Term
| what should not deter the physician from starting feeding in acute pancreatitis |
|
Definition
|
|
Term
| when should you treat acute pancreatitis with Abx |
|
Definition
| only if patient is septic |
|
|
Term
| 2 potential Tx of acute pancreatitis and their affect on mortality and complications |
|
Definition
1. somastatin - dec mortality, no effect on complications
2. antiprotease - Gabexate Mesylate, no effect on mortality, dec complications |
|
|
Term
| what is the new bedside severity index in acute pancreatitis and what did it replace? |
|
Definition
| BISAP replacing Ranson's and Apache2 |
|
|
Term
| 5 items on the BISAP - Bedside Severity Index in Acute Pancreatitis |
|
Definition
1. BUN>35
2. impaired mental status
3. SIRS
4. age>60
5. PE on CXR |
|
|
Term
| how do you interpert the BISAP - Bedside Index of severity in acute pancreatitis |
|
Definition
| 3 and over items ~ with an increased in-hospital mortality |
|
|
Term
| 2 signs on physical examination that indicate severe necrotizing pancreatitis in acute pancreatitis |
|
Definition
cullen's sign - blue around the umbilicus
Turner's sign - blue in the flanks |
|
|
Term
| 6 causes of acute pancreatitis by order of incidence |
|
Definition
1. gallstones
2. alcohol
3. ERCP
4. TG>1000
5. Valproic acid
6. anti HIV Tx |
|
|
Term
| 5 predisposing factors to Acalculous Cholecystitis |
|
Definition
1. trauma
2. burns
3. postpartum
4. TPN
5. postoperative |
|
|
Term
| what could you see on US/CT in acalculous cholecystitis? |
|
Definition
| billiary sludge and/or tense gallbladder |
|
|
Term
| with what method could you see an absent flow from the gallbladder in acalculous cholecystitis |
|
Definition
| hepatobilliary scintography |
|
|
Term
| 3 step mgmt of acalculous cholecystitis |
|
Definition
1. flagyl
2. PTC
3. when stabilized - early cystectomy |
|
|
Term
| 2 MCC of liver transplantation |
|
Definition
|
|
Term
| what is the ratio of ALT/AST in non-alcoholic fatty liver disease? |
|
Definition
|
|
Term
| what syndrome is non alcoholic fatty liver disease a part of? |
|
Definition
|
|
Term
| 2 Dx steps for non alcoholic fatty liver disease |
|
Definition
1. alcohol intake<20 g/d
2. exclude other causes of liver steatosis by serology, ceruloplasmin, iron, alpha-1-antitrypsin |
|
|
Term
| what is the Tx for non alcoholic fatty liver disease |
|
Definition
|
|
Term
|
Definition
1. salt restriction < 2g/d
2. spirinolactone
3. fusid
4. TIPS |
|
|
Term
| what do you give for prophylaxis of upper GI bleeding? |
|
Definition
|
|
Term
| 4 step mgmt of upper GI bleeding |
|
Definition
1. 2 large bore IV catheters
2. endoscopy and sclerotherapy - band ligation not in acute settings
3. if emergent endoscopy not available - blackemore/minnesota tube
4. vasopressors, somatostatin |
|
|
Term
| what is the discriminate factor in acute alcoholic hepatitis? |
|
Definition
|
|
Term
| what finding associated with poor prognosis and is an indication for Tx in acute alcoholic hepatitis? |
|
Definition
|
|
Term
| what are 2 Px models in acute alcoholic hepatitis? |
|
Definition
| MELD (model for end stage liver disease) and discriminate factor |
|
|
Term
| 2 elements in the pathogenesis of autoimmune hepatitis |
|
Definition
1. genetic predisposition
2. environmental trigger, viral or chemical, such as previous HAV/HBV infection |
|
|
Term
| evidence of autoimmune hepatitis (5) |
|
Definition
1. liver Bx -> cytotoxic T cells
2. circulating Abs
3. other autoimmune disorders present: RA, Sjogrens, Celiac
4. HLA present in other autoimmune diseases
5. responsive to steroids |
|
|
Term
| 18 s/s of autoimmune hepatitis |
|
Definition
| fatigue, anorexia, amenorrhea, acne, arthralgia/arthritis, rash, erythema nodosum, colitis, pericarditis, edema, encephalopathy, hypersplenism, coagulopathy, anemia, acute renal failure |
|
|
Term
| 5 lab finding in autoimmune hepatitis (similar to those in chronic viral hepatitis) |
|
Definition
1. increased aminotransferases
2. increases billirubin
3. hypoalbuminemia
4. increased PT
5. hypergammaglobulinemia >2.5 |
|
|
Term
| what autoantibodies are present in autoimmune hepatitis and which is MC |
|
Definition
| MC - ANA, RF, anti-smooth muscle |
|
|
Term
| 3 type classification of autoimmune hepatitis by autoantibodies and clinical presentation |
|
Definition
1. type 1 - young females, hyperglobulinemia, lupoid features, ANA, HLA DR3/4, autoantibodies against actin and pANCA
2. type 2 - children, HLA DRB1, anti-LKM and no ANA
3. type 3 - close to type 1 |
|
|
Term
| 3 step Dx in autoimmune hepatitis |
|
Definition
1. exclude liver disease caused by genetic, viral, drug and alcohol (all can have hyperglobulinemia, autoantibodies, and similar histology)
2. factors that weigh in favor: female, and other typical findings
3. factors that weigh against: inc ALP, mitochondrial autoantibodies, and evidence that is suggestive of DD |
|
|
Term
| Tx of autoimmune hepatitis (2) |
|
Definition
| corticosteroids, response in 80% and azathioprine |
|
|
Term
| what to do when refractory to Tx in autoimmune hepatitits |
|
Definition
|
|
Term
| what is the Px of autoimmune hepatitis |
|
Definition
mild disease - limited progression to cirrhosis
severe/progressive disease - 40% mortality in 6 months - 20% of patients |
|
|
Term
| what % of patients with an HCV infection progress to chronic disease, cirrhosis? |
|
Definition
| 85%, 20% of those who progress to chronic |
|
|
Term
| what % of patients with HCV don't experience a rise in aminotransferases at presentation |
|
Definition
| 33%, 25% of those will develop a rise in the future |
|
|
Term
| 8 risk factors for the development of cirrhosis in the setting of HCV |
|
Definition
1. long duration of infection
2. old age
3. liver disease
4. HIV
5. complex quasi-species
6. genotype 1
7. obesity
8. histology - grade |
|
|
Term
| what is the most predictive factor for cirrhosis and poor Px in the setting of HCV? |
|
Definition
| histology: severe inflammation or necrosis/fibrosis |
|
|
Term
| what is the treatment of HCV |
|
Definition
|
|
Term
| which genotypes are more responsive to Tx in HCV |
|
Definition
| genotypes 1 and 4 more responsive to Tx than 2 and 3 |
|
|
Term
| in HCV, when patients don't show biochemical or virologic response does it mean they are unresponsive? |
|
Definition
| no, 75% of those patients will show response on histology |
|
|
Term
|
Definition
1. age>60
2. severe renal insufficiency
3. mild hepatitis in Bx |
|
|
Term
| follow up on Tx in HCV - what is the likelihood of sustained virologic response? |
|
Definition
1. if dec in viral load less than 2 logs SVR is unlikely
2. if over than 66% likelihood
3. if viral load undetected 80% of SVR |
|
|
Term
| what population suffers most from HEV infection? |
|
Definition
|
|
Term
|
Definition
| water-borne, no human to human transmission |
|
|
Term
| what is a promising prophylaxis Tx for HCV chronicity? |
|
Definition
|
|
Term
| whats an unexpected mode of transmission in acute HBV infection? |
|
Definition
|
|
Term
| what are the typical billirubin levels in Crigler-Najar syndrome? |
|
Definition
|
|
Term
| what are the symptoms of Crigler Najar? |
|
Definition
| neurologic damage d/t Kernicterus |
|
|
Term
| how do you classify crigler najar - 2 classes |
|
Definition
type 1 - 10% UDP glucoronidase, lower billirubin levels
type 2 - 0% UDP glucoronidase, higher billirubin levels |
|
|
Term
| MC manifestation of liver disease |
|
Definition
|
|
Term
| what is the correlation btwn nonvisualization of appendix on CT and white appendix in surgery? |
|
Definition
|
|
Term
| MCC of appendicitis and other causes (6) |
|
Definition
ficalith
enlarged lymph nodes(measles), barium, worms (pinworms, ascaria, Tinea), carcinoid, carcinoma, Y.Enterocolitica |
|
|
Term
| 3 causes of chronic appendicitis |
|
Definition
| TB, amebiasis, actinomyces |
|
|
Term
| what is the clinical presentation of perianal/anorectal abscess (4) |
|
Definition
1. 3rd-5th decade of life
2. pain with defecation
3. fever
4. male > female |
|
|
Term
| 3 risk factors for perianal/anorectal abscess |
|
Definition
| DM, immunosuppression, IBD |
|
|
Term
|
Definition
1. enlargement + bleeding
2. prolapse and return spontaneously
3. prolapse and return manually
4. doesn't return |
|
|
Term
| Tx of hemorrhoids according to stage |
|
Definition
stage 1 and 2 - fiber, cortisone suppositories, sclerotherapy
stage 3 and 4 - same as stage 1/2 + banding or hemorrhoidectomy |
|
|
Term
|
Definition
| fever, leukocytosis, LLQ pain, anorexia |
|
|
Term
| what is the incidence of perforation in diverticulitis |
|
Definition
|
|
Term
| Dx of diverticulitis - what do you see (3) |
|
Definition
| CT w oral contrast: thickend wall>4 mm, pericolic inflammation, sigmoid diverticula |
|
|
Term
| what are the CI in diverticulitis? |
|
Definition
|
|
Term
| when and why should colonoscopy be preformed in diverticular disease? |
|
Definition
| 6 wks after cessation of symptoms for malignancy |
|
|
Term
| 3 complications of diverticular disease |
|
Definition
| perforation, fistula, abscess |
|
|
Term
| what is the classification of perforation in diverticular disease |
|
Definition
HINCHEY: 1. confined pericolic abscess
2. closed spontaneously with distant abscess
3. noncommunicating with fecal peritonitis
