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GI Flashcards

1
Q

A neuroendocrine tumor that arises from the beta cells of the pancreas is what?

A

Insulinoma

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2
Q

Patient has weight gain and continual hypoglycemia and gets better after given glucose

A

Insulinoma

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3
Q

Whipples triad?

A

Plasma glucose concentration ≤ 55 mg/dL
Signs or symptoms consistent with hypoglycemia
Resolution when plasma glucose increases
Seen in pts. with insulinoma

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4
Q

Diagnostic indications of insulinoma

A

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

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5
Q

How to differentiate sulfonylurea use from insulinoma

A

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.

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6
Q

Tx of insulinoma

A

surgery

Medication–> diazoxide which inhibits insulin release

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7
Q

IBD that involves terminal ileum?

A

Crohn’s
Mimics appendicitis
Fe deficiency

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8
Q

IBD that is continuous that involves rectum?

A

UC

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9
Q

IBD increasing risk for Primary Sclerosing Cholangitis?

A

UC

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10
Q

IBD most likely to have fistula forming?

A

Crohn’s

Metronidazole

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11
Q

IBD most likely to granulomas on biopsy?

A

Crohn’s

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12
Q

UC is cured by what?

A

Colectomy

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13
Q

IBD where smokers have a lower risk?

A

UC

smokers have higher risk for Crohn’s

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14
Q

IBD that has highest risk of colon cancer?

A

UC

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15
Q

IBD associated w/ p-ANCA?

A

UC

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16
Q

Treatment for IBD?

A

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

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17
Q

LFT Buzzwords

• AST>ALT (2x) + high GGT

A

Alcoholic Hepatitis

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18
Q

LFT Buzzwords

ALT>AST & in the 1000s

A

Viral Hepatitis

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19
Q

LFT Buzzwords

AST and ALT in the 1000s after surgery or hemorrhage

A

Ischemic Hepatitis (“shock liver”)

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20
Q

LFT Buzzwords

Elevated Direct bilirubin

A

Obstructive (stone/cancer) or Dubin’s Johnsons, Rotor

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21
Q

LFT Buzzwords

Elevated Indirect bilirubin

A

Hemolysis or Gilbert’s, Crigler Najjar

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22
Q

LFT Buzzwords

Elevated alk phos and GGT

A

Bile duct obstruction, if IBD –> PSC

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23
Q

LFT Buzzwords

Elevated alk phos, normal GGT, normal Ca

A

Paget’s disease (incr hat size, hearing loss,

HA. Tx w/ bisphosphonates.

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24
Q

AMA- antibodies

antimitochondrial Ab

A

Primary Biliary Cirrhosis – tx w/ bile resins

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25
Q

ANA + antismooth muscle Ab

A

Autoimmune Hepatitis- tx w/ steroids

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26
Q

High Fe, low ferritin, low Fe binding capacity

A

Hemachromatosis- hepatitis, DM, golden skin

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27
Q

Low ceruloplasmin, high urinary Cu

A

Wilson’s-

hepatitis, psychiatric sxs (BG), corneal deposits

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28
Q

Unconjugated hyperbilirubinemia–> Increased hgb breakdown

A

Hemolysis; glucose-6-phosphate dehydrogenase deficiency, sickle cell anemia, spherocytosis, hemolytic disease of the fetus and newborn, and blood transfusions
thalassemia

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29
Q

Unconjugated hyperbilirubinemia–> Impaired hepatic uptake of bilirubin

A

Drugs (e.g., rifampin, probenecid, sulfonamides)

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30
Q

Conjugated hyperbilirubinemia–> Intrahepatic cholestasis

A

Primary biliary cholangitis

Pregnancy

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31
Q

Conjugated hyperbilirubinemia–> Extrahepatic cholestasis

A

Choledocholithiasis
pancreatic cancer, cholangiocellular carcinoma
primary sclerosing cholangitis
Malformations of the bile ducts; biliary cysts
Postoperative bile leaks or biliary duct strictures

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32
Q

Common causes of hyperbilirubinemia

A

HOT Liver: Hemolysis, Obstruction, Tumor, and Liver disease!

