Term
| a protuberance into the lumen from a normally flat colonic mucosa |
|
Definition
|
|
Term
| features of an adenomous polyp that create a worse prognosis |
|
Definition
size >1cm
villous histology
high grade dysplasia
>3 polyps |
|
|
Term
general rules about adenomatous polyps:
__% are tubular, <1cm, LGD
__% prevalence of at least one at 60 y/o
__% synchronous lesions |
|
Definition
|
|
Term
| ____ is considered the optimal exam for the detection of polyps, as symptoms are not reliable |
|
Definition
|
|
Term
| 2nd leading cause of cancer death |
|
Definition
|
|
Term
| risk factors for colon cancer |
|
Definition
high fat, low fiber diet
>50 y/o
personal hx of adenoma or CRC (x3)
first degree relative w/ CRC (x3)
familial polyposis syndromes
hereditary non-polyposis CRC
IBD
african americans
obese
smokers |
|
|
Term
|
Definition
asymptomatic anemia - 50%
change in bowel habits - 43%
weight loss - 6% |
|
|
Term
| elderly pt with iron deficiency anemia have ___ until proven otherwise |
|
Definition
|
|
Term
|
Definition
|
|
Term
extension of CRC through ___ (T2) is the tipping point for prognosis. Probably needs colon resection.
having any pos nodes cuts CRC 5 year survival by __% |
|
Definition
|
|
Term
CT scan with air insuflated in colon lumen
85-90% sensitive for CRC
can miss flat lesions
no therapeutic intervention can be done |
|
Definition
|
|
Term
screening recommendations for CRC
1. FAP
2. HNPCC
3. Fm Hx CRC <60 y/o
4. IBD |
|
Definition
1. FAP - flex sig/colon q yr at puberty
2. HNPCC - colonoscopy q 2 years age 20-25, q year at 40
3. Fm Hx: colonoscopy at 40 y/o or 10 yr before family member was diagnosed
4. IBD - colonscopy q yr after 8 years |
|
|
Term
Post polypectomy surveillance:
1. Low risk - <2 adenomas, <1cm diameter, neg fmhx
2. high risk - >3 adenomas, >1 cm diameter, villous histology, high grade dysplasia, pos fmhx
3. hyperplastic polyp |
|
Definition
1. colonoscopy every 5 years
2. colonoscopy every 3 years, or 3-
6 mos if >2 cm, 3 mos if malignant
3. 10 years if no fmhx |
|
|
Term
|
Definition
1. surgery is only cure
2. adjuvant therapy:
- chemo for stage II or III colon ca, 305 weeks post-op
- chemo and/or radiation for stage II or III rectal cancer
3. stenting for pts who are not surgical candidates |
|
|
Term
| most common form of rectal cancer? |
|
Definition
|
|
Term
a diffuse process characterized by fibrosis and a conversion of normal architecture into a structureally abnormal nodules.
consequences include vascular disturbances (portal venous htn), and impaired parenchymal fxn, including protein synthesis, hormone metabolism, and excretion of bile
causes: alcohol, hep b/c, drugs, toxins, clotting disorders, autoimmune, NASH, cryptogenic
effects of diminished cellular fxn: accumulation of toxins, reduced synthesis of proteins
effects of increased resistance to hepatic blood flow: increased portal venous pressure, portosystemic shunting of blood |
|
Definition
|
|
Term
| 3rd leading cause of death ages 25-65 |
|
Definition
|
|
Term
| by the time cirrhosis is clinically apparent, hepatic fxn reserve is impaired by __% |
|
Definition
|
|
Term
Neuropsychiatric condition where clinical manifestations range from almost imperceptible personality changes (forgetfulness) to coma. Neuromuscular (Parkinson-like) symptoms may also be present.
occurs in acute or chronic liver disease
results in failure of liver to detoxify
pathogenesis multifactorial
causative agent ammonia and ?
