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1
Q

Drugs which are hepatic enzyme inducer?

A

Alcohol, Barbaturate, Carbamazepin, Phenytion, Rifampicin, Primidone
Remember by (ABC PPR)

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2
Q

Drugs which are hepatic enzyme inhibitor?

A

Cimetidine, INH, Ketoconazole

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3
Q

Possibility of Drug toxicity should be high in the differential diagnosis of?

A

acute liver failure, jaundice and abnormal liver biochemistry.

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4
Q

the most common picture of hepatotoxic drug reaction is?

A

mixed cholestatic hepatitis

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5
Q

1-causative Drugs of cholestasis?
2-causative drugs of cholestatic hepatitis?
3-of acute hepatitis?
4-of Non-alcoholic steatohepatitis?
5-of Venous outflow obstruction?
6-of fibrosis?

A

1-Chlorpromazin, estrogens
2-NSAIDs, Co-amoxiclav, Statins
3-Rifampicin,Isoniazid
4-Amiodarone
5-Busulfan, Azathioprine
6-methotrexate

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6
Q

Drugs to be avoided in cirrhosis?

A

NSAIDs,Paracetamol,ACE inhibtor, codeine and narcotics, anxiolytics
(Analgesic should be given cautiously)

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7
Q

Histologcal finding of AIH is?

A

Interface hepatitis

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8
Q

The onset of AIH issues

A

Insidious

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9
Q

AIH management?

A

Predniosolone 40mg daily
Azathioprine 1-1.5 mg/day

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10
Q

What is the most common cause of acute parenchymal liver disease?

A

Viral hepatitis

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11
Q

Hepatic drug metabolism, involve the conversion of………………… to …………… metabolite

A

Non-polar
Polar

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12
Q

How long it take for liver function test to return to normal after therapy in drug induced, acute liver injury?

A

Weeks

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13
Q

Ductopenia caused by which drug?

A

Co-amoxiclave

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14
Q

Which Auto-antibodies are elevated in autoimmune hepatitis

A

ASMA,ANA,AMA

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15
Q

What clinical feature is the rule to be found in auto immune hepatitis if general health is good?

A

Amenorrhea

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16
Q

TIPSS is a stent between…………&………… structures

But the tube inserted in?

A

Portal vein (which carries blood from the intestines to the liver), hepatic vein (which carries blood from the liver to the heart).
This connection helps to reduce pressure in the portal vein, which can be caused by conditions such as cirrhosis of the liver or portal vein thrombosis. By reducing this pressure, TIPSS can help to relieve symptoms such as ascites (abdominal swelling), variceal bleeding, and hepatic encephalopathy (a condition that affects brain function).

Jugular vein

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17
Q

What are the precipitating factor of encephalopathy

A

High protein
G.I. bleed
Dehydration
Infection
H. pylori

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18
Q

Histological finding of alcoholic cirrhosis

A

Fibrosis and Micro-nodule regeneration

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19
Q

Histological, finding of a fatty liver, and alcoholic hepatitis

A

Fatty liver= centrilobular fat
Alcoholic hepatitis = Mallory bodies

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20
Q

How prognosis of alcoholic hepatitis measured

A

Maddrey scrore
Discrimination function >32
Glasgow alcoholic>9

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21
Q

What is the histological finding a fulminent hepatic failure?

A

Massive necrosis

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22
Q

Thrombosis of hepatic vein is called…………

A

Budd-chiari syndrome

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23
Q

Features of chronic liver failure

A

Parotid enlargement
Testicular atrophy
Gynecomastia
Spider névé
Palmer erythema

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24
Q

Fulminent hepatic failure is severe hepatic failure with ………

A

encephalopathy

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25
Q

Circulatory changes of cirrhosis causing?

A

Spider telangiectasia, palmer erythema, cyanosis

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26
Q

What are the scores that used for scoring prognosis of cirrhosis

A

The child pugh score
MELD

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27
Q

Coagulopathy of FHF treated with?

A

i.v vit. K, platlet,FFP.
H2 antagonist(or PPI) to prevent G.I bleeding.

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28
Q

Paracetol induced FHF should be treated with

A

N-acetylcysteine even after 10 (but< 36) hours

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29
Q

Is a benzodiazepine receptor antagonist may give a transient improvement of encephalopathy?

