Gastrointestinal Flashcards
Diagnosis of achalasia
Barium swallow and manometry
Rx for achalasia
Pneumatic dilation, surgical sectioning/ myotomy, botox- required every 3-6 months
Esophadeal spasm- radiology finding, treatment
Corkscrew appearance
High amplitude non peristaltic contractions
Rx- CCB, TCS, nitrates, PPI at times
Gastritis, hypercalcemia with weight loss. Diagnosis. Management
Zollinger Ellison syndrome- gastrinoma. Screen for MEN syndrome as well. Do serum gastrin levels. Do secretin stimulation test. Secretin inhibits gastrin. If still increased, ZES confirmed.
Rx- high dose PPI, surgery if no mets.
Malabsorption, arthritis, lymphadenopathy, PAS positive lamina propria. Diagnosis? Rx?
Whipple disease. Long term antibiotics
Initial test for carcinoid tumor. Treatment
Urine levels of 5-HIAA. Octreotide and surgery
Diagnosis of SBO. Rx?
1st x ray, accurate- CT abdomen
Fluid resuscitation
Partial SBO- supportive, NPO, NG, etc
Complete- Explorative laparotomy
Causes of ileus
Recent surgery, medical illness, electrolyte imbalance, hypothyroidism, DM, hypokalemia,
Most accurate test for mesenteric ischemia
CT angiography. Best initial- CT abdomen
Tests for diverticulosis and diverticulitis
Diverticulosis- colonoscopy, diverticulitis- CT abdomen
Causes of LBO
MCC- colon cancer
Diverticulosis, volvulus, fecal impaction, benign tumors
CF Cholangitis- triad
Fever, jaundice, RUQ pain
What indicated ascites is associated with portal hypertension?
SAAG >1.1- splenic or portal vein thrombosis, schistosomiasis, cirrhosis, RHF, constrictive pericarditis, BCS
Primary sclerosing cholangitis associated with ?
UC, P anca and onion skinning sclerosis
Med slowing progression of PBC
Ursodeoxycholic acid, cholestyramine, liver transplant
Gold standard for Wilson’s disease
24 hr urinary copper after penicillamine
Chain of lakes helps in diagnosis of ?
Chronic pancreatitis
Courvoisier sign associated with which cancer?
Pancreatic cancer
C diff treated with vancomycin developed C diff again. Next step?
Retreat with oral vancomycin. If that too doesn’t work, switch to fidaxomicin
Diarrhoea with urine showing low levels of D xylose. Diagnosis?
Celiac disease
Dx and Mx of TEF
Dx- NG tube, x ray
Mx- surgical correction, VACTERL screening
Syndromes associated with congenital umbilical hernia
Beckwith weidemann, ehlers danlos, Down’s syndrome
Tx of umbilical granuloma
Silver nitrate
Complications of gastroschisis. Mx?
Necrotising enterocolitis, bowel obstruction, SBO, FGR, oligohydramnios
Manage with sterile saline dressing and plastic wrap
Complications of Beckwith weidemann. Dx
Wilms tumor, hepatoblastoma. Monitor for hypoglycaemia
Dx- serum AFP, USG Abdomen- done from birth to age 4 yrs, USG renal - 4-8 yrs
Double and triple bubble sign seen in ?
Double- duodenal atresia, triple- jejunal atresia in x ray abdomen
Squirt sign positive on DRE in? Gold standard diag?
Hirschsprung disease. Rectal suction biopsy
Micro colon diagnostic of ?
Meconium ileus
Confirmatory diagnosis of malformation due to volvulus, tx, associated congenital anomalies?
Upper GI series, LADD procedure. Omphalocele, diaphragmatic hernia, heterotaxy syndrome
X ray findings of necrotising enterocolitis
Pneumatosis intestinalis, pneumoperitoenum
Pathogenesis of allergic proctocolitis
Non IgE mediated inflammation
Preventive therapy of cyclic vomiting syndrome
Age>5 - amitriptyline, age <5 - cyproheptadine. Risk factors- migraine in family
Risk factors of intussusception
Viral illness, rota vaccine
Meckels, HSP, Celiac, intestinal tumor, polyps
USG findings of intussception
Target sign, crescent sign
Diagnosis of mid gut volvulus
X ray, Double bird beak/ corkscrew in upper GI series, treitz on right.
Diagnosis of sigmoid volvulus. Mx?
X ray- coffee bean sign
CT scan - whirl sign
Mx- endoscopic detorsion, sigmoid colectomy
What is to be avoided in congenital diaphragmatic hernia?
Bag and mask ventilation, causes lung compression. Only ET to be done
Ogilvie syndrome, Dx, Tx?
X-ray- Colonic dilation, non dilated small bowel.
CT- colonic dilation without anatomic obstruction
Npo, NG/ rectal tube decompression
Neostigmine if no improvement
Diagnosis of diabetic gastroparesis
Nuclear gastric emptying scan
Rx of SIBO
Rifaximin
Major risk factors of CRC
Obesity and T2 DM
Hyperplastic polyps, colonoscopy screening
Every 10 years, every 5 years if high risk history, more frequent for adenomatous polyps
What should be initially done if a patient presents with CRC or adenomas?
Proctocolectomy
Lab findings in mesenteric ischemia
Leucocytosis, Hemoconcentration , elevated amylase and phosphate, lactic acidosis
Clostridium septicum or bovis increases risk of ?
CRC. Do colonoscopy if organisms positive
What is used to reduce anal sphincter pressure in anal fissure
Topical nifedipine
Risk factors for GI AVM
Vwf disease, CKD, AS
Initial steps of Mx of IBS
Low FODMAP - fermentable oligosaccharides, disaccharides, monosaccharides, polyols
When does diarrhoea episodes occur in secretory diarrhoea
Nocturnal , fasting diarrhoea
Which imaging is contraindicated in acute diverticulitis
Sigmoidoscopy and colonoscopy
Colonoscopy showing Melanosis coil suggests?
Laxative abuse, senna laxative
Rx for biliary atresia
Kasai procedure- surgical hepatoenterostomy, liver transplant
SBP prophylaxis
Fluoroquinolone
Which infectious gastroenteritis presents as pseudoappendicitis
Campylobacter
20M trauma to central upper abd- fever, pain, right flank pain, Xray- free air in retroperitoneum. Diag?
Duodenal tear- sx repair
2F lehargy, confusion. h/o fever, nasal discharge. Hepatomegaly, elevated LFT, acidosis, ammonia. CT- diffuse cerebral edema. Cause?
Medication effect- Reyes syndrome.
Risks of intrahep cholestasis of preg. mx?
IUD, preterm, meconium stained fluid, NRDS. Mx- ursodeoxy, anti histamine, deliver at 37 wks
Fecal impaction causes
Elderly- low fiber diet, less fluids, impaired mobility, chronic constipation, decreased sensation- dementia, spinal cord inj Can be associated with urine incontinence
