Gastroenterology Flashcards
Severe secretory diarrhea and flushing. (1) What is diagnosis? (2) What test would you order
(1) Carcinoid Syndrome (2) 24-hr urinary excretion of 5-HIAA
Whipple Disease
- symptoms
- how to diagnose
- length of treatment
- arthralgia, fever, neurologic, ocular, cardiac disease
- small bowel biopsy and PCR for Tropheryma whippelii
- Antibiotics for 12 months (1 year)
When to use SBT prophylaxis in cirrhosis with ascites?
Total prot <1.5 g/dL PLUS one: - Na =/<130 - Cr =/> 1.2 mg/dL - BUN =/>25 - Tbili =/> 3 mg/dL - Child Pugh class B or C
Treatment of amebic liver abscess
Metronidazole and paromycin
Treatment of functional dyspepsia
TCA (>SSRI, SNRI)
Must have at least 4 week trial of PPI, negative h pylori, no structural disease
What is Meltzer triad? Significance? Treatment ?
asthenia (weak/lack energy), arthralgia, and palpable purpura—which is the classic presentation of type II mixed cryoglobulinemia, a vasculitis that most often arises in the context of chronic hepatitis C virus (HCV) infection. Treat HCV!
Harvoni= sofosbuvir-ledipasvir. (to treat genotype 1 HCV include grazoprevir-elbasvir; paritaprevir-ritonavir, ombitasvir, and dasabuvir; glecaprevir-pibrentasvir; sofosbuvir-daclatasvir; and sofosbuvir-velpatasvir.)
Tx of microscopic colitis ? (Lymphocytic or collagenous)
- DC offending agent - NSAID, SSRI, PPI
- Supportive - loperamide, bismuth
- Budesonide
No increased risk of cancer
Melanosis Coli
Benign pigmentation of the colon caused by chronic senna use
Indication for colon resection in diverticulitis?
After 2nd episode. As risk of subsequent attacks increase by 50%
When is HBIG + Hep B vaccine indicated?
- Post exposure prophylaxis after needle stick injury
- for sexual and household contacts of patients with HBV
When to treat for HBV? What to use for treatment?
Tenofovir (preferred) or entecavir
pgylated interferon can be used in patients without cirrhosis, with high ALT, low HBV DNA levels
(Treat when elevated AST/ALT and HbeAg+ (with HBV dna >20,000) or HBeAg - (with HBV dna >2,000)
What disease is associated with Leukocytoclastic vasculitis?
HCV! (Palpable purpura).
When is prednisolone indicated for alcoholic hepatitis?
When is it contraindicated?
- MDF (maddery discriminators function) >/= 32 ..or..
- MELD >/= 18 …or…
- encephalopathy and ascites
——————
Don’t use if - AH + GIB, infection, pancreatitis, or kidney disease
autoimmune hepatitis
- demographic
- possible Antibodies
- Treatment?
- females 20-40yo
- *ANA, *anti smooth muscle (also p-ANCA, anti-LKM I antibody)
- Tx glucocorticoids and azathioprine
(Hint* high serum prot + low serum albumin = elevated serum gamma globulin, may be only clue to hypergammaglobulinemia)
which joints affected in Hemochromatosis?
What are other symptoms
2nd and 3rd MCP - destructive arthropathy with hook-like osteophytes
(ED, fatigue, DM, HF, hyperpigmentation (bronze skin), panhypopit)
