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00000 IM PLATINUM BOARD CORRELATES > GASTRO > Flashcards

GASTRO Flashcards

1
Q

cells in the stomach that secretes :
* mucus vs
* HCl vs
* intrinsic factor vs
* pepsinogen vs
* serotonin vs
* histamine

A
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2
Q

Cells that store vitamin A in the liver

A

Ito cells

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2
Q

Pacemaker cells of the GI tract (generate slow waves)

A

Interstitial cells ofCajal

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3
Q

part of the GI tract where the digestion of the following BEGINS
* carbohydrates
* fats
* proteins

A
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4
Q

part of GI tract where the ff are absorbed:
* iron vs
* intrinsic factor vs
* bile salts

A
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5
Q

part of GI tract where the ff are absorbed:
* vitamin C
* Vitamin B12
* Vitamin ADEK

A
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6
Q

part of GI tract where the ff are absorbed:
* carbohydrates
* proteins
* fats

A
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7
Q

Rule of 2s in Meckel’s Diverticulum
(six 2s eme )

A
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8
Q

Diagnostic Criteria for Irritable Bowel Syndrome (IBS) Rome IV

A
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8
Q

Charcot’s Triad for Ascending Cholangitis

A

FPJ
* fever
* RUQ pain
* jaundice

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9
Q

Reynolds’ Pentad

A

Charcot’s Cholangitis Triad + Shock and Altered mental status

Charcot’s Cholangitis Triad
* fever
* RUQ pain
* jaundice

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10
Q

Triad of Hepatopulmonary Syndrome

A
  • Liver Disease
  • Hypoxemia
  • Pulmonary Arteriovenous Shunting
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11
Q

Clinical manifestation suggestive of hepatopulmonary syndrome

A

Platypnea - shortness of breath that occur paradoxically upon the assumption of an upright position

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12
Q

Triad of Acute Cholecystitis

A
  • Sudden RUQ tenderness
  • Fever
  • Leukocytosis

vs. Charcot’s Cholangitis Triad
* fever
* RUQ pain
* jaundice

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13
Q

Triad of Choledochal Cyst

A
  • abdominal pain
  • jaundice
  • abdominal mass
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13
Q

Triad of Hemobilia

A
  • Biliary Pain
  • Obstructive Jaundice
  • Melena
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14
Q

Diagnosis of Acute Pancreatitis (Requires at least 2 of the 3)

A
  • Typical abdominal pain in the epigastrium that may radiate to the back
  • 3x or greater elevation in serum amylase and/or lipase levels
  • Confirmatory findings on cross-sectional abdominal imaging
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15
Q

Typical symptoms of GERD (2)

A

Heartburn and regurgitation

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16
Q

Most sensitive test for diagnosis of GERD

A

24-hour ambulatory pH monitoring

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17
Q

Endoscopic hallmark ofGERD

A

Erosive esophagitis at the esophagogastric junction

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18
Q

Perception of a lump or fullness in the throat that is felt irrespective of swallowing

A

Globus sensation, also known as globus pharyngeus

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19
Q

Characteristic symptom of Infectious Esophagitis

A

Odynophagia

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20
Q

Common cause of Steakhouse Syndrome

A

Schatzki ring in the lower esophagus (meat usually instigates intermittent food impaction)

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21
Q

Radiographic sign in achalasia

A

Bird’s beak appearance

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22
Q

Seen radiographically in diffuse esophageal spasm (DES) or spastic achalasia

A

Corkscrew or rosary bead esophagus

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23
Q

Detects impaired LES relaxation and absent peristalsis in achalasia

A

Esophageal Manometry

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24
Q

Test for evaluation of the proximal GIT

A

Endoscopy/esophagogastroduodenoscopy (EGD)

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25
Q

Cobblestone appearance of esophagus is seen in what disease

A

Crohn’s disease (on endoscopy or barium radiography)

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26
Q

Most severe histologic consequence of GERD

A

Barrett’s metaplasia with the associated risk of esophageal adenocarcinoma

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27
Q

What type of esophageal cancer has the ff characteristics:
* Proximal esophagus affected,
* associated with smoking alcohol consumption, caustic injury, and human papilloma virus infection

