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AGM 3 > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

effect of aging on hepatic and biliary perfusion

A

decreased by 30-40%

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2
Q

effect of aging on caffeine clearance

A

decreased

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3
Q

effect of aging on bile flow

A

decreased by 50%

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4
Q

effect of aging on hepatic function

A

hepatic function remains intact

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5
Q

effect of aging on liver regeneration capacity

A

reduced

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6
Q

effect of aging on antiviral therapy for hepatitis

A

elderly may not respond

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7
Q

effect of aging on risk of colelithiasis

A

elevated risk

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8
Q

why elevated risk of cholelithiasis in elderly

A

increased cholesterol synthesis with decreased bile acid secretion

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9
Q

why is gallbladder function impaired with age

A

impaired contractility, increased volume, decreased CCK receptors

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10
Q

“classic” signs of cholelithiasis that are absent in 50% of cases in elderly

A

fever, N/V

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11
Q

why are women more prone to cholelithiasis

A

estrogen’s effects on cholesterol synthesis

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12
Q

effects of aging on exocrine pancreas

A

pancreatic juice steadily decreases after the age of 50, limited ability to increase lipase and amylase, but there is adequate reserve to maintain normal digestive capacity. Increased production of autoimmune antibodies

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13
Q

what % of cases of pancreatitis are due to alcohol abuse

A

70%

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14
Q

when does alcoholic pancreatitis classically present

A

middle age

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15
Q

what etiology of pancreatitis increases in older people

A

gallstones

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16
Q

what to watch out for if underling pancreatitis is not due to ETOH or gallstones

A

adenocarcinoma

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17
Q

acute pancreatitis labs

A

amylase/lipase 3x upper limit

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18
Q

acute pancreatitis tx

A

bowel rest, IV fluids, pain control, ERCP if gallstones, IV abx if necrosis on CT scan, gastric decompression

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19
Q

when to use abx for acute pancreatitis

A

if necrosis on CT scan

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20
Q

how long does lipase remain elevated

A

5-7 days

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21
Q

which elevates first, amylase or lipase

A

amylase

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22
Q

when does amylase return to normal

A

48 hours

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23
Q

when does lipase elevate

A

24-48 hours

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24
Q

when does oral intake resume in acute pancreatitis

A

when pain free

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25
Q

what pain med to use in acute pancreatitis

A

meperidine

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26
Q

chronic pancreatitis usual etiology

A

alcoholism

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27
Q

most common location/type for pancreatic cancer

A

70% is adenocarcinoma of pancreas

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28
Q

what % of NASH progresses to cirrhosis and what % dies

A

4%, 2%

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29
Q

NASH ssx

A

asymptomatic or vague RUQ discomfort

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30
Q

risk factors for NAFLD/NASH

A

BMI>40, male, DM, metabolic syndrome, “hispanic”

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31
Q

what drugs can precipitate NAFLD

A

tamoxifen, methotrexate, amiodarone, prednisone

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32
Q

first step and gold standard for NAFLD diagnosis

A

abdominal US, biopsy

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33
Q

what intervention can lower ALT/AST and insulin level in NAFLD

A

10% weight loss

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34
Q

risk factors for HCC

A

hepatitis (of any cause), cirrhosis, hemochromatosis, alpha-1 antitrypsin, Wilson’s, NAFLD

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35
Q

screening for HCC

A

AFP followed by US

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36
Q

ssx of HCC

A

jaundice, anorexia, fatigue, weight loss, upper abdominal pain, ascites, LFT changes

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37
Q

what imaging to obtain after HCC diagnosis

A

chest x-ray to look for mets

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38
Q

gallbladder cancer is usually what kind

A

adenocarcinoma

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39
Q

CEA/CA 19-9 in gallbladder cancer

A

not specific

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40
Q

cholangiocarcinoma is usually what kind

A

adenocarcinoma (90%)

