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61 Cards in this Set

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pt may be asymptomatic or present with heartburn or vomiting after eating
hiatal hernia
Pt w/ history of liver cirrhosis begins vomiting massive amounts of blood
hemhorrage of esophageal verices
Pt reports pain aggevated by reclining. Bx shows hyperplasia of the esophagus & numerous eosinophils within the squamous epitheliam
reflux esophagitis
Pt w/hx of chronic reflux esophagitis has bx that shows metaplasia of squamous epithelium into columnar epithelium
Barrett esophagus.
Barrett esophagus is premalignant what type of CA can it become
adenocarcinoma
smoker with hx of etoh abuse and no hx of GERD develops CA of the esophagus. What type of CA would you suspect
squamous cell carcinoma
Pt recovering from an sports injury presents with epigastric pain, nausea, and vomiting. She reports occasionally vomiting up blood. Pt reports taking several NSAIDs a day while she has been recovering from her injury. Bx shows punctuate erosions—focal mucosal disruptions with hemorrhage
acute gastritis
65 y/o 40ppy smoker presents with epigastric pain, nausea and vomiting. He denies vomiting any blood. H pylori test is +. Bx shows replacement of gastric mucosal epithelium by intestinal metaplasia and inflammation of the lamina propria containing lymphocytes and plasma cells. There are no neutrophils present
CHRONIC GASTRITIS
Previous pt is at increased risk for ______
an increased risk of PEPTIC ULCER and GASTRIC CANCER
pt w/ hx of chronic gastritis presents with epigastric pain along w/ a burning, gnawing, aching sensation that is aggravated by eating. She has lost 10 pounds since this began. Bx shows a small (2 cm) ulcer with a sharply punched-out appearance. The margins are not elevated. The ulcer base is clean. A Steiner silver stain demonstrates the numerous darkly stained Helicobacter organisms along the luminal surface of the gastric epithelial cells. There is no tissue invasion by bacteria.
gastric ulcer
pt w/ hx of chronic gastritis presents with epigastric pain along w/ a burning, gnawing, aching sensation that is relieved by eating. She has gained 10 pounds since this began. Bx shows a small (2 cm) ulcer with a sharply punched-out appearance. The margins are not elevated. The ulcer base is clean. A Steiner silver stain demonstrates the numerous darkly stained Helicobacter organisms along the luminal surface of the gastric epithelial cells. There is no tissue invasion by bacteria.
duodenal ulcer
56 y/o japenese man presents with weight loss (cachexia), abdominal pain, and vomiting. Surgical specimen shows a ill defined excavted central ulcer surrounded by irregular HEAPED-UP borders. What is the Dx? Where is the most likely location of metastesis?
Focal gastric carcinoma
Liver
56 y/o japenese man presents with weight loss (cachexia), abdominal pain, and vomiting. Surgical specimen signet ring carcinoma cells What is the Dx? Where is the most likely location of metastesis? If he was a female?
diffuse gastric carcinoma (linitis plastica)
Liver
Ovary(Krukenberg tumor)
GI Endoscopy is generally not indicated when the results will not contribute to management. Would GI be indicated in the case of a liver metastasese with an unknown primary
no
Pt recovering from an sports injury presents with epigastric pain, nausea, and vomiting. She reports occasionally vomiting up blood. Pt reports taking several NSAIDs a day while she has been recovering from her injury. Bx shows punctuate erosions—focal mucosal disruptions with hemorrhage
acute gastritis
How is Esophagogastroduodenoscopy(EGD) used to follw gastric ulcers
Done within 12 weeks to make sure ulcer has healed
Pt w/ hx of AAA repair presents w/ black stool. EGD shows mesh from AAA repair. What is the dx?--
aorto-duodenal fistula
In an average risk pt, how often should you perform a colonoscopy, following removal of premalignant/malignant polyps ?
3-5 year intervals
in pts with one primary relative w/ colorectal CA or adenomatous polyp before age 40 OR 2 or more 1st degree relative with colorectal CA what is the indication for colonoscopy
every 5 yrs, beginning at age 10 yrs earlier than the affected relative or by age 40
In pts with one primary relative w/ colorectal CA or adenomatous polyp > 60 or two secondary relatives with CRC, what is the indication for colonoscopy
colonoscopy every 10 yrs (same as avg risk) beginning at age 40
what liver lab tests tests measure liver or biliary INJURY as opposed to fx
ALT, AST, GGT, ALKP, and 5’-nuc
what liver lab tests measure liver FUNCTION
Albumin, bilirubin, protime/INR
Damage to biliary system or bile transport system would show an increase in these 2 lab values
alkp, bilirubin
this serum transaminase is more specific for liver injury than AST
ALT
if GGT nml, ALKP elevated, chances are you are dealing with a problem with this?
bone issue
if high ALKP AND GGT is high chances are you are dealing with this type of injury
liver source (GGT not in bone)
Albumin measures ________, however it is not good in acute situations. If you have an acute situation it is better to measure PT/INR.
liver fx
Most common cause of mild elevations of transaminases (AST,ALT) (<250)
(NASH: non-alcoholic steatohepatitis)
hepatitis A is an ______ infection
acute (does not cause chronic)
this lab test tells you it's an acute Hep A vs previous exposure & immunity
HAV-IgM:
This lab marker indicates previous exposure and immunity to Hep A
HAV-IgG:
Hepatitis C Antibody (HCV Ab) is used to screen for infection a positive test indicates this
exposure, but NOT active infection
If HCV Ab +, then order this test to see if there is active infection [TEST]
HCV RNA
This dz is a common liver dz in in obese persons. It may coexist with diabetes type II or hyperlipidemia.
Fatty Liver Disease/NASH:
genetic d/o where the small intestine absorbs too much iron and there is an iron overload of liver & other organs. Consider it if iron saturation (iron/TIBC >50-55%)
Hemochromatosis
Pt presents with liver and lung dz. What is the dx
Alpha-1-Antitrypsin (A1-AT) deficiency
What is the genetic association with Alpha-1-Antitrypsin (A1-AT) deficiency
SPEP-ZZ
Caused by deficiency in ceruloplasmin enzyme leading to copper accumulation
decreased Cu+ in urine & increased Cu+ serum
20% have psychiatric symptoms (neurotic behavior and depression is common)
Wilson's dz
Abnormal immune response to liver parenchyma of unknown cause
Autoimmune Hepatitis
older women presents with an autoimmune disease characterized by immune-mediated destruction of bile ducts. What is it? What diagnostic test should be ordered [TEST]
Primary Biliary Cirrhosis
( Name is misleading, because most patient are not cirrhotic)

