GI Flashcards
Complications of Primary Biliary Cholangitis (+Anti-mitochondrial, autoimmune destruction intrahepatic bile ducts, xanthomas, pruritis)
- Cirrhosis
- malabsorption (fat-soluble deficiencies)
- HCC
- metabolic bone dz: Osteoporosis/Osteomalacia
Blunting of villi + Malabsorption
Celiac (not Lactose def –>would have normal villi)
colonoscopy rules for Crohns/UC pts
Initiate 8 years post-dx and repeat with biopsy every 1-2 years
AST and ALT ratio in alcoholic hepatitis (not full-blown cirrhosis)
2:1 AST:ALT “ASSHOLE”
usually both <300
Chronic pancreatitis presents with chronic epigastric pain, diabetes, and malabsorption; it is classically relieved by:
Sitting forward!!! (just like pericarditis)
–>dx using CT, not lipase levels
AFP is used to screen for ________ in pts with cirrhosis/viral hepatitis
Hepatocellular carcinoma
Drug of choice for Primary Biliary Cholangitis
Ursodeoxycholic acid (UDCA)
Malabsorption + duodenal and jejunal ulcers
Zollinger-Ellison Syndrome
Gastrin-secreting tumor of pancreas or duodenum
Zollinger-Ellison Syndrome
Acid hypsecretion = duodenal/jejunal ulcers
What is the mechanism behind malabsorption in Zollinger Ellison Syndrome?
“Pancreatic enzyme INACTIVATION” (not deficiency)
–>gastrin-secreting tumor = acid hypersecretion = inactivation of enzymes
Bile acids are resorbed in the ______; impaired absorption is typically seen in:
Ileum
Crohns, secondary to ileal resection
Cancers associated with Lynch syndrome
Colorectal
Endometrial
Ovarian
The female CEO got Lynched
Hyperbilirubinemia + Predom elevated ALP: dx + next step
Cholestasis (intra vs extrahepatic on ddx)…get abdominal US/CT
–>Biliary dilatation = extrahepatic
Pt with ALT >150, epigastric pain radiating to back, and no hx of alcohol use…what’s suspected dx/next step?
Most likely Gallstone Pancreatitis…need US of RUQ!!! (Not CT of abdomen).
when do you start colonsocopy?
If no hx of CRC, 50
If affected 1st-degree relative, at 10 years before their age at dx or at 40, whichever comes first
Malabsorption + normal D-xylose absorption test
enzyme deficiencies (pancreatic insuff)
Malabsorption + impaired absorption fo D-xylose (decreased excretion)
small intestine mucosal disease (Celiac)
–>xylose is absorbed in small intestine without enzymes
How do you stage gastric adenocarcinoma after dx is made with biopsy?
CT abdomen/pelvis
major cause of morbidity in cirrhosis (i.e. this is what you want to be checking for in next step mgmt)
Esophageal Varices!!! Get an upper endoscopy every year
Primary prophylaxis for esophageal varices (i.e. pt with cirrhosis)
- non-selective beta blockers (propranolol, nadolol)
- ->reduce portal pressure b/c unopposed alpha = vasoconstrction - endoscopic variceal ligation
birds beak on barium swallow
Achalasia
Impaired peristalsis in distal esophagus and impaired relaxation of LES
Achalasia
Best way to dx achalasia?
Manometry
note: barium esophagram, which has bird beak finding, is not the most sensitive
Tx protocol for Esophageal varice hemorrhage (cirrhosis patients)
- Large Bore IV Fluids
- Prophylactic Antibiotics (ceftriaxone) + OCREOTIDE (inhibits vasodilating hormones, get splanchnic vasoconstriction)
- Urgent endoscopic therapy:
A)Bleeding stopped: beta blocker + endoscopic band ligation in 1-2 weeks
B)Bleeding: temp balloon tamponade, then Transjugular Intrahepatic Portosystemic Shunts (TIPS)