GI Flashcards
(203 cards)
1
Q
Etiology of colorectal CA
A
Most adenocarcinomas from mucosa
rarely carcinoid, lymphomas, kaposi
3rd common CA
2
Q
Screening for colorectal CA begins?
if family Hx?
A
50
10 yrs younger than youngest afflicted
3
Q
Most common site of distal colorectal spread
A
liver
also lumbar/vertebral veins to lungs, lymphatic regionally
20% mets at presentation
4
Q
Familial adenomatous polyposis
Tx?
A
Auto dom disease
hundreds of adenomatous polyps in colon
Colon ALWAYS involved q/ duodenum 90%
prophylactic colectomy
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
6
Q
Turcots Syndrome
A
Auto recessive
polyps plus cerebellar medulloblastoma or gioblastoma multiforme
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
8
Q
pigmented spots on lips, oral mucosa and maybe genitalia and has increased risk of other carcinomas w/ already harmatomas
A
Peutz jeghers
9
Q
Familial juvenile polyposis
A
rare
presents in childhood w/ small risk of CRC
10 -100s polyps
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)
11
Q
Signs of Colorectal CA?
A
melana/hematochezia
ab pain, bowel habit change, Fe deficiency anemia
12
Q
most common cause of bowl obstruction in adults
A
Colorectal CA
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?
14
Q
L sided CRC see?(3)
A
more obstruction
Change in bowel habits, pencil stools
hematochezia more common
15
Q
Rectal CA has (3)
A
hematochezia
tenesmus
rectal mass
high rate of recurrence
16
Q
Tx of CRC is?
A
surgery
adjuvant therapy depends on stage
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
18
Q
What Tx is NOT indicated for CRC?
A
radiation
19
Q
Hyperplastic polyps
A
most common nonneoplastic polyps
no therapy needed, just removed,
20
Q
PSeudopolyps seen in?
A
UC
inflammatory polyps
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
22
Q
most CRC polyps found in
A
rectosigmoid region
usually asymptomatic
23
Q
Cause of diverticulosis
A
increased intraluminal pressure
- bulges through weakness in colon wall (blood vessel)
24
Q
Risk factors for diverticulosis (2)
A
low fiber diets
family history
25
Most common location of diverticulosis?
sigmoid colon
but can occur anywhere
26
Symptoms of diverticulosis (4)
Usually asymptomatic
20% -> Vague LLQ pain, bloating, constipation/Diarrhea
27
Dx of diverticulosis
usually incidental
barium enema**
Can be seen in colonoscopy
28
TX of diverticulosis(2)
High fiber foods
| psyllium
29
Complications of diverticulosis (2)
```
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
30
Recurrence rate of diverticulitis
30% Tx medically, usually w.in 5yrs
Lower GI bleed > in diverticulosis
31
fever LLQ pain and leukocytosis?
diverticulitis
32
Complications of diverticulitis (4)
abcess
colovesical fistula - 50% close spontaneously
obstruction
free colonic perforation ** - uncommon but BAD
33
Test for diverticulitis
CT scan Ab/pelvis w/ oral and IV contrast**
Radiograph r/o other causes
NOT - barium enema or colonoscopy due to perforation risk
34
Tx of diverticulitis
Uncomplicated - IV Abx, bowel rest.
Surgery if symptoms for 3-4 days
Abx 7-10days
35
Angiodysplasia of colon affects?
Pts>60
common cause of lower GI bleeding
diagnosed by colonoscopy
36
Painless bleeding from colon
Angiodysplasia - >60
Diverticulosis
Colorectal CA
37
4 types of acute mesenteric ischemia
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
38
Abdominal pain disproportionate to physical findings
ischemic pain and infarct of intestines
39
Test to get is acute mesenteric ischemia concerns
lactate level
See AMS, fever, hypotension, tachycardia, anorexia, vomittin, Minimal GI bleeding
40
Test of choice for acute mesenteric ischemia
mesenteric angiogram
plain films r/o other etiology
thumbprinting on barium enema
41
Tx of acute mesenteric ischemia (2)
Support - IV fluids, broad septum Abx
intra arterial infusion w/ papaverine (vasidialator) in superior mesenteric system
heparin if venous, thrombolytucs? Surgery
42
atherosclerotic occlusive disease of colon ->
Pain when?
chronic mesenteric ischemia - celiac, superir and inferior,
Abdominal angina postprandial
Weight loss,
Get angiography
43
Ogilvie Syndrome is?
