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Clin Med III Disease Key Notes > GI 2 (Exam #2) > Flashcards

GI 2 (Exam #2) Flashcards

1
Q

What portion of the GI tract is most affected with Diverticulosis, and why?

A

Sigmoid colon

- Highest intraluminal pressure

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2
Q

How does Diverticulosis typically present? What is the diagnostic recommendation?

A 
Often asxs (incidental finding)
- NO labs or imaging
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3
Q

What is the treatment for Diverticulosis?

A

High fiber diet

- Increase hydration

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4
Q

How does Diverticulitis differ from Diverticulosis (2)?

A

Diverticulitis is sxs AND has inflammation

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5
Q

What condition involves progressive/steady aching pain in LLQ, fever/chills +/- N/V?

A

Diverticulitis

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6
Q

What is the gold standard dx test for Diverticulitis?

A

CT WITH contrast

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7
Q

What is the recommended disposition and tx for uncomplicated Diverticulitis (2)?

A

HOME

  • Abx
  • F/U in 2 days
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8
Q

What are the recommended abx choice for uncomplicated Diverticulitis (2, __+__ vs. __)

A

G- anaerobic coverage

  • Metronidazole + Cipro/Bactrim
  • Augmentin
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9
Q

What is the recommended disposition and tx for complicated Diverticulitis (4)?

A

ADMIT

  • NPO
  • IVF
  • IV abx
  • Consult GI/Surgery
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10
Q

For Diverticulitis, what diagnostic test should always be performed after resolution of acute sxs, and when?

A

Colonoscopy 6-8 weeks after sxs resolve

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11
Q

What is the recommended diet for during and after Diverticulitis?

A
  • During = clear liquid

- After (NON-acute) = high fiber

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12
Q

What is a common cause of overt lower GI bleed?

A

Diverticular Bleeding

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13
Q

What condition involves painless hematochezia +/- bloating/cramping, abnormal vital signs?

A

Diverticular Bleeding

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14
Q

What is the tx for Diverticular Bleeding (__ vs. __)?

A
  • Resolve spontaneously
    vs.
  • Admit and resuscitate if severe
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15
Q

What are the four classifications of Colon Polyps, and why are benign vs. pre-cancerous?

A
  • Hyperplastic = benign
  • “Pseudopolyps” = benign (inflammatory)
  • Adenomas = pre-cancerous
  • Sessile serrated polyps = pre-cancerous
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16
Q

Are Adenoma Colon Polyps benign or pre-cancerous, and what is the most common type?

A

Pre-cancerous

- Tubular = most common

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17
Q

What is the most common type of CRC?

A

Adenomas

- Early detection/removal vital

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18
Q

What are the two types of CRC, and which is more common vs. increasing in incidence?

A
  • Left-sided = more common

- Right-sided = increased incidence

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19
Q

What are five important RF of CRC, and which is most important?

A
  • Tobacco use = most important
  • Personal/family hx (includes FAP, HNPCC)
  • IBD hx
  • 50+ years
  • AA
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20
Q

What positive test indicates recurrent CRC?

A

Carcinoembryonic Antigen (CEA)

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21
Q

What is the test of choice for CRC, and what finding may be seen?

A

Colonoscopy

- “Apple core” lesion

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22
Q

What is the recommended tx for CRC? What test should be done serially?

A

Partial colectomy

- Serial CEA levels

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23
Q

What is the gold standard dx test for colon CA, and why (2)?

A

Colonoscopy

  • Dx and therapeutic
  • Can visualize ENTIRE colon
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24
Q

What is the only test that can be used to prevent colon CA, and why?

A

Colonoscopy

- Evaluates entire colon and can remove polyps

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25
Q

Which colon CA screening test ONLY visualizes distal 1/3 of colon (does NOT show entire colon/right side)?

A

Flex Sigmoidoscopy

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26
Q

Which colon CA screening test is a “virtual colonoscopy”; reserved for those with comorbidities? What is a major con associated with this test?

A

CT Colonography

- Can miss flat/small polyps

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27
Q

Why are visualization tests preferred over stool-based tests for colon CA screening?

A

MOST polyps do NOT bleed = low sensitivity

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28
Q

What is the preferred stool-based detection test for colon CA screening?

A

FIT (Fecal Immunochemical Test)

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29
Q

Which colon CA screening test is good for average risk patient? What should you caution with this test?

A

FIT-DNA (Cologuard)

- Caution false +

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30
Q

If a patient is being screened for colon CA and is asxs/average-risk, what is the recommended start and end age?

A
  • Begin at age 45/50 (45 if AA)

- Discontinue at age 75

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31
Q

If a patient is being screened for colon CA and has a FH of colon CA, what is the recommendation (2)?

A
  • Begin at age 40 years and every 5 years

- 10 years younger than age at which 1st degree relative was diagnosed

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32
Q

If a patient is being screened for colon CA and has IBD, what is the recommendation?

A

Begin 8-10 years after onset of IBD sxs

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33
Q

What condition involves 100+ adenomatous polyps → increased risk for CRC?

A

Familial Adenomatous Polyposis (FAP)

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34
Q

What are the two hereditary colon CA syndromes? What are patients at increased risk for?