A

Flumazenil

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30
Q

Bacteriological sterilization: using what kind of AB

A

broad spectrum- non-absorbable

Neomycin

Metronidazole

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31
Q

Is 7-12cm,30-50ml, distended 300ml?

A

GB

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32
Q

Is +/- 3cm,1-3mm in diameter

A

Cystic duct

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33
Q

Cystic duct nerve supply

A

.Sympathatic via celiac plexus (inhibitory)
Vagus via its hepatic branch (stimulant)

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34
Q

Cystic duct arterial supply

A

Cystic A and hepatic A

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35
Q

Is 1-4mm, 4mm in diameter

A

Commom HD

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36
Q

Is - 7-11 cm, 5-10 mm in diameter depending on the age

A

CBD

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37
Q

in duodenum stimulate CCK which contract
GB & relax BD, Oddi & duod.

A

Acid fat proteins

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38
Q

inhibit GB contraction so treatment with it increase gal stone formation.

A

Somatostatin

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39
Q

Charcot triad and reynold pental found in ……………

A

Cholangitis

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40
Q

Charcot triad:

A

Pain - fever- jaundice

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41
Q

Reynold pental:

A

Pain, fever, jaundice, hypotension(shock), change in mental status

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42
Q

Beading apperance in ERCP found in

A

Sclerosing cholangitis

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43
Q

One important clinical feature of cholidocholithiasis is

A

Obstructive jaundice

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44
Q

Filling defect in ERCP found in

A

Fasciola hepatica

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45
Q

The most commonly used technique in liver transplant is

A

orthotopic
transplantation

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46
Q

About ? Liver transplant are performed for acute liver failure
And for cirrhosis

A

10% acute liver failure
71% cirrhosis

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47
Q

Patients in transplantation should match for

A

Patients are ABO- and size-matched but not HLA-matched with donors.

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48
Q

Indication for Liver transplant in cirrhosis?

A

First episode of Bact. Peritonitis.
Diuretic resist Ascites.
Recurrent variceal hemorrhage.
HCC < 5cm.
Persistent hepatic Encephalopathy.
Bilirubin > 5.8 mg\ dl in PBC.
MELD > 12,Child- Pugh C

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49
Q

Absolute Contraindications in liver transplant

A

1- Active sepsis outside the hepatobiliary system
2- Advanced cardiopulmonary disease or acute -
hemodynamic compromise accompanied by compromise or failure of one or more of the vital organs .
3- Presence of malignancy; metastatic or extrahepatic
4- Active alcohol or drug abuse
5- AIDS

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50
Q

Relative Contraindications in liver transplant

A

1- Age great than 72 years
2- Portal vein thrombosis with mesenteric vein
thrombosis
3- Extrahepatic cholangiocarcinoma
4- HIV positivity

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51
Q

is a common infection in the first 3
months after transplantation and can cause hepatitis.

A

Cytomegalovirus

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52
Q

The outcome LT for acute liver
failure is ? than that for chronic liver

A

worse

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53
Q

Nondirected donors are also referred to as

A

altruistic donor

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54
Q

Relaxation of the LES occurs when

A

vagal efferent
impulses activate myenteric neurons that release non-
adrenergic, non-cholinergic neurotransmitters,
predominantly nitric oxide (NO), and vasoactive intestinal
polypeptide (VIP).

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55
Q

In ? locates the site
of symptoms specifically to the region of the cervical
esophagu

A

Oropharyngeal dysphagia

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56
Q

In ? Most patients localize the symptom to the lower
sternum, or at times the epigastrium

A

Esophageal dysphagia

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57
Q

Three important questions should be asked in Esophageal dysphagia

A

• 1. is the dysphagia for solid or liquid or both?
• 2. is it intermittent or progressive?
• 3. Does the patient have heartburn?

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58
Q

Patients who report dysphagia with solids and
liquids are more likely to have

A

an esophageal
motility disorder than mechanical obstruction.

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59
Q

In ? pts may complain of
chest pain and sensitivity to hot or cold liquids.

A

Diffuse esophageal spasm

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60
Q

Episodic and non-progressive dysphagia without
weight loss is characteristic of

A

an esophageal
web or a distal esophageal (Schatzki) ring.
*Daily dysphagia is likely not caused by a lower
esophageal ring

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61
Q

characterized by esophageal aperistalsis and
impaired relaxation of the lower esophageal
sphincter and Long history of intermittent dysphagia

A

Achalasia

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62
Q

? Is achalasia complication

A

aspiration pneumonia

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63
Q

bird-beak’ appearance is feature of?

