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Step III
Step III - GI 2
| Question | Answer |
|---|---|
| What other diseases is Primary biliary cirrhosis a/w | scleroderma and CREST |
| Anti-smooth muscle Ab and (+) ANCA are found in what disease | Primary sclerosing cholangitis |
| Diagnostic study for Primary sclerosing cholangitis uses what and shows what | Cholangiography/ERCP: “beading pattern” |
| Tx for Primary sclerosing cholangitis | Ursodeoxycholic acid OR Liver transplant |
| ↑ LFTS in Primary sclerosing cholangitis is due to what | Narrowing of intr and extra hepatic ducts |
| What is MC risk factor for Primary sclerosing cholangitis | IBD (UC) |
| What are the two dz where both conj bili and urobili ↑ | Rotor and Dubin Johnson |
| Dubin Johnson has one other ↑ lab finding in addition to ↑ conj bili/urobili that distinguishes it from Rotor | ↑ TOTAL bili |
| Which COPRO is elevated in Rotor and Dubin Johnson respectively | Rotor = COPRO II; DJ = COPRO I |
| The GB can be seen with oral cholecystography in Rotor or DJ | Rotor |
| The liver is BLACK in Rotor or DJ and why | DJ; defective liver excretion |
| What two dz show ↑ UNConj bili | Crigler Najjar and Gilbert’s |
| Crigler Najjar or Gilbert’s is seen in kids | Crigler Najjar |
| What enzyme is associated with Crigler Najjar and Gilbert’s syndrome | Glucuronyltransferase |
| How is Glucuronyltransferase pathology different in Crigler Najjar and Gilbert’s syndrome | Crigler Najjar = deficiency; Gilbert’s = decr activity |
| What is the tx for Crigler Najjar | Plasmapheresis and phototx |
| This disease shows UROporphyrinogen in the urine and affects the skin and liver. Dx | Porphyria cutanea tarda |
| Itching, Flushing, Wheezing, Murmur, Diarrhea, Ab pain. Dx | Carcinoid tumor |
| What is being secreted in Carcinoid tumor that causes the CC | Serotonin: diarrhea, murmur; Histamine: flushing, wheezing, itchy; Kallikrein |
| What lab markers are ↑ in Carcinoid tumor | 5-hydro blah blah (HIAA) ↑ + Chromogranins ↑ |
| Tx for Carcinoid tumor if there are no mets | Resection |
| Tx for Carcinoid tumor if unresectable | Octreotide |
| Where does Carcinoid tumor metx to | liver |
| Older pt c/o Ab pain AFTER eating + h/o afib/coag/valvular dz. Exam of abdomen is benign. FOBT (+). Dx | Mesenteric ischemia |
| Most accurate Diagnostic study for Mesenteric ischemia | Mesenteric arteriography |
| Tx for Mesenteric ischemia | EMERGENT surgical revascularization/resection |
| Pt > 50yo c/o Dysphagia to solids then liquids, h/o smoking, EtOH, (+) FOBT/anemia. Dx | Esophageal cancer (squamous cell) |
| Risk factors for Esophageal cancer | Betel nuts, nitrosamines, achalasia, HPV 16,18, hot food/drink |
| Straining/Vomiting w/ retrosternal chest pain. Dx | Boerhaave syndrome |
| Tx for Boerhaave syndrome | IVF, ABx, NG suction, NPO |
| If perf in Boerhaave syndrome not contained then tx | Open thoracotomy |
| Flushing, decr K+ (diarrhea), Glucose ↑, Urine shows dehydration. Dx | VIP tumor |
| Tx for VIP tumor | surgery |
| What is the tx for symptomatic FAP pt | Colon resection – pts have 100% risk of colon CA |
| What is the MC type of Anal cancer | Squamous cell CA |
| What are the Risk factors for Anal cancer | HPV, anal sex, smoking |
| What is the Test of choice for Lactose intolerance | Hydrogen breath test |
| What cancer type is Barrett’s esophagus | adenoCA |
| Recurrent aspiration PNA and h/o smoking, EtOH. Dx | Barrett’s esophagus (adenoCA) |
| Initial Diagnostic study for Esophageal cancer (squamous cell) | Endoscopy (if endo not a choice go w/ barium) |
| Most accurate test for Esophageal cancer (squamous cell) | biopsy |
| Initial Tx for Esophageal cancer (squamous cell) | Surgery if no local or distant mets + chemo w/ 5-FU |
| Peptic strictures are caused by what patho | Use of sclerosing agents/scarring from repetitive acid exposure to esophagus |
| Initial Diagnostic study for peptic stricture | Barium swallow |
| What are the different kinds of esophageal strictures | Plummer Vinson, Schatzki’s ring, peptic stricture |
| Middle aged woman c/o dysphagia, wt loss. Labs show microcytic anemia. Dx | Plummer Vinson |
| Where is the stricture located in Plummer Vinson | Proximal esophagus |
| Initial Tx for Plummer Vinson | Iron replacement |
| Plummer Vinson is a/w what type of CA | Esophageal cancer (squamous cell) |
| Pt c/o intermittment sx of dysphagia. Dx | Schatzki’s ring |
| Location of Schatzki’s ring | Distal |
| Initial Tx for Schatzki’s ring | Pneumatic dilation |
| What is the cause of peptic stricture | Acid reflux |
| Initial Tx for peptic stricture | Pneumatic dilation |
| Pt c/o dysphagia and has HORRIBLE bad breath. Dx | zencker’s diverticulum |
| Initial Diagnostic study for zencker’s diverticulum | Barium study |
| Initial Tx for zencker’s diverticulum | Surgical resection |
| What is the cause of the zencker’s diverticulum | Dilation of posterior pharyngeal constrictor muscles |
| What do the labs show in mesenteric ischemia | incr lactic acid (MA) and amylase |
Created by:
DrINFJ
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