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[2b] A- step 2 CK > Medicine - GI > Flashcards

Medicine - GI Flashcards

1
Q

When should AST/ALT be obtained in regards to Statin therapy?

A

BEFORE starting statins and then PRN

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2
Q

Gilbert’s Syndrome Etx

A

Dysfunctional conjugation of unconjugated bilirubin to Conjugated by UGT –> [⬆︎UnConjugated Bilirubin] worst w/[stress/virus/illness]

Crigler Najjar = WORST VERSION of this in which UGT is ABSENT!

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3
Q

Most Liver Dz has ALT > AST

What conditions involve [AST > ALT - 2:1 ratio]? -3

A

only a FEW…

  1. Fibrosis ADVANCED
  2. EtOH Hepatitis (Make a ToaSt to drinks)
  3. Wilson’s Dz
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4
Q

w/u for [Hepatitis / Alcoholic Liver Dz]-7

You’ve already gotten back Aminotransferases

A

**FIRST…REPEAT LIVER CHEMISTRIES!!!**

  1. Viral Hepatitis Serology
  2. [RUQ US]: Evaluates for Cirrhosis and biliary tree dz
  3. Iron studies: identifies hemochromatosis
  4. [PT/INR and Albumin]: Is liver making proteins
  5. HIV: often co-infected with HepC
  6. Lipid Panel: Eval for NASH/NAFLD
  7. HbA1C: Eval for NASH/NAFLD
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5
Q

Which bacteria are typically involved with Diverticulitis?-2

A

E.coli & Bacteroides Fragilis

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6
Q

Abx tx regimens for Diverticulitis-4

A

4 options

  1. PO: Augmentin
  2. [PO: Flagyl + Cipro]
  3. [PO: Flagyl + Bactrim]
  4. [IV: Flagyl + CefTriaxone]
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7
Q

What’s an effective way to determine if ascities is 2/2 Portal HTN Cirrhosis

A

SAAG = Serum to Ascites Albumin Gradient

(Serum Albumin - Ascites Albumin)

≥ 1.1 = Ascites from Portal HTN (Cirrhosis/Budd-Chiari)!

<1.1 = other cause (Ovarian CA,nephrOtic syndrome,TB, R HF)

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8
Q

Normal Range for ALT and AST is _____. What etx’s would cause Aminotransferases to be > 1000! -5

A

8-20;

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9
Q

Presentation for Autoimmune Hepatitis -3

A

“Tired w/ a Tan and Doesn’t Eat = Girls Best Dream!”

  1. Fatigue (most common)
  2. Jaundice
  3. Anorexia
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10
Q

What Labs support Autoimmune Hepatitis-5

A
  • Anti-LKM (Liver/Kidney/Muscle)
  • ANA
  • Antismooth muscle
  • ⬆︎ Immunoglobulins
  • ⬆︎ [ALT & AST]

Note: The only way to diagnose AH is Biopsy!!

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11
Q

What is a GI Cocktail consist of-3

A

the LAMe GI Cocktail waitress

  1. Antacid
  2. Lidocaine
  3. Muscarinic R Blocker
  4. GERD indication
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12
Q

Low platelets may indicate _____(4)

A
  1. Cirrhosis
  2. [DIC on Sepsis]
  3. [SLE Antiphospholipid Syndrome]
  4. Hemetologic abnormality (HUS, TTP, ITP)

Platelet range = 150 - 450 K

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13
Q

Mngmnt for UnComplicated Pancreatitis - 3

A

IVF

Pain Mngmt

NPO

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14
Q

Most common causes of Upper GI Bleed -4

A

PEEM

PUD > Esophageal Varices > Esophageal Erosion > Mallary-Weis tear

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15
Q

Most common causes of Lower GI Bleed -5

A

Diverticulosis > [Colitis (Ischemic>IBD>Radiation)]> [Hemorrhoids/Anal Fissure] > Colon CA > [s/p polypectomy]

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16
Q

____ is the most common cause of Upper GI Bleed. Name the risk factors for developing this-9

A

PUD

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17
Q

The 3 types of Shock are Cardiogenic, Hypovolemic and Distributive

Which 3 sub-types make up Distributive Shock ; what’s unique about this type of shock?

