GI Flashcards
1
Q
third most common cancer in US men
A
crc
2
Q
third most common cancer in us women
A
crc
3
Q
what kind of cancer gives rise to crc
A
virtually always adenomas – endoluminal adenocarcinomas
rarely carcinoid, lymphoma, kaposi sarcoma
4
Q
5 screening tests for crc
+1 for monitoring
A
fobt dre colonoscopy flexible sigmoidoscopy barium enema cea carcinoembryonic antigen
5
Q
sn and sp and ppv of fobt for crc?
A
sn sp poor
ppv ~20%
if positive get colonoscopy
6
Q
what % crc palpable by dre?
A
~10%
7
Q
what is the most sn and sp test for crc
A
colonoscopy
8
Q
diagnostic test of choice following +fobt
A
colonoscopy
9
Q
is colonoscopy diagnostic or therapeutic?
A
both
biopsy
polypectomy
10
Q
what % of polyps and cancers can be reached by flexible sigmoidoscopy?
A
50-70%
11
Q
how long is the flexible sigmoidoscope
A
60 CM
12
Q
is a flexible sigmoidoscopy longer or shorter than a colonoscope
A
shorter 60 CM only needs to reach sigmoid which is distal
13
Q
flexible sigmoidoscopy his diagnostic in roughly what percentage of CRC’s
A
two thirds
14
Q
when is barium enema used to screen for crc
A
to eval entire colon, complementary to flex sigmoidoscopy
15
Q
if abnormal finding on barium enema what is next step
A
colonoscopy
16
Q
True or false carcinoembryonic antigen CEA is useful for screening
A
false
use for establishing a baseline, monitoring treatment efficacy, surveilling for recurrence
17
Q
T/F CEA carcinoembryonic antigen has prognostic significance for crc
A
T
Preoperative CEA >5 NG/ML has worse prognosis
18
Q
how is colorectal cancer clinically staged
A
CT scan chest abdomen pelvis
Physical exam ascites hepatomegaly lymphadenopathy
19
Q
describe for patterns of colorectal cancer spread
A
Direct extension – circumferential then through the wall to invade other abdominoperineal organs
Hematogenous – portal circulation to liver, lumbar/vertebral veins to lungs
lymphatic - regionally
Transperitoneal and intraluminal
20
Q
what is the most common sight of distant spread of crc
A
liver
21
Q
how does colorectal cancer spread to the lungs
A
Hematogenously via lumbar and vertebral veins
22
Q
T/F
All CRC’s bleed all the time
A
F
Some bleed intermittently some not at all
23
Q
at what age does colon cancer screening begin
A
age 50 is standard
Begin at age 40 if one family history of colon cancer, or 10 years before onset of family member
24
Q
what % CRC presents already with mets
A
~20%
25
spontaneous substernal / interscapular pain, odynophagia to hot/cold foods are suggestive of...
esophageal spasm
26
T/F resolution of C/P w nitroglycerin is consistent with esophageal spasm
T
| nitrates and CCBs relax coronary vessel myocytes And esophageal myocytes as well
27
esophageal spasm suspected, diagnostic test of choice is...
esophageal manometry
| shows repetitive, non-peristaltic, high-amplitude contractions either spontaneously or after ergonovine stim
28
substernal pain radiating to back precipitated by emotional stress is more indicative of esophageal spasm or GERD?
more consistent w motility disorder
e.g. esophageal spasm
GERD more often "burning" not radiating, assoc w inflammation on endoscopy (spasm not)
29
If GERD suspected, diagnostic test of choice is...
trial of PPI
| Not 24 hr pH monitoring
30
how does duration of pain help differentiate between esophageal spasm and prinzmental variant angina
several hours more consistent w e spasm
| p v angina much shorter...
