Test 5 Reverse Flashcards
(223 cards)
1
Q
Vasoactive agents (Octreotide), replace coag factors & blood, abx, maybe balloon tamponade, endoscopy w/ banding/sclerotherapy - finally decompression w/ TIPS
A
Tx esophageal varices
2
Q
Esophageal rupture - hematemesis w/ severe retrosternal pain, hypovolemia & shock, medical emergency, Hx alcoholism or ulcer common
A
What is Boerhaave’s syndrome & S/S?
3
Q
- Age 2. Male 3. White 4. Smoker
A
Risk factors for Barrett’s esophagus
4
Q
- Dysphagia 2. Odynophagia 3. Wt loss 4. Early satiety/vomiting 5. Anemia 6. Aspiration 7. Male >45yo 8. Elderly
A
Red flags of GERD
5
Q
- Inc. intra-abdominal pressure (pregnancy) 2. Tobacco 3. Foods 4. Hormones 5. Meds 6. High volume meals/positioning 7. H. pylori
A
Causes of GERD
6
Q
Fluconazole
A
Tx candidal esophagitis
7
Q
- Regurg of undigested food 2. Dysphagia 3. Cough 4. Nocturnal choking 5. Halitosis
A
S/S Zenker’s diverticulum
8
Q
- Stomach acid 2. Anxiety disorders 3. Achalasia
A
Causes of esophageal spasm
9
Q
Surgery, Botulinum
A
Tx of achalasia
10
Q
LES does not relax to allow food entry into the stomach**esophagram = bird beak
A
What is achalasia & what is it characterized by?
11
Q
connective tissue disease that can cause fibrosis of the esophagus
A
How is scleroderma related to the esophagus?
12
Q
smooth, circumferential structures in the lower esophagusmay be caused by stomach acid
A
What are Schatzki rings?
13
Q
pouching of esophagusmay be due to loss of elasticity at UES & reduced openings/s- regurgitation of undigested food, dysphagia, cough, nocturnal choking, halitosis
A
What is Zenker’s diverticulum?***
14
Q
Zenker’s diverticulum***
A
What disease is characterized by pouching of the esophagus?
15
Q
Achalasia***
A
What disorder causes a bird beak on an esophagram?
16
Q
immunocompromised Ptscommon pathogens: candida, CMV, Herpes
A
Who is at risk for infectious esophagitis?
17
Q
GERDTx: H2 antagonists, PPIs
A
What is a DDx for cough?
18
Q
columnar metaplasia of distal esophagus due to chronic inflammationZ-line at GE junctionrisk factor for adenocarcinoma*
A
What is Barrett’s esophagus?
19
Q
Barrett’s esophagus
A
What esophageal disorder is at risk for adenocarcinoma?
20
Q
Barrett’s esophagus -columnar metaplasia of distal esophagus
A
What can chronic inflammation of the esophagus cause?
21
Q
a benign condition, VSS***tear in the esophagushematemesis usually due to vomiting, retching
A
What is a Mallory-Weiss Tear?
22
Q
- MI - common in women2. Pneumonia - common in kids3. GU - PID, ectopic pregnancy, testicular torsion, nephrolithiasis
A
What disorders can cause abdominal pain but aren’t abdominal disorders?
23
Q
- Diet low in fiber2. Aging3. Dec. activity4. Meds5. Masses6. Hypothyroidism7. Diabetes8. Parkinson’s9. MS
A
What are some causes of constipation?
24
Q
inflammation of the stomachcauses: NSAIDS, peptic ulcer disease
A
What is gastritis & common causes?
25
Inflammation of the stomach & small intestinecauses: norwalk virus, N/V/D
What is gastroenteritis & common causes?
26
NSAIDS block COX1 & COX2 causing inc. acid & mucus, causing inflammation & pain
How is NSAID gastropathy caused?
27
1. Gastric2. Duodenal3. H. Pylori
What are the different types of peptic ulcer disease?
28
breakdown of mucosal lining that allows epithelial cells to be exposed to acidworse on empty stomach or immediately after food
What is gastric peptic ulcer disease & when is it exacerbated?
