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Test 5 GI Flashcards

1
Q

Tx esophageal varices

A

Vasoactive agents (Octreotide), replace coag factors & blood, abx, maybe balloon tamponade, endoscopy w/ banding/sclerotherapy - finally decompression w/ TIPS

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2
Q

What is Boerhaave’s syndrome & S/S?

A

Esophageal rupture - hematemesis w/ severe retrosternal pain, hypovolemia & shock, medical emergency, Hx alcoholism or ulcer common

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3
Q

Risk factors for Barrett’s esophagus

A
  1. Age 2. Male 3. White 4. Smoker
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4
Q

Red flags of GERD

A
  1. Dysphagia 2. Odynophagia 3. Wt loss 4. Early satiety/vomiting 5. Anemia 6. Aspiration 7. Male >45yo 8. Elderly
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5
Q

Causes of GERD

A
  1. Inc. intra-abdominal pressure (pregnancy) 2. Tobacco 3. Foods 4. Hormones 5. Meds 6. High volume meals/positioning 7. H. pylori
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6
Q

Tx candidal esophagitis

A

Fluconazole

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7
Q

S/S Zenker’s diverticulum

A
  1. Regurg of undigested food 2. Dysphagia 3. Cough 4. Nocturnal choking 5. Halitosis
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8
Q

Causes of esophageal spasm

A
  1. Stomach acid 2. Anxiety disorders 3. Achalasia
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9
Q

Tx of achalasia

A

Surgery, Botulinum

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10
Q

What is achalasia & what is it characterized by?

A

LES does not relax to allow food entry into the stomach**esophagram = bird beak

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11
Q

How is scleroderma related to the esophagus?

A

connective tissue disease that can cause fibrosis of the esophagus

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12
Q

What are Schatzki rings?

A

smooth, circumferential structures in the lower esophagusmay be caused by stomach acid

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13
Q

What is Zenker’s diverticulum?***

A

pouching of esophagusmay be due to loss of elasticity at UES & reduced openings/s- regurgitation of undigested food, dysphagia, cough, nocturnal choking, halitosis

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14
Q

What disease is characterized by pouching of the esophagus?

A

Zenker’s diverticulum***

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15
Q

What disorder causes a bird beak on an esophagram?

A

Achalasia***

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16
Q

Who is at risk for infectious esophagitis?

A

immunocompromised Ptscommon pathogens: candida, CMV, Herpes

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17
Q

What is a DDx for cough?

A

GERDTx: H2 antagonists, PPIs

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18
Q

What is Barrett’s esophagus?

A

columnar metaplasia of distal esophagus due to chronic inflammationZ-line at GE junctionrisk factor for adenocarcinoma*

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19
Q

What esophageal disorder is at risk for adenocarcinoma?

A

Barrett’s esophagus

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20
Q

What can chronic inflammation of the esophagus cause?

A

Barrett’s esophagus -columnar metaplasia of distal esophagus

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21
Q

What is a Mallory-Weiss Tear?

A

a benign condition, VSS***tear in the esophagushematemesis usually due to vomiting, retching

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22
Q

What disorders can cause abdominal pain but aren’t abdominal disorders?

A
  1. MI - common in women2. Pneumonia - common in kids3. GU - PID, ectopic pregnancy, testicular torsion, nephrolithiasis
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23
Q

What are some causes of constipation?

A
  1. Diet low in fiber2. Aging3. Dec. activity4. Meds5. Masses6. Hypothyroidism7. Diabetes8. Parkinson’s9. MS
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24
Q

What is gastritis & common causes?

A

inflammation of the stomachcauses: NSAIDS, peptic ulcer disease

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25
Q

What is gastroenteritis & common causes?

A

Inflammation of the stomach & small intestinecauses: norwalk virus, N/V/D

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26
Q

How is NSAID gastropathy caused?

A

NSAIDS block COX1 & COX2 causing inc. acid & mucus, causing inflammation & pain

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27
Q

What are the different types of peptic ulcer disease?

A
  1. Gastric2. Duodenal3. H. Pylori
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28
Q

What is gastric peptic ulcer disease & when is it exacerbated?

A

breakdown of mucosal lining that allows epithelial cells to be exposed to acidworse on empty stomach or immediately after food

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29
Q

What is duodenal peptic ulcer disease & when is it exacerbated?

A

inappropriate acid secretion in pyloric atrum cells worse 2-3 hrs after a meal, food relieves it

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30
Q

What percentage of each peptic ulcer diseases does H. pylori cause?

