GI Flashcards
PBC (+ antimitochondrial Ab) increases risk of (3 things)?
Osteomalacia (d/t malabsorption of fat soluble vits)
Hepatocellular carcinoma
Xanthelasmas
Tx - Ursodeoxycholic acid delays progression
Lynch syndrome is associated with which 3 cancers?
Colorectal
Endometrial
Ovarian
Familial adenomatous polyposis is associated with which 3 cancers?
Colorectal
Desmoids/Osteomas
Brain tumors
von Hippel-Lindau syndrome is associated with which 3 cancers?
Hemangioblastomas
Clear cell RCC
Pheo
MEN type 1, 3 cancers?
Parathyroid adenoma
Pituitary adenoma
Pancreatic adenoma
MENT type 2, 2 cancers?
Medullary thyroid cancer
Pheo
Parathyroid hyperplasia (type 2 A)
BRCA1/2 is associated with?
Breast
Ovarian
How do you screen for endometrial cancer in a pt with Lynch syndrome?
Annual endometrial bx (age 30-35)
Prophylactic hysterectomy
Middle aged male Diarrhea, abd pain weight loss Steatorrhea Skin hyperpigmentation, arthralgia Small bowel bx - villous atrophy s/ PAS-positive material in the lamina propria
Whipple’s
Infection with Tropheryma whippelii
Pt has dysphagia with regurgitation through his nose and frequent RLL PNA. Dx and workup?
Oropharyngeal dysphagia
Get a videofluoroscopic modified barium swallow to see swallowing mechanics/dysfxn/aspiration
Colon cancer tends to metastasis to?
The liver
RUQ pain, firm hepatomegaly
Most common cause of lower GI bleed in adults?
Diverticulosis
Why do acute pancreatitis pts become hypotensive?
Intravascular volume loss d/t vascular endotelial injury ( leads to vasodilation, increased permeability, plasma leak into the retroperitoneum)
Tx for hematemesis d/t esophageal varices?
Octreotide
Older pt with recurrent painless lower GI bleed
Angiodysplasia Dilated submucosal v. and AVM's Dx'd on colonoscopy but often missed If asyx - no tx If anemic, bleeding - cauterize
IBD w/ spared rectum, perianal dz, noncaseating granulomas
Crohn dz
Pt w/ ascities presenting with low grade fever, AMS
always need to r/o SBP
Does a negative guiac r/o nee for colonoscopy in a pt with high suspicion for GI bleed?
Nope
Dermatitis (of sun exposed skin)
Dementia
Diarrhea
Pellagra d/t niacin deficiency
Isoniazid use can cause pellagra
Synthesized from tryptophan, so vegetarian diet high in corn is a strong RF
GERD pt gets MALT. How?
H. pylori
Give quad therapy
SBP diagnostic criteria on paracentesis?
PMN > 250
+ Culture
Jaundice, scleral icterus
+ urine bili
NL LFTs, AP
Rotor’s syndrome
Benign, inherited defect in hepatic secretion of bilirubin
Mineral deficiency w/:
Alopecia, pustular rash, hypogonadism, impaired wound healing, impaired taste, immune dysfunction
Zinc
Mineral deficiency w/:
Brittle hair, skin depigmentation, Neurologic dysfunction, sideroblastic anemia, osteoporosis
Copper
Mineral deficiency S/:
thyroid dysfunction, cardiomyopathy, immune dysfunction
Selenium
Management of upper GI bleed that is losing consciousness
Intubate
EGD can wait until after the airway is secured
Cardiac finding in Carcinoid
Tricuspid regurg
Tx for esophageal spasm
CCB’s
corkscrew on esophagram
GI manifestations of a cholesterol embolism
Pancreatitis, mesenteric ischemia
Hematemesis following repeated vomiting in an alcoholic
Mallory-Weiss tear
Longitudinal tear at the GE junction
Dx on EGD
Tx - resolves spontaneously or endoscopy
Major modifiable RF’s for pancreatic cancer?
Smoking (most sig)
Obesity
Non hereditary pancreatitis (ie alcohol)
Cirrhosis pt develops SOB and dullness over one lung field. Why?
Hepatic hydrothorax
Transudative pleural effusion through small defects in the diaphragm
IBD
pseudopolyps
Mucosal ulcerations
crypt ascesses
Ulcerative colitis
Increases risk for PSC (+ p-ANCA)
How do you manage a non bleeding varices in a cirrhosis pt?
Beta Block - prophylactic tx to reduce the likelihood of progression to large varices and hemorrhage
EGD ligation is second line in those when BBlock is contra
epigastric pain and weight loss in pt w/ PMH sig for chronic pancreatitis
Pancreatic cancer
Get a CT
How do you define acute liver failure?
Severe liver injury w/ encephalopathy, impaired synthetic fxn (INR>1.5)
Drugs and virus is most common
What is recommended in addition to CCB’s in newly dx’d achlasia
EGD to r/o malignancy
Especially if they have red flags
Which path finding following colonoscopy bx would need to most intensive follow up?
Villous adenoma
Adenomatous polyps have the highest malignancy potential
If the adenomatous polyp is > 1cm, high grade dysplasia, or villous features this is even higher grade
Younger male has perianal skin tags, fistulas, aphthous ulcers
Bx woud reveal?
Focal ulcers w/ transmural inflammation
Crohn’s dz
