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2010-07-15 #1

Gastrointestinal disorder

QuestionAnswer
halitosis(due to trapped food particles); dysphagia; obstruction: Dx? definition? Zenker's diverticulum; herniation of mucosa at junction of pharynx & esophagus
MC site for diverticula in the GIT sigmoid colon
MCC of sigmoid diverticula low-fiber diet > ↑constipation
MC complication of sigmoid diverticula: cause? diverticulitis(inflammation of diverticula); stool impacted(fecalith) in diverticulum sac
"left-sided appendicitis"? sigmoid "diverticulitis"
best Dx for sigmoid diverticulitis CT scan or water-soluble barium study
MCC of hematochezia & fistula sigmoid diverticula: sigmoid "diverticulosis" with hematochezia(painless massive bleeding); X "diverticulitis" because of scarring preventing the gut from bleeding
a common fistula in GIT; associated with pneumaturia(air in urine) and recurrent UTI: Dx? cause? colovesical fistula; mostly caused by sigmoid diverticula
MCS for "false" diverticulum(X organ-related) where vasa recta perforate muscularis externa
MC inflammatory bowel disease; ulcerations in continuity but limited to mucosa/submucosa of rectum & colon: Dx? ulcerative colitis
chronic granulomatous disease; transmural inflammation; noncaseating granuloma discontinuous throughout GIT: Dx? Crohn's disease
definition of irritable bowel syndrome intrinsic colonic motility disorder
MC functional bowel disorder irritable bowel syndrome(IBS)
alternating bouts of diarrhea & constipation; increased mucus in stool; normal flexible endoscopy & sigmoidoscopy: Dx? irritable bowel syndrome(IBS)
criteria for IBS pain relieved by defecation; change in stool frequency; change in appearance of stool(+mucus)
Rx: IBS mainstay: adequate fiber intake; antiplasmodics-anticholinergics; loperamide: dirrhea; lubiprostone: constipation; rifaximin: bacterial overgrowth
least common site for malignancy in GI tract small bowel
MCS of 1' adenocarcinoma in SB duodenum
MC SB malignancy carcinoid tumor
definition of carcinoid tumor: metastasis-related, organs-related neuroendocrine tumor; metastatic potential: size > 2cm, ~50% of bowel thickness; foregut & hindgut: X metastasis and midgut: O metastasis
MCS of carcinoid tumor vermiform appendix; too small to metastasize to liver
MCS of carcinoid tumor in SB: Cc? terminal ileum; metastasize to liver > serotonin > metabolized in liver > X carcinoid syndrome
Cx: carcinoid syndrome bright yellow; flushing; diarrhea; wheezing; TR & PS(collagen production);↑urine 5-HIAA
bowel primary lymphoma: MCS, origin Peyer's patches of terminal ileum; B-cell origin
Rx: carcinoid syndrome somatostatin analogue
MCS for gastrointestinal polyps, diverticula, cancer sigmoid colon
MC polyp in adults hyperplastic polyp
MC polyp in children juvenile polyp
polyp in sigmoid colon in adult; "saw-tooth" appearance: Dx? malignancy? hyperplastic polyp; X malignant potential
solitary polyp in rectum: Dx? epidemiology? malignancy? juvenile(retention) polyp in children; common in children < 5yrs; X malignant potential
AD; multiple polyps in GI tract in children: Dx? Ax? juvenile polyposis syndrome; ↑risk of adenocarcinoma
AD; multiple polyps throughout GI tract; hypersegmented mouth, lips, hands, genitalia: Dx? type? location? Ax? Peutz-Jeghers polyposis; hamartomatous polyps in small bowel; associated with ↑risk of CRC & breast, gynecologic cancers(even though it's hamartoma)
MC neoplastic polyp? tubular adenoma(aka adenomatous polyps)
neoplastic polyp in sigmoid colon: Dx? type? tubular adenoma; stalked polyp
hypoalbuminemia; hypokalemia; sessile polyp in rectosigmoid: Dx? type? feature? villous adenoma; sessile polyp with primarily a villous component; secretion of protein & potassium-rich mucus
greatest risk for developing colon cancer? the more villous the polyp, the more likely it is to be malignant
familial adenomatous polyposis: MOI, gene, chromosome, CRC chance, MCS? AD; APC suppressor gene inactivation; chromosome 5q; 100% to CRC; rectum
Gardner's syndrome: MOI? definition? AD; FAP + benign osteomas & desmoid tumors + retinal hyperplasia
Turcot's polyposis: MOI? definition? AR; FAP + brain tumor(astrocytoma + medulloblastoma)
3rd MC cancer in men & women; 3rd MC COD in United States: Dx? colon cancer
risk factors for colon cancer age > 50yrs; smoking; 25% family history (1st degree relatives); IBD; S.bovis(distal colon: L side); colonic polyps(large villous adenoma, juvenile polyposis syndrome, PJP)
carcinogenesis of colon cancer: sporadic & HNPCC syndrome 15%; microsateillite instability pathway; DNA mismatch repair gene mutations > sporadic & HNPCC syndrome; accumulated mutation without defined morphologic correlates
