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Medicine > GI > Flashcards

GI Flashcards

1
Q

third most common cancer in US men

A

crc

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2
Q

third most common cancer in us women

A

crc

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3
Q

what kind of cancer gives rise to crc

A

virtually always adenomas – endoluminal adenocarcinomas

rarely carcinoid, lymphoma, kaposi sarcoma

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4
Q

5 screening tests for crc

+1 for monitoring

A 
fobt
dre
colonoscopy
flexible sigmoidoscopy
barium enema
cea carcinoembryonic antigen
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5
Q

sn and sp and ppv of fobt for crc?

A

sn sp poor
ppv ~20%
if positive get colonoscopy

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6
Q

what % crc palpable by dre?

A

~10%

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7
Q

what is the most sn and sp test for crc

A

colonoscopy

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8
Q

diagnostic test of choice following +fobt

A

colonoscopy

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9
Q

is colonoscopy diagnostic or therapeutic?

A

both
biopsy
polypectomy

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10
Q

what % of polyps and cancers can be reached by flexible sigmoidoscopy?

A

50-70%

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11
Q

how long is the flexible sigmoidoscope

A

60 CM

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12
Q

is a flexible sigmoidoscopy longer or shorter than a colonoscope

A

shorter 60 CM only needs to reach sigmoid which is distal

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13
Q

flexible sigmoidoscopy his diagnostic in roughly what percentage of CRC’s

A

two thirds

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14
Q

when is barium enema used to screen for crc

A

to eval entire colon, complementary to flex sigmoidoscopy

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15
Q

if abnormal finding on barium enema what is next step

A

colonoscopy

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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

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17
Q

T/F CEA carcinoembryonic antigen has prognostic significance for crc

A

T

Preoperative CEA >5 NG/ML has worse prognosis

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18
Q

how is colorectal cancer clinically staged

A

CT scan chest abdomen pelvis

Physical exam ascites hepatomegaly lymphadenopathy

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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

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20
Q

what is the most common sight of distant spread of crc

A

liver

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21
Q

how does colorectal cancer spread to the lungs

A

Hematogenously via lumbar and vertebral veins

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22
Q

T/F

All CRC’s bleed all the time

A

F

Some bleed intermittently some not at all

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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

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24
Q

what % CRC presents already with mets

A

~20%

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25
Q

spontaneous substernal / interscapular pain, odynophagia to hot/cold foods are suggestive of…

A

esophageal spasm

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26
Q

T/F resolution of C/P w nitroglycerin is consistent with esophageal spasm

A

T

nitrates and CCBs relax coronary vessel myocytes And esophageal myocytes as well

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27
Q

esophageal spasm suspected, diagnostic test of choice is…

A

esophageal manometry

shows repetitive, non-peristaltic, high-amplitude contractions either spontaneously or after ergonovine stim

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28
Q

substernal pain radiating to back precipitated by emotional stress is more indicative of esophageal spasm or GERD?

A

more consistent w motility disorder
e.g. esophageal spasm

GERD more often “burning” not radiating, assoc w inflammation on endoscopy (spasm not)

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29
Q

If GERD suspected, diagnostic test of choice is…

A

trial of PPI

Not 24 hr pH monitoring

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30
Q

how does duration of pain help differentiate between esophageal spasm and prinzmental variant angina

A

several hours more consistent w e spasm

p v angina much shorter…

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31
Q

esophageal spasm can be provoked by food and ___

A

emotional stress

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32
Q

___ establishes dx of diffuse esophageal spasm

A

manometry

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33
Q

HAV is
RNA or DNA
what virus family

A

RNA

picornavirus picoRNAvirus

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34
Q

Hep A

acute or chronic

A

acute

hep A, Acute

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35
Q

which hep viruses have fecal oral transmission

A

A E

fEcAl oral

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36
Q

7 symptoms of HAV infection

A 
acute onset
malaise
fatigue
anorexia
N
V
mild abdominal pain
aversion to smoking
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37
Q

aversion to smoking in setting of acute malaise, anorexia, mild abdominal pain, N/V, jaundice suggests

A

Hep A

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38
Q

T/F hepatomegaly is commonly seen w HAV infection

A

T

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39
Q

LFT pattern in HAV infection

A

AST & ALT spike early

then Bili and Alk Phos

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40
Q

natural hx of hep A

A

self-limiting
complete recovery in 3-6 wks w supportive therapy
no chronic hepatitis, cirrhosis, or hepatocellular carcinoma

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41
Q

T/F cirrhosis and hepatocellular ca are part of natural hx of HAV

A

F
self-limiting
no chronic hepatitis, cirrhosis, or hepatocellular carcinoma

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42
Q

T/F hep A infection is self-limiting

A

T

no chronic hepatitis, cirrhosis, or hepatocellular carcinoma

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43
Q

mortality rate of HAV infection

A
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44
Q

what lab value indicates increased mortality risk from HAV infection?

