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Flashcards in Uworld GI Deck (71):
0

Class of drugs for nausea?

5HT antagonists

1

liver cyst with egg-shell calcifications? Cause?

Hydatid cyst. Ecchinococcus. From dogs.

2

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

3

Aspiration of amoebic liver abscess would show? Dx by? Treatment?

Sterile abscess – diagnose by stool examination for trophozoites. Metronidazole

4

All patients with cirrhosis should be screened for? Prophylaxis?

Esophageal varices by endoscopy. Beta blockers

5

When to drain pancreatic pseudocyst?

Size >5 cm, lasts longer than six weeks, secondarily infected

6

Single most important test to assess liver function?

PT (acute rise can suggest Fulminant liver failure)

7

Extrahepatic findings with drug-induced liver injury? Exception?

Rash, arthralgias, fever, leukocytosis, eosinophilia

Exception: isoniazid (hepatitis without extrahepatic manifestations)

8

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)

9

Effects of oral contraceptives on liver?

Abnormal liver function tests without evidence of necrosis or fatty change

10

Fulminant liver failure definition? Caused by?

Hepatic encephalopathy (confusion) that develops within 8 weeks of acute liver failure

Acetaminophen, alcohol, amphetamines, hepatitis B/D

12

Symptoms of Wilson's disease?

Liver: hepatomegaly, elevated liver enzymes

Neuro: resting tremor, muscular rigidity, drooling?

13

Criteria for Toxic megacolon?

Radiologic findings

with 3 of: fever, HR>120, leukocytosis>10,500, anemia

with 1 of: altered MS, hypoNa, hypotension, electrolyte disturbances

14

Melanosis coli?

Dark discoloration of the colon with patches of lymph follicles. Due to diuretic abuse

15

Tests for dysphagia (in order?)

1. Barium Esophagram
2. Endoscopy
3. Motility Studies

16

Drugs that cause Pancreatitis if pt has: volume overload? IBD? Immunosupressants? Seziures? Infection?

furosemide, thiazides
Sulfasalazine, 5-ASA
azothioprine, L-asparaginase
Valproic acid
Metronidazole, tetracycline

17

Deficiency of Zinc causes?

alopecia, abnormal taste, blisters

18

Constant burning pain with intense pain with light touch to the abdomen with other signs?

HZV

19

Drugs that cause esophagitis?

KCl, Fe, Quinine
tetracyclines
NSAIDs
Bisphosphonates

20

Types of polyps and risk of cancer?

1. hyperplastic - no risk
2. hamartomatous - small risk
3. adenoma - largest risk (esp is villous)

21

Scleroderma - effect of ESO?

incompetency of LES over time

22

How to diagnose chronic pancreatitis?

CT scan shows calcifications of the pancreas

lipase and amylase NOT diagnostic

23

Pt with UC: regular surveillance only really beneficial if looking for? Other complications?

ColonCA

(doesn't help for other complications: toxic megacolon, sclerosing colangitis, uveitis, erythema nodosum, spondyloarthropathy)

24

Best test for C diff?

Stool cytotoxin assays, NOT stool cultures

25

Ischemic colitis - symptoms? affects what areas of the colon?

acute abdominal pain followed by diarrhea

Watershed areas: splenic flexure and recto-sigmoid junction

26

Zollinger-Ellison syndrome causes fat malabsorption because?

increased acid neutralizes lipase

27

pt with chronic abdominal pain, weight loss, and food avoidance with no specific findings on PE - think? Test by?

Mesenteric ischemia. Dopplers

28

Test for lactose intolerance?

1. positive H-breath test
2. increased stool osmotic gap
3. Reducing substances in stool

29

Hepatorenal syndrome? tx?

portal HTN leads to formation of NO, which dilates vessels, leading to decreased BP and renal hypoperfusion

Midodrine and octreotide

30

Medical treatment used to dissolve gallstones in individuals who are Symptomatic but poor surgical candidates?

Ursodeoxycholic acid

31

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

32

Hepatic hydrothorax?

Pleural effusions due to cirrhosis or liver disease (not due to underlying cardiac or pulmonary problem)

33

Treatments for hepatic hydrothorax?

1. Liver transplant
2. Thoracentesis followed by salt restriction and diuretics
3. Transjugular intrahepatic portosystemic shunt (TIPS)

34

Emphysematous cholecystitis? Caused by?

