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GIT 3 Flashcards

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1
Q

acute pancreatitis cause?

A

Alcohol
Gall stone
Drugs
Hypertriglyceridemia(>1000)

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2
Q

Drug?

A

Diuretics(lasix and HCT)
A drug used for IBD(5-ASA and sulfasalazine)
Immunosuppressive agent(azathioprine, corticosteroid)
HIV related medication(Didanosine and pentamidine)
Antibiotics(Metronidazol,Isoniazide,CTM and didanosine)
antiepiliptic(VA and Carbamazepine)
Ace inhibitors

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3
Q

CM?

A

Nausea
Vomiting
persistent Abdominal pain radiating to the back

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4
Q

Lab?

A

Elevated amylase and lipase

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5
Q

CT scan?

A

enlarged pancreas
peripancreatic fluid
fat around pancreas

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6
Q

management?

A

supportive fluid and electrolyte

drug-induced one mainly resoles

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7
Q

endoscopic ligation indication in VB?

A

active bleeding varices

no C/I for VBL

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8
Q

diuretics and Acute pancreatitis mechanism?

A

direct toxicity as sulpha drug
pancreatic ischemia
increase fluid viscosity

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9
Q

what is INR, and its normal value?

A

An INR test measures the time for the blood to clot. It is also known as prothrombin time, or PT.
In healthy people an INR of 1.1 or below
An INR range of 2.0 to 3.0 is generally an effective therapeutic range for people taking warfarin

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10
Q

Wilson disease future?

A

Rare
Autosomal recessive
Affect mainly liver and brain
Kayseri-fleisur ring in slit-lamp examination

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11
Q

Pathogenesis?

A

Defective copper excretion by liver-coper accumulate in serum, brain(basal ganglia and, and liver)

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12
Q

Liver damage CM?

A

Chronic hepatitis
Cirrhosis
ALF

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13
Q

Neurologic symptom?

A

Gait disturbance
Parkinsonism
Dysarthria

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14
Q

Psychiatric CM?

A

Depression
Personality change
Psychosis

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15
Q

Dysarthria?

A

is a motor speech disorder in which the muscles that are used to produce speech are damaged, paralyzed, or weakened. The person with dysarthria cannot control their tongue or voice box and may slur words.

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16
Q

Laboratory?

A

Decrease serum ceruloplasmin
Increase urinary copper
Increase copper content in liver biopsy

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17
Q

treatment?

A

chelasion
zink
transplnt

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18
Q

chelation?

A

D-Penisilamin

Trientine

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19
Q

Zink?

A

Decrease Cu absorbtion

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20
Q

Liver transplantation?

A

Curative
Drug-resistant one
Fulminant failure

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21
Q

Whipple disease cause?

A

an infectious disease caused by Trophyrema whippelli

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22
Q

CM?

A 
weight loss
common in white men
4-6 age of life
GI manifestations
Cardiac menifestation
Migratory polyarthrophaty
Chronic cough
Intermittent low-grade fever
hyperpigmentation
Lymphadenopathy
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23
Q

GI manifestations?

A

Abdominal pain
Diarrha
Malabsorbtion w/o distension,flatulence and steatorhea

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24
Q

Cardiac menifestation?

A

CHF

valvular regurgitation

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25
Q

Biopsy?

A

The PAS-positive lesion in biopsy

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26
Q

CNS involvement?

A

later stage
dementia
myoclonus
supranuclear ophthalmoplegia

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27
Q

Symptom of pellagra?

A

Dermatitis
Dementia
Diharoa

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28
Q

Dermatitis Cxs?

A

rough, hyperpigmented scaly lesion on sun exposed area

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29
Q

Dementia Cxs?

A

memory loss
affective symptome
psychosis

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30
Q

Risk factors?

A 
Undernutrision(corn diet)
Malnutrition e.g in alcoholic
Carcinoid syndrome
Hertnub disease
Prolonged isoniazid treatment
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31
Q

Non-Alcoholic fatty liver definition?

A

Hepatic steatosis on imaging and biopsy
Exclusion of alcohol usage
Exclusion of other cause of fatty liver

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32
Q

Clinical future?

A 
Mostly asymptomatic
Metabolic syndrome
Mild TA elevation with AST/ALT ratio <1(unlike ALD)
Mild ALP increment
The hyperechoic texture on U/S
Albumin and bilirubin is normal
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33
Q

management?

A

diet and exercise

bariatric surgery if BMI >35

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34
Q

positive anti-HBC-Ab indicates?

