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MTB Flashcards

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1
Q

Alarm symptoms that prompt endoscopy

A

Weight Loss
Blood in stool
Anemia

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2
Q

Achalasia Pathophys

A

Inability of LES to relax

loss of nerve plexus

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3
Q

Presentation of Achalasia

Age group

A

Young (<50)

Progressive dysphagia to BOTH solids and liquids conurrently

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4
Q

Is Achalasia related to alcohol and tobacco use?

A

NO

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5
Q

Best initial test for achalasia

A

Barium esophagram

- Bird’s beak

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6
Q

Most accurate test for achalasia

A

Manometry

- failure of LES to relax

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7
Q

What does CXR show for achalasia?

A

Widening of esophagus

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8
Q

What does endoscopy look like for achalasia?

A

Normal mucosa in Upper endoscopy

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9
Q

In esophageal patients, what test is acceptable to do first in MOST patients?

A

Barium studies

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10
Q

What is diagnosed by Bx in esophagus?

A

Cancer

Barrett esophagus

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11
Q

What is the tx for achalasia?

A

Simple mechanical dilation

  • Pneumatic dilation
  • Botulinum injection
  • Myotomy
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12
Q

What is Pneumatic dilation?

A

Place endoscope that can inflate a device to enlarge esophagus.
Works in 80-85% of pts

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13
Q

What risk occurs with pneumatic dilation?

A

Perforation in <3%

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14
Q

How long does botulinum work in pneumatic dilation?

A

3-6 months.

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15
Q

What is the MC AE of Myotomy?

A

Reflux dz

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16
Q

Presentation of esophageal cancer

A

Progressive dysphagia from solids to liquids
Ass’d with alcohol and tobacco use
>5 yrs GERD sx’s

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17
Q

Best initial test for esophageal cancer?

A

Barium possibly. NEED Bx for DX.

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18
Q

What is the role of CT/MRI in esophageal cancer?

A

Assess extent of spread

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19
Q

Tx for esophageal cancer?

A

Surgical resection

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20
Q

Chemo drug used in esophageal cancer?

A

5-FU

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21
Q

What cancers are treated with 5-FU?

A

Stomach
Esophagus
Colon

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22
Q

When is stent placement used in esophageal cancer?

A

Non resectable lesions

Palliative to improve dysphagia

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23
Q

Presentation of DES and nutcracker?

A

Sudden onset of chest pain NOT related to exertion

Precipitated by cold drinks

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24
Q

Pt w/ sudden, severe chest pain and normal EKG and stress test?

