Gastrointestinal

Question 1

what are the sx of spontaneous bacterial peritonitis?

Answer 1

person with evidence of cirrhosis + fever of at least 100F, ascites, and diffuse abdomonal pain

Question 2

what causes spontaneous bacterial peritonitis?

Answer 2

enteric bacteria translocate across intestinal wall and seed ascitic fluid

Question 3

how is spontaneous bacterial peritonitis diagnosed?

Answer 3

paracentisi of ascitic fluid shows neutrophil count of >250/mm3

Question 4

spontaneous bacterial peritonitis prophylaxis?

Answer 4

fluoroquinolones

Question 5

spontaneous bacterial peritonitis treatment?

Answer 5

third generation cephalosporins (cefotaxime)

Question 6

laboratory value that is increased in an upper GI bleed?

Answer 6

BUN;

BUN:creatinine ratio >20:1

Question 7

precipitating factors for hepatic encephalopathy

Answer 7

• drugs (sedative, narcotics)
• hypovolemia (diarrhea)
• electrolyte changes (hypokalemia)
• increased nitrogen load (GI bleed)
• infection (PNA, UTI, SBP)
• portosystemic shunting (TIPS)

Question 8

treatment for hepatic encephalopathy

Answer 8

treat precipitating cause then:

• lactulose or rifaximin

Question 9

steps in working up a variceal bleed

Answer 9

1. place 2 large bore IV catheters
2. volume resuscitation, PRBC infusion
3. IV octreotide, abx
4. intubation if pt has decreased level of consciousness and continued hematemesis
5. endoscopy

Question 10

AFP is elevated in ~50% of _______ cases

Answer 10

hepatocelluar carcinoma

Question 11

risk factors for hepatic cirrhosis

Answer 11

• alcohol abuse
• chronic viral hepatits
• nonalcoholic fatty liver disease

Question 12

benign liver lesion common in young females on oral contraception

Answer 12

hepatic adenoma; may undergo malignant transformation to hepatocellular carcinoma

Question 13

constant, knawing epigastric pain that is worse at night, anorexia with weight loss, jaundice

Answer 13

pancreatic cancer

Question 14

D-xylose test with decreased levels of D-xylose in venous blood an urine is a positive test for :

Answer 14

celiac disease

Question 15

what type of patient are you likely to see vitamin k deficiency in?

Answer 15

inadequate dietary intake, intestinal absorption, or hepatocellular disease.

increased PTT and PT.

pts with liver disease can become vitamin K deficient in 7-10 days.

Question 16

what lab values are seen in alcoholic hepatitis?

• AST and ALT
• GGT
• ferritin

Answer 16

• elevated AST and ALT, usually <500 IU/L
• AST:ALT ratio >2
• GGT elevated
• ferritin elevated

Question 17

when should hepatic adenomas be surgically removed?

Answer 17

• if they are symptomatic (painful)
• if they are more than 5cm
• they do not regress after discontinueation of oral contraception