GI Flashcards

1
Q

Adenocarcinoma of the esophagus

A

Caused from GERD progressing to Barrett metaplasia occurring at the lower half of the distal esophagus

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2
Q

Squamous cell carcinoma of the esophagus

A

Can occur at any part of the esophagus

  • Other risk factors include smoking and alcohol use
  • Esophageal cancer is the seventh most common cause of cancer death in males with a 5-yr survival rate of 19%
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3
Q

Hx/PE of esophageal cancer

A
Dysphagia
Wt loss
Bleeding
Chest pain
Hoarseness
Persistent cough
PE findings are typically nl
LAD in supraclavicular area occasionally or hepatomegaly for advanced cases
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4
Q

Work up of esophageal cancer

A
EGD
CMP to assess liver enzymes and albumin
CBC to assess for anemia
CT scan to assess for metastasis
Barium swallow rarely used now- EGD preferred
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5
Q

Tx of esophageal cancer

A

Staging- TNM classification
Stage 1 (T1aN0)- endoscopic -removal
T1b and any N- surgery plus multimodality therapy
-15-30% of those given neoadjuvant chemoradiation have the tumor completely disappear with a 3-yr survival of 50%
Stage IV dz usually given palliative care to try and keep esophagus patent and improve pain

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6
Q

Gastric neoplasm

A

Difficult to cur because most pts present with advanced disease
Early gastric cancer typically has no sx
5-yr survival rate is 30-50% with stage II
And 10-25% for pts with stage III

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7
Q

Hx- gastric neoplasm

A
Early stage- no sx
Most sx reflect advanced dz:
Severe indigestion
Nausea with vomiting
Dysphagia
Postprandial fullness
Loss of appetite
Very late complications- pleural effusion, obstruction, bleeding into stomach
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8
Q

Exam of gastric neoplasm

A
All PE signs are late events. By the time they develop, the cancer is too far advanced to cure
Enlarged stomach
Hepatosplenomegaly
Virchow nodes (L supraclavicular)
Wt loss in some
Melena
Pallor from anemia
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9
Q

RFs of gastric cancer

A
Diet
Obesity
Smoking
5% of those with H. pylori
Pernicious anemia
Chronic atrophic gastritis
Radiation exposure
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10
Q

Workup for gastric cancer

A

CBC to assess for anemia
CMP to check for liver enzymes
CEA is increased in 45-50% of cases
EGD with bx has a diagnostic accuracy of 95%
-CT scan of chest, abd, and pelvis to assess mets

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11
Q

Tx of gastric cancer

A

Surgery- subtotal or total gastrectomy
-Any nodal involvement indicates a poor prognosis
Most pts who undergo a surgical resection will have a recurrance

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12
Q

Cholecystitis causes

A

90% of cause is from stones (cholelithiasis)
10% is acalculous
-Biliary stasis- possibly from debilitation, severe trauma, or prolonged fasting
Diabetes is a RF, salmonella infections, CMV

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13
Q

Cholelithiasis

A

Gallstones can be present and remain asymptomatic for decades
Migration of a gallstone into the opening of the cystic duct may block the outflow of bile during gallbladder contraction, causing biliary colic

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14
Q

Ascending cholangitis

A

Gallstone in the common bile duct may impact distally in the ampulla of Vater, this leads to abdominal pain and jaundice.
Then, stagnant bile above the obstructing stone often becomes infected, and bacteria can spread rapidly backing up the dutctal system into the liver to produce a life-threatening infection

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15
Q

What is the common cause of cholangitis?

