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Med 1 > GI > Flashcards

GI Flashcards

1
Q

Etiology of colorectal CA

A

Most adenocarcinomas from mucosa

rarely carcinoid, lymphomas, kaposi

3rd common CA

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2
Q

Screening for colorectal CA begins?

if family Hx?

A

50

10 yrs younger than youngest afflicted

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3
Q

Most common site of distal colorectal spread

A

liver

also lumbar/vertebral veins to lungs, lymphatic regionally

20% mets at presentation

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4
Q

Familial adenomatous polyposis

Tx?

A

Auto dom disease
hundreds of adenomatous polyps in colon
Colon ALWAYS involved q/ duodenum 90%

prophylactic colectomy

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5
Q

Gardner’s syndome(5 things)

A

polyps plus: oseomas, dental abnormalities, benigh soft tissue tumors, desmoid tumors, sebacious cysts

CRC 100% by age 40

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6
Q

Turcots Syndrome

A

Auto recessive

polyps plus cerebellar medulloblastoma or gioblastoma multiforme

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7
Q

Peutz-Jeghers (4)

A

single or mtpl harmatomsa scattered throughout the GI in small bowel, colon, stomach

W/ pigments lips/oral mucosa, face, genitalia,

low malignant potential w/ slight increase risk w/ other carcinomas

intrussception or Gi bleed concerns

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8
Q

pigmented spots on lips, oral mucosa and maybe genitalia and has increased risk of other carcinomas w/ already harmatomas

A

Peutz jeghers

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9
Q

Familial juvenile polyposis

A

rare

presents in childhood w/ small risk of CRC

10 -100s polyps

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10
Q

Lynch Syndrome I

A

Site specific CRC - early onset w/o antecedent maple polyposis

Lynch II includes increased # and risk of other CA in the family (female genital tract, stomach, pancreas, brain, breast, biliary)

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11
Q

Signs of Colorectal CA?

A

melana/hematochezia

ab pain, bowel habit change, Fe deficiency anemia

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12
Q

most common cause of bowl obstruction in adults

A

Colorectal CA

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13
Q

R sided CRC CA see? (4)

A

LESS obstruction w/ larger lumen

occult blood loss and melana

RARE change in bowel movements

Triad - anemia, Weakness and RLQ mass?

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14
Q

L sided CRC see?(3)

A

more obstruction

Change in bowel habits, pencil stools

hematochezia more common

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15
Q

Rectal CA has (3)

A

hematochezia
tenesmus
rectal mass

high rate of recurrence

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16
Q

Tx of CRC is?

A

surgery

adjuvant therapy depends on stage

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17
Q

tumor marker of CRC and pt of it

other tests and timelines (3)

A

CEA **

measure recurrence risk- gotten q3-6 months

Also get

  • stool guiac,
  • annual CT of ab/pelvis and CXRfor 5yrs,
  • Colonoscopy 1yr then q3
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18
Q

What Tx is NOT indicated for CRC?

A

radiation

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19
Q

Hyperplastic polyps

A

most common nonneoplastic polyps

no therapy needed, just removed,

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20
Q

PSeudopolyps seen in?

A

UC

inflammatory polyps

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21
Q

3 types of adenoma CRC

how does shape change things?

A

Tubular - most common (60-80%)
Tubovillous - intermediate risk
Villious - great risk

Sessile (flat) is bad vs pedunculated

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22
Q

most CRC polyps found in

A

rectosigmoid region

usually asymptomatic

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23
Q

Cause of diverticulosis

A

increased intraluminal pressure

  • bulges through weakness in colon wall (blood vessel)
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24
Q

Risk factors for diverticulosis (2)

A

low fiber diets

family history

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25
Q

Most common location of diverticulosis?

A

sigmoid colon

but can occur anywhere

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26
Q

Symptoms of diverticulosis (4)

A

Usually asymptomatic

20% -> Vague LLQ pain, bloating, constipation/Diarrhea

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27
Q

Dx of diverticulosis

A

usually incidental

barium enema**

Can be seen in colonoscopy

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28
Q

TX of diverticulosis(2)

A

High fiber foods

psyllium

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29
Q

Complications of diverticulosis (2)

A 
Painless bleeding(40%)
-insignificant, and stops on its own,

diverticulitis(15-25%) - impaction and erosion
- fever, LLQ pain and leukocytosis and change in bowel movements

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30
Q

Recurrence rate of diverticulitis

A

30% Tx medically, usually w.in 5yrs

Lower GI bleed > in diverticulosis

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31
Q

fever LLQ pain and leukocytosis?

