GIT Flashcards

1
Q

Idiopathic loss of the normal neural structure of the lower esophageal sphincter resulting in the inability to relax.

A

Achalasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Features of Achalasia

A

dysphagia, regurgitation, weight loss, no relationship with alcohol or smoking, maybe hx of recurrent URTIs or aspiration pneumonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Investigations used for Achalasia

A

Barium Swallow and Manometric Studies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Which one is the most accurate investigation for Achalasia

A

Manometric Studies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the significant finding in the Barium Swallow for Achalasia?

A

Sigmoid esophagus or the “parrot’s beak”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

2 Management use for Achalasia

A

Heller’s Operation (myotomy) and Injection of Botulinum toxin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

It is an intermittern chest pain with dysphagia and can be precipitated by cold liquids. Pain can stimulate that of the MI, but has no relation to exertion. Relieved after the ingestion of nitrates.

A

Esophageal Spasm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the 2 investigations used for Esophageal Spasm

A

Manometric Study and Barium meal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Which among the 2 investigations for the esophageal spasm is the most accurate?

A

Manometric Studies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the significant finding you can find in Barium meal for Esophageal Spasm

A

Corkscrew pattern

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the treatment for Esophageal Spasm

A

Ca Channel blockers: Nifedipine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Dysphagia (painless/intermittent) + IDA + Post Cricoid Esophageal web

A

Plummer Vinson

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the management for the Plummer Vinson

A

Iron Supplement and Dilation of the web

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

It is associated with esophageal carcinoma. There is occasional dysphagia. It results from the long history of GERD. From sq. ep to columnar ep

A

Barret’s esophagus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

IDA + Esophageal Web

A

Plummer Vinson

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

painful dysphagia

A

Ulcers and esophageal candidiasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

dyspjhagia + regurgitation

A

Achalasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Hx of halitosis
Regurgitation of Stale food and a throat lump
Endoscopy should be avoided for fear of perforation
Barium swallow may show a residual pool of contrast within the pouch

A

Pharyngeal Pouch (Zenker’s Diverticulum)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

A long hx of GERD
Occasional Dysphagia not persistent

A

Barrett’s Esophagus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Symptoms of cancer

A

Esophageal Carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Dysphagia to both solids and liquids without regurgitation
Results from scarring due to:
Acid refulx
Persistent GERD (retrosternal discomfort
Ingestion of corrosives

A

Benign Esophageal Stricture
(Peptic Stricture)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the medications for theBenign Esophageal Stricture
(Peptic Stricture)?

A

Biphosphonates (Alendronate)
NSAIDS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Biphosphonates are used to treat Osteoporosis but long term use can cause this resulting in a stricture.

A

Esophagitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the most common esophageal cancer?

A

Adenocarcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Which part of the esophagus is the esophageal ca commonly located?

A

lower third

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Esophageal ca is more likely to devellop in pxs with hx of ___ and ____

A

GERD
Barret’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the least common type of esophageal ca and which part of the esophagus does it affect?

A

Squamous cell type, upper 2/3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are the RIsk Factors for Esophageal ca?

A

SAP - BAG
Smoking
Alcohol
Plummer Vinson

Barret’s
Achalasia
GERD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are the 2 diagnostic tool for the esophageal ca? and which one is the first line?

A

Upper GI Endoscopy and biopsy- 1st line
Barium Swallow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What can you find in the Barium Swallow that is diagnostic for Esophageal ca?

A

Rat Tail appearance
Apple core appearance
Shouldering

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Anemia
Loss of weight
Anorexia
Recent onset of progressive symptoms
Masses, melena or hematemesis
Swallowing difficulty

These are the red flags for ?

A

Dypepsia and H Pylori

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is the management for dyspepsia and H Pylori, with patients >55 yo?

A

Endoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Patient with no red flags, <55yo, serum Positive for H Pylori, negative urea breath test, What is the next best management?

A

Upper GI Endoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What are the treatments for H pylori eradication?

A

PPIs
Clarithromycin
Amoxicillin or Metronidazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

How is the H. Pylori antibody tested?

A

Carbon 13 Urea Breath Test
Stool Antigen Test
Serum Antibody Testing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

if the patient is taking PPIS, it should be stop for how many days prior to performing urea breath test or stool antigen test?

A

14 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

How many days should there have a break after the eradication with antibiotics prior to testing?