31
esophageal spasm can be provoked by food and ___
emotional stress
32
___ establishes dx of diffuse esophageal spasm
manometry
33
HAV is
RNA or DNA
what virus family
RNA
| picornavirus picoRNAvirus
34
Hep A
| acute or chronic
acute
| hep A, Acute
35
which hep viruses have fecal oral transmission
A E
| fEcAl oral
36
7 symptoms of HAV infection
```
acute onset
malaise
fatigue
anorexia
N
V
mild abdominal pain
aversion to smoking
```
37
aversion to smoking in setting of acute malaise, anorexia, mild abdominal pain, N/V, jaundice suggests
Hep A
38
T/F hepatomegaly is commonly seen w HAV infection
T
39
LFT pattern in HAV infection
AST & ALT spike early
| then Bili and Alk Phos
40
natural hx of hep A
self-limiting
complete recovery in 3-6 wks w supportive therapy
no chronic hepatitis, cirrhosis, or hepatocellular carcinoma
41
T/F cirrhosis and hepatocellular ca are part of natural hx of HAV
F
self-limiting
no chronic hepatitis, cirrhosis, or hepatocellular carcinoma
42
T/F hep A infection is self-limiting
T
| no chronic hepatitis, cirrhosis, or hepatocellular carcinoma
43
mortality rate of HAV infection
44
what lab value indicates increased mortality risk from HAV infection?
prolonged PT
| mortality rate
45
treatment of HAV infection
supportive therapy
| full recovery expected in 3-6 weeks
46
who should get HAV immune globulin?
close contacts of infected HAV
47
who should get HAV vaccine?
those with increased risk
living or traveling to endemic area
chronic liver disease
clotting factor disorders
MSM
48
HBV
| DNA or RNA?
DNA
49
incubation period of HBV
30-180 days
50
onset of HBV
| acute or insidious?
insidious typically
51
transmission of HBV
sexually
parenterally
vertically
52
rate of chronic hepatitis from HBV in immunocompetent
1-2% immunocompetent adults
| 90% newborns
53
rate of chronic hepatitis from HBV in newborns
90% newborns
| 1-2% in immunocompetent adults
54
HCV
| DNA or RNA
RNA
55
incubation period HCV
40-50 days
56
T/F clinical HCV infection is severe
F
| clinical HCV illness is mild and often asymptomatic
57
HCV transmission
primarily parenterally
| sex & vertical possible
58
rate of chronic hepatitis from HCV
>80%
| ^risk of cirrhosis and hepatocellular ca
59
T/F the rate of chronic hepatitis from HBV is 80%
F
HCV >80%
HBV 1-2% in immunocompetent adults
60
T/F rate of chronic hepatitis from HCV is 1-2%
F
HBV 1-2% in immunocompetent adults
HCV >80% chronic
61
chronic hepatitis ^risk of __ and __
cirrhosis and hepatocellular ca
62
HDV
| DNA or RNA?
incomplete RNA
63
this hep virus only causes hepatitis in assoc with this other hep virus
HDV only assoc w HBV
64
transmission of HDV
percutaneous
sexual
perinatal
65
T/F HBV infection is typically subclinical
F
HDV superinfection on chronic HBV can result in
fulminant hepatitis and rapid cirrhosis
66
T/F mono can cause hepatitis
T
67
6 signs and symptoms of infectious mononucleosis
```
sore throat
fever
LAN
rash
splenomegaly
hepatitis possible
```
68
mono typically affects...
adolescents and young adults
69
name 2 broad categories of info that help differentiate hepatitis virus infections
epidemiological (transmission route, incubation period, risk factors, etc)
serological testing to confirm
70
smooth "bird beak" narrowing at GE junction on barium esophagram
achalasia
| impaired peristalsis of distal esophagus and impaired relaxation of LES
71
T/F regurg can be associated with achalasia
T
| but so can difficulty belching...
72
T/F difficulty belching can be associated with achalasia
T
| but so can regurg...
73
patients on average have smx for how long before achalasia dxd?
