GI Pathophys Review: Waters

Question 1

Why are gastric ulcers particularly bad in pts w/ cirrhosis?

Answer 1

Low platelets and clotting factors due to failing liver. Also incr. blood flow to stomach due to shunting around liver—> incr. hemorrhage risk.

Question 2

25 yr old preg. woman in Afghanistan presents w/ n/v and dies 7 days later. What happened?

Answer 2

Hep. E- pregnant women, prob immune to Hep. A

Question 3

Abd pain, weight loss, temporal wasting, jaundice. What is causing it?

Answer 3

1- cancer, anywhere along biliary system. Prob, pancreas w/ jaundice + weight loss.

Question 4

Which pancreatic cyst is most worrisome for malignancy?

Answer 4

Mucinous

Question 5

How does severe chronic pancreatitis present?

Answer 5

Steatorrhea, diabetes, fat-soluble vitamin deficiency (DEAK), chronic pain

Question 6

epigastric mid-abd. pain, n/v.
AST elevated
ALP elevated
Lipase 2000

Answer 6

Pancreatitis and passing gallstone
ALP elevation + pancreatitis = * gallstone *
EtOH + pancreatitis does not elevate ALP

Question 7

Mechanism of pancreatitis?

Answer 7

Intracellular activation of proenzymes

Question 8

Weight loss, frequent diarrhea 24 yo woman. Fe deficient.

Answer 8

IBD, autoimmune dz targets parietal cells, CELIAC.

Do tissue transglutaminase blood test.

Question 9

Fecal elastase?

Answer 9

Protein present in stool

Question 10

Rome criteria used for?

Answer 10

s

Question 11

weight loss, abd. tenderness in RLQ. female.

Answer 11

Crohns in terminal ilium—> obstruction.

Skip lesions, anal fissures, small bowel involvement, granulomas, strictures, perforations, no bleeding.

Question 12

H. pylori, how to treat?

Answer 12

Treat everybody.
PPI + clarithromycin + amoxicillin X 14 days
Breath urease test to confirm eradication, stool antigen too, and biopsy stomach for bacterial presence.

Question 13

Who is likely to improve w/ PPI tx?

Answer 13

Not someone w/ dysphagia due to cancer of esophagus.

Erosive esophagitis, YES.

Question 14

Kid has food stuck in esophagus. You do a biopsy to look for?

Answer 14

Eosinophilic esophagitis.

Question 15

RFs for Barrett’s?

Worried about?

Answer 15

Obesity
Smokers
Drinkers
Males
Middle aged-older
\+10 yrs of reflux

Worried about adenocarcinoma

Question 16

MC syndromic form of colon cancer.

Answer 16

Lynch syndrome

Question 17

Diff. btwn left and right sided colon cancer?

Answer 17

Left: obstruction, overt bleeding

Right- Fe deficiency, occult bleeding

Question 18

Prog. gastric cancer?

Answer 18

best when found early w/ minimal spread/invasion

Question 19

Gold standard for dx of gastroparesis?

Answer 19

Radioactive breakfast. How fast does it move?

Question 20

Metoclopromide worries?

Answer 20

Tardave dyskinesia

Question 21

Postprandial n/v, Fe deficiency, diabetes mellitus.

What tests?

Answer 21

PUD
EGD (scope) to look for cause of obstruction

Question 22

Abd. pain, mild tenderness in LLQ, CT showing thickening in splenic flexure.

Answer 22

Scope to rule out cancer.
Biopsy ulcer.
Just observe in old ppl, it will heal.

Question 23

Abd. pain, mild tenderness in LLQ, CT showing thickening in splenic flexure.
pH is low.
Hypotension
High lactic acid.

Answer 23

Likely mesenteric ischemia. Very bad news.
Look for A-fib. –> throws clot to SMA
Do arteriogram

Question 24

40 yo vomits liquid and then bright red blood.

Answer 24

Mallory-Weiss tear

Question 25

Weight loss, fatigue, Fe deficiency. 70 yo.

Answer 25

Scope ‘em.

Bottom end, look for colon cancer.

Question 26

RUQ pain, epigastric pain, tenderness in RUQ, peritoneal signs, normal bilirubin, thickened gallbladder, fluid around gallbladder. Why not cholangitis?
Doesnt show stones.

Answer 26

Normal bilirubin = not cholangitis.

Prob. Cholecystitis. Just bc there are no VISIBLE stones, does not mean they are not there.

Question 27

30 yo RUQ pain, delivered healthy child 3 wks ago. Tenderness of right epigastrium. What happened?

Answer 27

Gallstone. Estrogen inhibits bile trafficking. Excect cholesterol gallstone. Not pigment bc pt does nto have hemolysis/longstanding infxn.

Question 28

Diarrhea, abd. ain, multiple gastric/duodenal ulcers.

Answer 28

Gastrinoma (Z-E syndrome)

High gastrin levels can stimulate carcinoid tumors (Type II) as well.

Question 29

Celiac dz associated w/ what malignancy?

Answer 29

T cell lymphoma (NHL)

Question 30

Review Gastrointestinal stromal tumor.

Answer 30

Do that.

Question 31

Weight loss in IBS?

Answer 31

Nope. Think about something more serious.