastric pian
enlarged left supraclavicular node (virchow)
periumbical node (sister mary joseph node)
```
110
labs in gastric CA
increased CEA
increased 2 glucuronidase in gastric secretions
anemia
need Bx
111
barium swallow is showing thickend leather bottle stomach
(linitis plastica)
112
Tx for gastric CA
subtotal gastrectomy for lesions in distal third.
total gastrectomy if lesions in middle or upper
adjuvant chemo and radiation
113
complications gastric CA
poor prognosis in later detection
114
pathophys celiacs
IgA against anti tissue tansglutaminase and antiendomysial ab that cause jejunal mucosal damage
115
celiacs is assoc with what conditions
down syndrome and dermatitis herpetiformis
116
labs in celiac
anti endomysial Ab
antigliadin Ab
biopsy will show blunting of duodenal and jejunal villi
117
Tropical sprue
malabsorption from celiac sprue
| acquired in tropical areas
118
sudan stain
indicates steatorrhea
119
D xylose test
if abrnomal then do Bx for sprue, whipple or bacterial overgrotwh
120
negative sudan stain and low stool pH
lactase deficiency
121
Tx celiac sprue
folic acid replacement
| tetracycline
122
What can cause lactose intolerance
crohns or bacterial overgrowth
123
labs in lactose intolerance
+ tolerance test
| + lactose breath H test
124
whipple disease
from tropheryma whippelii
| malabsorption
125
risk factors whipples
white male european
126
signs Sx whipples disease
weight loss, joint pain, abdominal pain, diarrhea, dementia, cough, bloating, steatorrhea, fever, vision abnormalities, lymphadenopathy, new heart murmur, wasting
127
labs in whipples
jejunal Bx will show foamy macrophages with PAS+ stain and villous atrophy
128
Tx for whipples
TMP SMX or ceftriaxone for 12 months
129
most common cause adult chronic diarrhea
lactase deficiency
130
most common cause acute diarrhea in kids
rotavirus
131
osmotic diarrhea
solute in bowel causing water to enter bowel too.
| decreases with fasting
132
inflammtory diarrhea
autoimmune inflammatory process or chronic infection
133
Tx for inflammatory diarrhea
hydration
134
IBS
chronic abdominal pain and irregular bowel habits
in teens and adolescence
F>M
CBC, electrolytes and stool culture to rule out other GI diseases
135
Tx for IBS
```
assurance
high fiber diet
psychosocial therapy
antispasmodic
antidepressnats
SSRI
```
136
IBD
disease of small and large bowel with Sx associated with inflammatory bowel processes, autoimmune reactions, extraintestinal manifestations and multiple complications
137
risk factors IBD
ashkenazi Jew
| whites>blacks
138
bowel obstruction
mechanical that can lead to vascular compromise
| adhesions, hernias and neoplasms
139
risk factors ischemic colitis
DM, atherosclerosis, CHF, PVD, lupus
140
extraintestinal findings in crohns
arthritis, anklyosing spondylitls, uveitis, nephrolithiasis
141
labs in crohns
ASCA +
pANCA rarely +
hemoccult +
142
Tx crohns
```
mesalamine
antibiotics
corticosteroids
immunosuppressants
surgical resections
```
143
extraintestinal manifestations UC
arthritis, uveitis, anklylosing spondylitis, primary sclerosing cholangitis, erythema nodosum, pyoderma gangrenosum
144
labs in UC
ASCA rare
| pANCA frequently +
145
lead pipe colon without haustra
UC
146
Cure for UC
colectomy
147
complications UC
colon CA
hemorrhage
toxic megacolon
obstruction
148
multiple loops bowel with ladderlike appearance
