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Step 1 12.22.12

GI IV

QuestionAnswer
What is the pathophysiology of secondary biliary cirrhosis? extrahepatic biliary obstruction(gallstone, stricture, chronic pancreatitis, carcinoma of pancreatic head)---> incr pressure in intrahepatic ducts-->injury/fibrosis and bile stasis
What is the presentation of primary,secondary biliary cirrhosis and primary sclerosisng cholangitis? pruritis, jaundice, dark urine, light stool, hepatosplenomegaly
What labs are seen in primary,secondary biliary cirrhosis and primary sclerosisng cholangitis? incr conjugated bilirubin, incr cholesterol, incr alkaline phosphatase
What condition might complicate a secondary biliary cirrhosis? ascending cholangitis
What is a key lab finidng in primary biliary cirrhosis compared to other biliary disease? incr in serum mitochondrial Ab, including IgM
What are some things associated with primary biliary cirrhosis ? AID: CREST, rheumatoid, arthritis, celiac disease
What is a key lab finding that can set primary sclerosing colangitis apart from the other biliary disease? hypergammaglobulinemia (IgM)
What is primary sclerosing cholangitis associated with? What can it lead to ? associated with ulcerative colitis. can lead to secondary biliary cirrhosis
What types of things cause gallstones (cholelithiasis)? incr cholesterol/bilirubin, decr bile salts, gallbladder stasis
What are the major RF for gallstones? 4 F's: Female, Fat, Fertile (pregnant), forty
How does cholangitis present? Charcot's triad: jaundice, fever ,RUQ pain
What is a positive Murphy's sign? inspiratory arrrest on deep palpation due to pain
What are the 2 types of gallstones and what are their general characterisitics? 1. Cholesterol stones: radiolucent with 10-20% opaque. 80%. 1. Pigment Stones: radiopaque, 20% of stones
What are the major things associated with getting cholesterol gallstones? obesity, Crohn's, cystic fibrosis, advanced age, clofibrate, estrogens, multiparity, rapid weight loss, Native americans
What are the major things associated with pigment gallstones? seen in patients with chronic hemolysis, EtOH cirrhosis, advanced age, biliary infection. Balck=hemolysis. Brown= infection
What is biliary colic? obstruction of common bile duct by gallstone causes bile duct contraction. can present without pain
Where might a gallstone cause a fistula>? b/w gallbladder and small intestine leading to air in the biliary tree, if it obstructs the ileocecal valve, can see air in biliary tree on imaging
How do you Dx and Tx gallstones? Dx: radionuclotide biliary scan, US. Tx: cholestetectomy
What is and what can cause cholecystitis? inflammtion. from gallstones or rarely ischemia or infectious (CMV)
What happens in cholecystits if the bile duct becomes invovled (ascending cholecystitis)? incr in alkaline phosphatase
What is the pathophys of acute pancreatitis? autodigestion of pancreas by pancratic enzymes
What is a mnemonic for the causes of acute pancreatitis? GET SMASHED: gallstones, ethanol, trauma, steroids, mumps, AID,. scorpion sting, hypercalcemia/hypertriglyceridemia, ECRP, Drugs ( esp sulfa)
What is the clinical presentation of acute pancreatitis? epigastric abdominal pain radiating to the back, anorexia, nausea
What labs are seen in acute pancreatitis? elevated amylase, lipase (more specific)
What can acute pancreatitis lead to? DIC, ARDS, diffuse fat necrosis, hypocalcemia (Ca++ collects in pancreatic soap deposits), pseudocysts formation, hemmorrhage, infection, m ultiorgan failure
What is a strong association with chronic pancreatitis? alcoholism, smoking
What can chronic pancreatitis lead to? pancreatic insufficeincy, steatorrhea, fat soluable vitamin deficiency, DM, incr risk of pancreatic adenocarcinoma
What is the prognosis of pancreatic adenocarcinoma? Where does it happen most often? < 6 months, very aggressive, usually already metastsized at presentation. Most common in pancreatic head causing obstructive jaundice.
