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Step2CK > GI Stepup > Flashcards

GI Stepup Flashcards

1
Q

causes of viral gastroenteritis

A

Norwalk, Coxsackie virus A1, echovirus and adenovirus

rota in kids

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2
Q

labs in viral gastroenteritis

A

no fecal WBC

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3
Q

fried rice and vomiting within a few hours of eating it

A

bacillus cereus

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4
Q

bloody diarrhea and abdominal pain after eating chicken

A

campylobacter jejuni

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5
Q

which pathogen is assoc with bacterial GI upset and guillain barre

A

campylobacter jejuni

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6
Q

flaccid paralysis from honey

A

clostridium botulinum

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7
Q

Tx for adult botulism toxin from canned foods

A

botulism antitoxin

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8
Q

watery or bloody diarrhea post antibiotics

A

clostridium difficile

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9
Q

Tx C diff

A

metro or vanco

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10
Q

what is travelers diarrhea from

A

enterotoxigenic E coli

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11
Q

bloody diarrhea, abdominal pain, renal failure

A

E coli O157:H7

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12
Q

vomiting several hours after eating past salad

A

staph aureus

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13
Q

bloody diearrha, fever vomiting after eggs

A

salmonella

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14
Q

whats the most common foodbourne bacterial GI infection

A

salmonella from fresh produce

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15
Q

severe bloody diarrhea after eating

A

shigella

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16
Q

Tx for sigella bloody diarrrhea

A

hydration
can use cipro
if severe use tMP SMX

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17
Q

copious watery diarrhea after eating shellfood

A

vibrio cholera

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18
Q

Tx for vibrio cholera

A

tetracycline or doxy decrease length

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19
Q

watery diarrhea after oysters

A

vibrio parahaemolyticus

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20
Q

Bloody diarrhea and right lower pain after eating pork and fresh produce

A

yersinia

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21
Q

greasy foul smelling diarrhea with abdominal pain

A

giardia

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22
Q

Tx giardia

A

metro and hydration

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23
Q

mild to severe bloody diarrhea abdominal pain

after drinking water in poor area

A

entamoeba histolytics

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24
Q

Tx entamoeba histolytica

A

metro and paromomycin

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25
Q

watery diarrhea, abdominal pain, in immunocompromised patient

A

cryptosporidium

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26
Q

fever with myalgias and periorbital edema after eating undercooked pork

A

trichinella spiralis

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27
Q

Tx trichinella spiralis

A

albendazole, mebendazole

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28
Q

what causes neurocystercosis

A

taenia solium

fecal oral transmission

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29
Q

cysts in muscles, subcut tissues and brain

A

taenia solium neurocysticercosis

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30
Q

Tx for neurocysticercosis

A

albendazole and corticosteroid

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31
Q

Sx hepattis

A

malaise, arthralgias, fatigue, nausea, vomiting, RUQ pain, jaundice, scleral icterus, tender hepatomegaly, splenomegaly and lymphadenopathy

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32
Q

labs in hepatitis

A

bilirubinuria
increased AST and ALT!!!
increased alkaline phos

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33
Q

anti HAV IgM Ab

A

during acute illness

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34
Q

anti HAV IgG Ab

A

after resolution

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35
Q

how to test for HCV

A

Ab and PCR for HCV

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36
Q

Tx HCV

A

IFN alpha and can add ribavirin

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37
Q

Tx HBV

A

IFN-a or antivirals

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38
Q

what is the double stranded DNA hepatitis virus

A

HEPB

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39
Q

how does Hep A spread

A

fecal-oral

food (shellfish)

