general gi 3

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  1. Risk factors for CRC
    african american, long-term smokers, diabetics, obese patients, and patients who have received abdominal radiation therapy.
  2. What is the recommendation for treatment for patients with acute hep c
    Acute hcv virus is rare, but if treated has a high rate seroconversion

    try and start tx within 12 weeks of infection.
  3. what is the size cut off for resection of a hepatic adenoma?
    greator that 5cm that does not shrink with cessation of OCP's
  4. elevated liver tests and conjunctival suffusion
    leptosporosis
  5. diarrhea dysmotility heart failure and neuropathy
    amyloid

    look for peri vascular inflitration of congo red staining proteins.
  6. cutoff size for treatment of a fibrovascular polyp
    2 cm
  7. Needle shaped clefts on mucosal biopsy
    cholesterol embolization

    associated with eosinophilia
  8. hematemesis, subcutaneous air, l-sided effusion.
    Boerhaave's syndrome-
  9. AIDS, diarrhea,
    trophozoites on the surface layer of ileal biopsy
    cryptosporidiosis

    often b-12 defiency because of ileal involvement
  10. c1 esterase deficiency, how is it teated
    c1 esterase concentrate

    danazol- long term ppx
  11. dark velvety rash on anterior neck, axilla or hands
    acanthosis nigracans
  12. diarrhea, erythematous palques on legs and face, TPN, alcoholism
    Zinc deficiency
  13. seborrheic keratosis
    colon cancer
  14. necrolytic migratory erythema
    glucagonoma
  15. abnormal elastic tissue deposits in the skin
    pseudoxanthoma elasticum

    pagets disease (increased alk phos)
  16. TI , apthous ulcers and oral and genital lesions
    Bechets syndrome.
  17. hyperkeratinization of the palms and soles.
    tylosis.

    scc of esophagus
  18. multiple gi polyps, dystrophic nails,
    Cronckhite-Canada syndrome

    gi hamartomas
  19. multiple hamartomas, multiple cancers
    Cowdens syndrome

    PTEN
  20. location of absorption of
    Iron
    B12
    bile salts
    • duodenum
    • ileum
    • ileum.
  21. B-12 absorption
    • pepsin release b-12 (cobalamin) from animal proteins, . In an acidic environment b-12 binds R binder protein
    • in alkaline small bowel, r-binder is hydrolyzed by pancreatic proteases to liberate cobalamin. this binds intrinsic factor .
    • This compound is absorbed in the ileum.
  22. Fat digestion
    • Some triglycerides are digested by lingual and gastric lipase
    • Pancreatic lipases work most of action in jejunem.
    • free fatty acids and b monoglycerol mix with bile salts to form mixed micelles.
    • Mixed micelles enter the enterocyte. Here free fatty acids and b-monoglycerol are re esterified into triglycerides. From here the triglicerides are encorporated into lipoproteins and are secreted into the systemic circulation
  23. mechanism of folate absorption
    enzymes on jejunal brush border. pH dependent carrier mediated transport into enterocyte. Binds albumin and other carrier proteins and is stored in the liver.
  24. conditon that can lead to increased folate levels.
    Small bowel bacterial overgrowth. The bacteria make folate in small bowel where it is absorbed in large quantity
  25. mechanism of absorption of fat soluble vitamins
    • similar to fat absorption
    • micelle formation, with fat soluble vitamins inside, absorption to enterocytes,
  26. Calcium abosrption
    • ionic calcium like in milk requires no digestion
    • protein bound calcium is cleaved in the acid environment in the stomach. and absorbed in the duodenum.
    • fiber and vegetables in diet can bind ca and form insoluble compleses that reduce ca absorption.
    • Ca absorption requires vit d.
  27. iron absorption
    Ferric Fe3+ must be converted to FE2+. This occurs in the acid environment of the stomach. and by ferrireductase (on the brush border of enterocytes)

    DMT-1 transporter mostly in duodenum
  28. how to calculate the osmotic gap
    290- ((Na)-(K))*2
    • less than 50 = secretory
    • greator than 50 = osmotic
  29. List an uncommon manifestations of SIBO

