amboss 7/4 Flashcards
what is the presentation of hepatitis A infections
fever, jaundice, high bili, Serum transaminase levels are highly elevated (400–1000 U). Unlike in alcoholic hepatitis, ALT levels are greater than AST levels (the AST/ALT ratio is usually < 1). If the AST/ALT ratio is > 1 in a patient with acute viral hepatitis, acute liver failure (fulminant hepatitis) should be suspected.
what is the presentation of hepatitis B
usually asymptomatic, can produce a chronic hepatitis years later
how is hep B transmitted
sexually, parentally (needlestick), perinatally
bacillus cerus food poisoning occurs in what foods
foods that are heated/coooked and then reheated
It grows in heated food that cools down too slowly or in food that is improperly refrigerated. Reheated rice is a common source of infection.
which leads to nausea and vomiting approximately 30 minutes to 6 hours after ingestion.
what is the presentation of amebiasis from entameoba histolytica
and causes both intestinal disease (bloody loose stools) and extraintestinal disease (amebic liver abscess). Patients with an amebic liver abscess typically present with fever and pain in the RUQ that is possibly exacerbated by inspiration.
how is entamoeba spread
This pathogen is spread fecal-orally in endemic regions (Mexico, Southeast Asia, India)
what are the ultrasound findings for entamoeba infection
a solitary hypoechoic lesion in the liver makes the diagnosis of amebiasis extremely likely.
what is the diagnostic test of choice for suspected GI bleed
Esophagogastroduodenoscopy (EGD)
what is the test of choice for boerhaave sydnrome
CT scan chest; contrast esophgram with gastrographin NOT barium. contrast only done if patient is stable `
what is the difference between boerhaave and mallory weis
borehaave is transmural rupture
how is the diagnosis made for mallory Weiss tear
endoscopy
treatment for boerhaave
surgical repair
what is the treatment for entamoeba histolytica
metronidazole
what is the treatment for anal fissure
sitz bath and nifedipine
is hep c RNA or DNA
RNA
glutamate dehydrogenase antigen screening is for what
C diff
what is the test for lactose intolerance
hydrogen breath test
what is the test for celiac disease
antitissue transglutaminase; IgG deaminated gliadin peptide test
how do you treat whipples disease
IV ceftriaxone; maintenance therapy with Bactrim should be followed for one year
what is the presentation of whipples
joint pain and malabsorption
what can happen when an amoebic cyst is drained
anaphylactic shock
what is first line therapy for hemorrhoids
docusate and lidocaine if painful
what is the therapy for internal hemorrhoids if first line medical therapy fails
rubber band ligation
what is the next step in management after achalasia is found on barium swallow
endoscopy because must rule out pseudoachalasia
what is the most common cause of gastroenteritis in adults
norovirus
presentation of norovirus
presents with gastroenteritis caused by norovirus, which usually manifests with nausea, acute-onset vomiting, watery, non-bloody diarrhea, and abdominal cramps following an incubation period of 12–48 hours. Because norovirus is transmitted fecal‑orally, the woman might have contracted the illness from eating contaminated food or water or contact with contaminated surfaces.
what antibody is associated with ulcerative colitis
pANCA
what is the treatment for GERD
Proton-pump inhibitors (PPIs) are the first-line treatment for moderate to severe GERD. Of all medications that are used in GERD, PPIs are associated with the greatest reduction in symptoms and relapse rates. Since this patient has had symptoms daily for the past month, PPIs are the treatment of choice in combination with dietary and lifestyle modifications, including avoiding late night meals, elevating the head of the bed while sleeping, and weight loss.
what does the stool look like in someone with giardiasis
it will have cysts in it
what is the treatment for giardiasis
metronidazole
are we vaccinated for hep A f
yes. between the ages of 12-23months
Is PEP necessary for children exposed to hep A
no….if they are up too date on vaccines and above the age of 2
what is the treatment for acute hep c
Sofosbuvir and ledipasvir, both direct-acting antivirals, are the first-line treatment for chronic hepatitis C infection of genotypes 1, 4, 5, and 6. Treatment of chronic hepatitis C infection depends on viral genotype, history of antiviral treatment, and the degree of liver fibrosis. The duration of treatment is typically 12 weeks.
