GIT 1 Flashcards
First line therapy for Diffuse esophageal spasm and Hypertensive peristalsis (Nutcracker Esophagus)
CCB ( Diltiazem)
Hepatitis A: ________ correlates with ↑ mortality
a significant prolonged PT
Hepatitis A labs
Early changes:
Late chabges:
Early:↑ ALT, AST
Several days later: Bilirubin and ALP increase
Hepatitis A jaundice occurs _______
within 2 weeks.
not so early
Acute liver failure diagnostic criteria
- HE
- Synthetiv liver function INR >1.5
- ALT, AST >1000
Most important prognostic factor for ALF is
PT
Diagnosis of acute pancreatitis requires tests….
First: Amylase, lipase
second: CT with contrast
Abdominal USG for identifying cause
Precipitating factors of hepatic encephalopathy:
Hypovolemia
Hypokalemia
Infection
Hepatic encaph treatment steps
- Supportive (volume repletion and electrolyte correction)
- Adequate nutrition without protein-restricted diet
- Treat precipitating causes
- Lower serum ammonia —– Lactulose. If no improvement in 48 hours with lactulose then Rifamixin
Neomycin if unable to take rifamixin
SAAG <1.1 indicates?
Conditions?
↑ capillary permeability
TB, peritoneal carcinomatosis, pancreatic ascites, nephrotic syndrome
Gastric carcinoma evaluation?
- EGD
- CT scan of abdomen to reveal mets
- H. Pylori removal before cancer removal to avoid future adenocarcinoma.
Acute cholecystits vs Acute cholangitis:
Acute cholecystitis: No inc. bilirubin and ALP
USG shows thick gallbladder wall and pericholecystic fluid
Acute cholangitis: inc. bilirubin, inc. ALP.
Jaundice, RUQ pain, fever (Charcot triad)
USG shows biliary dilation
Bilirubin and aminotransferases in acetaminophen toxicity:
Indirect bilirubin
aminotransferases >3000
HEPATIC HYDROTHORAX
Best option for treatment:
liver transplant
HEPATIC HYDROTHORAX
Primary treatment:
thoracocentesis followed by diuresis and salt restriction no response→ TIPS→
TIPS contraindicated→ pleurodesis
Hepatic transplant is treatment for:
HEPATORENAL SYNDROME
HEPATIC HYDROTHORAX
CRIGGLER NAJJAR SYNDROME - Type 1
BILIARY ATRESIA
Mycophenolate is discontinued in _____
patients with active infection due to risk of neutropenia.
Ursodeoxycholic acid is treatment of
PBC
Surveillance USG in cirrhotic patients
every 6 months to exclude a mass.
Eosinophilic esophagitis
treatment:
Dietary modification
± Topical glucocorticoids
Eosinophilic esophagitis
Diagnosis:
Endoscopy & esophageal biopsy (≥15 eosinophils per high-power field)
Diagnosis of pancreatic cancer is made by
Abdominal ultrasound (if jaundiced) or CT scan with contrast (if no jaundice)
Primary biliary cholangitis
Complications:
- Malabsorption, fat-soluble vitamin deficiencies
- Metabolic bone disease (osteoporosis, osteomalacia)
- Hepatocellular carcinoma
Packed red blood cell transfusions are recommended in
- acute gastrointestinal bleeding for patients with hemoglobin <7 g/dL.
- A higher threshold of hemoglobin <9 g/dL is considered for unstable patients with acute coronary syndrome or with active bleeding and hypovolemia.
Platelet transfusions are typically given for a platelet count
• <10,000/mm3 (increased risk of spontaneous hemorrhage)
or
• for a platelet count <50,000/mm3 with active bleeding.
Treatment of Clostridioides difficile infection
• Fulminant
(eg, hypotension/shock,
ileus, megacolon)
- Metronidazole IV plus high-dose vancomycin PO (or PR if ileus is present)
- Surgical evaluation
Treatment of Clostridioides difficile infection
• Recurrence
• First recurrence
Vancomycin PO in a prolonged pulse/taper course
OR
Fidaxomicin if vancomycin was used in initial episode
• Multiple recurrences
Vancomycin PO followed by rifaximin (or above regimens)
Fecal microbiota transplant
Pancreatic cysts radiographic features are associated with higher risk for malignancy, including:
Large size (≥3 cm)
Solid components or calcifications
Main pancreatic duct involvement (ie, ductal dilation)
Thickened or irregular cyst wall
______ is the test of choice for diagnosis of IBD
Colonoscopy with biopsies
The diarrhea is typically large in volume and persists while fasting and at night.
Secretory diarrhea occurs due to
1. toxins (eg, produced by Vibrio cholerae),
2. hormones (eg, produced by VIPomas),
3. congenital disorders of ion transport (eg, cystic fibrosis),
or
4. bile acids (in postsurgical patients)
5. Microscopic colitis
pH of pleural fluid
• Empyema and pulmonary tuberculosis
• pancreaticopleural fistula (PPF)
• Normal pH
- Empyema and pulmonary tuberculosis low pH (<7.30)
- pancreaticopleural fistula (PPF) 7.3 - 7.5
- Normal pH: 7.6
Treatment of microscopic colitis:
withdrawal of triggering medications.
If diarrhea persists, budesonide and antidiarrheal medications (eg, loperamide)