Causes (4)
signs, symptoms and radiographic evidence of large bowel obstruction are present but NO mechanical obstruction
surgery, trauma, serious med issues, Rxs
44
Ogilvie Syndrome Tx
gentle enemas or nasogastric suction, colonscopic decompression if fails
45
Risk of bowl rupture when larger than?
10cm diameter
46
Symptoms of C dif begin?
3 symptoms
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
47
Dx of C dif includes (4)
toxins in stool (24hrs needed)
Flex sigmoid - rapid and diagnostic but uncomfortable
Ab radiograph r/o
Leukocytosis common
48
Tx of C dif (3)
stop Abx
Metronodazole drug of choice
Oral vance if not
2-8 wks after stopping Abx risk recurrence
Choestryamine for diarrhea?
49
Most common site of volvulus
Sigmoid colon, cecal all else
50
Risk factors for volvulus (4)
- chronic illness, age, institution, CNA disease
- cecal is lack of congenital fixation, young puts
- chronc constipation, lax abuse, antimotilty drug use
- prior ab surgery
51
Dx of volvulus (3)
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
52
Tx of volvulus (2)
Sigmoid - decompress via sigmoidscopy, recuurence is high-> elective sigmoid resection
Cecal - surgery
53
Cirrosis leads to 2 major things
portal HTN-> acities, edema, splenomegalu, varicose veins(gastro.esophageal/hemroid)
Heptocellular failure - biochem function fails
54
Gold standard for cirrosis
liver biopsy
55
Childs Classification of liver disease
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
56
Most common cause of cirrhosis - Others?
alcohol!!
Chronic Hep C and B next
Drugs (tylenol, methotrex), autoimmune, PBC, SBC, metabolic disorders (wilsons, hemochromatosis), hepatic congestion, alpha1 antitrypsam, Nonalcolholic steatohepatitis
57
Classic Signs of chronic live disease (6+)
ascities, varices, palmar erythema/spider anginomas, gynectomastia/testicular atrophy, hemorroids, Caput medusa
58
Most concerning feature of Portal HTN
Bleeding - melana, hematemesis, hematochezia
59
TIPS procedure
Transjugular intrahepatic portal systemic shunt -> lowers portal pressure
60
Varices treatment
90% esophageal
- IV abs prophylactically
- octreotide
upper GI endoscopy for diagnosis -> sclerotherapy or ligation
-beta blockers for long term lowering of rebelling risk
61
Ascites management
Salt restriction and diuretics (furosemide + spironolactone)
complicated by hypoalbunemia and hydrostatic pressure
62
Bleeding esophageal varices Rx(5)
```
variceal ligation/banding
Endoscopic sclerotherapy
IV vasopressin (rare)
IV Octreotide
```
Also - TIPS, shunts, transplant
63
DDX of ascites (9)
```
Cirrosis- portal HTN
CHF
Chronic renal disease
fluid overload
TB peritonitis
Malignancy
Hypoalbuminemia
Peripheral vasodialation
Impaired liver inactivation
```
64
Paracentesis Test
Cell count, albumin, gram stain , culutre -Ro SBP
65
Serum ascities albumin gradient
>1.1 g/dL -> portal HTN
<1.1 g/dL other causes considered (infection, malignancy)
66
Hepatic encphalopathe due to?
symptoms
ammonia
50% of cirrhosis,
Decreased mental function, confusion, poor concentration, stupor/coma
----asterixix,
rigidity/hyperreflexia
Fetro hepaticus(breath a musty odor)
67
Tx of hepatic encephalopathy
lactulose - > fomrs NH4 when digested by bacteria and not absorbed
Neomycin kills bacteria so less ammonia made
Limit protein intake to 30-40g/day
68
Hepatorenal syndrome is?
