Treatment - GI Exam Flashcards
1
Q
Chronic Cholecystitis:
A
NSAIDS/Laproscopic cholecystectomy
2
Q
Acute Cholecystitis (5):
A
- NPO +/- NG
- IV Opioids
- Correct fluids
- Surgery
Meds Option 1: 3rd Gen Cephalopsorin + (Metro. OR Piper/Tazo)
Meds Option 2: Ertapenum
3
Q
Choledocholithiasis:
A
- IF GB is gone already: ERCP sphincterotomy
- IF GB is not gone: Remove it and explore
4
Q
Ascending Cholangitis (3 meds):
A
- Amp./Sulbactam = Augmentin
- Piper/Tazo
- 3rd gen cephalo. + Metron.
5
Q
Ascending Cholangitis treatment of choice:
A
Biliary decompression - EMERGENT ERCP + biliary stent
6
Q
Primary Sclerosing Cholangitis (PSC) (5): MEN 2-40 - String of Pearls
A
- ERCP for strictures
- Surveillance for colon cancer
- Tx. cholangitis - Cipro. or Augmentin
- Cholestyramine for itching
- Liver transplant (9-20 yr survival)a
7
Q
Primary Biliary Cholangitis (PBC) (4): WOMEN 40-60 - Xanthelesmas
A
- Urosodiol
- Obeticholic acid
- Cholestyramine for pruruitis
- Liver transplant when decompressed
8
Q
Lab differences between PBC and PSC:
A
PSC: Only high Alk Phos (later bilirubin.)
PBC: High Alk Phos and High Bilirubin and a (+) AMA
9
Q
Two findings for Gallbladder cancer:
A
- High ALK phos and bilirubin
- Positive Courvosier sign - Palpable gall bladder
10
Q
Two types of Enteric fever and their pathogens:
A
- Typhoid: salmonella type **More common
- Paratyphoid: Other salmonellas
11
Q
Cause of dysentery:
A
Shigella dysenteriae
12
Q
Cause of Hemolytic Uremic Syndrome:
A
E. coli or shigella (anything that produces a Shiga toxin)
13
Q
Three medications for Non-inflammatory diarrhea:
A
- Pepto
- Loperamide
- MOA
14
Q
Oral rehydration solution contents:
A
1/2 tsp salt + 6 tsp sugar + 1 L H2O
15
Q
How do you treat someone with Traveler’s diarrhea caused by Typhoidal Salmonella (pea soup/constipation)?
A
- FQ or ceftriaxone
16
Q
Treatment for Inflammatory diarrhea (3):
A
- Azithromycin
- FQ
- Rifaximin
17
Q
Three most common causes of Traveler’s Diarrhea:
A
- Enterotoxigenic E. Coli
- Campy
- Shigella - Pea soup
18
Q
Prevention for traveler’s diarrhea (2)?
A
- Rifaximin
- Pepto with meals and before bed
19
Q
5 Medications that can cause constipation:
A
- Opiates
- Iron
- Anti-depressants
- CCB
- Calcium supplements
20
Q
Four most common ways to get cirrhosis:
A
- Alcohol
- Non-Alcoholic Fatty liver disease
- Hep C
- Heb B
21
Q
What labs reveal cirrhosis?
A
High INR and bilirubin, low albumin
22
Q
What are the four complications of cirrhosis? NO portal HTN in what?
A
- Ascites
- Esophageal varicies
- Hepatic encephalopathy
- Hepatocellular Carcinoma - Only one without portal HTN
23
Q
Treatment for ascites (4):
A
- Sodium restriction (corner stone)
- Bed rest (prevent activation of Ras system)
- 2:5 furosemide and spironolactone **no IV diuretics
24
Q
Esophageal varicies acutely:
A
EGD + rubber band ligation
After: IV octerotide and ceftriaxone
25
Post varicies hemorrhage (or if there are small varicies present):
Beta-blockers - (Non-specific - Carvediolol)
26
When should you transfuse someone that had a varicose bleed in the esophagus?
If their Hgb is under 7
27
Prevention for Esophageal varicies:
Screen at diagnosis of cirrhosis and if clear, every 2-3 years later
28
Hepatic Encephalopathy grading:
```
0 - None
1 - Hypersomnia
2- Lethargy + Asterixis
3 - Somnolence, only responds to pain
4 -Coma + clonus
```
29
What two drugs do you treat hepatic encephalopathy with?
- Lactulose
| - Rifaximin
30
Treatment for Liver cancer:
Liver transplant is best - palliative you can treat with TACE or Sorafenib
31
What is TACE?