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33
Q

Clinical Features of jaundice

A

Pale, clay-colored (acholic) stool
Darkening of urine
Pruritus
Fat malabsorption (steatorrhea, weight loss)

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34
Q

Who do Primary Biliary cholangitis usually affect?

A

Middle aged women

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35
Q

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?

A

PBC

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36
Q

Labs that are significant in PBC?

A

elevated AMA ab, ANA, ALP

AST/ALT will be normal or slightly elevated

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37
Q

What is the tx for PBC?

A

Ursodeoxycholic acid/urosdiol

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38
Q

PSC is associated with what?

A

UC

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39
Q

PSC is associated with what antibodies

A

pANCA

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40
Q

What diagnostic imaging should be used for dx PSC?

A

MRCP

magnetic resonance cholangiopancreatography

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41
Q

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?

A

PSC

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42
Q

Who does PSC affect vs PBC?

A

PSC affects middle aged men while PBC affects middle aged women

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43
Q

What is the main difference in the pathophysio between PSC and PBC?

A

PSC affects intrahepatic and extrahepatic ducts

PBC affects intrahepatic ducts

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44
Q

PBC is associated with what conditions?

A

Autoimmune conditions, such as RA, CREST syndrome, Sicca syndrome, autoimmune thyroid disease

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45
Q

Symptomatic treatment for PSC?

A

Ursodeoxycholic acid

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46
Q

Curative treatment for PSC?

A

Liver transplantation

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47
Q

Major complication of PSC?

A

Cholangiocarcinoma

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48
Q

The presence of gallstones in the gallbladder?

A

Cholelithiasis

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49
Q

The presence of gallstones in common bile duct

A

Choledocholithiasis

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50
Q

Inflammation of the gallbladder

A

Cholecystitis

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51
Q

Bacterial infection of the biliary tract?

A

Cholangitis

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52
Q

Cholelithiasis pathophys

A

Bile cholesterol oversaturation, bile stasis, impaired bile acid circulation → precipitation of gallstones in the gallbladder

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53
Q

Choledocholithiasis

A

Cholelithiasis → migration of gallstones into the common bile duct

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54
Q

Acute cholecystitis

A

Cholelithiasis (most common) or biliary sludge → inflammation of gallbladder wall

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55
Q

Acute cholangitis

A

Choledocholithiasis → obstruction and stasis within the biliary tract → subsequent bacterial infection

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56
Q

Cholelithiasis clinical features

A

RUQ pain less than 6h

biliary colic especially postprandial

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57
Q

Choledocholithiasis clinical features

A

colicky RUQ pain more than 6h
postprandial
Nausea vomiting

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58
Q

Acute cholecystitis

clinical features

A

RUQ pain (postprandial)
Fever
Murphy sign

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59
Q

Murphy sign

A

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.

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60
Q

Charcot triad

A

RUQ pain
Fever
Jaundice

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61
Q

Acute cholangitis clinical features

A

Charcot triad or Reynold Pentad

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62
Q

Reynold pentad

A

Charcot cholangitis triad PLUS hypotension and mental status changes

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63
Q

Cholelithiasis lab findings

A

Normal

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64
Q

Choledocholithiasis lab findings

A

elevated ALP, AST, ALT and total bilirubin

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65
Q

Acute cholecystitis lab findings

A

elevated WBC, CRP

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66
Q

Acute cholangitis lab findings

A

elevated WBC, CRP, ALP, AST, ALT and total bilirubin

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67
Q

Cholelithiasis dx test and findings

A

US: gallstones with posterior acoustic shadow

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68
Q

Cholelithiasis treatment

A

Supportive care NSAIDs,

elective cck

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69
Q

Choledocholithiasis dx test and findings

A

US: dilated common bile duct, intrahepatic biliary dilatation
MRCP or ERCP: filling defect in the contrast-enhanced duct

