GASTRO Flashcards
1
Q
cells in the stomach that secretes :
* mucus vs
* HCl vs
* intrinsic factor vs
* pepsinogen vs
* serotonin vs
* histamine
A
2
Q
Cells that store vitamin A in the liver
A
Ito cells
2
Q
Pacemaker cells of the GI tract (generate slow waves)
A
Interstitial cells ofCajal
3
Q
part of the GI tract where the digestion of the following BEGINS
* carbohydrates
* fats
* proteins
A
4
Q
part of GI tract where the ff are absorbed:
* iron vs
* intrinsic factor vs
* bile salts
A
5
Q
part of GI tract where the ff are absorbed:
* vitamin C
* Vitamin B12
* Vitamin ADEK
A
6
Q
part of GI tract where the ff are absorbed:
* carbohydrates
* proteins
* fats
A
7
Q
Rule of 2s in Meckel’s Diverticulum
(six 2s eme )
A
8
Q
Diagnostic Criteria for Irritable Bowel Syndrome (IBS) Rome IV
A
8
Q
Charcot’s Triad for Ascending Cholangitis
A
FPJ
* fever
* RUQ pain
* jaundice
9
Q
Reynolds’ Pentad
A
Charcot’s Cholangitis Triad + Shock and Altered mental status
Charcot’s Cholangitis Triad
* fever
* RUQ pain
* jaundice
10
Q
Triad of Hepatopulmonary Syndrome
A
- Liver Disease
- Hypoxemia
- Pulmonary Arteriovenous Shunting
11
Q
Clinical manifestation suggestive of hepatopulmonary syndrome
A
Platypnea - shortness of breath that occur paradoxically upon the assumption of an upright position
12
Q
Triad of Acute Cholecystitis
A
- Sudden RUQ tenderness
- Fever
- Leukocytosis
vs. Charcot’s Cholangitis Triad
* fever
* RUQ pain
* jaundice
13
Q
Triad of Choledochal Cyst
A
- abdominal pain
- jaundice
- abdominal mass
13
Q
Triad of Hemobilia
A
- Biliary Pain
- Obstructive Jaundice
- Melena
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
15
Q
Typical symptoms of GERD (2)
A
Heartburn and regurgitation
16
Q
Most sensitive test for diagnosis of GERD
A
24-hour ambulatory pH monitoring
17
Q
Endoscopic hallmark ofGERD
A
Erosive esophagitis at the esophagogastric junction
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
19
Q
Characteristic symptom of Infectious Esophagitis
A
Odynophagia
20
Q
Common cause of Steakhouse Syndrome
A
Schatzki ring in the lower esophagus (meat usually instigates intermittent food impaction)
21
Q
Radiographic sign in achalasia
A
Bird’s beak appearance
22
Seen radiographically in diffuse esophageal spasm (DES) or spastic achalasia
Corkscrew or rosary bead esophagus
23
Detects impaired LES relaxation and absent peristalsis in achalasia
Esophageal Manometry
24
Test for evaluation of the proximal GIT
Endoscopy/esophagogastroduodenoscopy (EGD)
25
Cobblestone appearance of esophagus is seen in what disease
Crohn's disease (on endoscopy or barium radiography)
26
Most severe histologic consequence of GERD
Barrett's metaplasia with the associated risk of esophageal adenocarcinoma
27
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
SCCA
28
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
AdenoCA
29
Most common cause of UGIB
Peptic ulcers
30
Most common cause of LGIB overall
Hemorrhoids
30
Most common cause of LGIB in adults if hemorrhoids and anal fissures are excluded
Diverticulosis
31
What is Heyde's syndrome
Bleeding vascular ectasias and aortic stenosis
31
What is Boerhaave Syndrome
Full-thickness esophageal tear (rupture)
## Footnote
vs mallory-weiss tear na partial-thickness lang
32
Most important cause of gastric and duodenal erosions
NSAID
32
Classic history of Mallory-Weiss Tear
Vomiting, retching, coughing preceding hematemesis in an alcoholic patient
33
Best way to initially assess a patient with GIB
Heart rate and BP
34
Should be performed within 24 h in most patients with UGIB
Upper endoscopy
35
Procedure of choice in LGIB
Colonoscopy after an oral lavage solution
36
Initial test for patients with massive bleeding suspected to be from the small intestine
Angiography
37
Key enzyme in rate-limiting step of prostaglandin synthesis
Cyclooxygenase (COX)
38
Most common causes of gastric/duodenal ulcers (GU/DU)
Helicobacter pylori and NSAIDs
39
Mechanism of survival of H. pylori in the Upper GI tract
Urease production
39
Most common location of Duodenal ulcers
first portion of the duodenum, with ~90% located within 3 cm of the pylorus
40
Most discriminating symptom of DUs
Pain that awakens the patient from sleep (between midnight and 3 AM)
41
Typical pain pattern in Duodenal ulcer
Occurs 90 min to 3 h after a meal and is frequently relieved by antacids or food.
