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
dysphagia for both solids and liquids
motility problem
Dysphagia for solids first then for liquids(2)
ca oesophage
stricture
best test for in case of dysphagia
baryum esophagram
if baryum esophagram is not conclusive next step in case of dysphagia
upper GI endoscopy
Ascites with fever and neurologic symptom(confusion and lethargy)
spontaneous bacterial infection(peritonitis)
criteria of SBP
> 250 WBC in fluid ascites
Important test for SBP DX
Paracenthesis
bugs causing SBP(2)
klebsiella
E coli
Rx of SBP
3 e generation cephalosporin
massive GI bleeding by cirrhosis RX first
ABC de l’urgence
octreoctide
Massive hemorrage with depressed consciousness
Intubation is indicated
indication of platelet transfusion in GI bleeding caused by cirrhosis
platelet
how to stop hemorrage in cirrhosis(2)
band ligation
or sclerotherapy
patient returning from mexico develops foul smelling diarrhea
giardiasis
zone in the US with giardiasis
rocky mountains
rx of giardiasis
Metronidazole
how giardiasis causes digestive problem
by adhering to mucosal surface by adhesive disks causing malabsorption
3 types of polyps(3)
hyperplastic
adenoma
hamartoma
pill esophagitis (3)
koh
quinidine
iron
antibio causing esophagitis
cycline
nsaids causing esophagitis
all NSAIDS
biphosphonate and pill esophagitis
alendronate
colonic angyodysplasia
painless GI bleeding
plus aortic stenosis
Quid of Heyde’s syndrome
painless GI bleeding
plus aortic stenosis
why GI bleeding in Heyde’s syndrome
Because of AV malformation
management of non bleeding cirrhosis
non selective B blocker
non selective b blocker used in non bleeding cirrhosis
propranolol
nadolol
mangement of non bleeding cirrhosis if B blocker is contreindicated
primary preventive band ligation
how BB prevents bleeding in cirrhosis
decreased portal flow
GI bleeding with anemia
packed red blood cell
condition of packed red blood cell in anemia
Hb
quid of speed ball
cocaine and heroin use
risk of speed ball use
rhabdomyolysis
vaccin a donner in IV drud user
Hep B vaccine
cause of hypotension in severe pancreatitis(Necrotizing pancreatitis)
increased capillary permeability
quid of severe pancreatitis
pancreatitis plus at least one organ failure
cullen sign
periumbilical bluish discoloration
Meaning of cullen sign
hemoperitoneum(pancreatitis)
grey turner sign
reddish discoloration in flank
Meaning of grey turner sign
retroperitoneum(pancreatitis)
risk factor for severe pancreatitis
age > 75 ans obesity alcohol CRP>150 Increase BUN ARDS
rx of acute pancreatitis(3)
fluid
pain control
bowel rest
aspirin and GI bleeding
acute erosive gastritis
mechanism of action of aspirin
block cyclooxygenase pathway—> no prostaglandin
role of prostaglandine
effect protecteur sur la muqueuse gastrique
rx of acsites(4)
sodium and water restriction spironolcatone loop diuretic(1 l/day of diuresis) frequent abdominal paracenthesis(2-4 l if renal perfusion is OK)
water restriction in cirrhosis
warning with diuretic in cirrhosis(spirono and furosemide)
agressive diuresis
can cause hepato renal syndrome
iron deficiency anemia in patient taking NSAIDS
GI bleeding
ca associated with hemochromatosis
hepatocellular carcinoma
what are the 3 mutations associated with Hemochromatosis(3)
HFE
L2824
H63D
cause of bacterial overgrowth(3)
motility problem
strictures in GI
other causes
motility problem causing overgrowth bacterial(2)
sclerodermia
diabetes
other causes of bacterial overgrowth(4)
end stage renal disease
cirrhosis
AIDS
advanced age
gold standard to Dx bacterial overgrowth
endoscopy with aspiration in jejunum
finding in endoscopy in jejunum aspiration in bacterial overgrowth
bacteria>10exposant 5 bact /ml
bacteria causing bacterial overgrowth(4)
E coli
lactobacillus
bacteroides
streptococci
manif of bacterial overgrowth
chronic diarrhea
Rx of bacterial overgrowth(2)
augmentin
or rifamixin pdt 7 a 10 jours
cause of mesenteric ischemia(abdominal angina)(2)
atherosclerosis
occlusion of visceral arteries
clue for mesenteric ishemia
severe abdominal pain after eating
Dx of abdominal angina(2)
Doppler abdomen
or
angiography
pain with foof d Dx(2)
PUD
abdominal angina
