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G.I.T. Flashcards

1
Q

Most accurate test for achlasia

A

Manometry

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2
Q

Most accurate test for cancer esophagus

A

Endoscopy with biopsy

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3
Q

Most common site for sq and adenoca in esophagus

A

SCC:most common
proximal 2/3

ADENOCARCINOMA
Distal 1/3
Precursor baretts esophagus

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4
Q

Which type of angina is mimicked by DES

A

Primzmetal

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5
Q

Main complaint of DES/Nutcracker esophagus

A

PAIN

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6
Q

How will u differentiate bw pain of DES and esophagitis

A

Pain only on swallowing in esophagitis

DES not related to food

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7
Q

Manometry is the most accurte test for

A

Achlasia

DES

Nutcracker esophagus

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8
Q

Most common cause of epigastric pain

A

NONULCER DYSPEPSIA

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9
Q

What it indicates if there is difficulty with solids only

A

Mechanical obstruction

Like lower isophageal ring
Peptic stricture
Esophageal ca.

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10
Q

What is the pathology if there is dysphagia with both solids and liquids

A

Motility problem

Like DES, scleroderma, achlasia

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11
Q

Haman sign

A

Mediastinal crunch produced by heart beating against air filled tissues

Seen in esophageal perforation

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12
Q

Most accurte test for esophageal perforation

A

Contrast esophaogram with gastrograffin not barium

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13
Q

Till what Sx can be done in case of esophageal perforation

A

Within 24 hrs

Otherwise risk of fistulization

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14
Q

RX OF esophageal perforation

A

SMALL
Medical: iv fluids, NPO ,Abs , H2 blockers

LARGE/COMMUNICATES WITH PLEURAL CAVITY
Sx within 24 hrs

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15
Q

Most accurate diagnostic test for esophageal diverticula

A

Barium swallow

Endoscopy can cause perforation

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16
Q

Cause of zenkers diverticula

A

Faiilure of cricopharyngeal m relaxation during swallowing

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17
Q

Differentiating between regurgitation of achlasia and zenker

A

Zenker : food can be expressed by oneself

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18
Q

RX of esophageal diverticula

A

If the diverticula is caused by motility ds like zenker/epiphrenic

Then Rx motility ds by myotomy
Diverticulectomy is of secondry importance

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19
Q

Types of hiatal hernia

A

TYPE 1
Sliding:GEJ is disturbed so GERD main complaint
Rx: benign , anatacids and lifestyle modification, if not then nissens fundoplication

TYPE2
Rolling/paraesophageal:strangulation/obstruction is the main complication.
Rx: elective surgery to reduce complication

TYPE3
Mixed

TYPE4
Mixed+abdominal content like biwels, spleen

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20
Q

Manometry is diagnostic test for

A

Achlasia

DES/Nutcracker

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21
Q

Mechanism of DES and achlasia

A

DES
Nonperistaltic spontaneuos contractions of esophagus but LES tone is normal

Achlasia
Abscence peristalsis
High LES pressure

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22
Q

Is plummer winson syndrome a premalignant condition?

A

Yes because 10 % develop SCC of oral cabity,hypopharynx,esophagus

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23
Q

Most common risk factor for scc and adenoca of esophagus

A

SCC
alcohol,tabacco
Diet; HPV, PV syn, caustic ing, nasopharyngeal ca

ADENOCA
GERD and baretts

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24
Q

Rx of achlasia

A

pneumatic dilation

Botulin toxin(repeat every 2 yrs)