Small bowel obstruction
149
labs in ischemic colitis
increased WBC increased serum lactate
150
imaging in ischmic colitis
barium enema shows diffuse change from localized bleeding "thumb printing"
sigmoidoscopy shows blood and edematous mucosa
151
Tx ischemic colitis
IV fluids, bowel rest, antibiotics, surgical resection if necrotic bowel
152
Tx SBO
NPO
maintain hydraion
nasogastric decompression
surgery if still there after decompression
153
what causes large bowel obstructions
neoplasm, diverticulitis, volvulus, congenital stricture
154
late feculent vomiting
LBO
155
Tx for LBO
NPO
maintain hydration
colonoscopy can relieve obstruction
surgery if colonoscopy does not help
156
what part of GI tract is most commonly invovled in ischmic colitis
left side
157
which GI pain is out of proportion to the PE
SBO
158
what causes appendicitis in children
lymphoid hyperplasia
159
what causes appendicitis in adults
fibroid bands or fecaliths
160
labs appendicitis
increased WBC with left shift
161
best test for appendicitis
Ct
162
woman with signs appendicitis, next step
urine B hCG
163
what is ileus
paralytic obstruction of bowel secondary to decreased peristalsis
164
what causes ileus
infection, ischemia, recent surgery, DM , opioid overdose
165
high clinical suspicision appendicitis
go right to surgery
166
imagin in ileus
distention affected bowel, air fluid levels, barium enema helps to rule it out
167
Tx for ileus
stop opioids, make patient NPO
| colonoscopic decompression
168
which part of GI tract takes longest to recover post surgery
the colon
169
volvulus
rotation of bowel causing obstruction
| usually at cecum and sigmoid
170
double bubble sign
volvuls
171
birds beak in distal abdomen
sigmoid volvulus
172
risk factors diverticulosis
low fiber diet
high fat diet
>60 years of age
173
most common cause acute lower GI bleeding in adults over 40 years old
diverticular disease
174
Tx diverticulitis
liquids only, PO antibiotics like cipro and metro
TMPSMX and metro
augmentin
175
internal hemorrhoids are from where
superior rectal veins above pectinate line
176
external hemorrhoids are from where
inferior rectal veins below pectinate line
| painful
177
Tx anal fissure
stool softeners, sitz baths, topical nitro
| partial sphincterotomy
178
throbbin rectal pain, fever and tenderness on DRE
anorectal abscess
179
Tx rectal fistula
formation between rectum and adjacent structures from unknown cause or secondary to IBD
180
Tx rectal fistula
fistulotomy, treat crohns patients with antibiotics
181
pilonidal disease
one+ cutaneous sinus tracts in superior midline gluteal celft
182
carcinoid arise from what
neuroectodermal cells that function as amine precursor uptake and decarboxylation cells (APUD)
183
where is carcinoid found
bronchopulmonary tree, ileum, rectum and appendix
184
labs in carcinoid
inc 5-HIAA in urine
| increased serum serotonin
185
Imaging for carcinoid
CT or indium labeled octreotide scintigraphy
186
Tx carcinoid
2 cm extensive resection
187
risk factors colorectal CA
```
FMH
UC
colonic polyps
hereditary polyposis syndromes
low fiber/high fiber diet
previous colon CA
alcohol smoking and DM
```
188
labs for colonic CA
+ guaic stool
dec Hb Hct
Bx diagnostic
CEA increased in 70% to monitor course
189
what imaging is used to detect extent of colorectal CA
CT or PET
190
Tx colorectal CA
resection and lymph node dissection
