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Step Up To Medicine > Diseases Of The Gastrointestinal System > Flashcards

Diseases Of The Gastrointestinal System Flashcards

1
Q

What are the 3 components required to diagnosed acute liver failure?

A
  1. Encephalopathy
  2. INR >1.5
  3. Elevated liver enzymes
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2
Q

What are the 2 major events that occur as a result of distortion of liver architecture in liver cirrhosis?

A
  1. Portal hypertension that leads to ascites, peripheral edema, splenomegaly, and varicosity of veins.
  2. Hepatocellular failure that leads to impairment of biochemical functions
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3
Q

What are the most common causes of cirrhosis?

A

Alcoholic liver disease and chronic hepatitis B and C

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4
Q

What are the classic signs of chronic liver disease?

A
  1. Ascites
  2. Varices
  3. Gynecomastia, testicular atrophy
  4. Palmar erythema, spider angiomas on skin
  5. Hemorrhoids
  6. Caput Medusa
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5
Q

What is the most life-threatening complication of portal HTN?

A

Bleeding secondary to esophageal varices

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6
Q

How are varices managed?

A
  1. Hemodynamic stabilization
  2. IV antibiotics (ceftriaxone)
  3. IV octreotide is initiated and continues for 3-5 days
  4. Emergent upper GI endoscopy once patient is stabilized for ligation or sclerotherapy
  5. Non-selective beta-blockers long-term to prevent rebleeding
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7
Q

What is the most common complication of cirrhosis?

A

Ascites

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8
Q

When is Paracentesis done in cases of ascites?

A

It is indicated in case of new onset ascites, worsening ascites, and suspected spontaneous bacterial peritonitis. Cell count, ascites albumin, gram stain, and culture are all examined.

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9
Q

What measurement is required to diagnosed portal HTN as the cause of ascites?

A

Serum ascites albumin gradient of >1.1 g/dL

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10
Q

How is ascites managed?

A

Low sodium diet, spironolactone and furosemide.

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11
Q

What is spontaneous bacterial peritonitis?

A

Infected ascitic fluid commonly caused by E.coli and presents with abdominal pain, fever, vomiting, rebound tenderness, and may lead to sepsis.

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12
Q

What screening test is offered to patients with cirrhosis?

A

Serum AFP and liver ultrasound every 6 months for HCC.

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13
Q

How are patients with cirrhosis followed up?

A
  1. All patients should vaccinate for hepatitis A and B
  2. Lab workout every 3-6 months which includes: CBC, LFT, albumin, PT, ammonia
  3. Serial US and AFP for HCC
  4. Upper endoscopy to assess for varices
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14
Q

What is the mode of inheritance of Wilson’s disease?

A

Autosomal recessive

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15
Q

What might happen to serum ceruloplasmin levels Wilson’s disease?

A

Decreases, but if found normal Wilson’s disease isn’t excluded.

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16
Q

How is Wilson’s disease managed?

A
  1. D-penicillamine (chelating agent)
  2. Zinc
  3. Liver transplant (last resort)
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17
Q

What is Budd-Chiari Syndrome?

A

Occlusion of hepatic venous outflow, which leads to hepatic congestion and subsequent microvascular ischemia

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18
Q

What are 3 major causes of jaundice?

A

Hemolysis
Liver disease
Biliary obstruction

19
Q

What clinical features of jaundice signals the diagnosis of conjugated hyperbilirubinemia?

A

Dark urine and pale stools

20
Q

What is the most sensitive liver enzyme indicating liver damage?

A

ALT

21
Q

What are the liver enzyme abnormalities in cholestasis?

A

Markedly elevated ALK-P and GGT

22
Q

What are the liver enzyme abnormalities in Hepatocellular necrosis or inflammation?

A

Markedly elevated ALT and AST

23
Q

What is primary sclerosing cholangitis?

A

A chronic idiopathic progressive disease of intrahepatic and/or extrahepatic bile ducts characterized by thickening of bile duct walls and narrowing of their lumens, leads to cirrhosis, portal hypertension, and liver failure. Strongly associated with UC. No curative treatment other than liver transplant

24
Q

How is PSC diagnosed?

A
  1. ERCP and PTC are diagnostic study of choice which shows bead-like stricturing and bead-like dilatations of intra and extrahepatic ducts
  2. Elevated ALP and GGT
25
Q

What is primary biliary cholangitis?

A

Chronic and progressive cholestatic liver disease (autoimmune) characterized by destruction of intrahepatic bile ducts with portal inflammation and scarring. No curative treatment other than liver transplant

26
Q

How is PBC diagnosed?

