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Ghita classes > gastro u world > Flashcards

gastro u world Flashcards

1
Q

acute pancreatitis : def

A

inflammation and hemorrhage of the pancreas , due to auto digestion of pancreatic parenchyma by pancreatic enzymes that results in liquefactive hemorrhagic necrosis of the pancreas and fat necrosis of the peri pancreatic fat

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2
Q

acute pancreatitis causes :

A

mot commonly due to alcohol (decrease drainage by contracting the sphincter of oddi ) and gallstones ( block )
trauma (automobile accident in children )

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3
Q

acute pancreatitis clinical features (5)

A

1-epigastric abdominal pain
2-nausea and vomiting
3-periumbilical and Flank hemorrhage
4-elevated lipase specific
5-hypocalcemia in severe cases ( calcium is used for saponification in fat necrosis )

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4
Q

acute pancreatitis :complications

A

1-shock
2-pancreatic pseudocyst
3-pancreatic abscess due to E.coli
4-DIC and ARDS

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5
Q

acute pancreatitis : physiopathologie

A

pancreatic zymogens are normally converted into their active form by trypsin in the duodenal lumen
in AP , begins with either a toxic or ischemic injury to the acinar cells that leads to premature activation of trypsin that activates the other enzymes and Starts auto digestion

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6
Q

lipase

A

hydrolyzes triglycerides into fatty acids and glycerol

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7
Q

specific enzyme to acute pancreatitis

A

lipase
causes the formation of characteristic calcium soap deposit ( fat necrosis )

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8
Q

gilbert syndrome

A

jaundice during stress , during an infection , NOT CLINICALLY significant
high UCB

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9
Q

UDP glucuronosyltransferase

A

form unconjugated bilirubine to conjugated bilirubine

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10
Q

intestinal beta glucuronidase

A

its a bacterial enzyme in the colon , that deconjugate the conjugated bilirubine

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11
Q

begnin neonatal hyperbilirubinemia
caracteristics and physiopathology

A
  • high bilirubin production due to physiologic breakdown of high RDC in the newborn
    -low bilirubin clearance due to low UDP glucuronyltransferase result in high UCB
    -high enteropatic circulation and absence of bacterial enzyme
    -2 to 5 days
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12
Q

traitement to begin neonatal hyperbilirubinemia

A

phototherapy that makes UCB water soluble

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13
Q

complication of begin neonatal hyperbilirubinemia

A

UCB is fat soluble and can deposit in the basal ganglia (kernicterus ) and lead to neurological defects and death

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14
Q

biliary atresia def

A

failure to form or early destruction = fibrous obliteration of extra hepatic biliary tree

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15
Q

biliary atresia clinical features

A

1/ biliary obstruction within the first 2 months of life —> elevated CB
2/acholic stools, dark urine and jaundice
3/may present cirrhosis

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16
Q

biliary atresia : anatomic caracteristics

A

-absent or abnormal gall bladder
-atretic : cystic duct, common hepatic duct , bile duct
-fibrosis
portal tract edema and inflammation

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17
Q

biliary atresia treatment

A

cannot be treated by medication
the surgeon will create a path so the bile can flow directly into the intestines
and removes the damage ducts
= hepatoportoenterestomy

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18
Q

carcinoid tumor

A

malignant proliferation of neuroendocrine cells , low grade malignancy
the tumor cells are positive for *chromogranin *
can ariseanywhere along the gut , in the small bowel commonly , also rectum , appendix

NOT carcinoid syndrome

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19
Q

carcinoid tumor biological marker

A

secretes serotonin into the portal circulation that is metabolized by liver monoamine oxidase into 5-HIAA that is excreted into urine

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20
Q

carcinoid syndrome
def

A

metastasis of the cracionoid tumor , the serotonin bypass the liver metabolism and leaks into the systemic circulation via hepatic systemic shunts

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21
Q

carcinoid syndrome characteristics

A

-bronchospasme
-diarrhea
-flushing of skin
-symptoms that can be triggered by alcohol or emotional stress that stimulate the serotonin release

22
Q

metastases of carcinoid tumor

A

carcinoid syndrome (liver metastase ) and then carcinoid heart

23
Q

carcinoid heart disease

A

is characterized by right-sided vascular fibrosis leading to tricuspid regurgitation and pulmonary valve stenosis , left sided valvular lesions are not seen due to presence of monoamine oxidase in the lung

