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2010-07-14 #1
Gastrointestinal disorder
| Question | Answer |
|---|---|
| bimodal; risk for esophageal cancer: Dx? | achalasia |
| pathogenesis: achalasia | autoimmune destruction of ganglion cells in myenteric (Auerback) plexus > decreased proximal smooth muscle contraction + loss of NO synthase producing neurons > incomplete relaxation |
| Cx: achalasia | nocturnal regurgitation of undigested food > nocturnal cough from aspiration; dysphagia for solids & liquids |
| Dx: achalasia | barium swallow: beak-like tapering at distal end + dilated, aperistaltic esophagus |
| Rx: achalasia | long-acting nitrates; calcium channel blocker; botulinum toxin injection |
| MC benign tumor of esophagus | leiomyoma |
| MC malignant tumor of esophagus | adenocarcinoma |
| MC predisposing cause of adenocarcinoma of esophagus | barrett's esophagus |
| MC primary cancer of esophagus in developing countries | squamous cell carcinoma |
| MCC of squamous cell carcinoma of esophagus | cigarettes smoking |
| Cx: squamous cell carcinoma of esophagus | progressive dysphagia (solids > liquid); weight loss; local invasion: trachea (dry cough & hemoptysis), recurrent laryngeal nerve (hoarseness), hypercalcemia (PTH-related peptide) |
| MC cause of hematemesis & melena | peptic ulcer disease; melena: conversion of Hb into hemetin by acid = bleed proximal to duodenojejunal junction |
| what does "gastric analysis" measures | basal acid output (5); maximal acid output (5~20); BAO:MAO ratio |
| projectile vomiting of non-bile-stained fluid; hypertrophied pylorus; olive palpation in "epigastrium": Dx? Mx? | congenital pyloric stenosis; hypertrophy of pyloric sphincter muscles |
| gastroparesis: indication? | sign of autonomic neuropathy (diabetes mellitus); previous vagotomy |
| Cx: gastroparesis | early satiety; vomiting of undigested food |
| Rx: gastroparesis | metoclopramide |
| difference between erosion & ulcer | erosion: epithelium of mucosa; ulcer: mucosa > submucosa or deeper |
| MCC of acute hemorrhagic (erosive) gastritis; 2nd MCC as well; burns; CNS injury | NSAIDs; alcohol; Curling; Cushing; uremia |
| Rx: acute hemorrhagic gastritis | misoprostol; proton pump inhibitors |
| MC site of type A chronic atrophic gastritis; MCC | body and fundus; pernicious anemia (Autoimmune) |
| MC site of type B chronic atrophic gastritis; MCC | antrum & pylorus; H.pylori |
| pathophysiology of type B chronic atrophic gastritis mediated by H.pylori | urease; colonizes mucus layer lining; noninvasive |
| chronic inflammatory infiltrate in lamina propria; intestinal metaplasia > precursor lesion for adenocarcinoma: Dx? | H.pylori-mediated chronic gastritis |
| most excellent screen test for H.pylori | stool antigen test; if active, [+]; if eradicated, [-] |
| disadvantage of urea breath test/serology | do not distinguish active vs old infection |
| Rx: H.pylori, consequence | bismuth, metronidazole/omeprazole, tetracycline; omeprazole, amoxicillin, clarithromycin; decreased risk of gastric cancer & B cell lymphoma |
| hyperplasia of mucus-secreting cells; hypoproteinemia; atrophy of parietal cells (achlorhydria): terminology, Dx? | giant rugal folds; menetrier's disease (hypertrophic gastropathy) |
| MCC of peptic ulcer disease | H.pylori; thus, eradication of H.pylori markedly reduces PUD recurrence |
| common type of PUD | duodenal > gastric: lesser curvature near incisura angularis |
| difference between duodenal & gastric ulcers in association with malignancy | duodenal: NEVER malignant; gastric: benign to malignant |
| secretion of excess gastrin; thus, producing hyperacidity: Dx? | Zollinger-Ellision (ZE) syndrome |
| malignant islet cell tumor secreting gastrin; single or multiple ulcers; Dx? Ax? | ZE syndrome; MEN type I in 20 to 30% of cases |
| suspicious for ZE syndrome | peptic ulcer disease + diarrhea; association with MEN I syndrome |
| heartburn; epigastric pain; weight loss; solitary duodenal ulcers; acid hypersecretion with diarrhea; maldigestion of food; increased BAO:MAO ratio; serum gastrin level > 1000 pg/mL: Dx? | ZE syndrome |
| complication of chronic gastritis & achlorhydria: Dx? | gastric polyps |
| MC gastric polyp type | hyperplastic polyp; hamartoma with no malignant potential |
