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30jan 24 Flashcards

1
Q

Colon cancer screen for average risk

A

Start age 45:

     Colonoscopy every 10y 
     FOBT or   FIT   Every year 
     FIT DNA.  Every 1-3years 
     CT colonography every 5y

Flexible Sigmoidoscopy every 5years (every 3 years with annual FIT)

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2
Q

Pts with FDR with CRC or high risk adenomatous polyp

A

Colonoscopy at age 40 (10 years prior to age of dx of FDR)

Repeat every 5 years (every 10y if FDR was dx after age 60)

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3
Q

Screening for colon cancer in pts with UC

A

Start screening at age 8-10y after dx
Colonoscopy every 1-3y

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4
Q

What are high risk folks for CRC

A

Pts with First degree relatives

High risk adenomatous polyp
>10mm
High grade dysplasia
Villous elements.

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5
Q

9yr old with classic FAP with non dysplastic polyps. Management

A

Elective proctocolectomy in late teen or early twenties
(Can develop CRC at age <40 if left untreated)

Young pts are monitored with freq colonoscopies until puberty. (1year after surgery and every 3-5years after)

Urgent proctocolectomy at any age if high grade dysplasia
Hemorrhage
Inc in polyp number on colonoscopies.

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6
Q

CRC screen after resection

A

Stage 1 : Colonoscopy in 1 yr and every 3-5yrs.

Stage 2/3 : Colonoscopy in 1yr and then every 3-5y

                   Periodic CEA 
                   Annual CT chest , abdpelvis

Stage 4; Individualize
Consider stage 2-3 strategy

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7
Q

Stages of CRC

A

Stage 1 : Superficial layers
Stage 2: Invade muscular and serosal layers.
Stage 3: Lymph node involvement
Sig risk of distant mets.

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8
Q

Pt with adenoma of rectum.

A

Do colonoscopy of entire colon
(Pts with left sided adenoma or adenocarcinoma have synchronous neoplasia of right colon as well)

Do CT chest abd pelvis for mets

CEA for prognostication.

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9
Q

DX pf pancreatic CA

A

USG for pts of jaundice(head tumor)

CT scan for pts without jaundice. Body and tail tumors.

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10
Q

Jaundice in Pancreatic CA

A

Due to CBD obstruction by pancreatic head CA.

Steatorrhea is due to obstruction of main pancreatic duct

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11
Q

GOO with weight loss smoking history succussion splash cause

A

Pancreatic Ca.

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12
Q

GOO Cf

A

Abd distention
Intractable postprandial vomiting
Succussion splash

DX : upper GI endoscopy

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13
Q

GOO due to pancreatic Ca

A

Older patient
Early satiety
Smoker
Weight loss
Epigastric tenderness
Poor prognosis

Ttt:
Tumor is mostly too advanced for surgery
Palliative measures like
Stent placement for food intake.

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14
Q

HCC risk factors and CF

A

Cirrhosis
Chronic hep B
Env toxins (aflatoxin )

CF:

    Often AS 
    Abd pain,weight loss,paraneoplastic
    Bloody ascites
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15
Q

Evaluation of persistently bloody ascites in pt

A

Abd imaging (contrast enhaced CT)

Alpha feto protein (Inc in HCC)

Cytologic analysis.

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16
Q

Pancreatic cysts with high risk features

A

Large size >- 3cm
Solid components or calcifications
Main pancreatic duct involvement (ductal dilation)
Thick or irregular cyst walls

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17
Q

Management of high risk pancreatic cyst

A

Endoscopic USG guided biopsy for tissue sampling.

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18
Q

Cause of hyperbilirubinemia with predominantly high ALP

A

Cancer pancreas and ampullary
Cholangiocarcinoma
PBC
PSC
Choledocholithiasis
Cholestasis of pregnancy

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19
Q

CF of malignant biliary obstruction

A

Jaundice , pruritis , acholic stools , dark urine
Weight loss
RUQ pain
RUQ mass. Or hepatomegaly
Inc Direct bili
Inc ALP , GGT

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20
Q

Pt with bilious emesis if unstable

A

Do laparotomy asap

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21
Q

Pt with bilious emesis if stable

A

Do Xray.

