GI and Nutrition

Question 1

What are the acute symptoms associated with Hepatitis A?

How is Hepatitis A transmitted?

Answer 1

• Fatigue
• Malaise
• Vomiting
• Anorexia
• Fever
• RUQ pain

Fecal-oral route

Question 2

A positive IgG anti-HAV suggests what?

What serum level will be positive with an acute hepatitis A infection?

Answer 2

Previous infection with hepatitis A or acquired immunity

IgM anti-HAV

Question 3

Is there a vaccine available for hepatits A?

Answer 3

Yes, it is an inactivated vaccine given in 2 doses. Recommended to start at age 1. Recommended also for high risk travelers and lab workers.

Question 4

What are the clinical manifestations of acute viral hepatitis?

The phases

Answer 4

• Prodromal Phase: malaise, arthralgia, fatigue, URI sx, decreased desire to smoke, n/v, abdominal pain, loss of appetite, acholic stools (HAV is associated with fever)
• Icteric Phase: jaundice (most don’t develop this phase)
• Fulminant Phase: encephalopathy, coagulopathy, hepatomegaly, jaundice, edema, ascitis, asterixis

Question 5

What is the most common cause of fluminant hepatitis in the U.S.?

Answer 5

Acetaminophen Toxicity

Question 6

What is the name of the syndrome that is defined as fulminant hepatitis in children after receiving aspirin with a viral illness?

Answer 6

Reye’s Syndrome

Question 7

When is the hepatits B vaccine given?

Question 8

What viral hepatitis strains are reportable diseases?

Answer 8

Hepatitis A, B, and C

Question 9

What are the chronic forms of viral hepatitis?

Answer 9

Hepatitis B, C, and D

Question 10

What is the incubation period for Hepatitis A?

Answer 10

2 weeks - 6 months (average 30 days)

Question 11

What is a specific symptom in hepatitis A?

Answer 11

Aversion to smoking

Question 12

What can be some positives on physical exam with Hepatitis A?

Answer 12

• Low grade fever
• Hepatomegaly
• Splenomegaly
• Lymphadenopathy
• +/- Jaundice

Question 13

Will AST/ALT be elevated in Hepatitis A?

Answer 13

Yes

Question 14

What is the treatment for Hepatitis A?

Answer 14

• Self limited with improvement in 2-3 weeks
• Frequent hand washing to prevent spread
• Symptomatic treatment

Question 15

How is Hepatitis E transmitted?

Answer 15

Fecal-oral transmission

Question 16

What populations are at risk for Hepatitis E?

Answer 16

• Pregnant women
• Underlying liver disease
• HIV
• Immunosuppressed

Question 17

What are some extra-hepatic manifestations of Hepatitis E?

Answer 17

• Arthritis
• Pancreatitis
• Thrombocytopenia
• Guillain-Barre
• Peripheral neuropathy

Question 18

What is the treatment for Hepatitis E?

Answer 18

• Self-limited
• Symptomatic treatment (rest, fluids, avoid ETOH)

Question 19

How is Hepatitis B transmitted?

Answer 19

Blood borne

Question 20

Hepatitis B fomites can remain on surfaces for how long?

Answer 20

7 days

Question 21

Can Hepatitis B be vertically transmitted?

Answer 21

Yes

Question 22

What is the incubation period of Hepatitis B?

Answer 22

6 weeks to 6 months (average 12-14 weeks)

Question 23

How is chronic Hepatitis B defined?

Answer 23

• Infection persisting longer than 3-6 months (3-6 months of AST/ALT elevations)

*High rates of chronic hep B in infants who receive via vertical transmission

Question 24

What is the treatment for chronic hepatitis B?

Answer 24

Treatment is only indicated if the individual is actively replicating the virus –> antivirals

Question 25

What are the preferred antiviral treatments for chronic hepatitis B?

Answer 25

Entecavir and Tenfovir

Question 26

What Hepatitis strain is Hepatitis D a co-infection of?

Answer 26

Hepatitis B

Question 27

Hepatitis C is commonly co-infected with what other virus?

Answer 27

HIV

Question 28

Who should be periodically screened for Hepatitis C?

Answer 28

• IVDU
• Dialysis patients
• High risk co-morbidities (HIV)

Question 29

What is the treatment for acute Hepatitis C?

Answer 29

• None
• Consider PEG interferon +/- ribavirin if no spontaneous clearance by 3 months

Question 30

What are the first line antivirals for chronic hepatitis C?

Answer 30

Ledipasivir and Sofosbuvir (Harvoni)

*Response is dependent on genotype

Question 31

What serum antibody is present when there is immunity against HBV?

Answer 31

Anti-HBs

Question 32

What is the most sensitive imaging for diagnosing chronic pancreatitis?

Answer 32

ERCP

Question 33

List the osmotic laxatives

Answer 33

• polyethylene glycol
• magnesium citrate
• lactulose
• sorbitol

They work by drawing water into the intestine, which increases the frequency of bowel movements and improves the consistency of the stool.

Question 34

A 36-year-old man returns to the office for follow-up evaluation. He recently completed an antibiotic course of clarithromycin, amoxicillin, and omeprazole for acute gastritis. What would you expect to learn from his history based on this information?

A. A recent colonoscopy revealed transmural involvement with skip lesions

B. He had a biopsy revealing eosinophilic inclusions

C. He had a positive urea breath test

D. He was overusing NSAIDs for chronic back pain

Answer 34

He had a positive urea breath test

Question 35

Chronic use of what medications other than metformin may lead to vitamin B12 deficiency?

Answer 35

• PPI’s
• Antacids
• H2 Blockers

Medications that reduce gastric acids