Medicine - GI Flashcards
(151 cards)
1
Q
When should AST/ALT be obtained in regards to Statin therapy?
A
BEFORE starting statins and then PRN
2
Q
Gilbert’s Syndrome Etx
A
Dysfunctional conjugation of unconjugated bilirubin to Conjugated by UGT –> [⬆︎UnConjugated Bilirubin] worst w/[stress/virus/illness]
Crigler Najjar = WORST VERSION of this in which UGT is ABSENT!
3
Q
Most Liver Dz has ALT > AST
What conditions involve [AST > ALT - 2:1 ratio]? -3
A
only a FEW…
- Fibrosis ADVANCED
- EtOH Hepatitis (Make a ToaSt to drinks)
- Wilson’s Dz
4
Q
w/u for [Hepatitis / Alcoholic Liver Dz]-7
You’ve already gotten back Aminotransferases
A
**FIRST…REPEAT LIVER CHEMISTRIES!!!**
- Viral Hepatitis Serology
- [RUQ US]: Evaluates for Cirrhosis and biliary tree dz
- Iron studies: identifies hemochromatosis
- [PT/INR and Albumin]: Is liver making proteins
- HIV: often co-infected with HepC
- Lipid Panel: Eval for NASH/NAFLD
- HbA1C: Eval for NASH/NAFLD
5
Q
Which bacteria are typically involved with Diverticulitis?-2
A
E.coli & Bacteroides Fragilis
6
Q
Abx tx regimens for Diverticulitis-4
A
4 options
- PO: Augmentin
- [PO: Flagyl + Cipro]
- [PO: Flagyl + Bactrim]
- [IV: Flagyl + CefTriaxone]
7
Q
What’s an effective way to determine if ascities is 2/2 Portal HTN Cirrhosis
A
SAAG = Serum to Ascites Albumin Gradient
(Serum Albumin - Ascites Albumin)
≥ 1.1 = Ascites from Portal HTN (Cirrhosis/Budd-Chiari)!
<1.1 = other cause (Ovarian CA,nephrOtic syndrome,TB, R HF)
8
Q
Normal Range for ALT and AST is _____. What etx’s would cause Aminotransferases to be > 1000! -5
A
8-20;
9
Q
Presentation for Autoimmune Hepatitis -3
A
“Tired w/ a Tan and Doesn’t Eat = Girls Best Dream!”
- Fatigue (most common)
- Jaundice
- Anorexia
10
Q
What Labs support Autoimmune Hepatitis-5
A
- Anti-LKM (Liver/Kidney/Muscle)
- ANA
- Antismooth muscle
- ⬆︎ Immunoglobulins
- ⬆︎ [ALT & AST]
Note: The only way to diagnose AH is Biopsy!!
11
Q
What is a GI Cocktail consist of-3
A
the LAMe GI Cocktail waitress
- Antacid
- Lidocaine
- Muscarinic R Blocker
- GERD indication
12
Q
Low platelets may indicate _____(4)
A
- Cirrhosis
- [DIC on Sepsis]
- [SLE Antiphospholipid Syndrome]
- Hemetologic abnormality (HUS, TTP, ITP)
Platelet range = 150 - 450 K
13
Q
Mngmnt for UnComplicated Pancreatitis - 3
A
IVF
Pain Mngmt
NPO
14
Q
Most common causes of Upper GI Bleed -4
A
PEEM
PUD > Esophageal Varices > Esophageal Erosion > Mallary-Weis tear
15
Q
Most common causes of Lower GI Bleed -5
A
Diverticulosis > [Colitis (Ischemic>IBD>Radiation)]> [Hemorrhoids/Anal Fissure] > Colon CA > [s/p polypectomy]
16
Q
____ is the most common cause of Upper GI Bleed. Name the risk factors for developing this-9
A
PUD
17
Q
The 3 types of Shock are Cardiogenic, Hypovolemic and Distributive
Which 3 sub-types make up Distributive Shock ; what’s unique about this type of shock?
