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GIT steep 2 > GIT1 > Flashcards

GIT1 Flashcards

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1
Q

angiodysplesia CM?

A

episodic painless lower GI bleeding
Commonage >60
IDA

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2
Q

Associated disease?

A

AS
ESRD
VWD

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3
Q

Diagnosis?

A

Endoscopy

Frequently missed B/C inadequate bowel preparation and valves

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4
Q

Management?

A

Conservative if they are asymptomatic

Band ligation if symptomatic(anemia/GI bleeding)

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5
Q

pathophysiology?

A

Dilation of submucosal veins and AV malformation

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6
Q

clinical future of carcinoid?

A 
SKIN
GI
Cardiac
Pulmonary
Miscellaneous
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7
Q

SKIN?

A

Flushing
Telangiectasia
Cyanosis

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8
Q

GI?

A

Diarrhea

cramping

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9
Q

cardiac?

A

valvular(more at right)

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10
Q

pulmonary?

A

Bronchospasm

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11
Q

Miscellaneous?

A

Niacin deficiency (diharoa, dermatitis, and dementia)

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12
Q

diagnosis?

A

Elevated 24 Hr 5-HIAA
CT/MRI–detect metastasis
Osteoscan to detect metastasis
Echocardiogram

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13
Q

treatment?

A

Octreotide before surgery and anesthesia

Liver surgery for metastasis

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14
Q

common location?

A

Distal small bowl
Proximal colon
Lung

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15
Q

spontaneous bacterial peritonitis risk?

A

Temperature >37.8
altered mental status
Abdominal discomfort/tenderness
Hypotension/Hypothermia in severe infection

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16
Q

Diagnosis?

A

PMN>250g/dL
A positive culture(G-ve) for peritoneal fluid
Protein <1g/dl
SAAG>=1.1g/dl

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17
Q

Treatment?

A

3rd generation cephalosporin for Tx

Floroquinilol for prophlaxix

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18
Q

Future of Dubin Jhonson S and Rotor syndrome?

A

chronic relapsing and remitting jaundice
Bilirubin in urine(B/C of unecreted CB)
Normal AST/ALT and ALP
IN DJS-Dark liver due to lysosomal storage

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19
Q

trigger?

A

Acute illness
Pregnancy
OCP

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20
Q

pathophysiology?

A

Defect in CB excresion

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21
Q

ACute erosive gastropathy?

A

Severe hemorrhagic lesion after exposure to substance that damage gastric mucosa.

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22
Q

factors?

A

NSAID-Decrease PG secretion
Cocaine-vasoconstriction
Alcohol-direct injury to the mucosa

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23
Q

pathogenesis?

A

Mucosal injury–Acid/Bile acid/Protease enter to lamina propira–vascular injury

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24
Q

CM?

A

Hematemisis

Abdominal pain

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25
Q

Aorticoenteric fistula?

A

Life-threatening GI hemorrhage

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26
Q

RISK factor?

A

Older age
Previous aneurysm
Prior GI surgery
Malignancy

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27
Q

esophageal varicess?

A

Occurs in 30-60% of patients
The major cause of morbidity and mortality in cirrhosis
Screening endoscopy is recomended in all Pt with cirhosis

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28
Q

when to check ammonia level in cirrhosis?

A

symptom of hepatic encephalopathy

also, asses risk factor when HE present

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29
Q

Management(survilance)?

A

Liver U/S and alpha-fetoprotein every 6 month

EGD scopy

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30
Q

primary prophylaxis for VB indication?

A

small with bleeding risk

medium and large varices

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31
Q

what to do?

A

Endoscopic variceal ligation

Non-selective beta blocker

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32
Q

EVL Indication?

A

patient preference

large varices

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33
Q

NSBB drug and mechanism?

A

Propranolol/nadolol
beta blockage–inhibit adrenergic vasodilation in mesenteric arterioles and unopposed alpha effect–vasoconstriction-decrease blood flow

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34
Q

ascitic fluid protein level how determine the cause?

A

protein > =or <2.5 mg/dl

35
Q

protein > =2.5 mg/dl?

A 
Constrictive pericarditis
CHF
Budd Chiari
peritoneal carcinomatosis
TB
Fungal infection
36
Q

protein <2.5 mg/dl?

A

Cirrhosis

Nephrotic syndrome

37
Q

How SAAG?

A

> =/< 1.1 mg/dl

38
Q

> =1.1 mg/dl(portal HTN)?

A

cardiac
cirrhosis
BCS

39
Q

< 1.1 mg/dl(Non portal HTN)?

A

TB
Pancreatic ascitis
Nephrotic S
peritoneal carcinomatosis

40
Q

D-Xylulose test?

A

Give xylulose and assess urinary excretion

Help to D/T from enzyme deficiency and intestinal wall disease?

41
Q

enzyme deficiency?

A

Normal

42
Q

intestinal wall disease(e.g celiac disease)?

A

decrease

43
Q

what can give a false positive D-Xylulose test?

A

Delayed gastric emptying
Abnormal GFR
Small intestine bacterial overgrowth(metabolize xylulose0

44
Q

how to r/o this?