A

diverticulitis

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32
Q

Complications of diverticulitis (4)

A

abcess
colovesical fistula - 50% close spontaneously
obstruction
free colonic perforation ** - uncommon but BAD

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33
Q

Test for diverticulitis

A

CT scan Ab/pelvis w/ oral and IV contrast**

Radiograph r/o other causes

NOT - barium enema or colonoscopy due to perforation risk

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34
Q

Tx of diverticulitis

A

Uncomplicated - IV Abx, bowel rest.

Surgery if symptoms for 3-4 days

Abx 7-10days

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35
Q

Angiodysplasia of colon affects?

A

Pts>60

common cause of lower GI bleeding

diagnosed by colonoscopy

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36
Q

Painless bleeding from colon

A

Angiodysplasia - >60
Diverticulosis
Colorectal CA

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37
Q

4 types of acute mesenteric ischemia

A

Arterial embolism - 50%, cardiac origin - sudden

Arterial thrombosis - 25% - Atherosclerotic Hx, maybe low flow (MI?) - more gradual, less severe

Nonocclusive mesenteric ischemia -20% - splanchnic vasoconstriction 2/2 low CO, very old and very ill

Venous thrombosis <10%- hypercoaguable states and portal HTN, several days or wks

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38
Q

Abdominal pain disproportionate to physical findings

A

ischemic pain and infarct of intestines

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39
Q

Test to get is acute mesenteric ischemia concerns

A

lactate level

See AMS, fever, hypotension, tachycardia, anorexia, vomittin, Minimal GI bleeding

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40
Q

Test of choice for acute mesenteric ischemia

A

mesenteric angiogram
plain films r/o other etiology

thumbprinting on barium enema

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41
Q

Tx of acute mesenteric ischemia (2)

A

Support - IV fluids, broad septum Abx
intra arterial infusion w/ papaverine (vasidialator) in superior mesenteric system

heparin if venous, thrombolytucs? Surgery

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42
Q

atherosclerotic occlusive disease of colon ->

Pain when?

A

chronic mesenteric ischemia - celiac, superir and inferior,

Abdominal angina postprandial

Weight loss,

Get angiography

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43
Q

Ogilvie Syndrome is?

Causes (4)

A

signs, symptoms and radiographic evidence of large bowel obstruction are present but NO mechanical obstruction

surgery, trauma, serious med issues, Rxs

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44
Q

Ogilvie Syndrome Tx

A

gentle enemas or nasogastric suction, colonscopic decompression if fails

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45
Q

Risk of bowl rupture when larger than?

A

10cm diameter

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46
Q

Symptoms of C dif begin?

3 symptoms

A

duting 1st wk of ABx therapy but also up to 6 wks after

Profuse watery diarrhea, (NO blood/mucus)

Crampy ab pain

toxic megacolon w/ perf risk

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47
Q

Dx of C dif includes (4)

A

toxins in stool (24hrs needed)
Flex sigmoid - rapid and diagnostic but uncomfortable
Ab radiograph r/o
Leukocytosis common

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48
Q

Tx of C dif (3)

A

stop Abx
Metronodazole drug of choice
Oral vance if not

2-8 wks after stopping Abx risk recurrence

Choestryamine for diarrhea?

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49
Q

Most common site of volvulus

A

Sigmoid colon, cecal all else

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50
Q

Risk factors for volvulus (4)

A
  • chronic illness, age, institution, CNA disease
  • cecal is lack of congenital fixation, young puts
  • chronc constipation, lax abuse, antimotilty drug use
  • prior ab surgery
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51
Q

Dx of volvulus (3)

A

Xray
Sigmoid- omega loop sign, bent inner tube

cecal - coffebean sign, large air fluid level in RUQ

Sigmoidscope - only sigmoid, -> Tx

Barium enema - narrow colon at twist

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52
Q

Tx of volvulus (2)

A

Sigmoid - decompress via sigmoidscopy, recuurence is high-> elective sigmoid resection

Cecal - surgery

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53
Q

Cirrosis leads to 2 major things

A

portal HTN-> acities, edema, splenomegalu, varicose veins(gastro.esophageal/hemroid)

Heptocellular failure - biochem function fails

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54
Q

Gold standard for cirrosis

A

liver biopsy

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55
Q

Childs Classification of liver disease

A

A - no asicite, 3.5 alb

B- controlled ascities, Bili: 2-2-5, Minimal encephalopathy, goo nutrition, Albumin: 3-3.5

C - Ascities uncont, >3 bili, severe enceph, poor nutrition, > 3 Alb

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56
Q

Most common cause of cirrhosis - Others?

