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Gastroenterology Recall > Mixed > Flashcards

Mixed Flashcards

1
Q

Normal stool fat content

A

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

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2
Q

Indications to pursue stool micro studies

A

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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3
Q

INDICATED TO GIVE ANTIBIOTIC TREATMENT FOR ACUTE DIARRHEA

A
  • Immunocompromised
  • (+) mechanical heart valves or recent vascular grafts
  • Elderly
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4
Q

INDICATION TO GIVE ANTIBIOTIC PROPHYLAXIS for Diarrhea

A

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

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5
Q

DOC for diabetic diarrhea

A

Clonidine

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6
Q

Drug for diarrhea in IBS

A

5 HT3 antagonist (Ondansetron)

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7
Q

Treatment of diarrhea associated with IBS

A

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

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8
Q

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

A

-Copious bleeding
-Family hx of colon CA
-IDA

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9
Q

Conditions with SAAG < 1.1

A

“Bili Neph Peri Tub”

Biliary Leak
Nephrotic Syndrome
Peritoneal carcinomatosis
Pancreatitis
Tuberculosis

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10
Q

Conditions with SAAG >= 1.1 with Ascitic protein < 2.5

A

“C LB M”

Cirrhosis
Late Budd Chiari
Massive liver mets

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11
Q

Conditions when abx prophy needed for GI procedures

A

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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12
Q

Types of gastritis and their level of acid production

A

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

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13
Q

Nutrition deficient with long term PPI use

A

Iron
Magnesium
Vit B12

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14
Q

Chronic gastritis types and features

A

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

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15
Q

What stage of hemorrhoids are the following initially indicated?

RBL
Sclerotherapy

A

Sclerotherapy - II
RBL - III

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16
Q

GERD Warning Signs

A

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

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17
Q

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

A

“I love old ppl”

ICC state
Mechanical heart valves
Elderly

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18
Q

Most consistent clinical feature in IBS

A

Alteration in bowel habits

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19
Q

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

A

> 3cm

< 5cm may resolve with abx alone

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20
Q

What 2 conditions are contraindications to hemorrhoid procedures?

A

1) ICC state
2) Proctitis

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21
Q

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

A

Intaabdominal surgery

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22
Q

Acetaminophen blood level correlated with severe hepatic damage?

A

> 300 ug/mL 4hr

< 150 ug/mL - unlikely

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23
Q

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

A

Age > 45-50
Overweight/obese
T2DM

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24
Q

3 recommendations for cholecystectomy

A

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

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25
Q

Diagnostic algorithm for chronic pancreatitis

A

CT
MRI
EUTZ
Pancreas function test
ERCP

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26
Q

Most prevalent cause of drug induced acute liver failure?

A

Acetaminophen

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27
Q

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

A

Co-Amoxiclav

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28
Q

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

A

VIPS

Valproate
Isoniazid
Phenytoin
Statin

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29
Q

Most common pattern of liver injury

A

Hepatocellular injury

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30
Q

Pathologic findings in hepatocellular injury

A

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

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31
Q

Pathophysiology of cholestasis

A

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

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32
Q

R values and corresponding type of liver pattern injury

A
  • R value of >5 → HEPATOCELLULAR INJURY
  • R value of <2 → CHOLESTATIC INJURY
  • R value of 2.0 - 5.0 → MIXED HEPATOCELLULAR-CHOLESTATIC INJURY
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33
Q

Pathology in acetominophen liver injury

A

Dose related centrilobular necrosis

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34
Q

Laboratory findings in hyperacute acetaminophen injury

A

Very high ALT
Low bilirubin

Symptomatic phase –> clinical resolution –> markers deranged 3-5 days post ingestion

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35
Q

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

A

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

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36
Q

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

A

Within 30 mins

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37
Q

Recommended time to measure acetaminophen levels

A

8 hours post ingestion

38
Q

NAC recommended time for treatment administration

A

Within 8 hours; 24-36 hrs latest

39
Q

Which viral hepatitis is more predisposed to DILI?

