GIT Zatchot

Question 1

Complaints of patients with diseases of the
digestive system:

Answer 1

Abdominal pain
Gastric dyspepsia (dysphagia, belching,
nausea, vomiting, heartburn, changes in
taste and appetite, dry mouth,
salivation),
Intestinal dyspepsia (flatulence of the
abdomen, rumbling, tenesmus, stool
disorders: constipation, diarrhea,
qualitative changes in the stool).

Question 2

explain the Spastic pain

Answer 2

due to spasm of the smooth
muscles of the
gastrointestinal tract
sharp, paroxysmal with a
clear localization
сauses: gastric colic
(hypersecretion), intestinal
colic, biliary colic

Question 3

explain the Distension pain

Answer 3

associated with hypomotor
dyskinesia of smooth
muscles and hollow organ
distension
dull pains, non-intense,
without clear localization
сauses: flatulence,
hyposecretory syndrome

Question 4

explain the Vascular pain

Answer 4

associated with a violation of the blood supply to the
abdominal cavity, as a result of this, ischemia and
necrosis develop sudden onset, very intense,
progressive,
сauses: mesenteric thrombosis, embolism, ischemic
disease of the digestive system

Question 5

explain the Peritoneal pain

Answer 5

based on tension of the capsule or visceral sheet of
the peritoneum
peritoneal pain occurs gradually or suddenly (with
perforation), increases, intense, accompanied by
tension of the abdominal wall, a symptom of irritation
of the peritoneum, vomiting and fever
сauses: peritonitis due to inflammation of the organs
(appendicitis, acute cholecystitis, acute pancreatitis)
and perforation of the stomach and intestines

Question 6

explain the Dyspepsia in gastric and intestinalis

Answer 6

–1. Gastric:
* accompanied by pain in the
epigastric region;
* heartburn;
* vomiting;
* change in appetite
* belching;
* nausea;
2. Intestinal:
* accompanied by pain in
different parts of the
abdomen (in the projection
of the small and large
intestine;
* flatulence;
* diarrhea;
* сonstipation;
* tenesmus -painful impulse to
defecate

Question 7

Admixture of blood in the feces

Answer 7

bright scarlet blood from the anus in the form of drops or trickles is a
characteristic sign of»_space;hemorrhoidal bleeding;
scarlet blood on the surface of the feces - a symptom of lesions of the»_space; sigmoid and rectum;
dark red brown blood, evenly mixed with feces, is characteristic of
pathological processes localized in the initial section of the large intestine;
black mushy stools (melena) - a sign of massive bleeding from the esophagus, stomach or small intestine.

Question 8

THE MAIN RISK FACTORS OF DEVELOPMENT
OF DISEASES OF THE
HEPATOBILIARY SYSTEM

Answer 8

Alcohol consumption
Medication intake
Surgical intervention
Intravenous injections and / or blood
transfusions
Profession (blood contact)
Sex
Family history of liver disease

Question 9

Liver function

Answer 9

 Synthetic
- synthesis of albumin, coagulation factors,
fibrinogen, cholesterol, complement, binding
proteins for iron, copper, vitamin A
 Detoxification / excretion
- products of protein metabolism, steroids,
prostaglandins, drugs, alcohol, bilirubin, urea,
products of bacteria metabolism
 Accumulation - Glycogen, lipids, iron,
copper, vitamins A, B12, D, E, K
 Excretory - bile secretion

Question 10

Main complaints of liver

Answer 10

Pain
Dyspeptic complaints
Fever
Itch (pruritus)
Yellowness of the skin
Discoloration of urine and feces

Question 10

Peripheral signs of long-term liver
damage

Answer 10

 Spider veins
 Drumsticks
 Palmar erythema
 Scratches
 Hemorrhagic diathesis –petechial eruption
and hemorrhage into the skin (ecchymosis)

Question 11

Symptoms of liver disease

Answer 11

jaundice
hepatomegaly
dark urine
light faeces
pruritus
ascites
 pain in the right hypochondrium
 abdominal distention

