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GI Part 2 Flashcards

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1
Q

What is the most common benign esophageal tumor?

A

leiomyoma

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2
Q

Where is primary esophageal CA usually found? Inside or outside of the lumen?

A

inside the lumen

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3
Q

Who is most at risk for SCC in the esophagus?

A

African Americans by 4-5x
Men
more common in asia and south africa

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4
Q

What are some risk factors of SCC? Pick 5

A 
alcohol
tobacco
achalasia
HPV
lye ingestion
sclerotherapy
Plummer-Vinson syndrom
irradiation
esophageal webs
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5
Q

Which esophageal CA is most common?

A

SCC (75%)

adenocarcinoma (50% in whites)

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6
Q

Risk factors of adenocarcinoma?

A

smoking
NOT ALCOHOL
Barrett’s esophagus

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7
Q

Where is secondary esophageal CA usually found? Inside or outside of the lumen?

A

outside the lumen

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8
Q

What are the most common CAs to metastasize to the esophagus?

A

melanoma and breast CA

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9
Q

SSX: esophageal CA (early and later)
hint: there’s a ton of possibilities

A 
Early: asx
Later: progressive dysphagia
wt. loss
hoarseness
Horner's
nerve compression
dyspnea
maybe odynophagia, vomiting, hematemesis, melena, iron deficiency anemia, aspriation, cough
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10
Q

Work up: esophageal CA

A

endoscopy with biopsy
CT
endoscopic US

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11
Q

What does esophageal CA like to metastasize?

A

lung and liver

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12
Q

What is the prognosis of esophageal CA?

A

overall poor

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13
Q

What causes esophageal varices?

A

elevated pressure in the portal venous system, typically from cirrhosis

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14
Q

SSX: esophageal varices

A

sudden, painless, upper GI bleeding. often massive

maybe signs of shock

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15
Q

What labs and imaging would you want for esophageal varices?

A

Labs: evaluation for coagulophathy, CBC, PT PTT LFT
Imaging: endoscopy

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16
Q

What is the prognosis for esophageal varices?

A

80% resolve spontaneously
mortality is high
recurrence is common

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17
Q

What portion of the population is infected with H. pylori?

A

50% by age 60

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18
Q

Who is more at risk for H. pylori infx?

A

blacks, hispanics, asians

nurses and gastroenterologists

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19
Q

How much more likely is a person with H. pylori infx to develop stomach CA?

A

3-6x

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20
Q

SSX: H. pylori

A

often Asx
gastritis
PUD

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21
Q

What is the most sensitive, non-invasive test for H. pylori?

A

serologic test

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22
Q

Besides serologic testing, what other work-up could you do for H. pylori?

A

Non-invasive: Urea breath test/stool antigen test (confirm tx effectiveness)

Invasive: Endoscopy (not recommended for this dx alone)
with mucosal biopsy for RUT/histologic staining