    Hint

    Liver problem
    NASH
  30. List another source of "early peak" on breath testing other than SIBO
    • intestinal hurry-
    • in bypass patients where a large amt of glucose containing chyme is rapidly transferred to the colon
  31. Condition where B-12 is low and serum folate is elevated
    • SIBO
    • bacteria metabolize b-12 and generate high levels of folate.
  32. Early complication after extensive small bowel resection
    gastric hypersecretion and peptic ulceration
  33. diarrheal malabsorptive syndrome when more than 100cm of terminal ileum remains
    bile salt diarrhea. liver can compensate for fat absorption by increasing bile salt production. decreased ileal reabsorption of bile salts leads to diarrhea.
  34. diarrhea malabsorptive syndrome when less than 100cm of ileum remains
    fat malabsorption. Here liver can overcome bile salt defecit because of extensive ileal resection. ultimetly not enough bile salts are around in lumen and fat malabsorption begins. This is made worse by administration of a bile salt binder
  35. patient with extensive ileal resection presents with flank pain
    calcium oxalate stones.

    increased iltraluminal fat binds dietary calcuim. This leads to unbound oxilate in colon. This is taken up in blood and makes its way to kidney- forming oxalate stones
  36. treatment of Ca oxalate renal stones
    • increase Ca in diet
    • decrease oxalate in diet
    • low fat diet.
  37. diseases related to AIP
    • PSC
    • UC
    • sjogrens
    • sclerosing sialadenitis
  38. cutoff cea level for mucinous vs non mucinous cyst in panc
    192, above this faavor mucionus cyst.
  39. demerol should not be administered to patients on MAOI'

    Why
    Serotonnin syndrome

    confusion, hyperreflexia, autonomic dysfunction
  40. stenosis in the esophagus characterized by pseudodiverticuli, thickened mucosa, and asymmetrical narrowing
    peptic stricture
  41. What is the most potent stimulator of gb contractility (food not hormone)
    long chain fatty acids
  42. what enzyme converts serum lipoproteins into cholesterol
    HMG-COA reductase
  43. What enzyme converts cholesterol into bile
    • Cholesterol 7 alpha hydroxylas
    • and sterol 27 hydroxylase
  44. rate of bile salt loss (as a % of the total bile salt pool)
    20-30% daily loss

    5 -15 cycles daily of enterohepatic circulation
  45. Risk factors for cholesterol gallstone formation
    • obesity
    • female
    • parity
    • maternal family history
    • increasing age
    • ileal disease
    • rapid weight loss
    • high triglycerides
    • low high density liprotein cholesterol
    • ocp
    • estrogen
    • tpn
    • lipid lowering agents
    • fibric acid derivitives
  46. etiology of acute cholecystitis
    obstruction of the cystic duct (90%) of the time.
  47. sensitivity of ultrasound for CBD stones
    CT scanning?
    MRCP
    • 40-50%
    • 30-40%
    • 95-100%
  48. EUS ability to predict cbd stones
    • 98% positive predictive value
    • 88% negative predictive value
  49. size cutoffs for management of gallbladder stones
    • asymptomatic
    • and less than 3cm
  50. chronic acalculous cholecystitis
    gallbladder ejection fraction less than 35%
  51. surgical response to ccy for chronic cholecystitis
    • 25-40% pain will resolve on its own
    • 60-100% improve with surgery
  52. Risk factors for acute acalculous cholecystitis
    • TPN
    • samonella or cytomegalovirus infection
    • casculitis
    • PAN or SLE
  53. Best diagnostic criterion for diagnosis of chronic cholecystitis
    gallbladder wall thickening of >4mm.
  54. Size cutoff for gallbladder polyps
    18mm

    • other risk factors include
    • age
    • type I is cyst of main bile duct
    • type II is a diverticulum of main bile duct
    • Type III is the intraduodenal portion of the bile duct
    • Type IV is both intra and extra hepatic bile duct
    • type V is multiple intraheptaic.
  56. Association between IBD and PSC
    70% of patients with PSC have IBD

    but only 5% of patients with IBD have PSC
  57. Biliary hypoplasia with intrahepatic cholestasis
    Algille syndrome

    • autosomal dominant
    • JAG1 gene
  58. Most common indication for pediactric liver transplant
    biliary atresia
  59. Risk factors for Gallbladder cancer
    • PIma Indian
    • Salmonella typhi infection
    • Gallstones
  60. how often is early gastric cancer present in patients that have a large adenomatous polyp
    approx 30 % of the time. At EMR you should scan the stomach to look for metachronus disease prior to adenoma removal.
  61. What is the risk of metastasis of gastric carcinoids
    Type I
    Type II
    Type III
    • I and II is low (in lesions less than 1 cm it is < 5%
    • Type III is higher
  62. Eus characteristics of linitus plastica
    thickening of layers 3 and 4
  63. EUS findings in menitriers disease
    Thickeing of layer 2.

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Author:
 jonpnass
ID:
 113232
Filename:
 general gi 3
Updated:
2011-11-04 21:46:14
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general GI
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General GI 3
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