Upper GI

Question 1

Meds that worsen GERD

Answer 1

tetracycline
bisphosp
NSAID
CCB, anticholinergic, BB

Question 2

GERD clinical sx

Answer 2

MC heartburn worse after meals; regurgitation, dysphagia

Question 3

GERD dx

Answer 3

H&P, endoscopy for epithelial damage

*>45 yo, endoscopy

Question 4

Important test to do to distinguish GERD from something else

Answer 4

EKG (atypical MI)

Question 5

GERD tx

Answer 5

antacid, H2 blocker

*PPI if unresponsive to H2 blocker

Question 6

large deep ulcers in esophagus - what infection?

Answer 6

CMV

Question 7

multiple shallow ulcers in esphagous?

Answer 7

HSV

Question 8

infectious esophagitis clinical sx

Answer 8

dysphagia, odynophagia

Question 9

What is Zencker diverticulum?

Answer 9

outpouched posterior hypopharynx

Question 10

What is achalasia?

Answer 10

Smooth muscle of esophagus fails to relax, food stuck

Question 11

Characteristic imaging finding of achalasia?

Answer 11

parrot beak on barium swallow

Question 12

Type of Ca that arises from Barretts?

Answer 12

adenocarcinoma (squamos > columnar)

Question 13

Why would you want to avoid BB, benzos, CCB, nitrate in pt w/ GERD?

Answer 13

Lower sphincter tone

Question 14

Progressive dysphagia + wt loss - what dx are you thinking

Answer 14

esophageal Ca

Question 15

Tx for a Mallory Weiss tear

Answer 15

Most self resolve but endoscopic thermal coag if not’ avoid PPI until bleeding stops

Question 16

What is Budd-Chiari?

Answer 16

hepatic vein thrombosis

Question 17

Budd Chiari clinical manifestation

Answer 17

ascites, hptomegaly

Question 18

Budd Chiari etiology

Answer 18

hypercoag state (polycythemia, HCC,

Question 19

Budd Chiari tx

Answer 19

Drain ascites, anticoagulate/thrombolyse

Question 20

Budd Chiari labs

Answer 20

LFT high initially w/ low albumin, become more normal as the liver scars…

Question 21

MC cause of cirrhosis in US?

Answer 21

Hep C and ASH

Question 22

What’s “cardiac cirrhosis”?

Answer 22

R heart failure/cor pulmonale; causes chronic hepatic congestion

Question 23

What are Mallory bodies ?

Answer 23

Damaged intermediate filaments seen in stetohepatitis?

Question 24

MC micronodular cirrhosis

MC macronodular cirrhosis

Answer 24

micro - EtOH

macro - viral hepatitis

Question 25

Dx of viral hepatitis?

Answer 25

Bx w/ mononuclear protal infiltrate, HC necrosis, progressive fibrosis

Question 26

Hepatitis etiologies

Answer 26

Viral>autoimmune>drug>metabolic dz

Question 27

What Vitamin can cause chronic liver dz?

Answer 27

Vitamin A

Question 28

Ground glass hepatocytes are associated w/ what dz?

Answer 28

Hep B

Question 29

Lymphoid aggregates and fatty changes in the liver are associated with what?

Answer 29

Hep C

Question 30

Eisinophil + plasma cell in liver associated w what?

Answer 30

drug toxicity hep

Question 31

Plasma cell in liver associated w what dz?

Answer 31

autoimmune hep

Question 32

What does hepcidin do?

Answer 32

Blocks Fe uptake from intestine to liver? | Lack of it = hemochromatosis

Question 33

Hemochromatosis epi?

Answer 33

Middle aged males?

Question 34

What's bronze DM?

Answer 34

Fe in pancreas and skin; sign of hemochromatosis

Question 35

C287 gene mutation associated w/ what dz

Answer 35

primary hemochromatosis

Question 36

how are 1 hmctosis and 2 hmctosis different?

Answer 36

primary - no hepcidin | 2nd - exceed macrophage capacity

Question 37

What are Kay-Fleisher rings

Answer 37

ring around iris - Copper deposit from Wilson's dz

Question 38

Wilsons tx:

Answer 38

chelation, avoid Copper foods, transplant

Question 39

Congential dz causing neonatal hepatitis, young adult cirrhosis

Answer 39

alpha-1 antitrypsin deficiency

Question 40

alpha AT def pathogensis

Answer 40

- no proteinase inhibitor released, hepatocytes accumulate protein, proteinase induces tissue injury

Question 41

tx: alpha AT

Answer 41

stop smoking | liver transplant curative

Question 42

PAS resistant stain associated w/ what dz?