A

Achalasia

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64
Q

produce retrosternal chest pain and dysphagia. It
can accompany GERD. Swallowing is
accompanied by bizarre and marked contractions
of the esophagus without normal peristalsis.
*On barium swallow, the appearance may be that
of a ‘corkscrew’ esophagus

A

Diffuse esophageal spasm

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65
Q

Anti-reflux mechanisms

A
  1. LES tone
    • 2. intraabdominal segment of esophagus which acts as a
    flap valve
    • 3. crural diaphragm (a hiatus hernia can impair this
    mechanism)
    • 4. secondary peristalsis of esophagus
    • 5. swallowed saliva with its bicarbonate content
    • 6. gravity
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66
Q

Extra-esophageal features of GERD

A

• Asthma
• Chronic cough
• Excess mucus or phlegm
• Globus sensation
• Hoarseness
• Laryngitis
• Pulmonary fibrosis
• Sore throat

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67
Q

Regurgiatation: of food and acid into the mouth occurs,
particularly on bending or lying flat. This can lead to excess
salivation in the mouth, commonly known as

A

water-brash

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68
Q

Correlation between esophagitis and heartburn is

A

Poor

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69
Q

Water-brash occur due to

A

Regurgitation of the foot and acid into the mouth occur, particularly on bending of lying flat. This can lead to excess salivation in the mouth commonly known as water brush.

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70
Q

Alarming features that need OGD

A

Weight loss, dysphagia, bleeding, anemia and mass

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71
Q

Complication of GERD

A

Stricture
Barrett esophagus

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72
Q

Barrett esophagus almost always associated with

A

Haitus hernia

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73
Q

Treatment of barrett esophagus

A

Radio-frequency ablation

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74
Q

These are the most common benign liver tumours, %5

A

HAEMANGIOMAS

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75
Q

These are rare vascular tumours present as an abdominal mass, or with abdominal pain
or intraperitoneal bleeding.

A

HEPATIC ADENOMAS

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76
Q

Is useful for unresectable HCC.

A

Sorafenib

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77
Q

Normal billirubin

A

0.3 – 1.2 mg/dL

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78
Q

approximately ? bilirubin is produced daily in normal adults.

A

250-300 mg

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79
Q

Conjugation of bilirubin with glucoronic acid takes
place in liver by

A

uridine-glucoronyltransferase
(UGT)

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80
Q

It is typically inherited as an autosomal recessive gene,
but occasionally as an autosomal dominant.
Patients have
low levels of UGT enzyme in their livers.
Incidence: 3-10% of total population. Male : female = 8:1

A

Gilbert’s disease

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81
Q

This is a hereditary conjugated hyperbilirubinemia, that
results from defective hepatic excretion of bilirubin

A

Dubin-Johnson syndrome (DJS)

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82
Q

Is autosomal recessive disease and is a rare cause of
mixed type (conjugated and unconjugated) of
hyperbilirubinemia

A

Rotor syndrome

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83
Q

ALT/AST and serum albumin in hepatocellular jaundice

A

ALT/AST ↑↑↑ in acute, and ↑/↔ in chronic,
serum albumin normal in acute but ↓ in chronic.
INR may be prolonged in both
acute and chronic therefore of no use for differentiation

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84
Q

ALT/ALP
>5,2-5,<2

A

• If the ALT/ALP: ˃ 5 indicates a parenchymal liver
disease
• If < 2 indicates a cholestatic liver disease
• If 2-5 indicates a mixed type liver disease

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85
Q

If SAAG is ≥ 1.1 →?
If SAAG < 1.1 → ??

A

portal hypertension
Not portal hypertension

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86
Q

Most common liver abscess symptom?

A

Abdominal pain is the most common symptom,usually in the right hypochondrium, radiate to the right shoulder. The pain may be pleuritic in nature.

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87
Q

Melena happen due to?

A

digestion of blood by gastric HCL, enzymes & bacteria .
Less commonly, melaena may be the result of bleeding from the right colon in cases of slow intestinal transit.

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88
Q

is a pre-endoscopic risk assessment tool for patients presenting with upper gastrointestinal haemorrhage (UGIH). It can predict need for intervention or death and identifies low risk patients suitable for out-patient management

A

Glasgow-Blatchford score

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89
Q

vEGD within 12 hours is generally recommended only for patients with suspected

A

variceal bleeding

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90
Q

The main risk of capsule endoscopy is capsule retention that can occur in up to 1.5%, Patients at high risk for capsule retention are those with?