A

prolonged PT

mortality rate

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45
Q

treatment of HAV infection

A

supportive therapy

full recovery expected in 3-6 weeks

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46
Q

who should get HAV immune globulin?

A

close contacts of infected HAV

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47
Q

who should get HAV vaccine?

A

those with increased risk

living or traveling to endemic area
chronic liver disease
clotting factor disorders
MSM

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48
Q

HBV

DNA or RNA?

A

DNA

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49
Q

incubation period of HBV

A

30-180 days

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50
Q

onset of HBV

acute or insidious?

A

insidious typically

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51
Q

transmission of HBV

A

sexually
parenterally
vertically

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52
Q

rate of chronic hepatitis from HBV in immunocompetent

A

1-2% immunocompetent adults

90% newborns

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53
Q

rate of chronic hepatitis from HBV in newborns

A

90% newborns

1-2% in immunocompetent adults

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54
Q

HCV

DNA or RNA

A

RNA

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55
Q

incubation period HCV

A

40-50 days

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56
Q

T/F clinical HCV infection is severe

A

F

clinical HCV illness is mild and often asymptomatic

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57
Q

HCV transmission

A

primarily parenterally

sex & vertical possible

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58
Q

rate of chronic hepatitis from HCV

A

> 80%

^risk of cirrhosis and hepatocellular ca

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59
Q

T/F the rate of chronic hepatitis from HBV is 80%

A

F
HCV >80%
HBV 1-2% in immunocompetent adults

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60
Q

T/F rate of chronic hepatitis from HCV is 1-2%

A

F
HBV 1-2% in immunocompetent adults
HCV >80% chronic

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61
Q

chronic hepatitis ^risk of __ and __

A

cirrhosis and hepatocellular ca

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62
Q

HDV

DNA or RNA?

A

incomplete RNA

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63
Q

this hep virus only causes hepatitis in assoc with this other hep virus

A

HDV only assoc w HBV

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64
Q

transmission of HDV

A

percutaneous
sexual
perinatal

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65
Q

T/F HBV infection is typically subclinical

A

F
HDV superinfection on chronic HBV can result in
fulminant hepatitis and rapid cirrhosis

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66
Q

T/F mono can cause hepatitis

A

T

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67
Q

6 signs and symptoms of infectious mononucleosis

A 
sore throat
fever
LAN
rash
splenomegaly
hepatitis possible
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68
Q

mono typically affects…

A

adolescents and young adults

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69
Q

name 2 broad categories of info that help differentiate hepatitis virus infections

A

epidemiological (transmission route, incubation period, risk factors, etc)
serological testing to confirm

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70
Q

smooth “bird beak” narrowing at GE junction on barium esophagram

A

achalasia

impaired peristalsis of distal esophagus and impaired relaxation of LES

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71
Q

T/F regurg can be associated with achalasia

A

T

but so can difficulty belching…

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72
Q

T/F difficulty belching can be associated with achalasia

A

T

but so can regurg…

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73
Q

patients on average have smx for how long before achalasia dxd?

A

5 years

often initially dxd w GERD

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74
Q

impaired peristalsis of distal esophagus and impaired relaxation of LES

A

achalasia

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75
Q

achalasia

A

impaired peristalsis of distal esophagus and impaired relaxation of LES

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76
Q

why is swallowing easier in upright position w achalasia?

A

helps esophageal pressure column increase above closing pressure of LES

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77
Q

most sensitive diagnostic test for achalasia

A

manometry

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78
Q

T/F barium esophagram is the diagnostic test of choice for achalasia

A

F
manometry = TOC
barium esophagram bird beak sign helpful if manometry not diagnostic

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79
Q

when to consider barium esophagram for suspected achalasia

A

manometry not diagnostic

then bird beak sign on barium esophagram helpful

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80
Q

what kinds of solids are especially difficult early in dysphagia

A

bread and meat

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81
Q

esophageal webs are most commonly located in which part of the esophagus?