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40
Q

how is Hep B spread

A

sexual contact, blood and bodily fluids

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41
Q

prevention Hep B

A

vaccine

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42
Q

complications of Hep B

A

hepatocellular carcinoma

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43
Q

how does Hep C spread

A

blood, possible sexually

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44
Q

how does Hep D spread

A

blood, need Hep B to have infection

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45
Q

how does Hep E spread

A

water

fecal-oral

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46
Q

complications Hep E

A

high maternal mortality in pregnant women

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47
Q

Hep B markers for acute illness

A

HBsAg
HBeAg
anti-HBc IgM
DNA

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48
Q

Hep B markers for window period post exposure

A

anti-HBc IgM

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49
Q

Hep B markers for chronic infection with active viral repilication

A

+HBsAg
+HBeAg
+ antiHBc IgG

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50
Q

Hep B marker chronic infection low infectivitY

A

+HBSAG

+ ANTI-HBc IgG

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51
Q

Hep B marker for previoud infection

A

+ anti-HBs

+anti-HBc IgG

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52
Q

Hep B markers if had vaccination

A

only +antiHBs

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53
Q

what limits only solid foods

A

obstruction

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54
Q

what limits solids and liquids

A

neuromuscular pathology

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55
Q

patient has dysphagia, first step

A

barium swallow before EGD

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56
Q

Achalsia

A

impaired neuromuscular disorder

impaired peristalsis with decreased LES relaxation

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57
Q

what causes achalsia

A

intramural neuron dysfunction

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58
Q

signs achalsia

A

progressive dysphagia solids and liquids, regurg, cough, aspiration, heartburn, weight loss

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59
Q

birds beak

A

achalasia

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60
Q

Tx achalasia

A

nitrates and CCBs
pneumatic dilation
botulinum injections
myotomy

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61
Q

complications of achalasia

A

myotomy can cause GERD

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62
Q

Sx diffuse esophageal spasm

A

chest pain and dysphagia

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63
Q

corkscrew pattern on barium swallow

A

diffuse esophageal spasm

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64
Q

Tx diffuse esophgeal spasm

A

CCB
nitrates
TCA

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65
Q

secondary causes of achalasia

A

chagas, neoplasm, scleroderma

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66
Q

what relieves pain in diffuse esophgeal spasm but whats the trade off

A

nitrates help but worsen GERD

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67
Q

what causes zenker diverticulum

A

outpouching upper esophgaus by smooth mm weakness

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68
Q

Sx zenker

A

bad breath, regurg days after eating, dysphagia, feeling of aspiration, neck mass

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69
Q

Tx zenker diverticulum

A

cricopharyngeal myotomy or diverticulectomy

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70
Q

complications zenker

A

EGD can perforate
vocal cord paralysis
mediastinitis possible with surgery

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71
Q

labs to Dx GERD

A

esophageal pH monitoring

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72
Q

Tx for GERD

A

H2 antagonists and PPIs

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73
Q

complications GERD

A

esophageal ulceration, esophageal stricture, barrett esophagus, adenocarcinoma

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74
Q

most common esophageal CA in US

A

adenocarcinoma

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75
Q

most common esophageal CA in the world

A

squamous cell carcinoma

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76
Q

signs of esophageal cancer

A 
progressive dysphagia solides then liquids too
weight loss
odynophagia
reflux
GI bleeding
vomiting
weakness
cough
hoarseness
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77
Q

how to Dx esophgeal CA

A

biopsy

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78
Q

Tx esophageal CA

A

resection

radiation and chemo for nonoperative

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79
Q

complications esophageal CA

A

mets

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80
Q

what is a sliding hiatal hernia

A

GE junction and stomach through diaphragm

most common

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81
Q

what is a paraesophageal hiatal hernia

A

stomach protrudes through diaphragm but GEJ at normal location

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82
Q

labs for hiatal hernia

A

barium swallow

CXR

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83
Q

Tx sliding hernias

A

reflux control

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84
Q

Tx for paraesophageal hiatal hernias

A

gastropexy or nissen fundoplication

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85
Q

complications hiatal hernias

A

incarceration of stomach in herniation

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86
Q

acute gastritis

A

rapidly developing superficial lesions secondary to NSAID use, alcohol, ingestion corosive material, stress

