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397 Cards in this Set

  • Front
  • Back
What is defined by recurrent upper midabdominal pain?
Dyspepsia
When a pt presents with dyspepsia what is an important class of medications that always should be asked about?
NSAIDS- Aspirin
What type of diagnosis is IBS (Irritable Bowel Syndrome) generally referred to as?
Diagnosis of exclusion
GI patients- name three general classifications.
1. Young, uncomplicated
2. Older, complicated
3. Zebras
For the younger, uncomplicated pt complaining of dyspepsia, what would be the next step after pt history?
Intital testing includes:Stool guiac(to test for occult blood), CBC(anemia), H Pylori test,LFTs
Who discovered H Pylori?
To Aussies: Barry Marshall and Robin Warren
What is H Pylori?
A bacterium found in mucous overlaying the gastric mucosa.
What is H Pylori a risk factor for?
1.Gastric ulcers(90-95%)
2.Duodenal ulcers(60-70%)
3.Chronic gastritis
4.Ulcerative gastritis
5.Gastric Cancer 20-25%
What type of bacteria is H Pylori?
Gram (-) bacillis, flagillated.
Does colonization increase with age?
Yes
T or F: Most individuals with H Pylori are asymptomatic.
True
Percentage of people <30yo have colonization of H Pylori?
10%
What rate do people over 60yo colonize H Pylori at?
About the rate similar to thier age.
Describe the radio-immunoassay concept that is used to detect certain "bugs".
You give an antibody- if the antigen for the bug is present a complex is formed. This complex is detected and would be considered a positive result.
What are the 4 methods for testing for H Pylori?
1.Stool test
2.Breath test
3.Serologic test
4. Endoscopy(biopsy)
What 2 tests use urease to test for H Pylori?
The stool and breath tests.
What substances should you not be taking prior to (~1wk) having the H Pylori tests that use urease?
H2 blockers, PPIs,antacids
What are the two non invasive H Pyloir testing methods?
Stool and breath tests.
What is used during stool testing to detect H Pylori bacteria?
ELISA (Enzyme Linked Immunosorbent Assay)
What type of stool sample is required for H Pylori testing?
Fresh!
What is the H Pylori breath test based upon?
The ability of H Pylori to metabolize urea to CO2. The radiolabelled urea is swallowed and if H.Pylori is not present the urea is not broken down and excreted from the kidneys. If H.Pylori is present, urease breaks down the urea forming ammonium,bicarbonate, and radiolabelled CO2 which passed from stomach capillaries to lungs and is detected on the breath test.
What is the breath sample collected in during a H.Pylori test?
Mylar balloon.
Following infection by H.Pylori, how long after and in what order to the antibodies show up?
IgM(3-4wks)
IgA(2mo)
Last- IgG(~2mo)
What patients is the H.Pylori breath test contraindicated in and why?
Children and pregnant pts due to the exposure to radioactive carbon
If a patient takes an antacid within 1 week before H.Pylori breath testing, what type of result might be expected?
False negative.
Which antibody is most commonly used in an immunoassay to detect H.Pylori?
IgG
How long after tx do the 3 antibodies used to test for H.Pylori stay elevated?
IgM(2-3mo)
IgA(3-4wks)
IgG(1yr)
What are 5 advantages to using serology to test for H.Pylori?
1.Easiest test to perform
2.Requires no preparation
3.No abstinence from antacids is required
4.Used to document cure of infection
5.Often used to corroborate the finding of other H.Pylori testing methods.
When an older, more complicated patient presents with dyspepsia, dark and guiac positive stools, wt loss,etc. what does your list of initial testing include that the younger uncomplicated pt might not have?
Esophagogastroduodenoscopy (EGD) - AKA 'Upper Endoscopy'
What does an upper endoscopy allow visualization of?
Esophagus, stomach,duodenum.
What are the three channels on the upper endoscope?
One for: visualization,
insufflation/aspiration,
instrumentation
What is an estimate of the cost of an upper endoscopy?
$300-400
Is consent required for an upper endoscopy(EGD)?
Yes
When should the patient stop all solids/liquids prior to procedure?
After midnight.
What symptoms might a patient experience following an upper endoscopic procedure?
Hoarseness,Bloating, belching,flatulence.
What post procedure symptoms would you want your patient to call for if they experience?
Bleeding, fever, abd pain, dyspnea, dysphagia
What are 6 potential complications of upper endoscopy?
1.Perforation
2.Bleeding
3.Aspiration
4.Oversedation
5.Hypotension
6.Local IV Phlebitis
What are 3 methods for testing the tissue sample for H.Pylori following an upper endoscopy?
1.Gram Stain
2. CLO Test
3. Culture
Explain the CLO test.
A small piece of gastic mucosa is inserted into a testing gel and within hours if the H.Pylori bacteria is present the gel turns colors.
If the CLO test gel does not change color what does that mean?
No HPylori
If you culture a tissue sample taken from the gastric mucosa during an upper endoscopy, what must you ensure?
That the pt has not had any antibiotics,antacids,bismuth 5-14 days prior to the test.
What are 4 contraindications to upper endoscopy?
1.Severe GI bleeding
2.Pts with esophageal diverticula
3.Pts with susptected perforation
4.Pts who have recently had gastric/esophageal surgery.
What can stomach ulcers mimick?
Gastric CA
A 37 year old executive presents to your office with complaints of chronic and
recurrent, upper midabdominal pain (dyspepsia) with characteristics suggestive of peptic ulcer disease. This patient has undergone multiple treatment regimens for H. Pylori with followup endoscopy revealing
negative H. pylori but recurrent ulcer formation.
PMHX: Unremarkable, no meds besides antacids.
PE: AAOX3, BS clear, S1S2 no murmur, gallops, or rubs. Abdomen soft, NT, active BS x4 quadrants. Stool guaiac negative.

