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Gastrointestinal System > EXAM #3: REVIEW > Flashcards

EXAM #3: REVIEW Flashcards

1
Q

List 7x risk factors for colon cancer.

A

1) Family history
2) IBD
3) Smoking
4) Alcohol
5) Obesity
6) Inactivity
7) Poor diet

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2
Q

What is the inheritance pattern of the APC mutation seen in FAP?

A

Autosomal dominant

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3
Q

Name the three scenarios that will give a patient a positive family history for colon cancer.

A

1) Colon ca in 1st degree relative under 60 y/o
2) 2+ first degree relatives with colon ca at ANY age
3) 2nd degree relative under 50 y/o with colon ca

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4
Q

What is the biopsy protocol for a patient with IBD undergoing colonoscopy?

A

Collect 4x random samples every 10cm of bowel for a total of 30+ samples

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5
Q

What are the surveillance recommendations following resection of a colon or rectal cancer?

A

1) H/P + CEA Q3-6 months

2) CT Q1 year for 5x years

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6
Q

List seven diseases that are associated with pancreatic cancer.

A

1) FAP
2) Peutz-Jegher’s Syndrome
3) Von Hippel-Lindau
4) MEN1
5) HNPCC
6) BRCA
7) FAMMM

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7
Q

List five signs/ symptoms typically seen in the presentation of pancreatic cancer.

A

1) Abdominal pain
2) Weight loss
3) Jaundice
4) Steatorrhea
5) Pruritus

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8
Q

What should you be concerned about in an elderly, non-obese patient that develops glucose intolerance?

A

Pancreatic cancer

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9
Q

How is pancreatic cancer diagnosed i.e. what studies are needed for the diagnosis?

A

1) Spiral CT with IV contrast

2) Biopsy

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10
Q

What are the characteristics of resectable pancreatic cancer?

A

1) No extrapancreatic disease
2) No tumor extension into:
- Celiac axis
- SMA

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11
Q

What is a non-opiate approach to pain management in pancreatic cancer?

A

Celiac plexus neurolysis

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12
Q

What are the three hallmarks of a cystic neoplasm?

A

1) Bloating
2) Obstructive jaundice
3) Weight loss

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13
Q

What are the most common types of cystic neoplasms?

A
  • Mucinous cystadenomas

- Cystadenocarcinoma

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14
Q

Where are mucinous cystadenomas or cystadenocarcinomas located?

A

Body or tail of the pancreas

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15
Q

What is an intraductal papillary mucinous neoplasm referred to as?

A

Pancreatic precursor tumor

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16
Q

What studies should be ordered to work up a cystic neoplasm?

A

1) Abdominal CT
2) EUS
3) Biopsy

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17
Q

What confirms the diagnosis of an insulinoma with a 72 hour fast?

A

Elevated c-peptide and insulin

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18
Q

What lab is diagnostic for a Gastrinoma?

A

Elevated serum gastrin

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19
Q

List the four benign liver lesions. Which is the most common?

A

1) Hemangioma*
2) Focal Nodular Hyperplasia
3) Adenoma
4) Simple cyst

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20
Q

Where is HCC common geographically?

A

Worldwide except US and Europe

This is b/c of endemic viral hepatitis

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21
Q

What is the tumor marker for HCC?

A

Alpha-fetoprotein

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22
Q

List four surgical methods for treating HCC.

A

1) Wedge resection
2) Lobectomy
3) Trisegmentectomy
4) Liver transplant

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23
Q

What are the three major obstacles to liver surgery?

A

1) Dual blood supply
2) Liver reserve
3) Coagulopathy

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24
Q

List four characteristics of a good surgical candidate for HCC resection.

A

1) Class A Child Pugh Score
2) Solitary tumor
3) No vascular invasion
4) Tumor less than 3 cm

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25
Q

What drug is specifically used for HCC chemotherapy?

A

Sorafenib

Note that this drug block angiogensis and targets HCC surface proteins

26
Q

List three risk factors for cholangiocarcinoma.

A

1) Primary Sclerosing Cholangitis
2) Liver flukes
3) Choledochal cyst

27
Q

How does cholangiocarcinoma typically present?

A

1) Constitutional sx. of cancer
2) Painless jaundice
3) Biliary Tract Obstruction

28
Q

How is cholangiocarcinoma diagnosed?

A

1) ERCP
2) CT or MRI with cholangiography
3) US

29
Q

What surgery is used to treat perihilar cholangiocarcinoma i.e. the most common type of cholangiocarcioma?

A

Roux-en-Y Hepaticojejunostomy

30
Q

What patient is most likely to get gallbladder cancer?

A

Elderly Chilean female from an urban area

31
Q

List four risks associated with phototherapy to treat neonatal jaudice.

