GASTROENTEROLOGY ASL/ALT ratio: >2

Tx: alcohol abstinence, prednisone, TNF alpha inhibitor

VIRAL HEPATITIS (pentoxifylline)
S/sx: fever, jaundice, tea-colored urine
ALT: >400 GASTROESOPHAGEAL REFLUX DISEASE
Acute A Acute B Acute C S/sx: heartburn, epigastric/chest pain, odynophagia,
Anti-HAV + - - chronic cough
IgM Dx: 24-ambulatory pH monitoring (Gold standard),
HBsAg - + - empirical PPI of 2x standard dose, endoscopy, barium
Anti- - + - esophagogram
HBcIgM Tx: PPI: omeprazole (40mg) OD, 2-3 months; surgery:
Anti-HCV - - + Nissen fundoplication

Acute A: A diagnosis of acute hep A is based on the PEPTIC ULCER DISEASE

presence of anti-HAV IgM.
Acute B: Presence of HBsAg, with or without IgM anti-HBc
represents HBV infection. If IgM anti-HBc is present, HBV
infection is considered acute. If IgM anti-HBc is absent,
HBV infections is considered chronic.
A diagnosis of acute hep B can be made in the absence
of HBsAg when anti-HBc IgM is detectable.
Acute A and B: If IgM anti-HAV coexists with HBsAg, a
diagnosis of simultaneous HAV and HBV infections can be
made
Acute C: presence of anti-HCV in the absence of all
serologic markers supports diagnosis of acute hep C.
Acute Hepatitis B
1. HBsAg – first serologic marker, ongoing
infection
2. Anti-HBc IgM – recent infection
3. Anti-HBs – recovery and immunity
4. Anti HBe – resolving disease
Chronic Hepatitis B
1. (+) HBsAg and HBeAg for >6 months
2. (+) HBeAg – replicative phase
3. (+) anti HBeAg – non replicative phase
Treatment:
Acute: supportive
Chronic, replicative: interferon, peg interferon,
lamiduvine, adefovir, entecavir
Immunization
Hep A
- Post Exposure: hep A Ig
- Pre exposure: hep A vaccine at 0,6 mos
Hep B
- Post: hep B Ig
- Pre: hep B vaccine at 0,1,6 mos
ALCOHOLIC HEPATITIS
Increased AST and ALT but <400 IU/L
Hx: episodic gnawing or burning epigastric pain occurring 2-5 hours
after meals or on empty stomach, relieved by food intake, antacids
or antisecretory agents
PE: epigastric tenderness
Lab: CBC – rule out anemia
Urea breath test – H.pylori infection
Gold standard: upper endoscopy with gastric biopsy
Repeat endoscopy for gastric ulcer
Treatment:
Omeprazole + antibiotic
PPI + clarithromycin (500 mg) + amoxicillin (1000 mg)
BID
Acute Pancreatitis
CC: LUQ pain radiating to the back; usually 1-3 days after binge
alcohol drinking; nausea and vomiting
PE: abdominal pain, fever, hypotension, jaundice, ileus
Lab: increased serum amylase and serum lipase
WBC: 10,00 – 25,000/uL
Imaging: ultrasound, CT, MRI, ERCP
Treatment: meperidine, IV hydration, NPO,
Imipenem, fluoroquinolone, metronidazole (generally not indicated
for mild attacks)
Appendicitis
CC: RLQ pain
Hx: started as vague, colicky pain at the periumbilical area. Nausea
and vomiting was preceded by the pain. Anorexia
PE: direct tenderness (mc burney’s point), rovsing’s sign, psoas sign
and obturator sign
Labs: WBC >10,000/mm3 with polymorphonuclear predominance
Imaging: ultrasound
Treatment: surgery
Prophylactic antibiotics:
Uncomplicated – cefoxitin 2 gms IV single dose (adult) or 40mg/kg IV
single dose children
Allergic to beta lactams – gentamicin + clindamycin
Complicated: ertapenem or tazobactam-piperacillin
Acute Cholecystitis/choledolithiasis
CC: RUQ pain
RUQ steady pain radiating to right shoulder, aggravated by fatty
food intake with associated indigestion or bloating sensation
PE: murphy’s sign
Lab: acute cholecystitis – leukocytosis with band forms and shift to
the left
For choledolithiasis – direct hyperbilirubinemia >3mg/dL indicates  Family history of asthma
obstruction  Largely reversible
Imaging: Ultrasound – stones in the gallbladder with posterior
airflow limitation
acoustic shadow;
bile duct – usually dilated (>0.8 mm in diameter) Spirometry: Spirometry:
Treatment: ERCP + open or lap cholecystectomy + prophylactic  >12% or 2oo ml  FEV1/FVC <0.70
antibiotics improvement in FEV1 confirms presence of
from baseline after use airflow limitation that is
Cholangitis of inhaled BD not fully reversible
S/Sx:  >20% (minimum 250  Post bronchodilator
ml) FEV1 improvement FEV1 <80% predicted
Charcot’s triad – pain, jaundice, fever over time when
Reynaud’s triad – pain, jaundice, fever, altered mental symptoms are stable or
status, hypotension after 10 – 14 days of
Labs: leukocytosis, increased bilirubin and alkaline steroid TX
phosphatase Peak flow determination*:
Dx: ERCP  >15% change after
Tx: ERCP with endoscopic sphincterotomy, antibiotics, using inhaled BD in the
and cholecystectomy clinic
 Diurnal variability
>10% (if no BD) or
PULMONOLOGY >20% (if on BD)
Pneumonia
 Drop >15% with 6 min
Etiologic agents: running or exercise
Bacterial: Treatment
S. pneumoniae Inhaled corticosteroids Bronchodilator: B2 agonist,
Exacerbation: rapid anticholinergics,
PE: acting/Short acting/ long theophylline
Viral – crackles and wheezing on all lung fields (kalat) acting beta 2 agonist
Bacterial – crackles usually at the lower lobes