A

IgM–Acute infection and the window period

IgG-Chronic infection and recovery

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35
Q

a common cause of cirrhosis in the USA?

A

Viral hepatitis
Chronic alcoholism
Non-Alcoholic fatty liver
Hemochromatosis

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36
Q

Colonic polyp?

A

Malignant potential and non-malignant potensial

Growths of tissue within the colon

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37
Q

Malignant potential?

A

Malignant potential
Adenomatous polyp
Serrated polyp

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38
Q

adenomatous one?

A

Neoplastic

via chromosomal instability pathway with mutations in APC and KRAS

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39
Q

Faucher, that indicate adenomatous polyp have more malignant potential?

A

Villous
size >1 cm
more than 3 concourent polyp

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40
Q

Serrated polyp?

A

Neoplastic.
Characterized by CpG island methylator phenotype (CIMP; cytosine base followed by guanine, linked by a phosphodiester bond).
Defect may silence MMR gene (DNA mismatch
repair) expression.
Mutations lead to microsatellite instability and mutations in BRAF. “Sawtooth” pattern of crypts on biopsy.
Up to 20% of cases of sporadic CRC.

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41
Q

perforated PUD sign?

A 
abdominal pain
nausea
vomiting
guaiac positive stool
chemical peritonitis
42
Q

Diagnosis?

A

Plain chest and abdominal X-ray

IF negative and strong clinical suspicion- do a CT scan with IV contrast.

43
Q

Gilbert syndrome CM?

A

more common in male
most common inherited disorder of glucuronidation defect
AD/AR
increase UB
Intermittent jaundice precipitated by stress

44
Q

lab?

A

Increase UB

Normal liver enzyme and AP

45
Q

management?

A

conservative

46
Q

esophageal stricture future in barium swallow?

A

symmetric, circumferential narrowing

47
Q

Risk?

A

radiation
GERD
acoustic ingestion

48
Q

CM?

A

the difficulty of swallowing solid food

if develop after GEDR-Gerd symptom will resolve due to the fibrosis prevent reflux

49
Q

vascular ring?

A

aortic vessel incircle trachea or esophagus
children–inspiratory distress
Adult dysphagia

50
Q

Hepatic encephalopathy precipitating factor?

A 
Drug(alcohol,narcotics)
Hypovolemia
Electrolyte disturbance
Increase nitrogen load
Infection
Portosystemic shunt
51
Q

CM?

A

Sleep disturbance
Asterixis
Ataxia
Altered mental status

52
Q

Treatment?

A

Correct precipitating cause

Decreased blood ammonia concentration(Rifaximin and lactulose)

53
Q

Hypokalemia and HE?

A

Hypokalemia-Increase NH3 production in renal tubular cell

54
Q

Metabolic alkalosis and HE?

A

Increase conversion of NH4 to NH3

55
Q

Acute cholangitis etiology?

A

ascending gram-negative infection

56
Q

CM?

A

Charcot triad

Raynoud pentad

57
Q

Charcot triad?

A

fever, jaundice, and RUQ pain

58
Q

Raynaud pentad?

A

CT + hypotension and AMS change

59
Q

Diagnosis?

A

increase DB and ALP
mild increase TA
Common Biliary duct dilation on U/S
Anion gap metabollic acidosis due to sepsis

60
Q

management?

A

Enteric bacteria covering antibiotic

ERCP drainage within 24-48Hr

61
Q

Is the patient present with hepatosplenomegaly, mediastinal fullnes, lung opacification, and hypercalcemia? Diagnosis?

A

sarcoidosis

62
Q

liver and sarcoidosis?

A

Hepatomegaly
abnormal cholestasis sign followed by hepatocellular damage.
Granuloma in parenchyma

63
Q

UGI bleeding pathophysiologic relation to urea/cr ratio?

A

Hemoglobin metabolized to urea in intestine–Elevated BUN

Jypovolumia increase BUN absorbtion in intestine

64
Q

Infectious and iatrogenic cause of A.Pancrititis?

A 
CMV
Legionella
Aspergillosis
Post ERCP
Ischemia(MI) and thrombosis
Post vascular procedure(Coronary stent)
65
Q

when there is Post vascular procedure(Coronary stent)?

A

Due to cholesterol emboli

There will be livedo reticularis, AKI, and mesenteric ischemia

66
Q

AP diagnostic algorithm?

A

diagnosis requires 2 things from 3 criterion

67
Q

The three criteria?

A

Abdominal pain radiating to back
Increase amylase and lipase > 3x
Imaging fetcher

68
Q

Management?

