Liver (COL >> HCC) Joint Cardio

GI & liver Flashcards by Mishkha Myat

Intussussception

1.Meckel Diverticulum
Rule of 2
2.Infection
3.HSP

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HLA B27

IBD , Ankylosing Spondylitis , RA ,1 Scelrosing Cholangitis, Pyoderma Gran

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Recto-Sigmoid Junction + BPR + Abd Pain + Arthropathy +Fam Hx

IBD ( UC type) - Mucosa only / continuous lesions

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Drugs inducing Kernictus

HEPATIC ENCEPHALOPATHY
Aspirin /sulfa drugs/antibiotics

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If Phototherapy fails ?

Albumin Transfusion + Plasma Exchange

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Charcot Triad

Chonlangitis ( fever + Jaundice + RUQ pain)

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Raynold’s Pentad

Charcot triad+ hypotension + mental alternation ( confusion )

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Murphy Sign

Pain on palpation of RUQ costal area
1.Cholecystitis
2.Gallstone (Choledocholelithiasis) in CBD + GB distension

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Mc Burney Point

Appendicitis
Peritoneal irritation ( Guarding +Rebound )

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HCV test

HCV RNA (PCR) (+ after 1 month approx)
HCV antibody ( + after 3 months )

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Thiamine B1 function

aerobic cellular respiration
Oxidative Decarboxylation ( BCAA)
PPP( NADPH production)

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Thirst + Elevated RBG + bronze skin + elevated Fe+ transferrin

Bronze DM
Hemochromatosis

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Fe deposit organs ?

Liver (COL&raquo_space; HCC)
Joint
Cardio

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Copper deposit organ ( Ceruloplasmin )

Wilson DS
CNS Dominant

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NE Tumors

1.Gastrinoma (most common) ( pancreas and duodenum )
2.Insulinoma ( B cells )

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Gastrinoma asso syndromes

1.ZES ( PU + diarrhea + increase gastrin)
2.MEN-1 (3Ps)&raquo_space; pancreatitis , parathyroid , pituitary Adenomas

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Alcoholic Hepatitis (COL)

AST> ALT

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Congenital anomalies of Mesoderm

VACTERL
Vertebrae anomalies
Anal atresia
Cardiac defects
Tracheo-Esophageal fistula
Renal anomalies
Limb anomalies

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Transudate or Exudate in Ascites

SAAG
> 1.1 ~transudate(Portal HTN)
<1.1 ~ exudate (HRS , Ca)

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GI related SE of Clindamycin

Pseudomembranous Colitis
-C.Difficle
-Hospitalized patient
-fulminant colitis ( asso with Toxic Megacolon)
Rex- Metronidazole

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Posprandial non-bilious projectile vomiting+ lethargy + dehydration + M.alkalosis +olive mass on palpation

Pyloric stenosis

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Child ,
Recent Viral infection + Vomit + altered mental status
Hx of Aspirin Rx

Reye Syndrome
-fetal if not treated promptedly
-Mitochodrial dysfunction
-cerebral Edema
-severe transaminitis
Biopsy : Liver steatosis

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Ileum absorbs

Bile salt + B12
Short bowel syndrome ( if ileum resection )

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Impact on PT/aPTT from bile salt malabsorption

Increase ( Bile - Fat vitamin ADEK )
K important co-factor for CF 2/7/9/10

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What risk if Pernicious Anemia + Type A blood +Gastritis

Gastric Cancer

Most common gastric Ca

Adenocarcinoma Signet ring cell + leather bottle stomach Diffuse infiltration

Krukenberg tumor

Ovary tumor from gastric cancer

Virchow node

Left supraclavicular LN

Sister Mary Joseph node / Irish node

Periumblical /axillary nodes (lymphatic spread)

Ligament of triez

Differentiate between UGIB / LGIB

Subacute combined degeneration of SC + Chron’s + beefy tongue

B12 deficiency ( pernicious Anemia ) Parasthesia + Ataxia

Which hormone inhibit gastric Acid secretion ?

