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GI 2 Exam 1 > DSA 7: Fatigue, Unintentional Weight Loss > Flashcards

DSA 7: Fatigue, Unintentional Weight Loss Flashcards

1
Q

where are:

iron, calcium, folate, fats, carbs, triglycerides absorbed?

A

proximal small intestine

- absorbed as micelles after solubilization by bile salts

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2
Q

where are:

vitamin B12, bile salts and water absorbed?

A

distal small intestine

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3
Q

where are:

water and electrolytes absorbed?

A

colon

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4
Q

what should be on your DDX for fatigue? (5)

A
  • occult GIB
  • cancer
  • IBD
  • chronic liver dz
  • malnutrition/malabsorption
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5
Q

what should be on you DDX for unintentional wt loss? (4)

A
  • cancer
  • malabsorption syndromes
  • IBD
  • poor dentition
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6
Q

how does fatigue typically present?

A

difficulty initiating or maintain voluntary mental or physical activity

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7
Q

what ROS finding should raise you suspicious for an occult infection or malignancy?

A

presence of fever, chills, night sweats, or weight loss

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8
Q

what should be used instead of 10/10 scale for severity of fatigue?

A

impact of fatigue on daily functioning

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9
Q

what should be included for diagnosis of fatigue?

A
  • CBC with diff
  • electrolytes
  • thyroid function
  • testing for HIV
  • adrenal function
  • erythrocyte sedimentation rate (ESR), just helps support other findings
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10
Q

rapid fluctuation of weight over days suggest what?

A

loss or gain of fluid

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11
Q

long-term changes usually involve what?

A

loss of tissue mass

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12
Q

loss of how much weight should prompt further evaluation?

A

loss of 5-10% of body weight over 6 months

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13
Q

hx of GI symptoms should be obtained, including difficulty eating, dysgeusia (distorted sense of taste), dysphagia, anorexia, nausea, and change in bowel habits

A

for unintentional weight loss

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14
Q

causes of weight loss McGowan wants us to know

A
  • cancer
  • malabsoprtion
  • obstruction
  • peptic ulcer
  • celiac disease
  • IBD
  • pancreatitis
  • pernicious anemia
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15
Q

iron deficiency anemia is most commonly attributed to what, in premenopausal women?

A

menstrual bleeding and pregnancy-associated iron loss

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16
Q

what is the diagnostic eval for occult bleeding?

A

positive FOBT -> colonoscopy

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17
Q

pt with iron deficiency anemia should be evaluated for what?

A

possible celiac disease with either IgA anti-tissue TG or duodenal biopsy

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18
Q

what is the first think you should think of in a person over 45 with iron deficiency anemia?

A

colon cancer

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19
Q

what are the main complications of colonoscopy?

A

perforation and clinically significant bleeding

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20
Q

hundreds-thousands of colonic adenomatous polyps

  • 90% have mutation in APC gene (AD)
  • 10% have mutation in MUYTH gene (AR)
A

familial adenomatous polyposis (FAP)

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21
Q

what is the tx of FAP?

A

complete prostocolectomy with ileoanal anastomosis before age 20
- prophylactic colectomy recommended to prevent inevitable colon cancer

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22
Q

defect in one/several genes that are important in detection and repair of DNA base-pair mismatches (MLH1, MSH2, MSH6, PMS2)
- polyps believed to undergo rapid transformation over 1-2 years from normal tissue -> adenoma -> cancer

A 
Lynch syndrome (aka HNPCC)
- lifetime risk of colorectal cancer (22-75%), endometrial cancer (30-60%), ovarian, renal/bladder develop at a YOUNG age
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23
Q

what is the tx of HNPCC?

A

subtotal colectomy with ileorectal anastomosis (followed by ANNUAL surveillance of rectal stump)
- prophylactic hysterectomy and oophorectomy recommended in women over 40, or once they have finished childbearing

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24
Q

hamartomatous polyps throughout GI tract (esp small intestine)

  • mucocutaneous pigmented macules on the lips, buccal mucosa and skin
  • AD inheritance, serine threonine kinase 11 gene mutation
A

Peutz-Jeghers syndrome

25
Q

several juvenile hamartomatous polyps, mostly in colon

  • increased risk (up to 50%) of adenocarcinoma
  • AD inheritance, defects on loci 18q and 10q (MADH4 and BMPR1A)
A

familial juvenile polyposis

26
Q

hamartomatous polyps and lipomas throughout Gi tract

  • trichilemmomas (benign neoplasms on face/neck) and cerebellar lesions
  • increased rate of malignancy in thyroid, breast and urogenital tract
A

Cowden’s syndrome

27
Q

painless bleeding: melena, hematochezia or occult blood loss

  • proximal to ligament of Treitz (then presents as melena)
  • most common in pt over 70, and in those with chronic renal failure or aortic stenosis
A

AVM

  • dx: CBC with iron studies -> triggers us to do endoscopy, upper EGD, lower colonoscopy, capsule
28
Q

what type of esophageal cancer presents as:
more common in African American males, over 50
- heavy smokers, alcohol use
- progressive dysphagia, weight loss, anorexia, bleeding, hoarseness, cough
- 50% in MIDDLE 1/3 of esophagus

A

SCC of esophagus

29
Q

what type of esophageal cancer presents as:
more common in caucasian males
- DISTAL 1/3 of esophagus
- Barrett metaplasia -> dysplasia -> ?
- dx: EDG with biopsy
- tx: endoscopic ablation

A

adenocarcinoma of esophagus

30
Q

risk factors:

  • smoked fish/meat
  • pickled veggies
  • nitrosamines
  • benzpyrene
  • h. pylori
  • smoking
  • blood type A
A

gastric adenocarcinoma

  • histo shows signet ring cells
  • virchow’s node on PE
31
Q

streptococcus bovis bacteremia??