A

heavy NSAID use, tumors, Crohn disease, prior small bowel radiation, or surgery.

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91
Q

Triple therapy treatment for ? can prevent recurrent ulcers and bleeds

A

Helicobacter pylori

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92
Q

Bleeding peptic ulcer which commonly associated with ingestion of NSAID, ? Is the major source of bleeding

A

Gastroduodenal artery ( GDA)

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93
Q

It is partial-thickness tears of the mucosa and submucosa that occur near the
gastroesophageal junction. Classically, it develop in alcoholic patients

A

Mallory–Weiss tear

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94
Q

watermelon stomach,” is named for
the dilated, tortuous mucosal capillaries and veins in the gastric antrum

A

Gast ric Antral Vascular Ectasia

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95
Q

most common site for variceal bleeding.

A

Lower oesophagus

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96
Q

Colonic bleeding cause of LGIB

A

1-Diverticulosis 30%
2-Colitis 24%
3-Hemorrhoids 14%
4-Ischemic 12%
5-IBD %9

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97
Q

Is ascending bacterial infection in associated partial or complete obstruction of BD.

A

Cholangitis

98
Q

Charcots triad?

A

Charcots triad (pain,fever,jaundice)
If progress rapidly causing septicemia known as
Reynolds pental (pain, fever, jaundice, shock, mental state changes)

99
Q

Single or multiple stones in CBD

A

choledocholithiasis

100
Q

Uncommon inflammatory stricture of extra-& intrahepatic biliary tree and may involve GB & pancreas

A

Sclerosing cholangitis

101
Q

Grey turner sign of flanks and cullen sign of umblicus are sign of

A

Severe pancreatitis

102
Q

Ranson and glascow scoring used in assessment of severity of

A

Pancreatitis

103
Q

How severity of pancreatitis measured?

A

Ranson and Glasgow

104
Q

Causes of acute pancreatitis?

A

I GET SMASHED

105
Q

Which auto-antibody found in autoimmune chronic pancreatitis?

A

IgG4

106
Q

One mechanical cause of bowl obstruction

A

Volvulus

107
Q

What is borchardt triad?

A

Stomach volvulus has three features ( abdominal pain, nausea, inability to pass NG tube) this called borchardt triad

108
Q

Volvulus of small intestine is around which artery

A

Superior mesenteric artery

109
Q

Ddx of small intestine(mid gut) volvulus

A

Pyloric stenosis

110
Q

Are risk for the development of CD but protective for UC

A

Smoking and appendisectomy

111
Q

Common site for UC
Common site for CD

A

Rectum
Terminal ileum

112
Q

Patches of inflammation is common in

A

Crohn disease

113
Q

Ulcers in the inner lining of abdomen
Transmural ulcers

A

Ulcerative colitis
Crohn disease

114
Q

Abdominal distention, hypoactive bowel sound and rebound tenderness suggest

A

Fulminant colitis,perforation,toxic megacolon

115
Q

Histology in UC shows

A

Crypt architecture with shortened,branched crypts,inflammation of lamina propria

116
Q

Aphthous ulcers and granuloma are feature of

A

Crohn disease

117
Q

Fistula and perianal disease and granuloma are common in

A

Crohn disease

118
Q

• 1 .InflammatoryBowel disease includes:
• A.lschemic colitis.
• B.Infectious colitis.
C ) diopathic inflammattory colitis.
• D.Radiationcolitis.
• E.Behcet-associatedcolitis.

A

C

119
Q

The following are inflammatory Bowel disease except:
A.Ulcerativecolitis. B.Crohnsdisease.
C.Intdermined colitis.
D,TB-induced colitis. E.Microscopiccolitis.

A

D

120
Q

3.Theleast common sub type of IBDis:
A.Ulcerative colitis.
B.Crohnsdisease.
C.Intdermined colitis.
D.Collagenous colitis. E.Lymphocyticcolitis.

A

D

121
Q

4.Hematochesia is more common with:
A.ulcerative colitis. B.Crohnsdisease.
C .Bothabove.
D.Collagenouscolitis. E.Lymphocyticcolitis.

A

A

122
Q

5.Skipped lesions are more characteristic of:
A.Ulcerative colitis.
B)Crohns disease.
C .Bothabove.
D.Collagenouscolitis. E.Lymphocyticcolitis.

