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32 Cards in this Set
- Front
- Back
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What's normal/abnormal HVPG |
Hepatic venous pressure gradient (HVPG). Normal portal pressure is generally defined between 5 and 10 mm Hg. n HPVG of ≥10 mmHg defines clinically significant portal hypertension, and if the measurement exceeds 12 mmHg variceal haemorrhaging may occur.
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A patient with PBC has grade 1 varices on endoscopy. What is the recommended follow up for this?
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Repeat endoscopy in 1-2 years and see if these varices grew. Can consider starting non-selective beta blockers.
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EtOH Cirrhosis patient found to have gastric fundic varices that were bleeding. After endoscopic therapy, what's the next step?
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Antibiotics - make sure 7 days of ABX. Patients with cirrhosis and bleeding - 45% have bacterial infections, and ABX lower mortality.
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Bacterial peritonitis occurs in what % of hospitalized cirrhotics?
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33%
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Most common cause of AKI in cirrhotic patients?
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Volume responsive pre-renal azotemia. (68% of the cases).
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Empiric therapy for SBP while awaiting cultures?
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Oral quinolone or third gen IV cephalosporin until culture results are available.
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In Hep C related cirrhosis, what's the rate of HCC development per year?
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1-4%. Also remember that screening of african american males should start at age 20 because risk of HCC begins at young age.
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How to differentiate recurrent Hepatitis C from acute cellular rejection on Liver biopsy?
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Both entities may show portal inflammation, lymphocytic cholangitis, central vein endotheliaitis and fibrosis. Central endotheliatis is most commonly seen with acute cellular rejection, but foamy degeneration is seen with late chronic rejection.
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Where is B12 absorbed in the gut?
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Ileum (with bile salts)
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Where is folate absorbed in the gut?
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Jejunum.
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Where is Iron absorbed in the gut?
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Duodenum (also jejunum).
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Functional products of:
1. I cells - 2. Parasympathetic Ganglia in sphincters - 3. G cells - 4. Mo cells - 5. K cells - 6. P/D1 cells - |
1. I cells - cck
2. Parasympathetic Ganglia in sphincters - VIP 3. G cells - Gastrin 4. Mo cells - Motilin 5. K cells -GIP (in duodenum and jejunum) 6. P/D1 cells - Gherlin (in stomach) |
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Most common GI bug that causes Reiter's Syndrome.
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Shigella - 85% of cases
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What is the significance of ATG16L1 polymorphism
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this gene is involved in autophagy and regulation of T cell homeostasis. the SNP at this geen is highly assocaited with Crohn's disease.
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Which antibody is most commonly associated with UC?
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P-ANCA
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Peutz-Jeghers syndrome mutation
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STK11 (LKB1). It is a possible tumor suppressor gene. It is inherited in an autosomal dominant pattern. |
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Gardner's syndrome mutation
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APC gene. It is the same gene as is mutant in familial adenomatous polyposis (FAP) |
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Gardner's syndrome extraintestinal manifestations.
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1. Osteomas (jaw, skull)
2. Epidermoid cysts 3. Desmoid tumors 4. Extra dentition 5. Skin fibromas |
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Juvenile Polyposis Syndrome mutations
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Two genes associated with Juvenile Polyposis Syndrome are BMPR1A and SMAD4.
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What type of renal stones do patietns with colectomy/end-ileostomy get?
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Due to decreased intestinal absoprtion of water and sodium - Uric Acid stones. Patients with Crohn's disease in distal ileum or ileal resections - calcium oxalate stones.
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Risk factors for Crohn's recurrence after surgical resection.
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1. Smoking - the only modifiable one.
2. Penetrating disease (fistulae, abscess or perf) 3. Prior Surgery for Crohn's disease |
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a patient with Crohn's disease asks about a likelihood of his kids having Crohn's (assuming healthy spouse)
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8%
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What is the most common site of extranodal lymphoma?
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Stomach. (10%). Usually B cell.
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DDx for thickened gastric folds
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1. ZE |
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What is Menetrier's disease?
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AKA hypoproteinemic hypertrophic gastropathy. a rare, acquired, premalignant disease of the stomach characterized by massive gastric folds, excessive mucous production with resultant protein loss, and little or no acid production. The disorder is associated with excessive secretion of transforming growth factor alpha (TGF-α) |
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What prevents recurrence of pouchitis?
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VSL#3 is an oral probiotic, has been shown to prevent pouchitis relapse in patients with chronic or recurrent pouchitis.
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Best antibiotics to treat pouchitis?
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Cipro/flagyl (have the most evidence behind them)
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Sulfasalazine toxicity specific to males?
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Azospermia/Infertility, Up to 72 of males have semen abnormalities on sulfasalazine. Can switch to mesalamines if want fertility. |
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Patient with longstanding UC has multifocal low grade dysplasia. Next step?
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Refer to a surgeon for colectomy with ileal pouch-anal anastomosis. There is a significant risk for a synchronous cancer.
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Peutz-Jegers - most common malignancies?
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1. Breast
2. Colon 3. Pancreas |
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for IPMN - What features on EUS suggest malignancy?
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-A main pancreatic duct ≥7 mm in MD-IPMN |
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4 most common gene mutations in HNPCC (Lynch) |
MSH2, MSH6, MLH1, and PMS2 (not in that order) |
