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CPD II > CPD Upper GI - Liver > Flashcards

CPD Upper GI - Liver Flashcards

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1
Q

Most common benign esophageal tumor

A

Leimyoma

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2
Q

What are the two most prominent forms of primary esophageal cancer and where in the esophagus do they occur?

A

Squamous cell carcinoma: proximal 2/3 of esophagus

Adenocarcinoma: distal 1/3 of esophagus

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3
Q

Risk factors of adenocarcinoma vs. squamous cell carcinoma

A

Adeno: smoking (NOT alcohol), Barrett’s eso

SCC: alcohol, tobacco, achalasia, HPV, lye ingestion, sclerotherapy, Plummer-vinson syndrome, irradiation, eso webs.

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4
Q

What are the most common cancers to mets to outside of esophagus?

A

Breast ca and melanoma

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5
Q

SSX of Eso Cancer

A

Progressive dysphagia, weight loss, hoarseness, Horner’s syndrome, dypnea

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6
Q

What is a common cause of esophageal varices?

A

Elevated pressure in the portal venous system, cirrhosis

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7
Q

What common oral-fecal organism causes gastritis, PUD, gastric adenocarcinoma, and low grade gastric lymphoma?

A

H. pylori

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8
Q

What is the pathophysiology of a H. pylori infection?

A

1) Increased gastrin production - hypersecretion of acid

2) Increased production of IL-1beta - decreased acid production

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9
Q

Etiologies of gastritis

A

Infection, drugs, stress, AI phenomena

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10
Q

What is usually the first sx of erosive gastritis?

A

Hematemesis, melena, or blood in the nasogastric aspirate.

Also, dyspepsia, n/v

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11
Q

Inherited autoimmune dz that attacks parietal cells - hypochlorhydria and decreased intrinsic factor production

A

Autoimmune Metaplastic Atrophic Gastritis (AMAG)

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12
Q

Risk factors for PUD

A

H. pylori, NSAIDs, smoking, family hx, Zollinger-Ellison syndrome

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13
Q

SSX: Gastric vs. duodenal ulcer

A

Gastric: not consistent pain pattern

Duodenal: more consistent pain, appears mid-morning, is relieved by good, but recurs 2-3hrs post-meal, awakening at night COMMON

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14
Q

Complications of ulcers (6): most common and ssx.

A

1) Hemorrhage - hematemesis or “coffee grounds”

2) Penetration - confined perforation, radiates to back.
3) Free perforation - RLQ pain, radiates to one or both shoulders, lies still.
4) Gastric outlet obstruction - recurrent, large-volume vomiting, end of day or 6hr after meal.
5) Recurrence - failure to eradicate H. pylori, NSAID, smoking
6) Gastric cancer

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15
Q

Most common gastric cancer

A

Adenocarcinoma

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16
Q

SSX of gastric cancer

A

EARLY SATIETY, weight loss, weakness, dysphagia, often non-specific.

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17
Q

How are most all gastric and esophageal pathologies diagnosed?

A

Endoscopy (and biopsy)

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18
Q

Tightly packed collection of partially digested or undigested materials that is unable to exit the stomach?

A

Bezoar

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19
Q

3 types of bezoars

A

Phyto - vegetable matter, due to hypochlorhydria, diminished antral motility, incomplete mastication
Tricho- hair, more common in psychiatric patients
Pharmaco- medications

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20
Q

What are the two most common causes of acute pancreatitis?

A

Biliary tract dz

Chronic heavy alcohol intake

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21
Q

Acute pancreatitis: SSX

A

Steady, boring, upper abd pain, often radiating to back. Pain relieved by sitting forward or lying down, N/V, low-grade fever, pale stool/dark urine.

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22
Q

Acute pancreatitis: Labs

A

Elevated serum amylase and lipase (3x above norm).

WBC increase ~20,000

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23
Q

1 cause of chronic pancreatitis?

A

Chronic alcoholism

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24
Q

Chronic pancreatitis: SSX

A

Post-prandial pain, episodic abd pain that is sever and may last hours/days, pancreatic posture, steatorrhea, creatorrhea, glucose intolerance

