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GIT > 30jan 24 > Flashcards

30jan 24 Flashcards

1
Q

Colon cancer screen for average risk

A

Start age 45:

     Colonoscopy every 10y 
     FOBT or   FIT   Every year 
     FIT DNA.  Every 1-3years 
     CT colonography every 5y

Flexible Sigmoidoscopy every 5years (every 3 years with annual FIT)

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2
Q

Pts with FDR with CRC or high risk adenomatous polyp

A

Colonoscopy at age 40 (10 years prior to age of dx of FDR)

Repeat every 5 years (every 10y if FDR was dx after age 60)

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3
Q

Screening for colon cancer in pts with UC

A

Start screening at age 8-10y after dx
Colonoscopy every 1-3y

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4
Q

What are high risk folks for CRC

A

Pts with First degree relatives

High risk adenomatous polyp
>10mm
High grade dysplasia
Villous elements.

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5
Q

9yr old with classic FAP with non dysplastic polyps. Management

A

Elective proctocolectomy in late teen or early twenties
(Can develop CRC at age <40 if left untreated)

Young pts are monitored with freq colonoscopies until puberty. (1year after surgery and every 3-5years after)

Urgent proctocolectomy at any age if high grade dysplasia
Hemorrhage
Inc in polyp number on colonoscopies.

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6
Q

CRC screen after resection

A

Stage 1 : Colonoscopy in 1 yr and every 3-5yrs.

Stage 2/3 : Colonoscopy in 1yr and then every 3-5y

                   Periodic CEA 
                   Annual CT chest , abdpelvis

Stage 4; Individualize
Consider stage 2-3 strategy

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7
Q

Stages of CRC

A

Stage 1 : Superficial layers
Stage 2: Invade muscular and serosal layers.
Stage 3: Lymph node involvement
Sig risk of distant mets.

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8
Q

Pt with adenoma of rectum.

A

Do colonoscopy of entire colon
(Pts with left sided adenoma or adenocarcinoma have synchronous neoplasia of right colon as well)

Do CT chest abd pelvis for mets

CEA for prognostication.

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9
Q

DX pf pancreatic CA

A

USG for pts of jaundice(head tumor)

CT scan for pts without jaundice. Body and tail tumors.

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10
Q

Jaundice in Pancreatic CA

A

Due to CBD obstruction by pancreatic head CA.

Steatorrhea is due to obstruction of main pancreatic duct

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11
Q

GOO with weight loss smoking history succussion splash cause

A

Pancreatic Ca.

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12
Q

GOO Cf

A

Abd distention
Intractable postprandial vomiting
Succussion splash

DX : upper GI endoscopy

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13
Q

GOO due to pancreatic Ca

A

Older patient
Early satiety
Smoker
Weight loss
Epigastric tenderness
Poor prognosis

Ttt:
Tumor is mostly too advanced for surgery
Palliative measures like
Stent placement for food intake.

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14
Q

HCC risk factors and CF

A

Cirrhosis
Chronic hep B
Env toxins (aflatoxin )

CF:

    Often AS 
    Abd pain,weight loss,paraneoplastic
    Bloody ascites
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15
Q

Evaluation of persistently bloody ascites in pt

A

Abd imaging (contrast enhaced CT)

Alpha feto protein (Inc in HCC)

Cytologic analysis.

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16
Q

Pancreatic cysts with high risk features

A

Large size >- 3cm
Solid components or calcifications
Main pancreatic duct involvement (ductal dilation)
Thick or irregular cyst walls

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17
Q

Management of high risk pancreatic cyst

A

Endoscopic USG guided biopsy for tissue sampling.

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18
Q

Cause of hyperbilirubinemia with predominantly high ALP

A

Cancer pancreas and ampullary
Cholangiocarcinoma
PBC
PSC
Choledocholithiasis
Cholestasis of pregnancy

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19
Q

CF of malignant biliary obstruction

A

Jaundice , pruritis , acholic stools , dark urine
Weight loss
RUQ pain
RUQ mass. Or hepatomegaly
Inc Direct bili
Inc ALP , GGT

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20
Q

Pt with bilious emesis if unstable

A

Do laparotomy asap

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21
Q

Pt with bilious emesis if stable

A

Do Xray.

