GI / Nutritional Part 5 (Pancreatic carcinoma - Toxic Megacolon) Flashcards

1
Q

MC location of pancreatic cancer and MC cancer-type

A

Location = head of pancreas (90%)
Type = adenocarcinoma (ductal)

islet cell is the other type, but not as common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the #1 RF for pancreatic carcinoma and some others

A

Smoking

age > 55yo
chronic pancreatitis
DM
Males
Obesity
AA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Classic symptom of pancreatic cancer

A

Painless jaundice (d/t CBD obstruction)

also weight loss is seen, similar s/s of pancreatitis, new onset DM, depression, pruritis (from bile salt deposition in skin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Your patient has a carcinoma at the head of the pancreas which has caused CBD obstruction, what PE sign might you observe

A

Courvoisier’s sign: palpable, nontender, distended gallbladder due to common bile duct obstruction (esp. if head of pancreas is involved)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Your elderly patient has new onset DM and painless jaundice with weight loss. You suspect pancreatic cancer.

What imaging is first line?
What tumor marker will you follow after treatment?

A

CT scan
CA 19-9

CEA can be followed as well

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Your patient with pancreatic cancer is a candidate for surgery - what surgery will a surgeon likely perform?

chemo/radiation after?

A

Whipple procedure (pancreaticoduodenectomy) if confined to the head or duodenal area;
tail (distal resection);
post-op chemo (5-FU, gemcitabine) or radiotherapy

only 20% resectable at time of dx; overall 5yr survival rate is 5-15% :(

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Unfortunately, your patient with pancreatic cancer is not a candidate for surgery. What is your management and why?

A

ERCP w/ stent placement palliative for intractable itching

minimizes bile salt deposition?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is a pancreatic pseudocyst comprised of?

A

Cystic collection of tissue, fluid, and necrotic debris surrounding the pancreas

NO true epithelial lining in the capsule

Associated with:
*acute or chronic pancreatitis
*trauma to chest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Your patient comes in with abdominal pain and an abdominal mass.

What is the study of choice for diagnosing a pancreatic pseudocyst?

A

CT Scan

US is an option

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

You decide to do a FNA of a pancreatic pseudocyst. What do you expect to find?

A

*elevated amylase
*low CEA
*low fluid viscosity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Your patient’s abdominal pain and pancreatic pseudocyst mass persists for 4-6 weeks.

How do you manage this and why?

A

-percutaneous drainage
-surgical decompression
(pancreaticogastrostomy)
-drain into stomach or bowel

Apart from helping symptoms, untreated pancreatic psedocysts can lead to peritonitis and other infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

MCC of UGI bleed

A

PUD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

MC location of ulcers for PUD

A

Duodenum

duodenal ulcers are usually benign
4% of gastric ulcers are associated with gastric carcinoma - gastric ulcers also are not protected by mucous/bicarb as they are IN the stomach

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What layer of the intestine is their often a defect in for PUD?

A

defect in the mucosa that extends to the muscularis mucosa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

MCC of PUD

A

H pylori

NSAIDs/ASA – 2nd MC cause (GU – PG inhibition)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Classic presentation of PUD and how this varies whether it is a duodenal vs gastric ulcer

A

Dyspepsia (burning, gnawing, epigastric pain) hallmark; N/V

DU: dyspepsia classically relieved w/ food
GU: sxs worsened w/ food

DU = duodenal ulcers
GU = gastric ulcers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Your patient has a history of PUD and had an ulcer rupture. What are the expected s/s?

A

Severe abd pain that may radiate to the shoulder
Peritonitis

peritonitis = rebound tenderness, guarding, rigidity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How do you diagnose PUD? What if you are sus of H pylori (and gold standard)?

A

Upper endoscopy w/ bx

H. pylori testing:
*endoscopy w/ bxgold standard
*urea breath test (H. pylori converts labeled urea 🡪 labeled CO2; breathing out labeled urea = +)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Managment of H Pylori (+) PUD

A

Tripple or quad therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Managment of H Pylori (-) PUD

A

PPI

also H2 blocker and others

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the suffix for PPI vs H2 blockers?

A

PPI = -prazole
H2 blockers = -tidines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

MOA of a PPI

A

block H/K ATPase (proton pump) of parietal cell, reducing acid secretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What ADR is omeprazole associated with

A

C diff

also a P 450 inhibitor:
increases levels of theophylline, warfarin, phenytoin

24
Q

Which H2 blocker is associated with QT prolongation?