what is the treatment for chronic hep c
pegalyated interferon and riboviron
what is hepatitis core antibody indicate
Chronic -either inactive or acitve
what is the hepatitis B envelope antigen suggest
this means active –think “Envelope Ective”
what does an inactive chronic hep b infection look like on seriology
with chronic hepatitis B has a normal ALT level and a hepatitis B DNA load of less than 2,000 IU/mL
they will have a positive core antibody; positive envelope antibody; and positive surface antigen.
what is suppurative sialadenitis
The condition is most commonly caused by S. aureus and typically presents with sudden swelling of the salivary glands (most often the parotid gland), tenderness, fevers, chills, and secretion of purulent material from the salivary duct, as seen here.
what is the treatment for suppurative sialadenitis
nafcillin and metronidazole
what is candida esophagitis treated with
oral fluconazole
what is the difference between thrush and esophagitis
white plaques that are scraped off easily, indicating oral thrush. Additionally, her dysphagia is consistent with esophagitis. Together, oral thrush and esophagitis in a patient with a positive HIV test is most likely caused by Candida albicans.
what is the treatment for active hep b infection
pegylated interferon is indicated if the ALT is great than 2X the upper limit of normal; tenofovir is used for patients with contraindications such as autoimmune disease
what do you give patients with fulminant liver failure
n-acetyl cysteine
what is the intervention of choice for pancreatic head cancer
Whipple
what is the treatment of choice for acute cholangitis
ERCP
why is cholecystectomy not the treatment of choice for acute cholangitis
because that wouldn’t remove the stone in the common bile duct
what is the course of management for hiatal hernia with severe features
lifestyle modification and medical management with PPIs, H2 receptor antagonists, then surgical intervention
what is hiatal hernia with severe features
severe features are refractory GERD, esophageal ulceration, bleeding, strictures
what is type I hiatal hernia
when the gastroesophageal junction is above the diaphragm
this is also called sliding
what is type 2 hiatal hernia
when the fundus of the stomach is above the diaphragmatic barrier
what is type 3 hiatal hernia
when there is a fundus and the gastroesophageal line is above the diaphragm
what is a type 4 hiatal hernia
when the stomach is completely above the diaphragm
also call upside-down stomach
what is a femoral hernia
Rare type of hernia, they are always below the inguinal ligament. they are associated with increased bulging on increased intrabdominal pressure
what is an indirect hernia
most common type of hernia in both men and women. palpable groin protrusion above the inguinal ligament t these are located lateral to the epigastric arteries. these are treated with surgery immediately so that strangulation does not occur
what is a direct hernia
Direct inguinal hernias manifest as a visible and/or palpable groin protrusion above the inguinal ligament and are associated with pain that worsens during physical activity. However, they usually occur in men > 40 years of age and are uncommon in women.
what are the differences between direct and indirect hernias
indirect is the most common.
men age > 40 are more likely to get direct
direct hernias cause pain on exertion
what is the first step in someone with small bowel obstruction
conservative trial is indicated. nasogastric tube placement for decompression, fluid resuscitation, and electrolyte correction as well as bowel rest
what is the best prognostic indicator for pancreatitis
hematocrit. this is based on volume status. if significant third spacing is occurring then the hematocrit will become hemoconcentrated. Or the hematocrit can drop due to necrotizing pancreatitis
what is cholecystitis
inflammation of the gallbladder, most often caused by a stone blocking the cystic duct
what is cholangitis
biliary obstruction and stasis. if infection then acute
pregnancies/mulparity increases the risk for gallstones by how much and why
The risk of gallstone disease is about 10 times greater among multiparous women than nulliparous women. Higher estrogen levels during pregnancy increase the secretion of cholesterol into bile, while higher progesterone levels decrease the production of hydrophilic bile acids, resulting in a decreased ability of bile to sequester cholesterol.