29
inappropriate acid secretion in pyloric atrum cells worse 2-3 hrs after a meal, food relieves it
What is duodenal peptic ulcer disease & when is it exacerbated?
30
75% duodenal60% gastric
What percentage of each peptic ulcer diseases does H. pylori cause?
31
Zollinger-Ellison syndrome RARE
What is the name for the gastrin secreting pancreas tumor?
32
cobblestoning - skip lesions***chronic granulomatomous lesions
What is the tell-tale sign of Crohn's?
33
disease of small bowel, IBDmay extend & form fistulas w/ other organsS/S - diarrhea, cramping, wt loss, eye involvement, arthritis, anemiaabs. issues - ferritin, Fe, B12Cobblestoning - skip lesions
Describe Crohn's
34
1. Adynamic ileus2. Mechanical ileus
What are the different small bowel obstructions?
35
A - dec. intestinal motility, meds, surgery, electrolyte imbalance M - post op. adhesions, hernias, neoplasms, blockage
Adynamic ileus vs. mechanical ileus
36
mesenteric ischmia uncommon but deadly older Pts, occlusion, vasospasm, vasoconstriction of superior/inferior mesenteric artery
A disease process that has sever pain followed by vomiting is????
37
1. Ulcerative colitis2. Diverticulitis/diverticulosis3. Toxic megacolon4. Large bowel obstruction5. Pseudomembranous colitis
What are the large bowel disorders?
38
LLQ ab. pain***, fever, constipation/diarrhea
What is the S/S of diverticulitis?
39
herniation through muscles of intestinal wall-from low fiber diet, may be asymptomatic bowel rest, no colonoscopy for 6 wks, high fiber diet, wt loss
Describe diverticulitis
40
c - ulcerative colitis, Chron's, infectionsr - sepsis & bowel perforation
What are the causes & risks of toxic megacolon?
41
volvuluscecum & sigmoid most common, may constrict blood flow
What is twisting of the bowel called?
42
Intussusceptionexcacerbated peristalsis
What is telescoping of the bowel called?
43
1. Gangrene2. Shock3. Perforation
Large bowel obstructions may lead to...?
44
antibiotic assoc. colitis= C. Diff
Another name for pseudomembranous colitis?
45
Mucousy diarrhea****/constipationNOT IBS = blood, wt loss, fevers
What is a tell-tale sign of IBS?
46
congenital -absence of autonomic nerve ganglia, ENS usually affects rectosigmoid regioncomplications - constipation, bacterial growth, diarrhea & enterocolitis
What is Hirschsprungs?
47
Fe, B12, folate, Vit D & K --anemiaautoimmune
Which substances does Celiac cause a dec. absorption?
48
Very rare bacterial infection, farmer's soilS/S - steatorrhea, wasting, edema, endocarditis, uveitis, lymphadenopathy, dementia
What is Whipple's disease & S/S?
49
Dumping syndrome small gastric capacity, water pulled into intestine
What disease is from a loss of your pyloric sphincter?
50
1. Stomatitis2. Esophagitis3. Gastritis4. Peptic ulcer disease5. Crohn's6. Ulcerative colitis7. Enterocolitis8. Diverticulitis
Name the inflammation diseases of GI
51
1. Achalasia2. IBS3. Obstruction4. Volvulus5. Intussusception6. Hirschsprung
Name the motility disorders of GI
52
1. Celiac2. Dumping3. Short Bowel Syndrome
Name the malabsorption disorders of GI
53
wt. lossdysphagiahoarseness
What are the S/S of esophageal cancers?
54
most common in old black men, EtOH, tobacco, poor diet, Hx of head/neck radiation
Describe squamous cell carcinoma esophageal cancer
55
CA of glandsBarrett's esophagus & other high acid states
Describe adenocarcinoma esophageal cancer
56
Epigastric mass***
What is a tell-tale sign of gastric cancer?
57
2nd leading cause of CA death, risk doubles every decadeIBD, ulcerative colitis, Hx adenomatous polyps, 1st degree relative, tobacco, obesity, diet, high fat, low fiberFamilial adenomatous polyposis***Hereditary non-polyposis colon CA***watch CEA-125***
What are the risk factors for colon cancer?
