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43 Cards in this Set
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- Back
- 3rd side (hint)
Definition:
Neuroendocrine tumor arising from ectodermal stem cells in the gut |
Carcinoid Tumor
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MC place of a Carcinoid tumor
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90% in Ileum
(most in appendix) |
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What neurotransmitters and hormones does the Carcinoid tumor secrete?
(3) |
Serotonin;
Bradykinin; Histamine |
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MC places of mets w/ Carcinoid tumor
(2: in order of frequency) |
Liver;
Lung |
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Etiology of Carcinoid tumor
(2) |
Most are Idiopathic;
part of MEN-1 |
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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 |
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Dx test for Carcinoid tumor
(2) |
1. > 10mg/24 hour 5-HIAA
2. elevated serum and urine 5-HT |
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Tx for Carcinoid tumor
(3) |
Surgical excision;
Radiation therapy; Antihormonal therapy |
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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) |
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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 |
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Definition:
Aquired condition of the colon in which sac-like protrusions of colonic mucosa herniate through a defect in the muscular layer |
Diverticulosis
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MCC of massive GI bleed in patients over 60-yo
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Diverticulosis
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Dx:
painless rectal bleeding underlying Cause? |
Diverticulosis
inflammed diverticula erodes thru a colonic artery usually on RIGHT side |
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what is the non-Rx Tx for Diverticulosis?
if refractory? |
Bleeding scan and embolization;
Refractory: Surical removal |
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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) |
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Dx:
LLQ pain, fever, high WBC, possible sigmoid mass |
Diverticulitis
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Dx test for diverticulitis
What test should never be done? |
Abdominal CT
Never do Colonoscopy (risk of perforation) |
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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 |
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MC fistula associated w/ Diverticular Dz
how does it present? |
Colovesicular
(presents w/ recurrent UTI) |
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MCC of nosocomial pseudomembranous colitis
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C. difficile
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Dx:
Crampy, diffuse abdominal pain, fever, watery (occasionally bloody) diarrhea; recent URI |
Pseudomembranous Colitis
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Dx:
68-yo man in the hospital for 3 weeks for pneumonia returns w/ new-onset diarrhea |
C. difficile induced
Pseudomembranous Colitis |
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When is the only time Vancomycin is given PO?
What is the other Tx for this problem? |
Pseudomembranous colitis
also Tx w/: Metronidazole PO |
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Dx tests for Pseudomembranous Colitis
(3) |
C. difficile toxin in stool;
Fecal Leukocytes; Sigmoidoscopy (yellowish membranous plaques adhering to mucosa) |
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Dx:
fluctuating constipation and diarrhea, increased w/ stress, lack of systemic symptoms |
Irritable Bowel syndrome
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Tx for IBS
(2 together) |
1. High-fiber / Low-fat diet;
2. Antispasmotic / Antidiarrheal |
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What (2) Dx must be ruled-out when giving a Dx of IBS, b/c they present similarly?
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Giardia infection
Lactose intolerance |
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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 |
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What unusual topical Tx is there for Inflammatory Bowel Disease to improve Sx?
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Nicotine dermal patch
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IBD:
Inflammation of mucosa only |
UC
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IBD:
bloody diarrhea, rectal pain, more acute flares |
UC
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IBD:
tender RLQ mass, more chronic |
CD
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IBD:
Inflammation involves all bowel layers |
CD
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IBD:
Leads to fistulas, abscesses and involves granulomas |
CD
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IBD:
"Lead-pipe colon" |
UC
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IBD:
"Cobblestone appearance" |
CD
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IBD:
complications include perforation, stricture and megacolon |
UC
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IBD:
complications include abscess, fistula, perianal disease |
CD
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(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 |
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Tx for Inflammatory Bowel Dz
(5)* |
Inflam SCAM:
Immunomodulators; Sulfsalazine; Corticosteroids; Antibiotics (Metronidazole); Mesalamine |
Inflam SCAM
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Which drug class for IBD works better for UC?
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Corticosteroids
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Abx Tx for Crohn's Dz
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Metronidazole
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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
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