Gastro-Uworld Flashcards
1
Q
Pathophysiology of NEC ?
A
poor perfusion to the bowels, lead to destruction of enterocytes, transfer of GAS-producing cells to the Bowel wall.
2
Q
CF of NEC ?
A
Inspr. problems.
Bloody diarrhea
abdominal distention
feeding intolerance and Bilious vomiting
3
Q
Pathognomonic sign of NEC on xray ?
A
Pneumointestinalis
pneumoperitoneum
4
Q
RF of NEC ?
A
Low birth weight
prematurity
Enteral feeding
5
Q
Management of NEC ?
A
IV fluids
Stop Enteral feeds
ABx
Nasogastric decompression
Surgery in cases of perforation or deterioration despite medical Management.
6
Q
Isolated high Transaminases indicate
A
A hepatocellular injury.
7
Q
Ischemic Hepatic Injury is identidfied by
A
rapid and significant increase in transaminases
Could be cause because of liver shock or Buddchiari ( portal veim thromb
8
Q
Pathophysiology behind ascites in cirrhosis ?
A
- Cirrhosis –> Fibrosis –> portal HTN
- accumelation of bacterial toxins –> production of vasodilatory products –> NO –> splanchin vasodilation –> dec. in SVR –> high HR and CO (hyperdynamic circulation).
–> increase in fluid third spacing and due to decreased albumin production (low oncotic P.) cannot reverse this
–> low Renal perfusion, release of RAA system and Na and water retention( by Aldosterone) and widespread vasoconstriction ( by Angiotensin).
9
Q
What to look for in case of Perforated Peptic Ulcer in XRAY ?
A
Pneumoperitoneum. Free air under the diaphragm.
10
Q
What is Beckwith Wiedman Syndrome ?
A
Overgrowth disorder. Related to mutation in the gene on Growth number 11 ..that encodes Insulin Like GF-2
11
Q
CF of Beckwith Wiedman syndrome ?
A
Macrosomia, Macroglossia
Viscero/organomegaly
Hemihyperplasia
Abdominal wall defect ( Omphalocele, umbilical hernia).
Increased risks of tumors ( wilms tumor or hepatoblastoma).
12
Q
Boerhavve syndrome vs. Mallory Weiss tear
A
boerhave: esophageal perforation. Shows pneuomediastinum
Mallory Weiss Tear: Partial thickness rupture, asc with hematemesis.
13
Q
Boerhavve Syndrome is caused by ?
A
Protracted vomiting.
14
Q
Achalasia Vs. Pseudoachalasia
A
Achalasia: loss of esophageal peristalsis and norelaxation of the esophageal spinchter
Pseudoachalasia: narrowing of the distal esophagus secondary to other causes (like Malignancy).
15
Q
Achalasia on Xray
A
Bird beak
16
Q
CF of Eosinophillic Esophagitis ?
A
Dysphagia to solids mainly
Epigastric or chest discomfort
Reflux/ vomit
Food impaction
Hx of Atopy
17
Q
CF of Pyloric Stricture
A
- Epigastric pain after food
- Early satiety
- No dysphagia
- Succusion splash: retained gastric acid in the abdomen for more than 3 hours will form a splash sound.
18
Q
Diagnostics of EoE ?
A
Biopsy > 15 eosinophils in high power field
19
Q
Rx of EoE ?
A
Stop the allergen
Topical Steroids ( Fluticasone/ Budesonide).
20
Q
CF of IBS
A
Symptoms >3 days/ month for 3 months:
recurrent abdo pain
asc with constipation/ diarrhea
and >2 of the following:
1. Symptoms relieved with bowel movement
2. change in frequency of stools
3. change in the form of stools
21
Q
Bx features in IBS ?
A
Normal colonic mucosa
22
Q
CF of Mild UC ?
A
<4 watery diarrhea/ day, no or occasional hematochezia
No anemia
Normal CRP, ESR
23
Q
Colonoscopy findings of Mild UC ?
A
Superifical anorectal ulcers (extending to more proximal parts of the colon)
and transmural inflammation.
24
Q
Management of Mild UC, confined to the Rectum ?
A
Topical 5 aminosalicylic acid (mesalamine enema or supps).
25
PUD ?
Melena
Symptoms are worse on absence of food buffer
26
Mangement of severe and refractory UC ?
Ileoanal anastomosis with total proctocolectomy
27
Alarming features with diarrhea ?
