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Gastrointestinal Flashcards

1
Q

What is oropharyngeal dysphagia?

A

Problem of initiating swallowing

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2
Q

What is the treatment for oral HSV?

A

Acyclovir

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3
Q

What is the treatment for oral CMV?

A

Ganciclovir

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4
Q

What is the treatment for oral thrush?

A

Fluconazole PO and/or nystatin mouth rinses

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5
Q

What worsens and improves s/sx of esophageal spasms?

A

Worse with hot/cold foods, better with NTG

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6
Q

What are the typical s/sx of esophageal spasms?

A

Chest pain
GERD
Dysphagia
Odynophagia

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7
Q

What are the diagnostic test of choice for esophageal spasms? What do they reveal?

A

Ba swallow–Corkscrew shaped esophagus

Manometry–High amplitude, simultaneous contractions in greater than 20% of swallows

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8
Q

Corkscrew shaped esophagus on Ba swallow = ?

A

Esophageal spasm

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9
Q

What is the pharmacologic treatment for esophageal spasms? (3)

A

CCBs
TCAs
Nitrates

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10
Q

What is the treatment for severe esophageal spasms?

A

Esophageal myotomy

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11
Q

What is achalasia?

A

Impaired relaxation phase of the lower esophageal sphincter and loss of peristalsis

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12
Q

What is the etiologic of achalasia?

A

Degeneration of the inhibitory neurons in the myenteric plexus

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13
Q

What are the s/sx of achalasia?

A

Progressive dysphagia for solids and liquids

Regurgitation of food

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14
Q

What are the tests to diagnose achalasia?

A

EGD to r/o structural causes

Ba swallow

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15
Q

What will a Ba swallow show with achalasia?

A

Bird’s beak tapering of the distal esophagus

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16
Q

What will manometry show with achalasia?

A

Increased resting pressure of the LES

Incomplete LES relaxation

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17
Q

What is the short term pharmacologic treatment for achalasia?

A

Nitrates
CCBs
Endoscopic injection of botulinum toxin

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18
Q

What is the definitive treatment for achalasia?

A

Pneumatic balloon dilation or surgical myotomy

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19
Q

Is a Zenker diverticulum a true or false diverticulum?

A

False

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20
Q

Where does a Zenker diverticulum occur?

A

Through the cricopharyngeus muscle

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21
Q

What is the treatment for a Zenker diverticulum?

A

Myotomy

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22
Q

What is the most common type of esophageal cancer worldwide?

A

SCC

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23
Q

What is the most common type of esophageal cancer in developed nations?

A

Adenocarcinoma

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24
Q

What is SCC of the esophagus associated with?

A

EtOH
Smoking
Nitrosamines
Hot tea

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25
Q

What is the role of CT and endoscopic US in the workup of esophageal cancer?

A

Stagins

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26
Q

What is the treatment for esophageal cancer?

A

Chemoradiation and surgical resection

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27
Q

What is the prognosis for esophageal cancer in general?

A

Poor

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28
Q

Where in the esophagus does SCC vs adenocarcinoma generally occur?

A

SCC in the upper and middle thirds

Adenocarcinoma in the lower third

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29
Q

Why does esophageal cancer metastasize early?

A

Because the esophagus lacks a serosa

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30
Q

What is the cause of GERD?

A

Transient relaxation of the LES

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31
Q

True or false: GERD is a result of infection with H.Pylori

A

False–from relaxation of the LES

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32
Q

When is an EGD indicated in the workup of GERD? (3)

A

Refractory to medical treatment
Long standing
Associated with alarm s/sx

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33
Q

What is the definitive test for GERD?

A

24 hours pH monitoring with impedance

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34
Q

What is a sliding hiatal hernia?

A

GE junction and a portion of the stomach are displaced above the diaphragm

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35
Q

What is a paraesophageal hiatal hernia?

A

Just fundus herniates into the thorax

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36
Q

What are the symptoms of a hiatal hernia when symptomatic?

A

GERD

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37
Q

What is the treatment for a sliding hiatal hernia?

A

Medical therapy and lifestyle modifications

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38
Q

What is the treatment for a paraesophageal hernia?

A

Surgical gastropexy

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39
Q

What is type A chronic gastritis?