A

upper

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82
Q

Are esophageal webs assoc w mild or severe dysphagia?

A

mild
mild focal narrowing
dysph to solids but not liquids

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83
Q

what kind of esophageal obstruction is associated with iron deficiency

A

esophageal webs

Plummer-Vinson syndrome

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84
Q

Plummer-Vinson syndrome is associated with what nutritional deficiency and what esophageal abnorm?

A

iron deficiency

esophageal webs

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85
Q

globus sensation

A

sensation of lump in back of throat

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86
Q

T/F globus sensation is a functional disorder that does not cause any abnormalities on barium esophagram

A

T

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87
Q

T/F polymyositis can present w dysphagia

A

T
affects striated muscle in upper 1/3 of esoph
assoc w other muscle weakness (diff climbing stairs)

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88
Q

What part of the esophagus to polymyositis typically affect

A

upper 1/3 (striated muscle)

dysphagia, diff climbing stairs (muscle weakness)

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89
Q

why does polymyositis affect the area of the esophagus that it does?

A

affects striated muscle, so upper 1/3 of esophagus

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90
Q

where does Zenker diverticulum occur?

A

cricopharyngeal level of esophagus

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91
Q

typical presentation of Zenker diverticulum

A

age >60
dysphagia, halitosis, fullness of throat
(outpouching at cricopharyngeal esophagus)

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92
Q

the Key diagnostic test for achalasia is

A

manometry

barium swallow if manometry not diagnostic… looking for bird beak sign

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93
Q

pt discovered w + anti-HCV abs

what is best initial treatment?

A

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

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94
Q

when is prednisone used in tx of hepatitis

A

severe alcoholic hepatitis

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95
Q

presentation of alcoholic hepatitis

A

fever
abdominal pain
jaundice
N/V

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96
Q

what is lamivudine and what does it treat

A

RTI
HIV
chronic HBV

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97
Q

commercial names for lamivudine

A

3TC

Epivir

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98
Q

3TC and Epivir are commercial names for this drug

A

lamivudine

RTI for HIV and chronic HBV

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99
Q

T/F low salt diet recommended in cirrhosis

A

T

for ascites and peripheral edema

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100
Q

1 dietary change
1 drug
to address change in fluid status with cirrhosis

A

low salt diet
furosemide
cirrhotics are impressive salt retainers at risk for hypervolemia

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101
Q

PUD occurs where?

A

gastric or duodenal

102
Q

how do duodenal ulcer symptoms relate to food intake

A

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
Q

what landmark defines upper from lower GI?

A

suspensory ligament of Treitz!
suspends duod from crus of diaphragm
attachment variable… between 3rd/4th duod or D/J

104
Q

name the parts of the duodenum

A

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
Q

how dx PUD?

A

upper GI endoscopy

106
Q

melena think

A

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
Q

hematochezia think

A 
lower GI bleed (more large bowel than J/I distal to loTreitz)
CRC
diverticulosis
UC
ischemic colitis
-bright red blood per rectum
108
Q

how does ischemic colitic pain change with food

A

increased pain with food

more metabolic demand with motility/digestion

109
Q

do gastric cancer and ischemic colitis usually lead to weight loss or gain?

A

loss
food aversion
increased pain with eating

110
Q

does duodenal PUD usually lead to weight loss or gain?

A

can lead to weight gain

pain alleviated with alkaline secretions when eating

111
Q

adenocarcinoma of the esophagus arises from

A

Barrett esophagus

112
Q

adenocarcinoma typically arises in which part of the esophagus

A

The distal one third, from from Barrett esophagus

113
Q

2 types of acute pancreatitis and their relative frequency

A 
mild acute ~75% responds well to supportive
severe acute (necrotizing) ~25% signif M&M
114
Q

what distinguishes mild acute pancreatitis from severe?

A

mild responds well to supportive therapy

severe (necrotizing) assoc w sig m&m

115
Q

12 causes of pancreatitis

A 
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
Q

most common cause of acute pancreatitis in kids

A

blunt abdominal trauma

117
Q

bite that can cause pancreatitis

A

scorpion bite

118
Q

5 drugs that can cause pancreatitis (not all inclusive)

A 
sulfonamides
thiazide diur
furosemide
estrogens
anti-HIV
119
Q

what % of pts get pancreatitis post ERCP

A

up to 10%

120
Q

alcohol abuse accounts for what percent of acute pancreatitis?