A

DES

Nutcracker

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25
What is the most accurate test for DES and nutracker?
Manometry | Differentiates
26
Patient presents w/atypical chest pain - what is the initial workup?
1. EKG | 2. NST if old or risk factors
27
Tx for DES/Nutcracker?
DHP CCB's - work on vascular smooth muscle to vasodilate arteries - Nifedipine - Amlodipine Nitrates
28
CMV Esophagitis presentation of cells? What CD4 count?
Owl eye inclusions | CD4 < 50
29
Tx for CMV Esophagitis
Gancicyclovir Resistant HSV: Foscarnet Cidofovir
30
Gancicyclovir AE's
Agranulocytosis
31
AE's of Cidofovir
ATN
32
Infectious esophagitis in AIDS pts?
Esophageal candidiasis
33
Esophageal candidiasis Tx?
Fluconazole - response to tx is the Dx If not effecitive -> Endosocpy IV Ampho if confirmed
34
When to stop fluconazole in AIDS pt?
Lifelong or until T cell count increases. | Opportunisitic infxn all treated until T cell count rises
35
Pill Esophagitis presentation?
Pain on swallowing w use of pills - pt drinks water and sits up MC - Hx of HIV
36
What pills cause esophagitis?
Oledronate, Risondronate Iron pills Vit C pills Potassium pills
37
AE of "azoles"
Hepatotoxic
38
What causes Schatzki ring? Presentation? Ass'd with?
From acid reflux Scarring/tightening (peptic stricture) of distal esophagus Non painful, intermittent dysphagia Ass'd with hiatal hernia
39
Plummer-Vinson syndrome? Age group Ass'n with cancer?
Ass'd with IDA Rarely transforms to SQCC Middle aged woman
40
Location of Schatzki ring?
Distal, @ Sq/columnar Jnc, proximal to LES
41
Location of Plummer-Vinson syndrome?
Proximal, @ Hypopharynx
42
Which ring/web ass'd with intermittent dysphagia?
Schatzki ring
43
Ass'd with dysphagia with solid food/"steakhouse syndrome"?
Schatzki ring
44
Tx for Schatzki ring?
Pneumatic dilation
45
Tx for Plummer-Vinson?
Iron replacement
46
What is Zenker Diverticulum?
Outpouching of posterior pharyngeal constrictor muscles
47
How does Zenker present?
Dysphagia Halitosis Food particle regurgitation Aspiration Pneumonia
48
Dx test for Zenker?
Barium study | Confirm with contrast esphagram
49
Tx for Zenker?
Surgery
50
What studies are CI in Zenker pts?
Nasogastric tube Upper Endoscopy Cause Perforation!
51
What is scleroderma?
Decreased LES pressure from inability to close LES Progressive systemic sclerosis = From atrophy and fibrosis of esophageal smooth m. Diminished esophageal peristalsis
52
Scleroderma Dx test?
Manometry
53
Tx for scleroderma?
PPI's 1. Omeprazole 2. Metoclopromide - cost efficient
54
When is manometry the answer for esophageal disorders?
ASS Achalasia Spasm Scleroderma
55
What is Boerhaave's?
Esophageal Rupture resulting in full thickness tear of wall | Sudden increase intraesophageal pressure
56
Where is boerhaave's located?
Few cm's above GE Jnc | Postero-lateral distal esophagus
57
Boerhaave's presentation? | What sign is seen on auscultation?
Retrosternal pain Hamman's sign: crunching sound on auscultation of heart due to pneumomediastinum Subcutaneous emphysema
58
Causes of Boerhaave?
Vomiting - Mallory-Weiss, repeated | Protracted vomiting
59
Mallory-Weiss Tear pathophysiology?
Non penetrating tear of mucosa ONLY | Submucosal arteries of distal esophagus and proximal stomach
60
Mallory-Weiss presentation?
Upper GI bleeding after prolonged/severe vomiting/retching | Repeat retching = hematemesis of bright red blood, black stool
61
Is there dysphagia with Mallory-Weiss?
No.
62
Tx of Mallory-Weiss?
Resolves spontaneously | Severe - epinephrine injection/electrocautery
63
What are esophageal varices? How are they different from Mallory-Weiss?
Submucosal VEINS that are dilated with portal HTN in lower third of esophagus
64
Non-Ulcer Dyspepsia Presentation?
MCC epigastric pain esp with no identified etiology
65
Epigastric pain, DM and bloating?
Gastroparesis
66
Best test for epigastric pain?
Endoscopy Unless: s Stomach - barium poor
67
Best initial tx for epigastric pain?
1. PPIs | 2. H2 Blockers - less effective, work 70%
68
AE's of PPI's?
Osteoporosis C. Diff Aspiration Pneumonia (hospitalized, elderly pts)
69
What worsens GERD?
``` Nicotine Alcohol Caffeine Peppermint Chocolate Late night meals Obesity ```
70
GERD sx's?