A
Distributive = SAS
Sepsis / Anaphylaxis / Spinal
Distributive will have WARM extremities (others are cold)
18
Q
What are causes of Biliary-related elevated ALP -3
A
- Cholestasis
- Liver infection (TB/CMV/MAC)
- Liver damage (CHF/EtOH cirrhosis)
19
Q
You see a Jaundiced pt. What must his Total bilirubin at least be?
A
>2
20
Q
[Dubin Johnson syndrome] and [Rotor Syndrome] etx
A
Inability to secrete Conjugated bile into Bile Duct
21
Q
General Approach to Elevated ALP
A
22
Q
[Primary Biliary Cirrhosis] etx
A
23
Q
1st and 2nd symptom stages of [Primary Biliary Cirrhosis]
A
24
Q
[Primary Biliary Cirrhosis] Dx and tx-2
A
25
[Primary Sclerosing Cholangitis] etx
26
[Primary Sclerosing Cholangitis] dx
ERCP beading pattern
27
MOD for [HFE mutation 1° Hemochromatosis]
HFE mutation --\> Liver & Enterocytes **falsely** detecting low iron --\> [1 and 2] --\> [Liver Cirrhosis & HCC] AND **BRONZED SKIN**
1. Liver DEC Hepcidin release ---\> [INC Ferroportin on Enterocytes basolaterally]--\>INC iron absorption
2. Enterocytes [INC Apical DMT1] --\> ALSO INC iron absorption
*Presents after 40 yo*
28
FerriTin \> 1000 usually indicates \_\_\_\_. What other lab values is found with this?
**HEMOCHROMATOSIS** ; [95% Transferrin Saturation]
## Footnote
*Presents after 40 yo*
29
Wilson's Dz Etx
30
Wilson's Dz Sx -4
31
Wilson's Dz Tx
32
What is the most common cause of Cirrhosis and how is it diagnosed?
NASH! ; Liver Biopsy
## Footnote
*NASH RF: Obesity, DM, Hyperlipidemia*
33
Autoimmune hepatitis dx and tx-2
Dx = Biopsy
1. prednisone
2. azathioprine
34
Why is drinking alcohol in a pt with Hep C dangerous?
Hep C ⬆︎⬆︎⬆︎⬆︎ Liver damage from alcohol!!
35
How do you interpret positive Hep C serology?
Hep C Ab = exposure at some point
Hep C **RNA titers = determines status** *(HIGH = chronically active vs negative = resolved)*
36
A: Early signs of Hepatic Encephalopathy - 2
B: LATE signs of Hepatic Encephalopathy -3
A:
1A. **Reversed sleep cycle** (can't sleep @ night, only during day)
2A. Personality changes
1B: Asterixis (flapping hands)
2B: Coma
3B: focal neuro signs
*Hepatic Encephalopathy is caused by ⬆︎ NH3*
37
Tx for Hepatic Encephalopathy and their MOA (2)
1. Lactulose (converts NH3 --\> NH**4+** in colon - and ⬆︎peristalsis --\> DIARRHEA)
2. Rifaximin abx (⬇︎NH3 producing colonic bacteria)
38
Vaccinations for pts with Chronic Hepatitis -4
1. Hep A *(acute viral hepatits can --\> Fulminant Liver failure!)*
2. Hep B *(acute viral hepatits can --\> Fulminant Liver failure!)*
3. Flu
4. Pneumococcal
39
Why is Octreotide given for **active** Esophageal Varices Rupture
it vasoconstricts splanchnics --\> ⬇︎pressure from splanchnics to the esophagus
40
Spontaneous Bacterial Peritonitis Etx ; Sx-4
**Cirrhotic** **Immunosuppression** --\> Infection of ascitic fluid ---\> Hepatic Encephalpathy or [Type 1 Hepatorenal syndrome]! ;
1. *Diffuse* Abd pain
2. Fever
3. AMS evidenced by Reitan trail connect the number test
4. paralytic iLeus
*These pts may NOT have peritoneal signs because it's blunted by ascitic fluid!* Fluid cx will show organisms with neutrophils\>250
41
What are the purposes of Peritoneal fluid analysis in pt with ascities? -2
1. Determine **Cause**
2. Determine presence of **Infection**
## Footnote
*Causes = Cirrhosis \> [Ovarian CA=TB=nephrOtic syndrome=R HF]*
42
Other than Cirrhosis, what are other causes of ascites? -4
1. Ovarian CA
2. nephrOtic syndrome
3. TB
4. R HF
These will have a SAAG \< 1.1
43
*You've just obtained Ascitic fluid from Cirrhosis pt*
What labs should be ordered for this fluid AND why? -3
1. **Ascitic Albumin**: Determine SAAG for cause!
