IM: GI Flashcards
pt with cirrhosis and ascites accompanied by FEVER and LETHARGY which is concerning for what
dx how
SBP and hepatic encephalopathy
dx with paracentesis and neutro;hil count over 250
most common organisms with SBP and treatment and what would be for ppx
e coli and klebsiella most common then strep
3rd gen ceph to treat
fluoroquin for SBP ppx
SAAG of ____ or more is SBP
1.1
ascites fluid characteristics: total protein 2.5 or more
CHF, constritive pericarditis, budd chiari, fungal
under 2.5 is cirrhosis, nephrotic syndrome
SAAG of 1.1 or more indicates what
portal HTN
asictes can be due to what
portal HTN causes: cardiac ascites, cirrhosis
non portal HTN: malignancy, pancreattisis, nephrotic syndrome TB
SAAG calculated how
subtract the peritoneal fluid albumin from serum albumin
major risk factors for pancreatic cancer
hereditary
environmental
hereditary: fam history of cancer
hered pancreatitis
BRCA1,2 or peutz heghers
envir: smoking
elevated alkaline phosphatase out of proportion to the transaminases suggests what disease
intrahepatic cholestasis or biliary obstruction
how do you confirm PSC
endoscopic retrograde or magnetic resonance cholangiopancreatography
multifocal narrowing with intrahepatic and extrahepatic duct dilation
peptic ulcer disease refers to ulerations where
stomach or duodenum from h pylori or NSAIDs
melana occurs in what GI bleeds
proximal to ligament of treitz
niacin deficiency in devloping countries and in devloped
developing: pops taht subsist primarly on corn products
developed: pts with alcoholism or chronic ilness
abdominal pain, vomiting, diarrhea, with neuo sx that are episodic sx
AIP
etiology of colovesical fistula
diverticular disease (sigmoid most common)
crohns
malignancy
dx of colovesical fistula
abdominal CT with oral or rectal contrast (not IV)
colonscopy
treatment for giardia lamblia
metronidazole
diagnosing giardia
stool antigen assay or microsopy for oocysts and trophozoites
steps in variceal hemorrhage
1) 2 large bore IV caths
2) IV octreotide and abx
3) EGD therapy
- if stops bleed = done, do px with Block and band ligation 1-2 weeks later
- if bleed continues balloon tamponade
- if early rebleed then repeat endoscopy therapy
if variceal hemorrhage will not stop what is last effort
TIPS or shunt surgery
packed red blood cells can replenish what
hemoglobin, only need when under or at 7
platelet transfusions are generally reserved for what pts
with active bleed and platelet count under 50k
treatment for nonalcoholic fatty liver disease
diet and exercise
consider bariatric surgery if BMI is 35 or more
AST and ALT in NAFLD
mildly elevated, ratio near 1 or less
US finding in NAFLD
hyperchoic texture on US
antinuclear antibody titers are senstivie marker for what hepatitis
autoimmune
methylmalonic acid level is elevated in B12 or folate deficiency?