auscultation clue for abdominal angina
50 % des cas
abdominal bruit
similitude between Chron and TB
both have granuloma
characteristic of chron
transmural lesion skip lesions creeping fat appearrance fistula/fissure perianal disease mouth to anus
why fistula in chron
transmural lesion
disease with granuloma(4)
TB
Chron
sarcoidosis
yersinia infection
initial bleeding management caused by varices(3)
fluid
octreoctide IV
sclerotherapy or band ligation
quid of octreoctide
somatostatin analog
next step in managing bleeding varices if success in initial step(2)
Bblocker
repeat endoscopic band ligation in 2 a 3 weeks
failure of initial management of varices
ballon tamponnade
or
TIPS or shunt surgery
TIPS
transjugular intrahepatic portosystemic shunt
if rebleeding after initial management next step(2)
try endoscopic rx
or
TIPS/Shunt surgery
tube used in ballon tamponade(3)
sengstaken blackmore
Minessota
linton nachlas
type of problem in zencker
motor dysfunction and incoordination
rx of zencker
crycopharyngeal myotomy
localisation of zencker
above upper esophageal sphincter
quid of zencker
posterior herniation through the fibers of cricopharyngeal muscles
what cause the herniation in zencker
incoordination between the contraction of pharynx and contraction of upper esophageal sphincter
complication of zencker(4)
trachea compression
aspiration pneumonia
erosion and bleeding
regurgitation
indication of H pylory
indication of endoscopy in dyspepsia(2)
> 55 ans with new dyspepsia
any age with alarm symptom
quid of dyspepsia(3)
epigastric pain
bloating
early satiety
patient with dyspepsia,no alarm symptom an less 55 ans with negative H pylori
PPI for 4 a 8 semaines
cause of dyspepsia(5)
GERD AINS PUD Malignancy functionnal dyspepsia
workup for zollinger ellisson syndrome
gastrin level >1000 pg /ml
workup for zollinger ellisson syndrome gastrin test inconclusive next step
secretin stimulation test
biopsy finding in UC
neutrophylic cryptitis
patient after coronary bypass develops abdominal pain and bloody diarrhea
Ischemis colitis
why lactate is high in ischemic colitis
because of ischemia
what area is most commonly involved in ischemic colitis and why
-splenic flexure
rectosigmoid junction
vascularisation by ended artery
vascularisation of splenic flexure
narrow terminal branches of superior mesenteric artery
vascularisation of rectosigmoid junction
narrow terminal branches of inferior mesenteric artery
cause of ischemic colitis during coronary bypass (any surgery)
hypotension
watershed area involved in ischemic colitis
-splenic flexure
rectosigmoid junction
lactose intolerance workup(4)
H+ breath test
Low stool PH
high osmotic gap
osmotic substances in stools
quid of high osmotic gap
> 50
clue in lactose intolerance
no steatorrhea
quid of bright red blood cell per rectum(2)
scant hematochezia
minimal scant bleeding
Cause of red blood cell per rectum(4)
hemorroides
fissures
proctitis
rectal ulcer or Ca
Best test in red blood cell per rectum(2)
anoscopy
proctoscopy
quid of SAAG(2)
serum ascites albumin gradient
Albumin serum- albumin ascites
Value of SAAG in ascites caused by SBP
> 1,1
Importance of SAAG
> /1,1 ascites is caused portal hypertension
spontaneous bacterial infection of ascites(3)
Hypotension
hypothermia
ileus
Dx of SBP
SAAG > 1,1
Albumin ascites
when to avoid quinolones in SBP
patient already receives it for SBP prophylaxis
first step in the workup of acute pancreatitis
amylase
lipase
what are the main criteria to Dx acute pancreatitis
epigastric pain radiating in the back
amylase and lipase >3 f la normale
CT or U/S
U/S of acute pancreatitis
hypoechoic image
the most useful blood test in acute pancreatitis
Lipase
why lipase is most useful blood test in acute pancreatitis
rises in 4-8 h
stay up 8-14 jours
what about amylase
rises in 6-12h
apres 5 jours disparait
patient with acute pancreatitis with amylase and lipase increases 3 f la normale
ni image is needed for the Dx of acute pancreatitis
when to do CT in acute pancreatitis
Dx is unclear
failure of treatment
chronic pancreatitis workup(2)
plain film
CT of abdomen
image in Plain film or CT of abdomen for chronic pancreatitis
calcification
cause of chronic pancreatitis(3)