2. **CBC w/diff**: \>250 PMN means Spontaneous Bacterial Peritonitis
3. **Gram stain and Culture**:
44
Spontaneous Bacterial Peritonitis Tx -2
Cipro vs Norfloxacin
45
Indications for Liver Transplant -6
1. Type 1 Hepatorenal syndrome
2. Tx refractory Liver failure
3. Decompensating Liver failure
4. Acute Fulminant Liver Failure
5. [Cirrhosis 2/2 HCV with MELD score \> 10]
6. [Cirrhosis 2/2 HCV s/p major complication of Portal HTN]
46
D-Lactic Acidosis is seen in pts with \_\_\_\_\_. Etx? CP-2
Short bowel syndrome; Unabsorbed Carbs are metabolized by intestinal bacterial --\> D-lactic acid which is absorbed --\> **Confusion + Ataxia during carb loading**
47
Wilson's Dz Dx - 3
1. Low Ceruloplasmin ( \< 20 mg/dL) -*ceruloplasmin binds to ⬆︎ free flaoting copper*
2. ⬆︎Urinary Copper
3. Slit Lamp revealing Kayser Fleischer Rings
48
What are the most common biomarkers for unhealthy EtOH usage? - 6
1. AST: ALT ratio ≥ 2:1
2. ⬆︎GGT
3. ⬆︎Carbohydrate-deficient Transferrin
4. ⬆︎FerriTin
5. Macrocytosis
6. Pancytopenia
49
Why is Angiodysplasia also a cause of Upper GI bleed
it can occur **anywhere** in the GI tract BUT most commonly occurs in R Ascending Colon
## Footnote
*RF: Aortic Stenosis, von willebrand disease, renal disease*
50
In adults, what are the risk factors for developing Angiodysplasia - 3
## Footnote
*This can occur ANYWHERE in the GI tract but most commonly occurs in R Ascending colon*
1. Aortic Stenosis (vW multimers are disrupted as they pass through turbulent space --\> AVM)
2. Von Willebran disease
3. Renal disease
51
If a pediatric pt with hypertrophic pyloric stenosis has electrolyte abnormalitites, do you immediately go to surgery or correct electrolytes/hydration first?
Electrolytes/Hydration FIRST!
## Footnote
*Dx = US*
52
Dx for Celiac disease - 4
## Footnote
*malabsorption sx + iron deficiency anemia = CELIAC!*
Anti-**TED** (IgA or IgG)
**T**issueTransGlutaminase/**E**ndomysial/**D**eaminatedGliadin
---\> DUODENAL BX FOR CONFIRMATION (IgA test may result in false negative if concurrent IgA deficiency is present!)
*look for wt loss, iron deficiency anemia and dermatitis herpetiformis (elbows, knees, butt, back) in these pts!*
53
Why can't US be used to diagnose Primary Biliary Cholangitis?
