Gastroenterology Flashcards
t/f ALT is a more specific marker for liver damage compared to AST
true
in addition to measuring AST/ALT for suspected liver dysfunction, what else should you measure?
liver synthetic function ( albumin, coags, etc)
if there are mildly elevated liver enzymes on testing, what is the next best step in further evaluation?
repeat the test in 4 weeks
if you have concern for MASLD, then what is the next calculation to do in the evaluation for potential progression to fibrosis?
fibrosis 4 index
if the Fibrosis 4 index is elevated, what is the next step in evaluation?
liver MRI
what 3 medication options should be considered for the MASLD population?
GLP-1, SGLT2, and statins
what AST/ALT ratio is suggestive of alcohol liver disease?
> 2
t/f acetaminophen, Augmentin, sulfonamides, isoniazid and statin are the most common causes of drug induced liver injury
true
if there is suspicion for drug induced liver injury and the offending drug is removed, the AST/ALT should resolve within what period of time?
2-3 months
what is the USPSTF recommendation on general adult hep C screening?
screen adults 18-79 yo
what condition is characterized by hepcidin deficiency?
hereditary hemachromatosis
what are the two tests to perform if concerned about hereditary hemachromotosis?
iron panel and HFE mutation testing
where is A1AT produced?
liver
what is the acute and maintenance treatment for autoimmune hepatitis?
corticosteroid - acute treatment
azathioprine - maintenance treatment
after screening for Wilson’s disease with ceruloplasmin, what is the confirmatory test?
24 hour copper excretion
which AST to ALT ratio is indicative of MASLD?
< 0.8
what percentage weight loss results in improvement of steatosis in MASLD?
3-5%
what percentage weight loss results in improvement of fibrosis in MASLD?
10%
what are the two types of drug induced liver injury?
intrinsic - dose dependent
idiosyncratic - may not be dose related
how long does it take transaminase levels to normalize after cessation of the offending drug in drug induced liver injury
2-3 months
in the initial evaluation of jaundice, you should perform at least what 4 lab studies?
CBC, CMP, GGT, and coags
bilirubin is formed by the destruction of what cell type?
erythrocyte
which type of bilirubin is water soluble?
conjugated bili
where is bilirubin stored before secreation to the GI tract?
gallbladder
asterixis, hepatomegaly, splenomegaly, bruising, pallor, spider angioma, palmar erythema, gynecomastia, ascites can be found in chronic cases of disease of what organ?
liver
t/f elevated PT, INR and hypoalbuminemia are indicative of decompensated liver disease
true
t/f AST, ALT, and AP should be treated as markers of hepatocellular injury rather than functional markers
true
if you have suspicion that common bile duct obstruction could be the most likely source of jaundice, what is an appropriate first line imaging test?
MRCP / ERCP
anemia, hemoglobinopathy, impaired bilirubin uptake by the liver, and red blood cell enzyme or membrane disorders can cause what type of jaundice/bilirubinemia?
unconjugated hyperbilirubinemia
which enzyme activity is deficient in Gilbert syndrome?
bilirubin - UGT
t/f evidence of hemolysis and elevated LFTs will be present in most cases of Gilbert disease
false
cirrhosis can cause what type of bilirubinemia?
unconjugated (due to impaired bilirubin uptake by the liver)
hepatocyte damage or intrahepatic cholestasis is likely to cause what type of bilirubinemia?
conjugated
what syndrome is characterized by gallstones lodged in the cystic duct that cause jaundice by mechanically compressing the common hepatic duct ?
Mirizzi syndrome
when do GER symptoms peak in children?
4 months
infant GER typically resolves by what age?
1 year
maternal elimination of what food group can be attempted as a trial treatment for GER in children?
dairy elimination
what type of additive should be used in formula fed infants with GERD to reduce regurgitation and vomiting?
thickening agents
t/f feeding exclusively with breast milk appears to be protective against GERD symptoms in infants
true
an infant with reflux starts to experience vomiting, inconsolable crying, feeding refusal, coughing and choking. what may the diagnosis be at that point?
GERD
t/f PPI trial is considered a reasonable way of diagnosing GERd in infants
false - not recommended due to associated comorbidity and concern for overuse of these medications
a PPI trial of how many weeks can be used in children and adolescents for diagnosis of GERD
4-8 weeks
t/f long term use of H2 blockers and PPIs in children has been linked to obesity, allergies and higher risk of fracture
true
what is the treatment failure rate of non operative management with antibiotics for acute uncomplicated appendicitis ?
20%
what are the two first line imaging modalities to use for a new patient presenting with jaundice as an outpatient?
ultrasound or CT with contrast
what two imaging modalities may be useful for evaluation of CBD obstruction or malignant obstruction causing jaundice?
ERCP or MRCP
t/f hepatitis is an INTRAhepatic cause of conjugated hyperbilirubinemia
true
t/f exclusively feeding with breastmilk is considered protective for GERD
true
which medication class should be used for pain from biliary colic or cholecystitis, due to trials showing equivalent pain control compared to opiates
nsaids