A

Famotidine

careful in cardio patients

25
Which H2 blocker is associated with P450 inhibition?
Cimetidine ## Footnote like omeprazole, increases levels of theophylline, warfarin, phenytoin
26
What are the main SEs of H2 blockers based on?
CNS effects ## Footnote often leads to confusion and other s/s
27
Apart from PPIs and H2 blockers, what meds/classes are often used in the management of PUD?
Misoprostol Antacids Bismuth (pepto/kaopectate) Sucralfate
28
MOA of misoprostol ## Footnote used sometimes in PUD
**PG E1 analog** that increases bicarbonate & mucus secretion, & reduces acid production
29
When might a patient use misoprostol for PUD?
good for preventing NSAID-induced ulcers but not for healing already existing ulcers
30
MOA of antacids ## Footnote Tums
neutralize acid, prevents conversion of pepsinogen to pepsin (active form)
31
Which drug class for treatment of PUD sometimes results in darkening of tongue/stools
Bismuth compounds ## Footnote Pepto-Bismol Kaopecate
32
MOA of bismuth compounds ## Footnote Pepto-Bismol Kaopecate
MOA: antibacterial & cytoprotective that inhibits peptic activity ## Footnote limited use = used in quadruple therapy in H. pylori management)
33
Like bismuth compounds, sucralfate has limited use in PUD. What is it's indication?
MC used as **ulcer prophylactic** measurement than for tx
34
MOA of Sucralfate
**cytoprotective** (forms viscous adhesive ulcer coating that promotes healing, protects the stomach mucosa)
35
Why is Sucralfate often not used for PUD treatment?
may reduce bioavailability of H2RAs, PPIs when given simultaneously ## Footnote also tastes like metal and there can be nausea/constipation
36
What is the MCC of intestinal obstruction in infancy?
Pyloric stenosis
37
What is the pathophys of pyloric stenosis?
**Hypertrophy** & **hyperplasia** of the **pyloric muscles**, causing a functional gastric outlet obstruction (**preventing gastric emptying into the duodenum**)
38
What patient demographic would be MC for pyloric stenosis? 1) age 2) med use 3) ethnicity 4) gender
1) age = 3-12 weeks 2) med use = erythromycin 3) ethnicity = caucasian 4) gender = male ## Footnote also first born
39
Classic presentation of pyloric stenosis
Infant with **projectile vomitting** post-food | may have s/s of FTT ## Footnote PE: *palpable pylorus: “**olive shaped**” nontender, mobile hard mass to the right of the epigastrium
40
Dx of choice for pyloric stenosis
US ## Footnote showing an elongated, thickened pylorus
41
What is the characteristic finding found upon a GI series of pyloric stenosis?
**string sign** (thin column of barium through a narrowed pyloric channel) ## Footnote also maybe **railroad track sign**: excess mucosa in the pyloric lumen resulting in 2 columns of barium
42
What might be the acid/base lab findings associated with pyloric stenosis?
hypokalemia, hypochloremic metabolic alkalosis
43
Initial and definitive treatment of pyloric stenosis
Initial: rehydration (IV fluids) & potassium replacement Definitive: pyloromyotomy
44
Most common cancer type and location of small bowel carcinoma
Adenocarcinoma of the duodenum ## Footnote rare overall
45
RF of small bowel carcinoma (3)
*hereditary cancer syndromes: hereditary nonpolyposis colorectal cancer (HNPCC) *cystic fibrosis *Crohn’s disease | also alcohol and western diet ## Footnote remember, unlike UC - crohn's can effect the small bowel/intestine
46
MC presenting symptom of small bowel carcinoma
Abdominal pain | typically intermittent & crampy in nature ## Footnote others include: *N/V *anemia *GI bleeding *jaundice *weight loss *obstruction, perforation
47
What diagnostics might you use beside biopsy for small bowel carcinoma?
CT endoscopies
48
What tumor marker might you follow during management of small bowel carcinoma?
CEA
49
What is the management of small ball carcinoma? Chemo/radiation?
wide segmental surgical resection ## Footnote adjuvant chemo in pts w/ LN +
50
T/F: Toxic Megacolon is an obstructive disease?
False ## Footnote just a huge diameter colon
51
Apart from N/V, pain, distension, and systemic symptoms - this symptom is classic for toxic megacolon
PROFOUND bloody diarrhea
52
What diameter must the colon be to make the diagnosis of toxic megacolon and what imaging is used to evaluate this?
**> 6 cm** as shown on **abd xray**
53
What PE/ labs makes the diagnosis of toxic megacolon? ## Footnote in addition to > 6 cm colon
3 or more of the following: *fever >38C *pulse >120 *neutrophilic leukocytosis >10,500/microL *anemia PLUS 1 of the following: *hypotension *dehydration *electrolyte abnormalities *AMS
54
What is the supportive treatment associated with toxic megacolon?
bowel rest, bowel decompression w/ NG tube, broad spectrum abx, fluid & electrolyte replacement ## Footnote also management of underlying cause
55
What are the broad spectrum abx used in toxic megacolon?
Rocephin + Metro
56
When might you consider steroids for supportive treatment in toxic megacolon?
If the patient has associated ulcerative colitis (UC)