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GI II > Remediation > Flashcards

Remediation Flashcards

1
Q

Labs associated with pyloric stenosis

A

Hypochloremic, Hypokalemic

Metabolic Alkalosis

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2
Q

Diagnostics of gastroparesis

A 
Gastric scintigraphy (gastric emptying study)
Tx is non-specific
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3
Q

Achalasia diagnostics

A

blood smear for T Cruzi, then Barium esophagram: Bird’s beak

mandatory EGD to exclude stricture, CA

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4
Q

Lamivudine

A

Nucleoside analogue reverse transcriptase inhibitor for treating Hep B
Combo to treat HIV as well
Black box warning for pancreatitis

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5
Q

Biliary Atresia

A

Cholestatic Jaundice + Hepatomegaly + Acholic stools

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6
Q

Black gallstones

A

Sterile gallbladder bile
Oxidized polymers of Ca salts
Unconjugated
Radiopaque

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7
Q

FAP genetics

A

APC/WNT defect in the APC gene

AD, typical adenocarcinoma

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8
Q

Identify Hirschprung disease

A

Failure to pass meconium within first 1-2 days of life
Never had unassisted stool
Rectal Bx required for diagnosis

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9
Q

What is the HBcAb IgM?

A

Appears right after the HBsAg, its the only thing seen during window period

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10
Q

Manage a caustic esophageal injury

A

get an EGD in the first 12-24 hours looking for deep or circumferential ulcers, necrosis
Get radiographs looking for perforation

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11
Q

Factors that would seek to damage the stomach in normal circumstances

A

Gastric acid and peptic enzymes

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12
Q

Sjogren’s presentation

A

Auto-immune, dry eyes and mouth, risk of candida, cavities, gland enlargement
Dx via lip biopsy, anti-SSA/Ro and La

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13
Q

Brown Gallstone

A

Infected large bile ducts
Radiulucent
Ca Soaps

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14
Q

Measles in moiuth

A

Exanthema preceding the skin rash

Ulcers in cheeks around Stensen duct (koplik spots)

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15
Q

Labs of someone with a prior Hep B infection but is now immune

A

HBsAb+ and HBcAb/IgG+

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16
Q

MEN1

A

Pituitary adenoma (acromegaly etc)
Pancreatic (gastronoma)
PTH (hypercalcemia)

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17
Q

Auto-immune hepatitis type 2

A

Anti-liver/kidney microsomal Abs (anti-LKM)

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18
Q

Dubin-Johnson Syndrome

A

Reduced excretory function of hepatocytes
Conjugated jaundice
DARK BLACK LIVER
ABCC2 mutation for OAT-MRP2

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19
Q

Golimumab

A

TNFa inhibitor (test for Tb first!)
IgG4k mAb
UC ONLY

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20
Q

Presentation of Peutz Jeghers

A

Arborizing GI hamartomas
dark brown-blue macule on lips, nostrils, cheek mucosa, palm, genitals, peri-anal
Like freckles, but in the mouth

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21
Q

Stress ulcers

A

Curling: from extensive burns
Cushings: severe head injury

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22
Q

Wilsons disease mutation

A

ATP7B AR

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23
Q

Hep A labs

A

IgM and IgG are detectable soon after

IgG on its own means previous exposure, non-infectivity, immunity

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24
Q

Entecavir

A

Hep B nucleoside analogue reverse transcriptase

Black box warning for exacerbations, co-infections with HIV, Lactic acidosis, hepatomegaly

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25
Q

C Diff

A

Can cause toxic megacolon
Pseudomembranes, fecal-oral, obligate anaerobe, flagellated Gram+ curved bacillus, spore forming
Stool test for glutamate dehydrogenase

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26
Q

Guanylate cyclase C agonists

A

Linaclotide: binds GC-C on GI lumen
Increases cGMP, stimulates Cl-/HCO3- via CFTR
Treats constipation

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27
Q

HCC factors

A

Hep B and Hep C

EtOH, a1-AT deficiency, HFE, NAFLD, metabolic syndrome, Wilson disease, aflatoxin

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28
Q

Hepatic encephalopathy grading scale

A
  1. Euphoria / anxiety, short attention span
  2. Lethargy or apathy, disorientation
  3. Stupor, confusion, disorientation
  4. Coma
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29
Q

Tx Wilsons disease

A

Oral penicillamine

liver transplant

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30
Q

Sx of eosinophilic esophagitis

A

Odynophagia, CP, maybe Asx
Mostly from Candida, herpes (in healthy pt), CMV
Pyrosis, corrugations, eosinophilia