A

75% duodenal60% gastric

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31
Q

What is the name for the gastrin secreting pancreas tumor?

A

Zollinger-Ellison syndrome RARE

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32
Q

What is the tell-tale sign of Crohn’s?

A

cobblestoning - skip lesions***chronic granulomatomous lesions

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33
Q

Describe Crohn’s

A

disease of small bowel, IBDmay extend & form fistulas w/ other organsS/S - diarrhea, cramping, wt loss, eye involvement, arthritis, anemiaabs. issues - ferritin, Fe, B12Cobblestoning - skip lesions

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34
Q

What are the different small bowel obstructions?

A
  1. Adynamic ileus2. Mechanical ileus
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35
Q

Adynamic ileus vs. mechanical ileus

A

A - dec. intestinal motility, meds, surgery, electrolyte imbalance M - post op. adhesions, hernias, neoplasms, blockage

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36
Q

A disease process that has sever pain followed by vomiting is????

A

mesenteric ischmia uncommon but deadly older Pts, occlusion, vasospasm, vasoconstriction of superior/inferior mesenteric artery

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37
Q

What are the large bowel disorders?

A
  1. Ulcerative colitis2. Diverticulitis/diverticulosis3. Toxic megacolon4. Large bowel obstruction5. Pseudomembranous colitis
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38
Q

What is the S/S of diverticulitis?

A

LLQ ab. pain***, fever, constipation/diarrhea

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39
Q

Describe diverticulitis

A

herniation through muscles of intestinal wall-from low fiber diet, may be asymptomatic bowel rest, no colonoscopy for 6 wks, high fiber diet, wt loss

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40
Q

What are the causes & risks of toxic megacolon?

A

c - ulcerative colitis, Chron’s, infectionsr - sepsis & bowel perforation

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41
Q

What is twisting of the bowel called?

A

volvuluscecum & sigmoid most common, may constrict blood flow

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42
Q

What is telescoping of the bowel called?

A

Intussusceptionexcacerbated peristalsis

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43
Q

Large bowel obstructions may lead to…?

A
  1. Gangrene2. Shock3. Perforation
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44
Q

Another name for pseudomembranous colitis?

A

antibiotic assoc. colitis= C. Diff

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45
Q

What is a tell-tale sign of IBS?

A

Mucousy diarrhea**/constipationNOT IBS = blood, wt loss, fevers

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46
Q

What is Hirschsprungs?

A

congenital -absence of autonomic nerve ganglia, ENS usually affects rectosigmoid regioncomplications - constipation, bacterial growth, diarrhea & enterocolitis

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47
Q

Which substances does Celiac cause a dec. absorption?

A

Fe, B12, folate, Vit D & K –anemiaautoimmune

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48
Q

What is Whipple’s disease & S/S?

A

Very rare bacterial infection, farmer’s soilS/S - steatorrhea, wasting, edema, endocarditis, uveitis, lymphadenopathy, dementia

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49
Q

What disease is from a loss of your pyloric sphincter?

A

Dumping syndrome small gastric capacity, water pulled into intestine

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50
Q

Name the inflammation diseases of GI

A
  1. Stomatitis2. Esophagitis3. Gastritis4. Peptic ulcer disease5. Crohn’s6. Ulcerative colitis7. Enterocolitis8. Diverticulitis
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51
Q

Name the motility disorders of GI

A
  1. Achalasia2. IBS3. Obstruction4. Volvulus5. Intussusception6. Hirschsprung
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52
Q

Name the malabsorption disorders of GI

A
  1. Celiac2. Dumping3. Short Bowel Syndrome
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53
Q

What are the S/S of esophageal cancers?

A

wt. lossdysphagiahoarseness

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54
Q

Describe squamous cell carcinoma esophageal cancer

A

most common in old black men, EtOH, tobacco, poor diet, Hx of head/neck radiation

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55
Q

Describe adenocarcinoma esophageal cancer

A

CA of glandsBarrett’s esophagus & other high acid states

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56
Q

What is a tell-tale sign of gastric cancer?

A

Epigastric mass***

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57
Q

What are the risk factors for colon cancer?

A

2nd leading cause of CA death, risk doubles every decadeIBD, ulcerative colitis, Hx adenomatous polyps, 1st degree relative, tobacco, obesity, diet, high fat, low fiberFamilial adenomatous polyposisHereditary non-polyposis colon CAwatch CEA-125***

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58
Q

Describe bile composition

A
  1. Water2. Electrolytes3. Bile acids4. Cholesterol5. Pigment6. Phospholipids
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59
Q

What is the function of bile?