SCCA or AdenoCA

A

SCCA

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28
Q

What type of esophageal cancer has the ff characteristics:
* Distal esophagus affected,
* associated with GERD & Barrett’s Esophagus (metaplasia from squamous to columnar epithelium)

SCCA or AdenoCA

A

AdenoCA

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29
Q

Most common cause of UGIB

A

Peptic ulcers

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30
Q

Most common cause of LGIB overall

A

Hemorrhoids

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30
Q

Most common cause of LGIB in adults if hemorrhoids and anal fissures are excluded

A

Diverticulosis

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31
Q

What is Heyde’s syndrome

A

Bleeding vascular ectasias and aortic stenosis

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31
Q

What is Boerhaave Syndrome

A

Full-thickness esophageal tear (rupture)

vs mallory-weiss tear na partial-thickness lang

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32
Q

Most important cause of gastric and duodenal erosions

A

NSAID

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32
Q

Classic history of Mallory-Weiss Tear

A

Vomiting, retching, coughing preceding hematemesis in an alcoholic patient

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33
Q

Best way to initially assess a patient with GIB

A

Heart rate and BP

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34
Q

Should be performed within 24 h in most patients with UGIB

A

Upper endoscopy

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35
Q

Procedure of choice in LGIB

A

Colonoscopy after an oral lavage solution

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36
Q

Initial test for patients with massive bleeding suspected to be from the small intestine

A

Angiography

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37
Q

Key enzyme in rate-limiting step of prostaglandin synthesis

A

Cyclooxygenase (COX)

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38
Q

Most common causes of gastric/duodenal ulcers (GU/DU)

A

Helicobacter pylori and NSAIDs

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39
Q

Mechanism of survival of H. pylori in the Upper GI tract

A

Urease production

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39
Q

Most common location of Duodenal ulcers

A

first portion of the duodenum, with ~90% located within 3 cm of the pylorus

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40
Q

Most discriminating symptom of DUs

A

Pain that awakens the patient from sleep (between midnight and 3 AM)

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41
Q

Typical pain pattern in Duodenal ulcer

A

Occurs 90 min to 3 h after a meal and is frequently relieved by antacids or food.

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42
Q

Most frequent finding in patients with GU or DU

A

Epigastric tenderness

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43
Q

Test of choice for documenting eradication of H. pylori (2)

A
  • Monoclonal stool antigen test or
  • Urea breath test (UBT)
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44
Q

Invasive tests for H. pylori

A
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44
Q

Most sensitive and specific approach for examining the upper GI tract

A

Endoscopy

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45
Q

Noninvasive test for H. pylori that is not useful for early follow-up

A
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45
Q

Most potent acid inhibitory agents

A

Proton Pump Inhibitors (PPls)

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46
Q

Most common toxicity with sucralfate vs prostaglandin analogues for PUD

A

Constipation

vs

Diarrhea

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47
Q

Most common toxicity with

A

Diarrhea

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48
Q

Differentiate Refractory Peptic Ulcers (GU vs DU) in terms of weeks

A

GU: failure to heal after 12 weeks of therapy

DU: failure to heal after 8 weeks of therapy

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49
Q

Most common cause of treatment failure in
PUD in compliant patients

A

Antibiotic-resistant H. pylori strains

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50
Q

Most commonly performed operations for DUs (3)

A
  • Vagotomy and drainage
  • Highly selective vagotomy
  • Vagotomy with antrectomy
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51
Q

Which operation for DU has high ulcer recurrence rate, but lowest complication rate?
* Vagotomy and drainage
* Highly selective vagotomy
* Vagotomy with antrectom

A

Highly Selective Vagotomy

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52
Q

Which operation for DU has lowest ulcer recurrence rate, but highest complication rate?
* Vagotomy and drainage
* Highly selective vagotomy
* Vagotomy with antrectomy