- increased short chain aa's
- increased manganese
- increased serotonin
This disorder is reversible suggesting lack of persistent structural lesion in the brain
Studies of patients who died in hepatic coma revealed an Alzheimer’s type changes in astrocytes
PET scans (assess basic metabolic function, glucose uptake) suggest hypometabolism
often have an event that precipitates disease: azotemia/dehydration, sedatives, GI bleed, excess protein/nitrogen, metabolic alkylosis, infection, constipation
Gold standard test?
tx? |
|
Definition
hepatic encephalopathy
gold standard: arterial ammonia
tx: decrease ammonia w/ lactulose
abx: neomycin, rifaximin |
|
|
Term
s/s of _____:
Sub-Clinical--impaired psychomotor test
Stage 1--insomnia, confusion, forgetfulness,
ammonia increased
Stage 2--lethargy, disorientation, asterixis
Stage 3--somnolence, disorientation, aggression
Stage 4--coma, unresponsive, decerebrate
posture |
|
Definition
|
|
Term
a complication of a scarred (cirrhotic) liver impeding blood flow.
tx by reducing portal venous inflow via preload reduction (splanchnic vasoconstriction via beta blockers) OR reduce resistance to portal venous outflow via afterload reduction (outflow shunt) OR endoscopic sclerotherapy OR nitrates
- complicatoins of these?
develop when hepatic venous pressure exceeds 12 mmHg due to pressure build up in liver through LEFT GASTRIC VEIN
only 1/3 bleed but 30% death rate every time one bursts |
|
Definition
esophageal varices
shunt leads to severe encephalopathy
|
|
|
Term
| Risk factors for variceal bleeding (6) |
|
Definition
portal pressure >12 mm hg
large varices
varices in fundus of stomach
cherry red spots
degree of liver dz
presence of ascites |
|
|
Term
| tx of choice to prevent first esophageal varice bleed |
|
Definition
| non-selective beta blockers |
|
|
Term
| tx for acute esophageal varice hemorrhage |
|
Definition
1. octreotide
2. endoscopic sclerotherapy
3. TIPS - very effective
4. surgery to put in portacaval shunt |
|
|
Term
complication of cirrhosis that causes 50% of pts to die w/in 2 years
dx via US and CT
tx? |
|
Definition
ascites
tx: diuretics (spironolactone), bed rest, sodium restriction, paracentesis w/ albumin if >5 L |
|
|
Term
| complication of cirrhosis |
|
Definition
hepatic encephalopathy
ascites
scrotal edema
varices
hepatic pleural syndrome - hepatic hydrothorax
portal HTN (SAAG >1.1) |
|
|
Term
| indications and contraidndications for liver transplant |
|
Definition
indications: ascites, bacterial peritonitis, variceal hemorrhage, malnutrition, encephalopathy, metabolic bone disease, malignancy, pruritus
contras: extraheptaic malignancy, acive alcohol or substance abuse, HIV, severe comorbid disease
gauged via MELD score |
|
|
Term
| 3 most common places for GI bleed |
|
Definition
| esophagus, stomach, colon |
|
|
Term
| acute GI bleeds are more commonly upper or lower? |
|
Definition
|
|
Term
| Pt with rectal bleeding with normal Hgb, and elevated BUN with normal Cr |
|
Definition
|
|
Term
| medical therapy, dx studies for acute UGI bleed |
|
Definition
medical: IV, T&C, PRBC, correct coagulopathy, ICU monitoring, PPIs, NG tube
EGD - upper endoscopy |
|
|
Term
| most common causes of UGI bleeding |
|
Definition
PUD: 55%
gastric/esophageal varices: 14% |
|
|
Term
|
Definition
| uncommon bleed to due a vessel underneath the surface of the mucosa - 90% rebleed w/o cautery |
|
|
Term
| mucosal tear at GEJ that results from vomiting, dry heaving, and preceed hematemesis |
|
Definition
|
|
Term
| predisposing factors for peptic ulcers |
|
Definition
|
|
Term
|
Definition
cautery
epinephrine injection
correct coagulopathy
PPIs |
|
|
Term
GI bleed distal to the ligament of treitz
dx studies?
tx? |
|
Definition
lower GI bleed
dx: bleeding scan (have to be bleeding at 0.5 ml/min), angiography (have to be bleeding at 1 ml/min), capsule endoscopy, colonscopy
tx: epi, cautery, heater probe, hemoclips |
|
|
Term
| 2 most common reasons for rectal bleeding |
|
Definition
| diverticulosis, angiodysplasia |
|
|
Term
| ____ typically is caused by a colonic source or a rapidly bleeding UGI source |
|
Definition
|
|
Term
3 most common causes of acute pancreatitis
what are the 5 most common drugs to cause pancreatitis? |
|
Definition
gallstones (35%)
alcohol abuse (30%)
idiopathic (30%)
another important cause: hypertriglyceridemia
sulfas, azathiprine, 6-MP, pentamide, ACE-I |
|
|
Term
| how do gallstones cause pancreatitis |
|
Definition
| small gallstones get impacted at sphincter of oddi |
|
|
Term
sx of ?