If Xray is normal : Do upper GI series

If Rt sided ligament if treitz ➡️ malrotation

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22
Q

Pts who are stable with bilious emesis and non diagnostic Xray whats next?

A

Upper GI series

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23
Q

Malrotation with mid gut volvulus CF

A

Bilious emesis
Abd distention
Poor feeding
Dehydration
Hypovolemic shock

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24
Q

Management of Malrotation

A

Pts with normal vitals ;

    Cessation of enteral feeds 
    NG tube decompression 
    Give IV fluids

Imaging:

   Dilated bowel loops 
   Air fluid levels 
   Pneumoperitoneum(intestinal perforation) 
   Xray mayb normal 
   Do GI series   (Abnormally located Rt sided ligament of treitz , duodenal corkscrew , birds beak appearance -volvulus)

GI series is the gold standard dx

Ttt: Emergency laparotomy
Ladds procedure (to reposition malrotated bowel)

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25
Q

Tumor of head of pancreas CF

A

Painless jaundice
Weight loss
Non tender distended GB (courvoisier sign)

Imaging: double duct sign
(Dilation of CBD and pancraetic duct)

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26
Q

CF of esophageal CA

A

Progressive solid food dysphagia
GI bleed , iron def
Weight loss , aspiration

27
Q

RF for esophageal CA

A

Adenocarcinoma :

Uncontrolled GERD , obesity , male

Squamous cell CA :

Smoking ,alcohol , N-nitroso containing food (squamous cell)

28
Q

Esophageal CA types

A

Adenocarcinoma :
Distal esophagus , arises from barret esophagus

Sq cell carcinoma:
Proximal and mid esophagus

29
Q

DX of esophageal CA

A

For young and low risk with mild esophageal SS start with barium esophagogram

Age >50 and alarm symptoms: Endoscopy with biopsy

CT (PET/CT) used for staging (not initial dx)

30
Q

Focal nodular hyperplasia CF

A

Ass with anomalous arteries
Arterial flow and central scar on imaging

31
Q

Hepatic adenoma CF

A

Women on OCP
Possible hemorrhage or malignant transformation

32
Q

Pt with pale stools , hepatomegaly and direct hyperbili

A

Do liver biopsy for biliary atresia.

33
Q

Biliary atresia CF

A

Jaundice
Acholic stools (absent biliary pigment)
Dark urine
Age 2-8weeks
Hepatomegaly
Conj hyperbilirubinemia
Usg : absent or abnormal GB

34
Q

DX of biliary atresia

A

USG. : Abnormal/absent GB

Liver biopsy :

(Delay in biopsy and dx more than 8weeks is ass with high risk of liver transplant and mortality)

            Intrahepatic bile duct proliferation
            Portal tract inflammation
            Edema 
            Fibrosis (extrahepatic bile duct)
35
Q

Gold standard dx for biliary atresia

A

Intraoperative cholangiography

36
Q

Ttt of biliary atresia

A

Surgical hepatoportoenterostomy
(Kasai procedure)

Liver transplant

37
Q

Management of umbilical hernias

A

Small : Close spontaneously

Large : >1.5cm hernias surgery around age 5 (in persistent cases or if complicated)

38
Q

TEF with esophageal atresia patho

A

Defective div of trachea into esophagus and trachea

Causes prox esophageal pouch and fistula btw distal trachea and esophagus.

In utero affected fetus cant swallow amniotic fluid causing polyhydramnios
But anomaly is freq undetected until shortly after delivery.

39
Q

TEF clinical features

A

Coughing choking vomiting with feeds
Excessive oral secretions
Commonly part of VACTERL association

40
Q

DX of TEF

A

NG tube placement.

Xray :

     Enteric tube coiled in prox esophagus

Esophagography :

     Pooling of water soluble contrast medium in esophageal pouch.
41
Q

Ttt of TEF

A

Surgery

Screen for VACTERl : echo , renal USG

42
Q

Why do GIT malignancies metastasize to liver

A

Colorectal and pancreatic Ca metastasize to liver as their venous drainage is thru portal system directly to liver.

Also liver has dual blood supply (systemic and portal ) and hepatic sinusoidal fenestrations allow for easy metastatic deposition.