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87
Q

signs Sx gastritis

A

epigastric pain, indigestion, nausea vomiting, hematemesis, melena

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88
Q

labs for gastritis

A

+ urea breath test (ammonia producing bacteria)
+ IgG Ab to H pylori
antral Bx

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89
Q

what cells are attacked in pernicious anemia

A

the parietal cells

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90
Q

chronic gastritis usually attacks what part of stomach

A

antrum

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91
Q

associated condiitions with chronic gastritis in antrum

A

peptic ulcer disease and gastric cancer

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92
Q

Tx H pylori

A

PPI, clarithromycin, amoxicillin or metro

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93
Q

curling ulcer

A

secondary to severe burn or intracranial injury

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94
Q

H pylori causes what

A

most gastric ulcers and almost all duodenal

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95
Q

refractory peptic ulcer disease, next step

A

measure gastrin to look for zollinger ellison

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96
Q

free air under diaphgram in CXR of someone with known PUD

A

perforated ulcer

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97
Q

complications of peptic ulcer disease

A

hemorrhage
perforation gastroduodenal artery
perforation from anterior ulcers
lymphoproliferative disease

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98
Q

where are the gastrinomas causing zollinger ellison found

A

duodenum or pancreas

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99
Q

eating helps Sx of epigastric pain

A

duodenal ulcer

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100
Q

eating worsens Sx of epigastric pain

A

gastric ulcer

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101
Q

what type of NSAID to those with PUD

A

Cox2 selective

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102
Q

labs to Dx zollinger ellison

A

increased fasting gastrin

+ secretin stimulation

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103
Q

imaging for zollinger ellison tumor

A

SPECT to localize tumor

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104
Q

Tx for zollinger ellison

A

surgical resection
PPI and H2 antagonists
octreotide to reduce Sx

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105
Q

complications zollinger ellison

A

MEN1

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106
Q

most common gastric CA

A

adenocarcinoma

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107
Q

types of gastric Ca

A

ulcerating
polypoid
superfiicial spreading
linitis plastica

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108
Q

risk factors for gastric CA

A 
H pylori
FMH
japanese
tobacco
alcohol
Vit C def
high consumption preserved fod
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109
Q

Sx gastric CA

A 
weight loss
anorexia
early satiety
n/v
dysphagia
epigastric pian
enlarged left supraclavicular node (virchow)
periumbical node (sister mary joseph node)
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110
Q

labs in gastric CA

A

increased CEA
increased 2 glucuronidase in gastric secretions
anemia
need Bx

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111
Q

barium swallow is showing thickend leather bottle stomach

A

(linitis plastica)

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112
Q

Tx for gastric CA

A

subtotal gastrectomy for lesions in distal third.
total gastrectomy if lesions in middle or upper
adjuvant chemo and radiation

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113
Q

complications gastric CA

A

poor prognosis in later detection

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114
Q

pathophys celiacs

A

IgA against anti tissue tansglutaminase and antiendomysial ab that cause jejunal mucosal damage

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115
Q

celiacs is assoc with what conditions

A

down syndrome and dermatitis herpetiformis

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116
Q

labs in celiac

A

anti endomysial Ab
antigliadin Ab
biopsy will show blunting of duodenal and jejunal villi

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117
Q

Tropical sprue

A

malabsorption from celiac sprue

acquired in tropical areas

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118
Q

sudan stain

A

indicates steatorrhea

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119
Q

D xylose test

A

if abrnomal then do Bx for sprue, whipple or bacterial overgrotwh

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120
Q

negative sudan stain and low stool pH

A

lactase deficiency

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121
Q

Tx celiac sprue

A

folic acid replacement

tetracycline

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122
Q

What can cause lactose intolerance

A

crohns or bacterial overgrowth

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123
Q

labs in lactose intolerance

A

+ tolerance test

+ lactose breath H test

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124
Q

whipple disease

A

from tropheryma whippelii

malabsorption

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125
Q

risk factors whipples

A

white male european

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126
Q

signs Sx whipples disease

A

weight loss, joint pain, abdominal pain, diarrhea, dementia, cough, bloating, steatorrhea, fever, vision abnormalities, lymphadenopathy, new heart murmur, wasting