end stage liver disease
2/2 renal hypo perfusion from vasoconstriction
diuretic use. functional failure
azotmeia, oliguria, hyponatremia, hypotension low urine Na
69
Complications of liver failure - AC 9H
Ascites, Coaguopathy
```
Hypalbuniemia
portal HTN
hyperammonemia
Hepatic encephalopathy
Hepatorenal syndrome
hypoglucemia
hyperbilirubinemia
hyperestrinism
hepatocellular carcinoma
```
70
SBP due to(3)?
Features?
E coli, klebsiella, strep pneumo
Ab pain, fever, vomitin, rebound tenderness w/ ascitied
71
Dx of SBP confirmed by
paracenteisis
WBC > 500, PMNs>250
+ culture
72
deficency in ceruloplasm suspect?
Wilsons disease- Aout recessive
copper binding protein necessary for Cu excretion
73
Signs of Wilsons disease(4)
liver disease,
kayser Fleischner rings,
CNS
( parkinsonian symptoms, chorea, cooling, incoordination w/ Cu in basal ganglia); depression, neuroses, personality changes
Renal involvement - nephrocalcinosis
74
pencillamine used for
Tx of wilsons - chelating agent
Also use Zinc - prevents Cu uptake
75
Hemochromatosis affects which organs (6)
```
liver **
pancreas
heart
joints
skin
thyroid, gonads, hypothalamus
```
increased Fe as ferritin and hemosiderin -> fibrosis w/ hydroxyl radicals
76
Early hemochromatosis may only see?
mild AST/ALT elivation
get iron studoes
77
Complications of hemochromatosis (7)
```
Cirrosis-> hepatocellular carcinoma
Cardiomyopathy-> CHF/arrythmia
DM
Arthritis (2nd- 3rd MCP, hips, knees)
Hypogonadism
hypothyroidism
hyperpigmentism (Bronze)
```
78
Bronze DM
hyperpigmentism and FE in the pancreas
hemochromatosis
79
Dx of hemochromatosi
Elv serum Fe and ferritin
Elv iron saturation (transferrin sat)
LOW total iron binding capacity (TIBC)
liver biopsy**
80
Tx of hemochromatosis
phlebotomie
81
Young women w/ oral contreptive use and maybe anabolic steroids have increased risk of?
Tx?
hepatocellular adenoma
asymptomatic or maybe RUQ pain or fullness
Low Malignant potential
STOP oral contraceptive, Surgically resect >5cm
82
Most common type of benign liver tumor
Dx how?
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
NO association w/ oral contraceptives and liver tumor in young women
focal nodular hyperplasia
maybe see hepatomegaly - NO Tx
84
most common malignant liver CA (2)
hepatocellular CA(africa and Asia)
and cholangiocarcinoma
85
Hepatocellular CA types and associations (2)
nonfibrolamella - (most common)- W/ Hep B or C
- usually unresectable
fibrolamella - NOT hep B/C, adolescents y. adults
- more resectable,
86
Risks for hepatocellular CA
```
Cirrosis*
Chemical carcinogen - aflatoxin, vinyl chloride, thorotrast
AAt def
hemochromatosis/Wilson
schisto
hepatic adenoma
cigarette
Glycogen Storage type I
```
87
Paraneoplastic signs of hepatocellular CA
erythrocytosis, thrombocytosis, hypercalcemia, carcinoid, hypoglycemia, high cholesterol
88
Cirrosis, palable liver mass and elv AFP
Hepatocellular CA
89
Tumor marker for hepatocellular CA
USe
AFP
can be a screener and measure response to therapy
90
Gilber's syndrome
7% of pop w/ Auto Dom
decrease uridine disphosphate glucronyl transferase activity
isolated elevation in unconjugated bilirubin
91
Hemobilia
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
Polycystic liver cysts
Auto dom, associated w/ PCKD,
Rarely leads to hepatic fibrosis and failure - no Tx, vague Ab pain
93
Hydatid liver cysts
Cause?
