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133 Cards in this Set
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What are the main risk factors for CRC? x5
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i)Age ii)adenomatous polyps (esp villous) iii)IBD: esp UC iv)Diet: high fat or low fiber diet v)Major polyposis syndromes
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Where do CRCs come from? What is pattern of spread x3? How to screen?
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i)almost all colorectal tumors arise from adenomas ii)pattern of spread: circumferentially then thru bowel wall; portal circulation; lumbar/vertebral veins to lungs iii)Screening: FOBT has poor sn/sp and need scope afterwards if positive
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FAP: i)genetics ii)location iii)treatment
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i)AD ii)colon and often duodenum iii)colectomy. Tons of polyps!
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Gardners: i)features?
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polyps, osteomas, dental or benign soft tissue tumors
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Turcots: i)genetics? ii)diad?
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polyps + cerebellar medulloblastoma or GBM
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Peutz Jegher's: i)what is clinical features x3? ii)Where? iii)complications?
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i)low malig hamartomas in SI, colon or stomach; pigmented spots around lips, oral mucosa, palm, genitals; incr incidence in carcinoma ii)intussusception or GI bleed
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HNPCC: Diff b/w type I and II?
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i)early onset CRC; absent antecedent multiple polyposis ii)other cancers w/Lynch I
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What are signs and sxs common to all locations of CRC? x3
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i)blood ii)Ab pain (most common cause of obstruction in GI) iii)colonic perforation is worst complication
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Signs and sxs of diff locations of CRC? rt, left, rectum.
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i)Rt: No obstruction; melena; no change in bowel habits. Triad anemia, weakness, RLQ mass. ii)Lt: obstruction; change in bowel habits (constip/diarrhea alternates) w/pencil stool; hematochezia. iii)rect: hematochezia; tenesmus; feeling of incomplete evacuation of stool.
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What is the treatment of CRC x3? Dukes categories?
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1st: surgical resection; 2nd: CEA level checked; 3rd: adjuvant--i)Dukes C colon CA: chemo; ii)Dukes C or B2 Rec: Rads + chemo. 4th Follow up w/guaiac, CT/CXR, scope, CEA
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what are the determinants of malignant potential of adenomatous polyp?
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i)size: larger polyp=more malig potential ii)histo iii)shape: sessile is malig iv)atypia
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What is pathogenesis of diverticulosis? what are risk factors x2
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i)incr intraluminal pressure causes inner layer of colon to bulge thru weak wall (usually area of BV penetration). ii)Risks: low fiber diet->constipate->incr intralum pressures
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what are clinical features of diverticulosis? x4
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i)usually found incidentally on barium or scope ii)LLQ problem, bloat, constip/diarrhea
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how to DX diverticulosis? How to treat? x2
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i)barium enema; ab XRay can't pick up ii)high fiber foods, psyllium
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What are complications of diverticulosisx2? What is pathogenesis of diverticulitis, clin features (x3) and what is DX test
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i)painless rectal bleeding: usually insig and stops spontaneously. If severe, may need colectomy ii)Diverticulitis: feces impacted in diverticulum->erodes and microperforates. Fever, LLQ pain, leukocytosis. DX with CT scan w/contrast not scope or barium b/c perforation is possible. NO GI BLEED
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how to treat diverticulitis? x4. What are complications x3?
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i)NPO, ABx, fluids. If persists or recurs, need segmental colectomy. Complication: obstruction, colovesical fistula, free colonic perforation
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What is angiodysplasia of colon? What is complication? What is dX test? What is treatment?
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i)tortuous, dilated veins of submucosa of prox colon. ii)bleeding, but usually resolves iii)Scope iv)colonoscopic coagulation of lesion. if persistent, right hemicolectomy
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Where is acute mesenteric ischemia? What are the diff types x4?
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AMI: SM vessels. i)arterial embolism: cardiac origin (MI, AFib, valvular). ii)arterial thrombosis: pt w/atherosclerotic dz w/acute occlusion 2ndary to plaque or MI. CAD, PVD, stroke. iii)Nonocculsive mesenteric ischemia: splanchnic vasoconstriction 2ndary to low CO. iv)venous thrombosis: predisposing factors: infection, hypercoag state, OCP, Portal HTN.
