Liver? I hardly know her
Treatment for autoimmune hepatitis?
Prednisone and azathioprine
Charcot triad
Newly diagnosed IBS-D. First-line treatment (with at least one specific example)?
Lifestyle modifications.
- Diet: Increased fiber. Low FODMAP, avoid lactose/dairy products, probiotics (evidence mixed for this)
- Fiber supplements.
_______ is the most common cause of peptic ulcer disease
H pylori
_____ hyperbilirubinemia often results from increased heme turnover in hematologic disease or Gilbert disease. _______ hyperbilirubinemia reflects liver disorder
Unconjugated
Conjugated
36 year old female admitted with alcoholic hepatitis. MELD-score is 21.
What is the first-line treatment?
Prednisolone.
*Prednisone requires hepatic metabolism
*N-acetylcysteine is recommended as adjunct treatment
Risk factors for gallstones
Name 5
Old age
Female
American Indian
Western diet
Pregnancy
Rapid weight loss
Obesity
TPN
Estrogen supplementation
22 year old female. 6 month history of intermittent abdominal pain, watery diarrhea, poor weight gain. Occasional streaks of blood in stool. Only medication is OTC topical lidocaine for canker sores. CRP 15, ESR 45, Hg 10.2, MCV 78. Physical exam shows perianal fistula. What is the likely diagnosis?
Crohn's.
- watery diarrhea, intermittent blood. Perianal fistula. Poor weight gain due to malabsorption. Microcytic anemia from possible iron deficiency. Aphthous ulcers.
Antibiotics for uncomplicated diverticulitis
Fluoroquinolone
Metronidazole
What labs should be ordered initially for Celiac Disease evaluation?
IgA tissue transglutaminase antibody and total IgA level
(If IgA deficient, text would be anti-deamidated gliadin peptide IgG antibody or tissue transglutaminase IgG)
Name 4 drugs associated with drug induced liver injury
Augmentin
Phenytoin
Valproate
Acetaminophen
Antituberculosis drugs (isoniazid and pyrazinamide)
Sulfa-containing antimicrobial agents
Antifungal agents
30 year old patient with nausea and RUQ abdominal pain, made worse with eating. RUQ is inconclusive. Labs are as follows:
AST 49, ALT 60, alk phos 120, bilirubin 1.1, y-Glutamyl transpep 35 (normal)
What would be the next step?
HIDA scan
- Acute gallstone cholecystitis confirmed if gallbladder not visualized in 4 hours (no gallbladder filling because of obstruction)
- ERCP used to diagnosed choledocholithiasis
IBS diagnosis criteria
1. Recurrent abdominal pain (at least once per week for >/= 3 months)
2. At least two of the following:
- Pain related to defecation (improves or worsens)
- Change in stool frequency
- Change in stool consistency
Antibiotics targeting _______ should be initiated when cholangitis is suspected?
Enterobacteriaceae
Serum-ascites albumin gradient (SAAG) - 1 g/dL (LOW)
Ascites fluid total protein level - 2.1 g/dL (LOW)
45 year old man with history of diabetes mellitus, cigarette smoking, alcohol use disorder (3 drinks daily) presents with fatigue and SOB. PE shows JVD, pitting edema, and cutaneous hyperpigmentation. Echo shows L atrial and ventricular enlargement, ad mild mitral valve regurg. CT abdomen significant for cirrhotic morphology and hepatomegaly.
Labs show:
Hg 14.6, platelets 182k
Albumin 4.1, bilirubin 1.1
Alk phos 66, AST 66, ALT 69
Iron 261, ferritin 558, transferrin saturation 83%
ANA, HBV, HCV studies negative.
What treatment/intervention/prophylaxis/change could have prevented his current presentation?
Regular phlebotomy
Diagnosis of intrahepatic cholangiocarcinoma requires ____ and ____
CT or MRI
biopsy confirmation
Elevated CA 19-9 is supportive but insufficient for diagnosis
Male with history of UC. Bloody diarrhea for 4 weeks with abdominal pain. Temperature 100.9F, HR 112/min, BP 90/50. Distended abdomen.
To evaluate for _____, what should be ordered next? (give both answers)
Imaging. Abdominal XR (quicker), but can do CT scan with contrast.
Toxic megacolon
- Transverse colon > 6 cm; can see multiple air-fluid levels and loss of colonic haustra
Name 2 pathogens that lead to watery diarrhea and 2 that lead to bloody diarrhea
Bloody: campylobacter, hemorrhagic E.coli, entamoeba histolytica, shigella, and salmonella
In chronic HBV, give the lab finding that can indicate a high infectivity versus low infectivity
High infectivity: HBeAg +
Low infectivity: Anti-HBe
HBeAg is a viral protein antigen, indicating secretion by hepatocytes into circulation/active viral replication - poorer prognosis
Positive ANA
Positive smooth muscle antibody
Elevated IgG
Liver histology
Selected patients with unresectable perihilar cholangiocarcinoma smaller than ____ cm and without extrahepatic spread may be candidates for liver transplantation
3 cm
Name three morphologic findings of Crohn's disease (can be either gross morphology or microscopic)
Gross: fistulas, cobblestone mucosa, creeping fat, bowel wall thickening ("string sign"), linear ulcers, fissures
Microscopic: transmural inflammation, noncaseating granulomas, lymphoid aggregates
Patients who are chronically infected with ________ are at higher risk for gallbladder cancer
Salmonella typhi
Elevations in ____ and ____ represent a hepatocellular pattern; while elevations in ____ and ____ represent a cholestatic pattern
AST, ALT; ALP, bilirubin