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Step III

Step III - GI 7

Most effective non-invasive tx for Acute bleeding esophageal varices and effect Somatostatin analog (octreotide); decr portal HTN
If sclerotherapy and Rx tx fails for Acute bleeding esophageal varices then what is the next tx TIPS
What is the MCC complication of TIPs procedure Hepatic encephalopathy
What are the causes of upper GI bleeding Cancer/varices/gastritis/esophagitis/duodenitis/ulcer dz
What are the causes of lower GI bleeding Cancer/diverticular dz/ischemic colitis/angiodysplasia/IBD/polyps
If endoscopy does not tell you location of bleed what can be done next Tagged red cell scan (technetium scan) will ID location but not cause of bleed
What study tells you precisely what vessel is causing GI bleed Angiography (prior to surgery for resection)
If upper and lower endo is not definitive for location of bleed and you wish to investigate small bowel what test is used Capsule endoscopy
What are the common causes of constipation Dehydration/CCB/narcotics/HYPOthyroid/DM/iron supplementation/anti-cholinergics/TCA
Pt h/o gastric surgery c/o Shaking, weakness, sweating, HYPOtension, HYPOglycemia. Dx and tx Dumping syndrome; small frequent meals
Tx for diabetic gastroparesis Erythromycin and metoclopramide
MOA of erythromycin in tx for gastroparesis (+) motilin
Other causes of acute pancrx Trauma/ERCP/HYPERtriglyceridemia/infection/drugs (didanosine, stavudine, azathioprine, thiazides)
Pt dx w/ acute pancreatitis. CT shows dilated common bile duct but no pancreatic head mass. Next step in tx ERCP to remove stone or dilate stricture
What test is used to determine severity of pancreatitis and why Trysinogen activating peptide found in urine; if trypsinogen is pre-maturely activated while in pancreas (instead of in duodenum) it can cause inflmx
What is Ranson’s criteria used for and what has replaced it Operative criteria for pancreatic debridement; CT scan
CT scan shows >30% necrotic pancreatitis. Tx Imipenem + CT guided biopsy
CT biopsy of pancreas shows infected and necrotic pancreas. Next tx Surgical debridement
Hep B is a/w what other dz in 1/3 pts PAN
Hep C is a/w what other condition Cryoglobulinemia
Jaundice, fatigue, weight loss, dark urine. Dx Hepatitis
Jaundice, fatigue, weight loss, dark urine + urticaria/fever/joint pain. Dx Hep B/C
What are the levels of AST and ALT in viral vs drug induced hepatx Viral ALT; drug AST
What is the difference in testing for Hep A,B,C,D,E ACDE = serology testing; B = Surface Ag/Abs, core Abs, e Ag
HBsAg, IgM HBc, HBeAg = Prodrome period of acute disease
HBsAg, HBeAg = Incubation period
HBsAg, IgG HBc, +/- HBeAg = Chronic carrier
HBcAB = Window period
HBsAB, HBcAB = Complete recovery
HBsAB = immunized
How is chr Hep B different from acute Hep B in serology Presence of HBsAg beyond 6 mos
Hep B DNA polymerase = e-Ag = Hep B PCR DNA = active viral replication
Best initial test for Hep C Hep C Ab
Most accurate test for det response to tx/replication/infectivity of Hep C Hep C PCR for RNA (determines activity/replication/response to tx)
Most accurate test for severity of liver dz in Hep C liver bx
What is the tx for chr Hep B lamivudine/entecavir/telbivudine/IFN/adefovir
Which tx for chr Hep B has the most adverse effects IFN
What is the tx for chr Hep C IFN + ribavirin
MCC side effect of ribavirin Anemia
Which adults have the strongest indication for Hep A and B vaccination Chr liver dz/living w/ (+)HepA/B person/homosexuals/pts who receive blood chronically/IVD users
Who or what are the specific indicators for Hep A/B vaccine Hep A: travelers; Hep B: dialysis pts and healthcare workers
Healthcare worker never got Hep B vaccine and gets stuck by pt who has chr Hep B. Tx Give Hep B vaccine + Hep B Igs
Neonate born to mom w/ chr Hep B. Tx Vaccine + Hep B Igs
Heatlhcare worker already immunized w/ Hep B. Gets needle stick from pt w/ Hep B. Next step Order Hep B Ab serology for titer; if present no worry and no tx
Created by: DrINFJ