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What are the clinical features of AMI? x3 How to DX?
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i)Disproportionate ab pain. ii)anorexia, vomit iii)GI bleed (mild). iv)intestinal infarction signs: hypotension, tachypnea, lactic acidosis, fever. Check lactate. v)DX w/mesenteric angiography
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What is treatment for AMI? x5
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i)Abx and IV fluid ii)papverine into Sup mesenteric system for arterial causes: vasodilates. iii)heparin for venous causes iv)thrombolytics or embolectomy for embolic cause
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What is sign of CMI x2? DX? Treat?
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i)dull pain in abdomen, esp postprandial. Wt loss ii)DX w/mesenteric angiography. iii)surgical revascularization
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What is Ogilvie's Syndrome? What are causes x3? What is treatment x4?
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i)signs, sxs, and radiograph of obstruction, but no mechanical obstruction. ii)SXs, meds(narcs, psychotropics), serious illness (sepsis, malignancy) iii)Stop the agent, supportive, decompression w/enema, ng suction, or ostomy
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What are the most common causes of Pseudomembranous colitis x3? When are sxs apparent?
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i)ampicillin ii)clindamycin iii)cephalosporin. Sxs apparent after 1st week, but can be up to 6 weeks after stopping Abx
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What are clinical features of pseudomembranous? x3
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i)profuse water diarrhea ii)crampy ab pain iii)toxic megacolon w/perforation risk
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How DX pseudomembranous?
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i)C diff toxin stool test ii)ab radiograph iii)leukocytosis
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Treat pseudomembranous? x3
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i)metro ii)vanco if no metro. iii)cholestyramine can be used for diarrhea
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What are complications of volvulus? What is most common site? What are risk factors for left side x4
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i)can get obstruction and necrosis if fuck vascular supply. ii)sigmoid iii)cecal volvulus: rt colon not fixed; sigmoid: chronic constipation, laxative abuse, antimotility drugs, chronic illness, CNS disease
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What are clinical features of volvulus? x3
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i)acute onset of colicky ab pain ii)obstipation, ab distention iii)anorexia, N/V
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what is DX for volvulus? x3
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i)Sigmoidoscopy: preferred diagnostic and therapeutic test for sigmoid volvulus (not cecal) ii)plain film: omega loop sign=dilated sigmoid colon. Coffee bean sign on cecum: large air fluid level in RLQ. iii)bird's beak
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Treatment for volvulus? x2
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i)sigmoidoscopy decompression but recurs ii)resection usually for both sigmoid and cecum
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What is cirrhosis? What are the events that happen b/c of cirrhosis x2?
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i)cirrhosis=destruction of liver parenchyma with fibrosis, causing nodules. ii)dysfunctional biochemistry: coag factors, albumin; portal htn b/c of decr flow thru liver
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What are come causes of cirrhosis? x8
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i)#1:alcoholic liver dz #2:Hep C. ii)PBC SBC; AAT; NASH; Wilson's Hemachromatosis; constrictive pericarditis
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What are complications of liver failure?
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AC 9H: Ascites, Coagulopathy, portal Hypertension, Hyperestrinism, Hypoglycemia, Hyperammonemia, Hepatic encephalopathy, Hepatorenal syndrome, Hyperbilirubinemia/jaundice, Hepatocellular CA
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What is most serious threat in portal HTN, and how to treat?
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i)bleeding (hematemesis, melena, hematochezia) due to esogastric varices ii)TIPS lowers portal pressure
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How to treat eso bleeding varices? x3
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i)1st: hemodynamic stabilization:ligation, sclerotherapy, ADH or octreotide ii)2nd: upper GI endoscopy if presents w/hematemesis. iii)B blockers longterm
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i)What is ascites due to? x2 ii)How to know if its b/c of portal HTN or another process? iii)How to treat?