A

digestion of lipids/fattransport waste from liver (bilirubin, IgA, toxins, cholesterol)

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60
Q

What are the risk factors of gall stones?

A

FatFemaleFertileFortyFH, Sickle cell disease, TPN, pregnancy

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61
Q

What can gall stones be made of?

A

70% cholesterolBilirubinCaCO3phosphate

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62
Q

What is biliary colic?

A

Transient cystic obstruction

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63
Q

What is acute cholecystitis & S/S?

A

persistent cystic obstructionRUQ pain to R scapula***, +/- fever, anorexia, dyspepsia, N&V

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64
Q

Complications of acute cholecystitis

A
  1. Gangrenous cholecystitis 2. Empyema, Cholecystoenteric fistula, biliary peritonitis/sepsis, cholangitis/ascending cholangitis
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65
Q

Tx acute cholecystitis

A
  1. Laparoscopic cholecystectomy 2. Chemodissolution 3. ESWL (shock wave)
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66
Q

Dx acute cholecystitis

A

US - stones & gb wall thickening, distention into lumen, HIDA scan, maybe CT, MRCA, ERCP

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67
Q

What is characterized by RUQ pain to the R scapula?

A

acute cholecystitis

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68
Q

What is choledocholithiasis?

A

cacluli in common bile duct

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69
Q

How do you diagnose cholelithiasis?

A

US, HIDA scan, CT, MRCA, ERCP

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70
Q

What are the complications of cholelithiasis?

A

gangrene, empyema, cholecystoenteric fistula, biliary peritonitis/sepsis, cholangitis

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71
Q

What happens if there is an obstruction in the common bile duct?

A

cholecystitis & jaundice

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72
Q

What happens if there is an obstruction in the sphincter of oddi or hepatopancreatic duct?

A

pancreatitis

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73
Q

Risk factors of Acalculous Cholecystitis

A
  1. Critical illness/major surgery 2. Men >50 3. TPN more likely to get complications
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74
Q

Risk factors & S/S Primary Sclerosing Cholangitis

A

RF 1. IDB - ulcerative colitis, Crohn’s 2. AIDS 3. Fasciola hepatica 4. Males 20-50 S/S 1. RUQ pain 2. Jaundice 3. Fevers 4. Wt loss

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75
Q

What is acalculous cholecystitis?

A

inflammation of gall bladder w/o gall stones

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76
Q

What is primary sclerosing colangitis?

A

inflammation & fibrosis of the biliary treemay also involve inra/extrahepatic ductsS/S - RUQ pain, jaundice, fevers, wt loss RF - IBD, ulcerative colitis, Crohn’s, AIDS, fasciola hepatica

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77
Q

Describe biliary malignancy

A

rare, asymptomatic & insidious until late stages, only about 1/5 are found before they metastasize

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78
Q

What enzymes does the pancreas secrete?

A
  1. Amylase - carbs2. Lipase - fat, phospholipase A & lecithinase3. Proenzymes - protein, trypsinogen & others, inactive until duodenum4. Bicarb
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79
Q

What are the causes of acute pancreatitis?

A
  1. Obstruction of pancreatic duct - digests itself2. Alcohol3. Biliary obstruction4. HypertriglyceridemiaOthers: meds, sphinter of oddi dysfunction, idiopathic, infections
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80
Q

Chronic pancreatitis causes?

A

From alcoholism 1. Diabetes 2. Malabsorption of fat (Vit A,D,E & K)

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81
Q

Risk factors for pancreatic cancer

A
  1. Obesity 2. Tobacco use 3. >50 yo 4. Maybe familial, alcohol, diabetes
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82
Q

S/S pancreatic cancer

A
  1. Epigastric pain 2. Anorexia 3. Wt loss 4. Maybe jaundice
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83
Q

Dx pancreatic cancer

A
  1. CT scan w/ contrast 2. FNA 3. CA 19-9
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84
Q

Tx pancreatic cancer

A
  1. Head - whipple 2. Tail - distal pancreatectomy 3. Chemo 4. Maybe radiation
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85
Q

Ranson Criteria

A

Assessment of severity of Pancreatitis Admission 1. Age >55 2. Glucose >200 3. AST >250 4. LDH >350 5. WBC >16,000 After 48h 1. Hct dec. 10% 2. BUN >1.8 3. Serum Ca 4 6. Est fluid sequestration >6L

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86
Q

Tx acute pancreatitis

A
  1. NPO 2. IV hydration 3. Analgesics 4. Maybe abx
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87
Q

Necrotizing pancreatitis

A

20% Pts w/ acute pancreatitis get it, 30% death rate Pseudocysts - collections of digestive enzymes need drained Abscess formation - From liquefaction & necrosis of pancreatic tissue, abx & I&D

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88
Q

S/S of acute pancreatitis?