5 years
| often initially dxd w GERD
74
impaired peristalsis of distal esophagus and impaired relaxation of LES
achalasia
75
achalasia
impaired peristalsis of distal esophagus and impaired relaxation of LES
76
why is swallowing easier in upright position w achalasia?
helps esophageal pressure column increase above closing pressure of LES
77
most sensitive diagnostic test for achalasia
manometry
78
T/F barium esophagram is the diagnostic test of choice for achalasia
F
manometry = TOC
barium esophagram bird beak sign helpful if manometry not diagnostic
79
when to consider barium esophagram for suspected achalasia
manometry not diagnostic
| then bird beak sign on barium esophagram helpful
80
what kinds of solids are especially difficult early in dysphagia
bread and meat
81
esophageal webs are most commonly located in which part of the esophagus?
upper
82
Are esophageal webs assoc w mild or severe dysphagia?
mild
mild focal narrowing
dysph to solids but not liquids
83
what kind of esophageal obstruction is associated with iron deficiency
esophageal webs
| Plummer-Vinson syndrome
84
Plummer-Vinson syndrome is associated with what nutritional deficiency and what esophageal abnorm?
iron deficiency
| esophageal webs
85
globus sensation
sensation of lump in back of throat
86
T/F globus sensation is a functional disorder that does not cause any abnormalities on barium esophagram
T
87
T/F polymyositis can present w dysphagia
T
affects striated muscle in upper 1/3 of esoph
assoc w other muscle weakness (diff climbing stairs)
88
What part of the esophagus to polymyositis typically affect
upper 1/3 (striated muscle)
| dysphagia, diff climbing stairs (muscle weakness)
89
why does polymyositis affect the area of the esophagus that it does?
affects striated muscle, so upper 1/3 of esophagus
90
where does Zenker diverticulum occur?
cricopharyngeal level of esophagus
91
typical presentation of Zenker diverticulum
age >60
dysphagia, halitosis, fullness of throat
(outpouching at cricopharyngeal esophagus)
92
the Key diagnostic test for achalasia is
manometry
| barium swallow if manometry not diagnostic... looking for bird beak sign
93
pt discovered w + anti-HCV abs
| what is best initial treatment?
HAV and HBV vaccine if not already immune
All pts w chronic liver disease should get HAV and HBV vaccs as high risk for acute hepatic failure/cirrhosis upon infection with one of these
94
when is prednisone used in tx of hepatitis
severe alcoholic hepatitis
95
presentation of alcoholic hepatitis
fever
abdominal pain
jaundice
N/V
96
what is lamivudine and what does it treat
RTI
HIV
chronic HBV
97
commercial names for lamivudine
3TC
| Epivir
98
3TC and Epivir are commercial names for this drug
lamivudine
| RTI for HIV and chronic HBV
99
T/F low salt diet recommended in cirrhosis
T
| for ascites and peripheral edema
100
1 dietary change
1 drug
to address change in fluid status with cirrhosis
low salt diet
furosemide
cirrhotics are impressive salt retainers at risk for hypervolemia
101
PUD occurs where?
gastric or duodenal
102
how do duodenal ulcer symptoms relate to food intake
relieved with food (alkaline secretions anticipating food relieve pain)
-pain in absence of food buffer, 2-5 hours after meals, empty stomach, at night
103
what landmark defines upper from lower GI?
suspensory ligament of Treitz!
suspends duod from crus of diaphragm
attachment variable... between 3rd/4th duod or D/J
104
name the parts of the duodenum
superior 1
descending 2
horizontal 3
ascending 4 to ligament of Treitz, J afterward
(maybe some variability of loT.. can split 3rd/4th duod)
105
how dx PUD?
upper GI endoscopy
106
melena think
upper GI bleed (proximal to ligament of Triez... duod and up)
PUD
gastric cancer
Crohn's affecting upper GI or small bowel
-black stool
107
hematochezia think
```
lower GI bleed (more large bowel than J/I distal to loTreitz)
CRC
diverticulosis
UC
ischemic colitis
-bright red blood per rectum
```
108
how does ischemic colitic pain change with food
increased pain with food
| more metabolic demand with motility/digestion
109
do gastric cancer and ischemic colitis usually lead to weight loss or gain?
loss
food aversion
increased pain with eating
110
does duodenal PUD usually lead to weight loss or gain?
