Gastroenterology Flashcards
1
Q
esophageal disorders leading to narrowing will result in
A
dysphagia and weight loss
2
Q
name the causes of dysphagia (7)
A
- achalasia
- cancer
- rings/webs
- Zenker’s diverticulum
- spastic d/o’s
- scleroderma
- eosinophilic esophagitis
3
Q
- YOUNG nonsmoker
- dysphagia to solids AND liquids at the same time
- REGURGITATION of food
- ASPIRATION of previously eaten food
A
achalasia
4
Q
best INITIAL test for achalasia
A
barium swallow
5
Q
MOST ACCURATE test for achalasia
A
esophageal manometry
6
Q
endoscopy in achalasia is done for what purpose?
A
to EXCLUDE cancer
7
Q
best INITIAL treatment for achalasia
A
pneumatic dilation, or surgical myotomy
8
Q
pneumatic dilation for achalasia is done when?
A
surgical myotomy is UNSUCCESSFUL
9
Q
treatment for achalasia if pt refuses pneumatic dilation/surgical myotomy
A
botulinum toxin injection
10
Q
- dysphagia to solids THEN liquids
- +/- heme-positive stool, or ANEMIA
- often pts > 50 yoa
- smoker/drink alcohol
A
esophageal cancer
11
Q
best INITIAL test for esophageal cancer
A
endoscopy
barium swallow if endoscopy isn’t a choice
12
Q
best INITIAL treatment for esophageal cancer
A
RESECTION
13
Q
surgical resection of esophageal cancer should be followed by
A
5-fluorouracil (5-FU)
14
Q
name the causes of rings/webs causing dysphagia (3)
A
- Plummer-Vinson syndrome
- Schatzki’s ring
- peptic stricture
15
Q
best INITIAL test for rings/webs
A
barium swallow
16
Q
- PROXIMAL stricture
- IDA
- middle-aged females
A
Plummer-Vinson syndrome
17
Q
best INITIAL treatment for Plummer-Vinson syndrome
A
iron
18
Q
- DISTAL ring
- INTERMITTENT symptoms of dysphagia
A
Schatzki’s ring
19
Q
best INITIAL treatment for Schatzki’s ring
A
pneumatic dilation
20
Q
- dysphagia
- longstanding acid reflux
A
peptic stricture
21
Q
treatment for peptic stricture
A
pneumatic dilation
22
Q
- horrible bad breath from rotting food in back of esophagus
- dilation of posterior pharyngeal constrictor muscles
A
Zenker’s diverticulum
23
Q
best INITIAL test for Zenker’s diverticulum
A
barium swallow
24
Q
best INITIAL treatment for Zenker’s diverticulum
A
surgical resection
25
- dysphagia
- h/o allergies
- mean of 5 years before diagnosis is made
eosinophilic esophagitis
26
test for eosinophilic esophagitis
endoscopy w/ biopsy
27
treatment for eosinophilic esophagitis
PPT and budesonide
28
- 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
29
MOST ACCURATE test for diffuse esophageal spasm
manometry
30
barium swallow may show what during an episode of spasm in diffuse esophageal spasm
corkscrew pattern
31
treatment for diffuse esophageal spasm
- CCB
| - nitrate
32
difference between diffuse esophageal spasm and Prinzmetal's variant angina
ST segment elevation
33
- diffuse disease
| - reflux symptoms
scleroderma
34
- odynophagia
- HIV-NEGATIVE
what is the next step in management?
endoscopy
35
- odynophagia
| - HIV-POSITIVE w/ CD4 count
fluconazole
36
- odynophagia
| - HIV-POSITIVE w/ CD4 count
endoscopy
37
> 90% of esophagitis in HIV-positive pts are caused by?
Candida
38
treatment for pill esophagitis
- sit up
- drink a lot of water
- remain upright for 30 minutes after
39
- SUDDEN UGIB
- violent retching/vomiting
- there may be hematemesis or melena
Mallory-Weiss tear
40
test for Mallory-Weiss tear
endoscopy
41
treatment for Mallory-Weiss tear
most spontaneously resolve
42
treatment for Mallory-Weiss tear if bleeding does NOT resolve
endoscopic epinephrine injection
43
- epigastric pain/substernal chest pain
- sore throat
- metallic or bitter taste
- hoarseness
- chronic cough
- wheezing
- nausea
GERD!!