127
Q

labs in whipples

A

jejunal Bx will show foamy macrophages with PAS+ stain and villous atrophy

128
Q

Tx for whipples

A

TMP SMX or ceftriaxone for 12 months

129
Q

most common cause adult chronic diarrhea

A

lactase deficiency

130
Q

most common cause acute diarrhea in kids

A

rotavirus

131
Q

osmotic diarrhea

A

solute in bowel causing water to enter bowel too.

decreases with fasting

132
Q

inflammtory diarrhea

A

autoimmune inflammatory process or chronic infection

133
Q

Tx for inflammatory diarrhea

A

hydration

134
Q

IBS

A

chronic abdominal pain and irregular bowel habits
in teens and adolescence
F>M
CBC, electrolytes and stool culture to rule out other GI diseases

135
Q

Tx for IBS

A 
assurance
high fiber diet
psychosocial therapy
antispasmodic
antidepressnats
SSRI
136
Q

IBD

A

disease of small and large bowel with Sx associated with inflammatory bowel processes, autoimmune reactions, extraintestinal manifestations and multiple complications

137
Q

risk factors IBD

A

ashkenazi Jew

whites>blacks

138
Q

bowel obstruction

A

mechanical that can lead to vascular compromise

adhesions, hernias and neoplasms

139
Q

risk factors ischemic colitis

A

DM, atherosclerosis, CHF, PVD, lupus

140
Q

extraintestinal findings in crohns

A

arthritis, anklyosing spondylitls, uveitis, nephrolithiasis

141
Q

labs in crohns

A

ASCA +
pANCA rarely +
hemoccult +

142
Q

Tx crohns

A 
mesalamine
antibiotics
corticosteroids
immunosuppressants
surgical resections
143
Q

extraintestinal manifestations UC

A

arthritis, uveitis, anklylosing spondylitis, primary sclerosing cholangitis, erythema nodosum, pyoderma gangrenosum

144
Q

labs in UC

A

ASCA rare

pANCA frequently +

145
Q

lead pipe colon without haustra

A

UC

146
Q

Cure for UC

A

colectomy

147
Q

complications UC

A

colon CA
hemorrhage
toxic megacolon
obstruction

148
Q

multiple loops bowel with ladderlike appearance

A

Small bowel obstruction

149
Q

labs in ischemic colitis

A

increased WBC increased serum lactate

150
Q

imaging in ischmic colitis

A

barium enema shows diffuse change from localized bleeding “thumb printing”
sigmoidoscopy shows blood and edematous mucosa

151
Q

Tx ischemic colitis

A

IV fluids, bowel rest, antibiotics, surgical resection if necrotic bowel

152
Q

Tx SBO

A

NPO
maintain hydraion
nasogastric decompression
surgery if still there after decompression

153
Q

what causes large bowel obstructions

A

neoplasm, diverticulitis, volvulus, congenital stricture

154
Q

late feculent vomiting

A

LBO

155
Q

Tx for LBO

A

NPO
maintain hydration
colonoscopy can relieve obstruction
surgery if colonoscopy does not help