4. communicating and fecal peritonitis |
|
|
Term
| in diverticular disease a fistula can connect btwn the colon and 3 other organs |
|
Definition
|
|
Term
| what % of cases are complicated in diverticular disease? |
|
Definition
|
|
Term
| what is the Tx of uncomplicated diverticulitis (2) |
|
Definition
1. bowel rest
2. Abx - TMP-SMX or Cipro+Flagyl (7-10 days) |
|
|
Term
| what is the Tx of the 2nd and so forth episode of diverticulitis? |
|
Definition
| contrast to old misconception, recurrent disease doesn't confer increased risk of complication and Tx is similar to first time uncomplicated disease |
|
|
Term
| what is the long term mgmt of diverticulitis? (3) |
|
Definition
1. rifaxim - poorly absorbed broad spectrum abx ~ with a 30% decrease in recurrence
2. probiotics
3. fiber diet |
|
|
Term
| except patients with complicated disease, what other patients should undergo surgery in diverticulitis and why? |
|
Definition
recurrence and also 1. immunosuppressive Tx 2. chronic renal failure 3. collagen vascular disease
X5 risk of perforation |
|
|
Term
| is pyoderma gangrenosum ~ with UC or CD? |
|
Definition
|
|
Term
| 2 characteristics of pyoderma gangrenosum |
|
Definition
| lower extremities, unrelated to colectomy |
|
|
Term
|
Definition
|
|
Term
| what are 4 skin manifestations in IBD? |
|
Definition
| pyoderma gangrenosum, psoriasis, erythema nodosum, pyoderma vegetans |
|
|
Term
| erythema nodosum in CD or UC |
|
Definition
|
|
Term
| what is a risk factor for CD? |
|
Definition
|
|
Term
| what is the epidemiology of IBD? |
|
Definition
| bimodal distribution 15-30 and 60-80 |
|
|
Term
| what are 3 etiologies which most commonly lead to short bowel syndrome? |
|
Definition
1. mesenteric vascular ischemia
2. mucosal/submucosal disease (CD)
3. Trauma |
|
|
Term
| 4 complications of short bowel syndrome |
|
Definition
| cholesterol gallstones, renal oxalate calculi, gastric acid hypersecretion, steatorrhea |
|
|
Term
| how do you distinguish ZES from other gastrin secreting conditions and what are those conditions |
|
Definition
|
|
Term
| what is a risk factor for CD? |
|
Definition
|
|
Term
| what is the epidemiology of IBD? |
|
Definition
| bimodal distribution 15-30 and 60-80 |
|
|
Term
| what are 3 etiologies which most commonly lead to short bowel syndrome? |
|
Definition
1. mesenteric vascular ischemia
2. mucosal/submucosal disease (CD)
3. Trauma |
|
|
Term
| 4 complications of short bowel syndrome |
|
Definition
| cholesterol gallstones, renal oxalate calculi, gastric acid hypersecretion, steatorrhea |
|
|
Term
| how do you distinguish ZES from other gastrin secreting conditions and what are those conditions |
|
Definition
1. atrophic gastritis
2. G cell hyperplasia
3. acid suppression Tx
secretin stimulation test> 200pg |
|
|
Term
| definition of refractory PUD (2) |
|
Definition
1. DU - 8 wks, GU - 12 wks
2. exclude: NSAIDs, non-compliance, smoking, persistent H.Pylori |
|
|
Term
| 4 steps in the mgmt of refractory PUD |
|
Definition
1. confirm refractory PUD
2. consider ZES: fasting gastrin or secretin stimulation
3. increase dose of PPI
4. consider surgical Tx |
|
|
Term
| Tx of H.Pylori infection and rates of eradication |
|
Definition
1st line - triple Tx
2nd line - quadruple Tx |
|
|
Term
| what is the indication for noninvasive testing for H.Pylori |
|
Definition
| suggestive symptoms and no indication for endoscopy such as bleeding, atypical symptoms |
|
|
Term
| 3 noninvasive testing options for H.Pylori |
|
Definition
1. plasma serology (not for follow up - stays up)
2. urea breath test
3. fecal antigen - not established for follow up. |
|
|
Term
| what are 2 limitations for the urea breath test (H.Pylori) |
|
Definition
1. false negative: PPI, Abx, bismuth
2. exposure to radiation |
|
|
Term
| 4 non GI complications of GERD |
|
Definition
1. asthma
2. chronic cough
3. laryngitis
4. dental erosions |
|
|
Term
| what is Schatzki's ring, symptoms and Tx? |
|
Definition
| a ring of tissue at the squamocolumnar border in the esophagus. dysphagia only to solids. Tx: dilitation |
|
|
Term
| what is the only advantage of Barium of Endoscopy? |
|
Definition
|
|
Term
| what is the only advantage of Barium of Endoscopy? |
|
Definition
|
|
Term
| what is the workup of a resectable pancreatic lesion on imaging with a clinical presentation of carcinoma? |
|
Definition
| must go to surgery even w/o Bx or FNA d/t risk of peritoneal seeding |
|
|
Term
| what is the role of CA19-9 in the Dx of pancreatic carcinoma |
|
Definition
|
|
Term
| what does flow to the umbilicus from the lower abdomen indicate on doppler? |
|
Definition
|
|
Term
| what does flow to the umbilicus from the upper abdomen indicate on doppler? |
|
Definition
|
|
Term
| what does flow from the umbilicus on doppler indicate? |
|
Definition
|
|
Term
| 3 categories of causes for isolated unconjugated hyperbillirubinemia |
|
Definition
1. acquired: microangiopathic, PNH, autoimmune, nutritional ineffective erythropoiesis
2. inherited: sickle cell, spherocytes, G6PD def, Gilberts, Crigler Najar
3. drugs: probenecid, ribavirin, rifampicin
2. inherited |
|
|
Term
| what is the pathophysiology of mesenteric ischemia |
|
Definition
| arterial embolus or thrombosis |
|
|
Term
| 5 risk factors for mesenteric ischemia |
|
Definition
| age, AF, valvular disease, recent arterial catheterization, recent MI |
|
|
Term
| what is the GS for Dx of mesenteric ischemia and what could assist |
|
Definition
|
|
Term
| would you find unconjugated billirubin in the urine? |
|
Definition
| no, unconjugated billirubin is attached to albumin in the blood and cannot be excreted in the kidney |
|
|
Term
| when will conjugated billirubin be found in the urine |
|
Definition
| disease of the bile canaliculi |
|
|
Term
| 7 causes of a sudden worsening of ascites in the setting cirrhosis |
|
Definition
| noncompliance, portal vein thrombosis, bacterial peritonitis, HCC, alcoholic hepatitis, viral infection and peritoneal TB |
|
|
Term
| what is the 1st step in the evaluation of jaundice? |
|
Definition
| determining whether it is isolated hyperbillirubinemia or ~ with abnormal liver function tests |
|
|
Term
| what is the 1st step in the evaluation of isolated hyperbillirubinemia? |
|
Definition
| determining whether it is direct (>15% conjugated) or indirect |
|
|
Term
| 3 drugs that may cause indirect isolated hyperbillirubinemia |
|
Definition
| probenecid, rifampin, ribavirin |
|
|
Term
| in the evaluation of jaundice after establishing a hyperbillirubinemia with other abnormal live function tests, what is the next step? |
|
Definition
| determining whether the liver function test are predominantly abnormal in their cholestatic of cellular function |
|
|
Term
| in the evaluation of jaundice after testing negative for HAV, HBV, HCV, toxicologies (acetaminophen), ANA, LKM, SMA, SPEP - what is the next step? |
|
Definition
| testing for HEV, HDV, CMV, EBV |
|
|
Term
| in the evaluation of jaundice, after testing negative for CMV and EBV and having no indication for HEV or HDV testing, what is the next step? |
|
Definition
|
|
Term
| in the evaluation of jaundice, when is ceruloplasmin testing indicated? |
|
Definition
|
|
Term
| in the evaluation of jaundice, after establishing a predominantly hepatocellular dysfunction, what is the next step? |
|
Definition
| HAV, HBV, HCV, toxicology (acetaminophen), ceruloplasmin, ANA, SMA, LKM, SPEP |
|
|
Term
| in the evaluation of jaundice, after establishing a predominantly cholestatic liver dysfunction, whats the next step and why? |
|
Definition
| US to determine if intra/extrahepatic by checking for dilated ducts |
|
|
Term
| in the evaluation of jaundice, after establishing an extrahepatic cholestatic dysfunction, what are the 2 possible next steps? |
|
Definition
|
|
Term
| in the evaluation of jaundice, after establishing intrahepatic cholestatic dysfunction on US, what is the next step? (4) |
|
Definition
| AMA, EBV, CMV, Hepatitis serologies |
|
|
Term
| what 7 drugs cause cholestatic dysfunction? |
|
Definition
| chlorpromazine, erythromycin, OCP, anabolic steroids, penicillin, resprim, cimetidine |
|
|
Term
| in the evaluation of jaundice, after establishing an intrahepatic cholestatic dysfunction and getting all serologies negative, what are the 2 possible next steps? |
|
Definition
|
|
Term
| in the evaluation of jaundice, after establishing an intrahepatic cholestatic dysfunction and getting the AMA serology positive, what is the next step? |
|
Definition
|
|
Term
| 8 viruses that can cause hepatitis and jaundice |
|
Definition
| Hepatitis A,B,C,D,E CMV, EBV, HSV |
|
|
Term
| which drug causes jaundice in a hepatocellular dysfunction pattern in predictable doses and which in idiosyncratic doses? |
|
Definition
| acetaminophen and isoniazide |
|
|
Term
| 4 environmental exposures that can cause jaundice in an hepatocellular dysfunction mechanism? |
|
Definition
Kava Kava
Jamaican Tea Bush
wild mushrooms
vinyl chloride |
|
|
Term
| 5 viruses that cause jaundice thru an intrahepatic cholestatic mechanism |
|
Definition
|
|
Term
| 3 infiltrative diseases that cause jaundice in a intrahepatic cholestatic mechanism? |
|
Definition
| TB, lymphoma, amyloidosis |
|
|
Term
