SUTM - Diseases of GI (Part 2)

arold001's version from 2015-12-30 18:51

Section 1

Question Answer
whats the most common cause of large bowel obstruction in adults?colorectal cancer
which CRC cancer: signs of obstructionLEFT sided CRC
name 3 types of adenomatous polypstubular, tubulovillous, villous
which is more malignant: sessile (flat) or pedunculated?SESSILE polyp!
what causes diverticulosis?increased intraluminal pressure = inner layer of colon bulges thru focal area of weakness in colon wall
wheres the most common location for diverticulosis?SIGMOID colon!
pouches in colon wall diverticulosis
whats the test of choice when suspecting diverticulosis?barirum enema
whats the tx of choice for diverticulosis?high fiber foods (to increase stool bulk) --> or psyllium if cant tolerate bran
name 2 most common complications of diverticulosispainless rectal bleeding and diverticulitis
what are 3 complications of diverticulitis which is a complication of diverticulosisbowel obstruction, abscess, fistulas
what causes diverticulitis?when feces impact the diverticulum leading to erosion and microperforation
whats the difference in terms of bleeding btw diverticulosis and diverticulitis?diverticulosis: common lower GI bleeding

diverticulitis: RARE GI bleed
whats a feared complication of colonic perforation?peritonitis!
whats the test of choice for diverticulosis vs diverticulitis?diverticulosis: barium enema
diverticulitis: CT scan with contrast (barium enema and colonoscopy contraindicated due to risk of perforation)
whats the tx for uncomplicated diveriticulitis?IV antibiotics, NPO (bowel rest), IV fluids
tortuous dilated veins in submucosa of colon wallangiodysplasia of colon = common cause of lower GI bleed in pts >60
acute mesenteric ischemia is due to compromised blood supply of what vessel?superior mesenteric vessels

Section 2

Question Answer
what are the 4 causes of acute mesenteric ischemia?1) arterial embolism
2) arterial thrombosis
3) nonocclussive mesenteric ischemia (seen in critically ill pts)
4) venous thrombosis
pt presents with acute onset of SEVERE abd pain disproportionate to physical findingsacute mesenteric ischemia
if acute mesenteric ischemia is suspected, what lab test should we order?lactate! since signs of intestinal infarction include hypotension, tachypnea, lactic acidosis, fever
whats the definitive diagnostic test for acute mesenteric ischemia?mesenteric angiography
barium enema shows "thumbprinting" due to thickened edematous mucosal foldsacute mesenteric ischemia
whats the tx of choice for all arterial causes of acute mesenteric ischemiadirect intra-arterial infusion of Papaverine (vasodilator) into the superior mesenteric system during artiography --> relieves occlusion and vasospasm
whats the tx of choice for acute mesenteric ischemia due to venous thrombosisherparin anticoagulation
what causes CHRONIC mesenteric ischemia?atherosclerotic occlusive disease of main mesenteric vessels (celiac artery, superior and inferior mesenteric arteries)
whats the definitive tx for chronic mesenteric ischemia?surgical revascularization
why do pts with chronic mesenteric ischemia get POSTPRANDIAL abd angina?postprandial = when theres an increased demand for splanchnic blood flow
whats the diagnosis: signs, sxs, and imaging evidence of large bowel obstruction are present, BUT theres NO MECHANICAL OBSTRUCTIONOgilvie's Syndrome
what are 4 common causes of Ogilvies syndrome?recent surgery, trauma, medical illness (sepsis, malignancy), drugs
whats the tx for ogilvies syndrome?stop offending agent ans supportive measures (IV fluids, electrolyte repletion
another name for antibiotic-associated colitispseudomembranous colitis
what causes pseudomembranous colitis?antibiotic tx - kills orgs that normally inhibit growth of Clostridium difficile --> leading to C. diff overgrowth and toxin production
name 3 antibiotics that cause pseudomembranous colitisclindamycin, ampicillin, cephalosporins
profuse WATERY diarrhea after persistent antibiotic txthink pseudomembranous colitis = no blood or mucus in diarrhea
whats the feared complication of pseudomembranous colitistoxic megacolon! with risk of colonic perforation
hw can you diagnose pseudomembranous colitis?1) look for C. diff toxins in stool
2) flexible sigmoidoscopy (most rapid but not used much due to discomfort)
whats the tx of choice for C. diff pseudomembranous colitismetronidazole (DONT use this in infants or pregnancy) --> if cant tolerate metronidazole, use oral vancomycin

