1. Gastro Flashcards
Globus pharynges؟
foreign body sensation localised in the neck that does not interfere with swallowing and sometimes is relieved by swallowing.
Diarrhea is:
- More than normal bowel movement for that person.
- Three loose or liquid bowel movements a day.
constipation?
Less than three stools per week.
Coffee ground vomiting occurs in ?
UGIB
EGD contraindications ?
- No consent
- Lack of cooperation (?)
- Unstable angina, asthma or heart failure (?)
- Acute abdomen
- Suspected perforation
Relative EGD contraindications?
• Ventricular arrythmia
• Hemorrhagic diathesis
• Zenker’s diverticulum
• Repeated endoscopy due to mild conditions
(eg. gastritis, dyspepsia, uncomplicated DU)
Colonoscopy contraindications ?
- No consent
- Acute abdomen
- Suspected perforation
- Lack of cooperation (?)
- Unstable angina, asthma or heart failure (?)
- Ventricular arrythmia (?)
- Hemorrhagic diathesis (?)
- Aortic aneurysm (?)
- Repeated endoscopy due to benign diseases (eg. small polyp removed year before)
ERCP complication ?
which one is most common ?
- Acute pancreatitis 1-7% “ MOST COMMON “
- Bleeding 0.7-2%
- Retroperitoneal perforation 0.3-0.6%
- Cholangitis <1%
- Cholecystitis 0.2-0.5%
- Cardio-respiratory <1%
- Mortality rate 0.2% -1.5%
Endosonography - EUS ?
- Staging of tumors.
- **Assessment of submucosal lesions and structures adjacent to the wall of GI tract.
- FNA of lesions adjacent to the wall of GI tract.
- Drainage of fluid collections.
- Risk assessment of UGIB recurrence (doppler function)
Small bowel imaging ?
- Traditional barium study
- Small bowel MRI
- Capsule endoscopy
- Single/double-balloon enetroscopy
Before endoscopic procedure with high risk of bleeding low molecular weight heparin should be stopped ?
24 hrs before the procedure.
ERCP diagnostic indications ?
- Chronic pancreatitis
- Obstructive jaundice
- Vater’s papilla tumors
Before endoscopic procedure with high risk of bleeding Prasugrel should be stopped ?
5 days before the procedure.
Endoscopic procedure with higher risk of bleeding ?
EUS with FNA.
What is the most sensitive and Specific test for colorectal cancer ?
Colonoscopy.
- Diagnostic and therapeutic.
- The diagnostic study of choice for patients with positive FOBT.
CEA ?
- Not useful for a screening.
- Useful for establishing baseline.
- Monitoring treatment efficacy.
- Recurrence surveillance.
- Does not have prognostic significance. (Although patient with preoperative CEA > five have worse prognosis)
Recommendation and screening of colon cancer?
- colon cancer screening begins at age of 50.
- If one family member has colon cancer began at age of 40 or 10 years before the age of onset of family member.
what is the most common cause of large bowel obstruction in adults?
CRC.
- Colonic perforation can lead to peritonitis and it is the most life-threatening complication.
Sign and symptoms based on the specific location of the CRC?
Right side tumors: “Melena”
- Common findings: occult blood in stool iron deficiency anemia and Melena.
Left side: “Heamtochezia” :
- Signs of obstruction are common..
What is the most common symptom for rectal cancer?
Heamtochezia
Colorectal cancer predisposing factors ?
- No relative – CRC risk 1/50
- One 1st degree relative affected -1:17
- Two 1st degree relatives affected -1:10
- Certain genes mutations (APC, K- ras, DCC, p53 etc)
- ↑risk in families with increased cancer prevalence (HNPCC)
- Polyposis syndromes (FAP etc.)
- Long-standing IBD
Pseudopolyp ?
- the destruction of the mucosa in severe IBD, leaving “islands” protruding into the intestinal lumen.
Adenomas?
- increase incidence after 30yo.
- Detected in 30% of 50+ screened patients
- Majority <1cm
- The tendency to become malignant small, but increasing with the diamete.
Advanced adenoma ?