``` Epigastric pain radiating into chest Sore throat Bad taste (metallic) in mouth, "brackish" Hoarseness Cough Wheezing ```
71
Confirmation and most accurate test for GERD?
24-hr pH monitoring: electrode placed several cm's above GE Jnc and average pH determined Done if PPI's fail to work
72
When to do endoscopy for GERD?
Signs of obstruction - dysphagia or odynophagia Alarm sx's (Wt loss, Anemia, Blood in stool) 6mo's -> Persistent sx's
73
What is seen on endoscopy in GERD?
``` Redness Erosions Ulcerations Strictures Barrett ```
74
GERD Tx - non-medical
Wt loss Avoid irritants to decrease sphincter pressure (good for digestion, bad for reflux) Avoid eating before bed Elevate head 6-8 inches
75
GERD Tx mild/Intermittent
Liquid antacids | H2 blockers
76
GERD Tx Persistent sx's/Erosive esophagitis/Moderate
PPIs
77
GERD Tx not responsive to Meds
Tighten LES: 1. Nissen fundoplication - wrap stomatch around LES laparasocopically 2. Endocinch - suture around LES 3. Local heat/radiation of LES = scarring
78
What is a hiatal hernia?
Type I - Sliding. MC type. Jnc of stomach and GE slides into mediastinum Type II - Paraesophageal; stomach fundus through diaphragm; GE Jnc below diaphragm
79
Si/Sx's of hiatal hernia?
``` Incidental finding Asymptomatic Chest pain Heart burn GERD ```
80
Test for Hiatal hernia?
Barium swallow
81
Tx for hiatal hernia?
Sx management | Surgery for type II b/c risk of strangulation
82
What is Barrett esophagus?
>5 years of GERD causes LE columnar metaplasia
83
Dx test for Barrett and what do we see?
Bx. | Columnar metaplasia w/intestinal features - greatest risk of transforming into esophageal cancer
84
What is Tx for Barrett alone? | How often do we scope?
PPIs | Endoscopy every 2-3 yrs
85
Tx for low-grade dysplasia? | How often do we scope?
PPIs | Endoscopy every 6-12 months (some sources say every 3-6)
86
Tx for high-grade dysplasia? | How often do we scope?
Ablation with Endoscopy Distal esophagectomy or endoscopic mucosal secretion Photodynamic therapy
87
Which Barrett patients get PPIs?
All = PPIs BID
88
What is gastritis? Causes of gastritis?
``` Inflammation/Erosion of gastric lining Alcohol NSAIDs H.Pylori Portal HTN Stress: burns, trauma, sepsis, uremia ```
89
What is type A gastritis?
Atrophic gastritis Ass'd with: Achloridya - decreased gastric acid production -> increased gastrin b/c acid inhibits gastrin release from G cells B12 Deficiency (AI),
90
What does Gastrin do?
Stimulates gastric acid (HCl) release by parietal cells (stomach) and gastric motility G cells found in pyloric antrum, duodenum, pancreas
91
Presentation of gastritis?
GI bleeding w/out pain Severe, erosive can be epigastric pain Bleeding varies: mild "coffee-ground" emesis to large -volume red blood to melena (black stool)
92
5-10 mL bleeding is?
Coffee-ground emesis | Heme (guaiac) positive stool
93
50-100 mL bleeding is?
Melena
94
Dx test for gastritis?
Upper endoscopy
95
Most accurate test for H.Pylori?
Endoscopic Bx - but invasive
96
What H.pylori tests are only positive in active infxn?
1. Urea breath test | 2. H.Pylori stool Ag
97
Tx for gastritis?
PPIs
98
H.Pylori tx?
PPI + Clarithromycin + Amoxicillin | IF unresponsive, change to Metronidazole + Tetracycline
99
When do we do stress ulcer PPX?
``` Mechanical ventilation (ventilators) Burns Head trauma Coagulopathy Sepsis ```
100
PUD causes?
``` H.Pylori NSAIDs = inhibit PG's that produce mucus Burns Head trauma Crohn dz Gastric cancer Gastrinoma (Z-E syndrome) ```
101
Why peptic ulcers in burns and head trauma?
Intense vasoconstriction of vasculature that supplies gastric mucosa -> cells slough off and ulcer
102
Do Alcohol and tobacco cause ulcers?
Do NOT cause. Delay healing.
103
Complications of PUD?
MC = Hemorrhage Perforation Penetration Obstruction
104
PUD presentation?
Recurrent episodes epigastric pain - dull, sore, gnawing | Most ulcers don't bleed
105
MCC of upper GI bleed?
PUD
106
Most accurate test for PUD?
Upper Endoscopy
107
Is cancer ass'd with both gastric and duodenal ulcer?
No. Gastric only in 4%
108
Tx for PUD?
PPIs
109
What is confirmatory test for PUD?
CLO test - rapid urease test. | Done on Bx.
110
GU or DU ass'd with H.Pylori more often?
DU
111
Tx for PUD?