A

40%

121
Q

gallstones account for what percent of pancreatitis?

A

40%

122
Q

most cases of acute pancreatitis are caused by…

A

alcohol abuse (40%)
gallstones (40%)
…….70-80% total

123
Q

Recurrences of acute pancreatitis are common in…

A

alcoholics

124
Q

typical symptoms of acute pancreatitis

A

epigastric ab pain
50% radiates to back
steady, dull, severe
worse supine and after meals

N/V/anorexia

125
Q 
epigastric ab pain
50% radiates to back
steady, dull, severe
worse supine and after meals
N/V/anorexia
= suggestive of....
A

pancreatitis

126
Q

6 signs of pancreatitis

A 
low fever
tachycardia
hypotension
leukocytosis
epigastric tenderness
abdominal distention
127
Q

can you get a partial ileus w acute pancreatitis?

A

yes

indicated by decreased or absent bowel sounds

128
Q

PE finding for partial ilues

A

decreased or absent bowel sounds

129
Q

define ileus

A

temporary absence of normal contraction of bowel wall

130
Q

3 named signs of hemorrhagic pancreatitis

A

Grey Turner sign - flank ecchymoses
Cullen sign - periumbilical ecchymoses
Fox sign - inguinal ecchymoses

131
Q

where does blood go in hemorrhagic pancreatitis

A

tracks along fascial plane to flank, periumbilical, inguinal
Grey Turner sign - flank ecchymoses
Cullen sign - periumbilical ecchymoses
Fox sign - inguinal ecchymoses

132
Q

Grey Turner sign

A

flank ecchymoses from hemorrhagic pancreatitis

133
Q

Cullen sign

A

periumbilical flank ecchymoses from hemorrhagic pancreatitis

134
Q

Fox sign

A

inguinal flank ecchymoses from hemorrhagic pancreatitis

135
Q

flank ecchymoses from hemorrhagic pancreatitis

A

Grey Turner sign

136
Q

periumbilical flank ecchymoses from hemorrhagic pancreatitis

A

Cullen sign

137
Q

inguinal flank ecchymoses from hemorrhagic pancreatitis

A

Fox sign

138
Q

how sn and sp is amylasemia for dx acute pancreatitis?

A

not sn - does not r/o pancreatitis
not sp - does not r/o other conditions
*unless ^5x ULN then high sp for pancreatitis

139
Q

when is amylasemia specific for acute pancreatitis?

A

when ^5x ULN

140
Q

this lab enzyme is more specific for acute pancreatitis than amylase

A

lipase

141
Q

which is more specific for acute pancreatitis

amylase or lipase?

A

lipase
more other things cause amylasemia
but amylasemia pretty specific when ^5xULN

142
Q

why are LFTs used to dx pancreatitis

A

ID gallstones as cause

mechanical ampullary obstruction

143
Q

T/F

hyperglycemia, hypoxemia, leukocytosis may be seen in acute pancreatitis

A

T

144
Q

Ranson criteria for dx acute pancreatitis

A 
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
Q

what is the role of ab rad in acute pancreatitis

A

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
Q

sentinel loop

A

air filled bowel on rad LUQ usually = local ileus

147
Q

colon cut-off sign

A

air-filled transverse colon abruptly ending @ region of pancreatic inflammation

148
Q

utility of abdominal US in acute pancreatitis

A

ID cause e.g. gallstones

follow pseudocysts or abscesses

149
Q

most accurate test for dx acute pancreatitis

A

CT of abd

150
Q

most sensitive test for ID compx of acute pancreatitis

A

CT of abd

151
Q

when is CT indicated for acute pancreatitis

A

when severe

CT is most accurate test for acute pancreatitis

152
Q

indications for ERCP in acute pancreatitis

A

severe gallstone pancreatitis w biliary obst

ID uncommon cause if disease recurrent

153
Q

T/F

pseuodocysts caused by acute panc can appear at sites distant from panc

A

T

154
Q

describe endocrine abnormalities in cirrhosis

A

F - amenorrhea, irreg menses, anovulation

M - hypogonadism, v libido, ED, axillary/pubic hair loss, gynecomastia

155
Q

T/F cirrhosis can cause
F - amenorrhea, irreg menses, anovulation
M - hypogonadism, v libido, ED, axillary/pubic hair loss, gynecomastia

