GIT Flashcards
Cause of whipple disease
Tropherima whippeli
clue for whipple
PAS positive during biopsy
Extra intestinal manif of Whipple(2)
Polyarthropathy Migratoire
Heart problem–>CHF
What can you in late stage of whipple
Dementia
Clue for Celiac disease
Biopsy showing villous atrophy
Marker for cealiac disease(2)
IGA anti tissue transglutaminase
IGA anti endomysial antibodies
What can cause negativity of these markers in case of celiac disease(IGATT)
IGA deficiency
Other name of cealiac disease
celiac sprue
in GIT what can happen in celiac sprue
Malabsorption
Consequences of Malabsorption in celiac sprue(3)
Low
Vit D
Vit K
Iron
consequence of low vit D in celiac disease
hypocalcemia
consequence of hypocalcemia and low vit D in celiac disease(3)
Osteomalacia
bone pain
fracture
consequence of vit A deficiency in adult
Hyperkeratosis
Low vit K consequence
easy bruising
Clue for Achalasia
dysphagia for solids and liquids
Dx of Celiac and whiple
intestinal Biopsy
workup for achalasia(3)
baryum swallow
Manometry
endoscopy
finding in Bayum swallow for achalasia
bird beak appearance
Finding during manometry in Achalasia(3)
Elevating resting LES pressure
Incomplete LES relaxation
Absence of peristaltism in the esophageal body
why performing endoscopy in achalasia
to rule out a cancer in distal esophagus
quid of pseudo achalasia
cancer in distal esophagus causing achalasia
what to thing in achalasia and weight loss
cancer de l ‘oesophage
when thinking of cancer in achalasia(3)
Symptom > 6 months
patient more than 60 years
Weight loss
cause of constipation in multiple myeloma
Hypercalcemia
first thing to do in front of constipation
check calcium
Symptoms of hypercalcemia(4)
constipation
increased urination
neurologisc Symptom
renal dysfunction
most common complication of gastric ulcer
hemorrage
What to do if you suspect abdominal viscus perforation
chest x ray
chest x ray in abdominal viscus perforation
free air under the diaphragm
high yield question,characteristics of malignancy in polyps(3)
Macro:sessile
Micro:villous type
size:> 2,5 cm
Most common non neoplastic polyp in colon?
Hyperplastic
polyps in Peutz jeghrer syndrome
hamarthoma
quid of shifting phenomenon in acute appendicitis(2)
pain in ombilic
later pain oin RLQ
why shifting phenomenon occurs
visceral pain followed by somatic pain
exolanation of shifting phenomenon
Periombilical pain is visceral
but RLQ pain is somatic
what cause somatic pain in RLQ in appendicitis
irritation of parietal peritoneum
clue for acute pancreatitis
epigastric pain
worse when standing or lying supine
inproved with sitting up or leaning forward
etiology of acute pancreatitis(6)
chronic alcoholism Gallstones Hyperlipidemia drugs infection trauma
infection causing acute pancreatitis(3)
CMV
leginella
aspergillus
hyperlipidemia causing acute pancreatitis
type 1 ,4 et 5
drugs causing acute pancreatitis(3)
dianoxine
azathioprine
acid valproic
work up for acute pancreatitis(3)
Amylase and lipase
echo
CT
amylase and lipase in acute pancreatitis
3 a 4 fois la normale
local complication in acute pancreatitis(4)
pancreatic pseudocyst
pancreatic necrosis (necrotizing)
pancreatic abces
peripancreatic fluid
regional complication in acute pancreatitis(2)
ileus
Gi bleeding
A distance complication in acute pancreatitis(3)
ARDS
Left side pleural effusion
acute renal failure
clue for duodenal ulcer
pain relieved by eating
clue for gastric ulcer
pain worsened by eating
surveillance of patient with cirrhosis(2)
upper digestive endoscopy
sonograhy abdomen
when to perform sono abd in cirrhosis surveillance and why(2)
q 6 mois
to look for hepato cellular carcinoma
upper digestive endoscopy in cirrhosis why?
