Upgrade to remove ads
Terms in this set (57)
Cirrhosis, neuropsychiatric Sx, Kayser-Fleischer rings. Dx? Test to confirm? First-line Tx?
Wilson's disease (hepatolenticular degeneration)
Low serum ceruloplasm with increased urinary Cu or Kayser-Fleischer rings (common), liver biopsy (gold standard)
Cu chelators like d-penicillamine or trientine, oral zinc also prevents Cu absorption
Chest pain + dysphagia lasting few seconds to few minutes, no infectious signs, normal barium swallow. Dx? Test to confirm? First line Tx?
Diffuse esophageal spasm
Manometric study with simultaneous high amplitude contractions with normal relaxation of LES. Barium swallow may show "corkscrew" appearance.
Supportive (Antispasmodics, dietary modulation, psychiatric counseling)
NAFLD is seen in what type of patient? What is the mechanism? What is AST/ALT findings? Treatment?
Obese with metabolic syndrome (diabetes, hyperlipidemia, HTN)
Peripheral insulin resistance
-> increased peripheral lipolysis, TG synthesis, hepatic uptake of fatty acids -> intrahepatic fatty acid oxidation
-> increases oxidative stress and pro-inflammatory cytokines (TNF-a)
-> liver inflammation, increased fat in liver, fibrosis/cirrhosis
Increased AST and ALT, but ratio < 1
Diet/exercise, bariatric surgery if BMI > 35
Old man with diabetes, develops severe RUQ pain, nausea, fever. Elevated AST, ALT, WBC. Air-fluid levels in gallbladder but no gallstones. Dx? Cause? Treatment?
Emphysematous cholecystitis (form of acute cholecystitis)
Secondary infection of gallbladder wall with gas-forming bacteria (clostridium, escherichia, staph, strep, pseudomonas, klebsiella)
1. Immediate fluid/electrolyte resuscitation
2. Early cholecystectomy
3. Parenteral antibiotic therapy effective against Clostridium (ampicillin-sulbactam, piperacillin-tazobactam, combo of aminoglycoside or quinolone with clindamycin or metronidazole)
What is Charcot's triad? What condition is it seen in? What are the causes of this? What will be elevated?
1. High fever
3. RUQ pain
Choledocolithiasis (60%), biliary tract manipulations/stents, hepatobiliary malignancies
Elevated alk phos and WBC
70 yo M with DM, A-fib on warfarin presents with weakness, dizziness, back pain, tachycardia, and Hb 7. Dx? Test to confirm?
Hematuria, abdominal mass, flank pain. CT shows intrinsic kidney lesion that enhances with contrast
Renal Cell Carcinoma
Decreased esophageal peristalsis and impaired relaxation of LES sphincter a/w progressive dysphagia. Dx? Test to confirm?
Manometry (impaired LES relaxation) or barium swallow (bird's beak deformity)
Cirrhotic patient develops hypotension, hyponatremia, oliguria, azotemia, low urine sodium. Dx? Mechanism? Treatment?
Renal hypoperfusion from constriction of renal vessels (kidneys are functionally normal)
ONLY treatment is liver transplant
Young woman on OCPs, RUQ pain with palpable liver mass, elevated alk phos and GGT. Pathology shows mildly atypical enlarged hepatocytes containing glycogen and lipid deposits. Dx? Treatment? 2 most dreaded complications?
Hepatic adenoma (benign epithelial tumors)
Surgical resection (possibly conservative management if asymptomatic)
1. Severe intra-tumor hemorrhage
2. Malignant transformation
Dysphagia, regurgitation, halitosis, aspiration. Dx? Test to confirm? Tx?
Severe bloody diarrhea, fever, tachycardia, nonobstructive colonic dilation. Dx? Test to confirm? Treatment?
Toxic megacolon (inflammation extends to smooth muscle layer leading to muscle paralysis and colonic dilation)
Plain abdominal x-rays with at least 3 of: fever, tachycardia, high WBC, anemia
- IV steroids
- Nasogastric decompression
- Fluid management
- Possible surgery if colitis doesn't resolve
Periumbilical bluish coloration indicating hemoperitoneum
Can be seen in severe pancreatitis
Reddish-brown coloration around flanks indicating retroperitoneal bleed
What defines severe pancreatitis? How do you treat severe pancreatitis?