PPI + Clarithromycin + Amoxicillin for 10-14 days IF unresponsive, change to Metronidazole + Tetracycline Repeat endoscopy after GU to R/O cancer
112
No response to tx in DU with PPI/Clar/Amox, what is the most appropriate next step in management?
Urea breath test, stool Ag, Repeat endoscopy for BX Think Antibiotic resistance! Then change to Metronidazole + Tetracycline
113
Tx for refractory ulcers?
Detection of H.Pylori, Then change to Metronidazole + Tetracycline GU - Repeat endoscopy to r/o cancer
114
Common causes of Tx failure in PUD?
Nonadherence Alcohol Tobacco NSAIDs
115
Complications post partial gastrectomy?
Antrum removed -> Dumping = post-prandial GI discomfort, i.e. N/V/D, cramps Alkaline Reflux Gastritis - burning epigastric pain Vitamin Deficiency - B12, Iron, Calcium
116
Why do H2 blockers and PPIs increase risk of osteoporosis?
Calcium needs acid to be absorbed
117
What is MALT?
Low grade lymphoma Tx w/ H.pylori Abx - PPI/C/A If no mets, next step chemo with CHOP
118
What is CHOP chemo?
Cyclophosphamide Hydroxydanarubicin = Adriamycin Oncovin = Vincristine Prednisone
119
Non-ulcer Dyspepsia tx?
55 yoa - Endoscopy
120
Which patients with dyspepsia get endoscopY?
Pt over 45-55 yoa | Alarm sx's
121
Best initial tx for NUD?
PPIs
122
What is a gastrinoma?
``` Aka Zollinger-Ellison syndrome Ulcers that are: - Large ( >1-2 cm) - Recurrent after H.Pylori eradicated - Distal duodenum (1/2), Pancreas (1/4) - Multiple Diarrhea - acid inactivates lipase ```
123
What does Lipase do?
Catalyzes hydrolysis of fats/lipids = digest, transport, process lipids
124
Most accurate test for gastrinoma?
Functional test assessing response to secretion: 1. High gastrin levels off anti-secretory tx (PPIs or H2 blockers) w/gastric acidity 2. High gastrin levels despite high gastric acid output 3. Persistent high gastrin after secretin injection
125
Best initial test gastrinoma?
Endoscopy to confirm
126
What does secretin do?
Stimulates release of gastrin by gastrinoma cells
127
If Dx gastrinoma, next test?
Somatostatin receptor scintigraphy with endoscopic US to r/o metastatic dz
128
What is seen on Endoscopic US in gastrinoma?
Prominent gastric folds | ulcer below duodenal bubl
129
Assn b/t gastrinoma and somatostatin?
Massive increase in somatostatin receptors in abdomen
130
What is the tx for gastrinoma?
Local dz - surgical resection | Mets cannot be resected - lifelong PPIs - high dose BID to block acid production
131
What is dumping syndrome?
Surgery for Ulcer dz - cut vagus Nerve Rapid release of gastric contents from stomach to duodenum = rapid release of glucose into duodenum increases insulin -> Reactive Hypoglycemia Hypertonicity of gastric contents get dumped into duodenum, sucking volume/fluid into intestine. Causes large osmotic shift out of vasculature into duodenum Intravascular Volume depletion
132
Tx for Dumping syndrome?
Eat small portions
133
What is diabetic gastroparesis?
Autonomic neuropathy -> dysmotility from inability to sense stretch
134
Diabetic pt w/abdominal discomfort, bloating, constipation?
Diabetic Gastroparesis
135
Next best step in management pt presents w/gastric paresis?
If Dx clear -> Tx with Erythromycin, Metoclopromide
136
Most accurate test gastric paresis?
Nuclear gastric emptying study | - Rarely needed
137
What is the MCC of lower GI bleeding?
Diverticulosis
138
Upper GI bleeding causes?
``` Ulcer Dz Gastritis Esophagitis Duodenitis Cancer Varices ```
139
Lower GI bleeding causes?
``` Diverticulosis Angiodysplasia Polyps Cancer Hemorrhoids IBD Upper GI bleeding w/rapid transit (hi volume) ```
140
Most important initial management for GI Bleed?
``` Assess BP Orthostasis > 10 point rise in pulse from lying to standing OR BP drop of > 20 pts when sitting up ```
141
Si/Sx with Variceal bleeding?
``` Vomiting blood +/- black stool Spider Angiomata Caput Meduse Splenomegaly Palmer Erythema Asterixis ```
142
GI bleeding - what to check?
Fluids - replace PRN Hct Platelet count Coag profile - Pt/INR
143
Why is Nasogastric tube (NG) used in variceal bleeding?
Decompresses stomach by clearing out blood to help visualization in endoscopy
144
Black stool, no hematemesis, NG tube shows red blood?
Octreotide | Arrange urgent endoscopy for banding