Occurs where?
Tx:
tapeworm Echinococcus granulosus in the Right lobe
-> asymptomatic cysts, may rupture -> fatal shock
Surgery, mebendazole after
94
Liver abcess
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
Where are liver accesses?
right lobe usually for bot amebic and pyrogenic
96
Homosexual men have an increase risk of what liver disease
amebic liver abscess - fecal oral - Entamoeba histolytica
Fever, RUQm N/V, hepatomegaly, diarrhea
97
E histolytica Dx ?
Tx?
Causes amebic liver abcess
IgG testing, lets maybe, stool antigens not sensitive
IV metronidazole, maybe therapeutic aspration
98
Budd Chiari is?
Causes
occlusion of hepatic venous flow-> congestion and ischemia
hypercoagulable states, myeloproliferative disorders(polycythemia), pregnancy, Chronic inflame disease, infection, CA, truama
99
Features of budd chiari?
Dx?
hepatomegaly, ascites, ab pain, RUQ pain, jaundice, variceal bleedin ~cirrosis
hepatic venograph
SAAG >1.1g/dL
100
3 causes of jaundice(major)
hemolysis
liver disease
biliary obstruction
101
See dark urine in jaundice what type of high bilirubin is it?
Conjugated bilirubin
uncongugated is not water soluble and bound to albumin in the spleen
Pale stools
102
Causes on conjugated hyperbilirubinemia
2 categories
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
Unconjugated hyperbilirubinemia causes?
2 categories
excess production - hemolytic anemia
reduced uptake - Gilberts, Drugs (sulfonamides, penicillin, rifampin), Crigler Najjar syndrome I and II, physiologic, liver disease
104
Cholestasis see? (6)
-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
Normal LFTs w/ jaundice 2 categories
conjugated hyperbilirubinemia
- dubin johnson
- rotors
uncongugated hyperbilirubinemia
- DDx for hemolysis
- gilberts*
106
ALT vs AST
ALT - in liver, more sensitive
| AST in skeletal muscle, heart, kidney, brain
107
mildly elvated(100s) ALT and AST think
chronic viral hep or acute hep
Alcoholic AST never > 500, ALT never >300
108
moderately elv (high 100s-thousands) Ast and Alt think
acute viral hepatitis
109
Severely elv (>10 000) AST + ALT think
hepatic necrosis (normal alk phos)-> ischemia + shock liver, Acetomenophen, severe viral
110
Elv LFTs (ABCs)
```
Autoimmune
Hep B
Hep C
Drugs
Ethanol
Fatty liver
Growths (tumors)
Hemodynamic(CHF)
Iron, Cu, AAT def
```
111
Alk Phos elv in ?
very high- 10fold increase think?
obstruction to bile flow(pregnancy-placenta, bone disease)
extrahepatic biliary tract obstruction or intrahepatic cholestasis(PBC etc.)
Get a GGT to localize
112
stones in the gallbladder called?
3 types
cholelithiasis
Cholesterol - obesity, DM, Crohns, age, NAmerican, cirrosis, CF
Pigment - hemolysis ot alcoholic cirrohosis
Mixed - majority of stones
113
Biliary colic def:
temp obstrcution -> of cystic duct
Pain occurs as gallbladder contracts; RUQ or epigastrium; right after eating
114
Boas sign
- R sub scapular pain in biliary colic
115
obstruction of cyclic duct -> acute inflammation NOT infection is?
Signs/symptoms
Cholecystitis
RUQ pain or epigastrum, Radiate to R shoulder; N/V; anorexia;
tender, murpheys sign (stop breath), low grade fever, leukocytosis
116
Dx of cholecystitis
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
Acalculous Cholecystitis
10% of PTs w/ cholecystitis
dehydration, ischemia, burns, severe trauma, post op
still emergent cholescystectomy
118
Stone in common bile duct called?
other features
Choledocholithiasis
-> pancreatitis, biliary cirrhosis
Can be asymptomatic if stone just chilling but life threatening if progressive
119
Choledocholithiasis Dx test
ERCP, US - NOT sensitive but should be F/u test
tx and sphinterectomy
120
Infection of biliary tract 2/2 obstruction called?
