GI Flashcards
Type 2 autoimmune pancreatitis also called
Idiopathic duct centric pancreatitis. No igg4 positive cell but characterized by granulocytic lesion
Can associate with inflammatory bowel diseaae
First line treatment of autoimmune pancreatitis type 1
And second line
Prednisone
6-mercaptopurine. Azathioprine, mycophenolate, rituximab. These are slow onset, not use for induction therapy, just use in the maintenance phase of therapy for recurrent disease
Antibody in primary biliary cholangitis
Antimicrobial antibody
Primary biliary cholangitis is more common in sex?
Female 9:1
In PBC if antimitochodrial antibody is negative. Which pbc-specific antibodies should be check
Sp100 and gp 210
First line treatment of pbc
Ursodeoxycholic acid
Which size of bile duct does pbc affect
Small and medium
Which size of bile duct does primary sclerosing cholangitis affect
Large
Psc can affect which sex
Male more than female
Associate with IBD in 85% of cases
In psc what if elevated bilirubin and total protein
Presence of hypergammaglobulinemia
Which anitibody in psc
Anti smooth muscle antibody
What disease has positive anti smooth muscle antibody
Psc and anutoimmune hepatitis
Autoimmune pancreatitis may be associated with secondary sclerosing cholangitis
Abx for uncomplicated diverticulitis
Cefepime + metronidazole
A beta lactam
A beta lactam+beta lactamase inhibitor
Meropenem
When we treat uncomplicated diverticulitis with oral abx
Stable, immunocompetent
How high is meld score of acute alcohol hepatitis to begin prednisolone and N acetyl cystein
20
How long should continue prednisolone on acute alcohol hepatitis
28 days. If not response will discontinue after 4-7 days.
Colonoscopy done every 5-10 years when
One or two small < 10 mm sessile serrated polyp without dysplasia
Colonoscopy done every 3-5 years
3-4 polyps
Colonoscopy done 3 years
5-10 polyps > 10mm
Polyps > 10mm
Colonoscopy for multiple <= 20 and small < 10mm hyperplastic polyps in the rectum or sigmoid colon or proximal to the sigmoid or rectum
10 years
How to diagnose celiac disease on iga deficiency patients
Check anti deaminated gliadin peptide igg antibodies
When should we check hla-dq2 and hla-dq8 on celiac disease
On who have not had serologic testing before starting gluten free diet
When the result of celiac specific serology and histology are discrepant
Who should receive HAV immune globulin and HAV vaccine
Patient older than 40, chronic liver disease and immunosuppression
Most common type of neuroendorine tumor
1st gastrinomas
2nd insulinomas
Which gene to check in men2
Ret proto oncogene
Cafe au lait macules in which disease
Neurofibromas type 1
Which disease associate with pancreatic neuroendocrine tumor
Men1, von hippel lindau syndrome, neurofibromas type 1, tuberous sclerosis
How often do we do colonoscopy on psc
Every 1-2 years
Lifetime risk of cholangiocarcinoma on psc
15%
How often do we screen for cholangiocarcinoma on psc
Mrcp and ca19-9 every 1-2 years
How often do we screen gallbladder cancer on psc
Every year by Ultrasound
Barrett esophagus without dysplasia, how often to do endoscopy for monitoring dysplasia and precancerous change
3-5 years
How long should we continue immunosuppresant therapy on autoimmune hepatitis
2-3 years
Extracolonic manifestation of familial adenomatous polyposis
Desmoid tumor, papillary thyroid cancer, extra teeth, cyst, osteomas and congenital hypertrophy of the retinal pigmented epithelium
Which liver injury pattern cause by levofloxacin
Hepatocellular pattern of liver injury
Patient with ibd have increase risk for what
Colorectal cancer, cervical cancer, skin cancer, melanoma, nonmelanoma squamous cell cancer while on immunomofulator
When should screen for colon cancer on ibd
After 8 year diagnosis and immediately on diagnosis of psc
And repeat after 1-5 years base on risk factor
Dexa is recommended in all pt starting oral glucocorticoid therapy
Lupiroston mechanism
Activate type 2 chloride channels on emterocytes lining the gut lumen, causing ion cloride to move to the guy with sodium and water
Use to treat ibs constipation type and chronic idiopathic constipation
Four type of fluid collection in acute pancreatitis
Pancreatic pseudocyst
Acute peripancreatic fluid collection
