Remediation Flashcards
(252 cards)
1
Q
Labs associated with pyloric stenosis
A
Hypochloremic, Hypokalemic
Metabolic Alkalosis
2
Q
Diagnostics of gastroparesis
A
Gastric scintigraphy (gastric emptying study) Tx is non-specific
3
Q
Achalasia diagnostics
A
blood smear for T Cruzi, then Barium esophagram: Bird’s beak
mandatory EGD to exclude stricture, CA
4
Q
Lamivudine
A
Nucleoside analogue reverse transcriptase inhibitor for treating Hep B
Combo to treat HIV as well
Black box warning for pancreatitis
5
Q
Biliary Atresia
A
Cholestatic Jaundice + Hepatomegaly + Acholic stools
6
Q
Black gallstones
A
Sterile gallbladder bile
Oxidized polymers of Ca salts
Unconjugated
Radiopaque
7
Q
FAP genetics
A
APC/WNT defect in the APC gene
AD, typical adenocarcinoma
8
Q
Identify Hirschprung disease
A
Failure to pass meconium within first 1-2 days of life
Never had unassisted stool
Rectal Bx required for diagnosis
9
Q
What is the HBcAb IgM?
A
Appears right after the HBsAg, its the only thing seen during window period
10
Q
Manage a caustic esophageal injury
A
get an EGD in the first 12-24 hours looking for deep or circumferential ulcers, necrosis
Get radiographs looking for perforation
11
Q
Factors that would seek to damage the stomach in normal circumstances
A
Gastric acid and peptic enzymes
12
Q
Sjogren’s presentation
A
Auto-immune, dry eyes and mouth, risk of candida, cavities, gland enlargement
Dx via lip biopsy, anti-SSA/Ro and La
13
Q
Brown Gallstone
A
Infected large bile ducts
Radiulucent
Ca Soaps
14
Q
Measles in moiuth
A
Exanthema preceding the skin rash
Ulcers in cheeks around Stensen duct (koplik spots)
15
Q
Labs of someone with a prior Hep B infection but is now immune
A
HBsAb+ and HBcAb/IgG+
16
Q
MEN1
A
Pituitary adenoma (acromegaly etc)
Pancreatic (gastronoma)
PTH (hypercalcemia)
17
Q
Auto-immune hepatitis type 2
A
Anti-liver/kidney microsomal Abs (anti-LKM)
18
Q
Dubin-Johnson Syndrome
A
Reduced excretory function of hepatocytes
Conjugated jaundice
DARK BLACK LIVER
ABCC2 mutation for OAT-MRP2
19
Q
Golimumab
A
TNFa inhibitor (test for Tb first!)
IgG4k mAb
UC ONLY
20
Q
Presentation of Peutz Jeghers
A
Arborizing GI hamartomas
dark brown-blue macule on lips, nostrils, cheek mucosa, palm, genitals, peri-anal
Like freckles, but in the mouth
21
Q
Stress ulcers
A
Curling: from extensive burns
Cushings: severe head injury
22
Q
Wilsons disease mutation
A
ATP7B AR
23
Q
Hep A labs
A
IgM and IgG are detectable soon after
IgG on its own means previous exposure, non-infectivity, immunity
24
Q
Entecavir
A
Hep B nucleoside analogue reverse transcriptase
Black box warning for exacerbations, co-infections with HIV, Lactic acidosis, hepatomegaly
25
C Diff
Can cause toxic megacolon
Pseudomembranes, fecal-oral, obligate anaerobe, flagellated Gram+ curved bacillus, spore forming
Stool test for glutamate dehydrogenase
26
Guanylate cyclase C agonists
Linaclotide: binds GC-C on GI lumen
Increases cGMP, stimulates Cl-/HCO3- via CFTR
Treats constipation
27
HCC factors
Hep B and Hep C
| EtOH, a1-AT deficiency, HFE, NAFLD, metabolic syndrome, Wilson disease, aflatoxin
28
Hepatic encephalopathy grading scale
1. Euphoria / anxiety, short attention span
2. Lethargy or apathy, disorientation
3. Stupor, confusion, disorientation
4. Coma
29
Tx Wilsons disease
Oral penicillamine
| liver transplant
30
Sx of eosinophilic esophagitis
Odynophagia, CP, maybe Asx
Mostly from Candida, herpes (in healthy pt), CMV
Pyrosis, corrugations, eosinophilia
31
Opiod agonists for Diarrhea
Loperamide
Diphenoxylate (has some atropine)
Eluxadoline (pancreatitis risk)
32
Sjogrens associations and treatment
B cell Non-Hodgkin Lymphoma
33
Schatzki Ring