A

alcohol!!
Chronic Hep C and B next

Drugs (tylenol, methotrex), autoimmune, PBC, SBC, metabolic disorders (wilsons, hemochromatosis), hepatic congestion, alpha1 antitrypsam, Nonalcolholic steatohepatitis

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57
Q

Classic Signs of chronic live disease (6+)

A

ascities, varices, palmar erythema/spider anginomas, gynectomastia/testicular atrophy, hemorroids, Caput medusa

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58
Q

Most concerning feature of Portal HTN

A

Bleeding - melana, hematemesis, hematochezia

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59
Q

TIPS procedure

A

Transjugular intrahepatic portal systemic shunt -> lowers portal pressure

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60
Q

Varices treatment

A

90% esophageal
- IV abs prophylactically
- octreotide
upper GI endoscopy for diagnosis -> sclerotherapy or ligation
-beta blockers for long term lowering of rebelling risk

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61
Q

Ascites management

A

Salt restriction and diuretics (furosemide + spironolactone)

complicated by hypoalbunemia and hydrostatic pressure

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62
Q

Bleeding esophageal varices Rx(5)

A 
variceal ligation/banding
Endoscopic sclerotherapy
IV vasopressin (rare)
IV Octreotide

Also - TIPS, shunts, transplant

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63
Q

DDX of ascites (9)

A 
Cirrosis- portal HTN
CHF
Chronic renal disease
fluid overload
TB peritonitis
Malignancy
Hypoalbuminemia
Peripheral vasodialation
Impaired liver inactivation
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64
Q

Paracentesis Test

A

Cell count, albumin, gram stain , culutre -Ro SBP

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65
Q

Serum ascities albumin gradient

A

> 1.1 g/dL -> portal HTN

<1.1 g/dL other causes considered (infection, malignancy)

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66
Q

Hepatic encphalopathe due to?

symptoms

A

ammonia
50% of cirrhosis,

Decreased mental function, confusion, poor concentration, stupor/coma

—-asterixix,
rigidity/hyperreflexia
Fetro hepaticus(breath a musty odor)

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67
Q

Tx of hepatic encephalopathy

A

lactulose - > fomrs NH4 when digested by bacteria and not absorbed

Neomycin kills bacteria so less ammonia made

Limit protein intake to 30-40g/day

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68
Q

Hepatorenal syndrome is?

A

end stage liver disease
2/2 renal hypo perfusion from vasoconstriction

diuretic use. functional failure

azotmeia, oliguria, hyponatremia, hypotension low urine Na

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69
Q

Complications of liver failure - AC 9H

A

Ascites, Coaguopathy

Hypalbuniemia
portal HTN
hyperammonemia
Hepatic encephalopathy
Hepatorenal syndrome
hypoglucemia
hyperbilirubinemia
hyperestrinism
hepatocellular carcinoma
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70
Q

SBP due to(3)?

Features?

A

E coli, klebsiella, strep pneumo

Ab pain, fever, vomitin, rebound tenderness w/ ascitied

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71
Q

Dx of SBP confirmed by

A

paracenteisis
WBC > 500, PMNs>250
+ culture

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72
Q

deficency in ceruloplasm suspect?

A

Wilsons disease- Aout recessive

copper binding protein necessary for Cu excretion

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73
Q

Signs of Wilsons disease(4)

A

liver disease,
kayser Fleischner rings,

CNS
( parkinsonian symptoms, chorea, cooling, incoordination w/ Cu in basal ganglia); depression, neuroses, personality changes

Renal involvement - nephrocalcinosis

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74
Q

pencillamine used for

A

Tx of wilsons - chelating agent

Also use Zinc - prevents Cu uptake

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75
Q

Hemochromatosis affects which organs (6)

A 
liver **
pancreas
heart
joints
skin
thyroid, gonads, hypothalamus

increased Fe as ferritin and hemosiderin -> fibrosis w/ hydroxyl radicals

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76
Q

Early hemochromatosis may only see?

A

mild AST/ALT elivation

get iron studoes

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77
Q

Complications of hemochromatosis (7)

A 
Cirrosis-> hepatocellular carcinoma
Cardiomyopathy-> CHF/arrythmia
DM
Arthritis (2nd- 3rd MCP, hips, knees)
Hypogonadism
hypothyroidism
hyperpigmentism (Bronze)
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78
Q

Bronze DM

A

hyperpigmentism and FE in the pancreas

hemochromatosis

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79
Q

Dx of hemochromatosi

A

Elv serum Fe and ferritin
Elv iron saturation (transferrin sat)

LOW total iron binding capacity (TIBC)

liver biopsy**

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80
Q

Tx of hemochromatosis

A

phlebotomie

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81
Q

Young women w/ oral contreptive use and maybe anabolic steroids have increased risk of?

