Clinical Investigations Right Abdomen

Question 1

Labs for Hep A?

Answer 1

• WBC normal to low
• Mild proteinuria
• Bilirubinuria- preceeds jaundice
• Very elevated ALT/AST

Question 2

Complications of Hep A?

Answer 2

• Acute cholecystitis
• AKI
• Arthritis
• vasculitis
• Acute pancreatitis
• Aplastic anemia

Question 3

Tx for Hep a?

Answer 3

• Bed resst
• IV fluids if dehydrated due to N/V
• Avoid strenuous activites
• Avoid alcohol and hepatotoxic agents
• Steroids don’t help

Question 4

Hep B labs?

Answer 4

• WBC normal low
• Mild proteinuria
• Bilirubinuria
  
  • preecees jaundice
• Very elevated ALT/AST
  
  • higher than hep A
• Elevated prothrombin time assoc with higher mortality

Question 5

Complicatiosn of Hep B?

Answer 5

• 40% with chronic hep B develop cirrhosis
• Hepatitis D worsens prognosis

Question 6

Tx for Hep B?

Answer 6

• Bed rest
• IV fluids if dehydrated due to N/V
• Avoid strenuous activites
• Avoid alcohol and hepatotoxic agents
• Antivirals if liver failure or chronic reactivation
• Recover in 3-6 months

Question 7

Hepatitis C labs?

Answer 7

Enzyme immunoassay

Question 8

Hepatitis C complications?

Answer 8

• Membranoproliferative glomerulonephritis
• Lichen planus
• Autoimmune thyroiditis
• Lymphocytic sialaddenitis
• Idiopathic pulm fibrosis
• Sporadic porphyria cutanea tarda
• Monoclonal gammopathies
• inc. risk of NHL
• Inc. risk of end stage renal disease
• Hepatic steatosis

Question 9

Tx of Hep C?

Answer 9

6 weeks of :

• Ledipasivir
• Sofosbuvir

Question 10

Hep C prognosis?

Answer 10

• Acute dz becomes chronic 85% of the time
• 30% of chronic hep C leads to cirrhosis
• 3-5% of Hep C assoc cirrhosis leads to hepatocellular carcinoma

Question 11

With acute cholecystitis what labs are increased?

Answer 11

• WBC
• Serum bilirubin
• ALT
• Alkaline phosphatase
• Amlase elevated

Question 12

Tx of acute hcolecystitis?

Answer 12

• NPO
• IV’s
• Analgesics
• IV abx
• Cholecystectomy <24 hrs

Question 13

Choledocholithiasis labs and imagining?

Answer 13

• Bild duct >6mm on US
• Liver fxn tests ALT/AST >1000
• Bilirubinuria
• Secondary pancreatitis
• Elevated PT
• Lipasae 3x normal

Question 14

Tx of choledocholithiasis?

Answer 14

• Endoscopic retrograde cholangio pancreatography (ERCP)
  
  • endoscopic sphincterotomy to remove stones
• 72 hrs after ERCP perform laparascopic choelcystectomy

Question 15

Labs to order to rule in/out IBS?

Answer 15

• CBC shows anemia
• Fecal calprotectin (looks for IBS)
• Serologic testing for celiacs ( IgA)
• stool specimen if likeihood of parasites
• no routine sigmoid or colonoscopy

Question 16

DDx for IBS?

Answer 16

• Colonic neoplasia
• Bile acid diarrhea
• Hyper/hypothyroidism
• Parasites
• Malabsorption
• Carcinoid
• Gynecological issues
• Depression, panic do, anxiety

Question 17

Tx for IBS?

Answer 17

Reassurance education and support

• Avoid FODMAPs for 2-4 weeks
  
  • Fermentable Oligo Di Monosaccharides and Polyols
  • Fructose
  • Lactose
  • Fructans such as garlic onion asparagus and leeks
  • Wheat
  • Sorbitol-stone fruits
  • Raffinose- beans

Question 18

What are some medications for IBS?

Answer 18

1. Antispasmodics: anticholinergic
2. Antidiarrheal
3. Anti-Constipation: polyethylene glycol or lactulose/sorbitol but last two increase flatus
4. Psychotropic agents: low dose tricyclic antidepressants trial 4 weeks to see if it is worth it
5. Selective serotonin reuptake inhibitors
6. Non absorbable abx Rifaximin which decreases bacterial fermentation and bloating
7. Probiotics

Question 19

What other form of treatement, besides dietary and pharmacologic, is availabe for IBS patients?

Answer 19

• Cognitive behavioral therapy
• Relaxation
• Hypnotherapy

Question 20

What does the work up for appendicitis look like?

Answer 20

• CBC: woth left shift and mild leukocytosis
• Microscopic hematuria/pyruia in 25%
• Imaging
  
  • CT of abdomen/ pelvis with and w/o contrast
• US
  
  • used in pediactrics bc less radiation