1. Nocturnal diarrgea
2. GI bleed
3. High Inflm. markers
4. Elevated calprotectin
5. Unintended weight loss
6. Family Hx of early colon ca.
7. Iron def. anemia
28
What is Microscopic Colitis
Immune mediated colitis, asc with watery non bloody diarrhea (secretory can happen while fasting or at night)
29
Bx of Microscopic Colitis
1. Lymphocytic Infiltarion or
2. Collagen band in the subepithelium.
30
Triggers of Microscopic colitis
NSAIDS
SSRI
PPI
31
Management of Microscopic colitis
1. Stop the offending agent
2. if it persists use Budesonide or Anti-diarrheal ( like loperamide)
32
What type of feeds do we use in patients with burns ?
Since the patient is in a catabolic state. Patients needs feeds high in protein and carbs and high calories.
33
Diverticular bleed
Large amount of bleeding with defecation, painless
34
Causes of Splenic rupture
Trauma
Non-traumatic: EBV, CMV or malaria infection
35
When should Enteral (NG feeds) be started in patients with trauma burns ?
in 24 hours
36
What are the positive results of starting Enteral feeds ?
1. Prevents intestinal atrophy and bacterial translocation
2. Decrease the risk of Sepsis
3. Decreased Mortality
37
What happens to the metabolism in cases of burns ?
Increases ( catabolism)
38
Mangement of Hemochromatosis ?
Phlebotomy
| (High iron and ferritin levels).
39
Where does Iron accumulate in Hemochromatosis ?
1. heart (Cardiomyopathy)
2. Liver (cirrhosis)
3. Pancreas (DM)
4. Skin, broze pigmentation
5. Arthropathy ( MCP joints).
40
Patients with Alcohol use disorder are at risk of ?
Scurvy (Vit. C deficiency).
41
CF of Scury:
1. Gingival bleeding and recession
2. Poor wound healing
3. Petechiea, echymosis, bruising and coiled hair
42
CF of Zinc deficiency ?
Alopecia
Pustular rash around orifices and limbs
impaired wound healing
impaired taste
hypogonadism
43
The enzyme that is specific to Liver ? and to Gall bladder
1. ALP
2. GGT
44
Pathophysiology behind Physiologic Jaundice
Immature activity of UGT, responsible for Comjugation of bilirubin. ( develops at 2 weeks of life).
So unconjugated hyperbilirubenemia.
45
Management of Physiologic Jaundice ?
Increased feeding to improve gut bacteria and increase excretion of bilirubin by feces.
46
What is Primary sclerosing cholangitis ?
Stricture/ sclerosis in the bile duct, that leads to cholestasis ( increase in ALP and Bilirubin), increase risk of Infection
Severe Obstruction --> liver hepatitis and later cirrhosis (elevated transaminases).
| ASC with IBD (UC and Crohn).
47
Patients with Cirrhosis should be evaluated with abdo US for ? every ?
Hepatocellular Carcinoma
Every 6 months
48
What is Acute Cholangitis ?
Ascending infection due to biliary obstruction
| asc with pregnant ladies
49
CF of Acute cholangitis ?
Charcot Triad:
fever, RUQ pain and jaundice
or pentad:
hypotension, Altered mental status
50
Rx of acute cholangitis ?
ERCP within 24-48 hours
Abx treatment
51
Pregnant ladies are at high risk of ?
Cholestrol gallstones
52
Why are pregnant ladies are at higher risk of cholesterol stones ?
High progresterone and estrogen, causes gallbladder stasis and cholesterol saturation.
53
Woman on long term oral contraceptives will have ?
| Liver disease ?
Hepatic Adenoma
54
Hepatic Adenoma vS. focal nodular hyperplasia
FNH: is due to anomalous artery.
55
Non-Alchoholic Fatty liver disease
Similar to viral hepatitis. Negative viral serology.
Similar to alocholic fatty liver disease w/o alcohol intake.
Mostly due to Insulin resistance.
Increase FFA deposition in liver, increase synthesis and dec. clearance.
56
How to treat patients with esophageal varices ?
beta blockers
57
Biliary Atresia
Inuslt that leads to inflammation, fibrosis and obliteration of biliary duct.
well apearing children
Jaundice
Acholic stools
Dark urine.
- High Total and Conjugated Bilirubin.
- high GGT due to Inflammation of Gall Bladder
- Mildly elevated Transaminases
| Conjugated hyperbilirubenemia
58
Risk of Bilary cyst ?
Increase risk of Cholangiocarcinoma.
Needs resection to decrease the risk of Malignancy with Roux en Y hepaticojeujenostomy to allow for proper flow of bile.
59
Clinical Features of Biliary cyst
Asymptomatic or
RUQ mass
RUQ pain and jaundice in young children.
60
Management of Liver Abscess
- Blood cultures
- Abx
- Percutaneous Drainage
61
How to evaluate Ascites ?