- > 1cm
- villous component
- HGD
- advanced adenoma is found in 4% of screened 50+ patients
- Invasive cancer in 1% of the screened patients
Familial adenomatous polyposis (FAP) ?
- Responsible genes: APC (80%), MYH1
- AD inheritance
- Numerous colorectal polyps >100, duodoenal adenomas
- Lifetime risk of cancer 100% •CRC by age 40 ~100%
Familial adenomatous polyposis (FAP) ? clinical manifestations ?
- Gardner’s syndrome.
- Turcot’s syndrome.
- AFAP (attenuated FAP).
CRC prognosis ?
- 5yr survival according to Dukes classification:
- A>90%.
- D<10%.
- Only 60% amenable to radical surgery.
The most important (conclusive) aspect of CRC diagnostic approach is?
Tissue sample and microscopic assessment.
Which part of Large intestine is most commonly affected by CRC?
Rectum.
Diverticulosis ?
- is the condition of having diverticula in the colon that are not inflamed.
- These are outpockets of the colonic mucosa and submucosa through weaknesses of muscle layers in the colon wall.
- They typically cause no symptoms.
Complicated diverticulitis ?
With one of the following: bowel obstruction, abscess, fistula or perforation.
Uncomplicated diverticulitis ?
Without any associated symptoms.
Location of Diverculosis ?
- Diverculosis do not develop in the rectum.
- Diverculosis we find most often in the left half of the colon.
- > 90 % sigmoid colon.
Diverculosis - symptoms ?
• 70-90 % asymptomatic. • patients may have troublesome symptoms: - colicky abdominal pain, bloating flatulence or altered bowel habit.
What classification are used for diverticulitis?
Hinchey classification.
ttt of mild diverticulitis?
• Mild diverticulitis : without fever, good general condition, without burdening other serious diseases, not treated with immunosuppressants, with good care at home, younger- ambulatory treatment
- liquid diet.
- rest.
- Antibiotics 7-10 day: amoxicillin clavulanate acid or cotrimoxazole + metronidazole or ciprofloxacin + metronidazole.
indication for inpatient ttt for diverticulitis ?
- no effect outpatient
- antibiotic intolerance
- fever.
- dehydration
- destruction of immunosuppression
- serious comorbidities
- old age
- cachexia.
Treatment – in the hospital for dverticulitis ?
• diet „zero” • fluids iv • parenteral nutrition • Clindamycin iv or • Metronidazole iv with: - ciprofloxacin iv or - third-generation cephalosporin or - aminoglycoside or - aztreonam.
Indications for surgery diverticulitis ?
- intra abdominal abscess.
- intestinal fistula
- obstruction caused by narrowing the intestine
- intestinal perforation and peritonitis
- When the patient presents with perforation and defuse peritonitis, whether it is purulent or feculent. (Hinchey classification III and IV)
When we perform colonoscopy for diverticulitis?
- Acute state (divercutitis) – NO !!! (gnerally)
* After acute state – yes !!! (ok. 6 weeks )
Chronic diverticulitis symptoms ?
- persist at least six months
- are milder than acutely
- can mimic the symptoms of inflammatory bowel diseases and irritable bowel syndrome
- More likely to have complications.
It’s the most common cause of lower G.I. bleeding?
Diverticular bleeding is the source of 17 to 40 percent of lower gastrointestinal (GI) hemorrhage in adults, making it the most common cause of lower GI bleeding.
- Most diverticular bleeding is self-limited, although it should be suspected in patients with massive and painless rectal hemorrhage.
What is the most common presentation of diverticular bleeding?
- Massive, painless rectal hemorrhage.
- In approximately 80% of patients, diverticular hemorrhage resolves spontaneously.
Hepatitis A ؟
- incubation period of ~4 weeks.
- virus is present in the liver, bile, stools and blood 2 weeks before manifestations.
- antibody response - IgM class for 3 -6 (12) months (than IgG).
- elevated ALT.
Hep B - treatment ?
- incubation 6weeks to 6 months.
- self-limiting within weeks to months.