58
1. Water2. Electrolytes3. Bile acids4. Cholesterol5. Pigment6. Phospholipids
Describe bile composition
59
digestion of lipids/fattransport waste from liver (bilirubin, IgA, toxins, cholesterol)
What is the function of bile?
60
FatFemaleFertileFortyFH, Sickle cell disease, TPN, pregnancy
What are the risk factors of gall stones?
61
70% cholesterolBilirubinCaCO3phosphate
What can gall stones be made of?
62
Transient cystic obstruction
What is biliary colic?
63
persistent cystic obstructionRUQ pain to R scapula***, +/- fever, anorexia, dyspepsia, N&V
What is acute cholecystitis & S/S?
64
1. Gangrenous cholecystitis 2. Empyema, Cholecystoenteric fistula, biliary peritonitis/sepsis, cholangitis/ascending cholangitis
Complications of acute cholecystitis
65
1. Laparoscopic cholecystectomy 2. Chemodissolution 3. ESWL (shock wave)
Tx acute cholecystitis
66
US - stones & gb wall thickening, distention into lumen, HIDA scan, maybe CT, MRCA, ERCP
Dx acute cholecystitis
67
acute cholecystitis
What is characterized by RUQ pain to the R scapula?
68
cacluli in common bile duct
What is choledocholithiasis?
69
US, HIDA scan, CT, MRCA, ERCP
How do you diagnose cholelithiasis?
70
gangrene, empyema, cholecystoenteric fistula, biliary peritonitis/sepsis, cholangitis
What are the complications of cholelithiasis?
71
cholecystitis & jaundice
What happens if there is an obstruction in the common bile duct?
72
pancreatitis
What happens if there is an obstruction in the sphincter of oddi or hepatopancreatic duct?
73
1. Critical illness/major surgery 2. Men >50 3. TPN more likely to get complications
Risk factors of Acalculous Cholecystitis
74
RF 1. IDB - ulcerative colitis, Crohn's 2. AIDS 3. Fasciola hepatica 4. Males 20-50 S/S 1. RUQ pain 2. Jaundice 3. Fevers 4. Wt loss
Risk factors & S/S Primary Sclerosing Cholangitis
75
inflammation of gall bladder w/o gall stones
What is acalculous cholecystitis?
76
inflammation & fibrosis of the biliary treemay also involve inra/extrahepatic ductsS/S - RUQ pain, jaundice, fevers, wt loss RF - IBD, ulcerative colitis, Crohn's, AIDS, fasciola hepatica
What is primary sclerosing colangitis?
77
rare, asymptomatic & insidious until late stages, only about 1/5 are found before they metastasize
Describe biliary malignancy
78
1. Amylase - carbs2. Lipase - fat, phospholipase A & lecithinase3. Proenzymes - protein, trypsinogen & others, inactive until duodenum4. Bicarb
What enzymes does the pancreas secrete?
79
1. Obstruction of pancreatic duct - digests itself2. Alcohol3. Biliary obstruction4. HypertriglyceridemiaOthers: meds, sphinter of oddi dysfunction, idiopathic, infections
What are the causes of acute pancreatitis?
80
From alcoholism 1. Diabetes 2. Malabsorption of fat (Vit A,D,E & K)
Chronic pancreatitis causes?
81
1. Obesity 2. Tobacco use 3. >50 yo 4. Maybe familial, alcohol, diabetes
Risk factors for pancreatic cancer
82
1. Epigastric pain 2. Anorexia 3. Wt loss 4. Maybe jaundice
S/S pancreatic cancer
83
1. CT scan w/ contrast 2. FNA 3. CA 19-9
Dx pancreatic cancer
84
1. Head - whipple 2. Tail - distal pancreatectomy 3. Chemo 4. Maybe radiation
Tx pancreatic cancer
85
Assessment of severity of Pancreatitis Admission 1. Age >55 2. Glucose >200 3. AST >250 4. LDH >350 5. WBC >16,000 After 48h 1. Hct dec. 10% 2. BUN >1.8 3. Serum Ca 4 6. Est fluid sequestration >6L
Ranson Criteria
86
1. NPO 2. IV hydration 3. Analgesics 4. Maybe abx
Tx acute pancreatitis
87
20% Pts w/ acute pancreatitis get it, 30% death rate Pseudocysts - collections of digestive enzymes need drained Abscess formation - From liquefaction & necrosis of pancreatic tissue, abx & I&D
Necrotizing pancreatitis
88
steady & boring epigastric painN/VRanson criteria assesses pancreatitis , Maybe fever, maybe abd distention
S/S of acute pancreatitis?