can lead to weight gain
| pain alleviated with alkaline secretions when eating
111
adenocarcinoma of the esophagus arises from
Barrett esophagus
112
adenocarcinoma typically arises in which part of the esophagus
The distal one third, from from Barrett esophagus
113
2 types of acute pancreatitis and their relative frequency
```
mild acute ~75% responds well to supportive
severe acute (necrotizing) ~25% signif M&M
```
114
what distinguishes mild acute pancreatitis from severe?
mild responds well to supportive therapy
| severe (necrotizing) assoc w sig m&m
115
12 causes of pancreatitis
```
alc abuse 40%
gallstones blocking ampulla of Vater 40%
post-ERCP ~10% incidence
viral (cocksackie B, mumps)
Drugs (sulfonamides, thiazide diur, furosemide, estrogens, anti-HIV, others implicated)
postop compx
scorpion bites
panc divisum
panc ca
HTAG, H Ca
uremia
blunt trauma (most common cause in kids)
```
116
most common cause of acute pancreatitis in kids
blunt abdominal trauma
117
bite that can cause pancreatitis
scorpion bite
118
5 drugs that can cause pancreatitis (not all inclusive)
```
sulfonamides
thiazide diur
furosemide
estrogens
anti-HIV
```
119
what % of pts get pancreatitis post ERCP
up to 10%
120
alcohol abuse accounts for what percent of acute pancreatitis?
40%
121
gallstones account for what percent of pancreatitis?
40%
122
most cases of acute pancreatitis are caused by...
alcohol abuse (40%)
gallstones (40%)
.......70-80% total
123
Recurrences of acute pancreatitis are common in...
alcoholics
124
typical symptoms of acute pancreatitis
epigastric ab pain
50% radiates to back
steady, dull, severe
worse supine and after meals
N/V/anorexia
125
```
epigastric ab pain
50% radiates to back
steady, dull, severe
worse supine and after meals
N/V/anorexia
= suggestive of....
```
pancreatitis
126
6 signs of pancreatitis
```
low fever
tachycardia
hypotension
leukocytosis
epigastric tenderness
abdominal distention
```
127
can you get a partial ileus w acute pancreatitis?
yes
| indicated by decreased or absent bowel sounds
128
PE finding for partial ilues
decreased or absent bowel sounds
129
define ileus
temporary absence of normal contraction of bowel wall
130
3 named signs of hemorrhagic pancreatitis
Grey Turner sign - flank ecchymoses
Cullen sign - periumbilical ecchymoses
Fox sign - inguinal ecchymoses
131
where does blood go in hemorrhagic pancreatitis
tracks along fascial plane to flank, periumbilical, inguinal
Grey Turner sign - flank ecchymoses
Cullen sign - periumbilical ecchymoses
Fox sign - inguinal ecchymoses
132
Grey Turner sign
flank ecchymoses from hemorrhagic pancreatitis
133
Cullen sign
periumbilical flank ecchymoses from hemorrhagic pancreatitis
134
Fox sign
inguinal flank ecchymoses from hemorrhagic pancreatitis
135
flank ecchymoses from hemorrhagic pancreatitis
Grey Turner sign
136
periumbilical flank ecchymoses from hemorrhagic pancreatitis
Cullen sign
137
inguinal flank ecchymoses from hemorrhagic pancreatitis
Fox sign
138
how sn and sp is amylasemia for dx acute pancreatitis?
not sn - does not r/o pancreatitis
not sp - does not r/o other conditions
*unless ^5x ULN then high sp for pancreatitis
139
when is amylasemia specific for acute pancreatitis?
when ^5x ULN
140
this lab enzyme is more specific for acute pancreatitis than amylase
lipase
141
which is more specific for acute pancreatitis
| amylase or lipase?
