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GASTROINTESTINAL > HARRISON'S Q&AQ > Flashcards

HARRISON'S Q&AQ Flashcards

1
Q

the most common cause of acute hepatic failure is .

A

drug-induced liver injury

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2
Q

The most common drug or toxin causing direct hepatocyte toxicity is________

A

acetaminophen

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3
Q

one of the metabolites of acetaminophen, _____________ can overwhelm the glutathione stores of the liver that are necessary to convert NAPQI to a nontoxic metabolite and lead to hepatocyte necrosi

A

N-acetyl-p-benzoquinone imine (NAPQI),

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4
Q

Other medications or toxins that cause direct hepatocyte injury are carbon tetrachloride, trichloroethylene, tetracycline, and the _________ mushroom

A

Amanita phalloides

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5
Q

Common medications that can lead to idiosyncratic drug reactions include halothane, isothane, isoniazid, 3-hydroxy-3-methylglutaryl–coenzyme A (HMG-CoA) reductase inhibitors, and chlorpromazine.

A

idiosyncratic drug reactions i

Idiosyncratic drug reactions, also known as type B reactions

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6
Q

Syndromes with well-established association with GERD include chronic cough, laryngitis, asthma, and dental erosions

A

ss well established. These include pharyngitis, pulmonary fibrosis, chronic sinusitis, cardiac arrhythmias, sleep apnea, and recurrent aspiration pneumonia.

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7
Q

. Chylous ascites often is characterized by an opaque milky fluid with a triglyceride level greater tha______{mg/dL in addition to a low SAG.

A

1000

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8
Q

White, milky fluid indicates a triglyceride level ________ (and often >1000 mg/dL), which is the hallmark of chylous ascites.

A

White, milky fluid indicates a triglyceride level >200 mg/ dL (and often >1000 mg/dL), which is the hallmark of chylous ascites.

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9
Q

The SAAG is calculated by ______ and does not change with diuresis

A

The SAAG is calculated by subtracting the ascitic albumin concentration from the serum albumin level and does not change with diuresis

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10
Q

A SAAG ≥1.1 g/dL reflects the presence of _______ and indicate

A

portal hypertension

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11
Q

A SAAG <1.1 g/dL indicates that the ascites is not related to portal hypertension, as in

A

tuberculous peritonitis, peritoneal carcinomatosis, or pancreatic ascites.

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12
Q

In patients without cirrhosis, an elevated ascitic adenosine deaminase level has a sensitivity of >90% when a cut-off value of _______ is used.

A

30–45 U/L

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13
Q

postcricoid dysphagia, upper esophageal webs, and iron deficiency anemia

includes esophageal rings, but typically, the rings occur in the proximal esophagus, are associated with iron-deficiency anemia, and occur in middle-aged women.

A

Plummer-Vinson syndrome

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14
Q

ntermittent solid food dysphagia is a classic symptom in_____ in which a distal esophageal ring occurs at the squamocolumnar mucosal junction

A

Schatzki ring

When the lumen is less than 13 mm, dysphagia may occur

typically occur in persons older than 40 years and often cause “steakhouse syndrome” from meat getting stuck at the ring

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15
Q

_________ is the most common cause of acute liver failure and the most common cause of drug-induced liver failure that leads to transplantation.

A

Acetaminophen overdose

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16
Q

ith therapeutic use of acetaminophen, _______ in the liver rapidly converts NAPQI to a nontoxic metabolite that is excreted in the urine

A

glutathione

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17
Q

Given the known hepatotoxicity of acetaminophen, the U.S. Food and Drug Administration has recommended a maximum daily dose of no more than ____, with lower doses in individuals with chronic alcohol use

A

recommended a maximum daily dose of no more than 3.25 g

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18
Q

Acute ingestions of ______ of acetaminophen are sufficient to cause clinical evidence of liver injury, and doses higher than ____ can lead to fatal hepatic necrosis.

A

Acute ingestions of 10–15 g of acetaminophen are sufficient to cause clinical evidence of liver injury, and doses higher than 25 g can lead to fatal hepatic necrosis.

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19
Q

ACETAMINOPHEN TOXICITY

Nausea, vomiting, abdominal pain, and shock occur within 4–12 hours after ingestion

Within 24–48 hours, these symptoms subside and are followed by evidence of hepatic injury.