A

Vagotomy with antrectomy

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53
Q

Surgery of choice for an Antral Ulcer

A

Antrectomy (including the ulcer) with a Billroth 1 anastomosis

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54
Q

Cornerstone of therapy for Dumping Syndrome (DS)

A

Dietary modification

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55
Q

Severe peptic ulcer diathesis secondary to gastric acid hypersecretion due to unregulated gastrin release from gastrinomas

A

Zollinger-Ellison Syndrome (ZES)

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56
Q

Most common clinical manifestations ofGastrinoma

A

Peptic ulcer, followed by diarrhea

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57
Q

First step in the evaluation of Gastrinoma

A

Obtain a fasting gastrin level

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58
Q

Most sensitive/specific Gastrin Provocative Test

A

Secretin study

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59
Q

Treatment of choice for Gastrinoma

A

PPI

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60
Q

Most common presentation of Stress-Related Mucosal Injury (SRM)

A

GI bleeding

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61
Q

Treatment of choice for Stress Prophylaxis

A

PPis (preferably oral if tolerated)

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62
Q

Important predisposing factor for Gastric Cancer

A

Intestinal metaplasia

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62
Q

Most common causes of Acute Gastritis

A

Infectious

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63
Q

which type of gastritis is associated wtih anti parietal cell antibodies

Type A or Type B

A
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64
Q

which type of gastritis is associated with H. pylori

Type A or Type B

A
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65
Q

which type of gastritis is more common

Type A or Type B

A
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65
Q

which type of gastritis is antral-predominant

Type A or Type B

A
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66
Q

which type of gastritis Involves primarily the fundus and body, with antral sparing

Type A or Type B

A
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67
Q

What GI disease:
large tortuous gastric mucosal folds (not a form of gastritis)

A
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68
Q

Mucosal disease that usually involves the rectum & extends proximally to involve all or part of the colon

UC or CD

A
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69
Q

Can affect any part of the GIT from mouth to anus, but rectum is often spared

UC or CD?

A
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70
Q

Transverse or right colon with diameter of >6 cm and loss ofhaustrations in severe attacks of UC

A

toxic megacolon

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71
Q

pANCA Positivity (Perinuclear Anti-neutrophil Cytoplasmic Antibodies)

which is more predisposed.. UC or CD?

A

UC&raquo_space; CD

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72
Q

ASCA Positivity (Anti-Saccharomyces cerevisiae Antibodies

which is more predisposed.. UC or CD?

A

CD&raquo_space; UC

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73
Q

2 markers of Intestinal Inflammation

Used frequently to rule out active inflammation versus symptoms of irritable bowel or bacterial overgrowth.

A

Fecal lactoferrin and calprotectin (leukocyte-derived proteins)

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74
Q

Earliest macroscopic findings of colonic CD

vs

Pathognomonic feature of CD

A

apthoid ulcers

vs

noncaseating granuloma

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75
Q

Most common site of inflammation in CD

A

terminal ileum

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76
Q

Most common ocular complications of IBD

A

Conjunctivitis, anterior uveitis/iritis, and episcleritis

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76
Q

Most dangerous local complication of UC

A

Perforation

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77
Q

Most common genitourinary complications of IBD

A

Calculi, ureteral obstruction, and fistulas

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78
Q

Most frequent late complication of IPAA ( ileal pouch–anal anastomosis)

A

Pouchitis

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79
Q
  • major sx: diarrhea, rectal bleeding, tenesmus, passage of mucus
  • signs: tendenr anal canal, blood on rectal exam, and tenderness to palpation directly over the colon with more extensive disease

UC or CD?

A

UC

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80
Q
  • gross bleeding not as common as to the other IBD
  • significant perineal or perianal disease occur more frequently

UC or CD?

A

CD

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81
Q

continuous, symmetric, and diffuse involvement of colon only

UC or CD?

A

UC

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81
Q

rectum is typically involved

UC or CD?

A

UC

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82
Q

with rectal sparing

UC or CD?