lipase
more other things cause amylasemia
but amylasemia pretty specific when ^5xULN
142
why are LFTs used to dx pancreatitis
ID gallstones as cause
| mechanical ampullary obstruction
143
T/F
| hyperglycemia, hypoxemia, leukocytosis may be seen in acute pancreatitis
T
144
Ranson criteria for dx acute pancreatitis
```
GA LAW; C HOBBS
gluc >200 Ca v8
age >55
Hc v more than 10%
LDH >350 PaO2 v60mmhg
AST >250 BUN inc >8
WBC >16 Base deficit >4
sequestration of fluid >6L
```
v3 1% mort, 3-4 15% mort, 5-6 40%, >7 100%
145
what is the role of ab rad in acute pancreatitis
r/o other dx e.g. perf (free air on rad)
spot chronic pancreatitis (calcifications)
sentinel loop - air filled bowel LUQ usually = ileus
colon cut-off sign - air-filled TC abruptly ending @ panc inflam
146
sentinel loop
air filled bowel on rad LUQ usually = local ileus
147
colon cut-off sign
air-filled transverse colon abruptly ending @ region of pancreatic inflammation
148
utility of abdominal US in acute pancreatitis
ID cause e.g. gallstones
| follow pseudocysts or abscesses
149
most accurate test for dx acute pancreatitis
CT of abd
150
most sensitive test for ID compx of acute pancreatitis
CT of abd
151
when is CT indicated for acute pancreatitis
when severe
| CT is most accurate test for acute pancreatitis
152
indications for ERCP in acute pancreatitis
severe gallstone pancreatitis w biliary obst
| ID uncommon cause if disease recurrent
153
T/F
| pseuodocysts caused by acute panc can appear at sites distant from panc
T
154
describe endocrine abnormalities in cirrhosis
F - amenorrhea, irreg menses, anovulation
| M - hypogonadism, v libido, ED, axillary/pubic hair loss, gynecomastia
155
T/F cirrhosis can cause
F - amenorrhea, irreg menses, anovulation
M - hypogonadism, v libido, ED, axillary/pubic hair loss, gynecomastia
T
156
12 physical exam findings in cirrhosis
telangiectasias, caput medusa
gynecomastia
ascites, firm or nodular liver, splenomegaly
testicular atrophy
palmar erythema, dupuytren contracture (palmar fibrosis causing contraction of pinky and ring mostly), clubbing, Muehrcke nails (paired, white, transverse lines, abnorm of vascular bed), Terry nails (white w "ground glass" no lunula, thought to be due to dec vascularity inc connective tissue in the nail bed).
157
dpuytren contracture
palmar fibrosis causing contraction of pinky and ring mostly
158
Muerhcke nails
paired white transverse lines ... abnorm of vasc bed
159
Terry nails
white ground glass nails w no lunula prob d/t dec vasc inc connective bed
160
mechanism of hypogonadism in cirrhosis
possibly:
primary gonadal injury
hypothalamic-pituitary dysfunction
161
what thyroid hormone changes and why in cirrhosis
normal TSH
normal free T3&T4
low total T3&T4
-because liver makes serum T3&T4 binding proteins like thyroxine-binding globulin, transthyretin, albumin, lipoproteins
162
do patients gain or lose weight w cirrhosis
loss w initial anorexia
| gian w later ascites or peripheral edema
163
4 PE findings of excess estrogen in men
gynecomastia (uni or bilat)
testicular atrophy
palmar erythema
telangiectasias
164
T/F
| adrenal insufficiency can cause v axillary and pubic hair, v libido in men
F
commonly causes these things in women who produce T in adrenal glands
but men produce most androgens in testes
165
lymphocytic infiltration of thyroid causing hypothyroidism
Hashimoto's thyroiditis
166
Hashimoto's thyroiditis
lymphocytic infiltration of thyroid causing hypothyroidism
^ TSH
v T4
+ anti TPO abs
167
^ TSH
v T4
+ anti TPO abs
Hashimoto's thyroiditis
| lymphocytic infiltration of thyroid causing hypothyroidism
168
what GI dx can cause telangiectasias, palmar erythema, testicular atrophy, gyecomastia, and erectile dysfunction in men
```
liver cirrhosis
(via primary gonadal damage or hypothalamic/pituitary dysfunction)
```
169
all pts w chronic liver disease should be immunized against...