156
Q

what part of GI tract is most commonly invovled in ischmic colitis

A

left side

157
Q

which GI pain is out of proportion to the PE

A

SBO

158
Q

what causes appendicitis in children

A

lymphoid hyperplasia

159
Q

what causes appendicitis in adults

A

fibroid bands or fecaliths

160
Q

labs appendicitis

A

increased WBC with left shift

161
Q

best test for appendicitis

A

Ct

162
Q

woman with signs appendicitis, next step

A

urine B hCG

163
Q

what is ileus

A

paralytic obstruction of bowel secondary to decreased peristalsis

164
Q

what causes ileus

A

infection, ischemia, recent surgery, DM , opioid overdose

165
Q

high clinical suspicision appendicitis

A

go right to surgery

166
Q

imagin in ileus

A

distention affected bowel, air fluid levels, barium enema helps to rule it out

167
Q

Tx for ileus

A

stop opioids, make patient NPO

colonoscopic decompression

168
Q

which part of GI tract takes longest to recover post surgery

A

the colon

169
Q

volvulus

A

rotation of bowel causing obstruction

usually at cecum and sigmoid

170
Q

double bubble sign

A

volvuls

171
Q

birds beak in distal abdomen

A

sigmoid volvulus

172
Q

risk factors diverticulosis

A

low fiber diet
high fat diet
>60 years of age

173
Q

most common cause acute lower GI bleeding in adults over 40 years old

A

diverticular disease

174
Q

Tx diverticulitis

A

liquids only, PO antibiotics like cipro and metro
TMPSMX and metro
augmentin

175
Q

internal hemorrhoids are from where

A

superior rectal veins above pectinate line

176
Q

external hemorrhoids are from where

A

inferior rectal veins below pectinate line

painful

177
Q

Tx anal fissure

A

stool softeners, sitz baths, topical nitro

partial sphincterotomy

178
Q

throbbin rectal pain, fever and tenderness on DRE

A

anorectal abscess

179
Q

Tx rectal fistula

A

formation between rectum and adjacent structures from unknown cause or secondary to IBD

180
Q

Tx rectal fistula

A

fistulotomy, treat crohns patients with antibiotics

181
Q

pilonidal disease

A

one+ cutaneous sinus tracts in superior midline gluteal celft

182
Q

carcinoid arise from what

A

neuroectodermal cells that function as amine precursor uptake and decarboxylation cells (APUD)

183
Q

where is carcinoid found

A

bronchopulmonary tree, ileum, rectum and appendix

184
Q

labs in carcinoid

A

inc 5-HIAA in urine

increased serum serotonin

185
Q

Imaging for carcinoid

A

CT or indium labeled octreotide scintigraphy

186
Q

Tx carcinoid

A

2 cm extensive resection

187
Q

risk factors colorectal CA

A 
FMH
UC
colonic polyps
hereditary polyposis syndromes
low fiber/high fiber diet
previous colon CA
alcohol smoking and DM
188
Q

labs for colonic CA

A

+ guaic stool
dec Hb Hct
Bx diagnostic
CEA increased in 70% to monitor course

189
Q

what imaging is used to detect extent of colorectal CA

A

CT or PET

190
Q

Tx colorectal CA

A

resection and lymph node dissection

adjuvant if + nodes

191
Q

Familial adenomatous polyposis

A

hundred polyps
increased malignancy
need prophylactic subtotal colectomy

192
Q

mutaiton in familial adenomatous polyposis

A

APC gene

193
Q

gardner syndrome

A

lots of colonic polyps also with bone and soft tissue tumors

194
Q

Turcot syndrome

A

many colonic adenomas with high malignancy. also CNS tumors

195
Q

jevenile polyposis

A

hamartomatous polyps in colon small bowel and stomach

increased risk malignancy later in life

196
Q

peutz jeghers

A

hamartomas with low risk maliganncy

mucocutaneous pigmentation of mouth hands and genitals

197
Q

hereditary nonpoluposis colorectal cancer

A

proximal colon

many genetic mutations

198
Q

stage III colorectal CA

A

lymph node involvement

199
Q

stage II colorectal CA

A

penetration of tumor into colonic serosa or perirectal fat

200
Q

prevention for colorectal CA

A

anual FOBT
flexible sigmoidoscopy every 5 years
or
colonoscopy every 1o years

201
Q

GI bleeding separation

A

ligament of treitz, above is upper

below is lower GI bleed

202
Q

causes upper GI bleeeds

A 
PUD
mallory weiss tears (longitudinal tears from vomiting)
esophagitis
esophgeal varices
gastritis
203
Q

causes lower GI bleeds

A

diverticulosis, neoplasm, UC, mesenteric ischemia, AVMs, hemorrhoids and meckel diverticulum

