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Clin Med > Upper GI > Flashcards

Upper GI Flashcards

1
Q

Meds that worsen GERD

A

tetracycline
bisphosp
NSAID
CCB, anticholinergic, BB

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2
Q

GERD clinical sx

A

MC heartburn worse after meals; regurgitation, dysphagia

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3
Q

GERD dx

A

H&P, endoscopy for epithelial damage

*>45 yo, endoscopy

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4
Q

Important test to do to distinguish GERD from something else

A

EKG (atypical MI)

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5
Q

GERD tx

A

antacid, H2 blocker

*PPI if unresponsive to H2 blocker

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6
Q

large deep ulcers in esophagus - what infection?

A

CMV

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7
Q

multiple shallow ulcers in esphagous?

A

HSV

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8
Q

infectious esophagitis clinical sx

A

dysphagia, odynophagia

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9
Q

What is Zencker diverticulum?

A

outpouched posterior hypopharynx

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10
Q

What is achalasia?

A

Smooth muscle of esophagus fails to relax, food stuck

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11
Q

Characteristic imaging finding of achalasia?

A

parrot beak on barium swallow

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12
Q

Type of Ca that arises from Barretts?

A

adenocarcinoma (squamos > columnar)

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13
Q

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

A

Lower sphincter tone

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14
Q

Progressive dysphagia + wt loss - what dx are you thinking

A

esophageal Ca

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15
Q

Tx for a Mallory Weiss tear

A

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

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16
Q

What is Budd-Chiari?

A

hepatic vein thrombosis

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17
Q

Budd Chiari clinical manifestation

A

ascites, hptomegaly

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18
Q

Budd Chiari etiology

A

hypercoag state (polycythemia, HCC,

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19
Q

Budd Chiari tx

A

Drain ascites, anticoagulate/thrombolyse

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20
Q

Budd Chiari labs

A

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

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21
Q

MC cause of cirrhosis in US?

A

Hep C and ASH

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22
Q

What’s “cardiac cirrhosis”?

A

R heart failure/cor pulmonale; causes chronic hepatic congestion

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23
Q

What are Mallory bodies ?

A

Damaged intermediate filaments seen in stetohepatitis?

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24
Q

MC micronodular cirrhosis

MC macronodular cirrhosis

A

micro - EtOH

macro - viral hepatitis

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25
Q

Dx of viral hepatitis?

A

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

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26
Q

Hepatitis etiologies

A

Viral>autoimmune>drug>metabolic dz

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27
Q

What Vitamin can cause chronic liver dz?

A

Vitamin A

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28
Q

Ground glass hepatocytes are associated w/ what dz?

A

Hep B

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29
Q

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

A

Hep C

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30
Q

Eisinophil + plasma cell in liver associated w what?

A

drug toxicity hep

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31
Q

Plasma cell in liver associated w what dz?

A

autoimmune hep

32
Q

What does hepcidin do?

A

Blocks Fe uptake from intestine to liver?

Lack of it = hemochromatosis

33
Q

Hemochromatosis epi?

A

Middle aged males?

34
Q

What’s bronze DM?

A

Fe in pancreas and skin; sign of hemochromatosis

35
Q

C287 gene mutation associated w/ what dz

A

primary hemochromatosis

36
Q

how are 1 hmctosis and 2 hmctosis different?

A

primary - no hepcidin

2nd - exceed macrophage capacity

37
Q

What are Kay-Fleisher rings

A

ring around iris - Copper deposit from Wilson’s dz

38
Q

Wilsons tx:

A

chelation, avoid Copper foods, transplant

39
Q

Congential dz causing neonatal hepatitis, young adult cirrhosis

A

alpha-1 antitrypsin deficiency

40
Q

alpha AT def pathogensis

A
  • no proteinase inhibitor released, hepatocytes accumulate protein, proteinase induces tissue injury
41
Q

tx: alpha AT

A

stop smoking

liver transplant curative

42
Q

PAS resistant stain associated w/ what dz?

A

Alpha AT def

43
Q

Non-caseating liver granulomas

A

M. tuberculosis

44
Q

How would you expect cholesterol to change in ESLD?

A

decrease (liver synthesis)

45
Q

Antimitochondiral antibody (AMA) is + in

A

primary biliary cirrhosis

46
Q

Primary biliary cirrhosis epi

A

F:M is 9:1

50-60yo

47
Q

Primary sclerosing chloangitis epi

A

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

48
Q

Onion skin fibrosis classic ducing of

A

primary sclerosing cholangitis

49
Q

dx: primary sclerosing cholangitis

A

imaging

50
Q

dx: primary biliary cirrhosis

A

liver bx + AMA

51
Q

tx: PBC and PSC

A

ADEK supp
ursodeoxycholic acid
cholestyramine + opiate antagonist for pruritis

52
Q

Risk factors for HCC

A

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

53
Q

tx: HCC

A

transplant or resection if <5cm

54
Q

Stellate cells physiologic function

A

storage of vitamin A

55
Q

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

A

PT*
albumin
bilirubin

56
Q

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

A

acute hep

57
Q

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

A

chronic hep

58
Q

jaundice, flu-like, dark urine, pale stool

A

acute cholestasis

59
Q

jaundice, lipid deposites, dark urine, pale stool

A

chronic cholestasis

60
Q

unconjugated elevated bili

A

neonates
hemolysis
ineffective erythropoesis

61
Q

whats crigler najar type I

A

dz where the UDPG conjugating enzyme has no activity

62
Q

are AST and ALT more elevated in hepatitis or w obstruction

A

hepatitis (10-40x UNL)

obstruction is 3-20x

63
Q

dx: liver obstruction

A

US

64
Q

esophageal varices ppx

A

beta blocker (propranlol), EGD to band large varcies

65
Q

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

A

thrombocytopenia

anemia

66
Q

med to stop for ascites tx?

A

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

also, aminoglycosides

67
Q

what is hepatorenal syndrome?

A

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

68
Q

tx : hepatorenal syndrome:

A

TIPS or liver transplant

69
Q

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

A

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

70
Q

SBP tx

A

IV broad spectrum abx

71
Q

what’s the child’s pugh score

A

judges severity of cirrhosis

  • encephalopathy
  • ascites
  • bili
  • albumin
  • PT
72
Q

whats the MELD score

A 
judges ESLiverDz
- creatinine
- bili
- INR 
(higher score means less time to live)
73
Q

CI to OLT (orthoptic liver transplant)

A

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

74
Q

Hep A in stool - how many weeks post infection

A

1-6

75
Q

Hep A - which peaks first IGG, IGM, ALT

A

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

76
Q

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

A

extrahepatic obstruction

Clin Med (12 decks)

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