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i)hypoalbuminemia; portal htn. ii)paracentesis can tell the ascites albumin gradient: if large gradient, then portal HTN likely. iii)low Na, diuretics. If complications, do therapeutic paracentesis. TIPS
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How to monitor pts w/cirrhosis--what labs? What other modalities? x2
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i)Labs: CBC, LFT, RFT, lytes, coag tests. ii)endoscopy iii)bx if suspect liver CA
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What is hepatic encephalopathy due to and what are precipitants? x4
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i)ammonia and other toxins removed by liver ii)alkalosis, hypokalemia, sedating drugs (narcotics, sleep meds), GI bleed
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clinical features of hepatic encephalopathy x4? How to treat?
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i)fetor hepaticus ii)rigidity, hyperreflexia iii)asterixis. Treat: lactulose; ABx to kill bacteria making NH3, limit protein
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What is hepatorenal syndrome? Clinical features x4? Treat?
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i)functional renal failure (kidneys normal and no sp cause of dysfunction). Get renal hypoperfusion and vasoconstriction w/liver dz. No response to vol expansion. ii)Clinical features: azotemia, oliguria, hyponatremia, low urine Na. Treat: Liver xplant is cure
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What is SBP? What is most common organism? How to DX? What are clinical features? x4
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i)infected ascitic fluid. High mortality rate ii)E coli iii)DX: paracentesis w/lots of WBC. iv)Ab pain, fever, vomit, rebound tenderness
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How to treat coagulopathy in cirrhosis?
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No Vit K: need FFP
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What is pathogenesis of Wilson's and what organs are damaged x3?
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i)Deficient ceruloplasmin->Cu accumulates in hepatocytes->die, releasing Cu into blood.-->kidney, cornea, brain
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How to DX wilson's x3? how to treat? x2
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i)hepatic: incr LFTs; Bx=incr Cu conc ii)decreased serum ceruloplasmin. iii)treat: chelator penicillamine. Zinc: prevents uptake of dietary Cu.
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What is genetics of hemachromatosis? What are the main affected organs x6? What are common clinical findings? x6
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i)Autosomal recessive. ii)Liver, pancreas, heart, joints, thyroid, gonads iii)asympto->liver dz, fatigue, arthritis, sexual dysfcn, ab pain, cardiac arrhythmia
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Complications of hemochromatosis x6? DX? treat?
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i)arrhythmia, hypothyroid, cirrhosis, pancreas: DM, hypogonad, arthritis. ii)DX: elevated serum Fe and ferritin, transferrin saturation, liver BX: need for DX. iii)Treat: phlebotomy and treat symptoms
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Who do hepatic adenomas occur in? What are risk factors x3?How can they be dangerous? How to DX x3? How to treat?
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i)young women: OCP, anabolic steroid, female sex=risk factors. ii)Not malignant but if rupture->hemoperitoneum. iii)CT, U/S or hepatic arteriography. iv)Treat: D/c OCP, resect tumor >5cm not regressing
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What is the most common benign liver tumor? How does it present? what are some complications x5? How to DX? Treat?
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i)cavernous hemangioma. ii)as gets bigger (OCP/preg) the sxs incr and get RUQ pain and mass. iii)Complication: rupture, obstructive jaundice, coagulopathy, gastric outlet obstruction, CHF. iv)DX: U/S or CT w/contrast. No BX! v)Treat: none unless resect if large
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What is most common malig liver tumor? What are the types? x2
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i)HCC. ii)a)nonfibrolamellar: Hep B or C and cirrhosis ass'd. unresectable, short survival. b)fibrolamellar: not Hep B and C, resectable, longer survival.
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What are risk factors for HCC? x6
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i)cirrhosis ii)AAT iii)aflatoxin iv)schistosomiasis v)Glycogen storage dz vi)smoking
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What are clinical features of HCC? x4
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i)ab pain ii)wt loss, fatigue iii)signs and sxs of chronic liver dz: portal HTN, ascites, jaundice iv)paraneoplastic syndrome: erythrocytosis, thrombocytosis, hypercalcemia, carcinoid syndrome
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How to DX HCC? x4
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i)liver BX: need for dx ii)Hep B/C serology, LFTs, coags iii)imaging: U/S, CT iv)AFP
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What is NASH? What are risk factors x3? course? TX?