A

Increased risk of extracolonic malignancies

  • Familial Adenomatous Polyposis (FAP)
  • Hereditary Non-Polyposis Colon CA (HNPCC)
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35
Q

What is the recommended screening test for Familial Adenomatous Polyposis (FAP), and at what age? How often should is be repeated?

A

Colonoscopy/Flex Sigmoidoscopy by age 10-12 years

- Repeat every 1-2 years

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36
Q

What general type of malignancies are patients with Familial Adenomatous Polyposis (FAP) and Hereditary Non-Polyposis Colon CA (HNPCC) at increased risk for? Which specific type is most common for each?

A

Extracolonic malignancies

  • FAP = Gastric/Duodenal/Ampullary carcinoma
  • HNPCC = Endometrial CA
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37
Q

What is the recommended tx for Familial Adenomatous Polyposis (FAP)?

A

Prophylactic colectomy

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38
Q

What age group is most affected by Familial Adenomatous Polyposis (FAP)? What about Hereditary Non-Polyposis Colon CA (HNPCC)?

A
  • FAP = teens (16 years)

- HNPCC = 45-60 years

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39
Q

What condition involves multiple family members affected and increased risk for CRC? What sxs is often seen?

A

Hereditary Non-Polyposis Colon CA (HNPCC)

- Right-sided mass in age 45-60 years

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40
Q

What is the Amsterdam Criteria, and what condition is it associated with?

A

“3-2-1 rule” is 3 affected members, 2 generations, 1 under age 50 years
- Hereditary Non-Polyposis Colon CA (HNPCC)

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41
Q

What is the recommended screening test for Hereditary Non-Polyposis Colon CA (HNPCC), and at what age (2)?

A
  • Annual Colonoscopy beginning age 20-25 years

- Colonoscopy 2-5 years prior to earliest CRC diagnosis in family

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42
Q

What group of conditions should be considered if FH of CRC in 1+ members OR personal/FH of CRC at early age (<50 years) vs. multiple adenomas (10-20+) vs. multiple extracolonic malignances?

A

Hereditary Colon CA Syndromes

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43
Q

What is the most common obstruction, and what is the #1 RF?

A

Small Bowel Obstruction (SBO)

- RF: adhesions (prior abdominal/pelvic surgery)

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44
Q

What condition involves abdominal pain (periumbilical, intermittent cramping → focal/constant); bloating/distention, N/V?

A

Small Bowel Obstruction (SBO)

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45
Q

What SXS is indicative of a serious Small Bowel Obstruction (SBO)? What DX FINDING is indicative of a serious SBO?

A
  • Sxs: obstipation

- Dx finding: perforation

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46
Q

What condition, if severe, presents as shock, motionless, hypoactive/absent BS, peritoneal signs (guarding, rigidity, rebound)?

A

Small Bowel Obstruction (SBO)

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47
Q

What condition involves dilated loops of bowel and air fluid levels on XR?

A

Small Bowel Obstruction (SBO)

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48
Q

What is the tx for Small Bowel Obstruction (SBO) (3)? When would surgery be considered (3)?

A
  • Admit
  • Consult surgery/GI
  • Trial non-operative tx first (NPO, IVF, NG tube, antiemetics, abx)

Surgery if…

  • Peritonitis (ischemia/necrosis/perf)
  • Intestinal strangulation (necrosis)
  • Non-surgical tx ineffective
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49
Q

What condition involves hypomotility of GI tract in absence of mechanical BO?

A

Ileus

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50
Q

What is the most common cause of Ileus? What is another possible cause?

A

Post-op abdominal surgery

- Also, hypomotility meds

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51
Q

What condition involves dilated loops of bowel with air present in BOTH small and large bowel but NO air fluid levels on XR?

A

Ileus

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52
Q

How can you differentiate SBO from Ileus diagnostically?

A
  • SBO = air-fluid levels

- Ileus = NO air-fluid levels

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53
Q

What is the most common cause of Large Bowel Obstruction (LBO), and what two specific subtypes?

A

Adenocarcinoma

  • Colon
  • Rectum
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54
Q

What condition involves abdominal pain (cramping); bloating/distention, N/V, obstipation, hematochezia +/- fever/chills; diffuse tenderness,?

A

Large Bowel Obstruction (LBO)

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55
Q

What condition involves dilated bowel proximal to obstruction on XR?

A

Large Bowel Obstruction (LBO)

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56
Q

What condition involves abnormal twisting of portion of GI tract, and what is the most common type?

A

Volvulus

- Sigmoid

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57
Q

In what age group is Sigmoid Volvulus more common? What about Cecal Volvulus?

A
  • Sigmoid: 70 years

- Cecal: 33-53 years

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58
Q

What is the tx for Sigmoid Volvulus?

A

Flex Sig to decompress/de-rotate then surgery to resect and prevent recurrence

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59
Q

What is the tx for Cecal Volvulus?

A

Surgery

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60
Q

What three sxs are most often seen with anorectal disease?

A
  • Pain
  • Bleeding
  • Lump
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61
Q

How does Internal Hemorrhoid differ form External Hemorrhoid by location and sxs?

A

Internal = proximal to denate line
- Painless

External = distal to denate line
- Painful

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62
Q

What condition involves bleeding with BM +/- prolapse, pruritus, fecal incontinence, mucoid discharge?

