Git Flashcards
defect in achlasia
loss of inhibitory neurons in LES that are responsible for blocking the impulses that cause contraction
pattern of dysphagia in achlasia
progressive to both solids and liquids simultaneously
pattern of dysphagia in esophagial ca
to solids that progresses to liquids
when is there dysphagia to both liquids and solids
in motility disorder
in growing obstruction:first solids than liquids
which is the gold std/most accurate test for achlasia
manometry
barrium esophagraphy shows____in achlasia
bird beak
best initial therapy for achlasia
pneumatic dilation
Tt of achlasia
- pneumatic dilation
- botulinum injection
- myotomy
disadvantage of botulinum toxin
repeated injections needed
complication of myotomy in achlasia
reflux
eosophageal SCC and adenoca found in which regions of esophagus
SCC-proximal 2/3
ADENO- distal1/3
best initial diagnosis of esophageal ca via
endoscopy as Dx is biopsy based
best initial diagnosis of esophageal ca via
endoscopy as Dx is biopsy based
chemotherapeutic drug used for git malignancy
5FU
defect in esophagus of scleroderma
decreases motility
open tube which neither contracts nor relax
atrophy and fibrosis of smooth muscle
most accurate test for dysphagia in scleroderma
motility studies
diff bw nutcracker esophagus and DES
they are same except the difference in manometric pattern
dysphagia pattern in DES
intermittent chest pain and dysphagia
at any time(not always with swallowing as in esophagitis)
dysphagia pattern in DES
intermittent chest pain and dysphagia
at any time(not always with swallowing as in esophagitis)
barium studies in esophagial spasm shows
corkscrew pattern
most accurate test for DES/nutcracker esophagus
manometry
also in achlasia
Tt of nutcracker/DES
CCB/nitrates
DES can be confused with
prinzmetal angina
sublingual nitroglycerin relieves chest pain in both
diagnosis of rings/webs made by
barium
Tt of rings/webs
PVS-Fe
both pneumatic dilation
cause of the pain of esophagitis
since it occurs only on swallowing so causes by rubbing of food against an inflamed esophagus
main risk factors for candida esophagitis
HIV AIDS(<200/mm3 :CD4)
diabetes mellitus
common pills causing esophagitis
fe vitC K dronates tetracyclines quinine
if the patient is HIV + , we assume esophagitis due to
candida
give fluconazole(diagnostic as well as therapeutic)
if no imp then endoscopy with biopsy to R/o other causes.
characteristic features of zenkers diverticulum
express undigested food(eg on pillow)
halitosis
Dx of zenkers via
barium
mallory weis
nontransmural tears in lower esophagus and proximal stomach ass with retching/vomiting
most common presentation of mallory weis synd
upper git bleed(malena)
no dysphagia/odynophagia
criterion for endoscopy foe epigastric pain
all patients above 45yrs whether alarm symtoms present or not.
below 45 yrs : only if alarm symptoms present and if symptoms not resolving
alarm sym:wt loss, dysphagia, bleeding
LES is not an anatomic sphincter
yes
not found in cadaver
epigastric pain in GERD can be differentiated from others by
sore throat metallic taste hoarseness cough wheezing
most accurate test for gerd
24 hr PH monitering
is endoscopy useful in Dx of gerd
no
normal endoscopy does not exclude reflux
all PPIS/ H2 blockers are equal in efficacy
yes
tt of H.pylori
PPI+amoxicillin+ clarithromycin
if not tted then
PPI + metronidazole + tetracycline
features of ulcers of ZES
Recurrent
large
multiple
distal portion of duodenum
resistant to routine therapy
ass with diarrhoea and steatorrhoea
the most accurate test for metastatic ZES
endoscopic U/S
then somatostatin receptor scintigraphy
Dx of gastroparesis
gastric emptying study with rdiolabelled
ASCA anti saccharomyces cerevisae Ab positive in
crohns ds(neg in UC)
fistulising CD tt
infliximab( inhibits TNF)
main SE of infliximab
reactivation of Tb(do PPD)
arthralgia
mainstay of tt in IBD
mesalamine
acute exacerbation in IBD tted by
steroids
best BUDESONIDE(less systemic toxicity)
perianal IBD tted by
ciprofloxacin and metronidazole
why antibiotics are CI in EHEC diarrhoea
HUS happen when org dies
platelet transfusion also CI even if low
MCC of infectious diarrhoea
campylobactor
salmonella
presence of leukocytes in stool indicates
intestinal invasion
blood may not be present..appears 24-36 hrs after…(exception : E.histolytica)
best emperic therapy for infectious diarrhoea
ciprofloxacin (other FQs) +/- metronidazole
___ antibiotic is highly ass with C.diff
clindamycin
c.diff is largely a nosocomial ds
yes
c.diff is largely a nosocomial ds
yes
cause of c.diff diarrhoea.