| adjuvant if + nodes
191
Familial adenomatous polyposis
hundred polyps
increased malignancy
need prophylactic subtotal colectomy
192
mutaiton in familial adenomatous polyposis
APC gene
193
gardner syndrome
lots of colonic polyps also with bone and soft tissue tumors
194
Turcot syndrome
many colonic adenomas with high malignancy. also CNS tumors
195
jevenile polyposis
hamartomatous polyps in colon small bowel and stomach
| increased risk malignancy later in life
196
peutz jeghers
hamartomas with low risk maliganncy
| mucocutaneous pigmentation of mouth hands and genitals
197
hereditary nonpoluposis colorectal cancer
proximal colon
| many genetic mutations
198
stage III colorectal CA
lymph node involvement
199
stage II colorectal CA
penetration of tumor into colonic serosa or perirectal fat
200
prevention for colorectal CA
anual FOBT
flexible sigmoidoscopy every 5 years
or
colonoscopy every 1o years
201
GI bleeding separation
ligament of treitz, above is upper
| below is lower GI bleed
202
causes upper GI bleeeds
```
PUD
mallory weiss tears (longitudinal tears from vomiting)
esophagitis
esophgeal varices
gastritis
```
203
causes lower GI bleeds
diverticulosis, neoplasm, UC, mesenteric ischemia, AVMs, hemorrhoids and meckel diverticulum
204
what is used to detect arteriovenous malformation in abdomen
angiography
205
Tx for GI bleeds
fluids
transgusions
Tx underlying cause
206
how to stop AVM from bleeding
vasopressin can help
207
causes of pancreatitis
```
hyper PTH
Alcohol
Neoplasm
Cholelithiasis
Rx
ERCP
Abdominal surgery
Triglyceridemia
Infeciton (mumps)
Trauma
Idioapthic
Scorpion bite
```
208
grey turner sign
ecchymosis of flank
| pancreatitis
209
cullen sign
umbilical ecchymosis
| pancreatitis
210
labs in chronic pancreatitis
mildly increase amylase and lipase
| low fecal elastase
211
radiolgy in chronic pancreatiis
pancreatic calcifications
| enlargement or pseudocyts
212
imaging in acute pancreatitis
dilated loop of bowel, sentinel loop
may have pleural effusion and hemidiaphragm elevation
pseudocyst on CT or enlarged pancreas
213
complications chronic pancreatitis
ductal obstruction, malnutrition, glucose intolerance, pancreatic CA
214
complications acute pancreatitis
abscess, pseudocyst, necrosis, fistulas, renal failure, hemorrhage, shock, DIC, sepsis, resp failure
215
Ranson criteria
```
prognosis acute pancreatitis
BAD if:
glucose >200
AST>250
LDH >350
Age>55
WBC>16,000
```
216
where does adenocarcinoma of pancreas arise
head of pancreas
217
risk factors for pancreatic adenocarcinoma
chronic pancreatiis, DM, FMH, tobacco, high fat diet, male>female
obesity and sedentary ligestyle
218
Signs Sx pancreatic adenocarcinoma
abdominal pain radiating to back
anorexia, nausea, vomiting, weight loss, fatigue, steatorrhea, painless jaundice, nontender gallbladder that is palapable
splenomegaly if mass is in tail
219
labs in pancreatic adenocarcinoma
```
hyperglycemia
increased CEA
CA19-9
increased bili
inc alk phos
```
220
best imaging for pancreatic adenocarcinoma
CT unless small then eRCP
221
surgery for pancreatic CA in head of pancreas
whipples procedure
222
complications pancreatic CA
bad prognosis
| can have migratory thrombophelbitis- trousseau syndrome
223
whipples triad
insulinoma
Sx hypoglycemia with fasting
hypoglycemia and improvement after carbohydrate load
224
mutliple insulinomas