42
Most frequent finding in patients with GU or DU
Epigastric tenderness
43
Test of choice for documenting eradication of H. pylori (2)
* Monoclonal stool antigen test or
* Urea breath test (UBT)
44
Invasive tests for H. pylori
44
Most sensitive and specific approach for examining the upper GI tract
Endoscopy
45
Noninvasive test for H. pylori that is not useful for early follow-up
45
Most potent acid inhibitory agents
Proton Pump Inhibitors (PPls)
46
Most common toxicity with sucralfate vs prostaglandin analogues for PUD
Constipation
vs
Diarrhea
47
Most common toxicity with
Diarrhea
48
Differentiate Refractory Peptic Ulcers (GU vs DU) in terms of weeks
GU: failure to heal after 12 weeks of therapy
DU: failure to heal after 8 weeks of therapy
49
Most common cause of treatment failure in
PUD in compliant patients
Antibiotic-resistant H. pylori strains
50
Most commonly performed operations for DUs (3)
* Vagotomy and drainage
* Highly selective vagotomy
* Vagotomy with antrectomy
51
Which operation for DU has high ulcer recurrence rate, but lowest complication rate?
* Vagotomy and drainage
* Highly selective vagotomy
* Vagotomy with antrectom
Highly Selective Vagotomy
52
Which operation for DU has lowest ulcer recurrence rate, but highest complication rate?
* Vagotomy and drainage
* Highly selective vagotomy
* Vagotomy with antrectomy
Vagotomy with antrectomy
53
Surgery of choice for an Antral Ulcer
Antrectomy (including the ulcer) with a Billroth 1 anastomosis
54
Cornerstone of therapy for Dumping Syndrome (DS)
Dietary modification
55
Severe peptic ulcer diathesis secondary to gastric acid hypersecretion due to unregulated gastrin release from gastrinomas
Zollinger-Ellison Syndrome (ZES)
56
Most common clinical manifestations ofGastrinoma
Peptic ulcer, followed by diarrhea
57
First step in the evaluation of Gastrinoma
Obtain a fasting gastrin level
58
Most sensitive/specific Gastrin Provocative Test
Secretin study
59
Treatment of choice for Gastrinoma
PPI
60
Most common presentation of Stress-Related Mucosal Injury (SRM)
GI bleeding
61
Treatment of choice for Stress Prophylaxis
PPis (preferably oral if tolerated)
62
Important predisposing factor for Gastric Cancer
Intestinal metaplasia
62
Most common causes of Acute Gastritis
Infectious
63
which type of gastritis is associated wtih anti parietal cell antibodies
Type A or Type B
64
which type of gastritis is associated with H. pylori
Type A or Type B
65
which type of gastritis is more common
Type A or Type B
65
which type of gastritis is antral-predominant
Type A or Type B
66
which type of gastritis Involves primarily the fundus and body, with antral sparing
Type A or Type B
67
What GI disease:
large tortuous gastric mucosal folds (not a form of gastritis)
68
Mucosal disease that usually involves the rectum & extends proximally to involve all or part of the colon
UC or CD
69
Can affect any part of the GIT from mouth to anus, but rectum is often spared
UC or CD?
