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GI MKSAP

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zms2187's version from 2017-01-18 17:58

Section

Question Answer
F/u surveillance for pt w/FAP s/p colectomy? endoscopy- these pts are at high risk of biliary ampullar cancer
when to give albumin for pts w/liver dz?if pt comes in with SBP and also has AKI giving 1.5g/kg on day 1 and 1g/kg on day 3 reduces mortality by 20%
Pattern of LFT abnormalities in pts with PBC?disprop higher elevations of bili/alk phos than transaminases
how often to do screening colonoscopies in UC pts?every 1-2 years starting 8-10 years after dx
better drug to use in crohns, anti-TNF or 5-aminosalicylic acid agent like mesalamine?best is anti-tnf b/c crohns is transmural, uc ok to treat w/latter
when not to give steroids in alc hep?if SBP present, AKI or GIB
pts w/aortic stenosis could develop GIB due to ? Heyde syndrome- bleeding angioectasias due to mechanical disruption of von willebrand multimers during non-laminar flow. disruption of VWF is directly related to severity of aortic stenosis so would benefit from valve replacement if recurrent prob
SAAG and total protein utility ?if >1.1 then portal etiology. If >1.1 and total protein>2.5 then cardiac etiology
what is hepatopulmonary syndrome?pts w/advanced liver disease develop hypoxia due to vasodilation of pulmonary vasculature in setting of portal hypertension. dx with TTE which shows microbubbles in LA w/in 3-6 cardiac cycles c/w shunt
Painless jaundice in the context of a diffusely enlarged pancreas with a narrowed pancreatic duct suggests?autoimmune pancreatitis (tx with steroids)
elevated IgG4 suggestsautoimmune pancreatitis (Painless jaundice in the context of a diffusely enlarged pancreas with a narrowed pancreatic duct)
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Section 2

Question Answer
TCA and effect on stools ?constipation (antichol)
guidelines for rpt colonoscopy interval for pts with polypsscreen again in 3y if multiple polyps (3-10), high grade dysplasia, adenoma >1cm, or villous
pt with 2 tubular adenomas on colonoscopy (0.9cm), when to screen next5-10 years (ok to screen @normal interval if <1cm)
stool osmolar gap equation290 - 2 x {stool sodium + stool potassium). If >100 then osmotic cause of diarrhea
medication to treat fistulas in Crohn'sinfliximab (should be preceded by surgical drainage if abscess present etc). Cipro/flagyl ok for simple fistulas but not complex that has an abscess
serial measurements of what lab predict morbidity in pancreatitis ?BUN
how to dx SIBObreath test or EGD with SI cultures
Classic lab findings for SIBO macrocytic anemia with B12 deficiency, high folate (bacteria consume b12 and make folate)
risk factors for siboaltered gastric acid production (gastrectomy), structural abnormalities, altered gastric motility (neuro disorders, DM)
general prnciples for tx of Hep Bif pt is in a chronic carrier state (high viral load then monitor LFTs and biopsy only if on the rise b/c otherwise they are at low risk for dz progression.
tx of HRSIV albumin, could consider adding midodrine + octreotide.
Dx HRSSCr >1.5, no improvement of cr with 2 days of holding diuretics and 1.5L volume expansion w/albumin, no nephrotoxic drugs recently, no shock, no parenchymal disease.
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