GI #12

Question 1

What is Vitamin B2

Answer 1

Riboflavin

Question 2

Symptoms of B2 deficiency

Answer 2

-Oral, ocular, and genital

• Magenta colored tongue, glossitis, angular cheilitis, pharyngitis
• Photophobia, corneal lesions
• Scrotal dermatitis

Question 3

What is Vitamin B1

Answer 3

Thiamine

Question 4

Etiologies of Vitamin B1 deficiency?

Answer 4

-Chronic alcoholism (MC), weight loss surgery

Question 5

Symptoms of B1 deficiency

Answer 5

• Dry Beriberi: nervous system changes (peripheral neuropathy, paresthesias), cramps, muscle wasting
• Wet Beriberi: high output heart failure and dilated cardiomyopathy
• Wernicke encephalopathy: ataxia + global confusion + ophthalmoplegia (paralysis of ocular muscles)
• Korsakoff Dementia: short term memory loss and confabulation.

Question 6

Wernicke Encephalopathy is considered a neurologic emergency and common in

Answer 6

Chronic alcoholics

Question 7

Treatment for Vitamin B1 deficiency

Answer 7

-IV thiamine followed by oral thiamine

Question 8

What are some sources of Vitamin B3

Answer 8

• Meats
• Grains
• Legumes

Question 9

What is Vitamin B3

Answer 9

Niacin/Nicotinic Acid

Question 10

Etiologies of B3 deficiency

Answer 10

• Diets high in untreated corn
• Diets which lack tryptophan
• Alcoholism
• Anorexia
• Malabsorption

Question 11

Symptoms of B3 deficiency

Answer 11

-Pellagra (3Ds): dermatitis, diarrhea, dementia

Question 12

What is Vitamin B6

Answer 12

Pyridoxine

Question 13

Causes of B6 deficiency

Answer 13

• Chronic alcoholism
• Isoniazid
• Hydralazine
• Levodopa + Carbidopa
• OCP’s

Question 14

Symptoms of B6 deficiency

Answer 14

• Peripheral neuropathy, seizures, headache, mood changes
• Stomatitis, flaky skin, glossitis, anemia, seborrheic dermatitis

-Neuro, Skin, Mouth

Question 15

What are some sources of B12

Answer 15

Sources mainly animal in origin (meats, eggs, dairy)

Question 16

What is Vitamin B12?

Answer 16

Cobalamin

Question 17

Describe the absorption of B12

Answer 17

B12 is released by the acidity of the stomach and combines with intrinsic factor, where it is absorbed mainly by distal ileum

Question 18

MCC of B12 deficiency?

Answer 18

Pernicious anemia (lack of intrinsic factor due to parietal cell antibodies, leading to gastric atrophy)

Question 19

Other causes of B12 deficiency

Answer 19

Crohn Disease
Chronic alcohol Use
Meds: H2 blockers, PPIs, Metformin, Hydroxyurea
Fish tapeworm
Vegan diet

Question 20

Symptoms of B12 deficiency

Answer 20

• Symmetric paresthesias
• Lateral and posterior spinal cord demyelination (ataxia, sensory, vibratory, and proprioception deficits, decreased DTR), + Babinski, seizures, psychosis

Question 21

How do you diagnose a patient with B12 deficiency?

Answer 21

CBC with peripheral smear

Question 22

What is seen on a peripheral smear for B12 deficiency?

Answer 22

• Increased MCV (macrocytic anemia)
• Megaloblastic anemia (hyperhsegmented neutrophils , macroovalocytes)
• Increased homocysteine, increased methylmalonic acid

Question 23

If the patient has symptomatic anemia or neuro findings with B12 deficiency, what treatment should you start with?

Answer 23

IM B12

-injection weekly until deficiency corrects, then once monthly. Oral after resolution of symptoms

Question 24

However, patients with pernicious anemia need

Answer 24

lifelong monthly IM therapy (or high dose oral therapy)

Question 25

What is the pathophysiology of acute pancreatitis?

Answer 25

Acinar cell injury --> intracellular activation of pancreatic enzymes --> auto digestion of pancreas

Question 26

What are the 2 MCC of acute pancreatitis

Answer 26

Gallstones (MC) | Alcohol abuse

Question 27

Other causes of acute pancreatitis?

