acute GI pt 1

Question 1

esophageal cancer RF, s/s, dx, treatment

Answer 1

smoking & ETOH

dysphagia

EGD w biopsy

tx depends on stage - surgery, chemotherapy, radiation, brachytherapy/stenting

Question 2

gastric cancer RF, s/s, dx

Answer 2

M>W, pernicious anemia

most asymptomatic

EGD w biopsy, CT for mets

Question 3

gastric cancer treatment

Answer 3

depends on staging - surgery, chemo, radiation

Herceptin (humanized monoclonal antibody) for metastatic cancer w HER2/neu over expression

Keytruda - for unresectable/metastatic tumors with MSI-H or dMMR

added to chemo typically

Question 4

pancreatic cancer s/s, dx, tx

Answer 4

most asymptomatic at dx

abd US, CT, ERCP/MRCP

tx depends on staging - Whipple, Traverso-Longmire procedure

pancreas resection, need pancreatic enzyme replacement !

Question 5

pancreatic cancer biomarker

Answer 5

CA 19-9

used to monitor treatment

Question 6

hepatocellular carcinoma RF, s/s, dx

Answer 6

cirrhosis (85%), hep B/C, NAFLD, male

most asymptomatic, late s/s: jaundice, ascites, weight loss, etc.

dx - AFP, liver bx, CT/MRI

Question 7

recommended liver cancer screening

Answer 7

RUQ US q 6 months

AFP q 6 months

all patients with cirrhosis, fam hx of HCC, males, asians, blacks at risk

Question 8

HCC dx

Answer 8

CT/MRI, percutaneous liver biopsy

AFP (70% elevated)

Question 9

HCC treatment

Answer 9

depends on stage

transplantation

surgery (resection, ablation)

chemotherapy

transarterial chemoembolization (TACE)

Question 10

ulcerative colitis

Answer 10

inflammation of colonic mucosa

Question 11

Crohn’s disease

Answer 11

transmural inflammation of the GI tract

Question 12

IBD diagnosis

Answer 12

clinical suspicion & r/o other conditions

rule out Yersinia entercolitica

fecal calprotectin - differentiate IBD vs IBS

UC sigmoid/colonoscopy (unless perf risk!)

Crohn’s - colonoscopy w skip lesions/cobblestone appearance

Question 13

UC complication

Answer 13

toxic megacolon

Question 14

UC first line tx

Answer 14

mild to moderate. - mesalamine enema/suppository

severe - (>6 bloody stools/day, systemic s/s) - systemic steroids, PO mesalamine

fulminant (>10 stools daily, toxic megacolon, uncontrolled bleeding) - IV steroids, abx, consider surgery

refractory - immunosuppression/biologics

Question 15

Crohn’s treatment

Answer 15

mesalamine

IV abx

steroids (PO, IV)

immunosuppression

Question 16

IBD screening

Answer 16

colonoscopy 8 years after symptom onset

Question 17

illeus/SBO s/s, dx

Answer 17

nausea/vomiting, distention, abd pain, hypoactive BS, constipation

abd XR

SBO confirmed by CT

Question 18

RF for SBO

Answer 18

adhesions!!! previous abd surgery

Question 19

SBO treatment

Answer 19

start conservative - bowel rest, NG decompression, IVF

surgery consult

risk for peritonitis

Question 20

most common causes of pancreatitis

Answer 20

alcohol
gallstones

Question 21

pancreatitis s/s

Answer 21

abd pain
epigastric/RUQ pain, may radiate, knifelike, aggravated by PO intake

nausea/vomiting

Question 22

physical exam findings for pancreatitis

Answer 22

grey-turner’s sign - ecchmyotic discoloration of flank

Cullen’s sign - ecchymotic discoloration periumbilically

Question 23

pancreatitis labs, imaging

Answer 23

amylase elevation - 3x ULN

lipase elevation - more specific

hypocalcemia

can be diagnosed without imaging, consider CT 24-48 h later

Question 24

severity predictor for pancreatitis

Answer 24

ranson’s criteria

help determine where to admit pt

Question 25

pancreatitis mgmt

Answer 25

IVF
nutritional support if severe (low fat diet)
NG if N/V
pain mgmt

surgery if severe