| 12 bizarre causes of jaundice in a intrahepatic cholestatic mechanism (other than viral, drugs, alcohol, inherited) |
|
Definition
infiltrative: TB, lymphoma, amyloidosis
postsurgical
sarcoidosis
pregnancy induced
sepsis induced
primary billiary cirrhosis
primary sclerosing cholangitis
TPN
paraneoplastic
veno-occlusive disease
parasitic inf: malaria, leptospirosis
GVHD |
|
|
Term
| 2 parasitic infections that cause jaundice in a intrahepatic cholestatic mechanism |
|
Definition
| malaria and leptospirosis |
|
|
Term
| parasitic disease that causes jaundice in a extrahepatic cholestatic mechanism |
|
Definition
|
|
Term
| in what mechanism does AIDS cause jaundice? |
|
Definition
|
|
Term
| what is the vanishing bile duct syndrome and what 3 things cause it? |
|
Definition
intrahepatic cholestatsis manifesting as jaundice related to decreased bile ducts on liver Bx. causes:
post transplant: 1. chronic rejection
2. GVHD
3. sarcoidosis |
|
|
Term
| 3 options for alternative Dx to the skin coloration seen also in jaundice |
|
Definition
1. carotenoderma
2. Quinacrine - antiprotozoal, rheumatologic
3. phenols |
|
|
Term
| what is the difference btwn the discoloration seen in carotenoderma and jaundice? how to distinguish |
|
Definition
carotenoderma - palms, soles, nasolabial folds, forehead
jaundice - diffuse
look at sclerae |
|
|
Term
| 7 options for a sudden worsening of ascites in the setting of cirrhosis |
|
Definition
noncompliance with Tx
portal vein thrombosis
bacterial peritonitis
HCC
alcoholic hepatitis
viral infection
peritoneal TB |
|
|
Term
| do you Dx peritoneal TB with adenosin deaminase? |
|
Definition
| no, Dx is with peritoneal Bx or visual macro appearance |
|
|
Term
| what is the endoscopic appearance of pseudomembranous colitis? |
|
Definition
|
|
Term
| what is the endoscopic appearance of ischemic colitis? |
|
Definition
| edematous patches with bluish discoloration |
|
|
Term
| what is the endoscopic appearance of salmonella? |
|
Definition
| mucosal edema and enlarged payer's patches |
|
|
Term
| 3 causes of extreme rise in aminotransferases |
|
Definition
viral
toxic
vascular/hemodynamic |
|
|
Term
| 3 symptoms of Afferent loop syndrome |
|
Definition
| bloating pain 20-60 mins after eating malabsorption |
|
|
Term
| what is afferent loop syndrome? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| what is bilroth2 gastrojejunostomy? |
|
Definition
|
|
Term
| 4 DDs for CMV Esophagitis in an HIV+ patient |
|
Definition
herpes simplex
candida
VZV
HIV |
|
|
Term
|
Definition
|
|
Term
| what is the macro appearance of CMV esophagitis on endoscopy? |
|
Definition
| small ulcers coalesce to bigger ones |
|
|
Term
| 2 things to see in Bx of CMV esophagitis |
|
Definition
1.intranuclear and intacytoplasmic inclusion bodies
2. enlarged nuclei |
|
|
Term
| 2 line Tx for CMV esophagitis |
|
Definition
1st line: IV Gancyclovir or PO Valgancyclovir
2nd line: Foscarnat |
|
|
Term
| what is the macro appearance of HSV esophagitis on endoscopy? |
|
Definition
| vesicles and punched out lesions |
|
|
Term
| what do you see on Bx of HSV esophagitis? |
|
Definition
| ballooning degeneration and ground glass appearance of the nuclei |
|
|
Term
| 2 line Tx for HSV esophagitis |
|
Definition
|
|
Term
| macro appearance of Candida esophagitis |
|
Definition
| yellow plaques surrounded by erythema |
|
|
Term
| Tx of Candida esophagitis |
|
Definition
|
|
Term
| 2 characteristics of the macro appearanch of HIV esophagitis on endoscopy |
|
Definition
|
|
Term
| 3 item Tx for HIV esophagitis |
|
Definition
| Thalidomide, Corticosteroids, ART |
|
|
Term
| 4 organisms that cause bloody diarrhea |
|
Definition
| campylobacter, shigella, anaerobic, EHEC |
|
|
Term
| 2 organisms that cause watery diarrhea |
|
Definition
|
|
Term
| 2 signs that are present in chronic active hepatitis but not in chronic persistent hepatitis |
|
Definition
| arthritis and anti-smith Ab |
|
|
Term
| 3 items of the Dx of chronic active hepatitis |
|
Definition
1. lobular invasion
2. hepatocellular regeneration
3. piecemeal necrosis - erosion of hepatocytes bordering the portal triad |
|
|
Term
| what is the MCC of hematochezia in age>60? |
|
Definition
|
|
Term
| what is the MC position of a colonic diverticulum and what is the rate of rebleeding? |
|
Definition
|
|
Term
| how is the Tx for acute diverticulosis divided? |
|
Definition
1. hemodynamically stable - mesenteric angiography
2. hemodynamically unstable or received 6 units of blood in the past 24 hrs - surgery |
|
|
Term
| 3 s/s of acetaminophen toxicity |
|
Definition
| shock, confusion, abdominal pain |
|
|
Term
| what is the pathophysiology of acetaminophen toxicity |
|
Definition
| acetaminophen is metabolized by phase 2 in the liver. when levels rise in blood this pathway saturates, and some of the drug gets metabolized by phase 1 instead, into a toxic substance called NAPQI |
|
|
Term
| 2 indications for liver transplantation in a patient with acetaminophen toxicity |
|
Definition
1. new coagulation disorder
2. jaundice |
|
|
Term
| does lack of increase in transaminases R/O acetaminophen toxicity? |
|
Definition
| no, Transaminases can rise after 4-6 days of Acetaminophen ingestion |
|
|
Term
| 3 Tx options for acetaminophen toxicity |
|
Definition
| gastric lavage, activated charcoal, N-acetylcysteine |
|
|
Term
| what is the definition of chronic diarrhea? |
|
Definition
|
|
Term
| what 2 things distinguish secretory from osmotic diarrhea? |
|
Definition
1. secretory persists at night and during fasting
2. osmolar gap<50 in secretory |
|
|
Term
| 10 exmpls of agents causing secretory diarrhea |
|
Definition
| bisacodyl, castor oil, antibiotics, antihypertensives, carcinoid, VIP secreting tumor, medullary thyroid carcinoma, gastrinoma, villous adenoma, Crohn's Disease |
|
|
Term
| What type of diarrhea can CD cause? |
|
Definition
|
|
Term
| 5 conditions that predispose to HCC |
|
Definition
HBV
HCV
alcoholic cirrhosis
hemochromatosis
primary billiary cirrhosis |
|
|
Term
|
Definition
1. surgery
2. radiofrequency ablation
3. chemoembolization
4. liver transplantation |
|
|
Term
| how do you distinguish btwn small and large duct chronic pancreatitis? 2 characteristics of small duct disease and 3 of large duct disease |
|
Definition
small duct disease - females, pain responsive to pancreatic enzymes
large duct disease - pancreatic calcifications on CT, abnormal pancreatic exocrine function, steatorrhea |
|
|
Term
| 3 causes of recurrent bouts in chronic pancreatitis |
|
Definition
| pancreatic divisum, alcoholism, CF |
|
|
Term
| what 2 complications can be caused by chronic pancreatitis |
|
Definition
| DM (not DKA) and pancreatic Ca |
|
|
Term
| Tx of chronic pancreatitis |
|
Definition
|
|
Term
| what is the complication of Juvenile Hemartomatous Polyps |
|
Definition
|
|
Term
| how to distinguish btwn gastroparesis and gastric outlet obstruction? |
|
Definition
| GOO gives an radiographic image of an air bubble in the stomach while gastroparesis doesn't |
|
|
Term
| arthritis of large joints MC in CD or UC? |
|
Definition
|
|
Term
| Tx of large joint arthritis in CD |
|
Definition
|
|
Term
| what are 3 extraintestinal manifestations of CD for which Tx is control of bowel disease |
|
Definition
large joint arthritis
VTE
Erythema nodosum |
|
|
Term
| 3 extraintestinal manifestations of IBD seen more in CD than UC |
|
Definition
| ankylosing spondylitis, nephrolithiasis, large joint arthritis |
|
|
Term
| what % of patients with IBD develop primary sclerosing cholangitis, and out of those what % develop cholangiocarcinoma? |
|
Definition
|
|
Term
| in which case of acute pancreatitis is NPO preffered over TPN? |
|
Definition
|
|
Term
| 3 factors that may lower the sensitivity of amylase and lipase for acute pancreatitis |
|
Definition
chronic pancreatitis
hypertriglyceridemia
interval btwn symptoms and drawing the blood |
|
|
Term
| which is more sensitive for acute pancreatitis, amylase or lipase? |
|
Definition
|
|
Term
| where do hepatic adenomas MC appear |
|
Definition
|
|
Term
| when do hepatic adenomas MC appear |
|
Definition
|
|
Term
| what exacerbates hepatic adenomas |
|
Definition
| exposure to estrogen such as in pregnancy |
|
|
Term
| what is the risk of malignancy with hepatic adenomas |
|
Definition
|
|
Term
| 3 possible complications of hepatic adenomas |
|
Definition
| bleeding, pain, malignancy |
|
|
Term
| Tx of asymptomatic and small hepatic adenoma |
|
Definition
|
|
Term
| Tx of painful hepatic adenoma |
|
Definition
| discontinue OCP and follow up in one month |
|
|
Term
| when is surgery indicated in the Tx of hepatic adenoma |
|
Definition
| if after stop of OCP no change in size of adenoma |
|
|
Term
| 5 predominant s/s of cholangiocarcinoma |
|
Definition
increased liver enzymes
cholangitis
RUQ pain
jaundice
pruritus |
|
|
Term
| 5 risk factors for developing cholangiocarcinoma |
|
Definition
1. liver flukes - clonorchis and opisthorchis
2. choledochal cysts
3. caroli disease
4. primary sclerosing cholangitis
5. toxic dyes in the automobile and rubber industry |
|
|
Term
| definitive Dx of cholangiocarcinoma |
|
Definition
|
|
Term
| 2 mechanisms of secretory diarrhea |
|
Definition
|
|
Term
| 4 causes of osmotic diarrhea |
|
Definition
celiac
lactase def.