This pt is considered a zebra. What labs do you order?
CBC, Serum Gastrin, Abd CT imaging
Cost of Gastrin lab test?
$40
What is gastrin?
A hormone produced by G cells in the stomach antrum that stimulates parietal cells to secrete acid.
What are 2 conditions associated with elevated gastrin levels >500pg/mL?
1.Zollinger-Ellison syndrome
2.G Cell hyperplasia
What is Zollinger-Ellison syndrome?
A gastroma of duodenum or pancreas is present increasing levels of gastrin which works on parietal cells causing increased output of hydrochloric acid (H+ ions).
In what condition are there increased numbers of G-cells in the stomach?
G-cell hyperplasia
What are some conditions that can cause increased gastrin levels (not as high as ZE or G-cell hyperplasia)?
1.Pts taking antacid peptic ulcer meds 2. Previous peptic ulcer surgery-like vagal nerve clip 3.Atrophic gastritis 4. Gastric carcinoma
5.Renal failure
6.Pernicious anemia 7. Pyloric obstruction
What population of patients are given a gastrin stimulation test?
Those with serum gastrin
>150-500pg/mL.
What conditions will a gastrin stimulation test help to differentiate btwn?
ZE Syndrome/G-cell hyperplasia vs routine peptic ulcer dz.
What is used to stimulate gastrin secretion during the gastrin stimulation test?
Either Calcium or Secretin(used more often)
What are 5 interfering factors of the gastrin stimulation testing?
1.Peptic ulcer disease
2.Ingestion of high protein food
3.Diabetes
4.Drugs(increase gastrin)-antacids,H2 blockers,PPIs
5.Drugs(decrease gastrin)-anticholinergics,tricyclic antidepressants
How does the patient prepare for the gastrin stimulation test?
Fast x12hrs(water permitted),Avoid alcohol x24hrs
How is calcium administered if used for the gastrin stimulation test?
Calcium gluconate administered IV x3hrs. You draw a preperfusion gastrin and then draw levels at 30 minute intervals x4hrs.
How is secretin administered if used for the gastrin stimulation test?
Secretin IV given. Gastrin drawn preinjection,postinjection, and every 15 minutes for 1 hour after injection.
What type of test is a barium swallow?
An xray with contrast dye.
What does a barium swallow allow visualization of?
The upper oropharynx and down to mid-esophagus - this test can detect defects in filling or narrowing of the esophagus which can indicate tumors or strictures.
On a barium swallow, what do varices appear as?
Serpiginous, linear filling defects.
What are 2 materials used for contrast during imaging?
Barium and Gastrografin
Why might barium be a poor choice for contrast material during a barium swallow?
This is a chemically inert substance that is not okay to use with a hole in the GI tract. It can cause chemical peritonitis if it leaks in.
How is gastrografin excreted?
It is water soluble and excreted by the kidneys.
What is the danger with gastrografin contrast?
It would be okay to leak into the peritoneum but if it is aspirated, you can develop terrible chemical pneumonitis.
What are some diagnoses that can be made with an Upper GI series?
1. Hiatal hernia 2. Schatzki's ring 3.Diverticula 4. Reflux dz 5. Achalasia
6. Perforations
What are some contraindications of an upper GI series?
1. Bowel obstruction
2. Perforated viscus
3. Unstable pts
4. Uncooperative pts
What is a potential complication of a barium swallow?
Barium induced fecal impaction - you can give a cathartic behind it.
What are 4 barium swallow pre-procedure steps?
1.NPO after MN
2. Assess ability to swallow
3. Inform pt post procedure that stools will be white until barium is expelled
4. Laxatives may be necessary to prevent impaction.
Why might barium cause a fecal impaction?
It decreases GI motility.
Does the GI tract show up well on a plain film?
No
Why would you order an upper GI series with SBFT? (small bowel follow through)
To ID abnormalities in the stomach and small bowel.
What is a SBFT?
An xray study using contrast dye.
How does the SBFT work?
The pt drinks barium and the xrays are taken at 30 minute intervals to follow the progression of barium through the small intestine.
What test can be a more accurate radiographic eval of the small bowel (other than SBFT)?
A small bowel enema, where the dye is injected into a tube previously passed to the small bowel. Less dilution of barium by gastric and duodenal juices
What can a small bowel enema identify?
Partial SBO of unknown origin- Tumors, ulcers, and fistulas more easily.
What are 3 contraindications to perform a SBFT?
Complete small bowel obstruction, Perforated viscus (relative), unstable pt
What is a potential complication for a SBFT?
Barium induced small bowel obstruction.
What are 2 interfering factors for a SBFT?
1. Barium from a previous study
2. Food/fluid in GI tract (could look like an abnormality)
What are some important SBFT pre-procedural notes?
1.NPO after MN
2.Study may take several hours(up to 24 with delayed barium progression)
3.Initial stools are white, then clear
What are some abnormal findings of SBFT?
SB tumor,obstruction,inflammatory bowel dz,malabsorption syndrome(Whipples,sprue),Congenital abnormality,Intussusception,perforation
What does ALT stand for?
Alanine aminotransferase - formerly SGPT
What is a normal value for ALT?
Adults 4-36 u/L, elderly maybe higher.
Where is ALT found?
Primarily liver, also in kidneys, heart, and skeletal muscle.
Why is ALT tested for during liver function studies?
Liver parenchymal trauma releases ALT into the blood. ALT levels are sensitive and specific for hepatocellular dz.
For viral hepatitis, what is the ALT/AST ratio?
>1
For cirrhosis and/or liver congestion,metastatic tumor what is ALT/AST ratio?
<1
How do some antibiotics, TB meds, and OCPs affect the ALT level?
They may increase it.
What is AST?
Aspartate aminotransferase, formerly known as SGOT.
What are normal values for AST and when does this enzyme peak?
0-35 units/L - Increases 8 hours after injury, peaks 24-36hours then back to normal in 3-7 days.
Where is AST found and when might it be increased?
Enzyme found in heart, liver, musculoskeletal cells, and is released when cells are lysed. Levels 20x normal with acute hepatitis. 10x normal in acute extrahepatic obstruction.