PBC involves Anti-mitochondrial abs attaching **intra**hepatic biliary duct ONLY. US can only see EXTRAhepatic
54
Other than complications from cholestasis, what other complications are associated with Primary Biliary Cholangitis? - 3
1. HLD with Xanthelasma
2. Metabolic bone disease
3. Autoimmune thyroid disease
55
Although CXR in Boerhaave syndrome can show \_\_(3)\_\_, what is the confirmation dx?-2
Boerhaave = violent vomiting --\> esophageal rupture
1. uL pleural effusion +/- PTX
2. pleural fluid high in amylase ( \> 2500)
3. widened mediastinum with emphysema
Confirmation dx = CT or [contrast esophagography with Gastrografin]
56
Complications of GERD - 3
1. Barrett's esophagus
2. Erosive sophagitis
3. Esophageal peptic strictures (circumferential narrowing)
57
Causes of Esophageal pepetic strictures (circumferential esophageal narrowing --\> solid food dysphagia only) - 4
1. GERD
2. Radiation
3. Systemic slcerosis
4. Caustic ingestions
58
Characteristics for Carcinoid Syndrome - 10
**C**ardiac (Tricuspid Regurgitation)
## Footnote
*Do not confuse with VIPoma which presents similarly but affects Pancreas while Carcinoid affects small intestine*
59
[T or F] Screening Ammonia levels should be ordered on pts with cirrhosis with or without encephalopathy
FALSE - only order Ammonia if hepatic encephalopathy is suspected
60
*Pt has cirrhosis with esophageal varices*
What is the prophylactic mngmt for this pt? - 2
[**General B Blockers (nadalol) OR Variceal ligation**] --(if refractory)--\> [TIPS-Transjugular intrahepatic portosystemic shunt]
61
what is the tx for **Ascities** secondary to Cirrhosis - 3
1. Furosemide
2. Spironolactone
3. Salt restriction
62
what is the tx for Hepatic Encephalopathy - 2
1. Lactulose
2. Rifaximin
63
A pt has been diagnosed with Gastric ADC
What's the next immediate step?
**TUMOR STAGING** via CT to determine px/tx
## Footnote
*Note: HPylori eradication is only helpful for gastric MALT*
64
Tx for asymptomatic gallstones
**NOTHING**
## Footnote
*Lap Chole is only indicated for sympatomatic gallstones!*
65
Tx for Complicated Gallstones
## Footnote
*GS with concomitant cholecysitis, choleDocholithiasis, pancreatitis*
Lap Chole **sometime within 3 days**
66
Tx for ACTIVE variceal bleeding - 3
1. Octreotide (splanchnic vasoconstriction & ⬇︎glucagon --\>⬇︎portal blood flow)
2. Endoscopic Sclerotherapy
3. Intubation if airway compromised from vomiting
67
In Cirrhosis, what all does ⬆︎Estrogen cause? - 5
1. Gynecomastia
2. ⬇︎Body Hair
3. Palmar Erythema
4. Spider Angiomas
5. Testicular Atrophy
68
Describe Biliary Cyst ; Tx?
[Congenital or Acquired] Biliary tree Dilatations that may be [intra or extrahepatic], [single or multiple]
Tx = Surgery
69
When do you typically see pancreatic pseuocyst
as a complication of acute or chronic pancreatitis
70
Esophageal Spasm cp - 3 ; dx?
1. retrosternal chest pain **precipiated by emotional stress** and relieved with NTG
2. dysphagia **precipiated by emotional stress** and relieved with NTG
3. regurgitation **precipiated by emotional stress** and relieved with NTG
Dx = Manometry showing multiple simultaneous contractions of the mid and lower esophagus
71
what is the most common Cancer of the liver
**Metastasis**(can be solitary) from another primary (i.e. COLON or pancreatic - since these send their venous blood directly to liver)
## Footnote
2nd = Hepatocellular carcinoma
72
Heaptic angiosarcoma etx
(Vinyl Chloride gas, arsenic, thorium) exposure --\> **RARE** liver neoplasm in older men
73
Focal nodular hyperplasia and Hepatic Adenoma are typically seen in \_\_\_\_\_. Which is typically asymptomatic?