- antiviral drugs include lamivudine, adefovir, tenofovir, telbivudine, entecavir, interferon alpha-2a and PEGylated interferon alpha-2a
- prevention - vaccination
Hepatitis C ?
- Causes acute symptoms in 15% of cases
- Generally mild
- ledipasvir, sofosbuvir, paritaprevir, ombitasvir, dasabuvir
and ribavirin - Pegylated interferon (gen. 3)
drugs induced liver injury “DILI” diagnosis ?
- ALT>AST
- mixed hiperbilirubinemia
- peripheral eosinophilia
- elongated PT >5 x
- histopatologu
Roussel Uclaf Causality Assessment Method ?
was developed to quantify the strength of association between a liver injury and the medication implicated as causing the injury.
King’s College Hospital criteria ?
to assess Acute liver failure.
which is NOT used for Liver encephalopathy - therapy ? A- Lactulose B- L- ornithine. C- Rifaximine D- Neomycin E- Terlipresine
E- Terlipresine
Hepatitis A - prevention ?
- vaccination
- hygiene
- sanitation
- The two types of vaccines are one containing inactivated hepatitis A virus, and another containing a live but attenuated virus.
In amanita poisoning, treatment of choice is ?
Cristal penicillin.
Irritable bowel syndrome (1) Definition according to Rome IV Criteria (2016):
“Recurrent abdominal pain on average at least 1 day a week in the last 3 months associated with two or more of the following:
- Related to defecation
- Associated with a change in a frequency of stool
- Associated with a change in form (consistency) of stool.
- Symptoms must have started at least 6 months ago.”
IBS - Genetic background:
• Isoform of serotinine reuptake transporter SERT • Cytokine genes’ polymorphism – TNF-α – IL-10 – TGF-β
Which part of diagnostic approach plays the most important role in patient with functional G.I. disorders?
Subjective examination.
Extraintestinal manifestations of IBS may be?
Sleepiness, headaches, lumbar spine pain.
Diarrhea definitions according to the duration of symptoms:
- Acute: 14 days or fewer.
- Persistent diarrhea: more than 14 but fewer than 30 days in duration.
- Chronic: More than 30 days in duration.
Invasive diarrhea, or dysentery ?
- Is defined as diarrhea with visible blood or mucus, in contrast to watery diarrhea.
- Dysentery is commonly associated with fever and abdominal pain./
Why it is not preferred to implement antibiotic therapy as a first line treatment of acute diarrhea?
A. Most Causes are likely.
B. Treatment is conservative because the area is self-limiting.
C. Most cases are benign.
D. Antibiotics cause bacterial resistance.
what is most important single test for celiac disease is ?
IgA antibodies against tissue transglutaminase 2
Which groups of patients should be tested for celiac disease ?
Down syndrome.
GERD is ?
Pathological reflux of gastric content
(acidic pH < 4 or alkaline if pH > 4) into the esophagus, producing subjective symptoms
and/ or their sequelae,
leading to the lowering of the patients’ quality of life
Alarming symptoms – indications for immediate gastroscopy in GERD patients ?
— bleeding for the upper gastrointestinal tract. — unexplained weight loss. — dysfagia — odynofagia — unexplained anemia. — vomiting — palpabale mass in the upper abdomen — failure of farmacological treatment — exacerbation of symptoms
Erosions of the esophgus and mucosal breaks ?
- A common characteristics of ?
- A common characteristics of esophagitis.
- Can be seen at first histologically And as the disease progresses may be served endoscopically.
What classification do we use to evaluate Erosions of the esophgus?
Los Angeles classification.
- Grade A, B, C and D.
Esophageal stricture ?
- Dysphagia -> solid food then liquid food.
- ttt: endoscopic and PPI.
Barrett’s esophagus (precancerous condition) ?
- stratified squamous epithelium changes into simple columnar epithelium with goblet cells.
- Is associated with an increased risk of developing esophageal cancer.
- It’s an indication of monitoring of disease progression using gastroscopy plus biopsy and histopathological examination.
How often are you supposed to monitor Barrett’s esophagus progression ?