89
1. Necrotizing2. Pseudocysts - inc. enzymes, needs drained3. Abscess formation - results in liquefaction & necrosis of pancreatic tissue, collections of pus
What are the complications of pancreatitis?
90
chronic alcoholism
What is the most common cause of chronic pancreatitis?
91
Lipase - specific, returns to normal w/in 7-14 daysAmylase - returns to normal w/in 2-3 days, does not predict severityinc. WBC, triglycerides, bilirubin, ALP, AST, LDH *CT abdomen w/ contrast & US Gold standard*
Dx pancreatitis
92
head 3:1 chance in head than tail2% of new CA, 4th leading cause of CA death usually mets if showing S/SDx CA 19-9
Where in the pancreas is the most cancer found?
93
A D E K if liver probs, can't abs these
What are the fat soluble vitamins?
94
glucocorticoids & sex hormonesmen - gynecomastia, impotence, testicular atrophy women - irregular menses
What hormones does the liver metabolize & what problems can liver disease cause as a result?
95
Build & maintain cell membrane, myelin sheathintracellularly - precursor, bile, vit D, steroid hormones20-25% produced in liver
What are the functions of cholesterol?
96
1. Hemolysis2. Gilberts3. Sickle cell4. Crigler-Najarr syndrome
What are the prehepatic causes of inc. bilirubin?
97
pre-hepatic causes of inc. bilirubin
What has high serum unc. bilirubin, with no bilirubin and high urobilinogen in urine?
98
probs getting through biliary tree1. Liver disease/CA2. Hepatitis3. Primary sclerosing cholangitis4. Dubin-Johnson syndrome
What are the hepatocellular causes of bilirubin problems?
99
hepatocellular or post-hepatic bilirubin problems
What has high serum conj. bilirubin, with high conj. bilirubin with no or little bilinogen in the urine?
100
obstruction - gallstones, pancreatitis
What are the post-hepatic causes of bilirubin problems?
101
inflammation to fibrosis to scar tissue & nodulesirreversible****Causes: alcoholism, autoimmune primary biliary cirrhosis
Describe the process & causes of cirrhosis?
102
Portal HTN & cirrhosis, vomit blood - medical emergency
What can cause esophageal & periumbilical varices ascites?
103
an inc. NH4+ from liver disease that crosses the blood-brain barrier
What causes hepatic encephalopathy?
104
1. Reversal of ppting factors 2. Limit protein 3. Thiamine 4. Osmotic diuretics (lactulose) 5. abx - supress bacterial conversion to NH4+
Tx hepatic encephalopathy
105
1. Elevated LFT 2. CT Tx underlying cause..stop drinking
Dx & Tx of fatty liver disease
106
1. GI bleeding2. Azotemia/renal failure3. Constipation4. Inc. protein intake5. Hypokalemia6. Hypoxia7. Hypercarbia8. Sepsis9. CNS depressantsGraded: 1-4, 4 is worst (flap)
What can worsen hepatic encephalopathy?
107
1. Cirrhosis2. CA3. CHF4. TB5. PancreatitisTx - Na restriction, diuresis, paracentesis
What are the causes of ascites & Tx?
108
renal failure w/o intrinsic kidney diseasecauses: disturbance of arterial blood flow assoc. w/ portal HTNTx: hemodialysis
What is hepatorenal syndrome?
109
1. Alcoholism2. Non-alcoholic steatohepatitis (NASH)obesity, DM, protein malnutrition, TPN, drugs, rapid wt loss/starvation
What are the causes of fatty liver disease?
110
Hepatitis C
What is the main cause of liver transplant in the U.S.?
