Fatigue and Weight Loss DSA

Question 1

What is absorbed in the:

1. proximal SI
2. distal SI
3. colon

Answer 1

1. calcium, iron, folate, fats, carbs, triglycerides
2. vitamin b12, bile salts, water
3. electorlytes, water

Question 2

If a pt comes in with fever, chills night sweats, or weight loss associated with their fatigue, you should think of?

Answer 2

infection or malignancy

Question 3

When should you evaluate weight loss?

Answer 3

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

Question 4

When presenting with weight loss, what should all pts receive?

Answer 4

stool test for occult blood

men - recta/prostate exam

women - pelvic exam

Question 5

What are the most common causes of occult bleeding with iron deficiency?

Answer 5

1. Cancer
2. Vascular abnormalities
3. Acid-peptic lesions (ex. PUD)
4. Infections (ex. nematdes, TB)
5. Medications (ex. NSAIDs)
6. IBD (CD > UC)

Question 6

If a premenopausal woman has iron deficiency anemia, it is most likely due to what?

Answer 6

menstraul and pregnancy associated iron loss

Question 7

Patients with iron deficiency anemia should be evaluated for?

Answer 7

celiac disease

Question 8

What is a big difference between colonoscopy and CT colonography?

Answer 8

Colonoscopy is diagnostic and therapeutic

CT colonography is diagnostic only

Question 9

What is a distinguishing sx of Peutz-Jeghers syndrome? What type of polyps are present?

Answer 9

mucocutaneous pigmented macules on lips, buccal mucosa, and skin

harmartomatous polyps - not malignant

Question 10

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?

Answer 10

Lynch Syndrome - prophylactic hysterectomy and oophorectomy recommended age 40+ or when they are done having kids

Question 11

What is Cowden Disease?

Answer 11

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

Question 12

In tests that detect mutated genes associated with colon cancer, what can cause a false positive? false negative?

Answer 12

positive - red meat, iron, aspirin, UGIB

negative - vitamin C, intermittent bleeding

Question 13

What do you suspect to be the cause of liver cancer in an Asian or African pt? What might have helped prevent this cancer?

Answer 13

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)

Question 14

What do iCCAs arise from? eCCAs?

Answer 14

1. iCCA originates from adult cholangiocytes, trans- differentiation of adult hepatocytes and hepatic progenitor cells
2. eCCA arises from the biliary epithelium and peribiliary glands

Question 15

What is a big risk factor for cholangiocarcinomas?

Answer 15

Primary sclerosing cholangitis

PSC pts are recommended to get CA 19.9 serum testing and annual imaging for CCA surveillance

Question 16

What is the major risk factor for GB cancer? What polyps are a risk?

Answer 16

cholelithiasis

GB polyps > 10mm in diameter

Question 17

What IBD is associated with toxic megacolon?

Answer 17

UC

Question 18

How is chronic hepatitis classified?

Answer 18

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

Question 19

Pts with cirrhosis should receive what?

Answer 19

HAV, HBV, pneumococcal vaccines

yearly influenza vaccines

Question 20

What are atypical sx of celiac disease?

Answer 20

dermatitis herpetiformis (not present in IgA deficient pts)

iron deficiency anemia

osteoporosis

Question 21

What type of diarrhea is seen in bile salt malabsorption?

Answer 21

watery secretory diarrhea

Question 22

What are the significant lab values for pancreatic insufficiency?

Answer 22

decreased fecal chymotrypsin

decreased pancreatic fecal elastase

Question 23

How common is it for ppl w/ pancreatitis to develop DM?

Answer 23

80% develop DM after 25 yrs of chronic pancreatitis

Question 24

What is the pneumonic for chronic pancreatitis?

Answer 24

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)

Question 25

Where are bile salts reabsorbed?

Answer 25

terminal ileum

Question 26

Where is a biopsy performed to dx whipple dz?

Answer 26

duodenum –> do PAS to look for macrophages w/ bacilli

Question 27

Is weight loss characteristic of bile salt reabsorption?

Answer 27

it is minimal in this dz

Question 28

What lower GI complication is a complication of cystic fibrosis?

Answer 28

rectal prolapse

Question 29

What is CEA used for?

Answer 29

done before surgery to remove colon CA

also used as a marker of Tx

not for dx

Question 30

What is alpha fetoprotein a marker of?

Answer 30

hepatocellular CA

Question 31

What should you consider in a pt w/ painless jaundice, elevated CA 19-9, and hx of UC?

Answer 31

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