Gastroenterology Flashcards
(124 cards)
1
Q
Esophagus length?
A
25-30 cm
2
Q
Esophagus diameter?
A
2-3 cm
3
Q
From upper central incisors to upper esophageal sphincter length?
A
15 cm in adult
4
Q
Cervical esophagus?
A
C6 to T4
5
Q
Thoracic esophagus?
A
T4 to T10
6
Q
Abdominal esophagus?
A
T10 to T11
7
Q
Manometry of esophagus?
A
Contractions of muscles
8
Q
Impedancemetry of esophagus? معاوقة
A
Function - GERD - Air solid liquid
9
Q
Provocative Tests?
A
Bernstein test - Tensilon test - Balloon distention test
10
Q
البلع المؤلم in English
A
Odynophagia
11
Q
Zenker diverticula?
A
Pulsion, upper 3rd, posterior wall, males more, both sex, +50 years, angry
12
Q
Type I HH?
A
Sliding HH, most common, reflux disease, cardia and Z line up
13
Q
Type II HH?
A
Rolling HH, fundus, cardia & Z line normal, (paraesophageal hiatus, gerd, mechanical complications)
14
Q
Type III HH?
A
Mixed type I + II
(paraesophageal hiatus, gerd, mechanical complications)
15
Q
Type IV HH?
A
Esophagohiatal membrane, visceral organs up, (paraesophageal hiatus, gerd, mechanical complications)
16
Q
SAINT syndrome?
A
HH
Gallstones
Colic diverticulum
صدفة
17
Q
Ciprofloxacin?
A
- is a fluoroquinolone antibiotic
- to treat a number of bacterial infections
- bone and joint infections
- intra abdominal infections
- certain types of infectious diarrhea
- respiratory tract infections
- skin infections
- typhoid fever
- urinary tract infections…
- 2nd generation (…floxacin (2nd&3rd))
18
Q
Flagyl?
A
Metronidazole (Flagyl)
Tinidazole
Nimorazole
Ornidazole
Secnidazole
- antibiotic and antiprotozoal medication
- pelvic inflammatory disease
- endocarditis
- dracunculiasis
- giardiasis
- trichomoniasis
- amebiasis
19
Q
Infliximab?
A
- a chimeric monoclonal antibody
- brand name: Remicade
- treat a number of autoimmune diseases : Crohn’s disease - ulcerative colitis - rheumatoid arthritis - ankylosing spondylitis - psoriasis - psoriatic arthritis - Behçet’s disease
20
Q
Pain after 10 min from eating?
A
Stomach / Colon
21
Q
Pain after 2 hours from eating?
A
Duodenum
22
Q
Pain after 0.5-1 hour from eating?
A
Gall bladder
23
Q
Obstructive jaundice?
A
- Old people
- Ampulla of Vater (leads to anemia)
- Repeating yellowish color
24
Q
Best way to examine pancreas?
A
CT scan
25
Best way to examine bile ducts?
MRCP
Magnetic resonance cholangiopancreatography (MRCP) is a special type of magnetic resonance imaging (MRI) exam that produces detailed images of the hepatobiliary and pancreatic systems, including the liver, gallbladder, bile ducts, pancreas and pancreatic duct.
26
Best way to examine common bile duct?
EUS
27
Bile stones origin?
80% gall bladder
20% bile ducts
28
Vomit after 1/4 hour?
Stomach pyloric stenosis
29
ماذا نشاهد في تأمل البطن؟
- الحجم
- التناظر
- السرة
- آثار جراحة
- دوران جانبي
- حبن
- متنفس؟
30
DD of diarrhea?
- stomach/intestines inflammation
- pharmaceutical
- hyperthyroidism
- diabetes in late stages
- ulcerative colitis 100٪ يصيب المستقيم + زحير دائم
- Crohn's disease يصيب كل طبقات الامعاء
- malabsorption
- colon spasm
- colon tumors
- tuberculosis
- bacterial
- parasitic
31
Colonoscopy limitation w.r.t Hb?
Hb<7
32
Normal MCV?
80-100
33
Normal Urea?
20-50
34
Normal CRP?
1-5
35
Normal Na?
135-145 mEq/L
36
Normal K?
3.5-5.5
37
Normal Plt?
150,000 to 450,000 platelets per microliter of blood
38
Mesacol?
- Mesalazine = Mesacol = mesalamine = 5-aminosalicylic acid
- treat inflammatory bowel disease (ulcerative colitis, Crohn's disease)
- mild to moderate severe disease
- oral/rectal
39
Azathioprine (Imuran)?
