GI Flashcards
Sudan Stain?
Fat in stool - pancreatic insufficiency
D xylose test?
tests for problems absorbing carbs. Abnl in sprue, whipples, bacterial overgrowth
How/why to confirm UC/crohns before starting tx?
Abd XR. Look for toxic megacolon if patient is looking toxic
Breast ‘non feeding’ jaundice
First week or so of life. Hyperbili and dehydration. Low stool and OUP. Red urate xtals in diaper. Tx - optimizing lactation and increase feeding frequency
Physical sign typical of acute mesenteric ischemia?
Pain OOP for exam
Fecal elastase?
Decreased in chronic panc
Elevated Cr, UNa<10 in setting of cirrhosis
Hepatorenal synd (renal hypoperfusion)
Tx of ascities
Lasix and spironolactone
Tx for SBP
Albumin and cefotaxime
Cancers with high EPO?
"Potentially Really High Hct" Pheo RCC HCC Hemangioblastoma (CNS)
Campylobacter diarrhea tx
eryhtromycin
shigella diarrhea tx
bactrim
M-W bleeds are from what vessels?
submucosal ARTERY bleeds
Vitiligo, atrophic glossitis/thyroid dz/neuro problems
Pernicious anemia (Anti IF abs)
INH AE?
Other than neuropathy - can also cause liver damage similar looking to viral hepatitis
Rapid emptying of hypertonic gastric content into small bowel. Fluid shifts from intravascular space to lumen, increase vasoactive peptide secretions and stim autonomic reflexes. s/p gastrectomy.
dumping syndrome. tx with diet mods
Acalculous cholecystitis patient population, presentation
Critically ill patients. Presents like calculous cholecystitis. Imaging will show distended gallbladder with wall thick and pericholecystic fluid. Tx is I/D and cholecystectomy
Most worrisome complication of pneumatic dilation of esoph?
Esophageal rupture - which can lead to mediastinitis
Prevent Gallstones in gastretomy patients?
Ursodeoxyxholic Acid
PTH changes in renal failure?
Typically hyperplasia because of low calcium and renal failure
SIADH changes to urine sodium?
Elevated. It retains water and exchanges sodium
Hyperbili with pancreatic cancer. Tx?
Palliative - stent placement, usually
corkscrew shaped duodenum abnormally located in right abdomen. Seen in infants with bilious emesis
Midgut volvulus/malro
What vaccine should all patients with chronic liver disease get?
HAV
Lamivudine. Works on what hepatitis virus?
B
Extra hepatic manifestations of HCV?
Essential mixed cryoglobulinemia, porphiria cutanea tarda, MPGN.
Chronic HCV can be asx or present with nonspecific sxs like fatigue, arthralgias, etc. Can also have normal or elevated LFTs
Don’t let normal LFTs throw you off from HCV
Liver abscess plus travel to endemic area. Tx?
Think amebic liver abscess. tx with oral metronidazole. dont aspirate
CXR shows wide mediastinum, pleural effusion, subQ emphysema. Effusion has high level of amylase
Think boerhaave.
Treatment for asymptomatic gallstones?
NOPE! dont.
when do we use ursodeoxycholic acid?
Sx gallstones but poor surgical candidates
When do we manage SBO conservatively vs operatively?
Depends on how stable patient is. If hemodynamic instability - do surgery (metabolic acid/alk, fever, leukocytosis, tachy, bp messed up)
Sphincter of Oddi dysfunction. Treatment?
ERCP and sphincterotomy.
BRBPR if less than 50 y and no rf’s
can monitor with anoscopy/sigmoidoscopy
Persistent abd pain/dyspepsia s/p chole.
postchole syndrome/ get ercp
Watery, frequent diarrhea. Bx of colon shows brown discoloration of colon with lymph follicles shining thru as pale patches. melanosis coli
LAxative abuse
What metabolic abnormality can iron tox give you?
Met acidosis
liver with fatty vacuolization, diffuse mitochondrial injury.
Reyes syndrom. tx ffp, glucose and mannitol
When d o you start UC colon CA surveillance?
8 yrs s/p dx - then do cscope every 1-2 years
How do you treat non bleeding esoph varicies?
BBLOX. no sclerotherapy
Noncaseating granulomas are seen with which IBD?
Chrons
what antibodies do you look for UC? Chrons?
PANCA for UC. Anti Saccharomyces cerevisiae for chrons
what sex abnormalities do we see in chronic liver dz?
test atrophy, gynecomastia, hypogonadism
Mild DM, necrolytic migratory erythema, wt loss, diarrhea. dx?
Think glucagonoma
Ductopenia is seen with?
PBC, liver failure, tplant (called vanishing bile duct synd)
How can systemic sclerosis cause malapsorption?
Low gi motility leads to bact overgrowth
suspected achalasia. What else do you need to rule out?
Malignancy obvs/. so do endoscopy
What raises your suspicion for angiodyplasia over diverticulosis?
Aortic stenosis or ESRD
What meds can we use to treat HBV?
even though none actually cures dz - INFa along with a bunch of HIV drugs, like lamivudine (Epivir), adefovir (Hepsera), tenofovir (Viread), telbivudine (Tyzeka) and entecavir
Alopecia, abnormal taste, bullous/pustules on orifices, poor wound healing. Seen in TPN and IBD
Zinc def
Best imaging for diverticulitis?
Abd CT
How does severe acute panc lead to severe hypotension?
systemic vascular injury and permeability
How does bowel ischemia lead to met acidosis?
because increase lactate
Corn based diets are deficient in?
Niacin - pellagra
If urine dipstick is positive for bili, what type (UCB, CB) of hyperbili are we thinking?
Conjugated
Pathophys of rotors?
benign. defect in hepatic storage of bili. Conj bili leaks to plasma
Why can antiTTG sometimes be negative in celiac?
Because celiac is also assoc with concurrent IgA def.
Most common complication of PUD?
Hemorrhage > Perforation
Mechanism of NASH?
insulin resistance leads to hepatic uptake of fatty acids
PAtient with HCV. What should you do prior to starting antiviral tx?
Do liver bx - best indicator of clinical disease progression.
Patient looks like he has pancreatitis. What test should you get to evaluate underlying cause of patient’s condition?
RUQ US. Even if it doesn’t look like he has gall stones. ETOH and stones account for 75% of cases.
Elevated liver enzymes with tremor, rigidity, abnormal gait?
Wilson’s dz. COpper can affect basal ganglia. SLit lamp tests. decreased serum ceruloplasmin
periorbital edema, eosinophilia, and myositis. splinter hemorrhages/conjunctival or retinal hemorrhages. dx?
trichinella infection
ARF in HCV patient. Does not respond to bolus, no urinary retention. DX? Tx?
This patient has hepatorenal syndrome prolly. Only way to tx is with liver tplant. Very quick mortality.
Suspected esoph perforation. How do you diagnose?
Barium swallow
Jet black liver?
Dubin Johnson. Not Rotor. Johnson = Jet Black