A

T

156
Q

12 physical exam findings in cirrhosis

A

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
Q

dpuytren contracture

A

palmar fibrosis causing contraction of pinky and ring mostly

158
Q

Muerhcke nails

A

paired white transverse lines … abnorm of vasc bed

159
Q

Terry nails

A

white ground glass nails w no lunula prob d/t dec vasc inc connective bed

160
Q

mechanism of hypogonadism in cirrhosis

A

possibly:
primary gonadal injury
hypothalamic-pituitary dysfunction

161
Q

what thyroid hormone changes and why in cirrhosis

A

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
Q

do patients gain or lose weight w cirrhosis

A

loss w initial anorexia

gian w later ascites or peripheral edema

163
Q

4 PE findings of excess estrogen in men

A

gynecomastia (uni or bilat)
testicular atrophy
palmar erythema
telangiectasias

164
Q

T/F

adrenal insufficiency can cause v axillary and pubic hair, v libido in men

A

F
commonly causes these things in women who produce T in adrenal glands
but men produce most androgens in testes

165
Q

lymphocytic infiltration of thyroid causing hypothyroidism

A

Hashimoto’s thyroiditis

166
Q

Hashimoto’s thyroiditis

A

lymphocytic infiltration of thyroid causing hypothyroidism
^ TSH
v T4
+ anti TPO abs

167
Q

^ TSH
v T4
+ anti TPO abs

A

Hashimoto’s thyroiditis

lymphocytic infiltration of thyroid causing hypothyroidism

168
Q

what GI dx can cause telangiectasias, palmar erythema, testicular atrophy, gyecomastia, and erectile dysfunction in men

A 
liver cirrhosis
(via primary gonadal damage or hypothalamic/pituitary dysfunction)
169
Q

all pts w chronic liver disease should be immunized against…

A

HAV & HBV
unless already immune
because high risk of acute hepatic failure or cirrhosis upon infection with viral hepatitis

170
Q

hepatitis panel positive for chronic HCV infection… what is best first recommendation for pt?

A

HAV & HBV vaccination if not already immune

because high risk of acute hepatic failure or cirrhosis upon infection with viral hepatitis

171
Q

when is prednisone used for hepatitis

A

tx severe alcoholic hepatitis

172
Q

Lamivudine

A

aka 3TC
RTI
tx HIV and chronic HBV

173
Q

aka 3TC
RTI
tx HIV and chronic HBV

A

Lamivudine

174
Q

recommended diet for cirrhotic

A

low salt

impressive salt retainers at risk of ascites and peripheral edema

175
Q

3 etiologies of colovesical fistula

A

diverticulosis (acute diverticulitis)
Crohn’s
colon, bladder, pelvic malignancy

176
Q

3 clinical presentations of colovesical fistula

A

pneumaturia (air in urine)
fecaluria (stool in urine)
recurrent UTI w coliform mixed flora

177
Q

pneumaturia suspicious for

A

colovesical fistula

178
Q

fecaluria suspicious for

A

colovesical fistula

179
Q

recurrent UTI w mixed flora suspicious for

A

colovesical fistula (coliform mixed flora)

180
Q

dx colovesical fistula

A

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
Q

what kind of contrast w CT to dx colovesical fistula

A

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
Q

exquisitely tender prostate on rectal exam, think..

A

acute bacterial prostatitis

183
Q

irritative urinary sympx and painless hematuria is classic presentation of

A

bladder cancer

184
Q

define emphysematous pyelonephritis

A

pyelo due to gas-producing infection, typically in diabetics

185
Q

content of staghorn calculi

A

struvite stones
staghorn
struvite
Staghorn Struvite

186
Q

synthetic liver dysfunction = what in labs

A

INR >/= 1.5

187
Q

6 etiologies of acute liver failure

A 
viral (HSV CMV HAV HEV HBV HDV)
drug tox (acetaminophen, idiosyncratic)
ischemia (shock liver, budd chiari (hepatic vein obs))
AI
Wilson
malignant infiltration
188
Q

hepatic vein outflow obstruction causes this syndrome

A

budd-chiari syndrome

189
Q

3 diagnostic requirements for acute liver failure

Triad for dx of ALF

A 
AST&ALT > 1000 (severe acute liver inj)
hepatic encephalopathy (confusion, asterixis)
synthetic dysfunc (INR >1.5)
190
Q

