Dr. DeMonseserte Flashcards
(85 cards)
1
Q
what TE fistula is the most common?
A
type C
-esophageal atresia w/ a DISTAL TE fistula
-distal fistula -> abdomen distends (air in GI tract from lungs)
2
Q
what do you do for child born with fistula or esophageal atresia?
A
get ECHO & renal US
3
Q
esophageal atresia in infant
A
polyhydramnios in mother
4
Q
hypertrophic pyloric stenosis
A
- thicken pyloric musculature -> outlet obstruction
- projectile NON-billous vomit
- palpable olive
- DOUBLE BUBBLE sign
5
Q
Meckel’s Diverticulum
A
- contains gastric mucosa
- current jelly bleeding
- rule of 2’s -> 2% of population, 2 feet from ileocecal valve, 2 inches or younger, 2 years or younger, 2 different mucosae
6
Q
Gastroschisis
A
- paraumbilical defect
- bowel protrudes NOT in sac
- elevated MSAFP
7
Q
Omphalocele
A
- midline defect
- bowel contents contained within membrane
8
Q
Hirschsprung disease
A
- aganglionic colon
- aut. dominant -> RET mutations
- empty rectal vault
- associated w/ Waardenburg and Downs
- Dx: rectal SUCTION biopsy
9
Q
achalasia
A
- failure of LES to relax
- bird beak appearance
- nocturnal regurg and weight loss
- treat with Heller myotomy or per oral endoscopic myotomy
10
Q
Ogilvie’s syndrome
A
-if cecal diameter >9cm -> emergency
11
Q
what can bacteria do to folate & vit. B 12?
A
bacteria metabolized B12 and produce folate
12
Q
how is glucose absorbed at brush border?
A
with Na+ via SGLT1
13
Q
most common carbohydrate malabsorption disorder
A
lactose intolerance
-deficiency in lactase enzyme
14
Q
medium chain TGs
A
-absorbed directly into portal bloodstream w/o the need for micelles
15
Q
what do you see with fat malabsorption?
A
steatorrhea and fat soluble vit. deficiencies
16
Q
what do you see with protein malabsorption?
A
edema, ascites, muscle atrophy
17
Q
small intestinal bacterial overgrowth (SIBO)
A
- see bloating and diarrhea
- draw vit. B12 and folate levels -> bacteria eat B12 and produce folate
18
Q
what happens if you resect terminal ileum?
A
won’t absorb bile salts
-cholestyramine only works up to 100cm of recection
19
Q
Crohns disease (IBD)
A
- creeping fat
- terminal ileum most affected - can be ANY portion of GI tract
- transmural involvement
- cobblestoning mucosa
- ASCA Abs or C-bir1
- diagnosed with CTE + colonoscopy
- smoking makes worse
- granulomas
20
Q
Ulcerative Colitis (IBD)
A
- ONLY involves colon
- PSC
- p-ANCA
- bloody diarrhea
- smoking helps
- crypt abscesses
21
Q
type 1 peripheral arthritis from IBD
A
- paucyarticular
- associated w/ IBD activity
- LARGE joints
- other extra intestinal manifestations
- self limited
22
Q
type 2 peripheral arthritis
A
- polyarticular
- independent of IBD
- SMALL joints
- no association w/ other extra intestinal manifestations
- chronic
23
Q
ankylosing spondylitis
A
- HLA-B27 +
- bamboo spine
- Tx: anti-TNF
24
Q
Primary Sclerosing Cholangitis
A
- inflammation/strictures of INTRA and EXTRAhepatic bile ducts
- associated with UC
- p-ANCA +
- associated with cholangiocarcinoma and colorectal carcinoma
- yearly colonoscopy after Dx
25
Celiac Disease
- immune response to gliadin
- Dermatitis Herpetiformis
- Dx: small bowel biopsies -> distal duodenum
- Tx: gluten free diet
- Anti-gliadin, anti-endomysial, anti-TTG
- HLA-DQ2, HLA-DQ8
- crypt hyperplasia, flattened villi
26
PUD
-due to H. pylori and NSAIDs
27
gastric ulcers
-post-prandial pain and weight loss
28
duodenal ulcers
- eating and antacids help with pain
| - weight gain
29
1st line Treatment for H. pylori
-Clarithromycin (or Macrolide if already taken macrolide)
30
what do you do for ALL H. pylori gastric ulcers?
follow up EGD
31
what are you at risk for with H. pylori?
