GIT Flashcards
(242 cards)
1
Q
Drugs which are hepatic enzyme inducer?
A
Alcohol, Barbaturate, Carbamazepin, Phenytion, Rifampicin, Primidone
Remember by (ABC PPR)
2
Q
Drugs which are hepatic enzyme inhibitor?
A
Cimetidine, INH, Ketoconazole
3
Q
Possibility of Drug toxicity should be high in the differential diagnosis of?
A
acute liver failure, jaundice and abnormal liver biochemistry.
4
Q
the most common picture of hepatotoxic drug reaction is?
A
mixed cholestatic hepatitis
5
Q
1-causative Drugs of cholestasis?
2-causative drugs of cholestatic hepatitis?
3-of acute hepatitis?
4-of Non-alcoholic steatohepatitis?
5-of Venous outflow obstruction?
6-of fibrosis?
A
1-Chlorpromazin, estrogens
2-NSAIDs, Co-amoxiclav, Statins
3-Rifampicin,Isoniazid
4-Amiodarone
5-Busulfan, Azathioprine
6-methotrexate
6
Q
Drugs to be avoided in cirrhosis?
A
NSAIDs,Paracetamol,ACE inhibtor, codeine and narcotics, anxiolytics
(Analgesic should be given cautiously)
7
Q
Histologcal finding of AIH is?
A
Interface hepatitis
8
Q
The onset of AIH issues
A
Insidious
9
Q
AIH management?
A
Predniosolone 40mg daily
Azathioprine 1-1.5 mg/day
10
Q
What is the most common cause of acute parenchymal liver disease?
A
Viral hepatitis
11
Q
Hepatic drug metabolism, involve the conversion of………………… to …………… metabolite
A
Non-polar
Polar
12
Q
How long it take for liver function test to return to normal after therapy in drug induced, acute liver injury?
A
Weeks
13
Q
Ductopenia caused by which drug?
A
Co-amoxiclave
14
Q
Which Auto-antibodies are elevated in autoimmune hepatitis
A
ASMA,ANA,AMA
15
Q
What clinical feature is the rule to be found in auto immune hepatitis if general health is good?
A
Amenorrhea
16
Q
TIPSS is a stent between…………&………… structures
But the tube inserted in?
A
Portal vein (which carries blood from the intestines to the liver), hepatic vein (which carries blood from the liver to the heart).
This connection helps to reduce pressure in the portal vein, which can be caused by conditions such as cirrhosis of the liver or portal vein thrombosis. By reducing this pressure, TIPSS can help to relieve symptoms such as ascites (abdominal swelling), variceal bleeding, and hepatic encephalopathy (a condition that affects brain function).
Jugular vein
17
Q
What are the precipitating factor of encephalopathy
A
High protein
G.I. bleed
Dehydration
Infection
H. pylori
18
Q
Histological finding of alcoholic cirrhosis
A
Fibrosis and Micro-nodule regeneration
19
Q
Histological, finding of a fatty liver, and alcoholic hepatitis
A
Fatty liver= centrilobular fat
Alcoholic hepatitis = Mallory bodies
20
Q
How prognosis of alcoholic hepatitis measured
A
Maddrey scrore
Discrimination function >32
Glasgow alcoholic>9
21
Q
What is the histological finding a fulminent hepatic failure?
A
Massive necrosis
22
Q
Thrombosis of hepatic vein is called…………
A
Budd-chiari syndrome
23
Q
Features of chronic liver failure
A
Parotid enlargement
Testicular atrophy
Gynecomastia
Spider névé
Palmer erythema
24
Q
Fulminent hepatic failure is severe hepatic failure with ………
A
encephalopathy
25
Circulatory changes of cirrhosis causing?
Spider telangiectasia, palmer erythema, cyanosis
26
What are the scores that used for scoring prognosis of cirrhosis
The child pugh score
MELD
27
Coagulopathy of FHF treated with?
i.v vit. K, platlet,FFP.
H2 antagonist(or PPI) to prevent G.I bleeding.
28
Paracetol induced FHF should be treated with
N-acetylcysteine even after 10 (but< 36) hours
29
Is a benzodiazepine receptor antagonist may give a transient improvement of encephalopathy?