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70
Q

Choledocholithiasis treatment

A

Supportive care NSAIDs,
Endoscopic stone retrieval (ERCP)
Elective cholecystectomy

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71
Q

Acute cholecystitis dx test and findings

A

US: gallbladder wall thickening and/or edema (double wall sign)
HIDA scan if diagnosis uncertain

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72
Q

Acute cholecystitis treatment

A

Supportive care, analgesics
IV antibiotics
Cholecystectomy (timing depends on severity)

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73
Q

Acute cholangitis dx test and findings

A

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

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74
Q

Acute cholangitis treatment

A

Supportive care, analgesics
IV antibiotics
Urgent biliary drainage and decompression via ERCP
Interval cholecystectomy if gallstones are present or concurrent cholecystitis

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75
Q

Risk factors for cholelithiasis

A

female forty, fat, fertile, fair skinned, family history

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76
Q

Why is x-ray rarely diagnostic for cholelithiasis?

A

X-ray is rarely diagnostic because only 10–15% of stones (i.e., pigment stones) are radiopaque. Cholesterol stones (majority) are radiolucent!

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77
Q

Mirizzi syndrome

A

complication of cholelithaisis
Gallstones in the cystic duct or Hartmann pouch of the gallbladder obstruct the common hepatic duct or common bile duct.

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78
Q

Complications of Choledocholithiasis ?

A

gallstone ileus

gallstone pancreatitis

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79
Q

Gallstone ileus

A

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

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80
Q

pneumobilia

A

The accumulation of gas in the biliary system. Common causes include sphincterotomy of the sphincter of Oddi, biliary-enteric anastomosis, and gallstone ileus.

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81
Q

Bacterial infection most common Acute cholecystitis ?

A

E. coli, Klebsiella, Enterobacter, Enterococcus spp.

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82
Q

Emphysematous cholecystitis (rare)

A

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

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83
Q

Complications of acute cholecystitis

A

Gallbladder empyema
gallbladder perforation
chronic cholecystitis

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84
Q

Porcelain gallbladder

A

complication of chronic cholecystitis

fibrotic and calcified gallbladder due to chronic inflammation

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85
Q

Chronic gallbladder inflammation increases the risk of what?

A

gallbladder carcinoma

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86
Q

Postcholecystectomy syndrome?

A

persistent abdominal pain or new symptoms following gallbladder removal

87
Q

Postcholecystectomy syndrome features

A

Etiology; sphincter of Oddi dysfunction

Clinical features: abdominal pain and upper GI tract (e.g., dyspepsia) or lower GI tract (e.g., diarrhea) symptoms

88
Q

Postcholecystectomy syndrome diagnosis?

A

ultrasound or CT scan followed by ERCP (preferred test if intervention is planned) or MRCP

89
Q

Biliary Cancers

A

Cholangiocarcinoma

Gallbladder carcinoma

90
Q

Cholangiocarcinoma

A

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)

91
Q

Gallbladder carcinomas

A

originate within the mucosal lining of the gallbladder

92
Q

Risk factors for cholangiocarcinoma

A

Primary sclerosing cholangitis

Liver fluke infection (e.g., Clonorchis sinensis, Opisthorchis viverrini) –> most common risk factor in asian countries

93
Q

Risk factors for gallbladder carcinoma

A

Cholelithiasis with chronic inflammation (most common risk factor)
Porcelain gallbladder

94
Q

Courvoisier sign

A

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.

95
Q

Tumor markers helpful in biliary cancers

A

AFP
CA 19-9
CEA

96
Q

Imaging for suspected biliary carcinoma

A

US for initial

MRCP for definitive dx

97
Q

what type of pathology is usually biliary cacners

A

adenocarcinoma

98
Q

Primary peritonitis (SBP) predisposing conditions?