alcohol
autoimmune
cystic fibrosis
symptom of chronic pancreatitis(4)
Diabetes
weight loss
malabsorption
epigastric pain
Rx of chronic pancreatitis(4)
Pain management
stop smoking
enzyme replacement
frequent small meals
clue for inflammatory diarrhea(5)
anemie High ESR Acute phase reactant thrombocytosis blood in stool or leucocyte
what to think in chronic inflammatory diarhhea
IBD
characteristics of fat malabsorption(3)
foul smelling diarrhea
difficult to flush
floating diarrhea
3 main problem causing steatorrhee(3)
pancreatic insufficiency
bile salt related
impaired intestinal surface epithelium
2 causes of pancreatic insufficiency
chronic pancreatitis
ca pancreatic
What can impair epithelium intestinal surface(3)
AIDS
celiac disease
giardiasis
problem with bile salt
foie
ileon
Hepatic problem related to malabsorption(2)
PBC
PSC
iIeal problem related to malabsorption(3)
cron
bacterial overgrowth
surgical resectionof ileon
other causes related to malabsorption(3)
whipple
ZES
Medication induced
Dx test for steatorrhea
sudan stain
clue for diverticulitis(3)
LLQ pain
fever
elderly
Diverticulitis rebelle aux antibiotiques DX(3)
complication
abcess
fistula
perforation
best test yto evaluate complication in diverticulitis
CT scan of abdomen
patient with barret and Heartburn 3 weeks later without Rx no more heart burn Dx?
benign peptic strictures
What to do in peptic benign strictures and why(2)
biopsy
to ruleout adenocarcinoma
quid of barret
intestinal metaplasuia of lower esophagus
cause of peptic strictures(4)
GERD
Scleroderma
radiation
caustic ingestion
clue for abdominal herpes pain
immunocompromised patient
develops abdominal pain elicits by light touch of abdomen
what will appear in 1 week in this patient with abdominal herpes
skin lesion
what appear first in herpes
the local pain
Pain and rash in herpes(2)
pain can precede rash
or
both can appear simultaneously
in manometry record how appears a contraction of esophagus
positive deflection
in manometry record how appears a relaxation of esophagus
negative deflection
next if ca gastric is detected
CT extent evaluation
UC with high ALP
PSC
what test to do in UC
sigmoidoscopy
sigmoidoscopy finding in UC(2)
Mild erythema
mucosal inflammation
complication of UC(2)
colorectal cancer
toxic megacolon
extraintestinal manif of UC(4)
PCS
uveitis
eryhtema nodosum
spondyloarthropathy
patietnn with multiple thrombophlebitis
check a cancer
why cancer can cause thrombophlebitis
Hypercoagulability
clue for factitious diarrhea
laxative abuse
confirmatory Dx of factitious diarrhea
biopsy
biopsy of factitious diarrhea
dark brown discoloration with lymph follicles shining through as a pale pathes(melanosis coli)
laxative causing melanosis coli
antraquinone containing laxative
antraquinone containing laxative
bisacodyl
Dx of zencker
contrast esophagram
Complication of PSC(5)
cholelthiasis cholestasis cholangiocarcinoma colon ca biliary stricture intra et extra hepatique
epigastric pain and weight loss
ca pancreas
Dx test for ca pancreas
CT abdomen
why patient on total parenteral nutrition develops gallstones
gallbladder stasis
why gallbladder stasis in total parenteral nutrition
because no food in duodenum to cause activate release of cholecystokinine
role of cholecystokinine
contraction of gallbladder
why ileal resection causes gallstones(3)
because of decreased enterohepatic cycle
hepatic bile is oversaturated with cholesterol
gallstone formation
why megaloblastic anemia in tropical sprue
B12-folic acid deficiency
dx of tropical sprue
blunting villi
chronic infiltrationof inflammatory cells(Lymphs,plasma cells,eosinophils)
important feature of tropical sprue
malabsorption
why in GI bleeding causes high BUN
bacteria in gut degraded hb en Urea
cause of BUN elevation with normal creat(3)
GI bleeding
prerenal azotemia
systemic steroids
major side effect of digoxin toxicity
anorexia
drug that can increase the level of digoxin
verapamil
furosemide
why verapamil causes increase level of digoxin
by decrease the renal clearance of digoxin
why furosemide causes increase level of digoxin
by causing hypokaliemia
cardiac problem in digoxin toxicity(2)
