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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
Q

What is most sensitive and specific test for H.pylori

A

Sensitive(SNOUT)
serology

specific(SPIN)
Biopsy

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26
Q

Which is the best test to see response to Rx in H.pylori

A

Urea breath test
Or
Stool antigen

But done only if there is persistance /reccurence/recrudenscence of symptoms

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27
Q

What are the common causes of epigastric pain related to git

A 
Non ulcer dyspepsia(mc)
GERD
DU/GU
gastritis
Cancer
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28
Q

What is the single most important stimulant for gastrin and mucus secretion

A

STRETCH

Release both acid and mucus

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29
Q

When is Sx indicated in PUD

A

When complication develops

Bleeding
Perforation
Gastric outlet obstruction

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30
Q

Best triple and quadruple regimen for h.pylori eradication are

A

TRIPLE
PPI+ amoxicillin+ clarithromycin

QUADRUPLE
PPI+ bismuth subsalicylate+ metronidazole+ tetracycline

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31
Q

Best triple and quadruple regimen for h.pylori eradication are

A

TRIPLE
PPI+ amoxicillin+ clarithromycin

QUADRUPLE
PPI+ bismuth subsalicylate+ metronidazole+ tetracycline

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32
Q

Mcc of upper git bleeding

A

Peptic ulcer

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33
Q

Metastasis of gastric carcinoma

A

KRUKENBERG
to ovary

BLUMER SHELF
To rectum(pelvic cul de sac)

SISTER MARY JOSEPH NODE
Periumblical

VIRCHOW NODE
Supraclavicular

IRISH NODE
Lefy axillary adenopathy

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34
Q

Drug for fistulas in crohns ds

A

Infliximab
TNF alpha inhibitor
Can reactivate TB so get a PPD done

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35
Q

Antibodies found in UC and CD

A

UC:ANCA

CD:ASCA

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36
Q

Drug used to relieve the spasm of irritable bowel syndrome

A

DICYCLOMINE

HYOSCYAMINE

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37
Q

Antispasmodic drugs

A

ANTIMUSCAINIC

Dicyclomine

Hyoscyamine

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38
Q

How to differentiate bw proximal and distal small bowel obstruction

A

PROXIMAL
more vomiting
Less distension

DISTAL
Less vomiting
More distension

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39
Q

Difference in abdominal plain films of small bowel obstruction and paralytic ileus

A

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

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40
Q

Dematitis herpetiformis seen in

A

Celiac sprue

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41
Q

What is seen in biopsy for whipple ds

A

PAS positive macrophages in the lamina propria containg non acid fast gram bacilli

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42
Q

Surgical rx is for which type of IBD

A

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

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43
Q

Extraintestinal manifestations of IBD

A

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

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44
Q

Most common extraintestinal manifestation of IBD

A

Arthritis

Migartory monoarticular, AS

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45
Q

Which type of stones are formed in CD

A

Calcium oxalate on kidney

Because of increased colonic absorption of dietery oxalate

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46
Q

Why is there gallstones in CD

A

Because bile salts are normally involved in terminal ileum and if it is diseased no absorption leadinv to cholesterol concentration

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47
Q

Drugs used for perianal ds in CD

A

Ciprofloxacin and metronidazole

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48
Q

Drugs used for diverticulitis

A

Metronidazole and ciprofloxacin

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49
Q

All the clotting factors are made in liver except

A

Factor 8 and vWF which are made in endothelium

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50
Q

Drugs used for hepatic encephalopathy

A

Lactulose
Or
Neomycin

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51
Q

Dx of Spontaneous bacterial peritonitis

A

More than 5000 WBC
More than 250 neutrophils

Rx:cefotaxime(ad: renally metabolised)

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52
Q

Most accurate diagnostic test for primary scleosing cholangitis

A

ERCP
Shows beading and tortusity of biliary tree

IT IS NOT LIVER BIOPSY

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53
Q

Anti-mitochondrial Abs are found in

A

Primary biliary cirrhosis

Not in PSC

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54
Q

What is the initial step for patient who presents with Git bleeding?

A

Fluids , blood , platelets , plasma

NOT TO WASTE TIME ON FINDING THE EITIOLOGY OF BLEEDING

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55
Q

What is the sequence of Mx for variceal bleeding?

A

Fluids, blood,platelets,plasma

Octreotide

If not banding

If not TJIH shunt

Start Propanolol once the pateint has been stabilised and are better

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55
Q

What is the sequence of Mx for variceal bleeding?