A

Ascites
Cirrhosis
Peritoneal dialysis

99
Q

Primary peritonitis SBP organisms?

A

Gram-negative : E.coli, Klebseilla pneumiae, bacteroides

100
Q

Secondary peritonitis is due to what pre-existing acute abdominal condition

A

Hollow organ perforation, appendicitis, diverticulitis, necrotizing pancreatitis, postoperative complications

101
Q

Secondary peritonitis organisms?

A

Mixed infection: aerobic (E. coli, Klebsiella, Enterobacter, Streptococci, Enterococci) and anaerobic (Bacteroides species, Eubacteria, Clostridia)

102
Q

How to diagnosis hiatal hernia?

A

endoscopy or barium studies

103
Q

Best initial therapy for hiatal hernia

A

Weight loss and PPIs

symptoms persist = surgical correction (Nissen fundoplication)

104
Q

Dysphagia

A

Difficulty swallowing

indicating esophageal disorder

105
Q

Odynophagia

A

Pain while swallowing

106
Q

Alarm symptoms for esophageal disorders?

A

weight loss
blood in stool
anemia
Endoscopy should be performed

107
Q

Achalasia

A

inability of the lower esophageal sphincter to relax due to a loss of the nerve plexus within the lower esophagus

108
Q

Key hx of achalasia pt.

A

young pt <50
progressive dysphagia to both solids and liquids at the same time
no association with etoh and tob

109
Q

Diagnostic test for achalasia ?

A

barium= birds beak

Manometry most accurate test

110
Q

in the esophagus what two things are diagnosed by biopsy?

A

cancer and barrett esophagus

111
Q

Key hx of esophageal cancer pt.

A

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

112
Q

Tx for esophageal cancer

A

Surgical resection

113
Q

2 forms of esophageal spastic disorders

A

diffuse esophageal spasm

Nutcracker esophagus

114
Q

How do esophageal spastic disorders present?

A

Sudden onset of chest pain not related to exertion with normal EKG and stress test

115
Q

How to diagnose esophageal spastic disorders ?

A

Manometry

116
Q

How to treat esophageal spastic disorders?

A

CCB and nitrates simliar to Prinsmetal angina

117
Q

Hx of patient with eosinophilic esophagitis

A

Dysphagia, food impaction, heartburn, with hx of asthma and allergic disease, endoscopy will show multiple concentric rings

118
Q

Most accurate diagnostic test for eosinophilic esophagitis

A

endoscopy with biopsy finding eosinophils

119
Q

Treatment for eosinophilic esophagitis

A

initial therapy PPI and eliminating allergenic foods 2nd line swallowing steroid inhalers

120
Q

Dysphagia with HIV CD4<100 what do you do?

A

Empirically start fluconazole, if dont improve get upper endoscopy with biopsy

121
Q

Dysphagia with HIV CD4<100 with large linear ulcerations?

A

CMV esophagitis

start Ganciclovir or foscarnet

122
Q

Dysphagia with HIV CD4<100 with small ulcerations

A

HSV esophagitis

start acyclovir

123
Q

steakhouse syndrome

A

dysphagia from solid food associated with Schatizki ring

124
Q

Schatzki ring

A

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

125
Q

Plummer-Vinson syndrome

A

associated with iron deficiency anemia , dysphagia, upper esophageal webs
tx first with iron replacement
complication is squamous cell cancer

126
Q

Zenker diverticulum hx

A

dysphagia, halitosis, regurgitation of food (which can lead to aspiration pneumonia)

127
Q

Zenker diverticulum diagnosis and treatment

A

Diagnosed with barium studies

treated with surgery (never NG tube or upper endoscopy)

128
Q

Manometry is the diagnostic test for what?

A

Achalasia
Spasm
Scleroderma

129
Q

Mallory- Weiss tear

A

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

130
Q

pt. presents with recurrent episodes of nausea, vomiting and crampy abdominal pain symptoms improve with hot shower and has a hx of marijuana use?