Is AST used for cardiac assessment?
NO
In cirrhosis, what is AST directly related to?
Amount of inflammation present.
In what disease states do you find increased AST levels?
Hepatitis-Cirrhosis-Pancreatitis-Acute hemolytic anemia.
In what disease states do you find decreased AST levels?
Acute renal dz-beriberi(lack of vitamin B1)-Pregnancy-Diabetes-Chronic renal dialysis
Generally ALT and AST will be increased with what type of disease?
Intrahepatic
Alkaline phosphatase is usually increased with what type of disease?
Biliary, bone,liver disorders
What are normal values for Alkaline phosphatase?
Adult: 30-120 units/L
Where is Alkaline phosphatase found and excreted (as far as teh biliary system)?
In Kupffer cells that line the biliary collecting system, and is excreted in the bile.
What is the most sensitive test to detect a metastatic tumor in the liver?
Alkaline phosphatase
Does the Alkaline phosphatase testing require fasting?
No
When would fasting be required for the Alkaline phosphatase testing?
If you are trying to determine which isoenzymes -ALP1(liver) and ALP2(bone) are present
When would Alkaline phosphatase be increased?
Cirrhosis-Liver tumor-biliary obstruction-bone tumor-hyperparathyroidism-Paget's dz-rheumatoid arthritis-intestinal infarction/ischemia-sarcoidosis
What is a good lab to use in testing for an alcoholic?
GGT-Gamma-glutamyl transpeptidase
What are normal values for GGT?
Male/female over 45yo: 8-38units/L;
Female<45 5-27units/L
How long do you need to be NPO before GGT testing?
8 hours
What does GGT do?
Helps to transport amino acids and peptides across cell membranes.
Where is GGT found?
Liver, biliary tract(levels parallel alk phos) - lesser concentrations elsewhere.
When alk phos is increased as in bone or liver disease, which of these would GGT also be increased?
Hepatobiliary dz.
With an increase in alk phos as in bone dz, would the GGT enzyme be increased?
No
What enzyme detects chronic alcohol ingestion in >75% of cases?
GGT(Gamma-glutamyl transpeptidase)
Specifically what diseases can increase GGT enzymes?
Hepatitis-Cirrhosis-Hepatic Necrosis-Hepatic Tumor/metastasis-Hepatoxic Drugs-Cholestasis-Jaundice-MI-Alcohol ingestion-Pancreatitis-Pancreatic CA-EBB-CMV-Reye's syndrome
What are two hepatotoxic drugs that can cause an increase in GGT enzyme?
Phenobarbitol and Phenytoin
What adds color to our stools?
Bile/Bilirubin
What are the two types of bilirubin?
Direct + Indirect = Total
What are normal levels of Bilirubin (Adult, Elderly, child)?
Total:0.3-1.0mg/dL - Indirect:0.2-0.8mg/dL - Direct:0.1-0.3mg/dL
Where does bilirubin come from?
Bilirubin is one of the many constituents of bile. In the spleen RBCs are lysed releasing hemoglobin (broken into Heme and Globin). The Heme is transformed to unconjugated bilirubin there in the spleen.
Where is conjugated bilirubin formed and from what?
The conjugated bilirubin is formed after the unconjugated(indirect) form moves to the liver. It combines with Glucuronide to form conjugated(direct) bilirubin.--> This is then excreted in the bile.
What is jaundice and how much bilirubin would be present in the blood for this to appear?
Jaundice-discoloratio of body tissues caused by abnormally high levels of bilirubin. >2.5mg/dL
When would physiologic jaundice of a newborn occur?
If the newborn's liver is immature and does not have enough conjugating enzymes. Then, there would be a high level of circulating unconjugated bilirubin.
What is an important danger for infants with physiologic jaundice?
With high levels of circulating unconjugated bilirubin, passage can be made through the BBB and deposited into the brain cells of the newborn causing encephalopathy (Kernicterus).
Generally, jaundice caused by a hepatocellular defect (like hepatitis) results in an ↑ levels of what type of bilirubin?
Unconjugated (indirect)- RBC hemolysis,Gilbert's,viral hepatitis
What type of jaundice results from an extrahepatic obstruction (gallstones or tumor blocking bile ducts)?
Conjugated (direct)
Which type of jandice can usually be resolved with surgery or endoscopy?
That due to excess conjugated from extrahepatic obstruction.
Conjugated and unconjugated bilirubinemia results when what percentage of the total bilirubin is conjugated?
Conjugated bilirubinemia = >50%;
Unconjugated bilirubinemia = <15-20%
What is delta bilirubin?
A form bound to albumin. Longer half life than other bilirubins.
What are two enzymes that are important in the diagnosis of pancreatitis and which will elevate first?
Amylase(1st) and Lipase
What is a normal amylase level?
60-120 somogyi units/dl
What is a normal range for lipase levels?
0-160 units/L
Where is amylase secreted from and to where?
Acinar cells into the pancreatic duct and then to the duodenum.
How long after the onset of disease will the amylase levels rise?
about 12 hours.
How long after the onset of disease will amylase levels normalize?
48-72hours
Is amylase sensitive or specific for pancreatic disorders?
Sensitive
After blood levels of amylase rise, levels of what bodily fluid would rise next?
Urine
What conditions would cause an ↑ in amylase levels?
Acute pancreatitis-Penetrating peptic ulcers-Perforated peptic ulcers-Necrotic bowel-Perforated bowel-Acute cholecystitis
Which of the 2 important pancreatic enzymes remains elevated longer with disease?
Lipase
What is the purpose of lipase?
This enzyme is secreted by the pancreas into the duodenum to break down triglycerides into fatty acids.
When would lipase appear in the blood stream?
After damage/dz of pancreatic Acinar cells (as does amylase).
Why would serum lipase levels be elevated?
Acute pancreatitis(5-10x), Nonpancreatic dz(<3x), Renal failure,Intestinal infarction,Gallbladder dz
What pancreatic enzyme is good for diagnosis of patients with delayed presentation of pancreatitis?
Lipase because it rises a bit later than amylase(24-48hrs after onset) and remains elevated for 5-7 days.
What of the following labs would be significantly altered with biliary colic?
CBC(WBC)-Alk Phos-AST-ALT-Bilirubin-Amylase/Lipase
