Flashcards in Uworld GI Deck (71):
Class of drugs for nausea?
liver cyst with egg-shell calcifications? Cause?
Hydatid cyst. Ecchinococcus. From dogs.
Treatment of a patient with Hepatic encephalopathy?
1. Treat precipitant
2. Lactulose (decreases ammonia levels)
3. Antibiotics (neomycin and rufaximin) to decrease ammonia-producing bacteria in colon
Aspiration of amoebic liver abscess would show? Dx by? Treatment?
Sterile abscess – diagnose by stool examination for trophozoites. Metronidazole
All patients with cirrhosis should be screened for? Prophylaxis?
Esophageal varices by endoscopy. Beta blockers
When to drain pancreatic pseudocyst?
Size >5 cm, lasts longer than six weeks, secondarily infected
Single most important test to assess liver function?
PT (acute rise can suggest Fulminant liver failure)
Extrahepatic findings with drug-induced liver injury? Exception?
Rash, arthralgias, fever, leukocytosis, eosinophilia
Exception: isoniazid (hepatitis without extrahepatic manifestations)
Types of drug-induced liver disease?
1. Cholestasis (chlorpromazine, nitrofurantoin, erythromycin, anabolic steroids)
2. Fatty liver (tetracycline, valproate, antiretrovirals)
3. Hepatitis (halothane, phenytoin, Isoniazid, Alpha-methyldopa)
4. Fulminant liver failure (acetaminophen, Carbon tetrachloride)
5. Granuloma (allopurinol, phenylbutazone)
Effects of oral contraceptives on liver?
Abnormal liver function tests without evidence of necrosis or fatty change
Fulminant liver failure definition? Caused by?
Hepatic encephalopathy (confusion) that develops within 8 weeks of acute liver failure
Acetaminophen, alcohol, amphetamines, hepatitis B/D
Symptoms of Wilson's disease?
Liver: hepatomegaly, elevated liver enzymes
Neuro: resting tremor, muscular rigidity, drooling?
Criteria for Toxic megacolon?
with 3 of: fever, HR>120, leukocytosis>10,500, anemia
with 1 of: altered MS, hypoNa, hypotension, electrolyte disturbances
Dark discoloration of the colon with patches of lymph follicles. Due to diuretic abuse
Tests for dysphagia (in order?)
1. Barium Esophagram
3. Motility Studies
Drugs that cause Pancreatitis if pt has: volume overload? IBD? Immunosupressants? Seziures? Infection?
Deficiency of Zinc causes?
alopecia, abnormal taste, blisters
Constant burning pain with intense pain with light touch to the abdomen with other signs?
Drugs that cause esophagitis?
KCl, Fe, Quinine
Types of polyps and risk of cancer?
1. hyperplastic - no risk
2. hamartomatous - small risk
3. adenoma - largest risk (esp is villous)
Scleroderma - effect of ESO?
incompetency of LES over time
How to diagnose chronic pancreatitis?
CT scan shows calcifications of the pancreas
lipase and amylase NOT diagnostic
Pt with UC: regular surveillance only really beneficial if looking for? Other complications?
(doesn't help for other complications: toxic megacolon, sclerosing colangitis, uveitis, erythema nodosum, spondyloarthropathy)
Best test for C diff?
Stool cytotoxin assays, NOT stool cultures
Ischemic colitis - symptoms? affects what areas of the colon?
acute abdominal pain followed by diarrhea
Watershed areas: splenic flexure and recto-sigmoid junction
Zollinger-Ellison syndrome causes fat malabsorption because?
increased acid neutralizes lipase
pt with chronic abdominal pain, weight loss, and food avoidance with no specific findings on PE - think? Test by?
Mesenteric ischemia. Dopplers
Test for lactose intolerance?
1. positive H-breath test
2. increased stool osmotic gap
3. Reducing substances in stool
Hepatorenal syndrome? tx?
portal HTN leads to formation of NO, which dilates vessels, leading to decreased BP and renal hypoperfusion
Midodrine and octreotide
Medical treatment used to dissolve gallstones in individuals who are Symptomatic but poor surgical candidates?
Tx options for gallstones?
If asymptomatic, do nothing
If low risk or have acute cholecystitis or porcelain gallbladder do laparoscopic cholecystectomy
If high-risk, use ursodeoxycholic acid (to dissolve) or shock-wave lithotripsy
Pleural effusions due to cirrhosis or liver disease (not due to underlying cardiac or pulmonary problem)
Treatments for hepatic hydrothorax?