A

Cannabinoid Hyperemesis syndrome

treat with antiemetics (zofran) or benzos (lorazepam)

131
Q

Primary peritonitis empiric antibiotic therapy

A

3rd gen cephalosprorin

132
Q

Statin potency and cost in increasing order

A

Fluvastatin low
lovastatin and pravastatin medium
simvastatin adn atrovastatin high

133
Q

Statin does what?

A

Competitive inhibition of HMG-CoA reductase decreasing mainly LDL cholesterol

134
Q

When to use statins

A

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

135
Q

Statins are metabolized by CYP3A4 so cant be combined with CYP3A4 inhibitors (what are they)

A

HIV/HCV protease inhibitors
Macrolides (especially erythromycin and clatihromycin)
Azole antifungals
cyclosprine

136
Q

Warfarin and statin interaction

A

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.

137
Q

complications of acute appendicitis

A

Pylephlebitis

138
Q

Pylephlebitis

A

septic thrombosis of the portal vein due to due to perforated appendicitis, diverticulitis, or necrotizing pancreatitis

139
Q

High SAAG > 1.1g/dL

A 
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 syndrome
140
Q

Low SAAG ascites < 1.1. g/dL

A

Hypoalbuminemia (Nephrotic syndrome, Severe malnutrition, Protein-losing enteropathy)
Malignancy
Infections (except SBP)
Pancreatitis

141
Q

Ascites due to portal hypertension >1.1g/dL (SAAG) with protein >2.5 g/dL, what is the cause?

A

right heart failure

142
Q

Ascites due to portal hypertension >1.1g/dL (SAAG) with protein <2.5 g/dL, what is the cause?

A

Hepatic cirrhosis

143
Q

Ascites due to other causes <1.1g/dL (SAAG) with protein >2.5 g/dL, what is the cause?

A 
Hepatic malignancy
Peritoneal carcinomatosis
Pancreatitis
Chylous ascites
Tuberculosis
144
Q

Ascites due to other causes <1.1g/dL (SAAG) with protein <2.5 g/dL, what is the cause?

A

Nephrotic syndrome

145
Q

complications of ascites

A

Spontaneous bacterial peritonitis (ascitic fluid infection): abdominal tenderness, fever, altered mental status (see peritonitis for more information)

146
Q

epigastric pain, pain worse with food

A

gastric ulcer

147
Q

epigastric pain, pain better with food

A

duodenal ulcer

148
Q

epigastric pain with weight loss

A

cancer, gastric ulcer

149
Q

epigastric pain with tenderness

A

pancreatitis

150
Q

epigastric pain with bad taste, cough, hoarse

A

Gastroesophageal reflux

151
Q

epigastric pain patient with diabetes and bloating

A

gastroparesis

152
Q

epigastric pain with no other symptoms or physical exam findings

A

Non-ulcer dyspepsia

153
Q

Right Upper Quadrant Pain differential diagnosis

A

Cholecystitis
Biliary colic
Cholangitis
Perforated duodenal ulcer

154
Q

Left Upper Quadrant Pain differential diagnosis

A

Splenic rupture

IBS–Splenic flexure syndrome

155
Q

Right lower Quadrant Pain differential diagnosis

A

Appendicitis
Ovarian torsion
Ectopic pregnancy
Cecal diverticulitis

156
Q

Left Lower Quadrant Pain differential diagnosis

A

Sigmoid volvulus
Sigmoid diverticulitis
Ovarian torsion
Ectopic pregnancy

157
Q

Barret esophagus managment

A

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

158
Q

What is gastritis caused by?

A 
ETOH
NSAIDs
H. pylori
Portal hypertension
Stress such as burns, trauma, sepsis and multiorgan failure (uremia)
159
Q

Atrophic gastritis is associated with what?

A

Vitamin B12 deficiency

160
Q

Stress ulcer prophylaxis is indicated in what?