Distal esophagus, associated with Hiatal Hernia
Steakhouse Syndrome
Dx w/ Barium swallow
Tx w/ dilation, maybe long-term PPI
34
Genetic mutation associated with HCC
b-catenin activated subtype
35
GERD alarm symptoms
Unexplained weight loss
persistent vomiting and dehydration
Constant and severe pain
Melena, anemia, occult bleeding
36
Endemic to sub-saharan africa and southeast asia
Hep B
37
Leukoplakia
```
Cannot be scraped off
Hyperkeratosis and acanthuses
Balloon cells in upper spinous layer
HIV
Precancerous until proven otherwise
```
38
Mucoepidermoid tumor presentation
Circumscribed, infiltrative at margins, pale gray-white and frequently have mucin-containing cysts
Most are primary malignant tumor of salivary glands
39
Maddrey Score
Test for alcoholic liver disease
PT and serum bilirubin, 32+ have a poor Px
May benefit from steroids
40
Diptheria in the mouth
Dirty white, fibrins-suppurative tough inflammatory membrane over the tonsils and retropharynx
41
Chronic Hep B vs chronic Hep C
B: polyarteritis nodosa
C: mixed cryoglobulinemia
42
Achalasia etiology
Denervation after losing NO-producing inhibitory neurons (ganglion cells) in myenteric plexus
Can come from Chagas Dz from T Cruzi from reduviid bug (romana sign - unilateral painless eye swelling)
43
Imaging findings of acute pancreatitis
Gallstones (if thats the etiology)
Sentinel loop of air-filled small intestine
Colon cutoff sign: gas in transverse colon ending at pancreatic inflammation
Focal linear atelectasis of lower lobe of lungs
44
Esophageal varices
Red wale markings
Tx w/ emergent EGD, fluids or blood products, fresh frozen plasma, platelets, IV vitamin K
Non selective b-blockers reduce re-bleeding, band ligation
45
CPA1
Carboxypeptidase A1
| Exopeptidase involved in regulated zymogen activation
46
Celiac Diagnostics
```
IgA tTg Ab
IgA anti-endomysial Abs
Anti-gliadin Abs
Dual-energy XR densitometry scan for osteoporosis
Atrophy or scalloping of duodenal folds
```
47
Chronic type B gastritis
Antral type
H Pylori Gastritis
Risk adenocarcinoma, gastric B cell lymphoma, B12 deficiency
48
Certolizumab
```
TNFa inhibitor (test for Tb first!)
Fab' fragment, doesnt fix complement
Treats CD only
```
49
SAAG above 1.1
Portal HTN origin: cirrhosis, budd-chiari, liver mets, CHF, IVC obstruction, sinusoidal obstruction syndrome
50
Lichen planus in the mouth
Reticulate, lace-like, white keratitis lesions that sometimes ulcerate
51
Treat Taenia solium
Praziquantel
| cysticercosis version gets albendazole
52
Confirmatory test for ZE
Fasting Gastrin above 1000
53
3 drug regimen for RINV
NK1 antagonist (aprepitant), Alesetron, dexamethasone
54
Labs of acute pancreatitis
Leukocytosis, hypoerglycemia, hyperbilirubinemia, elevated BUN and Alk Phos
Hypocalcemia, elevated Hct
55
HNPCC genetics
DNA mismatch defect of MSH2/MLH1
| AD, Right side predominant, Mucinous adenocarcinoma
56
Presentation of Crohn Dz
```
Cobblestoning skip-lesions
Fistulas, ano-rectal fissures
Strictures causing SBO
String Sign on Barium enema
RLQ pain (pseudo-appendicitis)
Creeping fat, bowel wall thickening
Canker sores, non-caveating granulomas, calcium oxalate stones, ADEK fucked
Anti-Saccharomyces Abs
ASCA+
```
57
Zenker Diverticulum Sx
False diverticulum
Upper affected first, coughing/discomfort
becomes halitosis, regurgitation, nocturnal choking, gurgling, protrusion
Voice changes, weight loss, aspiration
58
vomiting of feces
SBO
59
Crigler-Najjar
Total EDPGR deficiency
| Severe hyperbilirubinemia with high risk of kernicterus
60
Sporadic colon cancer, APC/WNT pathway genetics
Targets APC on the left side
| Typical adenocarcinoma
61
Scarlet fever in mouth
