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151 Cards in this Set
- Front
- Back
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most common mets site for CRC
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liver
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polyps with highest malignant potential
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villous are villainous
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CRC staging
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A - muscularis
B - past muscularis with no node involvement C - regional lymph nodes D - distant mets |
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cancer by what age in:
FAP Gardners |
20
40 |
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polyps
cerebellar medulloblastoma or GBM |
Turcot's
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hamartomas throughout GI tract
pigmented spots around lips |
Peutz-Jeghers
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polyps
dental abnormalities benighn soft tissue tumors desmoid tumors sebaceous cysts |
Gardners
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anemia
weakness RLQ mass |
right sided CRC
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hematochezia vs. melena
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hematochezie in left sided CRC
melena more common on right |
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when is rectal used in tx fo CRC and rectal cancer
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used for rectal not colon
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which is more likely malignant, sessile or pedunculated?
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sessile
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diagnosis of diverticulosis vs diverticulitis
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barium enema
CT |
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tx of diverticulosis
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high fiber foods
psyllium |
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why no barium enema and colonoscopy in acut diverticulitis
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risk of perforation
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common finding in patients with bleeding AVMs
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aortic stenosis
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acute onset severe abdominal pain disproportionate to physical findings
anorexia, vomiting mild GI bleeding |
acute mesenteric ischemia
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diagnosis of acute mesenteric ischemia
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mesenteric angiography
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thumbprinting on barium enema
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acute mesenteric ischemia
thumb printing is due to thickened edematous mucosal folds |
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what meds to avoid in mesenteric ischemia
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vasopressors
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signs, symptoms and radiographic evidence of large bowel obstruction but no mechanical obstruction
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Ogilvie's syndrome
usually becaus eof recent surgery or medical illness |
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tx of acute mesenteric ischemia
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supportive fluids and abx
intra-arterial papaverine (vasodilator), and possibly thrombolytics |
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profuse watery diarrhea with no blood or mucus
crampy abdominal pain toxic megacolon |
c difficile colitis
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tx of c diff
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metronidazole
vanc if metro resistant |
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on film of colon:
- omega loop - coffee bean |
colonic volvulus
omega is dilated sigmoid coffe bean is air fluid level |
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most common causes of cirrhosis
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alcohol
chronic hep B and C acetaminophen, methotrexate autoimmune hapatitis PBC |
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rx for esophageal varices
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beta blockers
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serum/ascites albumen:
>1.1 <1.1 |
> is portal HTN
less is other cause |
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decreased mental function
asterisix rigidity, hyperreflexia fetor hepaticus |
Hepatic encephalopathy
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tx for hepatic encephalopathy
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- lactulose (to prevent ammonia absorption)
- neomycin (which kills bowel flora to lower ammonia) - protein limited diet |
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progressive renal failure in advanced liver disease secondary to renal hypoperfusion caused by vasoconstriction of renal vessels
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hepatorenal syndrome
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tx for hepatorenal syndrome
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transplant
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bugs in infected ascitic fluid
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e coli
klebsiella strep pneumo |
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abdominal pain
fever vomiting rebound tenderness |
spontaneous bacterial peritonitis
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spider angiomatas
palmar erythema gynecomastia testicular atrophy |
hyperestrinism in cirrhosis
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inheritance of Wilson's
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AR
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parkinsonian symptoms in a young person
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Wilson's disease
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dx for Wilson's disease
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biopsy
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tx for Wilson's disease
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penicillamine
(or zinc and penicillamine) |
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pathophys of hemochromatosis
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excessive iron absorption
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liver cancer associated with oral contraceptives
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hepatocellular adenoma
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common cause of nonfibrolamellar HCC
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Hep B or C cirrhosis
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which has better prognosis, fibrolamellar or nonfibrolamellar HCC
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fibrolamellar (which is NOT associated with hep B or C)
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increased AFP
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hepatocellular carcinoma
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diagnosis of HCC
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liver biopsy
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obesity
hyperlipidemia DM nondrinker mild AST ALT elevations |
Non Alcoholic Steato Hepatitis
NASH |
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tx of NASH
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not established
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inheritance of Gilberts
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AD
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pathophys of Gilberts
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decreased activity of hepatic uridine diphosphate glucuronyl transferase UDGT
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isolated elevation of unconjugated bilirubin, often in context of fasting, fever, infection
normal liver biopsy |
Gilberts
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tx for Gilberts
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not needed
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increased unconjugated bilirubin
crash diet |
Gilberts
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parasites causing liver cysts
tx? |
echinococcus
tx is surgery followed by mebendazole entamoeba histolytica tx is IV metronidazole |
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pyogenic liver abscess in right lobe... bugs causing?