70
Transverse or right colon with diameter of >6 cm and loss ofhaustrations in severe attacks of UC
toxic megacolon
71
pANCA Positivity (Perinuclear Anti-neutrophil Cytoplasmic Antibodies)
which is more predisposed.. UC or CD?
UC >> CD
72
ASCA Positivity (Anti-Saccharomyces cerevisiae Antibodies
which is more predisposed.. UC or CD?
CD >> UC
73
2 markers of Intestinal Inflammation
Used frequently to rule out active inflammation versus symptoms of irritable bowel or bacterial overgrowth.
Fecal lactoferrin and calprotectin (leukocyte-derived proteins)
74
Earliest macroscopic findings of colonic CD
vs
Pathognomonic feature of CD
apthoid ulcers
vs
noncaseating granuloma
75
Most common site of inflammation in CD
terminal ileum
76
Most common ocular complications of IBD
Conjunctivitis, anterior uveitis/iritis, and episcleritis
76
Most dangerous local complication of UC
Perforation
77
Most common genitourinary complications of IBD
Calculi, ureteral obstruction, and fistulas
78
Most frequent late complication of IPAA ( ileal pouch–anal anastomosis)
Pouchitis
79
* 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?
UC
80
* gross bleeding not as common as to the other IBD
* significant perineal or perianal disease occur more frequently
UC or CD?
CD
81
continuous, symmetric, and diffuse involvement of colon only
UC or CD?
UC
81
rectum is typically involved
UC or CD?
UC
82
with rectal sparing
UC or CD?
CD
82
most common site of inflammation in CD is what part of GIT
terminal ileum
83
appendectomy is protective
UC vs CD
UC
83
smoking is protective vs risk factor
UC vs CD
UC: protective
CD: risk factor ang smoking
84
NSAIDS may exacerbate disease activity.
UC vs CD
CD
84
pANCA vs ASCA
vs
ASCA vs pANCA
UC: pANCA vs ASCA
CD: ASCA vs pANCA
85
earliest radiologic finding in UC vs CD
* UC: fine mucosal granularity
* CD: thickened folds and aphtous ulcerations
86
What is string sign? and on what IBD is it observed?
String sign: narrowed intestinal lumen on radiographic tests due to edema, bowel wall thickening and bowel wall fibrosis
87
UC or CD?
UC
88
UC or CD?
CD
89
Defining lesion in histopathology of UC
abscesses and ulcers
89
granuloma formation is more common in UC or CD?