No significant alteration.
What of the following labs would be significantly altered with acute cholecystitis?
CBC(WBC)-Alk Phos-AST-ALT-Bilirubin-Amylase/Lipase
CBC ↑ - Alk Phos ↑↑↑ - AST and ALT ↑
What of the following labs would be significantly altered with choledocholithiasis?
CBC(WBC)-Alk Phos-AST-ALT-Bilirubin-Amylase/Lipase
CBC(WBC)↑ -Alk Phos ↑ -AST ↑ -ALT ↑ -Bilirubin ↑ -Amylase/Lipase ↑ or normal
What of the following labs would be significantly altered with cholangitis?
CBC(WBC)-Alk Phos-AST-ALT-Bilirubin-Amylase/Lipase
CBC(WBC)↑ -Alk Phos ↑ -AST ↑ -ALT ↑ -Bilirubin ↑ -Amylase/Lipase ↑ (if at a point below duct of Wirsung)
With a perforated ulcer, will a patient be writhing about or sitting motionless?
Sitting motionless-acute peritonitis
With kidney stones, will a patient be writhing about or sitting motionless?
Writhing about.
What are some major clinical manifestations of Acute Viral Hepatitis?
1.Low grade fever,Malaise,Anorexia,Fatigue
2. RUQ pain
3.Elevated AST/ALT
4.Jaundice(hallmark that develops late-can have anicteric case)
What is hepatitis?
Inflammation of liver caused by: Viruses-Alchohol ingestion-Drugs-Toxins-Overwhelming bacterial sepsis
What are 9 possible causes of viral hepatitis?
Hepatitis A-E, CMV, EBV, Herpes Simplex, Hep G
What are 4 phases of acute viral hepatitis?
1. Incubation period - peak infectivity(last asymptomatic days-days of early acute symptoms); 2. Pre-Icteric Period(Symptomatic)-Malaise,Distaste,Circulating Immune Complex; 3. Icteric peroid (Symptomatic)-Hyperbilirubinemia(conjugated and unconjugated), elevated transaminases; 4. Convalescent Period
What phase of acute hepatitis would most likely go undetected?
Incubation Period
Which acute viral hepatitis is deemed "infectious hepatitis"?
HAV
What type of virus is HAV?
Unenveloped, single stranded, RNA virus.
How is HAV transmitted?
Fecal-oral
What is the incubation period of HAV?
15-45 days (3-5wks)
With HAV is there possibility of chronic disease or carrier state?
No
What is the fatality rate of HAV?
Low, 0.1%
Is there a high likelihood of developing cancer from HAV?
No
Where is HAV replicated, excreted into, and shed?
Liver - Bile- Stool
When is peak infectivity for HAV?
2 weeks before and 1 wk after onset of jaundice or increased liver enzymes
After jaundice appears what will begin to decrease?
Concentration of HAV in stool
Is chronic fecal shedding present with HAV?
No
What is found in the blood at the onset of symptoms with HAV?
IgM anti-HAV
When is total anti-HAV (also referred to IgG anti-HAV) present with HAV?
Present early and for a life time; provides future immunity.
What enzyme will be increased through the course of HAV?
ALT
Which comes first during HAV infection IgM or IgG anti-HAV?
IgM anti-HAV
When travelling what are two options to try to avoid HAV infection?
Immunoglobulin-for shorter term travel(only lasts weeks) or Vaccination for lifelong immunity-need 4 weeks prior to travel
Who are candidates for HAV?
Military personnel-
Day care center employees-
Primate handlers -
Lab workers with exposure-
Children >2 in high frequency area-
Individuals with chronic liver disease-
Individuals traveling to foreign countries particularly Mexico and south America
What type of virus is HEV?
Non-enveloped single stranded RNA virus
What is the incubation period of HEV?
15 days
How is HEV transmitted?
Fecal-oral route; It is waterbourne.
Does HEV have a chronic state?
No
What group of individuals are more prone to HEV?
Young to middle aged adults.
Where is HEV endemic?
India
What population does HEV have a high mortality rate in?
Pregnant women
What HEV marker appears first and then declines rapidly to negative with recovery?
IgM anti-HEV
Which HEV marker is present for life indicating past infection and immunity?
IgG anti-HEV (or total anti-HEV)
Is the HEV virus present in the stools?
Yes, for about 1wk before symptoms to about 1 wk after(this varies).
Symptoms are present with HEV when ____?
Liver enzymes (ALT) are increased.
What are six courses of HBV?
1. Acute Hepatitis
2. Fulminant hepatitis with massive necrosis-Rare <1%
3. Nonprogressive chronic hepatitis-Chronic persistent hepatitis
4. Progressive chronic hepatitis (into cirrhosis) Chronic active hepatitis
5. Carrier asymptomatic state
6. Backdrop for Hepatitis D
What is the difference btwn Nonprogressive chronic hepatitis B and Progressive chronic hepatitis B?
With the latter you are not just a carrying the dz you have progressive damage occuring.
Can a carrier in asymptomatic state of HBV infect others?
Yes
What type of virus is HBV?
Encapsulated, double stranded, DNA virus.
How is HBV transmitted?
Parenteral, sexual
What is the incubation period of HBV?
40-180 days
Are those with chronic HBV at risk for hepatocellular CA?
yes
For HBV, which are you measuring with the blood test? Core antigen or antibody?
Core antibody.
What are important notes about HBsAg (HBV surface angitgen)?
The earliest to appear - Surface coat protein - Marker meaning HBV infection - about 1 mo after exposure
What is usually detected with HBsAg?
HBV DNA
What are important notes about HBeAg (HBV secreted protein-funtion unknown)?
Usually appears soon after HBsAg - indicates greater infectivity(active viral replication) during acute dz
With HBV, what is occuring when anti-HBe?
The acute infection has reached its peak and is going away.
If you have had HBV what serological markers would you see?
Anti-HBs and Total Anti-HBc
Which long term serological marker would you see if you received the HBV vaccine?
Anti-HBs - Not: Total Anti-HBc
With HBV, what is known as the window period?
After the HBsAg has disappeared and before the Anti-HBs is detectable. Usually during this period the only detectable markers are IgM anti-HBc and total anti-HBc(or IgG anti-HBc).
How is chronic HBV diagnosed?
2 ways: On two samples 6 months apart: (+) HBsAg & Total anti-HBc - or - (+) HBsAg & Total anti-HBc & (-) IgM anti-HBc on one occassion.
During HBV -HDV co-infection,what are the serological characteristics?
The following are detectable during dz:
1. Total anti-HDV
2. HBsAg
3. Total anti-HBc
4. IgM anti-HBc

