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HARRISSONS > GASTRO > Flashcards

GASTRO Flashcards

1
Q

Excess gastric acid damages the mucosa, accelerates transit, impair pancreatic enzyme activation

A

ZOLLINGER ELLISON SYNDROME

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2
Q

Most common intestinal maldigestion syndrome involving dairy products

A

Lactose deficiency

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3
Q

Gastric acid hypersecretion

A

ZOLLINGER Ellison syndrome
G cell hyperplasia
Retained antrum syndrome
Duodenal ulcer disease

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4
Q

Gastric acid hyposecretion

A

ATROPHIC GASTRITIS

PERNICIOUS ANEMIA

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5
Q

Intestinal and hypersecretory conditions that causes diarrhea:

A

Acute bacterial and viral infections
Chronic giardia or cryptosporidia infection
Small intestinal bacterial overgrowth
Bile salt diarrhea

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6
Q

Characterized by impaired esophageal body peristalsis and incomplete LES RELAXATION

A

Achalasia

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7
Q

Symptomatic delay in gastric emptying of solid or liquid meals

A

GASTROPARESIS

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8
Q

Results from injury to enteric nerves or intestinal smooth muscle

A

Intestinal pseudoobstruction

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9
Q

Mucosal inflammation sec to ingesting GLUTEN containing grains

A

Celiac disease

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10
Q

Mucosal break of ____mm depth to the SUBMUCOSA

A

> 5mm

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11
Q

Site of acid secretion

A

Microvilli

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12
Q

Mucosal protective agents

A

Sucralfate
Prostaglandin analogue : Misoprostol
Bismuth subsalicylate

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13
Q

Refractory ulcers defininition

A

NO HEALING after therapy
GU 12 weeks
DU 8 weeks

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14
Q

Percentage of GU found to be malignant

A

70%

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15
Q

1st effective triple therapy for Hp

A

BTM
BISMUTH
TETRACYCLINE
METRONIDAZOLE

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16
Q

DO NOT Use TETRACYCLINE IF WITH PRIOR USE OF

A

MACROLIDE

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17
Q

are probably the most common cause of LGIB

A

Hemorrhoids

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18
Q

If these local anal processes, which rarely require hospitalization, are excluded, the most common cause of LGIB in adults is

A

diverticulosis

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19
Q

Diverticular bleeding is abrupt in onset, usually painless, sometimes massive, and often from the ___ colon;
chronic or occult bleeding is Not characteristic.

A

right colon

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20
Q

is recommended for persistent or refractory diverticular bleeding.

A

Segmental surgical resection

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21
Q

Diarrhea may be further defined as acute if <2 weeks, persistent if 2–4 weeks, and
chronic if ____?

A

> 4 weeks in duration.

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22
Q

the frequent passage of small volumes of stool, is often associated with rectal urgency, tenesmus, or a feeling of incomplete evacuation, and accompanies IBS or proctitis.

A

Pseudodiarrhea

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23
Q

Stool weight that can generally be considered diarrheal

A

> 200 g/day

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24
Q

is the involuntary discharge ofrectal contents and is most often caused by neuromuscular disordersor structural anorectal problems.

A

Fecal incontinence

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25
Q

Indications for evaluation of diarrhea include

A 
profuse diarrhea with dehydration, 
grossly bloody stools, 
fever ≥38.5°C (≥101°F), 
duration>48 h without improvement, 
recent antibiotic use, 
new community outbreaks,
associated severe abdominal pain in patients aged>50 years, 
and elderly (≥70 years) 
or immunocompromised patients.
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26
Q

The cornerstone of diagnosis in those suspected of severe acute infectious diarrhea is

A

microbiologic analysis of the stool

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27
Q

is an increasingly recognized entity characterized by an abrupt-onset diarrhea that persists for at least 4 weeks, but may last 1–3 years, and is thought to be of infectiousorigin. It may be associated with subtle inflammation of the distal small intestine or proximal colon

A

Brainerd diarrhea

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28
Q

Bismuth subsalicylate may reduce symptoms of vomitingand diarrhea but should not be used to treat immunocompromisedpatients or those with renal impairment because of the risk of

A

bismuth encephalopathy

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29
Q

True or false
In acute diarrhea, Antibiotic coverage is indicated, whether or not a causative organism is discovered, in patients who are immunocompromised, have mechanical heart valves or recent vascular grafts, or are elderly

A

True

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30
Q

constipation responds to ample hydration, exercise, and supplementation of dietary fiber

A

(15–25 g/d)

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31
Q

Prevention of recurrent bleeding focuses on the three main factors in ulcer pathogenesis:

A

Helicobacter pylori

non-steroidal anti-inflammatory drugs(NSAIDs),

acid

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32
Q

vomitus of red blood or “coffee-grounds”material

A

hematemesis

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33
Q

passage of red or maroon blood from the rectum.