- endoscopy every 3 years, if earlier histopathological examination did not confirm dysplasia.
- endoscopy every year, if earlier hist-pat confirms low grade of dysplasia.
- endoscopy every 3 months , if earlier hist-pat confirms high grade of dysplasia.
Barrett’s esophagus treatment ?
- Endoscopic mucosectomy.
- Endoscopic submucosal dissection.
- Photodynamic therapy.
- High-frequency wave ablation .
Esophageal cancer ?
- mostly adenocarcinoma.
- Located in proximity of LES, lower portion of esophagus.
The two main sub-types of the esophageal cancer are
- esophageal squamous-cell carcinoma (often abbreviated to ESCC), which is more common in the developing world.
- esophageal adenocarcinoma (EAC), which is more common in the developed world
Diagnosis of GERD ?
- basic medical interview. –>
- eartburn, backward reflux of gastric contents to the esophagus, burning of the sternum for at least 3 months authorizes the initiation of pharmacological treatment. –>
- PPI test
Diagnostics of GERD – Proton pump inhibitor test ?
- PPI administration on en empty stomach ~30–45 minutes before breakfast and ~30 minutes before supper.
- The test is administered in syndromes of chest pain and in syndromes related to extraesophageal symptoms.
- Effects of treatment can be observed in 2–3 months.
Gastroscopy rule in GERD ?
For patients with GERD being treated for prolonged periods of time, regardless of symptoms at present, gastroscopy should be performed to rule out other pathologies.
- It is recomended to perform gastroscopy in all pts who present symptoms of esophagitis.
pH Probe study info?
- Standard method of diagnosing GERD.
- Indicated in pts with unexplained chest pain after ruling out MI.
- The study is conducted in pts with extraesophageal symptoms.
- Standard proceedure for surgical eligibity and post-op control.
24 hour pH-probe study ? how to function ?
- Probe placement for measuring of hydrogen concentration.
- The probe is placed ~5cm from the LES and is connected to a battery operated registrator.
ttt of GERD ?
- PPI.
- H2- receptor blockers.
- Prokinetic drugs.
- Antaacids.
- Surgery.
Achalasia general info?
- Degeneration of esophageal mesenteric plexus.
- Aperistalsis of esophagus.
- Hypertensive LES with impaired relaxation.
Achalasia diagnosis ?
- CXR.
- Barium esophagogram “birds beak”.
- Manometry ( is defintive diagnosis).
- Endoscopy. (to rule out pseudoacalasia.
Diffuse esophageal spasm Symptoms?
- Chest pain and dysphagia.
- Aggravated by stress, ingestion of cold food liquid, GERD.
- Often associated with history of other specific GI conditions.
Diffuse esophageal spasm treatment ?
CCB, nitrates To reduce amplitude but ultimately surgery.
Pulsion diverticula - Zenker’s ?
- Most common symptomatic diverticula.
- Diagnosis by barium swallow.
- Treatment by Criocopharyngeal Myotomy and diverticulectomy or suspension.
Necessary blood tests for patient with UGIB ?
- FBC
- U and E
- LFT
- Cross match
- Prothrombin time.
- old question (wrong-> blood gases)
Risk assessment for patient with UGIB ?
- the Blatchford score at first assessment.
* the full Rockall score after endoscopy.
Blatchford score ?
- Should be used to assess the likelihood that the patient with UGIB will need medical intervention.
- Early discharge for patients with a pre-endoscopy Blatchford score of 0.
- Score<2 – patient less likely to require endoscopic intervention.
Rockall score ?
Total score of <3 excellent prognosis, >8 high risk of death.
Timing of endoscopy for patient with UGIB ?
- Immediate endoscopy to haemodynamically unstable patients with severe acute UGIB within 2 hours after optimal resuscitation.
- Endoscopy within 24 hours of admission for people who are haemodynamically stable.
Endoscopy in UGIB ?
- Does not decrease mortality
- Decreases re-bleeding rate/emergency surgery
- Can reduce the length of hospital stay
Modalities of
endoscopic treatment for patient with non-variceal UGIB ?