Raspberry tongue: fiery red with prominent papillae
| white-coated with papillae projecting through
62
PEG-IFN2a
Tx Hep B and hep C
| Black box warning for ribavirin-associated sides
63
Pemphigus in the mouth
Vesicles and bullae prone to rupture
| Leave hyperemic erosions covered with exudate
64
SAAG below 1.1
Non-portal HTN: Biliary leak, nephrotic syndrome, pancreatitis, peritoneal carcinomatosis, Tb
65
Hep E
Immunocompromised hosts
Fecal-oral spread, waterborne epidemics
PCR for HEV RNA
66
Tx Acute paralytic ileus
Nasogastric suction
| patient controlled epidural, gum chewing
67
Zenker diverticulum diagnostics and treatment
Video esophagography or barium swallow BEFORE egd (risk of perforation)
Tx w/ surgery, upper myotome or surgical diverticulectomy
68
Phases of hepatocyte proliferation after damage
1. Il-6 from Kupffer cells prime tissues
2. GFs act to stimulate quiescent cells
3. Anti-proliferative TGF-b resolve things
69
Barrett esophagus
Squamous to columnar with goblet cells
risk for Adenocarcinoma
Dx w/ EGD w/ Biopsy: orange, gastic epithelium extending upward in tongue like circumferential fashion
Tx w/ long-term PPI, endoscopic ablation
70
SBP diagnostics
Something Above 250
71
Factors that decrease the normal protection of the stomach
Ischemia, shock, NSAID
72
Risks associated with Hep C
HCC, mixed cryoglobulinemia, cirrhosis
73
How does a1-antitrypsin deficiency cause liver damage?
Unfolded protein response and ER stress
74
Diffuse esophageal spasm etiology
Multiple spastic contractions of circular muscle in the esophagus (disrupted coordination)
75
Erythema multiforme in the mouth
maculopapular visiculobullous eruption that sometimes follows an infection somewhere else
This becomes Stevens Johnson when its wide-spread
76
3rd spacing
leakage of fluid into pancreatic bed
| For our purposes this occurs in acute pancreatitis
77
Drugs to treat abdominal pain
Antimuscarinics Hyoscyamine, Dicyclomine
Competitively inhibit autonomic post-ganglionic cholinergic receptors
Classic anti-cholinergic side effects
78
Auto-immune hepatitis type 1
Anti-smooth muscle and/or anti-nuclear
| Most common
79
What is the HBcAb IgG?
Appears in the late acute phase and lasts forever, whether it goes chronic or resolves
80
Diagnostics of eosinophilic esophagitis
Multiple circular esophageal rings making a corrugated appearance on EGD
"feline" or "trachea" looking esophagus
Squamous epithelial eosinophil-predominant inflammation
81
What is the HBsAb?
Surface Ab, means youre immunized
82
Significance of fecal elastase
Below 100 indicates chronic pancreatitis
83
CMV-caused eosinophilic esophagitis
several large, shallow, superficial ulcerations
| Treat with immune restoration and antiretrovirals in HIV patients
84
Cancers associated with H Pylori
Adenocarcinoma, MALTomas
85
Nutcracker esophagus
Hypertensive peristalsis, normal coordination
Atypical CP
Dx with Manometry/EGD
Associated with depression, anxiety
86
Mesalamine
Treats UC
| this is 5-ASA
87
Presentation of cholelithiasis
Most are Asx, maybe initiated by fatty meal
| RUQ or epigastrium, may radiate to shoulder
88
Bismuth
Prostaglandin inhibitor for treating diarrhea
89
Sulfasalazine
Sulfapyridine + 5-ASA
| Treats UC
90
Enzymes involved in acute pancreatitis
Activated trypsin does auto-digestion
| Lipase releases fatty acids that get saponified by Ca++
91
Selective chloride (C2) channel activators
Lubiprostone: PGE-1 derivative
| Increaes intestinal fluid secretion by activating GI-specific Cl-2 channels in luminal cells of intestines
92
Patient lying motionless with knees drawn up to avoid stretching nerve fibers. Coughing and sneezing hurts like hell.
