clin med final
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Questions and Answers

What would the presence of skip lesions in the digestive tract indicate in this patient?

  • Ulcerative colitis
  • Irritable bowel syndrome
  • Gastroesophageal reflux disease
  • Crohn's disease (correct)

    • What is the significance of an elevated stool lactoferrin level in this patient?

  • Infection in the digestive tract
  • Inflammation in the digestive tract (correct)
  • Malabsorption in the digestive tract
  • Obstruction in the digestive tract

    • What is the primary mechanism of action of cholestyramine in this patient?

  • Inhibits colonic motility and reduces diarrhea
  • Binds to bile salts and reduces diarrhea (correct)
  • Reduces inflammation in the digestive tract
  • Enhances colonic absorption of fluids and electrolytes

    • What is the most critical management action in cases of diarrhea?

    <p>Fluid replacement with oral or IV rehydration</p> Signup and view all the answers

    What is the most common site of inflammation in Crohn's disease?

    <p>Terminal ileum</p> Signup and view all the answers

    What is the primary goal of treatment for diarrhea?

    <p>To manage symptoms and prevent dehydration</p> Signup and view all the answers

    What is the main characteristic that distinguishes Ulcerative Colitis from Crohn's disease?

    <p>Inflammation limited to the mucosal layer of the colon</p> Signup and view all the answers

    What is the term for the manual removal of stool from the rectum?

    <p>Digital disimpaction</p> Signup and view all the answers

    What is the most common extraintestinal manifestation of Inflammatory Bowel Disease?

    <p>Arthritis/arthropathy</p> Signup and view all the answers

    What is the typical duration of acute diarrhea?

    <p>Less than 14 days</p> Signup and view all the answers

    What is the primary goal of corticosteroids in the treatment of Inflammatory Bowel Disease?

    <p>To induce and maintain remission</p> Signup and view all the answers

    What is the most likely diagnosis for a patient with right lower abdominal pain, diarrhea, and weight loss?

    <p>Crohn’s Disease</p> Signup and view all the answers

    What is the significance of fecal calprotectin in the evaluation of Inflammatory Bowel Disease?

    <p>It is a marker of inflammation in the stool</p> Signup and view all the answers

    What is the term for a type of diarrhea characterized by the presence of blood and mucus in the stool?

    <p>Dysentery</p> Signup and view all the answers

    What is the primary difference in the treatment of Crohn's disease and Ulcerative Colitis?

    <p>Cholestyramine is used in Crohn's disease but not Ulcerative Colitis</p> Signup and view all the answers

    What is the definition of constipation?

    <p>Two of the following for at least 3 months: fewer than three bowel movements per week, straining with defecation, lumpy or hard stools, sensation of incomplete emptying</p> Signup and view all the answers

    What is the primary role of fiber supplements in the treatment of constipation?

    <p>To soften stool and ease bowel movements</p> Signup and view all the answers

    What is the pathophysiology of slow-transit constipation?

    <p>Impaired colonic motor activity with infrequent bowel movements</p> Signup and view all the answers

    What is the primary cause of constipation in patients with hypothyroidism?

    <p>Decreased gut motility</p> Signup and view all the answers

    What is the typical duration of persistent diarrhea?

    <p>14 days to 30 days</p> Signup and view all the answers

    What is the primary purpose of stool studies in the evaluation of constipation?

    <p>To rule out other causes of constipation such as hypothyroidism</p> Signup and view all the answers

    What is the term for a type of diarrhea characterized by the presence of a pathogen?

    <p>Infectious diarrhea</p> Signup and view all the answers

    What is the primary mechanism by which Helicobacter pylori causes gastric ulcers?

    <p>By producing urease, which increases the pH of the stomach and allows the bacteria to thrive</p> Signup and view all the answers

    Which of the following is a complication of Peptic Ulcer Disease?

    <p>Gastric outlet obstruction</p> Signup and view all the answers

    What is the primary difference between gastric and duodenal ulcers?

    <p>Gastric ulcers are exacerbated by eating, while duodenal ulcers are relieved by eating</p> Signup and view all the answers

    What is the primary role of antacids in the treatment of gastritis?

    <p>To neutralize stomach acid</p> Signup and view all the answers

    Which of the following is a risk factor for developing Peptic Ulcer Disease?

    <p>Smoking</p> Signup and view all the answers

    What is the primary mechanism of action of H2 receptor antagonists (H2RAs) in the treatment of gastritis?

    <p>To reduce the production of stomach acid</p> Signup and view all the answers

    What is the primary goal of the triple therapy regimen for H. pylori treatment?

    <p>To eradicate the pathogen</p> Signup and view all the answers

    What is the primary cause of gastroparesis?

    <p>Delayed gastric emptying</p> Signup and view all the answers

    What is the most common type of malignant tumor of the stomach?

    <p>Gastric adenocarcinoma</p> Signup and view all the answers

    What is the primary risk factor for gastric carcinoma?

    <p>Tobacco use and untreated H. pylori infection</p> Signup and view all the answers

    What is the primary treatment for gastric carcinoma?