- immunosuppressive medication
- rheumatoid arthritis
- granulomatosis with polyangiitis
- Crohn's disease
- ulcerative colitis
- systemic lupus erythematosus
- kidney transplants to prevent rejection
40
Crohn Disease Activity Index (CDAI): 0-149 points?
0 to 149 points: Asymptomatic remission
41
Crohn Disease Activity Index (CDAI): 150-220 points?
150 to 220 points: Mildly to moderately active Crohn's disease
42
Crohn Disease Activity Index (CDAI): 221-450 points?
221 to 450 points: Moderately to severely active Crohn's disease
43
Crohn Disease Activity Index (CDAI): 451-1100 points?
451 to 1100 points: Severely active to fulminant disease
44
Platelet high count causes?
- David syndrome
- hemorrhage
- iron deficiency anemia
45
Best way to examine a patient's nutritional status?
Albumin
(pre-albumin for acute malnutrition)
46
أي مريض بهجمة IBD
تمييع
47
كبر حجم البطن DD؟
#1 - obesity
#2 - gases
#3 - pregnant
#4 - ascites
#5 - tumors
#6 - chronic neurogenic bladder
48
ألم شرسوفي يخف بالانحناء للامام؟
بنكرياس
49
زحير = مشكلة في ال؟
مستقيم
50
صدر برميلي يوجه ل؟
توسع قصبات
COPD
51
ALP sources?
- bone
- intestines wall
- placenta
- liver
- bile ducts
52
حواف مشرشرة للكبد توجه نحو؟
- cirrhosis
- metastatic liver
53
Normal PVD (portal vein diameter)?
7-15 mm
54
Ascites symptoms?
#1 - ↗️ abdomen size
#2 - continuous generalized pain
#3 - early satiety
#4 - liquid leakage to pleural space
#4 - dyspnea
#5 - nausea
55
Normal IJV diameter (internal jugular vein)?
9.1–10.2 mm
56
Normal number of times going to bathroom?
3 times/day - 3 times/week
57
Spleen normal length?
12-14 cm
58
Normal EF (ejection fraction)?
50-70%
59
Normal blood albumin?
3.4-5.4 g/dL
60
Normal blood creatinine?
0.7 to 1.3 mg/dL for men
0.6 to 1.1 mg/dL for women.
61
Normal blood LDH?
140 U/L to 280 U/L for adults and tend to be higher for children and teens
62
Normal blood TP (total protein)?
6.0 to 8.3 g/dL
63
Penicillamine?
- Penicillamine (Cuprimine)
- Wilson's disease treatment
- Kidney stones and high urine cystine levels
- Rheumatoid arthritis
- various heavy metal poisonings
- Taken by mouth
64
Zinc relation with insulin?
- Stimulates insulin action and insulin receptor tyrosine kinase activity
- People with diabetes have been known to have more zinc in their urine and less in their bloodstream
- Higher zinc levels in blood are linked to a lower risk of diabetes.
65
Most common site of PUD
Stomach & 12
66
Most commin cause for PUD
HP & NSAIDs (95%)
67
ماذا تفرز ECL بالمعدة
Ach
Gastrine
Histamine
68
ماذا يحفز مضخة البروتون والخلايا الجدارية على العمل
Ach
Gastrine
Histamine
69
ماذا تفرز خلايا Chief
Pepsinogen
الذي يتحول الى pepsin بفعل HCl
70
اين تعيش HP
في مخاطية من نمط معدي فقط
- حؤوول في 12
- حؤول في المري
- رتج ميكل في الامعاء الدقيقة
71
كيف تحمي HP نفسها من حمض المعدة
فعالية اليورياز
Urea ➡️ Ammonia
الفعالية الحركية
72
ماذا يفيد التخلص من HP
يزيل القرحات المعدية والعفجية ويمنع النكس
73
ماهي بعض الذيفانات التي تفرزها بعض انواع HP
- Cag A : cytotoxin accociated gene
- Vac A : vaculating accociated gene
74
PUD symptoms
Sometimes no symptoms
Dyspepsia
Hemmorhage - perforation - blockage
Heartburn
75
NSAIDs effect on COX 1
decreased blood flow which leads to mucosal injury
76
NSAIDs effect on COX 2
Increased neutrophil adherence which leads to mucosal injury
77
NSAIDs effect on topical imitation
Epithelial damage which leads to mucosal injury
78
NSAIDs side effects on GIT
نزف تحت مخاطية
تسحجات
قرحات
79
NSAIDs risk factors for PUD
age > 60 years
First 30-90 days of NSAIDs treatment
Past history
HP
Use with steroids, anti-platelet drugs, or anti-coagulant drugs
80
Other causes for PUD
Zollinger-Ellison disease
Mastocytosis (↗️ histamine)
CML (↗️ histamine)
After Billroth II
SI removal
Syphilis - Tb ...