A

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
Q

Cause of steatorrhoea

A

Pancreatitis

Celiac sprue

57
Q

Most accurate test for chronic pancreatitis

A

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
Q

Most sensitive and specific test for CRC

A

Colonoscopy

59
Q

Most common histological type of ca in colon

A

Adenocarcinoma

60
Q

Most common site of distant metastasis of CRC

A

Liver

61
Q

What is the age limit to begin screening for CRC

A

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
Q

Major polyposis synd

A

FAP

gardner

Turcot

Peutz jeghers

Familial juvenile polyposis coli

HNPCRC

63
Q

Gardner syndrome

A

Polyps

Osteoma

Dental abnormality

Benign soft tissue tumors( Desmoid tumors,Sebaceous cyst)

64
Q

Turcot syndrome

A

Polyps

Cerebellar medulloblastoma or glioblastoma multiforme

65
Q

Peutz jeher syndrome

A

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
Q

HNPCRC

A

WITHOUT ADEMATOUS POLYPOSIS

inc risk for other types of ca also

67
Q

When to begin CRC surveillance in a person with IBD

A

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
Q

Mc cause of large bowel obstructiom in adults

A

CRC

69
Q

Difference in presentation left and right side CRC

A

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
Q

Test of choice for diverticulosis and diverticulitis

A

DIVERTICULOSIS
barium enema

DIVERTICULITIS
CT scan with contrast (barium enema and colonoscopy are c/i because of risk of perforation)

71
Q

Complications of DIVERTICULOSIS AND DIVERRICULITIS

A

DIVERTICULOSIS
Painless rectal bleeding
Diverticulitis

DIVERTICULITIS
Abcess fornation
Colovesical fistula
Obstruction
Free colonic perforation
72
Q

Classic presentation of acute mesentric ischemia

A

Severe abdominal pain disproportionate to physical findings

73
Q

Most accurate test for acute mesenteric ischemia

A

Mesentric angiography

74
Q

Thumbprinting on plain abd film indicates

A

Thickened edematous mucosal fold of intestine

75
Q

Cause of chronic mesentric ischemia

A

Artherosclerotic ds

76
Q

Special features of chronic mesentric ischemia

A

Postprandial abd pain like MI

Weight loss (fear of food due to pain not due to loss of appetite)

77
Q

Ogilive syn

A

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
Q

Types of acute mesentric ischemia

A

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
Q

How does pseudomembranous colitis present

A

Profuse watery diarrhoea

Crampy abd pain

Toxic megacolon with risk of perforation

80
Q

Diagnostic test for c.difficle

A

TOXIN in stool

81
Q

DOC for c .difficle

A

METRONIDAZOLE (if recurr retreat with metronidazole only)

VANCOMYCIN(if resistant to metronidazole, cant give , no change in symptoms)

82
Q

Mc site for colonic volvulus

A

Sigmoid colon

83
Q

Omega loop and coffe bean sign seen in

A

Volvulus

84
Q

Differentiating be caecal and sigmoid volvulus

A

Caecal: ass with small bowel obstruction
Can go anywhere

Sigmoid: ass with large bowel obst also
Goes up and right

85
Q

Test of choice for sigmoid colon volvulus

A

Sigmoidosopy

Dx as well as therapeutic(unwind)

For caecal:Sx has to be done

86
Q

Role of ursodeoxycholoc acidin PBC

A

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
Q

Ursodeoxycholic acid used in

A

PBC (not psc)

To prevent or dissolve gallstones

88
Q

Cholesyramine used in

A

Reduce itching(PBS,PSC)

Lowering cholesterol

Treat diarrhoea due to bile acid (ikeal resection,CD)

89
Q

Most accurate test for diagnosis of acute and chronic pancreatitis

A

ACUTE PANCREATITIS
Ct scan abdomen

CHRONIC PANCRATITIS
ERCP

90
Q

Pseudocyst

A

Encapsulated fluid collection that appears 2- 3 weeks after an acute attack(it lacks epithelial lining unlike true cyst)

91
Q

Complications of acute pancreatitis

A

Pancreatic necrosis(sterile/infective)

Pancreatic pseudocyst

Haemorrhagic pancreatitis

ARDS

Pancreatic ascites /effusion

Ascending cholangitis(in gallstone)

Pancreatic abcess

92
Q

Why morphine should not be used in pancreatitis for pain relief

A

Cause spasm of shincter of oddi and can worsen it

93
Q

Causes of acute pancreatitis

A

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
Q

Ranson criteria used for

A

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
Q

What type of vit deficiency is seen in chronic pancreatitis

A

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
Q

Chain of lakes appearance on ERCP is seen in which condition?