Maximal levels of aminotransferases can reach more than 10,000 IU/L and may not occur until ______ after ingestion

A

4-6 DAYS

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20
Q

ACETAMINOPHEN TOXICITY

The first level should be measured no sooner than ______ after a known ingestion.

A

The first level should be measured no sooner than 4 hours after a known ingestion.

If, at 4 hours, the acetaminophen level is greater than 300 μg/mL, significant hepatotoxicity is likely.

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21
Q

The primary treatment for acetaminophen overdose is _________.

acts to replete glutathione levels in the liver and also provides a reservoir of sulfhydryl groups to bind to the toxic metabolites

A

N-acetylcysteine

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22
Q

typical regimen of N-acetylcysteine is ______ given as a loading dose, followed by _____every 4 hours for a total of 15–20 dose

A

typical regimen of N-acetylcysteine is 140 mg/kg given as a loading dose, followed by 70 mg/kg every 4 hours for a total of 15–20 dose

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23
Q

Gastrin levels may go up with a meal (>200%), but this test does not distinguish G-cell hyperfunction from ZES. The best test in this setting is the secretin stimulation test. An increase in gastrin levels _______ WITHIN minutes of administering 2 µg/kg of secretin by intravenous bolus has a sensitivity and specificity of >90% for ZES.

A

> 200 pg within 15

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24
Q

Multiple endocrine neoplasia type 1 (MEN1) is an endocrine tumor syndrome caused by inactivating mutations of the ____tumor suppressor gene at the ____ locus.

A

MEN1

11q13

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25
Q

combination of parathyroid tumors, pancreatic islet cell tumors, and anterior pituitary tumors

A

Multiple endocrine neoplasia type 1 (MEN1)

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26
Q

Free peritoneal perforation occurs in _______ of DU patients

A

Free peritoneal perforation occurs in ~2%–3% of DU patients

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27
Q

IN PUD

The procedure that provides the lowest rates of ulcer recurrence (1%) but has the highest complication rate is ________.

_______is aimed at eliminating an additional stimulant of gastric acid secretion, gastrin.

A

vagotomy (truncal or selective) in combination with antrectomy

Antrectomy

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28
Q

arise from the rapid emptying of hyperosmolar gastric contents into the small intestine, resulting in a fluid shift into the gut lumen with plasma volume contraction and acute intestinal distention

consists of a series of vasomotor and GI signs and symptoms and occurs in patients who have undergone vagotomy and drainage (especially Billroth procedures)

A

eARLY Dumping syndrome

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29
Q

Early dumping takes place 15–30 minutes after meals and consists of crampy abdominal discomfort, nausea, diarrhea, belching, tachycardia, palpitations, diaphoresis, light-headedness, and, rarely, syncope

A

rarely, syncope

30
Q

The late phase of dumping typically occurs _________ after meals. Vasomotor symptoms (light-headedness, diaphoresis, palpitations, tachycardia, and syncope) predominate during this phase

This component of dumping is thought to be secondary to hypoglycemia from excessive insulin release

A

90 minutes to 3 hours

31
Q

worsening pain after eating suggesting a _____ ulcer

A

duodenaL

32
Q

=occur most often in the first portion of the duodenum (>95%), with ~90% located within 3 cm of the pylorus.

A

DU

33
Q

The typical pain pattern in DU occurs _______ after a meal and is frequently relieved by antacids or food.

Pain that awakes the patient from sleep (between midnight and 3 A.M.) is the most discriminating symptom, with two-thirds of DU patients describing this complaint.

A

90 minutes to 3 hour

34
Q

Encephalopathy can occur in as many as _____ % of patients after TIPS and is particularly problematic in elderly patients and in patients with preexisting encephalopathy

A

20%

35
Q

AUTOIMMUNE HEPATITIS

Antinuclear antibodies are positive in a ________staining pattern almost invariably in the disease, and rheumatoid factor is also common

A

homogeneous

36
Q

AUTOIMMUNE HEPATITIS

Antinuclear antibodies are positive in a ________staining pattern almost invariably in the disease, and rheumatoid factor is also common

A

homogeneous

Perinuclear antineutrophilic cytoplasmic antibody may be positive, but in an atypical fashion. Anti–smooth muscle antibodies and anti-liver/kidney microsomal antibodies are frequently seen,

37
Q

KIND of gallbladder stone in PBC

A

CHOLESTEROL

38
Q

a chronic multisystem disease often including diarrhea/steatorrhea, migratory arthralgias, weight loss, and central nervous system (CNS) or cardiac problems. Generally the presentation is of insidious onset, and dementia is a late finding and poor prognostic sign.