81
Smoking and PUD
More common
More complications
↗️ need for surgery
↘️ treatment duration
↗️ recurrance rate
82
Alcohol and PUD
Injury on mucus
↗️ HCl secretion
لا يوجد دليل قوي انه عامل خطر
83
هل تكفي الحمية والنمط الغذائي او العوامل التفسية لتسبب PUD
لا يوجد علاقة
84
Comparison of gastric and 12 ulcers
Gastric:
- directly after food
- ↗️ pain after eating
- do not wake up
- +/- ↘️ weight
- vomit is common
- can become cancerous
Duodenal:
- after 4 hours from food
- ↘️ pain after eating
- wake up
- +/- ↗️ weight
- vomit is uncommon
Both lead to hemmorhage, perforation, blockage
85
Favourite diagnosis of PUD
Endoscopy
86
Treatment of PUD
#1 - PPIs
(Anti H2)
Associated with antibiotics
For 10 to 14 days
87
Gastric neoplasms?
Benign : epithelial - mesenchymal
Malignant : primary (adenocarcinoma 95% - lymphoma 5% - GIST <5%) - secondary (#1-Breast #2-Melanoma #3-Colon)
88
Gastric adenocarcinoma?
#3 most lethal neoplasm
50 - 70 YO
Males+
More aggressive in young
Dyspepsia symptoms
55YO male living in Japan working in industry
89
Environmental RF for stomach carcinoma
HP
Diet (↗️ salt ↘️fruits & vegetables)
↘️ Socio-economic status
90
Genetic RF for stomach carcinoma
Family history
P53 / BRCA2
Familial adenomatous polyposis (FAP)
hereditary non-polyposis colorectal cancer (HNPCC) (Lynch syndrome)
91
Predisposing RF of stomach carcinoma
Pernicious anemia
Chronic PUD
Smoke
Alcohol
Atrophic gastritis
Gastric polyps
Previous gastric resections
92
Signs of gastric adenocarcinoma
Anemia
↘️Weight
Epigastric mass
Hepatomegaly
Ascites
Jaundice
Blumer shelf
Virchow's jode (left)
Irish node (left)
Sister Mary Joseph nodule
Krukenberg tumor (ovaries)
اورام المعدة والكبد متحركة بالتنفس
93
Proximal vs Distal stomach cancer
Cardia/Fundus - Antrum
More - less
Diffuse↗️ - intestinal↗️
Females↗️ - Males↗️
Younger↗️ - older↗️
More aggressive - less aggressive
Developed countries - poor countries
HP X - HP↗️
GERD
94
Spread of gastric carcinoma
#1-Liver
#2-Lung
#3-Bone
95
Adenocarcinoma investigation
#1-Endoscopy: gold - safe - biopsies - 98% diagnosis - PUD 25% - Polyp 25%
Double contrast study
CT Scan (metastases)
MRI / US (wall thickness)
EUS : diagnosis in Radial - Biopsies in Linear - DEPTH
96
Management of stomach adenocarcinoma
#1-Surgery
#2-Chemotherapy
#3-Radiology
97
Gastric Lymphoma
20% of all extranodal lymphomas
Late YO
Males +
Two types:
#1-DLBCL: 55%
#2-ENMZL: Maltoma - 40% - HP - NH-lymphoma
98
GIST?
Cajal cells
Muscular layer
Stomach
Asymptomatic
CD117 (KIT)
non-epithelial +
63-69 YO
Diag: Endoscopy (biopsies not enough) - EUS - CT
Mitotic index > 5 per 50 HPF
Treat: surgery
99
تطور الجيوب
الشهر 3 - 4 fetal : يبدأ تشكل الجيوب
عند الولادة : فكي + خلايا غربالية
3 سنوات : وتدي
5-7 سنوات : جبهي
18 - 20 سنة : اكتمال نمو الجيوب
100
يصب في الصماخ المتوسط
فكي
جبهي
غربالية امامية
101
تشخيص الفتق الحجابي
تنظير هضمي علوي
تصوير ظليل للمري (وضعية تراندلبرغ)
قياس ضغزط المري
قياس ph المري
102
Metabolic associated fatty liver disease (MAFLD)
previously termed non-alcoholic fatty liver disease, is the leading global cause of liver disease and is fast becoming the most common indication for liver transplantation.