A

Distributive = SAS

Sepsis / Anaphylaxis / Spinal

Distributive will have WARM extremities (others are cold)

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18
Q

What are causes of Biliary-related elevated ALP -3

A
  1. Cholestasis
  2. Liver infection (TB/CMV/MAC)
  3. Liver damage (CHF/EtOH cirrhosis)
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19
Q

You see a Jaundiced pt. What must his Total bilirubin at least be?

A

>2

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20
Q

[Dubin Johnson syndrome] and [Rotor Syndrome] etx

A

Inability to secrete Conjugated bile into Bile Duct

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21
Q

General Approach to Elevated ALP

A
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22
Q

[Primary Biliary Cirrhosis] etx

A
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23
Q

1st and 2nd symptom stages of [Primary Biliary Cirrhosis]

A
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24
Q

[Primary Biliary Cirrhosis] Dx and tx-2

A
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25
Q

[Primary Sclerosing Cholangitis] etx

A
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26
Q

[Primary Sclerosing Cholangitis] dx

A

ERCP beading pattern

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27
Q

MOD for [HFE mutation 1° Hemochromatosis]

A

HFE mutation –> Liver & Enterocytes falsely detecting low iron –> [1 and 2] –> [Liver Cirrhosis & HCC] AND BRONZED SKIN

  1. Liver DEC Hepcidin release —> [INC Ferroportin on Enterocytes basolaterally]–>INC iron absorption
  2. Enterocytes [INC Apical DMT1] –> ALSO INC iron absorption

Presents after 40 yo

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28
Q

FerriTin > 1000 usually indicates ____. What other lab values is found with this?

A

HEMOCHROMATOSIS ; [95% Transferrin Saturation]

Presents after 40 yo

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29
Q

Wilson’s Dz Etx

A
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30
Q

Wilson’s Dz Sx -4

A
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31
Q

Wilson’s Dz Tx

A
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32
Q

What is the most common cause of Cirrhosis and how is it diagnosed?

A

NASH! ; Liver Biopsy

NASH RF: Obesity, DM, Hyperlipidemia

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33
Q

Autoimmune hepatitis dx and tx-2

A

Dx = Biopsy

  1. prednisone
  2. azathioprine
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34
Q

Why is drinking alcohol in a pt with Hep C dangerous?

A

Hep C ⬆︎⬆︎⬆︎⬆︎ Liver damage from alcohol!!

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35
Q

How do you interpret positive Hep C serology?

A

Hep C Ab = exposure at some point

Hep C RNA titers = determines status (HIGH = chronically active vs negative = resolved)

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36
Q

A: Early signs of Hepatic Encephalopathy - 2

B: LATE signs of Hepatic Encephalopathy -3

A

A:

1A. Reversed sleep cycle (can’t sleep @ night, only during day)

2A. Personality changes

1B: Asterixis (flapping hands)

2B: Coma

3B: focal neuro signs

Hepatic Encephalopathy is caused by ⬆︎ NH3

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37
Q

Tx for Hepatic Encephalopathy and their MOA (2)

A
  1. Lactulose (converts NH3 –> NH4+ in colon - and ⬆︎peristalsis –> DIARRHEA)
  2. Rifaximin abx (⬇︎NH3 producing colonic bacteria)
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38
Q

Vaccinations for pts with Chronic Hepatitis -4

A
  1. Hep A (acute viral hepatits can –> Fulminant Liver failure!)
  2. Hep B (acute viral hepatits can –> Fulminant Liver failure!)
  3. Flu
  4. Pneumococcal
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39
Q

Why is Octreotide given for active Esophageal Varices Rupture

A

it vasoconstricts splanchnics –> ⬇︎pressure from splanchnics to the esophagus

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40
Q

Spontaneous Bacterial Peritonitis Etx ; Sx-4

A

Cirrhotic Immunosuppression –> Infection of ascitic fluid —> Hepatic Encephalpathy or [Type 1 Hepatorenal syndrome]! ;

