GI Flashcards
A neuroendocrine tumor that arises from the beta cells of the pancreas is what?
Insulinoma
Patient has weight gain and continual hypoglycemia and gets better after given glucose
Insulinoma
Whipples triad?
Plasma glucose concentration ≤ 55 mg/dL
Signs or symptoms consistent with hypoglycemia
Resolution when plasma glucose increases
Seen in pts. with insulinoma
Diagnostic indications of insulinoma
Hypoglycemia with inappropriately high insulin levels (hyperinsulinism)
Fasting test: Positive if serum glucose levels remain low (< 40 mg/dL) and insulin levels remain high even after fasting for 72 hours.
↑ C-peptide and ↑ proinsulin levels
How to differentiate sulfonylurea use from insulinoma
Elevated C-peptide and proinsulin levels may also be the result of sulfonylurea use! This can be ruled out by screening serum samples for sulfonylureas.
Tx of insulinoma
surgery
Medication–> diazoxide which inhibits insulin release
IBD that involves terminal ileum?
Crohn’s
Mimics appendicitis
Fe deficiency
IBD that is continuous that involves rectum?
UC
IBD increasing risk for Primary Sclerosing Cholangitis?
UC
IBD most likely to have fistula forming?
Crohn’s
Metronidazole
IBD most likely to granulomas on biopsy?
Crohn’s
UC is cured by what?
Colectomy
IBD where smokers have a lower risk?
UC
smokers have higher risk for Crohn’s
IBD that has highest risk of colon cancer?
UC
IBD associated w/ p-ANCA?
UC
Treatment for IBD?
ASA, sulfasalzine to maintain remission, Corticosteroids to induce remission
For Crohns give metronidazole for any ulcer abscess
Give Azathioprine, 6MP, and methotrexate for severe dz
LFT Buzzwords
• AST>ALT (2x) + high GGT
Alcoholic Hepatitis
LFT Buzzwords
ALT>AST & in the 1000s
Viral Hepatitis
LFT Buzzwords
AST and ALT in the 1000s after surgery or hemorrhage
Ischemic Hepatitis (“shock liver”)
LFT Buzzwords
Elevated Direct bilirubin
Obstructive (stone/cancer) or Dubin’s Johnsons, Rotor
LFT Buzzwords
Elevated Indirect bilirubin
Hemolysis or Gilbert’s, Crigler Najjar
LFT Buzzwords
Elevated alk phos and GGT
Bile duct obstruction, if IBD –> PSC
LFT Buzzwords
Elevated alk phos, normal GGT, normal Ca
Paget’s disease (incr hat size, hearing loss,
HA. Tx w/ bisphosphonates.
AMA- antibodies
antimitochondrial Ab
Primary Biliary Cirrhosis – tx w/ bile resins
ANA + antismooth muscle Ab
Autoimmune Hepatitis- tx w/ steroids
High Fe, low ferritin, low Fe binding capacity
Hemachromatosis- hepatitis, DM, golden skin
Low ceruloplasmin, high urinary Cu
Wilson’s-
hepatitis, psychiatric sxs (BG), corneal deposits
Unconjugated hyperbilirubinemia–> Increased hgb breakdown
Hemolysis; glucose-6-phosphate dehydrogenase deficiency, sickle cell anemia, spherocytosis, hemolytic disease of the fetus and newborn, and blood transfusions
thalassemia
Unconjugated hyperbilirubinemia–> Impaired hepatic uptake of bilirubin
Drugs (e.g., rifampin, probenecid, sulfonamides)
Conjugated hyperbilirubinemia–> Intrahepatic cholestasis
Primary biliary cholangitis
Pregnancy
Conjugated hyperbilirubinemia–> Extrahepatic cholestasis
Choledocholithiasis
pancreatic cancer, cholangiocellular carcinoma
primary sclerosing cholangitis
Malformations of the bile ducts; biliary cysts
Postoperative bile leaks or biliary duct strictures
Common causes of hyperbilirubinemia
HOT Liver: Hemolysis, Obstruction, Tumor, and Liver disease!
