GI Tumors

Question 1

Patient with a history of tobacco use presents w/ weight loss, fatigue, anorexia, and painless jaundice with dilation of the common bile duct on ultrasound.

Labs show: Cholestasis (↑↑↑ ALP & direct bilirubin)
& ↑ AST/ALT

This presentation is concerning for ____.

Answer 1

pancreatic cancer

↑CA-19-9 (not as a screening test)

Question 2

If there is a concern for GI cancer initial work up includes:
1. _____ (if jaundiced)
or
2. ______ (abdominal pain w/o jaundice or 1 isn’t helpful)

Answer 2

Abdominal ultrasonography

CT scan

***Abdominal u/s is used in the initial evaluation of patients with painless jaundice, anorexia, or weight loss.
However, it is not the preferred modality for screening patients who have abdominal pain without jaundice;

Question 3

Presentation of pancreatic cancer depends on location:

Tumors in the pancreatic HEAD cause → ___

Tumors in the pancreatic body or tail cause → ___

Answer 3

painless obstructive jaundice

abdominal pain w/o jaundice

Question 4

Bile acids are primarily reabsorbed in the ___; impaired absorption can cause malabsorption of fats.

Answer 4

ileum

Question 5

Steatorrhea is s/t malabsorption of fats.

This is typically seen following extensive ileal resection in pts with [illness]

Answer 5

Crohn disease (CD)

Question 6

[illness] should be suspected in patients with MULTIPLE duodenal ulcers refractory to treatment or ulcers distal to the duodenum.

Answer 6

Zollinger-Ellison syndrome

*INACTIVATION of pancreatic enzymes by increased production of stomach acid may lead to malabsorption.

Question 7

Pancreatic exocrine (enzyme) DEFICIENCY can be seen in:

1. ____
2. ____
3. pancreatic resection

Answer 7

chronic pancreatitis

cystic fibrosis

Question 8

↑ ALP & ↑ gamma glutamyl transpeptidase (GGT) suggests _____

Answer 8

biliary compression or obstruction

Question 9

____ are caused by Echinococcus tapeworm infections.

Commonly seen in immigrants, exposed to sheep and dogs.

Answer 9

Hydatid cysts

multiple cystic lesions in liver

Question 10

Occurs in patients with cirrhosis or chronic Hepatitis B or C.
Characterized by a rapidly enlarging liver mass, often with satellite lesions.

Answer 10

Hepatocellular carcinoma

Question 11

Trousseau syndrome is a hypercoagulability disorder presenting with recurrent and migratory superficial thrombophlebitis at unusual sites (arm, chest area).

It is usually associated with an occult visceral malignancy such as ____ (most common), stomach, lung, or prostate carcinoma.

Answer 11

pancreatic

Question 12

Microcytic anemia and a positive fecal occult blood should raise concern for GI bleeding or ___

Answer 12

Colorectal Cancer

Question 13

Microcytic anemia and a positive fecal occult blood should raise concern for GI bleeding or ___

Answer 13

Colorectal Cancer

Question 14

____ typically presents with symptoms of biliary obstruction:

• jaundice
• pruritus
• light-colored stools
• dark urine.

Answer 14

Cholangiocarcinoma

*Risk factor: primary sclerosing cholangitis

Question 15

Pt presents with anorexia and weight loss.
Physical remarkable for Hepatomegaly and mucosal pallor.
Labs show microcytic anemia and ↑ ALP.
Fecal occult blood is +
U/S shows solitary liver mass.
DIagnosis?

