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151 Cards in this Set

  • Front
  • Back
most common mets site for CRC
liver
polyps with highest malignant potential
villous are villainous
CRC staging
A - muscularis
B - past muscularis with no node involvement
C - regional lymph nodes
D - distant mets
cancer by what age in:
FAP
Gardners
20
40
polyps
cerebellar medulloblastoma or GBM
Turcot's
hamartomas throughout GI tract
pigmented spots around lips
Peutz-Jeghers
polyps
dental abnormalities
benighn soft tissue tumors
desmoid tumors
sebaceous cysts
Gardners
anemia
weakness
RLQ mass
right sided CRC
hematochezia vs. melena
hematochezie in left sided CRC
melena more common on right
when is rectal used in tx fo CRC and rectal cancer
used for rectal not colon
which is more likely malignant, sessile or pedunculated?
sessile
diagnosis of diverticulosis vs diverticulitis
barium enema
CT
tx of diverticulosis
high fiber foods
psyllium
why no barium enema and colonoscopy in acut diverticulitis
risk of perforation
common finding in patients with bleeding AVMs
aortic stenosis
acute onset severe abdominal pain disproportionate to physical findings

anorexia, vomiting
mild GI bleeding
acute mesenteric ischemia
diagnosis of acute mesenteric ischemia
mesenteric angiography
thumbprinting on barium enema
acute mesenteric ischemia

thumb printing is due to thickened edematous mucosal folds
what meds to avoid in mesenteric ischemia
vasopressors
signs, symptoms and radiographic evidence of large bowel obstruction but no mechanical obstruction
Ogilvie's syndrome

usually becaus eof recent surgery or medical illness
tx of acute mesenteric ischemia
supportive fluids and abx
intra-arterial papaverine (vasodilator), and possibly thrombolytics
profuse watery diarrhea with no blood or mucus
crampy abdominal pain
toxic megacolon
c difficile colitis
tx of c diff
metronidazole
vanc if metro resistant
on film of colon:
- omega loop
- coffee bean
colonic volvulus

omega is dilated sigmoid

coffe bean is air fluid level
most common causes of cirrhosis
alcohol
chronic hep B and C
acetaminophen, methotrexate
autoimmune hapatitis
PBC
rx for esophageal varices
beta blockers
serum/ascites albumen:

>1.1
<1.1
> is portal HTN
less is other cause
decreased mental function
asterisix
rigidity, hyperreflexia
fetor hepaticus
Hepatic encephalopathy
tx for hepatic encephalopathy
- lactulose (to prevent ammonia absorption)
- neomycin (which kills bowel flora to lower ammonia)
- protein limited diet
progressive renal failure in advanced liver disease secondary to renal hypoperfusion caused by vasoconstriction of renal vessels
hepatorenal syndrome
tx for hepatorenal syndrome
transplant
bugs in infected ascitic fluid
e coli
klebsiella
strep pneumo
abdominal pain
fever
vomiting
rebound tenderness
spontaneous bacterial peritonitis
spider angiomatas
palmar erythema
gynecomastia
testicular atrophy
hyperestrinism in cirrhosis
inheritance of Wilson's
AR
parkinsonian symptoms in a young person
Wilson's disease
dx for Wilson's disease
biopsy
tx for Wilson's disease
penicillamine

(or zinc and penicillamine)
pathophys of hemochromatosis
excessive iron absorption
liver cancer associated with oral contraceptives
hepatocellular adenoma
common cause of nonfibrolamellar HCC
Hep B or C cirrhosis
which has better prognosis, fibrolamellar or nonfibrolamellar HCC
fibrolamellar (which is NOT associated with hep B or C)
increased AFP
hepatocellular carcinoma
diagnosis of HCC
liver biopsy
obesity
hyperlipidemia
DM
nondrinker
mild AST ALT elevations
Non Alcoholic Steato Hepatitis
NASH
tx of NASH
not established
inheritance of Gilberts
AD
pathophys of Gilberts
decreased activity of hepatic uridine diphosphate glucuronyl transferase UDGT
isolated elevation of unconjugated bilirubin, often in context of fasting, fever, infection

normal liver biopsy
Gilberts
tx for Gilberts
not needed
increased unconjugated bilirubin
crash diet
Gilberts
parasites causing liver cysts

tx?
echinococcus
tx is surgery followed by mebendazole

entamoeba histolytica
tx is IV metronidazole
pyogenic liver abscess in right lobe... bugs causing?
PEEK

