GI 2

Question 0

Esophageal cancer

Answer 0

Proximal 2/3: squamous cell carcinoma. Risk factors: alcohol, tobacco, achalasia, esophageal webs

Distal 1/3: adenocarcinoma. Risk factors: smoking but not alcohol, Barrets/GERD

Question 1

Esophageal cancer metastasizes to

Answer 1

Lung and liver

And mets from melanoma and breast cancer

Question 2

Hematemesis DDX

Answer 2

Frank blood: esophageal cancer, rupture (eating disorder? Huge food bolus?), varices (do you have liver dz?)

Coffee ground: gastric ulcer that hemorrhages, erosive gastritis (NSAIDs, alcohol, stress virus?)

Question 3

Symptom that indicates dysphagia due to esophageal cancer

Answer 3

Progressive! (No solids–> no liquids–> drooling)

Weight loss

Question 4

How to dx esophageal cancer

Answer 4

Endoscopy w biopsy

Question 5

Gastritis versus PUD

Answer 5

Erosive gastritis: caused by NSAIDs, alcohol, stress, radiation, viral. Sxs: dyspepsia, N/V, hematemesis, melena

Non erosive: caused by H pylori. Asx.

PUD: caused by H pylori, NSAIDs, cigarettes, family hx, Zollinger Ellison syndrome. Sxs: epigastric pain, relieved by food/antacids, burning/gnawing

Question 6

What predisposes patient for gastric cancer?

Answer 6

H pylori, autoimmune metaplastic atrophic gastritis

Question 7

Gastric ulcer versus duodenal ulcer Sxs

Answer 7

Gastric- no pattern

Duodenal- consistent pattern, better w food, worse 2-3 hrs after meal (post prandial), pain awakens pt at night

Question 8

Complications of PUD…

Answer 8

Hemorrhage
Penetration
Free perforation 
Gastric outlet obstruction
Recurrence
Gastric cancer

Question 9

Acute pancreatitis

Answer 9

Cause: chronic, heavy alcohol intake, biliary tract dz

Sxs: steady, boring, upper abdominal pain, radiating to back, N/V

Labs: 3x elevated amylase and lipase, elevated WBCs
X-rays: pancreatic duct calcification, US may show gallstone

Question 10

What is the pancreatic position?

Answer 10

Bent over, sitting froward, fetal position

Question 11

Classic triad of chronic pancreatitis

Answer 11

Pancreatic calculi, steatorrhea, DM

Question 12

Labs for acute vs chronic pancreatitis vs pancreatic cancer

Answer 12

Acute: very high amylase and lipase
Chronic: normal to low
Cancer: normal to low amylase and lipase, high alk phos and bilirubin

Question 13

Chronic pancreatitis Sxs

Answer 13

Post-prandial pain is dominant sx. Episodic, hours-days

Dx based on Sxs and history

Question 14

Pancreatic cancer

Answer 14

Serious dx if found late (90%).
Sxs: severe abdominal pain, wt loss, jaundice and pruritis (head), splenomegaly, gastric/esophageal varices (body and tail); diabetes in 25-30%

Question 15

Hepatitis B virus

Answer 15

Acute–> chronic, cirrhosis, hepatocellular carcinoma

Risks: dialysis, oncology pts, IV drug users, sex workers, closed institutions

Question 16

Hepatitis C Virus

Answer 16

Acute–> chronic (75%), cirrhosis, hepatocellular carcinoma

Risks: blood, IV drugs, tattoos, sexual transmission

Question 17

Chronic hepatitis

Answer 17

Sxs: asx!! May have malaise, anorexia, fatigue, jaundice absent, may be upper abdominal discomfort

PE: splenomegaly, palmar erythema, spider nevi

Question 18

Alcoholic liver disease

Answer 18

Fatty liver–> alcoholic hepatitis –> cirrhosis

Sxs: vascular spiders, peripheral neuropathy, Dupuytren’s contractures of palmar fascia, folate/thiamin def, confabulation
Labs: high: **AST> ALT, elevated GGT, if severe: high serum bilirubin and high PT/INR

Question 19

Post prandial pain DDX

Answer 19

Chronic pancreatitis and duodenal ulcer