Gastroentero Flashcards by Deleted Deleted

esophageal disorders leading to narrowing will result in

dysphagia and weight loss

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name the causes of dysphagia (7)

achalasia
cancer
rings/webs
Zenker’s diverticulum
spastic d/o’s
scleroderma
eosinophilic esophagitis

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YOUNG nonsmoker
dysphagia to solids AND liquids at the same time
REGURGITATION of food
ASPIRATION of previously eaten food

achalasia

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best INITIAL test for achalasia

barium swallow

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MOST ACCURATE test for achalasia

esophageal manometry

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endoscopy in achalasia is done for what purpose?

to EXCLUDE cancer

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best INITIAL treatment for achalasia

pneumatic dilation, or surgical myotomy

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pneumatic dilation for achalasia is done when?

surgical myotomy is UNSUCCESSFUL

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treatment for achalasia if pt refuses pneumatic dilation/surgical myotomy

botulinum toxin injection

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dysphagia to solids THEN liquids
+/- heme-positive stool, or ANEMIA
often pts > 50 yoa
smoker/drink alcohol

esophageal cancer

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best INITIAL test for esophageal cancer

endoscopy

barium swallow if endoscopy isn’t a choice

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best INITIAL treatment for esophageal cancer

RESECTION

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surgical resection of esophageal cancer should be followed by

5-fluorouracil (5-FU)

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name the causes of rings/webs causing dysphagia (3)

Plummer-Vinson syndrome
Schatzki’s ring
peptic stricture

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best INITIAL test for rings/webs

barium swallow

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PROXIMAL stricture
IDA
middle-aged females

Plummer-Vinson syndrome

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best INITIAL treatment for Plummer-Vinson syndrome

iron

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DISTAL ring

- INTERMITTENT symptoms of dysphagia

Schatzki’s ring

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best INITIAL treatment for Schatzki’s ring

pneumatic dilation

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dysphagia

- longstanding acid reflux

peptic stricture

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treatment for peptic stricture

pneumatic dilation

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horrible bad breath from rotting food in back of esophagus

- dilation of posterior pharyngeal constrictor muscles

Zenker’s diverticulum

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best INITIAL test for Zenker’s diverticulum

barium swallow

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best INITIAL treatment for Zenker’s diverticulum

surgical resection

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- dysphagia - h/o allergies - mean of 5 years before diagnosis is made

eosinophilic esophagitis

test for eosinophilic esophagitis

endoscopy w/ biopsy

treatment for eosinophilic esophagitis

PPT and budesonide

- severe chest pain w/o risk factors for ischemic heart disease - pain after drinking cold beverage - normal EKG/stress test/coronary angiography

diffuse esophageal spasm

MOST ACCURATE test for diffuse esophageal spasm

manometry

barium swallow may show what during an episode of spasm in diffuse esophageal spasm

corkscrew pattern

treatment for diffuse esophageal spasm

- CCB | - nitrate

difference between diffuse esophageal spasm and Prinzmetal's variant angina

ST segment elevation

- diffuse disease | - reflux symptoms

scleroderma

- odynophagia - HIV-NEGATIVE what is the next step in management?

endoscopy

- odynophagia | - HIV-POSITIVE w/ CD4 count

fluconazole

- odynophagia | - HIV-POSITIVE w/ CD4 count

endoscopy

> 90% of esophagitis in HIV-positive pts are caused by?

Candida

treatment for pill esophagitis

- sit up - drink a lot of water - remain upright for 30 minutes after

- SUDDEN UGIB - violent retching/vomiting - there may be hematemesis or melena

Mallory-Weiss tear

test for Mallory-Weiss tear

endoscopy

treatment for Mallory-Weiss tear

most spontaneously resolve

treatment for Mallory-Weiss tear if bleeding does NOT resolve

endoscopic epinephrine injection

- epigastric pain/substernal chest pain - sore throat - metallic or bitter taste - hoarseness - chronic cough - wheezing - nausea

GERD!!