A

CD

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82
Q

most common site of inflammation in CD is what part of GIT

A

terminal ileum

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83
Q

appendectomy is protective

UC vs CD

A

UC

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83
Q

smoking is protective vs risk factor

UC vs CD

A

UC: protective

CD: risk factor ang smoking

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84
Q

NSAIDS may exacerbate disease activity.

UC vs CD

A

CD

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84
Q

pANCA vs ASCA

vs

ASCA vs pANCA

A

UC: pANCA vs ASCA

CD: ASCA vs pANCA

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85
Q

earliest radiologic finding in UC vs CD

A
  • UC: fine mucosal granularity
  • CD: thickened folds and aphtous ulcerations
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86
Q

What is string sign? and on what IBD is it observed?

A

String sign: narrowed intestinal lumen on radiographic tests due to edema, bowel wall thickening and bowel wall fibrosis

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87
Q

UC or CD?

A

UC

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88
Q

UC or CD?

A

CD

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89
Q

Defining lesion in histopathology of UC

A

abscesses and ulcers

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89
Q

granuloma formation is more common in UC or CD?

A

CD

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90
Q

differentiate UC vs CD in terms of depth of inflammation

A
  • UC: mucosal
  • CD: mucosal, submucosal, transmural
91
Q

differentiate UC vs CD in terms of management of mild to moderate disease

A
92
Q

differentiate UC vs CD in terms of management of moderate to severe disease

A
92
Q

differentiate UC vs CD in terms of antibiotics needed

A
93
Q

Prerequisite clinical feature of IBS

A

Abdominal pain

94
Q

Most consistent clinical feature in IBS

A
  • Altered bowel habits (most common pattern is constipation alternating with diarrhea)
95
Q

Initial therapy of choice for IBS-D (Diarrhea Predominant)

A

Peripherally acting opiate-based agents

95
Q

Best management for postprandial pain

A

Antispasmodics 30 minutes before meal

96
Q

Most common site of diverticular disease

A

sigmoid

96
Q

Only antibiotic for IBS with sustained benefit beyond therapy cessation

A

Rifaximin

97
Q

Most common cause of hematochezia in oatients >60 years

A

Hemorrhage from a colonic diverticulum

97
Q

Staging system for predicting outcomes after surgery for perforated diverticulitis

A

Hinchey Classification System

98
Q

Safety window for colonoscopy for px who have diverticular disease

A

6 weeks after an attack of diverticular disease (should not be performed in acute setting due to higher risk of perforation)

98
Q

Best management for massive Diverticular Bleeding in a stable patient

vs

asymptomatic Diverticular Disease

A

Angiography± coiling (if patient unstable or has had a 6-unit bleed within 24 hours, emergent surgery should be performed)

vs

Lifestyle changes

99
Q

init

A
100
Q

Mainstay of Therapy for Rectal Prolapse

A

Surgical correction

101
Q

3 Hemorrhoidal Complexes in the Anal Canal

A
  • left lateral
  • right anterior
  • right posterior
102
Q

Most common presentation of Hemorrhoids

A

Bleeding and protrusion

103
Q

Most common location of Anorectal Abscess

A

Perianal, followed by ischiorecta

104
Q

Most common location of Anal Fissures

A

Posterior position, followed by anterior (lateral fissure is worrisome, and systemic disorders should be ruled out)

105
Q

Most common location of Internal Opening of Fistula In Ano (FIA)

A

Dentate line

106
Q

Most common type of Fistula In Ano (FIA)

A

lntersphincteric, followed by transsphincteric

107
Q

Best Management for Newly Diagnosed FIA

A

Seton (vessel loop or silk tie placed through the tract)

108
Q

Goodsall’s Rule for FIA

A
109
Q

Most prevalent gastrointestinal disease complicating cardiovascular surgery

A

Nonocclusive mesenteric ischemia

109
Q

The most significant indicator of survival in intestinal ischemia patients

A

Timeliness of diagnosis and treatment

110
Q

Clinical presentation of patients with acute mesenteric ischemia resulting from arterial embolus or thrombosis

A

Severe acute, nonremitting abdominal pain strikingly out of proportion to the physical findings