145
Massive, nonresponsive bleeding?
Angiography to localize vessel bleed
146
EKG in GI bleeding?
Shows ischemia in severe bleeding
147
Tx for GI bleed
1. Fluid replacement (1-2 L/hr) saline or Ringer lactate (acute, severe) 2. PRBCs if Hct <50,000 AND bleeding 5. Octreotide for variceal bleed 6. Endoscopy for Dx/Tx 7. IV PPI for Upper GI bleeding 8. Surgery
148
When do we transfuse platelets?
Platelets if <10-20,000
149
Tx for esophageal and gastric varices?
1. Octreotide decrease portal pressure 2. Banding - by endoscopy 3. TIPS - decrease portal pressure if 1 and 2 fails 4. Propranolol - prevention
150
If suspect C.diff diarrhea: best initial test and tx?
Stool C.diff toxin test Metronidazole If no response - switch to oral vancomycin
151
Recurrent C.diff tx?
1st episode: Metronidazole oral 10 days IV only w/pts that can't tolerate, i.e. adynamic ileus 2nd epi: Vanco oral (taper hi to low) +/- probiotics 3rd epi: Fidoxamycin (Macrolide) 4th epi: Fecal transplant
152
When do we use IV Vancomycin in antibiotic resistant diarrhea?
Never. It will not pass bowel wall.
153
How is severe C.diff treated?
Severe C.diff = - WBC >15,000 - Creatinine > 1.5 (Dehydration) Tx: Oral Vancomycin
154
Malabsorption ass'd with which vitamin deficiencies ? How do they present?
``` ADEK, B12, B6 D: Hypocalcemia, osteoporosis E: Hemolytic Anemia K: Bleeding, easy bruising, elevated PT B12: Anemia, hypersegmented neutrophils, neuropathy B6: Sideroblastic Anemia ```
155
What is celiac dz and how does it present?
Gluten insensitivity - malabsorption Anti-tissue transglutaminase IgA antigliadin Ab Antiendomysial Ab
156
What is the best initial test for celiac dz?
Anti-tissue transglutaminase - pts w selective IgA deficiency will inhibit the Ab tests
157
How can one differentiate chronic pancreatitis and gluten insensitivity?
Celiac = Iron deficiency | Iron needs in tact bowel wall to absorb iron, not pancreatic enzymes
158
What skin disorder ass'd with Celiac?
Dermatitis herpetiformis - pruritic papules and vesicles on elbows, knees, buttocks, neck, scalp - Granular IgA seen on dermal papillae - Tx: Dapsone
159
Most accurate test for Celiac?
Small Bowel Bx shows flattening of villi
160
What does Whipple Dz present with?
``` Arthralgias Ocular findings - opthalmoplegia Neuro sx's - dementia, seizures Fever LA ```
161
Most accurate test for Whipple dz?
Small Bowel Bx shows organism | - also for tropic sprue
162
Most accurate test for chronic pancreatitis?
Secretin stimulation test Place NG tube - unaffected pancreas releases large volume HCO3-rich fluids after IV secretin injection Pancreatitis - pancreas will not release into duodenum
163
What drugs cause acute pancreatitis?
``` Valproic acid Diuretics: loops, HCTZ IBD: Sulfalazine, 5-ASA Azothioprine Didanosine, Pentamidine Metronidazole, Tetracycline ```
164
What is the tx for Celiac Dz?
Gluten free diet | Avoid wheat, oats, rye, barley
165
What is the tx for Whipple dz?
Ceftriaxone, TMP/SMX | Doxycycline
166
Tx for Chronic Pancreatitis?
Enzyme replacement | amylase and lipase - 1 pill
167
What is the Tx for tropic Sprue?
TMP/SMX | Doxycyline
168
What are the sx's of carcinoid syndrome?
``` BFDR Bronchoconstriction/wheezing Flushing Diarrhea Right sided heart dz - Tricuspid insufficiency, Pulmonary stenosis Follow eating, exertion, excitement ```
169
Why do we see flushing in Carcinoid syndrome?
Increased serotonin -> Decreased tryptophan -> Decreased Niacin ->
170
What is the best initial test for carcinoid syndrome?
Urinary 5-HIAA test
171
What is the tx for carcinoid syndrome?
Octreotide
172
What causes carcinoid syndrome? Where are they most often found?
Liver mets of carcinoid tumors (hormone producing enterochromaffin cells) Appendix Ileum
173
What is tx if carcinoid syndrome is localized tumor?
Resection
174
How does lactose Intolerance present?
No weight loss Increased stool osmolality Oral lactase replacement
175
What are the sx's of IBS?
Pain syndrome Diarrhea, constipation, or both No weight loss Pain relieved w/BM, less at night, relieved by change in bowel habits
176
What is the Tx for IBS?