HAV & HBV
unless already immune
because high risk of acute hepatic failure or cirrhosis upon infection with viral hepatitis
170
hepatitis panel positive for chronic HCV infection... what is best first recommendation for pt?
HAV & HBV vaccination if not already immune
| because high risk of acute hepatic failure or cirrhosis upon infection with viral hepatitis
171
when is prednisone used for hepatitis
tx severe alcoholic hepatitis
172
Lamivudine
aka 3TC
RTI
tx HIV and chronic HBV
173
aka 3TC
RTI
tx HIV and chronic HBV
Lamivudine
174
recommended diet for cirrhotic
low salt
| impressive salt retainers at risk of ascites and peripheral edema
175
3 etiologies of colovesical fistula
diverticulosis (acute diverticulitis)
Crohn's
colon, bladder, pelvic malignancy
176
3 clinical presentations of colovesical fistula
pneumaturia (air in urine)
fecaluria (stool in urine)
recurrent UTI w coliform mixed flora
177
pneumaturia suspicious for
colovesical fistula
178
fecaluria suspicious for
colovesical fistula
179
recurrent UTI w mixed flora suspicious for
colovesical fistula (coliform mixed flora)
180
dx colovesical fistula
abd CT w oral or rectal contrast (not IV)
-contrast in bladder w thickened colonic and vesicular walls
colonoscopy to r/u colon ca
181
what kind of contrast w CT to dx colovesical fistula
oral or rectal (not IV)... sounds like flow from colon to vesical usually... or avoid renal damage?
-rad sign = contrast in bladder w thickened colonic and vesicular walls
182
exquisitely tender prostate on rectal exam, think..
acute bacterial prostatitis
183
irritative urinary sympx and painless hematuria is classic presentation of
bladder cancer
184
define emphysematous pyelonephritis
pyelo due to gas-producing infection, typically in diabetics
185
content of staghorn calculi
struvite stones
staghorn
struvite
Staghorn Struvite
186
synthetic liver dysfunction = what in labs
INR >/= 1.5
187
6 etiologies of acute liver failure
```
viral (HSV CMV HAV HEV HBV HDV)
drug tox (acetaminophen, idiosyncratic)
ischemia (shock liver, budd chiari (hepatic vein obs))
AI
Wilson
malignant infiltration
```
188
hepatic vein outflow obstruction causes this syndrome
budd-chiari syndrome
189
3 diagnostic requirements for acute liver failure
| Triad for dx of ALF
```
AST&ALT > 1000 (severe acute liver inj)
hepatic encephalopathy (confusion, asterixis)
synthetic dysfunc (INR >1.5)
```
190
T/F cirrhosis or underlying liver disease should not be present to dx acute liver failure
T
191
detail mech of liver tox from acetaminophen
- toxic metabolite NAPQI N-acetyl-p-benzoquinone imine overwhelms glucuronidation mech of detox in liver
- hepatic necrosis
192
toxic metabolite from acetaminophen
NAPQI N-acetyl-p-benzoquinone imine
| hepatic necrosis when overwhelms glucuronidation detox
193
how does chronic alc use potentiate acetaminophen hepatotox
depletes glutathione levels for glucuronidation detox
194
antidote for acetaminophen overdose when given early
N-acetylcysteine
^glutathione levels
binds NAPQI N-acetyl-p-benzoquinone imine
195
T/F
| acetaminophen is toxic to renal tubules
T
| ATN and ALF
196
T/F
| acetaminophen hepatotox has relatively low serum bilirubin compared to the elevations seen in other ALF etiologies
T
197
for acute alcoholic hepatitis, aminotransferase elevations are usually ___
in patients who drink ___
with AST/ALT ratio usually ___
moderate (v 500)
heavily (^ 100g/day)
>2:1
198
adenocarcinoma typically arises in which part of the esophagus
The distal one third, from Barron esophagus from Barrett esophagus
199
squamous cell carcinoma typically arises and which part of the esophagus
anywhere along length of the esophagus
200
three risk factors for adenocarcinoma of the esophagus include
reflux
smoking
Obesity
201
to risk factors for a squamous cell carcinoma of the esophagus include
smoking
| Alcohol
202
chest pain,Weight loss, dysphasia to solids
