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CPD II > CPD Upper GI - Liver > Flashcards

CPD Upper GI - Liver Flashcards

1
Q

Most common benign esophageal tumor

A

Leimyoma

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2
Q

What are the two most prominent forms of primary esophageal cancer and where in the esophagus do they occur?

A

Squamous cell carcinoma: proximal 2/3 of esophagus

Adenocarcinoma: distal 1/3 of esophagus

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3
Q

Risk factors of adenocarcinoma vs. squamous cell carcinoma

A

Adeno: smoking (NOT alcohol), Barrett’s eso

SCC: alcohol, tobacco, achalasia, HPV, lye ingestion, sclerotherapy, Plummer-vinson syndrome, irradiation, eso webs.

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4
Q

What are the most common cancers to mets to outside of esophagus?

A

Breast ca and melanoma

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5
Q

SSX of Eso Cancer

A

Progressive dysphagia, weight loss, hoarseness, Horner’s syndrome, dypnea

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6
Q

What is a common cause of esophageal varices?

A

Elevated pressure in the portal venous system, cirrhosis

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7
Q

What common oral-fecal organism causes gastritis, PUD, gastric adenocarcinoma, and low grade gastric lymphoma?

A

H. pylori

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8
Q

What is the pathophysiology of a H. pylori infection?

A

1) Increased gastrin production - hypersecretion of acid

2) Increased production of IL-1beta - decreased acid production

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9
Q

Etiologies of gastritis

A

Infection, drugs, stress, AI phenomena

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10
Q

What is usually the first sx of erosive gastritis?

A

Hematemesis, melena, or blood in the nasogastric aspirate.

Also, dyspepsia, n/v

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11
Q

Inherited autoimmune dz that attacks parietal cells - hypochlorhydria and decreased intrinsic factor production

A

Autoimmune Metaplastic Atrophic Gastritis (AMAG)

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12
Q

Risk factors for PUD

A

H. pylori, NSAIDs, smoking, family hx, Zollinger-Ellison syndrome

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13
Q

SSX: Gastric vs. duodenal ulcer

A

Gastric: not consistent pain pattern

Duodenal: more consistent pain, appears mid-morning, is relieved by good, but recurs 2-3hrs post-meal, awakening at night COMMON

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14
Q

Complications of ulcers (6): most common and ssx.

A

1) Hemorrhage - hematemesis or “coffee grounds”

2) Penetration - confined perforation, radiates to back.
3) Free perforation - RLQ pain, radiates to one or both shoulders, lies still.
4) Gastric outlet obstruction - recurrent, large-volume vomiting, end of day or 6hr after meal.
5) Recurrence - failure to eradicate H. pylori, NSAID, smoking
6) Gastric cancer

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15
Q

Most common gastric cancer

A

Adenocarcinoma

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16
Q

SSX of gastric cancer

A

EARLY SATIETY, weight loss, weakness, dysphagia, often non-specific.

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17
Q

How are most all gastric and esophageal pathologies diagnosed?

A

Endoscopy (and biopsy)

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18
Q

Tightly packed collection of partially digested or undigested materials that is unable to exit the stomach?

A

Bezoar

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19
Q

3 types of bezoars

A

Phyto - vegetable matter, due to hypochlorhydria, diminished antral motility, incomplete mastication
Tricho- hair, more common in psychiatric patients
Pharmaco- medications

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20
Q

What are the two most common causes of acute pancreatitis?

A

Biliary tract dz

Chronic heavy alcohol intake

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21
Q

Acute pancreatitis: SSX

A

Steady, boring, upper abd pain, often radiating to back. Pain relieved by sitting forward or lying down, N/V, low-grade fever, pale stool/dark urine.

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22
Q

Acute pancreatitis: Labs

A

Elevated serum amylase and lipase (3x above norm).

WBC increase ~20,000

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23
Q

1 cause of chronic pancreatitis?

A

Chronic alcoholism

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24
Q

Chronic pancreatitis: SSX

A

Post-prandial pain, episodic abd pain that is sever and may last hours/days, pancreatic posture, steatorrhea, creatorrhea, glucose intolerance

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25
Q

Chronic pancreatitis: Labs

A

Normal amylase and lipase. (adapts)

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26
Q

Classic chronic pancreatitis triad

A

DM, pancreatic calculi, steatorrhea

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27
Q

Most common pancreatic cancer

A

Primary ductal adenocarcinoma

28
Q

Early diagnosis of pancreatic cancer occurs due to what clinical finding and where is the cancer usually found?

A

SSX: Obstructive jaundice, pruritis, diabetes

Location: head of pancreas

29
Q

What SSX accompany pancreatic cancer in the body/tail of the pancreas?

A

Splenic vein obstruction = splenomegaly, gastric and eso varices, and GI hemorrhages

30
Q

Pancreatic cancer: Labs and Imaging

A

Elevated alk phos and bilirubin
Amylase and lipase are NORMAL

CT or MRCP - visualize tumor

31
Q

What pancreatic cancer has the best prognosis and what is the typical prognosis of pancreatic cancer?