44
diagnosis and treatment for GERD
PPI
45
if no response to PPI for GERD symptoms, next step in management
endoscopy
46
if GERD symptoms persist and EGD is normal, next step in management
24-hour pH monitoring
47
alarm symptoms in pt w/ GERD indicating endoscopy
- weight loss
- anemia
- blood in stool
- dysphagia
- reflux for more than 5-10 years
48
- PREcancerous lesion of lower esophagus
| - 0.5%/year transform into cancer
Barrett esophagus
49
test for Barrett esophagus
endoscopy
50
endoscopic finding: Barrett esophagus (metaplasia)
next step in management
PPI and repeat EGD every 2-3 years
51
endoscopic finding: low-grade dysplasia
next step in management
PPI and repeat EGD in 3-6 months
52
endoscopic finding: high-grade dysplasia
next step in management
- endoscopic mucosal resection
- endoscopic ablation
- distal esophagectomy
53
MCC of epigastric discomfort
non-ulcer dyspepsia (diagnosis of exclusion)
54
test for non-ulcer dyspepsia
endoscopy
55
treatment for non-ulcer dyspepsia
- H2 blocker
- liquid antacid
- PPI
56
treatment for REFRACTORY non-ulcer dyspepsia
treat for Helicobacter pylori
57
MCC of peptic ulcer disease (duodenal/gastric)
H. pylori
58
after H. pylori, MCC of PUD
- NSAIDs
- head trauma
- burns
- intubation
- Crohn's disease
- Zollinger-Ellison syndrome
59
what % of GU pts develop gastric cancer?
4%
60
gastritis can be associated w/
H. pylori
61
treatment for H. pylori
- omeprazole
- clarithromycin
- amoxicillin
62
MOST ACCURATE test for gastritis
endoscopy w/ biopsy
63
treatment if initial H. pylori treatment fails
repeat triple therapy w/ 2 new abx
- PPI
- metronidazole
- tetracycline
64
if H. pylori treatment fails twice
evaluate for ZES (gastrinoma)
65
stress ulcer prophylaxis should be given to the following:
- head trauma
- intubation and mechanical ventilation
- burns
- coagulopathy AND steroid use in combination
66
- epigastric pain
- H. pylori positive
- NO ulcer or gastritis
non-ulcer dyspepsia
67
EVERYONE on an H2 blocker or PPI has an
ELEVATED GASTRIN LEVEL
68
diagnostic test ZES
gastrin level and gastric acid output
69
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
70
if gastrin level and acid output are elevated in ZES, next step
localize the gastrinoma
71
MOST ACCURATE test for ZES
secretin suppression test
72
treatment of ZES for LOCAL disease
surgical resection
73
treatment of ZES for metastatic disease
lifelong PPI
74
clue about the presence of a parathyroid problem w/ ZES, and multiple endocrine neoplasia (MEN) syndrome
hypERcalcemia
75
both CD and UC can present w/
- fever
- abdominal pain
- diarrhea
- bloody stools
- weight loss
76
extraintestinal manifestations of IBD
- joint pain
- iritis/uveitis
- pyoderma gangrenosum/erythema nodosum
- sclerosing cholangitis
77
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
78
diagnosis for CD and UC
barium swallow or endoscopy
79
when diagnosis of CD or UC, what can be helpful
blood tests
80
ASCA and ANCA in CD
ASCA POSITIVE
81
ASCA and ANCA in UC
ANCA POSITIVE
82
best INITIAL treatment for both CD and UC
mesalamine
83
adverse effects of sulfasalazine
- rash
- hemolytic anemia
- interstitial nephritis
84
treatment for acute exacerbation of CD and UC
budesonide
85
treatment for severe CD and UC w/ recurrent symptoms when steroids are STOPPED
azathioprine, or 6-mercaptopurine
86
most useful treatment for CD associated w/ FISTULA formation
infliximab
87
treatment for perianal involvement in CD
metronidazole and ciprofloxacin
88
curative treatment for UC
surgical resection of colon
89
most important feature of infectious diarrhea
presence of blood indicating invasive bacterial pathogen
90
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
91
- diarrhea
| - MCC of food poisoning
Campylobacter
92
Campylobacter can be associated w/
- Guillain-Barre syndrome
| - reactive arthritis
93
- diarrhea
| - transmitted by chickens and eggs
Salmonella
94
- diarrhea
| - associated w/ seafood
Vibrio parahaemolyticus