toxins A and B
enterotoxic and cytotoxic effects
tt of c.diff diarrhoea
metronidazole
when is oral vancomycin given in c.diff
failed therapy with metro
resist to metro
allergic to metro
pregnant
<10 yr child
critically ill
if c.diff recurrs which antibiotic to be given
metronidazole
not vanco
fodaxomicin
can be used in c.diff
Dx of c.diff
LAMP(loop mediated isothermal amplification)
detects toxin A and B genes
earlier ELSIA was used: detects toxin
main symptom in IBS
pain
other:
only diarrhoea
only constipation
or both
no nocturnal symptom-as in UC/CD
pain relieved by change in bowel habbit
no constitutional symptom
tegaserod amd alosetron
constipation predominant IBS
diarrhoea induced IBS
both work by manipulating serotinin level
how does TCA work in IBS
relax bowel
treats depression
analgesic effect with neuropathic pain
carcinoid treated with
octreotide(somatostatin analog )
CF of carcinoid
diarrhoea
flushing
tachycardia
hypotension
right heart- tricuspid insufficiency, pul stenosis
rash- due to niacin deficiency
why is endoscopy or nasogastric tube CI in zenkers
for the risk of perforation
name malabsorption syndromes
most common : celiac ds and chronic pancratitis
others:
tropical sprue
whipple ds
what is common in all the malabsorption syn
steatorrhoea
wt loss
deficiency of fat sol vitamins
what is unique to celiac ds
its association with dermatitis herpetiformis ..seen in apprx 10% of people.
what are the distinguishing features of whipple ds to other Malabs syn
arthralgia 80%
dementia 10%
ophthaloplegia
most accurate test for
- celiac
- ch pancreatitis
- tropical sprue
- whipple
- secretin/low trypsin
- biopsy- loss of villi
- biopsy -org
- biopsy - specific Trophyrema whippelii
secretin test in ch. pancreatitis
if u place nasogastric tube into duodonem and inject secretin in blood , the pancreas ll not release bicarbonate and enz in gut.
trypsin and not amylase/lipase are used as a measure of ch pancreatitis.
yes
low trypsin( in acute: high)
amylase/lipase may be normal
why is biopsy done in celiac ds if it can be found out by serology
to rule out small bowel lymphoma
diff ch pancreatitis from other causes
repeated episodes of pancreatitis( from alcohol/ gallstones)
calcification
diff ch pamcreatitis and mucosal defect on the basis of the following. D-xylose in urine Fe B9 B12 A,D,E,K
ch pancreatitis: \+ \+ \+ - -
mucosal defect - - - - -
antibodies seen in celiac ds
IgA—— endomysial Ab
IgA/G- tissue transglutaminase
IgA/G- deamidated gliadin peptide
most senistive and specific Ab in celiac ds
IgA anti-tissue transglutaminase
diagonsing celiac ds in IgA deficiency with Abs
IgA endomysial and transglutaminase are falsely normal
Rx of celiac ds
gluten free diet
dermatitis herpetiformis-dapsone
Rx of ch. pancreatitis
oral replacement of enz
Rx of tropical sprue
TMP-SMX or doxycycline
Rx of whipple ds
TMP-SMX or doxycycline or ceftriaxone (×1yr)
when is the colour of the stool is blackish
ferrous sulphate tablets
bleeding
bismuth subsalicylate
blood causes diarrhoea and iron tablets cause constipation
yes
best Dx of diverticulosis via
colonoscopy
best diagnosis of diverticulitis via
CT scanning
Barium and endocopy are contraindicated because of risk of perforation.