- severe, boring, steady epigastric pain. radiats to upper back
- anorexia, n/v
- low grade fever
- shock, multisystem organ failure, confusion
Cr >2
PE:
- abd tenderness
- fever
- guarding
- distension
- tachycardia
- jaundice
- dyspnea
- melena/hematemesis
- cullen's or grey-turner sign |
|
Definition
|
|
Term
cullens sign
grey-turner sign |
|
Definition
cullen's: blue belly button
grey-turner: ecchymosis on flanks
both are signs of hemorrhage from pancreatitis |
|
|
Term
dx and tx of acute pancreatitis
most serious complication? |
|
Definition
dx:
- high serum amylase
- high serum lipase --> GOLD STANDARD
- elevated liver enzymes --> indicate common bile duct problem causing the pancreatitis
- CT w/ contrast --> GOLD STANDARD - will show fuzzy pancreas or blocked common bile duct
Tx:
- mild: NPO, IV fluids, analgesia
- severe: ICU, volume status, NPO, NG tube, ERCP + sphincterotomy
administering at least 300 ml NS/hr makes biggest difference in terms of outcome
Complications: pancreatic necrosis (most serious), pseudocyst after 4 weeks
- MRCP |
|
|
Term
| 2 scoring systems that indicate severe pancreatitis |
|
Definition
APACHE-II
Ranson
both used in research, but rarely in practice |
|
|
Term
| most common cause of chronic pancreatitis |
|
Definition
|
|
Term
chronic pancreatitis
more common in men
looks like cancer on CT
associated with elevated levels of immunoglobulin subtype 4(IgG4)
tx: steroids |
|
Definition
|
|
Term
| calcifications in pancreas on CT = ? |
|
Definition
|
|
Term
sx:
- intermittent attacks of abd pain
- steatorrhea, glucose intolerance
- diarrhea, weight loss
- sx may be exacerbated by eating
eventually leads to endocrine and exocrine insufficiency
CT: calficications
Labs:
- amylase/lipase only increased in acute exacerbations
- trigs may be high
- high fecal fat
- low fecal elastase
- low serum trypsinogen
dx studies: CT w/ contrast, ERCP, EUS (endoscopic US), MRCP
tx? |
|
Definition
chronic pancreatitis
on CT; shrunken pancreas
ERCP: irregular pancreatic duct, possibly a pseudocyst
tx: no good therapy!!!
- pancreatic enzymes
- endoscopic stenting, dilation, sphincterotomy, pseudocyst drainage
- surgery: whipple, roux-en-Y, preancreatectomy
- no ETOH or smoking
- narcotics
- high CHO, low fat diet |
|
|
Term
A 45-y.o. woman presents with acute pancreatitis with a serum amylase concentration of 2010 U/L, and a temperature of 37.2oC. The leukocyte count is 12,000/uL; plasma glucose is 250 mg/dL; and serum calcium is 8.4 mg/dL. She recovers after 1 week of supportive therapy. No obvious cause for the pancreatitis is found; ultrasonography is normal, and the fasting serum triglycerides are 350 mg/dL.
The best course of action to diagnose the cause of the pancreatitis is:
(A). Endoscopic retrograde cholangiopancreaticography (ERCP)
(B). No further testing until another attack occurs
(C). Contrast-enhanced CT scan
(D). Measurement of serum CA 19-9
(E). MRI of the pancreas |
|
Definition
B
if neg US - no further tests for first attack
probably passed a stone
|
|
|
Term
A 70-y.o. woman is hospitalized with severe abdominal pain but without rebound tenderness or a palpable mass. Her temperature is 39.8oC; BP is 100/60 mmHg; pulse 104/min; and she is slightly tachypneic. Five months ago she had an attack of right upper quadrant pain lasting 7 hours. Flat plate of the abdomen shows distended bowel loops. Ultrasonography is inconclusive due to overlying gas shadows, and CT scan shows and edematous pancreas. Blood cultures are taken.
