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PANCE 2.0 > GI #7 > Flashcards

GI #7 Flashcards

1
Q

What is the difference between gastritis and gastropathy?

A

Gastritis: superficial inflammation or irritation of the stomach mucosa without mucosal injury

Gastropathy: mucosal injury without evidence of inflammation

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2
Q

MCC of gastritis

A

H. Pylori

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3
Q

Diagnostic of choice for gastritis

A

Upper endoscopy with biopsy

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4
Q

What is a gastrinoma?

A

-Gastrin-secreting neuroendocrine tumor leading to severe PUD and diarrhea

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5
Q

Gastrinomas are MC in what location?

A

Duodenal wall (45%

-Other areas: Pancreas, lymph nodes

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6
Q

When should you suspect a gastrinoma in a patient?

A

If the patient has severe, recurrent, multiple, or refractory ulcers + diarrhea

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7
Q

What is the best initial test for a gastrinoma?

A

-Elevated fasting gastrin levels ( >1,000 pg/mL + gastric pH < 2)

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8
Q

However, for a gastrinoma, what is the confirmatory test?

A

Secretin test: persistent gastrin elevations. Normally, gastrin release is inhibited by secretin.

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9
Q

What is the most sensitive test for a gastrinoma localization?

A

Somatostatin receptor scintigraphy (increased somatostatin receptors in gastrinomas)

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10
Q

Treatment for gastrinomas

A
  • Local: Tumor Resection

- Metastatic, Unresectable: Lifelong high-dose PPI’s

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11
Q

Where are the MC sites for mets for a gastrinoma?

A

-The liver and abdominal lymph nodes

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12
Q

55% of carcinoid tumors arise in the GI tract. What are Carcinoid tumors?

A

-Rare, well-differentiated neuroendocrine tumors that arise from enterochromaffin cells

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13
Q

What are the symptoms of carcinoid syndrome?

A

Periodic episodes of diarrhea (serotonin release), flushing, tachycardia, and bronchoconstriction (histamine release) and hemodynamic instability (hypotension)

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14
Q

What are some diagnostics that can be done to diagnose a carcinoid tumor?

A
  • Many are asymptomatic (incidental finding on endoscopy)
  • 24 hour urinary 5-hydroxyindolacetic acid/5-HIAA excretion
  • Radiolabeled somatostatin analogs for localization
  • Contrast, triple-phase CT or abdomen and pelvis
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15
Q

MC type of gastric carcinoma

A

Adenocarcinoma

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16
Q

Biggest risk factor for gastric carcinoma?

A

H. Pylori

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17
Q

Other risk factors for gastric carcinoma

A
  • Males
  • > 40 years old
  • Preserved foods
  • Obesity
  • Smoking
  • Blood Type A
  • Non-Hodgkin Lymphoma
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18
Q

What are some things that have been proven to decrease risk of gastric carcinoma?

A
  • Chronic Aspirin and NSAID use
  • Fruits and vegetables
  • Wine consumption
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19
Q

Symptoms of gastric carcinoma

A
  • Most patients are advanced at time of presentation
  • Weight loss, persistent abdominal pain
  • Early satiety
  • Dysphagia
  • Melena
  • Hematemesis
  • Iron deficiency anemia (chronic blood loss)
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20
Q

What are some things that have been proven to decrease risk of gastric carcinoma?

A
  • Chronic Aspirin and NSAID use
  • Fruits and vegetables
  • Wine consumption
21
Q

What are some things that have been proven to decrease risk of gastric carcinoma?

A
  • Chronic Aspirin and NSAID use
  • Fruits and vegetables
  • Wine consumption
22
Q

There are numerous physical exam findings that can be found with a gastric carcinoma. Name some of them.

A
  • Supraclavicular lymph nodes: Virchow’s Node
  • Umbilical LN: Sister Mary Joseph’s Node
  • Ovarian Mets: Krukenburg Tumor
  • Palpable Nodule on Rectal Exam: Blumer’s Shelf
  • Left axillary lymph node: Irish Sign
23
Q

Initial test of choice for most gastric cancers is

A

-Upper endoscopy with biopsy

24
Q

Even though gastric carcinoma has a poor prognosis, because it presents late in disease, what are some treatment options?