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31
Q

Opiod agonists for Diarrhea

A

Loperamide
Diphenoxylate (has some atropine)
Eluxadoline (pancreatitis risk)

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32
Q

Sjogrens associations and treatment

A

B cell Non-Hodgkin Lymphoma

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33
Q

Schatzki Ring

A

Distal esophagus, associated with Hiatal Hernia
Steakhouse Syndrome
Dx w/ Barium swallow
Tx w/ dilation, maybe long-term PPI

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34
Q

Genetic mutation associated with HCC

A

b-catenin activated subtype

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35
Q

GERD alarm symptoms

A

Unexplained weight loss
persistent vomiting and dehydration
Constant and severe pain
Melena, anemia, occult bleeding

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36
Q

Endemic to sub-saharan africa and southeast asia

A

Hep B

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37
Q

Leukoplakia

A 
Cannot be scraped off
Hyperkeratosis and acanthuses
Balloon cells in upper spinous layer
HIV
Precancerous until proven otherwise
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38
Q

Mucoepidermoid tumor presentation

A

Circumscribed, infiltrative at margins, pale gray-white and frequently have mucin-containing cysts
Most are primary malignant tumor of salivary glands

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39
Q

Maddrey Score

A

Test for alcoholic liver disease
PT and serum bilirubin, 32+ have a poor Px
May benefit from steroids

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40
Q

Diptheria in the mouth

A

Dirty white, fibrins-suppurative tough inflammatory membrane over the tonsils and retropharynx

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41
Q

Chronic Hep B vs chronic Hep C

A

B: polyarteritis nodosa
C: mixed cryoglobulinemia

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42
Q

Achalasia etiology

A

Denervation after losing NO-producing inhibitory neurons (ganglion cells) in myenteric plexus
Can come from Chagas Dz from T Cruzi from reduviid bug (romana sign - unilateral painless eye swelling)

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43
Q

Imaging findings of acute pancreatitis

A

Gallstones (if thats the etiology)
Sentinel loop of air-filled small intestine
Colon cutoff sign: gas in transverse colon ending at pancreatic inflammation
Focal linear atelectasis of lower lobe of lungs

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44
Q

Esophageal varices

A

Red wale markings
Tx w/ emergent EGD, fluids or blood products, fresh frozen plasma, platelets, IV vitamin K
Non selective b-blockers reduce re-bleeding, band ligation

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45
Q

CPA1

A

Carboxypeptidase A1

Exopeptidase involved in regulated zymogen activation

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46
Q

Celiac Diagnostics

A 
IgA tTg Ab
IgA anti-endomysial Abs
Anti-gliadin Abs
Dual-energy XR densitometry scan for osteoporosis 
Atrophy or scalloping of duodenal folds
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47
Q

Chronic type B gastritis

A

Antral type
H Pylori Gastritis
Risk adenocarcinoma, gastric B cell lymphoma, B12 deficiency

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48
Q

Certolizumab

A 
TNFa inhibitor (test for Tb first!)
Fab' fragment, doesnt fix complement 
Treats CD only
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49
Q

SAAG above 1.1

A

Portal HTN origin: cirrhosis, budd-chiari, liver mets, CHF, IVC obstruction, sinusoidal obstruction syndrome

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50
Q

Lichen planus in the mouth

A

Reticulate, lace-like, white keratitis lesions that sometimes ulcerate

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51
Q

Treat Taenia solium

A

Praziquantel

cysticercosis version gets albendazole

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52
Q

Confirmatory test for ZE

A

Fasting Gastrin above 1000

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53
Q

3 drug regimen for RINV

A

NK1 antagonist (aprepitant), Alesetron, dexamethasone

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54
Q

Labs of acute pancreatitis

A

Leukocytosis, hypoerglycemia, hyperbilirubinemia, elevated BUN and Alk Phos
Hypocalcemia, elevated Hct

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55
Q

HNPCC genetics

A

DNA mismatch defect of MSH2/MLH1

AD, Right side predominant, Mucinous adenocarcinoma

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56
Q

Presentation of Crohn Dz

A 
Cobblestoning skip-lesions
Fistulas, ano-rectal fissures
Strictures causing SBO
String Sign on Barium enema
RLQ pain (pseudo-appendicitis)
Creeping fat, bowel wall thickening
Canker sores, non-caveating granulomas, calcium oxalate stones, ADEK fucked
Anti-Saccharomyces Abs
ASCA+
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57
Q

Zenker Diverticulum Sx

A

False diverticulum
Upper affected first, coughing/discomfort
becomes halitosis, regurgitation, nocturnal choking, gurgling, protrusion
Voice changes, weight loss, aspiration

