GI Flashcards
1
Q
three upper GI disorders
A
peptic acid disorders
gastric cancer
esophageal cancer
2
Q
three types of peptic acid disorders
A
benign peptic ulcers
GERD
zollinger-ellison syndrome (gastrinoma)
3
Q
how common are peptic ulcers
how has the epidemiiology changed
A
very common (500,000 new cases yearly)
increasing numbers of gastric ulcers vs duodenal
4
Q
two main types of peptic ulcers
A
duodenal and gastric
5
Q
what type of peptic ulcer is most common
what age
what age of gastric
A
duodenal 4:1
35-55
55-70
6
Q
four complications of peptic ulcers
A
pain 100% of the time
bleeding 10%
perforation 3-5%
gastric outlet obstruction 2%
7
Q
differing pain in gastric ulcers
A
intermittent heartburn type vs chronic boring pain with deep ulcers
8
Q
symptoms of the chronic vs acute bleeding
A
black tarry stools vs hematemesis
9
Q
common etiology prior to 1981
A
stress
enviromment (smoking, spicy food)
alchool
glucocortioids and NSAIDs
10
Q
what changed in peptic ulcer treatment after 1981
A
helicobacter pyloria was linked to PUD
11
Q
what type of bacteria is helicobacter pylori
where is it common
if H pylori is not erradicated what is the risk
A
gram negative spirochet that causes gastritis
most common in places with poor santitation
85% of ulcers will recur
12
Q
how has PUD disease changed
A
H pylori
nsaid and sterioids effect
increase acid production (smoking and stress)
inadequate mucosal effect (smoking)
13
Q
describe the effect of H pylori on cancer
A
increaesd risk of gastric cancer, decreased risk of esophageal cancer
14
Q
PUD treatment
A
eradicate H pylori
reduced acid secretion
neutralize acid
enhance mucosal defense
15
Q
treatment of H pylori
A
2 week course of abx with bismuth or PPI
16
Q
two methods to reduce acid production related to PUD
A
H2 receptor antagonist
PPI
17
Q
what is the benefit of antacids
but?
A
the provide rapid pain relief but the effect is short lived and there is no indication that they promote healin
18
Q
when are antacids contraindicated
tablets or liquid more effective
A
renal failure
liquid better than tablets
19
Q
what are the protective effects of gastric prostaglandins
A
suppression of acid production
stimulates mucin production
increase HCO3
increase muscosal blood flow
20
Q
how do H2 inbitors block acid production
A
block the binding f histamine in to receptors, stopping the production of cMAP from adenylate cyclase and reducting proton pump action
21
Q
What is responsible for GERD
A
a disorder of the lower esophageal sphincter that allow acid to come up
22
Q
where is GERD most common
A
develop countries 10-20%
23
Q
risk factors for GERD
A
obesity
hiatal hernia
increased acid production
24
Q
three symptoms of GERD
A
esophageal pain
nausea
coughing
25
three conditons associated with GERD
Barrett's esophagus
Esophageal carcinoma
esophageal stricture
26
three options for GERD treatment
gastric acid suppression
lifestyle modification
surgery
27
what is the mean age of diagnosis of Gastric cancer
what is the gender bias
63, men 2:1
28
three risk factors for gastric cancer
chronic H pylori
smoking
diet high in nitrates but low in vitamin c
29
symptoms of gastric cancer
none, in the early stages
upper abdominal pain
anorexia/weight loss
blood loss anemia
30
diagnosis of gastric cancer
double contrast upper GI xray
esophagogastroduodenoscopy (EGD)
31
treatment for gastric cancer
gastrectomy (only possible for 30% of patients)
chemo
32
what is the prognosis of gastric cancer based on stage
1 60%
2 44%
3 20%
4 3%
33
what is the age and gender bias for esophageal cancer
50-70
3x more common in men to women
34
two types of esophageal cancer
squamous cell (most common)
adenocarcinoma
35
main symptoms of esophageal cancer
dysphagia
weight loss
pain
36
risk factors for esophageal cancer
tobacco (specifically for squamous cell)
obesity
GERD/Barrett's esophagus
37
diagnossis of esophageal cancer
endoscopy, biopsy, Ct for stagin
38
what is the 5 year survivable prognosis for esophageal cancer
less than 20%
39
what is the treatment for a cure in esophageal cancer
surgery, radiation, chemo
40
four liver and biliary tract disorders
heptaitis
fatty liver
cirrhosis
gallbladder disorder
41
define hepatitis
acute inflammation of the liver that disrupts normal function and causes scarring
42
causes of hepatitis
medication, chemicals, parastites, viruses
43
what are the most common viral causes of cirrhosis
hep A, B, and C
44
how common is Hep A
how is it spread
what is the mortality rate
30% of americans are serologically positive for Hep A
fecal oral transmission from sanitation, shellfish
