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GI Studies 1e


Anti-HBe: Presence indicates: less viral replication & infectivity
Hep B immunity (types) Recovered from infxn: Anti-HBs pos, Anti-HBc IgG pos; Vax: Anti-HBs pos, Anti-HBc IgG NEG
HBV DNA Parallels HBeAg, but is more sensitive/ precise marker of viral replication & infectivity; Low levels may persist in serum & liver after recovery from acute Hep B; HBV DNA in serum is bound to IgG & rarely infectious
Hep C high rate of chronic infxn (85%); cause of cryoglobulinemia; Dx: anti-HCV by ELISA, may need confirm w/HCV RNA & anti-HCV RIBA; Ab levels rise slowly
Only test for Hep D if: if pt has confirmed & unexplained worsening of Hep B
Hep D: Requires HBsAg; worsens Hep B prognosis, inc risk of liver ca; Dx anti-HDV or HDV RNA in serum
Hep E Usu benign & self-limited; rare; 10-20% mortality in PG; Dx anti-HEV
Biliary labs bilirubin, alk phos, ALT, AST
Cholestatic vs hepatitis: labs cholestasis: bili/alk phos high; hep: ALT/AST high
US: useful in biliary dz to: Detect GS; eval dilation of biliary ducts (limits: obesity; eval liver parenchyma/panc)
Gold standard for Gall Stones US; sensitivity > 95% for stones > 2mm (less sensitive for stones in CBD); GS best seen after 8hrs of fast; Stones seen as echogenic, mobile objects with acoustic shadow
ace of spades deformity on barium enema imaging: sigmoid volvulus
chronic hepatitis panel HBCAb IgG, HBCAb IgM, HBSAg, HbSAb
Hep B: past infxn vs vax PAST INFXN: pos HBSAb, HBCAb; neg HBSAg, HBeAg, var HBeAb. VAX: pos HBSAb, all others neg
Hep B labs: infectivity HbeAg: infective; HbeAb: not actively infective; HBV DNA: Marker of ongoing infection
jaundice labs Icterus: bili >3mg/dl; Unconjugated (indirect) high = hemolysis; Conjugated (direct) high = liver dz; AST/ALT up = hepatocellular dz; Alk phos up = cholestatis or obstruction
PUD TOC EGD + biopsy
PUD perf dx imaging free air on CXR; US; CT to confirm
IBS Imaging/Invasive Testing: < 40 yo with diarrhea: flex sig; > 40 yo: ACBE or colonoscopy
IBD labs CBC, ESR/CRP, albumin, stool C&S, O&P, WBC, fecal fat; CD also p-ANCA & ASCA
IBD imaging CD: UGI, ABCE, capsule endoscopy; UC: abd film; colonoscopy, sig
Celiac dz labs CBC, ESR, PT, Fe, B12, folate; Ca, alk phos, albumin, beta-carotene; anti-endomysial IgA (most specific); anti-tTGA (tissue transglutaminase; TOC); Total IgA
Zollinger Ellison testing fasting gastrin level (>1000 is dx); secretin stim test (normal pt: no fx on gastrin; ZE pt: dramatic increase)
Positive FOBT should always be followed by: colonoscopy (and no more FOBTs needed) Negative FOBT tests: should be:
Flexible Sigmoidoscopy examines: left colon; some bowel prep needed; can performed w/o sedation in Dr’s office; 5-year interval between exams
Patients w/ adenomas found on flex sig: should go for colonoscopy
Primary sclerosing cholangitis (PSC) labs: Dx high alk phos; LFT, anti-mito Ab; ERCP/MRCP
comma shaped GNR, sensitive to low pH V cholera; stims adenyl cyclase to overproduce cAMP
Shigella dx studes fecal WBC & RBCs, +stool cx; sigmoidoscopy: inflamed engorged mucosa, punctate lesions, ulcers
Created by: Abarnard