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Flashcards in GI Stepup Deck (314):
1

causes of viral gastroenteritis

Norwalk, Coxsackie virus A1, echovirus and adenovirus
rota in kids

2

labs in viral gastroenteritis

no fecal WBC

3

fried rice and vomiting within a few hours of eating it

bacillus cereus

4

bloody diarrhea and abdominal pain after eating chicken

campylobacter jejuni

5

which pathogen is assoc with bacterial GI upset and guillain barre

campylobacter jejuni

6

flaccid paralysis from honey

clostridium botulinum

7

Tx for adult botulism toxin from canned foods

botulism antitoxin

8

watery or bloody diarrhea post antibiotics

clostridium difficile

9

Tx C diff

metro or vanco

10

what is travelers diarrhea from

enterotoxigenic E coli

11

bloody diarrhea, abdominal pain, renal failure

E coli O157:H7

12

vomiting several hours after eating past salad

staph aureus

13

bloody diearrha, fever vomiting after eggs

salmonella

14

whats the most common foodbourne bacterial GI infection

salmonella from fresh produce

15

severe bloody diarrhea after eating

shigella

16

Tx for sigella bloody diarrrhea

hydration
can use cipro
if severe use tMP SMX

17

copious watery diarrhea after eating shellfood

vibrio cholera

18

Tx for vibrio cholera

tetracycline or doxy decrease length

19

watery diarrhea after oysters

vibrio parahaemolyticus

20

Bloody diarrhea and right lower pain after eating pork and fresh produce

yersinia

21

greasy foul smelling diarrhea with abdominal pain

giardia

22

Tx giardia

metro and hydration

23

mild to severe bloody diarrhea abdominal pain
after drinking water in poor area

entamoeba histolytics

24

Tx entamoeba histolytica

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