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PEEK
Proteus E coli Enterococcus Klebsiella |
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how is entamoeba histolytica transmitted
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fecal-oral contact -- most common in men (9:1), especially gay men
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diagnosis of Budd-Chiari
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hepatic venography
serum ascites albumin gradient >1.1 |
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three main causes of jaundice
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hemolysis
liver disease biliary obstruction |
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dark urine
pale stools |
conjugated hyperbilirubinemia
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why is only conjugated bilirubin able to cause dark urine
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because it's the one conjugated with albumen and therefore water soluble
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cause of unconjugated hyperbilirubinemia
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excess production due to hemolytic anemias
or reduced hepatic uptake or impaired conjugation |
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caues of decreased intrahepatic excretion of bilirubin
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dubin-johnson
rotor's hepatitis, cirrhosis contraceptives PBC PSC |
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diseases causing unconjugated hyperbilirubinemia
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Gilberts
Crigler-Najjar |
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drugs causing unconjugated hyperbilirubinemia
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sulfonamides
penicillin rifampin radiocontrast |
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what kind of bilirubinemia does extrahepatic biliary obstruction cause?
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conjugated
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which is found only in the liver, AST or ALT
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aLt is in the Liver
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markedly elevated alk phos and GGT
ALT adn AST slightly elevated |
cohlestasis
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normal or slightly elevated alk phos
markedly elevated ALT and AST |
hepatocellular necrosis or inflammation
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increased alk phos
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obstruction/cholestasis
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which does liver disease affect, PTT or PT
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PT
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source of brown gallstones
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biliary tract infection
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source of black gallstones
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hemolysis
alcoholic cirrhosis |
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source of yellow/green gallstones
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obesity, diabetes, hyperlipidemia
multiple pregnancies Crohns, ileal resection age native american cirrhosis CF |
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referred right subscapular pain
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biliary colic
"Boas' sign" |
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elevated alk phos
increased GGT jaundice clay colored stools dark urine |
biliary tract obstruction
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diagnosis of acute cholecystitis
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RUQ u/s
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tx for acute cholecystitis
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hydration, bowel rest
IV abx surgery (esp in first 24 to 48 hours) |
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difference between cholelithiasis and choledocholithiasis
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in docho the stone is in the CBD
vs gallbladder for cholelithiasis |
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asymptomatic; biliary colic
asymptomatic, RUQ/epigastric pain, jaundice |
cholelithiasis
vs choledocholithiasis |
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test of r choledocholithiasis
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ERCP
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complications of choledocholithiasis
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cholangitis
acute pancreatitis biliary cirrhosis |
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RUQ pain
jaundice fever |
charcot's triad for cholangitis
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RUQ pain
Jaundice fever septic shock altered mental status |
Reynold's pentad for highly toxic cholangitis
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dreaded consequence of acute cholangitis
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liver abscess
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PSC can lead to
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cholangiocarcinoma
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PSC associated with
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UC
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intramural calcification of the gallbladder wall
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porcelain gallbladder
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chronic cholestasis
fatigue malaise weight loss |
PSC
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bile ducts in PSC vs PBC
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PSC is intra and/or extra
PBC is intra only |
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fatigue
pruritis jaundice RUQ discomfort xanthomata and xhanthelasma osteoporsis portal HTN |
PBC
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tx for PBC, PSC
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PBC - symptomatic, ursodeoxycholic acid to slow progression, liver txplnt for cure
PSC stents, liver txplnt for cure |
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tumor in proximal third of CBC
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klatskin
unresectable so bad prognosis |
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bile ducts where cholangiocarcioma is found
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intra dn extra
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prognosis for cholangiocarcinoma
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dismal
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risk factors for cholangiocarcinoma
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PSC is major one
UC choledochal cysts clonorchis sinensis infestation (hong kong) |
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dark urin
clay-colored stools prirutis weight loss |
cholangiocarcinoma
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hormone that relaxes the sphincter of oddi
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CCK
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diagnosis of biliary dyskinesia
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HIDA scan
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HIDA scan to diagnose
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biliary dyskinesia as cause of biliary colic
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deep palpation in LLQ causes referred pain in RLQ
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Rovsngs sign for acute appendicitis
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RLQ pain when right thigh extended as patient lies on left side
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psoas sign for acute appendicits
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pain in RLQ when flexed right thigh is internall rotated when patient supine
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Obturator sign for acute appendicitis
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most common site for carcinoid tumors
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appendix
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common causes of pancreatitis
