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Rotation > Med 1 EOR - GI > Flashcards

Med 1 EOR - GI Flashcards

1
Q

what do the different cells of the stomach secerete? (parietal, chief)

A

parietal: HCl - dissolves food, activates pepsin, stimulates duodenal enzyme release, kills food bacteria
chief: pepsinogen (prehormone to pepsin) - digests proteins

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2
Q

what does the pancreas release for negative feedback of digestion?

A

somatostatin –> inhibits secretion of gastrin, insulin, glucagon, pancreatic enzymes and inhibits gallbladder contraction

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3
Q

where does MOST of the small intestine absorption take place?

A

duodenum

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4
Q

what is secretin? (Where does it come from and what does it do?) what is the secretin test for?

A

Secretin: duodenum release secretin → inhibits parietal cell gastrin/HCl production → stim pancreas to release bicarb (buffer)
*clinical pearl: secretin test = reduced gastrin levels EXCEPT in Zoster-Ellison syndrome.

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5
Q

what 3 things does cholecystikinin do?

A
  1. stimulates pancreatic release of digestive enzymes (trypsin, amylase,lipase) = helps breakdown fats + proteins.
  2. Increase bicarb release (pancreatic enzymes work best in buffered -basic environment)
  3. Stimulates gallbladder contraction + bile release. Bile salts → emulsify fats into smaller micelle (to make breakdown by lipase easier)
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6
Q

excorine pancreas: what 4 substances do the acinar cells produce?

A

amylase, lipase, proteases (trypsinogen and chemotrypsinogen), bicarb

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7
Q

endocrine pancrease: what 3 substances do the islets of langerhan’s produce?

A

insulin, glucagon, somatostatin

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8
Q

MC cause of esophagitis? what are other causes?

A

GERD. also infectious (candida, CMV, HSV), meds (NSAIDS, etc), radiation, eosinophilic

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9
Q

odynophagia, dysphagia, retrosternal chest pain. Kids- feeding difficulty.
Hematemesis + dyspnea w/ corrosive ingestion

A

esophagitis

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10
Q

MC type of esophageal CA in the world , which part of the esophagus is it most commonly found?

A

Squamous: MC worldwide, MC in upper ⅓ of esophagus.

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11
Q

MC type of esophageal CA in the US? what is the typical pt?

A

Adenocarcioma: MC young, obese, Caucasian. Usually a complication of GERD → Barret’s esophagus.

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12
Q

Upper endoscopy = superficial longitudinal mucosal erosions. Dx?

A

mallory weiss tear

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13
Q

txt options for mallor weiss tear

A

supportive (most stop bleeding w/out intervention). Acid suppression promotes healing. If severe bleeding → epi injection, sclerosing agent, band ligation, hemoclipping or balloon tamponade

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14
Q

pathophys of achalsia

A

idiopathic loss of Auerbach’s plexus (usually produce inhibitory nitrous oxide to relax smooth muscle) → incr. LES pressure → lack of peristalsis + obstruction. → dilation if untreated.

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15
Q

best first line to Dx pyloric stenosis?

A

US

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16
Q

symptoms achalasia

A

dysphagia solids and LIQUIDS.

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17
Q

Dx of achalasia (2 ways)

A 
esophageal manometry (GOLD std) = pressure >40 mmHg + decr peristalsis. 
Double contrast esopahgram = “birds beak”
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18
Q

txt options for achalasia

A

botox lasts 6-12mo, nitrates, CCBs, pneumatic dilation, esophagomyomectomy.

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19
Q

unknown cause. EXCESSIVE contraction of esophagus w/ peristalsis
S+S: dysphagia (solids + LIQUIDS), CP, maybe asympt.

A

nutcracker esophagus

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20
Q

Dx of nutcracker esophagus

A

manometry = incr pressure DURING peristalsis

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21
Q

txt options for nutcracker esophagus

A

CCBs, nitrates, botox, sildenafil

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22
Q

patho of zenckers diverticulum?

A

pharyngoesophageal pouch (false diverticulum, only involves mucosa) weakness of jxn between cricopharyngeus muscle + lower inferior constrictor → herniation/outpouch.