- Adrenaline Injections.
- Applications of heat.
- Mechanical clips.
- Homespray.
- old question (wrong->rubber bands)
pharmacological treatment for patient with UGIB ?
- PPI for patient with non-variceal UGIB.
H.pylori treatment
?
- H. pylori should be tested at initial endoscopy and eradicated
- Confirmation of successful eradication should only be taken after PPI and antibiotic therapy has been completed and discontinued (2 weeks)
WHEN? Patients with UGIB and features of cirrhosis should have endoscopic examination done?
as soon as possible (within 12 h of admission).
Failed endotherapy ?
- Sengstaken-Blakemore tube
- SEMS placement
- TIPSS.
Most common cause of upper G.I. bleeding is?
peptic ulcer.
Spurting hemorrhage is visible during endoscopy in the forest classification is?
- Ia.
- Forrest classification is instrumental when stratifying patients with upper gastrointestinal hemorrhage into high and low risk categories for mortality.
Types of gallstone ?
- Cholesterol stones (Western countries 75%)
- Pigment stones
- Mixed
Pathogenesis of Cholesterol stones ?
Imbalance between bile salts/lecithin and cholesterol allows
cholesterol to precipitate out of solution and form stones.
Pathogenesis of pigment stones ?
Occur due to excess of circulating bile pigment (e.g. Heamolytic anaemia).
Symptoms and complications of gallstones ?
- biliary colic
- acute cholecystitis
- gallbladder empyema
- gallbladder gangrene
- gallbladder perforation
- obstructive jaundice
- Mirizzi syndrome
- cholangitis
- pancreatitis
- gallstone ileus (rare)
Biliary Colic ?
- Transient obstruction of cystic duct by sludge or stones/
- USG confirms presence of gallstones.
- Treatment
• analgesics, spasmolytics
• fluid resuscitation
• diet zero.
Primary sclerosing cholangitis ?
- Inflammation and fibrosis of bile ducts ( intra- and extrahepatic).
Diagnosis of Primary sclerosing cholangitis ?
- Serum liver tests (cholestatic profile)
- IgM i IgG total
- pANCA (30-80% patients)
- cholangiography
- CT and MRI • Liver biopsy.
Todani’s classification ?
- The Todani classification of bile duct cysts divides choledochal cysts into five groups/
Primary sclerosing cholangitis is usually concomitant with ?
Carcinoma hepato-cellulare (HCC)
Perihilar cholangiocarcinoma is also called?
Klatskin tumor
Charcot’s triad includes ?
jaundice; fever, usually with rigors; and right upper quadrant abdominal pain.
indication for Cholecystectomy ?
- Bubbles of gas in gallbladder detected an ultrasound.
- Symptomatic cholelithiasis.
- One episode of acute pancreatitis caused by gallstones.
- Preparation for bariatric treatment.
- Mortality rate 0.1-0.2%.
Reynold’s pentad is ?
Charcot’s triad + Shock and altered mental status.
What is are the most common symptoms of primary sclerotising cholangitis ?
Jaundice and pruritus.
What is Mirizzi’s syndrome?
A gallstone impaction in the neck of the gallbladder or cystic duct.
After non-complicated acute cholecystitis, when should be Cholecystectomy performed?
after 6 wks
What dietry habit increased risk of gallstones?
Fat rich diet.
What is the most common cause of acute pancreatitis?
- Gallstones.
- Alcohol
Post ERCP acute pancreatitis ?
- AP in 1-9% of ERCP patients.
- Asymptomatic hyperamylasemia 30-70%.
Post ERCP acute pancreatitis risk factors ?
young age, female gender, number of attempts to canniulate papilla
- Poor emptying of pancreatic duct after opacification.
Post ERCP acute pancreatitis prophylaxis ?
- NSAID (indomethacin or diclofenac p.r.).
- Temporary pancreatic duct stenting.
Clinical features of acute pancreatitis ?
- Severe abdominal pain located in mid- epigastrium.