Flumazenil
30
Bacteriological sterilization: using what kind of AB
broad spectrum- non-absorbable
Neomycin
Metronidazole
31
Is 7-12cm,30-50ml, distended 300ml?
GB
32
Is +/- 3cm,1-3mm in diameter
Cystic duct
33
Cystic duct nerve supply
.Sympathatic via celiac plexus (inhibitory)
Vagus via its hepatic branch (stimulant)
34
Cystic duct arterial supply
Cystic A and hepatic A
35
Is 1-4mm, 4mm in diameter
Commom HD
36
Is - 7-11 cm, 5-10 mm in diameter depending on the age
CBD
37
in duodenum stimulate CCK which contract
GB & relax BD, Oddi & duod.
Acid fat proteins
38
inhibit GB contraction so treatment with it increase gal stone formation.
Somatostatin
39
Charcot triad and reynold pental found in ……………
Cholangitis
40
Charcot triad:
Pain - fever- jaundice
41
Reynold pental:
Pain, fever, jaundice, hypotension(shock), change in mental status
42
Beading apperance in ERCP found in
Sclerosing cholangitis
43
One important clinical feature of cholidocholithiasis is
Obstructive jaundice
44
Filling defect in ERCP found in
Fasciola hepatica
45
The most commonly used technique in liver transplant is
orthotopic
transplantation
46
About ? Liver transplant are performed for acute liver failure
And for cirrhosis
10% acute liver failure
71% cirrhosis
47
Patients in transplantation should match for
Patients are ABO- and size-matched but not HLA-matched with donors.
48
Indication for Liver transplant in cirrhosis?
First episode of Bact. Peritonitis.
Diuretic resist Ascites.
Recurrent variceal hemorrhage.
HCC < 5cm.
Persistent hepatic Encephalopathy.
Bilirubin > 5.8 mg\ dl in PBC.
MELD > 12,Child- Pugh C
49
Absolute Contraindications in liver transplant
1- Active sepsis outside the hepatobiliary system
2- Advanced cardiopulmonary disease or acute -
hemodynamic compromise accompanied by compromise or failure of one or more of the vital organs .
3- Presence of malignancy; metastatic or extrahepatic
4- Active alcohol or drug abuse
5- AIDS
50
Relative Contraindications in liver transplant
1- Age great than 72 years
2- Portal vein thrombosis with mesenteric vein
thrombosis
3- Extrahepatic cholangiocarcinoma
4- HIV positivity
51
is a common infection in the first 3
months after transplantation and can cause hepatitis.
Cytomegalovirus
52
The outcome LT for acute liver
failure is ? than that for chronic liver
worse
53
Nondirected donors are also referred to as
altruistic donor
54
Relaxation of the LES occurs when
vagal efferent
impulses activate myenteric neurons that release non-
adrenergic, non-cholinergic neurotransmitters,
predominantly nitric oxide (NO), and vasoactive intestinal
polypeptide (VIP).
55
In ? locates the site
of symptoms specifically to the region of the cervical
esophagu
Oropharyngeal dysphagia
56
In ? Most patients localize the symptom to the lower
sternum, or at times the epigastrium
Esophageal dysphagia
57
Three important questions should be asked in Esophageal dysphagia
• 1. is the dysphagia for solid or liquid or both?
• 2. is it intermittent or progressive?
• 3. Does the patient have heartburn?
58
Patients who report dysphagia with solids and
liquids are more likely to have
an esophageal
motility disorder than mechanical obstruction.
59
In ? pts may complain of
chest pain and sensitivity to hot or cold liquids.
Diffuse esophageal spasm
60
Episodic and non-progressive dysphagia without
weight loss is characteristic of
an esophageal
web or a distal esophageal (Schatzki) ring.
*Daily dysphagia is likely not caused by a lower
esophageal ring
61
characterized by esophageal aperistalsis and
impaired relaxation of the lower esophageal
sphincter and Long history of intermittent dysphagia
Achalasia
62
? Is achalasia complication
aspiration pneumonia
63
bird-beak’ appearance is feature of?
Achalasia
64
produce retrosternal chest pain and dysphagia. It
can accompany GERD. Swallowing is
accompanied by bizarre and marked contractions
of the esophagus without normal peristalsis.