A

28 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Dilated sub-mucosal veins in the lower 1/3 of the esophagus
Often severe and life-threatening
Hx of chronic liver disease - portal hypertension ->

A

Esophageal varices

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What are the features of Esophageal varices

A

Hematemesis and melena
Signs of chronic liver disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Investigative tool for Esophageal varices at an early stage

A

Endoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Acute management of variceal bleeding?

A

ABC,
Clotting - FFP and Vit K
TIPSS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Acute management of variceal bleeding that is offered to patients with suspected variceal bleeding at presentation

A

Terlipressin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Acute management of variceal bleeding that reduces mortality in patients with upper GI bleeding in association with the chronic liver disease

A

Antibiotic Prophylaxis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Acute management of variceal bleeding, if the endoscopic variceal band ligation is not available

A

Sclerotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Acute management of variceal bleeding, if there is uncontrolled hemorrhage

A

Sengstaken-Blakemore tube

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What is the prophylaxis of variceal hemorrhage given at discharge to reduce the portal pressure in order to decrease the risk of repeat bleeding

A

Propanolol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Severe sudden localized epigastric pain
May worsen with coughing or moving
May radiate to the shoulder tip

A

Perforated Peptic Ulcer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What are the investigative tools for the Perforated Peptic Ulcer?

A

Erect X ray
CT Scan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What are the examination features of a Perforated Peptic Ulcer?

A

Absent bowel sounds
Shock
Generalized Peritonitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What are the management for the Perforated Peptic Ulcer

A

IV analgesics
Antiemetic (Metoclopramide 10mg)
Resuscitate with IV 0.9% Saline
Iv Antibiotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

For bleeding peptic ulcer without perforation

A

Endoscopy or IV PPIs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Bowel disease that forms ulcer in the
colon and rectum only

A

Ulcerative Colitis - Lt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Bowel disease that forms anywhere in the GIT mostly in the
ileum and colon

A

Crohn’s Disease - Rt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

BD, that only affects the mucosa and the submucosa

A

Ulcerative Colitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

BD that extends to the serosa

A

Crohn’s Disease - Rt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

BD that is autoimmune and bloody diarrhea is more prominent

A

Ulcerative Colitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

BD where weight loss is more prominent
then there is steatorrhea (fats in the poop)

A

Crohn’s disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

BD , Pain in LLQ (rectum)
LI: Bloody diarrhea more common

A

Ulcerative Colitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

BD , Pain in RLQ (rectum)
LI: Bloody diarrhea not bloody
SI: Malabsorption

A

Crohn’s disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Transmural/deep ulcers
Skip lesions (cobblestone appearance)
on endoscopy
Peri-anal fistulas
Kantor-s string sign
Rose thorn ulcers

A

Crohn’s disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Circumferential, Continuous, Crypt Abscesses, 1ry sclerosing cholangitis
Aphtous oral ulcers

A

Ulcerative Colitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Colonoscopy
Barium enema (loss of haustration, drain pipe colon)
CT/MRI
Decreased goblet cells on histology
In children -> P-ANCA positive

A

Ulcerative Colitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Barium swallow
CT
Increased goblet cells + Granuloma on histology

A

Crohn’s disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Treatment for inducing remission in Ulcerative Colitis

A

1st line - Topical Aminosalicylates
eg Rectal Mesalazine

If not responding - Oral Mesalazine (5-ASA)

Still not responding or motions 5/day - PREDNISOLONE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Treatment for inducing remission in Crohn’s disease

A

1st line - PREDNISOLONE
2nd line - BUDESONIDE
3rd line - MESALAZINE (5-ASA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Treatment for severe colitis in children with
1. > 6 bowel movements
2. Visible blood in a large amount
3. pyrexia >37.8 C
4. Tachycardia
5. Anemic
6. ESR > 30

A

IV steroids, INFLIXIMAB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What is the treatment for Crohn’s disease for maintaining remission after surgery?

A

1st line - AZATHIOPRINE, MERCAPTOPURINE or 5-ASA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

IN severe cases, this tool would be appropriate in the setting to look for features suggestive of toxic megacolon

A

ABDOMINAL EXRAY

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

What is the treatment for Ulcerative Colitis for maintaining remission?

A

Mesalazine

If not well maintained -> Oral Azathioprine or Mercaptopurine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

IBD or infective colitis characterized by total or segmental non-obstructive colonic dilatation + systemic toxicity

Presentation:
Severe Abdominal Pain
Marked toxicity (weakness, lethargy, confusion)

A

Toxic Megacolon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

What is the diagnostic tool for the toxic megacolon?

