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Gastroenterology > MTB 2 > Flashcards

MTB 2 Flashcards

1
Q

Tx for ascites

A
  1. Na+ and H2O Restriction
  2. Spironolactone
  3. Loops - no more than 1 L/day if renal fnc OK
  4. Frequent abdominal paracentesis
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2
Q

What is the SAAG?

A

Serum ascites albumin gradient

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3
Q

SAAG < 1.1 g/dL in what dz?

A

Infxn - NOT SBP
Cancer
Nephrotic syndrome

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4
Q

SAAG > 1.1 g/dL in what dz?

A

Portal HTN
CHF
Hepatic vein thrombosis
Constrictive pericarditis

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5
Q

Spontaneous Bacterial Peritonitis (SBP)
What is it?
Ass’d bugs?

A

Infxn w/out perforation of bowel

E.coli, anaerobes, pneumococcus

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6
Q

Best initial test for SBP?

A

Cell count with > 250 Neutrophils - start tx

>500 WBCs

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7
Q

TX for SPB?

A

Cefotaxime, Ceftriaxone

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8
Q

What is the most accurate test for SBP?

A

Fluid culture

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9
Q

Presentation of SBP?

A

Pt presents with fever, abdominal pain, AMS

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10
Q

How does hepatopulmonary syndrome present?

A

Liver failure causes lung disease and hypoxia

Orthodexia - hypoxia sitting upright

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11
Q

Most accurate test for alcoholic liver dz?

A

Liver Bx

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12
Q

How does Primary Biliary Cirrhosis present?

A 
Women
40's-50's
Fatigue and itching
Normal BR
Elevated Alk Phosph
Xanthelesma/xanthoma
Osteoporosis
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13
Q

Most accurate test for PBC?

A

Liver Bx

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14
Q

Most accurate blood test for PBC?

A

Antimitochondrial Ab

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15
Q

Tx for PBC?

A

Ursodeoxycholic acid

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16
Q

How does Primary Sclerosing Cholangitis present?

A 
Women
40's-50's
Pruritis
Elevated Alk Phosph and GGTP
Elevated BR
UC in 80%
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17
Q

Most accurate test for PSC?

A

ERCP shows beading, narrowing, strictures

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18
Q

Tx for PSC?

A

Cholestyramine

Ursodeoxycholic acid

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19
Q

Alpha 1 Antitrypsin Deficiency

A

Liver dz
Emphysema (COPD)
Young pt < 40
Nonsmoker

20
Q

Hemochromatosis Pathophysiology?

A

Genetic disorder - mutation C282y gene

Overabsorption of iron in duodenum

21
Q

Presentation of hemochromatosis?

A 
Male earlier than female (menstruation delays)
50's
mild elevation in AST and Alk Phos
Fatigue
Pseudogout = joint pain
ED men, Amenorrhea women
Skin darkens
DM
Cardiomyopathy - restrictive, dilated, conduction abnormalities
Hypothyroidism
22
Q

Best initial test for hemochromatosis?

A

Iron studies
Increased serum Iron and Ferritin and Transferrin saturation
Decreased TIBC

23
Q

Most accurate test for hemochromatosis?

A

Liver Bx

24
Q

When is iron chelation used in hemochromatosis?

A

Pt cannot be managed w/phlebotomy

Anemic and have hemochromatosis from overtransfusion (thalassemia)

25
Q

Wilson Disease pathophysiology?

A

Abnormally decreased Copper excretion
Genetic = ATP 7B Dysfunction
Decrease in ceruloplasmin, copper accumulates in liver, kidney, RBCs and CNS

26
Q

Pt presents w/cirrhosis, hepatic insufficiency, neuro sx’s, Coombs Negative HA, RTA or nephrolithiasis?

A

Wilson Disease

27
Q

Neuro sx’s in Wilson?

A 
psychosis
tremor
dysarthria
ataxia
seizures
rigidity
catatonia
28
Q

Best initial test for Wilson?

A

Slight-light exam for Kayser Fleischer rings = brownish ring around eye

29
Q

What test is used for staging Wilson?

A

Liver Bx

30
Q

Most specifid blood test for Wilson

A

Low Ceruloplasmin

31
Q

Most accurate dx test for Wilson?

A

Increased amt of copper excretion into urine after penicillamine administration?

32
Q

Tx for Wilson Dz?

A

Penicillamine = chelates copper, removes from body
Zinc - interferes w/intestinal copper absorption
Trientine - alternative copper-chelating compound

33
Q

What is seen on liver Bx in hepatic failure w/Wilson?

A 
Inflammation
Portal fibrosis
hepatocyte necrosis
macrovesicular steatosis
vacuolated hepatocellular nuclei
Mallory bodies
34
Q

Autoimmune hepatitis presentation

A

Young woman
Liver inflammation
+ ANA
microsomal abs

35
Q

Anti-smooth muscle abs in what dz?

A

AI hepatitis

These are anti liver kidney microsome abs

36
Q

Most accurate test for AI hepatitis?

A

Liver Bx

37
Q

Tx for AI hepatitis

A

Prednisone

Azathiorpine

38
Q

Labs with AI hepatitis?

A

Elevated AST, ALT in thousands
Elevated AP
Ass’d with other AI dz - elevated IgG 1.5X Normal, Protein elevated, Albumin decreased

39
Q

Nonalcoholic Fatty Liver Dz or Nonalcoholic Steatohepatitis

A 
Ass'd with metabolic syndrome
TPN
Cushings
Steroid use
DM
40
Q

Most accurate test for NASH?

A

Percutaneous liver Bx shoes microvesicular fatty deposits

41
Q

Si/Sx’s in NASH?

A

Hepatomegaly

Labs: mild increase in AP, AST/ALT <1

42
Q

What is Reye syndrome?

A

ASA in children

Hepatic encephalopathy

43
Q

Presentation of Reye?

A

Children N/V, HA, delirium, hypoglycemia, liver failure, CNS

44
Q

Sudden onset of mental status changes, emesis, liver dysnfunction, taking aspirin?

A

Reye syndrome

45
Q

Labs seen with Reye syndrome?

A

Elevated LFTs
Elevated ammonia
Elevated PT
Metabolic Acidosis

46
Q

Treatment for Reye syndrome?

A

Glucose with FFP

Mannitol to decrease cerebral edema

47
Q

Rapid, massive increase in liver enzymes (thousands) with modest elevation in total BR and AP

A

Ischemic Hepatic Injury/Shock Liver

Gastroenterology (2 decks)

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