    <p>Surgery, radiation, and/or chemotherapy</p> Signup and view all the answers

    What is the primary diagnosis associated with dark, sticky stools?

    <p>Melena</p> Signup and view all the answers

    What is the primary cause of ischemia and necrosis in acute appendicitis?

    <p>Vascular compromise due to increased intraluminal pressure</p> Signup and view all the answers

    What is the significance of a normal ultrasound abdomen/pelvis in a patient with suspected acute appendicitis?

    <p>It does not rule out the diagnosis of appendicitis</p> Signup and view all the answers

    What is the most common location of colonic diverticula?

    <p>Sigmoid</p> Signup and view all the answers

    What is the purpose of IV antibiotics in the treatment of acute appendicitis?

    <p>For prophylaxis</p> Signup and view all the answers

    What is the significance of rebound tenderness in a patient with acute appendicitis?

    <p>It is a sign of peritoneal irritation</p> Signup and view all the answers

    What is the typical demographic affected by acute appendicitis?

    <p>Male &gt; female, 2:1</p> Signup and view all the answers

    What is the most common cause of lower GI bleeding in patients over 40 years old?

    <p>Diverticulosis</p> Signup and view all the answers

    What is the primary goal of treatment for uncomplicated diverticulitis?

    <p>To manage symptoms and prevent complications</p> Signup and view all the answers

    What is the primary diagnostic study of choice for ischemic colitis?

    <p>Colonoscopy</p> Signup and view all the answers

    What is the indication for surgery in a patient with diverticulitis?

    <p>All of the above</p> Signup and view all the answers

    What is the diagnostic test of choice to locate the site of bleeding in a patient with diverticulosis?

    <p>Tagged RBC arteriography</p> Signup and view all the answers

    What is the most common etiology of ischemic colitis?

    <p>Non-occlusive mesenteric ischemia</p> Signup and view all the answers

    What is the primary goal of treatment for ischemic colitis?

    <p>Restoring colonic blood flow</p> Signup and view all the answers

    What is the term for a type of hernia that can become trapped and cannot be reduced into the abdomen?

    <p>Incarcerated</p> Signup and view all the answers

    What is the characteristic appearance of the air-fluid levels in bowel obstruction?

    <p>Multiple air-fluid levels with a flat surface at the air-fluid interface</p> Signup and view all the answers

    What is the primary risk factor for developing an incisional hernia?

    <p>All of the above</p> Signup and view all the answers

    What is the primary risk factor for ischemic colitis?

    <p>Advanced age</p> Signup and view all the answers

    What is the typical presentation of ischemic colitis?

    <p>Mild cramping abdominal pain with diarrhea</p> Signup and view all the answers

    What is the primary purpose of a Hartmann's procedure in the treatment of diverticulitis?

    <p>To create a temporary colostomy</p> Signup and view all the answers

    What is the term for a type of hernia that can cause blood flow to be compromised?

    <p>Strangulated</p> Signup and view all the answers

    What is the primary indication for performing a colonoscopy in a patient with diverticulitis?

    <p>To exclude other etiologies of CT findings</p> Signup and view all the answers

    What is the typical presentation of an epigastric hernia?

    <p>Painless protrusion above the umbilicus</p> Signup and view all the answers

    What is the characteristic of a direct inguinal hernia?

    <p>Abdominal contents pass through the abdominal wall medial to the inferior epigastric vessels</p> Signup and view all the answers

    What is the most common complication of an inguinal hernia?

    <p>Strangulation</p> Signup and view all the answers

    What is the primary indication for surgical repair of an inguinal hernia?

    <p>Risk of incarceration</p> Signup and view all the answers

    What is the characteristic of a femoral hernia?

    <p>Abdominal contents pass through the femoral canal</p> Signup and view all the answers

    What is the primary cause of bowel obstruction?

    <p>Adhesions</p> Signup and view all the answers

    What is the primary symptom of bowel obstruction?

    <p>All of the above</p> Signup and view all the answers

    What is the primary imaging modality used to evaluate bowel obstruction?

    <p>CT abdomen/pelvis with contrast</p> Signup and view all the answers

    What is the primary treatment for bowel obstruction?

    <p>Surgery</p> Signup and view all the answers

    What is the most likely diagnosis for a patient with right lower quadrant abdominal pain, nausea, vomiting, and fever?

    <p>Acute appendicitis</p> Signup and view all the answers

    What is the most appropriate screening advice for a 41-year-old female with a family history of metastatic colon cancer?

    <p>Screening colonoscopy now, and repeat every 3-5 years if normal</p> Signup and view all the answers

    What is the primary treatment for Dukes stage I colorectal cancer?

    <p>Surgical resection</p> Signup and view all the answers

    What is the significance of Rovsing's sign in a patient with abdominal pain?

    <p>Pain in the right lower quadrant with deep palpation in the left lower quadrant</p> Signup and view all the answers

    What is the gold standard imaging study for diagnosing mesenteric ischemia?

