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PANCE 2.0 > GI #12 > Flashcards

GI #12 Flashcards

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1
Q

What is Vitamin B2

A

Riboflavin

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2
Q

Symptoms of B2 deficiency

A

-Oral, ocular, and genital

  • Magenta colored tongue, glossitis, angular cheilitis, pharyngitis
  • Photophobia, corneal lesions
  • Scrotal dermatitis
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3
Q

What is Vitamin B1

A

Thiamine

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4
Q

Etiologies of Vitamin B1 deficiency?

A

-Chronic alcoholism (MC), weight loss surgery

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5
Q

Symptoms of B1 deficiency

A
  • Dry Beriberi: nervous system changes (peripheral neuropathy, paresthesias), cramps, muscle wasting
  • Wet Beriberi: high output heart failure and dilated cardiomyopathy
  • Wernicke encephalopathy: ataxia + global confusion + ophthalmoplegia (paralysis of ocular muscles)
  • Korsakoff Dementia: short term memory loss and confabulation.
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6
Q

Wernicke Encephalopathy is considered a neurologic emergency and common in

A

Chronic alcoholics

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7
Q

Treatment for Vitamin B1 deficiency

A

-IV thiamine followed by oral thiamine

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8
Q

What are some sources of Vitamin B3

A
  • Meats
  • Grains
  • Legumes
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9
Q

What is Vitamin B3

A

Niacin/Nicotinic Acid

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10
Q

Etiologies of B3 deficiency

A
  • Diets high in untreated corn
  • Diets which lack tryptophan
  • Alcoholism
  • Anorexia
  • Malabsorption
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11
Q

Symptoms of B3 deficiency

A

-Pellagra (3Ds): dermatitis, diarrhea, dementia

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12
Q

What is Vitamin B6

A

Pyridoxine

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13
Q

Causes of B6 deficiency

A
  • Chronic alcoholism
  • Isoniazid
  • Hydralazine
  • Levodopa + Carbidopa
  • OCP’s
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14
Q

Symptoms of B6 deficiency

A
  • Peripheral neuropathy, seizures, headache, mood changes
  • Stomatitis, flaky skin, glossitis, anemia, seborrheic dermatitis

-Neuro, Skin, Mouth

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15
Q

What are some sources of B12

A

Sources mainly animal in origin (meats, eggs, dairy)

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16
Q

What is Vitamin B12?

A

Cobalamin

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17
Q

Describe the absorption of B12

A

B12 is released by the acidity of the stomach and combines with intrinsic factor, where it is absorbed mainly by distal ileum

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18
Q

MCC of B12 deficiency?

A

Pernicious anemia (lack of intrinsic factor due to parietal cell antibodies, leading to gastric atrophy)

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19
Q

Other causes of B12 deficiency

A 
Crohn Disease
Chronic alcohol Use
Meds: H2 blockers, PPIs, Metformin, Hydroxyurea
Fish tapeworm
Vegan diet
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20
Q

Symptoms of B12 deficiency

A
  • Symmetric paresthesias
  • Lateral and posterior spinal cord demyelination (ataxia, sensory, vibratory, and proprioception deficits, decreased DTR), + Babinski, seizures, psychosis
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21
Q

How do you diagnose a patient with B12 deficiency?

A

CBC with peripheral smear

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22
Q

What is seen on a peripheral smear for B12 deficiency?

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A
  • Increased MCV (macrocytic anemia)
  • Megaloblastic anemia (hyperhsegmented neutrophils , macroovalocytes)
  • Increased homocysteine, increased methylmalonic acid
23
Q

If the patient has symptomatic anemia or neuro findings with B12 deficiency, what treatment should you start with?

