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Step III

Step III - GI 8

QuestionAnswer
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 = acute disease (Prodrome period)
HBsAg, HBeAg = Incubation period
HBsAg, IgG HBc, HBeAg = Chronic carrier/infection w/ active viral replication
HBcAB (IgG or IgM)= Window period
HBsAB, HBcAB (IgG), HBeAB = Complete recovery past infection
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
What are the presentations of cirrhosis Palmar erythema/gynecomastia/splenomegaly/edema/low plts/encephalopathy/ascites/esophageal varices
When should paracentesis be performed on pts w/ ascites Fever/tenderness/pain/new onset ascites
What does SAAG stand for Serum to ascites albumin gradient
If SAAG is >1.1 then what is present portal HTN from cirrhosis or congestive failure
If SAAG <1.1 then what is conclusion Portal HTN NOT present
What value/measure is used to dx SBP Cell count > 250 neutrophils
Tx for SBP Cefotaxime
What are the different types/causes of chr liver dz/cirrhosis Alcoholic cirrhosis/autoimmune hepatitis/primary sclerosing cholangitis/NASH/primary biliary cirrhosis/hemochromatosis/wilson’s dz
What drug will prevent bleeding in esophageal varices bleeding Propranolol
Middle aged woman c/o RUQ pain, Itching, Fatigue and has h/o other autoimmune dz. Exam shows jaundice, xanthelasmas. Dx Primary biliary cirrhosis
Best initial testing and what does it show Blood work: alk phos, nL bili,  IgM
Most accurate test for Primary biliary cirrhosis Anti-mitochondrial Abs/liver bx
Tx for Primary biliary cirrhosis Ursodeoxycholic acid
Anti-mitochondrial Abs are found in what disease Primary biliary cirrhosis
What is being destroyed by immune system in Primary biliary cirrhosis intrahepatic bile ducts
RUQ pain, Itching, Jaundice, Fatigue, Weight loss, Fever. Dx Primary sclerosing cholangitis
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
Most accurate Diagnostic study for Primary sclerosing cholangitis uses what and shows what Cholangiography/ERCP: “beading pattern”
Most accurate lab tests for Primary sclerosing cholangitis Anti smooth muscle Abs and (+) ANCA
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 is the difference in labs b/t Primary sclerosing cholangitis and Primary biliary cirrhosis PSC: BOTH alk phos and bili ; PBC: alk phos, nL bili
Pt w/ Liver cirrhosis, dancing mvts, neuropysch S/S and hemolysis Wilson’s
Best Initial test for Wilson’s dz Slit lamp (Kayser Fleischer rings) >> low ceruloplasmin
Most accurate test for wilson’s dz Liver bx >> urinary copper
Tx for Wilson’s dz Penicillamine
Pt has new murmur, darkening skin, joint pain, infertile, panhypopituitaryism, DM and hepatoma. Dx Hemochromatosis
Best Initial test for Hemochromatosis showing Blood work:  iron/ferritin,  TIBC
Most accurate test for Hemochromatosis Liver bx OR MRI liver + HFe gene mutation
Tx for Hemochromatosis Phlebotomy
Young woman, has other autoimmune dz (Coomb positive hemolytic anemia/thyroiditis/ITP). Type of hepatitis Autoimmune hepatx
Best Initial studies for Autoimmune hepatx ANA and anti-smooth muscle Ab/SPEP (Igs)/anti-liver/kidney microsomal Ab
Most accurate test for Autoimmune hepatx Liver bx
Tx for Hemochromatosis Prednisone then wean off steroids w/ azathioprine
Type of liver cirrhosis a/w DM, obesity, hyperlipidemia NASH
Initial study for NASH shows ALT > AST
Most accurate test for NASH Liver bx showing fatty infiltration
Tx for NASH Tx underlying causes (DM, lipidemia, obesity)
Tx for cryptosporidiosis non bloody diarrhea Nothing, use HAART to incr CD count
HBsAg, IgG HBc, HBeAB Chronic carrier/infection W/O active viral replication
Which Hep B particle does the body make IgG and IgM against HBc Ag
every carrier/chr Hep B infection has what two Hep serology markers HBsAg + anti-HBc AB (IgG)
every carrier/chr Hep B infection has HBsAg + anti-HBc AB (IgG). Presence of what marker distinguishes active vs non-active viral replication? active = HBeAg; non active = anti-HBe AB
Created by: DrINFJ