A

Mechanical Ventilation
Burns
Head trauma
sepsis with Coagulopathy

161
Q

Cirrhosis causes

A 
Hepatotxicity (ETOH, NSAIDs, Aflatoxin by aspergillus)
Inflammation (Hepatitis, PBC, PSC, autoimmune hepatitis) 
Metabolic disorders (fatty liver, hemochromatosis, wilson's disease, alpha-1 antitrypsin)
162
Q

Most common causes cirrhosis in the US

A

ETOH, Hep C, Non-alcoholic steatohepatitis

163
Q

Child Pugh score

A

Prognosis in Chronic liver failure

164
Q

Child Pugh score based on what?

A 
serum albumin
serum bilirubin
INR
Ascites
Hepatic encephalopathy
165
Q

What are the most common causes of Peptic Ulcer Disease?

A

1st H. pylori

2md NSAIDs

166
Q

How to treat H. pylori infection?

A

PPIs + clarithromycin + amoxicillin (metronidazole in pCN allergy)
For those who do not respond to this tx –> Metronidazole and tetracycline can be used

167
Q

Scope patients with dyspepsia if ?

A

Patient is over 55 yo old

Alarm symptoms are present (dysphagia, weight loss, anemia)

168
Q

Management of Non-ulcer dyspepsia

A

age <45 = PPIs

Age > 55= PPIs + scope

169
Q

Patient with recurrent diarrhea who has multiple large ulcers (>1-2cm) recurrent after h. pylori treatment, distal in duodenum ?

A

Gastrinoma (zollinger ellsion syndrome)

will have gastrin levels despite giving secretin

170
Q

Diabetic gastroparesis

A

Look for diabetic patient with chronic abdominal discomfort, bloating and constipation with nausea vomiting and early satiety

171
Q

Side effects of metoclopramide

A

dystonia, prolonged QT, and hyperprolactinoma

172
Q

Management of gastroparesis

A

Dietary modifications
persists then–> metclopramide
persists then–> erythromycin and antiemetics
if that fails–> gastric electrical simulation

173
Q

Orthostatic hypotension

A

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

174
Q

What is the treatment for C. diff?

A

Oral vancomycin and if there is no response switch to fidaxomicin
IV vancomycin is never used because it will not pass the bowel wall

175
Q

what is fulminant C. diff?

A

antibiotic- associated diarrhea, positive stool toxin assay
high WBC
Metabolic acidosis
high lactate
high creatinine
tx using both vancomycin and metronidazole

176
Q

Differential diagnosis for steatorrhea (oily greasy foul smelling stool)

A

Celiac disease
Chronic Pancreattis
Tropical sprue
Whipple Disease

177
Q

Any fat malabsorption can present with deficiency in A, D, E, K

A

Vitamin D hypocalcemia, osteoporosis
Vitamin K, bleeding easy bruising
Vitamin B12, anemia, hypersegmented neutrophils

178
Q

Whipple disease

A 
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
179
Q

What is one of the main distinctions between chronic pancreatitis and celiac disease

A

Presence of iron deficiency in celiac disease

180
Q

What is the main test for Celiac disease

A

anti-tissue transglutaminase (TTG)

most accurate diagnostic test is small bowel biopsy showing flattening of the villi

181
Q

Patient presents with intermittent diarrhea and flushing, with episodes of wheezing and JVD and pedal edema?

A

Carcinoid syndrome

best initial test is urinary 5-hydroxyindoleacetic acid (5-HIAA)
therapy is with octreotide

182
Q

Treatment for IBS

A
  1. Fiber in the diet
  2. Antispasmodic agents (hyoscyamine, dicyclomine, peppermint oil)
  3. TCAs
183
Q

When should screening occur for IBD patients

A

After 8-10 years of colonic involvement, with colonoscopy every 1 to 2 years

184
Q

UC is positive for what

CD is positive for what

A

UC is positive for antineutrophil cytoplasmic antibody (ANCA)
CD is positive for Anti-Saccharomyces cerevisiae antibody (ASCA)

185
Q

Anti TNF

A 
Adalimumab
Infliximab
Certolizumab
Golimumab
can be used for IBD
186
Q

If IBD is refractory to all other treatment give what?

