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OMS2 - Semester 2 - BECOM Exam 1 > Dr. DeMonseserte > Flashcards

Dr. DeMonseserte Flashcards

1
Q

what TE fistula is the most common?

A

type C
-esophageal atresia w/ a DISTAL TE fistula

-distal fistula -> abdomen distends (air in GI tract from lungs)

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2
Q

what do you do for child born with fistula or esophageal atresia?

A

get ECHO & renal US

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3
Q

esophageal atresia in infant

A

polyhydramnios in mother

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4
Q

hypertrophic pyloric stenosis

A
  • thicken pyloric musculature -> outlet obstruction
  • projectile NON-billous vomit
  • palpable olive
  • DOUBLE BUBBLE sign
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5
Q

Meckel’s Diverticulum

A
  • contains gastric mucosa
  • current jelly bleeding
  • rule of 2’s -> 2% of population, 2 feet from ileocecal valve, 2 inches or younger, 2 years or younger, 2 different mucosae
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6
Q

Gastroschisis

A
  • paraumbilical defect
  • bowel protrudes NOT in sac
  • elevated MSAFP
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7
Q

Omphalocele

A
  • midline defect

- bowel contents contained within membrane

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8
Q

Hirschsprung disease

A
  • aganglionic colon
  • aut. dominant -> RET mutations
  • empty rectal vault
  • associated w/ Waardenburg and Downs
  • Dx: rectal SUCTION biopsy
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9
Q

achalasia

A
  • failure of LES to relax
  • bird beak appearance
  • nocturnal regurg and weight loss
  • treat with Heller myotomy or per oral endoscopic myotomy
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10
Q

Ogilvie’s syndrome

A

-if cecal diameter >9cm -> emergency

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11
Q

what can bacteria do to folate & vit. B 12?

A

bacteria metabolized B12 and produce folate

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12
Q

how is glucose absorbed at brush border?

A

with Na+ via SGLT1

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13
Q

most common carbohydrate malabsorption disorder

A

lactose intolerance

-deficiency in lactase enzyme

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14
Q

medium chain TGs

A

-absorbed directly into portal bloodstream w/o the need for micelles

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15
Q

what do you see with fat malabsorption?

A

steatorrhea and fat soluble vit. deficiencies

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16
Q

what do you see with protein malabsorption?

A

edema, ascites, muscle atrophy

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17
Q

small intestinal bacterial overgrowth (SIBO)

A
  • see bloating and diarrhea

- draw vit. B12 and folate levels -> bacteria eat B12 and produce folate

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18
Q

what happens if you resect terminal ileum?

A

won’t absorb bile salts

-cholestyramine only works up to 100cm of recection

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19
Q

Crohns disease (IBD)

A
  • creeping fat
  • terminal ileum most affected - can be ANY portion of GI tract
  • transmural involvement
  • cobblestoning mucosa
  • ASCA Abs or C-bir1
  • diagnosed with CTE + colonoscopy
  • smoking makes worse
  • granulomas
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20
Q

Ulcerative Colitis (IBD)

A
  • ONLY involves colon
  • PSC
  • p-ANCA
  • bloody diarrhea
  • smoking helps
  • crypt abscesses
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21
Q

type 1 peripheral arthritis from IBD

A
  • paucyarticular
  • associated w/ IBD activity
  • LARGE joints
  • other extra intestinal manifestations
  • self limited
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22
Q

type 2 peripheral arthritis

A
  • polyarticular
  • independent of IBD
  • SMALL joints
  • no association w/ other extra intestinal manifestations
  • chronic
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23
Q

ankylosing spondylitis

A
  • HLA-B27 +
  • bamboo spine
  • Tx: anti-TNF
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24
Q

Primary Sclerosing Cholangitis

A
  • inflammation/strictures of INTRA and EXTRAhepatic bile ducts
  • associated with UC
  • p-ANCA +
  • associated with cholangiocarcinoma and colorectal carcinoma
  • yearly colonoscopy after Dx
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25
Q

Celiac Disease

A
  • immune response to gliadin
  • Dermatitis Herpetiformis
  • Dx: small bowel biopsies -> distal duodenum
  • Tx: gluten free diet
  • Anti-gliadin, anti-endomysial, anti-TTG
  • HLA-DQ2, HLA-DQ8
  • crypt hyperplasia, flattened villi
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26
Q

PUD

A

-due to H. pylori and NSAIDs

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27
Q

gastric ulcers

A

-post-prandial pain and weight loss

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28
Q

duodenal ulcers

A
  • eating and antacids help with pain

- weight gain

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29
Q

1st line Treatment for H. pylori

A

-Clarithromycin (or Macrolide if already taken macrolide)

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30
Q

what do you do for ALL H. pylori gastric ulcers?

A

follow up EGD

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31
Q

what are you at risk for with H. pylori?

