GI 6 Flashcards

Question

_____________ prevention through screening prevents deaths from CRC

Answer 1

1) Primary: Avoid or modify risk factors: smoking, physical inactivity, overweight or obesity, eating processed meat, excessive alcohol intake 2) Secondary: screening at appropriate time for determined risk

Answer 2

1) Most common primary malignant tumor of the liver 2) Men are generally more susceptible 3) Incidence increases progressively with advancing age in all populations

Answer 3

1) Smoking 2) Hereditary hemochromatosis 3) Alpha-1-antitrypsin deficiency

Answer 4

1) Weight loss - unintended 2) Weakness 3) Abdominal swelling - ascites 4) Nonspecific GI symptoms – nausea, malaise, jaundice

Answer 5

1) Hepatomegaly 2) Ascites 3) Jaundice 4) Wasting/cachexia

Answer 6

1) Anemia (normocytic) 2) Elevated alkaline phosphatase 3) HCV Ab, or HBV sAg /Ab 4) Elevated AFP level 5) Rare: malignant ascitic fluid cytology

Answer 7

1) IV Contrasted CT, MRI or U/S 2) Arterial phase enhancement of the lesion followed by delayed hypointensity (“washout”) is most specific for hepatocellular carcinoma 3) Consider biopsy

Answer 8

1) Surgical resection 2) +/- Liver transplantation 3) Alcohol injection or radiofrequency ablation 4) Chemoembolization

Answer 9

1) h/o Chronic hepatitis B 2) Hepatitis B-induced cirrhosis 3) Hepatitis C-induced cirrhosis 4) Alcohol-induced cirrhosis

Answer 10

1) Cavernous hemangioma 2) Hepatocellular adenoma 3) Infantile hemangioendothelioma (benign vascular tumor of the liver usually 0-6 mo)

Answer 11

Most common benign liver tumor, congenital malformation that increases in size, more common in 3rd-5th decades of life, F>M

Answer 12

Most small & asymptomatic; larger or multiple lesions cause upper abdominal pain, early satiety, nausea, vomiting; only physical feature hepatomegaly

Answer 13

1) U/S, MRI, or CT (do not biopsy) 2) Observation & surveillance imaging (asymptomatic), possible surgical resection (symptomatic)

Answer 14

Uncommon, benign, anabolic steroids, 25x risk with >9 years of OCP use

Answer 15

Asymptomatic, acute hemoperitoneum; large, solitary, often superficial tumors may rupture (often while menstruating)

Answer 16

1) U/S, MRI, needle Bx limited value, normal AFP 2) Surgery recommended, ligate hepatic artery, **discontinue OCPs**

Answer 17

Should be resected

Answer 18

1) Nodular regenerative hyperplasia: liver nodularity without fibrosis, associated with RA 2) Macroregenerative nodules occur in advanced cirrhosis or after massive hepatic necrosis

Answer 19

1) Hydatid cysts (prior infection) 2) Fibrocystic disease of the liver 3) Solitary congenital cysts

Answer 20

1) Most pts symptomatic & have advanced, incurable disease at presentation 2) ~25% candidates for curative resection 3) Surgically curable early cancers usually asymptomatic (infrequent detection) 4) Screening only in high-incidence regions (Japan, Korea, Venezuela, Chile)

Answer 21

4th most common cause of cancer death worldwide; higher rates in Japan, Asia, Eastern Europe, Chile, Colombia, & Central America; M>F; mean age 68; associated with environmental factors

Answer 22

Usually asymptomatic until advanced; dyspepsia, vague epigastric pain, anorexia, early satiety, & weight loss, hematemesis or melena (ulcer,) postprandial vomiting (pyloric obstruction)

Answer 23

1) Gastric mass palpated (20%), + Guaiac-positive stools, Signs of metastasis on exam (Virchow node, Sister Mary Joseph nodule) 2) IDA, elevated ALP (if mets to liver)

Answer 24

1) Endoscopic biopsy 2) Surgical resection, perioperative chemotherapy or adjuvant chemoradiation, endoscopic mucosal resection for select patients, palliative surgery and/or chemotherapy for unresectable disease

Answer 25

1) H. pylori infection risk factor, lymphocytic inflammatory response 2) Abdominal pain, weight loss, or bleeding; ulcer, mass or diffusely infiltrating lesion on endoscopy