Heller myotomy

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25
What is most sensitive and specific test for H.pylori
Sensitive(SNOUT) serology specific(SPIN) Biopsy
26
Which is the best test to see response to Rx in H.pylori
Urea breath test Or Stool antigen But done only if there is persistance /reccurence/recrudenscence of symptoms
27
What are the common causes of epigastric pain related to git
``` Non ulcer dyspepsia(mc) GERD DU/GU gastritis Cancer ```
28
What is the single most important stimulant for gastrin and mucus secretion
STRETCH Release both acid and mucus
29
When is Sx indicated in PUD
When complication develops Bleeding Perforation Gastric outlet obstruction
30
Best triple and quadruple regimen for h.pylori eradication are
TRIPLE PPI+ amoxicillin+ clarithromycin QUADRUPLE PPI+ bismuth subsalicylate+ metronidazole+ tetracycline
31
Best triple and quadruple regimen for h.pylori eradication are
TRIPLE PPI+ amoxicillin+ clarithromycin QUADRUPLE PPI+ bismuth subsalicylate+ metronidazole+ tetracycline
32
Mcc of upper git bleeding
Peptic ulcer
33
Metastasis of gastric carcinoma
KRUKENBERG to ovary ``` BLUMER SHELF To rectum(pelvic cul de sac) ``` SISTER MARY JOSEPH NODE Periumblical VIRCHOW NODE Supraclavicular IRISH NODE Lefy axillary adenopathy
34
Drug for fistulas in crohns ds
Infliximab TNF alpha inhibitor Can reactivate TB so get a PPD done
35
Antibodies found in UC and CD
UC:ANCA CD:ASCA
36
Drug used to relieve the spasm of irritable bowel syndrome
DICYCLOMINE HYOSCYAMINE
37
Antispasmodic drugs
ANTIMUSCAINIC Dicyclomine Hyoscyamine
38
How to differentiate bw proximal and distal small bowel obstruction
PROXIMAL more vomiting Less distension DISTAL Less vomiting More distension
39
Difference in abdominal plain films of small bowel obstruction and paralytic ileus
SMALL BOWEL OBSTRUCTION Air-fluid level proximal to the point of obstruction(on upright film) and minimal gas in colon(if complete SBO) PARALYTIC ILIEUS Uniforn distribution of gas in small bowel ,colon and rectum
40
Dematitis herpetiformis seen in
Celiac sprue
41
What is seen in biopsy for whipple ds
PAS positive macrophages in the lamina propria containg non acid fast gram bacilli
42
Surgical rx is for which type of IBD
UC Curative since involvement is limited to colon so total colectomy CD Various sites Recurrence at the site of Sx in the form of stricture
43
Extraintestinal manifestations of IBD
EYE Episcleritis Ant uvietis SKIN Erthyema nodosum Pyoderma gangrenosum ARTHRITIS:MC migratory monoarticular arthritis AS Sacroiliatis THROMBOEMBOLIC HYPERCOAGUABLE STATE ITP OSTEOPOROSIS(Dec ca and vit D absorption) GALL STONES(CD:bile salts are not absorbed) SCLERORISING CHOLANGITIS
44
Most common extraintestinal manifestation of IBD
Arthritis Migartory monoarticular, AS
45
Which type of stones are formed in CD
Calcium oxalate on kidney Because of increased colonic absorption of dietery oxalate
46
Why is there gallstones in CD
Because bile salts are normally involved in terminal ileum and if it is diseased no absorption leadinv to cholesterol concentration
47
Drugs used for perianal ds in CD
Ciprofloxacin and metronidazole
48
Drugs used for diverticulitis
Metronidazole and ciprofloxacin
49
All the clotting factors are made in liver except
Factor 8 and vWF which are made in endothelium
50
Drugs used for hepatic encephalopathy
Lactulose Or Neomycin
51
Dx of Spontaneous bacterial peritonitis
More than 5000 WBC More than 250 neutrophils Rx:cefotaxime(ad: renally metabolised)
52
Most accurate diagnostic test for primary scleosing cholangitis
ERCP Shows beading and tortusity of biliary tree IT IS NOT LIVER BIOPSY
53
Anti-mitochondrial Abs are found in
Primary biliary cirrhosis Not in PSC
54
What is the initial step for patient who presents with Git bleeding?
Fluids , blood , platelets , plasma NOT TO WASTE TIME ON FINDING THE EITIOLOGY OF BLEEDING
55
What is the sequence of Mx for variceal bleeding?
Fluids, blood,platelets,plasma Octreotide If not banding If not TJIH shunt Start Propanolol once the pateint has been stabilised and are better
55
What is the sequence of Mx for variceal bleeding?