diagnosis and treatment for GERD

PPI

if no response to PPI for GERD symptoms, next step in management

endoscopy

if GERD symptoms persist and EGD is normal, next step in management

24-hour pH monitoring

alarm symptoms in pt w/ GERD indicating endoscopy

- weight loss - anemia - blood in stool - dysphagia - reflux for more than 5-10 years

- PREcancerous lesion of lower esophagus | - 0.5%/year transform into cancer

Barrett esophagus

test for Barrett esophagus

endoscopy

endoscopic finding: Barrett esophagus (metaplasia) next step in management

PPI and repeat EGD every 2-3 years

endoscopic finding: low-grade dysplasia next step in management

PPI and repeat EGD in 3-6 months

endoscopic finding: high-grade dysplasia next step in management

- endoscopic mucosal resection - endoscopic ablation - distal esophagectomy

MCC of epigastric discomfort

non-ulcer dyspepsia (diagnosis of exclusion)

test for non-ulcer dyspepsia

endoscopy

treatment for non-ulcer dyspepsia

- H2 blocker - liquid antacid - PPI

treatment for REFRACTORY non-ulcer dyspepsia

treat for Helicobacter pylori

MCC of peptic ulcer disease (duodenal/gastric)

H. pylori

after H. pylori, MCC of PUD

- NSAIDs - head trauma - burns - intubation - Crohn's disease - Zollinger-Ellison syndrome

what % of GU pts develop gastric cancer?

gastritis can be associated w/

H. pylori

treatment for H. pylori

- omeprazole - clarithromycin - amoxicillin

MOST ACCURATE test for gastritis

endoscopy w/ biopsy

treatment if initial H. pylori treatment fails

repeat triple therapy w/ 2 new abx - PPI - metronidazole - tetracycline

if H. pylori treatment fails twice

evaluate for ZES (gastrinoma)

stress ulcer prophylaxis should be given to the following:

- head trauma - intubation and mechanical ventilation - burns - coagulopathy AND steroid use in combination

- epigastric pain - H. pylori positive - NO ulcer or gastritis

non-ulcer dyspepsia

EVERYONE on an H2 blocker or PPI has an

ELEVATED GASTRIN LEVEL

diagnostic test ZES

gastrin level and gastric acid output

test the gastrin level and gastric acid output for ZES when the following is present:

- large ulcer (> 1cm) - multiple ulcers - ulcer distal to ligament of Treitz - recurrent/persistent ulcer despite H. pylori treatment

if gastrin level and acid output are elevated in ZES, next step

localize the gastrinoma

MOST ACCURATE test for ZES

secretin suppression test

treatment of ZES for LOCAL disease

surgical resection

treatment of ZES for metastatic disease

lifelong PPI

clue about the presence of a parathyroid problem w/ ZES, and multiple endocrine neoplasia (MEN) syndrome

hypERcalcemia

both CD and UC can present w/

- fever - abdominal pain - diarrhea - bloody stools - weight loss

extraintestinal manifestations of IBD

- joint pain - iritis/uveitis - pyoderma gangrenosum/erythema nodosum - sclerosing cholangitis

features more common to CD

- masses - skip lesion - upper GI tract - perianal disease - transmural granulomas - fistulae - hypocalcemia from fat malabsorption - obstruction - calcium oxalate kidney stones - cholesterol gallstones - vitamin B12 malabsorption from terminal ileum involvement

diagnosis for CD and UC

barium swallow or endoscopy

when diagnosis of CD or UC, what can be helpful

blood tests

ASCA and ANCA in CD

ASCA POSITIVE

ASCA and ANCA in UC

ANCA POSITIVE

best INITIAL treatment for both CD and UC

mesalamine

adverse effects of sulfasalazine

- rash - hemolytic anemia - interstitial nephritis

treatment for acute exacerbation of CD and UC

budesonide

treatment for severe CD and UC w/ recurrent symptoms when steroids are STOPPED

azathioprine, or 6-mercaptopurine

most useful treatment for CD associated w/ FISTULA formation

infliximab

treatment for perianal involvement in CD

metronidazole and ciprofloxacin

curative treatment for UC

surgical resection of colon

most important feature of infectious diarrhea

presence of blood indicating invasive bacterial pathogen

infectious diarrhea +/- blood may be d/t which pathogens?