    <p>Mesenteric angiography</p> Signup and view all the answers

    What is the most common site for metastasis of colorectal cancer?

    <p>Liver</p> Signup and view all the answers

    What is the primary indication for surgical intervention in toxic megacolon?

    <p>Failure to respond to medical therapy</p> Signup and view all the answers

    What is the term for a type of colon polyp that carries a higher risk of progressing to malignancy?

    <p>Villous adenoma</p> Signup and view all the answers

    What is the primary screening test recommended for average-risk individuals starting at age 45?

    <p>Colonoscopy</p> Signup and view all the answers

    What is the primary treatment for mesenteric venous thrombosis?

    <p>Anticoagulation therapy</p> Signup and view all the answers

    What is the most common symptom of mesenteric ischemia?

    <p>Abdominal pain</p> Signup and view all the answers

    What is the primary laboratory test used to diagnose hypercoagulable states?

    <p>Coagulation studies</p> Signup and view all the answers

    What is the primary complication of untreated toxic megacolon?

    <p>Perforation</p> Signup and view all the answers

    What is the primary indication for colectomy in the treatment of colorectal cancer?

    <p>Bowel obstruction</p> Signup and view all the answers

    What is the hallmark symptom of pyloric stenosis?

    <p>Forceful vomiting</p> Signup and view all the answers

    What is the most common genetic mutation associated with celiac disease?

    <p>HLA-DQ2 and/or DQ8</p> Signup and view all the answers

    What is the primary imaging modality used to diagnose pyloric stenosis?

    <p>Ultrasound</p> Signup and view all the answers

    What is the primary complication of untreated celiac disease?

    <p>Intestinal lymphoma</p> Signup and view all the answers

    What is the primary treatment for pyloric stenosis?

    <p>Surgical repair with pyloromyotomy</p> Signup and view all the answers

    What is the primary characteristic of the pyloric muscle in pyloric stenosis?

    <p>Hypertrophy</p> Signup and view all the answers

    Which of the following is the gold standard for diagnosing celiac disease?

    <p>Duodenal biopsy</p> Signup and view all the answers

    What is the most common cause of intestinal obstruction in children aged 3 months to 6 years?

    <p>Intussusception</p> Signup and view all the answers

    What is the typical presentation of intussusception?

    <p>Recurring paroxysms of abdominal pain with vomiting and diarrhea</p> Signup and view all the answers

    What is the term for a type of abdominal pain that worsens when pressure is applied to the abdomen?

    <p>Rebound tenderness</p> Signup and view all the answers

    What is the most common congenital GI abnormality?

    <p>Meckel's diverticulum</p> Signup and view all the answers

    What is the primary treatment for intussusception?

    <p>Hydrostatic or pneumatic reduction with barium or water-soluble contrast enema</p> Signup and view all the answers

    What is the characteristic finding on ultrasound in a patient with intussusception?

    <p>All of the above</p> Signup and view all the answers

    What is the most common cause of bloody stools in a pediatric patient?

    <p>Meckel's diverticulum</p> Signup and view all the answers

    What is the primary indication for surgical excision in a patient with Meckel's diverticulum?

    <p>Recurrent bleeding</p> Signup and view all the answers

    What is the most common indication for acute abdominal surgery in children?

    <p>Appendicitis</p> Signup and view all the answers

    What is the term for the replacement of normal squamous mucosa of the distal esophagus with specialized columnar metaplasia in patients with Gastroesophageal Reflux Disease?

    <p>Barrett's esophagus</p> Signup and view all the answers

    What is the primary mechanism of injury to the esophagus in Gastroesophageal Reflux Disease?

    <p>Lower esophageal sphincter dysfunction</p> Signup and view all the answers

    What is the primary treatment approach for patients with Esophagitis?

    <p>Antacids and lifestyle modification</p> Signup and view all the answers

    What is the risk factor for Adenocarcinoma of the esophagus?

    <p>Barrett's esophagus</p> Signup and view all the answers

    What is the goal of Nissen fundoplication surgery?

    <p>To prevent complications of large hiatal hernias</p> Signup and view all the answers

    What is the primary cause of infectious esophagitis?

    <p>Candida infection</p> Signup and view all the answers

    What is the most common location of esophageal webs?

    <p>Upper 1/3 of esophagus</p> Signup and view all the answers

    What is the characteristic finding on esophageal manometry in patients with achalasia?

    <p>Decreased peristalsis</p> Signup and view all the answers

    What is the most common risk factor for developing esophageal cancer?

    <p>All of the above</p> Signup and view all the answers

    What is the primary treatment for Mallory Weiss syndrome?

    <p>Bleeding should resolve spontaneously</p> Signup and view all the answers

    What is the location of Schatzki's rings?

    <p>Squamocolumnar junction</p> Signup and view all the answers

    What is the primary difference between Boerhaave's syndrome and Mallory Weiss syndrome?

    <p>Depth of the tear</p> Signup and view all the answers

    What is the primary cause of chronic pancreatitis?

    <p>Toxic and metabolic factors</p> Signup and view all the answers

    What is the term for the tumor marker used to diagnose pancreatic cancer?

