GI Flashcards
if abnormal D-xylose absorption, think ?
small intestinal mucosal disease (celiac), NOT enzyme deficiencies as it doesn’t need degradation to be absorbed
LFT levels in alcoholic hepatitis
AST and ALT usually not over 300, ^GGT (in liver) and ^ferritin (acute phase reactant)
if marked elevations in AST and ALT (+25x upper limit) think??
toxin induced (tylenol), ischemic, or viral hepatitis
SBP diagnosis
t 100+, abd pain, AMS
PMNs 250+, +Cx (E. coli, Kleb)
Protein less than 1, SAAG more than 1.1
SBP treatment
3rd gen cephs (cefotaxime)
FQs for ppx
lactose intolerance is characterized by what test results
+ H+ breath test, + stool test for reducing substances, low stool pH, increased stool osmotic gap
acalculous cholecystitis typically presents in the setting of ?
severe trauma, burns, recent surgery, prolonged fasting/TPM, critical illness
meds guilty in pill-induced esophagitis
tetracyclines, ASA and NSAIDs, bisphosphonates, KCl, iron
when to begin colonoscopys for UC pts?
8 years after dx, then every 1-2 years
complications of PBC include ?
severe hyperlipidemia, malabsorption, metabolic bone disease (osteoporosis, osteomalacia), and hepatocellular carcinoma
suspect ? in chronic pancreatitis pts presenting with abdominal pain in weight loss
what imaging to dx?
if jaundiced, US for tumors in head of pancreas
if not jaundiced, CT for tumors in body/tail of pancreas
ppx for esophageal variceal hemorrhage
nonselective B blockers: propranolol, nadolol
When should patients with typical GERD symptoms get an EGD with biopsy?
if present with dysphagia, odynophagia, weight loss, anemia, GIB, recurrent vomiting
or male over 50 with chronic (5+ yrs) symptoms and cancer risk factors (smoking)
other pts just get PPI trial
in ascites, a SAAG (serum-ascites albumin gradient) greater than 1.1 indicates? while a SAAG less than 1.1 indicates?
greater than/= 1.1: portal HTN including cirrhosis, cardiac ascites, Budd-Chiari
less than 1.1: TB, peritoneal carcinomatosis, pancreatic ascites, nephrotic syndrome
labs for ascending cholangitis
imaging?
^alk phos, ^GGT, ^direct bili, ^WBCs, ^CRP
biliary dilation on US or CT
ascending cholangitis tx
ERCP with sphincterotomy or percutaneous transhepatic cholangiography
abx: B-lactam + inhib or 3rd gen ceph + metro
dermatitis, diarrhea, dementia, think?
what are causes?
pellagra: Niacin deficiency
etiologies: dietary lack in developing countries that rely on corn
developed: impaired nutritional intake (etOH, chronic disease), carcinoid syndrome Hartnup (disorder of tryptophan absorption), Isoniazid therapy (interferes with tryp. metab)
meds associated with acute pancreatitis
anti-seizure (esp. valproic acid) diuretics (furosemide, thiazides) IBD drugs (sulfasalazine, 5-ASA) immunosuppressives (azathioprine) HIV meds (didanosine, pentamidine) abx (metro, tetra)
first step in identifying toxic megacolon
abdominal XR
risk factors for C. dif besides abx and hospitalization
gastric acid suppression with PPI
age 65+
features of vitamin malabsorption in celiac
iron: pallor, fatigue
calcium and vit D: bone pain (osteomalacia) fx (osteoporosis)
vit K: easy bruising
vit A: hyperkeratosis
if IgA anti-TTG negative but still suspect celiac, think?
selective IgA deficiency
stool osmotic gap (SOG)
SOG in osmotic and secretory diarrhea
plasma Osm - 2x (stool Na + stool K)
elevated in osmotic (125+)
decreased in secretory (less than 50)
causes of secretory diarrhea
caused by increased secretion of ions
infection (v. cholerae, rotavirus), CF, ileocolitis, postsurgical changes (unabs. bile acids reach colon and stimulate ion release)