- Campylobacter - Salmonella - Vibrio parahaemolyticus - Vibrio vulnificus - E. coli (including E. coli O157:H7) - Shigella - Yersinia - amoeba

- diarrhea | - MCC of food poisoning

Campylobacter

Campylobacter can be associated w/

- Guillain-Barre syndrome | - reactive arthritis

- diarrhea | - transmitted by chickens and eggs

Salmonella

- diarrhea | - associated w/ seafood

Vibrio parahaemolyticus

- diarrhea - most commonly associated w/ HUS (effects of verotoxin) - h/o undercooked beef

E. coli O157:H7

which treatments should be AVOIDED in HUS

platelet transfusion and antibiotics

- diarrhea - associated w/ shellfish - septicemia is MUCH more likely in pt w/ liver disease - - necrotizing wound infections can occur in skin lesions

Vibrio vulnificus

- diarrhea - secretes Shiga toxin - also, associated w/ reactive arthritis - 2nd MCC of HUS

Shigella

- diarrhea - rodents are natural reservoir - transmission is through food contaminated w/ infected urine/feces

Yersinia

diarrhea, which may be associated w/ liver abscesses

amoeba

best INITIAL test for infectious diarrhea

fecal leukocytes

MOST ACCURATE test for infectious diarrhea

stool culture

treatment for infectious diarrhea: mild disease

none; will resolve on its own

best INITIAL treatment for infectious diarrhea: severe disease

fluoroquinolones

severe infectious diarrhea is defined as having the following

- blood - fever - abdominal pain - hypotension and tachycardia

infectious diarrhea (which NEVER presents w/ blood) may be d/t which pathogens?

- viruses - Giardia - Staphylococcus aureus - Bacillus cereus - Cryptosporidium - Scombroid

- diarrhea - camping/hiking - men who have sex w/ men - bloating, flatus, signs of steatorrhea

Giardia

more accurate test for Giardia

stool ELISA Ag

treatment for Giardia

metronidazole or tinidazole

- diarrhea | - associated with mayonnaise and vomiting

Staphylococcus aureus

- diarrhea | - associated w/ refried Chinese rice and vomiting

Bacillus cereus

- diarrhea | - HIV-positive pt w/ CD4 cells

Cryptosporidium

test for Cryptosporidium

modified acid-fast stain

treatment for Cryptosporidium

HAART and nitazoxanide

- diarrhea - histamine fish poisoning - FASTEST onset diarrhea, w/i 10 MINUTES - vomiting, wheezing, flushing

Scombroid

treatment for Scombroid

diphenhydramine

- antibiotic-associated diarrhea | - develops several days to weeks after abx use

Clostridium difficile

best INITIAL test Clostridium difficile diarrhea

stool toxin assay

initial treatment for mild/moderate CDI

PO metronidazole or PO vancomycin

treatment for severe CDI

PO vancomycin +/- IV metronidazole

definition of severe CDI

- WBCs > 15,000 | - serum albumin

treatment for complicated CDI

- PO vancomycin and IV metronidazole | - surgery consult

definition of complicated CDI

- toxic megacolon - peritonitis - respiratory distress - hemodynamic instability

alternate treatment for severe and recurrent CDI

fidaxomicin

chronic diarrhea (> 4 weeks) causes

- lactose intolerance - carcinoid syndrome - IBD

MCC of chronic diarrhea and flatulence

lactose intolerance

chronic diarrhea associated w/ flushing and episodes of hypotension

carcinoid syndrome

test for carcinoid syndrome

urinary 5-HIAA level

treatment for carcinoid syndrome

octreotide (somatostatin analog)

chronic diarrhea w/ blood in stools, fever, and weight loss

IBD

- chronic diarrhea ALWAYS associated w/ weight loss

malabsorption

name the causes of malabsorption (4)

1. celiac disease (gluten sensitive enteropathy) 2. tropical sprue 3. chronic pancreatitis 4. Whipple's disease