    <p>CA 19-9</p> Signup and view all the answers

    What is the primary treatment for pancreatic cancer?

    <p>Surgical resection</p> Signup and view all the answers

    What is the hallmark of chronic pancreatitis?

    <p>Fibrosis</p> Signup and view all the answers

    What is the primary manifestation of chronic pancreatitis?

    <p>Abdominal pain and pancreatic insufficiency</p> Signup and view all the answers

    What is the primary imaging modality used to diagnose pancreatic cancer?

    <p>CT scan with contrast</p> Signup and view all the answers

    What is the main difference between cholelithiasis and choledocholithiasis?

    <p>Location of the gallstones</p> Signup and view all the answers

    What is the primary test used to diagnose acute cholangitis?

    <p>Ultrasonography</p> Signup and view all the answers

    What is the primary complication of acute pancreatitis?

    <p>Necrosis</p> Signup and view all the answers

    What is the primary treatment for symptomatic gallstones?

    <p>Laparoscopic cholecystectomy</p> Signup and view all the answers

    What is the primary mechanism of inflammation in acute cholecystitis?

    <p>Bacterial inflammation via Escherichia coli</p> Signup and view all the answers

    What is the most common complication of primary sclerosing cholangitis?

    <p>Hepatocellular cancer</p> Signup and view all the answers

    What is the primary risk factor for developing choledocholithiasis?

    <p>Female gender</p> Signup and view all the answers

    What is the primary diagnostic test used to diagnose acute cholangitis?

    <p>MRCP (cholangiopancreatography)</p> Signup and view all the answers

    What is the primary diagnosis associated with Charcot's triad?

    <p>Acute cholangitis</p> Signup and view all the answers

    What is the primary treatment for chronic cholecystitis?

    <p>Early surgical intervention via cholecystectomy</p> Signup and view all the answers

    What is the primary cause of acute pancreatitis?

    <p>Gallstones</p> Signup and view all the answers

    What is the primary test used to diagnose acute pancreatitis?

    <p>Amylase and lipase levels</p> Signup and view all the answers

    What is the primary association of primary sclerosing cholangitis?

    <p>Ulcerative colitis</p> Signup and view all the answers

    What is the primary laboratory test used to diagnose primary sclerosing cholangitis?

    <p>Atypical perinuclear antineutrophil cytoplasmic antibodies (P-ANCA)</p> Signup and view all the answers

    What is the primary complication of choledocholithiasis?

    <p>Acute cholangitis</p> Signup and view all the answers

    What is the primary characteristic of the gallbladder wall in acute cholecystitis?

    <p>Thickening of the gallbladder wall</p> Signup and view all the answers

    What is the primary treatment for choledocholithiasis?

    <p>Endoscopic retrograde cholangiopancreatography (ERCP)</p> Signup and view all the answers

    What is the primary indication for liver transplantation in primary sclerosing cholangitis?

    <p>Cholestasis and liver failure</p> Signup and view all the answers

    What is the primary mechanism of injury to the bile ducts in primary sclerosing cholangitis?

    <p>Inflammation and fibrosis of the bile ducts</p> Signup and view all the answers

    What is the primary clinical presentation of acute cholecystitis?

    <p>RUQ pain that may radiate to the right scapula region</p> Signup and view all the answers

    Which of the following hepatitis viruses requires the presence of Hepatitis B to replicate?

    <p>Hepatitis D</p> Signup and view all the answers

    What is the primary function of the liver in glucose metabolism?

    <p>Gluconeogenesis</p> Signup and view all the answers

    Which of the following laboratory results is diagnostic of Hepatitis B?

    <p>Presence of surface antigen</p> Signup and view all the answers

    What is the primary route of transmission for Hepatitis A?

    <p>Fecal-oral route</p> Signup and view all the answers

    Which of the following is a complication of Hepatitis B?

    <p>All of the above</p> Signup and view all the answers

    What is the primary function of the liver in lipid metabolism?

    <p>Both lipid synthesis and breakdown</p> Signup and view all the answers

    What is the prognosis for patients with fulminant hepatic failure with severe encephalopathy?

    <p>80% mortality rate</p> Signup and view all the answers

    What is the primary diagnosis for Wilson's disease?

    <p>Increased urinary copper</p> Signup and view all the answers

    What is the primary risk factor for hepatocellular carcinoma?

    <p>Chronic viral hepatitis (B/C)</p> Signup and view all the answers

    What is the primary treatment for hemochromatosis?

    <p>Serial phlebotomies</p> Signup and view all the answers

    What is the primary laboratory test used to diagnose liver dysfunction?

    <p>Prothrombin time</p> Signup and view all the answers

    What is the primary complication of APAP toxicity?

    <p>Cerebral edema</p> Signup and view all the answers

    What is the term for the accumulation of fluid within the peritoneal cavity, which is the most common complication of cirrhosis?

    <p>Ascites</p> Signup and view all the answers

    What is the primary goal of treatment for chronic hepatitis B?