A

NPO(except important medication)
IV fluid and antibiotic
Antipain

69
Q

Biliary pancreatitis suggesting fetcher?

A

ALT>150

70
Q

when to consider antibiotics in the case of AP?

A

Necrotizing pancreatitis with evidence of infection

71
Q

Facal impaction CM?

A

A patient who is at risk
Constipation
Bowel distension
Fecal incontinence

72
Q

A patient who is at risk?

A

Defective mobility
Decrease fluid and fiber intake
Chronic constipation
Decrease rectal sensation due to spinal cord injury or dementia

73
Q

Diagnosis?

A

Digital rectal examination

74
Q

Management?

A

Manual disimpaction followed by enema

Then advice on dietary alteration and laxative

75
Q

Loperamide?

A

C/I

It may exacerbate the incontinence

76
Q

Sign in cirrhosis due to hyperestrogenism?

A 
Gynecomastia
palmar erythema
Testicular atrophy
spider angioma
Decrease body hair in male
77
Q

Ischemic hepatic injury/shock liver futeure?

A 
Diffuse liver injury
ALT/AST>25-250x 
Mild increase ALP/bilirubin
Return to normal within 1-2 wk if the inciting event resolved
The cause can shock/HF
78
Q

Autoimmune metaplastic atrophic gastritis feucher?

A

non radiating epigatric pain
mild epigastric tendernes
Common in female
Another autoimmune disease like hypothyroidism and T1DM
Megaloblastic anemia due to IF deficiency
IDA due to hypochloremia

79
Q

Pill-induced esophagitis fetcher?

A

Acute retrosternal pain with odynophagia and epigastric burning
Occur in MID esophagus(Due to aortic arch compression)
Circumflesial ulcer with normal mucosa

80
Q

Risk factor?

A 
Tetracyclin(Direct acid injury)
NSAID(decrease mucosal injury)
Potassium Chloride(osmotic damage)
Biphosphonate
Iron
81
Q

Packed red blood cell indication?

A

Hg<7 mg/dl
Hg<9 mg/dl in ACS
Acute bleeding with hypovolemia(HCT may not indicate exact mechanism)

82
Q

Fresh frozen plasma?

A

Clotting factor and plasma protein in one pack of blood

83
Q

platelet transfusion indication?

A

PLT<10,0000

PLT<50,000 with bleeding

84
Q

Whole blood transfusion?

A

RBC + plasma

Used in severe acute bleeding in case of severe trauma to aid in volume expansion.

85
Q

Pathophysiology for NALD?

A

Insulin resistance–Increase FFA release from periphery and uptake by the liver–Oxidative stress –Inflammatory cytokine release–fibrosis and cirhosis

86
Q

sign of hepatic metastasis?

A

Hepatomegaly
P.Effusion(Left side)-Right side in cirrhosis
prominent ALP elevation with mild TA elevation
Common from Colon

87
Q

eosinophilic esophagitis feucher?

A

Chronic immune-mediated esophageal inflammation.

88
Q

CM?

A

Common in young
Epigastric /upper abdominal pain does not respond to PPI
Intermitent solid food dysphagia
Food impaction
Associated atopy
History of food impaction lately: Due to esophageal stricture

89
Q

Diagnosis?

A 
Esophageal biopsy(>15 eosinophils per HPF
Endoscopy(Linear furrow and ring)
90
Q

treatment?

A

Dietary modification

Topical glucocorticoid

91
Q

Bright minimal Lower GI bleeding approach?

A

DEpend on age and presence of the red flag

92
Q

red flag?

A 
Family history of colonic ca 
Abdominal Pain
Change in bowel habit
Weight loss
IDA
93
Q

Age?

A

<40
40-50
>=50

94
Q

<40 w/o red flags?

A

Anoscopy and if nothing detected sigmoidoscopy and colonoscopy.

95
Q

40-49 w/o red flag?

A

sigmoidoscopy/colonoscopy

96
Q

> 50/red flag?

A

colonoscopy

97
Q

cause of bright rectal bleeding?

A

Hemorrhoid
Anal fissure
Colonic polyp/ca
PProctitis

98
Q

anemia dut to hypothyroidism fetcher?

A

Mild

Not usually visible on laboratory

99
Q

Normal lipase and amylase level?

A

A-23-85 U/L (some lab results go up to 140 U/L)

L-0-160 U/L

100
Q

a common cause of SBP?

A

E.Coli
Klepsela
Streptococi

GIT steep 2 (4 decks)

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