Answer 26

1) Endoscopic biopsy 2) Depends on tumor histology, grade, & stage; radiation therapy, chemotherapy, and/or surgery; treatment for H. pylori in positive patients

Answer 27

1) Assumed origin from interstitial cells of Cajal- stem cells in wall of gut 2) Varies depending on primary tumor location (overt/occult GI bleeding (ulcer), obstruction, asymptomatic, abdominal pain, asymptomatic abdominal mass) -Can occur from esophagus to anus -Most common location is stomach & jejunum/ileum

Answer 28

Extragastrointestinal Stromal Tumors (EGISTs) in retroperitoneum, mesentery, and omentum; some asymptomatic; incidentally finding on imaging; often non-specific symptoms (bloating, early satiety)

Answer 29

1) Histopathology, immunohistochemistry, & identification of disease-specific mutations 2) Depends on confidence in preoperative diagnosis, tumor location & size, extent of spread, & clinical presentation -Complete resection possible in most cases of localized GIST; high recurrence rate

Answer 30

1) Adenomas, leiomyomas, lipomas, hamartomas, & fibromas 2) Due to rare nature & non-specific &variable nature of signs & symptoms. 3) Delayed diagnosis common (frequently leads to discovery at late stage & poor outcomes)

Answer 31

1) Ilium 2) Duodenum

Answer 32

small bowel

Answer 33

1) >11,000 new cases & 1,700 deaths from small bowel cancer annually (U.S.) 2) Small bowel malignancies 3% of all GI tract neoplasms & approximately 0.6% of all cancers in U.S. 3) Mean age of diagnosis of small bowel neoplasm 65; M>F

Answer 34

1) Intermittent & crampy abdominal pain most common symptom 2) Other symptoms: weight loss, nausea with vomiting, GI bleeding 3) Intestinal obstruction more common than perforation

Answer 35

1) >90% pts with carcinoid syndrome have mets from SB primary NET; ~40% of primary SB malignancies; (highest incidence in 60s) 2) Depends on extent of disease; wide resection, palliative procedures

Answer 36

SB NETs most commonly found in ileum; most asymptomatic; watery diarrhea & flushing m/c symptoms of carcinoid syndrome; pain m/c symptom in NET without carcinoid syndrome

Answer 37

Adenocarcinoma: most common neoplasm of pancreas (85%) 15% of all pancreatic cysts are neoplasms 75% in head, 25% in body & tail 2% of all cancers

Answer 38

Surgical cure usually not possible: due to late presentation, only 15-20% of patients are candidates for pancreatectomy **>90% expected to die from the disease**

Answer 39

Age, tobacco use, heavy alcohol use, obesity, chronic pancreatitis, DM, prior abdominal radiation, family history

Answer 40

Advanced cases: hard periumbilical (Sister Mary Joseph’s) nodule Possibly mild anemia hyperglycemia, impaired glucose tolerance or diabetes elevated amylase or lipase

Answer 41

Possible evidence of obstructive jaundice CA19-9: 70% sensitive & 87% specific; not useful for early detection CT (multi-phase, thin-cut) detects mass in >80% MRI is good alternative U/S not useful due to interference from intestinal gas

Answer 42

EUS – excellent for further imaging +/- bx, but not screening

Answer 43

1) Normal EUS excludes pancreatic cancer 2) ERCP: useful for ampullary or biliary neoplasm – can brush biopsy or place stent 3) MRCP: comparable to ERCP in diagnosing cancer, but not therapeutic 4) Radical pancreaticoduodenal (Whipple) resection is indicated for cancers strictly limited to the head of the pancreas, periampullary area, and duodenum (T1, N0, M0) 5) 5-years survival 20-25% (Whipple procedure) 6) Distal subtotal pancreatectomy: surgically resectable tumors of body or tail

Answer 44

1) Endoscopic stenting to relieve jaundice in unresectable cases 2) Adjuvant chemotherapy is superior to no adjuvant therapy -Adjuvant chemoradiation also used in U.S. 3) Surgical duodenal bypass if obstruction expected; 4) Chemoradiation for palliation of unresectable cancer confined to pancreas 5) Pain control: celiac plexus nerve block

GI 6 Flashcards

(71 cards)