young women ; FNH
74
What is long term relief for pts with PUD - 3
**TRIPLE TX!**
1. PPI
2. Amoxicillin
3. Clarithromycin
*Smoking and EtOH cessation can help but don't offer LONG TERM change*
75
Clinical manifestations of Cirrhosis - 13
76
What is the purpose of the D-xylose test
**In patients with steatorrhea**/**fatty stool**...
It differentiates between
1. **Celiac disease** (D-xylose will be LOW in the urine because it can't be reasbsorbed in the small intestine because of villous atrophy)
2. **Pancreatic insufficiency** (D-xylose will be HIGH because absorption occurs normally and pancreatic enzymes never break down D-xylose)
77
How are the results of the D-xylose test interpreted? ; How does Rifaximin play a role in this?
**In patients with steatorrhea**/**fatty stool**...
It differentiates between
1. **Celiac disease** (D-xylose will be LOW in the urine because it can't be reasbsorbed in the small intestine because of villous atrophy)
2. **Pancreatic insufficiency** (D-xylose will be HIGH because absorption occurs normally and pancreatic enzymes never break down D-xylose)
\*\*Small Intestine Bacterial Overgrowth can digest D-xylose before it has the chance to be reabsorbed --\> Falsely low D-xylose. Rifaxmin abx prevents this\*\*
78
Where do Mallory Weiss tears occur
longitudinal tears in the mucosa **near the Gastroesophageal junction**
79
Painless Jaundice DDx - 3
1. Pancreatic CA - obstructive
2. Biliary CA - obstructive
3. CholeDocholithiasis
80
When do you see GI bleeding from Gastritis - 2
1. ICU
2. Burns
81
Key signs of Laxative Abuse -3
1. **Nocturnal** watery diarrhea
2. Melanosis coli on cscope-image (dark brown discoloration of colon)
3. Metabolic ALKALOSIS (loss of K+ from laxative --\> ⬇︎Cl absorption --\>⬇︎Cl/HCO3 exchange --\> ⬆︎HCO3 in serum)
82
Describe colonic findings for Pseudomembranous colitis - 3
1. FRIABLE
2. Edematous
3. Erythematous
83
Toxic Megacolon cp - 3
1. Bloody Diarrhea
2. Systemic Toxicity (fever, tachycardia, hypotension)
3. Abd distension +/- peritonitis
84
Toxic Megacolon mngmt- 5
1. Abx
2. NPO
3. NG suction
4. +/- CTS if IBD associated
5. *SURGERY ONLY IF MEDICAL MNGMT FAILS*
85
Complications of Diverticulitis - 3
1. Colovesical fistula --\> pneumaturia, fecaluria, UTI sx
2. rupture
3. Abscess
86
Hepatic Adenoma is a benign \_\_\_type of tumor in young women, associated with ___ and \_\_\_
What are its complications?-2
epithelial ; OCP/Pregancy ; Rupture/MalignancyTransformation
## Footnote
*this CAN cause biliary obstruction*
87
What is Mesenteric Angioplasty indicated for?
Chronic Mesenteric ischemia (evidenced by postprandial intestinal pain+ wt loss)
88
Chronic Mesenteric Ischemia cp - 3
1. unexplained chronic postprandial abd pain (**intestinal angina**)
2. Wt loss
3. Food Aversion
## Footnote
*usually from atherosclerotic celiac or SMA*
89
Name the 6 major organ systems affected by Cystic Fibrosis and how they're affected
Respiratory = Nasal Polyps, Digital Clubbing, Bronchiectasis
90
Esophageal manometry showing hypercontractility inidcates what disease?
