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CPD Upper GI Wk 5 Quiz > CPD II Upper GI wk 5 quiz > Flashcards

CPD II Upper GI wk 5 quiz Flashcards

1
Q

What is main type of esophageal cancer?

  • who is it most prevalent in?
  • where is most prevalent?
A

Esophageal SCC (proximal 2/3)

  • AA
  • Asia and South Africa
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2
Q

Risk factors for SCC

A

alcohol, tobacco, achalasia, HPV, esophageal webs

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3
Q

What is second most common type of esophageal cancer?

- who is it most prevalent in?

A

Adenocarcinoma (distal 1/3)

- whites

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4
Q

Risk factors for adenocarcinoma?

A

smoking (not alcohol)

- most in Barretts esophagus

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5
Q

SSX of esophageal cancer?

A

early CA asx

  • progressive dysphagia
  • weight loss
  • hoarseness
  • Horner’s
  • Nerve compression
  • dyspnea
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6
Q

Workup for esophageal cancer?

A

endoscopy with biopsy

then CT and endoscopic US

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7
Q

Esophageal varices

A

dilated veins in distal esophagus or proximal stomach caused by elevated pressure in portal venous system from cirrhosis

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8
Q

SSX of esophageal varices

A

sudden, painless, upper GI bleeding

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9
Q

Workup for esophageal varices?

A

evaluation of coagulopathy
CBC
PT, PTT, LFT
Endoscopy

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10
Q

What does H. Pylori cause?

A

gastritis, PUD, gastric adenocarcinoma, low grade gastric lymphoma

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11
Q

SSX H pylori

A

gastritis, PUD

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12
Q

Etiology of gastritis

A

infection, drugs, stress, AI (atrophic gastritis)

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13
Q

SSX gastritis

A

dyspepsia

GI bleeding

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14
Q

workup gastritis

A

endoscopy

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15
Q

Causes of erosive gastritis

A

NSAIDS, alcohol, stress, radiation, viral infxn, direct trauma

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16
Q

SSX erosive gastritis

A

vomiting, dyspepsia, nausea

- fist sign can be hematemesis (vomiting blood), melena (black feces).

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17
Q

SSX of non erosive gastritis

A

asx, or mild dyspepsia

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18
Q

Autoimmune Metaplastic Atrophic Gastritis (AMAG)

A

inherited autoimmune disease that attacks parietal cells, resulting in decreased production of intrinsic factor

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19
Q

consequences of AMAG?

A

Atrophic gastritis, B-12 malabsorption, pernicious anemia, risk of adenocarinoma

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20
Q

AMAG workup?

A

endoscopic biopsy

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21
Q

PUD

A

erosion in segments of GI mucosa that penetrates musclaris mucosae.

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22
Q

Etiology/risk factors of PUD?

A 
H. Pylori
NSAIDS
smoking
family hx
zollinger-ellison syndrome
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23
Q

SSX PUD

A

can have none

burning/ gnawing pain relieved by food/antacids

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24
Q

difference between pain in gastric vs duodenal

A

gastric: eating sometimes makes it worse a
duodenal: consistent pain, relieved by food, pain awakens at night

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25
Q

What do you need to rule out with ulcers?

A

stomach cancer

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26
Q

complications of PUD?

A
  • hemorrhage
  • penetration (confined perforation)
  • free perforation (sudden intense, epigastric pn that spreads rapidly in RLQ and referred to one or both shoulders).
  • gastric outlet obstruction
  • recurrence
  • gastric cancer
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27
Q

Dx free perforation?

A

CT or X-ray shows free air under diaphragm or in peritoneal cavity

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28
Q

Gastric Cancer risk factors

A

H. pylori
AI atrophic gastritis
Dietary factors

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29
Q

SSX gastric cancer

A
  • nonspecific at first
  • later there is early satiety
  • weight loss
  • weakness
  • dysphagia
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30
Q

PE for later stage gastric cancer

A
  • epigastric mass
  • umbilical, supraclavicular, L axillary lymph nodes
  • hepatomegaly
31
Q

Bezoars

A

tightly packed collection of partially digested or undigested material that is unable to exit the stomach. In pt with abnormal gastric emptying.

- diabetic gastroparesis
- after gastric surgery
32
Q

Etiology of Acute pancreatitis

A

biliary tract disease

chronic heavy alcohol intake

33
Q

pathophysiology of pancreatitis

A

pancreatic enzymes activated within pancreas -> damage tissue and activate complement and inflammatory cascade, producing cytokines -> causing inflammation, edema, necrosis

34
Q

SSX pancreatitis

A
  • steady, boring, upper abdominal pain often radiating to the back and lasting for hours to days.
  • nausea
  • vomitting
  • low grade fever
35
Q

What relieves pain of pancreatitis?