A

Abdominal Xray

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

What is the management of the Toxic Megacolon?

A

Admission to ITU, IV fluids
IV steroids in case of IBD
IV antibiotics in case of infectious cases
Possible surgical resection (high risk of perforation and death)
If a rupture colon is suspected - Urgent laparotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Gastrinoma (tumours found in pancreas or duodenum) -> secretes gastrin - increase gastric acid - peptic ulcers at usual sites, such as 2nd part of duodenum or jejunum

Ulcers may occur after adequate surgery

A

Zollinger Ellison

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

What are the investigations used for Zollinger Ellison?

A

Fasting Gastrin levels
Secretin Stimulation test (gastrin goes up after secretin in case of Gastrinoma)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

ZES is suspected when

A
  1. Multiple ulcers that are resistant to drugs
  2. Associated with diarrhea and steatorrhea
  3. Family history of peptic ulcers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Management for the hard stool

A

Stool softeners + high fiber (residue) diet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Management for soft stool

A

Senna then lactulose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Management for impacted stool

A

Phosphate enema

79
Q

Management for constipation in pregnancy

A

Lactulose then Senna

80
Q

What is the best diagnostic investigation for Colorectal ca

A

Colonoscopy

81
Q

What is the gold standard for Colorectal ca

A

biopsy

82
Q

What are the alternative diagnostic tool for Colorectal Ca

A

Barium enema and Ct angiography

83
Q

CEA antigen is not used for diagnosis or staging but rather for

A

monitoring relapses

84
Q
A
85
Q

It is presented with change in bowel habits, abdominal pain, anemia and weight loss

A

Colorectal Carcinoma

86
Q

3 loose or watery stool/ day

A

Diarrhea

87
Q

acute <14 days of diarrhea,nxt mgt?

A

Microscopy, culture and sensitivity

88
Q

chronic >14 days of diarrhea, nxt mgt?

A

Colonoscopy

89
Q

MC adenoma causing electrolytes disturbances

A

Villous Adenoma

89
Q

MC electrolyte imbalance in diarrhea

A

Hypokalemia

90
Q

Acid-base imbalance in diarrhea

A

Non-anion gap metabolic acidosis

91
Q

MC cause of bloody diarrhea

A

Campylobacter ( a prdrome of headache, myalgia and fever)

92
Q

Second MC cause of bloody diarrhea

A

Shigella - Salmonella

93
Q

Diarrhea after camping

A

Giardia

94
Q

MC cause of travelers diarrhea (in less than 72 hrs)

A

E coli

95
Q

Traveler’ diarrhea lasting > 1 week and associated with steatorrhea and weight loss

A

Giadia

96
Q

MC cause of diarrhea in pediatrics

A

Viral (Rotavirus)

97
Q

Diarrhea followed by weakness and reflexia (Ascending paralysis)

A

GBS

98
Q

It is presented with change in bowel habits, abdominal pain, anemia and weight loss

A

Colorectal Carcinoma

99
Q

Diarrhea followed by renail impairment

A

HUS (HEmolytic Uremic Syndrome)

100
Q

Bloody diarrhea followed by RUQ pain

A

Ameba - Amebic Liver abscess

101
Q

Chronic bloody diarrhea in young male

A

IBO

102
Q

Diarrhea after long term antibiotics

A

Clostridium Difficile

103
Q

MC Antibiotic causing Clostridium difficile

A

Clindamycin
Cephalosporin
Co-Amoxiclav

104
Q

TTT of clostridium difficile

A

Metronidazole
Vancomycin- for severe cases
failure to respond - Metronidazole

105
Q

Diarrhea after eggs or chicken

A

Salmonella - Ciprofloxacin

106
Q

Diarrhea / vomiting just hours after meal

A

Staph toxin

107
Q

Diarrhea in bed ridden with constipation

A

Fecal impaction

108
Q

Main TTT of diarrhea

A

Fluid

109
Q

TTT of traveler diarrhea

A

Fluid only

110
Q

TTT of staph toxin

A

FLuid only

111
Q

TTT of shigella or campylobacter

A

Antibiotics

112
Q

TTT of ameba or giardia

A

Metronizadole

113
Q

ist line of choice for acute diarrhea < 14 days

A

Stool C and M

114
Q

HIV + watery diarrhea

A

Cryptosporidium Parvum

115
Q

HIV + bloody diarrhea

A

CMV

116
Q

Non-bloody/watery/steatorrhea in long standing diarrhea after recent travel

A

Giardiasis (1st- stool microscopy then stool PCR and ELISA)

117
Q

bloody long-standing diarrhea after recent travel

A

Campylobacter jejuni
(curved bacilli)

118
Q

What is the treatment of C. jejuni?