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23
Q

4 Etiologies: Gastritis

A

Infection (H. pylori)
Drugs
Stress
AI phenomena

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24
Q

SSX: gastritis

A

Asx or
dyspepsia
GI bleeding

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25
Work-up: gastritis
endoscopy
26
What is the most common type of gastritis?
erosive gastritis
27
What are specific causes of erosive gastritis? name 3
``` NSAIDS alcohol stress radiation viral infx vascular infx direct trauma ```
28
What is often the first sign of erosive gastritis?
hematemsis melena blood in nasogastric aspirate (bleeding can be mild-massive)
29
Dx: erosive gastritis
endoscopy
30
Prevalence of PUD?
any age | most often middle-aged though
31
What is a major history question when considering PUD?
Any family hx of PUD? (50-60% of duodenal ulcers have positive family hx)
32
What are the risk factors for PUD?
H. pylori infection (both gastric and duodenal ulcers) NSAIDS smoking Family hx
33
Genearl SSX: PUD
burning or gnawing pain | often chronic and recurrent
34
Pt. says epigastric pain occurs mid-morning and is relieved by food, but recurs 2-3 hrs. after a meal. You are thinking ulcer. Where do you think the ulcer is located?
Duodenum
35
Pt. says epigastric pain often awakes them at night. You are thinking ulcer.Where do you think the ulcer is located?
Duodenum
36
Pt. say epigastric pain is totally inconsistent and they see no pattern. You are thinking ulcer. Where do you think the ulcer is located?
Stomach (gastric)
37
Work-up: PUD
Lab: sometimes serum gastrin levels Imaging: endoscopy
38
What is the most common complication of PUD and what sxs would make you think this is happening?
``` Hemorrhage hematenesis of fresh blood or coffee ground material hematochezia (fresh blood out anus) melena (tarry upper GI blood out anus) weakness orthostasis syncope thirst ```
39
Your pt with known PUD comes in with pain that is persistent, intense and referring to the back? What complication are you considering? How would you confirm this dx?
Penetration (confined perforation) | CT/MRI
40
Your pt with known PUD comes in with sudden, intense continuous epigastric pain that spreads rapidly throughout the abdomen and is most prominent in RLQ. Pain is said to radiate to one or both shoulders. Pt. can only lay still. What PE findings would you expect and what would you do to confirm dx?
diminished or absent bowel sounds painful abdomen papation, rigidity, rebound tenderness CT or x-ray shows free air under the diaphragm or in peritoneal cavity
41
Your pt with known PUD calls the clinic reporting recurrent, large-volume vomiting occurring more frequently at the end of the day and often as late as 6-hr. after a meal. Loss of appetite with persistent bloating or fullness after eating. What complication are you considering?
Gastric outlet obstruction
42
What increases the risk of PUD recurrence?
failure to eradicate H. pylori continued NSAID use smoking gastrinoma (if refractory to tx)
43
What are the 6 possible PUD complications?
``` hemorrhage penetration free perforation gastric outlet obstruction recurrence gastric CA ```
44
What is the most common gastric CA?
gastric adenocarcinoma
45
What are the two most common causes of acute pancreatitis?
biliary tract disease | chronic alcoholism
46
SSX: acute pancreatitis?
steady, boring upper gi pain radiating to the back lasting hours to days N/V Pancreatic position low fever
47
PE: acute pancreatitis
tenderness to palpation hypoactive/absent bowel sounds maybe pleural effusion
48
work up: acute pancreatitis
``` labs: elevated serum amylase and lipase maybe elevated WBC imaging: abd. xray: pancreatic calcifications chest xray: atelectasis or pleural effusion CT after dx ```
49
Top two causes of chronic pancreatitis
chronic alcoholisms | idiopathic
50
SSX: chronic pancreatitis
post-prandial pain episodic abd. pain lasting hours to days pancreatic position
51
Dx: chronic pancreatitis
clinical suspicion based on Hx of abd. pain and chronic alcoholism
52
Work-up: chronic pancreatitis
Labs: amylase and lipase are normal (unlike in acute) imaging: plain film, CT to rule out CA
53
What is the most common pancreatic CA?
primary ductal adenocarcinoma
54
What part of the pancreas is more likely to have CA?
head | dx earlier because obstruction produces jaundice
55
What makes pancreatic CA in body or tail have a poorer prognosis?
usually dx at more advanced stages
56
SSX: pancreatic CA
``` 90% have advanced tumors at dx sever abd pain radiating to the back weight loss Head: jaundice and pruritis Body/tail: splenomegaly, gastric/esophageal varices, GI hemorrhage ```
57
What disease so pancreatic CA and chronic pancreatitis often cause?
diabetes
58
work-up: pancreatic CA
Labs: routine labs-elevated alk. phos and bilirubin CA 19-9 antigen (non-specific, used for monitoring) Imaging: ct or mrcp
59
What particular Hx questions are important when approaching pt. with liver disease?
exposures (toxins, alcohol, drugs, herbs, occupational)
60
Good ROS questions for liver disease?
general: fatigue, anorexia, fever skin: jaundice? GI: RUQ pain? N/V? Loose fatty stools?
61
What are the most common liver markers?
AST | ALT
62
What is the most sensitive technique for imaging the biliary system?
US
63
SSX: Hepatitis (prodromal/pre-icteric phase)
``` anorexia malaise n/v fever RUQ pain ```
64
SSX: Hepatitis (icteric phase)
dark urine jaundice systemic sxs enlarged tender liver
65
What is the most common cause of acute viral hepatitis?
HAV
66
Does HAV cause chronic hepatitis?
nope
67
What is the 2nd most common cause of acute viral hepatitis?
HBV
68
Which hep strains can become chronic hepatitis, cirrhosis and hepatocellular carcinoma?
HBV | HCV
69
Which hep strain has the highest rate of chronicity?
HCV
70
What are the Labs results seen with hepatitis?
elevated AST and ALT | antibodies to HAV, HBV or HCV
71
What happens to the liver in fulminant hepatitis?
it gets smaller
72
What are the risk factors for non-alcoholic fatty liver?
obesity dylipidemia glucose intolerance
73
SSX: non-alcoholic fatty liver
usually Asx | fatigue, malaise, RUQ discomfort
74
What is the main PE finding with non-alcoholic fatty liver?
hepatomegaly
75
Work-up: non-alcoholic fatty liver
Labs: elevated ast, alt procedure: liver biopsy
76
How do you dx non-alcoholic fatty liver?
presence of risk factors | r/o hep infx and excessive alcohol intake
77
risk factors: alcoholic liver disease
drinking lots of alcohol male genetic/metabolic traits poor nutritional status
78
what disorders can results from alcoholic liver disease?
alcoholic fatty liver alcoholic hepatitis cirrhosis
79
PE finding for alcoholic fatty liver?
non-tender enlarged liver
80
SSx: alcoholic hepatitis
``` undernourished fatigue fever jaundice RUQ pain ```
81
PE findings alcoholic hepatitis
hepatomegaly | hepatic bruits
82
SSX: cirrhosis
same as alcoholic hepatitis
83
PE findings cirrhosis
small liver | maybe nail clubbing

CPD 2 (5 decks)

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