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58
Q

vomiting of feces

A

SBO

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59
Q

Crigler-Najjar

A

Total EDPGR deficiency

Severe hyperbilirubinemia with high risk of kernicterus

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60
Q

Sporadic colon cancer, APC/WNT pathway genetics

A

Targets APC on the left side

Typical adenocarcinoma

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61
Q

Scarlet fever in mouth

A

Raspberry tongue: fiery red with prominent papillae

white-coated with papillae projecting through

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62
Q

PEG-IFN2a

A

Tx Hep B and hep C

Black box warning for ribavirin-associated sides

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63
Q

Pemphigus in the mouth

A

Vesicles and bullae prone to rupture

Leave hyperemic erosions covered with exudate

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64
Q

SAAG below 1.1

A

Non-portal HTN: Biliary leak, nephrotic syndrome, pancreatitis, peritoneal carcinomatosis, Tb

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65
Q

Hep E

A

Immunocompromised hosts
Fecal-oral spread, waterborne epidemics
PCR for HEV RNA

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66
Q

Tx Acute paralytic ileus

A

Nasogastric suction

patient controlled epidural, gum chewing

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67
Q

Zenker diverticulum diagnostics and treatment

A

Video esophagography or barium swallow BEFORE egd (risk of perforation)
Tx w/ surgery, upper myotome or surgical diverticulectomy

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68
Q

Phases of hepatocyte proliferation after damage

A
  1. Il-6 from Kupffer cells prime tissues
  2. GFs act to stimulate quiescent cells
  3. Anti-proliferative TGF-b resolve things
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69
Q

Barrett esophagus

A

Squamous to columnar with goblet cells
risk for Adenocarcinoma
Dx w/ EGD w/ Biopsy: orange, gastic epithelium extending upward in tongue like circumferential fashion
Tx w/ long-term PPI, endoscopic ablation

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70
Q

SBP diagnostics

A

Something Above 250

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71
Q

Factors that decrease the normal protection of the stomach

A

Ischemia, shock, NSAID

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72
Q

Risks associated with Hep C

A

HCC, mixed cryoglobulinemia, cirrhosis

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73
Q

How does a1-antitrypsin deficiency cause liver damage?

A

Unfolded protein response and ER stress

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74
Q

Diffuse esophageal spasm etiology

A

Multiple spastic contractions of circular muscle in the esophagus (disrupted coordination)

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75
Q

Erythema multiforme in the mouth

A

maculopapular visiculobullous eruption that sometimes follows an infection somewhere else
This becomes Stevens Johnson when its wide-spread

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76
Q

3rd spacing

A

leakage of fluid into pancreatic bed

For our purposes this occurs in acute pancreatitis

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77
Q

Drugs to treat abdominal pain

A

Antimuscarinics Hyoscyamine, Dicyclomine
Competitively inhibit autonomic post-ganglionic cholinergic receptors
Classic anti-cholinergic side effects

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78
Q

Auto-immune hepatitis type 1

A

Anti-smooth muscle and/or anti-nuclear

Most common

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79
Q

What is the HBcAb IgG?

A

Appears in the late acute phase and lasts forever, whether it goes chronic or resolves

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80
Q

Diagnostics of eosinophilic esophagitis

A

Multiple circular esophageal rings making a corrugated appearance on EGD
“feline” or “trachea” looking esophagus
Squamous epithelial eosinophil-predominant inflammation

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81
Q

What is the HBsAb?

A

Surface Ab, means youre immunized

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82
Q

Significance of fecal elastase

A

Below 100 indicates chronic pancreatitis

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83
Q

CMV-caused eosinophilic esophagitis

A

several large, shallow, superficial ulcerations

Treat with immune restoration and antiretrovirals in HIV patients

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84
Q

Cancers associated with H Pylori

A

Adenocarcinoma, MALTomas

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85
Q

Nutcracker esophagus

A

Hypertensive peristalsis, normal coordination
Atypical CP
Dx with Manometry/EGD
Associated with depression, anxiety

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86
Q

Mesalamine

A

Treats UC

this is 5-ASA

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87
Q

Presentation of cholelithiasis

A

Most are Asx, maybe initiated by fatty meal

RUQ or epigastrium, may radiate to shoulder

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88
Q

Bismuth

A

Prostaglandin inhibitor for treating diarrhea

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89
Q

Sulfasalazine

A

Sulfapyridine + 5-ASA

Treats UC

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90
Q

Enzymes involved in acute pancreatitis

A

Activated trypsin does auto-digestion

Lipase releases fatty acids that get saponified by Ca++

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91
Q

Selective chloride (C2) channel activators

A

Lubiprostone: PGE-1 derivative

Increaes intestinal fluid secretion by activating GI-specific Cl-2 channels in luminal cells of intestines

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92
Q

Patient lying motionless with knees drawn up to avoid stretching nerve fibers. Coughing and sneezing hurts like hell.

