More Holliday Flashcards
mid epigastric pain worse with eating, steroids, NSAIDS… think…
workup…
surgery if…
gastric ulcer
double-contrast barium swallow
EGD shows punched-out lesion w/ red margins, get Biopsy – tells H.Pylori, Malignant, Benign
Surgery if… lesion persists after 12 wks of treatment
most common gastric cancer
adenocarcinoma
where is gastric cancer most common
Japan
adenocarcinoma
Gastric Cancer mets to Ovaries eponymn
Krukenberg
Gastric Cancer mets to Left Supraclavicular Fossa lympn node eponymn
Virchow’s node
what is virchow’s node
GI cancer met to lymph node in Left Supraclavicular fossa
who gets gastric lymphoma
HIV pts
gastric cancer mets felt on DRE is called…
Blummer’s Shelf
what is Blummer’s Shelf
gastric cancer mets felt on DRE
gastric cancer mets to umbilical node is called…
Sister Mary Joseph
what is Sister Mary Joseph
gastric cancer mets to umbilical node
who gets gastric MALT lymphoma
pts w H.Pylori
eponymns assoc w Gastric Cancer GC
Krukenberg - GC mets to ovary
Virchow’s node - GC mets to L supraclavicular node
Blummer’s Shelf - GC mets felt on DRE
Sister Mary Joseph - GC mets to umbilical node
treat Gastric MALT Lymphoma
treat associated H.Pylori
-triple therapy… ppi, clarithromycin, amoxacillin
what are the cliff notes on mentrier’s disease
protein losing gastroenteropathy
(lose protein in GI tract)
also associated with enlarged rugae
gastric varices most often caused by…
splenic vein thrombosis
eg from pancreatitis
Dieulafoy’s is….
congenital superficial gastric? esophageal? vessel can cause hematemesis…. see other online meded flashcards
mid epigastric pain better with eating vs worse with eating
better with eating - duodenal ulcer
worse with eating - gastric ulcer
tests for h.pylori in peptic ulcer
stool or breath test
best is endoscopy with biopsy and CLO test… also best because can rule out cancer this way
how to assess effectiveness of H.Pylori treatment
stool or breath test
what to suspect if mid epigastric pain / ulcers do not improve with triple therapy?
best test?
tx?
what else to look for?
Zollinger Ellison syndrome (gastrinoma)
Secretin stim test (gastrin remains inappropriately high)
surgical resection - gastrinoma usually located in pancreas
look for MEN1 panc, pituitary, parathyroid tumors
patient lost a lot of weight, now has bilious vomiting and post-prandial pain
suspect. ..
treat. …
SMA syndrome aka Nutracker syndrome
-duodenum part 3 compressed between aorta and SMA, pain after eating when duodenum demands more blood
treat with Weight Restoration… can do surgery eg. Roux-Y… think you have to mobilize duodenum to do that…. or maybe just better with food bypassing duodenum less blood demand….
2 most common causes of pancreatitis
gallstones and alcohol
drinking and McDonalds
define pseudocyst
a fluid-filled cavity resembling a cyst but lacking a wall or lining.
most common cancer of pancreas
Adenocarcinoma
Pancreatic cancer (adenocarcinoma) usually asymptomatic until advanced unless maybe….
cancer in Head of pancreas, causing Obstructive Biliary symptoms
aka Courvoisier’s sign - large non-tender gallbladder, itching and jaundice
Large Non-tender Gallbladder, Itching, Jaundice think…
Courvoisier’s sign
pancreatic cancer of head of pancreas, fortunately causing symptoms early so maybe you can get it before widely metastasized
eponymned signs associated with pancreatic cancer
Courvoisier’s sign
- Large Non-tender Gallbladder, Itching, Jaundice think
- pancreatic cancer of head of pancreas, fortunately causing symptoms early so maybe you can get it before widely metastasized
Trousseau’s sign - migratory thrombophlebitis
what to you call migratory thrombophlebitis in setting of pancreatic cancer
Trousseau’s sign
what is Trousseau’s sign in setting of pancreatic cancer
migratory thrombophlebitis
when to Whipple pancreatic cancer
no mets Outside Abdomen no extension into SMA no extension into Portal Vein no Liver Mets no Peritoneal Mets
basically, if caught early, pretty local
Whipple’s triad
labs to get?
