gastric cancer and intestinal disorders

Question 1

What are the 4 forms of gastric cancer?

Answer 1

2. ulcerating
3. polypoid- large, intraluminal neoplasms
4. supferficial spreading- mucosal and submucosal only; best prognosis
5. linitis plastica- all layers involved; poor prognosis

Question 2

What are common nodes that indicate gastric cancer spread? Where else does gastric cancer often spread?

Answer 2

• Sister mary joseph node- periumbilical; virchow node- left supraclavicular
• Krukenberg tumor- bilateral ovarian mets with lots of mucus and signet rings

Question 3

What is the treatment for gastric cancer?

Answer 3

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

Question 4

Where is the damage of celiac disease most prominent (what part of the intestines)?

Answer 4

jejunum; blunted duododenal and jejunal villi

Question 5

What other conditions are associated with celiac disease?

Answer 5

trisomy 21, dermatitis herpetiformis, IgA deficiency

Question 6

What is plummer vinson syndrome?

Answer 6

iron deficiency anemia, esophageal webs that cause dysphagia, and glossitis

Question 7

What is a basic approach to suspected malabsorption?

Answer 7

1. 2-3 day stool collection with Sudan stain, which assesses steatorrhea
2. 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
3. If Negative sudan test, do a stool pH. Low pH suggests lactase deficiency. Normal pH requires schilling test:

Question 8

What is the treatment for tropical sprue

Answer 8

folic acid replaceent, tetracycline

Question 9

What are the manifestations of Whipple disease?

Answer 9

CAN: neuropathy, cardiac sx, arthralgias
H/p: weight loss, joint pain, abd pain, diarrhea, dementia, cough, steatorrhea, vision changes LAD, new heart murmur, wasting

Question 10

What is the treatment of whipple disease?

Answer 10

TMP-SMX or ceftriaxone for 12 mo

Question 11

What is the definition of diarrhea? What is chronic vs acute diarrhea?

Answer 11

> 200 g/day of stool

acute diarrhea- less than 2 wks

Question 12

What are the most common causes of diarrhea in kids?

Answer 12

infection, abx, or immunosuppression

Question 13

What is the approach to diarrhea that has normal pH, normal colonoscopy?

Answer 13

get stool electrolytes and osmolality.

1. 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.
2. If 290- 2(Na+K)

Question 14

Chron’s or UC: perianal fissures

Answer 14

crohn’s disease

Question 15

What are key extraintestinal manifestatiosn of IBD?

Answer 15

-arthritis, ankylosing spondylitis, vueitis, primary sclerosing cholangitis. erythema nodosum and pyoderma gangrenosum especially with UC

Question 16

What are the keye labs in Crohn’s disease and UC?

Answer 16

Crohn’s: ASCA often positive (though not specific)

UC: p-ANCA positive

Question 17

Significantly increased risk of colon cancer: Crohn’s or UC?

Answer 17

UC

Question 18

What are the general treatments for IBD?

Answer 18

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