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GIT steep 2 > GIT 4 > Flashcards

GIT 4 Flashcards

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1
Q

Clostridium difficile infection fetcher?

A 
A patient who has risk
Abdominal pain
Voluminous watery diharrha(rarely bloody)
Low-grade fever
Leukocytosis
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2
Q

Risk factor?

A

1) Recent broad-spectrum antibiotic use(Dis. Normal F)
2) Gastric acid suppression(Dis. Normal F)
3) Hospitalization(severely ill)
4) Age >65(immunodeficiency and have risk of above 3-factor exposure)

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3
Q

Pathogenesis?

A

Disruption of normal flora—CD overgrowth—release enterotoxin A and cytotoxin B—pass EC–epithelial cell loss TJ and apoptosis–diarrhea.

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4
Q

diagnosis?

A

Stool PCR for CD toxin

Stool EIA for CDT and Glutamate DHG antigen

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5
Q

complication?

A

fulmitant colitis

Toxic megacolon

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6
Q

fulminant colitis?

A
  • Most severe form of uncomplicated acute colitis, with intense symptoms, high fever, and some- times colectasia.
  • Is also used synonymously with that of acute severe colitis
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7
Q

Toxic megacolon?

A

An acute form of colonic distension.
It is characterized by a very dilated colon (megacolon), accompanied by abdominal distension (bloating), and sometimes fever, abdominal pain, or shock.
Risk factors: Chronic bowel disease
Complications: Septic shock, perforation of the …
Other names: Megacolon toxicum
Prognosis: Fatal without treatment

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8
Q

Treatment of TM?

A

Antibiotic
Colectomy if have peritonitis and not respond to Ab
Not do a procedure that increases the risk of perforation(endoscopy and enema)

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9
Q

Management?

A

Oral vancomycin/fidaxomicin

Infection control

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10
Q

Infection control?

A

Hand hygiene with soap and water

Contact precaution

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11
Q

Nocturnal dharrha Indicates?

A

Secretory diarrhea(develop during fasting)

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12
Q

cause?

A

Chronic GI infection
Microscopic colitis
Bile salt diarrhea
Hormonal increament(VIP/Gastrine)

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13
Q

Symptom of celiac disease?

A 
Bulky, foul-smelling stool
fatigue, loss of muscle, and SCF?
anemia
bone pain and #
easy bruising(K deficiency)
hyperkeratosis(A deficiency)
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14
Q

Diagnosis?

A

Villous atrophy, crypt hyperplasia, and submucosal LC
IGA-anti endomysial, tissue glutaminase
serum IgA level and IgG if negative IgA Ab if strong suspicion(B/C IgA deficiency is common)

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15
Q

Collagenous colitis?

A

Chronic diarrhea

Normal mucosa with supepitelial collagen deposition

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16
Q

UGI bleeding secondary to varices TX?

A

Fluid resuscitation
Prophylactic Ab(decrease infn, recurrence and mortality)
Endoscopic ligation(repeat after 1-2 wk)should be done within 12 Hr
Octreotide
Secondary prophylaxis with beta-blocker after ligation
Balloon tamponade (uncontrolled bleeding until definitive management(TIPS or shunt) done.
Serial HCT if HGB>9 and transfuse if it is less than this.

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17
Q

Patient with ascitis and rise ascitic bilirubin level indicate?

A

Biliary tract or bowel perforation
Abdominal pain and sign of peritonitis
brown(bilious ascitis

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18
Q

ascitis secondary to PH color?

A

straw-yellow color

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19
Q

low glucose and high LDH in AF?

A

Infection
Malignancy
Bowel perforation

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20
Q

In pancriatic ascitis?

A

Increase amylase

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21
Q

increase TG?

A

chylous ascitis

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22
Q

Diverticular bleeding?

A

massive bright red bleeding(b/C arterial)

no pain

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23
Q

How to D/T with heamoroid?

A

Hemorrhoid has minimal bleeding and has irritation symptoms like frequency.

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24
Q

Management of DB?

A

mostly resolve

endoscopic or surgical intervention.

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25
Q

Hepatic hydrothorax?

A

Pleural effusion in cirrhosis patient
common I right(passage of ascitic fluid in right b/c of muscle less in right)
The patient will have dyspnea, cough, pleuritic chest pain and hypoxemia.
PE in CXR

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26
Q

Management?

A

fluid restriction and diuretics
thoracentesis if sever symptom
Don’t do C-TUBE–loss of fluid, protein, electrolyte, and RF risk.