1. Increase fiber 2. Antispasmodic agents - Hyosyamine, Dicyclomine 3. TCAs - anticholingeric = antispasmodic/relaxing bowels 4. Antimotility agents - Loperamide for diarrhea 5. Lubiprostone -increases BM frequency
177
How does IBD present?
``` Diarrhea Bloody stool Weight loss fever Arthralgias Uveitis, Iritis Skin involvement ```
178
What skin lesions seen in IBD?
Erythema nodosum Pyoderma gangrenosum - Painful skin lesions; MC lower leg, neutrophilic dermatitis
179
What are sx's seen in Crohn DZ?
``` Rectal sparing Skip lesions Transmural granulomas (non-caseating) = palpable abd mass Fistulas Abscesses Masses Obstruction Perianal dz ```
180
What is the MC location of perianal dz in Crohn?
Terminal Ileum | Cobblestone colon
181
What oral lesion is seen with Crohn Dz?
Apthous Ulcer - painful, shallow ulcers on buccal mucosa
182
What are sx's seen in Ulcerative Colitis?
``` Rectal involvement Entirely mucosal and submucosal No fistulas, abscesses, obstruction Crypt Abscesses Limited to colon Bloody diarrhea MC than in Crohn's Pseudopolyps ```
183
What is primary sclerosing cholangitis ass'd with?
UC
184
When does screening occur with IBD?
After 8-10 years of colonic involvement -> colonoscopy every 1-2 years
185
What is the most accurate test for IBD?
Endoscopy
186
Where do we see positive P-ANCA?
``` UC Primary Sclerosing Cholangitis Pauci Immune GN Microscopic Polyangitis Churg-Strauss ```
187
Where do we see + ASCA (Antisaccharomyces cerevesiae Ab)?
Crohn's
188
What is the Tx for Crohn's?
Acute exacerbation: Steroids - Budesonide Chronic: 5-ASA agents: Mesalamine Pentasa - released in both Upper and lower bowel
189
What is the Tx for UC?
Acute exacerbation: Steroids - Budesonide Chronic: 5-ASA agents: Mesalamine Asacol Rowasa
190
What is the Tx for perianal Crohn's?
Cirpo and Metronidazole
191
What is tx for fistulae in Crohn's?
Infliximab
192
When is azathioprine and 6-mercaptopurine used in IBD?
To wean pts off steroids
193
What side of colon is bleeding more common?
Right - bc of thinner mucosa and more fragile blood vessels
194
What is diverticulosis?
Outpocketings of colon
195
Presentation of diverticulosis?
``` Meat filled diet >65-70 yoa Asymptomatic most of the time LLQ Abdominal pain Constipation Bleeding ```
196
Most accurate test for diverticulosis?
Colonosocpy
197
Tx for diverticulosis?
Increase dietary fiber = increases radius of colon and decreased intracolonic pressure Bran, psyllium, methylcellulose
198
What is presentation of diverticulitis?
LLQ pain and tenderness Fever Leukocytosis
199
Best initial test for diverticulitis?
CT scan
200
What tests are CI in diverticulitis and why?
Colonosocpy Barium enema Risk of perforation
201
Tx for diverticulitis?
``` Abx to cover E.coli and Anaerobes Cipro and Metronidazole Amoxicillin/clavulanate Ticarcillin/clauvulanate Piperacillin/Tazobactam ```
202
When is surgery done for diverticulitis?
No response to meds Frequent recurrences Perforation, fistula, abscess, strictures, obstruction
203
What does free air under diaphragm on upright xray indicate?
perforation of colon
204
What are some constipating drugs?
Opiates Anti-cholinergics (TCAs) CCBs Iron pills
205
When is capsule endoscopy done?
Detect sources of bleeding in small bowel not reachable by endoscopy
206
Who gets colon cancer screening?
All patients at age 50, every 10 years = colonoscopy
207
Colon cancer screening with 1 family member?
10 years earlier than age family member developed cancer OR age 40 whichever is younger
208
HNPCC (Lynch syndrome) is what and when to screen?
3 family members 2 generations 1 premature (before 50 yoa) Screening at 25 with colonoscopy, every 1-2 years
209
Which cancer is ass'd with Lynch syndrome?
Endometrial cancer
210
Are hyperplastic polyps precancerous?
No
211
What is Familial adenomatous polyposis (FAP) and when to screen for colon cancer?
Thousands of polyps w/ abnormal genetic test of APC | Start screening with sigmoidscopy at age 12 EVERY year
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Do we screen pts with a previous single adenomatous polyp?
Yes. Pts should have colonoscopy every 3-5 years
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Screening for pts with previous hx of colon cancer?
Colonoscopy at 1 year after resection, 3 years | Then every 5 years
