GI Part 2 Flashcards
What is the most common benign esophageal tumor?
leiomyoma
Where is primary esophageal CA usually found? Inside or outside of the lumen?
inside the lumen
Who is most at risk for SCC in the esophagus?
African Americans by 4-5x
Men
more common in asia and south africa
What are some risk factors of SCC? Pick 5
alcohol tobacco achalasia HPV lye ingestion sclerotherapy Plummer-Vinson syndrom irradiation esophageal webs
Which esophageal CA is most common?
SCC (75%)
adenocarcinoma (50% in whites)
Risk factors of adenocarcinoma?
smoking
NOT ALCOHOL
Barrett’s esophagus
Where is secondary esophageal CA usually found? Inside or outside of the lumen?
outside the lumen
What are the most common CAs to metastasize to the esophagus?
melanoma and breast CA
SSX: esophageal CA (early and later)
hint: there’s a ton of possibilities
Early: asx Later: progressive dysphagia wt. loss hoarseness Horner's nerve compression dyspnea maybe odynophagia, vomiting, hematemesis, melena, iron deficiency anemia, aspriation, cough
Work up: esophageal CA
endoscopy with biopsy
CT
endoscopic US
What does esophageal CA like to metastasize?
lung and liver
What is the prognosis of esophageal CA?
overall poor
What causes esophageal varices?
elevated pressure in the portal venous system, typically from cirrhosis
SSX: esophageal varices
sudden, painless, upper GI bleeding. often massive
maybe signs of shock
What labs and imaging would you want for esophageal varices?
Labs: evaluation for coagulophathy, CBC, PT PTT LFT
Imaging: endoscopy
What is the prognosis for esophageal varices?
80% resolve spontaneously
mortality is high
recurrence is common
What portion of the population is infected with H. pylori?
50% by age 60
Who is more at risk for H. pylori infx?
blacks, hispanics, asians
nurses and gastroenterologists
How much more likely is a person with H. pylori infx to develop stomach CA?
3-6x
SSX: H. pylori
often Asx
gastritis
PUD
What is the most sensitive, non-invasive test for H. pylori?
serologic test
Besides serologic testing, what other work-up could you do for H. pylori?
Non-invasive: Urea breath test/stool antigen test (confirm tx effectiveness)
Invasive: Endoscopy (not recommended for this dx alone)
with mucosal biopsy for RUT/histologic staining
4 Etiologies: Gastritis
Infection (H. pylori)
Drugs
Stress
AI phenomena
SSX: gastritis
Asx or
dyspepsia
GI bleeding
Work-up: gastritis
endoscopy
What is the most common type of gastritis?
erosive gastritis
What are specific causes of erosive gastritis? name 3
NSAIDS alcohol stress radiation viral infx vascular infx direct trauma
What is often the first sign of erosive gastritis?
hematemsis
melena
blood in nasogastric aspirate
(bleeding can be mild-massive)
Dx: erosive gastritis
endoscopy
Prevalence of PUD?
any age
most often middle-aged though
What is a major history question when considering PUD?
Any family hx of PUD? (50-60% of duodenal ulcers have positive family hx)
What are the risk factors for PUD?
H. pylori infection (both gastric and duodenal ulcers)
NSAIDS
smoking
Family hx
Genearl SSX: PUD
burning or gnawing pain
often chronic and recurrent
Pt. says epigastric pain occurs mid-morning and is relieved by food, but recurs 2-3 hrs. after a meal. You are thinking ulcer. Where do you think the ulcer is located?
Duodenum
Pt. says epigastric pain often awakes them at night. You are thinking ulcer.Where do you think the ulcer is located?
Duodenum
Pt. say epigastric pain is totally inconsistent and they see no pattern. You are thinking ulcer. Where do you think the ulcer is located?
Stomach (gastric)
Work-up: PUD
Lab: sometimes serum gastrin levels
Imaging: endoscopy
What is the most common complication of PUD and what sxs would make you think this is happening?
Hemorrhage hematenesis of fresh blood or coffee ground material hematochezia (fresh blood out anus) melena (tarry upper GI blood out anus) weakness orthostasis syncope thirst
Your pt with known PUD comes in with pain that is persistent, intense and referring to the back? What complication are you considering? How would you confirm this dx?
Penetration (confined perforation)
CT/MRI
Your pt with known PUD comes in with sudden, intense continuous epigastric pain that spreads rapidly throughout the abdomen and is most prominent in RLQ. Pain is said to radiate to one or both shoulders. Pt. can only lay still. What PE findings would you expect and what would you do to confirm dx?
diminished or absent bowel sounds
painful abdomen papation, rigidity, rebound tenderness
CT or x-ray shows free air under the diaphragm or in peritoneal cavity
Your pt with known PUD calls the clinic reporting recurrent, large-volume vomiting occurring more frequently at the end of the day and often as late as 6-hr. after a meal. Loss of appetite with persistent bloating or fullness after eating. What complication are you considering?