Ascitic fluid
Asses:
Neutrophils: peritonitis
Poteins: >2.5 ( CHF, ..)
< 2.5 ( Cirrhosis, nephrotic syndrome)
SAAG: <1abscence of portal HTN
>1potal hypertension
62
What is Intrauterine Cholestasis of Pregnancy ?
High Estrogen and Progesterone during pregnancy causes hepatobiliary tract stasis and biliary obstruction.
leading to high Bilirubin and bile salts --> pruritis.
Bile salts can cross the Placenta-blood barrier and cause fetal problems
63
Management of ICP ?
Anti-histamine
Ursodeoxycholic acid
Birth by 37 weeks
64
What is primary biliary cholangitis
AI liver disease caused by destruction of Intrahepatic bileducts and cholestasis.
xanthomas & xanthelasmas
Positive Anti-mitochondrial Abs and Inc ALP.
65
Side effect of Aspirin in children ?
Reye syndrome
66
Pathophysiology of Reye Syndrome
damaged mitochondria in the hepatic cells, leads to accumulation of fatty droplets in the liver.
Thus increase of ammonia in the blood and encephalopathy.
67
Labs of Reye Syndrome ?
1. Elevated Transaminases
2. High serum ammonia
3. Hypoglycemia
4. Metabolic acidosis
5. high Pt, aptt and INR
68
Detection of Hep B infection (during the early periods )
HBsAg
HBc-IgM (Ab).
69
Is HbcAg detectable in serum ?
No
70
Difference between cholangiocarcinoma and hepatocellular carcinoma
| Markers
Cholangiocarcinoma elevated CEA and CA19-9
71
Characteristic findings in Crohns disease
From mouth to anus, with rectal sparing
Tranmural inflammation
cobblestones and creeping fat
Compllications in clude: strictures, fistula and abscesses.
72
What is a Meckel Diverticulum ?
It is an outpouching due to incomplete obliteration of the omphalomesenteric duct.
It is a true diverticulum that has all 3 layers of SI
73
Intussuception ?
the telescoping of a proximal part of the bowel into a distal part
74
CF of Intussuseption
- Colicky, episodic abdominal pain
- Susage shaped mass in RUQ, and emptiness in RLQ
- Currant-jelly stools (due to ischemia and transmural necrosis)
75
Management of Intussuception ?
- Air or Saline enema
- Surgery if the above fails
76
Sign of Intussuseption on US ?
Target Sign.
77
Recurrent Intussusception will need ?
Meckel Scan or 99-tichnitum Neuclear Scintigraphy.
78
What is a Meckel scan ?
Scan used to identify gastric and ectopic gastric mucosa ( usually found in meckel diverticulum).
79
What is the Sign of volvulus on Xray
Inverted U-wave of Coffee bean sign.
80
Pathophysiology behind Sigmoid Volvulus ?
Sigmoid colon twists upon its mesentry, causing a closed loop. Distention due to gas producing bacteria from the lumen.
Can be complicated by perforation of peritonitis.
81
Management of Sigmoid Volvulus ?
1. No signs of perforation/ Peritonitis: flexible sigmoidoscopy to check for Colon Viability and to untwist the segment
2. Signs of Perforation or Peritonitis is present: Emergency sigomoid colectomy
82
What is the MC cause of Bilious vomit in neonates
Intestinal Malrotation
(1. Midgut volvulus
2. Duodenal Obstruction by LAD Bands).
83
Intestinal Malrotation Risk increased with ?
Other congenital anomalies (like Ompphalocele).
84
CF of Giardiasis
Abdominal pain, cramps
prolonged diarrhea x.4 weeks
Malabsorption
weight loss
History of International travel
85
Confirmatory test for Giardiasis ?
Stool Antigen and Microscopy.
86
Treatment of Giardiasis ?
Metronidazole
87
CF of UC ?
Hematochezia
tenesmus ( fecal urgency followed by straining and inability to defecate)
Inflammation of mucosa and submucosa
Complication: Toxic Megacolon
88
CF of Pancreatic Cancer ?
Epigastric pain worse at night or when lying supine
- Jaundice (due to obstruction of Bile ducts, esp. Head of pancreas ca.)
- Weight loss
- Steatorrhea ( in ability to produce fat-dissolving enzymes)
- Trousseu sign ( Migratory thrombophlebitis in unsual places).
89
What is Trussau sign ?
Hypercoagulable state of superficial thrombophlebitis, taking place in unusual places.
Likely an indication of malignancy
90
Pathophysiology of Hirschprung disease
Failure of Neural crest migration.