Secondary spontaneous bacterial peritonitis
93
Hep D Labs
HDV RNA on PCR
| This is a defective RNA that requires Hep B
94
Osmotic laxatives
Lactulose: tx liver disease, hyperammonemia (change in pH traps it in the GI system)
PEG
95
Alk Phos and GGT
Elevated Alk phos AND GGT means liver
| Normal GGT means bone, placenta
96
PSC
```
30 y.o. males
Periductal portal tract fibrosis
Segmental stenosis of bile ducts
pANCA+
Beads on a string
Onion-like duct lesions
Associated w/ UC because of released T-cells
```
97
Sx of PUD
Coffee-ground emesis, hematemesis, melon, hematochezia
| worse with stress, coffee, EtOH
98
Adalimumab
TNFa inhibitor (test for Tb first!)
IgG1 mAb
Treats moderate-severe UC and CD
99
Risk factors for ischemic bowel disease
atherosclerosis at mesenteric origin, AAA, hypercoaguable state, hypo perfusion, Wegener Granulomatosis
Cocaine
Radiation, NEC, angiodysplasia
100
Th2 cells
T-cells secrete IL-4. This makes Th2 cells
| Th2 secrete IL-4/5/13, causing UC
101
Dx PUD
Breath test for H pylori
| Stop PPI 2 wk before fecal and breath tests (can cause false NEGATIVE)
102
Pregnancy effects on the mouth
Friable, red, pyogenic granuloma protruding into the gingiva
103
Monocytic leukemia of the mouth
leukemic infiltrate and enlargement of gingiva, often with periodontitis
104
CFTR mutation
LOF mutations alter fluid pressure and limit bicarbonate secretion
Inspissation (thickened mucous from dehydration) and duct obstruction
105
Tx auto-immune hepatitis
Glucocorticoids (azathioprine)
106
Crofelemer
Cl- channel inhibitor to treat diarrhea
| Acts on CFTR and CaCC
107
Presentation of US
```
Only mucosa and submucosa
Pseudopolyps, abscesses in crypts
Always affects rectum, goes proximal
Bloody diarrhea
Lead pipe (no haustra) on contrast enema
Left sided abdominal pain
p-ANCA
Toxic megacolon that can penetrate
Recent smoking cessation
```
108
Labs of someone with chronic Hep B flaring up
Everything positive except for HBsAb
109
Triglycerides above 1000
Pancreatitis
110
MYH-associated polyposis genetics
DNA mismatch defect of MYH gene
| AR, mucinous adenocarcinoma
111
Whats the significance of HBV DNA?
detectable during current infection
112
Plummer-Vinson
Spoon nails, esophageal web, angular chelitis, glossitis, Iron-Deficient anemia
Dx via Barium swallow (esophageal)
Tx w/ dilation, maybe PPI
113
HIV in the mouth
herpes, candida, Kaposi, hairy leukoplakia
114
Natalizumab
A4 integrin inhibitor
IgG4k against a4b7 (MAdCAM-1) and a4b1 (VCAM-1)
CD Only
115
Presentation of upper GI bleed
supine orthostatic HPTN
Fe-deficient anemia
Hematemesis, coffee-ground emesis, melena
116
Risks associated with caustic esophageal injury
SCC (so do endoscopic check 15-20 years later)
| Risk long-term strictures requiring dilation
117
Sx of Wilson Disease
Hemolytic anemia (Cu is toxic to RBCs)
Kayser Fleischer rings
Liver disease in adolescents
Neuropsychiatric in young adults
118
Olsalazine
5-ASA and another 5-ASA
| Only for maintenance of remission of UC
119
Diagnostics for esophageal perforation
CXR or Chest CT w/ contrast shows air in the mediastinum / SubQ emphysema
Hamman's sign: auscultated crunching and rasping synchronous with heart beat mainly during systole and in LLD position
120
Lab findings in HCC
Pt with known liver disease
| Elevated AFP: screen that every 6 months
121
Velpatasvir + Sofosbuvir
NS5A inhibitor and NS5B inhibitor for the treatment of Hep C
| Avoid amiodarone because of bradycardia risk
122
SPINK1
Serine peptidase inhibitor, Kazal 1
Inhibits trypsin
LOF mutation increases trypsin
123
Balsaszide
5-ASA with an inert carrier
| Only for active UC disease
124
CASR
```
