GI #12 Flashcards
What is Vitamin B2
Riboflavin
Symptoms of B2 deficiency
-Oral, ocular, and genital
- Magenta colored tongue, glossitis, angular cheilitis, pharyngitis
- Photophobia, corneal lesions
- Scrotal dermatitis
What is Vitamin B1
Thiamine
Etiologies of Vitamin B1 deficiency?
-Chronic alcoholism (MC), weight loss surgery
Symptoms of B1 deficiency
- Dry Beriberi: nervous system changes (peripheral neuropathy, paresthesias), cramps, muscle wasting
- Wet Beriberi: high output heart failure and dilated cardiomyopathy
- Wernicke encephalopathy: ataxia + global confusion + ophthalmoplegia (paralysis of ocular muscles)
- Korsakoff Dementia: short term memory loss and confabulation.
Wernicke Encephalopathy is considered a neurologic emergency and common in
Chronic alcoholics
Treatment for Vitamin B1 deficiency
-IV thiamine followed by oral thiamine
What are some sources of Vitamin B3
- Meats
- Grains
- Legumes
What is Vitamin B3
Niacin/Nicotinic Acid
Etiologies of B3 deficiency
- Diets high in untreated corn
- Diets which lack tryptophan
- Alcoholism
- Anorexia
- Malabsorption
Symptoms of B3 deficiency
-Pellagra (3Ds): dermatitis, diarrhea, dementia
What is Vitamin B6
Pyridoxine
Causes of B6 deficiency
- Chronic alcoholism
- Isoniazid
- Hydralazine
- Levodopa + Carbidopa
- OCP’s
Symptoms of B6 deficiency
- Peripheral neuropathy, seizures, headache, mood changes
- Stomatitis, flaky skin, glossitis, anemia, seborrheic dermatitis
-Neuro, Skin, Mouth
What are some sources of B12
Sources mainly animal in origin (meats, eggs, dairy)
What is Vitamin B12?
Cobalamin
Describe the absorption of B12
B12 is released by the acidity of the stomach and combines with intrinsic factor, where it is absorbed mainly by distal ileum
MCC of B12 deficiency?
Pernicious anemia (lack of intrinsic factor due to parietal cell antibodies, leading to gastric atrophy)
Other causes of B12 deficiency
Crohn Disease Chronic alcohol Use Meds: H2 blockers, PPIs, Metformin, Hydroxyurea Fish tapeworm Vegan diet
Symptoms of B12 deficiency
- Symmetric paresthesias
- Lateral and posterior spinal cord demyelination (ataxia, sensory, vibratory, and proprioception deficits, decreased DTR), + Babinski, seizures, psychosis
How do you diagnose a patient with B12 deficiency?
CBC with peripheral smear
What is seen on a peripheral smear for B12 deficiency?
- Increased MCV (macrocytic anemia)
- Megaloblastic anemia (hyperhsegmented neutrophils , macroovalocytes)
- Increased homocysteine, increased methylmalonic acid
If the patient has symptomatic anemia or neuro findings with B12 deficiency, what treatment should you start with?
IM B12
-injection weekly until deficiency corrects, then once monthly. Oral after resolution of symptoms
However, patients with pernicious anemia need
lifelong monthly IM therapy (or high dose oral therapy)
What is the pathophysiology of acute pancreatitis?
Acinar cell injury –> intracellular activation of pancreatic enzymes –> auto digestion of pancreas
What are the 2 MCC of acute pancreatitis
Gallstones (MC)
Alcohol abuse
Other causes of acute pancreatitis?
- Thiazides
- Valproic Acid
- Malignancy
- Scorpion Sting
Symptoms of acute pancreatitis
- Epigastric pain: constant, boring pain that radiates to the back. Pain worse if supine or eating. Relieved with leaning forward, sitting, or fetal position.
- Nausea, vomiting, fever
- Epigastric tenderness
- Cullen’s Sign: periumbilical ecchymosis
- Grey Turner Sign: flank ecchymosis
To diagnose acute pancreatitis, at least 2 of the following 3 things need to present.
- Acute onset of pain radiating to the back
- Elevation in serum lipase or amylase 3 times greater than upper limit of normal
- Characteristic findings of pancreatitis on US, CT, MRI
True or False, if the patient meets the first 2 criteria of pancreatitis, no imaging is needed?
True
What are the best initial tests for acute pancreatitis?
Increased amylase and lipase
-Lipase more specific
ALT 3-fold increase is highly suggestive of
gallston pancreatitis
What is another lab that is characteristic of acute pancreatitis
Hypocalcemia (necrotic fat binds to calcium, lowering serum calcium levels)
What is the diagnostic imaging of choice for acute pancreatitis?
Abdominal CT
What is seen on abdominal radiographs with acute pancreatitis?
Sentinel loop: localized ileus in LUQ
-Colon cutoff sign: abrupt collapse of colon near pancreas
Management of acute pancreatitis
- 90% recover without complications in 3-7 days. Rest the pancreas!
- Supportive: NPO, High volume IV fluids (Lactated ringers). Analgesia (Demerol, Meperidine)
- ABX: Imipenem may be used if >30% necrosis on MRI, CT
What score is used to determine prognosis with pancreatitis and what is the score classification?
Ranson’s Criteria
Score of 3 or more: Severe pancreatitis likely
Score of less than 3: Severe pancreatitis unlikely
MCC of chronic pancreatitis
ETOH abuse
-Other causes: idiopathic, hyperlipidemia
Clinical manifestation triad for chronic pancreatitis
-Calcifications
-Steatorrhea
-Diabetes Mellitus
(but only seen in 1/3 of patients)
Other symptoms: weight loss, back pain, epigastric pain
True or False: Amylase and lipase are usually normal in chronic pancreatitis?
True
A CT scan is diagnostic imaging of choice for chronic pancreatitis. What is seen?
Calcified pancreas.
What is the most sensitive test for chronic pancreatitis?
-Pancreatic function testing (fecal elastase)
Management for chronic pancreatitis
- ETOH abstinence, pain control, low fat diet, vitamin supplementation
- Oral pancreatic enzyme replacement
- Pancreatectomy if no improvement
70% of the cancers found in the pancreas are found in which part?
Head of the pancreas
MC type of pancreatic carcinoma
Adenocarcinoma (ductal)
Risk factors for pancreatic carcinoma
- Smoking
- > 55 years old
- Chronic pancreatitis
- Diabetes Mellitus
- Obesity
- African American
Symptoms of pancreatic cancer
- Usually presents late in disease after METS
- Painless jaundice
- Weight loss
- Pruritus
- Abdominal pain radiating to back
- Dark urine
- Acholic stools
What are two physical exam findings associated with pancreatic carcinoma?
- Courvoisier’s Sign: palpable, non tender, distended gallbladder
- Trousseau’s Sign: migratory phlebitis
Initial test of choice for pancreatic carcinoma
-CT scan
If the CT is negative, what is the next step?
Endoscopic US with biopsy of pancreatic lesion
However, if the CT is positive, what is the next step?
-Simultaneous surgical removal/biopsy
What tumor markers are associated with pancreatic carcinoma?
CA 19-9 and CEA
What is the surgical procedure for pancreatic carcinoma?
Whipple Procedure (pancreaticoduodenectomy) -Post chemotherapy or radiation
Pancreatic carcinoma is the _____ leading cause of cancer-related death in the US
Fourth