A

MALT lymphoma

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32
Q

infectious gastritis

A
  • H. pylori most common bacteria

- CMV most common virus

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33
Q

stool osmotic gap

A
  • GAP <50 -> SECRETORY diarrhea w/ more volume
  • GAP >100 -> OSMOTIC diarrhea w/ less volume

290 - 2(stool [Na+] + [K+])

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34
Q

cholestryamine

A
  • works up to 100cm resection of terminal ileum

- change to MCT diet w/ >100cm resection

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35
Q

extra intestinal manifestations of IBD

A
  • peripheral arthritis
  • axial arthritis
  • AS
  • sacroilitis
  • Erythema nodosum
  • pyoderma gangrenous
  • sweet syndrome
36
Q

most common causes of acute pancreatitis?

A
  1. GALLSTONES

2. EtOH

37
Q

hypertriglyceridemia causing pancreatitis

A
  • # 3 most common cause

- if fasting for >12 hours -> REPEAT TGs levels

38
Q

drug induced pancreatitis

A
  • 4th most common cause

- Azathioprine

39
Q

Dx of acute pancreatitis

A
  1. epigastric pain radiating to back
  2. amylase/lipase (>3x ULN) - LIPASE MORE SPECIFIC
  3. imaging consistent w/ acute pancreatitis

neither lipase or amylase correlates w/ severity or outcomes

40
Q

severe AP management

A
  • aggressive fluids (>250-300 cc)
  • ENTERAL NUTRITION 1ST -> TPN if intolerant
  • EN prevents infection
41
Q

Antibiotic coverage pancreatitis

A
  • NOT recommended regardless of type or severity

- exception: infected necrosis -> start quinolones, carbapenems, metronidazole

42
Q

walled off pancreatic necrosis (WON) - aka pancreatic pseudocyst

A
  • fluid collection + necrosis

- Dx w/ MRI or CT

43
Q

infected pancreatic necrosis (IPN) - aka abscess

A
  • gas bubbles -> AIR in fluid collection on CT
  • due to anaerobes (E. coli)
  • Dx: +GM stain and FNA culture**
44
Q

Pseudoaneurysm

A
  • due to AP

- gastroduodenal or splenic artery -> GI bleed

45
Q

Splanchnic venous thrombosis (splenic, SMV, portal)

A
  • due to AP

- leads to gastric VARICES and GI BLEED

46
Q

type I autoimmune pancreatitis (AIP)

A
  • High IgG4
  • histo: lymphoplasmacystic sclerosing pancreatitis (LPSP)
  • older males
  • systemic
47
Q

type 2 autoimmune pancreatitis (AIP)

A
  • idiopathic duct centric pancreatitis (IDCP)
  • histo: GRANULOCYTE EPITH. LESION (GEL)
  • younger males
  • not systemic
48
Q

Tx for autoimmune pancreatitis

A

-steroids (prednisone) -> Rituximab if steroid intolerant

49
Q

chronic pancreatitis

A
  • atrophy and fibrosis
  • calcifications
  • pancreatic insufficiency
  • pseudocyst
  • amylase and lipase may or may not be elevated
50
Q

most common causes of chronic pancreatitis

A
  1. EtOH*** (Most common)
  2. SMOKING***
    - strongest risk factor for progression from AP to CP
  3. cystic fibrosis??
51
Q

does recurrent AP mean you have CP???

A

NO

-but structural changes do

52
Q

what mutation is seen in both hereditary pancreatitis and pancreatic cancer?

A

PRSS1

53
Q

preferred initial test for chronic pancreatitis

A

CT -> look for calcifications

-contract enhanced CT (CECT)

54
Q

indirect tests for CP/pancreatic insufficiency

A
  1. fecal fat quantification (72 hr.) -> best for steatorrhea
  2. FECAL ELASTASE (or chymotrypsin)
55
Q

genes associated w/ chronic pancreatitis

A

-PRSS1 (most common), CFTR, SPINK1

56
Q

therapy for CP

A

-PERT -> helps with pain and insufficiency

57
Q

complications of CP

A
  1. pseudocyst - due to EtOH
  2. bile duct stricture
  3. venous thrombosis -> gastric varices
  4. pseudo aneurysms
  5. OSTEOPOROSIS -> vit. D malabsorption
  6. DM
58
Q

surgery vs. endoscopy for CP

A

-surgery is SUPERIOR to endoscopy for PAIN relief

59
Q

most common cause of pancreatic cancer?