A

steady & boring epigastric painN/VRanson criteria assesses pancreatitis , Maybe fever, maybe abd distention

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89
Q

What are the complications of pancreatitis?

A
  1. Necrotizing2. Pseudocysts - inc. enzymes, needs drained3. Abscess formation - results in liquefaction & necrosis of pancreatic tissue, collections of pus
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90
Q

What is the most common cause of chronic pancreatitis?

A

chronic alcoholism

91
Q

Dx pancreatitis

A

Lipase - specific, returns to normal w/in 7-14 daysAmylase - returns to normal w/in 2-3 days, does not predict severityinc. WBC, triglycerides, bilirubin, ALP, AST, LDH CT abdomen w/ contrast & US Gold standard

92
Q

Where in the pancreas is the most cancer found?

A

head 3:1 chance in head than tail2% of new CA, 4th leading cause of CA death usually mets if showing S/SDx CA 19-9

93
Q

What are the fat soluble vitamins?

A

A D E K if liver probs, can’t abs these

94
Q

What hormones does the liver metabolize & what problems can liver disease cause as a result?

A

glucocorticoids & sex hormonesmen - gynecomastia, impotence, testicular atrophy women - irregular menses

95
Q

What are the functions of cholesterol?

A

Build & maintain cell membrane, myelin sheathintracellularly - precursor, bile, vit D, steroid hormones20-25% produced in liver

96
Q

What are the prehepatic causes of inc. bilirubin?

A
  1. Hemolysis2. Gilberts3. Sickle cell4. Crigler-Najarr syndrome
97
Q

What has high serum unc. bilirubin, with no bilirubin and high urobilinogen in urine?

A

pre-hepatic causes of inc. bilirubin

98
Q

What are the hepatocellular causes of bilirubin problems?

A

probs getting through biliary tree1. Liver disease/CA2. Hepatitis3. Primary sclerosing cholangitis4. Dubin-Johnson syndrome

99
Q

What has high serum conj. bilirubin, with high conj. bilirubin with no or little bilinogen in the urine?

A

hepatocellular or post-hepatic bilirubin problems

100
Q

What are the post-hepatic causes of bilirubin problems?

A

obstruction - gallstones, pancreatitis

101
Q

Describe the process & causes of cirrhosis?

A

inflammation to fibrosis to scar tissue & nodulesirreversible**Causes: alcoholism, autoimmune primary biliary cirrhosis

102
Q

What can cause esophageal & periumbilical varices ascites?

A

Portal HTN & cirrhosis, vomit blood - medical emergency

103
Q

What causes hepatic encephalopathy?

A

an inc. NH4+ from liver disease that crosses the blood-brain barrier

104
Q

Tx hepatic encephalopathy

A
  1. Reversal of ppting factors 2. Limit protein 3. Thiamine 4. Osmotic diuretics (lactulose) 5. abx - supress bacterial conversion to NH4+
105
Q

Dx & Tx of fatty liver disease

A
  1. Elevated LFT 2. CT Tx underlying cause..stop drinking
106
Q

What can worsen hepatic encephalopathy?

A
  1. GI bleeding2. Azotemia/renal failure3. Constipation4. Inc. protein intake5. Hypokalemia6. Hypoxia7. Hypercarbia8. Sepsis9. CNS depressantsGraded: 1-4, 4 is worst (flap)
107
Q

What are the causes of ascites & Tx?

A
  1. Cirrhosis2. CA3. CHF4. TB5. PancreatitisTx - Na restriction, diuresis, paracentesis
108
Q

What is hepatorenal syndrome?

A

renal failure w/o intrinsic kidney diseasecauses: disturbance of arterial blood flow assoc. w/ portal HTNTx: hemodialysis

109
Q

What are the causes of fatty liver disease?

A
  1. Alcoholism2. Non-alcoholic steatohepatitis (NASH)obesity, DM, protein malnutrition, TPN, drugs, rapid wt loss/starvation
110
Q

What is the main cause of liver transplant in the U.S.?

A

Hepatitis C

111
Q

What are the toxic storage diseases?

