GI Pathophys Review: Waters Flashcards
Why are gastric ulcers particularly bad in pts w/ cirrhosis?
Low platelets and clotting factors due to failing liver. Also incr. blood flow to stomach due to shunting around liver—> incr. hemorrhage risk.
25 yr old preg. woman in Afghanistan presents w/ n/v and dies 7 days later. What happened?
Hep. E- pregnant women, prob immune to Hep. A
Abd pain, weight loss, temporal wasting, jaundice. What is causing it?
1- cancer, anywhere along biliary system. Prob, pancreas w/ jaundice + weight loss.
Which pancreatic cyst is most worrisome for malignancy?
Mucinous
How does severe chronic pancreatitis present?
Steatorrhea, diabetes, fat-soluble vitamin deficiency (DEAK), chronic pain
epigastric mid-abd. pain, n/v.
AST elevated
ALP elevated
Lipase 2000
Pancreatitis and passing gallstone
ALP elevation + pancreatitis = * gallstone *
EtOH + pancreatitis does not elevate ALP
Mechanism of pancreatitis?
Intracellular activation of proenzymes
Weight loss, frequent diarrhea 24 yo woman. Fe deficient.
IBD, autoimmune dz targets parietal cells, CELIAC.
Do tissue transglutaminase blood test.
Fecal elastase?
Protein present in stool
Rome criteria used for?
s
weight loss, abd. tenderness in RLQ. female.
Crohns in terminal ilium—> obstruction.
Skip lesions, anal fissures, small bowel involvement, granulomas, strictures, perforations, no bleeding.
H. pylori, how to treat?
Treat everybody.
PPI + clarithromycin + amoxicillin X 14 days
Breath urease test to confirm eradication, stool antigen too, and biopsy stomach for bacterial presence.
Who is likely to improve w/ PPI tx?
Not someone w/ dysphagia due to cancer of esophagus.
Erosive esophagitis, YES.
Kid has food stuck in esophagus. You do a biopsy to look for?
Eosinophilic esophagitis.
RFs for Barrett’s?
Worried about?
Obesity Smokers Drinkers Males Middle aged-older \+10 yrs of reflux
Worried about adenocarcinoma
MC syndromic form of colon cancer.
Lynch syndrome
Diff. btwn left and right sided colon cancer?
Left: obstruction, overt bleeding
Right- Fe deficiency, occult bleeding
Prog. gastric cancer?
best when found early w/ minimal spread/invasion
Gold standard for dx of gastroparesis?
Radioactive breakfast. How fast does it move?
Metoclopromide worries?
Tardave dyskinesia
Postprandial n/v, Fe deficiency, diabetes mellitus.
What tests?
PUD EGD (scope) to look for cause of obstruction
Abd. pain, mild tenderness in LLQ, CT showing thickening in splenic flexure.
Scope to rule out cancer.
Biopsy ulcer.
Just observe in old ppl, it will heal.
Abd. pain, mild tenderness in LLQ, CT showing thickening in splenic flexure.
pH is low.
Hypotension
High lactic acid.
Likely mesenteric ischemia. Very bad news.
Look for A-fib. –> throws clot to SMA
Do arteriogram
40 yo vomits liquid and then bright red blood.
Mallory-Weiss tear
Weight loss, fatigue, Fe deficiency. 70 yo.
Scope ‘em.
Bottom end, look for colon cancer.
RUQ pain, epigastric pain, tenderness in RUQ, peritoneal signs, normal bilirubin, thickened gallbladder, fluid around gallbladder. Why not cholangitis?
Doesnt show stones.
Normal bilirubin = not cholangitis.
Prob. Cholecystitis. Just bc there are no VISIBLE stones, does not mean they are not there.
30 yo RUQ pain, delivered healthy child 3 wks ago. Tenderness of right epigastrium. What happened?
Gallstone. Estrogen inhibits bile trafficking. Excect cholesterol gallstone. Not pigment bc pt does nto have hemolysis/longstanding infxn.
Diarrhea, abd. ain, multiple gastric/duodenal ulcers.
Gastrinoma (Z-E syndrome)
High gastrin levels can stimulate carcinoid tumors (Type II) as well.
Celiac dz associated w/ what malignancy?
T cell lymphoma (NHL)
Review Gastrointestinal stromal tumor.
Do that.
Weight loss in IBS?
Nope. Think about something more serious.