95
- diarrhea
- most commonly associated w/ HUS (effects of verotoxin)
- h/o undercooked beef
E. coli O157:H7
96
which treatments should be AVOIDED in HUS
platelet transfusion and antibiotics
97
- diarrhea
- associated w/ shellfish
- septicemia is MUCH more likely in pt w/ liver disease - - necrotizing wound infections can occur in skin lesions
Vibrio vulnificus
98
- diarrhea
- secretes Shiga toxin
- also, associated w/ reactive arthritis
- 2nd MCC of HUS
Shigella
99
- diarrhea
- rodents are natural reservoir
- transmission is through food contaminated w/ infected urine/feces
Yersinia
100
diarrhea, which may be associated w/ liver abscesses
amoeba
101
best INITIAL test for infectious diarrhea
fecal leukocytes
102
MOST ACCURATE test for infectious diarrhea
stool culture
103
treatment for infectious diarrhea: mild disease
none; will resolve on its own
104
best INITIAL treatment for infectious diarrhea: severe disease
fluoroquinolones
105
severe infectious diarrhea is defined as having the following
- blood
- fever
- abdominal pain
- hypotension and tachycardia
106
infectious diarrhea (which NEVER presents w/ blood) may be d/t which pathogens?
- viruses
- Giardia
- Staphylococcus aureus
- Bacillus cereus
- Cryptosporidium
- Scombroid
107
- diarrhea
- camping/hiking
- men who have sex w/ men
- bloating, flatus, signs of steatorrhea
Giardia
108
more accurate test for Giardia
stool ELISA Ag
109
treatment for Giardia
metronidazole or tinidazole
110
- diarrhea
| - associated with mayonnaise and vomiting
Staphylococcus aureus
111
- diarrhea
| - associated w/ refried Chinese rice and vomiting
Bacillus cereus
112
- diarrhea
| - HIV-positive pt w/ CD4 cells
Cryptosporidium
113
test for Cryptosporidium
modified acid-fast stain
114
treatment for Cryptosporidium
HAART and nitazoxanide
115
- diarrhea
- histamine fish poisoning
- FASTEST onset diarrhea, w/i 10 MINUTES
- vomiting, wheezing, flushing
Scombroid
116
treatment for Scombroid
diphenhydramine
117
- antibiotic-associated diarrhea
| - develops several days to weeks after abx use
Clostridium difficile
118
best INITIAL test Clostridium difficile diarrhea
stool toxin assay
119
initial treatment for mild/moderate CDI
PO metronidazole or PO vancomycin
120
treatment for severe CDI
PO vancomycin +/- IV metronidazole
121
definition of severe CDI
- WBCs > 15,000
| - serum albumin
122
treatment for complicated CDI
- PO vancomycin and IV metronidazole
| - surgery consult
123
definition of complicated CDI
- toxic megacolon
- peritonitis
- respiratory distress
- hemodynamic instability
124
alternate treatment for severe and recurrent CDI
fidaxomicin
125
chronic diarrhea (> 4 weeks) causes
- lactose intolerance
- carcinoid syndrome
- IBD
126
MCC of chronic diarrhea and flatulence
lactose intolerance
127
chronic diarrhea associated w/ flushing and episodes of hypotension
carcinoid syndrome
128
test for carcinoid syndrome
urinary 5-HIAA level
129
treatment for carcinoid syndrome
octreotide (somatostatin analog)
130
chronic diarrhea w/ blood in stools, fever, and weight loss
IBD
131
- chronic diarrhea ALWAYS associated w/ weight loss
malabsorption
132
name the causes of malabsorption (4)
1. celiac disease (gluten sensitive enteropathy)
2. tropical sprue
3. chronic pancreatitis
4. Whipple's disease
133
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
134
best INITIAL test for malabsorption
Sudan black stain for stool
135
MOST SENSITIVE test for malabsorption
72-hour fecal fat
136
- iron malabsorption and microcytic anemia
- folate malabsorption
- dermatitis herpetiformis
celiac disease
137
best INITIAL tests for celiac disease
- anti-gliadin Ab
- anti-endomysial Ab
- anti-tissue transglutaminase Ab
138
MOST ACCURATE test for celiac disease
small bowel biopsy
139
D-xylose test result in celiac disease, Whipple's disease, and tropical sprue
ABNORMAL (villous lining is destroyed)
140
what test should be done even if diagnosis of celiac disease has been confirmed?
