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x Medicine 200 > GI and Hepatology > Flashcards

GI and Hepatology Flashcards

1
Q

Laxative abuse presentation

A

Very frequent, watery, nocturnal diarrhea. Melanosis coli.

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2
Q

Melanosis coli looks like

A

Dark brown colon with light patches which are the lymph follicles

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3
Q

Iron deficiency anemia DDx important

A

Always include colon cancer, colonoscopy is high on list of things to do

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4
Q

Most common cause of iron deficiency anemia in elderly

A

GI blood loss

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5
Q

Toxic megacolon most common cause

A

UC

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6
Q

Toxic megacolon tx

A

IV steroids, nasogastric decompression, and fluid management

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7
Q

BRBPR workup

A

In patients <50 with no risk factors for colon CA, do anoscopy/proctoscopy

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8
Q

Esophageal cancer vs. achalasia

A

CA can mimic achalasia very closely. Think of CA in old age, short history, rapid weight loss, and inability to pass endoscope through sphincter

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9
Q

Peptic strictures presentation

A

Pain with swallowing solids, but NO WEIGHT LOSS

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10
Q

What causes peptic strictures

A

GERD!!!, radiation, scleroderma, and caustic ingestions

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11
Q

Painless jaundice in old person is

A

Pancreatic head CA

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12
Q

How to treat ALL anal fissures

A

High fiber diet, large amount of fluids, stool softeners, local anesthetics

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13
Q

Multiple myeloma presentation

A

Back pain, anemia, renal dysfunction, elevated ESR, and hyperCa

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14
Q

Metastatic cancers to bone

A

Lung, breast, renal thyroid, prostate,

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15
Q

Constipation ddx

A

Always include hyperCa from myeloma or metastases to bone

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16
Q

Diagnosis of UC

A

Proctosigmoidoscopy with biopsy

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17
Q

Most commonly affected part of colon by ischemia

A

Splenic flexure

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18
Q

Most common abx cause of c.diff

A

Clindamycin

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19
Q

How to treat c.diff

A

Stop Abx and start flagyl

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20
Q

Scleroderma esophageal dismotility

A

Decreased LES tone

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21
Q

Any tests or signs of IBS

A

Nope, no lab tests or pathologic hallmark

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22
Q

Tx for asymptomatic diverticulosis

A

high fiber intake

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23
Q

H pylori diagnosis in patients <45

A

Noninvasive tests

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24
Q

Anti-endomysial antibodies

A

Celiac disease

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25
Q

Anti-scl 70 antibodies

A

Scleroderma

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26
Q

Anti-centromeric antibodies

A

CREST syndrome

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27
Q

Antimitochondrial antibodies

A

PBC

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28
Q

Gastrin in ZE syndrome for diagnosis

A

> 1000 pg/mL is diagnostic, if not this high, do secretin stimulation test

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29
Q

Causes of zinc deficiency

A

TPN or malnutrition.

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30
Q

Zinc def. signs

A

ALopecia, skin lesions, abnormal taste, and impaired wound healing

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31
Q

Endoscopy in achalasia?

A

Always, to rule out cancer

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32
Q

Most common complication of PUD

A

hemorrhage

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33
Q

Tx for ascites

A
  1. Sodium and water restriction 2. Spironolactone 3. Loop diuretic (not >1L/day) 4. Frequent abdominal paracentesis (2-4L/day, as long as renal function okay)
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34
Q

TPN RUQ complication

A

Gallstones due to sludging and decreased GB peristalsis. can lead to cholecystitis

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35
Q

chronic DIC

A

FOund in malignancy, can cause migratory thrombophlebitis and atypical venous thromboses

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36
Q

How to test for chronic pancreatitis

A

Fecal elastase to test for exocrine failure

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37
Q

VIPoma sxs

A

Pancreatic cholera

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38
Q

Unexplained chornic abd. pain, weight loss, and food aversion

A

Chronic mesenteric ischemia

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39
Q

Chronic mesenteric ischemia supporting signs

A

Atherosclerosis, psosible abdominal bruit

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40
Q

Lactose intolerance test

A

Positive hydrogen breath test, positive stool test for reducing substances, low stool pH, and increased stool osmotic gap. No steatorrhea

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41
Q

Antibiotic associated idarrhea is always

A

cdiff. use cytotoxin assay

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42
Q

most common causes of painless GI bleeding in >65

A

Diverticulosis and angiodysplasia

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43
Q

Angiodysplasia associated with

A

aortic stenosis

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44
Q

D-xylose absorption test

A

Abnormal in bacterial overgrowth and celiac sprue. With bacterial overgrowth, it normalizes with abx

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45
Q

Iron defieincy anemia and celiacs?