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27
Q

What to investigate in patients with sepsis of clostridium skepticum and streptococcus bovis?

A

Colonoscopy(Both highly associated with colonic ca)

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28
Q

Chest pain relieved by nitrate differential?

A

ACS

Diffiuze esophagial spasm

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29
Q

CM of microscopic colitis?

A 
watery diarrha
fecal urgency and frequancy
abdominal pain
fatigu
wight loss
artheralgia
common in older women
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30
Q

Trigers?

A

Smoking
drugs like NSAID,SSRIand PPI
Autoimune disease increase risk

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31
Q

pathology?

A

show both lymphocytic infilitrasion
collaginous collitis:subepithelial collagen band thikning
lymphocytic colitis:lymphocyte accumulation in lamina propria
Normal mucosa

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32
Q

managment

A

avoid trigaseers

if diharrha persisit–bedisonide/antidiharreal like loperamide

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33
Q

benifit of alcohol abestienance in patient with A.coirrhosis?

A

Decrease liver inflamation
Decease portal pressure
increase survival
Baclofen can be used for craving

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34
Q

CM of pancriatic ca?

A 
abdominal pain radiate to back and worse when patient eat,lies back and night
jaundice
wight loss
recent atypical DM
hepatomegaly and ascitis
migratory thrombophlebitis
35
Q

lab study?

A

ca 19-9 (not used for screenin
CT for body and tail an tumour < 3 cm
Head ==U/S

36
Q

Clinical Feucher of alcholic hepatitis?

A 
Jaundice,anorexia and fever
RUQ and epigastric pain
Abdominal distension due to ascitis
H.Encephalophaty
Proximal muscle wastuing\
37
Q

Labratory?

A 
AST and ALT usualy <300 and always <500
AST/ALT ratio >=2
Elevated INR/GGT,INR and biliribin
Lukocytosis predominantly nethrphil
Decrease albumin if malnuritiod
Abdominal immaging may show fatty liver
acute phase reacctant increment
38
Q

SIBO managment?

A

oral rifaximin or neomycine

39
Q

When we need endotrachial intubation in patient with UGIB?

A

If patient mental status is not normal

40
Q

When to start cancer screening?

A

USPSTF:at age of 50
ACS:at 45
Both recommend start 10 year earlier inpatient with risk(family history of colon cancer)

41
Q

modality?

A

FOBT and FIT anually
Colonoscopy every 10 year and flexible sigmoidoscopy every 5 year
Flexible sigmoidoscopy with FIT every 10 year

42
Q

when to start screening patient with UC?

A

8-10 year after initia diagnosis

43
Q

workup for dyspepsia?

A

Age >60 endoscopy

Age<60:Test and treat for H.pylori and endoscopy is >=1 alarming feuture

44
Q

what are alarming feuture?

A 
progresive dysphagia
IDA
odynophagia
family history of Gi malignancy
palpable mass/LDP
Persistent vomiting
45
Q

Non-invasive test for chronic pancreatitis?

A

Fecal elastase level

46
Q

recurrent clostridium difficile managment?

A 
First recurrence
vancomycin PO in prolonged /taper course
fidaxomicin if Vanco used in the initial episode
multiple recurrences
vancomycin PO followed by rifaximine
fecal transplant
47
Q

Fulmitant C.Difficile infection?

A

hypotension/shock/toxic megacolon

manage with Iv metronidazole with vancomycine/surgical evaluation

48
Q

Is symptom consistent with GERD approach?

A 
Perform endoscopy if
1-Age >50
2-Symptom >5 year
3-Cancer risk factor
4-Alarming symptom
49
Q

after endoscopy how classify?

A

1-cancer–biopsy
2-esophagitis
3-non-esophagitis

50
Q

if the sign of esophagitis what consider and to do next?

A

treat according to diagnosis

51
Q

what the diagnosis can be?

A 
Pill induced
Autoimmune skin disease
Zollinger Ellison syndrome
Eosinophilic esophagitis
Barret's esophagus
52
Q

3-non-esophagitis?

A 
consider further testing for the following
acalasia
gastroparesis
nonacid reflex disease
nocturnal acid breasthrogh
53
Q

If have no indication for endoscopy/

A

treat with PPI 1 per day for 2 months if not respond 2x/change regimen per day if not respond endoscopy and gastric PH

54
Q

CM of severe pancreatitis?