A
  1. Lab findings:
    • Cholestatic LFTs
    • Positive AMA
    • Elevated cholesterol, HDL
    • Elevated IgM
  2. Liver biopsy confirms the diagnosis
27
Q

What are the most common causes of acute pancreatitis?

A

Gallstones and alcohol abuse

28
Q

How is acute pancreatitis diagnosed?

A

Must fulfill 2 out of 3 criteria:
1. Classical clinical presentation of epigastric pain that radiates to the back
2. Lab findings: elevated lipase and amylase, LFT changes depend on underlying cause.
3. Imaging findings

29
Q

How is acute pancreatitis managed?

A
  1. Mild: NPO, IV fluids, pain control
  2. Severe: admit to ICU, early enteral nutrition in the first 72 hours, prophylactic antibiotics if >30% of pancreas is necrosed.
30
Q

What is the most common cause of upper GI bleeding?

A

Peptic ulcer disease

31
Q

What are the common causes of lower GI bleeding?

A
  1. If lower GI bleeding or positive occult blood test of stool occurs in a patient >40 years it is CRC until proven otherwise
  2. Diverticulosis is the most common source of GI bleeding in patients >60 and is usually painless
  3. Angiodysplasia is the second most common source in patients >60 years.
32
Q

What medications should be asked about in patients with GI bleeding?

A

If they took NSAIDs/aspirin, clopidogrel, or anticoagulants.

33
Q

What are the initial steps in any patient with GI bleeding?

A
  1. Vital signs
  2. Resuscitation is the first step: IV fluids and transfusion
  3. Perform rectal examination: hemoccult test
34
Q

What is achalasia?

A

An acquired motor disorder of esophageal smooth muscle in which the lower esophageal sphincter fails to completely relax with swallowing, and abnormal peristalsis of esophageal body replaces normal peristalsis.

35
Q

How is achalasia diagnosed?

A
  1. Barium swallow showing bird’s beak sign
  2. Upper GI endoscopy
  3. Manometry: confirms the diagnosis
36
Q

What is celiac sprue?

A

An autoimmune disease that cause damage to the small intestine mucosa, characterized by hypersensitivity to gluten. Present with diarrhea, weight loss, abdominal distention, bloating, weakness and fatigue. Dermatitis herpetiformis might be seen in some cases.

37
Q

How is celiac sprue diagnosed?

A
  1. IgA anti-tissue transglutaminase abx
  2. If biopsy was taken it will show flattening of villi
38
Q

What is Inflammatory Bowel Disease?

A

An idiopathic chronic systemic inflammatory condition associated with autoimmune, environmental and genetic factors whose effects mainly fall on the GI tract.

39
Q

What is Crohn’s disease?

A

A chronic transmural inflammatory disease that can affect any part of the GI tract (mouth to anus) but most commonly involves the ileocecum. Presents with chronic diarrhea that is not bloody and extra-GI presentation.

40
Q

What are the pathological features of Crohn’s disease?

A
  1. Skip lesions
  2. Fistulae
  3. Luminal strictures
  4. Noncaseating granulomas
  5. Transmural thickening and inflammation
  6. Mesenteric fat creeping onto the antimesenteric border of small bowel
41
Q

What is ulcerative colitis?

A

Chronic inflammatory disease of the colon or rectal mucosa. Involves the rectum in all cases and can involve the colon partially or entirely, but always continuous no skip lesions and only involves mucosa and submucosa. Commonly presents with bloody diarrhea.

42
Q

How is IBD diagnosed?

A

Colonoscopy with biopsy

43
Q

What is the treatment plan for CD?

A
  1. Medical:
    • Corticosteroids: initial therapy for low-risk patient, taper when clinically improved
    • Budesonide: used in low-risk patients, taper when clinically improved
    • Biologic agent (TNF inhibitor): used in patients with moderate to severe disease, either monotherapy, in combination with thiopurine or methotrexate
  2. Surgical: reserved for complications
  3. Nutritional supplementation and support
44
Q

What is the treatment plan for UC?

A
  1. Medical:
    • Sulfasalazine: mainstay of treatment, topical application as a suppository
    • Oral glucocorticoids: if failure to respond to above treatment or used in conjunction with it
    • TNF inhibitors and thiopurine: used if failure to respond to steroids or severe disease
  2. Surgical:
    • Often done if medical therapy fails or if there are complications
    • Often curative

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