What are 2 tumor markers for pancreatic adenocarcinoma? CA 19-9, CEA (less specific)
What are some major RF for pancreatic adenocarcinoma? 1. Tobacco use (not EtOH) 2. Chronic pancreatitis (esp>20 years) 3. Age >50 4. Jewish and AA males
What are some ways a pancreatic adenocarcinoma might present? 1. abdominal pain radiating to the back 2. weight loss )due to malabsorbtion and annorexia) 3. migratory thrombophlebitis- redness and tenderness onm palpation of extermities ( Trousseau's syndrome). 4. obstructive jauncdice with palpable gallbladder
What is Courvoisier's sign? obstructive jauncide with palpable gallbladder associated with pancreatic adenocarcinoma
What is the class of cimetidine, ranitidine, famotidine, nizatidine? H2 blockers, take them before you DINE
What is the mech of cimetidine, ranitidine, famotidine, nizatidine? reversible block of histamine H2 receptors-->decr H+ secretion by parietal cells
What is the clinical use of cimetidine, ranitidine, famotidine, nizatidine? peptic ulcer, gastritis, esophageal reflux
What are the major SE of cimetidine? potents inhibitor of P450, anti adronergic effects (prolactin release, gynecomastia, impotence, decr libido) can cross BBB causing confusion and dizziness, HA. crosses placenta
What is a major SE shared by both cimetidine and rimetidine? decr renal excretion of creatinine
What is the class of omeprazole, lansoprazole? proton pump inhibitors (PPI)
What is the mech of omeprazole, lansoprazole? irreversibly inhibits H+/K+ ATPase in stomach parietal cells
What is the use of omeprazole, lansoprazole? peptic ulcer, gastritis, esophageal reflux, Zollinger-Ellison syndrome
What is the mech of Bismuth, sucralfate? bind to ulcer base, provide physical protection, allow HCO# secretion to reestablish pH gradient iin the mucous layer
What is the clinical use of Bismuth, sucralfate? incr ulcer healing, traveler's diarrhea
What is the mech of misoprostol? PGE1 analog. incr production and secretion of gastric mucous barrier, decr acid production
What is the clinical use of misoprostol? prevention of NSAID-induced peptic ulcers; mainenece of patent ductus arteriosus, also used to induce labor
What are the major SE of misprostol? diarrhea, contraI in women of childbearing potential (abortafacient)
What is the mech of octreotide? long acting somatostatin analog
What is the cinical use of octreotide? acute variceal bleeds, acromegally, VIPoma, carcinoid tumors
What are the major SE of octreotide? nausea, cramps, steatorrhea
What effect on drug absorbtion might antacids have? can affect absorbtion, bioavailabilty, urinary excretion of other drugs by altering gastric and urinary pH or delaying gastric emptying
What can overuse of aluminum hydroxide antacid cause? constipation, hypophosphatemia, proximal muscle weakness, osteodystrophy, seizures
What can overuse of magnesium hydroxide antacid cause? diarrhea, hyporeflexia, hypotension, cardiac arrest
What can overuse of calcium carbonate antacid cause? hypercalcemia, incr in acid rebound
What is a common SE of all antacids? hypokalemia
What is the class of magnesium hydroxide, magnesium citrate, polyethylene glycol, lactulose? osmotic laxitives
What is the mech of magnesium hydroxide, magnesium citrate, polyethylene glycol, lactulose? provide osmotic load to draw water out
What is an additonal effect of lactulose? helps treat hepatic encephalopathy since gut flora degrade it into metabolites which promote the excretion of nitrogen as NH4
What is the clinical use of magnesium hydroxide, magnesium citrate, polyethylene glycol, lactulose? constipation
What are the major SE of magnesium hydroxide, magnesium citrate, polyethylene glycol, lactulose? diarrhea, dehydration, may be abused by bulemics
What is the mech of infliximab? monoclonal Ab to TNF
What is the clinical use of infliximab? Crohn's disease, RA
What are the major SE of infliximab? infection (incl reactivation of latent Tb), fever, hypoTN
What is the mech of sulfasalazine? combination of sulfapyridine (antibacterial), and 5 aminosalicylic acid (anti-inflammatory), activated by colonic bacteria
What is the use of sulfasalazine? ulcerative colitis, Crohn's disease
What are the major SE of sulfasalazine? malaise, nausea, sulfonamide toxicity, reversible oligospermia
What is the mech of ondansetron? 5-HT(3) antagonists, powerful central acting antiemetic
What is the clinical use of ondansetron? control vomiting postoperatively and in patients undergoing cancer chemotherapy
What are the major SE of ondansetron? HA, constipation
What is the mech of metoclopramide? D2 receptor antagonist. incr resting tone, contractility, LES tone, motility. does not influence colon transport time
What is the clinical use of metoclopramide? dibetic and post surgical gastroparesis
What are the major SE of metoclopramide? incr parkinsonisn effects. restlessness, drowsiness, fatigue, depression, nausea, diarrhea. drug interaction with digoxin and DM agents. CONTRAI: small bowel obstruction or Parkinson's disease
Created by: tjs2123