*On barium swallow, the appearance may be that
of a ‘corkscrew’ esophagus
Diffuse esophageal spasm
65
Anti-reflux mechanisms
1. LES tone
• 2. intraabdominal segment of esophagus which acts as a
flap valve
• 3. crural diaphragm (a hiatus hernia can impair this
mechanism)
• 4. secondary peristalsis of esophagus
• 5. swallowed saliva with its bicarbonate content
• 6. gravity
66
Extra-esophageal features of GERD
• Asthma
• Chronic cough
• Excess mucus or phlegm
• Globus sensation
• Hoarseness
• Laryngitis
• Pulmonary fibrosis
• Sore throat
67
Regurgiatation: of food and acid into the mouth occurs,
particularly on bending or lying flat. This can lead to excess
salivation in the mouth, commonly known as
water-brash
68
Correlation between esophagitis and heartburn is
Poor
69
Water-brash occur due to
Regurgitation of the foot and acid into the mouth occur, particularly on bending of lying flat. This can lead to excess salivation in the mouth commonly known as water brush.
70
Alarming features that need OGD
Weight loss, dysphagia, bleeding, anemia and mass
71
Complication of GERD
Stricture
Barrett esophagus
72
Barrett esophagus almost always associated with
Haitus hernia
73
Treatment of barrett esophagus
Radio-frequency ablation
74
These are the most common benign liver tumours, %5
HAEMANGIOMAS
75
These are rare vascular tumours present as an abdominal mass, or with abdominal pain
or intraperitoneal bleeding.
HEPATIC ADENOMAS
76
Is useful for unresectable HCC.
Sorafenib
77
Normal billirubin
0.3 – 1.2 mg/dL
78
approximately ? bilirubin is produced daily in normal adults.
250-300 mg
79
Conjugation of bilirubin with glucoronic acid takes
place in liver by
uridine-glucoronyltransferase
(UGT)
80
It is typically inherited as an autosomal recessive gene,
but occasionally as an autosomal dominant.
Patients have
low levels of UGT enzyme in their livers.
Incidence: 3-10% of total population. Male : female = 8:1
Gilbert’s disease
81
This is a hereditary conjugated hyperbilirubinemia, that
results from defective hepatic excretion of bilirubin
Dubin-Johnson syndrome (DJS)
82
Is autosomal recessive disease and is a rare cause of
mixed type (conjugated and unconjugated) of
hyperbilirubinemia
Rotor syndrome
83
ALT/AST and serum albumin in hepatocellular jaundice
ALT/AST ↑↑↑ in acute, and ↑/↔ in chronic,
serum albumin normal in acute but ↓ in chronic.
INR may be prolonged in both
acute and chronic therefore of no use for differentiation
84
ALT/ALP
>5,2-5,<2
• If the ALT/ALP: ˃ 5 indicates a parenchymal liver
disease
• If < 2 indicates a cholestatic liver disease
• If 2-5 indicates a mixed type liver disease
85
If SAAG is ≥ 1.1 →?
If SAAG < 1.1 → ??
portal hypertension
Not portal hypertension
86
Most common liver abscess symptom?
Abdominal pain is the most common symptom,usually in the right hypochondrium, radiate to the right shoulder. The pain may be pleuritic in nature.
87
Melena happen due to?
digestion of blood by gastric HCL, enzymes & bacteria .
Less commonly, melaena may be the result of bleeding from the right colon in cases of slow intestinal transit.
88
is a pre-endoscopic risk assessment tool for patients presenting with upper gastrointestinal haemorrhage (UGIH). It can predict need for intervention or death and identifies low risk patients suitable for out-patient management
Glasgow-Blatchford score
89
vEGD within 12 hours is generally recommended only for patients with suspected
variceal bleeding
90
The main risk of capsule endoscopy is capsule retention that can occur in up to 1.5%, Patients at high risk for capsule retention are those with?
heavy NSAID use, tumors, Crohn disease, prior small bowel radiation, or surgery.
91
Triple therapy treatment for ? can prevent recurrent ulcers and bleeds
Helicobacter pylori
92
Bleeding peptic ulcer which commonly associated with ingestion of NSAID, ? Is the major source of bleeding
Gastroduodenal artery ( GDA)
93
It is partial-thickness tears of the mucosa and submucosa that occur near the
gastroesophageal junction. Classically, it develop in alcoholic patients
Mallory–Weiss tear
94
watermelon stomach,” is named for
the dilated, tortuous mucosal capillaries and veins in the gastric antrum
Gast ric Antral Vascular Ectasia
95
most common site for variceal bleeding.