- cyanosis, dyspnea
- subileus
- low-grade fever
- hypotension, tachycardia, shock
- jaundice
- discoloration of abdominal wall – Turner’s or Cullen’s sign- very rare in late stages
What are the physical signs for acute pancreatitis?
- Grey-Turner’s sign.
- Cullen’s sign.
- Leoffler’s sign.
- Halsteadt’s sign.
What criterias are used to evaluate acute pancreatitis ?
- Ranson criteria.
- Simplified Glasgow criteria.
- Computed Tomography Severity Index (Balthazar).
- Acute Physiology and Chronic Health Evaluation (APACHE II).
- Sequential Organ Failure Assessment score (SOFA).
- BISAP score for pancreatitis mortality.
Ranson score ?
- Mortality
- 0-2 points <1%
- 3-4 points 15%
- 5-6 points 40%
- > 6 points 100%
- At admission and within 48 hrs.
BISAP ?
- The BISAP Score for Pancreatitis Mortality predicts mortality risk in pancreatitis with fewer variables than Ranson’s.
TTT of acute pancreatitis?
- Estabilish etiology.
- Analgesics
- Fluids and colloids.
- No oral alimentation (TPN or enteral nutrition)
- Antibiotics in certain situations
- Surgery ( complications)
Treatment ERCP ?
- ERCP as soon as possible in biliary pancreatitis.
* ERCP/sphincterotomy in 72 hours after onset of symptoms
Chronic pancreatitis def ?
Chronic inflammatory disease of the pancreas may present as episodes of acute inflammation or chronic damage with persistent pain and/or malabsorption
Chronic pancreatitis etiology ?
- TIGAR-O
1. Toxic-metabolic 2. Idiopathic
3. Genetic
4. Autoimmune
5. Recurrent and severe acute pancreatitis
6. Obstructive
Diagnosis of Chronic pancreatitis ?
- Diagnostic imaging ( calcifications, fibrosis of the pancreas)
- Laboratory tests- stool elastase, fecal fat
Treatment of Chronic pancreatitis ?
• analgesics. • Supplementation of pancreatic enzymes. • ERCP in selected cases: stenting of the Virsung duct, treatment of local complications. • surgery.
Autoimmune pancreatitis (AIP) typically presents with ?
- Obstructive jaundice.
- and is characterized histologically by the presence of a lymphoplasmacytic infiltrate with fibrosis and therapeutically by a dramatic response to steroid treatment.
Autoimmune pancreatitis (AIP) imaging studies ?
- “sausage-shaped pancreas”,
- “capsule sign”, a rim-like enhancement along the edge of the pancreas.
- focal enlargement –tumor (single or multifocal)
- Long stricture of pancreatic duct
- Multiple strictures
Autoimmune pancreatitis (AIP) types ?
- Type 1 AIP is the pancreatic manifestation of the multiorgan ( biliary ducts, gallbladder, liver, salivary and lacrmiary glands, retroperitoneum and others) disease called IgG4-related disease.
- Type 2 AIP is limited to the pancreas.
AIP treatment ?
** • steroids (Prednisolone 20-40 mg/day)
• azathioprine (6 MP).
• rituximab
Which solution is Proven to be best IV fluid in acute pancreatitis treatment and prophylaxis?
Ringer’s lactate.
what imaging findings DOES NOT indicate gallstones to be a cause of acute pancreatitis?
A. Extension of intrahepatic bile ducts.
B. Extension of the common bile duct.
C. Hyperechogenic body inside the common bile duct.
D. Small calculi inside the gallblader.
E. Enlarged, hypoechogenic pancreas of diffused margins.
E. Enlarged, hypoechogenic pancreas of diffused margins.
In course of acute pancreatitis when should be abdominal CT performed?
After 48-72 hrs from onset of symptoms if patient state does not require it sooner.
In course of acute pancreatitis with obstructive jaundice when should be ERCP performed?
No later than 72 hours.
What’s the most common cause of chronic pancreatitis?
Alcohol abuse.
Mutation of which genes IS NOT responsible for causing chronic pancreatitis? A- SPINK1. B- CFTR. C- ELANE D- gene for cationic tripsinogen. E- Gene for a1-antitrypsin.