Question 12

explain the Jaundice

Answer 12

–Jaundice staining of the skin and / or
sclera indicates hyperbilirubinemia
↑ bilirubin > 35 мкмоль/л
–Types of jaundice :
1. Hemolytic (suprahepatic or prehepatic) -
high blood levels of unconjugated (indirect) bilirubin
2. Hepatic cell (parenchymal) - increased blood
levels of both indirect and direct bilirubin.
3. Mechanical (subhepatic or post-hepatic,
obstructive) - high blood levels of conjugated
(direct) bilirubin

Question 13

EXPLAIN THE Hepatomegaly

Answer 13

—Hepatomegaly : its enlargement of the liver
-Causes of hepatic enlargement
(hepatomegaly) :
Venous congestion in the liver (HF, obstruction of the hepatic veins)
Hepatitis, cirrhosis (alcoholic, medicinal)
Infectious lesion (leptospirosis, malaria, echinococcosis)
Deposition of amyloid, iron, copper, etc.
Tumors (liver carcinoma, mts, hemoblastosis, cysts)
Obstruction of biliary tract

Question 14

explain the Dark urine (bilirubinuria)

Answer 14

–Dark urine (bilirubinuria) :Appears with an increase in direct
bilirubin in the urine - hepatic and
posthepatic jaundice

Question 15

explain the Decolorized feces (acholia)

Answer 15

– its Changing the color of feces resulting from the
absence or substantial reduction of stercobilin.

Question 16

what is the Pruritus

Answer 16

–Pruritus : Caused by irritation of the nerve
endings of the skin and mucous
membranes with bile acids

Question 17

explain the Ascites

Answer 17

–Ascites - the presence of freedom
of fluid (transudate) in the abdominal cavity
-Clinical manifestations:
increase in abdomen volume
navel bulge, umbilical hernia,
the appearance of stretch marks,
often combined with varicose veins of the anterior abdominal wall -
Caput medusae

Question 18

explain the Pain in the right hypochondrium

Answer 18

-Pain in the right hypochondrium : May be due to:
-distension of Glisson’s capsule
-liver abscess
-spastic contractions of muscles of the gall
bladder and large bile ducts

Question 19

Causes of spleen enlargement
(splenomegaly)

Answer 19

acute and chronic infectious diseases
(typhus, viral hepatitis, sepsis, malaria,
etc.),
in liver cirrhosis,
thrombosis or compression of the splenic
vein,
diseases of the hemopoietic system
(hemolytic anemia, thrombocytopenic
purpura, acute and chronic leucosis).
deposition of amyloid

Question 20

What is bilirubin , ?

Answer 20

–Bilirubin: is the product formed by the breakdown of red blood cells in the body. Red blood cells are continuously undergoing hemolysis ( or a breaking down) process, because their average life- span is about 120 days. As the red blood cells disintegrate, the hemoglobin is degraded or broken into globin- which is the protein part, iron (which is conserved for later use), and heme
-The heme initially breaks apart into biliverdin, a green pigment which is rapidly reduced to bilirubin, an orange-yellow pigment. This is called the unconjugated or indirect bilirubin. The bilirubin is then transported to the liver where it reacts with a solubilizing sugar called glucuronic acid. Here in the liver, the unconjugated or indirect bilirubin is converted to a more soluble form of bilirubin which is called the conjugated or direct bilirubin. This Direct bilirubin is excreted into the bile, which goes through the gall bladder into the intestines where the bilirubin is changed into a variety of pigments. The most important ones are stercobilin, which is excreted in the faeces, and urobilinogen, which is excreted as a normal component of the urine.
—Types of bilirubin :
There are two types of bilirubin in the blood…

1-Unconjugated (indirect) bilirubin is insoluble in water. This is the bilirubin before it reaches the liver.(pre hepatic )
2-Conjugated (direct) bilirubin has been converted to soluble bilirubin in the liver. It then goes into the bile to be stored in the gall bladder or sent to the intestines.( post hepatic )
-Note- Routine blood tests for total bilirubin measure both unconjugated and conjugated bilirubin.
–Normal Values of bilirubin:
1-Indirect Bilirubin > 0.00- 0.80 mg/dL
2-Direct Bilirubin > 0.01- 0.30 mg/dL
3-Total Bilirubin > 0.2- 1.2 mg/dL