Chymotrypsin C (Caldecrin)
Degrades trypsin
Protects pancreas
```
125
Presentation of mucormycosis
Black necrotic eschar on palate / turbinates
Can enter brain via cribriform plate
Tx w/ amphoticerin B, debridement
126
Labs of pancreatic insufficiency
Low trypsinogen
| Decreased fecal chymotrypsin and elastase
127
Osler Weber Reundu
AD with aneurysmal telangiectasia beneath the mucosal surfaces of the oral cavity and lips
128
PBC abs
Anti-mitochondrial
129
Alcoholic liver disease Abs
SAAG greater than 1.1
Elevated AST 2x more than the ALT
Elevated Bilirubin, PTT
Decreased Albumin, Platelets, Hgb
130
Zollinger Ellison association
MEN1, draw PTH, Prolactin, LH-FSH and growth hormone to rule this out
131
Celiac presentation
Fatigue, weight loss, growth retardation
fe-deficient anemia, short stature, delayed puberty, amenorrhea, reduced fertility
GI upset you'd expect to see
Osteoporosis
132
Bulk-forming laxatives
Psyllium
Methylcellulose
Calcium polycarbophil
133
Stimulant laxatives
```
Bisacodyl
Castor Oil (hydrolyzed to ricinoleic acid)
Glycerin (irritant, osmotic, lubricant)
Senna (discolors urine)
Na Picosulfate
```
134
Tenofovir Disoproxil
Nucleotide analog HIV-1 and HBV reverse transcriptase inhibitor
Black box warning for lactic acidosis, hepatomegaly with steatosis, exacerbation
135
Treatment of hemochromatosis
PPI, chelation with Deferoxamine
136
Mallory bodies
Alcoholic liver disease: hyalinization on biopsy
137
Breast Feeding Jaundice
Inadequate milk intake, increasing GI reabsorption of bilirubin / decreased excretion
138
Free air under diaphragm
Emergency: perforated viscus
CT or plain film XR
Pneumoperitoneum below diaphragm
Pneumomediastinum above diaphragm
139
PBC
Anti-mitochondrial E2 Abs
Associated with Sjogrens, Scleroderma, Thyroid
Dense Lymphocytic infiltrate in portal tracts
Granulomatous destruction of bile ducts
Mallory-Denk, Xanthelesmas, Hyperpigmentation, osteomalacia, splenomegaly, eventually jaundice
Normal radiology
elevated Alk Phos and cholesterol
50 y.o. female
Tx w/ Ursodeoxycholic Acid
140
Diagnostics of Wilson disease
Lower serum cerulplasmin
Brainstem MRI
ATP7B molecular analysis
141
Treat strongyloides
Ivermectin with albendazole
142
Tofacitinib
Jak inhibitor for the treatment of UC
| Dont combine with biologics / immunosuppressants
143
Pancytopenia of the mouth
Gingivitis, pharyngitis, tonsilitis
Maybe cellulitis of the neck
(leukemia looks similar)
144
Biggest factor in determining the malignancy of colonic adenocarcinoma
Size
145
What lobe would you expect to change in budd-chiari
Prominent caudate
146
Menetrier disease
Idiopathic, giant thickened gastric folds mostly in the body of the stomach
Chonic protein loss, whole body swells
Risk of gastric Adenocarcarcinoma
147
Stages of NSAID OD
1. N/V, abdominal pain, sweating, normal LFT
2. Liver injury, RUQ pain, rising LFTs
3. Liver failure, coma, death
4. Remission if they lived
148
Sx of esophageal stricture
difficulty swallowing, starting with solids
Reflux lessens as stricture increases
treat with dilation
149
Whipple Disease Sx
Weight loss: malabsorption diarrhea, dementia, lethargy, coma, seizures, ophthalmoplegia, peripheral enema, arthralgia
150
Dx esophageal stricture from GERD as opposed to carcinoma
Do an EGD with Biopsy: mandatory for all patients
151
Complications of cholelithiasis
Perforation, fistula, inflammation of biliary tree, obstructive cholestasis, pancreatitis
gallstone ileus
152
Diseases with melanotic pigmentation
Addison disease, hemochromatosis, fibrous dysplasia of bone, Peutz-Jeghers
153
Findings of NAFLD
Spiderweb fibrosis/collagen deposition (chicken-wire) on trichrome stain
