Ax GIT Flashcards
What’s abdominal recti diastrasis ( ARD ) and how to treat
It’s a separation of lines alba causing abdominal contacts to bulge. (From xiphistrnum to pubis symphisis) Could be congenital.
It’s not true hernia. Could be anywhere between xiphoid to the pubic bone.
Treatment -
1. Physiotherapy for abdominal wall muscles
2. Surgical repair comes next - classic abdominoplasty or endoscopic surgery and stabilize the defect.
Hernioplasty and mesh repair done for true hernias. Abdominal belt or truss used for hernia surgeries only.
What’s the Achalasia presentation
Progressive dysphasia
Sub sternal chest pain during meals
Heart burn
REGURGITATION OF UNDIGESTED FOOD
Modifying eating habits - arching the back when eating, raising arms when swallowing.
It’s due to insufficient relaxation of esophageal sphincter and loss of esophageal peristalsis
Barium swallow study - bird beak appearance.
What’s Peutz Jeghers syndrome ( PJS )
Autosomal dominant
Freckling ( pigments spots over mouth ,lips, fingers,toes) , gastrointestinal polyps ( associated with high risk of small intestinal intussusseption ) and increased risk of certain cancers.
What’s FAP
Familial adenomatous plyposis or Familial polyposis coli.
Inherited disease.
About 1% of all colorectal cancers are due to FAP.
ALMOST ALL people with FAP will develop cancer before 40y of age, if colon hasn’t removed to prevent it.
Also risk of stomach, small intestine, pancreas, liver cancers as well.
What are adenomatous polyps
70% of all polyps are adenomatous.
Only a small percentage becomes cancerous.
But most of the malignancy polyps are adenomatous.
What’s melanosis coli
Caused by chronic laxative abuse.
What’s schostosomiasis
Endemic parasitic infection, from eastern Mediterranean region.
Either GI or urogenital.
May cause various abdominal manifestations including ANAL FISSURES.
First line inn perianal abscess
Immediate surgical intervention ( I&D )
If delayed intervention - chronic tissue destruction, fibrosis, stricture formation that may result in anal incontinence.
Common cause of multi drug regimen failure against H.pylori infection
Antibiotic resistance.
Commonly used antibiotics are Amoxicillin, clarythromycin and metronidazole.
Clarithro and metro resistance is the common cause.
Metronidazole resistance can be overcome with INCREASING DOSE AND DURATION of therapy. But can’t do that with Clarithro resistance.
What’s Mallory Weiss tear
Linear laceration at the gastroesophageal junction.
One or more retching with vomiting could change gastric cardia or mucosa and ultimately lead to a gastric or esophageal tear.
Hemetemesis is the presentation in malleory Weiss tear.
What’s are simple liver cysts
Often congenital and developed from intrahepatic biliary ducts because they have a lining similar to biliary ducts.
Generally asymptomatic but may produce mild RHC pain.
Very rarely jaundice caused by obstruction or rupture of cyst.
Important to differentiate between malignant hepatic lesion from simple hepatic cyst.
If a cystic lesion is found on USS then CECT OF ABDOMEN should be done to characterize the lesion.
How would a hepatic cyst torsion would present
As acute abdomen
How would simple hepatic cyst rupture may present
Secondary infection leading to a presentation similar to hepatic abscess with abdominal pain, fever and leukocytosis.
Young patient with liver disease, neuropsychiatric symptoms and family history of such symptoms.. what to expect
It’s suggestive of Wilson disease
Autosomal recessive
Suggestive of copper accumulation in liver and CNS.
Liver disease( hepatitis, cirrhosis, fulminant liver failure are features )
Neuropsychiatric manifestations - dysarthria, dysphagia, dyskinesia, dementia, Parkinsonism, decreased memory, Labile emotions.
How to diagnose Wilson diesese
Clinical hallmark is Kayser- Fleischer ring of eyes.
Diagnostic test - serum copper ( increased) and serum ceruloplasmin ( decreased)
Gold standard is liver biopsy.
What’s primary eosinophilic esophagitis (EoE) ?
What’s are diagnostic criteria’s?
How to treat it?
Atopic inflammatory disease caused by abnormal immune response.
Characterized by esophageal dysfunction , dysphagia for solid foods, retro sternal pain and food impaction.
Diagnostic criteria for EoE
1. Symptoms related to esophageal dysfunction.
2. >15 EOSINOPHILS on esophageal biopsy
3. Persistent eosinophils after a course of PPIs for 8 weeks.
4. Secondary cause of esophageal eosinophilia is excluded.
Treatment -
1.dietary advice and alteration.