| Are symptoms of what
esophageal cancer
| Adenocarcinoma or squamous cell carcinoma
203
is smoking a risk factor for esophageal adenocarcinoma or squamous cell carcinoma
both
Risk factors for adenocarcinoma include smoking reflux obesity
Risk factors for us grass I'll carcinoma include smoking alcohol caustic injury
204
definitive diagnosis of esophageal cancer requires
upper endoscopy
205
in the setting of suspicion for esophageal cancer, when is upper endoscopy considered
for definitive diagnosis
If greater than age 55 or if alarm symptoms (significant weight loss, gross or a cold bleeding,Oakholt bleeding a cult bleeding Oakholt bleed, early satiety)
May start with barium esophagram in younger low-risk patients with indeterminate esophageal symptoms
206
when are CT and or PET considered for esophageal cancer
for staging after upper and DOS could be has diagnosed the esophageal cancer. After upper endoscope he has diagnosed the office soffit Geo cancer
207
what is the definitive cure for esophageal cancer
surgery
208
when is bronchoscopy generally considered
for E Val of accessible lesions and or him up to sis
Evaluation of accessible lesions and him up to sis he mopped assistshe mopped assist coughing up blood
209
Weight loss due to
Behavior disorder
Dysphasia
Food intolerance
Are all indications for
evaluation by nutritionist
210
proton pump inhibitor's are useful for
patients with symptoms of Gerd refractory to other medications
211
how is dyspepsia different from dysphasia
dyspepsia is indigestion
| Dysphasia is difficulty swallowing
212
is H pie Laurie infection H pie Laurie infection more consistent with dysphasia or dyspepsia
dyspepsia
213
True/false
| Abdominal distention due to ascites is a clinical feature of alcoholic hepatitis
True
214
transit aminase pattern and alcoholic hepatitis
Transaminase pattern in alcoholic hepatitis
elevated AST and AL T mild, typically less than 300
AST/ALT ratio greater than 2:1
215
elevated labs other than transaminases an alcoholic hepatitis in alcoholic hepatitis
GGT Billy Rubin INR
216
decreased album in in the setting of alcoholic hepatitis is a sign of
malnutrition
217
this is a sign of malnutrition this LFT is a sign of Mount nutrition in an alcoholic
decreased albumin
218
how elevated are transaminases in alcoholic hepatitis
typically less than 300
| Almost always less than 500
219
why is AST elevated more than a LT and alcoholic hepatitis
More than a LT in alcoholic hepatitis
AL T
thought to be due to a deficiency of. Doxil five phosphate pyridoxal five phosphate, a cofactor for ALT
220
T/F
AST greater than ALT is rare in conditions other than alcoholic hepatitis. Hey LT is typically more elevated than AST and other conditionsin other conditions
True
221
T/F
| Elevations in GGT and ferratin are expected in alcoholic hepatitis
True
GGT gamma-glutamyltransferase is an enzyme found in the parasites and other cells
Ferritin is it an acute phase reactants reactant
222
T/F ferritin is an acute phase reactants
T
| To sequester iron from possible infectious organisms
223
define marketed elevation of transaminases
| Define marked elevation of transaminases
greater than 25 times the upper limit of normal
224
Mark elevations of transaminases (greater than 25 times the upper limit of normal), is suspicious for
viral infection
Drug toxicity (acetaminophen)
Ischemic injury
225
T/F
| Degree of transaminitis is correlated to severity of liver disease
Falls
| Pattern of transaminitis helps the differential but degree of elevation does not correlate to severity of disease
226
T/F
| Pancreatic cancer presents late and typically has a poor prognosis even with a potential he respectable mass
T
227
for risk factors for pancreatic cancer number for risk factors
smoking
Obesity
DM
FH family history
228
pancreatic cancer and which location presents with pain and weight loss versus which location presents with Stateria and weight loss stay at Therea stay at Thereafatty diarrhea and jaundice
