CPD II Upper GI wk 5 quiz Flashcards
What is main type of esophageal cancer?
- who is it most prevalent in?
- where is most prevalent?
Esophageal SCC (proximal 2/3)
- AA
- Asia and South Africa
Risk factors for SCC
alcohol, tobacco, achalasia, HPV, esophageal webs
What is second most common type of esophageal cancer?
- who is it most prevalent in?
Adenocarcinoma (distal 1/3)
- whites
Risk factors for adenocarcinoma?
smoking (not alcohol)
- most in Barretts esophagus
SSX of esophageal cancer?
early CA asx
- progressive dysphagia
- weight loss
- hoarseness
- Horner’s
- Nerve compression
- dyspnea
Workup for esophageal cancer?
endoscopy with biopsy
then CT and endoscopic US
Esophageal varices
dilated veins in distal esophagus or proximal stomach caused by elevated pressure in portal venous system from cirrhosis
SSX of esophageal varices
sudden, painless, upper GI bleeding
Workup for esophageal varices?
evaluation of coagulopathy
CBC
PT, PTT, LFT
Endoscopy
What does H. Pylori cause?
gastritis, PUD, gastric adenocarcinoma, low grade gastric lymphoma
SSX H pylori
gastritis, PUD
Etiology of gastritis
infection, drugs, stress, AI (atrophic gastritis)
SSX gastritis
dyspepsia
GI bleeding
workup gastritis
endoscopy
Causes of erosive gastritis
NSAIDS, alcohol, stress, radiation, viral infxn, direct trauma
SSX erosive gastritis
vomiting, dyspepsia, nausea
- fist sign can be hematemesis (vomiting blood), melena (black feces).
SSX of non erosive gastritis
asx, or mild dyspepsia
Autoimmune Metaplastic Atrophic Gastritis (AMAG)
inherited autoimmune disease that attacks parietal cells, resulting in decreased production of intrinsic factor
consequences of AMAG?
Atrophic gastritis, B-12 malabsorption, pernicious anemia, risk of adenocarinoma
AMAG workup?
endoscopic biopsy
PUD
erosion in segments of GI mucosa that penetrates musclaris mucosae.
Etiology/risk factors of PUD?
H. Pylori NSAIDS smoking family hx zollinger-ellison syndrome
SSX PUD
can have none
burning/ gnawing pain relieved by food/antacids
difference between pain in gastric vs duodenal
gastric: eating sometimes makes it worse a
duodenal: consistent pain, relieved by food, pain awakens at night
What do you need to rule out with ulcers?
stomach cancer
complications of PUD?
- 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
Dx free perforation?
CT or X-ray shows free air under diaphragm or in peritoneal cavity
Gastric Cancer risk factors
H. pylori
AI atrophic gastritis
Dietary factors
SSX gastric cancer
- nonspecific at first
- later there is early satiety
- weight loss
- weakness
- dysphagia
PE for later stage gastric cancer
- epigastric mass
- umbilical, supraclavicular, L axillary lymph nodes
- hepatomegaly
Bezoars
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
Etiology of Acute pancreatitis
biliary tract disease
chronic heavy alcohol intake
pathophysiology of pancreatitis
pancreatic enzymes activated within pancreas -> damage tissue and activate complement and inflammatory cascade, producing cytokines -> causing inflammation, edema, necrosis
SSX pancreatitis
- steady, boring, upper abdominal pain often radiating to the back and lasting for hours to days.
- nausea
- vomitting
- low grade fever
What relieves pain of pancreatitis?
- pain can be moderately relieved by sitting forward or lying down on one side with knees flexed
What would you see on PE for pancreatitis?
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
Imaging for pancreatitis?
- plan X-rays show calcification of pancreatic duct
- chest X-rays show atelectasis or pleural effusion
- US done if gallstone pancreatitis suspected
Chronic pancreatitis
persistent inflammation of pancreas that results in permanent structural damage with fibrosis and ductal strictures followed by decline of exocrine and endocrine function
Etiology of chronic pancreatitis?
alcoholism
idiopathic
Pathophysiology of chronic pancreatitis
ductal obstruction by protein plugs
diabetes
SSX chronic pancreatitis
- post-prandial pain
- abdominal pain (episodic)
- sits up and leans forward to decrease pain
- steatorrhea
Most common type of Pancreatic Cancer
adenocarcinoma in head of pancreas
What symptom makes pancreatic cancer easy to diagnose and when do you see this in early stage vs late?
Jaundice
- if it’s in the head of pancreas, see early signs
SSX pancreatic cancer
- 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
Workup for pancreatic cancer
routine labs
amylase and lipase
CT
What does elevation of alk phis and bilirubin indicate in pancreatic cancer?
bile duct obstruction or liver mets
Pancreatic endocrine tumors
Produce many hormones that affect other organs
Insulinoma
pancreatic beta cell tumor that secretes insulin
SSX of insulinoma
hypoglycemia occurring during fasting
zollinger-ellison syndrome
gastrin producing tumor in pancreas that can cause PUD
SSX of zollinger-ellison syndrome
aggressive PUD
diarrhea
What does elevated serum gastrin indicate?
Zollinger-ellison syndrome
Vipoma
secretes VIP (vasoactive intestinal peptide) that causes vasodilation and intestines can’t produce enough water to decrease motility
SSX of vipoma
prolonged massive watery diarrhea crampy abdominal pain vomiting dehydration lathargy
Glucagonoma
pancreatic alpha cell tumor that secretes glucagon causing hyperglycemia and skin rash
SSX of glucagonoma
similar to db
weight loss
erythema
brownish red erythmatous lesion with superficial necrosis
mouth is smooth, shiny, vermillion tongue and cheilitis
Important hx question for issues of liver and gallbladder?
bowel movements
exposure to liver toxins
alcohol, drugs
RUQ pain
SSX of acute viral Hepatitis
first: anorexia, malaise, nausea, vomiting, fever, RUQ pain
next phase: dark urine, jaundice, enlarged liver
What pop has increased risk for hep B?
dialysis pt
healthcare workers
IV drug users
sex workers
Sequelae of hep B
chronic hep, cirrhosis, hepatocellular carcinoma
Which hep viruses can lead to cirrhosis and chronic hep?
Hep B and C (most common)
Workup for hep?
AST and ALT elevated (ALT>AST)
IgM antibody
Fulminant hepatitis
rare, massive necrosis, decrease in liver size
SSX chronic hep
malaise, anorexia, fatigue
low grade fever sometimes
no jaundice
PE for chronic hep
splenomegaly
palmar erythema
spider nevi
Non-alcoholic fatty liver (hepatic steatosis) etiology
most common liver response to injury
What are different types of hepatic steatosis
NAFLD - benign
NASH - not distinguishable from alcoholic hepatitis
Risk factors for NASH?
obesity
dyslipidemia
glucose intolerance
SSX NASH
fatigue
malaise
RUQ discomfort
PE NASH
hepatomegaly
risk factors alcoholic liver disease
quantity and duration of consumption
genetic metabolism traits
poor nutrition status
Sequelae of alcoholic liver disease
fatty liver
alcoholic hepatitis
cirrhosis
What tests for h. pylori?
urea breath test
stool antigen assay