T/F cirrhosis or underlying liver disease should not be present to dx acute liver failure

A

T

191
Q

detail mech of liver tox from acetaminophen

A
  • toxic metabolite NAPQI N-acetyl-p-benzoquinone imine overwhelms glucuronidation mech of detox in liver
  • hepatic necrosis
192
Q

toxic metabolite from acetaminophen

A

NAPQI N-acetyl-p-benzoquinone imine

hepatic necrosis when overwhelms glucuronidation detox

193
Q

how does chronic alc use potentiate acetaminophen hepatotox

A

depletes glutathione levels for glucuronidation detox

194
Q

antidote for acetaminophen overdose when given early

A

N-acetylcysteine
^glutathione levels
binds NAPQI N-acetyl-p-benzoquinone imine

195
Q

T/F

acetaminophen is toxic to renal tubules

A

T

ATN and ALF

196
Q

T/F

acetaminophen hepatotox has relatively low serum bilirubin compared to the elevations seen in other ALF etiologies

A

T

197
Q

for acute alcoholic hepatitis, aminotransferase elevations are usually ___
in patients who drink ___
with AST/ALT ratio usually ___

A

moderate (v 500)
heavily (^ 100g/day)
>2:1

198
Q

adenocarcinoma typically arises in which part of the esophagus

A

The distal one third, from Barron esophagus from Barrett esophagus

199
Q

squamous cell carcinoma typically arises and which part of the esophagus

A

anywhere along length of the esophagus

200
Q

three risk factors for adenocarcinoma of the esophagus include

A

reflux
smoking
Obesity

201
Q

to risk factors for a squamous cell carcinoma of the esophagus include

A

smoking

Alcohol

202
Q

chest pain,Weight loss, dysphasia to solids

Are symptoms of what

A

esophageal cancer

Adenocarcinoma or squamous cell carcinoma

203
Q

is smoking a risk factor for esophageal adenocarcinoma or squamous cell carcinoma

A

both

Risk factors for adenocarcinoma include smoking reflux obesity

Risk factors for us grass I’ll carcinoma include smoking alcohol caustic injury

204
Q

definitive diagnosis of esophageal cancer requires

A

upper endoscopy

205
Q

in the setting of suspicion for esophageal cancer, when is upper endoscopy considered

A

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
Q

when are CT and or PET considered for esophageal cancer

A

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
Q

what is the definitive cure for esophageal cancer

A

surgery

208
Q

when is bronchoscopy generally considered

A

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
Q

Weight loss due to

Behavior disorder
Dysphasia
Food intolerance

Are all indications for

A

evaluation by nutritionist

210
Q

proton pump inhibitor’s are useful for

A

patients with symptoms of Gerd refractory to other medications

211
Q

how is dyspepsia different from dysphasia

A

dyspepsia is indigestion

Dysphasia is difficulty swallowing

212
Q

is H pie Laurie infection H pie Laurie infection more consistent with dysphasia or dyspepsia

A

dyspepsia

213
Q

True/false

Abdominal distention due to ascites is a clinical feature of alcoholic hepatitis

A

True

214
Q

transit aminase pattern and alcoholic hepatitis

Transaminase pattern in alcoholic hepatitis

A

elevated AST and AL T mild, typically less than 300

AST/ALT ratio greater than 2:1

215
Q

elevated labs other than transaminases an alcoholic hepatitis in alcoholic hepatitis

A

GGT Billy Rubin INR

216
Q

decreased album in in the setting of alcoholic hepatitis is a sign of

A

malnutrition

217
Q

this is a sign of malnutrition this LFT is a sign of Mount nutrition in an alcoholic

A

decreased albumin

218
Q

how elevated are transaminases in alcoholic hepatitis

A

typically less than 300

Almost always less than 500

219
Q

why is AST elevated more than a LT and alcoholic hepatitis
More than a LT in alcoholic hepatitis
AL T

A

thought to be due to a deficiency of. Doxil five phosphate pyridoxal five phosphate, a cofactor for ALT

220
Q

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

A

True

221
Q

T/F

Elevations in GGT and ferratin are expected in alcoholic hepatitis

A

True
GGT gamma-glutamyltransferase is an enzyme found in the parasites and other cells
Ferritin is it an acute phase reactants reactant

