STEP 2 GI Flashcards
Hepatitis (drug/viral) histology?
Hepatic cell necrosis with mononuclear infiltrate.
Drugs causing hepatitis histology?
INH, phenytoin
alpha-methyldopa, halothane
Drugs causing fatty liver histology?
valproate, tetracyclines, antiretrovirals
Drugs causing fulminant/toxic liver failure?
acetaminophen, amanitoxin, CCl4
Drugs causing hepatic granulomas?
allopurinol
phenylbutazone
Drugs causing elevated liver enzymes but no histologic changes?
OCPs
Drugs causing cholestatic liver histology?
chlorpromazine, nitrofurantoin, anabolic steroids, erythromycin
Definition of acute liver failure / FHF?
Prognosis/Tx?
Rapid ( 1.5)
with no pre-existing liver disease or cirrhosis
Prognosis: 40% survive w/o transplant (acute)
TX of hepatic encephalopathy?
lactulose, rifaximin
Features of Crohn’s?
Skip lesions, perianal lesions, fistulas, fissures Cobblestone mucosa Noncaseating granulomas Transmural lesions Creeping fat mesentery
Features of UC?
rectal involvement
crypt abscesses
HLA-B27, PsorA/joints, PSC
bloody diarrhea
Migratory superficial thrombophlebitis?
Trousseau’s sign
Pancreatic, lung, etc ca
scan it
Abx for PBC?
anti-mitochondrial
Abx for autoimmune hepatitis?
anti-smooth muscle
Abx for PSC?
(p-ANCA?)
Diverticulitis mgmt: when outpt? when inpt with broad IV abx? When drainage? When surg?
If elderly, sick, or risk facs: hospitalize and IV abx
If fluid collection 3 cm: CT perc drainage
If fails: surgical I&D
If perfs or fistulizes: colonic resection
Peutz-Jeghers features?
Mucocutaenous pigmentation
GI polyposis
Maybe estrogen secreting tumor with precocious puberty
what is “succussion splash”?
stethoscope on LUQ, rock pt at hips, if splash sound indicates incomplete gastric emptying, sign of outflow obstruction
BRBPR ddx? Workup?
Brisk UGIB - check gastric aspirate diverticulosis - hx of constipation hemorrhoids - rectal exam angiodysplasia - hx of ESRD or AS (Heyde's sydndrome -> von Willebrand IIA) Workup: -colonoscopy / endoscopy -if negative, tagged RBC scan -surgery
enterobius (pinworm) dx/tx?
scotch tape test
albendazole or pyrantel pamoate for household
strongyloides tx?
ivermectin
onchocerca volvulus tx?
ivermectin
trypanosoma cruzi tx?
benznidazole
entamoeba histolytica dx, tx?
dx stool microscopy (trophozoites with ingested RBCs)
aspirate from liver abscess
serum antigen / antibodies
tx: metronidazole
cyclic vomiting syndrome associated with?
family hx of migraines, can consider sumatriptan
gastric dumping syndrome?
after gastric surgery (vagotomy, partial gastrectomy)
nausea, weakness, diaphoresis 30min after meal
simple carbohydrates provoke
dietary modification -> octreotide -> surgery
sudden vision loss with floaters, on exam
“red glow with loss of fundus details”
assoc / tx?
vitreous hemorrhage (seen with proliferative diabetic retinopathy) tx: conservative
SBP threshold for abx therapy?
250 neutrophils/uL
tx for esophageal varices?
prophylaxis: -propranolol or nadolol -nitrates -banding -TIPS acute: resuscitation endoscopy -> sclerotherapy / sengstaken tube octreotide
iron toxicity vs acetaminophen toxicity?
both: nausea, vomiting, abdominal pain, hepatotoxicity
iron only: GI hemorrhage
celiac dz antibodies?
anti-endomysial
liver cyst with eggshell calcifications?
hyatid cyst
causes of acute pancreatitis?
I GET SMASHED: Idiopathic Gallstones EtOH / MetOH Trauma Steroids Mumps / Malignancy Autoimmune (unusual) Scorpion sting/spider bite Hyperlipidemia/hypercalcemia ERCP or other surgery Drugs: -azathioprine -mercaptopurine -valproate -furosemide -estrogen -methyldopa -H2 blockers / cimetidine -organophosphates -abx
Tropical sprue endemic areas?
Tx?
nb it looks like celiac with a travel hx Haiti Cuba PR DR (not Jamaica) s/sx due to folate malabsorption tx: tetracycline and folate
how to test for chronic pancreatitis?
CT abdomen - lipase/amylase may be nl
prolonged PPI use: 3 risks
C diff
increased colonization of upper GI tract -> incr pneumonia risk
impaired calcium absorption -> osteoporosis
surveillance for cirrhotics?
ultrasound and serum AFP every 6 mos to screen for HCC
surveillance EGD for varices
-if variceal bleed, EGD yearly and beta blocker
phases of chronic hep b infection?
immune tolerance: 10-30 yrs -positive HbeAg and HbsAg, high replication -nl ALT immune clearance -HbeAg positive -> zero -HbsAg positive (if infection cleared, becomes negative) -inflammation, +ALT inactive carrier state: -HbsAg+ -dx: 3nl ALTs and 2-3 negative HBV DNA over 1 yr -variable inflammation HbeAg negative chronic hepatits: -+ALT, +HBV DNA
homocystinuria - enzyme defect?
lab abnormalities?
classic features?
tx?
cystathionine synthase
elevated homocysteine and methionine levels
fair hair and eyes, developmental delay, CVA, marfanoid body habitus
B12, folate, B6, antiplatelet/anticoagulation therapy
pill esophagitis drugs?
tetracyclines
KCl, Fe
bisphosphonates
NSAIDs
renal insufficiency + nitroprusside = ?
cyanide toxicity
dyspepsia workup?
dyspepsia = discomfort/fullness after meal
Alarm symptoms: weight loss, anemia, bleeding, vomiting, early satiety
If alarm symptoms: EGD
If typical GERD: acid reduce
If NSAIDs: stop them or add acid reduce
otherwise, if age 55, EGD
tx for hypothermia:
if mild-moderate (i.e. no coma, ventricular arrhythmias, pulmonary edema)
- room temp IVF, passive rewarming
if severe:
- active external (heated blankets) and internal warmed IVF and humidified O2
folate antagonists?
phenytoin phenobarbital primidone trimethoprim methotrexate
complications of carcinoid syndrome?
(after mets to liver) flushing diarrhea bronchospasm valvular lesions (R>L) niacin deficiency: -due to overproduction of serotonin -serotonin precursor is tryptophan -tryptophan is also a precursor for niacin synthesis
tx of serotonin syndrome?
benzos and cyproheptadine
clotting problem in alcoholic / other malnourished person?
think vitamin K deficiency
what is melanosis coli? what is the significance of this finding?
dark brown staining of colon with lymph nodes shining through as pale patches
sign of laxative abuse (anthraquinones = bisacodyl)
often nocturnal diarrhea