A

Chronic pancreatitis

leads to fibrotic tissue replacement of pancreatic parenchyma and alternation of pancreatic ducts( areas of stricture/ dilation)

97
Q

Mc site for pancreatic ca

A

Head>body>tail

98
Q

Tumor markers for pancreatic ca

A

CA 19-9

CEA

99
Q

Mcc of upper and lower git bleeding

A

UPPER GIT
Peptic ulcer ds

LOWER GIT
<60yr
Diverticulosis

> 60yr
Angiodysplasia

100
Q

Cause of malena , hemetemeis and hematochezia

A

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
Q

A lower git bleed (or a positive FOBT) in a person over 40 yrs is ____until proven otherwise

A

Colon cancer

102
Q

____of upper git bleeding stop spntaneously and only need supportive therapy

A

80%

103
Q

Causes of dark coloured (black,tarry) stools

A

Malena

Bismuth

Fe

Spinach

Charcoal

Licorice

104
Q

What is the initial test for haemetemsis

A

Upper Git endoscopy

105
Q

Initial test in case of hematochezia

A

First rule out anoractal ds(heamorrhoids etc)

Colonoscopy should be initial test because colon ca is main concern in patients over 50 yrs

106
Q

What is the initial test in order to investigate malena

A

Upper endoscopy(because mc)

Colonoscopy if no bleeding site identified from endoscopy

107
Q

What is the initial test in case of positive FOBT

A

Colonoscopy is the initial test (colon ca is the main concern)

108
Q

What happen to BUN-creatinine ration in upper git bleeding

A

Rise

109
Q

Most accurate diagnostic test in case of upper git bleeding

A

Upper endoscopy

110
Q

Sequence of pain in appendicitis

A

First pain then n/v

111
Q

Diagnostic test in appendicitis

A

It is a clinical diagnosis

112
Q

Warfarin and heparin therapy is monitered by

A

WARFARIN:PT
VII

HEPARIN:PTT
XII factor onwards

113
Q

what is INR

A

PT patient/PT normal

Normal value is 2-3

114
Q

Types of stones in cholelithiasis

A

Cholesterol: yellow to green(gb)

Pigment: black due to hemolysis(gb)

Infection:brown(in ducts)

115
Q

Cause of biliary colic

A

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
Q

Boas sign

A

Refered right subscapular pain of biliary colic seen in cholelithiasis

117
Q

Murphys sign

A

Pathognomic for acute cholecystitis

Inspiratory arrest during deep palpation of RUQ pain
Not present in many cases

118
Q

Cause of pain of biliary colic and acute cholecystitis

A

BILIARY COLIC
Contraction of gb against obstructed cystic duct

ACUTE CHOLECYSTITIS
Secondry to gb wall inflammation

119
Q

Initial test of choice for acute cholecystitis

A

USG

Thickened gb
Pericholecystic fluid
Distended gb
Presence of stones

120
Q

Cause of acalculous cholecystitis

A

Seen in

Severe underlying ds
Ass with dehydration
Ischemia
Burns
Severe trauma
Postop state
121
Q

What are the causes of cholangitis

A

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
Q

Charcots triad

A

Seen in Cholangitis:
RUQ pain
Jaundice
Fever

123
Q

Reynolds triad

A

Seen in cholangitis:
Charcots triad
Shock
Altered mental status

124
Q

PSC and PBCdefination

A

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
Q

PSC is strongly associated with__

A

UC>CD

The course of PSC os unaffected by a colectomy done for UC

126
Q

Moat accurate test for PSC and PBC

A

PSC:ERCP

PBC:liver biopsy (not Anti- mitochondrial Ab)

127
Q

Klatskin tumor

A

Cholangiocarcinoma occurring at the confluence of the right and left hepatic bile ducts

128
Q

Risk factors for cholangioca.

A

PSC

Choledochal cyst

Clonorchis sinensis

129
Q

Choledochol cyst

A

Cystic dilatation of biliary tree involving either extrahepatic or intrahepatic ducts or both

130
Q

Biliary dyskinesia

A

Motor dysfxn of the sphincter of oddi which leads to recurrent episodes of biliary colic without any evidence of gallstones

131
Q

What is SAAG

A

Serum ascites albumin gradient

132
Q

SAAG of more than 1.1 most likely indicates

A

Portal hypertension

133
Q

Cause of hepatic encephalopathy

A

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
Q

Hepatorenal syndrome cause

A

The predominant theory (termed theunderfilltheory) is that blood vessels in the kidney circulation are constricted because of the dilation of blood vessels in thesplanchnic circulation(which supplies theintestines), 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 thejuxtaglomerular apparatus, leading to the secretion ofreninand the activation of therenin–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
Q

What is hepatopulmonary syn

A

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 ofvasodilators, possibly involvingnitric oxide

The dilation of these blood vessels causes overperfusion relative to ventilation, leading toventilation-perfusion mismatchand hypoxemia

136
Q

Pathophysiology of hepatorenal and hepatopulmonary syn

A

HEPATORENAL
Vasoconstriction

HEPATOPULMONARY
Due to vasodilation

137
Q

Acitic fluid cell count in SBP

A

Paracentesis and examn:
WBC>500
neutrophils>250

138
Q

Etiologic agents for SBP

A

E.coli(mc)
Klebsiella
S.pnemonia

Step Up Medicine (3 decks)

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