small bowel biopsy to EXCLUDE bowel wall lymphoma
141
treatment for celiac disease
gluten free diet
142
MOST ACCURATE test for tropical sprue
small bowel biopsy showing microorganisms
143
treatment for tropical sprue
doxycycline, or TMP/SMX for 3-6 MONTHS
144
- malabsorption
- arthralgia (MCC presenting symptom)
- neurological abnormalities
- ocular findings
Whipple's disease
145
MOST ACCURATE test for Whipple's disease
small bowel biopsy showing PAS POSITIVE organisms
146
treatment for Whipple's disease
tetracycline, or TMP/SMX for 12 MONTHS
147
- malabsorption
- h/o alcoholism
- h/o multiple episodes of pancreatitis
- amylase/lipase will most likely be normal
chronic pancreatitis
148
best INITIAL tests for chronic pancreatitis
- abdominal XR (pancreatic calcifications)
| - CT scan of abdomen
149
MOST ACCURATE test for chronic pancreatitis
secretin stimulation testing
150
D-xylose test in chronic pancreatitis will be
NORMAL
151
treatment for chronic pancreatitis
pancreatic enzymes
152
- abdominal pain relieved by BM
- abdominal pain that's less at night
- abdominal pain w/ diarrhea alternating w/ constipation
irritable bowel syndrome (IBS)
153
all diagnostic tests for IBS will be?
normal
154
best INITIAL treatment for IBS
fiber
155
if fiber does not relieve pain in IBS, next treatment
- dicyclomine
| - hyoscyamine
156
if fiber, and dicyclomine don't work for IBS, last resort treatment
TCA
157
colonoscopy screening: general population
- begin at 50 yoa
| - repeat every 10 years
158
colonoscopy screening: 1 family member w/ colon cancer
- begin at 40 yoa, OR 10 years before age of family member who had cancer
159
colonoscopy screening: 3 family members, 2 generations, or 1 premature (
- begin at 25 yoa
| - repeat every 1-2 years
160
colonoscopy screening: FAP
- begin sigmoidoscopies at 12 yoa
| - COLECTOMY once polyps are found
161
- colon polyps
| - osteomas (benign bone tumors)
Gardner's syndrome
162
- hamartomatous polyps throughout small bowel and colon
| - melanotic spots on lips
Peutz-Jeghers syndrome
163
- multiple extra hamartomas in bowel
| - no significant increase in cancer risk
juvenile polyposis
164
colonoscopy screening: DYSplastic polyp found
repeat colonoscopy every 3-5 years after polyp was found
165
- LLQ abdominal pain
| - LGIB
diverticulosis
166
MOST ACCURATE test for diverticulosis
barium enema
167
- complication of diverticulosis
- LLQ abdominal pain
- TENDERNESS
- FEVER
- ELEVATED WBC COUNT
diverticulitis
168
best test for diverticulitis
CT scan of abd/pelvis
169
is CI in diverticulitis d/t increased risk of perforation
colonoscopy
170
treatment for diverticulosis
high-fiber diet
171
treatment for diverticulitis
antibiotics against GNR and anaerobes
metronidazole and ciprofloxacin
172
GI bleed: red blood
LGIB
173
GI bleed: black stool
UGIB (when proximal to ligament of Treitz (duodenum/jejunum))
174
MOST important step in managing an acute GI bleed
determine if pt is hemodynamically unstable
175
GI bleed management:
when do I transfuse PRBCs?
