GI Flashcards
prokinetic agents used to treat diabetic gastroparesis?
metoclopramide (antiemetic, promotility), erythromycin (IV for acute attacks), cisapride (limited due to cardiac side effects
drugs used to treat anorexia/cachexia related to cancer, etc?
megestrol acetate and medroxyprogesterone acetate
Clinical features of VIPoma?
watery diarrhea (tea-colored), hypochloremia, flushing, lethargy, nausea, vomiting, muscle cramps, hypokalemia (increased intestinal secretion), hyperglycemia, hypercalcemia. stool studies consistent with a secretory diarrhea (high sodium, low osmolal gap) tumor usually in pancreatic TAIL.
features of laxative abuse?
Increase in volume and frequency of stool, typically described as watery (10-20 bms/day) with nocturnal bowel movements. Biopsy shows dark brown discoloration of colon with lymph follicles shining through as pale patches (melanosis coli). Macrophages of the lamina propria will have pigment inside of them.
what is fulminant hepatic failure?
Hepatic encephalopathy that develops w/in 8 weeks of onset of acute liver failure. Symptoms include AMS, increased AST/PT/coagulopathy, asterixis. The only treatment is orthotopic liver transplantation. Otherwise, you die.
Features of inflammatory diarrhea?
Elevated ESR (and other acute phase reactants), blood/leuks in stool, weight loss, anemia, reactive thrombocytosis.
What is SAAG? What is used for?
serum albumin - ascites albumin > 1.1g/dL: cirrhosis, alcoholic hepatitis, massive liver mets, Budd-Chiari, portal vein thrombosis serum albumin - ascites albumin
Budd-Chiari syndrome
Thrombosis of the hepatic veins and subsequent congestion and microvascular congestion. Development of portal HTN with SAAG>1.1 surgery is usually needed–stent placement, portacaval shunts
ulcerative colitis vs. Crohn’s disease
UC: - mucosal & submucosal involvement only - involves the rectum in ALL cases and can involve the colon partially or entirely - usu. doesn’t affect small bowel - uninterrupted involvement—NO skip lesions! - associated with extraintestinal symptoms (e.g. uveitis, jaundice, arthritis, skin lesions) - symptoms include: hematochezia, tenesmus (rectal dry heaves), abdominal pain, small & frequent bms, fever, anorexia, weight loss - can cause sclerosing cholangitis or cholangiocarcinoma, toxic megacolon, spondyloarthropaties, erythema nodosum. 1% annual risk of colon cancer; screen annually 8 - 10 years after diagnosis is made Crohn’s: - transmural involvement - can involve ANY area of GI tract from mouth to anus; most commonly affects terminal ileum - SKIP LESIONS (cobblestone appearance, patchy involvement) - noncaseating granulomas - transmural thickening & inflammation - mesenteric “fat creeping” onto border of small bowel - symptoms include: diarrhea (usu. w/o blood), weight loss, extraintestinal symptoms, aphthous ulcers, etc. - complications: cholelithiasis, malbsorption of B12, SBO, fistulae, perianal abscesses
laboratory findings in alcoholic hepatitis? AST:ALT ratio?
elevated ALT, AST, GGT, ferritin, INR, bilirubin leukocytosis (neutrophils), low albumin AST:ALT >2 ALT & AST usu.
alpha-1 antitrypsin deficiency?
panacinar emphysema and liver cirrhosis.
clinical findings in acute cholecystitis? which duct is commonly obstructed?
- fever - leukocytosis - RUQ abd pain - N/V CYSTIC DUCT
what causes loss of intrahepatic bile ducts?
primary biliary cirrhosis graft-vs-host disease failing liver transplant sarcoid Hodgkin’s disease CMV infection
how do you treat hepatic encephalopathy?
lactulose - acidifies the colon, causing ammonia to become trapped as non-absorbable ammonium. also causes a catharsis. rifaximin - decreases the amount of ammonia-producing colonic bacteria
when would you take someone’s gallbladder out?
asymptomatic gallstones? NO surgery. exceptions: increased risk for complications (morbidly obese, porcelain gallbladder, etc.) symptomatic gallstones? If good surgical candidate, then yes. If poor surgical candidate, manage them medically.