Clinical Features of jaundice
Pale, clay-colored (acholic) stool
Darkening of urine
Pruritus
Fat malabsorption (steatorrhea, weight loss)
Who do Primary Biliary cholangitis usually affect?
Middle aged women
45 yo female presents with fatigue of 2 months duration, 1 month of RUQ dull pain, dry mouth and has noticed darker patches on her body what is it?
PBC
Labs that are significant in PBC?
elevated AMA ab, ANA, ALP
AST/ALT will be normal or slightly elevated
What is the tx for PBC?
Ursodeoxycholic acid/urosdiol
PSC is associated with what?
UC
PSC is associated with what antibodies
pANCA
What diagnostic imaging should be used for dx PSC?
MRCP
magnetic resonance cholangiopancreatography
40 yo male with chronic IBD comes in complaining of abdominal pain on the right side and itchiness, has elevated ALP, GGT, and conjugated bilirubin what is the most likely diagnosis?
PSC
Who does PSC affect vs PBC?
PSC affects middle aged men while PBC affects middle aged women
What is the main difference in the pathophysio between PSC and PBC?
PSC affects intrahepatic and extrahepatic ducts
PBC affects intrahepatic ducts
PBC is associated with what conditions?
Autoimmune conditions, such as RA, CREST syndrome, Sicca syndrome, autoimmune thyroid disease
Symptomatic treatment for PSC?
Ursodeoxycholic acid
Curative treatment for PSC?
Liver transplantation
Major complication of PSC?
Cholangiocarcinoma
The presence of gallstones in the gallbladder?
Cholelithiasis
The presence of gallstones in common bile duct
Choledocholithiasis
Inflammation of the gallbladder
Cholecystitis
Bacterial infection of the biliary tract?
Cholangitis
Cholelithiasis pathophys
Bile cholesterol oversaturation, bile stasis, impaired bile acid circulation → precipitation of gallstones in the gallbladder
Choledocholithiasis
Cholelithiasis → migration of gallstones into the common bile duct
Acute cholecystitis
Cholelithiasis (most common) or biliary sludge → inflammation of gallbladder wall
Acute cholangitis
Choledocholithiasis → obstruction and stasis within the biliary tract → subsequent bacterial infection
Cholelithiasis clinical features
RUQ pain less than 6h
biliary colic especially postprandial
Choledocholithiasis clinical features
colicky RUQ pain more than 6h
postprandial
Nausea vomiting
Acute cholecystitis
clinical features
RUQ pain (postprandial)
Fever
Murphy sign
Murphy sign
The act of the patient suddenly pausing during inspiration upon deep palpation of the right upper quadrant due to pain. A strong indicator of cholecystitis.
Charcot triad
RUQ pain
Fever
Jaundice
Acute cholangitis clinical features
Charcot triad or Reynold Pentad
Reynold pentad
Charcot cholangitis triad PLUS hypotension and mental status changes
Cholelithiasis lab findings
Normal
Choledocholithiasis lab findings
elevated ALP, AST, ALT and total bilirubin
Acute cholecystitis lab findings
elevated WBC, CRP
Acute cholangitis lab findings
elevated WBC, CRP, ALP, AST, ALT and total bilirubin
Cholelithiasis dx test and findings
US: gallstones with posterior acoustic shadow
Cholelithiasis treatment
Supportive care NSAIDs,
elective cck
Choledocholithiasis dx test and findings
US: dilated common bile duct, intrahepatic biliary dilatation
MRCP or ERCP: filling defect in the contrast-enhanced duct
Choledocholithiasis treatment
Supportive care NSAIDs,
Endoscopic stone retrieval (ERCP)
Elective cholecystectomy
Acute cholecystitis dx test and findings
US: gallbladder wall thickening and/or edema (double wall sign)
HIDA scan if diagnosis uncertain
Acute cholecystitis treatment
Supportive care, analgesics
IV antibiotics
Cholecystectomy (timing depends on severity)
Acute cholangitis dx test and findings
US: biliary dilation and/or evidence of obstruction (e.g., cholelithiasis)
MRCP if diagnosis uncertain
If high suspicion go directly to diagnostic and therapeutic ERCP
Acute cholangitis treatment
Supportive care, analgesics
IV antibiotics
Urgent biliary drainage and decompression via ERCP
Interval cholecystectomy if gallstones are present or concurrent cholecystitis
Risk factors for cholelithiasis
female forty, fat, fertile, fair skinned, family history
Why is x-ray rarely diagnostic for cholelithiasis?