A

Yes, one of th emost common presentations

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46
Q

Chronic pancreatitis can lead to

A

Pancreatic cancer

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47
Q

HIV chronic diarrhea CD4<180

A

cryptosporidium parvum

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48
Q

Carcinoid syndrome triad

A

Flushing, wheezing, diarrhea

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49
Q

Alarm signals of GERD

A

N/V, weight loss, anemia, melena/hematochezia, long duration of symptoms especially when white male>45, failure to respond to PPIs

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50
Q

Rocky mountain or foreign country diarrhea

A

Giardiasis, causes adhesive disks and malabsorption

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51
Q

Abd. surgery complication leading to malabsorption

A

Bacterial overgrowth

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52
Q

ZE syndrome can cause malabsorption how

A

Inactivation of pancreatic enzymes

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53
Q

Best dx and evaluation for diverticulitis

A

CT

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54
Q

Carcinoid syndrome nutrient deficiency

A

Niacin from 5HT production

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55
Q

MENI tumors

A

Primary hyperPTH, pituitary tumors, and enteropancreatic tumors (GASTRINOMA)

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56
Q

When to do esophagoscopy for GERD

A

When patient fails to respond to PPI tehrapy or the scary signs pop up

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57
Q

Initial test for all dysphagia

A

Barium swallow

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58
Q

Young person with chronic diarrhea, abd. pain, and weight loss

A

Crohn’s

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59
Q

Digoxin toxicity can be caused by this

A

Verapamil

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60
Q

Digoxin toxicity sxs

A

GI, anorexia, N/V

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61
Q

Tx for zenker’s

A

Cricopharyngeal myotomy.

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62
Q

BUN>40 in presence of normal Cr

A

Upper GI bleed. or steroids

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63
Q

Whipple’s disease presentation

A

Arthralgias, weight loss, fever, diarrhea, and abd. pain. PAS positive stain

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64
Q

Tropical sprue biopsy

A

blunting of villi with infiltration of chronic inflammatory cells, including lymphocytes, plasma cells, and eosinophils

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65
Q

How to dx zenker’s

A

Barium swallow

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66
Q

Dx of steatorrhea

A

quantitative estimatino of stool fat

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67
Q

Corkscrew esophagus on barium swallow

A

Diffuse esophageal spasm

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68
Q

When to think of diffuse esophageal spasm

A

Young female with intermittent chest pain and dysphagia

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69
Q

Diffuse esophageal spasm tx

A

Supportive, nitrates and CCBs?

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70
Q

WHen to tx Hep B

A

Persistently elevated ALT levels, detectable HBsAg, HBeAg, and HBV DNA should be treated with interferon and lamivudine

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71
Q

Recurrent pancreatitis with no clear cause w/u

A

ERCP

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72
Q

Most common cause of pancreatitis in men and women

A

Men: alcoholism, Women: gallstones

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73
Q

Liver metastases most commonly caused by

A

GI tract tumors, lung, breast

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74
Q

Post-cholecystectomy pain

A

Common bile duct stone, sphincter of Oddi dysfunction, or functional causes

75
Q

Chronic hep c vaccinations

A

Hep A and B

76
Q

Isoniazid and liver function

A

Causes idiosyncratic liver injury like viral hepatitis

77
Q

Hydatid cysts are

A

Due to infection with echinococcus granulosus

78
Q

Pancreatic pseudocyst effects

A

Causes an inflammatory response, but tends to respond spontaneously

79
Q

aminotransferases in alcoholic liver disease

A

Always lower than 500 IU/L

80
Q

Wilsons dz presentation

A

Low serum ceruloplasmin, increased Cu urine, kaiser fleischer rings

81
Q

Risk factors for cholangiocarinoma

A

Smoking and UC

82
Q

When to do TIPS

A

Refractory ascites, refractory hydrothorax, and surgical management of acute recurrent variceal bleeding

83
Q

Risk factors for pancreatic cancer

A

FH, chornic pancreatitis, smoking, DM, obesity, high fat diet. Alcohlism is not a risk FACTOR!