Proteus
E coli
Enterococcus
Klebsiella
how is entamoeba histolytica transmitted
fecal-oral contact -- most common in men (9:1), especially gay men
diagnosis of Budd-Chiari
hepatic venography
serum ascites albumin gradient >1.1
three main causes of jaundice
hemolysis
liver disease
biliary obstruction
dark urine
pale stools
conjugated hyperbilirubinemia
why is only conjugated bilirubin able to cause dark urine
because it's the one conjugated with albumen and therefore water soluble
cause of unconjugated hyperbilirubinemia
excess production due to hemolytic anemias
or
reduced hepatic uptake or impaired conjugation
caues of decreased intrahepatic excretion of bilirubin
dubin-johnson
rotor's
hepatitis, cirrhosis
contraceptives
PBC
PSC
diseases causing unconjugated hyperbilirubinemia
Gilberts
Crigler-Najjar
drugs causing unconjugated hyperbilirubinemia
sulfonamides
penicillin
rifampin
radiocontrast
what kind of bilirubinemia does extrahepatic biliary obstruction cause?
conjugated
which is found only in the liver, AST or ALT
aLt is in the Liver
markedly elevated alk phos and GGT
ALT adn AST slightly elevated
cohlestasis
normal or slightly elevated alk phos
markedly elevated ALT and AST
hepatocellular necrosis or inflammation
increased alk phos
obstruction/cholestasis
which does liver disease affect, PTT or PT
PT
source of brown gallstones
biliary tract infection
source of black gallstones
hemolysis
alcoholic cirrhosis
source of yellow/green gallstones
obesity, diabetes, hyperlipidemia
multiple pregnancies
Crohns, ileal resection
age
native american
cirrhosis
CF
referred right subscapular pain
biliary colic

"Boas' sign"
elevated alk phos
increased GGT
jaundice
clay colored stools
dark urine
biliary tract obstruction
diagnosis of acute cholecystitis
RUQ u/s
tx for acute cholecystitis
hydration, bowel rest
IV abx
surgery (esp in first 24 to 48 hours)
difference between cholelithiasis and choledocholithiasis
in docho the stone is in the CBD

vs gallbladder for cholelithiasis
asymptomatic; biliary colic

asymptomatic, RUQ/epigastric pain, jaundice
cholelithiasis
vs
choledocholithiasis
test of r choledocholithiasis
ERCP
complications of choledocholithiasis
cholangitis
acute pancreatitis
biliary cirrhosis
RUQ pain
jaundice
fever
charcot's triad for cholangitis
RUQ pain
Jaundice
fever
septic shock
altered mental status
Reynold's pentad for highly toxic cholangitis
dreaded consequence of acute cholangitis
liver abscess
PSC can lead to
cholangiocarcinoma
PSC associated with
UC
intramural calcification of the gallbladder wall
porcelain gallbladder
chronic cholestasis
fatigue
malaise
weight loss
PSC
bile ducts in PSC vs PBC
PSC is intra and/or extra
PBC is intra only
fatigue
pruritis
jaundice
RUQ discomfort
xanthomata and xhanthelasma
osteoporsis
portal HTN
PBC
tx for PBC, PSC
PBC - symptomatic, ursodeoxycholic acid to slow progression, liver txplnt for cure

PSC stents, liver txplnt for cure
tumor in proximal third of CBC
klatskin
unresectable so bad prognosis
bile ducts where cholangiocarcioma is found
intra dn extra
prognosis for cholangiocarcinoma
dismal
risk factors for cholangiocarcinoma
PSC is major one