A

Hemorrhoids

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63
Q

What is the 1st line tx for Hemorrhoids?

A

Dietary/lifestable changes for ALL patients

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64
Q

What two procedures/surgeries may be considered for Internal Hemorrhoids?

A
  • Rubber band ligation/banding

- Hemorrhoidectomy

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65
Q

What three medications can be considered for Hemorrhoids?

A
  • Stool softeners
  • SHORT-course steroids
  • Antispasmodics
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66
Q

What condition involves outgrowth of normal skin/loose and flesh-colored? What is the recommended tx?

A

Perianal Skin Tags

- NO tx unless discomfort

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67
Q

What condition involves intense itching, burning; circumferential redness and irritation of perianal skin?

A

Pruritus Ani

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68
Q

What condition is the most common cause of severe anorectal pain?

A

Anal Fissure

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69
Q

What is the most common area affected with Anal Fissure?

A

Posterior midline tear

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70
Q

What condition involves severe pain during/after defecation (“passing glass” or “sitting on a knife”)?

A

Anal Fissure

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71
Q

What three anorectal disorders may be associated with Crohn Disease?

A
  • Anal Fissure
  • Perianal Abscess
  • Anorectal Fistula
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72
Q

What condition involves obstructed/infected anal crypt gland? What can it progress to?

A

Anal Fissure

- Can progress to fistula

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73
Q

What condition involves chronic drainage of blood/pus +/- excoriated/inflamed perianal skin, palpable cord?

A

Anorectal Fistula

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74
Q

What condition is a chronic perianal abscess; can be associated with Crohn Disease?

A

Anorectal Fistula

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75
Q

What dx test can be used for Fistula if there is concern for IBD?

A

Colonoscopy

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76
Q

What is the mainstay treatment for Anorectal Fistula?

A

Surgery (fistulotomy)

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77
Q

What is the recommended tx for Anal Fissure?

A

Supportive (increase fiber/fluids, proper hygiene, Sitz baths, stool softeners, topical analgesics or vasodilators)

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78
Q

What anorectal condition is caused by HPV?

A

Anal Condyloma

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79
Q

What condition is often asxs +/- pruritus; cauliflower-like appearance in clusters or single entities?

A

Anal Condyloma

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80
Q

What is the most common type of Anal CA?

A

Squamous Cell CA

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81
Q

What is the recommended tx for Anal Condyloma (2)?

A
  • Removal/destruction of lesions

- Topical Podofilox or Imiquimod cream

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82
Q

What condition involves fecal incontinence, incomplete bowel evacuation; protruding circumferential tissue?

A

Rectal Prolapse

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83
Q

What is the recommended tx for Rectal Prolapse?

A

Surgery

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84
Q

What condition involves fascia weakens and allows rectum to bulge into vagina?

A

Rectocele

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85
Q

What condition involves pelvic pressure, constipation, fecal incontinence, sexual dysfunction?

A

Rectocele

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86
Q

How are Rectal Prolapse and Rectocele dx?

A

Defecography

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87
Q

What is the recommended tx for Rectocele?

A
  • Pelvic floor muscle training

- Pessary

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88
Q

What are the four RF of Cholelithiasis?

A

Four F’s

  • Female
  • Fluffy (obese)
  • Forty
  • Fertile (pregnant)
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89
Q

What is the most common type of Cholelithiasis?

A

Cholesterol

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90
Q

What is the initial test for Cholelithiasis?

A

US

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91
Q

What condition involves intense RUQ pain with radiation to R shoulder blade?

A

Biliary Colic (Uncomplicated Cholelithiasis)

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92
Q

What condition involves constant/steady pain (NOT colicky unlike name); typically lasts 30-60 minutes (<6 hours)?

A

Biliary Colic (Uncomplicated Cholelithiasis)

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93
Q

What does PE look like for a patient with Biliary Colic (Uncomplicated Cholelithiasis)?

A

NORMAL

  • No jaundice
  • Negative Murphy’s sign
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94
Q

What does dx look like for a patient with Biliary Colic (Uncomplicated Cholelithiasis)?

A

NORMAL labs

- Gallstones +/- GB sludge on US

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95
Q

What is the recommended tx for Biliary Colic (Uncomplicated Cholelithiasis)?

A

Cholecystectomy

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96
Q

What condition presents similar to Biliary Colic but NO gallstones, sludge or micro disease?

A

Functional Gallbladder Disorder

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97
Q

What condition is possible due to gallbladder dysmotility, and how do you dx?

A

Functional Gallbladder Disorder

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98
Q

How do you dx Functional Gallbladder Disorder? What test can be ordered to evaluate, and what is a positive finding?

A

Dx of exclusion

- HIDA Scan with CCK and if GBEF <40% = low = FGD

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99
Q

What Rome IV Criteria are used in dx of Functional Gallbladder Disorder (3)?

A
  • Biliary pain
  • Absence of gallstones
  • Supported by low GBEF, normal labs
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100
Q

What is the recommended tx for Functional Gallbladder Disorder?

A
  • Educate/reassure

- Cholecystectomy if biliary-like pain + low GBEF

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101
Q

What condition involves inflammation of GB WITH gallstones (cystic duct obstruction)?

A

Acute Calculous Cholecystitis

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102
Q

What condition involves persistent biliary pain (RUQ) lasts 6+ hours?