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i)same histo as AFL, but non-drinkers. ii)obesity, hyperlipids, DM. iii)benign iv)No TX
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What is Gilbert's inheritance? What is it? how exacerbated? x4
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i)AD ii)due to decr activity of hepatic glucuronyl transferase activity. Causes isolated elevation of unconj bili. iii)fever, crash diets, Etoh, infection exacerbate.
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What is hemobilia? What are causes x3? What are clinical features x3? How to DX x2? What is treatment?
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i)blood draining into duodenum via CBD. ii)Trauma, papillary thyroid CA, SX iii)Features: GI bleed, jaundice, RUQ pain iv)arteriogram; Upper GI scope shows blood ou of ampulla of Vater. v)resuscitate
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What are the types of liver cysts x2? What is the causes? What are clinical features? How to treat?
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i)polycystic vs hydatid. ii)AD vs. echinococcus. iii)polycystic: RUQ pain and mass vs. RUQ pain and rupture->anaphylaxis. iv)no treat vs. resection
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What are the 2 types of liver abscesses? What are their causes? What are clinical features? How to DX? How to treat?
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i)pyogenic vs amebic ii)pyogenic: biliary tract obstruction (E coli, Kleb grow); GI infection (appen, divert); penetrating liver injury. amebic: ameba, fecal oral. iii)pyogenic: fever, maaise, N/V, RUQ pain, jaundice. amebic: fever, RUQ pain, N/V, DIARRHEA. iv)pyogenic: DX US or CT; incr LFTs. amebic: serologic, elevated LFTs. v)Treat: pyogenic: IV abx and drainage. amebic: metronidazole, aspiration
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What are causes of Budd Chiari x2? Clinical features? DX? TX?
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i)hypercoag states, myeloprolif d/o ii)like cirrhosis iii)DX: hepatic venography w/albumin gradient >1.1. iv)Balloon stent, xplant if cirrhotic.
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What is jaundice due to? What is diff b/w conj and unconj?
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i)due to overproduction of bili or underexcretion ii)Conj: loosely bound to albumin so water soluble. makes urine dark. Unconj: toxic!
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What are causes of conj hyperbili?
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i)decreased intrahep excretion: hepatitis or cirrhosis; Dubin Johnson/Rotor; PSC/PBC. ii)extrahep obstruction: gallstone, CA of pancreatic head, cholangiocarcinoma
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causes of unconj hyperbili? x2
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i)excess bili production (hemolytic anemia) ii)reduced uptake or impaired conjugation: Gilberts, Crigler Najjar, hepatitis/cirrhosis
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Diff b/w LFT levels and type of dz?
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i)ALT/AST low hundred: chronic viral hep or acute EtOH hep ii)high hundreds-thousands: acute viral hep iii)>10000: extensive hepatic necrosis (ischemia, shock liver, tylenol tox, severe viral hep)
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Levels of AlkP and cause?
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i)10x increase: extrahep biliary tract obstruction or intrahep cholestasis. Need to measure GGT: hepatic origin (if not incr, then bone or intestinal)
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What is cholelithiasis? What are the 3 kinds of stones? What are they due to? What are risks for cholesterol stones?
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i)stones in GB ii)a)chol stone (yellow): obesity, DM, hyperlipid, multiparous, CF, Native Am. b)Pigment stone (black):from hemolysis or alcoholic cirrhosis. Brown stones=biliary tract infection. c)mixed
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What are the clinical features of cholelithiasis x3
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i)biliary colic b/c of obstruction of cystic duct by gallstone. Pain b/c contracts against obstruction (RUQ/epigastrum). ii)pain after eating and at night iii)Boas sign: right subscapular pain of biliary colic.
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What are complications of cholelithiasis? x4
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i)cholecystitis: b/c obstructed ii)choledocholithiasis iii)malignancy iv)gallstone ileus
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What is diff in pain in cholecystitis vs cholelithiasis? x2
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i)cholecystitis: inflamed GB wall causes pain; cholelithiasis: pain b/c of contraction against obstruction. ii)pain for days in cystitis; hours for lithiasis
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How to DX x2 and treat cholelithiasis?
