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101 Cards in this Set

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Disease that is associated with primary sclerosing cholangitis? What antibody may be seen?
Ulcerative colitis (70%)
+ p-ANCA (in 70%)
What is budd-chiari syndrome?
Occlusion of hepatic veins or IVC
Tx: heparin-->coumadin
What is common hematologic cause of budd-chiari?
polycythemia vera
What triad of sx are classic for budd-chiari?
hepatomegaly
RUQ pain
ascites
What ratio distinguishes ascites in portal hypertension from non portal causes?
SAAG=serum-ascities albumin gradient

SAAG>1.1 =portal hypertension

SAAG<1.1 = non-portal, peritonitis, cancer, hypoalbuminemia, pancreatitis
What lab is seen in ascitic fluid in spontaneous bacterial peritonitis?
>250 polys
+ ascites culture
What lab distinguishes cirrhosis ascites from cardiac ascites?
AFTP: ascites fluid total protein

AFTP <2.5 in cirrhosis
>2.5 in cardiac ascites
What labs are seen in hemochromatosis?
-HFE gene mutations
-Iron sat (iron/TIBC) >45%
- ^ Ferritin
Labs seen in alcoholic hepatitis?
AST: ALT > 2:1
how do you determine if treatment is warranted in alcoholic hepatitis?
Discrimination function = 4.6x (PT-control PT) + total bili

if >32 tx with prednisolone
if no infection, GI bleed

alt tx is pentoxifylline
Cause of GERD?
Sustained relaxation of lower esophageal sphincter.

Worse with increased abdominal pressure (pregnancy, obesity)
Presentation of GERD?
Heartburn or substernal pain 30-60 min after eating. Worse when lying down.
-May have nocturnal cough
Complication of chronic GERD?
Barrett's esophagus (growth of columnar epithelium)
-predisposition to develop adenocarcinoma
Cause of achalasia?
-Deffective LES nerve innervation
-Contacted LES with failure to relax
-Decreased peristalsis of lower 2/3 of esophagus
Imaging findings in achalasia?
-Esophageal manometry: absence of peristalsis
-Barium swallow: birds beak narrowing
Dx: Progressive dysphagia to solids and liquids?
Achalasia
Imaging findings in esophageal spasm?
Barium swallow: "corkscrew" or "rosary beads"
What medications relieve chest pain in esophageal spasms?
Nitro, CCB
Dx: Esophageal webs associated with iron deficiency in middle aged women?
Plummer-vinson syndrome
Dx: Esophageal webs located at squamocolumnar junction
Schatzkis ring
Dx: weakness in posterior pharyngeal wall associated with regurgitation, dysphagia and halitosis
zenkers diverticulum
Medication therapies for esophageal varices?
-Nadolol (chronic tx)
-Vasopressin, octreotide (vasoconstrictors)
-ABX in any cirrhosis patient with GI bleed (Ceftriaxone or norfloxacin)
Varices develop at what portal vein pressure?
>10 mmHg
Dx: Vomiting followed by painful hematemesis?
Mallory-Weiss Syndrome
(tear of mucosa at gastroesophageal junction)
Most common cause of upper GI bleeding?
PUD
Three major causes of PUD?
-H. pylori
-NSAIDS
-hypersecretory peptic states (Zollinger ellison syndrome)
Dx: Benign gastrin secreting tumor usually located in pancreas causing PUD?
Zollinger ellison syndrome
How do NSAIDs cause GI injury?
inhibits prostaglandin synthesis: decreased blood flow, bicarb synth, and mucus secretion
Dx: Epigastric gnawing pain relieved with food, worse at night?
duodenal ulcers
Dx: Epigastric pain aggravated by food and associated with weight loss?
gastric ulcer
What is the triple therapy used to treat H. pylori infection?
-PPI
-Clarithromycin
-Amoxicillin (Flagyl if PNC allergy)

x 2 wks
Zollinger ellison syndrome is associated with what metabolic disease?
MEN 1
Testing used to confirm dx of zollinger ellison syndrome?
-fasting serum gastrin (gold standard)
-gastric acid secretory studies
-secretin stimulation test
-somatostatin receptor scintigraphy
Common findings in MEN1 (Wermer syndrome)?
-Parathyroid tumor (hyper PTH,hypercalcemia)
-Gastrinoma (ZES)
-Insulinoma
-Prolactinoma
-Carcinoid tumor
What 2 lymph node findings are consistent with gastric or abdominal cancer?
sister mary joseph nodule (umbilical)
virchow's node (supraclavicular)
What is the most common cause of secretory diarrhea?
toxins from bacterial infection

(has normal stool ion gap in osm)
What are common causes of osmotic diarrhea?
celiac disease
laxative over use
lactose intolerance