A

Secondary spontaneous bacterial peritonitis

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93
Q

Hep D Labs

A

HDV RNA on PCR

This is a defective RNA that requires Hep B

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94
Q

Osmotic laxatives

A

Lactulose: tx liver disease, hyperammonemia (change in pH traps it in the GI system)
PEG

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95
Q

Alk Phos and GGT

A

Elevated Alk phos AND GGT means liver

Normal GGT means bone, placenta

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96
Q

PSC

A 
30 y.o. males
Periductal portal tract  fibrosis
Segmental stenosis of bile ducts
pANCA+
Beads on a string
Onion-like duct lesions
Associated w/ UC because of released T-cells
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97
Q

Sx of PUD

A

Coffee-ground emesis, hematemesis, melon, hematochezia

worse with stress, coffee, EtOH

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98
Q

Adalimumab

A

TNFa inhibitor (test for Tb first!)
IgG1 mAb
Treats moderate-severe UC and CD

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99
Q

Risk factors for ischemic bowel disease

A

atherosclerosis at mesenteric origin, AAA, hypercoaguable state, hypo perfusion, Wegener Granulomatosis
Cocaine
Radiation, NEC, angiodysplasia

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100
Q

Th2 cells

A

T-cells secrete IL-4. This makes Th2 cells

Th2 secrete IL-4/5/13, causing UC

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101
Q

Dx PUD

A

Breath test for H pylori

Stop PPI 2 wk before fecal and breath tests (can cause false NEGATIVE)

102
Q

Pregnancy effects on the mouth

A

Friable, red, pyogenic granuloma protruding into the gingiva

103
Q

Monocytic leukemia of the mouth

A

leukemic infiltrate and enlargement of gingiva, often with periodontitis

104
Q

CFTR mutation

A

LOF mutations alter fluid pressure and limit bicarbonate secretion
Inspissation (thickened mucous from dehydration) and duct obstruction

105
Q

Tx auto-immune hepatitis

A

Glucocorticoids (azathioprine)

106
Q

Crofelemer

A

Cl- channel inhibitor to treat diarrhea

Acts on CFTR and CaCC

107
Q

Presentation of US

A 
Only mucosa and submucosa
Pseudopolyps, abscesses in crypts
Always affects rectum, goes proximal
Bloody diarrhea
Lead pipe (no haustra) on contrast enema
Left sided abdominal pain
p-ANCA
Toxic megacolon that can penetrate
Recent smoking cessation
108
Q

Labs of someone with chronic Hep B flaring up

A

Everything positive except for HBsAb

109
Q

Triglycerides above 1000

A

Pancreatitis

110
Q

MYH-associated polyposis genetics

A

DNA mismatch defect of MYH gene

AR, mucinous adenocarcinoma

111
Q

Whats the significance of HBV DNA?

A

detectable during current infection

112
Q

Plummer-Vinson

A

Spoon nails, esophageal web, angular chelitis, glossitis, Iron-Deficient anemia
Dx via Barium swallow (esophageal)
Tx w/ dilation, maybe PPI

113
Q

HIV in the mouth

A

herpes, candida, Kaposi, hairy leukoplakia

114
Q

Natalizumab

A

A4 integrin inhibitor
IgG4k against a4b7 (MAdCAM-1) and a4b1 (VCAM-1)
CD Only

115
Q

Presentation of upper GI bleed

A

supine orthostatic HPTN
Fe-deficient anemia
Hematemesis, coffee-ground emesis, melena

116
Q

Risks associated with caustic esophageal injury

A

SCC (so do endoscopic check 15-20 years later)

Risk long-term strictures requiring dilation

117
Q

Sx of Wilson Disease

A

Hemolytic anemia (Cu is toxic to RBCs)
Kayser Fleischer rings
Liver disease in adolescents
Neuropsychiatric in young adults

118
Q

Olsalazine

A

5-ASA and another 5-ASA

Only for maintenance of remission of UC

119
Q

Diagnostics for esophageal perforation

A

CXR or Chest CT w/ contrast shows air in the mediastinum / SubQ emphysema
Hamman’s sign: auscultated crunching and rasping synchronous with heart beat mainly during systole and in LLD position

120
Q

Lab findings in HCC

A

Pt with known liver disease

Elevated AFP: screen that every 6 months

121
Q

Velpatasvir + Sofosbuvir

A

NS5A inhibitor and NS5B inhibitor for the treatment of Hep C

Avoid amiodarone because of bradycardia risk

122
Q

SPINK1

A

Serine peptidase inhibitor, Kazal 1
Inhibits trypsin
LOF mutation increases trypsin