- Hct
176
GI bleed management:
when do I transfuse FFP?
elevated PT/INR and vitamin K is too slow
177
GI bleed management:
when do I transfuse platelets?
- if pt is bleeding/undergo surgery w/ platelets
178
MCC of death in GI bleeding
myocardial ischemia
179
what should be ordered on an older pt w/ GI bleeding?
EKG to r/o ischemia
180
most important treatment for acute GI bleeding
fluid resuscitation
181
most important measure of severity of GI bleeding
pulse and BP
182
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
183
more important in GI bleed than endoscopy
correcting anemia, thrombocytopenia, or coagulopathy
184
with adequate fluid resuscitation, even w/o endoscopy 80% of GI bleeds
stop bleeding
185
should be added to initial fluid resuscitation if GI bleed is d/t ulcer disease
PPI
186
unnecessary stress ulcer ppx w/ PPIs increases risk of
pneumonia and Clostridium difficile colitis
187
- alcoholic and/or cirrhosis w/ hematemesis
- splenomegaly
- thrombocytopenia
- spider angiomata
- gynecomastia
variceal bleeding
188
should be added to initial fluid resuscitation if GI bleed is d/t variceal bleeding
octreotide (somatostatin analog)
| decreases portal hypertension
189
treatment for variceal bleeding aside from fluid resuscitation and octreotide
EGD to do banding
190
if variceal bleeding PERSISTS, next step in management
transjugular intrahepatic portosystemic shunt (TIPS)
| shunt between PORTAL vein and HEPATIC vein
191
MC complication of transjugular intrahepatic portosystemic shunt (TIPS) procedure
hepatic encephalopathy
192
prevents future episodes of variceal bleeding
propranolol
193
temporary measure to stop variceal bleeding to allow time for a shunt to be placed
Blakemore gastric tamponade balloon
194
UPPER GIB can have the following causes: (6)
1. PUD
2. esophagitis
3. gastritis
4. duodenitis
5. varices
6. cancer
195
LOWER GIB can have the following causes: (6)
1. angiodysplasia
2. diverticular disease
3. polyps
4. ischemic colitis
5. inflammatory bowel disease
6. cancer
196
- test performed to detect site of bleeding IF endoscopy cannot
- gives you location, but not exact cause
tagged red cell scan
| technetium bleeding scan
197
- 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
198
can detect location of GIB from SMALL BOWEL, IF upper and lower endoscopies cannot
capsule endoscopy
199
- 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
200
look for what on blood tests of acute mesenteric ischemia
- metabolic acidosis (elevated lactic acid d/t ischemia)
| - elevated amylase level
201
MOST ACCURATE test for acute mesenteric ischemia
angiography
202
treatment for acute mesenteric ischemia
surgical resection of bowel
| surgical emergency
203
treatment in mesenteric ischemia NOT caused by emboli
treat underlying flow state
204
management of constipation
correct underlying cause
205
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)
206
differentiating between UGIB and black stool d/t ferrous sulfate iron replacement
blood is cathartic causing RAPID BM
207
treatment of constipation
hydration and increased fiber
208
- prior gastric surgery
- SHAKING, SWEATING, WEAKNESS
- +/- hypotension
dumping syndrome
209
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
210
management of dumping syndrome
frequent small meals
211
- longstanding diabetes
- bloating