what does the serum-ascites-albumin gradient tell us
a SAAG > 1.1 indicates that the source is portal hypertension; < 1.1 hypoabuminemia, malignancy, infections or pancreatitis
what is the best way to diagnose choledochothiais
trans abdominal ultrasound
what is the treatment for an acute complicated inguinal hernia
this is an incarcerated hernia and must have open repair
what is the treatment of choice for uncomplicated hernias
laparoscopic repair
what is the management for Barretts esophagus
endoscopic mucosal resection and ablation therapy
is there a risk for malignancy in barretts
yes. the risk increases by 0.7%/per year for adenoma carcinoma
what is the management for borehaave syndrome
1) if healthy person with a small contained tear and no signs of sepsis then conservative management –ampicillin and sulbactam therapy.
2) if they do not meet the criteria for conservative management or fail then surgical intervention
what is a sharply defined liver mass with a central scar
focal nodular hyperplasia.
what is the treatment of choice for focal nodular hyperplasia
follow up imaging at 3-6 months is recommended to confirm the stability of the lesions, after which there is no further intervention
do you discontinue OCPs in someone with focal nodular hyperplasia
No. although the tumors tend to be more vascular on OCPs, they are generally very stable and do not require intervention
what are the treatment options for chronic pancreatitis
enzyme replacement therapy is recommended and can help control pain from stopping pancreatic stimulation.
if chronic pain persists then surgical intervention can help –whipple procedure has an 85% effectiveness for pain management
what causes spontaneous bacterial peritonitis
bacterial translocation
how is SBP defined
polymorphonuclear leukocyte concentration > 250
which bacteria cause SBP
E coli or klebsiella
what is the management of a hepatic adenoma
removing the OCPs and then reimage in 6 months-12 months for 2 years
when is surgical intervention indicated for hepatic adenoma
when they are greater than 5 cm in size
what is first line treatment for schatzki ring
mechanical dilation
what is the most likely cause of GI bleeding in an infant
meckels
what is the presentation of dumping syndomre
large amounts of carbohydrate rich foods causes fluid shifts and sympathetic activation due to the osmotic shift from the glucose. the person will experience flushing, palpitations diarrhea, need to lie down after eating
when do you drain a pancreatic pseudocyst
when they are greater than 6cm or symptomatic
which liver conditions have indirect hyperbilirubinemia
Gilberts and Criggler-Najjar
what are the conditions that lead to direct hyperbillirubinemia
Rotors and Dublin-johnson
what are the liver conditions that are asymptomatic and usually cause jaundice and scleral icterus sporadically; what are the differences between them
Gilbert’s and Rotors
Gilbert’s is indirect
Rotors is Direct.
Both are generally asymptomatic.
Gilbert’s usually causes bilirubinemia in after stress or fasting
do you give someone with esophageal varices antibiotics
yes. 7 days of ceftriaxoine is standard treatment
what is abdominal compartment syndrome
caused by tissue fluid build up due to prolonged surgery in which a lot of IVF or transfusions are undertaken. this causes compression of the vena cava and reduced blood return to the heart and JVD when the intraabdominal pressure extends into the thoracic cavity
Abdominal distention and a marked dilation of the colon and cecum on imaging indicate
acute megacolon.
when is appendicitis managed with conservative treatment
In patients with appendicitis who present after ≥ 5 days of symptoms, inflammation has usually led to a contained perforation (i.e., abscess) and immediate surgery is no longer indicated.
what is the course of action for a hypotensive trauma patient with an inconclusive FAST
diagnostic peritoneal lavage
what is the best indication for TIPS procedure
recurrent variceal hemorrhages
what is the presentation of a resolving hep B infection
no antigen but IgM core
still have transamnitis
what is the treatment for acute hep b infection
supportive therapy
what is the treatment for hep b chronic that is activated
interferon alpha or tenofovir
what is the treatment for acute hep c
pegylated Alpha interferon
what is the treatment of choice for anal cancer
The combination of chemotherapy and radiation is the treatment of choice for patients with anal squamous cell cancer; it has been shown to be superior to surgery, with a 5-year survival rate of ∼ 80%.
what can prevent pyloric stenosis
breast feeding only has a lower incidence of pyloric stenosis than infants that also bottle fed.