If Xray is normal : Do upper GI series

If Rt sided ligament if treitz ➡️ malrotation

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22
Q

Pts who are stable with bilious emesis and non diagnostic Xray whats next?

A

Upper GI series

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23
Q

Malrotation with mid gut volvulus CF

A

Bilious emesis
Abd distention
Poor feeding
Dehydration
Hypovolemic shock

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24
Q

Management of Malrotation

A

Pts with normal vitals ;

    Cessation of enteral feeds 
    NG tube decompression 
    Give IV fluids

Imaging:

   Dilated bowel loops 
   Air fluid levels 
   Pneumoperitoneum(intestinal perforation) 
   Xray mayb normal 
   Do GI series   (Abnormally located Rt sided ligament of treitz , duodenal corkscrew , birds beak appearance -volvulus)

GI series is the gold standard dx

Ttt: Emergency laparotomy
Ladds procedure (to reposition malrotated bowel)

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25
Tumor of head of pancreas CF
Painless jaundice Weight loss Non tender distended GB (courvoisier sign) Imaging: double duct sign (Dilation of CBD and pancraetic duct)
26
CF of esophageal CA
Progressive solid food dysphagia GI bleed , iron def Weight loss , aspiration
27
RF for esophageal CA
Adenocarcinoma : Uncontrolled GERD , obesity , male Squamous cell CA : Smoking ,alcohol , N-nitroso containing food (squamous cell)
28
Esophageal CA types
Adenocarcinoma : Distal esophagus , arises from barret esophagus Sq cell carcinoma: Proximal and mid esophagus
29
DX of esophageal CA
For young and low risk with mild esophageal SS start with barium esophagogram Age >50 and alarm symptoms: Endoscopy with biopsy CT (PET/CT) used for staging (not initial dx)
30
Focal nodular hyperplasia CF
Ass with anomalous arteries Arterial flow and central scar on imaging
31
Hepatic adenoma CF
Women on OCP Possible hemorrhage or malignant transformation
32
Pt with pale stools , hepatomegaly and direct hyperbili
Do liver biopsy for biliary atresia.
33
Biliary atresia CF
Jaundice Acholic stools (absent biliary pigment) Dark urine Age 2-8weeks Hepatomegaly Conj hyperbilirubinemia Usg : absent or abnormal GB
34
DX of biliary atresia
USG. : Abnormal/absent GB Liver biopsy : (Delay in biopsy and dx more than 8weeks is ass with high risk of liver transplant and mortality) Intrahepatic bile duct proliferation Portal tract inflammation Edema Fibrosis (extrahepatic bile duct)
35
Gold standard dx for biliary atresia
Intraoperative cholangiography
36
Ttt of biliary atresia
Surgical hepatoportoenterostomy (Kasai procedure) Liver transplant
37
Management of umbilical hernias
Small : Close spontaneously Large : >1.5cm hernias surgery around age 5 (in persistent cases or if complicated)
38
TEF with esophageal atresia patho
Defective div of trachea into esophagus and trachea Causes prox esophageal pouch and fistula btw distal trachea and esophagus. In utero affected fetus cant swallow amniotic fluid causing polyhydramnios But anomaly is freq undetected until shortly after delivery.
39
TEF clinical features
Coughing choking vomiting with feeds Excessive oral secretions Commonly part of VACTERL association
40
DX of TEF
NG tube placement. Xray : Enteric tube coiled in prox esophagus Esophagography : Pooling of water soluble contrast medium in esophageal pouch.
41
Ttt of TEF
Surgery Screen for VACTERl : echo , renal USG
42
Why do GIT malignancies metastasize to liver
Colorectal and pancreatic Ca metastasize to liver as their venous drainage is thru portal system directly to liver. Also liver has dual blood supply (systemic and portal ) and hepatic sinusoidal fenestrations allow for easy metastatic deposition.