    <p>Suppress HBV DNA to levels</p> Signup and view all the answers

    What is the characteristic laboratory finding in patients with cirrhosis?

    <p>Macrocytic anemia</p> Signup and view all the answers

    What is the primary risk factor for developing hepatocellular carcinoma?

    <p>All of the above</p> Signup and view all the answers

    What is the primary treatment for hepatic encephalopathy?

    <p>All of the above</p> Signup and view all the answers

    What is the primary indication for liver transplantation in patients with cirrhosis?

    <p>Liver failure</p> Signup and view all the answers

    What is the characteristic laboratory finding in patients with chronic hepatitis C?

    <p>Elevated AST and ALT levels</p> Signup and view all the answers

    What is the primary complication of chronic hepatitis C?

    <p>All of the above</p> Signup and view all the answers

    What is the primary treatment for chronic hepatitis C?

    <p>All of the above</p> Signup and view all the answers

    What is the primary risk factor for developing cirrhosis?

    <p>All of the above</p> Signup and view all the answers

    What is the minimum number of nutrients required by the human body?

    <p>40</p> Signup and view all the answers

    What is the purpose of the Dietary Reference Intakes (DRIs)?

    <p>To establish a standard for nutrient intake</p> Signup and view all the answers

    What is the term for the dietary intake sufficient to meet nutritional requirements of nearly all individuals in an age- and gender-specific group?

    <p>Recommended Dietary Allowance (RDA)</p> Signup and view all the answers

    What is the primary focus of the Dietary Guidelines?

    <p>Emphasizing whole foods and variety</p> Signup and view all the answers

    What is the primary purpose of fiber in the diet?

    <p>To support the growth of beneficial gut bacteria</p> Signup and view all the answers

    What is the term for the amount of metabolizable carbohydrate required by the body?

    <p>Small amount of metabolizable carbohydrate</p> Signup and view all the answers

    What is the primary role of a Gastroenterologist?

    <p>Diagnosing and treating diseases of the digestive tract and associated organs</p> Signup and view all the answers

    What is the primary role of a Radiation Therapist?

    <p>Administering radiation to patients with cancer</p> Signup and view all the answers

    What is the primary role of a Pathologist?

    <p>Examining bodies and body tissues</p> Signup and view all the answers

    What is the primary role of an Endoscopy Technician?

    <p>Assisting the endoscopist in patient positioning, medication administration, obtaining tissue specimens, and injecting various medications and dyes through the endoscope</p> Signup and view all the answers

    What is the primary use of an Abdominal Series (plain films) in Gastroenterology?

    <p>Evaluating perforation, obstruction or foreign objects</p> Signup and view all the answers

    What is the primary role of a Nutritionist in Gastroenterology?

    <p>Using food and nutrition to promote health and manage disease</p> Signup and view all the answers

    What is the primary indication for Urea Breath Test?

    <p>Diagnosing H.pylori infection</p> Signup and view all the answers

    Which of the following enzymes is used to detect pancreatitis?

    <p>Lipase</p> Signup and view all the answers

    What is the primary purpose of HBsAg test?

    <p>Indicating active infection</p> Signup and view all the answers

    What is the primary difference between Hepatitis B and Hepatitis D?

    <p>HDV requires HBV to enter the liver</p> Signup and view all the answers

    What is the primary purpose of amylase in the body?

    <p>Breaking down carbohydrates</p> Signup and view all the answers

    What is the primary characteristic of Hepatitis E?

    <p>Mostly endemic in Central Asia</p> Signup and view all the answers

    What is the primary purpose of barium enema?

    <p>To examine the colon and terminal ileum</p> Signup and view all the answers

    What is the primary advantage of endoscopic ultrasound (EUS) over other imaging modalities?

    <p>It allows for fine needle aspirate (FNA) of tissues</p> Signup and view all the answers

    What is the primary indication for upper endoscopy (EGD)?

    <p>Evaluate suspected or known upper GI pathology</p> Signup and view all the answers

    What is the primary difference between colonoscopy and flexible sigmoidoscopy?

    <p>Flexible sigmoidoscopy can only reach the splenic flexure</p> Signup and view all the answers

    What is the primary purpose of capsule endoscopy?

    <p>Evaluate the small intestine, particularly the jejunum and ileum</p> Signup and view all the answers

    What is the primary advantage of CT colonography over conventional colonoscopy?

    <p>It provides a virtual tour of the colon</p> Signup and view all the answers

    What is the primary indication for ERCP?

    <p>Evaluate the biliary and pancreatic ductal systems</p> Signup and view all the answers

    What is the primary purpose of manometry?

    <p>Assess esophageal motility and function</p> Signup and view all the answers

    What is the primary difference between abdominal ultrasound and CT scan?

    <p>Abdominal ultrasound uses high-frequency sound waves, while CT scan uses X-rays</p> Signup and view all the answers

    What is the primary advantage of EUS over CT scan?

    <p>EUS allows for fine needle aspirate (FNA) of tissues</p> Signup and view all the answers

    What is the purpose of a 24-hour pH monitoring test?