Section 3

Question Answer
whats the most common site for colonic volvulus?sigmoid colon (75%) and cecum (25%)
ABD XRAY shows omega loop sign (bent inner tube shape)indicates sigmoid volvulus --> dilated sigmoid colon
ABD XRAY shows coffee bean signindicates large air-fluid level in RLQ --> CECAL VOLVULUS
whats the diagnostic and theurapeutic test for SIGMOID volvulus?sigmoidoscopy! leads to untwisting and decompression
whats the tx for sigmoid volvulus?decompression via SIGMOIDOSCOPY
whats the tx for cecal volvulus?emergent surgery
ascites, peripheral edema, splenomegaly, varicose veins (gastric/esophageal varices, hemorrhoids)signs of PORTAL HTN
damage to hepatocytes leads to decreased production of what protein and what factors?albumin and clotting factors!
what are the most common cause of cirrhosis?1) alcoholic liver disease (most common) 2) chronic hepatitis B and C
whats the gold stanard for diagnosis of cirrhosis?liver biopsy
name 2 drugs that can cause cirrhosisacetaminophen toxicity and methotrexate!
what are 2 inherited metabolic disease that can cause cirrhosis?hemochromatosis and Wilsons disease
what are classic signs of chronic liver disease?ascites, varices, gynecomastia, testicular atrophy, palmar erythema, spider angiomas of skin, hemorrhoids, caput medusa
what procedure can lower portal pressure in cirrhosis?TIPS = transjugular intrahepatic portal-systemic shunt
if varices are present, what prophylactic drug should be started?beta blocker
whats the tx of bleeding esophageal varices?IV octreotide (causes splanchnic vasoconstriction) and reduces portal pressure) and upper GI endoscopic tx (sclerotherapy or variceal ligation)
physical exam sign for what: pt extends arms and dorsiflexes handsasterixis = flapping tremor --> seen in hepatic encephalopathy
what is fetor hepaticus?musty odor of breath in pts with hepatic encephalopathy
what antibiotic is used to tx hepatic encephalopathy and why?neomycin = kills bowel flora so decreases ammonia production by intestinal bacteria
whats are 4 treatment options of bleeding esophageal varices?1) variceal ligation/banding (initial endoscopic tx of choice) 2) endoscopic sclerotherpay 3) IV octreotide 4) IV vasopressin (not used)

Section 4

Question Answer
What causes hepatorenal syndrome?progressive renal failure in advanced liver disease, secondary to renal HYPOPERFUSION resulting from vasoconstriction of renal vessels
whats the tx for hepatorenal syndrome?liver transplant is only cure!
what are the complications of liver failure? (AC 9H)Ascites, Coagulopathy, Hypoalbuminemia, portal Hypertension, Hyperammonemia, Hepatic encephalopathy, Hepatorenal syndrome, Hypoglycemia, Hyperbilirubinemia/jaundice, Hyperestrinism, Hepatocellular carcinoma
another name for infected ascitic fluidspontaneous bacterial peritonitis
name 3 bacterias that cause spontaneous bacterial peritonitisE. coli, Klebsiella, Strep pneumoniae
4 signs of hyperestinism (high estrogen)1) spider angiomas = dilated cutaneous arterioles 2) palmar erythema 3) gynecomastia 4) testicular atrophy
why do you see prolonged PT and PTT in pts with cirrhosis?due to decreased synthesis of CLOTTING FACTORS = tx with fresh frozen plasma
why do you get hypoglycemic in pts with acute liver failure?liver stores glycogen
whats the tx for cirrhosis?stop alcohol or INTERFERON for hep B and C
what are the 3 most serious complications of cirrhosis?variceal bleeding, ascities, hepatic encephalopathy
what organ excretes excess copper?liver
what causes wilsons disease?deficiency of ceruloplasmin = copper binding protein thats necessary for copper excretion --> thus copper accumulates in liver cells --> as hepatocytes die, copper leaks into plasma and accumulates in organs including kidney, cornea, brain
copper and cirrhosiswilsons disease
impaired synthesis of coagulation factors and albumin is sign of what?hepatic disease
whats the tx for wilsons disease?D-penicillamine (chelates excess copper) and zinc (prevents dietary uptake of copper)
what are 2 causes of SECONDARY hemochromatosis (iron overload)multiple blood transfusions or chronic hemolytic anemia
excessive iron ABSORPTION in intestines leads to increased accumulation of iron (ferritin and hemosiderin) in various organshemochromatosis!
pt presents with BRONZE skin and cirrhosishemochromatosis!
whats the tx of hemochromatosis?repeated phlebotomies