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23
Q

Dx of zenker’s diverticulum is best made with what?

A

barium esophagram

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24
Q

txt options for zenker’s diverticulum

A

diverticulectomy, cricopharyngeal myotomy. Observe if small and asymp.

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25
Q

what is dermatitis herpetiformis? txt?

A

MC dermatologic manifestation assoc w/ celiac dz. It is an autoimmune rash with very pruritic papules and vesicles, usually on the arms, knees, buttocks, or scalp. Lesions occur in groups.
Txt: gluten-free diet and dapsone.

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26
Q

which vitamin deficiency is most assoc w/ poor wound healing?

A

vit C

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27
Q

what vitamin deficiency causes night blindness?

A

Vit A

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28
Q

which tumor marker is elevated with liver CA?

A

alpha fetoprotein

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29
Q

FULL THICKNESS rupture of distal esophagus. Assoc. w/ repeated forceful vomiting (Bulimia), or iatrogenic perf from endoscopy

A

borhaave syndrome

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30
Q

S+S of borhaave syndrome ?

A

retrosternal CP worse w/ deep breath + swallowing, hematemesis, crepitus on chest auscultation from pneumomediastinum.

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31
Q

Dx of borhaave

A

CXR, chest CT = pneumomediastinum, esoph thickening, left-sided hydropneumothorax.
*Contrast esophagram (gastrograffin) = leakage

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32
Q

txt borhaave syndrome

A

IV fluids, NPO, abx, H2 blockers. Sx if large/severe

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33
Q

MC cause of varices in adults and kids?

A

cirrhosis (MC cause in adults), portal vein thrombosis (MC in kids)

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34
Q

S+S gastroesophageal varices?

A

upper GI bleed (hematemesis, melena, hematochezia), maybe S+S of hypovolemia

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35
Q

medication options for varices txt?

A

(vasoconstriction)- octreotide, vasopressin

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36
Q

medications to prevent rebleed after varices txt ?

A

*prevent rebleed: nonselective BBs, isosorbide (long-acting nitrate - vasodilator)

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37
Q

MC cause of acute pancreatitis in kids?

A

mumps

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38
Q

2 “signs” of necrotizing/hemorrhagic acute pancreatitis?

A

Cullen’s (periumbilical ecchymosis), Grey Turner (flank ecchymosis).

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39
Q

what lab electrolyte level is low with acute pancreatitis?

A

Ca+ (necrotic fat binds to it)

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40
Q

what might imaging show for acute pancreatitis?

A

= sentinel loop = localized ileus (dilated small bowel in LUQ), “colon cutoff” = abrupt collapse of colon near pancreas.

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41
Q

txt of acute pancreatitis

A

“rest the pancreas”- supportive (NPO, IV fluids, analgesia)
Abx only if severe necrotizing
ERCP only if obstructive jaundice

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42
Q

triad of S+S for chronic pancreatitis?

A
  1. Calcifications 2. Steatorrhea 3. DM. Also weight loss
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43
Q

dx of chronic pancreatitis (image and labs)

A

abd Xray = calcified pancreas, amylase/lipase NOT elevated

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44
Q

MC kind of pancreatic CA, where is it found?

A

MC- adenocarcinoma- ductal MC, islet cell. 70% found in head of pancreas.

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45
Q

4 S+S severe pancreatic CA (asymp till METS)

A
  1. Abdominal pain → back pain (tumors in body/tail show symptoms later than in head)
  2. Painless jaundice (2ry common bile duct obstruction.
  3. Pruritis + trousseau’s malignancy sign (migratory phlebitis assoc. w/ malignancy)
  4. Courvoisier’s sign (palpable, non-tender, distended gallbladder assoc. w/ jaundice.
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46
Q

what tumor markers are increased with pancreatic CA?

A

CEA, CA 19-9.

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47
Q

MC cause gastric outlet obstruction ?

A

Malignancy is now the leading cause of gastric outlet obstruction (GOO) with pancreatic adenocarcinoma and distal gastic cancer being among the most common types of malignancy leading to this condition.