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i)RUQ US or CT/MRI. ii)Cholecystectomy
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What are signs of biliary tract obstruction? x4
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i)elevated ALKP and GGT ii)elevated conj bili iii)jaundice and pruritis iv)clay stool w/dark urine
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What is Acute cholecystitis due to? Who gets it commonly?
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i)due to obstruction of cystic duct (not infection) causing inflammation of GB wall. ii)pts w/gallstones
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What are signs and sxs of acute cholecystitis? x5
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i)RUQ pain radiates to right shoulder or scapula. ii)N/V and anorexia iii)RUQ tenderness/rebound tenderness iv)Murphy's sign: inspiratory arrest w/deep palpation of RUQ v)hypoactive BS
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How do you DX cholecystitis?x3 What is test of choice?
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i)RUQ U/S is test of choice: see thick GB wall, distended GB, stones. ii)CT is better at picking up complications (abscess, perforation, pancreatitis). iii)HIDA scan: if normal, can r/o. If no contrast after 4 hours, can r/in
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How to treat cholecystitis? (conservative x3 vs radical?)
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i)Conservative: IV fluids, NPO, IV Abx ii)SX: cholecystectomy
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What is acalculous cholecystitis? What is it due to x5? What are clinical features? What is treatment? x2
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i)inflammation of GB w/o an obstruction ii)trauma, dehydration, ischemia, burns, post op. iii)same sxs as cholecystitis. iv)cholecystectomy. Drain the GB if too ill
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What is choledocholithiasis? What is diff b/w primary and 2ndary stones?
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i)choledocho: stone in CBD. ii)primary: originate in CBD (usually pigmented). iii)Secondary: originate in GB and pass into CBD (chol or mixed stones).
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What are sxs of choledocho x2? How to DX x3? What is treatment
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i)jaundice, RUQ pain. ii)ERCP after RUQ U/S (not sn). Labs: AlkP, total and direct bili elevated. Treat: ERCP w/sphincterotomy and stone extraction w/stent placement
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What are the complications of CBD stones? x4
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i)cholangitis ii)obstructive jaundice iii)acute pancreatitis iv)biliary cirrhosis
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What is cholangitis, and what are the main causes? x5
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i)infection of the biliary tract due to obstruction, so there is stasis and bacterial overgrowth. ii)choledocho; pancreatic and biliary neoplasm; postop stricutres; ERCP/PTC; choledocho cysts
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What are the clinical features of cholangitis (what is triad)? How to DX (what test is 1st? 2nd? What are labs?)? How to treat x3
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i)Charcot: RUQ pain, fever, jaundice; Reynolds: Charcot + altered mental status and septic shock. ii)RUQ U/S first, then ERCP/PTC as definitive test after pt is stabilized. ERCP when duct system normal and PTC when duct system is dilated. Labs: hyperbili, leukocytosis, mild elevation in serum transaminases. iii)IV fluids/ABX, Decompress w/CBD via PTC/ERCP
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What is the most severe complication of cholangitis?
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hepatic abscess
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What are the risk factors for CA of GB x3? What are clinical features x4? How is PX?
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i)Gallstones, porcelain GB, cholecystenteric fistula. ii)extrahepatic obstruction: jaundice, RUQ mass, wt loss, anorexia biliary colic. iii)poor px: hard to do SX on it.
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What is PSC? What does it lead to x3? What are clinical findings x4? How to DX (x2)and treat x3?
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i)idiopathic, thickening of GB walls w/narrowing of lumen. ii)cirrhosis, portal HTN, liver failure. iii)Ass'd w/UC; chronic cholestasis findings (jaundice and pruritis); fatigue; wt loss. iv)DX: ERCP/PTC to DX and see beads. Labs: Cholestatic LFTs. v)Treat: if stricture causes cholestasis, then can ERCP w/stent and bile duct dilation. Cholestyramine for pruritis. No cure besides liver xplant
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What is PBC? Who does it affect? What are clinical features? x6
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i)autoimmune; cholestatic liver DZ w/destruction of intrahepatic bile ducts w/portal inflamm and scarring. can progress to cirrhosis and liver failure . ii)Affects middle aged women. iii)early pruritis, late jaundice, xanthomata, xanthelasmata, osteoporosis, portal HTN.