- constipation
- diarrhea
gastroparesis
212
mechanism of gastroparesis
- main stimulant to gastric motility is DISTENSION
| - DM damages sensory nerves
213
treatment for gastroparesis
- erythromycin
| - metoclopramide
214
mechanism of erythromycin in gastroparesis
increases motilin in gut (hormone that stimulates gastric motility)
215
- severe midepigastric abdominal pain and tenderness
- MCC are alcohol and gallstones
- vomiting w/o blood
- anorexia
acute pancreatitis
216
other causes of acute pancreatitis
- hypertriglyceridemia
- trauma
- infection
- ERCP
- medications (thiazides, didanosine, stavudine, azathioprine)
217
severe acute pancreatitis signs and lab findings
- hypotension
- metabolic acidosis
- leukocytosis
- hemoconcentration
- hyperglycemia
- hypocalcemia
- hypoxia
218
best INITIAL test for acute pancreatitis
amylase and lipase
219
MOST ACCURATE test for acute pancreatitis
CT scan of abdomen
220
detects causes of biliary and pancreatic duct obstruction not found on CT scan
MRCP
221
- consider if there is dilation of CBD WITHOUT pancreatic head mass
- detects presence of stones/strictures
- can REMOVE stones and DILATE strictures
ERCP
222
urinary test used to determine severity of pancreatitis
trypsinogen activation peptide
223
treatment for acute pancreatitis
- no feeding (bowel rest)
- hydration
- pain medications
224
most precise method of determining pancreatitis severity
CT scan
225
Ranson's criteria and CT scan are methods to determine which patients require
pancreatic debridement
226
when the CT scan shows > 30% NECROSIS of pancreas, the pt should:
- receive abx such as imipenem, and
| - undergo CT-guided biopsy
227
if biopsy shows INFECTED, NECROTIC pancreatitis, pt should undergo
surgical debridement
228
hepatitis B is associated w/ what in 30% of cases
polyarteritis nodosa (PAN)
229
hepatitis C is associated w/
cryoglobulinemia
230
- jaundice
- fatigue
- weight loss
- dark urine (bilirubin)
acute hepatitis
231
- jaundice
- fatigue
- weight loss
- dark urine (bilirubin)
- present w/ serum sickness-phenomena (joint pain, urticaria, and fever)
hepatitis B and C
232
hepatitis E is most severe in
pregnant females (can be fatal)
233
ALL patients w/ acute hepatitis will have an ELEVATED?
conjugated (direct) bilirubin
234
viraL hepatitis gives an ELEVATED
aLt
235
hepatitis from drugS gives and ELEVATED
aSt
236
MOST ACCURATE tests for hepatitis A, C, D, and E
serology
237
MOST ACCURATE tests for hepatitis B
- surface Ag
- core Ab
- e-Ag
- surface Ab
238
FIRST test to become abnormal in ACUTE hepatitis B infection
SURFACE Ag
239
ALT elevation, e-Ag, and symptoms all occur AFTER
SURFACE Ag
240
CHRONIC hepatitis B gives same serologic pattern as acute hepatitis B, but has
PERSISTENCE OF SURFACE AG > 6 MONTHS
241
ONLY acute hepatitis that CAN be treated
hepatitis C
242
best INITIAL test for acute hepatitis C
hepatitis C Ab
243
MOST ACCURATE tests for acute hepatitis C
- hepatitis C PCR
| - liver biopsy
244
MOST ACCURATE way of determining response to treatment for acute hepatitis C, which is based on GENOTYPE
hepatitis C PCR
245
MOST ACCURATE way to determine extent of liver damage in acute hepatitis C
liver biopsy
246
treatment for acute hepatitis C
interferon, ribavirin, and PI (ledipasvir, simeprevir, or sofosbuvir)
247
treatment for chronic hepatitis B
single agent!
