Step Up- GI Flashcards
This is the most common site of distant spread of colorectal cancer
Liver through the portal circulation
Risk of CRC in a patient with familial adenomatous polyposis?
100% by 3rd or 4th decade
Polyps + osteomas and dental abnormalities
Possibly with benign soft tissue tumors
Gardner syndrome
This test is an important screen in a patient with gardner syndrome
colonoscopy– nearly 100% develop CRC by age 40
Turcot syndome
Polyps + medulloblastoma or gliblastoma multiforme
patient with pigemented spots around lips and multiple GI hamartomas
Peutz-Jeghers syndrome
Most common cause of large bowel obstruction in adults?
CRC
Abx that are most commonly associated with pseudomembranous colitis
Clindamycin
Ampicillin
Cephalosporins
Tx for C. diff colitis?
Mtronidazole or oral vancomycin
Metronidazole can not be used in children and pregnant patients
Deficiency of this in wilson disease
ceruloplasmin
Medical tx for wilson disease
d-penicillamine
Zinc- prevents uptake
Potential effects of hemochromatosis
Cirrhosis
Cardiomyopathy
Diabetes
Artritis (2nd and 3rd mcp, hips and knees)
Hypogonadism
Hypothyriodism
Hyperpigmentation of skin
Lab findings in hemochromatosis
Decreased TIBC
Increased Transferrin saturation
Increased Iron
Elevated Ferritin
This tumor can develop in females on OCP…
Hepatocellular adenoma
treatment for hepatocellular adenoma
Stop offending agent like OCP
If it does not regress, resect it
Most common benign liver tumor
Cavernous hemangioma
27 year old female with RUQ pain, started OCPs a few months ago. Fullness in the RUQ, what test?
RUQ ultrasound or CT
Likely hepatocellular adenoma
Stop OCP and watch in case of rupture
Two kinds of hepatocellular carcinoma…
Which is associated with Hepatitis infection
nonfibrolamellar– most common and associated with HepB and C
Fibrolamellar– not associated. more treatable
These chemicals are associated with HCC
Aflatoxin
PVC
Thorotrast
These are diseases that increase risk for HCC
Cirrhosis
AAT deficiency
Hemochromatosis and wilson disease
schostosomiasis
hepatic adenoma
cigarette smoking
glycogen storage diseases
This tumor marker is commonly elevated in HCC
AFP
How is the histology of NASH different from alcoholic fatty liver?
It ISNT!
Histologically they are the same. Differentiated based on Hx (obesity, dm, HLD but NO ALCOHOL)
Gilbert disease cause
decreased activity of UDP-glucuronyl transferase
increased unconjugated bili
Cause of hydatid liver cysts
Echinococcus granulosis and multilocularis
This portion of the liver is the most commonly affected by hydatid liver cysts
Right lobe
Complication associated with hydatid cyst?
This medication is given with surgery
Rupture leading to anaphylaxis
Mebendazole given with surgery
Causes and treatment of pyogenic liver abscess
Causes: E. coli, klebsiella, proteus, enterococcus, anaerobes
IV Abx and drainage
Cause of amebic liver abscess
Entamoeba histolytica
Fecal-oral
Gay dudes…
Tx of entomoeba histolytica
metronidazole
Causes of budd chiari syndrome
hypercoagluable states
myeloproliferative disorders
pregnancy
chronic inflammatory disease
infection
cancer
trauma
Dark urine is an indication of this subset of hyperbilirubinemia. Why?
Direct
It is the only form that can be excreted in the urine
Intrahepatic causes of + urine bilirubin (conjugated)
Hepatocelluar disease
Dubin-johnson, rotor syndrome
Drug induced
PBC
PSC
Extrahepatic causes of + urine bilirubin
gallstones
pancreatic cancer (head)
cholangiocarcinoma
periampullary tumor
biliary atrisia
Causes of unconjugated hyperbilirubinemia
Gilbert
Crigler-Najjar
Haundice of the newborn
diffuse liver disease like cirrhosis
Mild elevations of AST and ALT (low hundreds) think about…
Chronic viral hepatitis or acute viral hepatitis
Moderately elevated ALT and AST (high hundreds to thousands) think about…
acute viral hepatitis
Severly elevated AST and ALT (>10,000) think about…
Extensive necrosis
- Shock liver (ischemia)
- Acetominophen tox
- Severe viral hepaitis
Mnemonic for causes of LFT elevation…
Autoimmuno hepatitis
Hep B
Hep C
Drugs or toxins
Ethanol
Fatty Liver
Growths
Hemodynamic compromise (CHF)
Iron and others (Wilson, and AAT deficiency)
Alk Phos is elevated but GGT is not. What should be suspected?
Pregnancy or bone disease
Most common cause for acute cholangitis
Choledocolithiasis
RUQ, jaundice and fever
Charcots triad
The pentad include AMS and septic shock– rapidly fatal
Cancer associated with primary sclerosin cholangitis
Cholangiocarcinoma
Primary sclerosing cholangitis is associated with this GI disorder
ulcerative colitis
Clinical features of primary sclerosing cholangitis
Puritis
fever
weight loss
obstructive jaundice
ERCP findings in PSC
Beads on a string of biliary tree
Biliary tree disease associated with +AMA
primary biliary cirrhosis– middle aged women
Treatment for primary biliary cirrhosis`
Cholestyramine– tx of puritis
Calcium, bisphosphonates and Vit D– osteoporosis
Ursodeoxycholic acid– slows disease progression
This is the most common cause of pancreatitis in children
Blunt abdominal trauma
Which is more specific for pancreatitis? Lipase or amylase?
Lipase
Cause of hypocalcemia in pancreatitis
Saponification
Calcium is chelated in the digesting fat
Ranson criteria
GA LAW
Glucose >200
LDH >350
AST >250
WBC >16000
Circumferential ring in the lower esophagus ALWAYS accompanied by a sliding hiatal hernia
Shatzki ring (distal esophageal web)
Plummer-vinson syndrome
upper esophageal webs accompanied by iron deficiency anemia, koilonychia and atrophic oral mucosa
What is the underlying cause of zenker and epiphrenic diverticula
motility disorder increasing esophageal pressure
This divertuculum is located near the tracheal bifurcation
traction diverticula
Most common cause of PUD
H. pylori
H. pylori more commonly causes ulcers in the area…do they have high malignancy potential?
duodenal
NO the high potential for malignancy exists in the stomach
Which blood type is associated with gastric ulcers? Duodenal ulcers?
Type A= gAstric ulcers
Type O= duOdenal ulcers
Most sensitive test for H. pylori? Most convenient?
Most sensitive is biopsy with microscopy
Most convenient is urease breath test– also asseses effective therapy
Pain better with food
Duodenal ulcer
Pain worse with food
Gastric ulcer
Diabetic with bloating and constipation
Gastroparesis from autonomic neuropathy