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How to DX PBC? What is treatment x3?
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i)LABS: cholestatic LFT (incr ALKP). +AMA->then need liver BX. elevated cholesterol, HDLs. Ab U/S or CT to r/o biliary obstruction. ii)Treat: cholestyramine for pruritus, treat osteoporosis. liver xplant
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What is cholangiocarcinoma? Where are they usually? What are risk factors? x4
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i)intra/extra hepatic bile duct adenocarcinoma. ii)Usually proximal (at rt/lt hepatic duct jcn): Klatskin tumor iii)PSC; UC; choledochal cysts, clonorchis
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What are clinical features of cholangioca? How to DX? How to treat?
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i)obstructive jaundice w/ass'd sxs: pruritus, dark urine, light stool. ii)DX: PTC/ERCP for DX and assessment of resectability. If proximal and unresectable, place stent for obstruction.
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What are choledochal cysts? What are complications x5? What are clinical features x4? How to DX x2? What is treatment?
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i)intra or extrahepatic cystic dilations of biliary tree more common in women. ii)hepatic abscess, cholangioca, rupture, portal htn and cirrhosis. iii)RUQ mass, epigastric pain, fever, jaundice iv)U/S is best noninvasive test, ERCP is definitive. v)Treat: surgery
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What is main cause of bile duct stricture x4? complications x3? treatment?
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i)iatrogenic (prior biliary sx: cholecystectomy, liver xplant); choledocholithiasis; PSC. ii)obstructive jaundice iii)SBC, liver abscess, asc cholangitis. iv)endoscopic stenting
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What is biliary dyskinesia? How to DX? How to treat? x2
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i)motor dysfcn of sphincter of Oddi, and leads to recurrent biliary colic w/o evidence of gallstones ii)DX by HIDA, and give CCK once contrast in there to see EF (if low=dyskinesia). Treat: cholecystectomy or sphincterotomy
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What is MOA for appendicitis?
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i)fecalith or lymphoid hyperplasia or FB blocks the lumen of appendix->stasis->inflamm. Can get necrosis if distended appendix cuts off blood, causing perforation->peritonitis
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What are SXs (x3) and signs (x5) appendicitis?
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i)Sxs: N/V following pain; anorexia. ii)Signs: Rebound tenderness, guarding decr BS. iii)Rovsing's sign: Deep palpation of LLQ->RLQ pain. Psoas: RLQ pain when rt thigh extended. Obturator: RLQ pain when flexed rt thigh internally rotated when pt supine.
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how to DX appendicitis? What is treat?
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i)DX: clinical. can use CT if atypical. ii)appendectomy
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Most common location for carcinoid tumor? What are signs of carcinoid syndrome? x6
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appendix. flushing, wheezing, sweat, diarrhea, ab pain, heart valve dysfcn
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What is MOA of pancreatitis? What are some causes? x5.
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i)inflamm of pancreas due to autodigestion by prematurely activated pancreatic enzymes. ii)EtOH; gallstone (blocks amp of vati); Post ERCP; HyperTG, Hyper Ca, Blunt trauma.
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What are some clinical features of pancreatitis x5
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i)Epigastric pain that radiates to back. ii)N/V iii)Low grade fever, tachycardia, leukocytosis. iv)ab distension, epigastric tenderness. v)ecchymoses for hemorrhagic panc
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How to DX acute pancreatitis?