Tx?

A

hepatocellular adenoma

asymptomatic or maybe RUQ pain or fullness

Low Malignant potential

STOP oral contraceptive, Surgically resect >5cm

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82
Q

Most common type of benign liver tumor

Dx how?

A

cavernous hemangioma- Vac tumor that is small asymptomatic

Complications; rupture, obstructive jaundice, coagulopathy, CHF 2/2 AV shunt, gastric outlet

NO biopsy -> bleed risk

usually NO Tx

83
Q

NO association w/ oral contraceptives and liver tumor in young women

A

focal nodular hyperplasia

maybe see hepatomegaly - NO Tx

84
Q

most common malignant liver CA (2)

A

hepatocellular CA(africa and Asia)

and cholangiocarcinoma

85
Q

Hepatocellular CA types and associations (2)

A

nonfibrolamella - (most common)- W/ Hep B or C
- usually unresectable

fibrolamella - NOT hep B/C, adolescents y. adults
- more resectable,

86
Q

Risks for hepatocellular CA

A 
Cirrosis*
Chemical carcinogen - aflatoxin, vinyl chloride, thorotrast
AAt def
hemochromatosis/Wilson
schisto
hepatic adenoma
cigarette
Glycogen Storage type I
87
Q

Paraneoplastic signs of hepatocellular CA

A

erythrocytosis, thrombocytosis, hypercalcemia, carcinoid, hypoglycemia, high cholesterol

88
Q

Cirrosis, palable liver mass and elv AFP

A

Hepatocellular CA

89
Q

Tumor marker for hepatocellular CA

USe

A

AFP

can be a screener and measure response to therapy

90
Q

Gilber’s syndrome

A

7% of pop w/ Auto Dom

decrease uridine disphosphate glucronyl transferase activity

isolated elevation in unconjugated bilirubin

91
Q

Hemobilia

A

blood draining into duodenum via common bile duct - source w/in tract -> melena etc

Causes trauma*, papilary thyroid carcinoma, surgery, tumors, infection

Arteriogram diagnostic

92
Q

Polycystic liver cysts

A

Auto dom, associated w/ PCKD,

Rarely leads to hepatic fibrosis and failure - no Tx, vague Ab pain

93
Q

Hydatid liver cysts

Cause?

Occurs where?

Tx:

A

tapeworm Echinococcus granulosus in the Right lobe

-> asymptomatic cysts, may rupture -> fatal shock

Surgery, mebendazole after

94
Q

Liver abcess

A

billiary obstruction -> stasis and infection or Gi infection/ penetrating wounds - E coli, proetus, klebsiella

DX w/ US or CT and elv LFTs

Drain? and IV Abx

95
Q

Where are liver accesses?

A

right lobe usually for bot amebic and pyrogenic

96
Q

Homosexual men have an increase risk of what liver disease

A

amebic liver abscess - fecal oral - Entamoeba histolytica

Fever, RUQm N/V, hepatomegaly, diarrhea

97
Q

E histolytica Dx ?

Tx?

A

Causes amebic liver abcess

IgG testing, lets maybe, stool antigens not sensitive

IV metronidazole, maybe therapeutic aspration

98
Q

Budd Chiari is?

Causes

A

occlusion of hepatic venous flow-> congestion and ischemia

hypercoagulable states, myeloproliferative disorders(polycythemia), pregnancy, Chronic inflame disease, infection, CA, truama

99
Q

Features of budd chiari?

Dx?

A

hepatomegaly, ascites, ab pain, RUQ pain, jaundice, variceal bleedin ~cirrosis

hepatic venograph
SAAG >1.1g/dL

100
Q

3 causes of jaundice(major)

A

hemolysis
liver disease
biliary obstruction

101
Q

See dark urine in jaundice what type of high bilirubin is it?

A

Conjugated bilirubin

uncongugated is not water soluble and bound to albumin in the spleen

Pale stools

102
Q

Causes on conjugated hyperbilirubinemia

2 categories

A

decreased intrahepatic excretion:hepatocellular disease, inherited (Dubin john sons, Rotors), Drug induced (OCP), PBC, PSC

Extra hepatic - gallstones, carcinoma of pancreas, cholangiocarcinoma, periampular tumors, biliary atresia

103
Q

Unconjugated hyperbilirubinemia causes?

