GI

Question 1

Alcoholic with elevated Bilirubin.
Fractionated Bili showed elevated Indirect bili/unconjugated.
DX?

Answer 1

Gilbert’s syndrome - MC inherited disorder that causes unconjugated hypebilirubinemia
- defect in UGT1A1 - responsible for conjugation of bilirubin with glucoronic acid

Question 2

IBS- irritable bowel syndrome- patient who tried Dicyclomine (Bentyl) already
What other medication?

Answer 2

Amitryptyline (TCA) - good for IBS

Question 3

Elderly with crampy lower abdominal pain and bloody diarrhea
No fever

Cause of bleeding?

Answer 3

Ischemic colitis!

Question 4

Patient with notable ALT elevation and normal AST. CMP, CBC and HBSAg, and Hep C normal. Not alcoholic or does not take any meds that can harm liver.

Possible DX?
Test?

Answer 4

Screen for Hemochromatosis

Do Iron Studies

Question 5

Characteristic of Crohns compared to UC?

Answer 5

Spares the Rectum

Question 6

61 y/o admitted for possible cellulitis
Has blisters along the left forearm, complains of itching
Lab show high ALT, AST
Had similar problems in the past; more on summer
Hx of alcohol use on weekends and smoking
DX?
TEST?

Answer 6

Porphyria Cutanea Tarda : blisters in sun exposed area due to liver damage from alcohol or smoking or hep c

Order Total serum, plasma or spot urine porphyrins – initial test!