MEN1
225
what are the endocrine pancreatic CA
zollinger ellsion
insulinoma
glucagonoma
VIPoma
226
Sx insulinoma
HA visual changes, confusion, weakness, mood instabiliyt, palpitations and diaphoresis
227
labs in insulinoma
increased fasting insulin, high C peptide
228
Tx for insulinoma
resection
| diazoxide and octreotide
229
what cells secrete glucagon
alpha cells in pancreas
230
Sx Signs glucagonoma
abdominal pain, diarrhea, weight loss, mental status changes, exfoliating rash(necrolytic migratory erythema) Sx of DM
231
labs in glucagonoma
hyperglycemia, increased glucagon
232
refractory DM
glucagonoma
233
Tx for glucagonoma
resection chemo and embolizaiton
234
where are VIPomas
non beta islet cells in pancreas
235
signs Sx VIPoma
watery diarrhea, wekaness, n/v and abdominal pain
236
labs in VIPoma
increased VIP, stool osmolality is secretory like
237
Tx VIPoma
surgical resection, corticosteroids, chemo, octreotide
238
pigmented stones are what
calcium bilirubinate from chronic hemolysis
239
complications cholelithiasis
recurrent
acute cholecystitis
pancreatitis
240
what causes acute cholecystitis
obsturction of cystic duct
241
labs in acute cholecystisi
icnreased WBC, increased bili and direct
| increased alk phos sometimes
242
what is used to detect cytic duct obstruction
HIDA scan
243
complications acute cholecystis
perforation, gallstone ileus, abscess
244
charcot triad
RUQ pain, jaundice and fever
| suspect cholangitis and do US or HIDA
245
What is cholangitis
infection bile ducts secondary to obstruction
246
signs Sx cholangitis
RUQ pain, chills, jaundice, fever, RUQ tenderness, change in mental status
247
labs in cholangitis
```
increased WBC
increased bili total and direct
increased alk phos
increased aST ALT
increased amylase
+ blood cultures
```
248
most sensitive test for cholangitis
HIDA
249
Tx cholantiis
hydration, IV antibiotics, endoscopic biliary drainage with delayed choecyetecomt
severe need emergency bile duct decompression
250
Sx signs adenocarcinoma of gallbladder
anorexia, weight loss, abdominal pain radiating to back, palpable gallbladder and juandice
resect to Dx
251
calcified gallbladder
adenocarcinoma of gallbladder in 10-30%
| usually from chronic cholecystitis
252
Tx adenocarcinoma gallbladder
cholecystectomy, lymph node dissection, partial removal of adjacent hepatic tissue, radiation and chemo
253
Primary biliary cirrhosis
autoimmune with intrahepatic bile destruction
254
risk factors PBC
RA
sjogrens
scleroderma
F?M
255
signs Sx PBC
fatigue, pruritis, arthralgias, jaundice, xanthomas, skin hyperpigmentation, HSM
256
labs in PBc
```
inc alk phos, GGT
normal LFTs
increasd cholesterol
increased direct and total bili
+ANA
+antimitochondrial!!!
```
257
Tx PBC
ursodeoxycholic acid to improve liver function and reduce Sx
| colchicines or MTX
258
Primary sclerosing cholangitis
progressive destruction intra and extrahepatic ducts
| leading to fibrosis and cirrhosis
259
risk factors for PSC
UC
| male >female
260
Signs Sx: PSC
aSx, fatigue, pruritis, RUQ pain, fever, night sweats, jaundice, xanthomas M>F
261
labs in PSC
inc alk phos and GGT
normal LFTs
inc bili total and direct
maybe + pANCA
262
how to differentiat PBC and PSC
PBC has antimitochondrial Ab and gender is usually female
| ERCP to be definitive
263
ERCP of PSC
stricturing and irregularity--- beads on a string!!