43
Hepatic adenoma dx
Benign epithelial tumor Young middle age women USG : Well demarcated hyperechoic lesions Contrast Enhanced CT : early peripheral enhancement. Needle biopsy : (not done) risk of bleeding
44
Hepatic adenoma vs Focal nodular hyperplasia
FNH : Hyperperfusion from anomalous arteries. Inc arterial flow on imaging Central scar Not related to OCP
45
Ttt of gastrinoma
High dose PPI Surgery : Exploratory laparotomy and resection
46
Gastric Adenocarcinoma dx on endoscopy. Next step in management?
CT abd pelvis for staging and mets. Tumor stage at time of dx determines prognosis and ttt. CT is initial staging modality.
47
Endoscopy of gastrinoma
Mutiple stomach ulcers and thick gastric folds.
48
DX of ZES
Markedly elevated gastrin >1000 in the presence of normal gastric acid pH<4
49
What is calcium infusion study. ?
Reserved for pts with strong suspicion of gastrinoma despite negative secretin test. It causes inc serum gastrin in patients with gastrinoma.
50
Nissen fundoplication post op complication
Dysphagia Gas bloat syndrome Gaatroparesis.
51
Dysphagia after nissen fundoplication
Cause : Disruption of peristalsis due to tight LES Develops in 12w of surgery Dx : Manometry Ttt : Self resolves Or esophageal dilation on EGD
52
Post op Gas bloat syndrome cause and ttt
Cause : Gastric air trapping due to tight LES SS : Bloating and inability to belch Dx : Clinically and resolve with consevative ttt (Simethicone)
53
Gastroparesis after nissen fundoplication cause and ttt
Cause : Inadvertent vagal nerve injury SS. : Bloating , satiety , post prandial emesis , food aversion , wt loss Ttt: small , low fat , low fibre meals Promotility agents.
54
What is nissen fundoplication?
A procedure where gastric fundus is folded and sewn around LES to decrease GERD.
55
DX of post gastroparesis
Negative esophagoduodenoscopy (done to rule out obstruction) Negative small bowel imaging. Scintigraphic gastric emptying scan (Measures percentage of standard meal left in stomach after a set no of hours) Is gold standard.
56
RF for stress ulcers
Shock Sepsis Coagulopathy Mechanical ventilation Traumatic spinal cord / brain injury Burns High dose steroids
57
Primary prophylaxis for esophageal varices
Non selective Beta blockers. Decrease portal pressure by promoting splanchnic vasoconstriction (by inhibiting b2 mediated vasodilation) And lower cardiac output 🚑 nadolol and propranolol are used in decompensated cirrhosis 🚑 carvedilol can be used in compensated cirrhosis ( no ascites , enceph, jaundice)
58
Contraindications to BB in varices pt
Bardycardia Hypotension AKI Serum sodium <130 Alternate : Variceal ligation is used as PP
59
Mech of octreotide in varices
Help active bleeding by inhibiting vasodilator release (promoting splanchnic vasoconstriction) But effect is transient Hence ineffective for long term prevention.
60
Diffuse esophageal spasm CF
Episodic dysphagia Intermittent Spontaneous retrosternal pain Ppt by emotional stress /hot /cold water Relieved by nitrates and CCB (Nitrates relax esophageal smooth muscles.) Normal cardiac exam Normal endoscopy
61
DX of DES
Esophageal manometry Repetitive , non peristaltic ,high amplitude contractions , either spontaneously or after ergonovine stimulation. (Happens in middle and lower esophagus . LES has normal relaxation) Esophagogram: Corkscrew pattern
62
DES pathophys
Uncoordinated simultaneous contractions of esophageal body (Impaired inhibitory innervation of esophagus )
63
Ttt of DES
CCB Nitrates TCA

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