Acute necrotic collection
Walled off necrosis
How to treat acute necrotic collection and walled off necrosis
Endoscopic cystogastrostomy and necrosectomy
Surgical drainage
Mechanism of metformin caused diarrhea
Pro-motility effect and stimulation of intestinal chloride secretion
Sub classify of microscopic colitis
Lymphocytic colitis and collagenous colitis
Medications associated with microscopic colitis
Ppi, nsaid and ssri
Fecal osmotic gap
290-(2x(stool Na +stool K))
If more than 100, suggest osmotic diarrhea
Treatment of bile salt induced diarrhea
Cholestyramin
Osmotic gap < 50
Vipoma cause secretory diarrhea
Achalasia show on esophageal manometry
Incomplete relaxation of the lower esophageal sphincter and aperistasis
Treatment of achalasia
Botulinum toxin injection, pneumatic balloon dilation, peroral endoscopic myotomy, laparoscopic myotomy
Dunping syndrome can be caused by
Vagotomy, pyloroplasty, roux en y bypass, sleeve gastrectomy, esophagectomy
Treatment of dumping syndrome
More frequent meal
Acarbose, somatostatin analogue
Hepatic adenomas does not excrete bile. Focal nodular hyperplasia excrete bile. Use MRI with gadoxetate sodium
Factor increase risk of malignant transformation of hepatic adenomas
> 5cm or greater
Adenomas with beta catenin activation
In men, hepatic adenoma has beta catenin so need to be surgically removed
If hepatic ademonas in female smaller than 5cm
Can do imaging every 6 months
Focal nodular hyperplasia, hepatic hemangioma, simple hepatic cyst
Do not transform to malignancy
Ppi side effect
Vitamin b12 deficiency, hypomagnesemia, subsequent hypocalcemia, hypokalemia. Community acquired pneumonia, c diff infection
Hepatitis b infection in immune active phase when hbv dna > 20000 if hbeag + or > 2000 if hbeag -
Treat esophageal chest pain in hypotonic motility disorder
Tricyclic antidepressant like amitriptyline, serotonin modulator or trazodone
Hepatic sarcoidosis can rarely cause liver failure but commonly cause portal hypertension
Pattern of liver injury in drug induced
Drug induced cholestasis
Most common is amoxicillin-clavulanic acid, phenytoin and valproate
Incubation period for hep A infection
15-50 days
When will we refer for liver transplant
Meld Na score more than 15 and those with findings of decompensated liver disease
How much bleeding can be seen on ct angio and tagged red cell scintigraphy
Ct angio 0.3ml/min
Tagged red cell scintigraphy 0.1-0.2 ml/min
Treatment for ulcerative colitis maintenance
Azathioprine and infliximab or golimumab
If patient has latent tb
Will treat with isoniazid 2 months before initiating of anti tnf therapy
How long thiopurine takes action: azathioprine and mercaptopurine
2-3 months
Certolizumab just used for crohn disease and not used on ulcerative colitis
Cause of steatorrhea
Pancreatic dysfunction, infection, like giardiasis, whipple, celiac disease, tropical sprue, sibo
Eluxadoline is a mixed kappa and u opioid receptor agonist and theta opioid receptor antagonist to decrease the frequency of bowel contraction and treat diarrhea predominant irritable bowel syndrome
Cystic neoplasm of the pancrease are subcategorized as mucin producing and non producing cysts. Mucin producing cyst include intraductal papillary mucinous neoplasm and mucinous cystic neoplasms are thought to have malignant potential, but namy never become malignant
Non mucin producing cyst include serous cystadenoma have no malignant potential
Emergent cholecystectomy when
Gallbladder perforation or emphysematous checystitis
Risk of gallbladder cancer
Gallstone larger than 3cm, porcelain gallbladder, gallbladder polyps larger than 1cm in size
Lynch syndrome gene mutation
MLH1, MSH2, MSH6, PMS2, EPCAM
Cirrhosis can cause hepatopulmonary syndrome and portopulmonary hypertension
Treatment functional dyspepsia
Nortriptytine
How mucj is high dose ppi
80mg bolus and 8mg/h infusion for 72 hours
Viral esophagitis is more with odynophagia rather than dysphagia
Candida esophagitis is more with dysphagia rather than odynophagia
Treatment of microscopic colitis
Discontinue offending drug and then budesonide
Treat dermatitis herpetiformis
Dapsone
Adverse effect of dapsone
Methemoglobinemia, agranulocytosis, hemolytic anemia, dapsone hypersensitivity reaction