123
Q

Balsaszide

A

5-ASA with an inert carrier

Only for active UC disease

124
Q

CASR

A 
Chymotrypsin C (Caldecrin)
Degrades trypsin
Protects pancreas
125
Q

Presentation of mucormycosis

A

Black necrotic eschar on palate / turbinates
Can enter brain via cribriform plate
Tx w/ amphoticerin B, debridement

126
Q

Labs of pancreatic insufficiency

A

Low trypsinogen

Decreased fecal chymotrypsin and elastase

127
Q

Osler Weber Reundu

A

AD with aneurysmal telangiectasia beneath the mucosal surfaces of the oral cavity and lips

128
Q

PBC abs

A

Anti-mitochondrial

129
Q

Alcoholic liver disease Abs

A

SAAG greater than 1.1
Elevated AST 2x more than the ALT
Elevated Bilirubin, PTT
Decreased Albumin, Platelets, Hgb

130
Q

Zollinger Ellison association

A

MEN1, draw PTH, Prolactin, LH-FSH and growth hormone to rule this out

131
Q

Celiac presentation

A

Fatigue, weight loss, growth retardation
fe-deficient anemia, short stature, delayed puberty, amenorrhea, reduced fertility
GI upset you’d expect to see
Osteoporosis

132
Q

Bulk-forming laxatives

A

Psyllium
Methylcellulose
Calcium polycarbophil

133
Q

Stimulant laxatives

A 
Bisacodyl
Castor Oil (hydrolyzed to ricinoleic acid)
Glycerin (irritant, osmotic, lubricant)
Senna (discolors urine)
Na Picosulfate
134
Q

Tenofovir Disoproxil

A

Nucleotide analog HIV-1 and HBV reverse transcriptase inhibitor
Black box warning for lactic acidosis, hepatomegaly with steatosis, exacerbation

135
Q

Treatment of hemochromatosis

A

PPI, chelation with Deferoxamine

136
Q

Mallory bodies

A

Alcoholic liver disease: hyalinization on biopsy

137
Q

Breast Feeding Jaundice

A

Inadequate milk intake, increasing GI reabsorption of bilirubin / decreased excretion

138
Q

Free air under diaphragm

A

Emergency: perforated viscus
CT or plain film XR
Pneumoperitoneum below diaphragm
Pneumomediastinum above diaphragm

139
Q

PBC

A

Anti-mitochondrial E2 Abs
Associated with Sjogrens, Scleroderma, Thyroid
Dense Lymphocytic infiltrate in portal tracts
Granulomatous destruction of bile ducts
Mallory-Denk, Xanthelesmas, Hyperpigmentation, osteomalacia, splenomegaly, eventually jaundice
Normal radiology
elevated Alk Phos and cholesterol
50 y.o. female
Tx w/ Ursodeoxycholic Acid

140
Q

Diagnostics of Wilson disease

A

Lower serum cerulplasmin
Brainstem MRI
ATP7B molecular analysis

141
Q

Treat strongyloides

A

Ivermectin with albendazole

142
Q

Tofacitinib

A

Jak inhibitor for the treatment of UC

Dont combine with biologics / immunosuppressants

143
Q

Pancytopenia of the mouth

A

Gingivitis, pharyngitis, tonsilitis
Maybe cellulitis of the neck
(leukemia looks similar)

144
Q

Biggest factor in determining the malignancy of colonic adenocarcinoma

A

Size

145
Q

What lobe would you expect to change in budd-chiari

A

Prominent caudate

146
Q

Menetrier disease

A

Idiopathic, giant thickened gastric folds mostly in the body of the stomach
Chonic protein loss, whole body swells
Risk of gastric Adenocarcarcinoma

147
Q

Stages of NSAID OD

A
  1. N/V, abdominal pain, sweating, normal LFT
  2. Liver injury, RUQ pain, rising LFTs
  3. Liver failure, coma, death
  4. Remission if they lived
148
Q

Sx of esophageal stricture

A

difficulty swallowing, starting with solids
Reflux lessens as stricture increases
treat with dilation

149
Q

Whipple Disease Sx

A

Weight loss: malabsorption diarrhea, dementia, lethargy, coma, seizures, ophthalmoplegia, peripheral enema, arthralgia

150
Q

Dx esophageal stricture from GERD as opposed to carcinoma

A

Do an EGD with Biopsy: mandatory for all patients

151
Q

Complications of cholelithiasis

A

Perforation, fistula, inflammation of biliary tree, obstructive cholestasis, pancreatitis
gallstone ileus