whipples disease
chronic pancreatitis |
|
|
Term
| if appendicitis occurs during pregnancy what trimester is MC |
|
Definition
|
|
Term
| what is the sign that is always present in FMF |
|
Definition
|
|
Term
|
Definition
| fever, serositis, monoarthritis, rash |
|
|
Term
| what is a late complication of FMF |
|
Definition
|
|
Term
|
Definition
| clinical and gene testing for the MC mutations |
|
|
Term
| what is the prophylaxis Tx of FMF and how does it help? |
|
Definition
| colchicine - reduce frequency of attacks and reduce rates of amyloidosis |
|
|
Term
| what is the natural history of FMF |
|
Definition
| self limited attacks that resolve in 72 hrs |
|
|
Term
| 9 unusual causes of constipation |
|
Definition
| CCBs, antidepressants, parkinson, MS, spinal cord injury, pregnancy, hypercalcemia, depression, hypocalcemia |
|
|
Term
| 2 adverse affects of azathioprine |
|
Definition
pancreatitis
increases risk of lymphoma X4 |
|
|
Term
| adverse effect of methotrexate |
|
Definition
|
|
Term
| 2 adverse effects of antiTNF |
|
Definition
| TB, disseminated histoplasmosis |
|
|
Term
| what should you suspect is the cause of cirrhosis in and elderly female with no risk factors |
|
Definition
|
|
Term
| primary billiary cirrhosis is associated with what serologic finding in 90% of patients |
|
Definition
|
|
Term
|
Definition
|
|
Term
| what is the adverse effect of alosetron |
|
Definition
|
|
Term
| what is the most important step in the evaluation of ascites |
|
Definition
| paracentesis to perform a serum-ascites albumin gradient (SAAG) to distinguish low and high SAAG causes |
|
|
Term
| what is the cutoff point btwn low and high SAAG in Ascites? |
|
Definition
|
|
Term
| 3 causes of high SAAG ascites |
|
Definition
| portal hypertension, right heart failure, nephrotic syndrome |
|
|
Term
| 4 causes of low SAAG ascites |
|
Definition
| malignancy, infection, inflammation, chylous ascites |
|
|
Term
| what is mandatory in the lab work of chylous ascites |
|
Definition
|
|
Term
| 4 organisms that reduce inflammation and the risk for IBD |
|
Definition
| Lactobacillus, Bifidobacterium, Taenia Suis, Sacharomyces Bonilardii |
|
|
Term
| what is the triad of whipples disease? |
|
Definition
| steatorrhea, migratory large joint arthritis, weight loss |
|
|
Term
|
Definition
|
|
Term
| 2 Tx options for whipples disease |
|
Definition
| chloramphenicol or resprim for 1 year |
|
|
Term
| 2 organs that may be damaged in whipples diseases |
|
Definition
|
|
Term
| what is the most sensitive indicator of metastasis to the liver |
|
Definition
|
|
Term
| malignancies in which 3 organs tend to metastasize the most to the liver? |
|
Definition
|
|
Term
| which type of melanoma particularly metastasizes to the liver |
|
Definition
|
|
Term
| when does Hb decrease in the setting of acute GI bleeding? |
|
Definition
| after 72 hrs from start of bleeding |
|
|
Term
| does the absence of blood in the nasogastric tube R/O upper GI bleeding? |
|
Definition
| no it is absent in 20% of cases of upper GI bleeding |
|
|
Term
| in case of cholestatic dysfunction w/o increase in transaminases and no signs of cholecystitis on CT/US, what is the next diagnostic step? and what are the 2 possible diagnoses |
|
Definition
| ERCP: cholangiocarcinoma, sclerosing cholangitis |
|
|
Term
| 2 Tx options for nutcracker esophagitis |
|
Definition
|
|
Term
| what does presence of anti-HBe indicate? |
|
Definition
| chronic infection is a non-replecative state |
|
|
Term
| what is the presence of the HBe antigen for over 3 months suggestive for? |
|
Definition
|
|
Term
| what vascular disease may result from Radiation or chemotherapy? |
|
Definition
|
|
Term
| 2 risk factors for constrictive pericarditis |
|
Definition
prior pericarditis
mediastinal irradiation |
|
|
Term
| what is the Dx of constrictive pericarditis? |
|
Definition
| right heart catheterization showing the "square root sign" - sudden stop of right ventricle filling during diastole |
|
|
Term
| PCR of HBV DNA > 1000 increases the risk of 2 things |
|
Definition
| liver injury and infectivity |
|
|
Term
|
Definition
stool bulking agents
antidepressants |
|
|
Term
| IBS is associated with what traumatic experience |
|
Definition
|
|
Term
| which rises before, HBsAg or symptoms and transaminases? |
|
Definition
|
|
Term
| what are the 2 atypical entities in the DD of IBD |
|
Definition
| collagenous and lymphocytic colitis |
|
|
Term
| what is the endoscopic appearance of the atypical colitides? |
|
Definition
|
|
Term
| Dx of the atypical colitides |
|
Definition
|
|
Term
| 5 risk factors for anal fissures |
|
Definition
constipation
CD
syphillis
TB
trauma |
|
|
Term
| how does smoking affct the risk of CD |
|
Definition
|
|
Term
| 3 CIs for liver transplantation |
|
Definition
| 1. drug/alcohol addiction 2. life threatening systemic disease 3. uncontrolled infections |
|
|
Term
| 3 causes of pigmented gallstones |
|
Definition
| cirrhosis, hemolysis, gilbert's/crigler-najar |
|
|
Term
| what is the organ that is most affected by hemochromatosis |
|
Definition
|
|
Term
| 2 lab findings suggestive of hereditary vs. acquired hemochromatosis |
|
Definition
Ferritin>500
trans sat>50% |
|
|
Term
| 2 step Dx of hemochromatosis |
|
Definition
1st genetic testing for HFE
if unconclusive, liver Bx to preform hepatic iron index. if over 2 suggestive of hemochromatosis
((microgram iron/gram tissue)/(56Xage)) |
|
|
Term
| what is the mechanism which causes patients with acute peritonitis to be hemodynamically unstable? |
|
Definition
| 3rd spacing of fluids to the bowel wall and decreases intravascular volume |
|
|
Term
| what is the 1st step in the workup of a patient with acute diarrhea? |
|
Definition
| find out how does the illness affect his daily functions |
|
|
Term
| how are the 3 classes of daily dysfunction in acute diarrhea |
|
Definition
mild - totally functional
moderate - daily function altered
severe - incapacitated |
|
|
Term
| what is the next step in the workup of acute diarrhea after establishing that the patient suffers a mild disease? |
|
Definition
|
|
Term
| what is the next step in the workup of acute diarrhea after establishing that the patient suffers a moderate disease? |
|
Definition
| check for fever, bloody stools, increased WBC in stool, immunocompromised or elderly |
|
|
Term
| any of one of 5 findings for which a patient with moderate acute diarrhea will continue to preform a stool microbiology test |
|
Definition
fever>38.5
blood in stool
WBC in stool
immunocompromised
elderly |
|
|
Term
| in a patient with moderate acute diarrhea and non of the 5 risk factors nesscesitating stool microbiology, what is the next step? |
|
Definition
|
|
Term
| what is the step in the mgmt of acute diarrhea |
|
Definition
| fluids and mgmt of electrolytes |
|
|
Term
| 6 drugs that may cause acute pancreatitis |
|
Definition
sulfonamides
anti HIV meds
azathioprine
6-MP
estrogen
valproic acid |
|
|
Term
| what is the scale to assess the severity of acute pancreatitis |
|
Definition
| ranson criteria done at admission and after 48 hrs |
|
|
Term
| what 4 criteria in the Ranson severity scale for acute pancreatitis differ in admission if the etiology is gallstone vs. other |
|
Definition
|
|
Term
| what 2 criteria in the Ranson severity scale for acute pancreatitis differ 48 hrs after admission if the etiology is gallstone vs. other |
|
Definition
base deficit
sequestration of fluids |
|
|
Term
| what is the MCC of Cirrhosis |
|
Definition
|
|
Term
| what are the histologic findings in alcoholic cirrhosis |
|
Definition
| micronodular cirrhosis - small regenerative scars |
|
|
Term
| in upper GI bleeding, what % of patients with a visible (either bleeding or non bleeding) vessel will have rebleeding requiring surgery |
|
Definition
|
|
Term
| in the evaluation of upper GI bleeding with endoscopy, what is the only finding that will not nescessitate a 3 day hospital observation |
|
Definition
|
|
Term
| what is the MCC of upper GI bleeding |
|
Definition
|
|
Term
| 7 skin conditions that may affect the esophagus |
|
Definition
| pemphigus vulgaris, bullous pemphigoid, Behçet's syndrome, epidermolysis bullosa, GVHD, SJS, lichen planus |
|
|
Term
| what is the MC complication of PUD |
|
Definition
|
|
Term
| what is the first step today in a patient presenting with dyspepsia (after ruling out conditions like GERD, IBS, billiary pain)? |
|
Definition
|
|
Term
| what is the treatment of a documented gastric or duodenal ulcer associated with h.pylori? |
|
Definition
| triple therapy is recommended for 14 days, followed by continued acid-suppressing drugs for a total of 4–6 weeks |
|
|
Term
| what should be done with a gastric ulcer? |
|
Definition
| Bx must be obtained, repeat endoscopy to document healing at 8–12 weeks or repeat Bx if no healing occurs |
|
|
Term
| 3 surgical options for the treatment of duodenal PUD |
|
Definition
| (1) vagotomy and drainage (by pyloroplasty, gastroduodenostomy, or gastrojejunostomy), (2) highly selective vagotomy (which does not require a drainage procedure), and (3) vagotomy with antrectomy |
|
|
Term
| 2 types of chronic gastric atrophy |
|
Definition
A. Type A: Autoimmune, body-predominant
B. Type B: H. pylori–related, antral-predominant |
|
|
Term
| what is the difference btwn bile acid diarrhea and fatty acid diarrhea |
|
Definition
| in both, increased bile acid secretion to the bowels causes diarrhea. in the former, the liver compensates by producing more bile acids so that there is no steatorrhea. such diarrhea is manageable with cholystyramine |
|
|
Term
| 3 indications for small intestinal biopsy in the patient suspected of malabsorption |
|
Definition
1. documented or suspected steatorrhea
2. chronic diarrhea >3 wks
3. findings on small intestinal series |
|
|
Term
| which condition causing malabsorption is characterized by a normal mucosal appearance |
|
Definition
|
|
Term
| patients with steatorrhea should undergo pancreatic exocrine function testing but this is only done in big centers, and it is the only test for pancreatic function |
|
Definition
|
|
Term
| which other cause of malabsorption can be present in celiac disease |
|
Definition
|
|
Term
| what is the treatment of dermatitis herpetiformis (DH), seen in celiac disease |
|
Definition
|
|
Term
| what is the most fearsome complication of celiac disease |
|
Definition
| gastrointestinal and nongastrointestinal neoplasms as well as intestinal lymphoma |
|
|
Term
| what is the primary treatment of bacterial overgrowth syndrome |
|
Definition
| surgical correction of an anatomic blind loop |
|
|
Term
| what is a non-definitive treatment of bacterial overgrowth syndrome? |
|
Definition
| metronidazole, amoxicillin/clavulanic acid, and cephalosporins for 3 wks maximum |
|
|
Term
| 4 ways to diagnose bacterial overgrowth syndrome |
|
Definition
the combination of a low serum cobalamin level and an elevated serum folate level, as enteric bacteria frequently produce folate compounds that will be absorbed in the duodenum