A

Autoantibodies to the parietal cells, causing pernicious anemia

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40
Q

What is type B chronic gastritis?

A

H/ Pylori infection

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41
Q

What are the s/sx of chronic gastritis, if present? (4)

A

Epigastric pain
N/v
Hematemesis
Melena

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42
Q

What are the components of triple therapy for H. pylori infection?

A

PPI
Amoxicillin
Clarithromycin

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43
Q

What are curling ulcers?

A

educed plasma volume leads to ischemia and cell necrosis

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44
Q

What are cushing ulcers?

A

Increased ICP causes vagal stimulation, leading to increased H+ output

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45
Q

What is the downside of using H/pylori antibody test for H. pylori infection?

A

Once infected, alway positive

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46
Q

A gastric adenocarcinoma that metastasizes to the ovary is called what?

A

Krukenberg tumor

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47
Q

What is the gold standard test for H. Pylori infection?

A

Endoscopic bx

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48
Q

What is the test that has both a high sensitivity and specificity for H. Pylori?

A

Stool antigen test

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49
Q

What is the only malignancy that can be cured by abx?

A

MALT lymphoma (from H. Pylori)

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50
Q

What cancer develops from chronic H. pylori infection?

A

MALT lymphoma

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51
Q

What is the most common type of gastric cancer, and what are the predisposing factors for it?

A

Adenocarcinoma

Diet high in nitrates and salt, low in fresh veggies

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52
Q

What is the definitive test for gastric cancer?

A

Bx

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53
Q

What is the treatment for gastric cancer?

A

Surgical resection

Very poor prognosis if metastasized

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54
Q

What are the two PE findings that classically suggest gastric cancer?

A

Virchow’s node

Sister mary joseph node

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55
Q

If you suspect a ulcer perforation 2/2 PUD, what study should you order?

A

AXR

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56
Q

What study should be done to r/o bleeding PUD?

A

Serial hematocrits

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57
Q

What is the treatment for an actively bleeding PUD? (4)

A

NG lavage
IVFs
IV PPIs
Urgent EGD

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58
Q

PUDs on the posterior aspect of the stomach risk which artery?

A

Gastroduodenal artery

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59
Q

How do you diagnose Zollinger-Ellison syndrome?

A

Increased fasting serum gastrin levels

Increased gastrin with administration of secretin

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60
Q

What is the treatment for Zollinger-Ellison syndrome?

A

high dose PPIs

Surgical resection

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61
Q

What drug can help patients with PUD who need an NSAID?

A

Misoprostol

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62
Q

What is the technical definition of diarrhea?

A

Production of more than 200g of fecal matter per day, along with liquidity of stool

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63
Q

What is the equation for stool osmotic gap? Normal range?

A

290 - 2*(Stool Na + stool K)

50-100

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64
Q

What are the three viruses that commonly cause pediatric diarrhea?

A

Rotavirus
Norwalk virus
Enterovirus

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65
Q

What defines chronic diarrhea?

A

Insidious onset over 4 weeks in duration

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66
Q

What are the two major, non-infectious causes of secretory diarrhea?

A

VIPomas

Carcinoid tumors

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67
Q

When does acute diarrhea warrant a further workup? (3)

A

Over 4-5 days
Bloody
Associated with a high fever

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68
Q

Watery or bloody diarrhea: Vibrio cholera

A

Water

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69
Q

Watery or bloody diarrhea: rotavirus

A

Watery

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70
Q

Watery or bloody diarrhea: Cryptosporidium

A

Watery

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71
Q

Watery or bloody diarrhea: norovirus

A

Watery

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72
Q

Watery or bloody diarrhea: Salmonella

A

Bloody

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73
Q

Watery or bloody diarrhea: Shigella

A

Bloody

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74
Q

Watery or bloody diarrhea: campylobacter

A

Bloody

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75
Q

Watery or bloody diarrhea: giardia

A

Watery

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76
Q

Low stool osmotic gap suggest what etiology of diarrhea?

A

Secretory diarrhea

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77
Q

High stool osmotic gap suggest what etiology of diarrhea?

A

Osmotic diarrhea

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78
Q

What is the most common etiology of bacterial diarrhea?

A

Campylobacter

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79
Q

What is the treatment for campylobacter diarrhea?

