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23 Cards in this Set

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HYQ: An EGD biopsy in a 65 yo M reveals gastric cancer. What is the next step in the management?
CT scan of the abdomen for staging purposes
HYQ: What is the next step in the mgmt of a pt w/ recurrent duodenal ulcers seen on at least 2 EGDs?
Check serum gastrin to r/o Zollinger-Ellison dz
HYQ: What presenting Sx help to distinguish gastric ulcer from duodenal ulcer?
Gastric = pain with eating
Duodenal = relief with eating, pain 2-4 hrs later
HYQ: what chem7 lab abnormality is often elevated in patients with an upper GI bleed?
BUN

gut bacteria break down the HgB --> increased BUN
What are Ranson's criteria for the prognosis of pts with acute pancreatitis
GA LAW: Glucose>200, AST> 250, LDH>350, Age>55, WBC>16k

Calvin & Hobbs: Calcium<8, Hct down 10%, 02<60, BUN up 5, Base deficit>4, Sequestration of fluid >6L
What are the 2 MCC's of pancreatitis?
Alcoholism and Gall Stones
What are the tumor markers for pancreatic cancer?

What are the tumor markers for gastric cancer?
Pancreatic: CEA and CA19-9

Gastric: CEA
HYQ: What is the most effective mgmt of duodenal ulcers not d/t ZE syndrome?
PPI + Clarithromycin + Erythromycin or Metronidazole

If its not ZE its probably H. Pylori
What is the one regimen used in the treatment of H. Pylori?
PPI + Clarithromycin + Erythromycin or Metronidazole
What is the treatment for gastric cancer?
Mid to upper 1/3 = total gastectomy

lower 1/3 = subtotal gastectomy
What is the treatment for pancreatic cancer in the head of the pancreas?
Whipple procedure

Connect the proximal stomach to the distal jejunum
What is the most sensitive and specific lab test for the diagnosis of chronic pancreatitis?
Low fecal eleastase level
What is the treatment for chronic pancreatitis?
Pancreatic enzyme replacement
Stop Alcohol!
Pain control
the two types of Hiatal hernias are _____(MC 95%) and _____. A hiatal hernia is Dx'd with a _____, and treated by ____.
Dx is with barium swallow

Sliding is MC: stomach and GE junction herniate. Tx is with acid control

Paraesophageal: just stomach herniates, TX is with surgery
Gastritis usually occurs in the _____(type A) or____(type B) and is caused by ____ and ____ respectively.
Type A: Fundus, d/t autoantibodies for parietal cells (pernicious anemia)
(MC) Type B: Antrum, d/t H. pylori
B12 is absorbed in the____.
Terminal ileum

I Fuck Better: Iron in the duodenum, Folate in the jejunum, B12 in the ilium.
What are some treatment options for Peptic Ulcer Disease (PUD)?
Sucralfate, bismuth salicylate, Misoprostol

use Cox-2 inhibitors for patients with PUD who require NSAID therapy
Zollinger-Ellison syndrome is a ____ producing tumor that is most commonly in the ____ but can also be in the ____. It is seen in the endocrine disorder _____. The treatment for ZE is __________.
Gastrin; duodenum or pancreas; MEN I

Tx: PPI + H2 blocker +/- Octreotide
What lymph nodes should you examine if you suspect gastric cancer?
Supraclavicular (Virchow's)
Periumbilical (Sister Mary Joseph)
What is..

Gray-Turner's sign
Cullen's sign
Sentinel loop
Colon Cutoff sign
All have to do with acute pancreatitis

GT: bluish discoloration of flank
Cullens: periumbilical discoloration
Sentinel: dilated loop of bowel near pancreas
Cutoff: Dilated bowel until pancreas
Tx for insulinoma from B-islet cell tumor
Diazoxide or Octreotide

Octreotide = somatostatin which decreases gut everything
Tx for glucogonoma from alpha-cell tumor
Octreotide, INF-alpha, chemo

poor prognosis
What endocrine pancreatic tumor can cause watery diarrhea?

and what is the TX?
VIPoma

Tx: gut resection for localized tumors, corticosteroids, chemotherapy, and octreotide