2 categories

A

excess production - hemolytic anemia

reduced uptake - Gilberts, Drugs (sulfonamides, penicillin, rifampin), Crigler Najjar syndrome I and II, physiologic, liver disease

104
Q

Cholestasis see? (6)

A

-jaundice w/ gray stools dark urine
-puritis (bile salt in skin)
-elv alk phos
elv cholesterol(not excreting)
skinxanthomas
**malabsorbtion of fats and vitamins

105
Q

Normal LFTs w/ jaundice 2 categories

A

conjugated hyperbilirubinemia

  • dubin johnson
  • rotors

uncongugated hyperbilirubinemia

  • DDx for hemolysis
  • gilberts*
106
Q

ALT vs AST

A

ALT - in liver, more sensitive

AST in skeletal muscle, heart, kidney, brain

107
Q

mildly elvated(100s) ALT and AST think

A

chronic viral hep or acute hep

Alcoholic AST never > 500, ALT never >300

108
Q

moderately elv (high 100s-thousands) Ast and Alt think

A

acute viral hepatitis

109
Q

Severely elv (>10 000) AST + ALT think

A

hepatic necrosis (normal alk phos)-> ischemia + shock liver, Acetomenophen, severe viral

110
Q

Elv LFTs (ABCs)

A 
Autoimmune
Hep B
Hep C
Drugs
Ethanol
Fatty liver
Growths (tumors)
Hemodynamic(CHF)
Iron, Cu, AAT def
111
Q

Alk Phos elv in ?

very high- 10fold increase think?

A

obstruction to bile flow(pregnancy-placenta, bone disease)

extrahepatic biliary tract obstruction or intrahepatic cholestasis(PBC etc.)

Get a GGT to localize

112
Q

stones in the gallbladder called?

3 types

A

cholelithiasis

Cholesterol - obesity, DM, Crohns, age, NAmerican, cirrosis, CF

Pigment - hemolysis ot alcoholic cirrohosis

Mixed - majority of stones

113
Q

Biliary colic def:

A

temp obstrcution -> of cystic duct

Pain occurs as gallbladder contracts; RUQ or epigastrium; right after eating

114
Q

Boas sign

A
  • R sub scapular pain in biliary colic
115
Q

obstruction of cyclic duct -> acute inflammation NOT infection is?

Signs/symptoms

A

Cholecystitis

RUQ pain or epigastrum, Radiate to R shoulder; N/V; anorexia;

tender, murpheys sign (stop breath), low grade fever, leukocytosis

116
Q

Dx of cholecystitis

A

US* -> thickened gallbladder, pericholecysic fluid, distension, stones

CT as accurate but more sensitive to complications

HIDA when US inconclusive, + HIDA scan mean stone NOT visualized

117
Q

Acalculous Cholecystitis

A

10% of PTs w/ cholecystitis

dehydration, ischemia, burns, severe trauma, post op
still emergent cholescystectomy

118
Q

Stone in common bile duct called?

other features

A

Choledocholithiasis

-> pancreatitis, biliary cirrhosis

Can be asymptomatic if stone just chilling but life threatening if progressive

119
Q

Choledocholithiasis Dx test

A

ERCP, US - NOT sensitive but should be F/u test

tx and sphinterectomy

120
Q

Infection of biliary tract 2/2 obstruction called?

A

Cholangitis

Choledocolithiasis common cause, also pancreatic/biliary neoplasms

121
Q

To do cholangitis (4)

A

blood cultures
IV fluids
IV Abx
Decompress CBD when stable

122
Q

Charcots triad in cholangitis

Reynaulds pentad

A

RUQ pain
jaundice
Fever

septic shock
AMS

123
Q

Definitive test in cholangitis

A

Cholangiography (PTC or ERCP) - done after stabilization

US initial study

124
Q

Porcelain gallbladder Def

Importance

A

intramural calcification

ppx cholescetomy recommended to risk of CA (50%)

125
Q

Gallbladder CA -

A

dismal prognosis
adenocarcinomas in old people

risks - gallstones, cholecystoenteric fistula, porcelin gallbladder

126
Q

Primary Sclerosing cholangitis def

Associated w?

A

ERCP and intrahepatic +/- extra hepatic disease of bile ducts -> thickening and narrowing -> cirrhosis, oral HTN and liver failure

UC

127
Q

Dx of PSC?

See?

A

ERCP and PTC -

multiple bead like stricturing and dilation

Cholestatic LFTs w. jaundice, prutuitis, fatigue, malaise

128
Q

TX of PSC

A

none other than transplant, cholestyramine for symptomatic relief (puritis)

129
Q

Primary biliary sclerosis def?