264
Tx for PSC
endoscopic stenting for strictures
| resection affected ducts
265
increase indirect bili
prehepatic
266
increase direct bili
posthepatic
267
what conjugates bilirubin
glucuronosyltransferase in hepatocytes
268
Gilbert
auto recessive or dominant
| mild deficiency in glucuronosyltransferase so get inc indirect bili
269
Crigler Najar type I
auto recessive, severe deficiency in glucuronosyltransferase
increased indiret bili
get kernicterus as infant
Tx is phothterapy, plasmaphereis, Ca phosphate with orlistat and liver transplant
270
causes of increased indirect bili
hemolytic anemia, disorders erythropoiesis
internal hemorrhage
physiologic jaundice newborn
gilber, cirgler najar and hepatocellular disease
271
causes of increased direct bili
```
dubin johnson, rotor
hepatocellular disease
drug impairment
PBC PSC
gallstone obstruction
cancers
biliary atresia
```
272
Crigler najar II
mild deficiency
| Tx with phenobarbital to help hepatic synthesis of glucuronyltransferase
273
labs in alcoholic liver disease
```
increased AST >ALT
increast GGT
increased alk phos
increased bili
prolonged PT
decreased lipids
increased WBC
```
274
fatty liver with many PMNs
alcoholic liver disease
275
Tx of alcoholic liver disease
stop drinking
thiamine
folic acid
high caloric intake
276
what causes cirrhosis
```
alcohol
HBV HCV
chrnoic obstruction
PBC PSC
hemochromatosis
wilsons
antitrypsin def
NASH
autoimmune hepatitis
```
277
paracentesis of ascites results in cirrhosis
278
small nodular livero n US
cirrhosis
279
what helps with encephalopathy from cirrhosis
lactulose and rifazimin
280
complications cirrhosis
portal HTN
hepatic encephalopathy
renal failure
spontaneous bacterial peritonitis
281
prehaptic causes of portal HTN
portal vein thrombosis
282
intrahepatic causes of portal HTN
cirrhosis, schistosomiasis, parenchymal disease and granulomatous disease
283
post hepatic causes of portal HTN
right sided HF
hepatic vein thrombosis
budd chiari syndrome
284
budd chiari syndrome
hepatic vein thrombosis secondary to hypercoagulability
285
paracentesis in portal HTN
serum-ascites albumin gradient >1.1
286
Tx for portal HTN
salt restriction and diuretics (furosemid and spironolactone)
IB antibiotics
dialysis
vsopressin for bleeding varices
287
severe portal HTN Tx
hepatic shunting bia laparotomy or transjugular intrahepatic portosystemic shunting
288
paracentesis has very high albumin and LDH
neoplastic etiology
| do workup
289
Sx signs hemochromatosis
```
abdominal pain
polydipsia and uria
arthralgias, impotence, lethargy
pigmented rash
hepatomegaly
testicular atrophy
```
290
labs in hemochromatosis
increased Fe, inc ferritin
inc transferrin
inc AST ALT
291
complications hematochromatosis
cirrhosis, hepatoma, CHF, DM hypopituitary
292
wilson disease
auto recessive
| coper depositts in liver brain and cornea
293
labs in wilsons
dec serum ceruloplasm
increased urinary copper
inc AST ALT
294
Tx wilsons disease
trientine or penicillamine for copper chelation
zine for maintaence
supp B6
295
complications wilsons disease
fulminant hepatic failure and cirrhosis
296
most common liver neoplasms
are mets from breast lung or colon
297
benign hepatic tumors
hepatic adenoma, focal nodular hyperplasia, hemangiomas and cysts
298
OCP increase risk for what hepatic tumor
benigh
299
why is Bx of hepatic mass contraindicated
hypervascularity and risk of hemorrhage
300
what is the primary malignant hepatic tumor
hepatocellular carinoma
301
risk factors hepatocellular carcinoma
HBV HCV, cirrhosis, hemochromatosis, increased consumption alflotoxin from aspergillus infected foods
schistosomiasis
302
labs in hepatocellular carcinoma
increased AST aLT
inc alk phos
inc bili
inc AFP
303
acid base in pyloric stenosis
hypoCl
hypoK
metabolic alkalosis
304
string sign in stomach
pyloric stenosis
305
necrotizing enterocolitis
bilious vomiting, lethargy, poor feeding, diarrhea, hematochezia, abdominal distention, abdominal tenderness, shock
306
Bx in hirschrpung
absent ganglia
307
most common cause bowel obstruction
intussuception
308
risk factors intussuception
MEckel diverticulum, henoch schonlein purpura
| adenovirus infections, CF
309
currant jelly stool
intussuception
310
sausage like abdominal mass
intussuception
311
Tx and Dx intussuception
barium ednema
312
intussuceptin in adult
CA until proven otherwise
313
meckel diverticulum is remnant of
vitelline duct
314
how to detect meckel diverticulum
technectium radionucleotide scan