A 
Fever, hypotension, and tachycardia
Dyspnea, tachypnea, and basilar crackle
Abdominal tenderness and distension
Cullen sign
gray turner sign
55
Q

Cullen sign?

A

periumbilical bluish discoloration indicating hemoperitoneum

56
Q

gray turner sign?

A

Redish discoloration around flank area indicating retroperitoneal bleeding

57
Q

the associated factor with severity?

A 
Age >75
Obesity
Alcoholism
C-reactive protein >150
rising BUN and Creatinin in first 48 Hr
pulmonary infiltration and effusion
pancreatic necrosis and extrapancreatic tissue inflammation
58
Q

S.pncrititis definition and epidemiology and definition?

A

15-20%

pancreatitis with one organ damage

59
Q

what test shod do?

A

Abdominal CT and MRCP to see pancreatic necrosis

60
Q

pathophysiology?

A

entrance of pancreatic enzymes to BV–vasodilation, increase vascular permeability

61
Q

How to differentiate ascites due to the liver and cardiac diseases like constrictive pericarditis and RSHF?

A 
in cardiac cases, there will be
RSHF
jugular venous distension
Kussmaul sign
pericardial knock
pulses paradoxus
62
Q

approach to elevated ALP?

A

First cheek GGT
if normal consider bone disease
If raised consider liver disease

63
Q

If raised GGT?

A

Do abdominal ultrasound and AMA
If both normal-L.Biopsy.ERCP and observation
show dilated duct–ERCP
raised AMA with liver abnormality-L.biopsy

64
Q

Ursodeoxycholic acid?

A

Is hydrophilic bile acid unlike natural one
Increase biliary acid secretion
anti-inflammatory and immunomodulatory effect

65
Q

Were tests done for lactose intolerance?

A

Positive hydrogen breath test
increase stool anion gap
acidic stool PH
Positive reducing sugar in the stool

66
Q

stool anion gap calculation and interpretation?

A

290-(stool NA + K)

If >75–Indicate osmotically diarrhea

67
Q

lactulose benefit and target?

A

acidifiy colon–change amonia to non absorbable form
increase bowel movt-increase clearance
target is to produce 2-3 x loss stool per day

68
Q

anorexia nervosa MC?

A 
osteoporosis
amenorrhea
lanugo, hair loss, and dry skin
gastroparesis,GERD and constipation
Elevated liver function
enlarged parotid gland
hypotension, bradycardia, and hypothermia
cardiac atrophy and arrhythmia
69
Q

how to D/T with hypothyroidism?

A

hypothyroidism
Weight gain
Diastolic HTN

70
Q

feucher of secretory dihareoa?

A

low stool osmotic GAP,50

Occur during fasting/night/

71
Q

feucher of osmotic diharoa?

A

high SOG >125

occur after feeding

72
Q

factitious diarrhea cause and future?

A

Mainly due to laxative abuse
Common in female and HCW
Hyperactive bowel sound

73
Q

colonic cancer screening indication inpatient with increase risk?

A

depends on the risk type indication

74
Q

Family history of adenomatous polyp or CRC

A

1 first degree relative with age <60

>=2 first degree relative at any age

75
Q

when to do?

A

first screening at 40 or age <10 from the diagnosis of affected family
then every 5 year

76
Q

IBD?

A

UC

CD with colonic involvement

77
Q

when to do?

A

8-10 year from first diagnosis and 12-15 year if only left colon affected
repeat every 1-3 year

78
Q

classic FAP?

A

age 10-12

repeat annually

79
Q

HNPCC?

A

age 20-25

repeat every 1-2 year

80
Q

drug-induced hepatitis liver histology?

A 
Idiosyncratic(isoniazid)--hepatic necrosis(Like AVH)
cholestasis-anabolic steroid
fatty liver--Valproate
toxic/fulminant--Acetaminophen
granoulomatous --allopirinol
81
Q

CM?

A 
Hepatitis future
Leukocytosis
Eosinophilia
Rash
Arthralgia
Fever
idiosyncratic--short latency
direct toxic drug--variable latency
82
Q

pseudo achalasia future?

A

Is due to gastric ca
Bird break appearance like achalasia in barium swallow
Do endoscopy to d/t with thru achalasia

83
Q

TNF indication in UC?

A

used in refractory cases.

84
Q

cause of splenic infarction?

A

embolism
hypercoagulable state
hemoglobinopathy
congestive/hypertrophic splleen

GIT steep 2 (4 decks)

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