GI 1 (Step up son) Flashcards
What causes viral gastro in adults? Kids?
Norwalk virus*
Coxsackie
Echovirus
Adenovirus
Rotavirus
What is the most common foodborne bacterial GI infection?
Salmonella (causes bloody diarrhea)
What pathogen in undercooked pork can cause GI and/or CNS symptoms? How is it treated?
Taenia solium
GI: praziquantel
CNS: albendazole + corticosteroid
Patient has a hard time swallowing solids, but does okay with liquids. What type of dysphagia is this?
Obstructive
Patient has a hard time swallowing solids and liquids. What type of dysphagia is this?
Neuromuscular
What are secondary causes of achalasia?
Chagas disease
Neoplasm
Scleroderma
Patient has chest pain and dysphagia. so you get a barium swallow and it shows a corkscrew. What is this?
Diffuse esophageal spasm
Nitrates relieve pain…if it were GERD, it would worsen the pain
What kind of esophageal cancer is most common world wide? In the US?
Squamous cell carcinoma
Adenocarcinoma
There are two types of chronic gastritis: Type A in the fundus (10%) and Type B in the antrum (90%). What causes Type A? what are associated conditions?
Autoantibodies for parietal cells
Pernicious anemia
Achlorhydria
Thyroiditis
There are two types of chronic gastritis: Type A in the fundus (10%) and Type B in the antrum (90%). What causes Type B? what are associated conditions?
H. pylori
PUD
Gastric cancer
What are Curling ulcers? Cushing ulcers?
Curling ulcers are secondary to stress from a severe burn
Cushing ulcers are from intracranial injuries
Which artery is concerning when it comes to PUD?
Gastroduodenal artery…posterior ulcers can erode into it
Where are Zollinger-Ellison tumors usually located?
Duodenum (70%)
Pancreas
There are four types of gastric cancers: Ulcerating, Polypoid, Superficial spreading, and Linitis plastica. Which has the best prognosis? Worst?
Superficial spreading has the best prognosis
Linitis plastica (all layers are involved) has a poor prognosis
What are some signs of a gastric cancer outside of gastric symptoms? Abnormal lab?
Virchow node (left supraclavicular lymph node) Sister Mary Joseph node (Periumbilical node)
Carcinoembryonic Antigen (CEA)
When would a D-xylose test be ordered (for malabsorption)? what does it indicate?
D-xylose is ordered if patient has a positive Sudan stain (indicates steatorrhea)
Normal D-xylose –> assess for pancreatic insufficiency
Abnormal D-xylose –> small biopsy (sprue vs whipple vs bacterial overgrowth)
When is a Schilling test done (for malabsorption)? What does it indicate?
Schilling test is done when a Sudan stain is negative and stool has a normal pH
Abnormal 1st stage and normal 2nd stage –> Pernicious anemia
Abnormal 1st and 2nd stages –> consider ileal disease or bacterial overgrowth
A patient comes in concerned about diarrhea, weight loss, joint pain, fever, and vision changes. On exam, found to have a new heart murmur. What is a likely diagnosis? What test should be done? How should it be treated?
Whipple disease (tropheryma whippelii)
Jejunal biopsy: periodic acid-Schiff (PAS) stain –> foamy macrophages; villous atrophy
Bactrim or ceftriaxone x 12months…often fatal if untreated
A patient is being worked up for chronic diarrhea and is found to have a high osmotic gap (290 -2[Na+ + K+]) > 125. What should be done next? what does it indicate?
Sudan test…looks for fat
Normal fat –> laxative abuse
High fat –> workup for malabsorption or pancreatic disorder
A patient is being worked up for chronic diarrhea and is found to have a high osmotic gap (290 -2[Na+ + K+]) less than 50. What should be done next? what does it indicate?
Weigh stool
normal –> IBS
Increased –> laxative abuse
What are the Manning criteria for IBS?
Pain relief w/ defecation More frequent poops following onset of pain Looser poops following onset of pain Visible abdominal distention Passage of mucus with stool Feeling of incomplete emptying
Likelihood of IBS increases with each criteria met
In differentiating b/w Crohn’s and UC, which has increased antiyeast Saccharomyces cerevisiae antibodies (ASCA)?
Crohn’s
In differentiating b/w Crohn’s and US, which has increased pANCA?
UC
What is the cure for UC? Should it be considered?
Colectomy…should be done, significantly increased risk of CRC w/ UC
What hurts more, ischemic colitis or small bowel ischemia?
Small bowel ischemia…tender out of proportion to exam
What is the most common cause of acute lower GI bleeding in patients >40yo?
Diverticulosis
What is a carcinoid tumor? Where do they often locate?
Tumor that arises from neuroectodermal cells that function in amine precursor uptake and decarboxylation (APUD)
Bronchopulmonary tree, ileum, rectum, appendix
When does a carcinoid tumor really become symptomatic? What are the symptoms?
When there are liver or extragastrointestinal involvement
Serotonin secretion –> flushing, diarrhea, bronchoconstriction, tricuspid/pulmonary valvular disease
How are carcinoid tumors treated?
Tumors less than 2cm –> resection
Tumors greater than 2cm –> extensive resection
Metastatic disease –> IFN-alpha, octreotide, and embolization
Where does CRC typically metastasize to?
Lung
Liver
What is Gardner syndrome?
FAP + bone and soft tissue cancers
A patient has mucocutaneous pigmentation of mouth, hands, and genitals. What should be looked for?
Peutz-Jeghers syndrome…hamartoma polyps with low risk of malignancy
A patient has many colonic adenomas and comorbid malignant CNS tumors. What does this person have?
Turcot syndrome…highly malignant
Where can polyps with juvenile polyposis be?
colon, small bowel, and stomach…often cause GI bleeding
slightly increased risk of malignancy later in life
