Island Med Student

Since I promised I would update all of you on my “stuff learned” during my gastroenterology rotation, here is a very incomplete list:

1) Hepatitis B seroconversion involves going from Hep B E antigen positiive to Hep B E antibody positive.

2) Hep B is a unique virus in that it’s the only DNA virus that carries reverse transcriptase.

3) Interferon is not used to treat Hep B as much these days, due to the many side effects.

4) For Asians, if they have Hep B core IgG, it can progress to hepatocellular Ca, so you always treat (although you wouldn’t for other races).

5) Alkaline phosphatase can be found in 4 places: liver, bone, kidney and placenta.

6) With extra-hepatic cholestasis, you usually see more symptoms and the bile ducts become dilated.

7) WIth intra-hepatic cholestasis, it’s usually more subtle and chronic, and can be caused by drugs.

8 ) A nuclear scintigraphy scan can detect .1 ml/min of blood flow.

9) Hepatorenal sydrome involves increased amounts of estrogen, which leads to systemic vasodilation, which leads to renal hypoperfusion.

10) You can use Questran (a bile binding resin) to treat relapsing c diff infections.

11) With a paracentesis you want to send the fluid to analyze albumin levels, cell counts, cytology, and gram stain and culture.

12) Blind loop syndrome can occur with diabetic patients. There is decreased gut motility, which leads to increased bacteria, which causes increased folic acid production, and decreased B12.

13) It takes a few times, but eventually you get quite accustomed to the sounds of very loud, long burps and farts coming from your patients.