ALL forms of fat malabsorption are associated w/

- hypocalcemia (vitamin D deficiency) - oxalate kidney stones - easy bruising and elevated PT/INR (vitamin K malabsorption) - vitamin B12 malabsorption

best INITIAL test for malabsorption

Sudan black stain for stool

MOST SENSITIVE test for malabsorption

72-hour fecal fat

- iron malabsorption and microcytic anemia - folate malabsorption - dermatitis herpetiformis

celiac disease

best INITIAL tests for celiac disease

- anti-gliadin Ab - anti-endomysial Ab - anti-tissue transglutaminase Ab

MOST ACCURATE test for celiac disease

small bowel biopsy

D-xylose test result in celiac disease, Whipple's disease, and tropical sprue

ABNORMAL (villous lining is destroyed)

what test should be done even if diagnosis of celiac disease has been confirmed?

small bowel biopsy to EXCLUDE bowel wall lymphoma

treatment for celiac disease

gluten free diet

MOST ACCURATE test for tropical sprue

small bowel biopsy showing microorganisms

treatment for tropical sprue

doxycycline, or TMP/SMX for 3-6 MONTHS

- malabsorption - arthralgia (MCC presenting symptom) - neurological abnormalities - ocular findings

Whipple's disease

MOST ACCURATE test for Whipple's disease

small bowel biopsy showing PAS POSITIVE organisms

treatment for Whipple's disease

tetracycline, or TMP/SMX for 12 MONTHS

- malabsorption - h/o alcoholism - h/o multiple episodes of pancreatitis - amylase/lipase will most likely be normal

chronic pancreatitis

best INITIAL tests for chronic pancreatitis

- abdominal XR (pancreatic calcifications) | - CT scan of abdomen

MOST ACCURATE test for chronic pancreatitis

secretin stimulation testing

D-xylose test in chronic pancreatitis will be

NORMAL

treatment for chronic pancreatitis

pancreatic enzymes

- abdominal pain relieved by BM - abdominal pain that's less at night - abdominal pain w/ diarrhea alternating w/ constipation

irritable bowel syndrome (IBS)

all diagnostic tests for IBS will be?

normal

best INITIAL treatment for IBS

fiber

if fiber does not relieve pain in IBS, next treatment

- dicyclomine | - hyoscyamine

if fiber, and dicyclomine don't work for IBS, last resort treatment

TCA

colonoscopy screening: general population

- begin at 50 yoa | - repeat every 10 years

colonoscopy screening: 1 family member w/ colon cancer

- begin at 40 yoa, OR 10 years before age of family member who had cancer

colonoscopy screening: 3 family members, 2 generations, or 1 premature (

- begin at 25 yoa | - repeat every 1-2 years

colonoscopy screening: FAP

- begin sigmoidoscopies at 12 yoa | - COLECTOMY once polyps are found

- colon polyps | - osteomas (benign bone tumors)

Gardner's syndrome

- hamartomatous polyps throughout small bowel and colon | - melanotic spots on lips

Peutz-Jeghers syndrome

- multiple extra hamartomas in bowel | - no significant increase in cancer risk

juvenile polyposis

colonoscopy screening: DYSplastic polyp found

repeat colonoscopy every 3-5 years after polyp was found

- LLQ abdominal pain | - LGIB

diverticulosis

MOST ACCURATE test for diverticulosis

barium enema

- complication of diverticulosis - LLQ abdominal pain - TENDERNESS - FEVER - ELEVATED WBC COUNT

diverticulitis

best test for diverticulitis

CT scan of abd/pelvis

is CI in diverticulitis d/t increased risk of perforation

colonoscopy

treatment for diverticulosis

high-fiber diet

treatment for diverticulitis

antibiotics against GNR and anaerobes metronidazole and ciprofloxacin

GI bleed: red blood

LGIB

GI bleed: black stool

UGIB (when proximal to ligament of Treitz (duodenum/jejunum))

MOST important step in managing an acute GI bleed

determine if pt is hemodynamically unstable

GI bleed management: when do I transfuse PRBCs?

- Hct

GI bleed management: when do I transfuse FFP?

elevated PT/INR and vitamin K is too slow

GI bleed management: when do I transfuse platelets?