A

COLON CANCER! (adenocarcinoma)

32
Q

what side colon cancer presents as:

  • rectal bleeding
  • altered bowel habits (narrowing, constipation, tenesmus)
  • abd or back pain
A

left-sided

33
Q

what side colon cancer presents as:

  • anemia (50%)
  • occult blood in stool
  • weight loss
  • perforation, fistula, volvulus, inguinal hernia are complications
A

right-sided

34
Q

CEA >5ng/mL ?

A

diagnostic marker for colon cancer

35
Q

painless jaundice, NV, fatigue, weight loss, steatorrhea

  • mid-epigastric pain that radiates to the back, hurts the most at night lying flat, is relieved by bending forward
    • Courvoisier sign (palpable, painless gallbladder)
  • Trousseau sign of malignancy -> hypocalcemia
A

pancreatic cancer

36
Q

CA19-9 >100U/mL ?

CA= tumor biomarker carbohydrate antigen

A

highly specific for PANCREATIC malignancy

  • NOTE: mutations on K-ras and p16 on xsome 9 may also be implicated
37
Q
  • smoking**
  • obesity
  • male
  • Af american
  • > 65 y/o
  • DM
  • chronic pancreatitis
  • liver cirrhosis
  • family hx
A

risk factors for pancreatic cancer

38
Q

pt with cachexia, abdominal pain, fever

  • jaundice, asthenia (abnormal physical weakness)
  • elevated a-fetroprotein (AFP)
A

hepatocellular carcinoma

39
Q

primary sclerosing cholangitis (PSC) is am important risk factor for what?

A

cholangiocarcinoma

  • surveillance in PSC pt recommended with annual imaging (MRCP: cholangiopancreatography) and CA19.9 serum testing
40
Q

acute ileitis, diarrhea (with/without blood)

A

Crohn disease

- tx: corticosteroids, immunoglobulating agents, ABX

41
Q

bloody diarrhea, mucus, fever, tenesmus

- recently stopped smoking

A

UC

- tx: corticosteroid, immunoglobulating agents

42
Q

pt presents with fatigue, malaise, anorexia, jaundice

- chronic inflammatory reaction in liver for at least 6 months

A

chronic hepatitis

43
Q

what are the two immuno-complex mediated types of hepatitis?

A
  • HBV: polyarteritis nodosa

- HCV: mixed cryoglobulinemia

44
Q

what is the most important treatment for cirrhosis?

A

abstinence from alcohol

- pt should also receive HAV, HBV, pneumococcal and yearly flu vaccines

45
Q

what are the most important classifications for liver biopsy?

A

grade and stage

46
Q

what test should be done on pt with ascites?

A

CMP (bilirubin, albumin)

- EGD to look for varices before they rupture

47
Q

what are the classic signs of malabsorption?

A

steatorrhea and weight loss

48
Q

what small bowel mucosal disorders are listed as malabsorption syndromes? (3)

A
  • celiac sprue
  • Whipple disease
  • bile salt malabsorption
  • Crohn disease
49
Q

what pancreatic disorders are listed as malabsorption syndromes?

A
  • cystic fibrosis

- pancreatic carcinoma

50
Q

what disease develops in people with HLA-DQ2 or HLA-DQ8 class II molecules?

A

celiac sprue

- causes diffuse damage to proximal small intestinal mucosa with malabsorption of nutrients

51
Q
  • weight loss
  • chronic diarrhea
  • dyspepsia
  • flatulence
  • abd distention/bloating
  • growth retardation/short stature
  • fatigue

can also have

  • depression
  • iron deficiency anemia
  • osteoporosis
A

celiac sprue

- histologically: see complete loss of intestinal villi

52
Q

what is one PE finding that you should always associate with celiacs?

A
  • *dermatitis herpetiformis**

- pruritis papulovesicles over extensor surfaces of extremities, trunk, scalp and neck

53
Q

other than tTG antibodies, what else should be tested for in celiacs?

A

IgG Ab to anti-DGP (deamidated GLIADIN peptides)

- for people with IgA deficiency!!!

54
Q

what does the malabsorption of triglycerides cause?

A

steatorrhea

- resulting in weight loss, gaseous distention/flatulence, large greasy foul-smelling stools

55
Q
  • decreased fecal chymotrypsin

- decreased pancreatic fecal elastase (<100mcg/gram)

A

exocrine pancreatic insufficiency

56
Q

what is the mnemonic TIGAR-O, and what is it for?

A

for causes of chronic pancreatitis

  • toxic/metabolic (alcohol 45-80% of cases)
  • idiopathic
  • genetic (CFTR)
  • autoimmune (IgG4 hypergammaglobulinemia)
  • recurrent
  • obstructive
57
Q

what can Crohn disease lead to?

A

bile salt malabsorption

  • if terminal ileum is resected -> that is where bile salts are resorbed
  • impaired absorption of fat-soluble vitamins (A, D, E, K) is common
  • causes watery secretory diarrhea
58
Q

rare multi-system disease

  • gram positive bacilus, not acid fast
  • weight loss
  • malabsorption
  • chronic diarrhea
  • endoscopy with duodenal biopsy: PAS positive macrophages with characteristic bacillus
A

Whipple disease

  • tx: ABX (should see dramatic improvement within weeks)
  • is FATAL if left untreated
59
Q

what should you always remember to ask your patient about who presents with weight loss?

A

teeth hygiene!

- poor dentition compromises oral intake

GI 2 Exam 1 (22 decks)

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