Cholangitis
Choledocolithiasis common cause, also pancreatic/biliary neoplasms
121
To do cholangitis (4)
blood cultures
IV fluids
IV Abx
Decompress CBD when stable
122
Charcots triad in cholangitis
Reynaulds pentad
RUQ pain
jaundice
Fever
septic shock
AMS
123
Definitive test in cholangitis
Cholangiography (PTC or ERCP) - done after stabilization
US initial study
124
Porcelain gallbladder Def
Importance
intramural calcification
ppx cholescetomy recommended to risk of CA (50%)
125
Gallbladder CA -
dismal prognosis
adenocarcinomas in old people
risks - gallstones, cholecystoenteric fistula, porcelin gallbladder
126
Primary Sclerosing cholangitis def
Associated w?
ERCP and intrahepatic +/- extra hepatic disease of bile ducts -> thickening and narrowing -> cirrhosis, oral HTN and liver failure
UC
127
Dx of PSC?
See?
ERCP and PTC -
multiple bead like stricturing and dilation
Cholestatic LFTs w. jaundice, prutuitis, fatigue, malaise
128
TX of PSC
none other than transplant, cholestyramine for symptomatic relief (puritis)
129
Primary biliary sclerosis def?
Autoimmune disease -> destruction of intrahepatic bile ducts w/ inflammation and scarring
progressive disease w// variable course
Middle age women
130
Symptoms of PBC?
fatigue, puritis(early), jaundice(late), RUQ discomfort, xanthomata xanthelsmata, osteoporosis, portal HTN
131
PBC serum marker
Antimitochondiral antibody (AMA)
Also cholestatic LFTs w/ alk phos
elv cholesterol and IgM
Biopsyy confirms
132
Ursodeoxycholic acid used to?
slow down progression of PBC
133
Klatskins Tumor is?
Tumors in proximal third of CBD -> junction of R and L hepatic duct
Poor prognosis - unresectble
134
Cholangiocarcinomas
affects who?
Risks?
Tumors in bile ducts - most adenocarcinomas
70s
PSC**, UC, Choledochal cysts, Clonorchis sinensis(Hong kong)
Weight loss, dark urine, clay colored stools, puritis
135
Choledochal Cysts
Symptoms/
Test?
systic deletions of biliary tree
W>M 4:1
epigastric pain, jaundice, fever, RUQ mass
US, ERCP for definitive
136
Bilairy dyskinesia
Hormone dysfunction?
dysfunction of sphincter of do -> colic w/o stones
Diagnose w/ HIDA,
CCK hormone that relaxes and contracts gull bladder
137
signs of appendices rupture
high fever, tachycardia, marked leukocytosis, peritoneal signs, toxic
138
Symptoms(3)/Signs(6) of appendicitis
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
Dx of appendicitis is?
Clinical
labs support, imaging helpful in uncertainty - CT lowers false +, US less sensitive
140
Carcinoid syndrome
Symptoms
Excess serotonin secretion w/ carcinoid tumor=>
Cutaneous flushing, diarrhea, sweating, wheezing, ab pain, Heart valve dysfunction)
141
Origination of carcinoid tumors
neuroendocrine cells - commonly in the appendix but also small bowel, rectum, broncus, kidney
-> carcinoid syndrom 10%
142
2 types of esophageal CA and risks and locations
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
Barretts esophagus
columnar metaplasia -> squamous epithelium in reflux disease
144
Barretts esophagus
columnar metaplasia -> squamous epithelium in reflux disease
145
Features of esophageal CA?