Periporatl fibrosis, then bridging vein, then cirrhosis
Ballooned hepatocytes in adults
154
Presentation of Ischemic bowel disease
Most often at splenic flexure, LUQ
Can progress to shock
Bloody diarrhea with periods of healing
155
treat enterobius vermicularis
Mebendazole
156
Candida-caused eosinophilic esophagitis
Diffuse linear yellow-white plaques adherent to mucosa
| Treat systemically w/ Fluconazole
157
Breast Milk Jaundice
Bilirubin de-conjugating enzymes in the breast milk
158
Treat nutcracker esophagus
```
Nitrates (isosorbide dinitrate)
Ca antagonists (nifedipine)
```
159
Ledipasvir + Sofosbuvir
NS5A inhibitor and NS5B nucleotide analogue polymerase inhibitor for the treatment of Hep C
160
Labs of Hep B window period
HBcAb/IgM+
161
Labs of acute liver failure
Prolonged PT even once AST/ALT fall
| Rising bilirubin, shrinking liver
162
Factors that cause injury to the stomach
H Pylori, NSAID, tobacco, EtOH, gastric acid, duodenal-gastric reflux
163
Sporadic colon cancer, DNA mismatch pathway
MSH2/MLH1 gene on the right side
| Mucinous adenocarcinoma
164
Dx Spontaneous Bacterial Peritonitis
250+ PMNs/uL
165
Treat cyclospora
TMP-SMX
| If they have a sulfa allergy give cipro
166
Achalasia presentation
Motility is fucked, progressive from solids to also liquids. No peristalsis, no LES relaxation
167
Ustekinumab
Fully human IgG1k mAb
SubQ q8w after first IV infusion
Il-12/23 inhibitor: binds P40 subunit, prevents T and NK cell response
Tb Test First. Tx UC and CD
168
What is the HBeAg?
Correlates with viral proliferation and infectivity
169
How does PUD cause pancreatitis?
Ulcer along posterior wall of duodenum or stomach can perforate into pancreas, liver, biliary tree.
Bleeding, edematous obstruction, perforation, penetration into pancreas
170
Tx Upper GI bleed
2 large-bore IVs, surgery
171
SCC
Black males over 50, heavy smoking, etc
Progressive dysphagia, hoarseness, cough
Dx w/ EGD and Bx
Tx w/ surgery - esophagectomy
172
Treatment of H pylori
PPI + Clarithromycin + Amoxacillin or Metro
(can substitute tetracycline in)
PPI + Metro + Tetra + Bismuth
173
Vedolizumab
A4 intern inhibitor
IgG1 against a4b7 (MAdCAM-1)
Treats UC and CD
May cause PML after 2 years
174
Cullens, gray turners
Acute pancreatitis. Think Hypocalcemia, because thats a major thing in acute pancreatitis
175
PRSS1
Serine protease 1 (trypsinogen1) cationic trypsin
| GOF mutations prevent self-activation
176
Morphological findings of HCC
Fibrolamellar: scirrhous tumor with fibrous bands, large polygonal cells with granular cytoplasm (abundant mitochondria)
Vesicular nuclei with prominent nucleolus
177
Genetics of mucoepidermoid tumors
CRTC1 + MAML2 = MECT1 fusion protein
| most are associated with 11;19 translocation
178
PT/INR as a diagnostic test
Above 1.5 is a life-threatening coagulation abnormality
Factors 2, 7, 9, 10 need vit K:
PT prolongation from fat malabsorption distinguished by a good Vit K response
179
Chronic Type A gastritis
Loss of rugal folds
Anti-parietal cell abs
Anti-intrinsic factor abs
Tx w/ parenteral B12
180
Saline laxatives
MAG hydroxide
| Na Phosphate
181
Telbivudine
Nucleoside analogue reverse transcriptase inhibitor for HBV
Combo w/PEG IFN-2a risks peripheral neuropathy
Black box for lactic acidosis, hepatomegaly with steatosis, exacerbations
182
Acute SBO
common from adhesions (SURGERY, Crohn)
N/V, Obstipation, decreased bowel sounds, high pitched tinkling
Dx w/ plain abdominal radiography or CT
NG tube to suction
183
Hep C labs
Hep C RNA
| Anti-HCV without any RNA means recovery from previous infection
184
Infliximab
TNFa inhibitor (test for Tb first!)