Gastric outlet obstruction
What increases the risk of PUD recurrence?
failure to eradicate H. pylori
continued NSAID use
smoking
gastrinoma (if refractory to tx)
What are the 6 possible PUD complications?
hemorrhage penetration free perforation gastric outlet obstruction recurrence gastric CA
What is the most common gastric CA?
gastric adenocarcinoma
What are the two most common causes of acute pancreatitis?
biliary tract disease
chronic alcoholism
SSX: acute pancreatitis?
steady, boring upper gi pain radiating to the back lasting hours to days
N/V
Pancreatic position
low fever
PE: acute pancreatitis
tenderness to palpation
hypoactive/absent bowel sounds
maybe pleural effusion
work up: acute pancreatitis
labs: elevated serum amylase and lipase maybe elevated WBC imaging: abd. xray: pancreatic calcifications chest xray: atelectasis or pleural effusion CT after dx
Top two causes of chronic pancreatitis
chronic alcoholisms
idiopathic
SSX: chronic pancreatitis
post-prandial pain
episodic abd. pain lasting hours to days
pancreatic position
Dx: chronic pancreatitis
clinical suspicion based on Hx of abd. pain and chronic alcoholism
Work-up: chronic pancreatitis
Labs: amylase and lipase are normal (unlike in acute)
imaging: plain film, CT to rule out CA
What is the most common pancreatic CA?
primary ductal adenocarcinoma
What part of the pancreas is more likely to have CA?
head
dx earlier because obstruction produces jaundice
What makes pancreatic CA in body or tail have a poorer prognosis?
usually dx at more advanced stages
SSX: pancreatic CA
90% have advanced tumors at dx sever abd pain radiating to the back weight loss Head: jaundice and pruritis Body/tail: splenomegaly, gastric/esophageal varices, GI hemorrhage
What disease so pancreatic CA and chronic pancreatitis often cause?
diabetes
work-up: pancreatic CA
Labs: routine labs-elevated alk. phos and bilirubin
CA 19-9 antigen (non-specific, used for monitoring)
Imaging: ct or mrcp
What particular Hx questions are important when approaching pt. with liver disease?
exposures (toxins, alcohol, drugs, herbs, occupational)
Good ROS questions for liver disease?
general: fatigue, anorexia, fever
skin: jaundice?
GI: RUQ pain? N/V? Loose fatty stools?
What are the most common liver markers?
AST
ALT
What is the most sensitive technique for imaging the biliary system?
US
SSX: Hepatitis (prodromal/pre-icteric phase)
anorexia malaise n/v fever RUQ pain
SSX: Hepatitis (icteric phase)
dark urine
jaundice
systemic sxs
enlarged tender liver
What is the most common cause of acute viral hepatitis?
HAV
Does HAV cause chronic hepatitis?
nope
What is the 2nd most common cause of acute viral hepatitis?
HBV
Which hep strains can become chronic hepatitis, cirrhosis and hepatocellular carcinoma?
HBV
HCV
Which hep strain has the highest rate of chronicity?
HCV
What are the Labs results seen with hepatitis?
elevated AST and ALT
antibodies to HAV, HBV or HCV
What happens to the liver in fulminant hepatitis?
it gets smaller
What are the risk factors for non-alcoholic fatty liver?
obesity
dylipidemia
glucose intolerance
SSX: non-alcoholic fatty liver
usually Asx
fatigue, malaise, RUQ discomfort
What is the main PE finding with non-alcoholic fatty liver?
hepatomegaly
Work-up: non-alcoholic fatty liver
Labs: elevated ast, alt
procedure: liver biopsy
How do you dx non-alcoholic fatty liver?
presence of risk factors
r/o hep infx and excessive alcohol intake
risk factors: alcoholic liver disease
drinking lots of alcohol
male
genetic/metabolic traits
poor nutritional status
what disorders can results from alcoholic liver disease?
alcoholic fatty liver
alcoholic hepatitis
cirrhosis
PE finding for alcoholic fatty liver?
non-tender enlarged liver
SSx: alcoholic hepatitis
undernourished fatigue fever jaundice RUQ pain
PE findings alcoholic hepatitis
hepatomegaly
hepatic bruits
SSX: cirrhosis
same as alcoholic hepatitis
PE findings cirrhosis
small liver
maybe nail clubbing