- if pt is bleeding/undergo surgery w/ platelets

MCC of death in GI bleeding

myocardial ischemia

what should be ordered on an older pt w/ GI bleeding?

EKG to r/o ischemia

most important treatment for acute GI bleeding

fluid resuscitation

most important measure of severity of GI bleeding

pulse and BP

what if pulse is still elevated, or BP is still low in pt w/ GI bleeding and is becoming hypotensive?

oxygenate (intubate if needed) and c/w IVF

more important in GI bleed than endoscopy

correcting anemia, thrombocytopenia, or coagulopathy

with adequate fluid resuscitation, even w/o endoscopy 80% of GI bleeds

stop bleeding

should be added to initial fluid resuscitation if GI bleed is d/t ulcer disease

PPI

unnecessary stress ulcer ppx w/ PPIs increases risk of

pneumonia and Clostridium difficile colitis

- alcoholic and/or cirrhosis w/ hematemesis - splenomegaly - thrombocytopenia - spider angiomata - gynecomastia

variceal bleeding

should be added to initial fluid resuscitation if GI bleed is d/t variceal bleeding

octreotide (somatostatin analog) | decreases portal hypertension

treatment for variceal bleeding aside from fluid resuscitation and octreotide

EGD to do banding

if variceal bleeding PERSISTS, next step in management

transjugular intrahepatic portosystemic shunt (TIPS) | shunt between PORTAL vein and HEPATIC vein

MC complication of transjugular intrahepatic portosystemic shunt (TIPS) procedure

hepatic encephalopathy

prevents future episodes of variceal bleeding

propranolol

temporary measure to stop variceal bleeding to allow time for a shunt to be placed

Blakemore gastric tamponade balloon

UPPER GIB can have the following causes: (6)

1. PUD 2. esophagitis 3. gastritis 4. duodenitis 5. varices 6. cancer

LOWER GIB can have the following causes: (6)

1. angiodysplasia 2. diverticular disease 3. polyps 4. ischemic colitis 5. inflammatory bowel disease 6. cancer

- test performed to detect site of bleeding IF endoscopy cannot - gives you location, but not exact cause

tagged red cell scan | technetium bleeding scan

- tells you precise vessel that is bleeding | - may be done PREOPERATIVELY in massive GI bleeding to let you know which part of the colon to resect

angiography

can detect location of GIB from SMALL BOWEL, IF upper and lower endoscopies cannot

capsule endoscopy

- embolus from heart resulting in infarction of bowel - SUDDEN onset of extremely severe abdominal pain - +/- bleeding - PE is relatively benign - older pt w/ h/o valvular heart disease

acute mesenteric ischemia

look for what on blood tests of acute mesenteric ischemia

- metabolic acidosis (elevated lactic acid d/t ischemia) | - elevated amylase level

MOST ACCURATE test for acute mesenteric ischemia

angiography

treatment for acute mesenteric ischemia

surgical resection of bowel | surgical emergency

treatment in mesenteric ischemia NOT caused by emboli

treat underlying flow state

management of constipation

correct underlying cause

possible causes of constipation: (7)

1. dehydration (decreased skin turgor in elderly pt w/ BUN:Cr ratio > 20:1) 2. CCB 3. opioids 4. hypothyroidism 5. DM (loss of sensation in bowels) 6. ferrous sulfate iron replacement 7. anticholinergics (including TCAs)

differentiating between UGIB and black stool d/t ferrous sulfate iron replacement

blood is cathartic causing RAPID BM

treatment of constipation

hydration and increased fiber

- prior gastric surgery - SHAKING, SWEATING, WEAKNESS - +/- hypotension

dumping syndrome

mechanism of hypotension in dumping syndrome (2 possible mechanisms)

1. rapid release of gastric contents in duodenum --> osmotic draw into bowel 2. rapid rise in blood glucose --> reactive hypoglycemia

management of dumping syndrome

frequent small meals

- longstanding diabetes - bloating - constipation - diarrhea

gastroparesis

mechanism of gastroparesis

- main stimulant to gastric motility is DISTENSION | - DM damages sensory nerves

treatment for gastroparesis

- erythromycin | - metoclopramide

mechanism of erythromycin in gastroparesis

increases motilin in gut (hormone that stimulates gastric motility)