    <p>To establish a diagnosis of GERD in patients with atypical symptoms</p> Signup and view all the answers

    Which of the following is NOT a test used to assess the liver's synthetic function?

    <p>Alkaline phosphatase</p> Signup and view all the answers

    What is the significance of an elevated conjugated bilirubin level in the blood?

    <p>It indicates a liver or biliary disease</p> Signup and view all the answers

    What is the significance of an elevated ammonia level in the blood?

    <p>It indicates muscle wasting and may be used to evaluate encephalopathy or occult hepatic disease</p> Signup and view all the answers

    Which of the following enzymes is specific to the liver and a marker of liver injury?

    <p>ALT</p> Signup and view all the answers

    What is the significance of an elevated alkaline phosphatase level in the blood?

    <p>It indicates cholestasis or liver metastasis</p> Signup and view all the answers

    What is the purpose of assessing the liver's excretory and detoxifying function?

    <p>To assess the liver's ability to eliminate bilirubin and other waste products</p> Signup and view all the answers

    What is the significance of an elevated prothrombin time (PT) in the blood?

    <p>It indicates a clotting disorder</p> Signup and view all the answers

    What is the purpose of a hepatic function panel in diagnosing liver disease?

    <p>To assess the liver's synthetic, excretory, and detoxifying functions</p> Signup and view all the answers

    Study Notes

    Acute and Chronic Hepatitis

    • Hepatitis is a vital organ with various functions:
      • Metabolic regulation of glucose production (gluconeogenesis)
      • Lipid synthesis and breakdown (triglycerides and cholesterol)
      • Amino acid metabolism
      • Synthesis of plasma proteins (albumin, fibrinogen, globulins)
      • Storage of fat-soluble vitamins (A, D, E, and K) and B12
      • Storage of iron (as ferritin complexes)
      • Removal of circulating hormones
      • Drug inactivation and toxin removal
      • Synthesis and secretion of bile

    Hepatitis Etiology

    • Viral causes:
      • Hepatitis A: RNA virus, transmitted through fecal-oral route
      • Hepatitis B: DNA virus, transmitted through exchange of infectious body fluids (blood, sex)
      • Hepatitis C: RNA virus, transmitted through injection drug use, sex, tattoos, and post-transfusion
      • Hepatitis D: RNA virus, requires Hepatitis B to replicate
      • Hepatitis E: RNA virus, transmitted through fecal-oral route, waterborne in endemic areas (India/Asia)
    • Other non-specific hepatitis-causing viruses: EBV, CMV, HSV
    • Non-viral causes:
      • Alcoholic steatohepatitis
      • Non-alcoholic steatohepatitis (NASH)
      • Medications and toxins
      • Autoimmune hepatitis

    Clinical Presentation and Diagnosis of Hepatitis

    • Symptoms: abdominal pain, malaise, anorexia, fatigue, nausea, flu-like syndrome, arthritis
    • Signs: jaundice, hepatomegaly, splenomegaly, dark (tea-color) urine, acholic stools
    • Laboratory findings:
      • Elevated ALT and AST levels
      • Elevated bilirubin levels
      • Positive Hepatitis A IgM and IgG antibodies
      • Positive Hepatitis B surface antigen and core antibody
      • Positive Hepatitis C antibodies
    • Diagnostic tests:
      • Liver function tests (LFTs)
      • Viral serology
      • Liver biopsy

    Fulminant Hepatic Failure

    • Defined as severe liver dysfunction with encephalopathy and coagulopathy
    • Causes:
      • Acetaminophen toxicity
      • Idiosyncratic drug reactions
      • Viral hepatitis
    • Management:
      • Supportive care
      • Antiviral therapy for fulminant Hepatitis B
      • Liver transplantation

    Hepatic Steatosis (Fatty Liver Disease)

    • Also known as non-alcoholic fatty liver disease (NAFLD)
    • Risk factors:
      • Obesity
      • Dyslipidemia
      • Diabetes
    • Clinical features:
      • Asymptomatic
      • Elevated liver enzymes
      • Hepatomegaly
    • Management:
      • Weight loss
      • Exercise
      • Statins
      • Diabetic medications

    Cirrhosis and Liver Failure

    • Irreversible liver fibrosis and nodule formation
    • Causes:
      • Chronic viral hepatitis
      • Alcoholic liver disease
      • Non-alcoholic steatohepatitis (NASH)
      • Hemochromatosis
    • Clinical features:
      • Weight loss
      • Weakness
      • Fatigue
      • Anorexia
      • Amenorrhea
      • Impotence
    • Complications:
      • Ascites
      • Spontaneous bacterial peritonitis
      • Varices
      • Hepatic encephalopathy
      • Coagulation defects

    Hepatocellular Carcinoma (HCC)

    • Primary liver cancer
    • Risk factors:
      • Chronic viral hepatitis
      • Cirrhosis
      • NASH
      • Hemochromatosis
    • Clinical features:
      • Abdominal pain
      • Weight loss
      • Anorexia
      • Malaise
      • Jaundice
    • Diagnostic tests:
      • CT or MRI scans
      • Liver biopsy
      • Alpha-fetoprotein (AFP) levels### Swallowing Studies
    • Pressures of contractility are recorded during swallowing studies to diagnose motility disorders such as achalasia and esophageal spasm.
    • Upper and lower esophageal sphincters begin with higher pressure and relax during swallowing, while the intersphincteric esophagus shows peristalsis.
    • 24-hour pH monitoring is useful for establishing a diagnosis of GERD when the disease is in question despite treatment or if atypical symptoms are present.