Question 21

What is Jaundice and hyperbiliruimia

Answer 21

-Jaundice: is the result of the accumulation of bilirubin in the blood, it is also called hyperbilirubinemia. Jaundice clinically manifests asthe yellowing of the skin and mucosa in the body, as well as itching (pruritus).
–Signs and symptoms of Jaundice :
pale-colored stools
dark-colored urine
skin itching
nauseaandvomiting
rectal bleeding
diarrhea
feverandchills
weakness
weight loss
–Types of Jaundice :
There are three types of jaundice, depending on what’saffecting the movement of bilirubin out of the body.They are:
1-pre-hepaticcauses
2-hepatic (liver) causes
3-post-hepatic causes
——
1-pre-hepaticcauses of Jaundice ( unconjegated bilirubin ) :
-Jaundice caused during the pre-hepatic phase is due to the excessive destruction (hemolysis) of red blood cells from various conditions. This rapid increase in bilirubin levels in the bloodstream overwhelms the liver’s capability to properly metabolize the bilirubin, and consequently the levels of unconjugated bilirubin increase. Conditions which can lead to an increase in the hemolysis of red blood cells include:
Malaria,
Sickle cell disease,
Hereditary spherocytosis,
Thalassemia,
—–
2-hepatic (liver) causes of Jaundice ( congregated and unconjugated bilirubin )
-Jaundice caused during the hepatic phase can arise from abnormalities in the metabolism and/or excretion of bilirubin. This can lead to an increase in both unconjugated and/or conjugated bilirubin levels. Conditions with a hepatic cause of jaundice include:
Acute or chronichepatitis(commonly viral [Hepatitis A, B, C, D, E] or alcohol related),
Cirrhosis(caused by various conditions),
Drugs or other toxins,
Crigler-Najjar syndrome,
—–
3-post-hepatic causes of Jaundice ( Conjugated (direct)
bilirubin )
-Jaundice from a post-hepatic cause arises from a disruption (or an obstruction) in the normal drainage and excretion of the now conjugated bilirubin in the form of bile from the liver into the intestine. This leads to increased levels of conjugated bilirubin in the bloodstream. Conditions that can cause post-hepatic jaundice include
Gallstones
Cancer(pancreatic cancer, gallbladder cancer andbile duct cancer),
Strictures of the bile ducts,
Cholangitis,
Pancreatitis, and Parasites (for example, liver flukes).

Question 22

explain the Chronic Pancreatitis

Answer 22

chronic pancreatitis is caused by long term inflammation of the pancreas, which eventually leads to irreversible distraction of pancreatic tissue , and its develops slowly over time due to :
1- alcohol drinking
2- smoking cigarettes
-less common causes :
1-medication
2-elevated tryglecerol
3-Auto immune condition
4- inherited genetics : like cyctic fibrosis , hedetry paneacritits
function of Pancreas
1- Endocrine function : produce hormons that regulate the blood sugar ex glucagon , insulin
2- Exocrine : produce enzyme to breakdown food
ex amylase , protease , lipase
—- Unhealthy pancreas :
affect of most nutrient absorption or mentining the blood sugar which lead to nutration related diseases such as :
1- week bones
2- vision loss
3- loss wight or gaining wight
— symptoms and sings:
the main symptom its :
abdominal pain : the pain could be intermetnt or chronic and is frequently very sever and located in between billy button and chest and may redaite to back , and also triggered by eating especially a food with. high fat
in the advance stage of the pancreatitis symphony:
1-oily and smiling stool
2- wight loss
3- diabetes may develop
diagnosis :
1- CT scan or MRI
-NB! blood test its not useful for pancreatitis
recommend treatment :
1- no alcohol
2- no smoking
3- avoid high fat food

Question 23

Main complaints of kidney dieses

Answer 23

1-Pain
2- Urinary Disorders
3-Discoloration of urine
4-Edema
5-Headache, dizziness, palpitations, pain in the region of the heart (increase in blood pressure)
6-Fever
7-Urea smell from the mouth
8- Itchy skin
9-Nausea
10-Vomiting
11- Hemorrhages on the skin
12-Decreased vision

Question 24

explain the Pain in kidney diseases and its mechanism

Answer 24

–Pain
* During the questioning it is necessary to establish:
* localization of pain
* irradiation of pain
* character
* duration
* intensity
* provoking factors
* factors that relieve pain
* accompanying symptoms Pain
* In various kidney diseases, the nature, intensity and
duration of pain depend on a combination of three main
mechanisms:
1) muscle spasm of the ureter;
2) stretching of the renal cavity system (pyelocaliceal);
3) stretching renal capsule.