A

hematochezia

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34
Q

In GIT, Patients with lower-risk findings (flat pigmented spot or cleanbase) do not require endoscopic therapy and receive standard doses of-oral PPI

TRUE OR FALSE

A

True

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35
Q

Recent meta-analysis of randomizedtrials documents that high-dose intermittent PPIs are non-inferior toconstant-infusion PPI therapy and thus may be substituted in this population

A

patients with high-risk ulcers (active bleeding, nonbleeding visible vessel, adherent clot)

36
Q

Eradication of H. pylori in patients with bleedingulcers decreases rebleeding rates to

A

<5%

37
Q

If a bleeding ulcer develops in a patient taking NSAIDs, the NSAIDs should be discontinued. However, If NSAIDs must be given what should be recommended?

A 
a cyclooxygenase (COX)-2 selective NSAID plus
 a PPI is recommended
38
Q

Patients with established cardiovascular disease who develop bleeding ulcers while taking low-dose aspirin for secondary prevention should restart aspirin as soon as possible after their bleeding episode

A

Within (1–7days) or 1 week

39
Q

True or false

In contrast, aspirin probably should Be discontinued in most patients taking aspirin for primary prevention of cardiovascular events who develop UGIB.

A

True

40
Q

Patients with bleeding ulcers unrelated to H. pylori or NSAIDs should remain on PPI therapy for how long?
given a 42% incidence of rebleeding at 7 years without protective therapy

A

indefinitely

41
Q

The classic history is vomiting, retching, orcoughing preceding hematemesis, especially in an alcoholic patient

A

MALLORY-WEISS TEARS

42
Q

Urgent endoscopy within 12 h is recommended in cirrhotics with UGIB, and if esophageal varices are present,endoscopic ligation is performed and an IV vasoactive medication(octreotide, somatostatin, vapreotide, terlipressin) is given for 2–5days.

A

Esophageal variceal tear

43
Q

What combination is more effective than either alone in reduction of recurrent esophageal variceal bleeding

A

Over the long term,treatment with nonselective beta blockers plus endoscopic ligation is recommended

44
Q

is recommended in patients with esophageal varices who have persistent or recurrent bleeding despite endoscopic and medical therapy ,

advanced liver disease (e.g., Child-Pugh class C with Child-Pughscore 10–13) considered in the first 1-2days

A

Transjugular intrahepatic portosystemic shunt (TIPS)

45
Q

Bleeding gastric varices due to cirrhosis are treated with

A

endoscopic injection of tissue adhesive (e.g.,n-butyl cyanoacrylate), if available; if not, TIPS is performed.

46
Q

(in which an aberrant vessel in themucosa bleeds from a pinpoint mucosal defect)

A

Dieulafoy’s lesion

47
Q

The most common cause in adults >40years with Gastrointestinal bleeding with normal upper endoscopy and colonoscopy , CHRONIC and only occasionally is hemodynamically significant.

A

vascular ectasias

48
Q

The most common causes of GASTROINTESTINAL BLEEDING in adults >40years are

A
  1. vascular ectasias
  2. neoplasm (e.g., GI stromal tumor, carcinoid,adenocarcinoma, lymphoma, metastases)
  3. NSAID-induced erosions and ulcers.
49
Q

Other causes in patients <40 years include Crohn’s disease, polyposis syndromes, or neoplasm. what is the most common cause of significant small-intestinal GIB in children, decreasing in frequency as a cause of bleeding with age?

A

Meckel’s diverticulum

50
Q

True or false:

A positive FOBT necessitates colonoscopy

A

TRUE

51
Q

is abrupt in onset + painless + massive hematochezia

Usually stop bleeding spontaneously in~80–90% of patients and, on long-term follow-up, rebleed in ~15–40%of patients

A

Diverticular bleeding

52
Q

hemoglobin may be normal or only minimally decreased at the initial presentation of a severe bleeding episode. As extra vascular fluid enters the vascular space to restore volume, thehemoglobin falls, but this process may take up to

A

72 h

53
Q

Transfusionis recommended when the hemoglobin drops below

A

BELOW 7 g/dL

54
Q

the mean corpuscular volume is low and red blood cell distribution width is increased.