The colon remains contracted as it has no ability to relax
91
CF of Hirschprung disease
Failre pf passage of meconium in the first 48 hours of life
Increased rectal tone, positive squirting sig ( gas and stool expulsion on temporary relief of Obstruction).
92
Hirschprung disease in different age groups
1. affecting long colonic segment: neonates
2. affecting short colonic segments: adolescents or children
93
Diagnostics of Hirschprung disease
1. Suction Bx ( confirmatory)
2. Contrast enema/ Anorectal manometry
94
CF of Colovesical Fistula ?
Pneumoturia ( air in urine)
Fecaluria ( stool in urine)
Recurrent UTI with mixed flora
95
Pathophysiology of Colovesical Fistula ?
Hx of Diverticulitis, with perforation extending into the bladder
96
Diagnostics of Colovesical Fistula ?
CT abdomen with oral or rectal contrast ( not IV contrast).
97
Celiac Disease is asc with
Dematitis Herpetiform (IgA - epidermal transglutaminase)
98
What is Dermatitis Herpitiformis ?
Rash on the extensor surface of the elbow and knees.
Rash with vesicles that rupture and crust.
99
RF of C. deficile Colitis ?
Abx use
Hospitalization
Inflammatory Bowel disease
All change the gut microbiome.
100
CF of C. deficile Colitis ?
Watery diarrhea
( No blood or melena)
Abdo pain
nausea
low grade fever
Leukocytosis
101
Rx of C. deficile Colitis ?
Mild/ severe infection: fidaxomicin or vancomycin
Fulminant:
Oral Vancomycin, IV metronidazole.
102
Lactose Intolerance ?
Post-prandial Abdominal pain
Flatulence
Watery diarrhea
103
Diagnostocs for Lactose Intolerance
Lactose breath test, to detect the hydrogen gas post lactose ingestion.
104
Differentials of Watery diarrhea ?
Microscopic Colitis
Lactose Intolerance
IBS
Mild UC
105
CF of Cancer of tail of pancreas
Back pain/ referred thoracic pain ( innervated by splanchnic and thoracic nerves), pain is worse at night or when lying supine.
106
Indication for Bariatric Surgery
BMI > 40
BMI > 35 + comorbid conditions
BMI >30 with resistant DM or metabolic syndrome
107
Screening for Colon Cancer ?
Colonoscopy:
After age of 50 at interval of 10 years for patients with low risk
At intervals of 5 years for patients with high risk ( first degree relative diagnosed before age of 60).
108
Do hyperplasticnpolyps increase the risk of colon ca ?
No
109
CF Pyloric Stenosis
Projectile vomiting (NON-BILIOUS)
Followed by refeeding interest ( hungry vomiter)
Olive mass in the abdomen
Hypochloremic, hypokalemic Metabolic Alkalosis
Dehydration (sunken fontanells, decreased skin turgor and increased CRT)
110
Diagnostics of Hypertrophic pyloric stenosis ?
US
111
Pathophysiology of hypertrophic Pyloric stenosis in neonates on Formula
The neonates on formula feed larger volumes in smaller time.
The Stomach has delayed emptying, this leads to hypertrophy of the pyloric muscle.
112
Pathophysiology of Perianal abscess
RF: anorectal intercourse and constipation.
Infection of crypt glands leads to abscess that can progress to fistula if not treated.
113
CF of Tracheoesophageal Fistula ?
Coughing while feeding
copious oral secretions/ Vomiting
114
Xray findings of Tracheo-esophageal fistula with pouch
Nasogastric tube seen in pouch on Xray
115
Pancreatic Pseudocyst
Walled off pancreatic fluid collection surrounded by a capsule. Containing enzyme rich fluids, tissue and debris
Can become infection or causes duodenal or biliary obstruction.
116
Appendeceal Abscess
Usually noted with psoas sign, especially of an abscess lying behind the appendix and anterior to the psoas muscle.
117
What are carcinoid tumors ?
they are well differentiated neuroendocrine tumors that screte seretonin, histamin and Vasoactive substances
118
When does Carcinoid syndrome occur ?
Carcinoid syndrome occurs when the tumor mets. to the liver which starts secreting the hormones directly to the circulation.
119
What is the hallmark of Carcinoid syndrome ?
episodic flushing
120
CF of Carcinoid syndrome
Flushing
Diarrhea
Bronchospasm (wheezing)
Tricuspid regurgitation
121
Confirmation of Carcinoid syndrome ?
high 5-hydroxyindoloacetic acid ( in 24-hour urine collection).
122
Management of external hemmorhoids ?
stool softeners
topical anathestics (lidocaine)
sitz baths