84
Q

How to tx symptomatic gallstones

A

With surgery, if they aren’t good surgical candidates, then just do medical management

85
Q

Dubin-Johnson liver appearnce

86
Q

Which cholestatic liver disease are fine

A

Dubin-Johnson, Rotor, Gilbert’s, Crigler-Najjar type 2

87
Q

Dx of dubin-johnson

A

Conjugated hyperbilirubinemia with a direct bilirubin fraction of at least 50% and otherwise normal liver function profile must be present

88
Q

Which cholestatic liver disease is bad

A

Crigler-Najjar type 1 Can result in kernicterus and death

89
Q

Causes of acute acalculous cholecystitis

A

Extensive burns, severe trauma, prolonged TPN, prolonged fasting, mechanical ventilation

90
Q

What is fulminant hepatic failure

A

If you get hepatic encephalopathy within 8 weeks and liver failure.

91
Q

What is acute hepatic failure

A

If you get liver failure within 8 wweeks

92
Q

Most common cause of acute liver injury and fulminant hepatitis

A

acetaminophen toxicity

93
Q

High serum AFP (>500 ng/mL) in an adult with liver disease and no obvious GI malignancy

A

is strongly suggestive of Hepatocellular cancer

94
Q

Hyperestrogenism signs

A

Gynecomastia, testicular atorphy, decreased body hair, spider angiomas, and palmar erythema

95
Q

Cause of hyperestrogneism in liver disease

A

Liver cant metabolize the estrogen that is present

96
Q

Screen people for HCVc and b in what blood transfusions

A

For B if before 1986, for C if before 1992

97
Q

In patients with oliguria and abd./pelvic surgeries

A

Do a foley catherization because they might have post-renal obstructive failure

98
Q

Patients with first episode of acute pancreatitis should always get this test to rule it out as ac ause

A

an Abd u/s to rule out gallstones as a cause

99
Q

Risk factors for nonalcoholic steatohepatitis

A

Obesity, DM, HLD, TPN, and using certain meds

100
Q

ABO mismatch signs

A

Fever, hemolysis, shock, and DIC

101
Q

Ursodeoxycholic acid uses

A

Used in PBC to relieve symptoms and lengthen transplant-free survival time

102
Q

Risk factors for cirrhosis in Hep C patients

A

Male, acquiring infection after age 40, longer duration of infection, coinfeciton with HBV or HIV, immunosuppresion, liver comorbidities like alcoholic liver disease, hemochromatosis, alpha-1 antitrypsin deficiency, alcohol intake

103
Q

postexposure ppx for HBV

A

HBIG and three shots of HBV vaccine at set intervals

104
Q

SAAG levels

A

High SAAG >1.1 is going to transudative like CHF and cirrhosis due to high portal HTN. Low SAAG is going to be exudative like malignancy,

105
Q

Postoperative cholestasis

A

Especially in surgeries with hypotension, extensive blood loss into tissues, and massive blood replacement

106
Q

Hepatic adenoma

A

Young women with OCPs

107
Q

Most commonc ause of cirrhosis in the US, then second

A

Alcohlism, HCV is second

108
Q

Best testing for Acute HBV infection

A

HBsAg and anti-HBc

109
Q

Isoniazid and liver

A

Mild aminotransferase elevations within first few weeks and will resolve without intervention

110
Q

When to treat Hep C

A

If persistently normal liver enzymes, there is minimal histological abnormalities, therefore no tx with interferon or antiviral drugs needed