Pancreatitis with failure of at least one organ
Supportive care with SEVERAL LITERS of IV fluid
What causes hypotension and end-organ damage to develop in severe pancreatitis?
Local release of activated pancreatic enzymes
-> enter vascular system and increase vascular permeability within and around pancreas
-> large volumes of fluid migrating from vascular system to surrounding retroperitoneum
Inflammatory mediators also enter systemic vascular system
-> systemic inflammation
-> widespread vasodilation, capillary leak, shock, associate end-organ damage
Painless large amounts of bright red blood from rectum in elderly man is most likely due to what? What is most common predisposing factor? Treatment?
Constipation from low fiber diet
High fiber foods (bran) to increase stool bulk, psyllium if patient can't tolerate bran
A female with HNPCC should be evaluated for what cancer other than colon cancer?
57 yo M with longstanding heartburn and smoking history develops significant weight loss, fatigue, and chest pain. What is likely diagnosis? Test to confirm?
Barium swallow followed by endoscopy
Right-sided pleural effusion in cirrhotic patient with no cardiac or pulmonary abnormalities. Dx? Treatment?
- Small defects in diaphragm allows passage of ascitic fluid into pleural space
Thoracentesis followed by diuretics and fluid restriction
- If that fails then transjugular intrahepatic portosystemic shunt (TIPS)
- Liver transplant is best option, but not always available
Screening for pancreatic cancer in asymptomatic patient?
What's the most common complication of PUD?
What patients with dyspepsia warrant endoscopy for evaluation of possible esophageal or gastric cancer (5)? If none of these what should you do?
1. Age > 55
2. Gross or occult bleeding
5. Early satiety
If on NSAID, stop it
If not on NSAID, test for stool H. pylori antigen
Treatment for acute pancreatitis
Conservatively with analgesics, IV fluids, and NPO
Intermittent elevations of transaminases, fatigue, arthralgias, mitral valve replaced. Dx?
Extrahepatic manifestations a/w this:
Chronic hepatitis C
- Essential mixed cryoglobulinemia
- Membranoproliferative glomerulonephritis
- Porphyrea cutanea tarda (erosions/vesicles on dorsum of hand), lichen planus
- Increased risk of diabetes
Drugs a/w acute pancreatitis:
- IBD Tx?
- Valproic acid
- Furosemide, thiazide
- Sulfasalazine, 5-ASA
- Didanosine, pentamidine
- Metronidazole, tetracycline
Treatment of choice in symptomatic cholelithiasis? What's alternative for patients who don't want that choice? What are its downsides?
- Bile salt that decreases cholesterol content of bile by reducing hepatic secretion and intestinal absorption of cholesterol
Expensive, takes several months to dissolve stones, recur in 50% of patients once treatment is stopped
Most common site of metastasis of colon cancer
RUQ pain, mildly elevated liver enzymes, firm hepatomegaly, microcytic anemia in old man
Colon cancer with liver metastasis
Lactose intolerance is characterized by:
- Positive ________ breath test
- Positive stool test for ___________ substances
- ______ stool pH
- ______ stool osmotic gap
- Low (acidic)
Acid steatocrit test is a test for what?
Test to order if you suspect pancreatic cancer
CT abdomen with contrast (if no jaundice)
U/S abdomen useful to exclude biliary obstruction in patients with jaundice
What are the 3 stages of alcoholic liver changes?
1. Fatty liver (steatosis)
2. Alcoholic hepatitis (steatohepatitis)
3. Alcoholic fibrosis/cirrhosis
Alcoholic with liver biopsy showing Mallory's hyaline and a neutrophilic infiltrate without evidence of fibrosis. Dx? Would this be reversible if the patient stopped drinking alcohol?
Potentially reversible with cessation of alcohol
Young patient with chronic diarrhea, abdominal pain,, weight loss and oral ulcers. Also elevated WBC, ESR and platelets
Cirrhosis with ascites, fever, high WBC, and change in mental status. Dx? Test? What results would confirm?
