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STEP1 > Gi > Flashcards

Gi Flashcards

1
Q

Gastric adenoma risk

A

Chronic gastritis
- H pylori
- meds
- alcohol
Age >50

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2
Q

Gastric adenome px

A

Premalignant
Good it caught at this stage

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3
Q

Risk gastric adenoma →adenocarcinome

A

Flat lesion
Large > 2 cm
Highly dysplastic
-Irregular_architecture
_Cytologic atypia

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4
Q

Gastric Adenocarcinoma genes

A

-50%e-cadherin CDH1 LOF
Fap
β - catenin LOF dt-microsatellite_instability or hyper methylation
Tp53

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5
Q

Mx h pylori’s → cancer

A

Ros, proinflammatory cytokines
Decades
Virulence factor CagA → unregulated growth - not presentin all h. Pylori

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6
Q

Mx EBV → gastric c

A

~10% of gastric tumors
Poorly defined Mx

Tp53 mutation
Lymphocytic infiltrate

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7
Q

Lifestyle fx gastric cancer

A

Smoking
Alcohol
Obesity
High salt
Nitrate consumption - processed meatand fish
Birth outside US.
Asian, South American East Europe

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8
Q

Diffuse type gastric cancer

A

Younger pt
Fewer risk fx
Less likely precursor lesion
More likely e-cadherin orβ - catenin

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9
Q

Massintestinal type gastric AC

A

Distal stomach
Exophytic
Heaped up borders
Central ulceration
Typically mucousgland dysplasia

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10
Q

Diffuse type gastric Ac path

A

No focal site of origin
Infiltrative pattern
Excess collagen, fibroblasts 7 “ leather bottle” stomach
“Iceberg” small apparent mass bc deep infiltration

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11
Q

Tx gastric cancers

A

Total orpartial gastrectomy
Chemo in late stage, survival <20%

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12
Q

Malt lymphoma

A

Most often in stomach
H pylori → B cell proliferation →acquired mutations

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13
Q

Malt histology

A

Marginal zone b-cell lymphomas.
Mature lymphocytes
Invasion and destruction of gastric glands

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14
Q

Malt px/tx

A

W eradication of H pylori ‘ crr > 70%
Often noother tx but chemo, radiation, surgery in advanced

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15
Q

Gist

A

Gastrointestinal_stromal tumors
Tyr k mutations- go f
Interstitial cells of cajal

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16
Q

Gists site

A

Mostly stomach and si
Submucosal
Well circumscribed solitary mass

17
Q

Gist histo

A

Interstitial cells of cajal
Submucosal
Spindle alls

18
Q

Esophageal Ac

A

Often progression from barret’s esophagus
Distal 1/3 ofesophagus
Risk:
- chronic GERD
- obesity
- achalasia

19
Q

Esophageal SCC

A

More common
Upper 2/3 of esophagus
Risk:
- smoking
- alcoho
- hot Bev
R caustic agents
-Plummer Vinson syndrome:esophageal web

20
Q

Hepatic adenoma risk, demo

A

F 20-45 yo
OcPs and anabolic steroids
Glycogen storage disease
Dt Er on hepatocyses

21
Q

Hc_adenoma p x

A

Usually benign
Can → HCC or cause intraperitoneal hemorrhage
Bleeding in trauma

Resect

22
Q

HCC risk

A

Hep B, c ~75%
Any cirrhosis
Alcohol
Nafld
Aspergillus_toxins
Primary biliary cholangitis
Hereditary hemochromatosis
Wilson disease
α-1- antitrypsin def.

23
Q

Paraneoplastic syx in HCC

A

Insulin-like gf → hypoglycemia
EPO → erythrocytosis
PTHrP → hypercalcemia, osteoporosis
Watery diarrhea

24
Q

Biopsy HCC

A

Don’t do it, hemorrhage risk

25
Q

HCC tx 1px

A

Surgery
Chemo, radiation not generallyhelpful
30-50% 5 yr Os if resectable <6 mo if not

26
Q

Cholangiocarcinoma

A

Biliary tree, not gall bladder
Mucin-producing, moderate-to-poor differentiation

27
Q

Cholangiocarcinome risk

A

Primary sclerosing cholangitis
Clonorchis sinensis- Chinese liver fluke
Thorotrast-dc’d contrast dy e
Congenitalcholedochal cysts

28
Q

Cholangiocarcinoma st

A

Obstructive jaundice
Hepatonegoly
Palpable gall bladder

29
Q

Pancreatic carcinoma risk fx

A

Smoking
FHx
Obesity
Chronic pancreatitis
Alcoholism
Genetics

30
Q

Genetic syndromes pancreatic c

A

BRCA 1 and 2
PRSS1 -familial pancreatitis
Lynch-MLH1, MSH2, MSH6, PMS2, EPCAM
STK11 peutz jeghers
VHL - Von hippel lindau

31
Q

Mutations pancreatic c

A

KRAS, p16, p53
DPC4/SMAD4
HER2 ~50%

32
Q

Pancreatic c sx

A

If obstructing pancreatic duct
-Pain
- jaundice
- indigestion
- pruritis
- pale, smelly stools
- malabsorption
Tail = silent
Often d x stage 4 → metastatic sx

33
Q

Pancreatic c px marker

A

CA 19-9

34
Q

Chemo pancreatic.

A

Most common:
5-fu
Paclitaxel

35
Q

site of folate absorption

A

jejunum

36
Q

site of B12 absorption

A

ileum

37
Q

site of bile salt absorption

A

ileum

STEP1 (15 decks)

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