Gastric outlet obstruction, as the name suggests, is mechanical obstruction of the gastric outflow tract and classically presents with epigastric abdominal pain and postprandial vomiting

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48
Q

Which of the following Vitamin deficiencies presents with the 3 D’s (diarrhea, dermatitis, and dementia)?

A

niacin - this presentation is “pellagra”

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49
Q

gastritis/gastroenteritis - MC cause and other two causes

A
  1. Helicobacter pylori (MC) 2. NSAIDs/ASA 3. Acute stress (if critically ill).
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50
Q

Dx gastritis

A

endoscopy = thick, edematous erosions. Hpylori test

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51
Q

txt of gastritis: H pyolir + or H pylori -

A

H pylori pos: Clarithromycin + Amox + PPI (Flagyl if PCN allergic)
H pylori neg: acid suppression (PPI, H2 block, antacids, sucralfate)

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52
Q

MC cause gastroenteritis?

A

viral (MC) - norovirus + rotavirus

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53
Q

gold std for dx GERD (although not commonly done)

A

24 hr ambulatory pH monitoring

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54
Q

txt for hematemesis from upper GI bleed?

A

IV PPI to reduce stomach acid and promote clot formation , IV fluids + blood, Sx

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55
Q

peptic ulcer dz is secondary to an imbalance of protective and damaging factors: what is the difference between the cause of gastric vs duodenal ulcer ?

A

Gastric Ulcer- DECR mucosal protective factors

Duodenal Ulcer- INCR damaging factors (acid, pepsin).

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56
Q

which type of peptic ulcer is more common in older males + with steroid use?

A

duodenal ulcer

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57
Q

causes of peptic ulcer dz

A

H Pylori (MC cause)
NSAIDs
Zollinger-Ellison syndrome (gastrin producing tumor)
EtOH, smoking, stress (burns, trauma, Sx), CA

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58
Q

S+S peptic ulcer dz (which is specific for duodenal vs gastric location)

A

dyspepsia (epigastric pain - burning, gnawing, hunger-like). WORSE at night. May be relieved with food (DU) or worse with food (GU)

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59
Q

txt peptic ulcer dz ( H pylori positive (triple and quadruple) vs H pylori negative)

A

HPylori positive: triple therapy - Clarithromycin + Amox + PPI. Metronidazole if PCN allergic.
Quadruple therapy - Bismuth subsalicylate + tetracycline + PPI + metronidazole

H Pylori negative: PPI, H2 blocker, misoprostol, antacids, Bismuth compounds, sucralafate

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60
Q

txt for refractory PUD

A

Refractory: parietal cell vagotomy. Bilroth II Surgical procedure (gastrojejunostomy)

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61
Q

pyloric stenosis incidence increases with use of what abx?

A

erythromycin

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62
Q

nonbilious vomiting/regurgitation → projectile after feeding → hyerchloremic metabolic alkalosis. Olive-shaped nontender, mobile, hard mass- palpated after vomiting. Hyperperistalsis.

A

pyloric stenosis

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63
Q

dx of pyloric stenosis (first line in US) but what will contrast CT show?

A

upper GI contrast = “string sign” (dye through narrow channel) + delayed gastric emptying

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64
Q

MC type of gastric CA, most common risk factor

A

MC- adenocarcinoma. MC risk factor - H pylori.

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65
Q

which part of the GI tract is MC area for extranodal spread of nonhodgekins lymphoma

A

stomach

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66
Q

multiple peptic ulcers, refractory, “kissing” (either side of luminal wall). Abd pain, diarrhea (acid in duodenum inactivates the pancr enzymes that need a basic environment to be active = malabsorption).

A

zoster ellison syndrome (gastrin-secreting neuro endocrine tumor)

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67
Q

dx of ZES

A

INCR fasting gastric level , positive secretin test (normally gastrin is inhibited by secretin, but positive test = increased gastrin).

