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PANCE 2.0 > GI #12 > Flashcards

GI #12 Flashcards

1
Q

What is Vitamin B2

A

Riboflavin

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2
Q

Symptoms of B2 deficiency

A

-Oral, ocular, and genital

  • Magenta colored tongue, glossitis, angular cheilitis, pharyngitis
  • Photophobia, corneal lesions
  • Scrotal dermatitis
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3
Q

What is Vitamin B1

A

Thiamine

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4
Q

Etiologies of Vitamin B1 deficiency?

A

-Chronic alcoholism (MC), weight loss surgery

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5
Q

Symptoms of B1 deficiency

A
  • 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.
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6
Q

Wernicke Encephalopathy is considered a neurologic emergency and common in

A

Chronic alcoholics

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7
Q

Treatment for Vitamin B1 deficiency

A

-IV thiamine followed by oral thiamine

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8
Q

What are some sources of Vitamin B3

A
  • Meats
  • Grains
  • Legumes
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9
Q

What is Vitamin B3

A

Niacin/Nicotinic Acid

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10
Q

Etiologies of B3 deficiency

A
  • Diets high in untreated corn
  • Diets which lack tryptophan
  • Alcoholism
  • Anorexia
  • Malabsorption
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11
Q

Symptoms of B3 deficiency

A

-Pellagra (3Ds): dermatitis, diarrhea, dementia

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12
Q

What is Vitamin B6

A

Pyridoxine

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13
Q

Causes of B6 deficiency

A
  • Chronic alcoholism
  • Isoniazid
  • Hydralazine
  • Levodopa + Carbidopa
  • OCP’s
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14
Q

Symptoms of B6 deficiency

A
  • Peripheral neuropathy, seizures, headache, mood changes
  • Stomatitis, flaky skin, glossitis, anemia, seborrheic dermatitis

-Neuro, Skin, Mouth

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15
Q

What are some sources of B12

A

Sources mainly animal in origin (meats, eggs, dairy)

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16
Q

What is Vitamin B12?

A

Cobalamin

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17
Q

Describe the absorption of B12

A

B12 is released by the acidity of the stomach and combines with intrinsic factor, where it is absorbed mainly by distal ileum

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18
Q

MCC of B12 deficiency?

A

Pernicious anemia (lack of intrinsic factor due to parietal cell antibodies, leading to gastric atrophy)

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19
Q

Other causes of B12 deficiency

A 
Crohn Disease
Chronic alcohol Use
Meds: H2 blockers, PPIs, Metformin, Hydroxyurea
Fish tapeworm
Vegan diet
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20
Q

Symptoms of B12 deficiency

A
  • Symmetric paresthesias
  • Lateral and posterior spinal cord demyelination (ataxia, sensory, vibratory, and proprioception deficits, decreased DTR), + Babinski, seizures, psychosis
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21
Q

How do you diagnose a patient with B12 deficiency?

A

CBC with peripheral smear

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22
Q

What is seen on a peripheral smear for B12 deficiency?

A
  • Increased MCV (macrocytic anemia)
  • Megaloblastic anemia (hyperhsegmented neutrophils , macroovalocytes)
  • Increased homocysteine, increased methylmalonic acid
23
Q

If the patient has symptomatic anemia or neuro findings with B12 deficiency, what treatment should you start with?

A

IM B12

-injection weekly until deficiency corrects, then once monthly. Oral after resolution of symptoms

24
Q

However, patients with pernicious anemia need

A

lifelong monthly IM therapy (or high dose oral therapy)

25
Q

What is the pathophysiology of acute pancreatitis?

A

Acinar cell injury –> intracellular activation of pancreatic enzymes –> auto digestion of pancreas

26
Q

What are the 2 MCC of acute pancreatitis

A

Gallstones (MC)

Alcohol abuse

27
Q

Other causes of acute pancreatitis?

A
  • Thiazides
  • Valproic Acid
  • Malignancy
  • Scorpion Sting
28
Q

Symptoms of acute pancreatitis

A
  • 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
29
Q

To diagnose acute pancreatitis, at least 2 of the following 3 things need to present.

A
  • 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
30
Q

True or False, if the patient meets the first 2 criteria of pancreatitis, no imaging is needed?

A

True

31
Q

What are the best initial tests for acute pancreatitis?

A

Increased amylase and lipase

-Lipase more specific

32
Q

ALT 3-fold increase is highly suggestive of

A

gallston pancreatitis

33
Q

What is another lab that is characteristic of acute pancreatitis

A

Hypocalcemia (necrotic fat binds to calcium, lowering serum calcium levels)

34
Q

What is the diagnostic imaging of choice for acute pancreatitis?

A

Abdominal CT

35
Q

What is seen on abdominal radiographs with acute pancreatitis?

A

Sentinel loop: localized ileus in LUQ

-Colon cutoff sign: abrupt collapse of colon near pancreas

36
Q

Management of acute pancreatitis

A
  • 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
37
Q

What score is used to determine prognosis with pancreatitis and what is the score classification?

A

Ranson’s Criteria

Score of 3 or more: Severe pancreatitis likely
Score of less than 3: Severe pancreatitis unlikely

38
Q

MCC of chronic pancreatitis

A

ETOH abuse

-Other causes: idiopathic, hyperlipidemia

39
Q

Clinical manifestation triad for chronic pancreatitis

A

-Calcifications
-Steatorrhea
-Diabetes Mellitus
(but only seen in 1/3 of patients)

Other symptoms: weight loss, back pain, epigastric pain

40
Q

True or False: Amylase and lipase are usually normal in chronic pancreatitis?

A

True

41
Q

A CT scan is diagnostic imaging of choice for chronic pancreatitis. What is seen?

A

Calcified pancreas.

42
Q

What is the most sensitive test for chronic pancreatitis?

A

-Pancreatic function testing (fecal elastase)

43
Q

Management for chronic pancreatitis

A
  • ETOH abstinence, pain control, low fat diet, vitamin supplementation
  • Oral pancreatic enzyme replacement
  • Pancreatectomy if no improvement
44
Q

70% of the cancers found in the pancreas are found in which part?

A

Head of the pancreas

45
Q

MC type of pancreatic carcinoma

A

Adenocarcinoma (ductal)

46
Q

Risk factors for pancreatic carcinoma

A
  • Smoking
  • > 55 years old
  • Chronic pancreatitis
  • Diabetes Mellitus
  • Obesity
  • African American
47
Q

Symptoms of pancreatic cancer

A
  • Usually presents late in disease after METS
  • Painless jaundice
  • Weight loss
  • Pruritus
  • Abdominal pain radiating to back
  • Dark urine
  • Acholic stools
48
Q

What are two physical exam findings associated with pancreatic carcinoma?

A
  • Courvoisier’s Sign: palpable, non tender, distended gallbladder
  • Trousseau’s Sign: migratory phlebitis
49
Q

Initial test of choice for pancreatic carcinoma

A

-CT scan

50
Q

If the CT is negative, what is the next step?

A

Endoscopic US with biopsy of pancreatic lesion

51
Q

However, if the CT is positive, what is the next step?

A

-Simultaneous surgical removal/biopsy

52
Q

What tumor markers are associated with pancreatic carcinoma?

A

CA 19-9 and CEA

53
Q

What is the surgical procedure for pancreatic carcinoma?

A 
Whipple Procedure (pancreaticoduodenectomy) 
-Post chemotherapy or radiation
54
Q

Pancreatic carcinoma is the _____ leading cause of cancer-related death in the US

A

Fourth

PANCE 2.0 (62 decks)

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