EH: Gastroenterology

Question 1

IBD Involves terminal ileum?

Answer 1

Crohn’s.

Mimics appendicitis.

Fe deficiency.

Question 2

IBD continuous involving the Rectum?

Answer 2

UC.

Rarely ileal backwash but never higher

Question 3

IBD Incr risk for Primary Sclerosing Cholangitis?

Answer 3

UC.

PSC leads to higher risk of cholangioCA

Question 4

IBD, Fistulae likely?

Answer 4

Crohn’s.

Give Metronidazole.

Question 5

IBD Granulomas on biopsy?

Answer 5

Crohn’s

Question 6

IBD, Transmural inflammation?

Answer 6

Crohn’s

Question 7

IBD Cured by colectomy?

Answer 7

UC

Question 8

IBD, Smokers have lower risk?

Answer 8

UC.

Smokers have higher risk for Crohn’s.

Question 9

IBD, Highest risk of colon cancer?

Answer 9

UC.

Another reason for colectomy

Question 10

IBD, Associated w/ p-ANCA?

Answer 10

UC

Question 11

IBD Treatment?

Answer 11

Treatment = 5-ASA, Sulfasalzine to maintain remission.

Corticosteroids to induce remission.

For CD, give Metranidazole for ANY ulcer or abscess.

Azathioprine, 6-MP and Methotrexate for severe dz.

Question 12

AST>ALT (2x) + high GGT ?

(gamma-glutamyltransferase)

Answer 12

Alcoholic Hepatitis

Question 13

ALT>AST & in the 1000s ?

Answer 13

Viral Hepatitis

Question 14

AST and ALT in the 1000s after Surgery or Hemorrhage?

Answer 14

Ischemic Hepatitis (“shock liver”)

Question 15

Elevated D-bili

Answer 15

Obstructive (stone/cancer)

or

Dubin’s Johnsons Syndrome

or

Rotor Syndrome

Question 16

Elevated I-bili ?

Answer 16

Hemolysis

or

Gilbert’s, Crigler Najjar

Question 17

Elevated alk phos and GGT ?

Answer 17

Bile duct obstruction, if IBD PSC

Primary Sclerosing Cholangitis

Question 18

Elevated alk phos, normal GGT, normal Ca ?

Answer 18

Paget’s disease (incr hat size, hearing loss, HA)

Tx w/ Bisphosphonates

Question 19

Antimitochondrial Ab ?

Answer 19

Primary Biliary Cirrhosis

Tx w/ bile resins

Question 20

ANA + antismooth muscle Ab ?

Answer 20

Autoimmune Hepatitis – tx w/ ‘roids

Question 21

High Fe, low ferritin,
low Fe binding capacity ?

Answer 21

Hemachromatosis

• hepatitis, DM, Golden skin

Question 22

Low ceruloplasmin, high urinary Cu ?

Answer 22

Wilson’s

• hepatitis, psychiatric sxs Basal Ganglia (BG), corneal deposits