A

Gastrectomy, chemotherapy, radiation for lymphona

25
Q

Pyloric Stenosis is due to hypertrophy of pyloric muscles, causing a functional gastric outlet obstruction and prevents what?

A

Gastric emptying into the duodenum

26
Q

Risk factors for pyloric stenosis

A
  • Most common in first 3-12 weeks of life
  • Erythromycin use (within first 2 weeks of life)
  • Caucasians
  • Males
  • First-borns
27
Q

Symptoms of pyloric stenosis

A
  • Nonbilious, projectile vomiting after feeding
  • Weight loss, dehydration, malnutrition
  • Palpable pylorus (olive shaped, mobile hard mass to right of epigastrium)
28
Q

Initial diagnostic of choice for pyloric stenosis

A

-Abdominal US

29
Q

What does an upper GI series show for pyloric stenosis?

A
  • String sign: thin column of barium through narrowed pyloric channel
  • Railroad track sign: excess mucosa in pyloric lumen
30
Q

Labs for pyloric stenosis shows

A

-Hypokalemia and hypochloremic metabolic alkalosis from vomiting

31
Q

Treatment for pyloric stenosis

A
  • Rehydration (IVF) and electrolyte repletion (potassium replacement)
  • Definitive: Pyloromyotomy
32
Q

What is autoimmune hepatitis?

A

Idiopathic chronic inflammation of the liver due to circulating autoantibodies

33
Q

Autoimmune hepatitis is MC In

A

Young women

34
Q

Diagnostics for autoimmune hepatitis

A
  • Type I: Positive ANA, smooth muscle antibodies

- Type II: Anti-liver/kidney microsomal antibodies

35
Q

What do labs show for autoimmune hepatitis?

A

-LFTs: Increased ALT > 1,000

36
Q

Definitive diagnostic for autoimmune hepatitis?

A

Liver biopsy

37
Q

Treatment for autoimmune hepatitis

A

-Corticosteroids +Azathioprine

38
Q

Hepatitis A is transmitted via

A

Fecal-oral

-Associated with international travel, day care workers, MSM, homelessness, shellfish, and IVDU

39
Q

Symptoms of Hepatitis A

A
  • Most are asymptomatic
  • May be associated with spiking fever
  • Malaise, anorexia, nausea, vomiting
  • Jaundice, hepatomegaly
40
Q

Diagnostics/Labs for Hepatitis A

A
  • LFT: elevated ALT, AST, bilirubin
  • Acute: IgM anti-HAV
  • Past Exposure: IgG HAV with negative IgM
41
Q

Explain the IgM and IgG antibodies

A

IgM means you have it right now (right meow)

IgG means you got it a while ago

42
Q

Treatment for Hepatitis A

A

-No treatment needed (self-limited like HEV)

43
Q

Prevention of Hepatitis A

A
  • Handwashing
  • Food safety
  • Immunization
44
Q

If a patient has an increased risk of Hepatitis A infection, what should you do?

A

2 doses given 6 months apart of the vaccination

45
Q

Explain the post-exposure prophylaxis for Hepatitis A (there are three and depends on ages and immunocompromised or not)

A
  • Healthy individuals 1-40 years old: HAV vaccine (within 2 weeks of exposure)
  • Healthy individuals > 40 years old: HAV vaccine (with or w/o immunoglobulin) within 2 weeks of exposure
  • Immunocompromised or chronic liver disease > 1 year old: HAV vaccine + HAV immunoglobulin within 2 weeks of exposure
46
Q

What is fulminant hepatitis?

A

Acute hepatic failure in patients with hepatitis

47
Q

What are the most common etiologies of fulminant hepatitis?

A

Acetaminophen toxicity: MCC in US
Viral hepatitis, drug reactions, sepsis
Reye syndrome: if children are given aspirin after viral infection

48
Q

Symptoms of fulminant hepatitis

A
  • Encephalopathy: asterixis, coma, AMS, seizures, cerebral edema
  • Coagulopathy: increased PT, increased PTT
  • Hepatomegaly
  • Jaundice
  • Reye Syndrome: rash (hands and feet), vomiting, liver damage, dilated pupils with minimal response to light, multi-organ failure
49
Q

Treatment for fulminant hepatitis

A
  • Supportive: IVF, electrolyte repletion, Blood products

- Liver transplant is definitive

PANCE 2.0 (62 decks)

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