Form of acute cholecystitis due to infection by gas forming bacteria (SPECKS - Clostridium, E. coli, staph, Streptococcus, Pseudomonas, Klebsiella)

35

Treatment for emphysematous cholecystitis?

Fluid resuscitation, cholecystectomy, parenteral antibiotic therapy

36

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

37

Disease that can cause an aversion to smoking?

Hepatitis A

38

Pathogenic factors involved in the development of hepatic encephalopathy?

1. Ammonia accumulation
2. Production of false neurotransmitters
3. Increased GABA sensitivity
4. Zinc deficiency

39

Treatment of acute cholangitis?

1. Broad-spectrum antibiotics and supportive care
2 If no response, ERCP

40

Acute pancreatitis: when to do abdominal CT scan?

In patients with clinical findings suggestive of pancreatitis but fail to improve with conservative treatment

41

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

42

Shock liver?

Ischemic hepatopathy from shock leads to a massive increase in transaminases, and smaller increases and bilirubin and alkaline phosphatase.

43

Evaluations of patients with acute versus chronic hepatitis?

Liver function tests and viral serology versus liver biopsy

44

Causes of acalculous cholecystitis?

Gallbladder inflammation in the absence of gallstones
1. Burns
2. Trauma
3. prolonged TPN
4. prolonged fasting
5. mechanical ventilation

45

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.

46

Bilirubinuria suggests and increase in?

Conjugated hyperbilirubinemia

47

Tranfusion threshold?

7 in normal pt
10 in pt with cardiac dz

48

Angiodysplasia is commonly seen in patients with?

Aortic stenosis or end stage renal disease

49

Vessels in Mallory Weiss tears versus variceal tears?

Submucosal arteries versus submucosal veins

50

Biopsy findings in:
1. Ischemic colitis
2. IBD

1. Epithelial necrosis
2. Neutrophilic cryptitis

51

Steps to treat ascites?

1. Sonja at water restriction
2. Spironolactone
3. Loop diuretic
4. Paracentesis

52

Patient with enlarged, non-tender gallbladder with evidence of biliary obstruction?

Pancreatic cancer

53

Treatment for patients with small non-bleeding varices?

Non-selective beta blockers (propanolol, nadolol) to reduce progression to large varices

54

VIPoma location? Symptoms?

"Pancreatic cholera"

Head of the pancreas. Diarrhea and hypoK

55

Glucagonoma presents with?

1. Necrotizing dermatitis
2. Weight loss
3. Anemia
4. Hyperglycemia

56

Cullen Sign? Grey-Turner sign?

Both seen in pancreatitis

Periumbilical bluish coloration indicating hemopericardium

Reddish brown coloration around flanks indicating retroperitoneal bleed

57

Clues to inflammatory diarrhea?

Weight loss
Anemia
Reactive thrombocytosis
Elevated ESR

58

Extra pancreatic complications of pancreatitis?

Plural effusion
Ileus
ARDs
Renal failure

59

G.I. pathology that is alleviated by nitroglycerin? Test?

Diffuse esophageal spasm. Manometry

60

Manometry shows absent peristaltic waves in lower ESO and absent LES?

Scleroderma

61

Chlamydia vs gonorrhea?

Mucopurulent discharge, absent bacteriuria vs purulent and gram-staining

62

Lengthy history of OCP increases chance of?

Hepatic adenoma

63

Gastric pain alleviated by nitrates? Test to confirm?

Diffuse esophageal spasm; motility studies

64

Initial treatment for anal fistulas?

Stool softeners

65

Non-transaminase signs of alcoholic hepatitis?

#Elevated GGT
#Elevated Billy Rubin
#Elevated INR
#Neutrophil predominant leukocytosis

66

Early test patient with newly diagnosed hepatitis C?

Liver biopsy – for prognosis and likely response to therapy

67

Infection that affects liver and kidney?

Cryoglobulinemia from hepatitis

68

yellow red papules on arms and shoulders?

Xanthomas

69

D-xylose test assesses for?

Celiac's

70

+ Anti-mitochondrial bodies?

Symptoms without positive anti-mitochondrial antibodies?

Primary sclerosing cholangitis

Malignant biliary stricture

71

Acute erosive gastritis? Seen with intake if?

Severe hemorrhagic erosive lesions after exposure to substances (large doses of aspirin)

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