2. Pharmacotherapy ( PPI COURSE—-> if fails —-> topical swallowed steroids - fluticasone,budesonide) —> if still fails —> systemic corticosteroids/ prednisolone can be given)
3. Surgery
Commonest mode of transmission of hep B
Sexual transmission
Secondly needle injuries ,piercing,tattooing
Comment presenting features of rectal cancer
Rectal bleeding ( 60%)
Changes of bowel habits ( 43%)
Back pain - late sign
Malaise
Bowel obstruction
Constipation ,melena are unlikely to be presenting complains.
Commonly affected part for volvulus
Sigmoid colon
Followed by right colon, terminal ileum
Rarely in transverse colon and splenic flexure
Sigmoid volvulus is commonly in patient with-
Elderly debilitated
Bedridden patients
With chronic constipation
CF- cramping colicky abdominal pain , dissension, constipation, progressively increasing abdominal dissension, ( TYMPANIC OVER THE GAS FILLED ,THIN WALLED, COLON LOOP) With progressive obstruction nausea and vomiting may be seen.
Initial investigation for volvulus
Plain abdominal X-ray - massive dilatation of sigmoid colon loop arising from pelvis and extending to diaphragm is typical.
DISTENDED LOOP MIMICKING A COFFEE BEAN OR DILATED U SHAPED COLON with a cut off at the site of obstruction.
Confirmatory diagnostic tool- CECT of abdomen. ( helps find the causing pathology and diagnosis of colonic ischemia.
USS has NO PLACE in volvulus
What’s the commonest cause for small bowel obstruction and investigation to diagnose
Commonest - Adhesions from previous abdominal surgeries
Unlike in large bowel obstruction ,in small bowel obstruction NAUSE AND VOMITING are prominent signs
BARIUM MEAL AND FOLLOW THROUGH is investigation for small bowel obstruction.
Second commonest is malignant tumors
Third is hernias
Other less common causes- strictures by Crohn’s disease, small bowel tumors, trauma, intussusception.
Should we use barium as a contrast if we suspect bowel perforation
NO. Avoid barium if viscus perforation is suspected
Or if the goal is to find postoperative leak.
Treatment of sigmoid volvulus
Definitive is surgery
But endoscopic detortion can be done followed by leaving a rectal tube in place for 1-3 Daya to maintain reduction.
Surveilance of colorectal polyps guidelines
What’s post cholecystectomy syndrome ( PCS)
Dyspepsia manifested by bloating and belching after cholecystectomy is suggestive of PCS.
SYMPTOMS-
Upper abdominal pain, nausea and vomiting , diarrhea, jaundice, bloating, dyspepsia.
These symptoms can be caused by -
1. Choledocolithiasis- stones remained or formed in CBD or cystic duct remnant. ( commonest cause)
2. Biliary dyskinesia
3. Continuously increased bile flow to GI tract
4. Dilatation of cystic duct remnant
Ix of choice - USS if suspected PCS.
Commonest finding of RHC pain in USS
Gallstones
Chronic pancreatitis presentation
Rpigastric pain that radiates to the back.
Pain may or may not be triggered by eating and lasts for several hours.
Serum amylase and lipase are often normal or slightly elevated.
USS may show calcification of pancreas ( only in 60%)
Common presentation of cholecystitis
Pain often aggravated by fatty foods.
Right upper quadrant pain or epigastric pain.
Pain can radiate to tip of right shoulder.
Fever is a common feature.
ALP and Gamma GT can be elevated.
It it unlikely that USS to miss the diagnosis.
Post infectious exposure of hep A. How to advise patient
Incubation period- 30 days
Presentation - fever,malaise,anorexia,abdominal discomfort ( prodromal symptoms) followed by dark urine and jaundice a few days later.
Symptoms usually lasts for several weeks.
Viral load in stools is highest - just before jaundice.
Considered infectious from - a few days before onset of prodromal symptoms to a few days after onset of jaundice.
Non infectious after 1 week from jaundice or 2 weeks from prodromal symptoms onset.
Gold standard of HAV diagnosis
Serum IgM and anti-HAV antibody
Lifestyle advises reguarding GERD
What’s the best method in incomplete colonoscopy
Colonic capsule endoscopy (CCE) or CT colonography can be used. ( CCE is supirior)
Is GERD has relationship with H.pylori infection
Nope
H.pylori Irradiation doesn’t improve GERD.
I’m H.pylori eradication therapy what would you do if patient is allergic to penicillin
Then amoxicillin should be replaced with Clarithromycin or metronidazole and given with PPI.
So chance of treatment failure is higher.
How to investigate for small bowel obstruction
Initially plain abdominal X-ray ( at least two views- upright and supine )
Most accurate diagnostic test is - double contrast Abdominal CT