gastric cancer and intestinal disorders Flashcards
What are the 4 forms of gastric cancer?
- ulcerating
- polypoid- large, intraluminal neoplasms
- supferficial spreading- mucosal and submucosal only; best prognosis
- linitis plastica- all layers involved; poor prognosis
What are common nodes that indicate gastric cancer spread? Where else does gastric cancer often spread?
- Sister mary joseph node- periumbilical; virchow node- left supraclavicular
- Krukenberg tumor- bilateral ovarian mets with lots of mucus and signet rings
What is the treatment for gastric cancer?
subtotal gastrectomy for lesions in the distal 1/3 of stomach; total gastrectomy for lesions in the middle or upper stomach or invasive lesions; adjuvant chemo and radiation
Where is the damage of celiac disease most prominent (what part of the intestines)?
jejunum; blunted duododenal and jejunal villi
What other conditions are associated with celiac disease?
trisomy 21, dermatitis herpetiformis, IgA deficiency
What is plummer vinson syndrome?
iron deficiency anemia, esophageal webs that cause dysphagia, and glossitis
What is a basic approach to suspected malabsorption?
- 2-3 day stool collection with Sudan stain, which assesses steatorrhea
- If positive sudan stain, do a D-xylose test. If normal, assess for pancreatic insufficiency. If abnormal, do a small bowel biopsy to look for celiac, whipple disease, bacterial overgrowth. Note that this test is uncommon now due to antibody testing
- If Negative sudan test, do a stool pH. Low pH suggests lactase deficiency. Normal pH requires schilling test:
What is the treatment for tropical sprue
folic acid replaceent, tetracycline
What are the manifestations of Whipple disease?
CAN: neuropathy, cardiac sx, arthralgias
H/p: weight loss, joint pain, abd pain, diarrhea, dementia, cough, steatorrhea, vision changes LAD, new heart murmur, wasting
What is the treatment of whipple disease?
TMP-SMX or ceftriaxone for 12 mo
What is the definition of diarrhea? What is chronic vs acute diarrhea?
> 200 g/day of stool
acute diarrhea- less than 2 wks
What are the most common causes of diarrhea in kids?
infection, abx, or immunosuppression
What is the approach to diarrhea that has normal pH, normal colonoscopy?
get stool electrolytes and osmolality.
- If 290-2(Na+K) is >125, you have an osmotic diarrhea. do sudan stain (looks at fecal fat). If normal, consider laxative abuse. If high, consider malapsorption or pancreatic disorder.
- If 290- 2(Na+K)
Chron’s or UC: perianal fissures
crohn’s disease
What are key extraintestinal manifestatiosn of IBD?
-arthritis, ankylosing spondylitis, vueitis, primary sclerosing cholangitis. erythema nodosum and pyoderma gangrenosum especially with UC
What are the keye labs in Crohn’s disease and UC?
Crohn’s: ASCA often positive (though not specific)
UC: p-ANCA positive
Significantly increased risk of colon cancer: Crohn’s or UC?
UC
What are the general treatments for IBD?
mesalamine, steroids, immunosuppressives.
abx used for Crohn’s iron given for UC (because of the blood loss)
surgery is used in both, but colectomy can be curative for UC