A

Acute Calculous Cholecystitis

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103
Q

What four signs/sxs are indicative of Acute Calculous Cholecystitis?

A
  • Fever
  • Tachycardia
  • Ill-appearing
    • Murphy’s sign
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

What lab finding is indicative of Acute Calculous Cholecystitis? What is seen on US?

A

Leukocytosis with left shift

- Gallstones, wall thickening/edema on US

105
Q

What is the recommended tx for Acute Calculous Cholecystitis (3)?

A

ADMIT

  • IV (fluids, pain control, abx)
  • Cholecystectomy
106
Q

What is the most common complication associated with Acute Calculous Cholecystitis?

A

Gangrene

107
Q

What condition involves chronic inflammation of GB almost ALWAYS associated with gallstones?

A

Chronic Cholecystitis

108
Q

What condition involves inflammation of GB WITHOUT gallstones?

A

Acute Acalculous Cholecystitis

109
Q

What condition should be considered in a critically ill patient with sepsis, without a clear source or jaundice present?

A

Acute Acalculous Cholecystitis

110
Q

What is the recommended tx for Acute Acalculous Cholecystitis (3)?

A
  • Obtain cultures
  • Start abx
  • Cholecystectomy vs. GB drainage
111
Q

What condition involves stones in common bile duct (CBD)?

A

Choledocholithiasis

112
Q

What condition involves asxs or biliary-type pain; jaundice, normal VS, Courvoisier sign?

A

Choledocholithiasis

113
Q

What condition involves elevated LFTs, early = ALT/AST (later = cholestatic pattern: Bili, ALP exceed ALT/AST)?

A

Choledocholithiasis

114
Q

What is the recommended tx for Choledocholithiasis?

A

ERCP

- Dx and tx to remove stones

115
Q

What condition involves inflammation of biliary duct due to ascending bacterial inf. in patient with biliary obstruction?

A

Acute Cholangitis

116
Q

What condition involves Charcot’s Triad, and what are the three components?

A

Acute Cholangitis

  • Fever
  • Abdominal pain
  • Jaundice
117
Q

What triad involves fever, abdominal pain, jaundice? And what condition does it present with?

A

Charcot’s Triad

- Acute Cholangitis

118
Q

What condition involves Reynolds Pentad, and what are the five components?

A

Acute Cholangitis

  • Charcot’s Triad (fever, abdominal pain, jaundice)
  • AMS
  • Hypotension
119
Q

What condition involves leukocytosis; LFTs show cholestatic pattern (elevated Bili, ALP, GGT)?

A

Acute Cholangitis

120
Q

What is the recommended tx for Acute Cholangitis (4)?

A

ADMIT

  • Empirical abx
  • Emergent consult with GI/surgery
  • ERCP: relieves biliary obstruction via drainage
121
Q

What condition involves mostly women; autoimmune destruction of bile ducts → cholestasis?

A

Primary Biliary Cholangitis (PBC)

122
Q

What two conditions often present with fatigue, pruritus, jaundice, and what sxs is most common?

A
  • Primary Biliary Cholangitis (PBC)
  • Primary Sclerosing Cholangitis (PSC)

Pruritus = most common

123
Q

What condition presents with cholestatic pattern, specifically elevated ALP; +AMA?

A

Primary Biliary Cholangitis (PBC)

124
Q

What two lab findings are seen with Primary Biliary Cholangitis (PBC)?

A
  • Elevated ALP (cholestatic pattern)

- +AMA

125
Q

What are the three Inherited/Autoimmune Biliary Conditions, and what is the tx for all?

What gender does each present in?

A
  • Primary Biliary Cholangitis (PBC) = women
  • Primary Sclerosing Cholangitis (PSC) = men
  • Gilbert Syndrome = men (post-puberty)

Tx = refer to GI

126
Q

What condition involves mostly men; strong association w/ IBD (UC > CD) → cholestasis, ES liver disease?

A

Primary Sclerosing Cholangitis (PSC)

127
Q

What two lab findings are seen with Primary Sclerosing Cholangitis (PSC)?

A
  • Cholestatic pattern

- -AMA

128
Q

What three complications can present with Primary Sclerosing Cholangitis (PSC)?

A
  • End-stage liver disease
  • Hepatobiliary CA
  • Colon CA
129
Q

What condition involves unconjugated hyperbilirubinemia in absence of hemolysis?

A

Gilbert Syndrome

130
Q

What condition involves inherited; deficiency in enzyme for glucuronidation (conjugates bili)?

A

Gilbert Syndrome

131
Q

What condition involves asxs with normal PE: mild intermittent episodes of jaundice triggered by dehydration, fasting, period?

A

Gilbert Syndrome

132
Q

What is the most common Biliary Neoplasm? What is the prognosis for this CA?

A

Gallbladder CA

- HIGHLY fatal

133
Q

What is a major RF associated with Gallbladder CA?

A

Porcelain GB

134
Q

What type of Biliary Neoplasm arises from epithelial cells of bile ducts?

A

Cholangiocarcinoma

135
Q

What condition is often associated with Cholangiocarcinoma? What two sxs are often seen?

A

PSC

  • Jaundice
  • Pruritus
136
Q

What two conditions are often associated with Ampullary CA?