Answer 27

- Thiazides - Valproic Acid - Malignancy - Scorpion Sting

Question 28

Symptoms of acute pancreatitis

Answer 28

- Epigastric pain: constant, boring pain that radiates to the back. Pain worse if supine or eating. Relieved with leaning forward, sitting, or fetal position. - Nausea, vomiting, fever - Epigastric tenderness - Cullen's Sign: periumbilical ecchymosis - Grey Turner Sign: flank ecchymosis

Question 29

To diagnose acute pancreatitis, at least 2 of the following 3 things need to present.

Answer 29

- Acute onset of pain radiating to the back - Elevation in serum lipase or amylase 3 times greater than upper limit of normal - Characteristic findings of pancreatitis on US, CT, MRI

Question 30

True or False, if the patient meets the first 2 criteria of pancreatitis, no imaging is needed?

Answer 30

True

Question 31

What are the best initial tests for acute pancreatitis?

Answer 31

Increased amylase and lipase -Lipase more specific

Question 32

ALT 3-fold increase is highly suggestive of

Answer 32

gallston pancreatitis

Question 33

What is another lab that is characteristic of acute pancreatitis

Answer 33

Hypocalcemia (necrotic fat binds to calcium, lowering serum calcium levels)

Question 34

What is the diagnostic imaging of choice for acute pancreatitis?

Answer 34

Abdominal CT

Question 35

What is seen on abdominal radiographs with acute pancreatitis?

Answer 35

Sentinel loop: localized ileus in LUQ | -Colon cutoff sign: abrupt collapse of colon near pancreas

Question 36

Management of acute pancreatitis

Answer 36

- 90% recover without complications in 3-7 days. Rest the pancreas! - Supportive: NPO, High volume IV fluids (Lactated ringers). Analgesia (Demerol, Meperidine) - ABX: Imipenem may be used if >30% necrosis on MRI, CT

Question 37

What score is used to determine prognosis with pancreatitis and what is the score classification?

Answer 37

Ranson's Criteria Score of 3 or more: Severe pancreatitis likely Score of less than 3: Severe pancreatitis unlikely

Question 38

MCC of chronic pancreatitis

Answer 38

ETOH abuse -Other causes: idiopathic, hyperlipidemia

Question 39

Clinical manifestation triad for chronic pancreatitis

Answer 39

-Calcifications -Steatorrhea -Diabetes Mellitus (but only seen in 1/3 of patients) Other symptoms: weight loss, back pain, epigastric pain

Question 40

True or False: Amylase and lipase are usually normal in chronic pancreatitis?

Answer 40

True

Question 41

A CT scan is diagnostic imaging of choice for chronic pancreatitis. What is seen?

Answer 41

Calcified pancreas.

Question 42

What is the most sensitive test for chronic pancreatitis?

Answer 42

-Pancreatic function testing (fecal elastase)

Question 43

Management for chronic pancreatitis

Answer 43

- ETOH abstinence, pain control, low fat diet, vitamin supplementation - Oral pancreatic enzyme replacement - Pancreatectomy if no improvement

Question 44

70% of the cancers found in the pancreas are found in which part?

Answer 44

Head of the pancreas

Question 45

MC type of pancreatic carcinoma

Answer 45

Adenocarcinoma (ductal)

Question 46

Risk factors for pancreatic carcinoma

Answer 46

- Smoking - > 55 years old - Chronic pancreatitis - Diabetes Mellitus - Obesity - African American

Question 47

Symptoms of pancreatic cancer

Answer 47

- Usually presents late in disease after METS - Painless jaundice - Weight loss - Pruritus - Abdominal pain radiating to back - Dark urine - Acholic stools

Question 48

What are two physical exam findings associated with pancreatic carcinoma?

Answer 48

- Courvoisier's Sign: palpable, non tender, distended gallbladder - Trousseau's Sign: migratory phlebitis

Question 49

Initial test of choice for pancreatic carcinoma

Answer 49

-CT scan

Question 50

If the CT is negative, what is the next step?

Answer 50

Endoscopic US with biopsy of pancreatic lesion

Question 51

However, if the CT is positive, what is the next step?

Answer 51

-Simultaneous surgical removal/biopsy

Question 52

What tumor markers are associated with pancreatic carcinoma?

Answer 52

CA 19-9 and CEA

Question 53

What is the surgical procedure for pancreatic carcinoma?

Answer 53

``` Whipple Procedure (pancreaticoduodenectomy) -Post chemotherapy or radiation ```

Question 54

Pancreatic carcinoma is the _____ leading cause of cancer-related death in the US

Answer 54

Fourth