  1. Diffuse Abd pain
  2. Fever
  3. AMS evidenced by Reitan trail connect the number test
  4. paralytic iLeus

These pts may NOT have peritoneal signs because it’s blunted by ascitic fluid! Fluid cx will show organisms with neutrophils>250

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41
Q

What are the purposes of Peritoneal fluid analysis in pt with ascities? -2

A
  1. Determine Cause
  2. Determine presence of Infection

Causes = Cirrhosis > [Ovarian CA=TB=nephrOtic syndrome=R HF]

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42
Q

Other than Cirrhosis, what are other causes of ascites? -4

A
  1. Ovarian CA
  2. nephrOtic syndrome
  3. TB
  4. R HF

These will have a SAAG < 1.1

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43
Q

You’ve just obtained Ascitic fluid from Cirrhosis pt

What labs should be ordered for this fluid AND why? -3

A
  1. Ascitic Albumin: Determine SAAG for cause!
  2. CBC w/diff: >250 PMN means Spontaneous Bacterial Peritonitis
  3. Gram stain and Culture:
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44
Q

Spontaneous Bacterial Peritonitis Tx -2

A

Cipro vs Norfloxacin

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45
Q

Indications for Liver Transplant -6

A
  1. Type 1 Hepatorenal syndrome
  2. Tx refractory Liver failure
  3. Decompensating Liver failure
  4. Acute Fulminant Liver Failure
  5. [Cirrhosis 2/2 HCV with MELD score > 10]
  6. [Cirrhosis 2/2 HCV s/p major complication of Portal HTN]
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46
Q

D-Lactic Acidosis is seen in pts with _____. Etx? CP-2

A

Short bowel syndrome; Unabsorbed Carbs are metabolized by intestinal bacterial –> D-lactic acid which is absorbed –> Confusion + Ataxia during carb loading

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47
Q

Wilson’s Dz Dx - 3

A
  1. Low Ceruloplasmin ( < 20 mg/dL) -ceruloplasmin binds to ⬆︎ free flaoting copper
  2. ⬆︎Urinary Copper
  3. Slit Lamp revealing Kayser Fleischer Rings
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48
Q

What are the most common biomarkers for unhealthy EtOH usage? - 6

A
  1. AST: ALT ratio ≥ 2:1
  2. ⬆︎GGT
  3. ⬆︎Carbohydrate-deficient Transferrin
  4. ⬆︎FerriTin
  5. Macrocytosis
  6. Pancytopenia
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49
Q

Why is Angiodysplasia also a cause of Upper GI bleed

A

it can occur anywhere in the GI tract BUT most commonly occurs in R Ascending Colon

RF: Aortic Stenosis, von willebrand disease, renal disease

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50
Q

In adults, what are the risk factors for developing Angiodysplasia - 3

This can occur ANYWHERE in the GI tract but most commonly occurs in R Ascending colon

A
  1. Aortic Stenosis (vW multimers are disrupted as they pass through turbulent space –> AVM)
  2. Von Willebran disease
  3. Renal disease
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51
Q

If a pediatric pt with hypertrophic pyloric stenosis has electrolyte abnormalitites, do you immediately go to surgery or correct electrolytes/hydration first?

A

Electrolytes/Hydration FIRST!

Dx = US

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52
Q

Dx for Celiac disease - 4

malabsorption sx + iron deficiency anemia = CELIAC!

A

Anti-TED (IgA or IgG)

TissueTransGlutaminase/Endomysial/DeaminatedGliadin

—> DUODENAL BX FOR CONFIRMATION (IgA test may result in false negative if concurrent IgA deficiency is present!)

look for wt loss, iron deficiency anemia and dermatitis herpetiformis (elbows, knees, butt, back) in these pts!

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53
Q

Why can’t US be used to diagnose Primary Biliary Cholangitis?