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What is presentation of Peutz-Jeghers Syndrome?
Multiple hamartomatous polyps | Melanotic spots on lips and skin
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Which cancers are seen in Peutz-Jeghers Syndrome
Increased frequency of: breast cancer gonadal cancer pancreatic cancer
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What is Gardner syndrome?
Colon cancer + osteomas desmoid tumors Other soft tissue tumors - mandible
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What is an osteoma?
new bone growth under existing bone | typically in skull
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What is next step in a patient with osteoma found in xray as incidental finding?
Colonoscopy
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What is screening with Peutz-jeghers, Gardner, Turcot, juvenile polyposis of colon cancer?
Same as healthy individual
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What are the most common causes of acute pancreatitis?
``` Alcohol Cholelithiasis Trauma Hypertriglyceridemia Hypercalcemia Infxn Drugs - allergy, toxicity ```
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What is the pathophysiology of pancreatitis?
premature activation of trypsinogen into trypsin while in pancreas -> cleaves peptide binds (Lysine, Arginine) -> Pancreatic self digestion
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Pt presents w/acute epigastric pain radiating straight to back + tenderness + N/V?
Pancreatitis
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Best initial test in acute pancreatitis?
Amylase and Lipase
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Most accurate test in acute pancreatitis?
CT scan
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Epigastric pain that goes to back around the side?
Cholecystitis
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What is the best imaging for acute pancreatitis?
Abdominal CT with IV and oral contrast for better definition
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What does plain xray show with acute pancreatitis?
Sentinel loop of bowel | air filled piece of small bowel in LUQ
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Tx for Acute pancreatitis?
1. NPO 2. IVF 3. Analgesia 4. PPIs
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Why are PPIs used in acute pancreatitis?
To decrease pancreatic stimulation from acid entering duodenum
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When do we add abx in acute pancreatitis?
> 30% necrosis on CT | Imipenem added to decrease mortality
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What is management for pseudocyst?
CT guided percutaneous drainage
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When does a pseudocyst develop?
2-4 weeks post pancreatitis
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Why do we resect necrotic pancreatitis?
To prevent ARDS and death
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When is ERCP used?
Remove obstructing stones Dilate strictures Place stents
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When is imaging not needed in a pancreatitis?
When 2+ of following are present - Acute epigastric pain radiating to back - Elevated amylase/lipase 3X Normal - ?
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Ranson's Criteria on admission
``` GALAW Glucose >200 Age > 55 LDH > 350 AST >250 WBC > 16,000 ```
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Ransom's criteria after 48 hours
``` C HOBBS Calcium < 8 Hct down by 10% paO2 4meq/L BUN up by >5 mg/dL Sequestered fluid >6L ```
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What clotting factors are made in endothelial cells?
Factor VIII | VWF
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What tx for decreasing high TG levels fast?
IV Insulin drip b/c insulin inhibits HSL which hydrolyzes TG's to FFAs Then d/c pt home w/metformin, fibrates, omega-3
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When to do paracentesis in ascites patients?
New-onset ascites Abd pain and tenderness Fever

Gastroenterology (2 decks)

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