204
Q

what is used to detect arteriovenous malformation in abdomen

A

angiography

205
Q

Tx for GI bleeds

A

fluids
transgusions
Tx underlying cause

206
Q

how to stop AVM from bleeding

A

vasopressin can help

207
Q

causes of pancreatitis

A 
hyper PTH
Alcohol
Neoplasm
Cholelithiasis
Rx
ERCP
Abdominal surgery
Triglyceridemia
Infeciton (mumps)
Trauma
Idioapthic
Scorpion bite
208
Q

grey turner sign

A

ecchymosis of flank

pancreatitis

209
Q

cullen sign

A

umbilical ecchymosis

pancreatitis

210
Q

labs in chronic pancreatitis

A

mildly increase amylase and lipase

low fecal elastase

211
Q

radiolgy in chronic pancreatiis

A

pancreatic calcifications

enlargement or pseudocyts

212
Q

imaging in acute pancreatitis

A

dilated loop of bowel, sentinel loop
may have pleural effusion and hemidiaphragm elevation
pseudocyst on CT or enlarged pancreas

213
Q

complications chronic pancreatitis

A

ductal obstruction, malnutrition, glucose intolerance, pancreatic CA

214
Q

complications acute pancreatitis

A

abscess, pseudocyst, necrosis, fistulas, renal failure, hemorrhage, shock, DIC, sepsis, resp failure

215
Q

Ranson criteria

A 
prognosis acute pancreatitis
BAD if:
glucose >200
AST>250
LDH >350
Age>55
WBC>16,000
216
Q

where does adenocarcinoma of pancreas arise

A

head of pancreas

217
Q

risk factors for pancreatic adenocarcinoma

A

chronic pancreatiis, DM, FMH, tobacco, high fat diet, male>female
obesity and sedentary ligestyle

218
Q

Signs Sx pancreatic adenocarcinoma

A

abdominal pain radiating to back
anorexia, nausea, vomiting, weight loss, fatigue, steatorrhea, painless jaundice, nontender gallbladder that is palapable
splenomegaly if mass is in tail

219
Q

labs in pancreatic adenocarcinoma

A 
hyperglycemia
increased CEA
CA19-9
increased bili
inc alk phos
220
Q

best imaging for pancreatic adenocarcinoma

A

CT unless small then eRCP

221
Q

surgery for pancreatic CA in head of pancreas

A

whipples procedure

222
Q

complications pancreatic CA

A

bad prognosis

can have migratory thrombophelbitis- trousseau syndrome

223
Q

whipples triad

A

insulinoma
Sx hypoglycemia with fasting
hypoglycemia and improvement after carbohydrate load

224
Q

mutliple insulinomas

A

MEN1

225
Q

what are the endocrine pancreatic CA

A

zollinger ellsion
insulinoma
glucagonoma
VIPoma

226
Q

Sx insulinoma

A

HA visual changes, confusion, weakness, mood instabiliyt, palpitations and diaphoresis

227
Q

labs in insulinoma

A

increased fasting insulin, high C peptide

228
Q

Tx for insulinoma

A

resection

diazoxide and octreotide

229
Q

what cells secrete glucagon

A

alpha cells in pancreas

230
Q

Sx Signs glucagonoma

A

abdominal pain, diarrhea, weight loss, mental status changes, exfoliating rash(necrolytic migratory erythema) Sx of DM

231
Q

labs in glucagonoma

A

hyperglycemia, increased glucagon

232
Q

refractory DM

A

glucagonoma

233
Q

Tx for glucagonoma

A

resection chemo and embolizaiton

234
Q

where are VIPomas

A

non beta islet cells in pancreas

235
Q

signs Sx VIPoma

A

watery diarrhea, wekaness, n/v and abdominal pain

236
Q

labs in VIPoma

A

increased VIP, stool osmolality is secretory like

237
Q

Tx VIPoma

A

surgical resection, corticosteroids, chemo, octreotide

238
Q

pigmented stones are what

A

calcium bilirubinate from chronic hemolysis

239
Q

complications cholelithiasis

A

recurrent
acute cholecystitis
pancreatitis

240
Q

what causes acute cholecystitis

A

obsturction of cystic duct

241
Q

labs in acute cholecystisi

A

icnreased WBC, increased bili and direct

increased alk phos sometimes

242
Q

what is used to detect cytic duct obstruction

A

HIDA scan

243
Q

complications acute cholecystis

A

perforation, gallstone ileus, abscess

244
Q

charcot triad

A

RUQ pain, jaundice and fever

suspect cholangitis and do US or HIDA

245
Q

What is cholangitis

A

infection bile ducts secondary to obstruction

246
Q

signs Sx cholangitis

A

RUQ pain, chills, jaundice, fever, RUQ tenderness, change in mental status

247
Q

labs in cholangitis

A 
increased WBC
increased bili total and direct
increased alk phos
increased aST ALT
increased amylase
\+ blood cultures
248
Q