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25
Chronic pancreatitis: Labs
Normal amylase and lipase. (adapts)
26
Classic chronic pancreatitis triad
DM, pancreatic calculi, steatorrhea
27
Most common pancreatic cancer
Primary ductal adenocarcinoma
28
Early diagnosis of pancreatic cancer occurs due to what clinical finding and where is the cancer usually found?
SSX: Obstructive jaundice, pruritis, diabetes Location: head of pancreas
29
What SSX accompany pancreatic cancer in the body/tail of the pancreas?
Splenic vein obstruction = splenomegaly, gastric and eso varices, and GI hemorrhages
30
Pancreatic cancer: Labs and Imaging
Elevated alk phos and bilirubin Amylase and lipase are NORMAL CT or MRCP - visualize tumor
31
What pancreatic cancer has the best prognosis and what is the typical prognosis of pancreatic cancer?
Cystadenocarcinoma Pancreatic cancer: 5yr survival: <2%
32
What are the 2 general manifestations of pancreatic endocrine tumors?
Non-functioning - may cause obstructive sx, local Functioning - hypersecrete a particular hormone, systemic
33
Insulinoma: Define and SSX
Pancreatic B-cell tumor that hypersecretes insulin. Hypoglycemia during fasting, anxiety
34
Syndrome caused by gastrin-producing tumor located in pancreas or duodenal wall.
Zollinger-Ellison Syndrome
35
When should you suspect Zollinger-Ellison syndrome?
When ssx are refractory to standard acid suppressive therapy!
36
What percentage of gastrinoma are malignant and what often accompanies them?
50% MEN! (multiple endocrine neoplasia)
37
Non-B pancreatic islet cell tumor secreting vasoactive intestinal peptide.
VIPoma, often malignant and BIG
38
VIPoma: SSX
Prolonged massive watery DIARRHEA, crampy abd pain, dehydration, vomiting, lethargy, muscle weakness, electrolyte imbalance.
39
VIPoma: Work-up
Lab: hypokalemia, acidosis, elevated VIP levels Imaging: endoscopic ultrasonography, PET to localize
40
Pancreatic a-cell tumor that secretes glucagon, causing hyperglycemia and characteristic skin rash?
Glucagonoma - RARE 80% are malignant, mostly in women
41
Glucagonoma: SSX
diabetes! necrolytic migratory erythema vermillion tongue cheilitis
42
Glucagonoma: Work-up
``` Serum glucagon (>1000pg/mL) Normochromic anemia ``` CT, endoscopic US to localize
43
Elevated levels of alpha-Fetoprotein prompts consideration of what condition?
Primary hepatocellular carcinoma
44
Labs to investigate liver injury?
ALT and AST
45
Labs to assess liver function/biliary tract?
ALP, GGT, serum bilirubin, albumin, PT
46
Labs to assess hepatic synthetic capacity?
PT and INR, serum protein, albumin
47
What is the most sensitive technique for imaging the biliary system?
Abd ultrasound
48
Three major causes of hepatitis?
Virus, alcohol, drugs
49
Most common hepatitis virus, transmitted fecal-oral, especially in young people? What form is it's genome?
Hep A, ssRNA
50
Second most common hepatitis virus, spread by blood?
Hep B, dsDNA
51
What hepatitis virus has the highest rate of chronicity and is spread by blood?
Hep C, ssRNA
52
What hepatitis virus is dependent on co-infection with another hepatitis virus?
Hep D
53
Enterically transmitted hepatitis virus that does NOT cause chronic hepatitis?
Hep E
54
What laboratory findings would indicate viral hepatitis?
LFTs: very elevated, viral serologic testing Imaging and biopsy usually unnecessary.
55
Massive necrosis often involve HBV and HDV co-infection.
Fulminant hepatitis
56
What would you find on PE of an individual with chronic hepatitis?
Splenomegaly, palmar erythema, spider nevi
57
What makes acute hepatitis become chronic?
Time (>6mo)
58
What are two types of non-alcoholic fatty liver and what conditions are they associated with?
NAFLD -benign, pregnancy NASH -metabolic syndrome, obesity, dyslipidemia, glucose intolerance
59
What is a PE often found with fatty liver dz?
Hepatomegaly!
60
Describe the pathophysiology of alcoholic liver dz.
1) Increasing alcohol catabolization over time inhibits fatty acid oxidation and gluconeogenesis 2) Export of fat from liver decreased- triglyceride accumulation 3) Alcohol changes gut permeability 4) Oxidative stress/damage 5) Inflammation, cell death, and fibrosis
61
What disorders often occur in sequence with regard to alcohol consumption and the liver?
Alcoholic fatty liver- reversible/often asx Alcoholic hepatitis-fatigue, jaundice, RUQ pain, hepatomegaly Cirrhosis
62
What would LFTs look like for a patient with chronic alcoholic liver dz?
``` Elevated GGT (first to rise) Elevated AST and ALT but AST>ALT at a ratio of >2 ```
63
What two types of injury are caused by drugs on the liver?
Hepatocellular - acetaminophen, elev in AST and/or ALT Cholestatic -amoxicillin, elevated alk phos
64
SSX of chronic alcoholism
Vascular spiders, peripheral neuropathy, Dupuytren's contracture, hypogonadism, under-nutrition (deficiencies)
65
What type of imaging is best for looking at ducts?
MRI, ERCP

CPD II (3 decks)

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