Laboratory studies
Leukocyte count 18,000/uL Serum ALT 350 U/L
Serum calcium 7 mg/dL Serum AST 300 U/L
Serum bilirubin 8.2 mg/dL Serum amylase 3010 U/L
Serum alkaline phosphatase 300 U/L
The treatment of choice would be:
(A). Oral antibiotics and observation
(B). Intravenous antibiotics and consultation for ERCP
(C). Intravenous vancomycin
(D). Intravenous hydration and octreotide therapy
(E). Rehydration only |
|
Definition
B
pt had at least 3 ranson criteria --> severe pancreatitis
- needs to go to ICU
- sphincter of oddi obstruction
- ERCP is necessary + abx |
|
|
Term
A 36-y.o. man with a long history of Crohn’s disease is hospitalized with a recurrent attack of abdominal pain. He has a long history of alcohol abuse, which he claims relieves his abdominal pain. He has been taking low-dose prednisone (5 mg/d) and 6-mercaptopurine (100 mg/d) for 2 years and calcium supplements to prevent calcium oxalate urinary crystals. Abdominal radiograph shows pancreatic calcification.
The most likely cause of his pancreatic calcification is chronic pancreatitis due to:
(A). 6-mercaptopurine
(B). Alcohol
(C). Corticosteroids
(D). Hypercalcemia
(E). Oxalosis |
|
Definition
B
alcohol use is usually most common cause
|
|
|
Term
The diagnosis of infected necrosis during an attack of acute pancreatitis is best made by:
(A). Clinical deterioration of physical signs suggested by
fever, low PaO2, rising blood urea, decreasing albumin
(B). MRI
(C). Early surgical exploration
(D). Image-guided fine-needle aspiration of necrotic areas or fluid collections
(E). Contrast-enhanced CT scan |
|
Definition
D
however, should have clinical suspicion |
|
|
Term
|
Definition
1. at admission:
- age >55
- WBC >16K
- glucose >200
- LDH >350
- AST >250
2. During first 48 hours
- Hct decrease by 10% w/ hydration
- BUN increase >5 mg/dl
- Ca <8 mg/dl
- pO2 <60 mmHg
- evidence of fluid sequestration
|
|
|
Term
| Functions of biliary tract |
|
Definition
transport bile from liver to duodenum at 500-1500 ml/day
storage and concentration of bile in the gallbladder until needed. bile volume reduced by 80-90% |
|
|
Term
| components of the triangle of calot |
|
Definition
hepatic duct
cystic duct
edge of liver
used as reference for gallbladder surgery
can be variations in cystic duct/artery variations |
|
|
Term
1. gold standard for assessing for gallbladder stones
2. gold standard for assessing gallbladder function
3. gold standard for assessing cystic duct patency |
|
Definition
1. US
2. HB scan and CCK
3. HB scan
before getting any of these tests, get abd xray first |
|
|
Term
| patent cystic duct but can't see gallbladder on HB scan? |
|
Definition
|
|
Term
| pt has RUQ pain when eating... what test to get first? |
|
Definition
|
|
Term
Cholelithiasis (gallbladder stones)
1. 75% of stones are ____
2. 5 F's that are risk factors
3. what if pt has cholelithiasis w/o sx?
4. sx?
5. tx? |
|
Definition
1. cholesterol
2. Fat, female, fam hx, fertile, forty
- also: american indian, DM, parenteral nutrition, rapid weight loss
3. don't do anything
4. biliary colic, RUQ pain after eating, lasts 15-60 min, n/v,
5. tx: cholecystectomy. if pt has only mild sx, consider medical management first |
|
|
Term
| what is a definite indication for prophylactic cholecystectomy? |
|
Definition
|
|
Term
What dx?
sx: biliary colic, jaundice, pancreatitis, episodic cholangitis
elevated bilirubin at 3-6
studies?
tx? |
|
Definition
choledocholithiasis (common bile duct stones)
studies: ERCP
tx: open or lap cholecystectomy |
|
|
Term
1. ACUTELY elevated bilirubin, amylase, and lipase... think?
2. pt w/ pancreatitis but no hx of alcohol use... think?
3. bilirubin >10? |
|
Definition
1. stone in pancreatic duct
("gallstone pancreatitis)
2. stone in pancreatic duct
3. cancer |
|
|
Term
what dx?
- characterized by either charcot's triad (colic, fever, jaundice) OR reynold's pentad (colic, fever, jaundice, hypotension, confusion)
- is caused by biliary obstruction
- can progress to shock
- 50% due to anaerobes
- pos murphy's sign
tx? |
|
Definition
cholangitis
tx: wide spectrum abx
if unsure of cause - do ERCP |
|
|
Term
what dx?