A

iron-deficiency anemia

55
Q

Melena indicates blood has been present in the GI tract for

A

≥14 h,

and as long as 3–5 days.

56
Q

Other clues to UGIB include

due to volume Depletion and blood proteins absorbed in the small intestine

A

hyperactive Bowel sounds

elevated blood urea nitrogen

57
Q

The promotility agent_____, 250mg intravenously ~30 min before endoscopy, also may be considered to improve visualization at endoscopy: it provides a small but significant increase in diagnostic yield and decrease in red cell transfusions.

A

erythromycin

58
Q

Upper endoscopy should be performed within how many hours in most patients with UGIB?

A

Within 24 hours

59
Q

is the procedure of Choice in most patients admitted with LGIB unless bleeding is toomassive, in which case angiography is recommended.

A

Colonoscopy after an oral lavage solution

60
Q

is used primarily in patients <40 years old with minor bleeding.

A

Sigmoidoscopy

61
Q

is recommended for surveillance of patients with Barrett’s esophagus.

A

Periodic EGD with biopsies

62
Q

are performed when high-grade dysplasia or intramucosal cancer are found in the Barrett’s mucosa

A

Endoscopic resection (EMR or ESD)and/or ablation

63
Q

is the commonest ablative modality used for endoscopic treatment ofBarrett’s esophagus, and other modalities, such as cryotherapy, are alsoavailable

A

Radiofrequency ablation (RFA)

64
Q

In contrast to the low diagnostic yield of small bowel radiography, positive findings on capsule endoscopy are seen in 50–70% of patients with suspected small intestinal bleeding.The most common finding is

A

mucosal vascular ectasia.

65
Q

Colon ca screening recommendation for Long-standing (>8 years) ulcerative pancolitis orCrohn’s colitis, or left-sided ulcerative colitis of>15 years’ duration

A

Colonoscopy with biopsies every 1–2 years

66
Q

Esophagitis occurs when refluxed gastric acid and ___ cause necrosis of the esophageal mucosa causing erosions and ulcers.

A

pepsin

67
Q

account for about 90% of Reflux in normal subjects or GERD patients “without” hiatus hernia, but patients with hiatus hernia have a more-heterogeneous mechanistic profile

A

Transient LES relaxations

68
Q

The mucosal defense system can be envisioned as a three-level barriers, composed of preepithelial, epithelial, and subepithelial elements. What is The first line of defense?

A

is a mucus-bicarbonate phospholipids layer, which serves as a physicochemical barrier to multiple molecules, including hydrogen ions.

69
Q

Most common cause of gastritis

A

Infection

70
Q

Most consistent clinical feature of Irritable bowel syndrome

A

ALTERED BOWEL HABITS

71
Q

Most prevalent GI disease complicating cardiovascular surgery

A

Non occlusive mesenteric ischemia

72
Q

In Chronic Hepatitis C, what is the best prognostic indicator?

A

Liver HISTOLOGY

73
Q

Drugs with direct toxic effect

A

Acetaminophen

Carbon tetrachloride

74
Q

Drugs with idiosyncratic features

A

Amoxicillin clavulanate
Isoniazid
Ciprofloxacin

75
Q

If aminotransferases > 1000, likely diagnosis:

A

Viral hepatitis
Ischemic liver injury
Toxin or drug induced liver injury

76
Q

Most potent hepatitis b anti-viral agent

A

ENTECAVIR

77
Q

First line of drugs for Chronic hepatitis B

A

1ST ET

entecavir

tenofovir

78
Q

Second line of drugs for Chronic hepatitis B

A

Second-line: lamivudine, adefovir, telbivudine

SECOND TAB

79
Q

Management of alcoholic hepatitis

A

Prednisolone 32 mg Od x 4 weeks

Prednisone 40mg OD X 4weeks

80
Q

What bodies are seen in alcoholic hepatitis

A

Mallory denk bodies

81
Q

The most common organisms in spontaneous bacterial peritonitis are;

A

Escherichia coli and other gut bacteria

82
Q

Definitive treatment for spontaneous bacterial peritonitis

A

3rd generation cephalosporins

83
Q

When to give prophylaxis for SBP spontaneous bacterial peritonitis (once weekly)

A

Patients presenting with UGIB in cirrhosis

Px with prior SBP

84
Q

Better outcome type of hepatorenal syndrome

A

Type II HRS

85
Q

Best therapy for HRS

A

Liver transplant

86
Q

Current treatment for HRS hepatorenal syndrome

A

IV albumin + OCTREOTIDE + MIDODRINE (alpha agonist)

HARRISSONS (62 decks)

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