C- ELANE
What is used in exocrine pancreatic insufficiency treatment?
Pancreatic enzyme replacement therapy.
Which biomarker is the most useful and diagnosis of pancreatic cancer?
Ca 19-9
What is the mean five-year survival rate for the pancreatic cancer?
10%
What farther diagnostic test requires an asymptomatic patient with 2 cm pancreatic cyst detected in CT scan performed due to different causes?
Further imaging - EUS,MRI
SCN - seorus cystic neoplasms?
are usually benign.
IPMN stands for ?
Intraductal papillary Mucinous neoplasm.
Predictors of higher risk of malignancy in ID - IPMN includes ?
Associated solid component.
Early symptoms of pancreatic cancer?
Nausea.
Pancreatic pseudocyst?
Is a late complication of acute pancreatitis.
peripancreatic walled-off necrosis ?
Can be treated by endoscopic necrosectomy.
which of the following IS NOT used to assess patient with alcoholic hepatitis? A- De ritis ratio. B- Maddrey's score. C- Balthazar's scale D- Physical examination. E- MELD.
C- Balthazar’s scale
its used for Computed Tomography Severity Index (Balthazar). for acute pancreatitis
Typical laboratory findings in alcoholic hepatitis do NOT include? A- Elevated serum GGTP level. B- Elevated mean capsular volume (MCV). C- AST/ALT = 2:1. D- Leukocytosis. E- elevated serum troponin I
E- elevated serum troponin I
Typical histopathological changes in alcohol hepatitis is NOT?
A- Mallory’s hyaline body.
B- Ballooning degeneration.
C- Lymphatic infiltration.
D- Necrotic changes.
E- Presence of cellular debris inside the lobules.
C- Lymphatic infiltration.
Treatment of nonalcoholic fatty liver disease is include?
- *- Weight loss.
- Mediterranean diet.
- exercise.
- antiglicemic drugs (metformine).
- statins.
What is the most common liver disease?
Fatty liver disease
gold standard for diagnosis of cirrhosis ?
Liver Biopsy.
Pathophysiology of liver cirrhosis?
often preceded by hepatitis and fatty liver (steatosis), independent of the cause activation of stellate cells, which increases fibrosis
secretion of TGF-β1, which leads to a fibrotic response and proliferation of connective tissue
- Terry’s nails (double nails)
- Clubbing
- Dupuytren’s contracture:
are symptoms of which disease ?
liver cirrhosis
Child - Pugh Score?
is a system for assessing the prognosis — including the required strength of treatment and necessity of liver transplant — of chronic liver disease, primarily cirrhosis.
Causes of liver cirrhosis decompensation do NOT include ?
A- Constipation.
B- Infectious diarrhea.
C- Mild UTI.
D- Two portions of alcohol drink occasionally.
E- High carbs diet
E- High carbs diet
What medications are used to treat ascites in course of liver cirrhosis ?
- Spironolactone.
- Furosemide.
- Albumins.
- Hydrochlorothiazide.
Clinical symptoms of liver cirrhosis?
- Spider angiomata.
- Jaundice.
- Fetor hepaticus.
Milan criteria?
- For liver transplantation in HCC.
- one lesion smaller than 5 cm.
- up to 3 lesions smaller than 3 cm
- no extrahepatic manifestations.
- no vascular invasion.
In esophageal variceal bleeding in patient with cirrhosis and ascites treatment include?
- Administration of terlipresine during active bleeding.
- Endoscopy.
- ** - Ceftriaxone IV as a prevention.
TTT of hepatorenal syndrome include?
Terlipresine and albumins.
Which type is more severe in hepatorenal syndrome?
type 1 is more severe than type 2.
In a patient with liver cirrhosis screening for hepatocellular carcinoma includes؟
USG every 6 months, AFP every 6 months.
Accidentally found a liver tumor in a young woman taking oral contraception, no history of hepatitis, without any other signs of symptoms is probably?
Focal nodular hyperplasia.
The bismuth - Corlete classification regards ?
Exact location of hilar cacinoma.