X-ray is rarely diagnostic because only 10–15% of stones (i.e., pigment stones) are radiopaque. Cholesterol stones (majority) are radiolucent!
Mirizzi syndrome
complication of cholelithaisis
Gallstones in the cystic duct or Hartmann pouch of the gallbladder obstruct the common hepatic duct or common bile duct.
Complications of Choledocholithiasis ?
gallstone ileus
gallstone pancreatitis
Gallstone ileus
mechanical ileus due to obstructive gallstones
perforation and fistula formation between the inflamed gallbladder and bowel → gallstones pass down into bowel lumen
clinical features: abdominal pain and distention, nausea, vomiting
Sign: pneumobilia
pneumobilia
The accumulation of gas in the biliary system. Common causes include sphincterotomy of the sphincter of Oddi, biliary-enteric anastomosis, and gallstone ileus.
Bacterial infection most common Acute cholecystitis ?
E. coli, Klebsiella, Enterobacter, Enterococcus spp.
Emphysematous cholecystitis (rare)
most often in elderly diabetic men
infection of the gallbladder with gas-forming bacteria (e.g., Clostridium welchii)
Ultrasound or CT demonstrates air in the gallbladder wall or lumen.
Treatment: emergent cholecystectomy
Complications of acute cholecystitis
Gallbladder empyema
gallbladder perforation
chronic cholecystitis
Porcelain gallbladder
complication of chronic cholecystitis
fibrotic and calcified gallbladder due to chronic inflammation
Chronic gallbladder inflammation increases the risk of what?
gallbladder carcinoma
Postcholecystectomy syndrome?
persistent abdominal pain or new symptoms following gallbladder removal
Postcholecystectomy syndrome features
Etiology; sphincter of Oddi dysfunction
Clinical features: abdominal pain and upper GI tract (e.g., dyspepsia) or lower GI tract (e.g., diarrhea) symptoms
Postcholecystectomy syndrome diagnosis?
ultrasound or CT scan followed by ERCP (preferred test if intervention is planned) or MRCP
Biliary Cancers
Cholangiocarcinoma
Gallbladder carcinoma
Cholangiocarcinoma
Cancer of the bile ducts
most common extraheaptic –> perihilar ducts = Klatskin tumor which is the junction of the right and left hepatic ducts
or Distal extrahepatic: common bile duct (40% of cases)
Gallbladder carcinomas
originate within the mucosal lining of the gallbladder
Risk factors for cholangiocarcinoma
Primary sclerosing cholangitis
Liver fluke infection (e.g., Clonorchis sinensis, Opisthorchis viverrini) –> most common risk factor in asian countries
Risk factors for gallbladder carcinoma
Cholelithiasis with chronic inflammation (most common risk factor)
Porcelain gallbladder
Courvoisier sign
The finding of painless obstructive jaundice and a palpable, nontender gallbladder should be presumed to be due to an obstructive pancreatic, periampullary, or biliary malignancy until proven otherwise.
Tumor markers helpful in biliary cancers
AFP
CA 19-9
CEA
Imaging for suspected biliary carcinoma
US for initial
MRCP for definitive dx
what type of pathology is usually biliary cacners
adenocarcinoma
Primary peritonitis (SBP) predisposing conditions?
Ascites
Cirrhosis
Peritoneal dialysis
Primary peritonitis SBP organisms?