111
Q

30% of patients with hemochromatosis die from this dz

112
Q

Pseudocyst occurs when

A

> 5 wks s/p acute pancreatitis

113
Q

When to drain pseudocyst

A

If >5 cm or doesnt go away in 6 wks

114
Q

All pancreatic pathology diagnostic test

115
Q

How does pancreatic pseudocyst present

A

Early satiety and abd. pain

116
Q

When does pancreatic abscess occur

A

2 weeks s/p (pseudocyst is 5 weeks), abd. pain and early satiety

117
Q

Tx pancreatic abscess

A

Perc drainage and IV Abx

118
Q

Chronic pancreatitis presentation

A

Chronic abd. pain, steatorrhea, DM

119
Q

Treating Chronic pancreatitis

A

Insulin, enzyme packets, for acute attacks: IVFs, NPO, pain meds

120
Q

Most common causes of chronic pancreatitis

A

Alcoholism in adults, Cystic fibrosis in young

121
Q

Grey-Turner sign

A

Flank ecchymoses

122
Q

Cullen’s sign

A

Periumbilical ecchymoses

123
Q

Fox sign

A

Ecchymosis along inguinal ligament

124
Q

How to diagnose pancreatic Ca

125
Q

How to treat pancreatic Ca

A

Head: whipple, Tail/body: distal pancreatectomy, mets or local invasion, palliation

126
Q

Tumor markers for pancreatic Ca

A

CA 19-9 and CEA

127
Q

Causes of Pancreatitis

A

I GET SMASHED. Idiopathic. Gallstones (#1), Ethanol (#2), Trauma, Steroids, Mumps, autoimmune, scorpion sting, Hypertriglyceridemia (#3), hyperCa, ERCP, drugs

128
Q

I GET SMASHED

A

Idiopathic, gallstones, etoh, trauma, steroids, mumps, autoimmune, scorpion sting, hyperTGs, hyperCa, ERCP, Drugs

129
Q

Trousseau syndrome

A

Migratory thrombophlebitis, think of Pancreatic cancer. It is a superficial venous thromboembolism

130
Q

Courvosier’s sign

A

Palpable GB w/o pain in pancreatic cancer in 30%

131
Q

Chronic viral Hepatitis LFTs

A

ALT>AST, moderately elevated

132
Q

Acurte viral hepatitis LFTs

A

ALT>AST, in the thousands

133
Q

Alcohlic hepatitis LFTs

134
Q

LFTs in the 10,000s

A

Severe hepatic necrosis

135
Q

Elevated alk phos w/o elevated GGT

A

Pregnancy or Paget’s dz

136
Q

Elevated alk phos with elevated GGT

A

Obstructive process

137
Q

Conjugated bilirubin >50%

A

Dubin-Johnson, Rotor?, cancer, choledocholithiasis

138
Q

Conjugated bilirubin <20%

A

Hemolytic jaundice

139
Q

Conjugated bilirubin 20-50%

A

Hepatocellular jaundice (viral or alcoholic)

140
Q

When to do HIDA scan

A

If RUQ u/s is inconclusive

141
Q

When to do ERCP

A

Choledocholithiasis and acute cholangitis

142
Q

Charcot triad

A

RUQ pain, jaundice, fever

143
Q

Reynold’s Pentad

A

RUQ pain, jaundice, fever, AMS, hypotension

144
Q

Boas sign

A

Referred right scapular pain of biliary colic

145
Q

Cause of SBO in patient with gallbaldder dsiease

A

Gallstone ileus in distal ileum caused by a cholecystenteric fistula

146
Q

N/V in normal biliary colic

A

yes, can happen, not automatically a warning sign

147
Q

Tx for symptomatic gallstones

A

Elective! cholecystectomy

148
Q

Acute cholecystitis treatment

A

Cholecystectomy w/i 24 hrs

149
Q

Gallstone pancreatitis tx

A

If amylase goes down, lap chole. If amylase remains elevated, ERCP to remove stone.

150
Q

Acute cholangitis tx

A

Immediate ERCP.