Section 5

Question Answer
whats the most common type of benign liver tumor?cavernous hemangiomas
what are the main risk factors in pts with hepatocellular adenoma (benign liver tumor)oral contraceptives, female, anabolic steroid use
what benign liver tumor is associated with oral contraceptive use versus no oral contraceptive use?hepatocellular adenoma: a/w oral contraceptives
focal nodular hyperplasia: NOT a/w oral contraceptives
another name for malignant hepatomahepatocellular carcinoma
what are the 2 pathological types of hepatocellular carcinoma?1) Nonfibrolamellar (most common) = associated with hep B, hep C or cirrhosis. UNRESECTABLE with months to live. 2) Fibrolamellar = NOT associated with hep B or C. Resectable, longer survival time
name the 2 most common MALIGNANT liver tumorshepatocellular carcinomas and cholangiocarcinomas
name 3 chemical carcinogens that can cause HCCaflatoxin, vinyl chloride, thorotrast
name 3 diseases that can lead to HCCA1AT deficiency, hemochromatosis, wilsons disease
tumor marker for hepatocellular carcinomaAFP
3 associations of nonalcoholic steatohepatitisobesity, hyperlipidemia, DM
what causes gilberts syndrome?decreased hepatic uridine diphosphate (UDP) gluconuryl transferase activity --> causes isolated elevation of UCB
cause of isolated elevation of UCBgilberts syndrome
whats hemobiliablood draining into DUODENUM via COMMON BILE DUCT
what tapeworm causes hyatid liver cysts in RIGHT lobe of liverEchinococcus granulosus
wheres the most common location for liver abscesses?right lobe
name 5 causative agents of pyogenic liver abscessesE. coli, Klebsiella, Proteus, Enterococcus, anaerobes
whats the tx for pyogenic liver abscesses?IV antibiotics and percutaneous drainage of abscess
what ameba causes liver abscesses?Entamoeba histolytica = reaches the liver via hepatic portal vein
whats the tx for amebic liver abscesses?IV metronidazole

Section 6

Question Answer
occlusion of hepatic venous outflow leading to hepatic congestion and microvascular ischemiaBudd-Chiari syndrome
What are 3 major causes of jaundice?hemolysis, liver disease, biliary obstruction
clinical jaundice becomes evident when total bilirubin reaches what level?total bilirubin >2 mg/dL
direct bilirubinconjugated bilirubin
indirect bilirubinunconjugated bilirubin
describe conjugated bilirubinLOOSELY bound to ALBUMIN and therefore water soluble and excreted in URINE.
dark urine is associated with which type of bilirubinDIRECT (conjugated) bilirubin = since its water soluble
TIGHTLY bound to albumin and tehrefore NOT water solubleunconjugated bilirubin
dark urine and pale stoolsconjugated hyperbilirubinemia
blockage of bile flow with resultant increase in conjugated bilirubincholestasis
whcih is more sensitive for liver damage: ALT or ASTALT
if ALT and AST levels are MILDLY elevated (low hundreds) think of: acute alcoholic hepatitis or chronic viral hepatitis
if ALT and AST levels are MODERATELY elevated (high hundreds to thousands) think of: ACUTE viral hepatitis
if ALT and AST levels are SEVERELY elevated (>10,000), think of: HEPATIC NECROSIS! due to ischemia/shock liver, tylenol toxicity
when is ALKP elevated?whens there obstruction to bile flow (cholestasis)
If you want to know whether ALKP is hepatic in origin (rather than bone or intestine), what do you order?GGT = if ALKP and GGT are elevated, means hepatic in origin
if elevated ALKP but normal GGT, suggests which 2 originspregnancy or bone disease
Liver synthesizes which clotting factors?clotting factors 1, 2, 5, 7, 9, 10, 12, 13 = reflected by PT (PT is not prolonged until most of liver's synthetic capacity is lost)

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