A

asses GFR

repeat test after 4-week rifaximin tx

45
Q

Lynch syndrome pathogenesis?

A 
mismatch repair gene defect
autosomal dominant
microsatellite instablity
serrated polyp pathway
usually, right-side colon affected
46
Q

associated cancer risk in LS?

A

colon
endometrial
ovarian

47
Q

things to do after LS made?

A

colonoscopy at time of diagnosis
endometrial biopsy start at age 30-35 anualy
bilateral salphingnoopherectomy at 40 or earlier if reproduction completed

48
Q

pheripherial neuropathy and antiacid?

A

loss of position and vibration
Gastric acid-detach animal protein-bound to B12 and maker protein secreted by salivary gland attach to B-12-aids absorption

49
Q

HIV neuropathy?

A

pain predominate

all sensory modality affected

50
Q

Multiple myeloma neuropathy?

A

another finding will be there
pain predominate
all sensory and motor will be affected

51
Q

cryoglobulinemia neuropathy?

A

Hep C positive
rash/purpura
arthralgia

52
Q

gastric MALT lymphoma?

A

B-cell clonal proliferation
Associated with H.PYlori
common in the gastric body
ALL patients should be tested for H.Pylori

53
Q

management?

A

low grade with positive H.Pylori-eradication therapy

High grade/negative H.Pylori test-radiotherapy/imunotherapy/

54
Q

Test to be done in suspicion of acute HBV infn?

A

HBS Ag and anti core Mab -

55
Q

Which appear first?

A

HBsAg

56
Q

When HBC AB positive and why should be done?

A

When symptom starts

B/C patient may be in window period and HBsAg negative

57
Q

use of testing HBV DNA?

A

For chronic infection
To assess a candidate for antiviral Tx
To follow up after Tx

58
Q

chronic giardiasis CM?

A

malabsorption
weight loss
Persistent GI distress

59
Q

management?

A

metronidazole for symptomatoc patient

60
Q

diagnosis?

A

Stool AG
Microscopy
NAAT

61
Q

Why ALT is more specific than AST?

A

AST present in skeletal muscle. heart and kidney

62
Q

primary sclerosis cholangitis CM?

A

Asymptomatic
fatigue and pruritis
associated with IBD(mainly UC)

63
Q

laboratory?

A

increase ALP and bilirubin

normal/mildly elevated TA

64
Q

diagnosis?

A

MRI(cholangiopancreatography)
endoscopic retrograde cholangiopancreatography-If have C/I to MRI
Liver biopsy-uncertain diagnosis-only 25% positive for biopsy

65
Q

complication?

A

biliary stricture
cholangitis
cholangiocarcinoma,colonic and biliary ca
cholestasis(fat malabsorption)

66
Q

future in MRI and BIOPSY?

A

Fibrosis both intra and extrahepatic bile duct

Narrowing and dilation in BD-Beads in string

67
Q

CM of pancreatitis?

A

abdominal pain worsens with meal
nausea
vomiting
ascitis

68
Q

asccitis future in pancratitis?

A 
high total protein
high amylase(>1000)
High total protein(>2.5 mg/dl)
Low SAAG
serosanguinous color
69
Q

approach to dysphgia?

A

differ whether oropharyngeal or esophageal

70
Q

oropharyngeal future?

A

Difficulty in initiating swallowing
chocking, cough, and nasal congestion during swallowing
food stuck in throat
recurent aspiration pnumonia

71
Q

Risk factor?

A

dementia
stroke
oropharyngeal ca
motor dysfunction(MG)

72
Q

the first test in this case?

A

videofluoroscopic modified barium swallow

73
Q

if esophageal?

A

No difficulty in initiating swallowing
No chocking, cough, and nasal congestion during swallowing
food stuck in the esophagus
dysphagia occurs after few seconds of swallowing

74
Q

test to do in this case?

A

If both solid and liquid dysphagia occur simultaneously-barium swallow followed by manometry–esophageal motility disorder
progressive dysphagia–if have a risk for ca(Upper endoscopy) but if not barium swallow followed by endoscopy–suspect mechanical one

75
Q

risk for Ca?

A

radiation
complex stricture
caustic injury
the previous laryngeal ca/esophageal ca

76
Q

Roux-en-Y procedure?

A

Do gastric poch—anastosis with jujnum and make other jujuno jujunostomy
used for wt loss

77
Q

Complication?

A

Anastomosis site stenosis(at GJ site)

78
Q

CM?

A

progressive dyspagia

79
Q

diagnosis?

A

esophagogastrododinoscopy

80
Q

diverticular disease etiology?

A

Diverticulitis
Diverticular bleeding
Diverticulosis

81
Q

Diverticulosis?

A

Increase intraluminal pressure causing herniation of bowl through weakness(vasa recta penetration)
no symptom

82
Q

Diverticular bleeding?

A

Injury to exposed vasa recta

Hematocasia

83
Q

Diverticulitis?

A

traped food particles and increase intraluminal pressure and result in perforation.
LLQ pain, tenderness, fever, and vomiting

84
Q

Risk factor DD?

A

high fat, red meat, and low fiber

obesity, physical inactivity, and smoking

GIT steep 2 (4 decks)

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