A
  • FAP

- HNPCC

137
Q

Which Biliary Neoplasm is associated with PSC? Which Biliary Neoplasm is associated with FAP and HNPCC?

A
  • PSC = Cholangiocarcinoma

- FAP and HNPCC = Ampullary CA

138
Q

What sxs is most commonly seen with Ampullary CA?

A

Obstructive jaundice

139
Q

What condition presents with an AST:ALT ratio >1.5? AST:ALT ratio <1?

A
  • AST:ALT ratio >1.5 = EtOH (alcoholic liver disease)

- AST:ALT ratio <1 = NASH or acute/chronic viral Hepatitis

140
Q

What are the two types of NAFLD (Non-Alcoholic Fatty Liver Disease)?

A
  • Isolated Steatosis (NAFL)

- Non-Alcoholic Steatohepatitis (NASH)

141
Q

What is the strongest predictor associated with NAFLD (Non-Alcoholic Fatty Liver Disease)?

A

Metabolic Syndrome

142
Q

What finding is seen on VCTE/US with NAFLD (Non-Alcoholic Fatty Liver Disease)?

A

Hepatic steatosis

  • 5+% liver fat on VCTE
  • US shows fat present
143
Q

What is the first line tx of NAFLD (Non-Alcoholic Fatty Liver Disease)? What med should be started?

A

1st Line = Exercise/weight loss

- Start Statin

144
Q

What hereditary liver disorder is a disorder of iron metabolism (iron accumulation)?

A

Hereditary Hemochromatosis

145
Q

What hereditary liver disorder is a disorder of copper metabolism (copper accumulation)?

A

Wilson’s Disease

146
Q

What condition involves Bronze Diabetes, and what are the three components?

A

Hereditary Hemochromatosis

  • DM
  • Bronze pigmentation of skin
  • Cirrhosis
147
Q

What condition involves triad of DM, bronze pigmentation of skin, cirrhosis? What is this called?

A

Bronze Diabetes

- Seen with Hereditary Hemochromatosis

148
Q

What is the tx goal with Hereditary Hemochromatosis?

A

Goal = prevent cirrhosis from iron overload

- Avoid Vit C/iron, uncooked shellfish, EtOH

149
Q

What condition can present as acute hepatitis, chronic liver disease/failure; also, neuro/psych = confusion, dysarthria, incoordination, seizures?

A

Wilson’s Disease

150
Q

What condition presents with Kayser-Fleischer ring + neuro manifestations?

A

Wilson’s Disease

151
Q

What two sxs/signs may present with Wilson’s Disease?

A
  • Kayser-Fleischer ring

- Neuro manifestations

152
Q

What lab finding is seen with Wilson’s Disease?

A

LOW serum ceruloplasmin

153
Q

What is the recommended tx for Wilson’s Disease?

A

Chelating agents

154
Q

What condition should you suspect in a non-smoker with early onset emphysema (<45)?

A

Alpha-1 Antitrypsin Deficiency

155
Q

What condition should you suspect if neonatal cholestasis OR childhood cirrhosis?

A

Alpha-1 Antitrypsin Deficiency

156
Q

What lab finding is seen with Alpha-1 Antitrypsin Deficiency (2)?

A
  • LOW serum alpha-1 antitrypsin

- Alpha-1 antitrypsin phenotype

157
Q

What three lab findings are seen with Autoimmune Hepatitis (AIH)? What is also seen in peds?

A
  • +ANA
  • +SMA
  • +IgG

In peds, +LKMA-1

158
Q

What is the recommended tx for Autoimmune Hepatitis (AIH) (2)?

A

For 2+ years or lifelong:

  • Prednisone
  • Azathioprine
159
Q

Which two Viral Hepatitis are acute ONLY? Which type is chronic only? Which two Viral Hepatitis have a vaccine available? Which type can be fatal in pregnancy?

A
  • Acute ONLY = A, E
  • Chronic = D
  • Vaccine = A, B
  • Fatal in pregnancy = E
160
Q

Which Viral Hepatitis is more common in Asia, Africa, US (homeless); areas with inadequate sanitation (fecal-oral)?

A

Hepatitis A

161
Q

How does presentation differ between peds and adults?

A
  • Peds = asxs

- Adults = sxs

162
Q

What are the three phases of Hepatitis A? What sxs are seen with the Icteric phase (4)?

A
  1. Incubation
  2. Prodrome (“flu-like” sxs)
  3. Icteric = jaundice (1-week post-sxs onset), dark urine, pruritus, light-colored stool
163
Q

What two populations are at increased risk of becoming chronic if they have Hepatitis B?

A
  • IC adult

- Infant/child <5 years

164
Q

What is the leading cause of cirrhosis and hepatocellular carcinoma?

A

Hepatitis B

165
Q

What type of Viral Hepatitis involves DNA? Which involves RNA?

A
  • Hepatitis B = DNA

- Hepatitis C = RNA

166
Q

Which Viral Hepatitis involves 5% of adults become chronic; 80-90% of infants become chronic?

A

Hepatitis B

167
Q

What does +IgM anti-HAV imply? +IgG anti-HAV?

A

Hepatitis A

  • +IgM anti-HAV = acute infection
  • +IgG anti-HAV = implies immune
168
Q

What does +HbsAg imply? +IgM anti-HBc? +IgG anti-HBc?