CD
90
differentiate UC vs CD in terms of depth of inflammation
* UC: mucosal
* CD: mucosal, submucosal, transmural
91
differentiate UC vs CD in terms of management of mild to moderate disease
92
differentiate UC vs CD in terms of management of moderate to severe disease
92
differentiate UC vs CD in terms of antibiotics needed
93
Prerequisite clinical feature of IBS
Abdominal pain
94
Most consistent clinical feature in IBS
* Altered bowel habits (most common pattern is constipation alternating with diarrhea)
95
Initial therapy of choice for IBS-D (Diarrhea Predominant)
Peripherally acting opiate-based agents
95
Best management for postprandial pain
Antispasmodics 30 minutes before meal
96
Most common site of diverticular disease
sigmoid
96
Only antibiotic for IBS with sustained benefit beyond therapy cessation
Rifaximin
97
Most common cause of hematochezia in oatients >60 years
Hemorrhage from a colonic diverticulum
97
Staging system for predicting outcomes after surgery for perforated diverticulitis
Hinchey Classification System
98
Safety window for colonoscopy for px who have diverticular disease
6 weeks after an attack of diverticular disease (should not be performed in acute setting due to higher risk of perforation)
98
Best management for massive Diverticular Bleeding in a stable patient
vs
asymptomatic Diverticular Disease
Angiography± coiling (if patient unstable or has had a 6-unit bleed within 24 hours, emergent surgery should be performed)
vs
Lifestyle changes
99
init
100
Mainstay of Therapy for Rectal Prolapse
Surgical correction
101
3 Hemorrhoidal Complexes in the Anal Canal
* left lateral
* right anterior
* right posterior
102
Most common presentation of Hemorrhoids
Bleeding and protrusion
103
Most common location of Anorectal Abscess
Perianal, followed by ischiorecta
104
Most common location of Anal Fissures
Posterior position, followed by anterior (lateral fissure is worrisome, and systemic disorders should be ruled out)
105
Most common location of Internal Opening of Fistula In Ano (FIA)
Dentate line
106
Most common type of Fistula In Ano (FIA)
lntersphincteric, followed by transsphincteric
107
Best Management for Newly Diagnosed FIA
Seton (vessel loop or silk tie placed through the tract)
108
Goodsall's Rule for FIA
109
Most prevalent gastrointestinal disease complicating cardiovascular surgery
Nonocclusive mesenteric ischemia
109
The most significant indicator of survival in intestinal ischemia patients
Timeliness of diagnosis and treatment
110
Clinical presentation of patients with acute mesenteric ischemia resulting from arterial embolus or thrombosis
Severe acute, nonremitting abdominal pain strikingly out of proportion to the physical findings
111
Most common locations for colonic lschemia
* Griffith's point: splenic flexure
* Sudeck's point: descending/sigmoid colon
112
Gold standard for diagnosis of Acute Arterial Occlusive Disease
Angiography
113
Management of Acute Arterial Occlusive Disease
laparotomy
114
Intervention of choice to maintain hemodynamics in Nonocclusive/Vasospastic Mesenteric lschemia
Fluid resuscitation
115
Optimal treatment for lschemic Colitis
Resection of ischemic bowel & formation of a proximal stoma Primary anastomosis should not be performed oatients with acute intestinal ischemia
116
Best prognosis of all Acute Intestinal lschemic Disorders
Mesenteric venous insufficiency
117
Most commonly identified form of functional bowel obstruction
Ileus that occurs after intraabdominal surgery
118
Responsible for the majority of cases of early postoperative obstruction that require intervention
Adhesions
119
Most common cause of Colonic Obstruction
Colon cancer
120
Most common precursor for strangulation
Closed-loop obstruction
121
Cardinal signs of acute intestinal obstruction
Colicky abdominal pain, abdominal distention, emesis, and obstipation
122
Classical findings seen in patients with small-bowel obstruction on abdominal radiography (which must include upright or cross-table lateral views)
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
Most common site of intestinal obstruction in patients with gallstone ileus
Ileum
Enters the intestinal tract most often via a cholecvstoduodenal fistula
124
Cecal diameter that increases likelihood of perforation
>10-12 cm
125
Most common emergency general surgical disease affectine the abdomen
Appendicitis
126
Sequence of symptoms in acute appendicitis that helps distinguish it from gastroenteritis
Nausea followed the development of abdominal pain
In gastroenteritis, nausea occurs first
127