- invovles two pathologic processes: bowel obstruciton and cholecystoenteric fistulas
- women more common, >70 y/o
- caused by a gallstone >2.5cm
tx? |
|
Definition
gallstone ileus
tx: surgery |
|
|
Term
acute RUQ pain and tenderness and + murphy's
fever, leukocytosis, nausea, emesis
US: thickened gallbladder w/ peri-cholecystic fluid
90-95% have gallstones
HB scan: cannot see gallbladder
tx? |
|
Definition
acute cholecystitis
tx: IV fluids and abx, cholecystectomy or drainage |
|
|
Term
Thickened gallbladder on US w/o fluid collection
HB scan: gallbladder is visualized |
|
Definition
|
|
Term
rare, severe form of acute cholecystitis
anaerobic infection w/ clostridia or e. coli
often in DM pts
pts will be very sick
xray: air in gallbladder wall
tx? |
|
Definition
emphysematous cholecystitis
tx: surgery |
|
|
Term
cystic duct obstruction
pus w/in gallbladder
may be severely septic
often had an acute gallbladder infection recently
tx? |
|
Definition
gallbladder empyema
tx: drainage or surgery |
|
|
Term
complication in 3-10% of acute cholecystitis cases
20% mortality
w |
|
Definition
|
|
Term
| primary vs. secondary chronic cholecystitis |
|
Definition
primary: no prior acute disease. usually due to a thin walled gallbladder w/ gallstones present
secondary: follows acute infection, thickened wall w/ adhesions |
|
|
Term
AKA chronic cholecystitis, acalculus, cholecystitis, sphincter of oddi syndrome
non-specific GI, biliary-like sx
- failed antacid therapy
US: negative
HB: ejection fx <35%
tx? |
|
Definition
biliary dyskinesia - basically a blanket term for a non-functioning/poorly-functioning gallbladder
tx: cholecystectomy |
|
|
Term
| hepatic and non-hepatic causes of jaundice |
|
Definition
Hepatic: hemolysis, bilirubin metabolism defect, cholestasis (hepatitis, cirrhosis, neoplasm, toxins),
- not treated surgically
non-hepatic: choledocholithiasis, cancer, inflammatory, biliary duct stricture |
|
|
Term
most commonly present in childhood
increased risk for cholangiocarcinoma
classic triad: jaundice, pain, palpable mass
Jaundice is most common
evaluation according to obstructive jaundice algorithm
ERCP to define anatomy
need to consider with any child presenting with jaundice |
|
Definition
|
|
Term
| stones larger than 2.5-3 cm w/ calcified (porcelain) gallbladder in a typhoid carrier... think? |
|
Definition
| gallbladder carcinoma --> needs cholecystectomy |
|
|
Term
slow growing cancer of the cystic or common bile duct
the one gallbladder disorder thats more common in males
higher chances for asians, UC, choledochocysts, sclerosing cholangitis
most commonly in the proximal third - Klatskin's tumor
fixed by hepaticojejunostomy or whipple procedure |
|
Definition
|
|
Term
characterized by chronic GI inflammation, fibrosis and obstruction, and bowel wall perforation
occurs in exacerbations and remissions
increased risk of malignancy with prolonged disease
caused by a combo of genetic (NOD2 gene), environmental, and immunologic factors |
|
Definition
|
|
Term
characterized by transmural mucosal inflammation that involves the entire GI tract except the rectum
Hallmarks: diarrhea, abd pain, weight loss
absence of gross bleeding
dx: barium enema - apthos ulcers
colonoscopy - skip lesions, cobblestone polyps
tx? |
|
Definition
crohn's disease
steroids, infliximab, methotrexate |
|
|
Term
pain and drainage from large skin tags
perirectal abscesses
anal fissures
anorectal fistula |
|
Definition
|
|
Term
| extraintestinal complications of crohn's |
|
Definition
eyes - uveitis, episcleritis
skin - erythema nodosum, pyoderma gangrenosum
arthritis
amyloidosis --> renal failure
DVT
sclerosing cholangitis |
|
|
Term
pt scenario that sounds like IBD but just involves the rectum?