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68
Q

txt of ZES

A

local = Sx, metastatic= PPIs + Sx resection if liver involved

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69
Q

MC causes small bowel obstruction, MC causes of large bowel obstruction

A

post-Sx adhesions (MC small bowel), incarcerated hernias (2nd MC small bowel),
malignancy(MC large bowel)
* other causes, crohn’s, intussusception

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70
Q

bowel obstruction: closed vs open loop, partial vs complete

A

Closed (vs open) loop- lumen occluded @ two points = decreased blood supply, necrotitis, peritonitis
Complete (vs partial)-obstipation - unable to BM or pass gas

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71
Q

how was distal small bowel obstruction present differently than proximal?

A

Distal (vs proximal) - presents more w/ abd distention + less vomiting.

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72
Q

abd xray of small bowel obstruction

A

abd Xray = air fluid levels (step ladder pattern)

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73
Q

txt of small bowel obstruction: nonstrangulated vs strangulated

A

nonstrangulated - NPO, IV fluids, bowel decompression (NG tube)
Strangulated -Sx

74
Q

MC type colon cancer and MC area of METS

A

adenocarcinoma (usually from adenametous polyp), to liver

75
Q

3 genetic predisoposing syndromes to colon CA? which is MC?

A
  1. familial adenomatous polyposis (APC gene)
  2. Lynch syndrome (hereditary nonpolyp) (MC)
  3. Peutz-Jehgers (autosomal dominant → hamartomatous polyps, mucocutaneous hyperpigmentation (lips, oral mucosa, hands)
76
Q

risk of colon CA from familial adenomatous polyopisis vs lynch syndrome

A

familial - 100% by age 40

lynch- 40% risk (hereditary nonpolyp)

77
Q

UC or Crohns puts you at higher risk for colon CA?

A

UC

78
Q

what ethnicity is at higher risk for colon CA?

A

african americans

79
Q

signs colon CA (left vs right sided)

A 
right/proximal = bleeding lesions - anemia/fecal occult blood, diarrhea
left/distal= bowel obstruction, present later, hematochezia.
80
Q

tumor marker for colon CA

A

CEA

81
Q

txt guidlines for colon CA based on stage

A

stage I-III= resection, stage III+ = chemo (5FU)

82
Q

colon CA screening guidelines: avg risk, 1st degree relative <60, 1st degree relative >60
(age to start. how frequent for fecal occult, colonoscopy, flex sigmoid)

A

*screen: avg risk: 50yo annual fecal occult, Q10yr colonoscopy (or flex sigmoid Q5yr)
1st degree relative >60: 40yo annual fecal occult, Q10yr colonoscopy
1st degree relative <60: 40yo annual fecal occult, Q 5yr colonoscopy

83
Q

txt for diverticulosis vs diverticulitis

A

Diverticulosis: fiber +/- vasopressin
Diverticulitis: clear liquid diet, abx( cipro, bactrom + metronidazole)

84
Q

congenital absence of enteric ganglion cells (failure complete neural crest migration= absence auerbach and meissner plexus) → functional obstruction (failure of relaxation of aganglionic segment).

A

hirschprungs dz

85
Q

MC area for hirschprungs dz, MC pt population

A

MC distal colon and rectum. Risk - males, down syndrome

86
Q

S+S hirschsprungs

A

meconium ileus (failure to pass >48hrs in full term), bilious emesis, abd distention. Failure to thrive. +/- enterocolitis (vomit/diarrhea, signs of toxic megacolon). Chronic constipation.

87
Q

what is the initial screening used for hirschsprungs

A

anorectal manometry = lack of relaxation of internal sphincter w/ balloon distension. (initial screening).

88
Q

gold std dx of hirschsprungs

A

*rectal (+/-suction) biopsy (GOLD std) = absence of ganglion cells. Full thickness if suction is non-dx.

89
Q

“double bubble” on abd xray is significant for what?

