Mixed Flashcards by Berni Mariño

Normal stool fat content

< 14 g/day
14-20: investigate small bowel causes
>20: investigate pancreatic causes

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Indications to pursue stool micro studies

Fever >38.5
bloody stools
high stool WBC
elderly aged 70 and above
ICC state
Duration >48 hours without improvement
Recent antibiotic use
New community outbreak
Associated severe abdominal pain in patients >50 years

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INDICATED TO GIVE ANTIBIOTIC TREATMENT FOR ACUTE DIARRHEA

Immunocompromised
(+) mechanical heart valves or recent vascular grafts
Elderly

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INDICATION TO GIVE ANTIBIOTIC PROPHYLAXIS for Diarrhea

“GIIH”
- Immunocompromised**
- IBD**
- Hemochromatosis**
- Gastric achlorhydria**

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DOC for diabetic diarrhea

Clonidine

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Drug for diarrhea in IBS

5 HT3 antagonist (Ondansetron)

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Treatment of diarrhea associated with IBS

5 HT3 antagonist (Ondansetron)
Rifaximin
eluxadoline (κ-OR agonist and δ-OR antagonist)

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What 3 conditions would make colonoscopy among < 40 years old preferable than flexible sigmoidoscopy?

-Copious bleeding
-Family hx of colon CA
-IDA

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Conditions with SAAG < 1.1

“Bili Neph Peri Tub”

Biliary Leak
Nephrotic Syndrome
Peritoneal carcinomatosis
Pancreatitis
Tuberculosis

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Conditions with SAAG >= 1.1 with Ascitic protein < 2.5

“C LB M”

Cirrhosis
Late Budd Chiari
Massive liver mets

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Conditions when abx prophy needed for GI procedures

ERCP
-Sterile pancreatic fluid collection*
-Bile duct obstruction ⊖ cholangitis (with expected incomplete drainage)*

EUS FNA
-Cyst along GI, pancreas, mediastinum

PEG

Cirrhosis with GI bleed

Continuous PD

Transmural drainiage
-Sterile pancreatic collection

*continue after procedure

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Types of gastritis and their level of acid production

Type I - body; low
II- antrum; normal to low
III- pylorus with DU; normal to high
IV - cardia; low

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Nutrition deficient with long term PPI use

Iron
Magnesium
Vit B12

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Chronic gastritis types and features

Type A - Autoimmune
Type B
-antral
-assoc with adenocarcinoma
-aging

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What stage of hemorrhoids are the following initially indicated?

RBL
Sclerotherapy

Sclerotherapy - II
RBL - III

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GERD Warning Signs

Dysphagia/Odynophagia
Recurrent vomiting
GI bleed
Jaundice
Weight loss
Palpable adenopathy or mass
Familial hx of GI malignancy

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Antibiotic coverage is required in these patients who present with acute diarrhea, whether or not a causative organism is discovered

“I love old ppl”

ICC state
Mechanical heart valves
Elderly

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Most consistent clinical feature in IBS

Alteration in bowel habits

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Percutaneous drainage in Hinchey II is highly recommended with what abscess size?

> 3cm

< 5cm may resolve with abx alone

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What 2 conditions are contraindications to hemorrhoid procedures?

1) ICC state
2) Proctitis

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Which of the following is the most common cause of functional bowel obstruction?

Intaabdominal surgery

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Acetaminophen blood level correlated with severe hepatic damage?

> 300 ug/mL 4hr

< 150 ug/mL - unlikely

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Risk factors for progression to advanced liver fibrosis to those with NASH

Age > 45-50
Overweight/obese
T2DM

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3 recommendations for cholecystectomy

1) symptomatic
2) prior history of gallstone disease
3) calcified GB/porcelain gallbladder

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Diagnostic algorithm for chronic pancreatitis

CT MRI EUTZ Pancreas function test ERCP

Most prevalent cause of drug induced acute liver failure?