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i)clinical, labs are supportive, CT scan is confirmatory. ii)Labs: amylase (nonsp), but if levels 5x normal, then high sp; lipase: more sp than amylase. iii)Orders: For Ranson's criteria, Glu, Ca, Hct, BUN, ABG, LDH, AST, WBC. iv)Can use ERCP if recurrent panc or if severe gallstone pancreatitis w/biliary obstruction
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What are complications of acute pancreatitis? x5
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i)pancreatic necrosis: sterile vs infected--use CT guided aspiration for gram stain/culture. Infected is worse. ii)Pseudocyst: 2-3 weeks post attack. Can rupture, get infected, gastric outlet obstruction, may impinge on adjacent ab organs, or compress CBD. iii)Hemorrhagic pancreatitis iv)ARDS v)effusions: pancreatic ascites or pleural effusion. Cause is inflamm of peritoneal surfaces
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How do you treat acute pancreatitis? x4
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i)NPO ii)IV fluids iii)pain killer iv)NG tube if severe NV or ileus
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What is the triad for chronic pancreatitis? What is diad? What happens to the pancreas? x3
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i)steatorrhea, Diabetes, epigastric pain. ii)epi pain and calcifications. iii)fibrotic tissue replaces parenchyma; stricture/dilations of panc ducts; endocrine/exocrine fcns of pancreas impaired
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How is pancreatitis DX'd? x2
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i)CT scan; ERCP is gold std but not done often b/c of invasiveness. ii)LABS are NOT helpful (no incr in amylase or lipase)
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What are complications of chronic pancreatitis? x7
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i)narcotic addiction ii)DM iii)malab/steato iv)pseudocyst v)Vit B12 malab vi)effusions vii)pancr CA
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What is treatment of pancreatitis? x4
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i)narcotics ii)NPO iii)panc enzymes + H2 blockers at same time: panc enzyme inhibit CCK and thus panc secretions after meals, decr H+ prevents degradation of panc enzymes. iv)surgery
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In desc order, where is panc cancer?
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head>body>tail
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What are 4 risk factors of panc CA
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i)Cigs ii)chronic pancreatitis iii)DM iv)heavy EtOH
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What are 5 clinical features of panc CA?
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i)painful ii)jaundice: esp if head of pancreas iii)wt loss: malab and decr intake. iv)Courvoisier's sign v)migratory thrombophlebitis
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How to DX panc CA? How to treat?
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i)ERCP: most sensitive test for DX. ii)CT scan: preferred for DX and assessment iii)Tumor marker: CA 19-9. iv)Whipples; if unresectable, then ERCP w/stent for biliary obstruction
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What are the 2 types of esophageal cancers? Who has more common in each? risk factors?
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i)SCC: Black men; ADC: White men. ii)SCC risks: EtOH, tobacco, HPV, achalasia, PV syndrome. ADC: GERD and Barrett's
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What are the clinical features of eso CA? x4
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i)dysphagia (solids, then both). ii)wt loss iii)anorexia iv)hematemesis, hoarseness of voice b/c of recurrent laryngeal
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How to DX eso CA x4? How to treat?
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i)DX: Barium swallow; upper endoscopy w/brush cytology to confirm; TE U/S for depth and staging; Full mets workup: CXR, CT scan, bone scan. ii)treat: chemo+rads then SX
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What are the criteria for DX of achalasia x2? What are the causes? x3. what are clinical features x3?
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i)incomplete relaxation of LES; aperistalsis of esophagus. ii)idiopathic>ADC of prox stomach>Chagas. iii)dysphagia equally with liq and solids. they move body to force food in; regurg leading to possible aspiration; recurrent pulm complications due to aspiration.
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How to DX achalasia x3? How to treat x4?
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i)Barium swallow (bird's beak); Upper GI endoscopy to r/o other causes; manometry is confirmation. ii)Instruct lots of chewing; Botulinum toxin into LES vs pneumatic balloon dilation vs Heller myotomy
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What is Diffuse eso spasm? What are clinical features?
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i)many parts peristalse at same time, so no movement. Normal LES tone. ii)dysphagia but no regurge. Noncardiac CP like angina
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How to DX Diffuse eso Spasm x2? What is treatment x3?
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i)DES: eso manometry. Upper GI barium swallow shows corkscrew. ii)Nitrates and CCBs (decr amp of contractions); TCAs.
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What are clinical features of eso hiatal hernias x3? What are complications for each kind x2 and x3? How to DX x2? What is treat for 2 kinds?
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i)heartburn, CP, dysphagia. ii)complications: sliding: GERD, reflux esophagitis; paraeso: obstruction, hemorrhage, strangulation. iii)Barium swallow and EGD. iv)Type 1 w/antacids and sleep w/head up. Type 2: surgery
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What is Mallory Weiss Syndrome? What is Booerhaave? How to DX? How to treat?