Eosinophilic esophagitis
91
Dx for Zenker's Diverticulum
Barium Contrast Esophagram
## Footnote
*Dysphagia, Foul Breath, Regurgitation, Aspiration*
92
Postcholecystectomy syndrome etx ; Dx-2
Biliary or Extra-Biliary causes --\> persistent abd pain or dyspepsia in pts s/p cholecystectomy
Dx = Abd US --\> ERCP/MRCP
93
cp for Niacin B3 deficiency - 4
**DDDD** Pellagra
## Footnote
**D**iarrhea
**D**ermatitis symmetrical hyperpigmented rash on sun areas
**D**ementia
**D**EATH
94
How do you confirm diagnosis for Esophageal Rupture?
Contrast Esophagram water soluble
95
Pt presents with narrowed "colon"
How do you differentiate between Cystic Fibrosis and Hirschsprung disease
*almost all newborns with meconium iLeus have CF*
96
What are the main causes of Ascities - 5
******Cirrhosis from EtOH** \> [Ovarian CA=TB=nephrOtic syndrome=R HF]
97
What type of diarrhea is associated with decreased stool osmotic gap \< 50
Secretory
## Footnote
*these are larger volume diarrhea that occurs during fasting or sleep*
98
What type of diarrhea is associated with diarrhea during fasting
Secretory
## Footnote
*these are larger volume diarrhea that occurs during fasting or sleep*
99
What type of diarrhea is associated with INCREASED stool osmotic gap \> 125
Osmotic
## Footnote
*ex: Lactose intolerance*
100
Between Osmotic and Secretory Diarrhea, which type of diarrhea occurs during sleep?
Secretory
## Footnote
*these are larger volume diarrhea that occurs during fasting or sleep*
101
What is the diagnosis in this infant?
Jejunal atresia
## Footnote
*image shows TRIPLE bubble sign with gasless colon*
102
What is the major risk factor for the development of this condition?
maternal COCAINE use
## Footnote
\*\*Jejunal atresia\*\*
*image shows TRIPLE bubble sign with gasless colon*
103
Why are NSAIDs a common cause of iron deficiency anemia
chronic blood loss from GI tract ulcers
104
pancreatic calcifications on CT indicate what disease? ; how is the lipase affected by this?
Chronic Pancreatitis ; **MINIMAL CHANGE TO LIPASE** because of pancreatic burn out
105
Where is the intestinal enzyme lactase located? ; cp for lactose intolerance?
Duodenal brush border ;
Chronic crampy postprandial pain and waterry diarrhea
106
Pt comes in with Hematochezia
How do you work them up? (after doing a rectal)
107
Why does Carcinoid Syndrome cause Niacin B3 deficiency?
Carcinoid tumors utilize Tryptophan to secrete tons of Serotonin. Tryptophan is also needed to make Niacin B3. This can --\> Pellagra DDDD
## Footnote
*Do not confuse Carcinoid Syndrome with VIPoma which presents similarly but VI**P**oma affects **P**ancreas while Carcinoid affects small intestine*
108
What is a good empiric abx regimen for abdomianl infections? - 3
1. Amp
2. Gent
3. Flagyl
109
Why do pts with Crohn disease have ⬆︎ development of Kidney stones?
They have fat malabsorption which --\> ⬆︎oxalate absorption --\> Ca+Oxalate precipitation in the kidneys
110
major signs of bowel obstruction - 3
1. NV
2. peritoneal signs
3. hyperactive bowel sounds (unless perforation)
111
Diagnostic criteria for Toxic Megacolon
Confirmatory Abd X rays
+ ≥3 of the following:
- Fever \>38C
- HR \>120
- WBC \>10,500
- Anemia
112
Tx for Toxic Megacolon - 4
1. NG Decompression
2. IV CTS
3. Abx
4. IVF
113
What are the imaging findings for Ascending Cholangitis
Common Bile Duct dilation
## Footnote
*Fever, RUQ pain, Jaundice = Charcot Triad*
114
Tx for Esophageal Spasm
CCB
115
Endoscopic findings for Ulcerative Colitis
Continuous Friable mucosa with ulcers
116
Zenkers Diverticulum etx
**ESOPHAGEAL DYSMOTILITY** --\> Diverticulum above upper esophageal sphincter with posterior herniation **between fibers of cricopharyngeal muscle**
117
Achalasia cp?-2 ; Dx?