| gastric polyp with potential for malignant transformation | adenomatous polyp |
| MC benign tumor in stomach | leiomyoma |
| decreasing incidence in US; increasing incidence in Japan with blood A type: Dx? | primary stomach adenocarcinomas |
| MC gastric carcinoma | intestinal type of gastric adenocarcinoma |
| precursor lesion for gastric adenocarcinoma | intestinal metaplasia due to H.pylori |
| MC site of intestinal type of gastric adenocarcinoma | lesser curvature pylorus & antrum |
| risk factor for intestinal type of gastric adenocarcinoma | intestinal metaplasia due to H.pylori; nitrosamines (smoked foods); achlorhydria; chronic gastritis; type A blood |
| not associated with H.pylori; linitis plastica: Dx? | diffuse gastric adenocarcinoma |
| X peristalsis of stomach; signet-ring cells infiltration into the stomach wall; Dx? | diffuse gastric adenocarcinoma |
| metastatic signet ring cells to both ovaries: Dx? | Krunkenberg tumor of ovaries: hematogenous spread |
| Virchow's node | left supraclaviular node: abdomen > stomach or pancreas |
| Cx: gastric adenocarcinoma | MC: cachexia & weight loss; paraneoplastic skin lesions: acanthosis nigricans; multiple outcroppings of seborrheic keratoses (Leser-Trelat sing); metastasis to umbilicus (Sister Mary Joseph sign) |
| MC site for extranodal malignant lymphoma | stomach; primary gastric malignant lymphoma |
| MCC of gastric lymphoma | H.pylori; low-grade B-cell lymphoma "MALToma" |
| symptom of small bowel obstruction | colicky pain; pain followed by a pain-free interval |
| blood diarrhea (small bowel): sign? | infarction; volvulus; dysentery |
| difference of diarrhea between small & large bowels? | small bowel: infection, malabsorption, osmotic diarrhea; large bowel: infection, laxative abuse, inflammatory bowel disease |
| definition of dysentery | bloody diarrhea + mucus |
| melanosis of the large intestinal mucosa due to accumulation of pigment of uncertain composition within macrophages in the lamina propria: term? | melanosis coli |
| massive loss of whole blood per rectum: Dx? causes? | hematochezia; signmoid diverticulosis (MC), angiodysplasia |
| criteria for diarrhea: stool/acute/chronic/types | more than 250g of stool; < 3wks = acute; > 4 wks = chronic; invasive, osmotic, secretory |
| screen test for invasive diarrhea | fecal smear for leukocytes |
| loss of isotonic fluid | secretory fluid |
| loss of hypotonic fluid | osmotic diarrhea |
| stool osmotic gap < 50 mOsm/kg from POsm: type/indication | secretory diarrhea; diarrheal fluid approximates POsm |
| stool ostmoic gap < 100 mOsm/kg from POsm: type/indication | osmotic diarrhea; hypotonic loss of stool due to presence of osmotically active subsutances |
| causes of malabsorption | pancreatic insufficiency; bile salt/acid deficiency; small bowel disease |
| signs & symptoms of malabsorption | diarrhea; steatorrhea; weight loss; weakness |
| MCC of pancreatic insufficiency | chronic pancreatitis; alcohol in adults; CF in children |
| pathogenesis of pancreatic insufficiency | malabsorption of fat & proteins(trypsin-related); X carbohydrate-related(amylase, disaccharidase in brush border of intestinal epithelium) |
| function of bile salt/acid | to micellarize monoglycerides & FAs |
| loss of villous absorptive surface: Dx? function of villi? | small bowel disease; villi required to reabsorb micelles into enterocytes (increased surface absorptive surface) |
| inability to reabsorb micelles due to loss of villous surface | celiac disease; Whipple's disease |
| inability to reabsorb micelles due to lymphatic obstruction | Whipple's disease; abetalipoproteinemia |
| general screening test for malabsorption | quantitative stool for fat(best: [+] > 7g of fat/24hrs); qualitative stool for fat (X sensitivity); serum beta carotene (decreased due to decreased vitamion A) |
| decreased reabsorption of D-Xylose: indication | small bowel disease; Xylose X require pancreatic enzyme for absorption |
| excellent newborn screen for CF & chronic pancreatitis | kserum immunoreactive trypsin; trypsin specific for the pancreas |
| CT scan of pancreas with dystrophic calcifications | chronic pancreatitis |