A

Supportive, then fluoroquinolones if severe

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80
Q

What is the abx that is often associated as the cause of C.diff?

A

Clindamycin

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81
Q

What is the major complication of C.Diff?

A

Toxic megacolon

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82
Q

Flask-shaped ulcers on endoscopy = ?

A

Entamoeba histolytica

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83
Q

Steroids + entamoeba histolytica = ?

A

Perforation

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84
Q

What is the treatment for entamoeba histolytica?

A

Metronidazole

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85
Q

What are the s/sx of entamoeba histolytica infection?

A

Fever and bloody diarrhea

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86
Q

What is the treatment for E.coli O157:H7?

A

Supportive–abx may precipitate HUS

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87
Q

What classically causes salmonella infection?

A

Ingestion of uncooked eggs

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88
Q

What are the prodromal s/sx of salmonella infection?

A

Abdominal pain, Fever, n/v

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89
Q

What complication may sickle cell patients get from a salmonella infection?

A

Osteomyelitis

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90
Q

What is the treatment for Salmonella?

A

IVFs

Treat bacteremia with TMP-SMX

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91
Q

How contagious is shigella?

A

Extremely

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92
Q

What is the treatment for shigella?

A

TMP-SMX

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93
Q

What are the complications that can arise from shigella infection?

A

Severe dehydration

Seizures in children

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94
Q

When are antidiarrheal medication contraindicated in the treatment of diarrhea?

A

If bloody

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95
Q

What are the two antibody tests for celiac disease?

A

IgA anti-transglutaminase or antiendomysial

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96
Q

In what part of the intestines are bile salt reabsorbed?

A

terminal ileum

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97
Q

Why do patients with carcinoid syndrome develop pellagra?

A

Tryptophan is metabolized into serotonin

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98
Q

Why do patients with hartnup disease develop pellagra?

A

Tryptophan needed to make niacin

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99
Q

What are the four D’s of pellagra?

A

Diarrhea
Dermatitis
Dementia
Death

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100
Q

What is the diagnostic test for lactase deficiency?

A

hydrogen breath test reveals increase hydrogen

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101
Q

Where do carcinoid tumors usually develop?

A

Ileum

Appendix

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102
Q

What are the s/sx of carcinoid tumors?

A 
Cutaneous flushing
Diarrhea
Abdominal cramp
Wheezing
Right sided cardiac valve lesions
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103
Q

How do you diagnose carcinoid syndrome?

A

High urine levels of serotonin metabolite 5-HIAA

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104
Q

What is the treatment for carcinoid syndrome?

A

Octreotide, and surgical resection

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105
Q

What is the classic presentation of IBS?

A

Abdominal s/sx that improve with defecation

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106
Q

true or false: IBS s/sx usually awaken patients from sleep

A

False

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107
Q

What are the diagnostic criteria for IBS?

A

At least 3 days in 3 months of episodic abdominal discomfort that is:

  1. relieved by defecation
  2. associated with a change in stool frequency or consistency
  3. associated with a change in stool appearance
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108
Q

What is the dietary and pharmacologic treatment for IBS?

A

high fiber

SSRIs and TCAs

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109
Q

what are the top two causes of SBOs?

A

Adhesions (60%)

Hernias (15%)

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110
Q

What is the difference between a partial SBO vs a complete SBO

A

Partial still allows the passage of flatus but no stool

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111
Q

What are the s/sx of a SBO?

A

Crampy abdominal pain every 4-5 minutes

Vomiting

112
Q

What are the PE findings of an SBO? (4)

A

Distention
TTP
hyperactive bowel sounds
High pitched tinkles and peristaltic rushes

113
Q

What are the complications of an SBO?

A

Ischemic necrosis and/or bowel rupture

114
Q

Where does the gallstone lodge in a gallstone ileus?

A

Ileocecal valve

115
Q

Abdominal plain films in an SBO reveal what?

A

Stepladder pattern of dilated small bowel loops

Air fluid levels

116
Q

What might a CBC show with an SBO?

A

Leukocytosis

117
Q

What will a BMP show with an SBO?

A

Dehydration and metabolic alkalosis

118
Q

What is the treatment for a partial SBO?

