GI Flashcards
MCC of cirrhosis in US?
alcohol
Skin changes associated with cirrhosis?
palmar erythema; dupuytren’s contractures
CM of hepatic encephalopathy:
confusion + lethargy; asterixis (flapping tremor) and fetor hepaticus
Tx of hepatic encephalopathy:
lactulose; rifaximin
Pruritus tx in hepatitis
cholestyramine
HCC screening:
US + AFP
Esophageal varices tx
BB (propranolol, timolol, nadolol)
Ruptured esophageal varices tx
- stabilize, abx, octreotide
- Once stabilized, emergency GI endoscopy to ligate
MC complication of cirrhosis
ascites
Serum ascites albumin gradient of x makes portal HTN likely?
> 1.1 g/dL
MCC of gastritis
h. pylori
dx of gastritis
endoscopy (thick edematous erosions <0.5 cm)
Gastritis (h.pylori +) tx (3)
clarithromycin + amoxicillin + PPI
Gastritis (h.pylori +) tx (4)
PPI + bismuth + metronidazole + tetracycline
Gastritis (h.pylori -) tx
PPI, H2, antacids, sucralfate
If no response to gastritis treatment after x, one should pursue?
4-8 weeks
GI endoscopy, US, test for h.pylori
Backpacker’s diarrhea
Giardia
Gastroenteritis associated with: fried rice
bacillus cereus
Gastroenteritis associated with: raw shellfish in Gulf of Mexico
vibrio parahaemolyticus and vibrio
Gastroenteritis associated with: rice water stools
vibrio parahaemolyticus and vibrio
Gastroenteritis associated with: clindamycin use
c. diff
Tx for c. diff
metronidazole
MCC of bacterial enterits
camplobacter jejuni
MC antecedent event in post-infectious GBS
camplobacter jejuni
Gastroenteritis associated with: S comma, seagull shaped
camplobacter jejuni
Camplobacter jejuni tx
Erythromycin
Shigella tx
bactrim
Gastroenteritis associated with: typhoid fever
salmonella
Typhoid fever CM:
cephalic phase (HA, constipation, pharyngitis, cough) –> crampy abdominal pain, diarrhea, pea soup stools, tractable fever, relative brady, hepatospleno, blanching rose spots
Gastroenteritis associated with: pea soup stools
salmonella
Gastroenteritis associated with: large voluminous stools
non-invasvie
Gastroenteritis associated with: many small volume stools
invasive
Types of hepatitis assoc with chronicity
HBV, HCV, HDV
Jaundice occurs when levels >
2.5 mg/dL
Is bilirubin seen with conjugated or unconjugated bilirubin?
conjugated
Dark urine is seen with conjugated or unconjugated bilirubin?
conjugated
Is conjugated or unconjugated bilirubin toxic?
unconjugated
AST; ALT >2
alcoholic hepatitis
ALT > AST
>1000
acute viral hepatitis
ALT > AST
<400
chronic viral hepatitis
Increase alk phosphate assoc with
biliary obstruction
What is the most sensitive indicator of biliary injury?
GGT
What type of hepatitis is associated with spiking fevers?
hepatitis A
Hep A transmission
fecal oral
MCC of hep A
asymptomatic children <6 y/o
Hep A tx
self-limiting
Post-exposure Hep A
HAV immune globulin
Which hep is most likely to become chronic?
hep c (80%)
Tx of hep C
pegylated interferon a-2b and ribavirin
Hep D requires Hep x co-infection
Hep B
PID treatment
doxy + ceftriaxone +/- metro
Chronic cases of Hep B are MC
perinatally acquired
Hep B causes increase risk of?
hepatocellular cancer
First evidence of Hep B infection?
HBsAg
If HBsAg is + for >6 months –>
chronic
HBsAb indicates?
distant resolved infection or vaccination
If no development of HBsAb within 6 months?
chronic
HBcAb indicates?
IgM vs. IgG
HBeAg (envelope) indicates?
increase viral replication and increased infectivity; if increased for >3 mo, likelihood of developing chronic
HBeAb (envelope) indicates?
waning viral replication
Acute hep B tx?
supportive
Chronic hep B tx?
a-interferon 2 b