After resolution of dz:
Only #3 remains denoting immunity and there is no evidence of the HDV - usually no chronic infection.
During HBV -HDV super-infection,what are the serological characteristics?
The following are detectable indefinately:
1. Total anti-HDV
2. HBsAg
3. Total anti-HBc
What type of virus is HDV? Incubation period? Transmission?
Defective single stranded RNA virus. Coated with HBsAg. 28-150 days. Parenteral,?sexual
What is a tumor marker for hepatocellular carcinoma?
Alpha feta protein - you do have this marker at birth.
What populations does HCV occur more often in?
1.Homosexuals
2.IVDA
3.Hemodialysis pts
4.Hemophiliacs
What type of kidney dysfunction can HCV lead to?
Immune complex glomerulonephritis
What type of virus is HCV?
Encapsulated, single stranded, RNA virus.
What are some modes of transmission of HCV?
Oral (not likely)- Percutaneous - Sexual(uncommon) - Perinatal
What is the incubation of HCV and can chronic HCV lead to hepatocellular carcinoma?
15-150d - yes
Can antibody tests for HCV differentiate btwn a recent, chronic, or resolved infection?
No - maybe look at liver enzymes too.
What enzyme would you look for with HCV?
Anti-HCV
What serological marker can alternate btwn detectable and undetectable during HCV?
HCV RNA
When liver enzymes are sky high during HCV what can you say?
Acute HCV.
How do liver enzymes behave with chronic HCV?
They fluctuate from high to around normal but they never reach the level of acute HCV.
Would one negative result for HCV RNA indicate that chronic dz is not present?
No, because this marker can be negative at points.
Elevation of liver enzymes usually are present during what stages of hepatitis?
symptomatic
When viral hepatitis is suspected, what serological markers should be tested for?
1. IgM anti-HAV
2. IgM anti-HBc
3. HBsAg
4. anti-HCV
Igm anti-HBC indicates what?
Recent infection of HBV
MSM- males having sex with males- are at increased risk for?
HAV infection - no greater than normal risk for HCV.
+ Total anti-HBc indicates? Do you need a vaccine?
Past HBV infection, no vaccine needed.
An asymptomatic person who is HBsAg (+) is likely to have?
Chronic HBV infection.
Presence of HCV RNA indicates?
Current HCV infection
Immunity to HBV also means immunity to what?
HDV - because D needs B to replicate.
If your anti-HBs are <10mlU/mL within 1-2 months after your vaccine series what does that indicate?
No protection against HBV. Repeat the series.
What is a KUB?
Kidney,ureters,bladder - it is a plain film of the abdomen.
What are four advantages of a plain film of the abdomen?
1. Simple,cheap
2. Readily available
3. No discomfort to pt
4. May provide diagnostic info
What lateral decubitus film is more common and why?
Left, to determine air in the belly.(on right stomach or intestine might be confused for free air)
What films does an acute abdominal series include?
1. Flat/recumbent abd film
2. Upright or lateral decubitus film
3. PA chest radiograph (free intraperitoneal air)
How does most of the air in the GI tract get there?
From swallowing it.
What can plain films show (5)?
1. Intraperitoneal air
2. Bowel obstruction
3. Organomegaly
4. Abnormal masses
5. Abnormal calcifications
What is a mnemonic for viewing an abdominal film?
I'd Quit But Gotta Study...Controlling Everyone's Future"
I - ID film (M/F too); Q - Quality [Location: pubic symphysis inferiorly to upper abd. At least to margins of kidney, ideally diaphram and both flanks -
Iliac crests…centered here -
Penetration]; B - Bony structures; G - Gas patterns[Stomach, SB, Large bowel, Rectum]; S - Soft tissue masses; C - calcifications[Gallbladder, kidney, pancreas]; E - Extraluminal air[Pneumoperitoneum]; F - Funny looking things.
What are gastric rugae?
Long, thick, linear folds that extend along the long axis of the stomach.
What is the mucosal folding pattern found the the small intestine?
Valvulae Connivente - thin, circumferential folds, that extend across the entire lumen. There is increased fold density in the jejunum (less in ileum)
What is the mucosal folding pattern found the the large intestine?
Haustral folds- Thick, transverse, incomplete(non circumferential) folds.
What is the normal gas pattern of the stomach, small bowel, large bowel?
Stomach - Always present;
Small bowel - 2-3 loops of non-distended bowel,about size of a quarter 3cm;
Large bowel - In rectum or sigmoid colon,2 quarter size 6cm
The large bowel is slightly dropped on which side?
Right
What soft tissue structures can be see in the LUQ on a plain film of the abd?
Stomach and spleen
What soft tissue structures can be see in the RUQ on a plain film of the abd?
Liver -usually no GB unless stones are present.
What soft tissue structures can be see in the midabdomen on a plain film of the abd?
Kidneys encased in intraperitoenal fat.
What soft tissue structures can be see in the pelvis on a plain film of the abd?
Bladder
Can you 'call' hepatomegaly based on a plain film?
No
Can you 'call' splenomegaly based on a plain film?
Yes, you usually do a f/u U/S though.
Which kidney is larger in size and which lower? How are the upper poles of the kidneys tilted?
Larger - R; Lower - R; Upper pole tilted midline
When might the pancreas be visible on a plain film?
If it was calcified (maybe in an alcoholic)
When would the bladder be visible on a plain film?
If it was full.
If you lose your Flank Stripe on a plain film what might you suspect?
An inflammatory process.
When you break the pelvis, how many places does it normally break in?
2
What generates the sound waves used in ultrasonography?
Piezolectric crystals
What determines the image generated by ultrasonography?
The echogenic differences in structures being viewed- solid vs fluid.
What are 7 strengths of U/S?
1. No known harmful effect (vs. ionizing radiation).
2. Multi-planar.
3. Extremely portable and Less Expensive than Other Cross Sectional Imaging Modalities.
4. Increased Availability (Compared w/ CT & MRI).
5. Can Quantify Blood Flow Velocity and Direction (Doppler).
6. Can Distinguish Solid vs. Cystic Readily.
7. Real-time (Can Guide for Biopsies and Drainages)
What are 3 weaknesses of U/S?
1. Sound Beam cannot penetrate bone or gas or into very deep structures.
2. Poor tissue contrast.
3. Highly operator dependent.
What are the 2 basic orientation conventions of U/S?
1. Longitudinal
2. Transverse(similar to axial)
What can be detected using U/S in the liver?
Masses, hematoma
What can be detected using U/S in the GB?
CA,Acute inflammation, porcelain, stones, wall thickening, pericholecystic fluid
What can be detected using U/S in the bile ducts?
Dilation(>8cm=worrisome), stricture
What can be detected using U/S in the Pancreas?
Masses, inflammatory changes
(retroperitoneal so CT better usually)
What can be detected using U/S in the Kidney?
Dilation,masses, stones, hydronephrosis
What can be detected using U/S in the abd aorta?
Masses
What can be detected using U/S in the Abd cavity?
Ascites, Abscess
Characterize cholelithiasis biliary colic.
Just stones in the GB - Biliary colic is when pain starts to develop - you can have normal labs.
Characterize acute cholecystitis.
When a stone gets stuck in the cystic duct - GB becomes inflamed and wall thickens - Fever,RUQ pain,Murphy's sign - Alk phos ↑↑↑ - AST/ALT/Bilirubin not really affected - Next get U/S - ↑ WBC
Characterize Choledocholithiasis.
Not an entire blockage;just obstructing stone blocking bile and liver - Alk phos ↑↑↑, AST/ALT/direct Bili all are ↑ - can do U/S,ERCP,MRCP(diagnos,not therapeutic)
Characterize ascending cholangitis.
Complete obstruction causing back pressure and dilated ducts - Charcot's triad,Reynold's pentad - All labs,WBCs ↑↑↑ - Can result in Death!
What is HIDA scanning used for?
To evaluate the GB in pts whom cholecystitis is suspected but cannot be confirmed; Acute cholecystitis or Acalculous cholecystitis(Sludge or other problems with GB emptying)
Basically how does a HIDA scan work?
Pts are given IV radiolabelled substance which is normally taken up by the liver and excreted into the bile. 60-120min after injection if you can see the GB,CBD,and Duodenum then your test is normal.