A

IVFs
NPO
NG suction

119
Q

What is the treatment for a complete SBO?

A

Exploratory laparotomy

120
Q

What is an ileus?

A

Loss of peristaltic action of the bowel, without obstruction

121
Q

What are the s/sx of an ileus?

A

n/v

Absence of flatus or bowel movements

122
Q

What will an ileus show on exam?

A

Diffuse TTP
Abdominal distention
Decreased or absent bowel sounds

123
Q

What must be done to r/o fecal impaction in elderly patients suspected of having an ileus?

A

DRE

124
Q

What will plain films show with an ileus?

A

Distended loops of small and large bowel, with air seen throughout small and large bowel

125
Q

What is the treatment for an ileus?

A

bowel rest
NG suction
Supportive

126
Q

What is the most common cause of mesenteric ischemia?

A

Embolism from the heart

127
Q

Which vessel is most commonly affected by thrombosis in mesenteric ischemia?

A

SMA

128
Q

What is the classic history of mesenteric ischemia?

A

Pain out of proportion to exam findings

129
Q

How do you diagnose mesenteric ischemia?

A

AXR and CT

130
Q

What is the classic radiographic findings of mesenteric ischemia?

A

Thumbprint sign and air within the bowel wall

131
Q

What is the treatment for mesenteric ischemia?

A

IVFs
Anticoagulation
Resect infarcted bowel

132
Q

What is the most common cause of acute lower GI bleed in patients over 40 yo?

A

Diverticulosis

133
Q

Where in the bowel are most diverticula found?

A

Sigmoid colon

134
Q

What type of diet predisposes to diverticular disease?

A

low fiber

High fat

135
Q

What is the classic presentation of diverticulitis?

A

LLQ abdominal pain, fever and bleeding

136
Q

Why is colonoscopy/sigmoidoscopy contraindicated in acute diverticulitis?

A

risk of perforation

137
Q

What is the treatment for uncomplicated diverticulosis?

A

f/u and prescribe fiber diet

138
Q

What is the treatment for bleeding diverticulitis?

A

Bleeding usually stops spontaneously. Surgery or colonoscopy if not

139
Q

What is the treatment for acute diverticulitis?

A

NPO

Broad spectrum Abx

140
Q

What is the treatment for a perforated bowel?

A

Surgery

141
Q

Which has more emesis: SBO or LBO?

A

SBO

142
Q

SBO or LBO: feculent emesis

A

LBO

143
Q

SBO or LBO: high pitched :tinkling’ bowel sounds

A

Both

144
Q

What is the usual etiology of SBOs?

A

Adhesions

145
Q

What is the usual etiology of LBOs?

A

Neoplasms

146
Q

True or false: assume the cause of a LBO is colon cancer until proven otherwise

A

True

147
Q

What is the treatment for a SBO?

A

NG decompression

Surgical correction PRN

148
Q

What is the treatment for a LBO?

A

Rectal tubes

Surgery

149
Q

What enema may relieve a bowel obstruction?

A

Gastrografin

150
Q

How are most right sided colon cancers discovered?

A

Anemia or occult blood

151
Q

What are the s/sx of left sided colon cancer?

A

Apple core obstructing lesions
Pencil thin stools
Constipation/obstipation

152
Q

What is the definitive way to diagnose colon cancer?

A

Colonoscopy

153
Q

Which has a higher propensity to develop colon cancer: UC or CD?

A

UC

154
Q

What is the order of decreasing cancer risk of colonic lesions?

A

Villous > tubular; sessile > pedunculated.

155
Q

What is ischemic colitis? What part of the colon is usually affected?

A

Insufficient blood supply to the colon

Usually the watershed areas of the left colon

156
Q

What are the s/sx of ischemic colitis?

A

Crampy lower abdominal pain, followed by bloody diarrhea

157
Q

How do you diagnose Ischemic colitis?

A

CT w/ contrast

Colonoscopy

158
Q

What will a CT show with ischemic colitis?

A

Thickened bowel wall,

artherosclerosis

159
Q

What will a colonoscopy show with ischemic colitis?

A

pale mucosa with petechial bleeding

160
Q

How often do patients with UC need to get colonoscopies?