hypoglycemic symptoms - such as sweating, tremors, hunger, seizures
hypoglycemia - blood glucose low v45
symptoms resolve with glucose administration
Dx is INSULINOMA
Labs Insulin (high) and C-peptide (to rule out exogenous abuse)
Glucagonoma
sx
hyperglycemia
diarrhea
weight loss
characteristic rash - necrolytic migratory erythema
Somatistatinoma
sx
benign or malignant?
malabsorption - steatorrhea, etc, because pancreas malfunction (somatistatin decreases like all GI secretions…)
commonly malignant
which is commonly malignant
insulinoma, glucagonoma, somatistatinoma, VIPoma
somatistatinoma is commonly malignant, the worst one to have
VIPoma
sx
looks similar to…
tx…
watery diarrhea, flushing
(hypokalemia and dehydration from diarrhea)
sx similar to carcinoid syndrome
treat with octreotide
differentiate between symptomatic gallstones and cholecystitis
fever and WBC with cholecystitis
when do symptomatic gallstones get percutaneous cystostomy
when too unstable for cholecystectomy
charcot’s triad
vs raynaud’s pentad
RUQ pain, fever, jaundice
-acute cholangitis
RUQ pain, fever, jaundice, shock (hypotension, AMS (confusion)
-ascending cholangitis
choledocal cysts
demographic
type 1
type 4
peds
type 1 - most benign. fusiform dilation of CBD. Excise
type 4 - most severe. cysts all the way up into intrahepatic bile ducts. liver transplant
risk factors for primary sclerosing cholangitis
treatment
UC ulcerative colitis
Liver Flukes
Thorotrast exposure (radiocontrast used in 1930’s-40’s)
surgery plus/minus radiation
AST mildly elevated 2x ALT think…
alcohol hepatitis
ALT greater than AST
both highly elevated into 1000s… think…
viral hepatitis
AST and ALT elevated s/p hemorrhage, surgery, or sepsis… think…
shock liver
liver ischemia from hypotension
when to band or sclerotherapy esophageal varices
as soon as they bleed once
treat portal htn from cirrhosis
watch out for…
how to treat that…
SS and VP somatostatin and vasopressin
to upstream vasoconstrict and decrease portal flow and pressure
BBs beta blockers for the same reason, drop BP decrease portal pressure
Endoscopic Sclerotherapy or Banding of esophageal varices if they bleed once
TIPS relieves portal htn but risks ENCEPHALOPATHY from ammonia accumulation because not being processsed in liver
treat encephalopathy with LACTULOSE to poop out ammonia
risk factors for hepatocellular carcinoma
chronic Hep B more so than Hep C
Cirrhosis for any reason
Aflatoxin (mycotoxin that contaminates corn, soybeans, peanuts)
Carbon Tetrachloride (used to be in fire extinguishers, refrigerants, cleaning agents)
diagnose hepatocellular carcinoma
treat
CT/MRI
AFP often elevated as well (70%)
- surgically remove soiltary mass
- radiation or cryoablation for palliation if multiple masses
woman on OCP, palpable abdominal mass w spontaneous rupture into hemorrhagic shock…
makes you think…
dx
tx
hepatic adenoma
Dx US or MRI
Discontinue OCPs (grows from estrogen). Resect if large or desire pregnancy (again, estrogen will make grow, so resect before pregnancy)
most common benign liver tumor
pres
dx
tx
hepatic adenoma
woman on OCP, palpable abdominal mass w spontaneous rupture into hemorrhagic shock…
Dx US or MRI
Discontinue OCPs (grows from estrogen). Resect if large or desire pregnancy (again, estrogen will make grow, so resect before pregnancy)
2nd most common benign liver tumor
tx
focal nodular hyperplasia
no tx
(hepatic adenoma the most common)
most common bugs in abdominal bacertial abscess
e.coli
bacteroides
enterococcus
RUQ pain, profuse sweating and rigors, palpable enlarged liver
….think….
dx….
entamoeba histolytica
metronidazole
2 abscesses surgeons DON’T drain
lung abscess
amoebic liver abscess
Mexico/South America, RUQ pain, large liver cysts on US…
think... mode of transmission lab findings tx watch out for
Enchinococcus
hydatic cyst paracyte from dog feces
eosinophilia, +Casoni skin test
albendazole and surgery to remove ENTIRE cyst
watch out for rupture causing anaphylaxis
what to give post-splenectomy
Aspirin (thrombocytosis ^1mil aka 1,000 platelet count
prophylactic Penicillin
S.pneumo H.flu N.meningitis vaccines
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