Fluids, blood,platelets,plasma Octreotide If not banding If not TJIH shunt Start Propanolol prophylactically once the pateint has been stabilised and are better simce it prevents next episode.it has no role in acute episode
56
Cause of steatorrhoea
Pancreatitis Celiac sprue
57
Most accurate test for chronic pancreatitis
Secretin stimulation test (SECRETIN: stimulates production of bicarbonate from pancreas and bicarbonate rich bile) Serum amylase and lipase have no role, they may be normal beacuse pancreas has been burnt out
58
Most sensitive and specific test for CRC
Colonoscopy
59
Most common histological type of ca in colon
Adenocarcinoma
60
Most common site of distant metastasis of CRC
Liver
61
What is the age limit to begin screening for CRC
begin at age of 50yrs If one family member has colon ca , begin at age of 40 or 10 yrs before the age of onset of family member
62
Major polyposis synd
FAP gardner Turcot Peutz jeghers Familial juvenile polyposis coli HNPCRC
63
Gardner syndrome
Polyps Osteoma Dental abnormality Benign soft tissue tumors( Desmoid tumors,Sebaceous cyst)
64
Turcot syndrome
Polyps Cerebellar medulloblastoma or glioblastoma multiforme
65
Peutz jeher syndrome
Polypsosis syn AD Single/multiple hamartomas that may be scattered throughout git PIGMENTED SPOTS ON LIPS, ORAL MUCOSA , FACE , GENITALIA, PALMAR SURFACES. Slight inc Risk of other ca
66
HNPCRC
WITHOUT ADEMATOUS POLYPOSIS inc risk for other types of ca also
67
When to begin CRC surveillance in a person with IBD
Whether CD(in case of colon involvement) or UC both have risk of colon ca. Begin surveillance colonoscopy for CRC 8 yrs following diagnosis
68
Mc cause of large bowel obstructiom in adults
CRC
69
Difference in presentation left and right side CRC
RIGHT Obstuction is unusual due to large luminal diameter Change in bowel habits less Malena usually LEFT Onstruction common Change in bowel habit as alternating diarrhoea and constipation,pencil stools Hematochezia
70
Test of choice for diverticulosis and diverticulitis
DIVERTICULOSIS barium enema DIVERTICULITIS CT scan with contrast (barium enema and colonoscopy are c/i because of risk of perforation)
71
Complications of DIVERTICULOSIS AND DIVERRICULITIS
DIVERTICULOSIS Painless rectal bleeding Diverticulitis ``` DIVERTICULITIS Abcess fornation Colovesical fistula Obstruction Free colonic perforation ```
72
Classic presentation of acute mesentric ischemia
Severe abdominal pain disproportionate to physical findings
73
Most accurate test for acute mesenteric ischemia
Mesentric angiography
74
Thumbprinting on plain abd film indicates
Thickened edematous mucosal fold of intestine
75
Cause of chronic mesentric ischemia
Artherosclerotic ds
76
Special features of chronic mesentric ischemia
Postprandial abd pain like MI Weight loss (fear of food due to pain not due to loss of appetite)
77
Ogilive syn
S/s,radiographs esuggests large bowel obstruction but there is no mechanical obstruction Usually ill H/o recent Sx, serous medical illness (sepsis,malignancy), medications(narcotics, psychotropic drugs, anticholinergic)
78
Types of acute mesentric ischemia
ARTERIAL EMBOLISM Cardiac origin ARTERIAL THROMBOSIS Artherosclerotic ds NONOCCLUSIVE MESENTRIC ISCHEMIA Splanchnic vasoconstriction 2° to low CO Seen in Critically ill VENOUS THROMBOSIS Hypercoaguable state, OCP,portal htn, malignancy ,pancreatitis.
79
How does pseudomembranous colitis present
Profuse watery diarrhoea Crampy abd pain Toxic megacolon with risk of perforation
80
Diagnostic test for c.difficle
TOXIN in stool
81
DOC for c .difficle
METRONIDAZOLE (if recurr retreat with metronidazole only) VANCOMYCIN(if resistant to metronidazole, cant give , no change in symptoms)
82
Mc site for colonic volvulus
Sigmoid colon
83
Omega loop and coffe bean sign seen in
Volvulus
84
Differentiating be caecal and sigmoid volvulus
Caecal: ass with small bowel obstruction Can go anywhere Sigmoid: ass with large bowel obst also Goes up and right
85
Test of choice for sigmoid colon volvulus
Sigmoidosopy Dx as well as therapeutic(unwind) For caecal:Sx has to be done
86
Role of ursodeoxycholoc acidin PBC