A

Whipple disease,

39
Q

a chronic multisystem disease often including diarrhea/steatorrhea, migratory arthralgias, weight loss, and central nervous system (CNS) or cardiac problems. Generally the presentation is of insidious onset, and dementia is a late finding and poor prognostic sign.

A

Whipple disease,

40
Q

Whipple disease, most likely finding on small bowel biopsy

A

periodic acid–Schiff (PAS)–positive macrophages within the small bowel

41
Q

Mononuclear cell infiltrate in the lamina propria is often demonstrated in patients with

A

tropical sprue

42
Q

flat villi with crypt hyperplasia is the hallmark of

A

celiac disease.

43
Q

Chronic hepatitis develops in about _____of all individuals affected with hepatitis C virus (HCV), and ______ of these individuals will progress to cirrhosis over about 20 years.

A

Chronic hepatitis develops in about 85% of all individuals affected with hepatitis C virus (HCV), and 20%–25% of these individuals will progress to cirrhosis over about 20 years.

44
Q

Chronic pancreatitis VIT DEFICIENCY

A

Vitamin B12, or cobalamin

fat-soluble vitamins (A, D, E, and K

45
Q

Generally, the clinical course of hepatitis E infection is mild and the rate of fulminant hepatitis is only 1%–2%. However, in pregnant women, this is as high as ?

A

10%–20%

46
Q

When cholecystectomy is needed

A

SURGICAL THERAPY In asymptomatic gallstone patients, the risk of developing symptoms or complications requiring surgery is quite small (see above). Thus, a recommendation for cholecystectomy in a patient with gallstones should probably be based on assessment of three factors: (1) the presence of symptoms that are frequent enough or severe enough to interfere with the patient’s general routine;

(2) the presence of a prior complication of gallstone disease, i.e., history of acute cholecystitis, pancreatitis, gallstone fistula, etc.; or
(3) the presence of an underlying condition predisposing the patient to increased risk of gallstone complications (e.g., calcified or porcelain gallbladder and/or a previous attack of acute cholecystitis regardless of current symptomatic status). Patients with very large gallstones (>3 cm in diameter) and patients harboring gallstones in a congenitally anomalous gallbladder might also be considered for prophylactic cholecystectomy

47
Q

In Gilbert syndrome, there is a mutation of the ________ that encodes bilirubin UDP-glucuronosyltransferase, which leads to a reduction in activity on the enzyme to 10%–35% of normal

A

UGT1A1 gene

48
Q

The highest priority (status 1) for liver transplantation continues to be reserved for patients with___

A

fulminant hepatic failure or primary graft nonfunction.

49
Q

multiple cystic dilatations of the intrahepatic biliary tree

A

Caroli disease

50
Q

recurrent hepatitis C is insidiously progressive, allograft cirrhosis develops in _______, and cirrhosis and late organ failure occur at a higher frequency beyond 5 years.

A

20%–30% at 5 years

51
Q

Because of the high rate of recurrent disease after transplantation, patients with ________ are not transplantation candidates.

A

cholangiocarcinoma

52
Q

Patients with primary hepatocellular carcinoma with a single tumor _____ cm or _____# tumors of ____ cm have 5-year recurrence-free survival rates similar to those with nonmalignant disease

A

Patients with primary hepatocellular carcinoma with a single tumor <5 cm or three or fewer tumors of <3 cm have 5-year recurrence-free survival rates similar to those with nonmalignant disease

53
Q

Cigarette smoking is associated with a decreased/increased incidence of ulcerative colitis but may cause Crohn disease. Oral contraceptive use is associated with a slightly higher incidence of______. __________ twins are highly concordant for Crohn disease but not ulcerative colitis.