(stool ion gap >100 osm)
What are common causes of excretory diarrhea?
Crohns
Ulcerative colitis
What serologic tests confirm celiac sprue?
IgA anti-endomysial and anti-tissue transglutaminase antibodies
Skip lesions and granulomas are seen with what condition?
crohns
Dx: Currant jelly stools and sausage like mass on abd exam?
intussusception
Mucosal changes seen in crohns disease?
skip lesions
cobblestoning
What serum antibody is found in crohns disease?
ASCA
(Anti-Saccharomyces cerevisiae antibodies)
What serum antibody is found in ulcerative colitis?
pANCA
(perinuclear antineutrophil cytoplasmic antibodies)
Area of GI tract most commonly involved in ulcerative colitis?
rectosigmoid colon
Dx: Fever, LLQ pain, n/v, palpable mass
diverticulitis
Best diagnostic imaging for diverticulosis?
barium enema
ABX treatment for mild diverticulitis?
flagyl + cipro or bactrim
What marker in blood indicates infection with HepB and infectivity?
HBsAg
and
HBeAg
What marker in blood indicates successful clearance of HepB or immunization?
anti-HBs
What marker in blood indicates acute infection or relapse in chronic HepB?
anti-HBc (IgM)
What treatment should be given to patient exposed to HepB?
Hep B immunoglobulin
(within 7 days of exposure)
What exam findings are consistent with cirrhosis?
gynecomastia
spider angiomas
palmar erythema
testicular atrophy
hepatomegaly
ascites
What is a bluish discoloration of umbilical skin caused by hemoperitoneum in severe pancreatitis?
cullen's sign
What is an ecchymotic discoloration of the flanks found in hemorragic pancreatitis?
Turner's sign
What peptic ulcer is caused by CNS stress?
cushings ulcer
What peptic ulcer is caused by stress in a burn patient?
curlings ulcer
Test of choice for diagnosis of PUD?
EGD with rapid urease test
Top 6 causes of uppper GI bleed?
1. PUD
2. Varices
3. Gastritis
4. Erosive esophagitis
5. Mallory-weiss tear
6. Arterio-venous malformations, angioectasias
Rare cause of rectal bleeding and intussusception, usually presenting <2yo?
Meckels diverticulum
What is the rule of 2s in meckels diverticulum?
-occurs in 2% of population
-located 2 feet from ileocecal valve
-usually in patients < 2 years old
-2 inches in length
-2x more common in males
-2 types of tissue common: gastric and pancreatic
Diagnostic test for meckels diverticulum?
technetium 99m scan
What tests are used to dx C-diff colitis?
Stool ELISA (toxins A and B
Stool cytotoxin assay (takes 24-48 hrs)
What types of diarrhea have an increased osmotic gap?
lactose intolerance
celiac disease
malabsorption disorders: pancreatic insufficiency, whipples disease
What blood tests confirm dx of celiac disease?
IgA antitissue transglutaminase
or
anti-endomysial antibody
Dx: acute colonic adynamic ileus with competent ileocecal valve
Ogilves
Diagnostic study of choice for diverticulitis?
Abdominal CT
Dx: abdominal pain out of proportion to abdominal tenderness on exam
mesenteric ischemia
Most common cause of mesenteric ischemia?
SMA embolism
Imaging of choice in mesenteric ischemia?
CT angiogram
Angiography (gold standard)
What pancreatic enzyme is most specific for pancreatitis?
Lipase
Which type of diarrhea has an increased osmotic gap (>50)?
osmotic: lactose intolerance, celiac disease, pancreatic insufficiency
What cause of diarrhea has increased fecal fat?
malabsorption: celiac disease, pancreatic insufficiency, whipples disease
A stool osmotic gap <50 indicates what cause of diarrhea?
secretory: carcinoid, zollinger ellison syndrome, hormonal causes

motility: irritable bowel syndrome, scleroderma
Ransons criteria for pancreatitis at initial diagnosis?
GALAW:
Glucose >200
Age >55
LDH >350
AST >250
WBC >16
Jaundice is seen when serum bili reaches what level?
>2.5
Causes of unconjugated (indirect) hyperbilirubinemia?
Overproduction: hemolysis, hematoma resorption, ineffective erythropoiesis

Defective conjugation: Gilberts syndrome, crigler-najjar syndrome
Cause of Gilbert syndrome?
Genetic deficiency of bilirubin-UGT enzyme. Decreased bili conjugation.
Which antibodies are seen in acute and chronic HepB?
Acute HepB: IgM
Chronic HepB: IgG
What is the max recommended dose of tylenol per day?
4g
What is the toxic metabolite of tylenol?
NAPQI
Antidote for tylenol toxicity?
N-acetylcysteine
(give up to 72 hrs after ingestion)
or later if chronic toxicity
Chart which determines treatment and risk of hepatotoxicity in tylenol overdose?
Rumack-Matthew nomogram
What nail findings may be seen in cirrhosis?
Muehrckes lines (horizontal white lines)

Terry's nails (white ground glass appearance)
Most common organism cause of spontaneous bacterial peritonitis?
gram negatives: E.coli, klebsiella
Tx of encephalopathy?
restrict dietary protein
lactulose
rifaximin
Scoring system used to stage liver failure?
child-turcotte-pugh
Scoring system used to stage survival and patients need for liver transplant?
MELD score
Cause of hemochromatosis?
genetic disorder causing iron overload and accumulation in liver
Tx of hemochromatosis?
phlebotomy weekly
Deferoxamine (binds iron)
Dx: genetic disorder causing copper overload and accumulation in liver?
wilsons disease
Eye finding in wilsons disease patients?
kayser-fleischer rings
Tx of wilsons disease?
chelation: penicillamine + pyridoxine

Zinc (decreases copper transport)
Most common type of gallstone?
cholesterol
Tx for choledocolithiasis?
ERCP
cholecystectomy 6wks later
Imaging that is more sensitive for cholecystitis than US?
HIDA scan
What is charcots triad and reynalds pentad?
Charcots: fever, jaundice, RUQ pain
Reynalds: above + altered mental status, shock

sx associated with cholangitis
Infectious cause of diarrhea that is also associated with development of Guillian-barre syndrome?
Campylobacter
ABX of choice for severe campylobacter diarrhea?
erythromycin
Initial rx of choice for inflammatory bowel disease?
Sulfasalazine
Prolonged use of PPIs can lead to reduced levels of what nutrient?
Vit B12