A
  • +HbsAg = active infection (acute/chronic)
  • +IgM anti-HBc = acute infection
  • +IgG anti-HBc = implies immune
169
Q

Which Viral Hepatitis involves OFTEN chronic; transmit via blood (IVDU, tattoos/piercings)?

A

Hepatitis C

170
Q

Which Viral Hepatitis involves lower LFTs than with HAV/HBV (~100 or less)?

A

Hepatitis C

171
Q

Which Viral Hepatitis involves new cases mostly IVDU in 20’s? What is the recommended screening?

A

Hepatitis C

- One-time screen for ALL 18+ years

172
Q

Which Viral Hepatitis is seen ONLY in co-infection with HBV?

A

Hepatitis D

173
Q

Which Viral Hepatitis is ONLY acute; fecal-oral; can be FATAL in pregnant women?

A

Hepatitis E

174
Q

Which Viral Hepatitis is often asxs; + test for 6+ months; comp. = HCC +/- cirrhosis?

A

CHRONIC Hepatitis B

175
Q

What are the three main patterns of injury seen with Alcohol-Related Liver Disease (ALD)?

A
  • Fatty liver
  • Chronic hepatitis with fibrosis/cirrhosis
  • Alcoholic hepatitis
176
Q

What are the four primary modifiable RF associated with Alcohol-Related Liver Disease (ALD)?

A
  • Daily drinking above threshold of 1/day (F) vs. 2/day (M)
  • F
  • Pattern of consumption (daily, with fasting, binge)
  • Increased BMI
177
Q

What are the three primary NON-modifiable RF associated with Alcohol-Related Liver Disease (ALD)?

A
  • Genetics
  • Co-existing chronic liver disease (CLD)
  • Smoking
178
Q

What type of Alcohol-Related Liver Disease (ALD) can be reversed after 4-6 weeks of abstinence?

A

Fatty Liver (Hepatic Steatosis)

179
Q

What is the recommended tx for Fatty Liver (Hepatic Steatosis) (2)?

A
  • Lifestyle modifications (weight loss, exercise)

- Alcohol cessation

180
Q

What condition involves liver inflammation, necrosis, fibrotic scaring; more likely if chronic/current heavy EtOH use?

A

Alcoholic Hepatitis (AH)

181
Q

What is associated with an increased likelihood that alcoholic hepatitis will progress to permanent damage?

A

Continued EtOH use

182
Q

What condition involves leukocytosis with L shift, macrocytosis, thrombocytopenia, AST/ALT of 1.5+?

A

Alcoholic Hepatitis (AH)

183
Q

What condition involves neutrophilic lobular inflammation; Mallory-Denk bodies?

A

Alcoholic Hepatitis (AH)

184
Q

What six conditions are used for the CLINICAL dx of Alcoholic Hepatitis (AH)?

A
  • 40+ g/day for F or 60+ g/day for M for 6+ months
  • Jaundice in prior 8 weeks
  • Total Bili 3.0+ mg/dL
  • AST/ALT 1.5+ IU/L
  • AST 50+ IU/L
  • <60 days abstinence of alcohol before jaundice onset
185
Q

What is the most important factor in tx of Alcoholic Hepatitis (AH)? If severe AH, is present, what medication may be recommended?

A

DISCONTINUE ETOH USE

- If severe, steroids (D/C after 7 days if ineffective)

186
Q

What condition involves positive asterixis = tremor; Stroop Test?

A

Hepatic Encephalopathy

187
Q

What condition involves neurotoxins accumulate bc not detoxified by liver, and what is the most common neurotoxin?

A

Hepatic Encephalopathy

- Ammonia

188
Q

What condition involves widespread destruction/regeneration of liver tissue with nodules and altered structure?

What are the two subtypes, and what is the survival rate for each?

A

Cirrhosis

  • Compensated Cirrhosis = 12 years
  • Decompensated Cirrhosis = <2 years
189
Q

What two medications can be used to treat Ascites seen with Cirrhosis? What other tx may be considered?

A
  • Lasix
  • Spironolactone

May consider paracentesis vs. shunt (TIPS) if refractory

190
Q

What sign/sxs is often seen with Compensated Cirrhosis? What four lab findings may be seen?

A

Splenomegaly

  • Thrombocytopenia
  • Leukopenia
  • Anemia
  • High AST
191
Q

What two signs/sxs are often seen with Decompensated Cirrhosis?

A
  • Portal HTN

- Port-systemic shunting

192
Q

What condition involves renal failure in setting of decompensated cirrhosis?

What is the prognosis?

A 
Hepatorenal Syndrome (HRS)
- Poor prognosis
193
Q

What are the two types of Hepatorenal Syndrome (HRS), and what is the prognosis for each?

A
  • Type 1 = rapid/progressive: 4 weeks survival

- Type 2 = a/w refractory ascites: 6 months survival

194
Q

What condition presents with azotemia (increased BUN); progressive rise in serum Cr?

A

Hepatorenal Syndrome (HRS)

195
Q

What are the three types of Alcohol-Related Liver Disease (ALD), and what is the general prognosis for each?