Symptom so common that the diagnosis of appendicitis should be questioned in its absence
Anorexia
128
Suggestive CT imaging findings in appendicitis (3)
129
Most common extrauterine condition requiring abdominal operation during pregnancy
Appendicitis
130
Best diagnostic exam for acute appendicitis during pregnancy
Ultrasound
131
Cardinal manifestations of Peritonitis
Acute abdominal pain and tenderness usually with fever
132
Criterion standard in evaluation of liver disease and most accurate means of assessing grade and stage
Liver biopsy
133
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
Child-Pugh Score
134
More objective means of assessing liver disease severity; utilizes serum bilirubin, serum creatinine, and PT-INR
Model for End-Stage Liver Disease (MELD}Score
135
Occurrence of signs or symptoms of hepatic encephalopathy in a person with severe acute or chronic liver disease
Hepatic Failure
136
Most common and most characteristic symptom of liver disease
Fatigue
137
Hallmark of liver disease and most reliable marker of severity
Jaundice
138
Best physical exam maneuver to appreciate ascites
Shifting dullness on percussion
139
Major criterion for diagnosis of Fulminant Hepatitis
Hepatic encephalopathy during acute hepatitis (indicates poor prognosis)
140
screening test for hepatopulmonary syndrome
Oxygen saturation by pulse oximetry
141
Exclusive site for synthesis of serum albumin
hepatocytes
141
Only clotting factor not produced in the liver
Factor VIII
142
Most helpful in recognizing Acute Hepatocellular Diseases
Elevated arninotransferases/transaminases
142
Single best acute measure of hepatic synthetic function
Protime (PT)
(PT prolongation >5 secs not corrected by parenteral vitamin K administration is a poor prognostic sign in acute viral hepatitis)
143
Differentials for striking elevations in aminotransferases (>1000 U/L)
(4)
* Viral hepatitis
* Ischemic liver injury
* Toxin- or drug-induced liver injury
* Acute phase of biliary obstruction passage or gallstone into CBD
144
which is more elevated in alcoholic liver disease...
AST or ALT
AST > ALT
145
which is more elevated in viral hepatitis
AST or ALT
ALT
146
Key events in hepatic fibrogenesis
Stellate cell activation and collagen production
147
First diagnostic test to use in patients whose liver tests suggest cholestasis
Ultrasonography to look for the presence or a dilated intrahepatic or extrahepatic biliary tree or to identify gallstones
148
First test for suspected Budd Chiari Syndrome (Hepatic Vein Thrombosis)
Ultrasound with Doppler imaging
149
Budd-Chiari Syndrome (BCS) vs. Cardiac Cirrhosis
Extravasation or RBCs in Budd-Chiari Syndrome
(but not in cardiac cirrhosis)
150
Kayser-Fleischer rings (golden-brown copper pigment deposited in the periphery of the cornea) is seen in what disease
Wilson's disease
151
Genetic testing for HFE gene mutations should ideally be done in what disease
Hemochromatosis
152
in portal hypertension, there is elevation of hepatic venous pressure gradient (HVPG) to >5 mm Hg
HPVG > 5mm Hg
153
3 primary complications of Portal HPN
* gastroesophageal varices with hemorrhage
* ascites
* hypersplenism
153
Most common cause of Portal HPN in the US
Cirrhosis
154
First indication of Portal HPN in Liver Cirrhosis
Hypersplenism with thrombocytopenia
155
Offers an alternative to surgery for acute decompression of portal hypertension
Transjugular lntrahepatic Portosystemic Shunt (TIPS)
156
First-line treatment to control Acute Variceal Bleeding
Endoscopic intervention
157
Most common cause of ascites
Portal HPN related to cirrhosis
158
Laterality of Hepatic Hydrothorax
More common on the right side
159
Recommended Sodium Restriction for Smal Amounts of Ascites
< 2g of sodium per day
160
Most common organisms causing Spontaneous Bacterial Peritonitis (SBP)
Escherichia coli and other gut bacteria
161
Presumed mechanism for development of SBP
Bacterial translocation
162
Treatment for SBP
Third-generation cephalosporin
162
Mainstay of treatment for Hepatic Encephalopathy
Lactulose, to promote 2-3 soft stools per day
163
Functional renal failure without renal pathology in patients with advanced cirrhosis or acute liver failure
Hepatorenal Syndrome (HRS)
164
Differentiate Type 1 vs Type 2 HRS
165
Best Therapy for HRS
liver transplantation
166
Most common indications for liver transplantation (2)
Hepatitis C infection and alcoholic liver disease
167
Phenotype of AlAT Deficiency with Greatest Risk for Developing Chronic Liver Disease
ZZ phenotype
168
Only human Hepatitis Virus that is a DNA Virus
Hepatitis B (others are RNAviruses)
It belongs to the HepaDNAviridae family.