During a HIDA scan, if the GB is not visualized what condition would you think was present?
Acute cholecystitis.
During a HIDA scan, if the delayed filling of the GB is present what condition would you think was present?
Chronic or acalculous cholecystitis.
If a pt has been NPO for a long period of time can it affect the HIDA scan? WHat can be given?
Yes - MSO4 to cause ampullary contraction simulating normal GB squeeze- if everything is normal.
What is a contraindication to HIDA scan?
Pregnancy- risk of fetal damage.
What is Magnetic Resonance Cholangiography?
Uses a magnet to displace the hydrogen atoms out of orbit when they realign images pick up the anatomy - Used as a diagnostic tool to aid in diagnosis of gallbladder stones - NO Ionizing radiation…a very powerful magnet.
(Watch your credit cards…)
What is Endoscopic Retrograde Cholangiopancreatography (ERCP)?
Allows visualization of biliary tree and pancreatic ducts.
What are some important procedural notes the pt should be aware of prior to ERCP?
1. Requires informed consent
2. NPO past midnight
3. Sore throat is expected as you find with endoscopy.
4. Check for signs of post-procedure pancreatitis.
What are 4 contraindications to ERCP?
1. Uncooperative patients
2. Patient’s whose anatomy has been altered by surgical procedures.
3. Esophageal diverticulum
4. Acute pancreatitis
Being that ERCP is a procedure using contrast dye what needs to be stopped prior to?
Metformin/Glucophage
What are 5 potential complications of ERCP?
1. Perforation-esophagus, stomach, duodenum
2. Gram negative sepsis-occurs in patients with obstructive jaundice- lodge a stone tighter
3. Pancreatitis
4. Aspiration
5. Respiratory distress due to oversedation
What are some of the abnormal findings on ERCP?
1. Tumor, stricture, gallstones of CBD
2. Sclerosing cholangitis
3. Biliary sclerosis
4. Cysts of CBD
5. Tumors, strictures, or inflammation of pancreatic duct
6. Pseudocyst of pancreas
7. Anatomic biliary or pancreatic variations
8. Cancer of duodenum or ampulla
What is Percutaneous Transhepatic Cholangiography?
When the biliary tree is accessed from above - can treat an immediate life threatening problem - probably not stone dz
When might Percutaneous Transhepatic Cholangiography be ordered?
If a pt exhibits signs of cholangitis and ERCP from below isn't possible.
What are the 3 types of contrast agents used for Abdominal CT?
1. IV (standard)
2. PO (standard) 1 Ltr, 2 hours prior to scan
3. Rectal (Called “triple contrast CT”)
What is an important lab needed prior to CT with contrast?
BUN/Creatinine - because the IV dye is nephrotoxic - could be used on dialysis pt not on pt with marginal decrease in kidney function.
When using iodine containing dyes, as in CT scanning what is an important question to ask?
Allergies to iodine or shellfish?
Which type of contrast agent with CT dye causes renal problems?
IV
What is the treatment for allergic rxns to IV dye?
Benadryl and steroids
What type of structures is CT better for?
Retroperitoneal because U/S cannot penetrate a lot of tissue.
What form of imaging is useful as a guide to aspirate fluid from the abdomen or one of the organs?
CT
What aspect of a tumor is CT an important imaging modality for?
Staging and monitoring before and after therapy.
What are 3 absolute contraindications to CT with contrast?
1. Unstable pts
2. Very obese >300lbs
3. Severe allergy to contrast
What are 2 relative contraindications to CT?
1. Allergies to iodinated dye or shellfish
2. Pregnancy-unless benefits outweigh risks
3. Patients who are claustrophobic
What are 3 potential complications for CT scan?
1. Allergic reaction to iodinated dye
2. Acute renal failure from dye infusion
(Adequate hydration before the infusion may reduce this likelihood)
3. Hypoglycemia or acidosis may occur in patients who are taking Glucophage and receive iodine dye.
What are 3 interfering factors for CT scan?
1. Metallic objects (hemostasis clips)
2. Retained barium from a previous study
3. Large amounts of fecal material or gas in the bowel
What are 5 types of barium studies?
1. Barium Swallow (aka: Esophagram) = Evaluation of the Pharynx, Esophagus, And GE Junction
2. Upper GI Study = Evaluation of Pharynx, Esophagus, GE Junction, Stomach, and Duodenum
3. Small Bowel Follow Thru = Stomach, Duodenum, Jejunum, Ileum
4. UGI with SB followthrough = Pharynx-Ileum
5. Barium Enema = Evaluation of the Colon and Appendix
What is a barium enema?
Instillation of barium into the rectum and use of xray to visualize the colon.
What is a double contrast barium enema?
When air is insufflated into the colon after the barium which provides air contrast to the barium. - you can visualize smaller polyps.
What are 3 contraindications to barium enema?
1. Perforation of colon-use Gastrografin (a water soluble contrast medium)
2. Uncooperative
3. Toxic Megacolon-can worsen disease
What are 2 potential complications for barium enema?
1. Perforation
2. Barium fecal impaction
What are several interfering factors for barium enema?
1. Residual barium from other studies
2. Stool may be confused for polyps
3. Colonic spasm can mimic radiographic signs of cancer
Using glucagon IV helps minimize spasm
What can minimize colonic spasm during barium enema?
(Using glucagon IV helps minimize spasm)
What kind of prep does a barium enema require?
1. Requires informed consent
2. Requires a bowel prep & NPO past MN
a. Prior to exam (day before): Clear liquids one day prior to exam, 10 ounces of magnesium citrate, 5 mg of bisacodyl (dulcolax) po at 7 pm; Day of exam: dulcolax suppository at 6AM or cleansing enema.
Stools may be white after exam, laxatives may help facilitate evacuation of barium after testing.
What does the Lead Pipe sign indicate during barium enema?
IBD, UC
What is the systematic approach to interpreting an EKG?
1. Rate
2. Intervals (3)
3. Axis
4. Rhythm
5. P waves
6. QRS waves
7. T (and U) waves
What are the two planes that axis is determined in?
1. Limb leads
2. Precordial leads
What is the definition of normal axis?
-30 to +90
What degree of deviation is considered left?
-30 to -90
What degree of deviation is considered right?
+90 to -90
What does right axis deviation implicate?
1. Excessive right sided forces
2. Loss of left sided forces
What does left axis deviation implicate?
1. Excessive left sided forces
2. Loss of right sided forces
What type of anatomical variation of the heart might a tall thin person have?
Vertical heart
What type of anatomical variation of the heart might an obese person have?
Horizontal heart
With all of the leads combined for an EKG how many degrees are btwn each point of electrical assessment?
30 degrees
At what degree marking are the postive vectors for each limb lead located?
I 0;
II +60;
III +120;
AVL -30;
AVF +90;
AVR -150;
What are 7 types of intraventricular conduction delays?
1. Incomplete Bundle Branch Block (R or L)
2. Right Bundle Branch Block
3. Left Bundle Branch Block
4. Left Anterior Fascicular Block
5. Left Posterior Fascicular Block
6. Non-specific Intraventricular Conduction Delay
7. Intermittent blocks
What is the most common cause of an intraventricular conduction defect? Others?
1. MI
2. Hypertensive Cardiovascular Dz
3. Cardiomyopathy
4. Aortic or Mitral valve dz
Criteria for a RBBB?
1. QRS Duration > 0.12 sec
2. RSR’ in Right Precordial Leads
Criteria for a LBBB?
1. QRS Duration > 0.12 sec
2. RSR’ in Left Precordial Leads
4 major types of cardiac chamber abnormalities?
1. Left Atrial Enlargement(LAE)
2. Right Atrial Enlargement (RAE)
3. Left Ventricular Hypertrophy (LVH)
4. Right Ventricular Hypertrophy (RVH)
Why do the atria dilate and not really hypertrophy?
Their walls are not big enough
What should the duration and amplitude of a P wave be?
1. Duration < 0.12 sec
2. Amplitude < 2.5 mm (limb lead)
What are 4 causes of Right Atiral Enlargment?
1. Cor pulmonale (chronic lung disease)
2. Idiopathic pulmonary HT
3. Pulmonary stenosis
4. Congenital heart diseases
What are 2 definitions of P when left atrial enlargment has occured?
1. P > 0.12 sec and
Notched in limb lead