- severe midepigastric abdominal pain and tenderness - MCC are alcohol and gallstones - vomiting w/o blood - anorexia

acute pancreatitis

other causes of acute pancreatitis

- hypertriglyceridemia - trauma - infection - ERCP - medications (thiazides, didanosine, stavudine, azathioprine)

severe acute pancreatitis signs and lab findings

- hypotension - metabolic acidosis - leukocytosis - hemoconcentration - hyperglycemia - hypocalcemia - hypoxia

best INITIAL test for acute pancreatitis

amylase and lipase

MOST ACCURATE test for acute pancreatitis

CT scan of abdomen

detects causes of biliary and pancreatic duct obstruction not found on CT scan

MRCP

- consider if there is dilation of CBD WITHOUT pancreatic head mass - detects presence of stones/strictures - can REMOVE stones and DILATE strictures

ERCP

urinary test used to determine severity of pancreatitis

trypsinogen activation peptide

treatment for acute pancreatitis

- no feeding (bowel rest) - hydration - pain medications

most precise method of determining pancreatitis severity

CT scan

Ranson's criteria and CT scan are methods to determine which patients require

pancreatic debridement

when the CT scan shows > 30% NECROSIS of pancreas, the pt should:

- receive abx such as imipenem, and | - undergo CT-guided biopsy

if biopsy shows INFECTED, NECROTIC pancreatitis, pt should undergo

surgical debridement

hepatitis B is associated w/ what in 30% of cases

polyarteritis nodosa (PAN)

hepatitis C is associated w/

cryoglobulinemia

- jaundice - fatigue - weight loss - dark urine (bilirubin)

acute hepatitis

- jaundice - fatigue - weight loss - dark urine (bilirubin) - present w/ serum sickness-phenomena (joint pain, urticaria, and fever)

hepatitis B and C

hepatitis E is most severe in

pregnant females (can be fatal)

ALL patients w/ acute hepatitis will have an ELEVATED?

conjugated (direct) bilirubin

viraL hepatitis gives an ELEVATED

aLt

hepatitis from drugS gives and ELEVATED

aSt

MOST ACCURATE tests for hepatitis A, C, D, and E

serology

MOST ACCURATE tests for hepatitis B

- surface Ag - core Ab - e-Ag - surface Ab

FIRST test to become abnormal in ACUTE hepatitis B infection

SURFACE Ag

ALT elevation, e-Ag, and symptoms all occur AFTER

SURFACE Ag

CHRONIC hepatitis B gives same serologic pattern as acute hepatitis B, but has

PERSISTENCE OF SURFACE AG > 6 MONTHS

ONLY acute hepatitis that CAN be treated

hepatitis C

best INITIAL test for acute hepatitis C

hepatitis C Ab

MOST ACCURATE tests for acute hepatitis C

- hepatitis C PCR | - liver biopsy

MOST ACCURATE way of determining response to treatment for acute hepatitis C, which is based on GENOTYPE

hepatitis C PCR

MOST ACCURATE way to determine extent of liver damage in acute hepatitis C

liver biopsy

treatment for acute hepatitis C

interferon, ribavirin, and PI (ledipasvir, simeprevir, or sofosbuvir)

treatment for chronic hepatitis B

single agent! - lamivudine - adefovir - entecavir - telbivudine - tenofovir - interferon

MC adverse effect of ribavirin

anemia

treatment of chronic hepatitis C genotype 1

ledipasvir and sofosbuvir

treatment of chronic hepatitis C all other genotypes

- simeprevir | - boceprevir

MC reason to need liver transplantation in USA

chronic hepatitis C

strongest indications for hepatitis A and B vaccination in ADULTS

- chronic liver disease - household contacts w/ hepatitis A or B - men who have sex w/ men - chronic blood product recipients - IVDA

specific indication for hepatitis A vaccination

travelers

specific indications for hepatitis B vaccination

- health care workers - dialysis pts - DM pts

- edema from low oncotic pressure - gynecomastia - palmar erythema - splenomegaly - thrombocytopenia from splenic sequestration - encephalopathy - ascites - esophageal varices