schilling test
demonstrating increased colonic flora in the jejunum by inserting a tube
hydrogen breath test with lactulose which is not digested |
|
|
Term
| what is the treatment of whipple's disease? what is a dreaded complication? |
|
Definition
1st line trimethoprim/sulfamethoxazole
if not tolerated chloramphenicol
CNS involvement - dementia |
|
|
Term
| 6 congenital syndromes that incorporate inflammatory bowel disease |
|
Definition
Turner's syndrome
Hermansky-Pudlak
Wiskott-Aldrich syndrome (WAS)
Glycogen Storage disease
Immune dysregulation polyendocrinopathy, enteropathy X-linked (IPEX)
Early onset IBD - il10 receptor def. |
|
|
Term
| when is colectomy indicated in a patients with UC and hemorrhage |
|
Definition
| 6–8 units of blood within 24–48 hours |
|
|
Term
| of ANCA and ASCA, which is associated with UC and which with CD |
|
Definition
|
|
Term
| 9 indications for colectomy in UC |
|
Definition
Intractable disease
Fulminant disease
Toxic megacolon
Colonic perforation
Massive colonic hemorrhage
Extracolonic disease
Colonic obstruction
Colon cancer prophylaxis
Colon dysplasia or cancer |
|
|
Term
| where is bleeding from diverticular disease most common in the colon |
|
Definition
|
|
Term
| what is the indication to perform total abdominal colectomy in diverticular disease with massive hemorrhage |
|
Definition
|
|
Term
| what is the treatment of mild to moderate hemorrhage d/t diverticular disease |
|
Definition
|
|
Term
| what is the treatment of severe hemorrhage d/t diverticular disease |
|
Definition
|
|
Term
| how is the diagnosis of diverticulitis made? |
|
Definition
| sigmoid diverticula, thickened colonic CT: wall >4 mm, and inflammation within the pericolic fat ± the collection of contrast material or fluid |
|
|
Term
| 3 Abx options for the treatment of symptomatic diverticulitis and an adjunct to cover enterococci in non-responders |
|
Definition
trimethoprim/sulfamethoxazole or ciprofloxacin and metronidazole or 3rd generation Cephalosporin
in non responders add amoxicillin to cover enterococci |
|
|
Term
| 2 secondary prophylactic treatments for diverticular disease |
|
Definition
| Rifaximin (poorly absorbed), probiotics |
|
|
Term
| what is the treatment of Diverticular perforation Hinchey stages I and II (localized abscess and pelvic abscess) disease? |
|
Definition
| percutaneous drainage followed by resection with anastomosis about 6 weeks later |
|
|
Term
| what is the treatment of Diverticular perforation Hinchey stage III (purulent peritonitis) disease? |
|
Definition
| Hartmann's procedure or with primary anastomosis and proximal diversion |
|
|
Term
| what is the treatment of the patient with a high operative risk with a diverticular perforation HINCHEY III? |
|
Definition
| intraoperative peritoneal lavage (irrigation), omental patch to the oversewn perforation, and proximal diversion of the fecal stream with either an ileostomy or transverse colostomy |
|
|
Term
| what are the transperineal surgical options for rectal prolapse |
|
Definition
| transanal proctectomy (Altmeier procedure), mucosal proctectomy (Delorme procedure), or placement of a Tirsch wire encircling the anus. The goal of the transperineal approach is to remove the redundant rectosigmoid colon |
|
|
Term
| transabdominal surgical options for rectal prolapse |
|
Definition
| presacral suture or mesh rectopexy (Ripstein) with (Frykman-Goldberg) or without resection of the redundant sigmoid |
|
|
Term
| what are the 2 surgical options for internal rectal prolapse? |
|
Definition
The STARR (stapled transanal rectal resection) procedure (Fig. 297-5) is performed through the anus
The Laparoscopic Ventral Rectopexy (LVR) (Fig. 297-6) is performed by creating an opening in the peritoneum |
|
|
Term
| what is the treatment of stage 4 hemorrhoids (Irreducible protrusion) |
|
Definition
| Fiber supplementation Cortisone suppository Operative hemorrhoidectomy |
|
|
Term
| what is the treatment of stage 3 hemorrhoids(Protrusion requiring manual reduction) |
|
Definition
| Fiber supplementation Cortisone suppository Banding Operative hemorrhoidectomy (stapled or traditional) |
|
|
Term
| what is the treatment of stage 2 hemorrhoids (Protrusion with spontaneous reduction) |
|
Definition
| Fiber supplementation Cortisone suppository |
|
|
Term
| what is the treatment of stage 4 hemorrhoids (Enlargement with bleeding) |
|
Definition
| Fiber supplementation Cortisone suppository Sclerotherapy |
|
|
Term
| Child-Pugh clinical staging of cirrhosis - interpertation of scores |
|
Definition
|
|
Term
| 5 factors in the Child-Pugh staging of cirrhosis |
|
Definition
serum bilirubin
serum albumin
prothrombin time
ascites
hepatic encephalopathy |
|
|
Term
| what is the order of clinical and laboratory findings in HAV |
|
Definition
2 wks after exposure begins the presence of virus in feces
4-wks - virus peaks in feces and aminotransferases and jaundice first present, remain for another 4 wks (ALT remains a bit later)
at around this time starts the production of IgM anti-HAV (last 12 wks after exposure) and IgG anti HAV (lasts indefinitely) |
|
|
Term
| 2 situations where HBsAg and anti-HBs are both positive |
|
Definition
HBsAg of one subtype and heterotypic anti–HBs (common)
Process of seroconversion from HBsAg to anti– HBs (rare) |
|
|
Term
| what would be the serologic pattern in a Low–level hepatitis B carrier? |
|
Definition
| anti-HBc IgG +/- anti-HBe (no HBsAg) |
|
|
Term
| what are the serologic markers in acute hepatitis B infection |
|
Definition
|
|
Term
| what are the serologic markers of acute hepatitis A and B |
|
Definition
| HBsAg + anti-HBc IgM + anti-HAV IgM |
|
|
Term
| 4 clinical and laboratory features suggest progression of acute hepatitis to chronic hepatitis |
|
Definition
| (1) lack of complete resolution of clinical symptoms of anorexia, weight loss, fatigue, and the persistence of hepatomegaly; (2) the presence of bridging/interface or multilobular hepatic necrosis on liver biopsy during protracted, severe acute viral hepatitis; (3) failure of the serum aminotransferase, bilirubin, and globulin levels to return to normal within 6–12 months after the acute illness; and (4) the persistence of HBeAg for >3 months or HBsAg for >6 months after acute hepatitis. |
|
|
Term
| 6 drugs which cause hepatic granulomas |
|
Definition
Allopurinol
Phenylbutazone
Carbamazine
Sulfonamides
Quinidine, diltiazem |
|
|
Term
| 8 drugs which cause fatty liver |
|
Definition
Amiodarone
Tetracycline
Valproic acid
zidovudine, indinavir, ritonavir
Asparaginase, methotrexate |
|
|
Term
| 10 drugs that cause hepatic injury in an Idiosyncratic mechanism |
|
Definition
Halothane
Methyldopa
Isoniazid
Sodium Valproate
Phenytoin
Amiodarone
Erythromycin
Resprim
Statins
Haart |
|
|
Term
| side effects of IFN in the treatment of HBV |
|
Definition
| "flu-like" symptoms; marrow suppression; emotional lability (irritability, depression, anxiety); autoimmune reactions (especially autoimmune thyroiditis); and miscellaneous side effects such as alopecia, rashes, diarrhea, and numbness and tingling of the extremities |
|
|
Term
| which 2 drugs used for HBV may be toxic in CKD |
|
Definition
|
|
Term
| which drug for the treatment of HBV causes the largest reduction in viral load in HBeAg-reactive patients |
|
Definition
|
|
Term
| which drug for the treatment of HBV causes the highest number of HBeAg seroconversion within one year |
|
Definition
|
|
Term
| which drug for the treatment of HBV causes the largest reduction in viral load in HBeAg-negative patients |
|
Definition
|
|
Term
| which 4 patient subtypes are not eligible for treatment for HBV |
|
Definition
1. undetectable HBeAg, normal ALT, HBV DNA < 10^3 IU/ml
2. detectable HBeAg, HBV DNA levels >2 x10^4 IU/ml and ALT<2 ULN
3. patients with decompensated cirrhosis and undetectable HBV DNA
4. HBeAg positive, ALT<2 ULN, in whom sustained responses are not likely and who would require multiyear therapy
5. compensated cirrhosis (regardless of ALT or HBeAg status) with HBV DNA<2 x 10^3 IU/ml |
|
|
Term
| which subset of patients with chronic HBV are indicated for liver biopsy in order to decide on whether to treat or not |
|
Definition
HBV DNA>2x10^3 IU/ml and ALT<2 ULN if:
1. age>40 with family history of HCC or
2. ALT is constantly close to 2X ULN
(regardless of HBeAg status) |
|
|
Term
| which 3 drugs are recommended as the first choice for treatment of HBV |
|
Definition
| PEG IFN, entecavir, or tenofovir |
|
|
Term
| which is expected to create a bigger HBeAg response during the first year, oral antivirals or PEG IFN |
|
Definition
|
|
Term
| which is expected to suppress HBV DNA more profoundly oral antivirals or PEG IFN |
|
Definition
|
|
Term
| which agent for the treatment of HBV has the highest rates of resistance and which has the lowest |
|
Definition
|
|
Term
| in a chronic HBV patient undergoing liver transplantation, what is the prophylactic therapy indicated to prevent infection of the new liver |
|
Definition
| anti-HBV immunoglobulins and an oral antiviral |
|
|
Term
| 2 recommended drug therapies for HBV-HIV co-infected patients |
|
Definition
Tenofovir
combination of tenofovir and emtricitabine |
|
|
Term
| which monotherapy should never be given to HBV-HIV co-infected patients |
|
Definition
|
|
Term
| Patient variables that tend to correlate with sustained virologic responsiveness to IFN-based therapy of chronic HCV |
|
Definition
| favorable genotype (genotypes 2 and 3 as opposed to genotypes 1 and 4), low baseline HCV RNA level, histologically mild hepatitis and minimal fibrosis, age <40, absence of obesity as well as insulin resistance and type-II diabetes mellitus, and female gender |
|
|
Term
| variables reported to correlate with increased responsiveness to chronic HCV treatment include |
|
Definition
| brief duration of infection, low HCV quasispecies diversity, immunocompetence, absence of hepatic steatosis and insulin resistance, and low liver iron levels |
|
|
Term
| what is the most significant side effect of ribavirin for the treatment of HCV? which patients shouldn't be treated? |
|
Definition
hemolysis (2-3 g expected decreases)
patients with anemia, hemoglobinopathies, CHD, cerebrovascular disease |
|
|
Term
| what is the primary factor that determines duration of therapy in chronic HCV |
|
Definition
genotype: 1,4 - 48 wks
2,3 - 24 wks |
|
|
Term
| indication for treatment of chronic HCV |
|
Definition
1. detectable virus in serum and fibrosis or active hepatitis on biopsy
2. Relapsers after a previous course of standard interferon monotherapy or combination standard interferon/ribavirin therapy (unless it was full course)
3. Nonresponders to a previous course of standard IFN monotherapy or combination standard IFN/ribavirin therapy (unless full course) |
|
|
Term
| 3 conditions where Antiviral Therapy for chronic HCV is not Recommended Routinely but Management Decisions Made on an Individual Basis |
|
Definition
Age >60
Mild hepatitis on liver biopsy.