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41
Q

what % of acute cholelithiasis are geriatric

A

50-70%

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42
Q

test of choice for cholelithiasis/cholecystitis

A

US/HIDA

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43
Q

benefit of ERCP in cholelithiasis/cholecystitis

A

can be diagnostic and therapeutic

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44
Q

tx of choice for cholelithiasis/cholecystitis

A

laparoscopic removal

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45
Q

pancreatic exocrine deficiency in elderly

A

rare without underlying pathology

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46
Q

bicarbonate in the elderly

A

decreases steadily after 4th decade

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47
Q

what scale is used to assess severity of acute pancreatitis

A

Ranson criteria

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48
Q

amylase/lipase in chronic pancreatitis

A

mildly elevated

49
Q

imaging findings in chronic pancreatitis

A

calcifications

50
Q

what may be needed to make diagnosis of chronic pancreatitis

A

ERCP, MRCP, EUS

51
Q

chronic pancreatitis treatment

A

pancreatic enzyme replacement

52
Q

what % of pancreatic cancer pts are >55

A

87%

53
Q

5-year survival of pancreatic cancer

A

5%

54
Q

effect of aging on liver volume

A

40% decrease

55
Q

effect of aging on coags/LFTs

A

unaffected

56
Q

NAFLD pathophys

A

insulin resistance enhances triglyceride lipolysis and increases serum free fatty acids which are taken up by the liver

57
Q

conditions associated with NAFLD

A

hyperlipidemia, insulin resistance/DM, metabolic syndrome, hep C, rapid weight loss, TPN, Wilson’s disease, diverticulosis, PCOS, OSA

58
Q

risk factors for NAFLD

A

insulin resistance, metabolic syndrome, jejunoileal bypass, age, genetics, some drugs

59
Q

HCC screening for patients at risk

A

AFP (alpha-fetoprotein) and US q 6-12 months

60
Q

what to do if screening AFPs are rising

A

order imaging to see if there is a mass

61
Q

what to do if no mass is confirmed after AFP is elevated

A

follow up q 3 months with AFP, liver imaging

62
Q

which ethnic group has lowest incidence of NAFLD

A

African Americans

63
Q

Claire is 69 and has had non-alcoholic fatty liver for about five years. Recently, she was diagnosed with atherosclerosis in her coronary arteries. The most likely mechanism that links these two disorders is

A

endothelial dysfunction

64
Q

aging effect on gastric acid

A

decreased due to fewer cells and use of acid suppressing meds

65
Q

implications of decreased gastric acid in elderly

A

decreased B12, iron, folic acid, altered gut flora leading to diminished immune response

66
Q

effect of aging on GI motility and why

A

decreased, loss of neurons and atrophy of muscle layer

67
Q

implications of decreased GI motility in elderly

A

atrophy of muscle layer leads to diverticula

68
Q

effect of aging on splanchnic bloodflow and implications

A

reduced, results in decreased nutrient absorption

69
Q

implications of SIBO in elderly

A

bacteria take up nutrients, bacterial proliferation damages epithelium brush border leading to malabsorption

70
Q

causes of SIBO in elderly

A

impaired motility, abx disrupting balance, undigested carbs feed bacteria

71
Q

SIBO diagnosis

A

breath tests or biopsy

72
Q

abx associated colitis prognosis

A

usually mild and self-limited, resolves after discontinuation of abx

73
Q

cautions with vancomycin

A

ototoxic, nephrotoxic

74
Q

tx for mild/moderate c diff

A

metronidazole

75
Q

tx for severe c diff

A

vanc

76
Q

tx for very severe c diff

A

both metronidazole and vancomycin possible colectomy

77
Q

gold standard for c diff diagnosis

A

stool culture

78
Q

when will they test formed stool for c diff

A

only if you suspect ileus/obstruction

79
Q

considerations with metronidazole for c diff

A

don[t use it after the first occurrence or for long-term treatment due to neurotoxicity