chimeric IgG1k mAb
Continuous IV infusion
Moderate-severe CD and severe UC
185
Labs of someone with chronic Hep B thats dormant
HBsAg+ and HBcAb/IgG+
| DNA could go either way
186
Elbasvir + Grazoprevir
NS5A inhibitor and NS3/4A protease inhibitor for the treatment of Hep C
187
Presentation of hemochromatosis
```
Cirrhosis with hepatomegaly
Abnormal skin pigmentation
DM
HF
Can later cause hypogonadism/ED
```
188
Ribavirin
Tx Hep C, BB for Fetal Death
Dont get pregnant for 6 months afterward
Nucleoside analogue
Combo with IFN a2a
189
Boceprevir
NS3/4A protease inhibitor
| Combo with PEG IFNa and Ribavirin
190
1 drug regimens for treating RINV
Dexamethasone or 5HT3 antagonist or metoclopramide or Prochlorperazine
191
What is the HBsAg?
Surface Ag, first evidence of infection
| Positive during acute and carrier state
192
What is the HBcAg?
Core Antigen
193
Corkscrew esophagus / rosary bead esophagus
Diffuse Esophageal spasm
Primary or secondary from GERD, Stress, DM, etc
Dx w/ barium swallow XR
194
Adefovir
Treats chronic Hep B
| Black box warning for nephrotoxicity
195
Sporadic colon cancer, hypermethylation pathway
Targets MLH1/BRAF on the right side
| Mucinous adenocarcinoma
196
Secretory diarrhea signs
Doesnt improve with fasting, high volume watery diarrhea
| This is the kind you get from Senna laxative abuse
197
Factors that protect the stomach in normal circumstances
Surface mucous, bicarb, mucosal blood flow, epithelium, regeneration
198
Albumin as a diagnostic test
decrease from decreased hepatic synthesis
| Only good for looking for chronic hepatic dysfunction because the serum half like is like 2-3 god damn weeks
199
Gilbert syndrome MOA
Reduced activity or Uridine Diphosphate Glucuronyl Transferase
200
Mono in mouth
Pharyngitis and tonsilitis
Maybe gray white coating membrane
enlarged LNs in the neck and palate
201
Genetics of PEutz-Jeghers
AD mut STK11 LOF mutation, median age 11
202
Scleroderma presentation
Topoisomerase I abs (Scl-70)
| Calcinosis, Raynaud's, Esophageal dysmotility, Sclerodactyly, Telangiectasias
203
Dx and Tx of Whipple Dz
G+ bacillus T Whipple
Endoscopy with duodenal Bx
PAS+ Macrophages with the bacillus
Tx w/ Abs, fatal without. Takes a while.
204
Peripheral opioid antagonists
Methylnaltrexone
Naloxegol
Alvimopan (Prevents post-op ileus, MI risk)
205
Rotor Syndrome
Mut OATP1B1/3 mutation
Great Px, benign hereditary jaundice
gallbladder CAN be visualized
no black liver
206
Wisons disease etiology
Impaired copper excretion into bile and failure to incorporate it into ceruloplasm
It accumulates in the liver, brain and eye
207
2 drug regimen for RINV
Alosetron and dexamethasone
208
Labs of someone immunized to Hep B
HBsAb positive. Thats it.