MALT lymphoma
32
infectious gastritis
- H. pylori most common bacteria
| - CMV most common virus
33
stool osmotic gap
- GAP <50 -> SECRETORY diarrhea w/ more volume
- GAP >100 -> OSMOTIC diarrhea w/ less volume
290 - 2(stool [Na+] + [K+])
34
cholestryamine
- works up to 100cm resection of terminal ileum
| - change to MCT diet w/ >100cm resection
35
extra intestinal manifestations of IBD
- peripheral arthritis
- axial arthritis
- AS
- sacroilitis
- Erythema nodosum
- pyoderma gangrenous
- sweet syndrome
36
most common causes of acute pancreatitis?
1. GALLSTONES
| 2. EtOH
37
hypertriglyceridemia causing pancreatitis
- #3 most common cause
| - if fasting for >12 hours -> REPEAT TGs levels
38
drug induced pancreatitis
- 4th most common cause
| - Azathioprine
39
Dx of acute pancreatitis
1. epigastric pain radiating to back
2. amylase/lipase (>3x ULN) - LIPASE MORE SPECIFIC
3. imaging consistent w/ acute pancreatitis
neither lipase or amylase correlates w/ severity or outcomes
40
severe AP management
- aggressive fluids (>250-300 cc)
- ENTERAL NUTRITION 1ST -> TPN if intolerant
- EN prevents infection
41
Antibiotic coverage pancreatitis
- NOT recommended regardless of type or severity
| - exception: infected necrosis -> start quinolones, carbapenems, metronidazole
42
walled off pancreatic necrosis (WON) - aka pancreatic pseudocyst
- fluid collection + necrosis
| - Dx w/ MRI or CT
43
infected pancreatic necrosis (IPN) - aka abscess
- gas bubbles -> AIR in fluid collection on CT
- due to anaerobes (E. coli)
- Dx: +GM stain and FNA culture****
44
Pseudoaneurysm
- due to AP
| - gastroduodenal or splenic artery -> GI bleed
45
Splanchnic venous thrombosis (splenic, SMV, portal)
- due to AP
| - leads to gastric VARICES and GI BLEED
46
type I autoimmune pancreatitis (AIP)
- High IgG4
- histo: lymphoplasmacystic sclerosing pancreatitis (LPSP)
- older males
- systemic
47
type 2 autoimmune pancreatitis (AIP)
- idiopathic duct centric pancreatitis (IDCP)
- histo: GRANULOCYTE EPITH. LESION (GEL)
- younger males
- not systemic
48
Tx for autoimmune pancreatitis
-steroids (prednisone) -> Rituximab if steroid intolerant
49
chronic pancreatitis
- atrophy and fibrosis
- calcifications
- pancreatic insufficiency
- pseudocyst
- amylase and lipase may or may not be elevated
50
most common causes of chronic pancreatitis
1. EtOH*** (Most common)
2. SMOKING***
- strongest risk factor for progression from AP to CP
3. cystic fibrosis??
51
does recurrent AP mean you have CP???
NO
| -but structural changes do
52
what mutation is seen in both hereditary pancreatitis and pancreatic cancer?
PRSS1
53
preferred initial test for chronic pancreatitis
CT -> look for calcifications
| -contract enhanced CT (CECT)
54
indirect tests for CP/pancreatic insufficiency
1. fecal fat quantification (72 hr.) -> best for steatorrhea
2. FECAL ELASTASE (or chymotrypsin)
55
genes associated w/ chronic pancreatitis
-PRSS1 (most common), CFTR, SPINK1
56
therapy for CP
-PERT -> helps with pain and insufficiency
57
complications of CP
1. pseudocyst - due to EtOH
2. bile duct stricture
3. venous thrombosis -> gastric varices
4. pseudo aneurysms
5. OSTEOPOROSIS -> vit. D malabsorption
6. DM
58
surgery vs. endoscopy for CP
-surgery is SUPERIOR to endoscopy for PAIN relief
59
most common cause of pancreatic cancer?