43
Q

Hepatic adenoma dx

A

Benign epithelial tumor
Young middle age women

USG : Well demarcated hyperechoic lesions

Contrast Enhanced CT : early peripheral enhancement.

Needle biopsy : (not done) risk of bleeding

44
Q

Hepatic adenoma vs Focal nodular hyperplasia

A

FNH :
Hyperperfusion from anomalous arteries.
Inc arterial flow on imaging
Central scar
Not related to OCP

45
Q

Ttt of gastrinoma

A

High dose PPI

Surgery : Exploratory laparotomy and resection

46
Q

Gastric Adenocarcinoma dx on endoscopy. Next step in management?

A

CT abd pelvis for staging and mets.

Tumor stage at time of dx determines prognosis and ttt.
CT is initial staging modality.

47
Q

Endoscopy of gastrinoma

A

Mutiple stomach ulcers and thick gastric folds.

48
Q

DX of ZES

A

Markedly elevated gastrin >1000 in the presence of normal gastric acid pH<4

49
Q

What is calcium infusion study. ?

A

Reserved for pts with strong suspicion of gastrinoma despite negative secretin test.
It causes inc serum gastrin in patients with gastrinoma.

50
Q

Nissen fundoplication post op complication

A

Dysphagia
Gas bloat syndrome
Gaatroparesis.

51
Q

Dysphagia after nissen fundoplication

A

Cause :

    Disruption of peristalsis due to tight LES  Develops in 12w of surgery

Dx : Manometry

Ttt : Self resolves
Or esophageal dilation on EGD

52
Q

Post op Gas bloat syndrome cause and ttt

A

Cause : Gastric air trapping due to tight LES

SS : Bloating and inability to belch

Dx : Clinically and resolve with consevative ttt
(Simethicone)

53
Q

Gastroparesis after nissen fundoplication cause and ttt

A

Cause : Inadvertent vagal nerve injury

SS. : Bloating , satiety , post prandial emesis , food aversion , wt loss

Ttt: small , low fat , low fibre meals
Promotility agents.

54
Q

What is nissen fundoplication?

A

A procedure where gastric fundus is folded and sewn around LES to decrease GERD.

55
Q

DX of post gastroparesis

A

Negative esophagoduodenoscopy (done to rule out obstruction)

Negative small bowel imaging.

Scintigraphic gastric emptying scan
(Measures percentage of standard meal left in stomach after a set no of hours)
Is gold standard.

56
Q

RF for stress ulcers

A

Shock
Sepsis
Coagulopathy
Mechanical ventilation
Traumatic spinal cord / brain injury
Burns
High dose steroids

57
Q

Primary prophylaxis for esophageal varices

A

Non selective Beta blockers.

Decrease portal pressure by promoting splanchnic vasoconstriction (by inhibiting b2 mediated vasodilation)

And lower cardiac output

🚑 nadolol and propranolol are used in decompensated cirrhosis
🚑 carvedilol can be used in compensated cirrhosis ( no ascites , enceph, jaundice)

58
Q

Contraindications to BB in varices pt

A

Bardycardia
Hypotension
AKI
Serum sodium <130

Alternate : Variceal ligation is used as PP

59
Q

Mech of octreotide in varices

A

Help active bleeding by inhibiting vasodilator release (promoting splanchnic vasoconstriction)
But effect is transient
Hence ineffective for long term prevention.

60
Q

Diffuse esophageal spasm CF

A

Episodic dysphagia
Intermittent Spontaneous retrosternal pain
Ppt by emotional stress /hot /cold water
Relieved by nitrates and CCB
(Nitrates relax esophageal smooth muscles.)

Normal cardiac exam
Normal endoscopy

61
Q

DX of DES

A

Esophageal manometry

 Repetitive , non peristaltic ,high amplitude contractions , either spontaneously or after ergonovine stimulation.  (Happens in middle and lower esophagus . LES has normal relaxation)

Esophagogram:

 Corkscrew pattern
62
Q

DES pathophys

A

Uncoordinated simultaneous contractions of esophageal body
(Impaired inhibitory innervation of esophagus )

63
Q

Ttt of DES

A

CCB
Nitrates
TCA

GIT (20 decks)

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