A
  • Fatty Liver/Alcoholic Fatty Liver: complete resolution if EtOH stopped in 4-6 weeks
  • Alcoholic Hepatitis (AH): depends on severity (mild often reversible); NEED to D/C EtOH use
  • Chronic Hepatitis (Alcoholic Cirrhosis) = WORSE: if continue to drink, 4-year survival rate is <20% if patient has major complication
196
Q

What dx criteria can be used to evaluate Hepatorenal Syndrome (HRS) - besides signs of decompensated liver disease and renal impairment (3)?

A
  • NO shock
  • No improvement with correction of volume status/Albumin in 2+ days
  • Absence of other AKI causes
197
Q

When is Hepatocellular CA (HCC) surveillance recommended?

A

ANY patient at high-risk for liver CA

198
Q

What type of CA is a majority of all primary liver CA?

A

Hepatocellular CA (HCC)

199
Q

When should Hepatocellular CA (HCC) be suspected in a patient (2)?

A
  • Cirrhosis

- Non-cirrhosis chronic HBV

200
Q

If a patient has non-cirrhosis chronic HBV, what two tests can be used as screening tools, and what are you screening for? How often should screening be done?

A

Screen for Hepatocellular CA (HCC) every 6 months with…

  • AFP
  • US
201
Q

What lab test will be elevated with Hepatocellular CA (HCC)?

What imaging test should be performed first?

A 
Elevated AFP (alpha-fetoprotein)
- Tri-phasic CT
202
Q

What condition involves high levels of activated trypsin → organ auto-digestion = injury/inflammation?

A

Acute Pancreatitis

203
Q

What condition involves inflammation of parenchyma/peripancreatic WITHOUT necrosis?

A

Interstitial Edematous Acute Pancreatitis

204
Q

What condition involves inflammation + parenchymal necrosis +/- peripancreatic necrosis?

A

Necrotizing Acute Pancreatitis

205
Q

What condition involves possible etiologies of ‘I GET SMASHED’? Which two are more common, and which of these two is MOST common?

A

Acute Pancreatitis

  • Gallstones = most common
  • Chronic alcohol abuse
206
Q

What condition involves acute/constant, boring, severe, epigastric radiates to back?

A

Acute Pancreatitis

207
Q

What positions/things make Acute Pancreatitis worse (2)? Better (3)?

A
  • Worse with food or supine

- Better sitting, leaning forward, knees flex

208
Q

If a patient has severe Necrotizing Acute Pancreatitis, what two signs may be positive?

A
  • +Cullen sign
  • +Grey-Turner sign
  • Panniculitis
209
Q

What is the diagnostic criteria for Acute Pancreatitis (2 out of 3…)?

A
  • Clinical presentation (acute/constant, boring, severe abd. pain)
  • High serum lipase/amylase (3x normal)
  • Consistent imaging findings
210
Q

What is the recommended initial imaging test for Acute Pancreatitis? What other two tests may need to be performed?

A

Abdominal US

- EUS → MRCP

211
Q

What is the recommended tx for Acute Pancreatitis (3)?

A

ADMIT

  • IVF
  • Meds (analgesics, abx)
212
Q

What complication of Acute Pancreatitis should you be concerned for?

A

Pancreatic pseudocyst

213
Q

What condition involves localized fluid collection with palpable mass in mid-epigastric area; can be resolve spontaneously or need surgery vs. drainage if sxs/infected?

What is it a complication of?

A

Pancreatic pseudocyst

- Comp. of Acute Pancreatitis

214
Q

What condition involves possible exocrine dysfunction (steatorrhea, weight loss) or endocrine dysfunction (DM)?

A

Chronic Pancreatitis

215
Q

What condition involves epigastric pain worse with alcohol/high-fat meals; N/V; weight loss?

A

Chronic Pancreatitis

216
Q

What are the three components of the “classic” triad associated with Chronic Pancreatitis?

A
  • DM
  • Steatorrhea
  • Calcifications
217
Q

What is the gold standard test for Chronic Pancreatitis? What test should be considered if steatorrhea is present?

A

72-Hour Quantitative Fecal Fat

- Fecal Elastase if steatorrhea

218
Q

What gender and age if most affected by Pancreatic CA?

A
  • M

- 45+ years

219
Q

What is the most common type of Pancreatic CA?

A

Ductal adenocarcinoma

220
Q

What three sxs are often associated with Pancreatic CA?

A
  • Epigastric pain
  • Jaundice
  • Weight loss
221
Q

What is the tumor marker test associated with Pancreatic CA?

A

CA 19-9

222
Q

If jaundice is present with Pancreatic CA, what imaging test is preferred? What if epigastric pain or weight loss?

A
  • Jaundice = US (CT if mass)

- Epi pain/weight loss = triple phase thin sliced enhanced helical CT, 3D reconstruction

223
Q

What condition involves dx test of triple phase thin sliced enhanced helical CT, 3D reconstruction?

A

Pancreatic CA (epigastric pain or weight loss sxs)

224
Q

What is the only CURATIVE tx for Pancreatic CA?

A

Resection via Whipple

225
Q

What is the prognosis for Pancreatic CA, and why is this?

A 
Poor prognosis (5-year survival is <5%)
- Patients often present with advanced disease or metastasis
226
Q

What condition involves increased risk if men, 20-29 years, AA/Hispanics; higher risk if MSM?