1. Chronic dysphagia to BOTH solids and liquids
2. Regurgitation
Dx = Manometry
118
Wilson disease cp - 2
1. Liver dysfunction
2. NeuroPsychiatric sx (parkinsonism, dysarthria, depression)
3. Kayser Fleisher rings
## Footnote
*etx: hepatic copper accumulation --\> leakage into serum --\> copper deposition in tissues*
119
Which lab value can be used to diagnose Wilson disease? ; Tx?-2
⬇︎Ceruloplasmin ;
Tx:
1. D-penicillamine chelator
2. Zinc (interfes with Copper absorption)
* etx: hepatic copper accumulation --\> leakage into serum --\> copper deposition in tissues*
120
Pts with Ulcerative Colitis are at risk for _____ CA; What's px for this?
Colorectal ;
8 years after diagnosis --\> Screening Cscope with mucosal sampling q2years
121
Whipples disease cp -3 ; dx?
Come to my Whipple **PAD**!
1. **P**igmentation
2. **A**RTHRALGIAS
3. **D**IARRHEA a/w abd pain and wt loss +/- fever
Dx = PAS-positive material in lamina propria of small intestine bx
122
What would a liver biopsy of a child with Reye syndrome show?
microvesicular steatosis
## Footnote
*Reye --\> fulminant liver failure --\> Hyperammoniemia --\> neurotoxicity. Tx = supporitve*
123
Pts with Familial Adenomatous Polyposis have ⬆︎ risk for ___ Cancer
Px?
Colorectal
## Footnote
Annual sigmoidoscopies (cscope if adenomas are found or if age 50) screening **starting 10 yo** ---\> elective proctocolectomy in early 20s (or if severe sx/CA develops)
124
Genetic testing revealing Lynch Syndrome puts pts at risk fro what CA? - 4
**COS****E**
1. **C**olorectal proximal colon
2. **O**varian
3. **S**kin
4. **E**ndometrial
125
What are other system complications of Primary Biliary Cirrhosis - 2
1. Metabolic bone disease (osteoporosis, osteomalacia)
2. Hepatocellular carcinoma
## Footnote
*only INTRAhepatic*
126
Down syndrome is strongly associated with what GI conditions- 2
1. Duodenal atresia (double bubble xray)
2. Hirschsprung
127
cp for Cyclic Vomiting Syndrome - 2
**IN THE CONTEXT OF PERSONAL OR FAMILY _MIGRAINE_ HX**
recurrent and predictable vomiting that spontaneously resolves with no sx in between episodes
tx = antiemetics and antimigraine
128
Which IBD condition are Pseudopolyps associated with?
Ulcerative Colitis
129
Which conditions are associated with transaminases \> 1000 - 5
**D**ark **CASA**
1. **D**rug/toxin injury (APAP) (serum transminases are \> 3000!)
2. **C**ommon Bile Duct stone
3. **A**cute viral hepatitis
4. **S**hock Liver
5. **A**utoimmune Hepatitis
130
Which condition is associated with transaminases \> 3000
APAP --\> Acute Liver Failure
## Footnote
*These pts should undergo early **consideration for Liver transplantation**, especially if not improving over time!*
131
Name the most common site of colon cancer metastasis
Liver
132
What's the first step in evaluating a pt with asymptomatic transaminitis?
Thorough HISTORY (EtOH, drug, travel, blood transfusion, sexual practices)
133
Dx for Diverticulitis
Contrast CT Abd Pelvis (PO and IV)
134
Endoscopic findings for Zollinger Ellison Gastrinoma - 2; Dx?-2
1. Thickened Gastric Folds
2. Multiple Peptic Ulcers (with some DISTAL TO DUODENUM IN THE JEJUNUM)
Fasting Serum Gastrin \> 1000 --\> low gastric pH for confirmation
135
You suspect a pt has Zollinger Ellison Gastrinoma but their Fasting Serum Gastrin was \< 1000
next steps?