Bridge to transplant - chemo delivered directly to the liver via a catheter (spares SE of traditional chemotherapy)
32
What is the outcome for those with Cholangiocarcinoma?
Death sentence, cannot be transplanted for this - Adenocarcinoma of the hepatic ducts
33
What is a preventative test to look for hepatocellular carcinoma?
Alpha-fetal protein
34
Serology present for someone with a chronic HBV infection: Both persist
HBsAg
| Anti-HBc
35
Serology present for someone with acute HBV infection:
HbsAg
Anti-HBc
Anti-HBcIgM
36
Hepatitis B infection:
Refer for treatment - Lifelong infection and virostatic
37
Hepatitis B vaccine type:
Recombinant given on 2/4 dose schedule
38
Symptoms of acute symptomatic viral hepatitis:
- Low grade fever
- Malaise
- Anorexia
- NV
- Abdominal pain
- +/- jaundice
39
Immune via natural infection positive HBV serology:
Anti-Hbc
| Anti- Hbs
40
Immune via vaccination to HBV serology:
Anti-Hbs
41
Screening for Cancer with someone that has HBV:
Ultrasound every 6 months +/- Alpha fetal protein testing
42
Hepatitis D (serology, phase, co-infection):
- Anti- HDV ab
- CHRONIC only
- Co-infection with B (increases risk for cancer and cirrhosis)
43
Most common Hepatitis infection:
C
44
Hepatitis and Acute or Chronic:
```
A: Acute
B: Both
C: Both
D: Chronic
E: Both
```
45
Serology for positive HCV acute infection:
- Anti-HCV
| - NAT (RNA positive)
46
Serology for positive HCV chronic infection:
- Anti-HCV for at least 6 motnhs
| - NAT (RNA positive)
47
Most common hepatitis C genotype:
Hep 1A/1B
48
What is pathognomonic for an HCV infection?
Porphyria cutanea tarda
49
Who should you screen for HCV?
All adults 18 -79
50
Treatment for HCV:
Daily oral direct acting antivirals - Expensive and toxicity
51
Two major cofactors that cause the progression of Hep B/C
Immunosuppression and alcohol
52
Serology testing for Hep A:
Hep A IgM: Within 1 week
| Hep A IgG: within 2 weeks (will remain permanent)
53
How can you prevent a Hep A infection?
Give immunoglobulins after exposure within 2 weeks
54
Two most common indications for a PEG/G tube:
- Neuro impaired problems with swallowing
| - Neoplasm in the throat that obstructs the ability to get food down
55
Most common causes for mechanical dysphasia:
- Stricture
- Cancer
- Schatzki
- Zenker's diverticulum
- Web
- Eosinophilic esophagitis
56
Who gets esophageal cancer (epidemiology) and what type?
- 50-70 (men 3x as more)
| - SCC and Adenocarcinoma
57
Who gets SCC and Adenocarcinoma more (racial)?
SCC: Blacks
Adenocarcinoma: Whites
58
Esophageal 2 PE findings:
Lymphadenopathy and anemia
59
How do you treat eosinophilic esophagitis?
Fluticasone 2 buffs BID
60
How do you treat an Esophageal Web?
EGD with dil
61
How do you treat a food impaction? (3)
EMERGENT:
1. EGD with disimpaction
2. Follow up EGD with biopsy 6 weeks later
3. Treat GERD with PPI if present
62
Food impaction can be associated with:
Boerhaave's Syndrome - Spontaneous rupture of the esophagus (can be from vomiting and force)
63
How do you treat esophageal spasm? (3)
- Reduce stress
- Reduce GERD if present (PPI)
- Hyoscyamine (relax muscles)
64
Difference between spasm and achalasia in terms of difficulty with liquids and solids:
Spasm: Liquids are harder
Achalasia: Same
65
What are the two pathologies involved in Achalasia?
- Loss of peristalsis in the lower 1/3
| - Tight LES
66
Three treatments for Achalasia?
- Botox (Short-term only)
- EGD with dilation
- Surgical Myotomy
67
Two main complications of GERD:
- Strictures
| - Barrett's Esoph.
68
Three causes of esophagitis: **Esp. in those that are immunosuppressed*
- Herpes
- CMV
- Candida
69
Diagnosis and Treatment for Boerhaave's:
Dx: Esophagram with gastrograffin
Tx: Surgery
70
After a diagnosis of Barrett's, how often should you get an EGD?
Every three years
71
When should you intervene with Barrett's?