Persons with severe renal insufficiency (glomerular filtration rate <60 ml/min) who don't need hemodialysis |
|
|
Term
| in which 2 cases is Long-Term Maintenance Therapy for chronic HCV Recommended |
|
Definition
| Cutaneousvasculitis and glomerulonephritis |
|
|
Term
| what is the recommendation for Long-Term Maintenance Therapy for chronic HCV in Nonresponders |
|
Definition
|
|
Term
| 4 situations where treatment of chronic HCV is not recommended |
|
Definition
Decompensated cirrhosis
Pregnancy (teratogenicity of ribavirin).
Contraindications to use of interferon or ribavirin
Long-Term Maintenance Therapy in Nonresponders |
|
|
Term
| 14 Features Associated with Reduced Responsiveness to chronic HCV treatment |
|
Definition
Single nucleotide polymorphism
Genotype 1
High-level HCV RNA (>2 x10^6 copies/ml)
Advanced fibrosis (bridging fibrosis, cirrhosis)
Long-duration disease
Age >40
High HCV quasispecies diversity
Immunosuppression
African-American ethnicity
Latino ethnicity
Obesity
Hepatic steatosis
Insulin resistance, type-II diabetes mellitus
Reduced adherence (lower drug doses and reduced duration of therapy) |
|
|
Term
| what is the treatment of hereditary hemochromatosis |
|
Definition
|
|
Term
| what is the indication of liver transplantation In sclerosing cholangitis and Caroli's disease (multiple cystic dilatations of the intrahepatic biliary tree) |
|
Definition
| recurrent infections and sepsis associated with inflammatory and fibrotic obstruction of the biliary tree |
|
|
Term
| what is the post-operative treatment of patients with hepatic vein thrombosis (budd chiari syndrome) |
|
Definition
|
|
Term
| 2 of the most common indications for liver transplantation |
|
Definition
| chronic hepatitis C and alcoholic liver disease |
|
|
Term
| 10 absolute CIs to liver transplantation |
|
Definition
Uncontrolled extrahepatobiliary infection
Active, untreated sepsis
Uncorrectable, life-limiting congenital anomalies
Active substance or alcohol abuse
Advanced cardiopulmonary disease
Extrahepatobiliary malignancy (not including nonmelanoma skin cancer)
Metastatic malignancy to the liver
Cholangiocarcinoma
AIDS
Life-threatening systemic diseases |
|
|
Term
| 13 relative CIs to liver transplantation |
|
Definition
Age <70
Prior extensive hepatobiliary surgery
Portal vein thrombosis
Renal failure not attributable to liver disease
Previous extrahepatic malignancy (not including nonmelanoma skin cancer)
Severe obesity
Severe malnutrition/wasting
Medical noncompliance
HIV seropositivity with failure to control HIV viremia or CD4 <100/L
Intrahepatic sepsis
Severe hypoxemia secondary to right-to-left intrapulmonary shunts (PO2<50 mmHg)
Severe pulmonary hypertension (mean pulmonary artery pressure >35 mmHg)
Uncontrolled psychiatric disorder |
|
|
Term
| what are 5 neurological side effects with the use of either tacrolimus or cyclosporine |
|
Definition
| tremor, seizures, hallucinations, psychoses, coma |
|
|
Term
| what are the 2 MC side effects associated with mycophenolate mofetil |
|
Definition
| bone marrow suppression and gastrointestinal complaints |
|
|
Term
| In patients undergoing liver transplantation with pretransplantation renal dysfunction or renal deterioration that occurs intraoperatively or immediately postoperatively, which drugs cannot be used in immunosuppression? which are used? |
|
Definition
tacrolimus or cyclosporine
used: antithymocyte globulin (ATG, thymoglobulin) or monoclonal antibodies to T cells, OKT3 |
|
|
Term
| when should Antiviral prophylaxis for CMV with gancyclovir be administered in patients undergoing liver transplantation |
|
Definition
| when a CMV-seropositive donor organ is implanted into a CMV-seronegative recipient |
|
|
Term
| 4 conditions that cause gallbladder hypomotility which, in its turn, is a cause for cholesterol gallstone formation |
|
Definition
a. Prolonged parenteral nutrition
b. Pregnancy
c. Fasting
d. Drugs such as octreotide |
|
|
Term
| which disease causes decreased bile acid secretion and therefore increased cholesterol gall stones |
|
Definition
| primary billiary cirrhosis |
|
|
Term
| which drug is associated with increased cholesterol secretion in bile, and therefore increased cholesterol gallstones |
|
Definition
|
|
Term
| 7 conditions associated with an increased risk of pigmented gallstones |
|
Definition
2. Chronic hemolysis
3. Alcoholic cirrhosis
4. Pernicious anemia
5. Cystic fibrosis
6. Chronic biliary tract infection, parasite infections
7. Increasing age
8. Ileal disease, ileal resection or bypass |
|
|
Term
| 2 indications for treatment with ursodeoxycholic acid (UDCA) in cholecystitis/choledocholithiasis |
|
Definition
1. recurrent choledocholithiasis after after cholecystectomy
2. cholecystitis with stone < 5mm |
|
|
Term
| what % of cases of acute cholecystitis turn out to be acalculus |
|
Definition
|
|
Term
| which 2 drugs usually employed for analgesia in acute cholecystitis because they may produce less spasm of the sphincter of Oddi than drugs such as morphine |
|
Definition
| Meperidine or nonsteroidal anti-inflammatory drugs (NSAIDs) |
|
|
Term
| what are the indications for antibiotic treatment in the setting of acute cholecystitis? which organisms and drugs? |
|
Definition
severe acute cholecystitis
streptococcus, E.coli, klebsiella - ampicillin sulbactam, ciprofloxacin, and third-generation cephalosporins
if gangrenous or emphysematous cholecystitis - Anaerobic, metronidazole should be added |
|
|
Term
| how is the diagnosis of primary sclerosing cholangitis made? |
|
Definition
| multifocal, diffusely distributed strictures with intervening segments of normal or dilated ducts, producing a beaded appearance on cholangiography (MRCP or ERCP) |
|
|
Term
| 4 variables that predict survival in PSC |
|
Definition
| age, serum bilirubin level, histologic stage, and splenomegaly |
|
|
Term
| 7 drugs/groups that cause acute pancreatitis |
|
Definition
| azathioprine, 6-mercaptopurine, sulfonamides, estrogens, tetracycline, valproic acid, anti-HIV medications |
|
|
Term
| 3 risk factors for severe acute pancreatitis |
|
Definition
Age >60 years
Obesity, BMI >30
Comorbid disease |
|
|
Term
| what are the 4 clinical markers of severity of acute pancreatitis within the initial 24 hours |
|
Definition
1. SIRS [temperature >38° or <36°C, Pulse >90, Tachypnea >24, WBC >12,000
2. Hemoconcentration (Het>44)
3. BISAP
4. organ failure |
|
|
Term
| what does BISAP stand for, part of the clinical acute pancreatitis severity scale at 24 hrs |
|
Definition
(B) Blood urea nitrogen (BUN) >22 mg%
(I) Impaired mental status
(S) SIRS: 2/4 present
(A) Age >60 years
(P) Pleural effusion |
|
|
Term
| 3 clinical elements considered in the 'organ failure' marker of acute pancreatitis severity scale? |
|
Definition
Cardiovascular: systolic BP <90 mmHg, heartrate >130
Pulmonary: Pao2 <60 mmHg
Renal serum creatinine >2.0 mg% |
|
|
Term
| 3 clinical markers of acute pancreatitis severity at hospitalization |
|
Definition
Persistent organ failure
Pancreatic necrosis
Hospital-acquired infection |
|
|
Term
| of what is the CT severity index comprised? |
|
Definition
A Normal pancreas: normal size, sharply defined, smooth contour, homogeneous enhancement, retroperitoneal peripancreatic fat without enhancement 0
B Focal or diffuse enlargement of the pancreas, contour may show irregularity, enhancement may be inhomogeneous but there is no peripancreatic inflammation 1
C Peripancreatic inflammation with intrinsic pancreatic abnormalities 2
D Intrapancreatic or extrapancreatic fluid collections 3
E Two or more large collections or gas in the pancreas or retroperitoneum 4
Necrosis, % Score
0 - 0
<33 - 2
33–50 - 4
>50 - 6
CT severity index equals unenhanced CT score plus necrosis score: maximum = 10; 6 = severe disease. |
|
|
Term
| how is the BISAP score for severity of acute pancreatitis interpreted |
|
Definition
| Presence of three or more factors is associated with substantially increased risk for in-hospital mortality |
|
|
Term
| what is the mainstay of therapy in acute pancreatitis (uncomplicated)? |
|
Definition
| (1) analgesics for pain, (2) IV fluids and colloids to maintain normal intravascular volume, and (3) no oral alimentation, enteral feeding if doesn't get better within 72 hrs |
|
|
Term
| when should Percutaneous aspiration of necrosis with Gram stain and culture be preformed in acute pancreatitis |
|
Definition
| at least 7–10 days after establishing a diagnosis of necrotizing pancreatitis and only if there are ongoing signs of possible pancreatic infection such as sustained leukocytosis, fever, or organ failure. |
|
|
Term