103
لا ندخل الابرة بمكان...
- طبلية
- فيه التهاب
104
دائماً نطلب في حال بزل سائل؟..
1. لون + حجم السائل + المشاهدة والاجراء
2. Chemistry
Glucose Alb Tp Chol CRP
3. Cbc
4. تحري خلايا شاذة
5. دراسة جرثومية
105
Cirrhosis ↗️↗️↗️ ALP
قد يكون آفة شاغلة للحيز مع التشمع
106
اسباب نقص كريات حمر
نقص نتاج النقي
نزف أنبوب هضمي
قصر عمر كريات حمر
فرط توتر وريد باب
107
طين مراري قد يكون في سياق..
الحبن ونقص alb
لا نحول لعمل جراحي
108
سماكة جدار مرارة معممة
مريض ليس عالريق
↘️ Alb
بدء تشكل الحبن
كل التهابات الكبد خاصة HAV
بورسلانية
اندخالات كوليسترانية بجدار المرارة
التهاب مرارة مزمن
التهاب مرارة حاد
109
Afp
ورم خصية
اكتر من 400 ورم كبد
كل تجدد كبدي يزداد افرازه
(و PSA)
110
مدروج حبن عالي :
غالباً آلية فرط توتر وريد الباب
111
Groove pancreatitis
- rare form of chronic pancreatitis
- affecting the “groove” between the pancreatic head, duodenum, and common bile duct
- unknown, although there are strong associations with long-term alcohol abuse, functional obstruction of the duct of Santorini, and Brunner gland hyperplasia
- 50-60 YO
112
Alb serum - Alb ascites =?
<1.1 فرط توتر وريد باب عالي مدروج
>1.1 حدثية التهابية جوف بريتوان منخفض مدروج
113
Common bile duct diameter
7 normal
up to 11 mm
(But normal liver tests)
Every 10 years + 1mm
114
AST higher than ALT?
Alcoholism
Wilson
A. I.
Cirrhosis
Drugs
115
فرط توتر وريد باب
دوران جانبي
حبن
دوالي
ضخامة طحالية
116
قصور خلية كبدية
- اظافر بيضاء
- راحة حمراء
- لون يرقاني
- دنف
- تثدي
- اضطراب توزع اشعار
- تبقرط
- عنكبوت وعائي
- وذمات طرفين سفليين
117
Amlodipine?
- sold under the brand name Norvasc
- calcium channel blocker medication
- used to treat high blood pressure and coronary artery disease.
- taken by mouth
- Common side effects include swelling, feeling tired, abdominal pain, and nausea.
118
Nystatin A1?
- sold under the brandname Mycostatin among others, is an antifungal medication.
- used to treat Candida infections of the skin including diaper rash, thrush, esophageal candidiasis, and vaginal yeast infections.
- may also be used to prevent candidiasis in those who are at high risk.
119
Rituximab?
The chimeric anti-CD20 antibody rituximab induces apoptosis in B-cell chronic lymphocytic leukemia cells through a p38 mitogen activated protein-kinase-dependent mechanism.
Treat non-Hodgkin lymphoma
120
Caldivit syrup
Caldivit syrup is used as bone joint supplement.It contains Calcium Carbonate ,Vitamin D3(cholecalciferol)Zinc Sulphate and Magnesium Hydroxide. Calcium carbonate is a mineral that is required for the formation of bones and maintaining them. Calcium carbonate is required to prevent breakage of bones.
121
أين نشاهد قرحات قلاعية؟
IBD
داء بهجت
يرسينيا - شيغيلا - سالمونيلا - كامبيلوباكتر - اشريكية قولونية
CMV
122
GAVE (Gastric antral venous ectasia) اين نشاهد
#1 فرط توتر وريد باب
#2 صلابة جلد
123
Scleroderma on GIT?
نقص حركات قسم سفلي مريء
SIBO
امساك مزمن
رتوج +
ضمور عضلات ملساء
نقص تقلصية مرارة => حصيات
124
علامات نقص K على ECG
تسطح P
تطاول PR
موجة منقلبة U