+/- at 6 months but DEF at 3 months
72
Treatment for Barrett's:
PPI indefinitely and other modifications with GERD
73
How do you diagnosis and stage esophageal cancer?
Dx: EGD
Stage: EUS (local), CT (distant mets), or PET (distant mets)
74
Two major risk factors for pancreas problems:
Alcohol and gallstones
75
What are the symptoms of acute pancreatitis? (4):
- LUQ pain with radiation to the back
- Nausea and vomiting
- No rebound rigidity
- Cullens (belly button) or Grey turner (flank bruising)
76
What 4 labs indicated acute pancreatitis?
1. Lipase 3x (gold standard)
2. Elevated Amylase
3. Triglycerides >1000
4. Leukocytosis and ALT elevated (indicate an abscess or biliary involvement)
77
What are three extreme labs in acute pancreatitis that would infer more serious disease?
1. Serum creatinine 1.8 = Necrosis
2. Hypocalcemia under 7 = Tetany
3. Elevated CRP >150 = Necrosis
78
When should you image someone with acute pancreatitis?
3 days after they have been admitted with a CT + IV contrast to look for any complications - imaging is not necessary for the diagnosis
79
When would you use a MRI over a CT with contrast for acute pancreatitis?
If there are stones involved and there could be one impinging on the biliary system - NEVER US
80
What are some complications from acute pancreatitis?
- ileus
- necrosis
- abscess
- ascites
- pseudocysts
- Chronic pancreatitis
- Left pleural effusion - ARDS
81
Treatment for mild or moderate acute pancreatitis (5):
- Admit to hospital
- NPO +/- NG
- Pain control with IV opioids
- Crystalloid IV (lactated ringers)
- Diet: NPO --> Clears --> Low fat
82
Treatment for severe acute pancreatitis (5):
- Admit to the ICU
- NPO
- Lots of fluids and pressers to raise BP
- Imipenum if necrotic pancreatitis
- Surgery if they have significant necrosis
83
What is TIGAR-O:
Epidemiology for chronic pancreatitis:
- Toxic/metabolic
- Idiopathic
- Genetic
- Autoimmune
- Recurrent
- Obstructive
84
Number one risk factor and other risks for chronic pancreatitis:
```
#1: Alcohol
Other: tobacco and high-fat diet
```
85
Late finding of chronic pancreatitis:
Steatorrhea
86
What imaging should you do for chronic pancreatitis?
- ERCP (gold standard) can also get a x-ray and may see calcifications
87
How do you treat the steatorrhea?
Give pancreatic enzymes
88
How do you treat autoimmune chronic pancreatitis?
- Corticosteroids
| - Azathioprine
89
You have an increased incidence for what when you have had chronic pancreatitis (80% after 2 years):
Diabetes Mellitus
90
How can you treat chronic pancreatitis?
- ERCP if strictures and you need to dilate the ducts
| - Surgery or US to drain cysts or abscesses
91
You should refer all chronic pancreatitis patients to:
GI
92
When would you admit someone for chronic pancreatitis? (3):
- Jaundice
- Fever
- Cannot control with meds
93
What labs are elevated with someone that has pancreatic cancer (4)?
- Anemia
- Elevated LFTs
- Glucose (or DM present)
- Mildly elevated pancreatic enzymes
94
What imaging can be done for the dx of pancreatic cancer (3)?
- CT with IV contrast
- MRCP if contrast allergy
- ERCP - double duct sign (diagnostic - dilation of the pancreatic duct and the common bile duct and the tumor is in between)
95
How do you treat pancreatic tumors?
Goal is to cut it out:
- Whipple procedure
- If too large - shrink with gemcitabine or 5-FU about 30% to allow resection
96
Pancreatic cysts and malignancy:
90% are benign - if they are under 2 cm
97
How should you evaluate pancreatic cysts?
Esophageal ultrasound and a fine needle aspiration
98
What vitamins are fat soluble?
DEAK
99
What vitamins are water soluble?
Vitamin B's + C + folate
100
Pellagra is a deficiency in what vitamin? What are the three symptoms?