A

DUCTAL ANDENOCARCINOMA

-poor prognosis

60
Q

marker for pancreatic adenocarcinoma

A

CA 19-9

61
Q

symptoms of pancreatic andenocarcinoma

A
  • PAINLESS JAUNDICE (Courvoisier’s sign) w/ palpable GB

- tumor usually in HEAD of pancreas

62
Q

Dx of pancreatic cancer

A

-multi-detector CT (MDCT) w/ contrast -> can’t detect tumors <1cm

63
Q

Tx of pancreatic cancer

A
  • WHIPPLE (pancreatico-duodenectomy)

- adjuvant chemo (5-FU, Gemcytabine, Folfirinox) + radiotherapy

64
Q

genetic factors increasing pancreatic adenocarcinoma risk

A
  • STK11 mut. (from Peutz-Jegher) has HIGHEST risk

- PRSS1 mut. (from hereditary pancreatitis) is MOST COMMON

65
Q

what is used to measure whether pancreatic cancer is resectable or not?

A

EUS

66
Q

look at tumors in DeMontesertes Chronic Pancreatitis/Cancer lecture

A
  1. serous cyst adenoma
  2. mucinous cystic neoplasm (MCN)
  3. branch duct IPMN
  4. main duct IPMN
67
Q

serous cystadeoma

A
  • benign, 60 y/o females
  • body/tail, microcytic
  • HONEYCOMB and CENTRAL SCAR
  • CEA <5
  • glycogen rich -> PAS+
68
Q

Mucinous cystic neoplasm (MCN)

A
  • malignant, females
  • head/tail, macrocytic
  • CEA >200
  • produce mucin
  • solitary
69
Q

branch duct IPMN

A
  • malignant
  • most common**
  • most frequent incidental pancreatic cyst**
  • dilated branch duct
  • CEA >200
  • produce mucin
  • multiple
  • cysts >1 cm (10mm) communicating w/ pancreatic duct
  • GNAS MUTATIONS
70
Q

main duct IPMN

A
  • malignant
  • dilated main duct
  • high risk of cancer if >10mm
71
Q

what is very worrisome of pancreatic malignancy?

A

-PANCREATITIS

only resect if branch duct is >3cm in diameter or main duct is >1cm in diameter

72
Q

cholelithiasis

A

-GB stone

73
Q

choledolithiasis

A

-common bile duct stone

74
Q

cholesterol stones

A
  • MOST COMMON
  • brown/yellow
  • Lucent
75
Q

pigment stones

A
  1. BLACK (opaque) -> Ca2+ bilirubinate due to hemolysis
  2. BROWN (Lucent) -> due to bacterial infection (B-glucoronidase) or parasites
    - brown stones ONLY found in bile ducts and most common after cholecystectomy
76
Q

acalculous cholecystitis

A
  • ICU

- ischemia and GB stasis

77
Q

Biliary colic

A
  • GB contracts against stone in cystic duct

- RUQ pain

78
Q

acute cholecystitis

A
  • cystic duct obstruction
    • Murphys sign
  • US 1st (HIDA more sensitive)
  • Tx: DRAINAGE or cholecystectomy
  • start Abx for gram neg
79
Q

what are the most common GB polyps?

A

cholesterol polyps - benign

80
Q

choledocholelithiasis

A
  • COMMON BILE DUCT stones
  • imaging: EUS best -> detects small stones
  • Tx: TAKE STONE AND GB OUT (even if asymptomatic)
  • ERCP + sphincterotomy standard of care
81
Q

acute cholangitis

A
  • CBD stone + infection
  • E. coli, Klebsiella, Enterococcus, Enterobacter, Pseudomonas, Clostridium
  • CHARCOT TRIAD: fever, RUQ pain, jaundice
  • Tx: Abx, URGENT DRAINAGE via ERCP
82
Q

gallstone ileus/cholecystoenteric fistula

A

-GB forms fistula with bowel -> gallstone enters -> duodenal or gastric outlet obstruction obstruction (Bouvaret’s syndrome)

83
Q

Mirizzi’s syndrome

A
  • suspect GB CANCER and biliary fistulas*** (type 2-4 has fistulas)
  • Tx: cholecystectomy or ERCP
84
Q

Primary biliary cholangitis/cirrhosis (PBC)

A
  • autoimmune -> T cell destruction of intralobular bile ducts
  • risk of Sicca syndrome, CREST, Celiac, Scleroderma
  • Sx: PRURITIS and XANTHOMAS
  • anti-mitochondrial Abs + (AMA)
  • for AMA neg PBC -> do liver biopsy to Dx
  • Tx: ursodeoxycholic acid (UDCA)…Obeticholic acid or Fibrates if needed
  • cholestyramine for pruritus
85
Q

Primary sclerosing cholangitis (PSC)

A
  • inflammation/stricturing of intra and extra hepatic ducts -> beads on string
  • ULCERATIVE COLITIS
  • p-ANCA +
  • periductal fibrosis - “onion skin”
  • high risk of colorectal cancer (yearly colonoscopy) and cholangiocarcinoma
  • Dx: MRCP >ERCP
  • Tx: liver transplant only

OMS2 - Semester 2 - BECOM Exam 1 (7 decks)

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