A
  1. Hereditary hemachromatosis2. Wilson’s disease
112
Q

Describe hereditary hemachromatosis

A

abnormal Fe abs. & cirrhosis of liverautosomal recessive, abnormal HFE gene -alcohol inc. risks

113
Q

What is Wilson’s disease?

A

Toxic storage disease abnormal deposition of Cu in liver, autosomal recessive, stripped from ceruloplasminKaiser-Fleisher rings in eyes***

114
Q

Dx Wilson’s disease

A
  1. Kaiser-Fleisher rings 2. Low serum ceruloplasmin 3. Inc. urinary Cu2+
115
Q

What is Gilbert’s disorder?

A

can’t conjugate bilirubinautosomal dominant

116
Q

What disease is characterized by Kaiser-Fleischer rings?

A

Wilson’s disease

117
Q

What are the S/S & causes & Tx of liver abscesses?

A

S/S - fever, RUQ painc - portal vein infection, ascending cholangitis, bacteremia Tx - abx

118
Q

What are the causes of a hepatoma?

A

hep B & C, cirrhosis, hemachromatosismostly metastatic

119
Q

Define dysphagia

A

Difficulty swallowing

120
Q

Define odynophagia

A

Pain w/ swallowing

121
Q

Dx H. pylori

A
  1. IgG (may stay + for years) 2. Urea breath test 3. Stool Ag test 4. Endoscopy GOLD std (only do if Pt has red flag)
122
Q

Tx H. pylori

A
  1. Metronidazole 2. Tetracycline 3. Pepto-Bismol 4. Prilosec
123
Q

Can you drink on metronidazole?

124
Q

Risk factors of Gastric CA

A
  1. H. pylori 2. Familial NO EtOH
125
Q

Red flags of Constipation

A
  1. Age >50 2. Acute onset 3. Wt loss (>10lbs) 4. Abd pain/cramping 5. Bleeding/melena 6. N&V 7. Rectal pain 8. Fever 9. Change in stool caliber
126
Q

Tx Constipation

A
  1. Exercise 2. Fiber 3. Fruits/veggies 4. Hydration 5. Laxatives
127
Q

Risk factors of hemorrhoids

A
  1. Erect posture 2. Straining at defecation 3. Pregnancy 4. Obesity 5. FH 6. Portal HTN
128
Q

Tx hemorrhoids & anal fissures

A
  1. Meds (Anusol HC, Proctofoam HC) 2. Stool softeners 3. Good hygiene 4. Sitz bath 20 min 4. Cold pack - Surgical - 5. Rubber band ligation 6. Sclerotherapy 7. Hemorroidectomy
129
Q

What do lateral anal fissures suggest?

A
  1. IBD 2. TB 3. HIV 4. Leukemia 5. Syphilis
130
Q

What are sentinel piles?

A

Skin tags around booty hole, edema due to infection/swelling

131
Q

What is the most common cause of infectious diarrhea worldwide?

A

Norwalk virus - Gastroenteritis, food borne illness, contagious when ill & 3 days later

132
Q

What is the strain of diarrhea from E. Coli & describe

A

0157:H7 Rapid onset 12-72 hours, Bloody diarrhea, MCC of travelers diarrhea, foorborne illness

133
Q

Complications & Tx of E. coli diarrhea

A

Hemolytic Uremic Syndrome - causes renal failure - common in kids Tx - Bactrim only in severe cases

134
Q

MCC infectious diarrhea in US & Tx

A

Campylobacter jejuni Food poisoning, Onset 3-5 days, Assoc. w/ Guillan-Barre, Reiters sydrome, HUS, Tx - macrolides

135
Q

What is the MCC of food poisoning?

A

S. aureus, Onset 3-12 hours, Fevers, chills, GI Sx, Symptomatic Tx

136
Q

How do you get salmonella diarrhea?

A

Turtles, iguanas, Food, Onset 6-36 h, Duration =1wk of 3-4wks, Tx - maybe fluoroquinolone

137
Q

How do you get Shigella diarrhea?

A

Feces, fly contact, Most common bloody diarrhea, High fevers, Complications - Reiters, HUS Tx - fluoroquinolones

138
Q

Can kids take fluoroquinolones?

A

No mammary glands

139
Q

MCC of bloody diarrhea?

140
Q

What is a parasitic cause of diarrhea?