It is the only DNA virus that uses reverse transcriptase enzyme.
168
First detectable marker in Hep B
169
Qualitative marker for high infectivity / replication in Hep B
169
Quantitative marker for high infectivity / replication
170
First antibody to rise in Hep B
Anti HBc antibody
(1-2 weeks after HBsAg)
171
Positive during window period in Hep B
172
Protective antibody and the only marker to appear after immunization
173
Criteria for chronic HBV infection
HBsAg remains detectable beyond 6 months
174
Nonpercutaneous routes of HBV transmission with the greatest impact
Intimate (especially sexual) contact
Perinatal transmission (vertical transmission)
175
Most important mode of HBV perpetuation in the Far East and Developing countries
Perinatal transmission (particularly at time of delivery; not related to breastfeeding)
176
Risks of Cirrhosis and HCCAin Hepatitis B increase with the level of what serum marker
Level of HBV replication
177
Reverse transcriptase inhibitor used in managing HBV and HIV
Lamivudine
178
Most common symptom in Hepatitis C
Fatigue (jaundice is rare)
178
Vasculitic syndrome associated with HBV infection
Polyarteritis nodosa
179
Most common risk factor for Hepatitis C
Injection Drug Use
180
The most common genotype of Hepatitis C worldwide
Genotype 1
181
Gold standard for establishing a diagnosis of Hepatitis C (most sensitive indicator)
HCV RNA
182
Defective RNAVirus that coinfects with and requires helper function of HBV
Hepatitis D (HDV)
183
Best prognostic indicator in chronic Hepatitis C
Liver Histology
184
Autoantibody present in chronic Hepatitis D
Presence of antibodies to liver-kidney microsomes (anti-LKM3)
184
Most common cause of acute Hepatitis in India, Asia, Africa, and Central America
Hepatitis E
*High mortality among pregnant women
185
Most feared complication of Viral Hepatitis
Fulminant hepatitis (massive hepatic necrosis)
186
The striking postmortem finding in massive hepatic necrosis, referring to a small, shrunken, soft liver
Acute Yellow Atrophy
187
First approved therapy for chronic Hepatitis B
IFN-alpha (although no longer used for treatment)
187
First nucleoside analogue to be approved for Hepatitis B
Lamivudine
188
Most potent of the HBV antivirals
Entecavir
189
First*line drugs for Hepatitis B (3)
* PEG-IFN
* Entecavir
* Tenofovir
190
Goal of treatment in Hepatitis C
Eradicate HCV RNA during therapy and to document that the virus remains undetectable for at least 12 weeks after completion of therapy (SVR12).