Gram-negative : E.coli, Klebseilla pneumiae, bacteroides
Secondary peritonitis is due to what pre-existing acute abdominal condition
Hollow organ perforation, appendicitis, diverticulitis, necrotizing pancreatitis, postoperative complications
Secondary peritonitis organisms?
Mixed infection: aerobic (E. coli, Klebsiella, Enterobacter, Streptococci, Enterococci) and anaerobic (Bacteroides species, Eubacteria, Clostridia)
How to diagnosis hiatal hernia?
endoscopy or barium studies
Best initial therapy for hiatal hernia
Weight loss and PPIs
symptoms persist = surgical correction (Nissen fundoplication)
Dysphagia
Difficulty swallowing
indicating esophageal disorder
Odynophagia
Pain while swallowing
Alarm symptoms for esophageal disorders?
weight loss
blood in stool
anemia
Endoscopy should be performed
Achalasia
inability of the lower esophageal sphincter to relax due to a loss of the nerve plexus within the lower esophagus
Key hx of achalasia pt.
young pt <50
progressive dysphagia to both solids and liquids at the same time
no association with etoh and tob
Diagnostic test for achalasia ?
barium= birds beak
Manometry most accurate test
in the esophagus what two things are diagnosed by biopsy?
cancer and barrett esophagus
Key hx of esophageal cancer pt.
pt >50
dysphagia first for solids and later (progressing) to liquids
associated with long term EtoH and TOB use
More than 5-10 yrs of GERD symptoms
Tx for esophageal cancer
Surgical resection
2 forms of esophageal spastic disorders
diffuse esophageal spasm
Nutcracker esophagus
How do esophageal spastic disorders present?
Sudden onset of chest pain not related to exertion with normal EKG and stress test
How to diagnose esophageal spastic disorders ?
Manometry
How to treat esophageal spastic disorders?
CCB and nitrates simliar to Prinsmetal angina
Hx of patient with eosinophilic esophagitis
Dysphagia, food impaction, heartburn, with hx of asthma and allergic disease, endoscopy will show multiple concentric rings
Most accurate diagnostic test for eosinophilic esophagitis
endoscopy with biopsy finding eosinophils
Treatment for eosinophilic esophagitis
initial therapy PPI and eliminating allergenic foods 2nd line swallowing steroid inhalers
Dysphagia with HIV CD4<100 what do you do?
Empirically start fluconazole, if dont improve get upper endoscopy with biopsy
Dysphagia with HIV CD4<100 with large linear ulcerations?
CMV esophagitis
start Ganciclovir or foscarnet
Dysphagia with HIV CD4<100 with small ulcerations
HSV esophagitis
start acyclovir
steakhouse syndrome
dysphagia from solid food associated with Schatizki ring
Schatzki ring
Type of scarring or tightening (also called peptic stricture) of the distal esophagus
Often from acid reflux
Associated with intermittent dysphagia hiatal hernia
tx. with pneumatic dilation
Plummer-Vinson syndrome
associated with iron deficiency anemia , dysphagia, upper esophageal webs
tx first with iron replacement
complication is squamous cell cancer
Zenker diverticulum hx
dysphagia, halitosis, regurgitation of food (which can lead to aspiration pneumonia)
Zenker diverticulum diagnosis and treatment
Diagnosed with barium studies
treated with surgery (never NG tube or upper endoscopy)
Manometry is the diagnostic test for what?
Achalasia
Spasm
Scleroderma
Mallory- Weiss tear
non-penetrating tear of only mucosa will present with GI bleeding, severe vomiting or retching is the cause
no tx unless sever which is injection of epinephrine
pt. presents with recurrent episodes of nausea, vomiting and crampy abdominal pain symptoms improve with hot shower and has a hx of marijuana use?
Cannabinoid Hyperemesis syndrome
treat with antiemetics (zofran) or benzos (lorazepam)
Primary peritonitis empiric antibiotic therapy
3rd gen cephalosprorin
Statin potency and cost in increasing order
Fluvastatin low
lovastatin and pravastatin medium
simvastatin adn atrovastatin high
Statin does what?