Acetaminophen

The most common agent implicated as causing drug-induced liver injury

Co-Amoxiclav

Drugs with mild, transient, nonprogressive serum aminotransferase elevations that resolve with continued drug use

VIPS Valproate Isoniazid Phenytoin Statin

Most common pattern of liver injury

Hepatocellular injury

Pathologic findings in hepatocellular injury

Spotty necrosis in the liver lobule with a predominantly lymphocytic infiltrate resembling that observed in acute hepatitis A, B, or C

Pathophysiology of cholestasis

Binding of drugs to canalicular membrane transporters, accumulation of toxic bile acids resulting from canalicular pump failure, or genetic defects in canalicular transporter proteins

R values and corresponding type of liver pattern injury

- **R value of >5 → HEPATOCELLULAR INJURY** - **R value of <2 → CHOLESTATIC INJURY** - **R value of 2.0 - 5.0 → MIXED HEPATOCELLULAR-CHOLESTATIC INJURY**

Pathology in acetominophen liver injury

Dose related centrilobular necrosis

Laboratory findings in hyperacute acetaminophen injury

Very high ALT Low bilirubin Symptomatic phase --> clinical resolution --> markers deranged 3-5 days post ingestion

What acetaminophen levels will administration of N-acetylcysteine reduce the severity of hepatic necrosis?

>200 μg/mL measured at 4 h or >100 μg/mL at 8 h after ingestion

Time frame when there is benefit of charcoal or cholysteramine in Acetaminophen induced liver injury

Within 30 mins

Recommended time to measure acetaminophen levels

8 hours post ingestion

NAC recommended time for treatment administration

Within 8 hours; 24-36 hrs latest

Which viral hepatitis is more predisposed to DILI?

Hepatitis C

Pathophysiology involved in sodium valproate hepatotoxicity

Microvesicular fat and bridging hepatic necrosis, predominantly in the centrilobular zone

DOC for amelioration of sodium valproate

Carnitine

“Vanishing bile duct syndrome”

Co-amoxiclav Mixed pattern or cholestatic

Drug known to present as SJS and have eosinophils in the liver

Phenytoin -Idiosyncratic -2 months after ingestion

Drug known to present as SJS and have eosinophils in the liver

Phenytoin -Idiosyncratic -2 months after ingestion

Amiodarone toxicity - direct or idiosyncratic

Direct

Which of the following is a highly sensitive and specific marker for detecting intestinal inflammation?

Fecal lactoferrin

Which of the following markers correlate well with histologic inflammation, predict relapses and detect pouchtitis in patients with Ulcerative Colitis?

Fecal calprotectin

Smoking prevents disease in which type of IBD?

Appendectomy is protective in which IBD?

No increased risk of what type of IBD when it comes to OCPs?

Greater genetic concordance in which type of IBD?

Crohn's

Early onset IBD is associated with deficiency in what inflammatory marker?

IL-10

Early onset IBD is associated with deficiency in what inflammatory marker?

IL-10

Which IBD for the ff conditions: -Gross blood in stool -Mucus -Pain -Systemic symptoms -Fistulas -SI obstruction -Colonic obstruction -With response to abx -With recurrence even after surgery -Continuous disease -Rectal sparing -Cobblestoning -Granuloma on biopsy -Strictures -Abnormal imaging findings -limited to mucosa and superficial submucosa

-Gross blood in stool: UC -Mucus: UC -Pain: Crohns -Systemic symptoms: Crohns -Fistulas: Crohns -SI obstruction: Crohns -Colonic obstruction: Crohns -With response to abx: Crohns -With recurrence even after surgery: Crohns -Continuous disease: UC -Rectal sparing: Crohns -Cobblestoning: Crohns -Granuloma on biopsy:Crohns -Strictures: Crohns -Abnormal imaging findings: Crohns -limited to mucosa and superficial submucosa, with deeper layers unaffected except in fulminant disease: UC

Chronic UC/Crohns leads to development of what structure?

Pseudopolyps

Complications of UC

1. Bleeding 2. Toxic Megacolon 3. Strictures 4. Anal fissures 6. Perianal abscess 7. Hemorrhoids

Indications for Surgery in UC

1. Need 6-8 units prbc within 24-48 hrs 2. right colon and transverse colon with diameter of > 6cm and loss of haustrations 3. Strictures necessitating endoscope for dilation

Most serious complication of UC

Perforation

Pathologic feature of Crohns?