A

PBC involves Anti-mitochondrial abs attaching intrahepatic biliary duct ONLY. US can only see EXTRAhepatic

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54
Q

Other than complications from cholestasis, what other complications are associated with Primary Biliary Cholangitis? - 3

A
  1. HLD with Xanthelasma
  2. Metabolic bone disease
  3. Autoimmune thyroid disease
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55
Q

Although CXR in Boerhaave syndrome can show __(3)__, what is the confirmation dx?-2

A

Boerhaave = violent vomiting –> esophageal rupture

  1. uL pleural effusion +/- PTX
  2. pleural fluid high in amylase ( > 2500)
  3. widened mediastinum with emphysema

Confirmation dx = CT or [contrast esophagography with Gastrografin]

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56
Q

Complications of GERD - 3

A
  1. Barrett’s esophagus
  2. Erosive sophagitis
  3. Esophageal peptic strictures (circumferential narrowing)
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57
Q

Causes of Esophageal pepetic strictures (circumferential esophageal narrowing –> solid food dysphagia only) - 4

A
  1. GERD
  2. Radiation
  3. Systemic slcerosis
  4. Caustic ingestions
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58
Q

Characteristics for Carcinoid Syndrome - 10

A

Cardiac (Tricuspid Regurgitation)

Do not confuse with VIPoma which presents similarly but affects Pancreas while Carcinoid affects small intestine

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59
Q

[T or F] Screening Ammonia levels should be ordered on pts with cirrhosis with or without encephalopathy

A

FALSE - only order Ammonia if hepatic encephalopathy is suspected

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60
Q

Pt has cirrhosis with esophageal varices

What is the prophylactic mngmt for this pt? - 2

A

[General B Blockers (nadalol) OR Variceal ligation] –(if refractory)–> [TIPS-Transjugular intrahepatic portosystemic shunt]

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61
Q

what is the tx for Ascities secondary to Cirrhosis - 3

A
  1. Furosemide
  2. Spironolactone
  3. Salt restriction
62
Q

what is the tx for Hepatic Encephalopathy - 2

A
  1. Lactulose
  2. Rifaximin
63
Q

A pt has been diagnosed with Gastric ADC

What’s the next immediate step?

A

TUMOR STAGING via CT to determine px/tx

Note: HPylori eradication is only helpful for gastric MALT

64
Q

Tx for asymptomatic gallstones

A

NOTHING

Lap Chole is only indicated for sympatomatic gallstones!

65
Q

Tx for Complicated Gallstones

GS with concomitant cholecysitis, choleDocholithiasis, pancreatitis

A

Lap Chole sometime within 3 days

66
Q

Tx for ACTIVE variceal bleeding - 3

A
  1. Octreotide (splanchnic vasoconstriction & ⬇︎glucagon –>⬇︎portal blood flow)
  2. Endoscopic Sclerotherapy
  3. Intubation if airway compromised from vomiting
67
Q

In Cirrhosis, what all does ⬆︎Estrogen cause? - 5

A
  1. Gynecomastia
  2. ⬇︎Body Hair
  3. Palmar Erythema
  4. Spider Angiomas
  5. Testicular Atrophy
68
Q

Describe Biliary Cyst ; Tx?

A

[Congenital or Acquired] Biliary tree Dilatations that may be [intra or extrahepatic], [single or multiple]

Tx = Surgery

69
Q

When do you typically see pancreatic pseuocyst

A

as a complication of acute or chronic pancreatitis

70
Q

Esophageal Spasm cp - 3 ; dx?

A
  1. retrosternal chest pain precipiated by emotional stress and relieved with NTG
  2. dysphagia precipiated by emotional stress and relieved with NTG
  3. regurgitation precipiated by emotional stress and relieved with NTG

Dx = Manometry showing multiple simultaneous contractions of the mid and lower esophagus

71
Q

what is the most common Cancer of the liver

A

Metastasis(can be solitary) from another primary (i.e. COLON or pancreatic - since these send their venous blood directly to liver)

2nd = Hepatocellular carcinoma

72
Q

Heaptic angiosarcoma etx

A

(Vinyl Chloride gas, arsenic, thorium) exposure –> RARE liver neoplasm in older men

73
Q

Focal nodular hyperplasia and Hepatic Adenoma are typically seen in _____. Which is typically asymptomatic?