111
Q

Most common locations for colonic lschemia

A
  • Griffith’s point: splenic flexure
  • Sudeck’s point: descending/sigmoid colon
112
Q

Gold standard for diagnosis of Acute Arterial Occlusive Disease

A

Angiography

113
Q

Management of Acute Arterial Occlusive Disease

A

laparotomy

114
Q

Intervention of choice to maintain hemodynamics in Nonocclusive/Vasospastic Mesenteric lschemia

A

Fluid resuscitation

115
Q

Optimal treatment for lschemic Colitis

A

Resection of ischemic bowel & formation of a proximal stoma Primary anastomosis should not be performed oatients with acute intestinal ischemia

116
Q

Best prognosis of all Acute Intestinal lschemic Disorders

A

Mesenteric venous insufficiency

117
Q

Most commonly identified form of functional bowel obstruction

A

Ileus that occurs after intraabdominal surgery

118
Q

Responsible for the majority of cases of early postoperative obstruction that require intervention

A

Adhesions

119
Q

Most common cause of Colonic Obstruction

A

Colon cancer

120
Q

Most common precursor for strangulation

A

Closed-loop obstruction

121
Q

Cardinal signs of acute intestinal obstruction

A

Colicky abdominal pain, abdominal distention, emesis, and obstipation

122
Q

Classical findings seen in patients with small-bowel obstruction on abdominal radiography (which must include upright or cross-table lateral views)

A

A “staircasing’’ pattern of dilated air and fluid-filled small-bowel loops >2.5 cm in diameter with little or no air seen in the colon

123
Q

Most common site of intestinal obstruction in patients with gallstone ileus

A

Ileum

Enters the intestinal tract most often via a cholecvstoduodenal fistula

124
Q

Cecal diameter that increases likelihood of perforation

A

> 10-12 cm

125
Q

Most common emergency general surgical disease affectine the abdomen

A

Appendicitis

126
Q

Sequence of symptoms in acute appendicitis that helps distinguish it from gastroenteritis

A

Nausea followed the development of abdominal pain

In gastroenteritis, nausea occurs first

127
Q

Symptom so common that the diagnosis of appendicitis should be questioned in its absence

A

Anorexia

128
Q

Suggestive CT imaging findings in appendicitis (3)

A
129
Q

Most common extrauterine condition requiring abdominal operation during pregnancy

A

Appendicitis

130
Q

Best diagnostic exam for acute appendicitis during pregnancy

A

Ultrasound

131
Q

Cardinal manifestations of Peritonitis

A

Acute abdominal pain and tenderness usually with fever

132
Q

Criterion standard in evaluation of liver disease and most accurate means of assessing grade and stage

A

Liver biopsy

133
Q

Prognostication for cirrhosis and provides standard criteria for listing for liver transplantation (Class B & C); utilizes serum bilirubin, serum albumin, PT-INR and severity of ascites and hepatic encephalopathy

A

Child-Pugh Score

134
Q

More objective means of assessing liver disease severity; utilizes serum bilirubin, serum creatinine, and PT-INR

A

Model for End-Stage Liver Disease (MELD}Score

135
Q

Occurrence of signs or symptoms of hepatic encephalopathy in a person with severe acute or chronic liver disease

A

Hepatic Failure

136
Q

Most common and most characteristic symptom of liver disease

A

Fatigue

137
Q

Hallmark of liver disease and most reliable marker of severity

A

Jaundice

138
Q

Best physical exam maneuver to appreciate ascites

A

Shifting dullness on percussion

139
Q

Major criterion for diagnosis of Fulminant Hepatitis

A

Hepatic encephalopathy during acute hepatitis (indicates poor prognosis)

140
Q

screening test for hepatopulmonary syndrome

A

Oxygen saturation by pulse oximetry

141
Q

Exclusive site for synthesis of serum albumin

A

hepatocytes

141
Q

Only clotting factor not produced in the liver

A

Factor VIII

142
Q

Most helpful in recognizing Acute Hepatocellular Diseases

A

Elevated arninotransferases/transaminases

142
Q

Single best acute measure of hepatic synthetic function

A

Protime (PT)