Deficiency in Vitamin B3 (niacin) - Dermatitis, diarrhea, dementia
101
B vitamins and their names:
```
B1: Thiamine
B2: Riboflavin
B3: Niacin
B6: Pyridoxine
B12: Cobalamin
```
102
Symptoms of vitamin A deficiency: (3)
Night blindness, xerophthalmia, Bitot's spots (on eye)
103
Symptoms of vitamin D deficiency: (2)
Osteomalacia, rickets
104
Symptoms of vitamin E deficiency: (4)
Ataxia, hyporeflexia, loss of proprioception and vibration
105
Symptoms of vitamin K deficiency: (2)
bruising, GI/mucosal bleeding
106
Symptoms of Thiamine (B1) deficiency: (3)
Wernicke's encephalopathy, beriberi
107
Symptoms of cobalamin (B12) deficiency: (4)
Anemia, paresthesias, ataxia, depression
108
Symptoms of riboflavin (B2) and pyridoxine (B6) deficiency: (3)
Glossitis, cheilosis, stomatitis
109
Symptoms of folate deficiency: (2)
anemia, neural tube defects in a fetus
110
How is diarrhea defined in terms of grams/day
200 mL
111
How much fat is in steatorrhea for classification?
7 g
112
Diarrhea is chronic after:
4 weeks
113
Normal stool osmolality is:
290 Osm/kg
114
Secretory (watery) diarrhea is caused by (2):
Infection or microscopic colitis
115
How is microscopic colitis defined (2):
- Collagen (sub epithelial) band
| - Lymphocytic colitis (intraepithelial lymphocytic infiltrate)
116
Microscopic colitis is common in:
Women 65 and older
117
Smoking will ___ membranous colitis and make ____ better
Smoking worsens microscopic colitis and makes ulcerative colitis better
118
What special test would you order with someone that has chronic diarrhea?
Hydrogen breath test - is there small bacteria overgrowth?
119
How long do you collect stool for weight and to assess fat?
- Weight 24 hours
| - Fat 72 hours
120
What diarrhea tends to happen at night?
Secretory
121
Fasting prevents which type of diarrhea from occurring?
Osmotic only
122
Four causes of osmotic diarrhea:
- Carb malabsorption (lactose)
- Short gut syndrome
- Osmotic laxatives
- Factitious (giving themselves laxatives)
123
Four causes of secretory diarrhea:
- Decreased SA to absorb
- Bacterial toxins
- Non-osmotic laxatives
- Neuroendocrine tumors
124
One cause of inflammatory diarrhea?
Infection
125
What are two signs and two causes of malabsorpitive diarrhea?
Signs: wt loss and steatorrhea
| D/t: Celiac, pancreatic insufficiency
126
What are three causes of motility induced diarrhea?
- IBS *** Main
- Hyperthyroidism
- Diabetes (too much sugar)
127
Four meds that can cause diarrhea:
- SSRI
- PPI
- Metformin
- NSAIDS
128
What is the diagnosis and treatment process for microscopic colitis?
- Diagnose with a biopsy from a colonoscopy
| - Treat with no meds (self-limiting) (mild)
129
Where are diverticulum most present and where are they not found?
Present: Sigmoid colon (where blood vessels enter the muscle tissue)
Not present: Rectum (thicker muscle)
130
What do you not do if someone has acute diverticulitis?
A colonoscopy - perforation risk
131
When should you CT someone that has diverticulitis? (5)
- First attack
- Rule out other causes
- Severity staging
- Failed medication treatments
- Immunocompromised
132
What four characteristics make diverticulitis complicated?
- Macro-perforation
- Abscess
- Obstruction
- Fistula
133
Treatment for complicated diverticulitis (4):
1. Admit to hospital
2. IV Abx: Piper/Tazo OR ceftriaxone
3. NPO
4. Surgical/GI consult if not better in 72 hours
134
Treatment for uncomplicated diverticulitis (3):
1. Outpatient
2. Oral ABX: Ciproflox + Metron OR Augmentin
3. NPO
135
Bleeding is a __ finding for colon cancer
Late
136
Most common type of neoplastic adenoma:
Tubular
137
What is a hamargtoma?
Non-neoplastic; disorganized mix of normal cells
138
Epidemiology of colon cancer (race, gender, area, average age of dx)
- Blacks
- Males
- Right sided is more common
- 68 is average Dx
139
Which ethnic group has the highest risk of anyone in the world?
Ash. Jews
140
What are three causes of false + FOBT:
- NSAIDS
- Red meat
- Vitamin C
141
Two main differences between FOBT and FIT (sample number and what is more sensitive):
- FOBT (3 samples) FIT (1 sample)
- FIT is more sensitive (detects hemoglobin) but does not detect upper GI bleeds
* both are rec. annually
142
You need an entire BM for what stool test? This test is more sensitive than ____ testing!
