GI

Question 1

indications for antimicrobial therapy for acute diarrhea

Answer 1

• S.Typhi
  shigella
  cdiff
  cryptosporidium
  e. histolytica

** NO EHEC/hemorrhagic ecoli because it can increase risk of HUS due to shiga toxin

Question 2

acute bloody diarrhea bugs (CHESS)

Answer 2

Campylobacter
Hemorrhagic ecoli
Entamoeba histolytica
Salmonella
shigella

**do not use anti-diarrheal agents like imodium/loperamide.

Question 3

what liver conditions are related to ulcerative colitis

Answer 3

PSC

Question 4

criteria for IBS

Answer 4

romeIV criteria.

Question 5

diagnostic tests for AI hepatitis

Answer 5

ANA, SMA, LKM, Ig levels

Question 6

viral hepatitis

Answer 6

anti-HAV IgM, HBsAg, anti-HCV

Question 7

ALT>AST= ___
AST>ALT= __

Answer 7

ALT higher = most causes of hepatitis
AST = alcoholic liver disease.

Question 8

treatment options for HBV

Answer 8

tenofovir, entecavir. Vaccination if you don’t already have HBV

Question 9

what state of HBV is highily communicable

Answer 9

HBsAg+ (early high DNA proliferation stage)

Question 10

investigations for wilson’s disease

Answer 10

• 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.

Question 11

drugs for wilsons treatment

Answer 11

penicillamine; chelates copper
trientine: chelates copper
zinc: impairs copper excretion in stool and decreases copper absorption from gut.

Question 12

invesitgations for hereditary hemochromatosis

Answer 12

transferrin saturation (TIBC>45%)
serum ferritin (elevated >400)
HFE gene analysis

Question 13

MELD score use

Answer 13

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.

Question 14

treatment for hepatorenal syndrome (increase in creatine with worsening liver function )

Answer 14

octreotide + midodrine + albumin (increases renal blood flow by increasing systemic vascular resistance)

Question 15

hepatopulmonary syndrome

Answer 15

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)

Question 16

signs and management of portal hypertension

Answer 16

esophageal varices, melena, splenomegaly, ascites, hemorrhoids.

management: beta blockers, nitrates, shunts (TIPS)

Question 17

precipitating factors for hepatic encephalopathy (HEPATICS)

Answer 17

H-hemorrhage in GI/ hypokalemia
paracentesis
excess dietary protein
alkalosis/anemia
trauma
infection
colon surgery
sedatives

Question 18

treatment for hepatic encephalopathy

Answer 18

protein diet
lactulose to prevent diffusion of ammonia from the colon into the blood by lowering pH and forming non-diffusable NH4+
rifaximin

Question 19

if the SAAG (serum to ascitic albumin) is over 11, that means that the free fluid in the peritoneal cavity (ascites) is ___

Answer 19

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.

Question 20

medications for ascites

Answer 20

sodium restriction
diuretics: spironolactone, furosemide
therapeutic paracentesis
TIPS
liver transplantation

Question 21

markers and diagnosing PSC

Answer 21

increased ALP, mildly increased AST
pANCA, AMA and igM
then do an MRCP

Question 22

diagnosing PBC, and managemnet

Answer 22

increaed ALP, positive AMA, igM. Increased serum cholesterol markers. Do an MRCP

treatment: ursodiol, obeticholic acid. Cholestyramine for pruritis and hypercholesterolemia.

Question 23

charcots triad for ascending cholangitis

Answer 23

fever
RUQ pain
jaundice

+ hypotension and altered mental status for Reynold’s pentad.

Question 24

management for ascneding cholangitis

Answer 24

ERCP– drainage.
Antibiotic therapy.

Question 25

etiology of pancreatitis IGETSMASHED

Answer 25

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)