Gastrointestinal Disorders

Question 1

What are some of the rules regarding esophageal tamponade tubes?

Answer 1

Don’t leave in for more that 48hrs while waiting for definitive therapy, deflate every 12 hrs, maintain pressures 30-45

Question 2

What are the features of Budd-Chiari syndrome?

Answer 2

Hepatic outflow obstruction not due to passive causes.
Primary- obstruction due to occlusion of major hepatic veins or IVC usually thrombosis
Secondary- extrinsic or invasive causes

Question 3

How is CDiff severity defined?

Answer 3

Non-severe: WBC <15, Cr <1.5
Severe: WBC >15 or Cr >1.5
Fulminant: Shock, Ileus, or megacolon

Question 4

When treating Ogilvie’s syndrome with neostigmine, what meds should be on standby?

Answer 4

Albuterol for bronchospasm and atropine for bradycardia

Question 5

What is the BISAP score?

Answer 5

Bedside Index of Severity in Acute Pancreatitis

BUN >25
Impaired mental status
SIRS
Age >60
Pleural effusion

Question 6

How does high triglycerides affect amylase assay?

Answer 6

Decreases amylase, no may have a false normal amylase in TG-pancreatitis

Question 7

What is the antibiotic of choice with infected necrotic pancreatitis?

Answer 7

Carbapenem

Question 8

How is acute liver failure defined?

Answer 8

No underlying liver disease and insult in under 26 weeks
INR above 1.5 and/or encephalopathy
Hyperacute = under a week
Acute= up to 4 weeks
Subacute= up to 26 weeks

Question 9

What is the differential for transaminases above 10k?

Answer 9

Acetaminophen, ischemia, viral infection, mushrooms

Question 10

What are the buzzwords for amanita toxicity?

Answer 10

Mushroom hunter, acute liver failure with transaminases above 10k. Tx with charcoal, PenG, silibin

Question 11

Recall some pearls about acute hepatitis causes and their treatments

Answer 11

Question 12

When should NAC be given for non-APAP?

Answer 12

Early! Stage I-II shows improved survival

Question 13

How is hepatic encephalopathy graded?

Answer 13

0= normal
1= short attention span
2= disorientation, personality change, inappropriate behavior
3= stuporous but arousable
4= coma

3+ predicts poor outcomes

Question 14

How is HE treated differently in acute vs chronic liver failure?

Answer 14

Acute: rifaximin/neomycin is unproven, lactulose has limited efficacy data and is risky in ileus

Chronic: lactulose+rifaximin combo

Question 15

What are the labs consistent with acute alcoholic hepatitis?

Answer 15

AST>2x NL but rarely above 300, AST:ALT typically >2, Bili >3

Discriminant function > 32 = severe AH
DF= 4.6 x (patient -control PT) + bili

Question 16

Are steroids recommended for acute alcoholic hepatitis?

Answer 16

No survival benefit according to current studies

Question 17

Aside from antibiotics, what improves mortality for SBP?

Answer 17

Albumin 1.5g/kg on d0 then 1g/kg on d3
Avoid large volume paracentesis, hold nonselective BBers

Question 18

What is the definition of HRS?

Answer 18

Cr > 1.5
Unchanged after albumin 1g/kg
In the absence of nephrotoxic drugs, shock, or abnormal urine/renal US