cancers of the body and tail –-pain and weight loss
| Cancers of the head– Stay at Therea fatty diarrhea weight loss jaundice
229
T/F
| Pancreatic cancer can present with Johnice jaundice
T
More often cancer of the head that of the body or tail van of the body or two van of the body or tail more often the head then the body or tail than the body or tail
230
T/F
| Physical exam and pancreatic cancer is often unremarkable other than jaundice
T
231
Courvoisier sign
palpable but nontender gallbladder in jaundiced patient. Finding in pancreatic cancer
232
virchow's node
Supraclavicular lymphadenopathy Andy could've of G.I. pathology indicative of G.I. path all a G path ologies pathology
233
T/F
| Abdominal mass or ascites is present in the majority of pancreatic cancer presentations
false
Only roughly 20%
John this is more common if the head of the pancreas is affectedstay at sharia fatty diarrhea two
If bar your tail affected only sinus symptoms may be weight loss and pain body or tale tale
234
blank is the initial imaging performed on patients with jaundice, if this is not diagnostic blank is then performed
abdominal ultrasound
| CT
235
when is ERCP considered for suspicion of pancreatic cancer
when right upper quadrant ultrasound is nondiagnostic
And abdominal CT is nondiagnostic
(because the ERCP is invasive)
or to treat gallstone pancreatitis
236
when is percutaneous transhepatic cholangiogram typically considered
and patience where ERCP is contra indicated
237
what is percutaneous transit panic cholangiogram percutaneous transhepatic cholangiogram PTC
using needle to inject dye into biliary tree, can also be performed therapeutically like ERCP, removing stones placing stents etc
238
T/F
| Amylase and lipase are good labs and work up of pancreatic cancer
false
| Elevated and pancreatitis not pancreatic cancer
239
what is CA 19-9 in the context of pancreatic cancer
A tumor marker with sensitivity and specificity of 80 to 90% for pancreatic cancer
Maybe elevated in jaundice without pancreatic cancer, however, so not a good screening tool, Can be used to monitor tumor response to treatment
240
T/F a Dommel CT is a very sensitive and specific tool used for a diagnosis of pancreatic carcinoma
True
241
hemoglobin thresholds for packed red blood cell transfusion
greater than 10 generally not indicated
8-10 ongoing bleeding, symptomatic anemia, acute coronary syndrome, noncardiac surgery
7-8 cardiac surgery, heart failure, oncology patients currently undergoing treatment
Less than 7 generally indicated
242
what situation is fresh frozen plasma typically reserved for
Coagulopathy
With active bleeding
Fresh for frozen plasma has all coagulation factors just know RBCs RBCs
243
Octreotide is a
somatostatin analog
244
when is whole blood transfusion considered
severe hemorrhage
245
t/f
| severe pancreatitis can present w dyspnea, tachypnea, and basilar crackles
T
| severe pancreatitis can progress to multisystem organ dysfunction (shock, renal failure, early respiratory failure)
246
how long do most patients with acute pancreatitis take to recover
3-5 days
| with conservative mgmt. (bowel rest fluids, pain meds)
247
what % of acute pancreatitis progresses to severe pancreatitis
15-20%
248
define severe pancreatitis
pancreatitis with 1+ organ failure
249
5 clinical markers assoc w inc risk of acute pancreatitis turning to severe pancreatitis (at least 1 organ failure)
```
age >75
alcoholism
obesity
CRP > 150 at 48 hrs
^BUN/Cr in first 48 hrs
```
250
best labs to trend in pancreatitis
CRP
BUN
both elevated in severe pancreatitis (CRP >150 @ 48 hrs; BUN elevated in first 48 hrs)
251
how long do pseudocysts usually take to develop after acute pancreatitis
3-4 weeks
252
T/F
| severe pancreatitis can cause SIRS and shock
T
| inflammation, vasod, permeab, organ failure/shock