| when is urgent (within 24 hrs) ERCP indicated in acute pancreatitis |
|
Definition
| severe acute biliary pancreatitis with organ failure and/or cholangitis |
|
|
Term
| what is the preferred management of pseudocyst in acute pancreatitis |
|
Definition
| noninterventional, expectant management in patients with minimal symptoms and no evidence of active alcohol use in whom the pseudocyst appears mature by radiography and does not resemble a cystic neoplasm |
|
|
Term
| 4 complications of pseudocysts |
|
Definition
| (1) pain caused by expansion of the lesion and pressure on other viscera, (2) rupture, (3) hemorrhage, and (4) abscess |
|
|
Term
| definition of pseudocyst (distinct from walled off pancreatitis)? |
|
Definition
| extrapancreatic collections of pancreatic fluid containing pancreatic enzymes and a small amount of debris |
|
|
Term
| what is the indication for surgical therapy of a pseudocyst in acute pancreatitis |
|
Definition
| pseudocyst is expanding (follow-up by US) and is complicated by severe pain, hemorrhage, or abscess |
|
|
Term
| most pseudocyst go away within 6 wks |
|
Definition
|
|
Term
| The incidence of acute pancreatitis is increased in patients with AIDS for two reasons |
|
Definition
| (1) the high incidence of infections involving the pancreas such as infections with cytomegalovirus, Cryptosporidium, and the Mycobacterium avium complex; and (2) the frequent use by patients with AIDS of medications such as didanosine, pentamidine, trimethoprim-sulfamethoxazole, and protease inhibitors |
|
|
Term
| what is the first imaging modality utilized in the diagnosis of chronic pancreatitis? |
|
Definition
| CT: calcification, atrophy and/or dilated pancreatic duct |
|
|
Term
| what is the first imaging modality utilized in the diagnosis of chronic pancreatitis? |
|
Definition
| secretin enhanced MRCP: atrophy, dilated duct, filling errors indicating stones, |
|
|
Term
| what is the order of additional/imaging tests in the diagnosis of chronic pancreatitis |
|
Definition
| CT, sMRCP, EUS, pancreatic exocrine function test with secretin (measure bicarbonate secretion), ERCP |
|
|
Term
| how do you workup a 3 cm mass in the liver |
|
Definition
|
|
Term
| 2 steroid sparing options in Crohn's for maintanence |
|
Definition
|
|
Term
| which therapy used to induce remission in crohn's disease |
|
Definition
|
|
Term
| which treatment is effective for refractory perianal and enterocutaneous fistulas in Crohn's disease |
|
Definition
|
|
Term
| which treatment for crohn's disease is effective both for inducing remission and for maintanence |
|
Definition
|
|
Term
| what is the treatment of primary biliary cirrhosis |
|
Definition
|
|
Term
| what is the treatment of achalasia |
|
Definition
| pneumatic dilatation or Heller myotomy |
|
|
Term
| 2 indications for surgical therapy (long myotomy or even esophagectomy) in diffuse esophageal spasm |
|
Definition
| severe weight loss or unbearable pain |
|
|
Term
| what is the only proven medical therapy for DES |
|
Definition
|
|
Term
| what is the treatment of a bleeding Mallory-Weiss Tear |
|
Definition
| epinephrine or cauterization therapy, endoscopic clipping, or angiographic embolization |
|
|
Term
| Asymptomatic diverticular disease discovered on imaging studies or at the time of colonoscopy is best managed by... |
|
Definition
|
|
Term
| Symptomatic uncomplicated diverticular disease with confirmation of inflammation and infection within the colon should be treated initially with... |
|
Definition
| antibiotics and bowel rest. Nearly 75% of patients hospitalized for acute diverticulitis will respond to nonoperative treatment with a suitable antimicrobial regimen. The current recommended antimicrobial coverage is trimethoprim/sulfamethoxazole or ciprofloxacin and metronidazole targeting aerobic gram-negative rods and anaerobic bacteria. Unfortunately, these agents do not cover enterococci, and the addition of ampicillin to this regimen for nonresponders is recommended |
|
|
Term
| what is the second line treatment of nonresponsive diverticulitis |
|
Definition
| addition of ampicillin to Abx regimen for enterococci |
|
|
Term
| BM and peripheral blood findings in vit B12 def anemia |
|
Definition
hypercellular BM
hypersegmented neutrophils, leukopenia, thrombocytopenia, megaloblastic changes |
|
|
Term
| how is the diagnosis of esophageal diverticula made? |
|
Definition
|
|
Term
| what is the treatment of hepatorenal syndrome as part of cirrhosis |
|
Definition
| midodrine, an -agonist, along with octreotide and intravenous albumin. The best therapy for HRS is liver transplantation |
|
|
Term
| what is the treatment of hepatic encephalopathy |
|
Definition
| lactulose, neomycin, metronidazole, rifaximine, zinc |
|
|
Term
| what are the preconditions to performing liver transplantation for the indication of HCC? |
|
Definition
| unresectable HCC for single tumors <5 cm in diameter or for three or fewer lesions all <3 cm |
|
|
Term
| Absolute contraindications for liver transplantation |
|
Definition
| life-threatening systemic diseases, uncontrolled extrahepatic bacterial or fungal infections, preexisting advanced cardiovascular or pulmonary disease, multiple incorrectable life-threatening congenital anomalies, metastatic malignancy, and active drug or alcohol abuse |
|
|
Term
| what are the indications for post exposure prophylaxis in HAV |
|
Definition
|
|
Term
| populations recommended pre-exposure active HAV immunization |
|
Definition
| children, military personnel, populations with cyclic outbreaks of hepatitis A (e.g., Alaskan natives), employees of day-care centers, primate handlers, laboratory workers exposed to hepatitis A or fecal specimens, and patients with chronic liver disease |
|
|
Term
| what is the prophylactic regimen for post- exposure HBV? |
|
Definition
| passive + recombinant vaccines |
|
|
Term
| what is the effect of cimetidine on acetaminophen toxicity? |
|
Definition
| it decreases it because of P450 inhibition and thus lower levels of P450 induced NAPQI |
|
|
Term
| which substances render a patient more susceptible to acetaminophen toxicity |
|
Definition
| alcohol, phenobarbital, isoniazid etc. all the inducers of P450 |
|
|
Term
| what is the treatment of acetaminophen toxicity |
|
Definition
gastric lavage, supportive measures, and oral administration of activated charcoal or cholestyramine to prevent absorption of residual drug. Neither charcoal nor cholestyramine appears to be effective if given >30 min after acetaminophen ingestion
sulfhydryl compounds (e.g., cysteamine, cysteine, or N-acetylcysteine) |
|
|
Term
| what is a prognostic factor for the need to perform liver transplantation in patients with acetaminophen toxicity |
|
Definition
| lactate levels >3.5 mmol/L |
|
|
Term
| p. falciparum doesn't cause urticaria |
|
Definition
|
|
Term
| what findings on ascites fluid examination raise suspicion for HCC |
|
Definition
|
|
Term
| HAV - decrease in which factor is and indicator of severe liver damage and an indication for liver transplantation? |
|
Definition
|
|
Term
| FAP - polyps found anywhere in the colon? |
|
Definition
|
|
Term
| the diagnosis of salmonella typhi? |
|
Definition
| BM, blood, stool cultures all together |
|
|
Term
| what is the diagnosis of primary biliary cirrhosis? |
|
Definition
| biopsy is definitive and undertaken when patients are negative to AMA (10% with PBC are) |
|
|
Term
| 3 options for the treatment of pruritus in PBC |
|
Definition
| antihistamines, narcotic receptor antagonists (naltrexone), and rifampin |
|
|
Term
| which drugs cause dysphagia/odynophagia d/t xerostomia (dry mouth) |
|
Definition
| SSRIs, ACEi, antiemetics, antiarrhythmics, CCBs, antihistamines |
|
|
Term
| what is the MC site in the GIT for carcinoids |
|
Definition
|
|
Term
| how sensitive are the toxin tests for clostridium difficile? and what to do if clinical picture suggests infection but test is negative |
|
Definition
| not very sensitive. do not repeat test - treat empirically with metronidazole |
|
|
Term
| what is the workup of a person with epigastric pain after meals that wakes him/her from sleep at night? |
|
Definition
| usually gastroscopy/barium unless < 40 and then empirical treatment for PUD |
|
|
Term
| diagnosis of wilson's disease |
|
Definition
| reduced ceruloplasmin level, increased urinary excretion of copper, the presence of Kayser-Fleischer rings in the corneas of the eyes, and an elevated hepatic copper level |
|
|
Term
| mechanism of diarrhea in DM with neuropathy |
|
Definition
|
|
Term
| toxic megacolon improves in 50% of patients w/o surgery |
|
Definition
|
|
Term
normal values of lipase?