A

Erythromycin
/
Clarithromycin or Azithromycin
if macrolides are not tolerated -> Ciprofloxacin

119
Q

this disease is caused by the protein gluten (exacerbated by consumption of wheat)

Repeated exposure leads to villous atrophy which in turn causes malabsorption - buttock atrophy in children

A

Celiac Disease

120
Q

What are the signs and symptoms of Celiac Disease

A

diarrhea (chronic or intermittent)
Stinking stools, difficult to flush
Steatorhhea
Persistent GI symptoms
Fatigue
Recurrent abdominal pain
Sudden or unexpected weight loss
unexplained iron, folate or Vitamin B12 deficiency anemia

121
Q

What are the complications of Celiac Disease

A

1.Osteoporosis
2.T cell lymphoma of SI (rare)
3.Dermatitis herpetiform (presented as red raised patches, often with blisters and severe itching, treated with Dapsone)

122
Q

What are the complications of Celiac Disease

A

Osteoporosis
T cell lymphoma of SI
Dermatitis herpetiform (presented raised patches often with blisters and severe itching treated with Dapsone)

123
Q

What is the MC presentation of Celiac Disease

A

Iron Deficiency Anemia

124
Q

This deficiency in this mineral is more common than Vitamin B12 deficiency in Celiac Disease

A

Folate

125
Q

Celiac Disease is also associated in this disease

A

DM type 1

126
Q

Any patient with confirmed celiac disease who experience recurrence of the symptoms despite a gluten-free diet +/- weight loss until proven otherwise

A

Intestinal Lymphoma

127
Q

What are the investigations of Celiac Disease

A

Specific Auto-antibodies
Jejunal/duodenal biopsy

127
Q

It is presented with change in bowel habits, abdominal pain, anemia and weight loss

A

Colorectal Carcinoma

128
Q

Jejunal/duodenal biopsy

A

Villous atrophy
Crypt hyperplasia
increase in intraepithelial lymphocytes

129
Q

What is the management for the Celiac Disease

A

Gluten free diet

130
Q

Clostridium difficile is detected in stool, presented with watery diarrhea (could be bloody), abdominal pain, raised WBCs and fever

A

Pseudomembranous colitis

131
Q

What is the most common antibiotic that can cause the Pseudomembranous colitis

A

Clindamycin

132
Q

What is the management for the Pseudomembranous colitis?

A

Stop the antibiotic cause’
1st line - Oral Metronidazole
If severe or not responding - Oral Vancomycin

133
Q

It is presented with change in bowel habits, abdominal pain, anemia and weight loss

A

Colorectal Carcinoma

134
Q

What are the other antibiotics that can cause the Pseudomembranous Colitis?

A

Cephalosporin
Co-Amoxiclav
Quinolones
Aminopenicillins

135
Q

Prehepatic jaundice
with increased unconjugated hyperbilirubinemia
increase heme breakdown

A

Hemolysis
G6PD Deficiency
Malaria

136
Q

Intrahepatic jaundice
inability to conjugate
Increase hyperbilirubinemia

A

Gilbert’s Syndrome

137
Q

Intrahepatic jaundice
inability to excrete
Increase conjugated hyperbilirubinemia

A

Dubin JOhnson

138
Q

Posthepatc jaundice / obstructive

A

Gallstones
Cholangitis

139
Q

Autoimmune, idiopathic
Associated with Sjogren Syndrome and RA
Pruritus
Increase ALP
Positive AMA (Antimicrondiral Antibodies)

A

Primary Biliary Cholangitis / Cirrhosis

140
Q

Autoimmune, idiopathic
fibrosis at some areas of bile ducts “beaded appearance”
Associated with IBD
Pruritus with increased ALP

A

Primary Sclerosing Cholangitis

141
Q

What are the treatments for Primary Biliary Cholangitis / Cirrhosis

A

Urodeoxycholic Acid
Cholestyramine

142
Q

What are the treatments for Primary Primary Sclerosing Cholangitis

A

Urodeoxycholic Acid
Cholestyramine

143
Q

What is the most specific tool for Primary Sclerosing Cholangitis

A

ERCP

144
Q

What are the M rule for Primary Biliary Cholangitis (PBC)

A

igM
AMA
Middle aged female

145
Q

This is due to ascending bacterial infection (E. Coli) as a result of choledocholithiasis

It is presented by the Charcot’s triad
fever, RUQ pain and jaundice

A

Ascending Cholangitis

146
Q

What is the confirmatory test for Ascending Cholangitis?