A

duodenal atresia (infants, congenital- part of duodenum doesn’t form, causes a blockage of where development of it stopped)

90
Q

txt hirschsprungs dz

A

Sx resection of affected bowel

91
Q

infectious diarrhea: invasive vs noninvasive. (S+S)

A

noninvasive (enterotoxin) = vomit. diarrhea - watery, large volume (small intestine), no fecal WBCs or blood

invasive = high fever, fecal blood + leukocytes, not as voluminous (large intestine), mucus. DO NOT GIVE antimotility (=toxicity)

92
Q

infectious diarrhea: invasive vs noninvasive (bugs)

A

noninvasive: staph aureus, bacillus cereus, vibrio cholerae, enterotox E coli, Cdiff
invasive: campylobacter, shigella, salmonella, yersenia entero., enterohemorrhagic E coli

93
Q

MC cause bacterial enteritis in US (infectious diarrhea) (and MC cause of guillane-barre)

A

campylobacter jejuni

94
Q

w/in 6 hrs (heat stable enterotox), MC cause food (dairy, mayo, meat, eggs). S+S = vomit,diarrhea, abd cramps, HA . bug?

A

staph aureus

95
Q

w/in 6 hrs, MC contaminated food (fried rice). S+S = vomit, diarrhea, abd cramps. bug?

A

bacillus cereus

96
Q

S+S: copious watery diarrhea “rice water stools” (grey - no blood or pus), rapid severe dehydration.

A

vibrio cholerae : EXOtoxin = hypersecretion H2O + Cl- ions

97
Q

txt for noninvasvie diarrhea and invasive diarrhea

A

supportive
+/- tetracyclines (for cholerae)
+/- FQ or TMP/SMX all others

98
Q

MC cause of traveller’s diarrhea. S+S: abrupt onset, watery diarrhea, cramping, vomit.

A

enterotoxic E coli

99
Q

S+S: foul odor, striking increase lymphocytes, pseudomembranous colitis, +/- bowel perf, toxic megacolon.

A

C diff (usually after clindamycin)

100
Q

txt for C diff

A

Flagyl, vancomycin

101
Q

Source- uncooked poultry, raw milk/dairy cattle. S+S: mimics acute appendicitis + diarrhea watery → bloody.

A

campylobacter jejuni

102
Q

Dx and txt of Campylobacter jejuni

A

Dx: stool culture = gram - “S/ comma- shaped” organisms
Txt: supportive +/- erythromycin

103
Q

Highly virulent. S+S: high fever, low abd pain, explosive watery diarrhea → mucoid/blood. Severe = toxic megacolon, reactive arthritis, young - febrile seizures.

A

shigella

104
Q

Dx of shigella: stool and sigmoidoscopy

A

stool culture, fecal blood, leukemoid rxn (WBC >50,000). Sigmoidoscopy = punctate ulceration

105
Q

txt shigella diarrhea

A

+/- TMP/SMX

106
Q

txt salmonella

A

supportive +/- FQs

107
Q

sickle cell pts with salmonella can develop what?

A

osteomyelitis

108
Q

> 1-2wks incubation period. Cephalic phase (HA, sore throat, constipation, cough) → crampy abd pain, pea soup stools. → intractable fever

A

enteric/typhoid fever (salmonella)

109
Q

undercooked beef, unpasturized milk/apple cider, day care, contaminated water. Produces cytotoxin. S+S: watery diarrhea → bloody, crampy abd pain. Low fever/absent.

A

EnteroHemorrhagic E coli

110
Q

contaminated pork, milk, water, tofu. S+S: mimics acute appendicitis (can cause mesenteric adenitis = abd tenderness + guarding).

A

yersenia enterocolitica

111
Q
  1. LLQ colic abd pain. Tenesmus, urgency, bloody diarrhea, hematochezia
    2.RLQ crampy abd pain. Weight loss. Diarrhea w/ NO visible blood
    which is UC? crohns?
A
  1. UC

2. Crohns

112
Q

Dx of UC and Crohns: barium study, labs, colonoscopy

A

UC: colonoscopy = uniform inflammation, pseudopolyps. Barium study = “stovepipe sign”, labs = P-ANCA
Crohn’s: colonoscopy =skip lesions, cobblestone. Barium study = “string sign”. Labs = ASCA.