A

Autoimmune disease -> destruction of intrahepatic bile ducts w/ inflammation and scarring

progressive disease w// variable course

Middle age women

130
Q

Symptoms of PBC?

A

fatigue, puritis(early), jaundice(late), RUQ discomfort, xanthomata xanthelsmata, osteoporosis, portal HTN

131
Q

PBC serum marker

A

Antimitochondiral antibody (AMA)

Also cholestatic LFTs w/ alk phos

elv cholesterol and IgM

Biopsyy confirms

132
Q

Ursodeoxycholic acid used to?

A

slow down progression of PBC

133
Q

Klatskins Tumor is?

A

Tumors in proximal third of CBD -> junction of R and L hepatic duct

Poor prognosis - unresectble

134
Q

Cholangiocarcinomas

affects who?

Risks?

A

Tumors in bile ducts - most adenocarcinomas

70s

PSC**, UC, Choledochal cysts, Clonorchis sinensis(Hong kong)

Weight loss, dark urine, clay colored stools, puritis

135
Q

Choledochal Cysts

Symptoms/

Test?

A

systic deletions of biliary tree
W>M 4:1

epigastric pain, jaundice, fever, RUQ mass

US, ERCP for definitive

136
Q

Bilairy dyskinesia

Hormone dysfunction?

A

dysfunction of sphincter of do -> colic w/o stones

Diagnose w/ HIDA,

CCK hormone that relaxes and contracts gull bladder

137
Q

signs of appendices rupture

A

high fever, tachycardia, marked leukocytosis, peritoneal signs, toxic

138
Q

Symptoms(3)/Signs(6) of appendicitis

A

Epigastric pain, moves to umbilicus
anorexia-always
N/V

Tender RLQ-McBurneys Pt
Rebound tenderness
low fever
Rovings sign (deep LLQ pain -> RLQ)
Psoas sign (RLQ pain w/ extension of R thiagh)
Obturator sign- (RLQ pain w/ flexed R thigh is internally rotated)

139
Q

Dx of appendicitis is?

A

Clinical

labs support, imaging helpful in uncertainty - CT lowers false +, US less sensitive

140
Q

Carcinoid syndrome

Symptoms

A

Excess serotonin secretion w/ carcinoid tumor=>

Cutaneous flushing, diarrhea, sweating, wheezing, ab pain, Heart valve dysfunction)

141
Q

Origination of carcinoid tumors

A

neuroendocrine cells - commonly in the appendix but also small bowel, rectum, broncus, kidney

-> carcinoid syndrom 10%

142
Q

2 types of esophageal CA and risks and locations

A

Squamous Cell (Most) - African americans,

  • upper-> mid thoracic
  • Risk: alcohol, tobacco, nitrosamine, hot beverages, HOVm plummer vinson syndrome, caustic ingestion

Adenocarcinoma up 50% now (White Men 5:1)

  • distal third
  • Risk: GERD and barrets
143
Q

Barretts esophagus

A

columnar metaplasia -> squamous epithelium in reflux disease

144
Q

Barretts esophagus

A

columnar metaplasia -> squamous epithelium in reflux disease

145
Q

Features of esophageal CA?

A

Dysphagia* progression, weight loss,

Anorexia, Odynophagia, (late) hematemesis, aspiration pneumonia, tracheal esophageal fistula, Chest pain

146
Q

Diagnosis of esophageal CA TES

A

EGD

Barium useful initially

Full METS w/up after - CT CXR, bone scan

147
Q

Tx of esophageal CA

A

Chemo + radiation before surgery prolongs life

148
Q

2 types of acute pancreatitis and Tx

A

Mild acute- common an supportive TX

Severe acute/necrotizing - morbidity/mortality

149
Q

Causes of acute pancreatitis (12), 2 most common

A
  1. alcholol (40%)
  2. Gallstones (40%)

post ercp, viral (mumps, coxsackie), drugs *sulfonamides, thiazides, furosemide), Post op, scorpian sites, Hypertriglyceridemia, Uremia, blunt abdominal trauma (Kids)

150
Q

Steady dull severe abdominal pain (epigastric) worse when supine and after meals

  • radiates to back?

Signs?3

A

pancreatitis

low grade fever, tachy, hypotensics, leukocytosis, epic tendereness, decreased/absent bowel sounds,

Grey turners (flank echymoses)
Cullens (periumbilical ecchymoses)
fox ( inguinal ligament echymosis)

151
Q

Tests for pancreatis(3)

Imaging?

A

serum amylase most common but nonspecific

lipase - level does not predict severity

LFTs, tryglycerides, Calcium (saponification)

Ab US helpful but CT mot accurate(severe). ERCP if gallstones. Radiograph r/o

152
Q

Hypocalcemia and epigastric pain?