Answer 15

Colorectal Cancer met to liver

Question 16

___ and hepatic adenoma are usually benign liver tumors seen in young women

Answer 16

Focal nodular hyperplasia (FNH)

Asymptomatic

Question 17

Fecal occult blood +

causes (3)

Answer 17

Colorectal cancer
Gastric/Duodenal ulcers (Zollinger-Ellison/ H.pylori)
Gastric (adenocarcinoma) cancer typically causes anemia (due to tumor bleeding into the stomach)

Question 18

Helicobacter pylori infection is a significant risk factor for ____ and MALT lymphoma
(Mucosa-Associated Lymphoid Tissue)

Answer 18

gastric adenocarcinoma

Question 19

Helicobacter pylori infection is a significant risk factor for gastric adenocarcinoma and ____

Answer 19

MALT lymphoma

Mucosa-Associated Lymphoid Tissue

Question 20

In gastric adenocarcinoma, tumor stage at the time of diagnosis determines prognosis and treatment options.

_____ is the initial staging modality.

Answer 20

CT scan

Limited stage→ resect
Advanced stage → Chemo +/- pallative sx.

Question 21

Primarily used to excludecholecystitis in patients with suggestive symptoms but no gallbladder inflammation or biliary obstruction on ultrasound.

Answer 21

HIDA scan

Question 22

Chronic mesenteric ischemia
presents with postprandial, severe, intermittent pain and food aversion.
Diagnosis is made with ___

Answer 22

CT angiography (noninvasive)

vs Mesenteric angiography (an invasive procedure)

Question 23

The most common symptom of pancreatic cancer is insidious, [timing, location] pain that may radiate to the flanks or back and is sometimes worse with eating and lying down.

Answer 23

CONTINUOUS midepigastric

Question 24

Around 25% of ____ cancer is preceded by a recent (<2 years) diagnosis of diabetes mellitus.

Answer 24

pancreatic

Question 25

Pts w/ new-onset ___ AND who have symptoms like

(constant abdominal pain, weight loss) should undergo abdominal CT scan for pancreatic cancer screening.

Answer 25

Diabetes Mellitus

Question 26

Patients with __ or ___ often have

gnawing epigastric pain that is worse several hours after meals (when the food buffer is cleared).

Answer 26

gastric/duodenal ulcers
gastric tumors

*Diagnosed by EGD followed by H. pylori stool antigen test

Question 27

Patients with L colon adenoma/carcinomas seen on sigmoidoscopy have increased risk for R colon tumors and require a ____.

Answer 27

colonoscopy

• to visualize the entire colon

Question 28

Patients with Lynch syndrome (hereditary nonpolyposis colorectal cancer) are at increased risk for gastric adenocarcinoma and warrant periodic __ to detect early adenomatous polyps.

Answer 28

upper endoscopy

Question 29

Familial adenomatous polyposis (FAP) is caused by mutations in the Adenomatous Polyposis Coli (APC) gene and confers a very high risk of [cancer].

Answer 29

colorectal adenocarcinoma

*Typically have numerous colon adenomas
FAP is AD w/ nearly 100% penetrance

Question 30

Chinese immigrant with 4m h/o deep, mid-epigastric, persistent, and non-radiating abdominal pain, nausea, and emesis w/ no consistent relationship between the pain and food. Physical exam reveals abdominal TTP and Hepatomegaly. Labs show microcytic anemia and ↑↑ ALP & ↑ AST/ALT
Diagnosis?

Answer 30

Gastric Cancer

Question 31

Microcytic (iron deficiency) anemia in an elderly patient is more likely due to ___ or ____ cancer than to ___ cancer, which does not typically bleed into the gastrointestinal tract.

Answer 31

colonor gastric

pancreatic

Question 32

___ cancer is common in those from Eastern Asia, Eastern Europe, and South America. It generally presents with progressive epigastric pain and weight loss. Friable tumor vessels can bleed into the stomach lumen, leading to iron deficiency anemia. Metastasis to the liver can result in hepatomegaly and elevated transaminases and alkaline phosphatase.

Answer 32

Gastric cancer

Question 33

Hyperplastic polyps in the colon are a non-neoplastic and most commonly found in the rectosigmoid colon on colonoscopy.

Colorectal screening intervals for pts with:

Small (<1 cm) polyps → Repeat colonoscopy in ____

Repeat colonoscopy in ___ for individuals with a high-risk FMH of 1º relative w/colorectal cancer at age <60

Answer 33

10 years

5 years