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ABIM > GI 2 > Flashcards

GI 2 Flashcards

1
Q

Rx for Hep B?

A

Entecavir or Tenofovir

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2
Q

Management of acute liver failure (Encephalopathy within 26 weeks of developing jaundice(symptoms of liver dz)?

A

Liver Transplantation

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3
Q

Common causes of Hepatic Encephalopathy ?

A

GI bleeding, infection, Opiods/Benzos.

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4
Q

Who requires SBP ppx with Cipro?

A

Pt who had it once before, low sodium, low protein, elevated Cr, Bili ( Evidence of worsening liver failure)

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5
Q

Pt with liver dz who has a rise in Cr of atleast 0.3 or 50% from baseline within 48 hrs, bland urinalysis, negative Renal US.

Dx?
What medications to avoid?

A

Hepatorenal Syndrome

NSAIDs, ACE, ARBs

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6
Q

Test to diagnosis Hepatopulmonary syndrome.

Pt presents with playtpnea, orthodeoxia, (hypoxemia in upright position) ?

A

Echo with agitated Saline (bubble study) to r/o cardiac shunt (ASD)

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7
Q

Management of Hepatic Adenomas smaller than 5cm in size?

A

Discontinue OCP and follow up every 6 months

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8
Q

Management of Amebic Liver Abscess ( Mexico) ?

A

Metronidazole and Paromoycin

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9
Q

Treatment for Intrahepatic Cholestasis (pruritus and abnormal LFTs) of pregnancy?

A

Urosodexycholic Acid - the conditions improves 48 hrs after pregnancy

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10
Q

Late in 3rd trimester women develops pruritus and erythematous plaques in distribution of striae?

A

Pruritic Urticarial Papules and Plaques of Pregnancy

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11
Q

ED, Destructive Arthropathy, DM.
Dx?
Test?
Test to confirm?
Rx?

A

Hemochromatosis

Fasting Serum Transferrin Saturation

HFE gentotype to confirm

Rx with phelobotomy

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12
Q

Positive ANA and Anti-Smooth Muscle antibody, Anti-Liver Kidney Anti-body, Anti-Liver-cytosol antibody.
Dx?
Rx?

A

Autoimmune hepatitis

Most pt have another autoimmune dz.

Prednisone and Azathiorine

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13
Q

Women aged 40-60, Cholestatic Liver Pattern, Positive Anti-mitochondrial Antibody Titer.
Dx?
Test?
Rx?

A

PBC

ALP elevated 1.5 x normal with positive antibodies, Anti-mitochondria, sp100, gp210

Urosodeoxycholic acid

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14
Q

Management of Intrahepatic Biliary Dilatation of PSC with bacterial cholangitis?

A

ERCP

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15
Q
  1. Initial Management of Acute Cholecystitis?
  2. Next Step after initial management?
  3. Rx for an Older Patient with Acute Cholecystitis who has Failed conservative therapy (Pain meds, IV fluids and Abx)?

Management of Acalculous cholecystitis?

A
  1. IVF, Pain medication, Bowel Rest, Abx (Zosyn or Ceftriaxone + Metronidazole)
  2. Laproscopic Cholecystectomy
  3. Percutaneous Cholecystostomy.
    (Not a Candidate for Surgery)
  4. Laproscopic Cholecystectomy
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16
Q

Name that GI bleed:

  1. Painless, self limited, massive hematochezia?
  2. Chronic blood loss or acute painless hematochezia in older adult patient
  3. Recent Colonic polypectomy
  4. Evidence of vascular disease in an older adult pt, typical LLQ abdominal pain
  5. Aortic Stenosis
  6. Younger patient with hx of bloody diarrhea, tenesmus, abdominal pain and fever
  7. Aortic aneurysm repair
  8. Painless hematochezia in young patient and normal upper endoscopy and colonoscopy
  9. Mucoutaneous telangiectasia
A
  1. Diverticular bleeding
  2. Colonic Tumor, polyp or angiodysplasia
  3. Post-polypectomy
  4. Ischemic Colitis
  5. Angiodysplasia (Heyde Syndrome)
  6. IBD
  7. Aortoenteric fistula (UGI bleeding)
  8. Meckel diverticulum
  9. Hereditary hemorrhagic telangiectasia
17
Q
  1. Management of Severe Acute Gallstone Pancreatitis or Cholangitis?
  2. Management of Mild to Moderate gallstone pancreatitis?
  3. Which liver function study is significant for an acute attack?
  4. When is a CT-guided percutaneous aspiration done?
  5. Management of Walled-off pancreatic necrosis?
A
  1. ERCP THEN cholecystectomy to reduce risk of recurrence
  2. Supportive care
    (IV fluids + pain management)
  3. ALT > 150 U/L
  4. Infected Pancreatic Necrosis
  5. Observe
18
Q

For modest elevations in LFTs, what common disorders need to be excluded before NAFLD is diagnosed?

A
  1. ETOH or metabolism related
  2. Viral
  3. Medication
  4. Hemachromatosis
19
Q

What is the Next Step in Management for a patient with Anal Fissures with no improvement for > 8 weeks?