A

young women ; FNH

74
Q

What is long term relief for pts with PUD - 3

A

TRIPLE TX!

  1. PPI
  2. Amoxicillin
  3. Clarithromycin

Smoking and EtOH cessation can help but don’t offer LONG TERM change

75
Q

Clinical manifestations of Cirrhosis - 13

76
Q

What is the purpose of the D-xylose test

A

In patients with steatorrhea/fatty stool…

It differentiates between

  1. Celiac disease (D-xylose will be LOW in the urine because it can’t be reasbsorbed in the small intestine because of villous atrophy)
  2. Pancreatic insufficiency (D-xylose will be HIGH because absorption occurs normally and pancreatic enzymes never break down D-xylose)
77
Q

How are the results of the D-xylose test interpreted? ; How does Rifaximin play a role in this?

A

In patients with steatorrhea/fatty stool…

It differentiates between

  1. Celiac disease (D-xylose will be LOW in the urine because it can’t be reasbsorbed in the small intestine because of villous atrophy)
  2. Pancreatic insufficiency (D-xylose will be HIGH because absorption occurs normally and pancreatic enzymes never break down D-xylose)

**Small Intestine Bacterial Overgrowth can digest D-xylose before it has the chance to be reabsorbed –> Falsely low D-xylose. Rifaxmin abx prevents this**

78
Q

Where do Mallory Weiss tears occur

A

longitudinal tears in the mucosa near the Gastroesophageal junction

79
Q

Painless Jaundice DDx - 3

A
  1. Pancreatic CA - obstructive
  2. Biliary CA - obstructive
  3. CholeDocholithiasis
80
Q

When do you see GI bleeding from Gastritis - 2

81
Q

Key signs of Laxative Abuse -3

A
  1. Nocturnal watery diarrhea
  2. Melanosis coli on cscope-image (dark brown discoloration of colon)
  3. Metabolic ALKALOSIS (loss of K+ from laxative –> ⬇︎Cl absorption –>⬇︎Cl/HCO3 exchange –> ⬆︎HCO3 in serum)
82
Q

Describe colonic findings for Pseudomembranous colitis - 3

A
  1. FRIABLE
  2. Edematous
  3. Erythematous
83
Q

Toxic Megacolon cp - 3

A
  1. Bloody Diarrhea
  2. Systemic Toxicity (fever, tachycardia, hypotension)
  3. Abd distension +/- peritonitis
84
Q

Toxic Megacolon mngmt- 5

A
  1. Abx
  2. NPO
  3. NG suction
  4. +/- CTS if IBD associated
  5. SURGERY ONLY IF MEDICAL MNGMT FAILS
85
Q

Complications of Diverticulitis - 3

A
  1. Colovesical fistula –> pneumaturia, fecaluria, UTI sx
  2. rupture
  3. Abscess
86
Q

Hepatic Adenoma is a benign ___type of tumor in young women, associated with ___ and ___

What are its complications?-2

A

epithelial ; OCP/Pregancy ; Rupture/MalignancyTransformation

this CAN cause biliary obstruction

87
Q

What is Mesenteric Angioplasty indicated for?

A

Chronic Mesenteric ischemia (evidenced by postprandial intestinal pain+ wt loss)

88
Q

Chronic Mesenteric Ischemia cp - 3

A
  1. unexplained chronic postprandial abd pain (intestinal angina)
  2. Wt loss
  3. Food Aversion

usually from atherosclerotic celiac or SMA

89
Q

Name the 6 major organ systems affected by Cystic Fibrosis and how they’re affected

A

Respiratory = Nasal Polyps, Digital Clubbing, Bronchiectasis

90
Q

Esophageal manometry showing hypercontractility inidcates what disease?