usualyl low, the disease does not lead to chronic infection or liver damage
45
what is the process of Hep A
incubation for 30 days
prodrome for several days
icteric phase for 2-3 weeks with worsening symptoms
convalescence
46
prodromal symptoms of Hep A
malaise, anorexia, fatigue, myalgia, RUQ tenderness
47
Which is more common, Hep A or B
hep A 5-6% positive
48
how is hep b spread
transfusion
exchange of bodily fluids
vertical transmission (mother to off spring)
49
contrast the course of illness between Hep A and B
they have similar symptoms and rarely fatal, BUT chronic infection is possible that increases risk of cirrhosis and hepatoma
50
where does the majority of chronic Hep B fall in the population
90% in neonates and infants
1-5% in normal adults
51
what is the risk of cirrhosis with chronic Hep B
40%
52
what makes Hep C more problematic
chronic infection is a comon complication and is the leading cause of cirrhosis
53
how to prevent Hep A
sanitation
hep A vaccine
antiobodies for post exposure treatment
54
preventing Hep B
screening to protect blood supply
Hep B vaccine for children
HBIG for exposure
prevention of transmission at bith
55
preventing Hep C
screening to protect blood supply
no HCIG
no vaccine
56
is Hep C commonly spread to babies through breast feeding
not commonly
57
should patients with hep C us protection
its not necessary
58
what is the effect of Hep D and B infection
a significantly more severe disease than Hep B alone
59
who is Hep E most dangerous in
pregnany women and immunosuppressed patients
60
treating viral hepatitis
infereron
antivirals to reduce the risk of liver failure
there is a cure
61
fatty liver disease
steatosis (fatty deposits) in the liver common in obese adult that distorts the normal structure of the liver
62
how is fatty liver detected
liver function test
US
CT
63
FLD causes and management
chronic alcohol use
obestiy
metabolic disease
drug toxicity
64
methods to manage FLD
stop using alcohol
lose weight with bariatric surgery if necessary
65
Cirrhosis
irreversible inflamatory disease that disrupts the liver function and structure
66
what is the result of build up of nodular and fibrotic tissue from cirrhosis
obstruction of the biliary channels and portal hypertension
67
three types of liver failure
alcoholic
biliary
infectious (post necrotic)
68
five main functions of the liver
bilirubin elimination
blood filtering
synthesis of important substances
drug detoxificaiton
mineral and vitamin storage
69
what types of substances are synthesized in the liver
clotting factors
albumin
CHO
bile
70
symptoms of cirrhosis
chronic RUQ pain
jaundice
edema
portal hypertension
reduced coagulation
reduced drug metabolism
71
how much does liver failure incrase the risk of liver cancer
3-5% per year
72
symptomatic treatment of cirrhosis
paracentesis of ascities
shunts to reduce portal hypertension
correction of coagulopathy and hypoalbumemia
73
direct treatment of cirrhosis
anti viral drugs for hepatitis
anti-inflammatory and immunosuppresive drugs in the case of an autoimmune disorder
liver transplant
74
what is the prognosis of cirrhosis
severe cirrhosis 6 month survival at 50%
moderate 5-10 yrs
75
what is the gender bias of cholelithaisis
women over men, 8.6% to 5.5%
76
what are the risk factors for gall stones
gender
old age
obesity
child bearing
diet
77
explain the saying "female, forty, fat, and fertile"
delineates the risk factors for gall stones
78
what is one medication that increases the risk of gall stones
one that decreases
cephalosporin
aspirin
79
what kind of diet will lower the risk of galll stones
low carb high fiber
80
T/F gallstones are usually symptomatic
false
81
what percent of people will develop episodic biliary pain related to gallstones
what are the symptoms
10-25%
RUQ pain, often at night
pain related to a high fat meal
lasts from 30 minute to hours
82
what is the percent break down of gallstone composition
choleterol (80-85%)
calcium bilirubinate (\<20%)
83
what is the method of imaging a gall stone
ultrasound
84
what is the treatment for gallstones
laproscopy
stone dissolution with bile salts
85
five symptoms of acute cholecystitis
biliary pain
nausea/vomiting
fever
leukocytosis
jaudice
86
what is the most common cause of cholecystitis
distal occulsion of the bile duct by a gallstone
87
what is the risk of untreated cholecystitis
ischemia leading to perforation/rupture, followed by abcess, peritonitis, and death
88
signs and symptoms of acute cholecysitis
RUQ, nausea, fever
89
what are the laboratory signs of cholecystitis