Question 25

explain the Urolithiasis disease Pain

Answer 25

(local spasm of the smooth muscles of the ureter, with obstruction of the ureter with a stone - stretching of the
renal pelvis with urine)
- acute paroxysmal pain (renal colic)
- pain intense, unbearable
- localization - in the lower back or along the ureter, radiating to the inguinal region, to the genitals

Question 26

explain the Pyelonephritis pain

Answer 26

inflammation of the mucous membrane of the renal
pelvis, impaired passage of urine and distension of the
renal pelvis)
- intense pain
- localization in the lumbar region,
- the intensity gradually increases, then weakens

Question 27

explain the Glomerulonephritis Pain

Answer 27

(parenchymal kidney disease - inflammatory
swelling of the kidney tissue, gradual distension of
the renal capsule)
- pain is not intense, dull, aching
- constant, long
- pain symmetrical, bilateral

Question 28

explain Kidney infarction pain

Answer 28

(rapid and significant distension of the renal
capsule)
- intense pain,
- begins acutely, long

Question 29

explain the paranephritis

Answer 29

intense constant pain in the lumbar region,
radiating in the hypochondrium - with purulent
inflammation of the perirenal tissue

Question 30

what is the pain charechtarstic of diseases
of the bladder

Answer 30

Pain in the suprapubic region - observed in diseases
of the bladder.

Question 31

what is the pain charechtarstic inflammation of the urethra

Answer 31

Pain during urination, burning sensation in the
urethra occurs with inflammation of the urethra.

Question 32

what is the Provoking factors of pain and , Factors that relieves pain

Answer 32

–Provoking factors
1-Hypothermia
2-Fast walk
3-Running
4-Lifting weights
5-Act of urination
–Factors that relieves pain
1-Horizontal position (this improves blood flow to the kidneys)
2-Forced position (bringing the legs to the stomach while
lying on the side - paranephritis)
3-Taking antispasmodic drugs
4- Applying a heating pad to the pain site

Question 33

Urinary Disorders types:

Answer 33

Urinary Disorders
* this is a change in the amount and daily rhythm of
urine excretion:
* Polyuria
* Oliguria
* Anuria
* Nocturia
* Pollakiuria
* Stranguria
* Ishuria

Question 34

explain the Diuresis

Answer 34

–total amount of urine, excreted during 24 hours’ period is called diurnal urine excretion.
-Diuresis: is a condition in which the kidneys filter too much bodily fluid. That increases your urine production and the frequency with which you need to use the bathroom.
–Its volume ranges from 1000 to 2000 ml, though it
can increase or decrease depending on
physiological conditions, the amount of consumed
liquids, diet, nature of work, temperature, air
humidity or presence of some diseases. 60-80% of
the daily urine amount normally excretes during
the daytime - a period between 8 AM and 8 PM.
Diurnal urinal excretion may decrease in physical
exertion, hot weather or abundant perspiration

Question 35

explain the Polyuria , Oliguria , Anuria , Nocturia , Ishuria , Stranguria , Pollakiuria, oligakiuria