    Hepatic Function Panel

    • Used to assess liver function and diagnose liver disorders.
    • Tests which assess the liver's synthetic function:
      • Serum albumin: protein formed in the liver, making up ~ 60% of total protein.
      • Serum globulins: antibody building blocks, also a marker of nutritional status.
      • Coags: indicators of extrinsic and common clotting pathway function.
    • Tests which assess the liver's excretory and detoxifying function:
      • Serum bilirubin: bilirubin is derived from the breakdown of RBCs.
      • Urine bilirubin: conjugated bilirubin is water-soluble and may be excreted in urine.
      • Blood ammonia: produced during protein metabolism and by colonic flora.
    • Enzymes reflecting hepatocellular damage:
      • Transaminases (ALT, AST): sensitive indicators of acute hepatocellular injury or disease.
      • Alkaline phosphatase (Alk phos): highest concentrations in liver, biliary tract, and bone.
      • 5' nucleotidase: similar to Alk phos but specific to the liver.
      • Gamma-glutamyl transferase (GGT): highest concentrations in liver and biliary tract.

    Diseases of the Small and Large Bowel

    • Acute Appendicitis:
      • Pathophysiology: obstruction of the appendiceal lumen, causing inflammation and infection.
      • Causes: fecalith, inflammation, and demographics.
      • Clinical signs: fever, abdominal pain, nausea, vomiting, anorexia, and rebound tenderness.
    • Diverticular Disease:
      • Pathophysiology: small, bulging pouches or herniations develop in the digestive tract.
      • Causes: high intraluminal pressure, atherosclerosis, and other factors.
      • Clinical presentation: nausea, vomiting, and fever.
      • Treatment: appendectomy, surgical resection, chemotherapy, and radiation therapy.
    • Ischemic Bowel Disease:
      • Ischemic colitis: disruption of blood flow to the colon.
      • Acute mesenteric ischemia: sudden onset of intestinal hypoperfusion.
      • Chronic mesenteric ischemia: persistent intestinal hypoperfusion.
      • Causes: systemic hypotension, hypovolemia, extreme physical activity, and other factors.
      • Clinical presentation: abdominal pain, bloating, nausea, vomiting, diarrhea, and fever.
      • Treatment: eliminate vasopressors, aggressive fluid resuscitation, and bowel rest.

    Hernias

    • Ventral hernias:
      • Incisional hernia: protrusion of abdominal contents through a weakness in the abdominal wall.
      • Umbilical hernia: weakness in the linea alba, usually due to poor wound healing.
      • Epigastric hernia: weakness in the linea alba, above the umbilicus.
    • Inguinal hernias:
      • Direct hernia: abdominal contents pass through the abdominal wall medial to the inferior epigastric vessels.
      • Indirect hernia: abdominal contents pass through the inguinal ring, lateral to the inferior epigastric vessels.
      • Femoral hernia: loop of bowel passes through an opening in the femoral canal.

    Bowel Obstructions

    • Pathophysiology: obstructive process that prevents food, liquid, or stool from passing through the intestine.
    • Causes: adhesions, hernias, inflammatory bowel disease, NSAID-induced strictures, and neoplasms.
    • Symptoms: abdominal pain, distention, nausea, vomiting, and obstipation.
    • Physical exam: bowel sounds, fever, and tachycardia.
    • Labs: dehydration, electrolyte imbalances.
    • Imaging: CT abdomen/pelvis with contrast, abdominal plain films.### Mesenteric Ischemia
    • Acute condition characterized by sudden interruption of blood flow to the small intestine
    • Causes: hypercoagulable states, portal hypertension, abdominal infection, blunt trauma
    • Clinical presentation: rapid onset of severe periumbilical pain, nausea, vomiting, diarrhea, and absent bowel sounds
    • Laboratory tests: leukocytosis, acidosis, and genetic abnormalities (e.g., Protein C and S, Factor V Leiden, Antithrombin III)
    • Imaging studies: mesenteric angiography (CTA) is the gold standard, followed by mesenteric artery ultrasound (duplex) and plain films
    • Treatment: embolectomy is the gold standard, followed by surgery, revascularization, and partial bowel resection
    • Prognosis: favorable with mesenteric venous thrombosis, less favorable with arterial thrombosis