111
1. Hereditary hemachromatosis2. Wilson's disease
What are the toxic storage diseases?
112
abnormal Fe abs. & cirrhosis of liverautosomal recessive, abnormal HFE gene -alcohol inc. risks
Describe hereditary hemachromatosis
113
Toxic storage disease abnormal deposition of Cu in liver, autosomal recessive, stripped from ceruloplasminKaiser-Fleisher rings in eyes***
What is Wilson's disease?
114
1. Kaiser-Fleisher rings 2. Low serum ceruloplasmin 3. Inc. urinary Cu2+
Dx Wilson's disease
115
can't conjugate bilirubinautosomal dominant
What is Gilbert's disorder?
116
Wilson's disease
What disease is characterized by Kaiser-Fleischer rings?
117
S/S - fever, RUQ painc - portal vein infection, ascending cholangitis, bacteremia Tx - abx
What are the S/S & causes & Tx of liver abscesses?
118
hep B & C, cirrhosis, hemachromatosismostly metastatic
What are the causes of a hepatoma?
119
Difficulty swallowing
Define dysphagia
120
Pain w/ swallowing
Define odynophagia
121
1. IgG (may stay + for years) 2. Urea breath test 3. Stool Ag test 4. Endoscopy GOLD std (only do if Pt has red flag)
Dx H. pylori
122
1. Metronidazole 2. Tetracycline 3. Pepto-Bismol 4. Prilosec
Tx H. pylori
123
NONONO
Can you drink on metronidazole?
124
1. H. pylori 2. Familial NO EtOH
Risk factors of Gastric CA
125
1. Age >50 2. Acute onset 3. Wt loss (>10lbs) 4. Abd pain/cramping 5. Bleeding/melena 6. N&V 7. Rectal pain 8. Fever 9. Change in stool caliber
Red flags of Constipation
126
1. Exercise 2. Fiber 3. Fruits/veggies 4. Hydration 5. Laxatives
Tx Constipation
127
1. Erect posture 2. Straining at defecation 3. Pregnancy 4. Obesity 5. FH 6. Portal HTN
Risk factors of hemorrhoids
128
1. Meds (Anusol HC, Proctofoam HC) 2. Stool softeners 3. Good hygiene 4. Sitz bath 20 min 4. Cold pack - Surgical - 5. Rubber band ligation 6. Sclerotherapy 7. Hemorroidectomy
Tx hemorrhoids & anal fissures
129
1. IBD 2. TB 3. HIV 4. Leukemia 5. Syphilis
What do lateral anal fissures suggest?
130
Skin tags around booty hole, edema due to infection/swelling
What are sentinel piles?
131
Norwalk virus - Gastroenteritis, food borne illness, contagious when ill & 3 days later
What is the most common cause of infectious diarrhea worldwide?
132
0157:H7 Rapid onset 12-72 hours, Bloody diarrhea, MCC of travelers diarrhea, foorborne illness
What is the strain of diarrhea from E. Coli & describe
133
Hemolytic Uremic Syndrome - causes renal failure - common in kids Tx - Bactrim only in severe cases
Complications & Tx of E. coli diarrhea
134
Campylobacter jejuni Food poisoning, Onset 3-5 days, Assoc. w/ Guillan-Barre, Reiters sydrome, HUS, Tx - macrolides
MCC infectious diarrhea in US & Tx
135
S. aureus, Onset 3-12 hours, Fevers, chills, GI Sx, Symptomatic Tx
What is the MCC of food poisoning?
136
Turtles, iguanas, Food, Onset 6-36 h, Duration =1wk of 3-4wks, Tx - maybe fluoroquinolone
How do you get salmonella diarrhea?
137
Feces, fly contact, Most common bloody diarrhea, High fevers, Complications - Reiters, HUS Tx - fluoroquinolones
How do you get Shigella diarrhea?
138
No mammary glands
Can kids take fluoroquinolones?
139
Shigella
MCC of bloody diarrhea?
140
Giardia Lamblia (protozoan) Transmitted fecal-oral route, Onset 5-25 days Bloody diarrhea, Stool ova & parasite/stool Ag test, no fecal leukocytes, Tx - Nitazoxanide, Tinidazole, metronidazole
What is a parasitic cause of diarrhea?