Study These Flashcards
A

IM B12

-injection weekly until deficiency corrects, then once monthly. Oral after resolution of symptoms

24
Q

However, patients with pernicious anemia need

Study These Flashcards
A

lifelong monthly IM therapy (or high dose oral therapy)

25
What is the pathophysiology of acute pancreatitis?
Acinar cell injury --> intracellular activation of pancreatic enzymes --> auto digestion of pancreas
26
What are the 2 MCC of acute pancreatitis
Gallstones (MC) | Alcohol abuse
27
Other causes of acute pancreatitis?
- Thiazides - Valproic Acid - Malignancy - Scorpion Sting
28
Symptoms of acute pancreatitis
- Epigastric pain: constant, boring pain that radiates to the back. Pain worse if supine or eating. Relieved with leaning forward, sitting, or fetal position. - Nausea, vomiting, fever - Epigastric tenderness - Cullen's Sign: periumbilical ecchymosis - Grey Turner Sign: flank ecchymosis
29
To diagnose acute pancreatitis, at least 2 of the following 3 things need to present.
- Acute onset of pain radiating to the back - Elevation in serum lipase or amylase 3 times greater than upper limit of normal - Characteristic findings of pancreatitis on US, CT, MRI
30
True or False, if the patient meets the first 2 criteria of pancreatitis, no imaging is needed?
True
31
What are the best initial tests for acute pancreatitis?
Increased amylase and lipase -Lipase more specific
32
ALT 3-fold increase is highly suggestive of
gallston pancreatitis
33
What is another lab that is characteristic of acute pancreatitis
Hypocalcemia (necrotic fat binds to calcium, lowering serum calcium levels)
34
What is the diagnostic imaging of choice for acute pancreatitis?
Abdominal CT
35
What is seen on abdominal radiographs with acute pancreatitis?
Sentinel loop: localized ileus in LUQ | -Colon cutoff sign: abrupt collapse of colon near pancreas
36
Management of acute pancreatitis
- 90% recover without complications in 3-7 days. Rest the pancreas! - Supportive: NPO, High volume IV fluids (Lactated ringers). Analgesia (Demerol, Meperidine) - ABX: Imipenem may be used if >30% necrosis on MRI, CT
37
What score is used to determine prognosis with pancreatitis and what is the score classification?
Ranson's Criteria Score of 3 or more: Severe pancreatitis likely Score of less than 3: Severe pancreatitis unlikely
38
MCC of chronic pancreatitis
ETOH abuse -Other causes: idiopathic, hyperlipidemia
39
Clinical manifestation triad for chronic pancreatitis
-Calcifications -Steatorrhea -Diabetes Mellitus (but only seen in 1/3 of patients) Other symptoms: weight loss, back pain, epigastric pain
40
True or False: Amylase and lipase are usually normal in chronic pancreatitis?
True
41
A CT scan is diagnostic imaging of choice for chronic pancreatitis. What is seen?
Calcified pancreas.
42
What is the most sensitive test for chronic pancreatitis?
-Pancreatic function testing (fecal elastase)
43
Management for chronic pancreatitis
- ETOH abstinence, pain control, low fat diet, vitamin supplementation - Oral pancreatic enzyme replacement - Pancreatectomy if no improvement
44
70% of the cancers found in the pancreas are found in which part?
Head of the pancreas
45
MC type of pancreatic carcinoma
Adenocarcinoma (ductal)
46
Risk factors for pancreatic carcinoma
- Smoking - > 55 years old - Chronic pancreatitis - Diabetes Mellitus - Obesity - African American
47
Symptoms of pancreatic cancer
- Usually presents late in disease after METS - Painless jaundice - Weight loss - Pruritus - Abdominal pain radiating to back - Dark urine - Acholic stools
48
What are two physical exam findings associated with pancreatic carcinoma?
- Courvoisier's Sign: palpable, non tender, distended gallbladder - Trousseau's Sign: migratory phlebitis
49
Initial test of choice for pancreatic carcinoma
-CT scan
50
If the CT is negative, what is the next step?
Endoscopic US with biopsy of pancreatic lesion
51
However, if the CT is positive, what is the next step?
-Simultaneous surgical removal/biopsy
52
What tumor markers are associated with pancreatic carcinoma?
CA 19-9 and CEA
53
What is the surgical procedure for pancreatic carcinoma?
``` Whipple Procedure (pancreaticoduodenectomy) -Post chemotherapy or radiation ```
54
Pancreatic carcinoma is the _____ leading cause of cancer-related death in the US
Fourth

PANCE 2.0 (62 decks)

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