Anti-mitochondrial Ab (AMA): + >90% (TEST)
Autoimmune disorder characterized by immune mediated inflammation of the bile ducts leading to multiple strictures.

Most patients also have this dz (TEST)
Primary Sclerosing Cholangitis

ulcerative colitis
pt with hx of alcohol abuse and gallstones presents w/ epigastric pain radiating to the back. Amylase and Lipase are elevated. What is the dx.
acute pancreatitis
what is Cullens sign?
periumbilical darkening of the skin from blood
What is Grey-Turner sign?
local areas of discoloration about the umbilicus and in the region of the loins
What are Cullens sign and Grey-Turners sign indicitive of
Hemhorragic pancreatitis
what is a common cause of pain 4-6 weeks after an episode of acute pancreatitis
pseudocyst
What is a pseudocyst?
collections of pancreatic juice encapsulated by a nonepithelialized wall of granulation tissue -
What are the 2 most common causes of acute pancreatitis
Gall stones- 45%
Etoh-35%
Pts with poorly controlled diabetes also are at risk of acute pancreatitis due to this?
Hypertriglyceridemia (Serum triglyceride concentrations above 1000 mg/dL)
Best for criteria for severity of acute pancreatitis
Ransons Criteria
Best test for dx of acute pancreatitis-
amylase & lipase
Best test for prognosis of acute pancreatitis
CA++ -lower pts Ca++worse the prognosis
Treatment of Acute Pancreatitis
P - pain control; meperidine
A - antacids[PPI]/anticholinergics
N - NPO
C - calcium monitoring
R - Rest
E - electrolytes
A - antibiotics
S – suction out acid
Pt presents with abdominal pain, diarrhea, and glucose intolerance Serum amylase and lipase are normal. Statorrheea is diagnosed qualitatively by Sudan stain of feces. X-rays show fibrotic pattern with areas of Calcification. What is the dx?
Chronic Pancreatitis
What is a new radiologic technique emerging in the diagnosis of chronic pancreatitis.
magnetic resonance cholangiopancreatography (MRCP)
in kids this is the most common cause of acute pancreatitis
CF
these are the most common symptoms in chronic pancreatitis
Abdominal pain
Diarrhea (caused by Pancreatic insufficiency)
In chronic pancreatitis what are you likely to find on X-ray
fibrosis &
calcifications
Fibrosis and calcification of the pancreas can lead to this
decreased levels of all enzymes and hormones that are associated with it, including insulin and glucagon.
Glucose intolerance is common
In patients diagnosed with chronic pancreatitis, pancreatic enzymes (amylase and lipase) tend to be _______
normal to below those seen in average individuals.
In Chronic Pancreatitis, _________ can be diagnosed qualitatively by Sudan staining of feces.
Steatorrhea