A

saponification of Ca 2/2 pancreatitis

153
Q

Ransons criteria for pancratits

GA LAW - admin
C HOBBS - 48 hrs

A 
Glucose >200
Age >55
LDH >350
AST >250
WBC >16000

Hematocrit >10%
paO28
Base def >4
fluid Sequestion > 6L

7 100%

154
Q

Complications of pancreatitis(7)

A

sterile/infected necrosis
-debride/ Abx if infected

pseudocyst (2-3wks after, lacks epithelial lining)
- rupture risk/infection, 5 cm drain

Hemorragic - cullens, grey or fox sign

ARDS

Ascities/pleural effusion

Ascedning Cholangitis

Abcess- rare

155
Q

Tx for acute pancreatitis (4)

A

Bowel rest
IV fluids
pain control
NG ube for severe N?V

Severe-> ICU - Entral nutrition through NJ tube w/in 72hrs (Ransons 3-4)

156
Q

Causes of Chronic pancreatis

A

Alcoholis *

hereditary, tropical, idiopathuc

157
Q

Chronic epigastrium pain w/ calcfications on abdominal X-ray think?

triad of symptoms

A

chronic pancreatitis

steatorrhea, DM, Calcifications

158
Q

Imaging for chronic pancreatitis

A

CT

Xray found 30%, ECRP gold standard but invasive

159
Q

TX of chronic pancreatitis

A

non op management- narcotics, NPO, pancreatic(block CCK release) and H2(less gastric acid) enzyme blockers; insulin, abstinence

Surgery - pancreaticojejunostomy or resection - Whipple

160
Q

Pancreatic CA risks (~6)

A

rare before 40, african americans, cigarette smoking, Chronic pancreatitis, DM, alcohol, chemical (benzidine naphthythlamine)

Usually in head of pancreas

161
Q

Signs of pancreatic CA

A

vague: ab pain, jaundice rarely, weight loss, depression, glucose intolerance, migratory thrombophlebitis

162
Q

Tumor markers for Pancreatic CA

A

CA 19-9

CEA

163
Q

Lower GI bleed in pts >40 is

A

Colon CA until otherwise

164
Q

Upper GI bleed therapy

A

80% spontaneous stop on own, supportive

165
Q

Upper GI bleeding DDx (10)

A

PUD; reflux esophagitis, gastric varices, gastric erosions, mallory weiss tear, hemobilia, dieulafoy’s vascular malformation (submucosal dialted arterial lesion); aortoenteric fistula; neoplasm

166
Q

Lower GI bleeds (8)

A

diverticulosis(40%),

angiodysplasia (40%), IBD (UC>Crohns), colorectal CA, ischemic cholitis, hemorroids, smill intestinal bleed

167
Q

coffee ground emesis means

A

upper GI bleed as well as lower rate of bleed

168
Q

Melana like stools other than blood

A

bisthmuth, Fe, spinach, charcoal licorice

suggest upper GI 90%

169
Q

Achalasia

Causes?

A

aquired motor disorder of esophageal smooth muscle in LES

idiopathic, Chagas worldwide

170
Q

Features of Achalasia(6)

A

Dysphagea - difficulty w/ both solids and liquids

Regurgitation
Chest pain
weight loss
pulm problems w/ aspiration

171
Q

Dx of achalasia?

TX?

A

barium swallow, upper endoscope to r/o 2ry causes, manometry

Antimuscarinics ?? sublingual nitro? botulinum?

heller myotomy

172
Q

Diffuse esophageal spasm

A

nonperistaltic spontaneous contraction of esophageal body, sphincter (LES) is normal

noncardiac chest pain, regurgitation is UNCOMMON, but has dysphagia

173
Q

Dx of esophageal spasm

A

manometry, upper GI barium -> corkscrews

No Tx- nitrates? CCB?

174
Q

Esophageal hiatal hernia - 2 types

A

Type 1 sliding - 90%- treated medically (antacids, small meals, elv of head)

type 2 paraesophageal - 10%, enlarge w/ time -> thorax - treated surgically nissen

175
Q

Mallory weiss syndrome

If trans mural?

A

mucosal tear ~ gastroesophageal junction 2/2 forceful committing

binge drinking and other causes

Get EGD

Boerhaave’s disease

176
Q

Plummer Vinson syndrome - (3)

A

upper esophageal webs

  1. dysphagia, 2. Fe def anemia, (koilnchia) 3. atrophic oral mucosa

SCC of oral cavity

TxL esophageal dialation, nutrition

177
Q

Schatzki’s rings

A

Distal esophageal web

w/ sliding hiatal hernia

asymptomatic usually, Caused by alkali acid, bleach or detergent ingestion

Tx - esophectomy

178
Q

Esophageal diverticula usually caused by?