Answer 35

–Polyuria (> 2000 mL/day voided) may be caused by
1-renal origin - with damage to the renal tubules; in
the recovery stage of acute renal failure
2-extrarenal origin - with abundant fluid intake,
diabetes mellitus and diabetes insipidus, at low
ambient temperatures, with a decrease in edema
after taking diuretics.
-Oliguria : decrease in daily urine (<500 ml / day) duo to :
1-physiological oliguria (not less than 800 ml per day) -
limited drinking regimen, increased sweating, physical
activity
2-profuse diarrhea, uncontrollable vomiting, fluid
retention in patients with heart failure, burn disease
(shock stage), shock (of any etiology)
3-impaired renal function (glomerulonephritis, uremia,
etc.)
-Anuria : –a sharp decrease (<50 ml per day) or complete cessation of urine excretion
* Secretory anuria: marked disorder of
glomerular filtration (shock, acute blood loss
-Nocturia :voiding during the night duo to :
1-various kidney diseases,
2-prostatic hypertrophy,
3- heart failure
-Ishuria : Excretory anuria (ishuria):
impaired separation of urine with preserved renal function
-Stranguria - soreness during urinating (a
sign of inflammation of the bladder and / or
urethra)- painful urination
Pain appears at the end of urination (with
maximum bladder contraction) with (cystitis-bladder )
Pain appears at the beginning and during
urination with (urethritis)
–Norma: urination frequency - 4-7 times per day
Pollakiuria - frequent urination (intake of large amounts of
fluid, inflammation of the urinary tract, severe prostate
adenoma)
Oligaciuria is a rare urination (limited fluid intake, the
formation and strengthening of edema of any origin due to
fluid retention in the body; significant extrarenal fluid loss -
intense sweating, indomitable vomiting, diarrhea; oliguria
with glomerulonephritis, uremia)

Question 36

explain the Discoloration of urine

Answer 36

-urine of red-brown color or red (admixture of
blood) - with glomerulonephritis, urolithiasis, kidney tumor;
–pale yellow (almost colorless) - with polyuria;
–clouded - from admixture of leukocytes, mucus, blood.
–Hematuria (blood in the urine) :
—–Painless
-cancer of the urinary tract
-glomerunephritis
- prostatic disease
-polycystic disease ( ovum syndrome long period ) ,
- hydronephrosis ( stretch of one of the kidneys or both
—-Painful
-ureteral calculi ( stones in the ureteral )
-bladder infections or lithiasis.
–

Question 37

explain the Headache, dizziness, pain in the heart,
palpitations, shortness of breath in the renal dieses

Answer 37

due to an increase in blood pressure. Arterial
hypertension is often found in kidney disease
(glomerulonephritis, chronic pyelonephritis). There
is often a significant increase in BP, especially
diastolic.

Question 38

explain the Fever

Answer 38

occurs in inflammatory diseases of the kidneys,
urinary tract (pyelonephritis, paranephritis, cystitis,
urethritis). The reason for the increase temperature
can be also tuberculosis kidney, kidney cancer - less
often.

Question 39

explain the Uremia (urine in the blood)

Answer 39

a toxic condition associated with excessive accumulation in the blood of protein metabolism by-products
GFR glomerular filtration rate declines to < 15 -30 ml\min
disturbances of multiple organ systems

Question 40

Kidney – percussion

Answer 40

–kidney - percussion (to detect areas of tenderness by costovertebral test, normally will feel a thudding sensation or pressure but not tenderness) and palpation (contour, size, tenderness, and lump) - in adult ordinary(usually) it won’t be palpable because of their deep location.
-Presence of tenderness and pain indicates a kidney infection or polycystic kidney disease ( acute infraction or polytnephritits)

Question 41

Bladder percussion

Answer 41

–Percussion you can determine dullness above the pubis from a full bladder.
-Percussion will be introduced from the navel from top to bottom along the midline, the finger plessimeter is set
perpendicular to the anterior midline.

Question 42

Anterior ureteric points , Posterior ureteric points

Answer 42

—-Ant
1/superior ureteric point - at the edge of the rectus abdominis muscle at the level of the umbilicus
2/medium ureteric point - at the intersection of the biiliac
line and the vertical line passing the pubic tubercle
—-Post
1-costovertebral point - in the angle formed with the inferior edge of 12-th rib and a columna vertebralis;
2-costolumbar point – at the intersection of lumbar muscle and 12-th rib.
–Pressure in these points in norm routinely painless becomes sharply responsive at a pyelonephritis, a paranephritis, a nephrolithiasis, a tumor and tuberculosis of kidneys.

Question 43

Palpation of the kidneys

Answer 43

—Normally, the kidneys usually do not palpate.
In pathology, the kidneys are palpable due to their increase
(tumor, polycystic) or omission (nephroptosis)