common presentation of diverticulosis
left lower quaderant pain
how to distinguish diverticulitis from diverticulosis
fever
more intense pain
increase in WBC
tenderness
cause of diverticulosis
MCC- low fibre diet
Rx of diverticulitis
ciprofloxacin + metronidazole
others
ampi/sul
pip/tazo
genta+cefotetan/cefoxitin
most likely cause of black coloured stool with diarrhoea
bleeding
blood acts as cathartic
left sided colon ca mostly presents with
obstruction and dec stool calibre
not seen with right sided(heme+ brown stool with ch anemia)
endocarditis by streptococcus bovis and clostridium septicum ass with
colon ca
what would you do if an xray finds osteomas as an incidental finding
colonoscopy
what would you do in a strepto.bovis endocarditis
colonoscopy(colon ca)
garderner syndrome
ass with colon ca with multiple soft tissue tumors: osteomas lipomas cysts fibrosarcoma
OSTEOMA PARTICILARLY IN MANDIBLE
peutz jeghers syn
ass with hamartomatous polyps and hyperpigmentation in skin, lips and buccal mucosa
turcot syn
ass with colon ca and CNS malingnancies
cowden syndrome
ass with colon ca
most accurate diagnostic test for colon ca
colonoscopy
sigmoidoscopy detects onl 60% of ca as it cant see entire colon
colon ca screening
everyone >50 yrs of age
- most accurate- COLONOSCOPY(every 10 yr)
- sigmoidoscopy (every 1-2 yr)
- fecal occult blood anually
why is colonoscopy better than sigmoidoscopy
sigmoidoscopy ll only reach the lesion upto 60 cm missing the rest 40% of ca.
lynch syndrome is ass strongly with ca of
colon
endometrium
ovarian
FAP
100%penetrance
initially adenoma (25yrs) which ll progress to ca (by 50 yrs)
a person presented with git bleeding with a history of abdominal aortic aneurysm repair in the past 6 mths to a yr
aortoenteric fistula
Rx of long term management of potal hypertension
propanolol
separation of upper and lower git bleeding done anatomically through
ligament of Treitz , which anatomically separates the duodenum from jejunum
treatment of acute bleeding due to varices
- general measures for git bleeding
- octreotide
- band(sclerotherapy not used as more side effects)
- TIPS( SE: hepatic encephalopathy)
how to manage case of git bleeding
Rx first and then search for eitology
1.bolus of NS/RL
- CBC
(a) .HCT - tranfuse packed RBC if <30 %
(b) . platelets - transfuse if <50,000
3. PT- if less: fresh frozen plasma
4. NG tube
5. endoscopy:both to find site and cause of bleeding
melena occurs when ____ amount of blood has been lost
atleast 100mL from upper git
lower and upper git bleeding presents as
lower–red blood in stools
upper–black stool/ malena, hemetemesis
define orthostasis
> 10 point rise in pulse when the patient goes from supine to the standing / sitting position.
OR >20 point drop in SP on change in position.
there should atleast be a min in the measurement of pulse / BP to allow time for normal ANS diacharge to acc position change
if pulse >100/min OR SP <100… .indicates how much blood loss
> 30 %
most accurate test to determine the cause of both upper and lower git bleeding
endoscopy
role of nuclear bleeding scan in GI bleeding
used when endoscopy is not able to reveal the cause even when there is active bleeding.
detects low vol bleeds 0.1-0.2mL / min
RBC of patient are tagged with Tc and reinjected….tagged cells are then detected.
how angiography can be used for evaluation og GI bleeding
rarely used because it needs a higher vol of blood loss >0.5mL/ min
when both upper and lower endoscope are unrevealing in GI bleeding ..the most likely site of bleeding is
small bowel
capsule endoscopy
new modality to visualize small bowel which is not visualised by upper (till lig treitz)/lower (just past ileocaecal valve)endoscope.
swallows capsule with electronic camera..tramsmits thousands of images