First, it increases the rate of bile flow from the hepatocytes. Second, it inhibits the body's production of toxic bile acids. Third, it inhibits apoptosis Fourth, it mildly inhibits the immune response in the liver and injury
87
Ursodeoxycholic acid used in
PBC (not psc) To prevent or dissolve gallstones
88
Cholesyramine used in
Reduce itching(PBS,PSC) Lowering cholesterol Treat diarrhoea due to bile acid (ikeal resection,CD)
89
Most accurate test for diagnosis of acute and chronic pancreatitis
ACUTE PANCREATITIS Ct scan abdomen CHRONIC PANCRATITIS ERCP
90
Pseudocyst
Encapsulated fluid collection that appears 2- 3 weeks after an acute attack(it lacks epithelial lining unlike true cyst)
91
Complications of acute pancreatitis
Pancreatic necrosis(sterile/infective) Pancreatic pseudocyst Haemorrhagic pancreatitis ARDS Pancreatic ascites /effusion Ascending cholangitis(in gallstone) Pancreatic abcess
92
Why morphine should not be used in pancreatitis for pain relief
Cause spasm of shincter of oddi and can worsen it
93
Causes of acute pancreatitis
Alcohol Gallstones Post ERCP Viral(mumps, coxsackie) Drugs-sulfonamides,thiazide, furosemide, estrogens, hiv medications Scorpion bites Pancreatic divisum Pancreatic ca Hypertriglyceridemia Hypercalcemia Uremia Blunt abdominal trauma
94
Ranson criteria used for
Tells aboit the prognosis of patient with acute pancreatitis Consists of 2 parts ``` ADMISSION CRITERIA(GA LAW) glucose Age Ldh Ast Wbc ``` ``` INITIAL 48 HR CROTERIA(C HOBBS) Calcium Hct SO2 bun Base deficiet Fluid sequestration ```
95
What type of vit deficiency is seen in chronic pancreatitis
Fat soluble vitamins (due to steatorrhoea) Vit B12 (lack of pancreatic protease leads to non dissociation of B12-R binder complex such that IF is not able to bind)
96
Chain of lakes appearance on ERCP is seen in which condition?
Chronic pancreatitis leads to fibrotic tissue replacement of pancreatic parenchyma and alternation of pancreatic ducts( areas of stricture/ dilation)
97
Mc site for pancreatic ca
Head>body>tail
98
Tumor markers for pancreatic ca
CA 19-9 CEA
99
Mcc of upper and lower git bleeding
UPPER GIT Peptic ulcer ds LOWER GIT <60yr Diverticulosis >60yr Angiodysplasia
100
Cause of malena , hemetemeis and hematochezia
HEMETEMESIS upper git bleeding that may be ongoing HEMATOCHEZIA Mostly due to lower git bleeding(typically left colon and rectum) BUT can be due to upper git if it is severe MALENA Mostly due to upper git bleeding BUT can be due to lower git(ascending colon)
101
A lower git bleed (or a positive FOBT) in a person over 40 yrs is ____until proven otherwise
Colon cancer
102
____of upper git bleeding stop spntaneously and only need supportive therapy
80%
103
Causes of dark coloured (black,tarry) stools
Malena Bismuth Fe Spinach Charcoal Licorice
104
What is the initial test for haemetemsis
Upper Git endoscopy
105
Initial test in case of hematochezia
First rule out anoractal ds(heamorrhoids etc) Colonoscopy should be initial test because colon ca is main concern in patients over 50 yrs
106
What is the initial test in order to investigate malena
Upper endoscopy(because mc) Colonoscopy if no bleeding site identified from endoscopy
107
What is the initial test in case of positive FOBT
Colonoscopy is the initial test (colon ca is the main concern)
108
What happen to BUN-creatinine ration in upper git bleeding
Rise
109
Most accurate diagnostic test in case of upper git bleeding
Upper endoscopy
110
Sequence of pain in appendicitis
First pain then n/v
111
Diagnostic test in appendicitis
It is a clinical diagnosis
112
Warfarin and heparin therapy is monitered by
WARFARIN:PT VII HEPARIN:PTT XII factor onwards
113
what is INR
PT patient/PT normal Normal value is 2-3
114
Types of stones in cholelithiasis
Cholesterol: yellow to green(gb) Pigment: black due to hemolysis(gb) Infection:brown(in ducts)
115
Cause of biliary colic
Cardinal symptom of gallstones and is due to temporary obstruction of cystic duct by a gallstone . Pain occurs as the gb contracts against thsi obstruction.
116
Boas sign
Refered right subscapular pain of biliary colic seen in cholelithiasis