any scenario involving red blood on finger from DRE |
|
Definition
| UC (proctitis) -- crohn's cannot involve rectum |
|
|
Term
self-limiting episode of rectal bleeding
then gradual onset of sx: recurring episodes of inflammation
limited to mucosa of colon
sx (depend on severity): intermittent rectal bleeding, mild crampy pain, tenesmus (spasm of anus), passage of mucus, constipation, mild diarrhea, anemia, abd pain, fever, colonic motility impaired, colon dilates, BMs less frequent, toxic megacolon, colonic perforation |
|
Definition
|
|
Term
swelling, scarring, and destruction of the bile ducts inside and outside the liver
sx: fatigue, itching, jaundice, hepatosplenomegaly, weight loss, repeated episodes of cholangitis
tests: abd CT, US< ERCP, liver biopsy, MRCP |
|
Definition
|
|
Term
which describes uC and which crohns?
1. colon only, continuous, mucosa, submucosa, crypt abscesses, superficial ulcers, friable mucosa, pseudopolyps, loss of haustra, rectal bleeding, diarreah, abd pain, weight loss
2. mouth to anus, skip lesions, transmural granulomas, aphtoid ulcers, cobblestoning, fistulas, fissures, abd pain, diarrhea, weight loss, fever, fistulas |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Patient age >70 and previous ulcer complications are the greatest risk factors in predicting -__ complications in NSAID users. |
|
Definition
|
|
Term
| most common complication of PUD? |
|
Definition
|
|
Term
what dx?
periodic sx of epigastric distress/tenderness, abd distension, bloating, belching, n/v, flatulence, halitosis
gold standard for diagnosis?
tx?
how do you know if h. pylori has been eradicated? |
|
Definition
culture via endoscopy
tx:
1. triple therapy - PPI, amoxicillin, clarythromycin OR metronidazole
2. quadruple therapy (most successful) - bismuth, metronidazole, tcn, PPI
stool antigen or urea breath testing to see if h. pylori is gone |
|
|
Term
t/f?
most people who develop GI complications from NSAID use have no abd discomfort |
|
Definition
true
most common finding is abd tenderness on palpation |
|
|
Term
| ___ is a drug recommended to prevent NSAID induced ulcers |
|
Definition
|
|
Term
epigastric pain 90 min - 3 hr after eating
wakens pt at night
relieved by food and antacids
intermittnet
epigastric tenderness most common PE finding
95% associated w/ infection
changes in pain may signal complications
dx: barium swallow, endoscopy
tx |
|
Definition
Duodenal ulcer
tx: eradicate h. pylori, PPIs |
|
|
Term
n/v, epigastric pain
70% associated with infection
heal slowly
dx: barium swallow, endoscopy |
|
Definition
gastric ulcer
tx: eradicate h. pylori, PPI |
|
|
Term
occult blood in stool w/o anemia
coffee-ground emesis
hematemesis
melena
sudden vascular collapse w/ shock w/o obv signs of hemorrhage
all suggest? |
|
Definition
|
|
Term
disease caused by over-secretion by a gastrin-producing tumor
25% are cancerous
present with MULTIPLE DU and GU ulcers
can be in pancreas or stomach
NO h. pylori!
dx: secretin stimulation test, octreotide scan
tx?
red flags?
signs that it might be cancerous? |
|
Definition
zollinger-ellison syndrome (AKA Gastrinoma)
tx: PPI, surgery (tx of choice)
red flags: multiple ulcers in unusual locations, resistance to resolution w/ tx, extensive fm hx, severe esophagitis, excess acid, unexplained diarrhea/steatorrhea, hyper calcemia, prominent gastric/duodenal folds
cancer: >45 y/o, rectal bleeding, weight loss, fm hx gastric cancer, prior PUD, anemia, dysphagia, abd mass, jaundice, anorexia |
|
|
Term
| what gastric cancer can be cured with a PPI? |
|
Definition
| MALT lymphoma - PPI eradicates cause, H. pylori |
|
|
Term
| 5 diseases cause by h. pylori |
|
Definition
chronic gastritis
autoimmune gastritis
ulcer
cancer
MALT |
|
|
Term
| pt presents w/ CP. you think it's related to esophagus/heartburn... what do you do first? |
|
Definition
|
|
Term
the sensation of delay in passage of a food bolus w/in ten seconds
dx via? |
|
Definition
| dysphagia -- do barium swallow |
|
|
Term
T/F?
