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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
What do you need to rule out with ulcers?
stomach cancer
26
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
27
Dx free perforation?
CT or X-ray shows free air under diaphragm or in peritoneal cavity
28
Gastric Cancer risk factors
H. pylori AI atrophic gastritis Dietary factors
29
SSX gastric cancer
- nonspecific at first - later there is early satiety - weight loss - weakness - dysphagia
30
PE for later stage gastric cancer
- epigastric mass - umbilical, supraclavicular, L axillary lymph nodes - hepatomegaly
31
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
32
Etiology of Acute pancreatitis
biliary tract disease | chronic heavy alcohol intake
33
pathophysiology of pancreatitis
pancreatic enzymes activated within pancreas -> damage tissue and activate complement and inflammatory cascade, producing cytokines -> causing inflammation, edema, necrosis
34
SSX pancreatitis
- steady, boring, upper abdominal pain often radiating to the back and lasting for hours to days. - nausea - vomitting - low grade fever
35
What relieves pain of pancreatitis?
- pain can be moderately relieved by sitting forward or lying down on one side with knees flexed
36
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
37
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
38
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
39
Etiology of chronic pancreatitis?
alcoholism | idiopathic
40
Pathophysiology of chronic pancreatitis
ductal obstruction by protein plugs | diabetes
41
SSX chronic pancreatitis
- post-prandial pain - abdominal pain (episodic) - sits up and leans forward to decrease pain - steatorrhea
42
Most common type of Pancreatic Cancer
adenocarcinoma in head of pancreas
43
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
44
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
45
Workup for pancreatic cancer
routine labs amylase and lipase CT
46
What does elevation of alk phis and bilirubin indicate in pancreatic cancer?
bile duct obstruction or liver mets
47
Pancreatic endocrine tumors
Produce many hormones that affect other organs
48
Insulinoma
pancreatic beta cell tumor that secretes insulin
49
SSX of insulinoma
hypoglycemia occurring during fasting
50
zollinger-ellison syndrome
gastrin producing tumor in pancreas that can cause PUD
51
SSX of zollinger-ellison syndrome
aggressive PUD | diarrhea
52
What does elevated serum gastrin indicate?
Zollinger-ellison syndrome
53
Vipoma
secretes VIP (vasoactive intestinal peptide) that causes vasodilation and intestines can't produce enough water to decrease motility
54
SSX of vipoma
``` prolonged massive watery diarrhea crampy abdominal pain vomiting dehydration lathargy ```
55
Glucagonoma
pancreatic alpha cell tumor that secretes glucagon causing hyperglycemia and skin rash
56
SSX of glucagonoma
similar to db weight loss erythema brownish red erythmatous lesion with superficial necrosis mouth is smooth, shiny, vermillion tongue and cheilitis
57
Important hx question for issues of liver and gallbladder?
bowel movements exposure to liver toxins alcohol, drugs RUQ pain
58
SSX of acute viral Hepatitis
first: anorexia, malaise, nausea, vomiting, fever, RUQ pain | next phase: dark urine, jaundice, enlarged liver
59
What pop has increased risk for hep B?
dialysis pt healthcare workers IV drug users sex workers
60
Sequelae of hep B
chronic hep, cirrhosis, hepatocellular carcinoma
61
Which hep viruses can lead to cirrhosis and chronic hep?
Hep B and C (most common)
62
Workup for hep?
AST and ALT elevated (ALT>AST) | IgM antibody
63
Fulminant hepatitis
rare, massive necrosis, decrease in liver size
64
SSX chronic hep
malaise, anorexia, fatigue low grade fever sometimes no jaundice
65
PE for chronic hep
splenomegaly palmar erythema spider nevi
66
Non-alcoholic fatty liver (hepatic steatosis) etiology
most common liver response to injury
67
What are different types of hepatic steatosis
NAFLD - benign | NASH - not distinguishable from alcoholic hepatitis
68
Risk factors for NASH?
obesity dyslipidemia glucose intolerance
69
SSX NASH
fatigue malaise RUQ discomfort
70
PE NASH
hepatomegaly
71
risk factors alcoholic liver disease
quantity and duration of consumption genetic metabolism traits poor nutrition status
72
Sequelae of alcoholic liver disease
fatty liver alcoholic hepatitis cirrhosis
73
What tests for h. pylori?
urea breath test | stool antigen assay

CPD Upper GI Wk 5 Quiz (2 decks)

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