A

Cigarette smoking is associated with a decreased incidence of ulcerative colitis but may cause Crohn disease. Oral contraceptive use is associated with a slightly higher incidence of Crohn disease but not ulcerative colitis. Monozygotic twins are highly concordant for Crohn disease but not ulcerative colitis.

54
Q

BISAP incorporates five clinical and laboratory parameters obtained within the first 24 hours of hospitalization

A

BUN >25 mg/dL, impaired mental status (Glasgow coma score <15), systemic inflammatory response syndrome, age >60 years, and pleural effusion on radiography

55
Q

he only clinical conditions in which absorption is increased are _______, in which absorption of iron and copper, respectively, is elevated

A

he only clinical conditions in which absorption is increased are hemochromatosis and Wilson disease, in which absorption of iron and copper, respectively, is elevated

56
Q

_________ can occur in up to 12% of patients with ulcerative colitis and is characterized by a lesion that begins as a pustule and progresses concentrically to surrounding normal skin

A

Pyoderma gangrenosum

57
Q

_________ can occur in up to 12% of patients with ulcerative colitis and is characterized by a lesion that begins as a pustule and progresses concentrically to surrounding normal skin

A

Pyoderma gangrenosum

Erythema nodosum is more common in Crohn disease and attacks correlate with bowel symptoms

58
Q

is a rare disorder in intertriginous areas reported to be a manifestation of IBD in the skin.

A

pyoderma vegetans

59
Q

Patients with Crohn disease may have an increased risk of non-Hodgkin lymphoma, leukemia, and myelodysplastic syndromes.

A

True

60
Q

______ is the presumed mechanism for development of SBP, with gut flora traversing the intestine into mesenteric lymph nodes, leading to bacteremia and seeding of the ascitic fluid.

A

Bacterial translocation

61
Q

The most common organisms are ____ and other gut bacteria; however, gram-positive bacteria, including Streptococcus viridans, Staphylococcus aureus, and Enterococcus spp., can also be found. If more than two organisms are identified, secondary bacterial peritonitis due to a perforated viscus should be considered.

A

E coli

62
Q

The diagnosis of SBP is made when the fluid sample has an absolute neutrophil count

A

> 250/μL

63
Q

prophylaxis against SBP is recommended when a patient presents with upper GI bleeding

A

TRUE

64
Q

Treatment is with a second-generation cephalosporin, with ______ being the most commonly used antibiotic.

A

cefotaxime

65
Q

Several distinct patterns can be observed. In acute hepatitis B, the core IgM, surface antigen, and e antigen are all positive, which is what is seen in this case. At this point, the patient is highly infectious, with viral shedding in body fluids, including saliva.

A

TRUE

66
Q

Irritable bowel syndrome (IBS) is characterized by the following: recurrence of lower abdominal pain with altered bowel habits over a period of time without progressive deterioration, onset of symptoms during periods of stress or emotional upset, absence of other systemic symptoms such as fever and weight loss, and small-volume stool without evidence of blood.

A

Warning signs that the symptoms may be due to something other than IBS include presentation for the first time in old age, progressive course from the time of onset, persistent diarrhea after a 48-hour fast, and presence of nocturnal diarrhea or steatorrheal stools. Each patient, except for patient C, has “warning” symptoms that should prompt further evaluation.

67
Q

IBS is a disorder that affects all ages, although most patients have their first symptoms before age ___

A

45.

68
Q

Uncomplicated disease involves fever, abdominal pain, leukocytosis, and anorexia/obstipation, whereas complicated disease is characterized by ___________________

A

abscess formation, perforation, strictures, or fistulae

69
Q
  1. inflammatory bowel disease
  2. discontinuous lesions
  3. typically affects the rectum and proceeds caudally from there without normal mucosa until the area of inflammation terminates
  4. presence of strictures and fissures
  5. more often transmural, full-thickness
A 
Crohn disease
Ulcerative colitis
Crohn disease
Crohn
Crohn
70
Q

The hallmark of Crohn disease is

A

granulomas

71
Q

Bleeding is not a feature of I rritableBS unless hemorrhoids are present, and malabsorption or weight loss does not occur.

A

TRUE

GASTROINTESTINAL (14 decks)

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