DUCTAL ANDENOCARCINOMA
| -poor prognosis
60
marker for pancreatic adenocarcinoma
CA 19-9
61
symptoms of pancreatic andenocarcinoma
- PAINLESS JAUNDICE (Courvoisier's sign) w/ palpable GB
| - tumor usually in HEAD of pancreas
62
Dx of pancreatic cancer
-multi-detector CT (MDCT) w/ contrast -> can't detect tumors <1cm
63
Tx of pancreatic cancer
- WHIPPLE (pancreatico-duodenectomy)
| - adjuvant chemo (5-FU, Gemcytabine, Folfirinox) + radiotherapy
64
genetic factors increasing pancreatic adenocarcinoma risk
- STK11 mut. (from Peutz-Jegher) has HIGHEST risk
| - PRSS1 mut. (from hereditary pancreatitis) is MOST COMMON
65
what is used to measure whether pancreatic cancer is resectable or not?
EUS
66
look at tumors in DeMontesertes Chronic Pancreatitis/Cancer lecture
1. serous cyst adenoma
2. mucinous cystic neoplasm (MCN)
3. branch duct IPMN
4. main duct IPMN
67
serous cystadeoma
- benign, 60 y/o females
- body/tail, microcytic
- HONEYCOMB and CENTRAL SCAR
- CEA <5
- glycogen rich -> PAS+
68
Mucinous cystic neoplasm (MCN)
- malignant, females
- head/tail, macrocytic
- CEA >200
- produce mucin
- solitary
69
branch duct IPMN
- malignant
- most common**
- most frequent incidental pancreatic cyst**
- dilated branch duct
- CEA >200
- produce mucin
- multiple
- cysts >1 cm (10mm) communicating w/ pancreatic duct
- GNAS MUTATIONS
70
main duct IPMN
- malignant
- dilated main duct
- high risk of cancer if >10mm
71
what is very worrisome of pancreatic malignancy?
-PANCREATITIS
only resect if branch duct is >3cm in diameter or main duct is >1cm in diameter
72
cholelithiasis
-GB stone
73
choledolithiasis
-common bile duct stone
74
cholesterol stones
- MOST COMMON
- brown/yellow
- Lucent
75
pigment stones
1. BLACK (opaque) -> Ca2+ bilirubinate due to hemolysis
2. BROWN (Lucent) -> due to bacterial infection (B-glucoronidase) or parasites
- brown stones ONLY found in bile ducts and most common after cholecystectomy
76
acalculous cholecystitis
- ICU
| - ischemia and GB stasis
77
Biliary colic
- GB contracts against stone in cystic duct
| - RUQ pain
78
acute cholecystitis
- cystic duct obstruction
- + Murphys sign
- US 1st (HIDA more sensitive)
- Tx: DRAINAGE or cholecystectomy
- start Abx for gram neg
79
what are the most common GB polyps?
cholesterol polyps - benign
80
choledocholelithiasis
- COMMON BILE DUCT stones
- imaging: EUS best -> detects small stones
- Tx: TAKE STONE AND GB OUT (even if asymptomatic)
- ERCP + sphincterotomy standard of care
81
acute cholangitis
- CBD stone + infection
- E. coli, Klebsiella, Enterococcus, Enterobacter, Pseudomonas, Clostridium
- CHARCOT TRIAD: fever, RUQ pain, jaundice
- Tx: Abx, URGENT DRAINAGE via ERCP
82
gallstone ileus/cholecystoenteric fistula
-GB forms fistula with bowel -> gallstone enters -> duodenal or gastric outlet obstruction obstruction (Bouvaret's syndrome)
83
Mirizzi's syndrome
- suspect GB CANCER and biliary fistulas*** (type 2-4 has fistulas)
- Tx: cholecystectomy or ERCP
84
Primary biliary cholangitis/cirrhosis (PBC)
- autoimmune -> T cell destruction of intralobular bile ducts
- risk of Sicca syndrome, CREST, Celiac, Scleroderma
- Sx: PRURITIS and XANTHOMAS
- anti-mitochondrial Abs + (AMA)
- for AMA neg PBC -> do liver biopsy to Dx
- Tx: ursodeoxycholic acid (UDCA)...Obeticholic acid or Fibrates if needed
- cholestyramine for pruritus
85
Primary sclerosing cholangitis (PSC)
- inflammation/stricturing of intra and extra hepatic ducts -> beads on string
- ULCERATIVE COLITIS
- p-ANCA +
- periductal fibrosis - "onion skin"
- high risk of colorectal cancer (yearly colonoscopy) and cholangiocarcinoma
- Dx: MRCP >ERCP
- Tx: liver transplant only