- lamivudine
- adefovir
- entecavir
- telbivudine
- tenofovir
- interferon
248
MC adverse effect of ribavirin
anemia
249
treatment of chronic hepatitis C genotype 1
ledipasvir and sofosbuvir
250
treatment of chronic hepatitis C all other genotypes
- simeprevir
| - boceprevir
251
MC reason to need liver transplantation in USA
chronic hepatitis C
252
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
253
specific indication for hepatitis A vaccination
travelers
254
specific indications for hepatitis B vaccination
- health care workers
- dialysis pts
- DM pts
255
- edema from low oncotic pressure
- gynecomastia
- palmar erythema
- splenomegaly
- thrombocytopenia from splenic sequestration
- encephalopathy
- ascites
- esophageal varices
cirrhosis
256
treatment for edema from low oncotic pressure in cirrhosis pts
spironolactone and diuretics
257
treatment for encephalopathy in cirrhosis pts
lactulose
258
treatment for ascites in cirrhosis pts
spironolactone
259
treatment for esophageal varices in cirrhosis pts
- propranolol to prevent bleeding
| - banding to stop acute bleeding
260
what should be done in the following?
- new ascites
- pt w/ ascites develops pain, fever, or tenderness
paracentesis
261
if serum-to-ascites albumin GRADIENT (SAAG) is > 1.1
- portal hypertension from cirrhosis
| - CHF
262
neutrophils > 250 on paracentesis
spontaneous bacterial peritonitis (SBP)
263
treatment for spontaneous bacterial peritonitis (SBP)
cefotaxime
264
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)
265
- diagnosis of exclusion
| - longstanding h/o alcohol abuse
alcoholic cirrhosis
266
- middle-aged FEMALE c/o itching
- +/- xanthelasma (cholesterol deposit)
- may have h/o AI d/o's
primary biliary cholangitis
267
best INITIAL test for primary biliary cholangitis
elevated alkaline phosphatase w/ a NORMAL bilirubin level
268
MOST ACCURATE tests for primary biliary cholangitis
- anti-mitochondrial Ab (AMA)
| - liver biopsy
269
treatment for primary biliary cholangitis
ursodeoxycholic acid
270
- associated w/ 80% of IBD cases
- also presents w/ itching
- elevated alkaline phosphatase
- ELEVATED BILIRUBIN level
primary sclerosing cholangitis
271
MOST ACCURATE tests for primary sclerosing cholangitis
- ERCP (shows "beading" of biliary system)
- anti-smooth muscle Ab (ASMA)
- ANCA positive
272
treatment for primary sclerosing cholangitis
ursodeoxycholic acid
273
- liver disease
- choreiform movement d/o
- neuropsychiatric abnormalities
- hemolysis
Wilson's disease
274
best INITIAL test for Wilson's disease
slit lamp looking for Kayser Fleischer rings
| on CCS check for low ceruloplasmin level as well
275
MOST ACCURATE test for Wilson's disease
liver biopsy
276
treatment for Wilson's disease
penicillamine, or trientine
277
most often caused by a genetic d/o causing overabsorption of iron
hemochromatosis
278
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
279
best INITIAL test for hemochromatosis
- ELEVATED SERUM IRON
- ELEVATED FERRITIN
- LOW TIBC
- EXTREMELY ELEVATED IRON SATURATION (> 45%)
280
MOST ACCURATE test for hemochromatosis
liver biopsy
281
what, in combination, are sufficient for diagnosis of hemochromatosis?
MRI of liver, AND HFe gene mutation
282
treatment for hemochromatosis
phlebotomy
283
- young female w/ other AI diseases
| - liver disease
autoimmune hepatitis
284
best INITIAL tests for autoimmune hepatitis
- ANA
- anti-smooth muscle Ab (ASMA)
- SPEP
285
MOST ACCURATE test for autoimmune hepatitis
liver biopsy
286
treatment for autoimmune hepatitis
- prednisone
| - azathioprine for steroid-sparing medication
287
- strongly associated w/ obesity, DM, hyperlipidemia
| - hepatomegaly
nonalcoholic steatohepatitis (NASH)
288
best INITIAL test for nonalcoholic steatohepatitis (NASH)
ALT > AST
289
MOST ACCURATE test for nonalcoholic steatohepatitis (NASH)
liver biopsy showing fatty infiltration
| looks just like alcoholic liver disease
290
treatment for nonalcoholic steatohepatitis (NASH)
control underlying causes (weight loss, DM control, DLD management)