113
Q

txt for UC and Crohn’s

A

Meds: aminosalicylates (sulfasalazine, mesalamine) → steroids → immune modifying agents (6-meraptopurine, azathrioprine, cyclosporine, methotrexate).–> anti-TNF biologics.
* ASAs better for UC.
*steroids for acute flares only
Sx curative for UC

114
Q

ischemic bowel dz: MC location

A

splenic flexure (less collateral blood flow)

115
Q

ischemic bowel dz: causes, which is most common?

A

Cause - MC occlusion (embolus, thrombus); Nonocclusive (shock, cocaine- vasospasm)

116
Q

chronic ischemic bowel dz: what causes it?

A

Chronic: mesenteric atherosclerosis of GI → inadequate perfusion esp @ splenic flexure - during postprandial states (usually come collateral flow) “intestinal angina”

117
Q

ischemic colitis: MC cause, MC areas involved

A

MC caused by systemic hypotension or atherosclerosis involving SMA and mesenteric arteries. MC @ “Watershed” areas w/ decreased collaterals (splenic flexure and rectosigmoid jxn)

118
Q

S+S ischemic colitis

A

LLQ pain w/ tenderness, bloody diarrhea (sloughing of colon)

119
Q

intussusception occurs often after what kind of illness? in what area?

A

viral + ileocecal junction

120
Q

dx of intussusception

A

US, Abd x ray (obstruction).barium contrast enema (Dx and therapeuric),

121
Q

ROME IV criteria of IBS

A

Recurrent abd pain @ least 1day/week in last 3 months with at least 2…
Related to defecation, change in stool frequency, change in stool appearance.

122
Q

meds for diarrhea vs constipation IBS

A

Diarrhea- anticholinergics (dicyclomine) antidiarrhea (loperamide)
Constipation - bulk-forming lax, osmotic lax. Lubipristone - activates intestinal Cl transporter. TCA (amitryptyline) for intractable pain.

123
Q

3 types of colon polyps: what is the risk of each for malignancy

A

pseudopolyps/inflammatory: due to IBD. not CA
Hyperplastic: low risk of malignancy
Adenomatous polyps: avg 10-20yrs until cancerous (esp >1cm).

124
Q

3 subtypes of adenomatous polyps and assoc risk

A

Tubular: non-pedunculated (MC and least risk)
Tubulovillous: intermediate risk
Villous: immobile, highest risk

125
Q

pathophys of celiac (sprue)

A

small bowel autoimmune inflammation 2ry to alpha-gliadin in Gluten → loss of villi & abs areas → impaired fat abs.

126
Q

nonobstructive, extreme colon dilation >6cm + S+S systemic toxicity.

A

toxic megacolon

127
Q

txt for toxic megacolon

A

bowel decompression, bowel rest. NG tube, Abx, electrolyte repletion. Colostomy if refractory

128
Q

gallbladder (cystic duct) obst by stone → inflammation/infection.

A

acute cholecystitis

129
Q

MC cause of cholecystitis (bugs)

A

MC E coli, also klebsiella, enterococci, B. fragilis, Clostridium

130
Q

what is + boas sign?

A

acute cholecystitis: referred pain to right shoulder/subscap area

131
Q

US = thickened gallbladder >3mm. Increased WBCs, HIDA (GOLD) = nonvisualization of gallbladder

A

acute cholecystitis

132
Q

txt acute cholecystitis

A

NPO, IV fluids, Abx ( ceftriaxone + metronidazole) → cholecystectomy (w/in 72hrs)

133
Q

what medication can be given to help dissolve gallbladder cholesterol stones

A

ursodeoxycholic acid (ursodiol)

134
Q

what is choledocholelithiasis? Dx? txt?

A

stones in common bile duct = ductal dilation (MC originate from gallbladder).
Dx w/ US then ERCP. Txt: ERCP extraction

135
Q

cholangitis: acute vs primary sclerosing

A

Acute: biliary tract infection 2ry to obstruction (gallstones/malignancy). MC from gram - enteric that ascend from duodenum (E Coli, also klebsiella, enterobacter)
Primary sclerosing: autoimmune, progressive cholestasis, diffuse fibrosis of INTRAhepatic and EXTRAhepatic ducts.