(PT prolongation >5 secs not corrected by parenteral vitamin K administration is a poor prognostic sign in acute viral hepatitis)

143
Q

Differentials for striking elevations in aminotransferases (>1000 U/L)

(4)

A
  • Viral hepatitis
  • Ischemic liver injury
  • Toxin- or drug-induced liver injury
  • Acute phase of biliary obstruction passage or gallstone into CBD
144
Q

which is more elevated in alcoholic liver disease…

AST or ALT

A

AST > ALT

145
Q

which is more elevated in viral hepatitis

AST or ALT

A

ALT

146
Q

Key events in hepatic fibrogenesis

A

Stellate cell activation and collagen production

147
Q

First diagnostic test to use in patients whose liver tests suggest cholestasis

A

Ultrasonography to look for the presence or a dilated intrahepatic or extrahepatic biliary tree or to identify gallstones

148
Q

First test for suspected Budd Chiari Syndrome (Hepatic Vein Thrombosis)

A

Ultrasound with Doppler imaging

149
Q

Budd-Chiari Syndrome (BCS) vs. Cardiac Cirrhosis

A

Extravasation or RBCs in Budd-Chiari Syndrome

(but not in cardiac cirrhosis)

150
Q

Kayser-Fleischer rings (golden-brown copper pigment deposited in the periphery of the cornea) is seen in what disease

A

Wilson’s disease

151
Q

Genetic testing for HFE gene mutations should ideally be done in what disease

A

Hemochromatosis

152
Q

in portal hypertension, there is elevation of hepatic venous pressure gradient (HVPG) to >5 mm Hg

A

HPVG > 5mm Hg

153
Q

3 primary complications of Portal HPN

A
  • gastroesophageal varices with hemorrhage
  • ascites
  • hypersplenism
153
Q

Most common cause of Portal HPN in the US

A

Cirrhosis

154
Q

First indication of Portal HPN in Liver Cirrhosis

A

Hypersplenism with thrombocytopenia

155
Q

Offers an alternative to surgery for acute decompression of portal hypertension

A

Transjugular lntrahepatic Portosystemic Shunt (TIPS)

156
Q

First-line treatment to control Acute Variceal Bleeding

A

Endoscopic intervention

157
Q

Most common cause of ascites

A

Portal HPN related to cirrhosis

158
Q

Laterality of Hepatic Hydrothorax

A

More common on the right side

159
Q

Recommended Sodium Restriction for Smal Amounts of Ascites

A

< 2g of sodium per day

160
Q

Most common organisms causing Spontaneous Bacterial Peritonitis (SBP)

A

Escherichia coli and other gut bacteria

161
Q

Presumed mechanism for development of SBP

A

Bacterial translocation

162
Q

Treatment for SBP

A

Third-generation cephalosporin

162
Q

Mainstay of treatment for Hepatic Encephalopathy

A

Lactulose, to promote 2-3 soft stools per day

163
Q

Functional renal failure without renal pathology in patients with advanced cirrhosis or acute liver failure

A

Hepatorenal Syndrome (HRS)

164
Q

Differentiate Type 1 vs Type 2 HRS

A
165
Q

Best Therapy for HRS

A

liver transplantation

166
Q

Most common indications for liver transplantation (2)

A

Hepatitis C infection and alcoholic liver disease

167
Q

Phenotype of AlAT Deficiency with Greatest Risk for Developing Chronic Liver Disease

A

ZZ phenotype

168
Q

Only human Hepatitis Virus that is a DNA Virus

A

Hepatitis B (others are RNAviruses)

It belongs to the HepaDNAviridae family.

It is the only DNA virus that uses reverse transcriptase enzyme.