141
1. Diarrhea (20-30 stools/day) 2. Mucus & blood sometimes 3. Crampy 4. Fevers
S/S C. diff
142
1. Abx (quinolones, amoxicillin), w/in 3 mo 2. Elderly, debilitated, immunosuppressed 3. Dec. acid - H2 blockers, PPIs 4. Hospitalization
Risk factors C. Diff
143
1. Colicky abd pain 2. N&V 3. Dec. bowel mvmts/flatus, Obstipation late 4. Abd distention 5. Early - hyperactive BS, Late - Hypoactive BS 6. Inc. tympany 7. Abd tenderness
S/S bowel obstruction
144
Plain film - string of pearls 2nd line - CT
Dx bowel obstruction
145
1. Surg consult - conservative mgmt (48h?) 2. NG tube 3. Fluid replacement 4. Maybe abx
Tx bowel obstruction
146
1. Maybe probiotics 2. Magnesium 3. Simethicone - GasX
Tx partial bowel obstruction
147
Angiography Surgery
Dx & Tx mesenteric ischemia
148
15-30yo Women Familial
Who commonly gets Crohn's?
149
1. Anterior uveitis 2. Arthritis 3. Anemia 4. Pyogenic gangrenosum 5. Cholelithiasis 6. Nephrolithiasis 7. Erythema nodosum
Extra-abdominal Sx of Crohn's
150
1. Colonoscopy 2. FOBT 3. Anal fissures, perirectal abscess 4. RLQ palpable mass 5. CBC (anemia & leukocytosis) 6. CRP, ESR 7.
Dx Crohn's
151
1. Salicylate Mod-Severe 1. Systemic corticosteroids 8-12wks 2. Immunosuppressant - Azathioprine 3. Anti-tumor necrosis factors - Humira, Remicade
Tx Crohn's
152
1. Diarrhea 2. Bloody stools 3. Abd pain 4. Wt loss 5. Fevers 6. Malaise
S/S ulcerative colitis
153
Colonoscopy Tx - same as Crohn's
Dx & Tx ulcerative colitis
154
if limited to recto-sigmoid
Where w/ ulcerative colitis is the risk ofcolon CA dec?
155
CT abdomen -Pericolic fat & wall thickening Tx - NPO or clear liquid diet, low fiber, Metronidazole & abx Prevention - high fiber diet, wt loss, avoid nuts & seeds
Prevention, Dx & Tx of Diverticulitis
156
No ma'am not for 6 wks
Can diverticulitis Pts get colonoscopys?
157
1. Abx 2. Steroids 3. Maybe colectomy
Tx toxic megacolon
158
1. Fibromyalgia 2. Fatigue 3. Noncardiac CP 4. GERD 5. Anxiety/depression 6. Chronic pelvic pain
Assoc. conditions w/ IBS
159
1. Exercise 2. Inc. fiber 3. Hydration 4. Avoid caffiene/alcohol 5. Consider probiotics 6. Meds for diarrhea/constipation
Tx IBS
160
1. Constipation 2. Fecal stagnation - bacterial overgrowth 3. Diarrhea & enterocolitis Tx - rectal irrigation & ileoanal pull through
Complications & Tx Hirschsprung's Disease
161
Celiacs
Who gets dematitis herpetiformis?
162
1. TTD 2. Confirm w/ EMA-IgA
Dx Celiac
163
Lactose breath Hydrogen test/ trial w/o lactose
Dx lactose intolerance
164
Whipple's disease
What disease affects heart, lung, brain, skin & eyes?
165
Duodenal/jejunal Bx Tx - abx for up to a year
Dx & Tx Whipple's disease
166
Obstructions
What do adenocarcinomas usually present as?
167
Adenocarcinoma, 3 or +, size>1cm, high grade bx changes
Risk factors for developing cancerous colon polyps?