152
Q

Diseases with melanotic pigmentation

A

Addison disease, hemochromatosis, fibrous dysplasia of bone, Peutz-Jeghers

153
Q

Findings of NAFLD

A

Spiderweb fibrosis/collagen deposition (chicken-wire) on trichrome stain
Periporatl fibrosis, then bridging vein, then cirrhosis
Ballooned hepatocytes in adults

154
Q

Presentation of Ischemic bowel disease

A

Most often at splenic flexure, LUQ
Can progress to shock
Bloody diarrhea with periods of healing

155
Q

treat enterobius vermicularis

A

Mebendazole

156
Q

Candida-caused eosinophilic esophagitis

A

Diffuse linear yellow-white plaques adherent to mucosa

Treat systemically w/ Fluconazole

157
Q

Breast Milk Jaundice

A

Bilirubin de-conjugating enzymes in the breast milk

158
Q

Treat nutcracker esophagus

A 
Nitrates (isosorbide dinitrate)
Ca antagonists (nifedipine)
159
Q

Ledipasvir + Sofosbuvir

A

NS5A inhibitor and NS5B nucleotide analogue polymerase inhibitor for the treatment of Hep C

160
Q

Labs of Hep B window period

A

HBcAb/IgM+

161
Q

Labs of acute liver failure

A

Prolonged PT even once AST/ALT fall

Rising bilirubin, shrinking liver

162
Q

Factors that cause injury to the stomach

A

H Pylori, NSAID, tobacco, EtOH, gastric acid, duodenal-gastric reflux

163
Q

Sporadic colon cancer, DNA mismatch pathway

A

MSH2/MLH1 gene on the right side

Mucinous adenocarcinoma

164
Q

Dx Spontaneous Bacterial Peritonitis

A

250+ PMNs/uL

165
Q

Treat cyclospora

A

TMP-SMX

If they have a sulfa allergy give cipro

166
Q

Achalasia presentation

A

Motility is fucked, progressive from solids to also liquids. No peristalsis, no LES relaxation

167
Q

Ustekinumab

A

Fully human IgG1k mAb
SubQ q8w after first IV infusion
Il-12/23 inhibitor: binds P40 subunit, prevents T and NK cell response
Tb Test First. Tx UC and CD

168
Q

What is the HBeAg?

A

Correlates with viral proliferation and infectivity

169
Q

How does PUD cause pancreatitis?

A

Ulcer along posterior wall of duodenum or stomach can perforate into pancreas, liver, biliary tree.
Bleeding, edematous obstruction, perforation, penetration into pancreas

170
Q

Tx Upper GI bleed

A

2 large-bore IVs, surgery

171
Q

SCC

A

Black males over 50, heavy smoking, etc
Progressive dysphagia, hoarseness, cough
Dx w/ EGD and Bx
Tx w/ surgery - esophagectomy

172
Q

Treatment of H pylori

A

PPI + Clarithromycin + Amoxacillin or Metro
(can substitute tetracycline in)
PPI + Metro + Tetra + Bismuth

173
Q

Vedolizumab

A

A4 intern inhibitor
IgG1 against a4b7 (MAdCAM-1)
Treats UC and CD
May cause PML after 2 years

174
Q

Cullens, gray turners

A

Acute pancreatitis. Think Hypocalcemia, because thats a major thing in acute pancreatitis

175
Q

PRSS1

A

Serine protease 1 (trypsinogen1) cationic trypsin

GOF mutations prevent self-activation

176
Q

Morphological findings of HCC

A

Fibrolamellar: scirrhous tumor with fibrous bands, large polygonal cells with granular cytoplasm (abundant mitochondria)
Vesicular nuclei with prominent nucleolus

177
Q

Genetics of mucoepidermoid tumors

A

CRTC1 + MAML2 = MECT1 fusion protein

most are associated with 11;19 translocation

178
Q

PT/INR as a diagnostic test

A

Above 1.5 is a life-threatening coagulation abnormality
Factors 2, 7, 9, 10 need vit K:
PT prolongation from fat malabsorption distinguished by a good Vit K response

179
Q

Chronic Type A gastritis

A

Loss of rugal folds
Anti-parietal cell abs
Anti-intrinsic factor abs
Tx w/ parenteral B12

180
Q

Saline laxatives

A

MAG hydroxide

Na Phosphate

181
Q

Telbivudine

A

Nucleoside analogue reverse transcriptase inhibitor for HBV
Combo w/PEG IFN-2a risks peripheral neuropathy
Black box for lactic acidosis, hepatomegaly with steatosis, exacerbations