A

Choledocholithiasis

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16
Q

Sx of cholangitis

A

Charcot triad of fever, jaundice, and RUQ pain

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17
Q

Workup for cholangitis

A
CBC
CMP
Blood cultures
Amylase
Lipase
-Blood cultures positive- 50% with E. coli or Enterococcus
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18
Q

Tx of cholangitis

A

Broad-spectrum abx-Piperacillin or ceftazidime and IV fluids

For severe cases- endoscopic drainage

19
Q

Cirrhosis

A

The diffuse hepatic process characterized by fibrosis and the conversion of nl liver tissue into structurally abnormal nodules

20
Q

Causes of cirrhosis

A
Alcoholism
Hep B and C
Biliary cirrhosis
Non-alcoholic steatohepatitis
Drugs, toxins
R heart failure can lead to liver failure
21
Q

Pancreatitis

A

An inflammatory process in which pancreatic enzymes autodigest the gland. The pancreas will sometimes heal without any impairment of function. Recurrent attacks are referred to as chronic pancreatitis

22
Q

Common causes of pancreatitis

A

MCC is gallstones passing into the bile duct and lodging at the sphincter of Oddi
Alcohol use is also a major cause (35%)
Triglycerides >1000 mg/dL and can be more severe

23
Q

Work up for pancreatitis

A
CBC
CMP
Amylase
Lipase
Abdominal u/s to look for gallstones
CT abdomen for severe cases only
Consider MRCP to detect
Biliary and pancreatic duct obstruction
24
Q

DDx of pancreatitis

A
Acute mesenteric ischemia
Cholangitis
Cholecystitis
Colon adenocarcinoma
Bowel obstruction
Duodenal ulcers
Myocardial infarction
Pancreatic cancer
25
Tx of pancreatitis
NPO IV fluid hydration Analgesics (antibiotics are generally not indicated) Cholecystectomy if needed Enteral feedings ICU for severe acute pancreatitis Pt is discharged when pain is well controlled and they are able to tolerate an oral diet and all complications have been addressed
26
Appendicitis
An inflammation of the inner lining of the vermiform appendix that spreads and can cause significant morbidity
27
What occurs in only 50% of cases of appendicitis?
Classic presentation: hx of loss of appetite, periumbilical pain followed by nausea, then RLQ pain and vomiting
28
Appendicitis workup
CBC- WBC > 10.5K in 80-85% of adults CMP- to r/o other problems UA to r/o other causes of pain Urine hCG level: all women of childbearing age that have not had sterilization: no matter what CT scan with PO contrast- important imaging study
29
Tx for appendicitis- criteria for referral
Refer to general surgeon if clinical hx and exam plus labs are highly suspicious for appendicitis If CBC and CT scan is inconclusive- consult with you physician and search for another cause of abd pain
30
Irritable bowel syndrome
Alternating bowel habits from constipation and diarrhea Abd cramping relieved by bowel movements Stress makes it worse and cramping usually occurs right after eating
31
Red flags to look for other causes than IBS
``` Nocturnal diarrhea Wt loss Fever Blood in stool Steatorrhea Gluten intolerance ```
32
Tx for inguinal hernia
Symptomatic pts should be repaired surgically
33
Tx of umbilical hernia
Children under 5 do not usually need surgery. Surgery in kids or adults only if incarceration
34
Acute diarrhea
In developed countries is almost always a benign, self-limited condition that subsides in a few days Giardia is rare but could be indicated if extremely foul smelling stool that floats Viruses include rotavirus, adenovirus, norovirus Bacteria- rare -E. coli, Klebsiella, C. diff, cholera, Campylobacter, salmonella Mexico- Entamoeba or Yersinia
35
Chronic diarrhea
R/o IBD R/o celiac dz R/o pancreatic d/o IBS is dx of exclusion
36
Diarrhea tx- Campylobacter
Erythromycin
37
Diarrhea tx- C. difficile
Metronidazole | Life-threatening: Vancomycin by mouth
38
Diarrhea tx- E. coli
TMP/SMX
39
Diarrhea tx- salmonella
Only infants and severely immune compromised: TMP/SMX
40
Diarrhea tx- shigella
TMP/SMX
41
Diarrhea tx- Yersinia
TMP/SMX
42
Diarrhea tx- Entamoeba
Flagyl then iodoquinol
43
Diarrhea tx- Giardia
Flagyl
44
Diarrhea tx- Cryptosporidium
paromomycin