A

Giardia Lamblia (protozoan) Transmitted fecal-oral route, Onset 5-25 days Bloody diarrhea, Stool ova & parasite/stool Ag test, no fecal leukocytes, Tx - Nitazoxanide, Tinidazole, metronidazole

141
Q

S/S C. diff

A
  1. Diarrhea (20-30 stools/day) 2. Mucus & blood sometimes 3. Crampy 4. Fevers
142
Q

Risk factors C. Diff

A
  1. Abx (quinolones, amoxicillin), w/in 3 mo 2. Elderly, debilitated, immunosuppressed 3. Dec. acid - H2 blockers, PPIs 4. Hospitalization
143
Q

S/S bowel obstruction

A
  1. Colicky abd pain 2. N&V 3. Dec. bowel mvmts/flatus, Obstipation late 4. Abd distention 5. Early - hyperactive BS, Late - Hypoactive BS 6. Inc. tympany 7. Abd tenderness
144
Q

Dx bowel obstruction

A

Plain film - string of pearls 2nd line - CT

145
Q

Tx bowel obstruction

A
  1. Surg consult - conservative mgmt (48h?) 2. NG tube 3. Fluid replacement 4. Maybe abx
146
Q

Tx partial bowel obstruction

A
  1. Maybe probiotics 2. Magnesium 3. Simethicone - GasX
147
Q

Dx & Tx mesenteric ischemia

A

Angiography Surgery

148
Q

Who commonly gets Crohn’s?

A

15-30yo Women Familial

149
Q

Extra-abdominal Sx of Crohn’s

A
  1. Anterior uveitis 2. Arthritis 3. Anemia 4. Pyogenic gangrenosum 5. Cholelithiasis 6. Nephrolithiasis 7. Erythema nodosum
150
Q

Dx Crohn’s

A
  1. Colonoscopy 2. FOBT 3. Anal fissures, perirectal abscess 4. RLQ palpable mass 5. CBC (anemia & leukocytosis) 6. CRP, ESR 7.
151
Q

Tx Crohn’s

A
  1. Salicylate Mod-Severe 1. Systemic corticosteroids 8-12wks 2. Immunosuppressant - Azathioprine 3. Anti-tumor necrosis factors - Humira, Remicade
152
Q

S/S ulcerative colitis

A
  1. Diarrhea 2. Bloody stools 3. Abd pain 4. Wt loss 5. Fevers 6. Malaise
153
Q

Dx & Tx ulcerative colitis

A

Colonoscopy Tx - same as Crohn’s

154
Q

Where w/ ulcerative colitis is the risk ofcolon CA dec?

A

if limited to recto-sigmoid

155
Q

Prevention, Dx & Tx of Diverticulitis

A

CT abdomen -Pericolic fat & wall thickening Tx - NPO or clear liquid diet, low fiber, Metronidazole & abx Prevention - high fiber diet, wt loss, avoid nuts & seeds

156
Q

Can diverticulitis Pts get colonoscopys?

A

No ma’am not for 6 wks

157
Q

Tx toxic megacolon

A
  1. Abx 2. Steroids 3. Maybe colectomy
158
Q

Assoc. conditions w/ IBS

A
  1. Fibromyalgia 2. Fatigue 3. Noncardiac CP 4. GERD 5. Anxiety/depression 6. Chronic pelvic pain
159
Q

Tx IBS

A
  1. Exercise 2. Inc. fiber 3. Hydration 4. Avoid caffiene/alcohol 5. Consider probiotics 6. Meds for diarrhea/constipation
160
Q

Complications & Tx Hirschsprung’s Disease

A
  1. Constipation 2. Fecal stagnation - bacterial overgrowth 3. Diarrhea & enterocolitis Tx - rectal irrigation & ileoanal pull through
161
Q

Who gets dematitis herpetiformis?

162
Q

Dx Celiac

A
  1. TTD 2. Confirm w/ EMA-IgA
163
Q

Dx lactose intolerance

A

Lactose breath Hydrogen test/ trial w/o lactose

164
Q

What disease affects heart, lung, brain, skin & eyes?

A

Whipple’s disease

165
Q

Dx & Tx Whipple’s disease

A

Duodenal/jejunal Bx Tx - abx for up to a year

166
Q

What do adenocarcinomas usually present as?

A

Obstructions

167
Q

Risk factors for developing cancerous colon polyps?