| functional tests for pancreatic insufficiency | secretin stimulation test: ability of pancreas to secret fluids & electrolyes; bentiromide test: ability of pancreatic chymotrypsin to cleave orally administered bentiromide to para-aminobenzoic acid (measured in urine) |
| test for bile salt/acid deficiency | serum bile acids(decreased in liver disease); bile breath test(oral radioactive test): decreased amount radioactive cholylglycine in breath = bacterial overgrowth or terminal ileal disease |
| clinical findings in malabsorption | fat/water[folate & B12] soluble vitamin deficiencies; anemia[folate & B12 & iron]; ascites[hypoproteinemia]; steatorrhea |
| immune disease directed against gluten in wheat, rye, barley: Dx? | celiac disease |
| disease associated with dermatitis herpetiformis | celiac disease[sprue] |
| pivotal role in celiac sprue | tissue transglutaminase [tTG: deamidating enzyme]: CD4 Th cell-related pathogenesis |
| Dx: celiac sprue | ↑anti-tissue transglutaminase IgA(MIP), IgG; ↑anti-endomysial (EMA) IgA antibodies; gliadin IgA antibodies; endoscopy: flattened villi in duodenum & jejunum[proximal small bowels] + hyperplastic glands |
| steatorrhea; weight loss; vesicles with erythema on the extensor surface of the forearm; villous atrophy; lymphocyte in lamina propria: Dx? | celiac sprue |
| Rx: celiac sprue | gluten-free diet; if refractory, corticosteroids |
| infectious agent causing Whipple's disease | Tropheryma whippelii |
| foamy PAS[+] macrophages in lamina propria & mesenteric nodes; obstructing lymphatics & reabsorption of chylomicrons: Dx? consequence? | Whipple's disease; malabsorption of fats |
| clinical findings in Whipple's disease; epidemiology | arthralgias; cardiac & neurologic symptoms in older men |
| MC site for obstruction in bowel | small bowel (SB) obstruction |
| bowel distention; air/fluid levels; absence of air distal to obstruction; Dx? | SB obstruction |
| pain alternating with pain free intervals: Dx? | colicky pain due to bowel obstruction |
| MC hernia | indirect inguinal hernia |
| ↑intra-abdominal pressure(cough, heavy weight lift); weakness in abdominal wall: Dx? | hernia |
| superior mesenteric artery (SMA) + inferior mesenteric artery (IMA) | watershed area: splenic flexure |
| MCC of SB infarction | occlusion of SMA; mostly transmural(mural or mucosal in hypoperfusion) |
| MC arrhythmia associated embolization | acute fibrillation: embolus from LH to SMA |
| sudden onset of diffuse abdominal pain; blood diarrhea; absent bowel sounds (ileus); X rebound tenderness (peritonitis); distention: Dx? | SB infarction |
| radiographic finding in SB infarction | "thumbprint sign": edema in bowel wall; bowel distention with air-fluid levels S/A bowel obstruction |
| Rx: SB infarction | thrombotic disease: anticoagulation & surgery |
| mesenteric angina after eating > weight loss: Dx? MCS? C of mesenteric angina? | ischemic colitis; splenic flexure of large bowel (Watershed area); atherosclerotic narrowing of SMA |
| Dx: ischemic colitis + infarction | mesenteric angina + bloody diarrhea (due to mucsoal or mural infarction); thumb-printing of colonic mucosa |
| CC of ischemic strictures & obstruction | ischemic colitis > normal repair of infarction site > fibrosis |
| dilation of mucosal & submucosal venules in cecum & R.colon: Dx? Cx? | angiodysplasia; hematochezia |
| 2nd MCC of hematochezia; epidemiology? | angiodysplasia; elder patients |
| vWD & calcific aortic stenosis associated disease | angiodysplasia |
| newborn with fecal material in umbilical area: Dx? | Meckel diverticulum; persistence of vitelline(omphalomesenteric) duct remnant |
| MC complication of Meckel diverticulum | bleeding; common cause of iron deficiency in newborns & young children |
| disease mimicking acute appendicitis | Meckel diverticulum (Y.enterocolitica) |
| 2 inches long; 2 feet from ileocecal valve; 2% of population; 2% symptomatic; first 2 years; 2 types of epithelia(gastric & pancreatic) | Meckel diverticulum; MC congenital anomaly of GIT |
| DDx: Meckel diverticulum | diverticulitis; contrast with omphalomesenteric cyst = cystic dilation of vitelline duct |
| MCS for SB diverticula | duodenum; wide-mouthed diverticula = systemic sclerosis |
| complication of SB diverticula | diverticulitis(perforation); bacteral growth(deficiency of nutrients) |
Created by:
mataos
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