to rule out varices
prevention of esophageal varices
non selective B blocker
Tetrad of carcinoid syndrome
flushing
diarrhea
wheezing
valvular heart disease
cause of carcinoid syndrome
carcinoid tumor
localisation of carcinoid tumor(4)
small intestine
appendix
colon
bronchial tubes
physiopatho of symptoms in carcinoid tumor
tumor secreting serotonin
RX of carcinoid tumor
octreoctide
complication of flushing in Carcinoid syndrome (2)
Hypotension
tachycardia
quid of rome 3 criteria
dx IBS(inflammatory bowel syndrome)
rome 3 criteria what symptom in center
abdominal cramps
rome 3 criteria(5)
abdominal cramps 3 days /month 2 month consecutifs and>/ 2 de ces symptomes -symptoms improved with bowel mvts -change infrequency of stool -change in form in stool
in what situation to not consider IBS(4)
abdominal cramps plus rectal bleeding
“ “ plus weight loss
“ “ plus anemia
nocturnal abdominal awakening the patient
colonoscopy in IBS
normal colonic mucosae
condition for carcinoid tumor to produce serotonin
when tumor has metastasis in liver
work up for carcinoid syndrome
5 hydroxy indol acetic in urine and blood
quid of 5 HIAA
metabolites of serotonin
why liver metastasis produces this syndrome
5 hydroxytryptophan is degraded in the liver to inactivate 5HIAA
precursor of serotonin(5 hydrohy tryptamine)
tryptophan
role of tryptophan
synthesis of niacin
why you have low niacin i carcinoid tumor(2)
tryptophan is used to produce serotonin
niacin is low produced
Niacin deficiancy symptom(4D)
Diarrhea
Dementia
Dermatitis
Death
origin of folate
green leafy vegetables and liver meat
why cooked food lack folate(toast type diet)
folate is heat sensitive
Most common cause of meleana(2)
upper GI bleeding
lower GI bleeding proximal to the splenic flexure
Most common cause of upper GI bleeding
peptic ulcer disease
clue for zollinger ellison syndrome(2)
multiple gastric and duodenal ulcer
fat in stool
Why fat in stool in zollinger ellison syndrome
inactivation of pancreatic enzyme by hyper acid production by stomach
quid of succusion splash
you place a sthetoscope on upper abdomen and rock the patient back and forth
you will hear a splash
interpretation of succusion splash
gastric outlet obstruction
what to do in presence of a patient with generalized adenopathy,weihgt loss and diarrhea?
test for HIV
differentiate Mono from HIV
no weight loss in Mono
characteristic of rash in pellagra
present on sun exposed area
cause of Zn deficiency(2)
total parenteral nutrition
malabsorption
clue for ZN deficiency(3)
alopecia
pustulous or bullous lesion periorificial
wound healing impaired
lieu of Zn absorption
jejunum
cause of pancreatic cholera
VIPOMA
pancreatic mass plus watery diarrhea
Vipoma
what vipoma secretes
vasoactive intestinal peptide
link between Vipoma and an carcinoid syndrome
both can produce flushing
more common cause of cirrhosis(4)
Hep B et C
alcoholic liver disease
non alcoholic fatty liver disease
hemochromatosis
Less common cause of cirrhosis(7)
autoimmune PBC PSC in IBD Alpha 1 antitrypsine cardiac cirrhosis medications wilson disease
medication causing cirrhosis(2)
metotrexate
INH
most common cause of cirrhosis in US(2)
Hep B and C
alcohol
Marker of PBC
antimitochondrial antibody
acute pancreatitis and suspiscion of gallstones
perform US
most common cause of acute pancreatitis (2)
alcohol
gallstones
first thing to do in patient with acute pancreatitis
U/S to rule out cholelithiasis and choledocholithiasis
first image in pancreatitis
sono abdomen
risk # 1 for pancreatitis cancer
chronic pancreatitis
the second major risk factor for pancreatic ca(2)
hereditary
and environmental
whta’s the major hereditary risk for pancreatic cancer(3)
hereditary pancreatitis
germline mutation
first relative with pancreas cancer
germline mutation for hereditary pancreatic cancer(3)
BRCA-1
BRCA-2
Peutz jegher
Environmental risk for pancreatic cancer(4)
cigarette
obesity
low exercice
non hereditary pancreatitis
epigastric pain and ictere best test to do
U/S to rule out biliairy obstruction
epigastric pain and weight loss best test to do
CT abdomen
anal fissure treatment
stool softener
local anesthetic
why use local anesthetic in anal fissure
