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Step 1 12.22.12
GI IV
| Question | Answer |
|---|---|
| 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
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