A

B

123
Q

6.Transmural colonic involvement is characteristic of:
A.Ulcerative colitis.
B.Crohns disease.
C.Bothabove.
D.Collagenouscolitis. E.Lymphocyticcolitis

A

B

124
Q

7.Granuloma in histology is characteristic of:
• A.Ulcerative colitis.
• B.Crohns disease.
• C.Bothabove.
• D.Collagenouscolitis.
• E.Lymphocyticcolitis.

A

B

125
Q

8.Extra intestinal features are characteristic of:
A-Ulcerative colitis. B.Crohnsdisease.
C.Bothabove.
D.Collagenous colitis.
E.Lymphocytic colitis.

A

A

126
Q

10.Patients with long-sanding IBD require the following long-term interventions except:
A.CRCsurveillance.
B .Nutritionalsupport.
C .Killedvaccine.
D;Attenuated vaccines. E.TBscreen.

A

D

127
Q

14.patients with long-standing active extensive disease should start surveillance
colonoscopy after howmany years:
A .15.
B .5 .
C .7 .
D .20.
E.8

A

E

128
Q

• 15important differential diagnosis of Microscopic colitis include:
A .UC.
B .IBS.
C.Celiac disease.
D.Crohns disease.
E .B,C,D .

A

E

129
Q

16.Common extra-intestinal features of IBD involves the following organs except:
A .Skin.
B .Eve.
C.Hepatobiliarysystem.
D.heart.
E.Joints

A

D

130
Q

Aggressive factors for peptic ulcer are

A

Aggressive factors,
such
a ms NSAIDs, H pylori infection, alcohol, bile salts, acid, and pepsin

131
Q

Happen more in males and relived by eating
*type of peptic ulcer

A

Duodenal ulcer

132
Q

Happen more in female and aggravate by eating
*type of peptic ulcer

A

Gastric ulcer

133
Q

Most common organic causes of dyspepsia are

A

Peptic ulcer
GERD
Gastric cancer
Medications(NSAIDs)

134
Q

H.pylori treatment

A

Lansoprazole 30mg/d
Clarithromycin 500mg/day
Amoxicillin(metronidazole)1000mg/day

For 7 days

135
Q

Bariatric surgery is the branch of surgery involving manip-
ulation of the stomach and/or small bowel to aid weight loss. Severe and complex obesity is a phrase commonly used for
patients with ?

A

body mass index (BMI) “35 and obesity-related disease, or BMI “40 by itself

136
Q

The main cause of death after bariatric surgery is now

A

DVT/PE

137
Q

minor salivary gland tumours are more likely to be

A

Malignant

138
Q

Several major structures enter and pass through or pass just deep to the parotid gland. These include

A
  1. The facial nerve [VII].
  2. The external carotid artery and its branches.
  3. The retromandibular vein and its tributaries.
139
Q

exits the skull from the stylomastoid foramen

A

Facial nerve

140
Q

The five terminal groups of branches of the facial nerve [VII] are

A
  1. Temporal,
  2. Zygomatic,
  3. Buccal,
  4. Marginal mandibular,
  5. Cervical
141
Q

is the most common VIRAL cause of acute painful parotid swelling and predominantly affects children.
It is spread via airborne droplets of infected saliva.

A

Mumps

142
Q

Acute ascending ? is described in dehydrated elderly patients following major surgery.

A

bacterial sialadenitis

143
Q

More commonly acute bacterial parotitis associated with a

A

salivary calculus

144
Q

It is characterised by rapid swelling of one or both parotid glands, in which the symptoms are made worse by chewing and eating.

A

Recurrent parotitis of childhood

145
Q

are common in the parotid gland and are responsible for about 20% of obstructive cases.

A

Stricture

146
Q

is the most common site for salivary tumours

A

Parotid gland

147
Q

Among primary parotid malignant tumours, ? is the most common, followed by?

A

mucoepidermoid carcinoma
adenocystic carcinoma.

148
Q

are paired salivary glands that lie below the mandible on either side.

A

The submandibular glands

149
Q

The most common cause of obstruction within the submandibular gland is

2nd is ?

A

stone formation
Stricture

150
Q

Three cranial nerves (CNs) are at risk during removal of the submandibular gland

A

1 the marginal mandibular branch of the facial nerve;
2 the lingual nerve;
3 the hypoglossal nerve.