182
Q

Acute SBO

A

common from adhesions (SURGERY, Crohn)
N/V, Obstipation, decreased bowel sounds, high pitched tinkling
Dx w/ plain abdominal radiography or CT
NG tube to suction

183
Q

Hep C labs

A

Hep C RNA

Anti-HCV without any RNA means recovery from previous infection

184
Q

Infliximab

A

TNFa inhibitor (test for Tb first!)
chimeric IgG1k mAb
Continuous IV infusion
Moderate-severe CD and severe UC

185
Q

Labs of someone with chronic Hep B thats dormant

A

HBsAg+ and HBcAb/IgG+

DNA could go either way

186
Q

Elbasvir + Grazoprevir

A

NS5A inhibitor and NS3/4A protease inhibitor for the treatment of Hep C

187
Q

Presentation of hemochromatosis

A 
Cirrhosis with hepatomegaly
Abnormal skin pigmentation
DM
HF
Can later cause hypogonadism/ED
188
Q

Ribavirin

A

Tx Hep C, BB for Fetal Death
Dont get pregnant for 6 months afterward
Nucleoside analogue
Combo with IFN a2a

189
Q

Boceprevir

A

NS3/4A protease inhibitor

Combo with PEG IFNa and Ribavirin

190
Q

1 drug regimens for treating RINV

A

Dexamethasone or 5HT3 antagonist or metoclopramide or Prochlorperazine

191
Q

What is the HBsAg?

A

Surface Ag, first evidence of infection

Positive during acute and carrier state

192
Q

What is the HBcAg?

A

Core Antigen

193
Q

Corkscrew esophagus / rosary bead esophagus

A

Diffuse Esophageal spasm
Primary or secondary from GERD, Stress, DM, etc
Dx w/ barium swallow XR

194
Q

Adefovir

A

Treats chronic Hep B

Black box warning for nephrotoxicity

195
Q

Sporadic colon cancer, hypermethylation pathway

A

Targets MLH1/BRAF on the right side

Mucinous adenocarcinoma

196
Q

Secretory diarrhea signs

A

Doesnt improve with fasting, high volume watery diarrhea

This is the kind you get from Senna laxative abuse

197
Q

Factors that protect the stomach in normal circumstances

A

Surface mucous, bicarb, mucosal blood flow, epithelium, regeneration

198
Q

Albumin as a diagnostic test

A

decrease from decreased hepatic synthesis

Only good for looking for chronic hepatic dysfunction because the serum half like is like 2-3 god damn weeks

199
Q

Gilbert syndrome MOA

A

Reduced activity or Uridine Diphosphate Glucuronyl Transferase

200
Q

Mono in mouth

A

Pharyngitis and tonsilitis
Maybe gray white coating membrane
enlarged LNs in the neck and palate

201
Q

Genetics of PEutz-Jeghers

A

AD mut STK11 LOF mutation, median age 11

202
Q

Scleroderma presentation

A

Topoisomerase I abs (Scl-70)

Calcinosis, Raynaud’s, Esophageal dysmotility, Sclerodactyly, Telangiectasias

203
Q

Dx and Tx of Whipple Dz

A

G+ bacillus T Whipple
Endoscopy with duodenal Bx
PAS+ Macrophages with the bacillus
Tx w/ Abs, fatal without. Takes a while.

204
Q

Peripheral opioid antagonists

A

Methylnaltrexone
Naloxegol
Alvimopan (Prevents post-op ileus, MI risk)

205
Q

Rotor Syndrome

A

Mut OATP1B1/3 mutation
Great Px, benign hereditary jaundice
gallbladder CAN be visualized
no black liver

206
Q

Wisons disease etiology

A

Impaired copper excretion into bile and failure to incorporate it into ceruloplasm
It accumulates in the liver, brain and eye

207
Q

2 drug regimen for RINV

A

Alosetron and dexamethasone

208
Q

Labs of someone immunized to Hep B

A

HBsAb positive. Thats it.

209
Q

Stool-softeners

A

Docusate
Mineral oil
Anionic surfactants

210
Q

Labs of acute infection with Hep B

A

Lots.