to remove the spasm
Patient seen in ED with hypotension and hematemesis(3)
or any patient received in ED
Airway
Breath
Circulation
Patient after several episodes of vomiting develops hematemesis
Malorry weiss syndrome
cause of mallory weiss
increased intragastric pressure causes tear in gastric mucosa and distal esophagus
what arteries are involved in Mallory weiss
submucosal arteries in proximal stomach and distal esophagus
pourcentage of bleeding caused by mallory weiss
10%
risk for barret
adenocarcinoma of esophagus
type of esophagus cancer in alcohol and smoker
SCC
Cause of increased bilirubin mainly conjugated with high ALP(5)
PSC PBC Choledocholithiasis pregnancy cholangiocarcinoma
work up for increased bilirubin conjugue with high ALP(3)
CT
U/S
Antimitochindrial antibody
Approach of hyperbilirubinemia(2)
Conjugue
non conjugue
approach of bilirubin conjugue(3)
know if it’s AST ALT ALP normal
Predominance of ALP
Predominance of AST/ALT
cause high bilirubin non conjugue
gilbert
hemolysis
reduced uptake
cause high bilirubin conjugue with normal everything else(2)
Rotor
dubin jhonson
Cause increased bilirubin conjugue and high AST ALT predominantely(2)
hepatitis
hemochromatosis
cause of Hepatitis(6)
viral ischemic autoimmune toxin drug alcohol
chest pain and dysphagia in young girl
spasm diffus de l’oesophage
work up for spasm diffus de l’oesophage
eosphagram
manometry
esophagram for spasm diffus de l’oesophage
corkskrew apperance
manometry for spasm diffus de l’oesophage
contraction and relaxation of LES
RUQ pain after cholecystectomy
post cholecystectomy syndrome
cause of post cholecystectomy syndrome(2)
biliairy
extra biliairy
biliary cause of post cholecystectomy syndrome(2)
cystic duct stone
common bile duct retained
extra biliary cause of post cholecystectomy syndrome(2)
pancreatitis
PUD
Dx of post cholecystectomy syndrome
ERCP
MRCP(Magnetic resonnance cholangiopancreatography)
what the two main things to look pseudomembranous colitis
WBC
Creatine level
CAT si WBC
Metronidazole
CAT si WBC> 15000 and creat> 1,5 fois baseline
oral vancomycin
CAT si WBC> 15000 and creat> 1,5 fois baseline plus ileus
oral vancomycin plus IV metro
or rectal vancomycin switch)
CAT si WBC> 20000 plus megacolon toxic plus ileus and lactate >/ 2,2
surgery
surgery for pseudomembranous colitis
si WBC> 20000 plus megacolon toxic plus ileus and lactate >/ 2,2
type de surgery in pseudomembranous colitis
subtotal colectomy
diverting loop ileostomy with colonic lavage
antibiotic most commonly involved in pseudomembranous colitis(4)
clindamycin
quinolone
penicilin
cephalosporin
confirmatory dx fror pseudomembranous colitis
Cdif toxin by PCR
indication of fidaxomycin in pseudomembranous colitis(2)
reccurent colitis
sevfer colitis not able to tolerate oral vancomycin
microcytic anemia first cause
GI blood loss
work up GI in microcytic anemia(2)
endoscopy
colonoscopy
in the work up of microcytic anemia what to do if endoscopy and colonoscopy are negative
capsule endoscopy to look small intestine
MEN 1
3 tumors
gastrinoma
2 adenomas(pituitaire and parathyroid)
MEN 2a
2 tumors
parathyroid hyperplasia
Pheo
Medullary thyroid cancer
clue for diarhhea cused cryptosporidium parvum(3)
HIV
low CD4
modified acid stain (oocyst)
acid fact stain plus oocyst
isospora belly
epidemio of isospora
no isospora is US
4 reasons to ask endoscopy in GERD(4)
> 50 ans
Symptoms> 5 ans
signes de danger
facteur de risque de ca
singnesd e danger dans GERD(5)
Persisting vomiting digestive hemorrage anemia perte de poids odynophagia and dysphagia
how’s platelet in in chron
reactive thrombocytosis
Hallmark of chron(2)
involvement mouth to anus
fistula
Clue for chron(4)
chronic diarrhea
with abd pain and
weight loss in
young patient
Back pain and anemia in patient on warfarin
spontaneous retroperitoneal hematoma
epigastric pain cause(4)
MI
PUD
cholecystitis
Aortic dissection
epigastric pain with irradiation in both arms
infero post MI
Management of asymptomatic diverticulosis
high fiber intake
how constipation causes diverticuli
Increase presure in colon creates weak spots
quid of diverticuli
saclike protrusion of colonic wall