patient with pain radiating to back for 2 days, amylase 500, lipase 40, and free air on abdominal XR? |
|
Definition
0-160 U/L
perforated peptic ulcer |
|
|
Term
| liver diseases that don't recur after transplantation |
|
Definition
|
|
Term
| how is the diagnosis of ZES made? |
|
Definition
1. fasting gastrin levels
2. Basal acid output
3. secretin suppression test |
|
|
Term
| conditions which raise suspicion of ZES |
|
Definition
Multiple ulcers
Ulcers in unusual locations; associated with severe esophagitis; resistant to therapy with frequent recurrences; in the absence of NSAID ingestion or H. pylori infection
Ulcer patients awaiting surgery
Extensive family history for peptic ulcer disease
Postoperative ulcer recurrence
Basal hyperchlorhydria
Unexplained diarrhea or steatorrhea
Hypercalcemia
Family history of pancreatic islet, pituitary, or parathyroid tumor
Prominent gastric or duodenal folds |
|
|
Term
| what % of people infected with HBV turn chronic |
|
Definition
|
|
Term
| what's recommended to someone who has not been vaccinated for HBV, and has just been pricked by a needle from an HBV infected person |
|
Definition
| active vaccine + Ig for HBV |
|
|
Term
| gold standard for diagnosis of HCV |
|
Definition
|
|
Term
| what must be done before start of HCV therapy |
|
Definition
|
|
Term
| what is the use of The modified Maddrey's discriminant function |
|
Definition
| short term prognosis especially mortality within 30 days |
|
|
Term
| chemistry abnormalities in pancreatitis |
|
Definition
| hypocalcemia, hyperglycemia, hyperbilirubinemia, increased ALP and AST |
|
|
Term
|
Definition
enzymes X3
rise together
lipase both more sensitive and specific |
|
|
Term
| enzymes are useless in CKD for the diagnosis of pancreatitis. only clinical picture |
|
Definition
|
|
Term
|
Definition
| HCT elevated - hemoconcentration |
|
|
Term
| when to do CT in pancreatitis |
|
Definition
| patients who don't get better after 48 hrs |
|
|
Term
| bad prognostic factors in pancreatitis |
|
Definition
|
|
Term
| when do you treat with Abx in acute pancreatitis |
|
Definition
| necrotizing acute pancreatitis |
|
|
Term
| steroids are not used in acute pancreatitis!!!! |
|
Definition
|
|
Term
| diffuse abnormalities of the pancreatic ducts on ERCP, elevated IgG4, mass in head of pancreas, fibrosis in Bx, obstructive jaundice |
|
Definition
|
|
Term
| steroids in autoimmune hepatitis |
|
Definition
helps, but doesn't delay cirrhosis
add azathioprine |
|
|
Term
| treatment of hepatorenal syndrome in cirrhosis |
|
Definition
bridging: midodrine (alpha blocker) + octreotide + IV albumin
definitive: liver transplantation |
|
|
Term
| 6 manifestations of ibd that don't correlate with gut condition |
|
Definition
| pyoderma gangrenosum, ankylosing spondylitis, PSC, anterior uveitis/irits, sacroiliitis, thromboembolism |
|
|
Term
|
Definition
| Bx and antibodies not enough - must demonstrate their disappearance with gluten-free diet |
|
|
Term
|
Definition
3 cases in at least 2 generations one of which is younger than 50
the types of malignancies: colon, ovary, endometrium, TCC, glioblastoma, stomach-intestinal type, intestinal |
|
|
Term
| what are the colonoscopy screening recommendations for patients who have had CRC |
|
Definition
|
|
Term
| what are the colonoscopy screening recommendations for patients who have had a tubular adenoma |
|
Definition
|
|
Term
| colonoscopy screening recommendations for patients who have had UC/CD for more than 8 yrs |
|
Definition
|
|
Term
| colonoscopy recommendations for patients with 1st degree CRC or adenoma at age > 60 and < 60 |
|
Definition
>60 - start 40, every 10 yrs
<60 - start 40, every 5 yrs |
|
|
Term
|
Definition
| SAAG<1.1, bloody/straw-like/mucinous fluid, WBC>1000 |
|
|
Term
| what to do when preforming therapeutic large volume paracentesis for the treatment of recurremnt ascites |
|
Definition
|
|
Term
| treatment of hepatic encephalopathy |
|
Definition
| lactulose, zinc, Rifaximin, liver transplantation |
|
|
Term
| indications for PCI in ACS |
|
Definition
| אנגינה חוזרת במנוחה / מאמץ קל למרות טיפול, עלייה בטרופונין, צניחות ST חדשות, אנגינה/איסכמיה חוזרת עם סימנים של CHF, מבחן מאמץ חיובי, EF<40%, ירידה בל"ד, sustained VT, צינתור לפני פחות מ-6 ח' או CABG בעבר. |
|
|
Term
| patient with cirrhosis and upper GI bleeding |
|
Definition
| give prophylaxis for SBP - resprim or cipro |
|
|
Term
|
Definition
| DM type 1, arthropathy, hepatomegaly, hyperpigmentation |
|
|
Term
| בUC מיד הקו הבא אחרי טיפול אנטיביוטי הוא.... |
|
Definition
| טיפול סטרואידלי רקטאלי, ולאחר מכן טיפול סטרואידלי פומי.... |
|
|
Term
| בקרוהן עם פיסולות מדלגים על שלב הטיפול הסטרואידלי - לא מטפלים בסטרואידים |
|
Definition
|
|
Term
|
Definition
• בחולים עם מחלה לא פעילה, לא מטפלים (HBeAg שלילי, ALT נורמלי, ודנ"א מתחת ל10 בחזקת 4)
• בחולים עם HBeAg ורמות דנ"א מעל ל10 בשישית: הטיפול מומלץ לאלו עם ALT גבוה, בדכ פי 2, באלו עם עליה קלה יותר בALT לא מומלץ לטפל
• בחולים עם HBeAg שלילי כרוני : אם ALT גבוה פי 2 מהנורמה ורמות דנא מעל ל10 ברביעית נטפל. אם הדנא מעל 10 ברביעית אך ALT תקין-ביופסיה ואז נחליט.
• בצירוזיס מפוצה- נטפל, לא משנה מה המדדים הסרולוגים וירולוגים וביוכימים
• בצירוזיס לא מפוצה – יש שממליצים על טיפול. אך יש כאלו שדורשים מעל ל10 בחמישית העתקי וירוס |
|
|
Term
|
Definition
o RNA של הוירוס , ללא תלות ברמות ALT
o וגם ביופסיה שהראתה portal/bridging fibrosis או mod to severe hepatitis
• מקרים בהם יש לשקול כל מקרה לגופו
o מתחת לגיל 18
o מעל גיל 60
o Mild hepatitis בביופסית כבד
• גנוטיפ 2, 3 יש פרוגנוזה טובה יותר וטיפול ל24 שבועות. לגנוטיפ 1 טיפול של 48 שבועות |
|
|
Term
|
Definition
• HCV כמעט לא מועברת בלידה ולא צריך ניתוח קיסרי.
• אין בעיה להניק.
• ריבאווירין הוא טראטוגני ולכן לא ניתן בהריון |
|
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Term
| מה הטיפול בהפטיטיס אלכוהולי |
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Definition
| פרדניזון ל4 שבועות ואז ירידה בהדרגה למעט בדימום GI, ספסיס, אי ספיקת כליות או פנקריאטיטיס |
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Term
| מתי נעשה ביופסיה בשאלה של צליאק (לא אבחנתי אבל בביופסיה חוזרת לאחר דיאטה נטולת גלוטן שמראה רירית נורמלית - כן אבחנתי) |
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Definition
| אם יש סימפטומים,אם TTG חיובי או יש תת תזונה או הפרעת ספיגה |
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Term
| סימפטומים נלווים להפטיטיס אוטואימוני |
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Definition
• ארתרלגיה
• ארתריטיס
• וסקוליטיס עורי
• GN |
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Term
| 3 סוגים של הפטיטיס אוטואימוני |
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Definition
• TYPE 1 – נשים צעירות , ANA חיוביות בטיטר גבוה יחד עם היפרגלובולינמיה. Anti SMA. יש להם מאפיינים אוטו אימונים נוספים.PANCA חיובי לעיתים
• - TYPE 2 בילדים יותר,LKM1(LKM2 נראה בהפטטיס תרופתי, LKM3 בהפטטיס D כרוני)
• TYPE 3- ללא ANA או LKM אבל יש להם נוגדנים כנגד SOLBULE LIVER AG. |
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Term
| אבחנה של הפטיטיס אוטואימונית |
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Definition
| שלילה של סיבות אחרות ונוכחות של היפרגלובולינמיה, נוגדנים עצמאיים והיסטולוגיה |
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Term
| טיפול בהפטיטיס אוטואימונית |
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Definition
| טיפול-פרדניזון +/- AZA. אם עמיד לכך-לתת מינון גבוה ואפילו לתת ציקלוספורין, טכרלימוס ומיקופנוללט |
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Term
| אבחנה של תסמונת הפטורנאלית |
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Definition
| • אבחנה נעשית לרוב על ידי נוכחות של כמות גדולה של מיימת בחולים שיש להם עליה פרוגרסיבית בקריאטנין |
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Term
| מעקב אחר BARRET'S ESOPHAGUS |
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Definition
• HGD- מתקדם לסרטן ב20 אחוז ממקרים.
o יש להציע לחולים עם HGD – כריתה חלקית של הושט, רסקציה של המוקוזה, תרפיה פוטודינמית
o מעבר לכך, מעקב צמוד כל 3 חודשים
• LGD- בהתחלה אחרי 6 חודשים ואחר כך ב12 חודש ולאחר מכן כל שנה
• חולים עם ברט ללא דיספלזיה – לעבור שתי בדיקות בשנה ראשונה ואחכ פעם כל 3 שנים
• לכל המקרים הנל יש להוסיף טיפול נוגד חומצה או פונדופליקציה אם מופיע אספוגיטיס פעילה
• לכל חולה מעל גיל 50 שיש לו סמפטומים קבועים של GERD מומלץ לעשות לפחות פעם אחת אספוגוסקופיה |
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Term
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Definition
• בדיקה רקטלית מעל גיל 40
• בדיקת דם סמוי כל שנה ובדיקת סיגמודיסקופיה כל 5 שנים החל מגיל 50 כאשר אין גורמי סיכון או קולונוסקופיה על 10 שנים
• לחצי מהחולים עם סרטן מעי יהיה דם סמוי שלילי
• מאלו שיש דם סמוי חיובי -ל10 סרטן ול20-30 אחוז פוליפים |
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Term
| follow up of Barret's esophagus |
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Definition
For patients with no dysplasia or endoscopic signs of neoplasia following adequate biopsy sampling, we suggest surveillance endoscopy at an interval of every three to five years
For most patients with verified low-grade dysplasia after extensive biopsy sampling, we suggest surveillance endoscopy at intervals of 6 to 12 months
high grade dysplasia - esophagectomy (young) or endoscopic eradication therapy |
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