151
Q

The most common malignant tumour in submandibular gland is

A
152
Q

is an autoimmune condition causing progressive destruction of salivary and lacrimal glands

A

Sjögren’s syndrome

153
Q

refers to the sensation of oral dryness, which can result from diminished saliva production

A

Xerostomia

154
Q

is the unintentional loss of saliva from the mouth

A

Drooling (Sialorrhoea)

155
Q

are the second largest salivary gland

A

The submandibular glands

156
Q

Parotid duct is called

A

Stensen

157
Q

Parotid duct opens in………

A

Buccal mucosa next to 2nd maxillary molar

158
Q

Symptoms of viral infection of parotid gland by mump need ……… days to appear and ……… to resolve

A

1-2,
5-10

159
Q

Most common organism cause bacterial infection of parotid gland are ………………&…………

A

Streptococcal + staphylococcus

160
Q

Bacterial infection of the parotid gland most commonly effect…………. Pole of the gland

A

Lower

161
Q

The characteristic feature that is similar to snowstorm in recurrent parotitis of childhood is called

A

Punctate sialectasis

162
Q

Parotid stones are …………on radiographs

A

Radiolucent

163
Q

The submandibular duct called

A

Whartons duct

164
Q

Malabsorption hallmark is

A

Steatorrhea

165
Q

In luminal phase the problem maybe ? which is happened by Pancreatic enzymes insufficiency

A

impaired nutrient hydrolysis

166
Q

Gastric cancer is ………… most common type of cancer

A

5th

167
Q

Gastric cancer is more common in people with…………… blood group.

A

A

168
Q

is the most common form of disaccharidase deficiency

A

Lactase deficiency

169
Q

Most common immunoglobulin deficiency is

A

IgA deficiency

170
Q

is an autosomal recessive disease with selective inability to absorb zinc, leading to villous atrophy and acral dermatitis.

A

Acrodermatitis enteropathica

171
Q

Painful, bloody, small-volume diarrhea is known as

A

Dysentery

172
Q

Gold standard test for steatorrhea is

A

72hours stool fat collection
>6gm/day is pathological
>20gm/day is steatorrhea

173
Q

What is schilling test

A

A test used to determine the cause of (B12)malabsorption

174
Q

used to asses proximal s.gut mucosal function.

A

D-xylose test

175
Q

Pathological findings of celiac disease is

A

Short or absent villi, MNC infiltration,crypt hypertrophy, Epithelial cell damage.

176
Q

is an immune-mediated dis. That primarily affects the s. gut in response to dietary GLUTEN and only in those who are genetically predisposed.

A

Celiac disease

177
Q

The genetic factors of celiac disease are

A

HLA DQ2 or DQ8 as well as non HLA genes

178
Q

Most common symptom of celiac disease is

A

Diarrhea

179
Q

The extra features of celiac disease are

A

Arthritis
Alopecia
Hyposplenism
Osteoporosis
Epilepsy
Recurrent abortion
Depression
Infertility
Polyneuropathy
Elevated liver enzyme

180
Q

A systematic disease cause by tropheryma whipplie and occurs mainly in farmers and associated with HLA-B27

A

Whipple disease

181
Q

Whipple disease treatment

A

Ceftriaxone or meropenium

Sulphmethaxaze and trimethoprim o prevent relapse

182
Q

It is a GI condition that affects the s. gut and causes MA. The exact cause is un- known & likely infectious in nature . It occurs in inhabitants of trop. areas OR who have traveled to trop. areas

A

TROPICAL SPRUE

183
Q

TROPICAL SPRUE treatment

A

Vit B12 and folate
Tetracycline

184
Q

is the inability to absorb lactose, caused by lactase deficiency. in which you have digestive symptoms—such as bloating, diarrhea, and gas

A

Lactose intolerance

185
Q

Appedix surgical incision types are

A

Grid iron
Lanz
Paramedian
Rutherford

186
Q

Blumberg sign is

A

Rebound tenderness in appendicitis

187
Q

Pelvic abscess present with ……………die to irritation of sigmoid colon

A

Diarrhea

188
Q

A type of Minimal access surgery where there is no requirement for gas insufflation as the operating space is held open by the rigidity of the thoracic cavity.