A

HIV

227
Q

What condition requires infectious body fluid AND port of entry for transmission?

A

HIV

228
Q

What are the four stages of HIV?

A
  1. Primary infection
  2. Clinical latency
  3. Symptomatic HIV
  4. AIDS
229
Q

In what stage of HIV does a patient seroconvert, and what does this mean?

A 
Clinical latency (2)
- Seroconversion = +Ab test

Ab test negative in primary infection

230
Q

What stage of HIV presents with leukopenia, thrombocytopenia; rash, fever, LAD, sore throat, diarrhea?

Which stage is often asxs?

A

Primary infection

- Clinical latency = asxs

231
Q

What HIV stage may present as fever, weight loss, night sweats, LAD?

What other three sxs may presents?

A

Symptomatic HIV (3)

  • Oral hairy leukoplakia
  • Thrush
  • Karposi’s Sarcoma
232
Q

What conditions (__ OR __) can indicate progression to AIDS?

A
  • CD4 T cell count <200
    OR
  • HIV+ AND 1 of 27 AIDS defining conditions
233
Q

With a CD4 count <200, what AIDS-defining condition should you consider?

A

PCP (Pneumocystis jirovecii PNA)

234
Q

With a CD4 count <100, what AIDS-defining condition should you consider?

A

Encephalitis

235
Q

With a CD4 count <50, what two AIDS-defining conditions should you consider?

A
  • MAC (Mycobacterium avium complex)

- Cytomegalovirus (CMV) Retinitis

236
Q

What condition is the most common intracranial lesion in HIV patients; caused by Toxoplasma gondii via cat feces?

What is the tx (2)?

A

Encephalitis

- Sulfadiazine + Pyrimethamine

237
Q

What is the tx for PCP (Pneumocystis jirovecii PNA)?

A

Bactrim DS

238
Q

What is the tx for MAC (Mycobacterium avium complex) (2)?

A

Macrolide + Ethambutol

239
Q

What is the most common retinal infection in AIDS patients? What sxs may be seen (2)?

What is the tx for this?

A

Cytomegalovirus (CMV) Retinitis

  • Sxs: hemorrhage, white fluffy exudates
  • Tx: IV Ganciclovir
240
Q

When prescribing HIV meds, what two things should generally be considered?

A
  • Significant AEs

- Many drug interactions

241
Q

What should ALL HIV patients be screened for?

A

TB

242
Q

For HIV, what is the prophylactic tx for Valley Fever? PCP? Encephalitis?

A
  • Valley Fever = Diflucan
  • PCP = Bactrim DS
  • Encephalitis = Bactrim DS
243
Q

What is the recommended screening for general patients?What four populations/situations should screening be considered MORE?

A

Everyone 13 to 64 years can voluntarily opt-out of testing

Consider more if…

  • Initiating TB tx
  • Presenting with an STD
  • Annually for at-risk patients (MSM)
  • Pregnant women
244
Q

What is the test of choice for HIV?

A

Combination HIV antibody AND antigen test

245
Q

What condition is called the “Great Imitator”; caused by Treponema pallidum?

A

Syphilis

246
Q

What are the four stages of Syphilis, and what sxs are seen in each (1, 3, 1, 4)

A
  1. Primary: painless chancre
  2. Secondary: rash, condyloma lata, mucous patches
  3. Latent: asxs
  4. Tertiary: damage to heart, blood vessels, brain, nervous system
247
Q

What condition involves a painless chancre, and at what stage?

A

Syphilis (primary stage)

248
Q

What two complications of Syphilis can be seen in ANY Stage?

A
  • Neurosyphilis

- Ocular Syphilis

249
Q

What is the recommended dx test for Syphilis (2)?

A

Serology

  • RPR
  • VDRL
250
Q

What is the recommended tx for Syphilis? What other two considerations must also be met with tx?

A

Benzathine Pen G

  • TREAT EVERYBODY (partners too)
  • REPORT to County Health Department
251
Q

With Syphilis, what must be done post-tx?

A

Test for cure = recheck RPR titer

- At 6, 12, 24 months

252
Q

What Syphilis complication should be considered in pregnant women, and what is the recommended screening to avoid this?

A

Congenital Syphilis = can lead to stillbirth, death or infant disorders
- Screen ALL at first prenatal visit

253
Q

What condition is caused by Chlamydia trachomatis; rare in U.S.?

A

Lymphogranuloma Venereum (LGV)

254
Q

What is the most common sxs associated with Lymphogranuloma Venereum (LGV)?

A

Unilateral inguinal bubo (swollen lymph node)

255
Q

What is the recommended dx test for Lymphogranuloma Venereum (LGV)?

Tx for LGV?

A
  • Dx = NONE (R/O Syphilis)

- Tx = Doxycycline

256
Q

What condition is caused by Haemophilus ducreyi; rare in U.S.?

A

Chancroid

257
Q

What is the most common sxs associated with Chancroid? What other sxs may present?

A

Painful/tender genital ulcer

- Contagious foul-smelling discharge

258
Q

What is the recommended tx for Chancroid (__ OR __ OR __)?

A 
- Azithromycin
OR
- Ceftriaxone
OR
- Ciprofloxacin

Clin Med III Disease Key Notes (18 decks)

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