UC
choledochal cysts
clonorchis sinensis infestation (hong kong)
dark urin
clay-colored stools
prirutis
weight loss
cholangiocarcinoma
hormone that relaxes the sphincter of oddi
CCK
diagnosis of biliary dyskinesia
HIDA scan
HIDA scan to diagnose
biliary dyskinesia as cause of biliary colic
deep palpation in LLQ causes referred pain in RLQ
Rovsngs sign for acute appendicitis
RLQ pain when right thigh extended as patient lies on left side
psoas sign for acute appendicits
pain in RLQ when flexed right thigh is internall rotated when patient supine
Obturator sign for acute appendicitis
most common site for carcinoid tumors
appendix
common causes of pancreatitis
alcohol
gallstones

mumps, coxsackie
drugs
scorpion bites
drugs causing pancreatitis
sulfonamides
thiazides
furosemide
estrogens
HIV meds
flank ecchymoses
grey turner's sign for pancreatitis
periumbilical ecchymoses
cullen's sign for pancreatitis
ecchymosis of inguinal ligament
fox's sign for pancreatitis
amylase level elevated 5x
pancreatitis
which is more specific for pancreatitis: amylase or lipase
lipase
ranson's criteria
pancreatitis
pancreatitis tx
bowel rest
IV fluids
pain control
NG tube
ranson's criteria
to assess prognosis of pancreatitis

GA LAW
Glucose >200
Age >55
LDH >350
AST >250
WBC >16,000

if more than 3 criteria met go to ICU
diagnosis of acute pancreatitis
lab values

amylase and lipase
LFTS to identify cause
Ranson criteria for prognosis
diagnosis of acute vs chronic pancreatitis
acute - lab values
chronic - CT scan
most pancreatic cancers are in
head
chain of lakes appearance in pancreas ERCP
chronic pancreatitis
#1 risk factor for pancreatic cancer
smoking
migratory thrombophlebitis
pancreatic cancer
palpable gallbladder without pain
courvoisier's sign of pancreatic cancer
CA19-9 and CEA elevated
pancreatic cancer
increased BUN/cr
no renal insufficiency
upper GI bleed
dysphagia
weight loss
anorexia
odynophagia
hoarse voice
esophageal cancer
risk factors for SCC vs Adeno esophageal cancer
SCC - alcohol, tobacco, nitrates, HPV

Adeno - GERD, Barrett's
bird's beak on barium swallow
achalasia
tx for achalasia
no cure

chewing
antimuscarinics usually unsatisfactory
nitroglycerin
botulinum toxin
dysphagia for food>liquid
cancer
dysphagia for food and liquids
achalasia
mallory weis vs boerhaave
mallory mucosal
boerhaave bore's a holw trasmurally
koilonychia (spoon shaped fingernails
Plummer Vinson (upper esophageal webs)
difference between Plummery Vinson and Schatzki
Plummer Vinson is upper webs
Schatzki is lower webs
tried to commit suicide by ingesting alkali, acids, bleach, detergents
schatzki's rings
location of Zenker's diverticulum
upper third of esophagus
dysphagia
regurgitation
halitosis
weight loss
chronic cough
Zenker's diverticulum
diagnostic test for eophageal diverticuli
barium swallow
tx for Zenker's diverticuli
surgery
Hamman's sign: mediastinal cruch produced by heart beating against air-filled tissues
esophageal perforation
mets to the rectum
Blumer's shelf in gastric carcinoma
mets to the periumbilical lymph node
Sister Mary Joseph's node in gastric cancer
mets to the left axillary adenopathy
Irish's node for gastric cancer
tx for small bowel obstruction

if complete?
incomplete?
complete: surgery

partial: surgery if it persists, pain or strangulation suspected
tx for paralytic ileus
IV fluids
NPO correction of electolyte imbalances
ng suction
causes of paralytic ileus
narcotics
anticholingergics
post op
spinal cord injury
shock
metabolic disorders like hypokalemia
peritonitis
diagnosing paralytic ileus
failure to pass contrast bedium beyond a certain point
air on xray of obstruction vs ileus
air throughout with ileus
tx for Crohns
sulfasalazine
metronidazole if no response
steroids for acute exacerbations
azathioprine,6 MCP if those not working
IBD that always involves the rectum
UC
IBD with transmural inflammation
Crohns
1/2 of bile duct cancers are associated with
UC
sclerosing cholangitis associated with
UC
leading cause of death in UC
toxic megacolon
tx for UC
sulfasalazine
steroids for exacerbations
(same as Crohns)
which can be cured by surgery: UC or Crohns
colectomy for UC UndoColon