Secretin test to stimulate gastrin release by abnormal gastrinoma cells
## Footnote
*normal gastric G cells are actually inhibited by secretin so if Secretin fails to stimulate gastrin increase, hypergastrienmia is caused by something else*
136
Pts with Familial Adenomatous Polyposis have ⬆︎ risk for ___ Cancer
Which Adenomatous Polpys require the MOST colonoscopic surveillance? - 4
Colorectal
1. large polpys ≥1cm
2. high grade dysplasia
3. villous features (long glands on histo)
4. multiple ≥3 concurrent adenomas
137
New Iron Deficiency Anemia in the elderly should always be considered to be from _____ until proven otherwise
GI blood loss
## Footnote
*a single negative FOBT should NOT desuade from cscope/escope*
138
All pts with suspected Achalasia should undergo _____ before any treatment - Why?
Endoscopy ; r/o Cancer as the cause which = pseudoachalasia
139
What are the risk factors for Clostridium Difficile - 3
1. Abx
2. Gastric acid suppression (PPIs)
3. \>65yo
140
cp for Riboflavin B2 deficiency - 3
1. Angular Cheilitis (fissures at corner of lips)
2. Glossitis (hyperemic tongue)
3. Seborrheic Dermatitis
141
Diagnostic criteria for Acute Liver Failure - 2
1. hepatic encephalopathy is present
2. INR≥1.5
## Footnote
*Most commonly from **D**rug/Toxin and **A**cute Viral hepatitis*
142
Which product is recommended to transfuse in acute GI bleeds
Packed RBCs
143
When is it indicated to tranfuse Platelets?
1. \<50K platelets **with active bleeding**
2. \<10K platelets total
144
cp for Zinc deficiency - 3
1. alopecia
2. impaired taste
3. dermatitis pustular with perioral involvement
145
How can Severe Pancreatitis cause Distributive Shock?
Pancreatitis releases pancreatic enzymes into vasculature which ⬆︎vascular permeability around the pancreas and allows fluid to enter the retroperitoneum --\> Even greater widespread vasoDilation
146
What's the most reversible risk factor for pancreatic cancer?
smoking
147
What are the laboratory findings for Lactose intolerance? - 5
## Footnote
*Lactose intolerance is most commonly seen in Asians*
1. ⬆︎stool osmotic gap (osmotic diarrhea)
2. +reducing substances in stool
3. **+hydrogen breath test (indicates intestinal bacterial carbohydrate catabolism)**
4. acidic stool pH
5. NO steatorrhea
## Footnote
*Lactose Intolerance is most commonly seen in Asians*
148
cp for iron intoxication - 4
1. abd pain **with radiopaque tablets on radiographs**
2. hematemesis
3. AMS
4. metabolic acidosis
## Footnote
*tx = deferoxamine or whole bowel irrigation*
149
Do you give activated charcoal (gastric decontamination) to an APAP OD pt who has no laboratory abnormalities on presentation?
YES! That and APAP levels - they may be asymptomatic for the first 24 hours after ingestion
150
Describe the guideline options for colon cancer screening - 4
1. FOBT annually - 50 yo
2. Sigmoidoscopy every 5 years if combined with FOBT every 3 years - 50 yo
3. Colonoscopy every 10 years - 50 yo
4. **If 1st degree relative with Colon CA -Begin screening at 40 yo or 10 years before age of relative's dx**
151
Both Intrahepatic Cholestasis of Pregnancy and Acute Fatty Liver are complications of Pregnancy
How do you discern the two?
Intrahepatic Cholestasis of Pregnacy = Pruritus cp
vs
Acute Fatty Liver = Liver Failure cp