A

Eosinophilic esophagitis

91
Q

Dx for Zenker’s Diverticulum

A

Barium Contrast Esophagram

Dysphagia, Foul Breath, Regurgitation, Aspiration

92
Q

Postcholecystectomy syndrome etx ; Dx-2

A

Biliary or Extra-Biliary causes –> persistent abd pain or dyspepsia in pts s/p cholecystectomy

Dx = Abd US –> ERCP/MRCP

93
Q

cp for Niacin B3 deficiency - 4

A

DDDD Pellagra

Diarrhea

Dermatitis symmetrical hyperpigmented rash on sun areas

Dementia

DEATH

94
Q

How do you confirm diagnosis for Esophageal Rupture?

A

Contrast Esophagram water soluble

95
Q

Pt presents with narrowed “colon”

How do you differentiate between Cystic Fibrosis and Hirschsprung disease

A

almost all newborns with meconium iLeus have CF

96
Q

What are the main causes of Ascities - 5

A

​Cirrhosis from EtOH > [Ovarian CA=TB=nephrOtic syndrome=R HF]

97
Q

What type of diarrhea is associated with decreased stool osmotic gap < 50

A

Secretory

these are larger volume diarrhea that occurs during fasting or sleep

98
Q

What type of diarrhea is associated with diarrhea during fasting

A

Secretory

these are larger volume diarrhea that occurs during fasting or sleep

99
Q

What type of diarrhea is associated with INCREASED stool osmotic gap > 125

A

Osmotic

ex: Lactose intolerance

100
Q

Between Osmotic and Secretory Diarrhea, which type of diarrhea occurs during sleep?

A

Secretory

these are larger volume diarrhea that occurs during fasting or sleep

101
Q

What is the diagnosis in this infant?

A

Jejunal atresia

image shows TRIPLE bubble sign with gasless colon

102
Q

What is the major risk factor for the development of this condition?

A

maternal COCAINE use

**Jejunal atresia**

image shows TRIPLE bubble sign with gasless colon

103
Q

Why are NSAIDs a common cause of iron deficiency anemia

A

chronic blood loss from GI tract ulcers

104
Q

pancreatic calcifications on CT indicate what disease? ; how is the lipase affected by this?

A

Chronic Pancreatitis ; MINIMAL CHANGE TO LIPASE because of pancreatic burn out

105
Q

Where is the intestinal enzyme lactase located? ; cp for lactose intolerance?

A

Duodenal brush border ;

Chronic crampy postprandial pain and waterry diarrhea

106
Q

Pt comes in with Hematochezia

How do you work them up? (after doing a rectal)

107
Q

Why does Carcinoid Syndrome cause Niacin B3 deficiency?

A

Carcinoid tumors utilize Tryptophan to secrete tons of Serotonin. Tryptophan is also needed to make Niacin B3. This can –> Pellagra DDDD

Do not confuse Carcinoid Syndrome with VIPoma which presents similarly but VIPoma affects Pancreas while Carcinoid affects small intestine

108
Q

What is a good empiric abx regimen for abdomianl infections? - 3

A
  1. Amp
  2. Gent
  3. Flagyl
109
Q

Why do pts with Crohn disease have ⬆︎ development of Kidney stones?

A

They have fat malabsorption which –> ⬆︎oxalate absorption –> Ca+Oxalate precipitation in the kidneys

110
Q

major signs of bowel obstruction - 3

A
  1. NV
  2. peritoneal signs
  3. hyperactive bowel sounds (unless perforation)
111
Q

Diagnostic criteria for Toxic Megacolon

A

Confirmatory Abd X rays

+ ≥3 of the following:

  • Fever >38C
  • HR >120
  • WBC >10,500
  • Anemia
112
Q

Tx for Toxic Megacolon - 4

A
  1. NG Decompression
  2. IV CTS
  3. Abx
  4. IVF
113
Q

What are the imaging findings for Ascending Cholangitis

A

Common Bile Duct dilation

Fever, RUQ pain, Jaundice = Charcot Triad

114
Q

Tx for Esophageal Spasm

115
Q

Endoscopic findings for Ulcerative Colitis

A

Continuous Friable mucosa with ulcers

116
Q

Zenkers Diverticulum etx

A

ESOPHAGEAL DYSMOTILITY –> Diverticulum above upper esophageal sphincter with posterior herniation between fibers of cricopharyngeal muscle

117
Q

Achalasia cp?-2 ; Dx?