222
Q

T/F ferritin is an acute phase reactants

A

T

To sequester iron from possible infectious organisms

223
Q

define marketed elevation of transaminases

Define marked elevation of transaminases

A

greater than 25 times the upper limit of normal

224
Q

Mark elevations of transaminases (greater than 25 times the upper limit of normal), is suspicious for

A

viral infection
Drug toxicity (acetaminophen)
Ischemic injury

225
Q

T/F

Degree of transaminitis is correlated to severity of liver disease

A

Falls

Pattern of transaminitis helps the differential but degree of elevation does not correlate to severity of disease

226
Q

T/F

Pancreatic cancer presents late and typically has a poor prognosis even with a potential he respectable mass

A

T

227
Q

for risk factors for pancreatic cancer number for risk factors

A

smoking
Obesity
DM
FH family history

228
Q

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

A

cancers of the body and tail –-pain and weight loss

Cancers of the head– Stay at Therea fatty diarrhea weight loss jaundice

229
Q

T/F

Pancreatic cancer can present with Johnice jaundice

A

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
Q

T/F

Physical exam and pancreatic cancer is often unremarkable other than jaundice

A

T

231
Q

Courvoisier sign

A

palpable but nontender gallbladder in jaundiced patient. Finding in pancreatic cancer

232
Q

virchow’s node

A

Supraclavicular lymphadenopathy Andy could’ve of G.I. pathology indicative of G.I. path all a G path ologies pathology

233
Q

T/F

Abdominal mass or ascites is present in the majority of pancreatic cancer presentations

A

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
Q

blank is the initial imaging performed on patients with jaundice, if this is not diagnostic blank is then performed

A

abdominal ultrasound

CT

235
Q

when is ERCP considered for suspicion of pancreatic cancer

A

when right upper quadrant ultrasound is nondiagnostic
And abdominal CT is nondiagnostic
(because the ERCP is invasive)
or to treat gallstone pancreatitis

236
Q

when is percutaneous transhepatic cholangiogram typically considered

A

and patience where ERCP is contra indicated

237
Q

what is percutaneous transit panic cholangiogram percutaneous transhepatic cholangiogram PTC

A

using needle to inject dye into biliary tree, can also be performed therapeutically like ERCP, removing stones placing stents etc

238
Q

T/F

Amylase and lipase are good labs and work up of pancreatic cancer

A

false

Elevated and pancreatitis not pancreatic cancer

239
Q

what is CA 19-9 in the context of pancreatic cancer

A

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
Q

T/F a Dommel CT is a very sensitive and specific tool used for a diagnosis of pancreatic carcinoma

A

True

241
Q

hemoglobin thresholds for packed red blood cell transfusion

A

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
Q

what situation is fresh frozen plasma typically reserved for

A

Coagulopathy
With active bleeding
Fresh for frozen plasma has all coagulation factors just know RBCs RBCs

243
Q

Octreotide is a

A

somatostatin analog

244
Q

when is whole blood transfusion considered

A

severe hemorrhage

245
Q

t/f

severe pancreatitis can present w dyspnea, tachypnea, and basilar crackles

A

T

severe pancreatitis can progress to multisystem organ dysfunction (shock, renal failure, early respiratory failure)

246
Q

how long do most patients with acute pancreatitis take to recover

A

3-5 days

with conservative mgmt. (bowel rest fluids, pain meds)

247
Q

what % of acute pancreatitis progresses to severe pancreatitis

A

15-20%

248
Q

define severe pancreatitis

A

pancreatitis with 1+ organ failure

249
Q

5 clinical markers assoc w inc risk of acute pancreatitis turning to severe pancreatitis (at least 1 organ failure)

A 
age >75
alcoholism
obesity
CRP > 150 at 48 hrs
^BUN/Cr in first 48 hrs
250
Q

best labs to trend in pancreatitis

A

CRP
BUN

both elevated in severe pancreatitis (CRP >150 @ 48 hrs; BUN elevated in first 48 hrs)

251
Q

how long do pseudocysts usually take to develop after acute pancreatitis

A

3-4 weeks

252
Q

T/F

severe pancreatitis can cause SIRS and shock

A

T

inflammation, vasod, permeab, organ failure/shock

Medicine (13 decks)

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