151
Q

Tx for acalculous cholecystitis

A

Usually ICU patients, lap chole, or med management if poor surgical candidate

152
Q

Porcelain GB

A

GB cancer! take it out 50% chance of adenocarcinoma

153
Q

PSC natural history

A

Intra and extrahepatic biliary ducts. liver failure, cirrhosis, portan HTN

154
Q

PSC dx

A

ERCP beading of bile ducts

155
Q

PSC tx

A

cholestyramine, liver txp

156
Q

PBC presentation

A

Antimitochondrial antibody (AMA) leads to destruciton of intrahepatic ducts, gradual juandice and pruritus, liver failure, cirrhosis, portal htn

157
Q

PBC dx

A

AMA and liver bx

158
Q

PBC tx

A

Ursodeoxycholic acid, liver txp eventaully

159
Q

Secondary biliary cirrhosis

A

Cirrhosis due to obstruction from any cause

160
Q

Cholangiocarcinoma presentaiton

A

tumor of bile ducts, obstructive jaundice

161
Q

Cholangiocarcinoma dx and tx

A

ERCP and Whipple

162
Q

Cholangiocarcinoma most common cause in USA and China

A

USA: PSC from UC. China: Liver fluke (chlonorchis sinensis)

163
Q

Klatskin tumor

A

tumor of proximal 1/3 of CBD, unresectable

164
Q

Choledochal cysts

A

Cystic dilation of biliary tree causing RUQ pain/mass, jaundice, fever. Dx ERCP and Tx Resection

165
Q

Biliary dyskinesia presntation

A

Motor dysfxn of sphincter of Oddi, recurrent biliary colic without stones

166
Q

Biliary dyskinesia dx and tx

A

HIDA scan and give CCK to determine ejection fraction. Lap chole for tx.

167
Q

Wilson disease is what degeneration

A

Hepatolenticular degeneration

168
Q

Wilson disease inheritance

A

Autosomal Recessive

169
Q

Wilson disease presentation

A

Cirrhosis, kaiser fleisher, movement disorders, Schistocytes

170
Q

WIlson disease dx and tx

A

Dx with decreased serum ceruloplasmin, increased ceruloplasmin urine, increased AST/ALT, liver bx. Tx with d-penicillamine (copper chelating agent) + zinc (copper uptake competition)

171
Q

Hemochromatosis synonym

A

Bronze Diabeetus

172
Q

Hemochromatosis presentation

A

Cirrhosis, restrictive CM, arthritis, bronze suntan, DM from incresaed Iron absorption in GI tract

173
Q

Hemochromatosis dx and tx

A

Increased ferritin, decreased TIBC (because transferrin saturation is high!??), liver bx. Tx with repeated phlebotomies

174
Q

Secondary hemochromatosis

A

Iron overlaod secondary to multiple transfusions or chornic hemolytic anemia

175
Q

Hepatic adenoma dx and tx

A

CT or u/s. stop OCP and resect if it doesnt disappear. can cause shock and distended abdomen. ALso seen in anabolic STEROIDS!

176
Q

MC benign liver tumor

A

Cavernous hemangioma, usually asymptomatic

177
Q

Cavernous hemangioma causes

A

VAT: vinyl chloride, aflatoxin, thorotrast

178
Q

HCC dx and tx

A

Elevated AFP and CT scan. tx with resection

179
Q

HCC causes

A

MCC is cirrhosis, A1AT deficiency, hemochromatosis, wilsons, smoking, chemical carcinogens

180
Q

Polycystic liver due to what

A

ADPKD simple cyst in liver and kidneys. tx with reassurance

181
Q

Hydatid cyst cause and tx

A

Echinococcus granulosus (dog tapeworm) causes multilocular cyst with calcified walls. Tx inject cyst with Hypertonic saline and excise, post-op with Mabendazole

182
Q

how to tx amebic abscess

A

In mexicans, use flagyl, NO DRAINAGE

183
Q

Liver abscess txs

A

Multiple/small bacterial tx IV Abx. Single/large tx perc drainB

184
Q

Budd-Chiari syndrome most common cause, tx, and dx

A

Polycythemia vera (MCC), OCPs (#2), causes portal HTN, ascites, jaundice. tx TIPS in bridge to liver txp

x Medicine 200 (14 decks)

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