Spontaneous bacterial peritonitis (SBP)
Positive ascitic fluid culture and PMN > 250
Arthralgias, weight loss, fever, diarrhea, abdominal pain with small bowel biopsy showing villous atrophy and PAS+ stain
Worsening of RUQ pain with inspiration, seen in acute cholecystitis
How can you differentiate acute cholecystitis and acute choledocholithiasis?
In choledocholithiasis there will be severe jaundice (icterus, etc.) and a very high alk phos
Whereas in cholcystitis there might only be a slightly high bilirubin and alk phos will be normal or high normal
Main risk factors for esophageal adenocarcinoma? Squamous cell carcinoma?
- BARRETT'S ESOPHAGUS and CHRONIC GERD
Squamous cell carcinoma:
- SMOKING and ALCOHOL
- Hot food and beverages
- Food rich in N-nitroso compounds
IBS: signs/symptoms? Colonic biopsy finding?
Change in form and or frequency of stool with recurrent abdominal pain/discomfort relieved by defecation
Normal colonic mucosa
Treatment for Familial Adenomatous Polyposis (FAP)
- 100% chance of developing cancer
Acute liver failure is most commonly due to what?
Signs of acute liver falure
1. Drugs (acetaminophen)*
2. Viral hepatitis (A, B)*
3. Alcoholic or autoimmune hepatitis, Wilson disease, Budd-Chiari, ischemia, malignant infiltration
Elevated transaminases (in the thousands)
Hepatic encephalopathy, worsening PT/INR, increasing bilirubin
Primary biliary cirrhosis
Middle-aged female with pruritis, jaundice, xanthomas, high alk phos. Dx? Treatment?
Primary biliary cirrhosis
Ursodeoxycholic acid - slows progression
Liver transplant - ultimately is only cure
Treatment of anal fissures
1. Dietary modification (high fiber and fluids)
2. Stool softener
3. Local anesthetic
Treatment for hepatic encephalopathy
1. Replace fluid and electrolytes
2. Lactulose (rifaximin if no improvement in 48 h)
Untreated hemochromatosis can result in what malignancy?
58 yo M with nagging epigastric pain, foot intolerance, weight loss, scleral icterus, enlarged non-tender gallbladder, no ascites
- Will see intrahepatic and extrahepatic biliary dilation
Sudden onset of intense epigastric pain with few month history of dull, achy, diffuse abdominal pain. Upright x-ray shows free air under the diaphragm
Perforated peptic ulcer
Conjugated hyperbilirubinemia with predominantly elevated alkaline phosphatase. What is next step?
RUQ ultrasound (or abdominal CT)
- Biliary dilation suggests extrahepatic cholestasis
- Absence of dilation suggests intrahepatic cholestasis
- Cholestasis of pregnancy
- Primary biliary cirrhosis
- Primary sclerosing cholangitis
Recent trip to south america, 4 week history of diarrhea with foul smelling stools, abdominal cramps, bloating. Dx? Treatment?
Initial treatment for suspected esophageal variceal hemorrhage
1. Volume resuscitation
2. IV octreotide
Then urgent endoscopic therapy
- Sclerotherapy or band ligation
For esophageal variceal hemorrhage, after banding, what should you do if....
- No further bleeding
- Continued bleeding
- Early rebleeding
Initiate secondary prophylaxis
- B-blocker + endoscopic band ligation 1-2 weeks later
Balloon tamponade (temporary) -> TIPS or shunt surgery
Repeat endoscopic therapy -> if recurrent hemorrhage then TIPS or shunt surgery
Prolonged PPIs or H2As are a risk factor for what type of infection?
Urea breath test is used to diagnose what?
Recurrent duodenal ulcers, GERD, diarrhea, elecated serum gastrin
THIS SET IS OFTEN IN FOLDERS WITH...
Post-op complications - general surgery
Wounds and wound healing - general surgery
Spleen and lymphatic conditions - general surgery
YOU MIGHT ALSO LIKE...
Patho Exam 5
Nursing 3600: Adult GI Disorders
Ch. 39 & 44 Pancreas/Liver/Biliary tract
Liver, Gallbladder, Pancreas Diseases
OTHER SETS BY THIS CREATOR
Neurology - UWorld
OB/GYN APGO - JD
First Aid - Rapid Review Treatments
OTHER QUIZLET SETS
Concurrency Exams 1 & 2
Exam 3: Lymphatics and Respiratory System