24
Q

carcinoid tumors
composition

A

are composed of island or sheets of uniform cells with eosinophilic cytoplasm and oval-to round stippled nuclei

25
Q

appendix

A

acute inflammation of the appendix most common cause of acute abdomen

26
Q

appendix clinical featrures

A

1/periumbilical pain (due to irritation of the parietal peritoneum ) and right lower quadrant ,(Mcburney point : tenderness ) and we can have pain with hip extension and intern rotation
2/fever
3/nausea

-rupture results in peritonitis

27
Q

complication of appendix

A

periappendiceal abscess

28
Q

peptic ulcer disease

A

solitary mucosal ulcer involving proximal duodenum (90%) or distal stomach (10%)

29
Q

duodenal ulcer causes :

A

-mostly due to Hpylori 95%
-due to ZE syndrome (gastrinoma)

30
Q

duodenal ulcer clinical features

A

-epigastric pain that improves with meals
-hypertrophy of Brunner Glands
-usually arises in anterior duodenum
-if present in posterior duodenum : rupture may lead to bleeding from gastroduodenal artery or acute pancreatitis

31
Q

duodenal ulcer in posterior duodenum complication

A

rupture that may cause bleeding of the gastroduodenal artery or acute pancreatitis

32
Q

gastric ulcer causes

A

-due to Hpylori 75%
-NSAIDs
-bile reflux

33
Q

gastric ulcer clinical features

A

-epigastric pain that worsens with meal
-ulser is usually located in the lesser curvature of the stomach (between the gastric corps and antrum )
-rupture carries risk of bleeding from left gastric artery

34
Q

risk of gastric ulcer

A

rupture with bleeding of the left gastric artery because they usually occurs in the lesser curvature

35
Q

diferential diagnosis of duodenal ulcers

A

duodenal carcinoma that are extremely malignant

36
Q

benign peptic ulcers and malignant ulcers differences :

A

-benign : small <3cm , punched out , radiating folds of mucosa
-malignant : large , irregular , heaped up margins
–biopsy is required

37
Q

necrotizing enterocolitis

A

-frequent gastrointestinal emergencies affecting new borns , *preterm * infants secondary to gastrointestinal and immunologic maturity
(bacteria proliferate excessively causing inflammation and ischemic necrosis of the terminal ileum and colon)

38
Q

pneumatosis intestinalis

A

= air in the bowel wall
-X RAY : thin curvilinear areas of lucency that parallel the lumen
-infant with abdominal distension and bloody stools : this finding is diagnostic for necrotizing enterocolitis

39
Q

necrotizing enterocoliti clinical features :

A

-preterm infants /newborn
-bloody stools
-abdominal distension
-pneumatosis intestinalis

40
Q

volvulus

A

twisting of bowel along its mesentery
common location : sigmoid colon for elderly , cecum for young adults
obstruction and disruption of the blood supply

41
Q

volvulus clinical features

A

-abdominal distension, pain, vomiting, constipation, and bloody stools , inability to pass gazs
The onset of symptoms may be insidious or sudden.
-The most sensitive radiographic signs : absence of rectal gas and distended sigmoid loop with an inverted-U appearance , coffee bean sign

42
Q

pyloric stenosis

A

congenital hypertrophy of pyloric snooty muscle , more common in males
-presents *2weeks after birth *

43
Q

pyloric stenosis clinical features

A

2 weeks after birth :
- projecting non bilious vomiting
-visible peristaltis
-olive like mass in the abdomen

44
Q

traitement of pyloric stenosis

A

myotomy : cut away the excess of muscle

45
Q

duodenal atresia

A

congenital failure of duodenum to canalize , associated with Down syndrome

46
Q

clinical features of duodenal atresia (3)

A
  • polyhydramnios
    -distension of stomach and blind loop of duodenum : double bubble sign
    -bilious vomiting shortly after birth
47
Q

crhon disease

A
48
Q

cholelithiasis

A
49
Q

ulcerative colitis

A
50
Q

irritable bowel syndrome
symtoms

A

-relapsing abdominal pain with bloating , flatulence and change in bowel habits (diarrhea or constipation ) , IMPROVES with defecation
-seen in middle aged women
-increased dietary fibers may improve symptoms

51
Q

irritable bowel syndrome
cause

A

related to disturbed intestinal motility , no identifiable pathologic changes

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