191
Viral indications for ribavirin use
HCV
RSV
192
most pronounced effect of ribavirin
Hemolysis
193
Most important variable in progression of liver disease in patients with chronic hepatitis C
Duration of infection
194
Hepatitis infection associated with essential mixed cryoglobulinemia
HCV
195
3 major lesions of ALD
Fatty liver, alcoholic hepatitis, cirrhosis
196
Initial and most common histologic response hepatotoxic stimuli
Fatty liver
197
198
Threshold for developing ALD
* Men: >14 drinks per week
* Women: >7 drinks per week
199
Major enzyme responsible for alcohol metabolism
Alcohol dehydrogenase
200
What is Zieve's Syndrome
Hemolytic anemia with spur cells and acanthocytes in patients with severe alcoholic hepatitis
201
Value of DF where there is improved survival at 28 days with the use of glucocorticoids in patients with severe alcoholic patients
Discriminant function > 32
202
Cornerstone of ALD treatment
complete abstinence from alcohol
203
in ALD, when should liver biopsy be done
liver biopsy should not be performed until abstinence maintained for at least 6 months
204
Most common drug causing acute liver failure
Acetaminophen
205
Acetaminophen dose producing clinical evidence of liver injury
vs
Acetaminophen dose usually associated with fatal fulminant disease
Single dose of 10-15 grams
vs
at least 25 grams
206
Last resort for Acetaminophen Hepatotoxicity
Liver transplantation (if with progressive hepatic failure despite NAC therapy)
207
Most important adverse effect of Erythromycin
Cholestatic reaction (infrequent)
208
Hepatotoxic component of trimethoprim sulfamethoxazole (TMP-SMX)
Sulfamethoxazole
209
Chronic disorder characterized by continuing hepatocellular necrosis and inflammation, usually with fibrosis, which can progress to cirrhosis and liver failure
Autoimmune Hepatitis (AIH)
210
Differentiate type I vs type II Autoimmune hepatitis in terms of age group usually affected
211
Differentiate type I vs type II Autoimmune hepatitis in terms of antibodies involved
212
Differentiate the the ff in terms of associated liver disease
* Anti-LKM1
* Anti-LKM2
* Anti-LKM3
* Anti-LKM1 - Type II AIH & hepatitis C
* Anti-LKM2 - Drug-induced hepatitis
* Anti-LKM3 - Chronic hepatitis D
213
Mainstay of treatment for AIH
Glucocorticoid therapy
214
2 major types of Gallstones
* Cholesterol stones (>80%)
* Pigment stones (<20%)
215
2 key changes during pregnancy that contribute to a cholelithogenic state
216
most important mechanism in the formation of lithogenic bile
increased biliary secretion of cholesterol
217
Most frequently isolated organisms in gallbladder bile
Escherichia coli, Klebsiella spp., Streptococcus spp., Clostridium spp
218
Most frequently isolated bacteria in emphysematous cholecystitis
* Anaerobes, such as Clostridium welchii or Clostridium perfringens
* Aerobes, such as E. coli (a facultative anaerobe)
219
Most frequent demographic for emphysematous cholecystitis
Elderly men and diabetics
220
What is Mirizzi's Syndrome
Gallstone becomes impacted in the cystic duct or neck of the gallbladder causing compression of the CBD,resulting in obstruction and jaundice
221
Radiographic diagnosis of Emphysematous Cholecystitis
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
What is Courvoisier's Law
Presence of a palpably enlarged gallbladder suggests that the biliary obstruction is secondary to an underlying malignancy rather than to calculous disease
223
Most common site of fistula formation in Cholecystitis
Fistula into the duodenum
224
Usual site of obstruction in Gallstone lieus
lleocecal Valve
225
Calcium salt deposition within the wall of a chronically inflamed gallbladder; associated with gallbladder carcinoma, so cholecystectomy is advised
porcelain gallbladder
226
Usual analgesics for Acute Cholecystitis
Meperidine or NSAIDs (produce less spasm of sphincter Oddi than morphine)
227
# ```
```
Gold standard for treating symptomatic Cholelithiasis
Laparoscopic cholecystectomy
228
Treatment of choice for uncomplicated Acute Cholecystitis
Early cholecystectomy (within 72 hours)
229
Most common type of Cholangitis
Nonsuppurative acute cholangitis (vs. suppurative)
230
Preferred initial procedure for both establishing a definitive diagnosis and providing effective therapy
ERCP with endoscopic sphincterotomy
231
Most common associated entity in patients with Nonalcoholic Acute Pancreatitis
Biliary tract disease
232
Preferred approach if CBD stones are suspected prior to Laparoscopic Cholecystectomy
Preoperative ERCP with endoscopic papillotomy and stone extraction
233