Labs:
NEPHROLOGY
CBC (WBC count)
Viral – normal or elevated but not more than 20,000/mm3 with UTI
lymphocyte predominance Urinalysis culture:
Bacterial – 15,000 – 40,000/mm3 with granulocyte predominance
- 102 bacteria in symptomatic
Chest X-ray: - 103 in men
Viral – interstitial Cystitis
Bacterial – lobar consolidation S/sx: dysuria, frequency, urgency, suprapubic
discomfort, hesitancy
Treatment: amoxicillin (500mg TID) or Azithromycin (500 mg OD) or
clarithromycin (500 mg BID)
Tx: fluoroquinolone (ciprofloxacin 500 mg BID) for 3
days
Pulmonary tuberculosis
S/sx: 2-3 weeks cough, pleuritic pain, dyspnea, hemoptysis, crackles Pyelonephritis
and bronchial breathsounds
S/sx: fever, N/V, flank pain, (+)CVA
DX: sputum AFB smear (gold standard) and CXR
Tx: 2 months HRZE, 4 months HR Tx:
uncomplicated - fluoroquinolone (ciprofloxacin 500 mg
Asthma and COPD BID) for 7 days
S/sx: dyspnea, wheezing, chest tightness, cough pregnant – nitrofurantoin, ampicillin, cephalosporin
Asthma COPD
 Onset early in life  Onset in mid-life (>40 Acute Prostatitis
(often childhood) years old)
S/sx: sudden onset, dysuria, frequency, pain in the
 Symptoms vary from  Symptoms slowly
day to day or episodic, progressive prostatic, pelvic or perineal area, fever and chills,
with exogenous triggers  Long smoking history bladder outlet obstruction
 Symptoms at  Dyspnea during Tx:
night/early morning exercise uncomplicated – fluoroquinolone or TMP_SMX
 Allergy, rhinitis, and/or  Largely irreversible (ciprofloxacin 500 mg BID) for 7 days – 24 days
eczema also present airflow limitation
minimally change disease Respi acid Acute: For every 10mmHg inc in CO2 =
patho: fusion of foot processes 1mmol/L inc in [HCO3]
no hematuria/casts Chronic: For every 10mmHg inc in CO2
Tx: steroids = 4mmol/L inc in [HCO3]
Respi alk Acute For every 10mmHg inc in CO2 =
Focal segmental glomerulosclerosis mmol/L inc in [HCO3]
Patho: sclerosis and hyalinosis of sections of glomeruli Chronic: For every 10mmHg inc in CO2
Tx: steroids = 4mmol/L inc in [HCO3]

Membranous glomerulopathy
Diffuse thickening of the GBM TOXICOLOGY
Microscopic hematuris Basic rules of rescucitation (A,B,C,D,E,F,G)
Tx: immunosuppressants - Airway
- Breathing
Membranoproliferative GN - Circulation
Low C3, microscopic hematuria - Disability
GBM thickening and mesangial proliferation - Electrolyte and metabolic problems
- Farenheit/Celsius (temp)
Acute glomerulonephritis - Glucose
Sudden onset of acute renal failure – decrease GFR poison Antidote/intervention
Edema aspirin Alkaline diuresis
Dysmorphic RBCs (>50%) paracetamol N-Acetylcysteine
Proteinuria Iron tablet Deferroxmine
Proligeration of endothelial.mesangial cells isoniazid Pyridoxine
Denatured alcohol Ethanol
Rapid progressive GN Diazepam Flumazenil
Urinalysis: epithelial cells, proteinuria, oliguria
cocaine in condoms, Whole bowel irrigation
HTN, hypervolemia, edema
swallowed by courier
Cresenteric formation
Heparin Protamine sulfate
Lugol’s iodine solution Starch slurry
Neprhrolithiasis
Lithium hemodialysis
S/sx: microscopic/gross hematuria, renal/uretheral
coli/lithuria, recurrent UTI
Eto daw lumabas last year:
Dx: urinalysis, creatinine, uric acid, Calcium,
Pedia
phosphorus, KUB or ultrasound, CT atonogram 6 month old pneumonia
Tx: potassium citrate, force oral fluids (3-4L /day), urine meds:amoxicillin (250 mg BID for 5 days)
alkalinization etiologic agent: Hib, strep, RSV
How to perform vaccination
How to spot pallor – palmar color
Metabolic acidosis/alkalosis
pH HCO3 PCO2 Medicine
Hypertension
Metab Dec Dec N Medications?
acid Asthma
Metab Inc Inc N Diagnostic criteria (ata) or extract something social history -
triggers
alkalosis Diagnostic Tool: spirometry
Respi Dec N inc Post strep MPGN
acid Read Case then diagnose

Respi Inc N dec Surge

alkalosis papillary carcinoma
HPI or social history (mainly ask questions that would help you
diagnose?
Compensation do PE
Metab acid pCO2 = [(1.5xHCO3) + 8] + 2
Clavicular Fracture.. perform bandaging
Metab pCO2 = [HCO3] + 15
Compute TBSA
alkalosis Anes
Tracheo intubation

Auscultate wear?

Neuro

Romberg

Radio

Subdural Hematoma

Diverticulosis