A

Adenocarcinoma, 3 or +, size>1cm, high grade bx changes

168
Q

S/S colon cancer

A
  1. Change in bowel patterns 2. Melena 3. Hematochezia 4. Narrow ribbony stools 5. Wt loss 6. Vomiting 7. Fatigue 8. Abd pain/discomfort, bloating, gas
169
Q

Screening for colon CA

A
  1. 50 yo then q10yr 2. 1st degree relative 60 yrs, 40 then q10yrs 4. Hx adenomatous polyps
170
Q

Acute massive upper GI bleeding causes

A
  1. Peptic ulcer disease 2. Esophageal varices 3. Gastritis 4. Esophageal ulcer 5. Mallory Weiss Tear 6. GI malignancy
171
Q

Acute massive lower GI bleeding causes

A
  1. Diverticular disease 2. Colon CA 3. IBD 4. Ischemic colitis 5. Internal hemorrhoids
172
Q

Chronic intermittent upper GI bleeding causes

A
  1. Gastritis 2. Esophatitis 3. Peptic ulcer disease 4. Gastric CA
173
Q

Chronic intermittent lower GI bleeding causes

A
  1. Hemorrhoids 2. Colonic polyps 3. Diverticular disease 4. Colorectal CA
174
Q

What is the MCC of lower GI bleeding?

A

Diverticular disease

175
Q

Transmission, Incubation, S/S of Hepatitis A

A

Oral-fecal, Incubation 2-7 wks S/S 1. Fever 2. N&V 3. RUQ pain 4. Hepatomegaly 5. Splenomegaly 6. Jaundice 5-7 days later , Infectivity: 2 weeks before to 1 week after symptoms appear; once jaundice, no longer contagious

176
Q

Dx & Tx hepatitis A

A
  1. IgM - 5-10 days before Sx up to 3 mo 2. IgG - 4 wks after exposure, lifelong immunity 3. Inc. LFT 4. Inc. bilirubin 5. ALP not that high Tx - Symptomatic
177
Q

Hepatitis A vaccines

A

V - active acquired immunity Immunoglobulin - passive immunity, given in cases of known exposure

178
Q

Transmission, Incubation, S/S of Hepatitis B

A

Bloodborne & body secretions, Incubation 60-90 days S/S - same as HepA w/ urticaria (Hardy virus)

179
Q

Hepatitis B Dx

A

Incubation - HBsAg +, Immune response/acute - xHBcAb +, Acute/seroversion - Ag lower, HBcAb+, HBeAb +, Recovery immunity - HBcAb + HBsAB + meaning immunity/prior infection

180
Q

Hepatitis B immunization

A
  1. 3 dose series at 0, 1m & 6 m 95% response rate
181
Q

Who gets HBIG?

A

May be protective, or attenuate the severity of illness, if given within 7 days after exposure followed by HBVvaccine

182
Q

Hepatitis D

A

Can’t survive unless HepB, Accelerates progression of liver disease

183
Q

Transmission & S/S Hepatitis C

A

Blood, mild clinical illness

184
Q

Dx Hepatitis C

A

Antit-HCV Ab, ELISA, confirm w/ PCR

185
Q

Who should be screened for Hepatitis C?

A

people born btwn 1945-1965

186
Q

Tx Hepatitis B & C

A

Causes cirrhosis & hepatocellular CA Tx -interferon & ribavirin… Tx for Hep B only req. in severe cases

187
Q

Who gets hepatitis E?

A

Nasty drinking water in developing countries

188
Q

What is bronze diabetes?

A

Assoc. w/ hemachromatosis 1. Hyperpigmented skin 2. Diabetes 3. Cirrhosis

189
Q

Tx of hemachromatosis

A
  1. Phlebotomy 2. Deferoxamine (Chelates iron)
190
Q

Dx & Tx Wilson’s disease

A
  1. Low ceruloplasmin 2. High Cu in 24h urine Tx - Chelation (penicillamine)
191
Q

S/S acetaminophen toxicity

A

0-24h Anorexia, N&V, malaise 18-72h RUQ pain, N&V 72-96h hepatic necrosis, jaundice, renal failure, MSOF 4d-3wk Complete resolution

192
Q

Levels of acetominohen toxicity & Tx

A

Adults - 7.5-10 g Kiddos - 100-150 mg/kg Tx - NAC (Mucomyst)

193
Q

Dx & Tx Gilbert’s disease

A
  1. Elevated unconj. Biluribin 2. No bilrubin in urine 3. No/low urobilinogen in urine No Tx
194
Q

Common organisms of liver abscesses

A
  1. Gram - anaerobes (E. coli, Klebsiella) 2. Staph/Strep
195
Q

S/S & Dx hepatoma

A
  1. RUQ pain 2. Anorexia 3. Wt loss 4. Jaundice Dx - 1. US 2. Liver Bx 3. Elevated ALP 4. Alpha-fetaprotein level
196
Q

Tx hepatoma

A
  1. Surgery 2. Liver transplant 3. Maybe chemo/radiation
197
Q

Indications for liver transplant

A
  1. Hepatitis 2. Alcoholic liver disease 3. Primary biliary cirrhosis 4. Primary sclerosing cholangitis 5. Hemachromatosis/Wilson’s disease 6. Malignancy
198
Q

Deciding who gets a liver transplant?