136
Q

primary sclerosing cholangitis: assoc w/ what bowel dz and what pt population?

A

MC assoc w/ IBD (UC). MC men 20-40y

137
Q

charcot’s triad and reynold’s pentad

A

ACUTE CHOLANGITIS
Charcot’s triad (fever/chills, RUQ pain, jaundice).
Reynold’s pentad (+ shock, AMS)

138
Q

S+S primary sclerosing cholangitis

A

jaundice, pruritus, hepatomegaly, splenomegaly

139
Q

gold std to dx both kinda of cholangitis

A

cholangiogram w/ ERCP

140
Q

leukocytosis, cholestasis (inc AP with inc GGT, bilirubin more than increased AST, ALT). US/CT shows dilated common bile duct.

A

acute cholangitis

141
Q

Txt acute cholangitis vs primary sclerosing cholangitis

A

Acute: Abx against colonic bacteria → common bile duct decompression/stone extraction w/ ERCP

Primary sclerosing: liver transplant definitive. Stricture dilation to relieve symptoms

142
Q

MC cause acute fulminant hepatitis (live failure)

A

tylenol OD

143
Q

how will fulminant liver failure change PT/INR?

A

PT/INR > 1.5 (decreased clotting factors)

144
Q

supportive and definitive txt for liver failure?

A

lactulose (neutralize ammonia), Rifaximin/neomycin (abx to breakdown bacteria producing ammonia in GI tract), protein restriction (reduces breakdown of protein into ammonia . liver transplant = DEFINITIVE txt

145
Q

+/- hepatomegaly, spider angiomata, palmar erythema, gynecomastia. → ascites, peripheral edema, hepatic encephalopathy.

A

cirrhosis (alcoholic or fatty)

146
Q

what types of hepatitis can lead to end-stage liver dz or hepatocellular carcinoma

A

only Hep B,C,D

147
Q

labs of viral hepatitis

A

increased ALT > increased AST. both >500 if acute. (<500 if chronic). Incr bili

148
Q

most chronic hep B is acquired how?

A

perinatally

149
Q

HBeAg vs HBV DNA

A

HBeAg: (envelop antigen): increased viral replications and increased infectivity. >3mo incr chance developing chronic Hep B
HBV DNA: presence in serum = active replication in liver

150
Q

what percentage of hep C cases become chronic?

A

80%

151
Q

fatigue, weak, weight loss, muscle cramps. Ascites, gynecomastia, hepatosplenomegaly, spider angioma, caput medusae, jaundice, palmar erythema.

A

cirrhosis

152
Q

how is hepatocellular carcinoma screened for?

A

alpha fetoprotein + US

153
Q

txt for symptoms of cirrhosis (encephalopathy, ascites, pruritis, definative)

A

Encephalopathy: lactulose or rifaxamin, neomycin 2nd line.
Ascites: Na+ restriction → diuretics, paracentesis
Prutitis: cholestyramine
Liver transplant = DEFINITIVE,

154
Q

hemachromatosis

A

hereditary - mutations of HH gene = increased intestinal Fe abs = Fe overload + tissue damage.

155
Q

S+S hemachromatosis

A

symptoms not till >40 in men, after menopause in women. Fatigue, lethargy. Common sites - liver, heart, pituitary. Untxted can develop into cirrhosis, heart failure, DM2, etc.

156
Q

Dx and txt of hemachromatosis

A

Dx: serum iron studies: high transferrin, high ferritin. + biallelic HFE mutation
Txt: great prognosis if identified early. - phlebotomy

157
Q

wilsons dz

A

free copper accumulation in the liver, brain, kidney, cornea due to rare autosomal recessive d/o (ATP7B) → inadequate bile excretion of Cu + increased small intestine abs. = Cu deposition in tissues = cellular damage.