    Toxic Megacolon

    • Acute condition characterized by extremely dilated colon, causing abdominal distension and pain
    • Typically secondary to another underlying problem, such as IBD flares or C. difficile colitis
    • Physical exam: distended abdomen, hypoactive bowel sounds, and tachycardia
    • Diagnosis: abdominal radiographs, and free air indicates perforation
    • Treatment: NPO for bowel rest, NG tube decompression, broad-spectrum antibiotics, and steroids
    • Complications: high risk of perforation, leading to sepsis, shock, and death

    Colorectal Cancer

    • 2nd leading cause of cancer deaths in the US (men and women combined)
    • Risk factors: ulcerative colitis, family history, low fiber diet, high fat diet, alcohol intake, obesity, and prolonged consumption of red meat or processed meat
    • Symptoms: iron deficiency anemia, rectal bleeding, change in bowel habits, and unintentional weight loss
    • Laboratory tests: CBC, microcytic anemia, liver function tests, fecal occult blood test, and CEA (colon cancer tumor marker)
    • Colonoscopy: primary screening and diagnostic tool, starting at age 45, with repeat every 10 years in average-risk patients

    Colon Polyps

    • Types: hyperplastic (benign), adenomas (all carry risk of progressing to malignancy), and sessile serrated adenomas
    • Cancer is more likely to develop in polyps >1cm
    • When to discontinue screening: USPSTF guidelines recommend against screening in adults ages 76-85, but individual risk factors and health state should be evaluated

    Pediatric GI Disorders

    • Pyloric Stenosis
      • Definition: thickening or swelling of the pylorus muscle, causing narrowing of the opening between the stomach and small intestine
      • Causes: unclear, but thought to be due to incomplete maturation of nerve fibers, hypertrophy of pylorus muscle, and genetic syndromes
      • Presentation: forceful vomiting, excessive sleeping, and crying without tears
      • Diagnosis: palpable pylorus, visible gastric peristalsis, and ultrasound or upper GI series
      • Treatment: rehydration, correction of electrolytes, and surgical repair with pyloromyotomy
    • Celiac Disease
      • Definition: gluten protein sensitivity causing chronic inflammation of the small intestine
      • Genetic mutations: HLA-DQ2 and/or DQ8
      • Presentation: GI symptoms, chronic diarrhea, abdominal distension, irritability, and poor weight gain
      • Diagnosis: serologic tests, duodenal biopsy, and genetic testing
      • Treatment: total lifelong avoidance of gluten ingestion and monitoring of micronutrient deficiencies

    Pediatric GI Bleeding

    • Intussusception
      • Definition: process in which a segment of intestine telescopes into the adjoining intestinal lumen, causing bowel obstruction
      • Presentation: recurring paroxysms of abdominal pain, vomiting, diarrhea, and currant jelly stools
      • Diagnosis: ultrasound, plain films, and contrast enema
      • Treatment: hydrostatic/pneumatic reduction or surgical reduction
    • Juvenile Polyps
      • Definition: benign hamartomas typically present between 2-8 years old
      • Presentation: bright red blood on the stool or protrusion from the rectum
      • Diagnosis: endoscopic resection
      • Treatment: curative
    • Meckel's Diverticulum
      • Definition: true diverticulum containing all bowel layers in the small intestine
      • Presentation: intermittent painless rectal bleeding
      • Diagnosis: nuclear imaging (Meckel radionuclide scan)
      • Treatment: surgical excision

    Esophageal Disorders

    • Esophageal Symptoms
      • Dysphagia
      • Odynophagia
      • Heartburn
      • Chest Pain
    • Gastroesophageal Reflux Disease (GERD)
      • Definition: recurrent reflux of gastric contents due to lower esophageal sphincter dysfunction
      • Presentation: heartburn, dysphagia, cough, hoarseness, and wheezing
      • Diagnosis: clinical, pH monitoring, and endoscopy with biopsy
      • Treatment: lifestyle modification, antacids, H2RAs, PPIs, and antireflux surgery
    • Barrett's Esophagus
      • Definition: specialized columnar metaplasia replacing normal squamous mucosa of the distal esophagus in GERD patients
      • Risk factor: adenocarcinoma of the esophagus
      • Screening: endoscopy for BE should be considered in chronic GERD (>10 years)
      • Treatment: radiofrequency ablation for select patients
    • Esophagitis
      • Definition: any inflammation or irritation of the esophagus
      • Causes: stomach acid, infections, medications, and allergic reactions
      • Presentation: odynophagia and chest pain
      • Diagnosis: endoscopy and biopsy
      • Treatment: cause-specific, including antacids, H2RAs, PPIs, and antibiotics
    • Mallory Weiss Syndrome/Tear
      • Definition: nonpenetrating mucosal laceration of the distal esophagus and proximal stomach
      • Causes: vomiting, retching, or hiccupping
      • Presentation: hematemesis and chest pain
      • Diagnosis: clinical, endoscopy, and CBC
      • Treatment: bleeding should resolve spontaneously, but persistent cases may require endoscopic hemostasis

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    Test your knowledge of Inflammatory Bowel Disease (IBD) including its types, epidemiology, and characteristics. Learn about Crohn's disease and Ulcerative colitis, their common sites of inflammation, and demographics.

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