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43 Cards in this Set

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Definition:
Neuroendocrine tumor arising from ectodermal stem cells in the gut
Carcinoid Tumor
MC place of a Carcinoid tumor
90% in Ileum
(most in appendix)
What neurotransmitters and hormones does the Carcinoid tumor secrete?
(3)
Serotonin;

Bradykinin;

Histamine
MC places of mets w/ Carcinoid tumor
(2: in order of frequency)
Liver;

Lung
Etiology of Carcinoid tumor
(2)
Most are Idiopathic;

part of MEN-1
Classic triad of Carcinoid tumor and reason for each sign.

(3) other signs
1. Flushing, Hypotension - Bradykinin

2. Diarrhea - Serotonin

3. Rt-sided Valvular heart Dz - Serotonin

other:
Wheezing (histamine);
Bowel obstruction;
Appendicitis
Dx test for Carcinoid tumor
(2)
1. > 10mg/24 hour 5-HIAA

2. elevated serum and urine 5-HT
Tx for Carcinoid tumor
(3)
Surgical excision;

Radiation therapy;

Antihormonal therapy
What is a 72-hour Fecal Fat test?

When is the only time it is used?
72-hour FFT:
Detects Intestinal Malabsorption

Only used:
if you strongly suspect fat malabsorption and the Sudan Black stain is negative

(best initial test for fat malabsorption is Sudan Black stain)
Type of GI cancer in the:

1. Espophagus (2)

2. Duodenum and Jejunum

3. Ileum (3)
Esophagus:
Squamous and Adenocarcinoma

Duodenum and Jejunum:
Adenocarcinoma

Ileum:
Carcinoid, Lipoma and Lymphoma
Definition:
Aquired condition of the colon in which sac-like protrusions of colonic mucosa herniate through a defect in the muscular layer
Diverticulosis
MCC of massive GI bleed in patients over 60-yo
Diverticulosis
Dx:
painless rectal bleeding

underlying Cause?
Diverticulosis

inflammed diverticula erodes thru a colonic artery usually on RIGHT side
what is the non-Rx Tx for Diverticulosis?

if refractory?
Bleeding scan and embolization;


Refractory: Surical removal
Difference b/t True and False Diverticula

which is more common?
on the right side (ascending colon)?
True:
herniation involving the full bowel wall thickness
(right side and tend to bleed)

False:
only mucosal herniation thru muscular wall (more common)
Dx:
LLQ pain, fever, high WBC, possible sigmoid mass
Diverticulitis
Dx test for diverticulitis

What test should never be done?
Abdominal CT


Never do Colonoscopy
(risk of perforation)
Tx for Diverticulitis

(3 hospital management and 2 sets of choices for Abx Tx)
NPO, IV fluids, Pain control;

Abx:
FQ and Metronidazole
or
Clindamycin and Gentamicin
MC fistula associated w/ Diverticular Dz

how does it present?
Colovesicular

(presents w/ recurrent UTI)
MCC of nosocomial pseudomembranous colitis
C. difficile
Dx:
Crampy, diffuse abdominal pain, fever, watery (occasionally bloody) diarrhea; recent URI
Pseudomembranous Colitis
Dx:
68-yo man in the hospital for 3 weeks for pneumonia returns w/ new-onset diarrhea
C. difficile induced
Pseudomembranous Colitis
When is the only time Vancomycin is given PO?

What is the other Tx for this problem?
Pseudomembranous colitis


also Tx w/: Metronidazole PO
Dx tests for Pseudomembranous Colitis
(3)
C. difficile toxin in stool;

Fecal Leukocytes;

Sigmoidoscopy
(yellowish membranous plaques adhering to mucosa)
Dx:
fluctuating constipation and diarrhea, increased w/ stress, lack of systemic symptoms
Irritable Bowel syndrome
Tx for IBS
(2 together)
1. High-fiber / Low-fat diet;

2. Antispasmotic / Antidiarrheal
What (2) Dx must be ruled-out when giving a Dx of IBS, b/c they present similarly?
Giardia infection

Lactose intolerance
Between UC and Crohn's, which is:
1. More common in Men
2. More common in women
3. Greater risk for Colon CA
1. CD

2. UC

3. UC
What unusual topical Tx is there for Inflammatory Bowel Disease to improve Sx?
Nicotine dermal patch
IBD:
Inflammation of mucosa only
UC
IBD:
bloody diarrhea, rectal pain, more acute flares
UC
IBD:
tender RLQ mass, more chronic
CD
IBD:
Inflammation involves all bowel layers
CD
IBD:
Leads to fistulas, abscesses and involves granulomas
CD
IBD:
"Lead-pipe colon"
UC
IBD:
"Cobblestone appearance"
CD
IBD:
complications include perforation, stricture and megacolon
UC
IBD:
complications include abscess, fistula, perianal disease
CD
(2) Drugs to Tx IBD that contain 5-ASA and Sulfapyridine

Which is also used to Tx Rheumatoid Arthritis?
Which only works in the colon?
Which works in the small bowel if taken orally,but need to be given by enema if needed for colon?
Sulfasalazine:
only in colon
(also Tx: RA)

Mesalamine:
oral for small bowel and enema for colon
Tx for Inflammatory Bowel Dz
(5)*
Inflam SCAM:

Immunomodulators;

Sulfsalazine;

Corticosteroids;

Antibiotics (Metronidazole);

Mesalamine
Inflam SCAM
Which drug class for IBD works better for UC?
Corticosteroids
Abx Tx for Crohn's Dz
Metronidazole
Immunomodulators used in Tx of Crohn's Dz
(4)*

Which is for severe cases?
Which (2) are purine analogs?
MIA-6:

Methotrexate;

Infliximab (severe cases);

Azathioprine (purine);

6-Mercaptopurine (purine)
MIA-6