Competitive inhibition of HMG-CoA reductase decreasing mainly LDL cholesterol
When to use statins
LDL cholesterol elevated ≥ 190 mg/dL
Patients with a clinical atherosclerotic cardiovascular disease (includes coronary artery disease (CAD), stroke, and peripheral arterial disease)
Patients aged 40–75 with diabetes and LDL levels of 70–189 mg/dL
Patients aged 40–75 with an estimated 10-year ASCVD risk ≥ 7.5% and LDL levels 70–189 mg/dL
Statins are metabolized by CYP3A4 so cant be combined with CYP3A4 inhibitors (what are they)
HIV/HCV protease inhibitors
Macrolides (especially erythromycin and clatihromycin)
Azole antifungals
cyclosprine
Warfarin and statin interaction
Warfarin is primarily metabolized by CYP2C9. Fluvastatin, pitavastatin, and rosuvastatin potentiate the effects of warfarin effects by competitively inhibiting CYP2C9, increasing the INR and the risk of bleeding.
complications of acute appendicitis
Pylephlebitis
Pylephlebitis
septic thrombosis of the portal vein due to due to perforated appendicitis, diverticulitis, or necrotizing pancreatitis
High SAAG > 1.1g/dL
Portal hypertension
-->Presinusoidal
------->Splenic or portal vein thrombosis
------->Schistosomiasis
Sinusoidal
------->Hepatic (common)
Cirrhosis
Alcohol-related liver disease
Liver metastases
Postsinusoidal
-->Cardiac
------>Right heart failure
------>Constrictive pericarditis
-->Budd-Chiari syndromeLow SAAG ascites < 1.1. g/dL
Hypoalbuminemia (Nephrotic syndrome, Severe malnutrition, Protein-losing enteropathy)
Malignancy
Infections (except SBP)
Pancreatitis
Ascites due to portal hypertension >1.1g/dL (SAAG) with protein >2.5 g/dL, what is the cause?
right heart failure
Ascites due to portal hypertension >1.1g/dL (SAAG) with protein <2.5 g/dL, what is the cause?
Hepatic cirrhosis
Ascites due to other causes <1.1g/dL (SAAG) with protein >2.5 g/dL, what is the cause?
Hepatic malignancy Peritoneal carcinomatosis Pancreatitis Chylous ascites Tuberculosis
Ascites due to other causes <1.1g/dL (SAAG) with protein <2.5 g/dL, what is the cause?
Nephrotic syndrome
complications of ascites
Spontaneous bacterial peritonitis (ascitic fluid infection): abdominal tenderness, fever, altered mental status (see peritonitis for more information)
epigastric pain, pain worse with food
gastric ulcer
epigastric pain, pain better with food
duodenal ulcer
epigastric pain with weight loss
cancer, gastric ulcer
epigastric pain with tenderness
pancreatitis
epigastric pain with bad taste, cough, hoarse
Gastroesophageal reflux
epigastric pain patient with diabetes and bloating
gastroparesis
epigastric pain with no other symptoms or physical exam findings
Non-ulcer dyspepsia
Right Upper Quadrant Pain differential diagnosis
Cholecystitis
Biliary colic
Cholangitis
Perforated duodenal ulcer
Left Upper Quadrant Pain differential diagnosis
Splenic rupture
IBS–Splenic flexure syndrome
Right lower Quadrant Pain differential diagnosis
Appendicitis
Ovarian torsion
Ectopic pregnancy
Cecal diverticulitis
Left Lower Quadrant Pain differential diagnosis
Sigmoid volvulus
Sigmoid diverticulitis
Ovarian torsion
Ectopic pregnancy
Barret esophagus managment
Metaplasia alone: PPIs and rescope every 2-3 yrs
Low-grade dysplasia PPIs and rescope every 6-12 months
High-grade dysplasia: ablation with endoscopy
What is gastritis caused by?
ETOH NSAIDs H. pylori Portal hypertension Stress such as burns, trauma, sepsis and multiorgan failure (uremia)
Atrophic gastritis is associated with what?