A

every 1-2 years starting 8-10 years after diagnosis

161
Q

How often do patients with first degree relatives with colon cancer need to get colonoscopies?

A

q5 years starting at age 40

162
Q

What is the treatment for ischemic colitis?

A

Supportive

Surgical resection if infarcted bowel

163
Q

What is the treatment for either an upper or lower GI bleed?

A

Protect airway

Stabilize with IVFs, and pRBCs PRN

164
Q

What are the boundaries of Hesselbach’s triangle?

A

Inguinal ligament
Inferior epigastric artery
Rectus abdominus

165
Q

What part of the colon is always involved in UC?

A

Rectum

166
Q

Which has continuous lesions: UC or CD

A

UC

167
Q

What is the major symptom with UC?

A

Bloody diarrhea

168
Q

What are the major symptoms with CD?

A

Abdominal pain, weight loss, water diarrhea

169
Q

What has the association with primary sclerosing cholangitis: CD or UC

A

UC

170
Q

What are the oral manifestations of UC and CD?

A

aphthous ulcers

171
Q

What are the colonoscopy findings with UC?

A

Pseudopolyps

172
Q

What are the colonoscopy findings of CD?

A

Cobblestoning and skip lesions

173
Q

What is the first line treatment for UC?

A

5-ASA agents

174
Q

What is the major complication associated with UC?

A

Toxic megacolon

175
Q

What is the curative treatment for UC?

A

Total proctocolectomy

176
Q

What is the treatment for UC and CD flares?

A

Steroids

177
Q

What is the classic immunomodulator for UC?

A

Azathioprine

178
Q

What is the classic biologic used to treat UC?

A

Infliximab

179
Q

Which has a higher incidence of associated malignancy: UC or CD?

A

UC

180
Q

Which is more common: direct or indirect inguinal hernias?

A

Indirect

181
Q

What is the etiology of indirect inguinal hernias?

A

Congenital patent processus vaginalis

182
Q

What is the etiology of femoral hernias?

A

Increased intraabdominal pressure, weakened pelvic floor

183
Q

Pigmented gallstones have what etiology?

A

hemolysis

184
Q

Are cholesterol gallstones radiopaque or radiolucent?

A

Radiolucent

185
Q

What are most gallstones comprised of?

A

Cholesterol

186
Q

What is cholelithiasis?

A

Stones in gallbladder

187
Q

What is choledocholithiasis?

A

Stones in the CBD

188
Q

What is cholangitis?

A

Infection of the CBD, usually 2/2 stone

189
Q

What are the s/sx of cholangitis?

A 
RUQ TTP
Fever
Jaundice
Shock
Altered mental status
190
Q

What is cholecystitis?

A

Inflammation of the gallbladder, typically due to stone occluding the cystic duct.

191
Q

What are the s/sx of cholecystitis?

A

RUQ pain
Fever
Murphy’s sign

192
Q

What are labs like with cholecystitis?

A

Leukocytosis

Normal bili, alk phos, and amylase

193
Q

What are labs like with choledocholithiasis?

A

Leukocytosis
Increased bili
Increased Amylase
Increased alk phos

194
Q

What are the labs like with cholangitis?

A

Increased WBC, bili, alk phos

195
Q

How do you diagnose cholelithiasis?

A

US

196
Q

How do you diagnose cholecystitis?

A

US, HIDA scan

197
Q

How do you diagnose choledocholithiasis?

A

MRCP and ERCP if US negative

198
Q

How do you diagnose cholangitis??

A

ERCP

199
Q

What is the treatment for choledocholithiasis?

A

ERCP to remove stone, then cholecystectomy

200
Q

What is the treatment for cholangitis?

A

ERCP, surgery if patient is toxic

201
Q

What are the components of charcot’s triad?

A

RUQ pain
Jaundice
Fever

202
Q

What are the components of Reynold’s pentad?

A 
RUQ pain
Jaundice
Fever
Shock
Altered mental status
203
Q

What are the two classic x-ray findings associated with gallstone ileus?

A

SBO + air in the biliary tree

204
Q

What are the labs that are increased in hepatocellular injury?

A

AST and ALT

205
Q

What are the labs that mark cholestasis?

A

Increased alk phos

206
Q

Jaundice is present when bilirubin is above what level?