Stool DNA testing *Rec. every 1-3 years and MORE sensitive than FIT
143
What testing is done for people at risk for colonoscopy every 5 years with FIT testing?
Flex sig (looking at the distal 1/3 of the colon) - 75% sensitivity when done together
144
What is recommended as the follow up to any other positive colon test?
A colonoscopy (most sensitive of any tests for detecting neoplasms)
145
A flat mucosa becomes a polyp in __ years and a polyp becomes cancer in __ years
Flat --> Polyp: 5 years
| polyp --> Cancer: 10 years
146
An apple core lesion on a barium enema indicates:
Colon cancer lesion
147
Familial Adenomatous Polyposis genetics, dx and treatment:
- Autosomal dominant - APC gene
- Diagnose at age 39 common
- Treatment - Total colectomy
148
Most common inherited colon cancer and gene defect:
Lynch (HNPCC) - MMR gene
149
What age of onset is Lynch Syndrome? What side are polyps commonly found in?
Age 43 - polyps are seen commonly on the R side
150
If you have Lynch syndrome what are two common other places to get cancer other than the intestines?
1. Endometrium
| 2. Gastric
151
Risk for Colorectal cancer with FAP and Lynch?
FAP: Nearly 100%
Lynch: Nearly 80%
152
What is the 3-2-1 rule for the Amsterdam criteria for Lynch?
3 relatives with Lynch associated cancer
2 generations with Lynch associated cancer
1 person diagnosed before the age of 50
153
When should you start screening for FAP and Lynch?
- FAP: Age 10/12 with flex sig
| - Lynch: Age 20-25 or 10 years younger than the first diagnosed family member
154
A colectomy is not recommended for what type of hereditary cancer?
Lynch - only 10% get colon cancer with proper screening
155
How and when should you screen someone for CC for average risk?
- 45 - 75
| - Screen with visual or blood detecting test (if positive, get colonoscopy)
156
What are options for annual screening if the first test was negative?
Any Annual Fit or FOBT
157
Screening for increased risk individuals begins when and repeats when?
- Screen 10 years earlier than first relative or age 40
| - Screen high risk every 5 years with a colonoscopy
158
If you have inflammatory bowel disease you are at risk for colon cancer, when should you biopsy? (pan colitis vs. left sided only colitis)
- Pancolitis: 8 years after disease onset and 1-2 years after
- Left sided only colitis: 12 years after onset and then 1-2 years after
159
If colorectal cancer is found on a colonoscopy, what two tests do you order next?
- CT
| - CEA (carcinoembryonoic antigen)
160
Prognosis for sated IV metastatic colon caner:
24 months
161
When would you need to start chemo with resection for colon cancer (what stages)?
stages III and IV (stage III is when lymph nodes become involved)
162
Who gets hemorrhoids? (Race, age, SES)?
White, 45-65, high SES
163
When can you relieve and cut open a thromboses hemorrhoid?
Within 48 - 72 hours of onset (VERY PAINFUL)
164
What are three reasons you can get an anal fissure?
- Trauma (sex, objects, pooping)
- Immunosuppressives (HIV, TB, Crohn's)
- If your anal tone is too tight
165
How do perianal abscess and fistulae differ? (Feeling, pain and associated?)
- Abscess: Constant pain; fistulae is intermittent
- Abscess feels boggy; fistulae will drain blood and pus
- Abscess associated with fever and const. sx; Fistulae is associated with pruritus ani
166
How do you treat an abscess and fistulae?
Abscess: I and D, Cipro + Flagyl
Fistulae: Surgery
167
What is a rectocele?
Posterior vaginal wall defect leads to an anterior protrusion of the rectum
168
How do you want to view a gastric ulcer and when do you F/U?
Screen with an EGD and follow up in 6-8 weeks to make sure it is not cancer
169
To look for H. Pylori, what is the most sensitive test?
H. Pylori stool antigen
170
What is the first line triple therapy with PCN allergy consideration for H. Pylori and peptic ulcers?
PPI + Clarithromycin + Amox. (If allergy - swap for flagyl)
171
What is first line quadruple therapy for H. Pylori?
PPI + Bismuth + Metron. + Tetracycline
172
What is the number one common thing that is a GI anomaly?
Meckel's Dicverticulum
173
What are the common presentations for Meckel's diverticulum (gastric mucosa in the small bowel)?
- Kids: Currant jelly stool
| - Adults: Obstruction
174
Most common type of cancer world wide:
Gastric adenocarcinoma
175
Risk factor for gastric adenocarcinoma and risk:
H. Pylori (x20) and smoking and diet
176
What is the most common cause of chronic dyspepsia and what kind of problem is it?