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alcohol
gallstones mumps, coxsackie drugs scorpion bites |
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drugs causing pancreatitis
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sulfonamides
thiazides furosemide estrogens HIV meds |
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flank ecchymoses
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grey turner's sign for pancreatitis
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periumbilical ecchymoses
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cullen's sign for pancreatitis
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ecchymosis of inguinal ligament
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fox's sign for pancreatitis
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amylase level elevated 5x
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pancreatitis
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which is more specific for pancreatitis: amylase or lipase
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lipase
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ranson's criteria
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pancreatitis
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pancreatitis tx
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bowel rest
IV fluids pain control NG tube |
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ranson's criteria
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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 |
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diagnosis of acute pancreatitis
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lab values
amylase and lipase LFTS to identify cause Ranson criteria for prognosis |
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diagnosis of acute vs chronic pancreatitis
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acute - lab values
chronic - CT scan |
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most pancreatic cancers are in
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head
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chain of lakes appearance in pancreas ERCP
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chronic pancreatitis
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#1 risk factor for pancreatic cancer
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smoking
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migratory thrombophlebitis
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pancreatic cancer
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palpable gallbladder without pain
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courvoisier's sign of pancreatic cancer
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CA19-9 and CEA elevated
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pancreatic cancer
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increased BUN/cr
no renal insufficiency |
upper GI bleed
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dysphagia
weight loss anorexia odynophagia hoarse voice |
esophageal cancer
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risk factors for SCC vs Adeno esophageal cancer
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SCC - alcohol, tobacco, nitrates, HPV
Adeno - GERD, Barrett's |
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bird's beak on barium swallow
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achalasia
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tx for achalasia
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no cure
chewing antimuscarinics usually unsatisfactory nitroglycerin botulinum toxin |
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dysphagia for food>liquid
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cancer
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dysphagia for food and liquids
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achalasia
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mallory weis vs boerhaave
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mallory mucosal
boerhaave bore's a holw trasmurally |
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koilonychia (spoon shaped fingernails
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Plummer Vinson (upper esophageal webs)
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difference between Plummery Vinson and Schatzki
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Plummer Vinson is upper webs
Schatzki is lower webs |
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tried to commit suicide by ingesting alkali, acids, bleach, detergents
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schatzki's rings
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location of Zenker's diverticulum
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upper third of esophagus
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dysphagia
regurgitation halitosis weight loss chronic cough |
Zenker's diverticulum
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diagnostic test for eophageal diverticuli
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barium swallow
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tx for Zenker's diverticuli
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surgery
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Hamman's sign: mediastinal cruch produced by heart beating against air-filled tissues
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esophageal perforation
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mets to the rectum
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Blumer's shelf in gastric carcinoma
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mets to the periumbilical lymph node
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Sister Mary Joseph's node in gastric cancer
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mets to the left axillary adenopathy
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Irish's node for gastric cancer
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tx for small bowel obstruction
if complete? incomplete? |
complete: surgery
partial: surgery if it persists, pain or strangulation suspected |
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tx for paralytic ileus
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IV fluids
NPO correction of electolyte imbalances ng suction |
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causes of paralytic ileus
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narcotics
anticholingergics post op spinal cord injury shock metabolic disorders like hypokalemia peritonitis |
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diagnosing paralytic ileus
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failure to pass contrast bedium beyond a certain point
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air on xray of obstruction vs ileus
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air throughout with ileus
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tx for Crohns
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sulfasalazine
metronidazole if no response steroids for acute exacerbations azathioprine,6 MCP if those not working |
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IBD that always involves the rectum
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UC
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IBD with transmural inflammation
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Crohns
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1/2 of bile duct cancers are associated with
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UC
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sclerosing cholangitis associated with
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UC
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leading cause of death in UC
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toxic megacolon
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tx for UC
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sulfasalazine
steroids for exacerbations (same as Crohns) |
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which can be cured by surgery: UC or Crohns
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colectomy for UC UndoColon
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