A
  1. Based on need 6 - least ill, 40 - critically ill 2. Bilirubin 3. INR 4. Creatinine
199
Q

S/S liver transplant rejection

A
  1. Tachycardia 2. RUQ pain 3. Jaundice Tx - immunosuppression, steroids, Tx for opportunistic infections
200
Q

Which Hepatitis viruses are transmitted via Fecal-oral route?

201
Q

Which hepatitis viruses are transmitted via parenteral/mucus membrane contact?

202
Q

What is the most common cause of viral chronic hepatitis?

203
Q

Which types of hepatitis can cause liver cirrhosis?

A

Hep B & C…C more coming

204
Q

Which types of hepatitis increase your risk of hepatocellular cancer?

A

Hep B & C ….also aflotoxin B1 exposure & cirrhosis

205
Q

Who is at risk for autoimmune hepatitis?

A
  1. Young-middle aged women 2. Wilson’s disease 3. a1-antitrypsin deficinecy 4. Whites & Northern Europeans
206
Q

LFT alcoholic liver disease vs. hepatitis

A

ALD - AST:ALT >2 H - ALT>AST

207
Q

LFT alcoholic liver disease

A

AST:ALT >2 GGT usually 3x normal Alcohol abstinence

208
Q

Causes of cirrhosis

A
  1. Chronic viral hepatitis 2. Alcohol 3. Drug toxicity 4. Autoimmune & metabolic liver disorders
209
Q

S/S cirrhosis

A
  1. Weakness 2. Fatigue 3. Disturbed sleep 4. Muscle cramps 5. Anorexia 6. Wt loss maybe 7. N&V 8. Jaundice 9. Abd pain 10. Hematemesis 11. Fever 12. Amenorrhea 13. Erectile dysfunction, sterility, gynecomastia 14. Splenomegaly 15. Ascites, pleural effusio
210
Q

Complications of cirrhosis

A
  1. Ascites 2. Esophageal varices 3. Spontaneous bacterial peritonitis 4. Hepatorenal syndrome 5. Hepatic encephalopathy 6. Anemia 7. Coagulopathy
211
Q

Who commonly gets primary biliary cirrhosis?

A

Women 40-60 yo May be assoc w/ 1. Hypothyroidism 2. Sjogren’s 3. Raynaud 4. Scleroderma 5. Celiac 6. Hx UTI 7. Smoking 8. Hormone replacement 9. Use of hair dye

212
Q

Lab values w/ primary biliary cirrhosis

A

Inc. 1. ALP 2. Cholesterol 3. Bilirubin 4. AMA 5. IgM

213
Q

What is Budd-Chiari syndrome?

A

Hepatic vein obstruction Can lead to esophageal varices

214
Q

What is the most common benign neoplasm of the liver?

A

Cavernous hemangioma

215
Q

What are the benign liver neoplasms?

A
  1. Cavernous hemangioma 2. Focal nodular hyperplasia 3. Hepatic adenoma
216
Q

Which benign liver neoplams are usually caused by oral contraceptives?

A
  1. Cavernous hemangioma 2. Hepatic adenoma
217
Q

What does a focal nodular hyperplasia show up on CT as?

A

Stellate lesions, Benign liver neoplasm, both M&F get it

218
Q

What is Charcot’s triad?

A

Characteristic of acute cholangitis 1. Fever & chills 2. Pain 3. Jaundice

219
Q

Differences in infectious esophagitis endoscopy

A

Large deep ulcers - CMV/HIV Multiple shallow ulcers - HSV White plaques - candida

220
Q

Where do squamous cell carcinomas of the esophagus commonly occur?

A

Proximal 2/3 of the esophagus

221
Q

Types of gastritis

A

A - body of stomach: autoimmune of noninfectious factors B - antrum & body of stomach: H. pylori

222
Q

What is the most common cause of peptic ulcers?

223
Q

What is the most common extranodal site for non-Hodgkin’s lymphoma?

Clinical Medicine (11 decks)

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