168
1. Change in bowel patterns 2. Melena 3. Hematochezia 4. Narrow ribbony stools 5. Wt loss 6. Vomiting 7. Fatigue 8. Abd pain/discomfort, bloating, gas
S/S colon cancer
169
1. 50 yo then q10yr 2. 1st degree relative 60 yrs, 40 then q10yrs 4. Hx adenomatous polyps
Screening for colon CA
170
1. Peptic ulcer disease 2. Esophageal varices 3. Gastritis 4. Esophageal ulcer 5. Mallory Weiss Tear 6. GI malignancy
Acute massive upper GI bleeding causes
171
1. Diverticular disease 2. Colon CA 3. IBD 4. Ischemic colitis 5. Internal hemorrhoids
Acute massive lower GI bleeding causes
172
1. Gastritis 2. Esophatitis 3. Peptic ulcer disease 4. Gastric CA
Chronic intermittent upper GI bleeding causes
173
1. Hemorrhoids 2. Colonic polyps 3. Diverticular disease 4. Colorectal CA
Chronic intermittent lower GI bleeding causes
174
Diverticular disease
What is the MCC of lower GI bleeding?
175
Oral-fecal, Incubation 2-7 wks S/S 1. Fever 2. N&V 3. RUQ pain 4. Hepatomegaly 5. Splenomegaly 6. Jaundice 5-7 days later , Infectivity: 2 weeks before to 1 week after symptoms appear; once jaundice, no longer contagious
Transmission, Incubation, S/S of Hepatitis A
176
1. IgM - 5-10 days before Sx up to 3 mo 2. IgG - 4 wks after exposure, lifelong immunity 3. Inc. LFT 4. Inc. bilirubin 5. ALP not that high Tx - Symptomatic
Dx & Tx hepatitis A
177
V - active acquired immunity Immunoglobulin - passive immunity, given in cases of known exposure
Hepatitis A vaccines
178
Bloodborne & body secretions, Incubation 60-90 days S/S - same as HepA w/ urticaria (Hardy virus)
Transmission, Incubation, S/S of Hepatitis B
179
Incubation - HBsAg +, Immune response/acute - xHBcAb +, Acute/seroversion - Ag lower, HBcAb+, HBeAb +, Recovery immunity - HBcAb + HBsAB + meaning immunity/prior infection
Hepatitis B Dx
180
1. 3 dose series at 0, 1m & 6 m 95% response rate
Hepatitis B immunization
181
May be protective, or attenuate the severity of illness, if given within 7 days after exposure followed by HBV vaccine
Who gets HBIG?
182
Can't survive unless HepB, Accelerates progression of liver disease
Hepatitis D
183
Blood, mild clinical illness
Transmission & S/S Hepatitis C
184
Antit-HCV Ab, ELISA, confirm w/ PCR
Dx Hepatitis C
185
people born btwn 1945-1965
Who should be screened for Hepatitis C?
186
Causes cirrhosis & hepatocellular CA Tx -interferon & ribavirin… Tx for Hep B only req. in severe cases
Tx Hepatitis B & C
187
Nasty drinking water in developing countries
Who gets hepatitis E?
188
Assoc. w/ hemachromatosis 1. Hyperpigmented skin 2. Diabetes 3. Cirrhosis
What is bronze diabetes?
189
1. Phlebotomy 2. Deferoxamine (Chelates iron)
Tx of hemachromatosis
190
1. Low ceruloplasmin 2. High Cu in 24h urine Tx - Chelation (penicillamine)
Dx & Tx Wilson's disease
191
0-24h Anorexia, N&V, malaise 18-72h RUQ pain, N&V 72-96h hepatic necrosis, jaundice, renal failure, MSOF 4d-3wk Complete resolution
S/S acetaminophen toxicity
192
Adults - 7.5-10 g Kiddos - 100-150 mg/kg Tx - NAC (Mucomyst)
Levels of acetominohen toxicity & Tx
193
1. Elevated unconj. Biluribin 2. No bilrubin in urine 3. No/low urobilinogen in urine No Tx
Dx & Tx Gilbert's disease
194
1. Gram - anaerobes (E. coli, Klebsiella) 2. Staph/Strep
Common organisms of liver abscesses
195
1. RUQ pain 2. Anorexia 3. Wt loss 4. Jaundice Dx - 1. US 2. Liver Bx 3. Elevated ALP 4. Alpha-fetaprotein level
S/S & Dx hepatoma
196
1. Surgery 2. Liver transplant 3. Maybe chemo/radiation
Tx hepatoma
197
1. Hepatitis 2. Alcoholic liver disease 3. Primary biliary cirrhosis 4. Primary sclerosing cholangitis 5. Hemachromatosis/Wilson's disease 6. Malignancy
Indications for liver transplant
198
1. Based on need 6 - least ill, 40 - critically ill 2. Bilirubin 3. INR 4. Creatinine
Deciding who gets a liver transplant?