A
  • pain can be moderately relieved by sitting forward or lying down on one side with knees flexed
36
Q

What would you see on PE for pancreatitis?

A

Mild to moderate pain on palpation of abdomen

  • hypoactive or absent bowel sounds
  • palpable mass 2 or more weeks after onset
  • chest may reveal pleural effusion
37
Q

Imaging for pancreatitis?

A
  • plan X-rays show calcification of pancreatic duct
  • chest X-rays show atelectasis or pleural effusion
  • US done if gallstone pancreatitis suspected
38
Q

Chronic pancreatitis

A

persistent inflammation of pancreas that results in permanent structural damage with fibrosis and ductal strictures followed by decline of exocrine and endocrine function

39
Q

Etiology of chronic pancreatitis?

A

alcoholism

idiopathic

40
Q

Pathophysiology of chronic pancreatitis

A

ductal obstruction by protein plugs

diabetes

41
Q

SSX chronic pancreatitis

A
  • post-prandial pain
  • abdominal pain (episodic)
  • sits up and leans forward to decrease pain
  • steatorrhea
42
Q

Most common type of Pancreatic Cancer

A

adenocarcinoma in head of pancreas

43
Q

What symptom makes pancreatic cancer easy to diagnose and when do you see this in early stage vs late?

A

Jaundice

- if it’s in the head of pancreas, see early signs

44
Q

SSX pancreatic cancer

A
  • severe upper abdominal pain
  • weight loss
  • jaundice and pruritis if in head
  • splenomegaly, GI varices, GI hem if in tail
  • diabetes in 25-50% polyuria and polydipsia
45
Q

Workup for pancreatic cancer

A

routine labs
amylase and lipase
CT

46
Q

What does elevation of alk phis and bilirubin indicate in pancreatic cancer?

A

bile duct obstruction or liver mets

47
Q

Pancreatic endocrine tumors

A

Produce many hormones that affect other organs

48
Q

Insulinoma

A

pancreatic beta cell tumor that secretes insulin

49
Q

SSX of insulinoma

A

hypoglycemia occurring during fasting

50
Q

zollinger-ellison syndrome

A

gastrin producing tumor in pancreas that can cause PUD

51
Q

SSX of zollinger-ellison syndrome

A

aggressive PUD

diarrhea

52
Q

What does elevated serum gastrin indicate?

A

Zollinger-ellison syndrome

53
Q

Vipoma

A

secretes VIP (vasoactive intestinal peptide) that causes vasodilation and intestines can’t produce enough water to decrease motility

54
Q

SSX of vipoma

A 
prolonged massive watery diarrhea 
crampy abdominal pain
vomiting
dehydration
lathargy
55
Q

Glucagonoma

A

pancreatic alpha cell tumor that secretes glucagon causing hyperglycemia and skin rash

56
Q

SSX of glucagonoma

A

similar to db
weight loss
erythema
brownish red erythmatous lesion with superficial necrosis
mouth is smooth, shiny, vermillion tongue and cheilitis

57
Q

Important hx question for issues of liver and gallbladder?

A

bowel movements
exposure to liver toxins
alcohol, drugs
RUQ pain

58
Q

SSX of acute viral Hepatitis

A

first: anorexia, malaise, nausea, vomiting, fever, RUQ pain

next phase: dark urine, jaundice, enlarged liver

59
Q

What pop has increased risk for hep B?

A

dialysis pt
healthcare workers
IV drug users
sex workers

60
Q

Sequelae of hep B

A

chronic hep, cirrhosis, hepatocellular carcinoma

61
Q

Which hep viruses can lead to cirrhosis and chronic hep?

A

Hep B and C (most common)

62
Q

Workup for hep?

A

AST and ALT elevated (ALT>AST)

IgM antibody

63
Q

Fulminant hepatitis

A

rare, massive necrosis, decrease in liver size

64
Q

SSX chronic hep

A

malaise, anorexia, fatigue
low grade fever sometimes
no jaundice

65
Q

PE for chronic hep

A

splenomegaly
palmar erythema
spider nevi

66
Q

Non-alcoholic fatty liver (hepatic steatosis) etiology

A

most common liver response to injury

67
Q

What are different types of hepatic steatosis

A

NAFLD - benign

NASH - not distinguishable from alcoholic hepatitis

68
Q

Risk factors for NASH?

A

obesity
dyslipidemia
glucose intolerance

69
Q

SSX NASH

A

fatigue
malaise
RUQ discomfort

70
Q

PE NASH

A

hepatomegaly

71
Q

risk factors alcoholic liver disease

A

quantity and duration of consumption
genetic metabolism traits
poor nutrition status

72
Q

Sequelae of alcoholic liver disease

A

fatty liver
alcoholic hepatitis
cirrhosis

73
Q

What tests for h. pylori?

A

urea breath test

stool antigen assay

CPD Upper GI Wk 5 Quiz (2 decks)

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