168
Q

First detectable marker in Hep B

A
169
Q

Qualitative marker for high infectivity / replication in Hep B

A
169
Q

Quantitative marker for high infectivity / replication

A
170
Q

First antibody to rise in Hep B

A

Anti HBc antibody
(1-2 weeks after HBsAg)

171
Q

Positive during window period in Hep B

A
172
Q

Protective antibody and the only marker to appear after immunization

A
173
Q

Criteria for chronic HBV infection

A

HBsAg remains detectable beyond 6 months

174
Q

Nonpercutaneous routes of HBV transmission with the greatest impact

A

Intimate (especially sexual) contact

Perinatal transmission (vertical transmission)

175
Q

Most important mode of HBV perpetuation in the Far East and Developing countries

A

Perinatal transmission (particularly at time of delivery; not related to breastfeeding)

176
Q

Risks of Cirrhosis and HCCAin Hepatitis B increase with the level of what serum marker

A

Level of HBV replication

177
Q

Reverse transcriptase inhibitor used in managing HBV and HIV

A

Lamivudine

178
Q

Most common symptom in Hepatitis C

A

Fatigue (jaundice is rare)

178
Q

Vasculitic syndrome associated with HBV infection

A

Polyarteritis nodosa

179
Q

Most common risk factor for Hepatitis C

A

Injection Drug Use

180
Q

The most common genotype of Hepatitis C worldwide

A

Genotype 1

181
Q

Gold standard for establishing a diagnosis of Hepatitis C (most sensitive indicator)

A

HCV RNA

182
Q

Defective RNAVirus that coinfects with and requires helper function of HBV

A

Hepatitis D (HDV)

183
Q

Best prognostic indicator in chronic Hepatitis C

A

Liver Histology

184
Q

Autoantibody present in chronic Hepatitis D

A

Presence of antibodies to liver-kidney microsomes (anti-LKM3)

184
Q

Most common cause of acute Hepatitis in India, Asia, Africa, and Central America

A

Hepatitis E

*High mortality among pregnant women

185
Q

Most feared complication of Viral Hepatitis

A

Fulminant hepatitis (massive hepatic necrosis)

186
Q

The striking postmortem finding in massive hepatic necrosis, referring to a small, shrunken, soft liver

A

Acute Yellow Atrophy

187
Q

First approved therapy for chronic Hepatitis B

A

IFN-alpha (although no longer used for treatment)

187
Q

First nucleoside analogue to be approved for Hepatitis B

A

Lamivudine

188
Q

Most potent of the HBV antivirals

A

Entecavir

189
Q

First*line drugs for Hepatitis B (3)

A
  • PEG-IFN
  • Entecavir
  • Tenofovir
190
Q

Goal of treatment in Hepatitis C

A

Eradicate HCV RNA during therapy and to document that the virus remains undetectable for at least 12 weeks after completion of therapy (SVR12).

191
Q

Viral indications for ribavirin use

A

HCV

RSV

192
Q

most pronounced effect of ribavirin

A

Hemolysis

193
Q

Most important variable in progression of liver disease in patients with chronic hepatitis C

A

Duration of infection

194
Q

Hepatitis infection associated with essential mixed cryoglobulinemia

A

HCV

195
Q

3 major lesions of ALD

A

Fatty liver, alcoholic hepatitis, cirrhosis

196
Q

Initial and most common histologic response hepatotoxic stimuli

A

Fatty liver

197
Q
A
198
Q

Threshold for developing ALD

A
  • Men: >14 drinks per week
  • Women: >7 drinks per week
199
Q

Major enzyme responsible for alcohol metabolism

A

Alcohol dehydrogenase

200
Q

What is Zieve’s Syndrome

A

Hemolytic anemia with spur cells and acanthocytes in patients with severe alcoholic hepatitis

201
Q

Value of DF where there is improved survival at 28 days with the use of glucocorticoids in patients with severe alcoholic patients

A

Discriminant function > 32

202
Q

Cornerstone of ALD treatment

A

complete abstinence from alcohol

203
Q

in ALD, when should liver biopsy be done

A

liver biopsy should not be performed until abstinence maintained for at least 6 months

