SUTM - Disease of GI (Part 1)

arold001's version from 2015-12-30 18:35

Section 1

Question Answer
What feature classifies SEVERE pancreatitis?NECROTIZING pancreatitis
name top 2 causes of pancreatitis?alcohol abuse and gallstones
how does gallstones cause pancreatitis?gallstone passes into the bile duct and blocks the ampulla of Vater
name 2 viral infections that cause pancreatitismumps and Coxsackivirus B
name 5 drugs known to cause pancreatits1) sulfonamides
2) thiazides
3) furosemide
4) estrogen
5) HIV meds
Name 2 metabolic disorders that cause pancreatitishypertriglyceridemia and hypercalcemia
pt presents with epigastric abd pain that radiates to BACK, that worsens when SUPINE and AFTER mealspancreatitis
which sign of hemorrhagic pancreatitis: flank ecchymosesgrey turners sign
which sign of hemorrhagic pancreatitis: periumbilical ecchymosescullens sign
which sign of hemorrhagic pancreatitis: inguinal ligament echhymosesfox's sign
pt with pancreatitis and decreased/absent bowel sounds may indicate what?partial ileus
which lab is more specific for pancreatitis: amylase or lipaseLIPASE!
why would a pt with pancreatitis be hyperglycemic?injured pancreas --> decreased production of insulin
what causes HYPOCALCEMIA in acute pancreatitis?fat saponification: fat necrosis binds calcium
calcification of the pancreas seen on XRAY is suggestive of what?chronic pancreatitis
whats the most accurate test for diagnosis of acute pancreatitis?CT scan abd
whats the main indication to get an ERCP?if theres severe gallstone pancreatitis with biliary obstruction

Section 2

Question Answer
what are 3 complications of acute pancreatitis?1) necrosis
2) pseudocyst (lacks epithelial lining)
3) hemorrhage
whats the diagnostic test for hemorrhagic pancreatitis?CT scan with IV contrast
how do you treat acute pancreatitis (3 things)?1) bowel rest (NPO to rest pancreas)
2) IV fluids to correct lytes abnormalities
3) pain control with fetanyl or meperidine > morphine
why fentanyl or meperidine > morphine for pain control?morphine causes an increase in sphincter of oddi pressure
how do you tx pts with SEVERE pancreatitis?EARLY enteral nutrition in first 72 hours thru nasojejunal tube --> if pancreatitis has not resolved, supplemental parenteral nutrition should be started
when should you give prophylactic antibiotics (imipenem) in pts with pancreatitis?if >30% of pancreas is necrosed
chronic epigastric pain and calcifications on plain abd x-raychronic pancreatitis
whats the triad of chronic pancreatitis?steatorrhea, diabetes, pancreatic calcification
continuing inflammation of the pancreas with fibrotic tissue replacing pancreatic parenchyma and alteration of pancreatic duct (strictures and dilation)chronic pancreatitis
whats the most common cause of chronic pancreatits?ALCOHOLISM
whats the INITIAL study of choice to diagnose chronic pancreatitis? whats the gold standard?Initial test: CT scan
Gold standard: ERCP (not done routinely since invasive)
pancreatic calcifications on CT scanCHRONIC pancreatitis
whats the difference btw amylase and lipase levels in ACUTE vs CHRONIC pancreatitis?acute pancreatitis: elevated lipase and amylase
chronic pancreatitis: NOT elevated!!!
whats the most common complication of chronic pancreatitis?narcotic addiction! then diabetes due to progressive loss of islets of langerhans
how does pancreatitis cause malabsorption/steatorrhea?caused by pancreatic EXOCRINE insufficiency - occurs when pancreatic enzyme secretion decreases significantly
whats the tx for CHRONIC pancreatitis?narcotics for pain, NPO for bowel rest, pancreatic enzymes and H2 blockers, insulin,
whats the MOA of pancreatic enzymes in relation to CCKpancreatic enzymes inhibit CCK release --> decreases pancreatic secretions after meals
why are H2 blockers given simultaneously with pancreatic enzymes in tx of chronic pancreatitisH2 blockers inhibit gastric acid secretion --> preventing degradation of pancreatic enzyme supplements by gastric acid
what are the 2 surgeries for tx of chronic pancreatitis?1) pancreaticojejunostomy (pancreatic duct drainage procedure to decompress the dilated pancreatic duct)
2) pancreatic resection (distal pancreatectomy, whipples procedure)

Section 3

Question Answer
what age group gets pancreatic cancer?eldery > 60 years old, more common in blacks
whats the most common location for pancreatic cancer?pancreatic head (75%), pancreatic body (20%), pancreatic tail (10%)
whats the #1 risk factor for pancreatic cancer?SMOKING!
name 5 risk factors for pancreatic cancer1) smoking
2) chronic pancreatitis
3) diabetes
4) alcoholism
5) exposure to naphthylamine
whats courvoisier's sign?palpable gallbladder
whats the most sensitive test for diagnosing pancreatic cancer? but whats the PREFERRED test?most sensitive test: ERCP. preferred test: CT scan
what are the 2 tumor markers for pancreatic cancerCA 19-9 and CEA
whats the tx of pancreatic cancer?whipples procedure = prognosis after surgery = 5-year survival rate of <10%
pt with pancreatic cancer with JAUNDICE likely has tumor in what part of the pancreas?HEAD of the pancreas

Section 4

Question Answer
What defines UPPER GI bleed?bleeding ABOVE ligament of Trietz in duodenum
What defines LOWER GI bleed?bleeding BELOW ligament of Trietz in duodenum
Whats the most common cause of UPPER GI bleed?peptic ulcer disease = duodenal ulcer (25%), gastric ulcer (20%), gastritis (25%)
what are the 2 most common causes of LOWER GI bleeds?diverticulosis (40%) and angiodysplasia (40%)
whats the most common source of lower GI bleeds in pts over 60?diveritculosis
whats the second most common source of LOWER GI bleed in pts over 60?angiodysplasia
coffee grounds emesisupper GI bleed at LOWER rate of bleeding
melena suggest bleed from whereupper GI bleed
bright red blood per rectumhematochezia = suggests LOWER GI source
hematochezia suggests a bleed from which part of the bowel?left colon or rectum!
if pt presents with hematemesis, whats the initial test to orderupper GI endoscopy
whats the initial test to order if pt comes in with hematochezia?colonscopy
what 4 things are included in coagulation profile?platelet count, PT, PTT, INR

Recent badges