A

US gallbladder and biliary ducts

147
Q

What are the complications of Ascending Cholangitis?

A

Reynold triad
= Charcot’s triad + hypotension + confusion

148
Q

What is the management for the Ascending Cholangitis

A

Emergency ERCP
Rehydration
Antibiotics

149
Q

Chronic disease of unknown cause characterized by continuiung hepatocellular inflammation and necrosis which tends to progress to cirrhosis.

Often seen with autoimmune diseases (autoimmune thyroid disorder, Addison’s or vitiligo)
Middle-aged women

A

Autoimmune Hepatitis (AIH)

150
Q

What are the features of Autoimmune hepatitis

A

Fever, malaise
Rash, polyarthritis
Pulmonary infiltration, pleurisy
Glomerulonephritis
Liver enzyme are usually elevated
Amenorrhea is common and disease tends to attenuate in pregnancy

151
Q

What are the investigations for the Autoimmune hapatitis

A

ANA/SMA/LKMI antibodies

Raised IgG levels

Liver biopsy - inflammation extending beyond limiting plate “piecemeal necrosis, bridging necrosis

152
Q

Pre-eclampsia
First pregnancies
Multiple pregnancies

Begins after 30 wks of gestation, may also appear immediately after delivery

Presents with:
Nausea, vomiting, abdominal pain
fever, headache, jaundice, pruritus

A

Acute fatty liver of pregnancy

153
Q

Investigations of Acute fatty liver of pregnancy

A

Elevated LFTs
Raised Bilirubin
Hypoglycemia and ammonia
Prolonged PT
Liver biopsy - diagnostic

154
Q

What is the management for the Acute fatty liver of pregnancy?

A

Treat hypoglycemia
Correct clotting disorders
N-acetylcysteine (NAC)
Consider early delivery

155
Q

HELLP + hypoglycemia + ammonia

A

Acute fatty liver of pregnancy

156
Q

Causes of elevated liver enzymes in the postpartum period

Pregnancy-related liver disease

A

Obstetric Cholestasis - severe pruritus due to high bile acids ? x20 ALT
Pre=eclampsia/Eclampsia
HELLP Syndrome
Acute Fatty Liver of pregnancy

157
Q

Causes of elevated liver enzymes in postpartum period

Liver diseases unrelated to pregnancy

A

Viral hepatitis
Autoimmune liver disease
Budd Chiari S
Acute Cholecystitis
Drug-induced Hepatotoxicity

158
Q

Autosomal recessive condition in which increased intestinal absorption of iron causes iron accumulation in tissues especially the liver which may lead to cirrhosis and HCC (hepatoma)

iron is accumulated mainly in the peripheral hepatocytes

A

Hemochromatosis

159
Q

iron is accumulated mainly in the Kuppfer cells and more in central than in peripheral hepatocytes

A

Hemosiderosis

160
Q

Hemochromatosis can lead to ___ and can prediscpose to _____

A

Cardiomyopathhy; HCC

161
Q

What is the triad of symptoms in Hemochromatosis

A

Diabetes
Hepatomegaly
Bronze pigmentation

162
Q

Presentation of Hemochromatosis

A

Asymptomatic
40-60s
symptoms vague and not specific
Iron overload - arthropathy and gynecomastia
may include cardiac arrhythmias or cardiomyopathy or neurological/psychiatric symptoms

163
Q

What are the main causes of acute pancreatitis

A

alcohol and gallstones

164
Q

Acute Pancreatitis
GET SMASHED

A

Gallstones
Ethanol
Trauma
Steroids
Mumps
Alcohol, autoimmune
Scorpion venom
Hypertriglyceridemia, increase Calcium, hypothermia
ERCP
Drugs ( Azathioprine, Bendroflumethiazide, didanosine, pentamidine, sodium valproate)

165
Q

What are the features of Acute Pancreatitis?