158
Q

S+S wilsons dz

A
  1. Basal ganglia deposition: parkinson-like symptoms (bradykinesia, tremor, rigidity), dementia. Personality + behavioral changes
  2. arthralgias from deposition in joints.
  3. Liver Dz: hepatitis, hepatosplenomegaly, cirrhosis, hemolytic anemia
  4. Corneal copper deposit → Kayser-Fleicher rings
159
Q

Dx of wilsons dz

A

decreased ceruloplasmin (serum carrier molecule for copper), increased urine copper excretion

160
Q

3 options of txt for wilsons dz, which is the best?

A
  1. *D-penicillamine: chelates copper (pyridoxine/VitB6 given to prevent depletion).
  2. Zinc: enhances fecal Cu excretion + blocks intestinal abs. (for those who cant do chelation therapy or as maintenance add-on)
  3. Ammonium tetrathiomolybdate: increases urine Cu excretion by binding to Cu.
161
Q

origin of sac is LATERAL to inferior epigastric vessels.

A

indirect hernia

162
Q

MC hernia

A

indirect inguinal

163
Q

at what age does an umbilical hernia usually resolve on its own? when do you consider surgery?

A

2yo . Sx if >5yo

164
Q

Dx of paraesophageal hernia

A

incidental imaging, barium swallow most sensitive.

165
Q

MC cause of vitamin B3 (niacin) deficiency? “pellagra”

A

alcoholism

166
Q

wet vs dry beriberi

A

types of thiamine deficiency:
Wet beriberi - cardiovascular system = high output HF from vasodilation and AV fistulas.
Dry beriberi - CNS =peripheral neuropathy, wernicke’s encephalopathy (AMS, ataxia, opthomalmoplegia), korsakoff psychosis (irreversible memory loss) .

167
Q

what type of vitamin are these? Retinol (animal-dervied), beta carotene (plant-derived), caratinoids

A

Vitamin A

168
Q

S+S vitamin A deficiency

A

night blindness, dry skin + hair, broken nails, weak immune system

169
Q

Dx of vitamin A deficiency: what 4 labs are you looking at?

A

serum retinol or RBP (retinol-binding protein), check zinc + iron (affect metabolism of vit a)

170
Q

how does vit D deficiency manifest differently in peds vs adults?

A

Rickets: bowing of legs- kids, osteomalacia - adults.

171
Q

what vitamin are they deficient in ? muscle aches, diffuse pain, periosteal pain w/ pressure (esp sternum,tibia)

A

Vit D

172
Q

Dx of vit D deficiency: what level of 25-OH Vit D is too low? what other lab will you check for secondary cause?

A

serum 25-OHVit D level (<20 is deficient). Check PTH to r/o 2ry hypoparathyroid

173
Q

vit K deficiency S+S, peds and adults

A

its a key clotting factor- infants = hemorrhagic dz of newborn = spontaneous intracranial bleed, bruising, petichiae.

174
Q

Dx of Vit K deficiency

A

differentiate from liver-failure-induced bleeding by checking factor V (not vit K dependent). PT increased PTT normal.

175
Q

txt of Vit K deficiency: for acute bleeds? for infants?

A

FFP for acute bleeds, prevention - vit K shot for infants

176
Q

while a trial of lactose elimination is MC used for Dx of intolerance, what lab can be done?

A

hydrogen breath test (produced when colonic bacteria ferment undigested lactose.

177
Q

what is PKU?

A

autosomal recessive d/o of amino acid metabolism. Decr ability to metabolize phenalalanine into tyrosine b/c lack of phenyalanine hydroxylase (PAH) = accumulation of phenylalanine in fluids/plasma = phenylketone neurotoxicity.

178
Q

at what age is PKU irreversible if not detected?

A

3yo

179
Q

after birth w/ vomiting, mental delays, increased DTRs, irritable. MC blonde, blue eyed w/ fair skin. urine w/ musty odor

A

PKU

180
Q

screening of PKU is done when?

A

screen at 24 wks gestation and within 1st wk.

181
Q

txt of PKU ?

A

lifetime restriction of phenylalanine (milk, cheese, nuts, fish, chicken, meat, eggs, legumes, aspartame) + tyrosine supplement.

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