cirrhosis

treatment for edema from low oncotic pressure in cirrhosis pts

spironolactone and diuretics

treatment for encephalopathy in cirrhosis pts

lactulose

treatment for ascites in cirrhosis pts

spironolactone

treatment for esophageal varices in cirrhosis pts

- propranolol to prevent bleeding | - banding to stop acute bleeding

what should be done in the following? - new ascites - pt w/ ascites develops pain, fever, or tenderness

paracentesis

if serum-to-ascites albumin GRADIENT (SAAG) is > 1.1

- portal hypertension from cirrhosis | - CHF

neutrophils > 250 on paracentesis

spontaneous bacterial peritonitis (SBP)

treatment for spontaneous bacterial peritonitis (SBP)

cefotaxime

causes of chronic liver disease (cirrhosis): (7)

1. alcoholic cirrhosis 2. primary biliary cholangitis 3. primary sclerosing cholangitis 4. Wilson's disease 5. hemochromatosis 6. autoimmune hepatitis 7. nonalcoholic steatohepatitis (NASH)

- diagnosis of exclusion | - longstanding h/o alcohol abuse

alcoholic cirrhosis

- middle-aged FEMALE c/o itching - +/- xanthelasma (cholesterol deposit) - may have h/o AI d/o's

primary biliary cholangitis

best INITIAL test for primary biliary cholangitis

elevated alkaline phosphatase w/ a NORMAL bilirubin level

MOST ACCURATE tests for primary biliary cholangitis

- anti-mitochondrial Ab (AMA) | - liver biopsy

treatment for primary biliary cholangitis

ursodeoxycholic acid

- associated w/ 80% of IBD cases - also presents w/ itching - elevated alkaline phosphatase - ELEVATED BILIRUBIN level

primary sclerosing cholangitis

MOST ACCURATE tests for primary sclerosing cholangitis

- ERCP (shows "beading" of biliary system) - anti-smooth muscle Ab (ASMA) - ANCA positive

treatment for primary sclerosing cholangitis

ursodeoxycholic acid

- liver disease - choreiform movement d/o - neuropsychiatric abnormalities - hemolysis

Wilson's disease

best INITIAL test for Wilson's disease

slit lamp looking for Kayser Fleischer rings | on CCS check for low ceruloplasmin level as well

MOST ACCURATE test for Wilson's disease

liver biopsy

treatment for Wilson's disease

penicillamine, or trientine

most often caused by a genetic d/o causing overabsorption of iron

hemochromatosis

aside from liver disease, other manifestations of hemochromatosis:

- restrictive cardiomyopathy - skin darkening - join pain - damage to pancreas (leads to DM) - pituitary accumulation w/ panhypopituitarism - infertility - hepatoma

best INITIAL test for hemochromatosis

- ELEVATED SERUM IRON - ELEVATED FERRITIN - LOW TIBC - EXTREMELY ELEVATED IRON SATURATION (> 45%)

MOST ACCURATE test for hemochromatosis

liver biopsy

what, in combination, are sufficient for diagnosis of hemochromatosis?

MRI of liver, AND HFe gene mutation

treatment for hemochromatosis

phlebotomy

- young female w/ other AI diseases | - liver disease

autoimmune hepatitis

best INITIAL tests for autoimmune hepatitis

- ANA - anti-smooth muscle Ab (ASMA) - SPEP

MOST ACCURATE test for autoimmune hepatitis

liver biopsy

treatment for autoimmune hepatitis

- prednisone | - azathioprine for steroid-sparing medication

- strongly associated w/ obesity, DM, hyperlipidemia | - hepatomegaly

nonalcoholic steatohepatitis (NASH)

best INITIAL test for nonalcoholic steatohepatitis (NASH)

ALT > AST

MOST ACCURATE test for nonalcoholic steatohepatitis (NASH)

liver biopsy showing fatty infiltration | looks just like alcoholic liver disease

treatment for nonalcoholic steatohepatitis (NASH)

control underlying causes (weight loss, DM control, DLD management)