80
Q

considerations for c diff testing

A

don’t test asymptomatic or test for cure

81
Q

how many have c diff relapse within 1-2 weeks after abx

A

20%

82
Q

infection control measures for c diff

A

decon with bleach, glove/gown upon entry to pt room

83
Q

treatment for diverticulitis

A

cipro plus metronidazole (or bactrim plus metronidazole) 10-14 days and clear liquid diet

84
Q

what to do if initial diverticulitis treatment doesn’t help

A

get imaging, must r/o malignancy

85
Q

when to get colonoscopy with diverticulitis

A

after resolution of attack, usually at least 6 weeks after discharge

86
Q

risk of colonoscopy during diverticulitis attack

A

converting sealed perforation into free perforation

87
Q

differences in how appendicitis may present in elderly

A

fewer have fever, may have diffuse pain, delayed left shift

88
Q

colon cancer screening after age 75

A

if no previous diagnosis of colon cancer, colonoscopy risk is greater that colon cancer risk

89
Q

reasons for increased polyp formation with age

A

NSAID use, calcium supplementation

90
Q

ulcerative colitis in the elderly

A

symptoms are similar as in younger people but milder

91
Q

which type of laxative does she think we should avoid

A

osmotic/magnesium

92
Q

which laxative does she think is safe for long term use

A

senna +/- stool softener

93
Q

how long does it generally take for diverticulitis ssx to resolve

A

48-72 hours

94
Q

diverticulitis complications

A

perforations, abscess

95
Q

which colon cancer annual test is recommended by USPTF

A

Cologuard instead of FOBT

96
Q

which IBD is more common in elderly

A

Crohns

97
Q

most prevalent neoplastic polyps

A

adenomatous

98
Q

risk of developing cancer in high-grade adenomatous polyps

A

25%

99
Q

what makes adenomatous polyps more risky

A

quantity, large size (at least 1 cm)

100
Q

what triggers colon cancer screening q 3 years

A

large number of polyps, high-grade adenomatous, large size of polyps

101
Q

screening frequency for 1-2 tubular adenomas

A

q 5 years

102
Q

mainstays of treatment in IBD in elderly

A

sulfasalazine, mesalamine, corticosteroids

103
Q

when does colon cancer risk increase with IBD

A

after 8-10 years of the disease

104
Q

“most common complaint in elderly”

A

constipation

105
Q

what to assess in elderly pt complaining of constipation

A

DRE, assess pelvic floor/rectal prolapse in females

106
Q

constipation diagnostic criteria

A

2 or more: straining, hard stools, incomplete evacuation, feeling of anorectal obstruction, manual maneuvers in 25% or more of defecations. LEss than 3 bowel movements/week

107
Q

most common cause of constipation

A

dehydration, low fiber diet

108
Q

initial treatment of constipation

A

drink 2x current amount of water (up to half body weight in ounces), fiber supplementation, increase physical activity

109
Q

“safest laxative option”

A

senna-based

110
Q

diverticulosis tx

A

increase fiber, prevent constipation, decrease fat, avoid seeds

111
Q

“class” diverticulitis ssx commonly absent in elderly

A

fever, rebound tenderness

112
Q

treatment of mild diverticulitis can be

A

empiric

113
Q

moderate-severe diverticulitis needs

A

CT +/- hospitalization

114
Q

tx for recurrent c diff

A

vancomycin taper x 1 month

115
Q

indications for fecal transplant with c diff

A

recurrent c diff not responding to vancomycin taper, 2 or more c diff episodes causing hospitalization, refractory moderate c diff infection, severe c diff not responding to tx within 48 hours

116
Q

when to consider SIBO diagnosis

A

weight loss, diarrhea, abd pain, macrocytic anemia, protein malnutrition

117
Q

gold standard SIBO diagnosis

A

aspirate and culture of proximal jejunal secretion

118
Q

SIBO tx

A

1-2 week broad spectrum abx with low fodmap diet

AGM 3 (2 decks)

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