204
Q

Most common drug causing acute liver failure

A

Acetaminophen

205
Q

Acetaminophen dose producing clinical evidence of liver injury

vs

Acetaminophen dose usually associated with fatal fulminant disease

A

Single dose of 10-15 grams

vs

at least 25 grams

206
Q

Last resort for Acetaminophen Hepatotoxicity

A

Liver transplantation (if with progressive hepatic failure despite NAC therapy)

207
Q

Most important adverse effect of Erythromycin

A

Cholestatic reaction (infrequent)

208
Q

Hepatotoxic component of trimethoprim sulfamethoxazole (TMP-SMX)

A

Sulfamethoxazole

209
Q

Chronic disorder characterized by continuing hepatocellular necrosis and inflammation, usually with fibrosis, which can progress to cirrhosis and liver failure

A

Autoimmune Hepatitis (AIH)

210
Q

Differentiate type I vs type II Autoimmune hepatitis in terms of age group usually affected

A
211
Q

Differentiate type I vs type II Autoimmune hepatitis in terms of antibodies involved

A
212
Q

Differentiate the the ff in terms of associated liver disease
* Anti-LKM1
* Anti-LKM2
* Anti-LKM3

A
  • Anti-LKM1 - Type II AIH & hepatitis C
  • Anti-LKM2 - Drug-induced hepatitis
  • Anti-LKM3 - Chronic hepatitis D
213
Q

Mainstay of treatment for AIH

A

Glucocorticoid therapy

214
Q

2 major types of Gallstones

A
  • Cholesterol stones (>80%)
  • Pigment stones (<20%)
215
Q

2 key changes during pregnancy that contribute to a cholelithogenic state

A
216
Q

most important mechanism in the formation of lithogenic bile

A

increased biliary secretion of cholesterol

217
Q

Most frequently isolated organisms in gallbladder bile

A

Escherichia coli, Klebsiella spp., Streptococcus spp., Clostridium spp

218
Q

Most frequently isolated bacteria in emphysematous cholecystitis

A
  • Anaerobes, such as Clostridium welchii or Clostridium perfringens
  • Aerobes, such as E. coli (a facultative anaerobe)
219
Q

Most frequent demographic for emphysematous cholecystitis

A

Elderly men and diabetics

220
Q

What is Mirizzi’s Syndrome

A

Gallstone becomes impacted in the cystic duct or neck of the gallbladder causing compression of the CBD,resulting in obstruction and jaundice

221
Q

Radiographic diagnosis of Emphysematous Cholecystitis

A

Gas within the gallbladder lumen on plain abdominal film, dissecting within the gallbladder wall to form a gaseous ring. or in the pericholecystic tissues

222
Q

What is Courvoisier’s Law

A

Presence of a palpably enlarged gallbladder suggests that the biliary obstruction is secondary to an underlying malignancy rather than to calculous disease

223
Q

Most common site of fistula formation in Cholecystitis

A

Fistula into the duodenum

224
Q

Usual site of obstruction in Gallstone lieus

A

lleocecal Valve

225
Q

Calcium salt deposition within the wall of a chronically inflamed gallbladder; associated with gallbladder carcinoma, so cholecystectomy is advised

A

porcelain gallbladder

226
Q

Usual analgesics for Acute Cholecystitis

A

Meperidine or NSAIDs (produce less spasm of sphincter Oddi than morphine)

227
Q

```

~~~

Gold standard for treating symptomatic Cholelithiasis

A

Laparoscopic cholecystectomy

228
Q

Treatment of choice for uncomplicated Acute Cholecystitis

A

Early cholecystectomy (within 72 hours)

229
Q

Most common type of Cholangitis

A

Nonsuppurative acute cholangitis (vs. suppurative)

230
Q

Preferred initial procedure for both establishing a definitive diagnosis and providing effective therapy

A

ERCP with endoscopic sphincterotomy

231
Q

Most common associated entity in patients with Nonalcoholic Acute Pancreatitis

A

Biliary tract disease

232
Q

Preferred approach if CBD stones are suspected prior to Laparoscopic Cholecystectomy

A

Preoperative ERCP with endoscopic papillotomy and stone extraction

233
Q
A

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