Gastrology

Question 1

cholelithiasis. Ethiopathogenesis

Answer 1

Stone in gallbladder. Cholesterol stones (yellow-greenm associated with the following): obesity, hyperlipidemia, DM, CF, Cirrohosi, OCP, multiple pregnancies. advanced age.
Pigmented stones: Black: hemolysis, or alaoholic cirrhosis.
Mixed stones = MOST COMMON

Question 2

Cholelithiasis. Clinical + complications

Answer 2

Asymptomatic, biliary colic (RUQ pain radiating to back. pain after fatty meal and at night) due to gallbladder contracting against obstruction of cystic duct due to stone.
Complication: Cholecytitis, choledocolithiasis, gallstone ileus, malignancy.

Question 3

Dx cholelithiasis.

Answer 3

USG, CT, MRI

Question 4

Tx cholelithiasis.

Answer 4

asymptomatic: no treatment

recurrent biliary colic = cholcystectomy.

Question 5

Acute pancreatitis: def

Answer 5

Inflammation of pancreas resulting from prematurely activated pancreatic digestive enzymes causing autodigestion. Mild types is the most common, responding well to supportive care. Severe: necrotizing pancreatitis: significant morality and morbidity.

Question 6

Acute pancreatitis

causes

Answer 6

Alcohol, gallstones, past ercp, viral infections: mumps, coxachievirus B, drugs, post op complications. Trauma is the MCC in children, pancreatic cancer.

Question 7

Clinical: Acute pancreatitis

Answer 7

epigastric pain, radiating to back. steady, dull pain, worse when supine and after meals. N/V/anorexia. Signs: Low grade fever. tachycardia, hypotension, leukocytosis, abdominal distention. Hemorrhagic pancreatitis: Grey Turner sign: flank ecchymosis, cullen sign: periumbilical.

Question 8

Dx Acute pancreatitis

Answer 8

Amylase, lipase (more specific). LFT (if pancreatitis is due to gallstones), hyperglycemia, cbc. CT, USG to look for gallstones, ERCP.

Question 9

Tx Acute pancreatitis

Answer 9

mild: NPO, IV fluids and correct electrolytes, pain control (fentanyl and meperdine), NG tube.
Severe: ICU, prophylactic AB (imipenem) if > 30 % is necrotized.

Question 10

Chronic pancreatitis Def

Answer 10

persistent or continuing inflammation of the pancreas with fibrotic tissue replacing pancreatic parenchyma and alteration of pancreatic duct, eventually leads to irreversible destruction of pancreas.

Question 11

Causes of Chronic pancreatitis

Answer 11

chronic alcoholism= MCC

hereditary pancreatitis, idiopathic chronic pancreatitis.

Question 12

clinical features of Chronic pancreatitis

Answer 12

severe pain in epigastrium: recurrent or persistent, radiating to back . N/V. weight loss due to malabsorption

Question 13

dx Chronic pancreatitis

Answer 13

CT scan + abdominal radiographs (look for calcifications). ERCP = gold standard. Note that amylase and lipase are NOT elevated.

Question 14

Tx Chronic pancreatitis

Answer 14

narcotic analgesia, NPO, pancreatic enzymes and H2 blockers, insulin, alco abstinence, frequent small meals with low fat. Surgeru: Pancreaticojejunostomy, wipple procedure.

Question 15

Gastritis vs PUD

Answer 15

Gastritis: inflammation of stomach mucose. non erosive = asymptomativ, erosive: cause bleeding but usually not pain (pain = ulcer). PUD: focal defect in the mucosa that penetrate muscularis mucosa layer results in scarring. Kan be gastric ulcer (DO BIOPSY) or duodenal ulcer (Hunger pain)

Question 16

Etiology of PUD

Answer 16

h. pylori, NSAIS, physiologic stress, ZE syndrome, idiopathic.

Question 17

6 classic features of duodenal PUD

Answer 17

epigastric pain, 1-3 hours after meals, relieved by eating and antacides, interrups sleep, periodicity.

Question 18

Diagnosis

Answer 18

Endoscopy (most accurate), H.pylori test: urea breath test, serology, stool antigen, histolgy = gold standard. Fasting serum gastrin measurment if ZE syndrome suspected.

Question 19

symptoms of pud

Answer 19

Dyspepsia. can present with complications = bleeding, perforation, gastric outlet obstruction.

Question 20

Tripple therapy H pylori

Answer 20

Clarithromycin + amoxicillin + PPI, or clarithromycin + metronidazole + PPi fo 10-14 days

Question 21

Quadruple therapy H pylori: when failed therapies

Answer 21

PPI, bismuth salt + metronidazole + tetracycline

Question 22

Presentation of NSAID induced ulcer

Answer 22

Most present with complications: bleeding perforation, obstruction. Gastric ulcer more common than duodenal ulcer.

Question 23

Stomach cancer: types

Answer 23

intestinal type: 90 %!!! lesser curvature with ulcer with heaped up margins + sister mary joseph nodes. Diffuse type/linitis plastica: NOT associated with H. pylori .

Question 24

RF for Stomach cancer

Answer 24

H. pylori
HNPCC
smoking 
alcohol 
Nitrosamines
Pernicious anemia
polyps
previous partial gastrectomy
blood type A

Question 25

Clinical features of Stomach cancer

Answer 25

suspicion: ulcer failt to heal, lesion on the GREATER curvature. Insicious or late onset of symptoms: postprandial abdominal fullness, vague epigastric pain, anorexia, weight loss. N/V, dyspepsia, dysphagia. Hepatomegaly, epigastric mass. Hematemesis. IDA.

Question 26

Stomach cancer metatasis

Answer 26

lung liver brain, peritoneum

Question 27

Dx Stomach cancer

Answer 27

gastroscopy + biopsy + EUS

chest/abdomen/pelvis CT

Question 28

Tx Stomach cancer

Answer 28

gastrectomy.

Question 29

CRC ethiopathogenesis

Answer 29

Genetic: FAP + HNPCC + FHx

adenomatous polyp: > 1 cm villous, UC. Diet: fat red meat, dec fiber, smoking. Age >50. DM + acromegaly ?

Question 30

CRC clinical

Answer 30

ofen ASYMPTOMATIC. hematochezia/melena, abd pain, change in bowel habits, anemia, weight loss, obstruction, weakness. most CRC are diagnosed at stage 3

Question 31

Diagnosis CRC

Answer 31

colonoscopy + histopathology - other investigations: CBC, urinalysis, liver enzymes, CEA; for staging: CT chest abdomen and pelvis. + Bone scan.

Question 32

TX CRC

Answer 32

surgery + chemo for colon cancer. rectal caner: radio + surgery + chemo(?)

Question 33

Irritable bowel syndrome

Answer 33

Functional bowel disease. > 12 weeks in the past 12 months of abdominal discomfort with 2 of the 3 following: releived by defecation, change in frequency, change in consistency.