Uworld GI Flashcards by Michael Salgado

liver cyst with egg-shell calcifications? Cause?

Hydatid cyst. Ecchinococcus. From dogs.

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Class of drugs for nausea?

5HT antagonists

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Treatment of a patient with Hepatic encephalopathy?

Treat precipitant
Lactulose (decreases ammonia levels)
Antibiotics (neomycin and rufaximin) to decrease ammonia-producing bacteria in colon

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Aspiration of amoebic liver abscess would show? Dx by? Treatment?

Sterile abscess – diagnose by stool examination for trophozoites. Metronidazole

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All patients with cirrhosis should be screened for? Prophylaxis?

Esophageal varices by endoscopy. Beta blockers

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When to drain pancreatic pseudocyst?

Size >5 cm, lasts longer than six weeks, secondarily infected

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Single most important test to assess liver function?

PT (acute rise can suggest Fulminant liver failure)

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Extrahepatic findings with drug-induced liver injury? Exception?

Rash, arthralgias, fever, leukocytosis, eosinophilia

Exception: isoniazid (hepatitis without extrahepatic manifestations)

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Types of drug-induced liver disease?

Cholestasis (chlorpromazine, nitrofurantoin, erythromycin, anabolic steroids)
Fatty liver (tetracycline, valproate, antiretrovirals)
Hepatitis (halothane, phenytoin, Isoniazid, Alpha-methyldopa)
Fulminant liver failure (acetaminophen, Carbon tetrachloride)
Granuloma (allopurinol, phenylbutazone)

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Effects of oral contraceptives on liver?

Abnormal liver function tests without evidence of necrosis or fatty change

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Fulminant liver failure definition? Caused by?

Hepatic encephalopathy (confusion) that develops within 8 weeks of acute liver failure

Acetaminophen, alcohol, amphetamines, hepatitis B/D

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Symptoms of Wilson’s disease?

Liver: hepatomegaly, elevated liver enzymes

Neuro: resting tremor, muscular rigidity, drooling?

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Criteria for Toxic megacolon?

Radiologic findings

with 3 of: fever, HR>120, leukocytosis>10,500, anemia

with 1 of: altered MS, hypoNa, hypotension, electrolyte disturbances

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Melanosis coli?

Dark discoloration of the colon with patches of lymph follicles. Due to diuretic abuse

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Tests for dysphagia (in order?)

Barium Esophagram
Endoscopy
Motility Studies

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Drugs that cause Pancreatitis if pt has: volume overload? IBD? Immunosupressants? Seziures? Infection?

furosemide, thiazides
Sulfasalazine, 5-ASA
azothioprine, L-asparaginase
Valproic acid
Metronidazole, tetracycline

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Deficiency of Zinc causes?

alopecia, abnormal taste, blisters

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Constant burning pain with intense pain with light touch to the abdomen with other signs?

HZV

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Drugs that cause esophagitis?

KCl, Fe, Quinine
tetracyclines
NSAIDs
Bisphosphonates

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Types of polyps and risk of cancer?

hyperplastic - no risk
hamartomatous - small risk
adenoma - largest risk (esp is villous)

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Scleroderma - effect of ESO?

incompetency of LES over time

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How to diagnose chronic pancreatitis?

CT scan shows calcifications of the pancreas

lipase and amylase NOT diagnostic

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Pt with UC: regular surveillance only really beneficial if looking for? Other complications?

ColonCA

(doesn’t help for other complications: toxic megacolon, sclerosing colangitis, uveitis, erythema nodosum, spondyloarthropathy)

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Best test for C diff?

Stool cytotoxin assays, NOT stool cultures

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Ischemic colitis - symptoms? affects what areas of the colon?

acute abdominal pain followed by diarrhea Watershed areas: splenic flexure and recto-sigmoid junction

Zollinger-Ellison syndrome causes fat malabsorption because?

increased acid neutralizes lipase

pt with chronic abdominal pain, weight loss, and food avoidance with no specific findings on PE - think? Test by?

Mesenteric ischemia. Dopplers

Test for lactose intolerance?

1. positive H-breath test 2. increased stool osmotic gap 3. Reducing substances in stool

Hepatorenal syndrome? tx?

portal HTN leads to formation of NO, which dilates vessels, leading to decreased BP and renal hypoperfusion Midodrine and octreotide

Medical treatment used to dissolve gallstones in individuals who are Symptomatic but poor surgical candidates?

Ursodeoxycholic acid

Tx options for gallstones?

If asymptomatic, do nothing If low risk or have acute cholecystitis or porcelain gallbladder do laparoscopic cholecystectomy If high-risk, use ursodeoxycholic acid (to dissolve) or shock-wave lithotripsy

Hepatic hydrothorax?

Pleural effusions due to cirrhosis or liver disease (not due to underlying cardiac or pulmonary problem)

Treatments for hepatic hydrothorax?