bidirectionnal ventricular tachycardia
accelarated junctionnal rythm
most common side effect of digoxin toxicity(3)
GI problem
anorexia
nausea
vomiting
medication for seizure causing pancreatitis
acid valproic
anti hta causing pancreatitis(2)
furosemide
thiazides
drugs used in IBD causing pancreatitis
sulfasalazine
5-ASA
immunosuppresor causing pancreatitis(2)
azathioprine
L asparaginase
patient with HIV with pancreatitis(2)
didanosine
pentamidine
Antibio involved in pancreatitis
metronidazloe
4 cycline
cause of renal failure in hepato renal syndrome
renal hypoperfusion
rx of hepatorenal syndrome
octreoctide
or
Midodrine
prerenal failure
urine Na+ less than 10meq/L
clue for intestinal occlusion(2)
vomiting
not passed gas
Dx of intestinal occlusion(2)
plain film of abdomen
multiple air fluid
rx for intestinal occlusion
surgery
cause of toxic megacolon(5)
UC ischemic colitis volvulus diverticulus obstructive cancer
LLQ pain(2)
diverticulitis
complicated Ca
localisation of celiac sprue
proximal intestine
test for diagnosing celiac sprue
D xylose test
D xylose test(3)
ingestion of D xylose
intact intestinal mucosa
urinary excretion 4,5-7,5g
absent peristaltic waves and low LES tone
scleroderma
UC plus fever Dx
rule out toxic megacolon
chronic bloody diarrhea
UC
Major criteria of Megacolon(4)
fever
HR>120
Neutrophilic leucocytes>10500
anemia
Minor criteria(4)
hypotension
electrolytes disturbances
altered sensorium
volume depletion
Dx of megacolon(2)
3 criteres major
plus one minor criteria
dx diffuse spasm of esophagus
manometry
clue for diffuse spasm of esophagus
retrosternal spasm
exacerbated by sttress and cold food
drug used in diffuse spasm
nitroglycerin
EKG in diffuse spasm of esophagus
normal
quid of angiodysplasia(2)
dialted
ectatic thin walled vessels lined by endothelium
disease with angyodysplasia(2)
end stage renal disease
aortic stenosis
cardiac problem in whipple disease(2)
CHF
valvular regurgitation
why many people with celiac disease has IDA antibody negative
because they have selective IGA deficiency
role of endoscopy in achalasia
to rule out ca du bas oesophage
quid of bird beak appearance
dilated esophagus with distal narrowing
level of calcemia to have constipation
> 12
severe epigastric pain spreadind all over the abdomen
chemical peritonitis due to perforated ulcer
quid of polyps
adenoma
condition of adenomas to become cancer(3)
villous
sessile
> 2,5 cm
CT of acute pancreatitis
focal or diffuse pancreatic enlargement with heterogenous enhancement
epigastric pain with high amylase and lipase and ALT>150 units/l
biliairy pancreatitis
3 types of IBS
constipation predominant
diarhhea predominat
Mixed
cause of pellagra
deficiency of NIACIN
patient with cirrhosis and smooth muscle antibody microsomal type 1 positive cause?
autoimmune
disease associated with autoimmune cirrhosis
thyroiditis
hows pancreatic hormone in chronic pancreatitis
Normal
post cholecystectomy syndrome work up(3)
abdomen U/S
ERCP
MRCP
Dx of C difficile
stool studies
microcytic anemia in elderly
FOBT
colonoscopy
meaning of negative FOBT in microcytic anemia(2)
cant’t exclude GI blood loss with one FOBT negatif
perform colonoscopy
what to do in any patient with acute abdominal pain
rule out MI with EKG
chron granuloma
non caseating
DX of ZES
fasting gastrin level
cobble stone appearance
chron
neutrophilic abcess
crhon
UC
confirmatory DX of SBP(2)
Neutro >250micro/l
positive peritoneal fluid culture
post ERCP patient develops epigastric pain
iatrogenic acute pancreatitis
most common cause of malabsorption
alcoholic chronic pancreatitis
complication of UC requiring surveillance
colon carcinoma
Quid of PSC
stricture of medium sized and large intrahepatic and extra hepatic bile ducts
most common consistent reversible risk factor of pancreatic cancer
smoking
charateristic finding in imaging in pancreas ca (tete pancreas)
intra and extra hepatic biliairy tract dilation
what will increase during GI bleeding
BUN/Creat ratio
patient with UC develops fever weight loss and colonic dilation abdominal xray
toxic megacolon
management of toxic megacolon(3)
IV steroids
Fluid management
nasogastric decompression
Dx test for diverticulitis
ct scan of abdomen