just B12
treatment for duodenal ulcer
PPI and antibiotic
amoxicillin plus clarithromycin
treatment for PBC
ursodeoxycholic acid
liver transplant for advanced disease
complications of PBC
malabsorption, fat soluble vitamin deficiencies
osteoporosis, osteomalacia
hepatocellular carcinoma
sever hyperlipidemia which may manifest with xanthelasmas
bile salt diarrhea occurs in what pts
with terminal ileal disease, bc impaired bile absorption in ileum leads to increase in coon = diarrhea
also can occur from insufficient bile salt absroption by TI immediately postop period after cholecystectomy, resolves in weeks to months
restrictive cardiomyopathy and liver cirrhosis may be seen in pts with what
hemochromatosis due to excess iron deposition
autoimmune destruction of intrahepatic bile ducts
how about intra and extrahepatic
intra = pbc
extra and intra = PSC
chronic liver disease and tsh and t3 and t4
liver usually makes Thyroxine binding globulin and transthyretin, albumin too
decreased in disease = lower T3 and T4 in circulation but free T3 and T4 unchanged so TSH normal
AI can cause fatigue weakness anorexia and weight loss and hypogonadism in what
women
other causes of acute pancreatitis besides alcohol and gallstones
hyperTGemia (3rd most common)
meds like azathioprine, valp acid, thiazide diuretics
CMV
ERCP
lab finding in biliary pancreatitis and how to evaluate
ALT over 150
ERCP
chronic pancreatitis etiology
alcohol use
CF (children mainly)
ductal obstruction (malignancy and stones)
autoimmune
causes of chronic pancreatitis
cx features
image
tx
alcohol
CF in children
obstruction
autoimmune
cx: malabsorption, diarrhea, weight loss, DM, pain intervals in epigastric region that is releived with leaning FORWARD or sitting up
(think endocrine and exocrine issues)
image: calcification, dilated pancreas and ducts
tx: pain managment, stop smoke and drink, panc enzymes
can kristie get IDA
yes, she has celiacs
how do you diagnose chronic pancreatitis
CT scan abdomen showing calcifications
amylase and lipase in Chronic panc
not that elevated
acute erosive gastropathy can be caused from what
aspirin, cocaine and alcohol
vomiting on first episode
mallory weis would not present on first vomit
hollow organ contraction and outlet obstruction describes what
biliary colic secondary to gallstones
where does pain from pancreatitis radiate
back
chronic GERD with new dysphagia and symmetric lower esophageal narrowing suggests what
asymmetric is more likely what
esophageal stricture
asym = adenocarinoma, takes around 20 yrs of barrets esophagus
symmetric circumferential narrowing on barium swallow
stricture
if have barrets esophagus and think it is a stricture still must do what
get a biopsy to rule out adenocarcinoma
do with endocsopy
dysphagia to both solids and liquids and regurgitaitno of undigested food or saliva
dilation of proximal esophagus and narrow GE junction
achalasia
treatment for hepatic encephalopathy
lactulose and rifaximin
population that gets lactose intolerance the most
age and race
20-40
blacks, latin americans, asians, eubanks people
where is lactose processed into glucose and galactase
brush border of duodenum
treatment for toxic megacolon
IVF, broad spectrum antibiotics and bowel rest
IV corticosteroids for IBD induced toxic megacolon
autoimmune hepatitis is characterized by what
elevated liver transaminases and postive ANA titer
drug of choice for PBC
ursodeozycholic acid
pharmacologic agents that can cause acute hepatitis
isoniazid, chlorpromazine, halothane, and antiretroviral therapy
pt presents with septic shock and developed AST and ALT elevations one day later
ischemic hepatic injury or shock liver
rapid massive increase in transaminases with modest accompanying elevations in total bilirubin and alk phosphatase
ischemic hepatic injury or shock liver
nontender but palpable gallbladder at the right costal margin in a jaundiced pt is classic for what
courvoisier’s sign in pancreatic cancer
diagnosing pancreatic cancer
US (often non diagnostic)
CT scan next
ERCP after first 2
diagnosing boerhaave syndrome
CXR or CT scan shows wide mediastinum, pneumomediaastinum
CT scan shows esophageal wall thickening
water soluble contrast esophagogram shows leak at perforation site
treatment for boerhaave
NPO, IV abx, PPI, nutrition
surgical drain and debridement of infected necrotic areas
a perforated duodednal ulcer would cause what
epigastric pain with free air visualized under the diaphragm on KUB
risk factors for acquiring C diff colitis
recent ABX
hospitalization
PPJ
what is a consequence of you BMs with pelivc splanchnic nerve damage