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i)MWS: mucosal tear at GE jcn b/c of incr intraluminal pressure. Boerhaave=transmural. ii)DX: upper endo iii)SX. Acid suppression.
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What is PV syndrome x4? What is a complication? What is treatment x2?
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i)upper eso webs(dysphagic), Fe def anemia, spoon nails, atrophic oral mucosa. ii)premalignant lesion iii)Treat: eso dilation, correct nutrition
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What are Schatzki's Ring? What are the clinical features? What is it due to? What are complications x3?
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i)distal eso webs (circumferential ring in lower eso) accompanied by sliding hiatal hernia. ii)dysphagia; if symptomatic, dilate esophagus. If reflux present, do antireflux SX. iii)due to ingestion of acid or alkali. iv)stricture formation, perforation, esophageal cancer
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What are diverticula due to? What are the 3 types? What is the best diagnostic test for them?
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i)Due to underlying motility d/o. ii)Zenker's (prox); Traction(midpt of esophagus); Epiphrenic (lower third of eso). ii)Barium swallow is best
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What is MOA of Zenker? What are clinical features x4? What is treatment?
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i)increased luminal pressure b/c cricopharyngeal m fail to relax during swallowing. Get an outpouching. ii)dysphagia, regurg, halitosis, wt loss. iii)Surgery: myotomy.
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What is MOA of traction diverticula? Symptoms? Treatment?
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i)TB causes hilar node scarring to cause retraction of esophagus. ii)No SXs iii)No treatment
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What is MOA of epiphrenic diverticula? Treatment?
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i)related to spastic esophageal dysmotility or achalasia ii)esophagomyotomy.
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What is etiology of esophageal perforation x2? What are clinical features x5? What is DX study?How to treat small vs large?
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i)blunt trauma, forceful vomiting. ii)pain, tachycardia, hypotension, tachypnea, dyspnea. iii)Contrast esophagram. iv)small: Fluids, NPO, Abx, H2 block. large: SX
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What are the most common causes of PUD x4? What are clinical features x3?
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i)NSAIDs; H pylori; ZES; smoking. ii)gnawing pain; N/V; early satiety
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How do you DX PUD? x2
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i)endoscopy: most accurate. Needed for gastric ulcers b/c need BX for H pylori and r/o malignancy (don't need BX for duodenal). ii)Labs: DX of H pylori needs BX; can do urease breath test to document active infection
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How to treat PUD? x4
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i)Supportive: stop NSAIDs, stop EtOH but eat food; stop smoking; stop stress; avoid food b/4 bedtime. ii)NSAID induced: stop NSAID; PPI and sucralfate. iii)Eradicate H pylori: triple or quad therapy. iv)cytoprotection: sucralfate (helps ulcer healing); misoprostol: decr risk of ulcer formation.
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What are causes of gastritis? x5
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NSAID; H pylori; EtOH; cigarettes; stress.
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What is relation b/w pain and food in gastritis?
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no relationship b/w onset of pain and eating.
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What is management of acute gastritis? x3
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i)asympto/little pain: acid suppression and d/c NSAIDs. if no response, after 4-8 weeks, then do DX workup: endoscopy and U/S (r/o gallstones); H pylori test
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What is most common cause of chronic gastritis? 2nd most common?
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i)H pylori; autoimmune gastritis w/serum anti parietal Igs and anti IF Igs (possible pernicious anemia).
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What are symptoms of chronic gastritis? What are complications? How common is this?
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i)usually asympto and no complications. ii)epigastric pain; N/V; anorexia but these are rare. iii)PUD, CA, MALT
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What kind of cancer is Gastric CA? What are 5 risk factors?
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i)ADC ii)severe atrophic gastritis; gastric polyps; H pylori infection; menetriers DZ; lots of preserved foods
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What are clinical features of gastric CA x4? How to DX? What is treatment?
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i)Ab pain and unexplained wt loss; early satiety, dyspepsia. ii)Endoscopy w/BX iii)SX resection w/possible chemo.
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What kind of lymphoma is gastric? What are clinical features? How to DX?
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i)NHL ii)same as gastric CA: wt loss, ab pain, early satiety. iii)EGD
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