OR

2. P terminal > 1 mm
Wide X 1 mm
deep in V1
What are some causes of Left atrial enlargment?
1. Left Ventricular Disease causing increased LA pressure (HTN, AS, Cardiomyopathy)
2. Mitral Valve Disease – MS or MR
What is LVH usually followed by?
LAE
Why is LVH the most common chamber abnormality?
Prevalence of HTN
What is an exception to the high specificity of an EKG for LVH?
A young athelete.
What are the criteria for LVH?
S:V1 (or V2)[biggest S] -->
+R:V5(or V6)[biggest R] =
> 35 mm = LVH;Also:

Look for coexisting LAD and strain pattern. and

Leftward rotation.
What are some causes of LVH?
1. Hypertension
2. Aortic Valve Disease (AS or AI)
3. Cardiomyopathy
What are the criteria for RVH?
1. R/S ratio in V1 >1 -R bigger than S (or)
R/S ratio in V5 or V6 <1 -S bigger than R;
Often comes with:
RAD
RAE
Rightward rotation;

Also:

Must have normal QRS; and exclude if RBBB, WPW type A; young child; posterior wall MI
What are some causes of RVH?
1. Pulmonic Stenosis
2. Cor Pulmonale
3. Variety of Congenital
4. Cardiac Defects
Primary Pulmonary Hypertension
What is the gold standard test to evaluate for colon CA?
Colonoscopy
What does rigid proctoscopy allow visualization of?
The anus and rectum
What does flexible sigmoidoscopy allow visualization of?
Anus, rectum, sigmoid colon
What does colonoscopy allow visualization of?
Evaluation of entire colon until ileocecal valve.
for what type of patients are colonoscopies recommended for?
1. Patients with hemoccult positive stools
2. Abnormal sigmoidoscopy
3. Lower GI tract bleeding
4. Changes in bowel habits
5. Patients at high risk for colon cancer
For what is a colonoscopy contraindicated?
1. Unstable patients
2. Coagulopathies
3. Suspected perforation
4. Toxic megacolon
5. Recent colon anastomosis
What are 3 potential complications for colonoscopy?
1. Bowel perforation
2. Persistent bleeding
3. Oversedation
Does a colonoscopy required informed consent, why?
Yes, this is an invasive procedure that requires sedation-pt needs a ride home.
What is an essential step to take prior to undergoing the colonoscopy?
Bowel prep. Clean the colon out!
What are some abnormal findings seen during colonoscopy?
1. Colon cancer
2. Colon polyps
3. Inflammatory bowel disease (CUC, Crohn’s)
4. AV malformations
5. Hemorrhoids
6. Ischemic or post-inflammatory strictures
7. Diverticulosis
What are indigenous bowel flora?
Bacteria that normal reside within the bowel and cause no problems.
Name 8 types of indigenous bowel flora.
1. Enterococcus
2. Staphylococcus aureus
3. Escherichia coli
4. Proteus
5. Pseudomonas
6. Candida albicans
7. Bacteriodes
8. Clostridium
When might normal bowel flora become overgrown and a problem?
After use of antibiotics, immunosuppression, overaggressive catharsis.
What is diarrhea usually caused by?
Virus
What types of S/S would you look for when a patient comes in with diarrhea?
Skin turgor, dryness of the oral mucosa, urine output, HR, Orthostatic BP, capillary reflex
What are some alarming symptoms that can occur with diarrhea?
Blood, fever, cramping, >2days
When ordering a stool culture, are ova & parasites automatically checked as well?
No, you must ask - normally only bacteria are checked.
What are several factors that can interfere with an accurate stool culture?
1. Urine (can inhibit growth of bacteria)
2. Barium (can obscure detection of parasites)
3. Antibiotics,bismuth,mineral oil (can kill the bugs you are looking for)
If you cannot get a stool sample to the lab with in 30 minutes after collection, what can you do?
Refrigerate up to 2 hours.
What condition is the 'Scotch tape test' used for?
Pin worms-obtained through inhalation or ingestion
How much blood can a hemoccult card detect?
About 5cc
Two men are occupying booths in a public restroom, when one calls to the other,
"There is no toilet paper over here, do you have any over there?"

The second man replies, "No, sorry, I don't seem to have any, either."

The first man then asks, "Well, do you have a magazine or newspaper?"

The second man says, "No, sorry!"

