Fatigue and Weight Loss DSA Flashcards
What is absorbed in the:
- proximal SI
- distal SI
- colon
- calcium, iron, folate, fats, carbs, triglycerides
- vitamin b12, bile salts, water
- electorlytes, water
If a pt comes in with fever, chills night sweats, or weight loss associated with their fatigue, you should think of?
infection or malignancy
When should you evaluate weight loss?
loss of 5-10% loss of body weight over 6 months
When presenting with weight loss, what should all pts receive?
stool test for occult blood
men - recta/prostate exam
women - pelvic exam
What are the most common causes of occult bleeding with iron deficiency?
- Cancer
- Vascular abnormalities
- Acid-peptic lesions (ex. PUD)
- Infections (ex. nematdes, TB)
- Medications (ex. NSAIDs)
- IBD (CD > UC)
If a premenopausal woman has iron deficiency anemia, it is most likely due to what?
menstraul and pregnancy associated iron loss
Patients with iron deficiency anemia should be evaluated for?
celiac disease
What is a big difference between colonoscopy and CT colonography?
Colonoscopy is diagnostic and therapeutic
CT colonography is diagnostic only
What is a distinguishing sx of Peutz-Jeghers syndrome? What type of polyps are present?
mucocutaneous pigmented macules on lips, buccal mucosa, and skin
harmartomatous polyps - not malignant
38 y/o women presents to her ob/gyn one month post-partum. She says her and her husband have decided they do not wish to have any more children. Based on her hx, she is recommended to get a hysterectomy. What condition would have encouraged this?
Lynch Syndrome - prophylactic hysterectomy and oophorectomy recommended age 40+ or when they are done having kids
What is Cowden Disease?
PTEN multiple hamartoma syndrome
- hamartomatous polyps and lipomas throughout the GI tract, trichilemmomas, and cerebellar lesions
- An increased rate of malignancy is demonstrated in the thyroid, breast, and urogenital tract
In tests that detect mutated genes associated with colon cancer, what can cause a false positive? false negative?
positive - red meat, iron, aspirin, UGIB
negative - vitamin C, intermittent bleeding
What do you suspect to be the cause of liver cancer in an Asian or African pt? What might have helped prevent this cancer?
Hep B or C infection
hep b vaccine
IFN-alpha can prevent liver cancer in those with chronic, active hep c (and maybe hep b)
What do iCCAs arise from? eCCAs?
- iCCA originates from adult cholangiocytes, trans- differentiation of adult hepatocytes and hepatic progenitor cells
- eCCA arises from the biliary epithelium and peribiliary glands
What is a big risk factor for cholangiocarcinomas?
Primary sclerosing cholangitis
PSC pts are recommended to get CA 19.9 serum testing and annual imaging for CCA surveillance
What is the major risk factor for GB cancer? What polyps are a risk?
cholelithiasis
GB polyps > 10mm in diameter
What IBD is associated with toxic megacolon?
UC
How is chronic hepatitis classified?
Grade- histologic assessment of necrosis and inflammatory
activity; based on exam of liver bx
Stage- reflects the level of disease progression and is based
on the degree of fibrosis
Pts with cirrhosis should receive what?
HAV, HBV, pneumococcal vaccines
yearly influenza vaccines
What are atypical sx of celiac disease?
dermatitis herpetiformis (not present in IgA deficient pts)
iron deficiency anemia
osteoporosis
What type of diarrhea is seen in bile salt malabsorption?
watery secretory diarrhea
What are the significant lab values for pancreatic insufficiency?
decreased fecal chymotrypsin
decreased pancreatic fecal elastase
How common is it for ppl w/ pancreatitis to develop DM?
80% develop DM after 25 yrs of chronic pancreatitis
What is the pneumonic for chronic pancreatitis?
TIGAR-O
Toxic-metabolic = alcoholic (45-80% of cases)
Idiopathic (early or late onset)
Genetic (CF, SPINK1, PSTI, PRSS1)
Autoimmune (hypergammaglobulinemia [IgG4], celiac dz)
Recurrent
Obstructive (stone, stricture, or tumor)
Where are bile salts reabsorbed?
terminal ileum
Where is a biopsy performed to dx whipple dz?
duodenum –> do PAS to look for macrophages w/ bacilli
Is weight loss characteristic of bile salt reabsorption?
it is minimal in this dz
What lower GI complication is a complication of cystic fibrosis?
rectal prolapse
What is CEA used for?
done before surgery to remove colon CA
also used as a marker of Tx
not for dx
What is alpha fetoprotein a marker of?
hepatocellular CA
What should you consider in a pt w/ painless jaundice, elevated CA 19-9, and hx of UC?
cholangiocarcinoma
CA 19-9 specific for pancreatic ductal CA only if there is not a ductal cause
bc pts hx of UC –> incr risk of primary sclerosing choliangitis –> incr risk of cholangiocarcinoma