carcinogenesis of colon cancer: adenoma-carcinoma 85%; APC/β-catenin pathway; normal colon > loss of APC gene (↓intercellular adhesion & ↑proliferation) > colon at risk > K-RAS mutation (unregulated intracellular signal transduction) > adenoma > loss of p53 (↑tumorigenesis) > carcinoma
MC site for colon cancer rectosigmoid
disadvantage of fecal occult blood test not very sensitive or specific for colon cancer because it doesn't distinguish hemoglobin from myoglobin; false[+]: myoglobin in meat; plant peroxidase(radish); false[-]
mechanism of FOBT detection of peroxidase activity of heme in HB
obstruction; colicky pain; hematochezia: Dx? distal colon (left-sided) due to small diameter; S.bovis endocarditis
dull pain; iron deficiency anemia; fatigue: Dx? proximal colon (right-sided) due to large diameter; iron deficiency in older males
ProRx: colon cancer aspirin; FOBT; dietary alternations; stop smoking
Dx: colon cancer barium edema: "apple-core" lesion; colonoscopy & FOBT; CEA (serum carcinoembryonic antigen) marker
MC abdominal surgical emergency in children acute appendicitis
viral infected; lymphoid hyperplasia; surgical intervention required: Dx? epidemiology acute appendicitis
colonoscopy; fecalith obstructing the proximal lumen; mucosal injury & bacterial invasion: Dx? epidemiology? acute appendicitis
pain in acute appendicitis in sequence initial diffuse periumbilical pain (C fiber on visceral peritoneal surface) > RLQ in 12 to 18hrs (Αδ fibers on parietal peritoneum) + Blumberg's(rebound tenderness at McBurney's) + psoas sign(pain with R thigh extension) + Rovsing's (on palpation of LLQ)
exact location of McBurney's point 1/3 the distance from iliac crest to umbilicus
Cx: acute appendicitis pain > nausea & fever > perforation > peritonitis
DDx: acute appendicitis diverticulitis(in elderly vs all age groups in appendicitis); ectopic pregnancy(Β-hCG to rule out); viral gastroenteritis; ruptured follicular cyst
Dx: rectocecal appendicitis sentinel loop; localized ileus from subjacent appendicitis
Cc of acute appendicitis: MC, Rest periappendiceal abscess with or without perforation; subpherenic abscess with persistent fever(usually due to Bacteroides fragilis); pyelophelbitis of portal vein > portal thrombosis(gas in portal vein)
Dx & Rx: acute appendicitis spiral CT RLQ after gastrografin enema; plain CT scan with rectal contrast agent; cefoxitin(proRx if perforation suspected)
MCC of anorectal bleeding "painless" internal hemorrhoids; receive visceral innervation = X painful
rectum prolapse; stool coated with bright red blood; painless bleeding: Dx? MCC? C? Ax? internal hemorrhoids; straining at stool; pregnancy, obesity, anal intercourse, "portal HTN"; constipation and low-fiber diet
adult; blood coating stool; DDx? internal hemorrhoid (MC); colorectal & anal cancer "NEVER assume that blood coating stool is always due to an internal hemorrhoid"
pRx: internal hemorrhoids topical hydrocortisone
anal pruritis; soiling of underwear: Dx? internal hemorrhoids
arterial supply from sup. rectal artery (of IMA); venous drainage to sup. rectal vein > inf. mesenteric vein > portal system: location? Ax? above pectinate line; internal hemorrhoids and adenocarcinoma
arterial supply from inf. rectal artery (of internal pudendal artery); venous drainge to inf. rectal vein > internal pudendal vein > internal iliac vein > IVC: location? Ax? below pectinate line; external hemorrhoids and squamous carcinoma
painful thrombosis of inferior rectal vein: Dx? Why painful? external hemorrhoids; dilated inf.hemorrhoidal veins below the pectinate line(inf. plexus); somatic innervation by inferior rectal nerve of pudendal n.
causes of rectal prolapse in children whooping cough; trichuriasis; cystic fibrosis "World Cup Team"
causes of rectal prolapse in elderly straining at stool
cause of rectal prolapse in power lifters heavy squates
definition of pilonidal sinus & abscess painful pass in deep gluteal fold
causes of pruritus ani internal hemorrhoids (Common); pinworm; diabetes
MCC of anorectal fistulas; Rest? Ax? nonspecific cryptoglandular infection; inflammatory bowel disease (Crohn's disease > ulcerative colitis); associated with constipation
film bowel movement; aggravated by spasm of internal sphincter; prominent proximal papilla: Dx? Cx? anal fissures; most posteriorly located; anal tag and verge marks location
MC anal carcinoma basaloid(epidermoid or cloacogenic) carcinoma in transitional zone above dentate line
squamous cell anal carcinoma: Ax? HPV16 & 18 relationship
Created by: mataos