A

Colonoscopy to evaluate for Crohn Disease

20
Q
  1. What study is important to do for Newly diagnosed Cirrhosis?
  2. What study is important after diagnosis of ascites ?
  3. What is the treatment for patients with Active Variceal Bleeding?
A
  1. EGD to document Varices and Assess for risk of variceal hemorrhage
  2. EGD
  3. IVF (Hemodynamic Resuscitation)
  4. Octreotide
  5. Prophylatic Abx (Continued for 7 days despite cultures)
  6. Endoscopic Therapy
21
Q

Pt reporting Recurrent Abdominal Discomfort of the last 2 years. Reports moderate epigastric discomfort that last 2-3 days. Reports he DRINKS 8-10 BEERs over the weekend and throughout the week. AXR shows Focal Calcifications. EGD shows Gastric Varices. Dx?

A

Splenic Vein thrombosis due to Chronic pancreatitis.

22
Q

Pt presenting with new onset Fever, Rash, B/L joint pains and Elevated AST (298) and ALT (355)

A

Acute Hep B infection ( serum sickness reaction).

Pt presents with rash and joint pains first for 2-3 weeks then the Icteric phase occurs.

23
Q

Ulcerative Colitis is associated with which Biliary Disease?

Which lab test helps to Confirm Diagnosis?

What imaging confirms diagnosis?

A

Primary Sclerosing Cholangitis. PSC

ALK Phos

MRCP or ERCP (done for patients or Cannot Tolerate MRCP or its done in Early Stages of Disease)

24
Q

HIV patient presenting with Fever, Retrosternal pain, Severe Odynophagia and no Thrush seen on Exam. What is the next step in management?

A

EGD to diagnosis for Ulcerative Esophagitis which is caused by Viral Infections (HSV and CMV.)

It is also important to r/o cancer due to level of severity with PAIN.

25
Q

Young woman presents with Rapid onset Abdominal Pain and Ascites.

Dx?
Test?
Rx?

A

Budd-Chiari Syndrome (Hepatic Vein Thrombosis).

US w/ Doppler flow or CT scan, MRA.

Rx: Blood thinners and if needed Angioplasty, TIPS, Transplant.

26
Q

Rx of Metastatic Colon Cancer to liver?

A

Hemicolectomy and resection of liver masses followed by chemotherapy.

27
Q
  1. Pt presents with abdominal pain, elevated AFP and 2cm mass on US. Next step in management?
  2. How often should routine surveillance of Chronic Hep B and C and Cirrhotic patients should be?
A
  1. MRI of liver (Helps to differentiate Malignant nodules from Regenerative nodules)
  2. US very 6 months.
28
Q

Rx of PSC?

Rx of PBC?

A
  1. Liver Transplant
  2. Ursodeoxycholic Acid
29
Q

Pt with Multiple Sexual Partners presents with Fever, Symmetric Polyathritis and Urticarial skin lesions for 1 week. LFTs are elevated. HIV negative. Dx? Test?

A
  1. Acute Hepatitis B infection (Presents with Serum Sickness-like Syndrome). Test: Presence of Hep B Surface Antigen.
  • Rash and joint problems resolve after 2-3 weeks
30
Q

Pt with liver cirrhosis and progressive SOB. Pulse ox is 88% while sitting and supine is pulse ox is 93%. He has slight bluish discoloration of his toes and digits. What is the best test to diagnosis this condition?

A

Contrast Echocardiography (Bubble Study) with agitated saline(bubble study-bubbles show passage in pulmonary vasculature).

He as orthodexia and platypnea due to hepatopulmonary syndrome.
It is associated with portal HTN.

These patients have IPVDs (intrapulmonary vascular dilatations) that can cause right to left shunting.

Rx for this is liver transplant.

31
Q

56 yo M presents with 45 pack year smoking hx, Active Smoker. He presents wih abdominal pain , bloating, anorexia, jaundice and weightloss over 2 months. RUQ US shows no gallstones but dilated intrahepatic and extrahepatic biliary ducts. What is the next step in management?

A

Abdominal CT Scan- to Assess for pancreatic Malignancy.

If choledocholithiasis was present then you would do ERCP.

32
Q
  1. RUQ Pain, Jaundice, Ascites, Muscle weakness, Low albumin, Elevated INR, Increased WBC, Ferritin 1000, AST:ATL ratio >2. Dx?
  2. RUQ Pain, Jaundice, AST and ALT > 1000. Dx?
A
  1. Alcoholic Hepatitis
  2. Tylenol Toxicity
33
Q

24 yo African American Man complains of abdominal pain while vacationing in the Mountains. 36 hrs after arrial He presents with Acute Upper Abdominal Pain and nausea. It is Sharp and Constant and increased by DEEP Inspiration. He also feels pain at TOP of his LEFT SHoulder. Dx? Rx?

A

Splenic Infarction in a patient with Sickle Cell Trait.

Treatment is Supportive

34
Q

What is the difference between PBC and Autoimmune hepatitis in regards to LFTs and Antibodies?

A

PBC has predominant Elevation in ALKALINE Phosphatase.

Anti-mitochondrial Antibodies can be present in PBC and Autoimmune, but Anti-Smooth Muscle Antibody is ONLY present in Auto-immune.

35
Q

Complications after Roux-en-Y:
1. Malabsorptive diarrhea with nutrient deficiencies, dehydration and weight-loss.
2. Nausea, vomiting, GERD and dysphagia several weeks after procedure?
3. Abdominal pain, diarrhea, nausea, hypotension and tachycardia 15-30 minutes after eating?

A
  1. Short Bowel Syndrome
  2. Stomal Stenosis
  3. Dumping Syndrome

ABIM (45 decks)

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