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Step III

Step III - GI 2

QuestionAnswer
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