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GI Flashcards

1
Q

What is the most important risk factor for adenocarcinoma and why?

A

GERD; causes barret’s esophagus

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2
Q

What does Barret’s metaplasia due?

A

Changes squamous to Columnar/Intestinal (glandular) epithelium

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3
Q

Squamous cell carcinoma affects which part of the esophagus?

A

Mid portion (upper 2/3)

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4
Q

Adenocarcinoma affects which part of the esophagus?

A

Lower 1/3

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5
Q

Gold standard for the diagnosis of esophageal cancer?

A

Endoscopic tissue biopsy

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6
Q

Best for staging esophageal cancers?

A

1) Endoscopy
2) PET
3) Chest and abdominal CT
4) EUS

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7
Q

Gold standard for diagnosing T stage of esophageal cancer?

A

EUS

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8
Q

Gold standard for diagnosing N stage of esophageal cancer?

A

EUS + CT and PET

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9
Q

Gold standard for diagnosing M stage of esophageal cancer?

A

CT and PET

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10
Q

Stage 1 esophageal cancer treatment?

A

Esophagectomy

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11
Q

Stage 2+3 esophageal cancer treatment?

A

Neoadjuvent therapy followed by esophagectomy

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12
Q

When do you do a gastrectomy?

A

Below GEJ involving the cardia (Siewert III)

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13
Q

Black gallstones are mainly made up of?

A

Calcium Carbonate

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14
Q

Brown gallstones are mainly made up of?

A

Calcium Palmitate

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15
Q

Black gallstones are formed in?

A

The gallbladder

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16
Q

Brown gallstones are formed in?

A

The billiary tree

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17
Q

What does hydroxylase do to free cholesterol ester?

A

Turns them into bile salt

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18
Q

What does ACAT do to free cholesterol ester?

A

Turns them to cholesterol ester

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19
Q

What can cause cholesterol saturation?

A

1) Increased secretion of cholesterol
2) Decreased secretion of bile salts
3) Decreased secretion of lecithin

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20
Q

Why do gallstones form in a defective gallbladder?

A

1) Impaired absorptive capacity = ↑tendency of nucleation.

2) Impaired secretion: lack of bile
acidification→ precipitation of Ca
palmitate+Ca bilirubinate+Ca carbonate→Nidus.

3) Impaired motility:
a) Impaired contraction:→↑fasting
volume→ ↑residual volume→↓rate of emptying▬►stasis (obesity,pregnancy, DM,TPN,post-gastrectomy).
b) Accelerated emptying▬►shrinkage of
bile acid pool→saturated bile.

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21
Q

Gallbladder risk factors?

A

1) Elevated estrogen
2) Obesity
3) Rapid weight loss
4) Spinal cord injury & disease with terminal ileum
5) Age
6) Hyperlipidemia
7) Intestinal hypomotility
a) Viral,drug induced
b) Diabetes
c) Increased production of lithogenic secondary bile acids
(deoxycholate)
9) Long term parenteral nutrition

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22
Q

Which drugs can cause gallbladder stones?

A

1) Ceftriaxone (Rocephin)
2) Octreotide

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23
Q

Pathogenesis of pigmented stones?

A

Increase in Beta-Glucuronidase

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24
Q

Pathogenesis of brown stones specifically?

A

Chronic low-grade infections

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25
Pathogenesis of black stones specifically?
Mucosa of gallbladder/billiary tree
26
What is peritonitis?
Inflammation of the serous lining of the peritoneal cavity
27
What are the causes of peritonitis?
1) Microorganisms 2) Chemicals 3) Foreign body
28
Risk factors of primary peritonitis?
1) Liver cirrhosis with ascites 2) Chronic ambulatory peritoneal dialysis 3) Abdominal catheters connecting to exterior body
29
Most common cause of Intra-abdominal abscess?
Appendicitis
30
On which side do you usually find colorectal polyps?
Left
31
Which type of colorectal polyp is most common?
Adenomatous polyps
32
Which type of colorectal polyp is most common?
Adenomatous polyps
33
What size are most adenomas?
<1cm
34
Adenomas are classified according to?
The growth pattern of the glands
35
Tubular adenomas?
0 to 25% of the glands are villous (MOST COMMON)
36
Tubulovillous adenomas?
25 to 75% of the glands are villous
37
Villous adenomas?
75-100% of the glands are villous
38
Which is more dangerous: a colorectal polyp on the right or the left side?
The right side
39
FAP is associated with which mutation?
APC gene
40
What is the risk of cancer in FAP?
100%
41
What is the blood supply of the appendix?
The appendiceal artery, is a terminal branch of the ileocolic artery
42
On which side do you usually find colorectal cancer?
Left
43
Which 2 inherited syndromes predispose to colorectal cancer?
1) FAP 2) Lynch syndrome (HNPCC)
44
Mutation in Lynch (HNPCC)?
Mismatched repair genes
45
Investigation for a rectal tumor?
Pelvic MRI
46
Which blood test is important before and after colorectal surgery?
Serum CEA levels
47
Can we give neoadjuvent therapy for colon cancer?
No, it can damage the small bowel. Go straight to surgery
48
Younger age is a risk factor for what in diverticular disease?
Recurrence
49
How to diagnose diverticulitis?
CT
50
Diverticulitis treatment?
Antibiotics
51
The high frequency of liver metastasis is caused by:
1) The liver's vast blood supply, which originates from portal and systemic systems. 2) The fenestrations of the hepatic sinusoidal endothelium may facilitate penetration of malignant cells into the hepatic parenchyma. 3) Humoral factors that promote cell growth and cellular factors, such as adhesion molecules, favor metastatic spread to the liver. 4) The liver's geographic proximity to other intra-abdominal organs may allow malignant infiltration by direct extension.
52
Best imaging for liver mets?
Ultrasound
53
Which cancer is most likely to metastasize to the liver?
Colorectal cancer
54
Best management for liver mets?
Hepatectomy (resection)
55
Where do carcinoid tumors originate?
Enterochromaffin cells
56
Midgut carcinoids secrete large amounts of what?
5-HT (Serotonin)
57
WHAT MAKES CARCINOIDS METASTASIZE?
THEIR SIZE!!!
58
What is highly specific for carcinoid syndrome?
Elevated urine levels of 5-HIAA
59
Treatment of local carcinoid tumors?
Resection with lymph drainage
60
Adenocarcinoma + Crohn's in ileum = good or bad prognosis?
Bad
61
Poor prognostic factor in gastric cancer?
The T stage (how much it invaded the wall)
62
What would a FAST exam reveal?
Hypoechoic rim on the spleen
63
What are the 2 rules of surgery in acute ulcerative colitis?
1) Stool frequency >8 times a day or CRP >45 for 3 days (not getting better) 2) IV steroids for 5 days (not getting better)
64
Best surgery in acute ulcerative colitis?
Subtotal colectomy and ileostomy
65
Best surgery in acute ulcerative colitis?
Subtotal colectomy and ileostomy
66
Which cancer is the most common pancreatic cancer?
Ductal adenocarcinoma
67
The most common presenting symptoms in pancreatic cancer are:
1) Pain 2) Jaundice 3) Weight loss
68
What sign do we look for on ERCP in pancreatic cancer?
"Double duct sign" = Dilation of both the pancreatic duct and the common bile duct
69
What is the only potentially curative modality of treatment for pancreatic cancer?
Complete surgical resection

Surgery (7 decks)

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