Noncaseating granulomas in all walls Submucosal or subserosal lymphoid aggregates

What symptom is characteristic of active disease in IBD?

Diarrhea

2 patterns of disease in Crohns

- Fibrostenotic obstructing pattern** - Penetrating fistulous pattern**

Type of gastritis in Crohns patients

H pylori negative gastritis

Earliest macroscopic findings in Crohns

Apthous ulcerations

Size when endoscopy is preferred for stricture

<= 4cm

Antibodies associated with CD

anti-Saccharomyces cerevisiae antibodies (ASCAs)

Immunologic marker for UC

pANCA

CLINICAL FACTORS AT DIAGNOSIS THAT PREDICT THE NATURAL HISTORY OF DISABLING CROHN’S DISEASE AFTER 5 YEARS

- **Initial requirement of steroids** - **Age at diagnosis below 40 years** - **Presence of perianal disease at diagnosis**

Tx of choice Mild UC Mod-Severe UC and Crohns

Mild UC: 5-ASA Mod-Severe UC and Crohns: Prednisone or Biologics (-mab, MTX, Cyclosporine, Tacrolimus)

Indication for annual or biennial colonoscopy with multiple biopsies in UC

8-10 years of extensive colitis (>1/3 of colon involved) OR 12-15 years of proctosigmoiditis (<1/3 but more than just the rectum)

Management of Flat high and flat low dysplasia

Flat high dysplasia: Colectomy Flat low dysplasia: Immediate colectomy

Which of the following HLA alleles has been linked with self-limited hepatitis C?

CC haplotype of the IL28B gene

Which of the following antiviral medications can be safely given during pregnancy?

Tenofovir Lamivudine

Favorable factor that may determine sustained virologic responsiveness in Hep C?

Female

Which of the following drug should not be given with amiodarone?

Sofobir

Indications for treatment of chronic hepatitis in pregnancy

HBV DNA > 200,000 IU/mL Third trimester Pregnancy

First line treatment for chronic Hep B

Tenofovir

Side effects of Tenofovir and Entecavir

Tenofovir disoproxil fumarate - renal toxicity; loss of bone density Entecavir - prone to resistance

Which Oral nucleotide analogs is safe to use during pregnancy

Tenofovir

Duration of treatment for HBeAg positive and negative chronic hepatitis

HBeAg +, non cirrhotic: for 12 months *monitor monthly for 6 months then q3 months for 1 yr HBeAg -: indefinitely or unti HBsAg disappears

DOC for Chronic Hepatitis C

SOFOSBUVIR + VELPATASVIR

Definition of sustained virologic response for Hep C

Undetectable HCV RNA 12 weeks after completion of treatment

DOC for Chronic Hepatitis D

PEG-IFN (for 48 weeks)

Difference in Type I VS Type II AIH

young women - children ANA + (homogeneous) pANCA - Anti LKM Marked hyperglobuliemia and lupoid features - anti liver cytosol

Therapy for AIH

-Combination therapy (Azathioprine 50 mg/d + Prednisone 30 mg/d) - High dose prednisone (60 mg/d) therapy is preferred Duration of Tx: 12-18 months Histo improvement: 6-24 months

DOC for decompesated/relapsed chronic hep c?

Ribavarin

Single most important measurement of hepatic synthetic measure for acute parenchymal disease

Clotting factors - Serum prothrombin II V VII X

Hydration for acute pancreatitis

15-20 mL/kg/hr, maintain at 2-3cc/hr to maintain UO >0.5mL/kghr

Mainstain of autoimmune hepatitis

Glucocorticoid

First-line pharmacotherapy for non-diabetic NASH patients

Vitamin E

What are considered low risk endoscopic procedures?

EGD/colo EUS without FNA ERCP for stent replacement

Components of grade III cholangitis

Hypotension PFR <300 Oliguria, crea >2 mg/dL Plt <100 INR >1.5

Indications for cholecystectomy for GB POLYP

1 age > 50 Polyp > 10 mm Growth in polyp size on UTZ

Mixed Flashcards

(92 cards)