A

1) Retinal degeneration
2) Increased fluid loss
3) Bronze Baby Syndrome
4) Congenital Erythropoietic Porphyria

32
Q

What are the four different types of gallstones?

A

1) Cholesterol-mixed
2) Pigmented
3) Sludge
4) Single large

33
Q

What are the signs and symptoms of a simple gallstones?

A
  • RUQ pain
  • Exacerbated with eating
  • Murphy’s sign
34
Q

How do you initially manage cholecystitis in the ED?

A

1) NPO
2) Hydration
3) Ketorlac

35
Q

Name four criteria that would warrant admission to the hospital with cholecystitis.

A
  • Impacted stone
  • Sepsis
  • Unrelenting pain
  • Uncertain diagnosis
36
Q

What are three medical therapies for gallstones?

A

1) Ursodiol
2) ESWL shock waves
3) Contact dissolution

37
Q

What are the quasi medical therapies for gallstones?

A

1) ERCP

2) Transcutaneous drain

38
Q

What is Charcot’s triad of cholangitis?

A

1) Fever
2) RUQ pain
3) Jaundice

39
Q

What are the three infectious etiologies of pancreatitis?

A

1) Mumps
2) Coxsackievirus
3) Mycoplasma pneumonia

40
Q

List seven complications of acute pancreatitis.

A

1) Shock
2) ARDS
3) Acute renal failure
4) DIC
5) Pancreatic abscess
6) Pancreatic pseudocyst
7) Duodenal obstruction

41
Q

How would you describe the microscopic appearance of chronic pancreatitis?

A

1) Acinar drop out
2) Inflammatory infiltrate
3) Fibrosis
4) Protein/ductal plugs

42
Q

What are the important clinical features of Von Hippel Lindau disease?

A
  • Mutation of chromosome 3
  • Renal cell carcinoma and pheochromocytoma are common
  • CYSTS in the PANCREAS, liver, and kidneys
  • Angiomas in the retina, cerebellum, and brainstem
43
Q

List the three major types of cystic neoplasia involving the pancreas.

A

1) Microcystic serous cystadenoma
2) Mucinous cystic tumor
3) Solid pseudopapillary tumor

44
Q

What are the major complications of cholecystitis?

A

1) Bacterial superinfection
2) Perforation/abscess formation
3) Fistula formation

45
Q

Name three functional disorders of the GI system.

A

1) Gastroparesis
2) IBS
3) Non-ulcer dyspepsia

46
Q

Name four organic disorders of the GI system.

A

1) Hepatitis
2) Pancreatitis
3) Cholecystitis
4) IBD

47
Q

What two things make constant bloating a red flag?

A

1) Ovarian cancer

2) Ascites

48
Q

How do you repair a TE fistula?

A

Right thoracotomy and extrapleural repair

49
Q

What does the VACTERL associated with TE fistuala stand for?

A 
Vertebral 
Anorectal 
Cardiovascular 
Tracheal 
Esophageal 
Renal  
Limb

Any patient with a TE fistual needs to be assessed for issues with these associated structures.

50
Q

What anomalies are associated with omphalocele?

A

1) Heart
2) Urinary tract
3) Beckwith-Wiedeman

51
Q

What is the classical sign for duodenal atresia with imaging?

A

Double bubble sign

52
Q

What is the US finding that is indicative of intussusception? What should you do if you see this?

A

“Target sign”

–>Barium enema

53
Q

How does biliary atresia present?

A

Persistent direct hyperbilirubinemia

54
Q

List 4x signs/sx. of pediatric cholestasis.

A

1) Jaundice
2) Dark urine
3) Pruritus
4) RUQ pain

55
Q

What does acholic stool suggest in an child?

A

Obstructive jaundice

56
Q

Outline the sequence required to diagnose pediatric biliary atresia.

A

1) Elevated direct bilirubin
2) US
3) Biopsy
4) Laparotomy
5) Intraoperative cholangiography

57
Q

How are choledochal cysts treated?

A

Roux-en Y cholechocojejunostomy

58
Q

What five anomalies are associated with Alagille Syndrome?

A

1) Facial changes
2) Peripheral pulmonic stenosis
3) Butterfly vertebrae
4) Posterior embryotoxon
5) Growth retardation

59
Q

What are the major criteria for Hy’s Law?

A

1) 3x normal transaminases
2) 2x normal bilirubin
3) No alternative explanation for elevation

60
Q

What is the definition of acute DILI?

A

Onset of sx. within 3 months of starting drug

61
Q

Name three extrahepatic manifestation of DILI.

A
  • Rash
  • Fever
  • Eosinophilia
62
Q

What are the three methods of indirect hernia repair with a “tissue repair?”

A

1) Bassini= 1 level
2) Shouldice= 4 level
3) McVay= Cooper’s ligament

Gastrointestinal System (42 decks)

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