The first man pauses, then inquires, "Do you have change for a twenty?"
4 weeks til finals (not counting this one!)
What does the FIT test detect?
The globin in the stool.
What types of foods can cause a false positive hemoccult?
Red meat
Cantaloupe and other melon
Grapefruit
Figs
Broccoli
Turnips
Radishes
Horseradish
Cauliflower
Maybe NSAIDS, ASA
What are 6 possible colon CA screening testing schedules recommended by the American Cancer Society?
Beginning at age 50, both men and women should follow 1 of these 5 testing schedules:

1. yearly fecal occult blood test (FOBT)
2. flexible sigmoidoscopy every 5 years
3. yearly FOBT, plus flexible sigmoidoscopy every 5 years
4. double-contrast barium enema every 5 years
5. colonoscopy every 10 years
What are 4 important risk factors for Colorectal CA?
1. Personal hx of colorectal CA or adenomatous polyps
2. Fm Hx of the same in 1st degree relative younger than 60yo or 2 1st degree relatives of any age.
3. Personal hx of IBD
4. Fm Hx of FAP or non-polyposis colon CA
What normal bacteria of the gut happens most frequently with antibiotic suppression of normal flora - how far after therapy begins to symptoms appear?
C-diff

4-10days (diarrhea, abd cramps, fever, leukocytosis)
What are 3 ways to make the diagnosis of C-diff?
1. C. toxin in the stool
2. Colonic-rectal tissue diagnosis
3. Stool cultures
What type of testing confirms steatorrhea?
Fecal fat testing
When would you suspect steatorrhea?
if a pt complains of large, greasy, foul smelling stools.
What are some conditions that can cause steatorrhea?
1. Short gut syndrome
2. Malabsorption (Celiac sprue, Crohn’s disease, Whipple’s dz)
3. Maldigestion
(Bile duct obstruction, pancreatic duct obstruction due to tumor or stone)
4. Cystic fibrosis-due to mucous plugging in GI tract and around pancrease
How does the fecal fat testing work?
Total output of fecal fat/24 hours in a 3 day specimen

Procedure: Adults ingest 3 days of 100 g/day of fat
What differs during the fecal fat test for children?
Children cannot tolerate 100 g/day of fat therefore a fat retention coefficient is calculated.

(Ingested fat-Fecal fat)/ Ingested fat

X 100%

= Fat retention coefficient
How much fat is normally retained?
95%
Lactose is a disaccharide composed of what component parts?
Glucose and Galactose
What do pts that cannot properly digest lactose lack?
Lactase enzyme - which if not present cannot break lactose into its component parts
If a person is lactose intolerant what type of symptoms will they experience?
after lactose ingestion, cramping, flatus, abdominal bloating, diarrhea
How does lactose tolerance testing work?
Patient drinks 100 g of lactose with 200 cc of H20. (peds dose based on weight)

With the condition- glucose levels will not rise as expected and a breath component measures expired hydrogen content.
What population of patients might have lactose intolerance?
Those with IBD, short gut syndrome, other malabsorption syndromes.
How is a patient with a general malabsorption syndrome differentiated from lactose intolerance during the test?
After the LTT, glucose is given and in the pt with a malabsorption condition the glucose level will not rise either.
What is a tumor marker?
A soluble molecule (usually glucoprotein) secreted by a tumor.
What are three possible types of tumor markers?
1. Hormones
2. Enzymes
3. Antigens
How are tumor markers detected?
Using monoclonal antibodies.
What type of setting would tumor markers usually not be useful in?
Screening for disease - not sensitive or specific enough for general population.
What are tumor markers useful for?
1. Monitoring treatment
2. Detecting tumor recurrence
If a tumor marker is absent does that mean malignancy is not present?
No
What are the three basic causes of anemia?
1. Increased RBC destruction
2. Decrease RBC production
3. Loss of blood
When would a CEA (carcinoembryonic antigen)test be ordered and what results would indicate a positive test?
After cancer (colon) is diagnosed - normal value is less than 5ng/mL
Does the presence or level of CEA help in deciding on adjuvant therapy?
No!
What are the two methods used for colon ca staging?
TMN, Dukes criteria
What are some benign conditions that can cause a falsely elevated CEA?
Cigarette smokers
PUD
IBS
Pancreatitis
Hypothyroidism
Biliary obstruction
Cirrhosis
What suggests that the CEA marker can be followed during surveillance following cancer treatment?
if that marker was increased pre-operatively.
How long after surgery/curative therapy do is CEA watched?
Q 3mo for 3 years
Why use CEA surveillance after curative colon CA treatment?
It is more cost effective than imaging as often - imaging would be performed if CEA became positive once again.
How often during active colon CA treatment is CEA checked?
At the beginning and every 1-3 months after.
What time period during colon CA treatment should you be cautious about using CEA?
First 4-6 weeks of treatment.
What is CA 19-9?
Cancer antigen 19-9 is found on the surface of cancer cells specifically in the pancreatic or hepatobiliary CA.
Can CA 19-9 be used as a screening tool?
This is not recommended.
What are 4 conditions that can produce a false positive CA 19-9?
Cirrhosis
Cholestasis
Cholangitis
Pancreatitis
When is CA 19-9 measured?
1. Pre-operatively or pre-treatment
2. Q 1-3 mo during active tx
An elevation following treatment for pancreatic CA of CA 19-9 would indicate?
Possible recurrence
An reduction following treatment for pancreatic CA of CA 19-9 would indicate?
Effective therapy
What is the major protein in fetal serum?
Alpha-fetoprotein (AFP)
When is serum AFP dominant?
In the first trimester of life- diminishes by 1 yo
What is AFP used for?
To detect neural tube defects (it would leak out from fetus to mother)
What would a low AFP indicate during pregnancy?
Possible Down syndrome in the fetus.
When would AFP be elevated in a non-pregnant patient?
Pt with liver CA (Hepatoma)
What are 2 benign conditions that might produce an elevated AFP?
1. Cirrhosis
2. Chronic active hepatitis
Can AFP be used as a screening serum marker?
Sometimes
How often would AFP be measuring when monitoring those with cirrhosis, hemachromatosis, hepatitis, or hepatocellular CA?
Q 6-12 months
What must an increased AFP be combined with to make a definitive diagnosis for liver disease?
Imaging
What is a carcinoid tumor?
A serotonin secreting tumor that originates in the appendix, intestines, or lung.
What type of test is used to detect carcinoid tumors?
5-hydroxyindoleacetic acid
(5 HIAA).
Why is 5 HIAA used to test for carcinoid tumors?
The serotonin released by these tumors is metabolized in the liver to 5 HIAA which is then excreted into the urine.
What type of testing is 5 HIAA?
24 hour urine test -urinate at time zero to begin with an empty bladder - combine all urine for the next 24 hours in a container and measure.
What are some foods that can interfere with 5 HIAA testing?
Bananas
Kiwi
Walnuts
Plums
Pecans
Eggplant
Tomatoes
Avacados