HBsAg+, HBcAb/IgM+, HBeAg+, DNA+

211
Q

Sx of Hep A

A

Anorexia, N/V, vomiting, malaise, RUQ/epigastric pain, smoking aversion, jaundice, myalgia, diarrhea, constipation

212
Q

Liver labs of Right heart failure

A

Marked elevation N-terminal-proBNP
LFT’s above 5000
Early rapid rise in serum LDH

213
Q

Herpes-caused eosinophilic esophagitis

A

Multiple small, deep ulcerations
Treat healthy patients as needed
Treat immunosuppressed patients with acyclovir

214
Q

Alosetron

A

5HT3 antagonist for treating Diarrhea

Black box warning for ischemic colitis (needs prescriber program)

215
Q

Diagnosticscs of Acute pancreatitis

A

At least 2: epigastric pain, Lipase 3x upper limit of normal, CT changes that look like pancreatitis

216
Q

Necrosis associated with acetaminophen

A

Centrilobular necrosis

217
Q

Diarrhea that decreases with fasting

A

Osmotic, this is the kind you get from sorbitol, Mg laxative abuse

218
Q

Hepatitis viral structures

A

ssRNA except Hep B (partially dsDNA)

219
Q

Fecal elastase below 100

A

Pancreatic insufficiency, chronic pancreatitis

220
Q

parotid tumors

A

mucoepidermoid: malignant
Pleiomorphic adenoma: PLAG1
Warthins tumor
Adenoid cystic cancer

221
Q

GI problems in a new smoker

A

Crohn

222
Q

Food Fear

A

chronic mesenteric ischemia

“Abdominal angina” often misdiagnosed as malignering

223
Q

Treat a variceal bleed

A

first get fluids and do a banding

Them TIPS procedure and octreotide

224
Q

calprotectin

A

IBD marker

225
Q

Angioectasia

A

associated with CKD and Aortic Stenosis

Fatigue from occult blood loss

226
Q

resected ileum

A

Causes B12 deficiency

227
Q

What GI disease are we most closely associated tennesmus with?

A

UC

This is straining to poop, mostly unsuccessfully

228
Q

uses of ERCP

A

choledocholithiasis

Acute pancreatitis

229
Q

Why is choledocolithiasis such a big deal?

A

risk of ascending cholangitis

230
Q

Decreased fecal chymotrypsin

A

This is chronic pancreatitis

Expect to also see low fecal elastase and hypokalemia

231
Q

first thing you do with a patient suspected to have acute pancreatitis

A

2 giant IVs

232
Q

new onset diabetes

A

probably pancreatic cancer, especially if they have a sudden plainless jaundice (which you would expect to be conjugated)

233
Q

increased lipase

A

acute pancreatitis

234
Q

what does BISAP tell you?

A

Mortality chances of a person with pancreatitis

235
Q

beads on a string

A

PSC

236
Q

infection associated with HFE

A

Yersinia / plague

Causes bloody stool, pseudoappendicitis

237
Q

Significance of Th1 Cells in IBD

A

Created by IL-12
Release IFNy
Hyperactivity Causes Crohn’s

238
Q

Significance of Th17 in IBD

A

Created by IL-6, 23, TGFb
Releases IL-17
Hyperactivity Causes Crohn’s

239
Q

Ca19-9

A

Pancreatic cancer marker

240
Q

Hepatic lymphoma

A

Usually diffuse large B cell lymphoma
Can be hepatosplenic T cell lymphoma
Usually middle aged men

241
Q

PVC, arsenic, thorotrast

A

Associated with angiosarcoma of the liver

242
Q

SE Asia, liver flukes

A

Associated with cholangiocarcinoma

243
Q

Cholangiocarcinoma

A

Adenocarcinoma from intra-hepatic biliary tree
Incidental finding or symptomatic liver mass
Clearly defined tubules wiled with malignant cells

244
Q

Hepatoblastoma

A

Pediatric abdominal swelling in Asx patient
Maybe have jaundice, itching
20% Metz to lungs, fatal without treatment
Epithelial or mixed with mesenchyme, osteoid, cartilage or striated muscle

245
Q

HNF-1a inactivated adenomas

A

Hepatocellular adenoma with strong female predilection

Minimal transformation risk to HCC

246
Q

Most common patient who gets inflammatory adenomas

A

Women, obesity and metabolic syndrome

247
Q

Focal nodular hyperplasia

A

Single well demarcated lesion with central scar
Map-Like pattern
Benign, incidental, young people

248
Q

Nodular Regenerative Hyperplasia

A

Multiple nodules, looks like cirrhosis, no fibrous septa
Can get portal HTN
Associated with HIV, benign

249
Q

Hepatocellular vs cholestatic processes

A

Hepatocellular: AST/ALT elevated
Cholestatic: Alk Phos and Bilirubin elevation

250
Q

Methylation-induced gene silencing

A

Enhances progression of colonic adenocarcinoma

251
Q

Classic sequence of sporadic colonic adenocarcinoma

A

KRAS activating mutation

SMAD2 and 4 effect on TGF-b signaling

252
Q

Napkin Ring contraction in the distal colon

A

Colonic adenocarcinoma

GI II (4 decks)

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