Vitamin B12 deficiency
Stress ulcer prophylaxis is indicated in what?
Mechanical Ventilation
Burns
Head trauma
sepsis with Coagulopathy
Cirrhosis causes
Hepatotxicity (ETOH, NSAIDs, Aflatoxin by aspergillus) Inflammation (Hepatitis, PBC, PSC, autoimmune hepatitis) Metabolic disorders (fatty liver, hemochromatosis, wilson's disease, alpha-1 antitrypsin)
Most common causes cirrhosis in the US
ETOH, Hep C, Non-alcoholic steatohepatitis
Child Pugh score
Prognosis in Chronic liver failure
Child Pugh score based on what?
serum albumin serum bilirubin INR Ascites Hepatic encephalopathy
What are the most common causes of Peptic Ulcer Disease?
1st H. pylori
2md NSAIDs
How to treat H. pylori infection?
PPIs + clarithromycin + amoxicillin (metronidazole in pCN allergy)
For those who do not respond to this tx –> Metronidazole and tetracycline can be used
Scope patients with dyspepsia if ?
Patient is over 55 yo old
Alarm symptoms are present (dysphagia, weight loss, anemia)
Management of Non-ulcer dyspepsia
age <45 = PPIs
Age > 55= PPIs + scope
Patient with recurrent diarrhea who has multiple large ulcers (>1-2cm) recurrent after h. pylori treatment, distal in duodenum ?
Gastrinoma (zollinger ellsion syndrome)
will have gastrin levels despite giving secretin
Diabetic gastroparesis
Look for diabetic patient with chronic abdominal discomfort, bloating and constipation with nausea vomiting and early satiety
Side effects of metoclopramide
dystonia, prolonged QT, and hyperprolactinoma
Management of gastroparesis
Dietary modifications
persists then–> metclopramide
persists then–> erythromycin and antiemetics
if that fails–> gastric electrical simulation
Orthostatic hypotension
More than 10 pt rise in pulse when going from lying to standing or sitting
Systolic BP drop of 20 pts or more when sitting
What is the treatment for C. diff?
Oral vancomycin and if there is no response switch to fidaxomicin
IV vancomycin is never used because it will not pass the bowel wall
what is fulminant C. diff?
antibiotic- associated diarrhea, positive stool toxin assay
high WBC
Metabolic acidosis
high lactate
high creatinine
tx using both vancomycin and metronidazole
Differential diagnosis for steatorrhea (oily greasy foul smelling stool)
Celiac disease
Chronic Pancreattis
Tropical sprue
Whipple Disease
Any fat malabsorption can present with deficiency in A, D, E, K
Vitamin D hypocalcemia, osteoporosis
Vitamin K, bleeding easy bruising
Vitamin B12, anemia, hypersegmented neutrophils
Whipple disease
Males >40 yo steatorrhea arthralgias (common 1st sign) Sacroiliitis fever, lymphadenopathy neurologic abnormalities dx Small intestine biopsies: detection of PAS-positive foamy macrophages in the lamina propria Treat with ceftriaxone followed by TMP/SMX
What is one of the main distinctions between chronic pancreatitis and celiac disease
Presence of iron deficiency in celiac disease
What is the main test for Celiac disease
anti-tissue transglutaminase (TTG)
most accurate diagnostic test is small bowel biopsy showing flattening of the villi
Patient presents with intermittent diarrhea and flushing, with episodes of wheezing and JVD and pedal edema?
Carcinoid syndrome
best initial test is urinary 5-hydroxyindoleacetic acid (5-HIAA)
therapy is with octreotide
Treatment for IBS
- Fiber in the diet
- Antispasmodic agents (hyoscyamine, dicyclomine, peppermint oil)
- TCAs
When should screening occur for IBD patients
After 8-10 years of colonic involvement, with colonoscopy every 1 to 2 years
UC is positive for what
CD is positive for what
UC is positive for antineutrophil cytoplasmic antibody (ANCA)
CD is positive for Anti-Saccharomyces cerevisiae antibody (ASCA)
Anti TNF
Adalimumab Infliximab Certolizumab Golimumab can be used for IBD
If IBD is refractory to all other treatment give what?