209
Stool-softeners
Docusate
Mineral oil
Anionic surfactants
210
Labs of acute infection with Hep B
Lots.
| HBsAg+, HBcAb/IgM+, HBeAg+, DNA+
211
Sx of Hep A
Anorexia, N/V, vomiting, malaise, RUQ/epigastric pain, smoking aversion, jaundice, myalgia, diarrhea, constipation
212
Liver labs of Right heart failure
Marked elevation N-terminal-proBNP
LFT's above 5000
Early rapid rise in serum LDH
213
Herpes-caused eosinophilic esophagitis
Multiple small, deep ulcerations
Treat healthy patients as needed
Treat immunosuppressed patients with acyclovir
214
Alosetron
5HT3 antagonist for treating Diarrhea
| Black box warning for ischemic colitis (needs prescriber program)
215
Diagnosticscs of Acute pancreatitis
At least 2: epigastric pain, Lipase 3x upper limit of normal, CT changes that look like pancreatitis
216
Necrosis associated with acetaminophen
Centrilobular necrosis
217
Diarrhea that decreases with fasting
Osmotic, this is the kind you get from sorbitol, Mg laxative abuse
218
Hepatitis viral structures
ssRNA except Hep B (partially dsDNA)
219
Fecal elastase below 100
Pancreatic insufficiency, chronic pancreatitis
220
parotid tumors
mucoepidermoid: malignant
Pleiomorphic adenoma: PLAG1
Warthins tumor
Adenoid cystic cancer
221
GI problems in a new smoker
Crohn
222
Food Fear
chronic mesenteric ischemia
| “Abdominal angina” often misdiagnosed as malignering
223
Treat a variceal bleed
first get fluids and do a banding
| Them TIPS procedure and octreotide
224
calprotectin
IBD marker
225
Angioectasia
associated with CKD and Aortic Stenosis
| Fatigue from occult blood loss
226
resected ileum
Causes B12 deficiency
227
What GI disease are we most closely associated tennesmus with?
UC
| This is straining to poop, mostly unsuccessfully
228
uses of ERCP
choledocholithiasis
| Acute pancreatitis
229
Why is choledocolithiasis such a big deal?
risk of ascending cholangitis
230
Decreased fecal chymotrypsin
This is chronic pancreatitis
| Expect to also see low fecal elastase and hypokalemia
231
first thing you do with a patient suspected to have acute pancreatitis
2 giant IVs
232
new onset diabetes
probably pancreatic cancer, especially if they have a sudden plainless jaundice (which you would expect to be conjugated)
233
increased lipase
acute pancreatitis
234
what does BISAP tell you?
Mortality chances of a person with pancreatitis
235
beads on a string
PSC
236
infection associated with HFE
Yersinia / plague
| Causes bloody stool, pseudoappendicitis
237
Significance of Th1 Cells in IBD
Created by IL-12
Release IFNy
Hyperactivity Causes Crohn's
238
Significance of Th17 in IBD
Created by IL-6, 23, TGFb
Releases IL-17
Hyperactivity Causes Crohn's
239
Ca19-9
Pancreatic cancer marker
240
Hepatic lymphoma
Usually diffuse large B cell lymphoma
Can be hepatosplenic T cell lymphoma
Usually middle aged men
241
PVC, arsenic, thorotrast
Associated with angiosarcoma of the liver
242
SE Asia, liver flukes
Associated with cholangiocarcinoma
243
Cholangiocarcinoma
Adenocarcinoma from intra-hepatic biliary tree
Incidental finding or symptomatic liver mass
Clearly defined tubules wiled with malignant cells
244
Hepatoblastoma
Pediatric abdominal swelling in Asx patient
Maybe have jaundice, itching
20% Metz to lungs, fatal without treatment
Epithelial or mixed with mesenchyme, osteoid, cartilage or striated muscle
245
HNF-1a inactivated adenomas
Hepatocellular adenoma with strong female predilection
| Minimal transformation risk to HCC
246
Most common patient who gets inflammatory adenomas
Women, obesity and metabolic syndrome
247
Focal nodular hyperplasia
Single well demarcated lesion with central scar
Map-Like pattern
Benign, incidental, young people
248
Nodular Regenerative Hyperplasia
Multiple nodules, looks like cirrhosis, no fibrous septa
Can get portal HTN
Associated with HIV, benign
249
Hepatocellular vs cholestatic processes
Hepatocellular: AST/ALT elevated
Cholestatic: Alk Phos and Bilirubin elevation
250
Methylation-induced gene silencing
Enhances progression of colonic adenocarcinoma
251
Classic sequence of sporadic colonic adenocarcinoma
KRAS activating mutation
| SMAD2 and 4 effect on TGF-b signaling
252
Napkin Ring contraction in the distal colon
Colonic adenocarcinoma