Is the most common manifestation of bile duct cancer?
Jaundice.
Which of following is NOT a Benign hepatic tumors? A. Hemangioma. B. FNH C. adenoma hepatocellular. D. Hepatoblastoma. E. Biliary papilloma.
D. Hepatoblastoma.
In HCC treatment?
Liver transplantation is highly effective.
Courvoisier- terrier’s sign is ?
Probably enlarged gallbladder which is nontender and accompanied with mild painless jaundice.
Grains allowed in gluten free diet include?
Millet.
Which syndrome may be associated with CRC?
Lynch syndrome
in Acute liver failure?
old qs
Glucose has to be controlled often due to Increased probability of hypoglycemia
Liver cirrhosis may be caused by all of the following except: A. Chronic liver hepatitis. B. Regular alcohol intake. C. Autoimmune hepatitis. D. Hemachromatosis. E. Tobacco smoking.
E. Tobacco smoking.
Main diuretic used in the treatment of ascites in the course of liver cirrhosis?
Spironolactone.
maybe furosemide.
bowel sounds may not be heard in ?
Peptic ulcer disease.
What metabolic disturbances may NOT be a cause of abdominal pain ? A. Uremia. B. Hyperlipidemia. C. Porphyria. D. Hyperglycemia. E. Vit C insufficiency
E. Vit C insufficiency
Colorectal polypectomy surveillance ?
- 1-2 tubular adenomas <10mm with LGD not require surveillance.
- Screening colonoscopy can be offered (depending on age) in 10 years.
- Stop surveillance at 75.
Q: in D-IBS pharma ttt include ?
Ryfaximine.
Q: DD of IBS include ?
Cervical cancer
Q: the indication for gastroscopy before starting GERD ttt ?
Anemia
Q: Risk factor of squamous cell carcinoma of the esophagus is? A. Barret's esophagus. B. H. pylori infection. C. GERD. D. Obesity. E. Excessive fat consumption.
B. H. pylori infection
????????
It is not a pre-malignant state if we consider colon cancer ? A. Adenoma. B. Familial adenomatous polyposis. C. Ulcerative colitis. D. Colonic diverticula. E. All are premalignant.
D. Colonic diverticula.
5 F’s, a list of risk factors for the development of gallstone disease?
“Female, Fertile, Fat, Fair, and Forty”
Local complication of acute pancreatitis ?
**• Porto-spleno-mesentric venious thrombosis.
• necrosis (sterile, infected)
• acute peripancreatic fluid
collections, pseudocysts, abscess, walled- of necrosis- Atlanta classifiaction
• pancreatic acites
Systemic complication of acute pancreatitis ?
- pleural effusion
- ARDS
- Shock
- DIC
- oliguria
- psychosis
- and many others
Q: Which of the following is not associated with autoimmune pancreatitis? A. Chronic sclerosing sialadenitis. B. Tubulointerstitia nephritis. C. Ulcerative colitis. D. Mediastinal fibrosis. E. Prostatitis
E. Prostatitis
Jaundice in acute hepatitis ?
Jaundice may be mixed
Standard drink of alcohol contain?
10 g of ethanol (300 ml of beer, 100ml of wine, 30 ml of vodka)
Q: Which of the following is not etheological factor of chronic hepatitis? A. HBV. B. HAV. C. HCV. D. Wilson's disease. E. Autoimmune disorders
B. HAV.
Drugs used in HCV do not include? A. Gancyclovir. B. Sofosbuvir. C. Rybavirin. D. Pegylated interferon. E. Elbasvir.
A. Gancyclovir.
Extrahepatic manifestation of chronic hepatitis C do NOT include? A. Autoimmune thyroiditis. B. B cell limphoproliferative disorders. C. Pancreatic cancer. D. Sjogren's syndrome. E. Microscopic colitis.
E. Microscopic colitis.
lab findings of liver cirrhosis does NOT include ? A. elongated PT. B. Hypoalbuminemia. C. Hypernatremia. D. Hyperkalemia. E. Hyperbilirubinemia.
C. Hypernatremia.