Secretin Somatostatin analogs ( Eg : Octreptides ) inhibits gastrin ,VIP,insulin ,glucagon

Gastric parietal cell receptors

1. Histamine ( Raniditine) 2.PP( omeprazole) 3.Acetylcholine (vagal Input) 4.PGs ( misoprostol ) 5.Gastrin

Xanthelesma Pruritis Scelra icterus Female Abd pain

PBC Associate with autoimmune d/o Anti-mitochondrial Ab Intrahepatic BD obstruction + inflammation

Peyer patches location and importance ?

Ileum ( mucosa - laminate propria) M cells -APC , plasma cell of ileum produce IgA Fight/ Deal w Intraluminal Antigens

Peyer patches location and importance ?

Ileum ( mucosa - laminate propria) M cells -APC , plasma cell of ileum produce IgA Fight/ Deal w Intraluminal Antigens

How to differentiate ?Internal and external hemorrhoids What happen w Portal HTN?

Int: painless ( visceral n) , dilated vein (Sup rectal v>> IMV>>Portal) Ext: painful ( somatic n) ,no dilated vein (Inf rectal >> I iliac > IVC)

Watershed areas Why importance ?

1. Splenic flexture 2. Rectosigmoid junction Vulnerable to Ischemia / obstruction / necrosis

Dual blood supply area ? Importance ?

SMA- IMA IMA- Int iliac a Rare for ischemia

Intermittent int obstruction ( after eating ) Underweight / malnourished Compression of duodenum. Which artery compress?

SMA / Aorta Superior mesenteric $

Compress left renal vein between aorta and SMA Flank pain Hematuria Risk of what urogenital anomalies ? Name of $

Varicocele Nutcracker $

Histology of stomach / esophagus

ESO- stratified squamous ep Stomach - simple columnar

Enteric nervous supply to which part of intestinal layer ?

Auerbach plexus ( Muscularis)

2 type of omentum

Lesser - liver and stomach / faliciform ligaments Greater - greater curvature of stomach below

Ligation of which ligament to stop bleeding or identifying source of bleeding? Why ?

Hepatoduodenal ligament Enclosed portal traid( Hepatic a/ Portal V/ Common bile duct )

Stomach content out surround by amnion and peritoneum Congenital abn Failure of lateral wall to migrate at umbilical ring

Omphalocele

Abd production increase wirhh breathing /crying Newborn. Congenital disorder

Umbilical hernia

Double bubble sign on X ray Cong defect

Duodenal atresia

Olive mass Projectile non-bilious vomiting First born male

Pyloric stenosis

Acute mesenteric Ischemia most common cause

Embolus from thrombus , heart disease

CCK

produce hormones ( FA/ protein digestion ) Pancreas secretion / jejunum /duodenum I cells)

Somatostatin

Inhibitory gastrointestinal hormones Decrease acid/ pancreas secretion / decrease gall bladder contraction Decrease glucagons and insulin

Secretin

Bicarbonates secretion Neutralize acid Duodenum

GIP

Increase insulin Fed state Decrease H+

VIP

Parasympathetic Increase water /E secretion Relax smooth m/s VIP Noma- pancreatic tumor

WDHA $

Watery diarrhea Hypokalemia Achlorhydria

Hunger hormone /fast state /increase appetite

Ghrelin Increase in Prada Willi Decrease after gastric bypass Sx

Motilin

Increase in Fast state Stimulate peristalsis

Warrior from Germany love smoking

Warthin Tumor (salivary glands tumor) Germinal Centre Smokers

Barium swallow -Dilated esophagus Distal stenosis Bird beak Associated ds- Chagus Infection Dx?

Achalasia (fail to relax LES -increase LEX pressure ) Dysphasia of solid /liquid Loss of inhibitory neurons in myentric plexus of eso wall

Budesonide ? MOA ?

Glucocorticoids used in Chron disease Attach to cytosolic receptors bind to heat shock protein ,enter nucleus alter RNA (translocation) - genes modification