A

Severe epigastric pain or central abdominal pain that radiates to the back and is relieved by sitting forwards
vomiting is prominent
tachycardia
fever
jaundice
shock
Right abdomen with local tenderness
periumbilical bruising (Cullen’s sign)

166
Q

What are the investigations for Acute Pancreatitis?

A

Serum amylase > 1000U/ml (however lipase levels are more sensitive and more specific but take more time to rise following an attack > 24 hrs)
CT with contrast

167
Q

What are the treatments for Acute Pancreatitis?

A

Fluid Resuscitation , analgesia, and nutritional support
IV antibiotics (IV mipenen)
Laparoscopy - only when there’s infection or necrosis

168
Q

half-life is only 20 days and it’s a good parameter for the chronic liver disease

Its main function is to regulate the oncotic pressure of blood, and it also binds to enzymes and hormones

it shifts the fluid into the intravascular compartment’

it is also useful to obtain diuresis in hypoalbuminemia patient

A

Albumin

169
Q

3 main causes of Chronic Pancreatitis

A

alcohol
smoking
autoimmune

170
Q

What are the features of Chronic Pancreatitis

A

Episodic with short periods of pain
-Pain free intervals are specific to chronic pancreaittis
-Radiates to the back
-Relieves by sitting doward
-Exacerbated by eating

Steatorrhea
Diabetes
Jaundice

171
Q

Due to malabsorption of fats from the lack of pancreatic lipase secretion which results on weight loss

Sometimes described as “loose, offensive tools which are difficult to flush”

A

Steatorrhea

172
Q

What are the investigations for the Chronic Pancreatitis

A

Serum amylase / lipase
US
CT with Contrast - gold standard

173
Q

What is the management of Chronic Pancreatitis?

A

Pain - Analgesia

Steatorrhea or malabsorption - Pancreatic enzymes supplements and fat-soluble vitamins

Diabetes - Oral hypoglycemics and insulin

174
Q

What are the drugs that induced the hepatitis?

A

Co-Amoxyclav
Flucloxacillin
Steroids
Sulphonylurea

175
Q

Elevated bilirubin + massive increase in ALP and AST

A

Drug-Induced Hepatitis

176
Q

May occur after esophageal perforation (after endoscopy)

Xray may show widened mediastinum or air in the mediastinum

A

Mediastinitis

177
Q

pain located in the substernal region

A

Anterior Medistinitis

178
Q

pain in the epigastric region with radiation to the interscapular region

A

Mediastinitis

179
Q

It is a protein that is seen by immunostaining which is used as a clinical marker for lung adenoca

A

TTF-1

180
Q

Very common in hospitals, especially with the spread of norovirus

they present with acute onset of diarrhea (sometimes with vomiting) and abdominal pain

Pain is usually central and could be epigastric

A

Gastroenteritis

181
Q

infection of the intestine that leads to severe diarrhea (blood + mucosa) and abdominal pain

A

Dysentery

182
Q

Courvoisier sign
(painless obstructive jaundice with a palpable mass)

A

Cancer head of Pancreas

183
Q

Celiac disease is associated with

A

Lymphoma

184
Q

Ulcerative Colitis and Crohn’s disease are associated with

A

Colon cancer

185
Q

Bloating
Constipation
Alternating with diarrhea
+ NO blood on stool

A

Irritable Bowel Syndrome

186
Q

Fetal Calpoprotein (measures protein in the sool) if it is elevated? ____

A

IBD (Inflammatory bowel Disease)

187
Q

Fetal Calpoprotein (measures protein in the sool) if it is normal

A

IBS (Irritable Bowel Syndrome)q

188
Q

severe recurrent rectal pain in the absence of any organic disease, and may occur at night after bowel actions or after ejaculation. Anxiety could be an associated feature.

A

Proctalgia fugax

189
Q

Treatment if patient has Ascites + bleeding

A

Terlipressin

190
Q

Management if the patient has ascites without bleeding?

A

Perform ascitic fluid aspiration to detect the Neutrophil count, gram stain, culture and obtain protein level

191
Q

It is presented with change in bowel habits, abdominal pain, anemia and weight loss

A

Colorectal Carcinoma

191
Q

Elevated bilirubin + massive increase in ALP and AST

A

Drug-Induced Hepatitis