Non-ulcer dyspepsia - it is a functional problem (could be meds, diet, H. Pylori, diabetic emptying)
177
What drugs (3) could you try for someone with Non-ulcer dyspepsia?
- PPI
- Anti-spasmotic
- Low dose TCA
178
Someone with a history of gastric surgery has risk for developing what gastric disorder? How is it treated?
Dumping:
| Treat with high protein, low fat, laying down after meals and drinking only a little bit of water
179
There are many things that can cause gastroparesis, what are 5?
- Commonly follows a viral infection
- Diabetes - hx of 10 years with peripheral neuropathy
- Drugs: Anti-cholinergics and narcotics
- Hypothyroidism
- Vagal nerve lesion/CNS lesions (parkinson's)
180
What are three medications for gastroparesis to speed things up?
1. Metoclopramide
2. Erythromycin
3. Domperidone
181
What is the gold standard study for gastroparesis? What is a positive diagnosis with this scan?
Gastric emptying study - NM scan (diagnostic when more than 60% of the meal is in the stomach after 2 hours)
182
What percentage of GI bleeds are upper and who gets them more?
80% are upper and men get them more (2X)
183
Upper GI bleed Vs. lower GI bleed stool findings:
Upper: Melena or vomiting blood
Lower: Hematochezia or bright red blood per rectum
184
When assessing an upper GI bleed what are the two steps?
1. Assess their hemodynamic stability
| 2. EGD (Therapy and diagnostic)
185
What lab will be elevated if there is a GI bleed?
BUN - nitrogenous waste
186
What do you use to measure blood in vomit?
Gastroccult
187
What is angiodysplasia (commonly occurs with and treatment)?
- Angiodysplasia (in the small bowel)
- Commonly occurs with aortic stenosis and Von Wille
- Treat with cautery
188
Mallory weiss tear treatment and common in?
Treat with injection or coagulation if active bleeding; common in younger people that are vomiting a lot (tear in the submucosa vino-arterial distal esophagus)
189
What side colon blood is darker?
Right
190
Angiography needs a blood leak of what to detect for an active bleed? What does RBC scan need?
Angiography: 1 mL/min
| RBC 0.1 mL/min
191
What are the three reasons you should operate when someone has a lower GI bleed?
1. Continual hematochezia
2. Recurrent bleeding from the same place
3. Lower GI malignancy
192
What is pathognomonic for Crohn's?
Granulomas
193
Bloody diarrhea is seen in what inflammatory bowel disease?
Ulcerative colitis
194
Skipped lesions are in what inflammatory bowel disease?
Crohn's
195
Mild disease treatment for Crohn's:
- Aminosalicylates
- Budenoside
- Abx
196
Moderate treatment for Crohn's:
- Steroids
- Immunomodulators
- Surgery
197
Severe treatment for Crohn's:
- Anti-TNF
| - Surgery
198
What immune tests are ordered for Alcoholism in liver disease?
IgA
199
What immune tests are ordered for Autoimmune disease in liver/
IgM and IgG
200
When should you biopsy the liver?
ALT x3 the upper normal limit for 6 months
201
What two things would mean you should NOT biopsy:
1. INR >1.6
| 2. <70K thrombocytopenia
202
When UNCONJUGATED bilirubin is elevated, what should you think of first?
Hemolysis - order a CBC reflex
203
What are the four causes of an AST/ALT over 500?
- Acute viral hep
- Autoimmune
- Medication induced
- Shock liver (trauma/transplant)
204
Dark urine and acholic stool in someone with liver disease most likely has:
Alcoholic Hepatitis
205
What two medications can you use to treat severe Alcoholic hepatitis for 30 days?
- Prednisolone
| - Pentoxifylline
206
When is a liver biopsy the gold standard?
For NAFLD
207
What do you use to treat NASH?
Vitamin E and Plog
208
What is the epidemiology and genetics of Hemochromatosis?
Younger men, older women - Autosomal recessive
209
What do you use to treat fulminant liver failure (D/T Tylenol?
N-Acetylcysteine
210
Are statins safe with high AST/ALT?
Yes
211
#1 scan to do for biliary disease:
Ultrasound
212
What does a HIDA scan measure?
The gallbladder contraction stimulated with CCK and the emptying with dye
213
What is the number 1 risk for an ERCP?
Pancreatitis
214
At what size should you remove gallstones?
Above 3 cm
215
Who is at risk for gallstones?
American Indian Fat women over 40