A

Vedolizumab (alpha integrin inhibitor)

187
Q

Steroids commonly used for IBD in acute exacerbations

A

Budesonide

Prednisone

188
Q

Short bowel syndrome

A

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

189
Q

Treatment for diverticulitis

A

Ciprofloxacin with metronidazole

190
Q

Colon cancer screening with FH of cancer

A

Begin 10 yrs earlier than the age at which the family member developed their cancer or age 40 and repeat every 5 years

191
Q

Peutz-Jeghers syndrome

A

Multiple hamartomatous polyps
Melanotic spots on lips and skin
Increase frequency of breast cancer, gonadal, and pancreatic cancer

192
Q

Gardner Syndrome

A

Colon cancer with osteomas
desmoid tumors
other soft tissue tumors

193
Q

Turcot Syndrome

A

Colon cancer with CNS malignancy

194
Q

What is associated with the worst prognosis in pancreatitis?

A

Low Calcium

195
Q

Treatment of SBP

A

Cefotaxime or ceftriaxone

196
Q

Female 45 yo with 2 month fatigue and itching, dry mouth and eyes and hx osteoporosis
with a normal bilirubin wiht elevated ALP

A

Primary biliary cholangitis

treat with ursodexoycholic acid or
obeticholic acid which decreases fibrosis

197
Q

Hemochromatosis

A

Genetic disorder leading to overabsorption of iron in duodenum
mutation in C282y gene

198
Q

Presentation of Hemochromatosis

A

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

199
Q

What type of infections is hemochromatosis pts. more at risk for

A

Vibrio vulnificus
Yersinia
Listeria
these feed on iron

200
Q

How to treat Chronic Hepatitis B?

A 
Adefovir
Lamivudine
Telbivudine
Entecavir
Tenofovir (especially in pregnancy)
Interferon
201
Q

How to treat acute Hepatitis C?

chronic is not treated

A 
Sofosbuvir-velpatasvir
Sofosbuvir-ledipasvir
sofosbuvir-daclatasvir
Elbasvir-grazoprevir
Ombitasvir-paritaprevir-dasabuvir-ritonavir
202
Q

What predicts the response to therapy for Hepatitis C?

A

Genotype

203
Q

What indicates if there is a response to treatment for HCV?

A

PCR-RNA viral load (should who suprression)

204
Q

What indicates the extent of liver damage in HCV?

A

Liver biopsy but is rarely needed (it wont be liver function test)

205
Q

Adverse effects of interferon?

A

Arthralgias
thrombocytopenia
depression
leukopenia

206
Q

Adverse effects of Ribavirin

A

Anemia

207
Q

Adverse effects of Adefovir

A

used for hepatitis

Renal dysfxn

208
Q

young patient presents with cirrhosis, psychosis, Coombs negative hemolytic anemia and renal tubular acidosis or nephrolithaisis?

A

Wilsons disease

209
Q

Wilsons disease dx test

A

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)

210
Q

MELD score

A

Model for end-Stage Liver Disease–> predicts survival in cirrhosis and alcoholic hepatitis
Used in prioritizing in who gets liver donor first

211
Q

MELD score consists of

A

Age
Creatinine and the need for dialysis
Bilirubin and INR

212
Q

Liver imaging showing central stellate scaring

A

Focal nodular hyperplasia

is from hyperplastic growth around abnormal blood vessel, it is benign and no treatment required

213
Q

What drugs are associated with causing acute pancreatitis?

A 
Valproic Acid
Diuretics= Furosemide, thiazides
IBD drugs= sulfasalazine, 5-ASA
Immunosupressive agents= Azathioprine
HIV meds= diadanosine Pentamidine
Abx= Metronidazole, tetracycline

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