Gastrointestinal

Question 1

porcelain gallbladder

Answer 1

calcification of gallbladder on CT

Bluish brittle consistency when gallbladder removed

Pathogenesis: maybe due to increase bile salt deposition

Increase risk of gallbladder adenocarcinoma

Requires cholescytectomy

Question 2

severe retrosternal pain, SOB, subcutaneous emphysema , odynophagia and sign of sepsis

Answer 2

think boerhaave syndrome

• due to esophageal rupture

Question 3

normal d-xylose test - what is dx then?

Answer 3

celiac disease

if normal - pancreatic disease

Question 4

cause of zener diverticulum

Answer 4

motor dysfunction

Question 5

prolonged isoniazid treatment can cause what skin condition?

Answer 5

pellagra ( roughen skin)

- due to nicin deficiency - dermatitis, diarrhea, dementia

Question 6

acute intermittent porphyria clinical

Answer 6

abdo pain
vomitting
diarrhea
neurological symptoms ( agitation, parenthesis, confusion)

Question 7

abdo pain, micocytic anemia, positive FOB, heapatomegly with hard edge on liver palpation with small pleural effusion on left

Answer 7

colon cancer with mets to liver

the pleural effusion - might be due to malignancy as well

Question 8

how does TPN cause gallstones

Answer 8

gallbladder stasis

Question 9

chronic abdo pain , diarrhea, WL and elevated ESR

Answer 9

chrons disase

Question 10

labs for alcoholic hepatitis

Answer 10

AST : ALT > 2
AST and ALT > 300

elevated GGT, bilirubin and INR

Decrease albumin
Leucocytosis

Question 11

most common cause of bleeding painless PR in elderly with a history of constipation

Answer 11

diverticulosis

Question 12

why do you get malabsorption in zollinger ellison syndrome

Answer 12

patients get inactivation of pancreatic enzymes by increase production of stomach acid may lead to malabsorption

Question 13

why does cirrhosis cause hypogonadism

Answer 13

due to primary gonadal injury or hypothalamic pituitary dysfunction

Question 14

what kind of anemia can NSAIDS cause

Answer 14

iro n deficiency anemia - through blood loss in GI tract

Question 15

painless jaundice and a patient with elevated CB and markedly elevated ALP - raise suspicion for?

Answer 15

biliary obstruction due to pancreas or billiary cancer

Question 16

difference b/w biliary obstruction from cancer VS acute choledocholithiasis

Answer 16

bother will have elevate ALP, elevated CB

Acute choledocholithiasis - usually have acute onset of right upper quadrant or epigastric pain

If malignant obstruction - usually have painless jaundice

Question 17

septic shock and then one day later develops elevation in AST and ALT (>1000) - what is that cause

Answer 17

ischemic hepatic injury or shock liver

Halmark: rapid and massive increase in transaminase with modest elevation in bile and alk phosphatase

Question 18

ischemic hepatic injury - treatment

Answer 18

if the patient durvies the underlying cause of hypotension ( septic shock, heart failure)

liver enzymes will normally return to normal within one to two weeks

Question 19

WL , jaundice and non tender distended gallbladder on exam

Answer 19

think pancreatic head tumour

Question 20

what is recommended in acute GI bleed in patients with hg < 7

Answer 20

packed red blood cell transfusion

Question 21

when do you get FFP

Answer 21

DDP - contains all clotting factors and plasma proteins from one unit of blood - given in severe coagulopathy ( liver disease ,DIC) when patient is actively bleeding

give INR > 1.6

Question 22

how do you elicit a succussion splash for gastric outlet obstruction

Answer 22

patient places stethoscope over the upper abdomen and rocks the patient back and forth at the hips

Question 23

patient with weeks of lower abode pain, bloody diarrhea, fecal urgency

who suddenly develops worsening fever, abode distention, leukocytosis , hypotension , tachycardia

what is happening

Answer 23

the patient most likely has undiagnosed IBD

then second presentation is suggestive of toxic megacolon - get abode x-ray

Treatment
– bowl rest
ng tube
antibitoics

• surgery - only if not responsive

Question 24

foul smelling bulky stools and Wl over last 6 months with small bowel biopsy showing villous atrophy - what does this suggest?

Answer 24

celiac disease

Question 25

when do you get malabsorption in chrons disease

Answer 25

usually only if the patient had a history of multiple bowl resections

Question 26

a positive urine bilirubin assay is typical of what ?

Answer 26

buildup of CB

Question 27

barium swallow shows a symmetric circumferential narrowing affecting the distal esophagus and a history of GERD

Answer 27

esophageal stricture

- due to chronic GERD

Question 28

chronic GERD increase risk of

Answer 28

strictures 
barretts esophagus ( intestinal metaplasia of the lower esophagus )

Question 29

barium swallow shows peristalsis poor emptying of barium and dilation of proximal oesophagus iwht narrowing in a bird beak appearance

Answer 29

achalasia

Question 30

CBD duct obstruction vs cystic duct obstruction

Answer 30

CBD - usually presents with jaundice

Cystic duct - sudden onset of epigastric or right upper quadrant pain after a large fatty meal

Question 31

positive hydrogen breath test
postive stool test for reducing substances
low stool ph
increase stool osmotic gap

• what does this indicated

Answer 31

lactose intolerance

no steatorrhea

Question 32

unexplained chronic abode pain , WL , food aversion

Answer 32

most likely due to chronic mesenteric schema

- due to atherosclerotic changes of celiac or superior mesenteric arteries

Question 33

diagnostic test for acute diverticulosis

Answer 33

CT abdo

recall sigmoidoscopy or colonoscopy is c/i in the setting of acute diverticulitis - due to perforation risk