A

2.5 mg/dL

207
Q

What are the features of fulminant liver failure?

A

INR more than 1.5

Hepatic encephalopathy

208
Q

What happens with ALT and AST with chronic hepatitis?

A

Normal or only slightly elevated

209
Q

What are the two inherited diseases that cause an increase in unconjugated bilirubin 2/2 defective conjugation?

A

Gilbert syndrome

Crigler-Najjar syndrome

210
Q

What are the two inherited diseases that cause an increase in conjugated bilirubin 2/2 defective secretion?

A

Dubin-johnson syndrome

Rotor syndrome

211
Q

What is the significance of: IgM to HAVAb?

A

IgM antibody to HAV; the best test to detect acute HAV.

212
Q

What is the significance of: HBsAb

A

Immunity to HBV. If alone, then vaccinated

213
Q

What is the significance of: HbcAg

A

Active infection

214
Q

What is the significance of: HbcAb

A

if IgM, then current infection or window period

If IgG, then prior or current

215
Q

What is the significance of: HBeAg

A

Infected, and transmissible

216
Q

What is the significance of: HBeAb

A

Antibody to e antigen; indicates low transmissibility

217
Q

What are the antibodies that are positive in autoimmune hepatitis?

A

Anti-smooth muscle
ANA
Anti-liver-kidney microsomal
Anti liver cystosol

218
Q

What happens to urine Cu with Wilson’s disease?

A

Increased

219
Q

What is the treatment for acute hepatitis?

A

Supportive

220
Q

What is the treatment for chronic HBV infection?

A

Tenofovir

Entecavir

221
Q

What is the treatment for HCV?

A

Two direct active antivirals

222
Q

What is the treatment for fulminant hepatic failure?

A

Liver transplant

223
Q

What are the histological findings of cirrhosis?

A

Bridging fibrosis and nodular regeneration

224
Q

What is the most common etiology of cirrhosis in the US?

A

Chronic HCV

225
Q

What are the extrahepatic causes of cirrhosis?

A

Biliary tract disease
Right sided heart failure
Budd-Chiari syndrome

226
Q

How is spontaneous bacterial peritonitis diagnosed?

A

more than 250 PMNs/mL in the ascitic fluid

227
Q

What are the three major labs that are used to determine the synthetic function of the liver, and what will they show in cirrhosis?

A

Albumin - decreased
PT/INR - increased
bilirubin - Increased

228
Q

What is the equation for the serum-ascites albumin gradient?

A

Serum albumin - ascites albumin

229
Q

What are the three major etiologies of an increased SAAG?

A
  • Presinusoidal
  • sinusoidal
  • Postsinusoidal
230
Q

What are the presinusoidal causes of portal HTN? (2)

A

Splenic or portal vein thrombosis

Schistosomiasis

231
Q

What is the cause of sinusoidal portal vein HTN?

A

Cirrhosis

232
Q

What are the three major causes of postsinusoidal portal vein HTN?

A

Right heart failure
Constrictive pericarditis
Budd-Chiari syndrome

233
Q

What are the causes of ascites with a SAAG less than 1.1? (3)

A

nephrotic syndrome
TB
Malignancy

234
Q

What are the components of the conservative treatment of ascites?

A

Na restriction
Diuretics
paracentesis

235
Q

What is the definitive treatment of ascites?

A

TIPS

236
Q

What are the s/sx of spontaneous bacterial peritonitis?

A

Fever
Abdominal pain
Vomiting

237
Q

What is the treatment for spontaneous bacterial peritonitis?

A 
IV abx (3rd gen cephalosporin)
IV albumin
238
Q

What is the prognosis of spontaneous bacterial peritonitis?

A

Associated with a poor 1 year prognosis

239
Q

What is hepatorenal syndrome?

A

Acute prerenal failure 2/2 splanchnic vasodilation and decreased blood flow to the kidneys

240
Q

What is the urinary Na excretion with hepatorenal syndrome?

A

Less than 10 mEq/mL

“healthy kidneys in an unhealthy environment”

241
Q

What is the medical prophylaxis of esophageal varices?

A

Endoscopic surveillance with beta-blockers

242
Q

What is the role of vitamin K in the setting of hepatic coagulopathy?