Vedolizumab (alpha integrin inhibitor)
Steroids commonly used for IBD in acute exacerbations
Budesonide
Prednisone
Short bowel syndrome
Have had a least 1/2 of the small bowel removed usually result of multiple surgeries for Crohn disease
present with diarrhea, dehydration and malnutrition, and weight loss
Key finding is deficiency in Vit A, D, E, K, B12, Ca, Mag, Fe, Zinc
Can look like celiac disease
Treatment for diverticulitis
Ciprofloxacin with metronidazole
Colon cancer screening with FH of cancer
Begin 10 yrs earlier than the age at which the family member developed their cancer or age 40 and repeat every 5 years
Peutz-Jeghers syndrome
Multiple hamartomatous polyps
Melanotic spots on lips and skin
Increase frequency of breast cancer, gonadal, and pancreatic cancer
Gardner Syndrome
Colon cancer with osteomas
desmoid tumors
other soft tissue tumors
Turcot Syndrome
Colon cancer with CNS malignancy
What is associated with the worst prognosis in pancreatitis?
Low Calcium
Treatment of SBP
Cefotaxime or ceftriaxone
Female 45 yo with 2 month fatigue and itching, dry mouth and eyes and hx osteoporosis
with a normal bilirubin wiht elevated ALP
Primary biliary cholangitis
treat with ursodexoycholic acid or
obeticholic acid which decreases fibrosis
Hemochromatosis
Genetic disorder leading to overabsorption of iron in duodenum
mutation in C282y gene
Presentation of Hemochromatosis
Typically male in 50’s with mild increase AST, ALP
Fatigue and joint pain, erectile dysfxn in men or amenorrhea in women
skin darkening
diabetes
cardiomyopathy
What type of infections is hemochromatosis pts. more at risk for
Vibrio vulnificus
Yersinia
Listeria
these feed on iron
How to treat Chronic Hepatitis B?
Adefovir Lamivudine Telbivudine Entecavir Tenofovir (especially in pregnancy) Interferon
How to treat acute Hepatitis C?
chronic is not treated
Sofosbuvir-velpatasvir Sofosbuvir-ledipasvir sofosbuvir-daclatasvir Elbasvir-grazoprevir Ombitasvir-paritaprevir-dasabuvir-ritonavir
What predicts the response to therapy for Hepatitis C?
Genotype
What indicates if there is a response to treatment for HCV?
PCR-RNA viral load (should who suprression)
What indicates the extent of liver damage in HCV?
Liver biopsy but is rarely needed (it wont be liver function test)
Adverse effects of interferon?
Arthralgias
thrombocytopenia
depression
leukopenia
Adverse effects of Ribavirin
Anemia
Adverse effects of Adefovir
used for hepatitis
Renal dysfxn
young patient presents with cirrhosis, psychosis, Coombs negative hemolytic anemia and renal tubular acidosis or nephrolithaisis?
Wilsons disease
Wilsons disease dx test
Slit lamp for kayser fleischer rings
liver biopsy
most accurate is urine copper after giving penicillamine (which is also the treatment) (if pcn allergy use zinc or trientine)
MELD score
Model for end-Stage Liver Disease–> predicts survival in cirrhosis and alcoholic hepatitis
Used in prioritizing in who gets liver donor first
MELD score consists of
Age
Creatinine and the need for dialysis
Bilirubin and INR
Liver imaging showing central stellate scaring
Focal nodular hyperplasia
is from hyperplastic growth around abnormal blood vessel, it is benign and no treatment required
What drugs are associated with causing acute pancreatitis?
Valproic Acid Diuretics= Furosemide, thiazides IBD drugs= sulfasalazine, 5-ASA Immunosupressive agents= Azathioprine HIV meds= diadanosine Pentamidine Abx= Metronidazole, tetracycline
