GI Flashcards
indications for antimicrobial therapy for acute diarrhea
- S.Typhi
shigella
cdiff
cryptosporidium
e. histolytica
** NO EHEC/hemorrhagic ecoli because it can increase risk of HUS due to shiga toxin
acute bloody diarrhea bugs (CHESS)
Campylobacter
Hemorrhagic ecoli
Entamoeba histolytica
Salmonella
shigella
**do not use anti-diarrheal agents like imodium/loperamide.
what liver conditions are related to ulcerative colitis
PSC
criteria for IBS
romeIV criteria.
diagnostic tests for AI hepatitis
ANA, SMA, LKM, Ig levels
viral hepatitis
anti-HAV IgM, HBsAg, anti-HCV
ALT>AST= ___
AST>ALT= __
ALT higher = most causes of hepatitis
AST = alcoholic liver disease.
treatment options for HBV
tenofovir, entecavir. Vaccination if you don’t already have HBV
what state of HBV is highily communicable
HBsAg+ (early high DNA proliferation stage)
investigations for wilson’s disease
- reduced serum ceruloplasmin
- slit lamp to assess for kayser-fleischer rings
- increased copper on liver biopsy
- genetic analysis imperfect as many mutations in ATP7B are possible.
drugs for wilsons treatment
penicillamine; chelates copper
trientine: chelates copper
zinc: impairs copper excretion in stool and decreases copper absorption from gut.
invesitgations for hereditary hemochromatosis
transferrin saturation (TIBC>45%)
serum ferritin (elevated >400)
HFE gene analysis
MELD score use
model for end-stage liver disease: predicts 3 month survival and used to stratify patients on transplant list. based on creatinine, INR, total bilirubin, serum sodium concentration.
treatment for hepatorenal syndrome (increase in creatine with worsening liver function )
octreotide + midodrine + albumin (increases renal blood flow by increasing systemic vascular resistance)
hepatopulmonary syndrome
majority of cases due to cirrhosis. thought to arise from ventilation-perfusion mismatch, intrapulmonary shunting and limitating of oxygen diffusion, failure of damaged liver to clear circulating pulmonary vasodilators vs production of a vasodilating substnace by the liver.
Key features are dyspnea and platypnea and orthodeoxia (desaturation in the upright position, improved by recumbency)
signs and management of portal hypertension
esophageal varices, melena, splenomegaly, ascites, hemorrhoids.
management: beta blockers, nitrates, shunts (TIPS)
precipitating factors for hepatic encephalopathy (HEPATICS)
H-hemorrhage in GI/ hypokalemia
paracentesis
excess dietary protein
alkalosis/anemia
trauma
infection
colon surgery
sedatives
treatment for hepatic encephalopathy
protein diet
lactulose to prevent diffusion of ammonia from the colon into the blood by lowering pH and forming non-diffusable NH4+
rifaximin
if the SAAG (serum to ascitic albumin) is over 11, that means that the free fluid in the peritoneal cavity (ascites) is ___
portal hypertension related (cirrhosis, chronic hepatic congestions from right heart failure, massive liver metastases, portal vein thrombosis, idiopathic portal fibrosis)
- ascitic fluid total protein >25g/L suggests cardiac portal hypertension
- ascitic fluid total protein <25g/L suggests cirrhosis portal hypertension.
medications for ascites
sodium restriction
diuretics: spironolactone, furosemide
therapeutic paracentesis
TIPS
liver transplantation
markers and diagnosing PSC
increased ALP, mildly increased AST
pANCA, AMA and igM
then do an MRCP
diagnosing PBC, and managemnet
increaed ALP, positive AMA, igM. Increased serum cholesterol markers. Do an MRCP
treatment: ursodiol, obeticholic acid. Cholestyramine for pruritis and hypercholesterolemia.
charcots triad for ascending cholangitis
fever
RUQ pain
jaundice
+ hypotension and altered mental status for Reynold’s pentad.
management for ascneding cholangitis
ERCP– drainage.
Antibiotic therapy.
etiology of pancreatitis IGETSMASHED
Idiopathic
gallstone pancreatitis
ethanol
tumors
scorpion stings
Microbiological
autoimmune: SLE
surgery/trauma (post ERCP)
hyperlipidemia
emboli or ischemia
drugs/toxins (axathioprine, mercaptopurine, furosemide, estrogens, metyldopa)
