GI and Liver

Question 1

Infectious diarrhea best initial tests

Answer 1

Blood, fecal lactoferrin (leukocytes if no lactoferrin)

Stool culture is most accurate

Question 2

Differential if blood in stool

Answer 2

Campylobacter (most common cause, GBS associated)
Salmonella: poultry
E. Coli: HUS
Shigella: also HUS
C. Diff.

Question 3

Dx for no blood or wbc’s in stool

Answer 3

Viral
Giardia (camping, frothy/foul)
Cryptosporidium: immunocompromised
B. Cereus

Question 4

Scombroid

Answer 4

Rapid acting histamine rxn from old fish

Question 5

Enteric hepatitadides

Answer 5

A&E

Question 6

Diagnostic tests for hepatitis?

Answer 6

Increased direct bilirubin
Alt>Ast
Increased alk phos
Increased PT (highest indicator of morality)

Question 7

What does e-antigen measure?

Answer 7

The amount of current hep b replication activity

Surface antigen is first to become positive after infection

Question 8

How do you test for hep C?

Answer 8

PCR and RNA levels

Question 9

What is the difference between e antigen and DNA polynerase testing?

Answer 9

Basically the same thing (qual vs quant).

Again, best indicator of viral activity

Question 10

What percentage of acute Hep B becomes chronic?

Answer 10

10%

Question 11

What to given in acute hep C to decrease the chances of it becoming chronic?

Answer 11

Ribivirin, interferon, boceprivir

Question 12

What defines chronic hep B?

Answer 12

Longer than 6 months of surface antigen

Treat with interferon or a “vir” med

Question 13

What are the adverse effects of interferon?

Answer 13

Leuko/thrombocytopenia
Arthralgia
Flu like symptoms
Depression

Question 14

First choice for hep c?

Answer 14

Sofosbuvir, ribavirin

Telaprivir/boceprivir are less effective

Question 15

What is the goal of tx with chronic hep B or C?

Answer 15

Undetectable viral load, conversion from e antigen to anti e antibody