most sensitive test for cholangitis

A

HIDA

249
Q

Tx cholantiis

A

hydration, IV antibiotics, endoscopic biliary drainage with delayed choecyetecomt
severe need emergency bile duct decompression

250
Q

Sx signs adenocarcinoma of gallbladder

A

anorexia, weight loss, abdominal pain radiating to back, palpable gallbladder and juandice
resect to Dx

251
Q

calcified gallbladder

A

adenocarcinoma of gallbladder in 10-30%

usually from chronic cholecystitis

252
Q

Tx adenocarcinoma gallbladder

A

cholecystectomy, lymph node dissection, partial removal of adjacent hepatic tissue, radiation and chemo

253
Q

Primary biliary cirrhosis

A

autoimmune with intrahepatic bile destruction

254
Q

risk factors PBC

A

RA
sjogrens
scleroderma
F?M

255
Q

signs Sx PBC

A

fatigue, pruritis, arthralgias, jaundice, xanthomas, skin hyperpigmentation, HSM

256
Q

labs in PBc

A 
inc alk phos, GGT 
normal LFTs
increasd cholesterol
increased direct and total bili
\+ANA
\+antimitochondrial!!!
257
Q

Tx PBC

A

ursodeoxycholic acid to improve liver function and reduce Sx

colchicines or MTX

258
Q

Primary sclerosing cholangitis

A

progressive destruction intra and extrahepatic ducts

leading to fibrosis and cirrhosis

259
Q

risk factors for PSC

A

UC

male >female

260
Q

Signs Sx: PSC

A

aSx, fatigue, pruritis, RUQ pain, fever, night sweats, jaundice, xanthomas M>F

261
Q

labs in PSC

A

inc alk phos and GGT
normal LFTs
inc bili total and direct
maybe + pANCA

262
Q

how to differentiat PBC and PSC

A

PBC has antimitochondrial Ab and gender is usually female

ERCP to be definitive

263
Q

ERCP of PSC

A

stricturing and irregularity— beads on a string!!

264
Q

Tx for PSC

A

endoscopic stenting for strictures

resection affected ducts

265
Q

increase indirect bili

A

prehepatic

266
Q

increase direct bili

A

posthepatic

267
Q

what conjugates bilirubin

A

glucuronosyltransferase in hepatocytes

268
Q

Gilbert

A

auto recessive or dominant

mild deficiency in glucuronosyltransferase so get inc indirect bili

269
Q

Crigler Najar type I

A

auto recessive, severe deficiency in glucuronosyltransferase
increased indiret bili
get kernicterus as infant
Tx is phothterapy, plasmaphereis, Ca phosphate with orlistat and liver transplant

270
Q

causes of increased indirect bili

A

hemolytic anemia, disorders erythropoiesis
internal hemorrhage
physiologic jaundice newborn
gilber, cirgler najar and hepatocellular disease

271
Q

causes of increased direct bili

A 
dubin johnson, rotor
hepatocellular disease
drug impairment
PBC PSC
gallstone obstruction
cancers
biliary atresia
272
Q