Dysphagia* progression, weight loss,
Anorexia, Odynophagia, (late) hematemesis, aspiration pneumonia, tracheal esophageal fistula, Chest pain
146
Diagnosis of esophageal CA TES
EGD
Barium useful initially
Full METS w/up after - CT CXR, bone scan
147
Tx of esophageal CA
Chemo + radiation before surgery prolongs life
148
2 types of acute pancreatitis and Tx
Mild acute- common an supportive TX
Severe acute/necrotizing - morbidity/mortality
149
Causes of acute pancreatitis (12), 2 most common
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
Steady dull severe abdominal pain (epigastric) worse when supine and after meals
- radiates to back?
Signs?3
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
Tests for pancreatis(3)
Imaging?
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
Hypocalcemia and epigastric pain?
saponification of Ca 2/2 pancreatitis
153
Ransons criteria for pancratits
GA LAW - admin
C HOBBS - 48 hrs
```
Glucose >200
Age >55
LDH >350
AST >250
WBC >16000
```
Hematocrit >10%
paO28
Base def >4
fluid Sequestion > 6L
7 100%
154
Complications of pancreatitis(7)
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
Tx for acute pancreatitis (4)
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
Causes of Chronic pancreatis
Alcoholis *
| hereditary, tropical, idiopathuc
157
Chronic epigastrium pain w/ calcfications on abdominal X-ray think?
triad of symptoms
chronic pancreatitis
steatorrhea, DM, Calcifications
158
Imaging for chronic pancreatitis
CT
Xray found 30%, ECRP gold standard but invasive
159
TX of chronic pancreatitis
non op management- narcotics, NPO, pancreatic(block CCK release) and H2(less gastric acid) enzyme blockers; insulin, abstinence
Surgery - pancreaticojejunostomy or resection - Whipple
160
Pancreatic CA risks (~6)
rare before 40, african americans, cigarette smoking, Chronic pancreatitis, DM, alcohol, chemical (benzidine naphthythlamine)
Usually in head of pancreas
161
Signs of pancreatic CA
vague: ab pain, jaundice rarely, weight loss, depression, glucose intolerance, migratory thrombophlebitis
162
Tumor markers for Pancreatic CA
CA 19-9
| CEA
163
Lower GI bleed in pts >40 is
Colon CA until otherwise
164
Upper GI bleed therapy
80% spontaneous stop on own, supportive
165
Upper GI bleeding DDx (10)
PUD; reflux esophagitis, gastric varices, gastric erosions, mallory weiss tear, hemobilia, dieulafoy's vascular malformation (submucosal dialted arterial lesion); aortoenteric fistula; neoplasm
166
Lower GI bleeds (8)
diverticulosis(40%),
| angiodysplasia (40%), IBD (UC>Crohns), colorectal CA, ischemic cholitis, hemorroids, smill intestinal bleed
167
coffee ground emesis means
upper GI bleed as well as lower rate of bleed
168
Melana like stools other than blood
bisthmuth, Fe, spinach, charcoal licorice
suggest upper GI 90%
169
Achalasia
Causes?
aquired motor disorder of esophageal smooth muscle in LES
idiopathic, Chagas worldwide
170
Features of Achalasia(6)
Dysphagea - difficulty w/ both solids and liquids
Regurgitation
Chest pain
weight loss
pulm problems w/ aspiration
171
Dx of achalasia?
TX?
barium swallow, upper endoscope to r/o 2ry causes, manometry
Antimuscarinics ?? sublingual nitro? botulinum?
heller myotomy
172
Diffuse esophageal spasm
nonperistaltic spontaneous contraction of esophageal body, sphincter (LES) is normal
noncardiac chest pain, regurgitation is UNCOMMON, but has dysphagia
173
Dx of esophageal spasm
manometry, upper GI barium -> corkscrews
No Tx- nitrates? CCB?