degree of esophagitis is dependent on severity of GERD
development of Barret's esophagitis is dependent on severity of GERD |
|
Definition
|
|
Term
sx: usually after age 50, dysphagia, regurgitation, cough w/ eating, extreme halitosis
PE: bulging left neck when eating, gurgling sound, aspiration pneumonia, scc
dx: barium swallow, CXR |
|
Definition
|
|
Term
aperistalsis of esophagus
partial or incompete relaxation of lower esophageal sphincter with swallowing
increased resting tone (poorly relaxing) of the LES
associated w/ dilated, tortuous esophagus
sx: dysphagia, regurgitation, CP, weight loss, nocturnal cough, aspiration pneumonia,
barium swallow: bird peak, sigmoid esophagus
tx? |
|
Definition
achalasia
tx: CCB to relax LES, dilation, heller myotomy, botulinum toxin |
|
|
Term
motility/spastic disorder that causes haphazard esophageal contractions
- presents in middle age women
- sx: intermittent dysphagia, CP
tests: barium swallow, esophageal manometry
tx? |
|
Definition
diffuse esophageal spasm
tx: narcotic analgesia, smooth muscle relaxants (nitrates, CCB) |
|
|
Term
autoimmune disorder associated with PSS or Crest
results in muscle atrophy and collagen deposition, decreased cholinergic excitation and abnormalities in muscle responsiveness
sx: dysphagia, esophagitis, stricture, GERD
tx?
tests: manometry - loss of smooth muscle, low amplitude contraction, low to normal LES pressur |
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Definition
scleroderma esophagus
tx: treat the GERD |
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Term
smooth muscle pouches off the lumen of the esophagus
sx: dysphagia, regurg, vomiting, CP
test: barium swallow
tx underlying pathology |
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Definition
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Term
Chronic disease present in all individuals that causes transient lower esophageal sphincter relaxation (TLESR)
dysfunction of upper esophageal sphincter
sx: pyrosis, regurg, dysphagia, odonyphagia, sailorrhea, globus, pharyngitis, throat clearing, otalgia, sinusitis, vocal cord granulomas, subglottic stenosis, laryngitis, hoarseness, cough
causes: constant low pressure LES, degree of acid concentraiton, hiatal hernia, weight gain, high fat foods, caffeine, alcohol, tobaccos, drugs, pregnancy
dx: clinical suspicion. pH manometry most important
tx? |
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Definition
GERD
tx:
- lifestyle changes: weight loss, avoid eating before bed, avoid ETOH and smoking
- antacids, H2 receptor antagonists
surgery: nissen fundoplication
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Term
hallmark finding: specialized intestinal metaplasia (SIM) w/ goblet cell metaplasia
- can be a consequence of long-standing, uncontrolled GERD
- NOT caused by h. pylori
- least controlled sx is regurg
dx: endoscopy w/ biopsy
tx? |
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Definition
barrett esophagus
tx: photodynamic therapy, surgery |
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Term
| 3 most common risk factors for esophageal cancer |
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Definition
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Term
| sx: dysphagia + weight loss |
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Definition
esophageal ca
5-20% surival |
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Term
| one of the main reasons for fulminant liver failure |
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Definition
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Term
Liver function tests:
1. a transaminase that is cytosolic and mitochondrial but is not specific to the liver
2. a transaminase that is cytosolic and is specific to the liver. Normal is 31IU in males nad 19 in females.