Crigler najar II

A

mild deficiency

Tx with phenobarbital to help hepatic synthesis of glucuronyltransferase

273
Q

labs in alcoholic liver disease

A 
increased AST >ALT
increast GGT
increased alk phos
increased bili
prolonged PT
decreased lipids
increased WBC
274
Q

fatty liver with many PMNs

A

alcoholic liver disease

275
Q

Tx of alcoholic liver disease

A

stop drinking
thiamine
folic acid
high caloric intake

276
Q

what causes cirrhosis

A 
alcohol
HBV HCV
chrnoic obstruction
PBC PSC
hemochromatosis
wilsons
antitrypsin def
NASH
autoimmune hepatitis
277
Q

paracentesis of ascites results in cirrhosis

A
278
Q

small nodular livero n US

A

cirrhosis

279
Q

what helps with encephalopathy from cirrhosis

A

lactulose and rifazimin

280
Q

complications cirrhosis

A

portal HTN
hepatic encephalopathy
renal failure
spontaneous bacterial peritonitis

281
Q

prehaptic causes of portal HTN

A

portal vein thrombosis

282
Q

intrahepatic causes of portal HTN

A

cirrhosis, schistosomiasis, parenchymal disease and granulomatous disease

283
Q

post hepatic causes of portal HTN

A

right sided HF
hepatic vein thrombosis
budd chiari syndrome

284
Q

budd chiari syndrome

A

hepatic vein thrombosis secondary to hypercoagulability

285
Q

paracentesis in portal HTN

A

serum-ascites albumin gradient >1.1

286
Q

Tx for portal HTN

A

salt restriction and diuretics (furosemid and spironolactone)
IB antibiotics
dialysis
vsopressin for bleeding varices

287
Q

severe portal HTN Tx

A

hepatic shunting bia laparotomy or transjugular intrahepatic portosystemic shunting

288
Q

paracentesis has very high albumin and LDH

A

neoplastic etiology

do workup

289
Q

Sx signs hemochromatosis

A 
abdominal pain
polydipsia and uria
arthralgias, impotence, lethargy
pigmented rash
hepatomegaly
testicular atrophy
290
Q

labs in hemochromatosis

A

increased Fe, inc ferritin
inc transferrin
inc AST ALT

291
Q

complications hematochromatosis

A

cirrhosis, hepatoma, CHF, DM hypopituitary

292
Q

wilson disease

A

auto recessive

coper depositts in liver brain and cornea

293
Q

labs in wilsons

A

dec serum ceruloplasm
increased urinary copper
inc AST ALT

294
Q

Tx wilsons disease

A

trientine or penicillamine for copper chelation
zine for maintaence
supp B6

295
Q

complications wilsons disease

A

fulminant hepatic failure and cirrhosis

296
Q

most common liver neoplasms

A

are mets from breast lung or colon

297
Q

benign hepatic tumors

A

hepatic adenoma, focal nodular hyperplasia, hemangiomas and cysts

298
Q

OCP increase risk for what hepatic tumor

A

benigh

299
Q

why is Bx of hepatic mass contraindicated

A

hypervascularity and risk of hemorrhage

300
Q

what is the primary malignant hepatic tumor

A

hepatocellular carinoma

301
Q

risk factors hepatocellular carcinoma

A

HBV HCV, cirrhosis, hemochromatosis, increased consumption alflotoxin from aspergillus infected foods
schistosomiasis

302
Q

labs in hepatocellular carcinoma

A

increased AST aLT
inc alk phos
inc bili
inc AFP

303
Q

acid base in pyloric stenosis

A

hypoCl
hypoK
metabolic alkalosis

304
Q

string sign in stomach

A

pyloric stenosis

305
Q

necrotizing enterocolitis

A

bilious vomiting, lethargy, poor feeding, diarrhea, hematochezia, abdominal distention, abdominal tenderness, shock

306
Q

Bx in hirschrpung

A

absent ganglia

307
Q

most common cause bowel obstruction

A

intussuception

308
Q

risk factors intussuception

A

MEckel diverticulum, henoch schonlein purpura

adenovirus infections, CF

309
Q

currant jelly stool

A

intussuception

310
Q

sausage like abdominal mass

A

intussuception

311
Q

Tx and Dx intussuception

A

barium ednema

312
Q

intussuceptin in adult

A

CA until proven otherwise

313
Q

meckel diverticulum is remnant of

A

vitelline duct

314
Q

how to detect meckel diverticulum

A

technectium radionucleotide scan

Step2CK (26 decks)

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