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Medicine > GI > Flashcards

GI Flashcards

1
Q

PBC features, criteria

A

Middle aged female
AI, destruction of intrahepatic bile ducts
Chronic progressive cholestatic disease of liver

Criteria (2 out of 3 is probable)

  1. AMA (M2 AMA)
  2. Increase ALP, GGT for >6m
  3. Histological features consistent with Dx
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2
Q

Tx of PBC

A

Specific therapy
- Ursodeoxycholic acid (UDCA)

Mx of Pruritus

  • Cholestyramine
  • Rifampicin
  • Opioid antagonist (uncommonly used)
  • Liver transplant

Mx of cholestasis Cx

  • Vit D, Ca, Bisphosphonate for metabolic bone disease
  • Statin for HL
  • Medium chain triglycerides for lipid malabsorption
  • Vit deficiency (Vit D; Vit K if increase PT)
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3
Q

Anti-smooth muscle Abs

A

For AI hepatitis

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4
Q

Alcoholic liver disease Dx

A

Hx of alcohol use (M:30 g/day; F:20 g/day)
PE for signs of CLD
Staging of severity with liver chemistry, CBC, PT

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5
Q

AutoAbs for AIH

A

Type 1:
Anti-smooth muscle Ab
ANA (Anti nuclear Ab)
Elevated IgG

Type 2: Anti-liver-kidney microsomal Ab (Anti-LKM Ab)

Type 3: Ab to soluble liver Ag (Anti-SLA)

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6
Q 
MELD score
(Model for end stage liver disease)
A

BICE

Bilirubin
INR
Creatinine
Etiology

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7
Q

Child-Pugh score

A

ABCDE

Albumin
Bilirubin
PT
Ascites (distension)
Encephalopathy

A - 5-6 (compensated, normal liver function)
B - 7-9 –> can go for transplant
C - 10-15

*5-15 score

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8
Q

Acute liver failure

What score for liver transplant?

A

King’s college criteria

- Panadol induced or not

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9
Q

Causes of Chronic diarrhea

A
  1. Osmotic (Lactase deficiency)
  2. Malabsorption
  3. Secretory (Endocrine tumors, BS malabsorption)
  4. Inflammatory (IBD)
  5. Motility (IBS)
  6. Chronic infection (uncommon in HK)
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10
Q

HP - Urea breath test, stool Ag ELISA affected by

RB

A

PPI
ABX
Bismuth

But not affected by H2 blocker / antacids
Post-tx do test 4 wk later
Ab test not used after tx as it will be positive for 6-12m

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11
Q

ELISA

A

Enzyme-linked immunosorbent assay

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12
Q

3 categories of GERD

RB

A
  1. Non-erosive reflux disease (Sx but OGD normal)
  2. Erosive esophagitis (OGD abnormal)
  3. Extra-esophageal disease
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13
Q

RF for GERD

RB

A
  1. Obesity (high BMI)
  2. Smoking
  3. Alcohol
  4. FH
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14
Q

Dx of GERD

RB

A
  1. Symptom questionnaires
  2. OGD
  3. Ambulatory 24h esophageal pH monitoring
  4. PPI testing
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15
Q

Tx of GERD

RB

A
  1. Dietary and lifestyle modification
  2. Medical: Antacids, H2 blocker, PPI
  3. Endoscopic: Fundal plication
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16
Q

Ix for HBV cirrhosis patient with ascites

RB

A
  1. CBC - degree of hypersplenism; anemia
  2. LFT
    - Albumin: chronic liver disease
    - Globulin: increased in cirrhosis
    - Bilirubin: only high when late stage of cirrhosis
    - AST/ALT does not reflect degree of cirrhosis
    - ALP/GGT also should be normal unless SOL
  3. Clotting: Prolong PT = liver dysfunction
  4. AFP
  5. HB serology
    - HBsAg tested annually,
  6. 1-1% annual rate of seroconversion
    - HBeAg / anti-HBe
    - HBV DNA
  7. Diagnostic paracentesis for ascites
    - WCC w/ D to r/o SBP
    - Protein level - tend to be low in cirrhosis
    - Malignant cytology
  8. RFT: as baseline before starting diuretics
  9. USG liver every 6m to detect HCC
17
Q

When to start antiviral for HBV

RB

A

HBV DNA viral load is high

ALT 1.5-2x ULN

18
Q

HBV vs HCV in causing HCC

A

HBV is directly oncogenic
20% HCC from HBV does not have cirrhosis (80% has)
but 100% of HCC from HCV has cirrhosis

19
Q

TACE

A

Transcatheter arterial chemoembolization

20
Q

Mx of HE

RB

A
  1. Identify and treat precipitating factor
  2. Normal protein diet
  3. IV 10% dextrose to provide adequate calorie intake (to prevent protein breakdown)
  4. Lactulose as enema and orally (to induce bowel movements 2-4 times/day)
    ?Rifaximin as abx
21
Q

S/S of Crohn’s disease

A

Inflammation (abd pain, diarrhea, LOW)
Obstruction (cramp, V, distension)
Fistulization

22
Q

S/S of UC

A

Bloody diarrhea
Abd pain
Tenesmus, urge
Fever, LOW

23
Q

Anti-Saccharomyces cerevisiae Abs (ASCA)

Anti-neutrophil cytoplasmic Abs (ANCA)

A

ASCA more for Crohn’s

ANCA more for UC

24
Q

Cx of UC

A
  1. Toxic megacolon
  2. Perforation
  3. Cancer
25
Q

Extraintestinal manifestations of IBD

A
  1. Arthritis: Large joints, AS, sacroilitis
  2. Uveitis, iritis, episcleritis
  3. Erythema nodosum, pyoderma gangrenosum
  4. Primary sclerosing cholangitis (PSC)
  5. Bone loss, osteoporosis
  6. Vit B12 deficiency
26
Q

Tx of IBD

A

Mild:

  • 5-ASA (aka Mesalazine)
  • ABX for acute

Moderate to severe

  • Steroid for acute flares
  • Immunosuppressants
    • Azathioprine, 6MP (Purine analog to inhibit T cell fx)
    • Infliximab (TNF-inhibitor)
27
Q

Precipitating factors for HE

RB

A
  1. Increased protein intake

Decreased blood supply

  1. GIB (high protein content in blood in the gut + decreased blood to already cirrhotic liver)
  2. Over-diuresis (with dehydration, electrolytes disturbances)

CNS disturbance (GABA)

  1. Constipation (bacteria produce bacteria?)
  2. Infection, esp SBP, HBV, HCV
  3. Hynoptics
  4. Alcohol
  5. Shunting procedures, e.g. TIPS
  6. Inappropriate paracentesis (w/o adequate albumin infusion)
28
Q

SBP usu which organism

A 
Gram neg
E coli, Klebsiella
(or Streptococci from skin)
Tx = 3rd gen cephalosporin
Long term: Norfloxacin (FQ)
29
Q

Complications of Cirrhosis

A
  1. Ascites
  2. SBP (Spontaneous bacterial peritonitis)
  3. Hepatorenal syndrome
  4. Variceal bleeding
  5. Hepatic encephalopathy
  6. HCC
30
Q

TIPS

A

Transjugular intrahepatic portosystemic shunt

For recurrent variceal bleeding

31
Q

Quadruple therapy for HP

A 
PPI
Bismuth
Metronidazole
Tetracycline
for 7 days
32
Q

Budd-Chiari syndrome

A

Abd pain
Ascites
Hepatomegaly

Caused by occlusion of hepatic vein (mainly thrombosis, can also be compression by tumor)

Medicine (9 decks)

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