A

Cystadenocarcinoma

Pancreatic cancer:
5yr survival: <2%

32
Q

What are the 2 general manifestations of pancreatic endocrine tumors?

A

Non-functioning - may cause obstructive sx, local

Functioning - hypersecrete a particular hormone, systemic

33
Q

Insulinoma: Define and SSX

A

Pancreatic B-cell tumor that hypersecretes insulin.

Hypoglycemia during fasting, anxiety

34
Q

Syndrome caused by gastrin-producing tumor located in pancreas or duodenal wall.

A

Zollinger-Ellison Syndrome

35
Q

When should you suspect Zollinger-Ellison syndrome?

A

When ssx are refractory to standard acid suppressive therapy!

36
Q

What percentage of gastrinoma are malignant and what often accompanies them?

A

50%

MEN! (multiple endocrine neoplasia)

37
Q

Non-B pancreatic islet cell tumor secreting vasoactive intestinal peptide.

A

VIPoma, often malignant and BIG

38
Q

VIPoma: SSX

A

Prolonged massive watery DIARRHEA, crampy abd pain, dehydration, vomiting, lethargy, muscle weakness, electrolyte imbalance.

39
Q

VIPoma: Work-up

A

Lab: hypokalemia, acidosis, elevated VIP levels

Imaging: endoscopic ultrasonography, PET to localize

40
Q

Pancreatic a-cell tumor that secretes glucagon, causing hyperglycemia and characteristic skin rash?

A

Glucagonoma - RARE

80% are malignant, mostly in women

41
Q

Glucagonoma: SSX

A

diabetes!
necrolytic migratory erythema
vermillion tongue
cheilitis

42
Q

Glucagonoma: Work-up

A 
Serum glucagon (>1000pg/mL)
Normochromic anemia

CT, endoscopic US to localize

43
Q

Elevated levels of alpha-Fetoprotein prompts consideration of what condition?

A

Primary hepatocellular carcinoma

44
Q

Labs to investigate liver injury?

A

ALT and AST

45
Q

Labs to assess liver function/biliary tract?

A

ALP, GGT, serum bilirubin, albumin, PT

46
Q

Labs to assess hepatic synthetic capacity?

A

PT and INR, serum protein, albumin

47
Q

What is the most sensitive technique for imaging the biliary system?

A

Abd ultrasound

48
Q

Three major causes of hepatitis?

A

Virus, alcohol, drugs

49
Q

Most common hepatitis virus, transmitted fecal-oral, especially in young people? What form is it’s genome?

A

Hep A, ssRNA

50
Q

Second most common hepatitis virus, spread by blood?

A

Hep B, dsDNA

51
Q

What hepatitis virus has the highest rate of chronicity and is spread by blood?

A

Hep C, ssRNA

52
Q

What hepatitis virus is dependent on co-infection with another hepatitis virus?

A

Hep D

53
Q

Enterically transmitted hepatitis virus that does NOT cause chronic hepatitis?

A

Hep E

54
Q

What laboratory findings would indicate viral hepatitis?

A

LFTs: very elevated, viral serologic testing

Imaging and biopsy usually unnecessary.

55
Q

Massive necrosis often involve HBV and HDV co-infection.

A

Fulminant hepatitis

56
Q

What would you find on PE of an individual with chronic hepatitis?

A

Splenomegaly, palmar erythema, spider nevi

57
Q

What makes acute hepatitis become chronic?

A

Time (>6mo)

58
Q

What are two types of non-alcoholic fatty liver and what conditions are they associated with?

A

NAFLD -benign, pregnancy

NASH -metabolic syndrome, obesity, dyslipidemia, glucose intolerance

59
Q

What is a PE often found with fatty liver dz?

A

Hepatomegaly!

60
Q

Describe the pathophysiology of alcoholic liver dz.

A

1) Increasing alcohol catabolization over time inhibits fatty acid oxidation and gluconeogenesis
2) Export of fat from liver decreased- triglyceride accumulation
3) Alcohol changes gut permeability
4) Oxidative stress/damage
5) Inflammation, cell death, and fibrosis

61
Q

What disorders often occur in sequence with regard to alcohol consumption and the liver?

A

Alcoholic fatty liver- reversible/often asx

Alcoholic hepatitis-fatigue, jaundice, RUQ pain, hepatomegaly

Cirrhosis

62
Q

What would LFTs look like for a patient with chronic alcoholic liver dz?

A 
Elevated GGT (first to rise)
Elevated AST and ALT but AST>ALT at a ratio of >2
63
Q

What two types of injury are caused by drugs on the liver?

A

Hepatocellular - acetaminophen, elev in AST and/or ALT

Cholestatic -amoxicillin, elevated alk phos

64
Q

SSX of chronic alcoholism

A

Vascular spiders, peripheral neuropathy, Dupuytren’s contracture, hypogonadism, under-nutrition (deficiencies)

65
Q

What type of imaging is best for looking at ducts?

A

MRI, ERCP

CPD II (3 decks)

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