A

Will not correct it, since liver doesn’t work

243
Q

Primary sclerosing cholangitis is strongly associated with what bowel disorder? Which gender is more often affected?

A

Ulcerative colitis

Young men

244
Q

What is primary sclerosing cholangitis?

A

Idiopathic disorder of progressive inflammation and resulting fibrosis of the extra and intrahepatic bile ducts

245
Q

Patients with primary sclerosing cholangitis are at risk for developing what malignancy?

A

Cholangiocarcinoma

246
Q

What are the s/sx of primary sclerosing cholangitis?

A

Jaundice
Pruritis
Fatigue

247
Q

What are the lab findings of primary sclerosing cholangitis?

A
  • Increased alk phos

- Increased bili

248
Q

What will an MRCP/ERCP show with primary sclerosing cholangitis?

A

Multiple bile duct strictures and dilatations (“beading”)

249
Q

Liver bx of primary sclerosing cholangitis will show what characteristic finding?

A

onion skinning

250
Q

What is the treatment for primary sclerosing cholangitis?

A

ERCP with dilation and stenting of strictures

Liver transplant is definitive treatment

251
Q

What is primary biliary cirrhosis?

A

Autoimmune disease characterized by destruction of intrahepatic bile ducts

252
Q

Who is most commonly affected with primary biliary cirrhosis?

A

Middle aged women with other autoimmune diseases

253
Q

What are the lab findings of primary biliary cirrhosis?

A

Increase alkphos

Increased bili

254
Q

What antibody is positive in primary biliary cirrhosis?

A

Antimitochondrial antibody

255
Q

What is the treatment for primary biliary cirrhosis?

A

Ursodeoxycholic acid

Cholestyramine for pruritus

256
Q

What is the treatment for nonalcoholic fatty liver disease?

A

Weight loss and exercise

257
Q

What fungal food toxin is associated with hepatocellular carcinoma?

A

Aflatoxin

258
Q

What marker can be used to help diagnose hepatocellular carcinoma?

A

AFP

259
Q

What is the pharmacotherapy for metastatic hepatocellular carcinoma?

A

Sorafenib

260
Q

What is the inheritance pattern and defect in primary hemochromatosis?

A

AR mutation in HFE gene

261
Q

What happens to the following lab values with hemochromatosis:

  • Serum Fe
  • % sat Fe
  • Ferritin
  • Transferrin
A
  • Serum Fe increased
  • % sat Fe increased
  • Ferritin increased
  • Transferrin DEcreased
262
Q

What is the treatment for hemochromatosis , regardless of etiology?

A

Weekly phlebotomy

Deferoxamine

263
Q

When do patients with Wilson’s disease usually present?

A

Before age 30

264
Q

What is the treatment for Wilson’s disease?

A

Penicillamine or trientine

Diet Cu restriction

265
Q

The hallmark PE finding of pancreatic cancer is what?

A

Nontender palpable gallbladder with jaundice

266
Q

What are the s/sx of a VIPoma? Stool osmotic gap?

A

Watery diarrhea

Low stool osmotic gap

267
Q

Why is there achlorhydria in a VIPoma?

A

VIP inhibits gastrin production

268
Q

What is Courvoisier sign?

A

nontender gallbladder (pancreatic cancer)

269
Q

What is Trousseau sign?

A

Migratory thrombophlebitis (pancreatic cancer)

270
Q

What are the typical s/sx of chronic pancreatitis?

A

Steatorrhea and epigastric pain

271
Q

What are the CT findings of chronic pancreatitis?

A

“chain of lakes”

alternating stenosis and dilation of the main pancreatic duct

272
Q

What is the treatment for acute pancreatitis?

A

IVFs
bowel rest
NG suction

273
Q

What is the treatment for chronic pancreatitis?

A

Pancreatic enzyme replacement

endoscopic dilation of ducts

274
Q

What are the two major complications of acute pancreatitis?

A

Fistula formation

Pseudocyst formation

275
Q

What is the tumor marker for pancreatic cancer?

A

CA19-9

276
Q

What are the CT findings of chronic pancreatitis?

A

Calcifications and dilated ducts

277
Q

What is the chemotherapy for pancreatic cancer?

A

5-Fu

A1 (32 decks)

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