117
Murphys sign
Pathognomic for acute cholecystitis Inspiratory arrest during deep palpation of RUQ pain Not present in many cases
118
Cause of pain of biliary colic and acute cholecystitis
BILIARY COLIC Contraction of gb against obstructed cystic duct ACUTE CHOLECYSTITIS Secondry to gb wall inflammation
119
Initial test of choice for acute cholecystitis
USG Thickened gb Pericholecystic fluid Distended gb Presence of stones
120
Cause of acalculous cholecystitis
Seen in ``` Severe underlying ds Ass with dehydration Ischemia Burns Severe trauma Postop state ```
121
What are the causes of cholangitis
Infection of the biliary tract secondry to obstruction which leads to biliary stasis and bacterial overgrowth. ``` choledocholithoasis Pancreatic ca Biliary ca Postop strictures ERCP,PTC ```
122
Charcots triad
Seen in Cholangitis: RUQ pain Jaundice Fever
123
Reynolds triad
Seen in cholangitis: Charcots triad Shock Altered mental status
124
PSC and PBCdefination
PSC Progressive ds of intrahepatic and/or extrahepatic bile ducts characterised by thickening of bile duct walls and narrowing of their lumen PBC Progressive cholestatic ds characterised by destruction of intrahepatic bile ducts with portal inflammation and scarring
125
PSC is strongly associated with__
UC>CD The course of PSC os unaffected by a colectomy done for UC
126
Moat accurate test for PSC and PBC
PSC:ERCP PBC:liver biopsy (not Anti- mitochondrial Ab)
127
Klatskin tumor
Cholangiocarcinoma occurring at the confluence of the right and left hepatic bile ducts
128
Risk factors for cholangioca.
PSC Choledochal cyst Clonorchis sinensis
129
Choledochol cyst
Cystic dilatation of biliary tree involving either extrahepatic or intrahepatic ducts or both
130
Biliary dyskinesia
Motor dysfxn of the sphincter of oddi which leads to recurrent episodes of biliary colic without any evidence of gallstones
131
What is SAAG
Serum ascites albumin gradient
132
SAAG of more than 1.1 most likely indicates
Portal hypertension
133
Cause of hepatic encephalopathy
Toxic metabolites( that are many , but ammonia is believed to be the most important) that are normally detoxified or removed by liver accumulates and reach brain ``` Precipitants: Alkalosis Hypokalemia Sedating drugs Gi bleeding Systemic infection Hypovolemia ``` ``` Cf: Dec mental fxn Confusion Stupor,coma Asterexia Rigidity hypereflexia Fetor hepaticus ``` Rx:lactulose Rifaximin (Neomycin)
134
Hepatorenal syndrome cause
The predominant theory (termed the underfill theory) is that blood vessels in the kidney circulation are constricted because of the dilation of blood vessels in the splanchnic circulation (which supplies the intestines), which is mediated by factors released by liver disease.Nitric oxide,prostaglandins,and other vasoactive substances. The consequence of this phenomenon is a decrease in the "effective" volume of blood sensed by the juxtaglomerular apparatus, leading to the secretion of renin and the activation of the renin–angiotensin system, which results in the vasoconstriction of vessels systemically and in the kidney specifically.However, the effect of this is insufficient to counteract the mediators of vasodilation in the splanchnic circulation, leading to persistent "underfilling" of the kidney circulation and worsening kidney vasoconstriction, leading to kidney failure
135
What is hepatopulmonary syn
The hepatopulmonary syndrome results from the formation of microscopic intrapulmonary arteriovenous dilatations . The mechanism is unknown but is thought to be due to increased liver production or decreased liver clearance of vasodilators, possibly involving nitric oxide The dilation of these blood vessels causes overperfusion relative to ventilation, leading to ventilation-perfusion mismatch and hypoxemia
136
Pathophysiology of hepatorenal and hepatopulmonary syn
HEPATORENAL Vasoconstriction HEPATOPULMONARY Due to vasodilation
137
Acitic fluid cell count in SBP
Paracentesis and examn: WBC>500 neutrophils>250
138
Etiologic agents for SBP
E.coli(mc) Klebsiella S.pnemonia

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