3. biliary enzyme that can become elevated in liver disease, hodgkin's, renal cancer, and granulomatous disease
4. biliary enzyme that is highly inducible by drugs and alcohol -- used to see if liver pt is drinking
5. test that tests hepatic synthetic capability for chronic disease
6. the "GFR of liver disease" - implies obstruction or colestatic hepatitis if >0.5 mg/dl
7. test that is frequently falsely pos but can indicate early liver disease if >1.0 mg/dl |
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Definition
1. AST
2. ALT
3. Alk phos
4. GGT
5. albumin
6. bilirubin
7. dipstick urobiligen
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Term
isolated bilirubin abnormality due to an enzyme deficiency: elevated at 1.5-6 mg/dl
- dipstick urobiligen is neg
- often found in males at puberty
- normal CBC, retic count, ALT, alk phos
- good general health
- jaundice may be seen during times of acute illness |
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Definition
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Term
Evaluating a pt with elevated liver enzymes:
1. AST/ALT <4 fold normal, normal PE, normal bilirubin, asymptomatic
2. Abnormal AST/ALT on repeat exam or sx or risk factors
3. abnormal PE (ascites, clubbing, splenomegaly, spiders), low platelets or albumin, high bilirubin or alk phos, and don't think it's obstruction |
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Definition
1. repeat labs in 2-6 mos
2. get more labs: HCV, HBV, ferritin, Fe/TIBC, platelet, PTT, CBC, ANA, endomysial ab, US
3. look for zebras - liver biopsy |
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Term
highly associated w/ BMI > 30, tricyclics, CCBs
ALT/AST both <2x normal, ALT>AST
mild increase in GGTP
biopsy: NO NECROINFLAMMATORY CHANGES OR FIBROSIS
improves w/ weight loss |
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Definition
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Term
associated w/ BMI > 30 and "syndrome x" insulin resistance
ALT/AST <4x normal. ALT>AST
biopsy: NECROINFLAMMATORY CHANGES AND PERICENTRAL VENULAR FIBROSIS OR BRIDGING
inconsistent response to weight loss
8-26% progression to cirrhosis w/in 7 years |
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Definition
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Term
| most common cause of liver disease |
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Definition
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Term
AST>ALT by at least 2:1
GGTP>Alk phos by 2:1
characterized by ballooning degeneration, spotty necrosis, polymorphonuclear infiltrate, fibrosis
sx: hepatomegaly, RUQ pain, nausea, jaundice |
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Definition
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Term
iron overload
one of the most common detectable/preventable genetic diseases in north america
- mildly elevated transaminases progressing silently to cirrhosis
- may look like NASH histologically
- FE/TIBC >45%, >1000 ng/ml
confirm w/ biopsy |
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Definition
| hereditary hemochromatosis |
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Term
defined as abnormal ALT > 6 mos + virus
- reactivation can occur after pt has cleared the dz serologically
progression of abs? |
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Definition
chronic HBV
1. HBV DNA
2. IgM
3. HBV surface antigens + HBVe antigen
4. rise in ALT and AST
5. loss of DNA
6. anit-HBV and anti-HBVe antigens
7. IgM --> IgG |
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Term
RNA virus that becomes chronic 85% of the time
- can have normal LFT and undetectable RNA, but fluctuating levles are typical
- 20-30% develop cirrhosis
tx: interferon, ribavirin, protease inhibs -- good outcome |
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Definition
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Term
| most common cause of liver transplant |
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Definition
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Term
| ROME II criteria are for diagnosing what disease? |
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Definition
IBS
abd pain which is relieved by defecation
lots of diff change in bowel movements
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Term
4 kids of IBS:
1. typically in kids, sporadic, crampy pain
2. typically in kids - colic + constipation
3. mid-later life with diarrhea
4. antigen sensitization w/ diarrhea |
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Definition
. 1. colic
2. constipation predominant
3. diarrhea predominant
4. episodic/explosive |
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Term
SRBW alarm symptoms
what tests should you get? |
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Definition
constant, unrelenting, localized pain
weight loss
anorexia, vomiting, sweats, bleeding
nocturnal sx
no prior hx of pain
mid- later-life
fm hx of gi cancer
H&P, CBC, ESR, CMP, lipase, Fe/TIBC, endomysial ab, chromogranin A, colonsocopy, US GB, CT |
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Term
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Definition
ROME II Criteria + endomysial antibody + no SRBW sx
tx: dietary modifications - find food allergies, restrict gas/fermenting foods, restrict gluten, lactose, fructose, sorbitol, fiber, caffeine
- antispasmodics
- TCA or SSRI
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Term
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Definition
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Term
upper abd/chest pain - pressure or squeezing
typically after meals
gas/bloating in upper abd/chest
dysphagia
responds to GERD tx but not fully
may need surgery |
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Definition
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Term
Gas/bloating - upper abdomen
Eructation, nausea, aerophagia
Pyrosis is usually minimal
Non specific multiple food intolerances
Vague upper or middle abdominal pain
Present over long time and usually daily occurrence
Responds poorly to medical Rx
Consider - post enteropathic gastric dysmotility |
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Definition
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Term
| pt has bloody diarrhea for the past 24 hours. she attended a picnic 24 hours ago. possible causes? |
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Definition
c. diff
hemorrhagic e. coli
salmonella
campylobacter
yersinia
shigella
entamoeba histolytica |
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Term
| A 24 year old woman has had non-bloody diarrhea for the past 24 hours. She is a daycare attendee. Identify at least 4 possible causes. |
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Definition
shigella
giardia
crypto
rotavirus |
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