A
  1. Chronic dysphagia to BOTH solids and liquids
  2. Regurgitation

Dx = Manometry

118
Q

Wilson disease cp - 2

A
  1. Liver dysfunction
  2. NeuroPsychiatric sx (parkinsonism, dysarthria, depression)
  3. Kayser Fleisher rings

etx: hepatic copper accumulation –> leakage into serum –> copper deposition in tissues

119
Q

Which lab value can be used to diagnose Wilson disease? ; Tx?-2

A

⬇︎Ceruloplasmin ;

Tx:

  1. D-penicillamine chelator
  2. Zinc (interfes with Copper absorption)
    * etx: hepatic copper accumulation –> leakage into serum –> copper deposition in tissues*
120
Q

Pts with Ulcerative Colitis are at risk for _____ CA; What’s px for this?

A

Colorectal ;

8 years after diagnosis –> Screening Cscope with mucosal sampling q2years

121
Q

Whipples disease cp -3 ; dx?

A

Come to my Whipple PAD!

  1. Pigmentation
  2. ARTHRALGIAS
  3. DIARRHEA a/w abd pain and wt loss +/- fever

Dx = PAS-positive material in lamina propria of small intestine bx

122
Q

What would a liver biopsy of a child with Reye syndrome show?

A

microvesicular steatosis

Reye –> fulminant liver failure –> Hyperammoniemia –> neurotoxicity. Tx = supporitve

123
Q

Pts with Familial Adenomatous Polyposis have ⬆︎ risk for ___ Cancer

Px?

A

Colorectal

Annual sigmoidoscopies (cscope if adenomas are found or if age 50) screening starting 10 yo —> elective proctocolectomy in early 20s (or if severe sx/CA develops)

124
Q

Genetic testing revealing Lynch Syndrome puts pts at risk fro what CA? - 4

A

COSE

  1. Colorectal proximal colon
  2. Ovarian
  3. Skin
  4. Endometrial
125
Q

What are other system complications of Primary Biliary Cirrhosis - 2

A
  1. Metabolic bone disease (osteoporosis, osteomalacia)
  2. Hepatocellular carcinoma

only INTRAhepatic

126
Q

Down syndrome is strongly associated with what GI conditions- 2

A
  1. Duodenal atresia (double bubble xray)
  2. Hirschsprung
127
Q

cp for Cyclic Vomiting Syndrome - 2

A

IN THE CONTEXT OF PERSONAL OR FAMILY MIGRAINE HX

recurrent and predictable vomiting that spontaneously resolves with no sx in between episodes

tx = antiemetics and antimigraine

128
Q

Which IBD condition are Pseudopolyps associated with?

A

Ulcerative Colitis

129
Q

Which conditions are associated with transaminases > 1000 - 5

A

Dark CASA

  1. Drug/toxin injury (APAP) (serum transminases are > 3000!)
  2. Common Bile Duct stone
  3. Acute viral hepatitis
  4. Shock Liver
  5. Autoimmune Hepatitis
130
Q

Which condition is associated with transaminases > 3000

A

APAP –> Acute Liver Failure

These pts should undergo early consideration for Liver transplantation, especially if not improving over time!

131
Q

Name the most common site of colon cancer metastasis

132
Q

What’s the first step in evaluating a pt with asymptomatic transaminitis?

A

Thorough HISTORY (EtOH, drug, travel, blood transfusion, sexual practices)

133
Q

Dx for Diverticulitis

A

Contrast CT Abd Pelvis (PO and IV)

134
Q

Endoscopic findings for Zollinger Ellison Gastrinoma - 2; Dx?-2

A
  1. Thickened Gastric Folds
  2. Multiple Peptic Ulcers (with some DISTAL TO DUODENUM IN THE JEJUNUM)

Fasting Serum Gastrin > 1000 –> low gastric pH for confirmation

135
Q

You suspect a pt has Zollinger Ellison Gastrinoma but their Fasting Serum Gastrin was < 1000

next steps?