174
Esophageal hiatal hernia - 2 types
Type 1 sliding - 90%- treated medically (antacids, small meals, elv of head)
type 2 paraesophageal - 10%, enlarge w/ time -> thorax - treated surgically nissen
175
Mallory weiss syndrome
If trans mural?
mucosal tear ~ gastroesophageal junction 2/2 forceful committing
binge drinking and other causes
Get EGD
Boerhaave's disease
176
Plummer Vinson syndrome - (3)
upper esophageal webs
1. dysphagia, 2. Fe def anemia, (koilnchia) 3. atrophic oral mucosa
SCC of oral cavity
TxL esophageal dialation, nutrition
177
Schatzki's rings
Distal esophageal web
w/ sliding hiatal hernia
asymptomatic usually, Caused by alkali acid, bleach or detergent ingestion
Tx - esophectomy
178
Esophageal diverticula usually caused by?
underlying motility disorder
Zenkers most common
179
dysphagia, regurg, halitosis, wight loss and cough
>50
3 types
zenkers diverticula (upper 1/3)
Reaction diverticula (midpoint - TB?)
epiphrenic diverticula (lower 1/3- spastic dysmotility and achalasia
180
mediastinum feels crunchy with CXR showing air
Hx of bulemia
Boerhaave's Syndrome
sontrast esophagram definitve (gastrogafin - soluble)
Medical mgmt if small, Large -> surgery in 24hrs
181
PUD causes(3+)
H Pyloris
NSAIDs
Zollinger ellison
Smoking, alcohol/coffee
182
Duodenal ulcer
eating relieves the pain w/ nocturnal pain more common later on
low malignancy - still get a biopsy
183
gastric ulcer
eating worsens the pain, higher complications
migher malignancy potenial
184
acute gastritis
causes?
inflammation of gastric mucosa
NSAIDs/ASA, h pylori, alcohol, cigarrettes, caffeine, physiologic stress
Chronically -> h pylori
185
metastases of gastric CA?
kuckenbergs
Blumers shelf
Sister may joseph node
Irish node
- ovary
- rectum
- periumbilical lymph node
- L axillary adenopathy
186
Risk factors for gastric CA
atropic gastritis,intestinal metaplasia
adenomatous gastric polyps
H pylory (-6x)
postantrectomy
pernicious anemia
menetrier's disease
preserved foods(Nitriates/nitires)
187
Key event in Small bowel obstruction
dehydration
| -distension -> vomitins and intestinal secretions -> hypochoremia, hypokalemia, metabolic alkalosis
188
causes of small small bowel obstruction (3)
adhesions, incarcerated hernias,
Malignancy, intrusseption, crohns, carcinomatois
189
Dx of Small bowel obstruction
Abdominal plan films w/ air fluid levels
barium enema to r/o colonic obstruction?
190
Tx of small bowel obstruction
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
Flattening of the villi -> malabsorbtion
celiac sprue
weight loss, ab dissection, bloating diarrhea
192
Transmural inflame disease that can affect any part of GI
Crohns
terminal ileum hallmark location
Skip lesions, fistulae, luminal strictures, noncaseating ganuloms, trasnmural thickening, mesenteric "fat creeping)
193
most common extra intestinal sign of IBD?
arthtitis
migratory polyarthritis
ankylosing spondylitis in UC
194
Skin lesions in Crohns and UC
UC - pyroderma gangreosusm
Crohns - erythema nodusim
195
Sclerosing cholongitis in what IBD
UC
196
Dx of Crohns?
endoscopy - w/ biopsy -> alphous ulcers, cobblestone appearance and pseudo polyps patchy lesions
Baroum enema
197
Fistulase in what IBD?
also risk of what complication leading to surgery
Decreased absorption of?
crohns
SBO (20-30%)
B12
198
Toxic megacolon more common in
UC>Crohns
199
Tx of Crohns (6)
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
Continuous mucusa/submucosal lesion confined to colon and rectum
UC
colectomy may be curative
CA more common
201
no skip lesions and rectum always involved
PMNs accululate in crypts called?
UC
Crypt abcesses
202
Symptoms of UC
hematochezia and ab pain
diarrhea, fever, anorexia, weight loss,
jaundice, uveitis, skin lesions
203
Tx of UC
Systemic corticosteriods for acute exacerbations
Sulfasalazine as suppository- mainstay
Surgery curative