A

Thoracoscopy

189
Q

Flexible or rigid endoscopes are introduced into hollow organs or systems, such as the urinary tract, upper or lower gastrointestinal tract, and respiratory and vascular systems

A

Endoluminal endoscopy

190
Q

Advantages of minimal access surgery

A

— Decrease in wound size — Reduction in wound infection, dehiscence, bleeding, herniation and nerve entrapment —
Decrease in wound pain — Improved mobility —
Decreased wound trauma — Decreased heat loss —
Improved vision

191
Q

Limitations of minimal access surgery

A

— Reliance on remote vision —
Loss of tactile feedback — Dependence on hand–eye coordination —
Difficulty with haemostasis — Reliance on new techniques — Extraction of large specimens

192
Q

Minimal access surgery contraindications

A

— Compromised cardiac status — Peritonitis —
Multiple Abdominal Surgeries — Bleeding Disorders —
Morbid Obesity —
Third Trimester Pregnancy — Portal Hypertension

193
Q

Why using co2 in MIS

A

Because it’s
Cheap-available-easily absorbed-released via respiration-highly diffusion coefficient

194
Q

Cells invade basement membrane using

A

collagenases and hydrolases
Invasive cancer

clumped chromatin, have not invaded basement membrane

195
Q

Most common gi cancer

A

Colorectal 3rd
Gastric 5th
Liver 6th
Esophagus 8th
Pancreas 12th

196
Q

Most mortality in gi cancers

A

Colorctal 2nd
Liver 3rd
Stomach 4th
Esophagus 6th
Pancreas 7th

197
Q

The esophagus disease like diverticula, acalasia and gerd are causing which type of esophagealcancer?

A

Gerd and diverticula causing adenocarcinoma(M 15=1 F)
Acalasia causing squamous carcinoma (M 3=1 F)

198
Q

The classic finding of an apple core lesion is

A

in patients with esophageal cancer

199
Q

The diagnosis of esophageal cancer is best made from

A

an endoscopic biopsy

200
Q

is the most critical component of esophageal cancer staging

A

Endoscopic ultrasound

201
Q

of the chest and abdomen is important to assess the length of the tumor, thickness of the esophagus and stomach
Also may identify fistula

A

CT scan

202
Q

Male to female ratio of gastric cancer

A

M 1.8 = 1 F

203
Q

is the most common predisposing condition for CCA in developed countries, with the lifetime incidence ranging 5–10%.

A

Primary sclerosing cholangitis

204
Q

What is saint traid

A

Gall stone hiatus hernia colon diverticulosis

205
Q

Gallstones Classified by their cholesterol content

According to its chemical composition

A

Cholesterol stones
Pigment stones

1-Cholesterol
2-Mixed stones
3-Pigments stones

206
Q

Pain at Rt.UQ, epigastric area, back, interscapular area or to chest -A, N, V, febrile, reluctant to move and murphy sign is positive

A

Acute cholecystitis

207
Q

Duo to obstruction of cystic duct causing GB distention& increasing tension

A

Chronic cholecystitis

208
Q

is the most common acute abdominal disorder encountered in daily practice. It occurs in 7– 12% of the population; peak incidence is in the second to third decade of life

A

Acute appendicitis

209
Q

The most prevalent theory regarding etiology of acute appendicitis is

A

appendiceal luminal obstruction

210
Q

Vomiting after pain is common in

A

acute appendicitis

211
Q

The most common flora associated with appendicitis are

A

Gram-negative aerobic and anaerobic enteric flora

212
Q

1-Palpation in the RLQ elicits tenderness ()
2-palpation in the LLQ elicits pain in the RLQ
3-Hyperextension of the flexed right extremity when in the left lateral decubitus position elicits right-sided pain
4-Medial and lateral rotation of the thigh elicits hypogastric pain
5-Rebound tenderness after pressing and taking the hand away from right iliac fossa

A

1-McBurney’s sign
2- rovsing sing
3-iliopsoas sign
4-obturator sign
5-Blumberg’s (release) sign

213
Q

Free perforation leads to

contained perforation may lead to

A

generalized peritonitis
phlegmon and/or abscess.

214
Q

pain arises in cases of pelvic appendicitis

pain arises in cases of retrocecal appendicitis

A

Cope’s obturator test

Psoas test and baldwing test

215
Q

score is a clinical scoring system used in the diagnosis of appendicitis

A

The Alvarado
MANTRELS ;
Migration to the right iliac fossa Anorexia Nausea Vomiting Tenderness in the right iliac fossa (2)
Rebound pain
Elevated temperature(fever) Leukocytosis (2)
Shift of leukocytes to the left

216
Q

sudden severe central colicky pain ,central distention and early vomiting with late constipation (usually small bowel )

A

Acute onset of IO

217
Q

lower abd.pain with constipation followed by distention of long duration (usually large bowel ).