A

Secretin test to stimulate gastrin release by abnormal gastrinoma cells

normal gastric G cells are actually inhibited by secretin so if Secretin fails to stimulate gastrin increase, hypergastrienmia is caused by something else

136
Q

Pts with Familial Adenomatous Polyposis have ⬆︎ risk for ___ Cancer

Which Adenomatous Polpys require the MOST colonoscopic surveillance? - 4

A

Colorectal

  1. large polpys ≥1cm
  2. high grade dysplasia
  3. villous features (long glands on histo)
  4. multiple ≥3 concurrent adenomas
137
Q

New Iron Deficiency Anemia in the elderly should always be considered to be from _____ until proven otherwise

A

GI blood loss

a single negative FOBT should NOT desuade from cscope/escope

138
Q

All pts with suspected Achalasia should undergo _____ before any treatment - Why?

A

Endoscopy ; r/o Cancer as the cause which = pseudoachalasia

139
Q

What are the risk factors for Clostridium Difficile - 3

A
  1. Abx
  2. Gastric acid suppression (PPIs)
  3. >65yo
140
Q

cp for Riboflavin B2 deficiency - 3

A
  1. Angular Cheilitis (fissures at corner of lips)
  2. Glossitis (hyperemic tongue)
  3. Seborrheic Dermatitis
141
Q

Diagnostic criteria for Acute Liver Failure - 2

A
  1. hepatic encephalopathy is present
  2. INR≥1.5

Most commonly from Drug/Toxin and Acute Viral hepatitis

142
Q

Which product is recommended to transfuse in acute GI bleeds

A

Packed RBCs

143
Q

When is it indicated to tranfuse Platelets?

A
  1. <50K platelets with active bleeding
  2. <10K platelets total
144
Q

cp for Zinc deficiency - 3

A
  1. alopecia
  2. impaired taste
  3. dermatitis pustular with perioral involvement
145
Q

How can Severe Pancreatitis cause Distributive Shock?

A

Pancreatitis releases pancreatic enzymes into vasculature which ⬆︎vascular permeability around the pancreas and allows fluid to enter the retroperitoneum –> Even greater widespread vasoDilation

146
Q

What’s the most reversible risk factor for pancreatic cancer?

147
Q

What are the laboratory findings for Lactose intolerance? - 5

Lactose intolerance is most commonly seen in Asians

A
  1. ⬆︎stool osmotic gap (osmotic diarrhea)
  2. +reducing substances in stool
  3. +hydrogen breath test (indicates intestinal bacterial carbohydrate catabolism)
  4. acidic stool pH
  5. NO steatorrhea

Lactose Intolerance is most commonly seen in Asians

148
Q

cp for iron intoxication - 4

A
  1. abd pain with radiopaque tablets on radiographs
  2. hematemesis
  3. AMS
  4. metabolic acidosis

tx = deferoxamine or whole bowel irrigation

149
Q

Do you give activated charcoal (gastric decontamination) to an APAP OD pt who has no laboratory abnormalities on presentation?

A

YES! That and APAP levels - they may be asymptomatic for the first 24 hours after ingestion

150
Q

Describe the guideline options for colon cancer screening - 4

A
  1. FOBT annually - 50 yo
  2. Sigmoidoscopy every 5 years if combined with FOBT every 3 years - 50 yo
  3. Colonoscopy every 10 years - 50 yo
  4. If 1st degree relative with Colon CA -Begin screening at 40 yo or 10 years before age of relative’s dx
151
Q

Both Intrahepatic Cholestasis of Pregnancy and Acute Fatty Liver are complications of Pregnancy

How do you discern the two?

A

Intrahepatic Cholestasis of Pregnacy = Pruritus cp

vs

Acute Fatty Liver = Liver Failure cp

[2b] A- step 2 CK (16 decks)

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