constipation
D-xylose test tests what
proximal small intestinal absorption
if d xylose test shows decreased urine output of d xylose then what does this mean
it means that less was absorbed so most was lost in feces = malabsoprtion of SI
proximal small intest mucosal disease like celiacs
d xylose test in pts with malabsorption due to enzyme deficiency like chronic pancreatitis
normal
d xylose test in pt with crohns
normal bc terminal ileum absorption disrupted in crohns and d xylose absorbed proximal SI
what mineral deficiency
brittle hair, skin depigmentation, neuro dysfunction, sideroblastic anemia, osteoperosis
copper
what trace mineral deficiency: thyroid dysfunction, cardiomyopathy, immune dysfunction
selenium
what trace mineral deficiency:
alopecia, pustular skin rash (mouth and extremities) hypogonads impaired wound healing impaired taste immune dysfunction
zinc
zinc deficiency can be due to what disease
crohns and celiac or bowel resection
patients dependent on what are at risk for trace mineral deficiency
TPN
most common causes of cirrhosis in US is what
viral hep
chronic alcoholism
NAFLD
hemochromatosis
cancers in the head of the pancreas present how
detect cancer how
jaundice (CBD obstruction) elevated alk phase and billy and steatorrhea
US to detect cancer and exclude other potential cuases of billy obstruction
cancers in the body and tail of pancreas present how
detect how
no obstructive jaundice and usually painless
Abdominal CT scan
ERCP in cancer use
reserved for pts with cholestasis who may require intervention like stenting
what pathogen plays fole in MALToma
h pylori from chronic inflammation
B and T cells go to gastric lamina
dx and treatment of MALToma
test for h pylori
h pylori eradication (quad therpay)
usually achieve complete remission
colon cancer screening
flex sigmoid Q what
flex sig + FOBT q what
colonscopy Q what
FS= 5
FS and FOBT = 3
colonoscopy = 10
diagnosing zenkers diverticulum
treating
contrast esophagram
surgery
elderly man with dysphagia, regurgitation, fould smeling breath, aspiration and occasionally a palpable mass
zenkers diverticulum
when should a proctocolectomy be done in a pt with FAP
when can it be delayed?
when pt initially presents with CRC or adenomas with high grade dysplasia
or pts with hemorrhage from neoplasia or significant increase in polyp number during screening interval
if not classic findings then surgery can be delayed until 20s
standard of care for FAP
sigmoidoscopies for kids starting at 10-12 followed by annual colonscopies once colorectal adenoma detected
PBC has intrahepatic or extrahepatic cholestasis on US?
intra
xanthelasma with what autoimmune disease
PBC
what other disease often occurs with PBC
autoimmune thyroid disease
autoimmune hepatitis antibodies
and treatment
antinuclear antibodies
anti-SM antibodies
anti SMA and anti NA
AH SMAsh, NA
treat with glucocorticoids
diagnosing esophageal perforation
CXR or CT scan: wide mediastinum, pneumomediastinum, pneumothorax, plueral effusion (late)
water soluble contrast esophagogram
managing esophageal perforation
abx and supportaive care
surgiery if leakeage with systemic inflamm response
salivary amylase in the pleural fluid
esophageal perforation
elderly pt with IDA and negative FOBT what next
still do colonscopy and endoscopy
what heart thing is associated with GI angiodysplasia
severe aortic stenosis causing occult GI bleed
spontaneous pain, odynophagia for cold and hot food is what
regurgitation, and or chest pain precipitated by emothional stress too
what relieves
diffuse esophageal spasm
nitroglycerin and CC
what is the diagnostic step for esophageal spasm
and what would it show
esophageal manometry
shows repetitive non peristaltic high amp contractions
what to order in pt with IDA suspected
how to confirm
blood counts, iron study, fecal occult blood test
upper and lower GI endoscopy to confirm
pleural fluid analysis: exudative, low pH and very high amylase
esophageal perforation (borhavee)
treatment for boerhaave syndrome
surgery for thoracic perforations
conservative measure (ABX) for cervical perforations
AR mutation of ATP7B
wilsons disease
treatment for wilsons diseaes
chelators like D-penicillamine, trientine
zinc
liver transplant cures
ceruloplasmin in wilsons
low
postcholecystetcomy syndrome
biliary cause (retained CBD or cystic duct stone, billy dyskinesia)
extra-biliary (pancreatitis, PUD, CAD)
same pain prior to surgery still there
tumors in FAP
CRC
desmoids and osteomas
brain tumors
Dez Brain FAPs
VhL syndrome tumors
hemangioblastomas
clear cell renal carcinoma
pheochromocytoma
HPC