Answer 42

Alpha AT def

Question 43

Non-caseating liver granulomas

Answer 43

M. tuberculosis

Question 44

How would you expect cholesterol to change in ESLD?

Answer 44

decrease (liver synthesis)

Question 45

Antimitochondiral antibody (AMA) is + in

Answer 45

primary biliary cirrhosis

Question 46

Primary biliary cirrhosis epi

Answer 46

F:M is 9:1 | 50-60yo

Question 47

Primary sclerosing chloangitis epi

Answer 47

M:F is 2:1 30-60yo IBD

Question 48

Onion skin fibrosis classic ducing of

Answer 48

primary sclerosing cholangitis

Question 49

dx: primary sclerosing cholangitis

Answer 49

imaging

Question 50

dx: primary biliary cirrhosis

Answer 50

liver bx + AMA

Question 51

tx: PBC and PSC

Answer 51

ADEK supp ursodeoxycholic acid cholestyramine + opiate antagonist for pruritis

Question 52

Risk factors for HCC

Answer 52

Hep B and C NASH, hctosis, trosinosis aflatoxin (p53 inducer)

Question 53

tx: HCC

Answer 53

transplant or resection if <5cm

Question 54

Stellate cells physiologic function

Answer 54

storage of vitamin A

Question 55

what 3 "liver function" tests are not released when any cell in the body is damaged?

Answer 55

PT* albumin bilirubin

Question 56

tender h-megaly, flu, jaundice - suspected dx?

Answer 56

acute hep

Question 57

firm liver, stigmata of liver dz (jaundice, bruising, asterixis)

Answer 57

chronic hep

Question 58

jaundice, flu-like, dark urine, pale stool

Answer 58

acute cholestasis

Question 59

jaundice, lipid deposites, dark urine, pale stool

Answer 59

chronic cholestasis

Question 60

unconjugated elevated bili

Answer 60

neonates hemolysis ineffective erythropoesis

Question 61

whats crigler najar type I

Answer 61

dz where the UDPG conjugating enzyme has no activity

Question 62

are AST and ALT more elevated in hepatitis or w obstruction

Answer 62

hepatitis (10-40x UNL) | obstruction is 3-20x

Question 63

dx: liver obstruction

Answer 63

US

Question 64

esophageal varices ppx

Answer 64

beta blocker (propranlol), EGD to band large varcies

Question 65

what is a lab abnormality seen d/t splenomegaly for portal HTN

Answer 65

thrombocytopenia | anemia

Question 66

med to stop for ascites tx?

Answer 66

NSAID (they decrease PG, which decreases RBF, and causes Na retention) also, aminoglycosides

Question 67

what is hepatorenal syndrome?

Answer 67

cirrhosis/ascites leading to renal failure that is unresponsive to volume expansion and diuresis

Question 68

tx : hepatorenal syndrome:

Answer 68

TIPS or liver transplant

Question 69

new onset ascites - something you have to do to tx?

Answer 69

tap - r/o perotinitis (SBP spontaneous bacterial perotionitis)

Question 70

SBP tx

Answer 70

IV broad spectrum abx

Question 71

what's the child's pugh score

Answer 71

judges severity of cirrhosis - encephalopathy - ascites - bili - albumin - PT

Question 72

whats the MELD score

Answer 72

``` judges ESLiverDz - creatinine - bili - INR (higher score means less time to live) ```

Question 73

CI to OLT (orthoptic liver transplant)

Answer 73

AIDS (not HIV) systemic infection severe cardiopulm dz metastic malignancy

Question 74

Hep A in stool - how many weeks post infection

Answer 74

1-6

Question 75

Hep A - which peaks first IGG, IGM, ALT

Answer 75

ALT - resolved in 2 mo IgM high for 3ish mo,then drops IgG increases from week 2

Question 76

feathery degenetration, bile infarcts, bile lakes, bile duct plugs are pathologic changes for

Answer 76

extrahepatic obstruction