199
1. Tachycardia 2. RUQ pain 3. Jaundice Tx - immunosuppression, steroids, Tx for opportunistic infections
S/S liver transplant rejection
200
A & E
Which Hepatitis viruses are transmitted via Fecal-oral route?
201
B, C & D
Which hepatitis viruses are transmitted via parenteral/mucus membrane contact?
202
Hep C
What is the most common cause of viral chronic hepatitis?
203
Hep B & C…C more coming
Which types of hepatitis can cause liver cirrhosis?
204
Hep B & C ….also aflotoxin B1 exposure & cirrhosis
Which types of hepatitis increase your risk of hepatocellular cancer?
205
1. Young-middle aged women 2. Wilson's disease 3. a1-antitrypsin deficinecy 4. Whites & Northern Europeans
Who is at risk for autoimmune hepatitis?
206
ALD - AST:ALT >2 H - ALT>AST
LFT alcoholic liver disease vs. hepatitis
207
AST:ALT >2 GGT usually 3x normal Alcohol abstinence
LFT alcoholic liver disease
208
1. Chronic viral hepatitis 2. Alcohol 3. Drug toxicity 4. Autoimmune & metabolic liver disorders
Causes of cirrhosis
209
1. Weakness 2. Fatigue 3. Disturbed sleep 4. Muscle cramps 5. Anorexia 6. Wt loss maybe 7. N&V 8. Jaundice 9. Abd pain 10. Hematemesis 11. Fever 12. Amenorrhea 13. Erectile dysfunction, sterility, gynecomastia 14. Splenomegaly 15. Ascites, pleural effusio
S/S cirrhosis
210
1. Ascites 2. Esophageal varices 3. Spontaneous bacterial peritonitis 4. Hepatorenal syndrome 5. Hepatic encephalopathy 6. Anemia 7. Coagulopathy
Complications of cirrhosis
211
Women 40-60 yo May be assoc w/ 1. Hypothyroidism 2. Sjogren's 3. Raynaud 4. Scleroderma 5. Celiac 6. Hx UTI 7. Smoking 8. Hormone replacement 9. Use of hair dye
Who commonly gets primary biliary cirrhosis?
212
Inc. 1. ALP 2. Cholesterol 3. Bilirubin 4. AMA 5. IgM
Lab values w/ primary biliary cirrhosis
213
Hepatic vein obstruction Can lead to esophageal varices
What is Budd-Chiari syndrome?
214
Cavernous hemangioma
What is the most common benign neoplasm of the liver?
215
1. Cavernous hemangioma 2. Focal nodular hyperplasia 3. Hepatic adenoma
What are the benign liver neoplasms?
216
1. Cavernous hemangioma 2. Hepatic adenoma
Which benign liver neoplams are usually caused by oral contraceptives?
217
Stellate lesions, Benign liver neoplasm, both M&F get it
What does a focal nodular hyperplasia show up on CT as?
218
Characteristic of acute cholangitis 1. Fever & chills 2. Pain 3. Jaundice
What is Charcot's triad?
219
Large deep ulcers - CMV/HIV Multiple shallow ulcers - HSV White plaques - candida
Differences in infectious esophagitis endoscopy
220
Proximal 2/3 of the esophagus
Where do squamous cell carcinomas of the esophagus commonly occur?
221
A - body of stomach: autoimmune of noninfectious factors B - antrum & body of stomach: H. pylori
Types of gastritis
222
H. pylori
What is the most common cause of peptic ulcers?
223
estomago
What is the most common extranodal site for non-Hodgkin's lymphoma?