1. Liver transplant 2. Thoracentesis followed by salt restriction and diuretics 3. Transjugular intrahepatic portosystemic shunt (TIPS)

Emphysematous cholecystitis? Caused by?

Form of acute cholecystitis due to infection by gas forming bacteria (SPECKS - Clostridium, E. coli, staph, Streptococcus, Pseudomonas, Klebsiella)

Treatment for emphysematous cholecystitis?

Fluid resuscitation, cholecystectomy, parenteral antibiotic therapy

Mechanism of non-alcoholic fatty liver disease?

Insulin resistance leads to increased fatty acid oxidation, which leads to increased oxidative stress, resulting in proinflammatory cytokines causing inflammation, fibrosis, cirrhosis

Disease that can cause an aversion to smoking?

Hepatitis A

Pathogenic factors involved in the development of hepatic encephalopathy?

1. Ammonia accumulation 2. Production of false neurotransmitters 3. Increased GABA sensitivity 4. Zinc deficiency

Treatment of acute cholangitis?

1. Broad-spectrum antibiotics and supportive care | 2 If no response, ERCP

Acute pancreatitis: when to do abdominal CT scan?

In patients with clinical findings suggestive of pancreatitis but fail to improve with conservative treatment

Patient with newly diagnosed hepatitis C. Should receive?

Vaccinations against hepatitis A and B if not already immune Treat with interferon-alfa and ribavirin unless pregnant

Shock liver?

Ischemic hepatopathy from shock leads to a massive increase in transaminases, and smaller increases and bilirubin and alkaline phosphatase.

Evaluations of patients with acute versus chronic hepatitis?

Liver function tests and viral serology versus liver biopsy

Causes of acalculous cholecystitis?

Gallbladder inflammation in the absence of gallstones 1. Burns 2. Trauma 3. prolonged TPN 4. prolonged fasting 5. mechanical ventilation

Paroxysmal nocturnal hemoglobinuria cause? Leads to?

Abnormal GP1(prohibits binding of CD 55 and CD 59 which inhibit RBC destruction). Leads to intravascular hemolytic anemia and hepatic vein thrombosis.

Bilirubinuria suggests and increase in?

Conjugated hyperbilirubinemia

Tranfusion threshold?

7 in normal pt | 10 in pt with cardiac dz

Angiodysplasia is commonly seen in patients with?

Aortic stenosis or end stage renal disease

Vessels in Mallory Weiss tears versus variceal tears?

Submucosal arteries versus submucosal veins

Biopsy findings in: 1. Ischemic colitis 2. IBD

1. Epithelial necrosis | 2. Neutrophilic cryptitis

Steps to treat ascites?

1. Sonja at water restriction 2. Spironolactone 3. Loop diuretic 4. Paracentesis

Patient with enlarged, non-tender gallbladder with evidence of biliary obstruction?

Pancreatic cancer

Treatment for patients with small non-bleeding varices?

Non-selective beta blockers (propanolol, nadolol) to reduce progression to large varices

VIPoma location? Symptoms?

"Pancreatic cholera" Head of the pancreas. Diarrhea and hypoK

Glucagonoma presents with?

1. Necrotizing dermatitis 2. Weight loss 3. Anemia 4. Hyperglycemia

Cullen Sign? Grey-Turner sign?

Both seen in pancreatitis Periumbilical bluish coloration indicating hemopericardium Reddish brown coloration around flanks indicating retroperitoneal bleed

Clues to inflammatory diarrhea?

Weight loss Anemia Reactive thrombocytosis Elevated ESR

Extra pancreatic complications of pancreatitis?

Plural effusion Ileus ARDs Renal failure

G.I. pathology that is alleviated by nitroglycerin? Test?

Diffuse esophageal spasm. Manometry

Manometry shows absent peristaltic waves in lower ESO and absent LES?

Scleroderma

Chlamydia vs gonorrhea?

Mucopurulent discharge, absent bacteriuria vs purulent and gram-staining

Lengthy history of OCP increases chance of?

Hepatic adenoma

Gastric pain alleviated by nitrates? Test to confirm?

Diffuse esophageal spasm; motility studies

Initial treatment for anal fistulas?

Stool softeners

Non-transaminase signs of alcoholic hepatitis?

``` #Elevated GGT #Elevated Billy Rubin #Elevated INR #Neutrophil predominant leukocytosis ```

Early test patient with newly diagnosed hepatitis C?

Liver biopsy – for prognosis and likely response to therapy

Infection that affects liver and kidney?

Cryoglobulinemia from hepatitis

yellow red papules on arms and shoulders?

Xanthomas

D-xylose test assesses for?

Celiac's

+ Anti-mitochondrial bodies? Symptoms without positive anti-mitochondrial antibodies?

Primary sclerosing cholangitis Malignant biliary stricture

Acute erosive gastritis? Seen with intake if?

Severe hemorrhagic erosive lesions after exposure to substances (large doses of aspirin)