what is there treatment of choice for enterocutaneous fistulas
TPN and ostomy pouch
they typically close on their own within 5-6 weeks
what is the treatment for olgilvie syndrome
neostigmine
what is the first step in treating postoperative ileus
reducing opioid use
can you advance diet with postoperative ileus
no. this would further compress the obstructed bowel
what is the treatment for congenital umbilical hernias
observation. most resolve spontaneous;ly
what is the treatment of choice for sigmoid volvulus
endoscopic detorsion
what is the treatment for duodenal hematomas
nasogastric decompression and TPN for bowel rest
what is necessary in people with ascites when planning surgery
paracentesis. this will be therapeutic for the patient and reduce complications as ascites increase abdominal pressure and causes a higher likelihood of would dehiscence
what are patients with pernicious anemia at risk for
gastric carcinoma. 90% have chronic atrophic gastritis
what is the main mode of transmission for Yersinia enterolitica
undercooked pork
what is the presentation of primary biliary cholangitis
a middle-aged woman, features of cholestatic jaundice (conjugated hyperbilirubinemia, ↑ ALP, unexplained itching), fatigue, hepatomegaly, and hepatocellular damage (↑ ALT, AST), along with symptoms of sicca syndrome (e.g., dry eyes, dry mouth) are highly suggestive of primary biliary cholangitis (PBC).
what is the presentation of MEN1
90% will have hypercalcemia, Zollinger-Ellison syndrome
what is the most significant environmental risk for pancreatic cancer
smoking
what are the mamometry findings for diffuse esophageal spasms
multipeak contractions
what is the definition of severe UC
, which is defined as ≥ 6 episodes of bloody diarrhea per day, severe abdominal cramps, systemic signs of toxicity (fever, tachycardia), and anemia or ESR ≥ 30 mm/hour.
what is the treatment of choice for severe UC
sulfasalazine suppositories and oral prednisone
what is the cause of Zener diverticulum
a pulsion-pseudodiverticulum and is caused by an inadequate relaxation of the upper esophageal sphincter (UES) leading to increased intraluminal pressure that results in outpouching of the pharyngeal wall. The condition usually forms in the hypopharynx within Killian triangle, an area of weakness in the posterior pharyngeal wall.
the test of choice for evaluating oropharyngeal dysphagia.
A videofluoroscopic modified barium swallow
what is hepatorenal syndrome
as the liver is dying, it secretes vasoactive compounds that reduce kidney perfusion. This causes increased RAAS, which then increases perfusion pressures but leads to further accumulation of ascites.
what is black liver
Dubin Johnson
what is the treatment for dubin-Johnson
None. usually no clinical findings
what is hypersensitivity to gliadin
celiac disease
what is a positive D-xylose test indicate
low levels indicate insufficient absorption. this could be due to damaged mucosa or bacterial overgrowth. testing after antibiotic treatment will resolve the difference
peutz-jeghers syndrome is associated with what
ovarian, breast, pancreatic cancer
40% chance of colorectal cancer
what is Gardner syndrome
The constellation of extracolonic manifestations of familial adenomatous polyposis (FAP), which includes hypertrophy of the retinal pigment epithelium, adrenal adenomas, osteomas, desmoid tumors, and cutaneous lesions.
what happens when you drink and take metronidazole
DONT DRINK ON THE METRO. disulfiram reaction
what follow up is required after treating H pyolri
urea breath test 4 weeks
what is the most common cause of acute pancreatitis is
biliary pancreatitis from a stone
what is a GI SE of amiodarone
transaminitis —it should be discontinued
how do we scan for heptocellular carcinoma in patients with cirrhosis
ultrasound every 6 months
what are the drugs of choice for primary prophylaxis against variceal bleeding
nadolol and propanolol
what is the treatment for gastroparesis
metoclopramide
where does squamous cell carcinoma of the esophagus usually occur and what causes it
upper 2/3 of the esophagus and its associated with smoking and drinking
where is adenoma carcinoma of the esophagus usually located and what is it associated with
lower or distal esophagus and GERD