A

Hepatitis C

40
Q

Pathophysiology involved in sodium valproate hepatotoxicity

A

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

41
Q

DOC for amelioration of sodium valproate

A

Carnitine

42
Q

“Vanishing bile duct syndrome”

A

Co-amoxiclav

Mixed pattern or cholestatic

43
Q

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

A

Phenytoin
-Idiosyncratic
-2 months after ingestion

44
Q

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

A

Phenytoin
-Idiosyncratic
-2 months after ingestion

45
Q

Amiodarone toxicity - direct or idiosyncratic

A

Direct

46
Q

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

A

Fecal lactoferrin

47
Q

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

A

Fecal calprotectin

48
Q

Smoking prevents disease in which type of IBD?

A

UC

49
Q

Appendectomy is protective in which IBD?

A

UC

50
Q

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

A

UC

51
Q

Greater genetic concordance in which type of IBD?

A

Crohn’s

52
Q

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

A

IL-10

53
Q

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

A

IL-10

54
Q

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

A

-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

55
Q

Chronic UC/Crohns leads to development of what structure?

A

Pseudopolyps

56
Q

Complications of UC

A
  1. Bleeding
  2. Toxic Megacolon
  3. Strictures
  4. Anal fissures
  5. Perianal abscess
  6. Hemorrhoids
57
Q

Indications for Surgery in UC

A
  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
58
Q

Most serious complication of UC

A

Perforation

59
Q

Pathologic feature of Crohns?

A

Noncaseating granulomas in all walls
Submucosal or subserosal lymphoid aggregates

60
Q

What symptom is characteristic of active disease in IBD?

A

Diarrhea

61
Q

2 patterns of disease in Crohns

A
  • Fibrostenotic obstructing pattern**
  • Penetrating fistulous pattern**
62
Q

Type of gastritis in Crohns patients

A

H pylori negative gastritis

63
Q

Earliest macroscopic findings in Crohns

A

Apthous ulcerations

64
Q

Size when endoscopy is preferred for stricture

A

<= 4cm

65
Q

Antibodies associated with CD

A

anti-Saccharomyces cerevisiae antibodies (ASCAs)

66
Q

Immunologic marker for UC

A

pANCA

67
Q

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

A
  • Initial requirement of steroids
  • Age at diagnosis below 40 years
  • Presence of perianal disease at diagnosis
68
Q

Tx of choice

Mild UC
Mod-Severe UC and Crohns

A

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

69
Q

Indication for annual or biennial colonoscopy with multiple biopsies in UC

A

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)

70
Q

Management of Flat high and flat low dysplasia

A

Flat high dysplasia: Colectomy
Flat low dysplasia: Immediate colectomy

71
Q

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

A

CC haplotype of the IL28B gene

72
Q

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

A

Tenofovir
Lamivudine

73
Q

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

A

Female

74
Q

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

A

Sofobir

75
Q

Indications for treatment of chronic hepatitis in pregnancy

A

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

76
Q

First line treatment for chronic Hep B

A

Tenofovir

77
Q

Side effects of Tenofovir and Entecavir

A

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

78
Q

Which Oral nucleotide analogs is safe to use during pregnancy

A

Tenofovir

79
Q

Duration of treatment for HBeAg positive and negative chronic hepatitis

A

HBeAg +, non cirrhotic: for 12 months
*monitor monthly for 6 months then q3 months for 1 yr

HBeAg -: indefinitely or unti HBsAg disappears

80
Q

DOC for Chronic Hepatitis C

A

SOFOSBUVIR + VELPATASVIR

81
Q

Definition of sustained virologic response for Hep C

A

Undetectable HCV RNA 12 weeks after completion of treatment

82
Q

DOC for Chronic Hepatitis D

A

PEG-IFN(for 48 weeks)

83
Q

Difference in Type I VS Type II AIH

A

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

84
Q

Therapy for AIH

A

-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

85
Q

DOC for decompesated/relapsed chronic hep c?

A

Ribavarin

86
Q

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

A

Clotting factors -

Serum prothrombin II V VII X

87
Q

Hydration for acute pancreatitis

A

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

88
Q

Mainstain of autoimmune hepatitis

A

Glucocorticoid

89
Q

First-line pharmacotherapy for non-diabetic NASH patients

A

Vitamin E

90
Q

What are considered low risk endoscopic procedures?

A

EGD/colo
EUS without FNA
ERCP for stent replacement

91
Q

Components of grade III cholangitis

A

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

92
Q

Indications for cholecystectomy for GB POLYP

A

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

Gastroenterology Recall (1 decks)

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