1. Liver transplant
2. Thoracentesis followed by salt restriction and diuretics
3. Transjugular intrahepatic portosystemic shunt (TIPS)
Emphysematous cholecystitis? Caused by?
Form of acute cholecystitis due to infection by gas forming bacteria (SPECKS - Clostridium, E. coli, staph, Streptococcus, Pseudomonas, Klebsiella)
Treatment for emphysematous cholecystitis?
Fluid resuscitation, cholecystectomy, parenteral antibiotic therapy
Mechanism of non-alcoholic fatty liver disease?
Insulin resistance leads to increased fatty acid oxidation, which leads to increased oxidative stress, resulting in proinflammatory cytokines causing inflammation, fibrosis, cirrhosis
Disease that can cause an aversion to smoking?
Pathogenic factors involved in the development of hepatic encephalopathy?
1. Ammonia accumulation
2. Production of false neurotransmitters
3. Increased GABA sensitivity
4. Zinc deficiency
Treatment of acute cholangitis?
1. Broad-spectrum antibiotics and supportive care
2 If no response, ERCP
Acute pancreatitis: when to do abdominal CT scan?
In patients with clinical findings suggestive of pancreatitis but fail to improve with conservative treatment
Patient with newly diagnosed hepatitis C. Should receive?
Vaccinations against hepatitis A and B if not already immune
Treat with interferon-alfa and ribavirin unless pregnant
Ischemic hepatopathy from shock leads to a massive increase in transaminases, and smaller increases and bilirubin and alkaline phosphatase.
Evaluations of patients with acute versus chronic hepatitis?
Liver function tests and viral serology versus liver biopsy
Causes of acalculous cholecystitis?
Gallbladder inflammation in the absence of gallstones
3. prolonged TPN
4. prolonged fasting
5. mechanical ventilation
Paroxysmal nocturnal hemoglobinuria cause? Leads to?
Abnormal GP1(prohibits binding of CD 55 and CD 59 which inhibit RBC destruction).
Leads to intravascular hemolytic anemia and hepatic vein thrombosis.
Bilirubinuria suggests and increase in?
7 in normal pt
10 in pt with cardiac dz
Angiodysplasia is commonly seen in patients with?
Aortic stenosis or end stage renal disease
Vessels in Mallory Weiss tears versus variceal tears?
Submucosal arteries versus submucosal veins
Biopsy findings in:
1. Ischemic colitis
1. Epithelial necrosis
2. Neutrophilic cryptitis
Steps to treat ascites?
1. Sonja at water restriction
3. Loop diuretic
Patient with enlarged, non-tender gallbladder with evidence of biliary obstruction?
Treatment for patients with small non-bleeding varices?
Non-selective beta blockers (propanolol, nadolol) to reduce progression to large varices
VIPoma location? Symptoms?
Head of the pancreas. Diarrhea and hypoK
Glucagonoma presents with?
1. Necrotizing dermatitis
2. Weight loss
Cullen Sign? Grey-Turner sign?
Both seen in pancreatitis
Periumbilical bluish coloration indicating hemopericardium
Reddish brown coloration around flanks indicating retroperitoneal bleed
Clues to inflammatory diarrhea?
Extra pancreatic complications of pancreatitis?
G.I. pathology that is alleviated by nitroglycerin? Test?
Diffuse esophageal spasm. Manometry
Manometry shows absent peristaltic waves in lower ESO and absent LES?
Chlamydia vs gonorrhea?
Mucopurulent discharge, absent bacteriuria vs purulent and gram-staining
Lengthy history of OCP increases chance of?
Gastric pain alleviated by nitrates? Test to confirm?
Diffuse esophageal spasm; motility studies
Initial treatment for anal fistulas?
Non-transaminase signs of alcoholic hepatitis?
#Elevated Billy Rubin
#Neutrophil predominant leukocytosis
Early test patient with newly diagnosed hepatitis C?
Liver biopsy – for prognosis and likely response to therapy
Infection that affects liver and kidney?
Cryoglobulinemia from hepatitis
yellow red papules on arms and shoulders?
D-xylose test assesses for?
+ Anti-mitochondrial bodies?
Symptoms without positive anti-mitochondrial antibodies?
Primary sclerosing cholangitis
Malignant biliary stricture