A

underlying motility disorder

Zenkers most common

179
Q

dysphagia, regurg, halitosis, wight loss and cough

> 50

3 types

A

zenkers diverticula (upper 1/3)

Reaction diverticula (midpoint - TB?)

epiphrenic diverticula (lower 1/3- spastic dysmotility and achalasia

180
Q

mediastinum feels crunchy with CXR showing air

Hx of bulemia

A

Boerhaave’s Syndrome

sontrast esophagram definitve (gastrogafin - soluble)

Medical mgmt if small, Large -> surgery in 24hrs

181
Q

PUD causes(3+)

A

H Pyloris
NSAIDs
Zollinger ellison

Smoking, alcohol/coffee

182
Q

Duodenal ulcer

A

eating relieves the pain w/ nocturnal pain more common later on

low malignancy - still get a biopsy

183
Q

gastric ulcer

A

eating worsens the pain, higher complications

migher malignancy potenial

184
Q

acute gastritis

causes?

A

inflammation of gastric mucosa

NSAIDs/ASA, h pylori, alcohol, cigarrettes, caffeine, physiologic stress

Chronically -> h pylori

185
Q

metastases of gastric CA?

kuckenbergs

Blumers shelf

Sister may joseph node

Irish node

A
  • ovary
  • rectum
  • periumbilical lymph node
  • L axillary adenopathy
186
Q

Risk factors for gastric CA

A

atropic gastritis,intestinal metaplasia

adenomatous gastric polyps

H pylory (-6x)

postantrectomy

pernicious anemia

menetrier’s disease

preserved foods(Nitriates/nitires)

187
Q

Key event in Small bowel obstruction

A

dehydration

-distension -> vomitins and intestinal secretions -> hypochoremia, hypokalemia, metabolic alkalosis

188
Q

causes of small small bowel obstruction (3)

A

adhesions, incarcerated hernias,

Malignancy, intrusseption, crohns, carcinomatois

189
Q

Dx of Small bowel obstruction

A

Abdominal plan films w/ air fluid levels

barium enema to r/o colonic obstruction?

190
Q

Tx of small bowel obstruction

A

incomplete (no fever, tachy, peritoneal signs, leukocytosis)- nonoperative -> IV fluids and K

NG tube decompress

Surgery if complete w/ lysis adhesions and resection of necrotic bowle

191
Q

Flattening of the villi -> malabsorbtion

A

celiac sprue

weight loss, ab dissection, bloating diarrhea

192
Q

Transmural inflame disease that can affect any part of GI

A

Crohns

terminal ileum hallmark location

Skip lesions, fistulae, luminal strictures, noncaseating ganuloms, trasnmural thickening, mesenteric “fat creeping)

193
Q

most common extra intestinal sign of IBD?

A

arthtitis

migratory polyarthritis

ankylosing spondylitis in UC

194
Q

Skin lesions in Crohns and UC

A

UC - pyroderma gangreosusm

Crohns - erythema nodusim

195
Q

Sclerosing cholongitis in what IBD

A

UC

196
Q

Dx of Crohns?

A

endoscopy - w/ biopsy -> alphous ulcers, cobblestone appearance and pseudo polyps patchy lesions

Baroum enema

197
Q

Fistulase in what IBD?

also risk of what complication leading to surgery

Decreased absorption of?

A

crohns

SBO (20-30%)

B12

198
Q

Toxic megacolon more common in

A

UC>Crohns

199
Q

Tx of Crohns (6)

A

Sulfasalazine - if colon involves(melamine released -5ASA)

Metronidazole if no 5ASA

Prednisone for acute exacerbations

Immune suppression - azathioprine and 6 mercaptopurine
Bile acid sequestants w/ terminal ill disease
Antidiarrheal?

Surgeryif high recurrence

200
Q

Continuous mucusa/submucosal lesion confined to colon and rectum

A

UC

colectomy may be curative

CA more common

201
Q

no skip lesions and rectum always involved

PMNs accululate in crypts called?

A

UC

Crypt abcesses

202
Q

Symptoms of UC

A

hematochezia and ab pain

diarrhea, fever, anorexia, weight loss,

jaundice, uveitis, skin lesions

203
Q

Tx of UC

A

Systemic corticosteriods for acute exacerbations

Sulfasalazine as suppository- mainstay

Surgery curative

Med 1 (11 decks)

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