A

Chronic presentation of IO

218
Q

Most common cause of IO

A

Adhesion
Hernia
Tumor

219
Q

Gas in the intestine is duo to

A
  1. Swallowed air
  2. Bacterial over growth
  3. Diffusion from blood
220
Q

Fluids in intestine come from

A
  1. Ingested fluids
  2. Saliva 500 mL
  3. Gastric 1000 mL and intestinal juice
  4. Bile 500 mL and pancreatic secretion 500 mL
221
Q

Clinical pictures of strangulation

A

Colicky pain changed to constant and severe.
An increase in serum potassium, amylase or LDH
leucocytosis or leucopenia.
Fever
Tenderness with rigidity peritonism
Shock

222
Q

Postoperative adhesions giving rise to intestinal obstruction usually involve and almost never ?.

A

the lower small bowel
involve the large bowel.

223
Q

This occurs when one portion of the gut invaginates into an immediately adjacent segment; almost invariably, it is the proximal into the distal.

A

Acute intussusception

224
Q

An intussusception is composed of three parts

A

● the entering or inner tube (intussusceptum);
● the returning or middle tube;
● the sheath or outer tube (intussuscipiens).

225
Q

firm mass of undigested hair ball
firm mass of fruit or vegetable
They’re cause of bolus obstruction as well as?

A

trichobezoar
phytobezoar

Food,gallstones,stercolith,worm

226
Q

Late manifestations of intestinal obstruction include

A

Dehydration: dry tongue and skin ,sunken eyes and poor venous filling
Oliguria,
Hypovolemic shock
Pyrexia,
Septicemia,
Respiratory embarrassment
Peritonism

227
Q

The pain of IO
In small bowel is
In large bowel is
In strangulation is
In paralaytic ileus

A

is central and colicky
is dull and peripheral or lower abdomen
is continuous and severe
is absent

228
Q

Time of onset of vomiting
Early,Late,Delayed and absent

Nature of vomitus
Clear,bilious,feculent

A

high small bowel obstruction
low small bowel obstruction
large bowel obstruction

Clear gastric :pyloric obstruction Bilious: high small bowel obstruction Feculent: low small bowel obstruction

229
Q

Absolute constipation is a cardinal feature of

A

complete intestinal obstruction

230
Q

Intractable diarrhoea with impaired absorption of nutrients following resection or bypass of the small intestine, ultimately leading to progressive malnutrition, is referred to as

A

Short bowel syndrome (SBS)

231
Q

skin condition that causes a dark discoloration in body folds and crease

A

Arcanthosis nigrans

232
Q

Features of short bowel syndrome usually appear when there is less than ? of small bowel

Norma length?

A

200 cm

The small intestine of the neonate is about 250 cm in length, 750 cm in
adult

233
Q

Most common cause of SBS

A

Crohn disease

234
Q

Manifestations of SBS

A

Malabsorption
Diarrhoea
Steatorrhea
Fluid and electrolyte disturbance
Cholelithiasis
Bone disease
Gastric acid hypersecrtion
Liver disease

235
Q

greatest proportion of digestive enzymes are
concentrated in

A

villi of jejunum

236
Q

Loss of physiological GI feedback mechanisms –result in

A

rapid gastric emptying

237
Q

Loss of ileocecal valve

A

Small bowel dilation and slower motility
Increased risk of bacterial overgrowth

238
Q

occurs 24-48 hrs after massive bowel resection.

The adaptation phase generally begins 2-4 days after bowel resection and may last up to 12-18months
•During this phase ,up to 90% of the bowel adaptation may occur.

A

Acute phase

Adaptation phase

239
Q

Lesion in lining of mucosa of the gi tract by action of pepsin and gastric acid

A

Peptic ulcer

240
Q

Lead pipe sign on barium enema is indicative of

A

Ulcerative collitis

241
Q

are used to reduce the amount of acid produced by the stomach.

A

PPI

242
Q

Which one is more common duodenal ulcer or gastric ulcer

A

duodenal ulcer
And also it’s never malignant so no need for biopsy

GIT (1 decks)

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