leukocytosis, elevated bilirubin, elevated liver enzymes
90
what are the physical exam findings present with cholecystitis
murphy's sign
91
conservative treatment of cholecystitis
NPO w/ IV fluids
analgesics
IV antibiotics
92
what is the surgical treatment for acute cholecystitis
laproscopy after the swelling has gone down unless there is sign of peritonitis
93
two types of pancreatic disorders
pancreatitis
pancreatic cancer
94
pancreatitis
acute or chronic inflammation of exocrine pancreas
95
5 risk factors for pancreatitis
alcohol abuse
smoking
female gender
biliary disease
medicaion
96
signs of pancreatitis
acute epigastric pain
N/V
fever
abdominal tenderness and distention
97
though the exact pathogenesis of pancreatitis is unknow, what are two suspected causes
edema/obstruction of the ampulla of vater
direct injury to secretory cells
98
two characteristics of acute epigastric pain associated with pancreatitis
abrupt onset of severe, boring pain that often radiates to the lower bac
99
diagnostic factors of pancreatitis
elevation of pancreatic enzymes
fever and leukocytosis
Ct imaging
100
what levels of lipase and amylase wuld indicate pancratitis
3x the normal limit
101
treatment of mild pancreatitis
bed rest with NPO
analgesia
Iv fluids
102
treatment of severe pancreatitis
intensive care
aggressive fluid and electrolyte replacement
possibly antibiotic use
103
what is the mortality for acute pancreatitis
5-25% depending on severity
104
what are the main risks for chronic pancreatitis
alcoholism, smoking, biliary tract disease
105
potential complications of chronic pancreatitis
opiod addiction
DM
malabsorption from enzyme deficiencies
pancreatic cancer
106
incidence and prognosis of pancreatic cancer
\>30,000 increasing over the last 2 decades
overall very poor
107
risk factors for pancreatic cancer
smoking
chronic pancreatitis
obestity
long term diabetes
108
T/F its common to have severe symptoms in the early stages of pancreatic cancer
false, it is commonly asymptomatic
109
symptoms of pancreatic cancer
gnawing visceral midabdominal pain
weight loss
jaundice from biliary obstruction
110
diagnosis of pancreatic cancer
CT/Pet scan
laparotomy with biopsy or resection
111
treatment of pancreatic cancer
surgical resection
chemo
radation
112
three lower GI disorders
acute appendicitis
colorectal cancer
IBS
113
what is the most common abdominal surgical emergency
appendicitis
114
four pathologies of appedicitis
obstruction form feces, foreign body, inflammation, neoplasm
115
signs of appendicitis
abdominal pain
nauseaa
low fever, leukocytosis
116
dscribe the abdominal pain associated with appendicitis
periumbilical and epigastric, migrating to the right lowe quadrand
117
PE findings for appedicitis
RLQ, pain, guarding, rebound, positive psoas or obturator
118
diagnostic factors for pancreatitis
PE findings
CT
US
119
what is the treatment for appendicitis
non surgical
laparoscopy/laparotomy
Ice, iv, transport
120
complications of appendectomy
perforation leading to peritonitis or pelvic abcess
death from septicemia
121
risk fastors for colorectal cancer
dietarty fcators
HPV
IBS (crohns or UC
122
dietary factors associated with colorectal cancer
high fat and meat, low fiber
123
four ways to reduce risk of colorectal cancer
screening
low dose aspirin
high fiber, low fat diets
hormone replacement in women
124
what is the purpose of screening procedures for colorectal cancer
the identification and removal of adenimoatous polyps
125
screening procedures for colorectal cancer
fecal occult blood testing
fecal immunochemistry screening
colonoscopy
126
who should be screened for colorectal cancer
low risk patients every 10 years at 50
high risk earlier and more often
127
treatment of colorectal cancer
surgical resection for all patients
chemo
immunotherapy
128
two main types of IBD
Ulcerative colitis or crohns
129
what demographic has the highest instance of IBD
ashkenazi jews
130
two possible pathophysiolgies of IBD
abnormailites of intestinal microflora
possible auto immune mechanisms
131
symptoms of UC
diarrhea, cramping, rectal bleeding, passage of mucus
132
symptoms of crohns
recurrent episodes of RLQ pain
malabsorption
steatorrhea
bowel obstruction
133
how is IBD diagnosed
diagnostic imaging
endoscopy
134
treatment of crohns
symptomatic
diet
antibiotics
corticosteroids
resecetion of the terminal ileum or other segments
135
treatment of UC
aminosalicylates
glucocorticoids
surgery
136
how does the IBD increase the risk of colon cancer based on duration
after 10 yrs 2%
after 20 8%
after 30 18%