Lower oesophagus
96
Colonic bleeding cause of LGIB
1-Diverticulosis 30%
2-Colitis 24%
3-Hemorrhoids 14%
4-Ischemic 12%
5-IBD %9
97
Is ascending bacterial infection in associated partial or complete obstruction of BD.
Cholangitis
98
Charcots triad?
Charcots triad (pain,fever,jaundice)
If progress rapidly causing septicemia known as
Reynolds pental (pain, fever, jaundice, shock, mental state changes)
99
Single or multiple stones in CBD
choledocholithiasis
100
Uncommon inflammatory stricture of extra-& intrahepatic biliary tree and may involve GB & pancreas
Sclerosing cholangitis
101
Grey turner sign of flanks and cullen sign of umblicus are sign of
Severe pancreatitis
102
Ranson and glascow scoring used in assessment of severity of
Pancreatitis
103
How severity of pancreatitis measured?
Ranson and Glasgow
104
Causes of acute pancreatitis?
I GET SMASHED
105
Which auto-antibody found in autoimmune chronic pancreatitis?
IgG4
106
One mechanical cause of bowl obstruction
Volvulus
107
What is borchardt triad?
Stomach volvulus has three features ( abdominal pain, nausea, inability to pass NG tube) this called borchardt triad
108
Volvulus of small intestine is around which artery
Superior mesenteric artery
109
Ddx of small intestine(mid gut) volvulus
Pyloric stenosis
110
Are risk for the development of CD but protective for UC
Smoking and appendisectomy
111
Common site for UC
Common site for CD
Rectum
Terminal ileum
112
Patches of inflammation is common in
Crohn disease
113
Ulcers in the inner lining of abdomen
Transmural ulcers
Ulcerative colitis
Crohn disease
114
Abdominal distention, hypoactive bowel sound and rebound tenderness suggest
Fulminant colitis,perforation,toxic megacolon
115
Histology in UC shows
Crypt architecture with shortened,branched crypts,inflammation of lamina propria
116
Aphthous ulcers and granuloma are feature of
Crohn disease
117
Fistula and perianal disease and granuloma are common in
Crohn disease
118
• 1 .InflammatoryBowel disease includes:
• A.lschemic colitis.
• B.Infectious colitis.
C ) diopathic inflammattory colitis.
• D.Radiationcolitis.
• E.Behcet-associatedcolitis.
C
119
The following are inflammatory Bowel disease except:
A.Ulcerativecolitis. B.Crohnsdisease.
C.Intdermined colitis.
D,TB-induced colitis. E.Microscopiccolitis.
D
120
3.Theleast common sub type of IBDis:
A.Ulcerative colitis.
B.Crohnsdisease.
C.Intdermined colitis.
D.Collagenous colitis. E.Lymphocyticcolitis.
D
121
4.Hematochesia is more common with:
A.ulcerative colitis. B.Crohnsdisease.
C .Bothabove.
D.Collagenouscolitis. E.Lymphocyticcolitis.
A
122
5.Skipped lesions are more characteristic of:
A.Ulcerative colitis.
B)Crohns disease.
C .Bothabove.
D.Collagenouscolitis. E.Lymphocyticcolitis.
B
123
6.Transmural colonic involvement is characteristic of:
A.Ulcerative colitis.
B.Crohns disease.
C.Bothabove.
D.Collagenouscolitis. E.Lymphocyticcolitis
B
124
7.Granuloma in histology is characteristic of:
• A.Ulcerative colitis.
• B.Crohns disease.
• C.Bothabove.
• D.Collagenouscolitis.
• E.Lymphocyticcolitis.
B
125
8.Extra intestinal features are characteristic of:
A-Ulcerative colitis. B.Crohnsdisease.
C.Bothabove.
D.Collagenous colitis.
E.Lymphocytic colitis.
A
126
10.Patients with long-sanding IBD require the following long-term interventions except:
A.CRCsurveillance.
B .Nutritionalsupport.
C .Killedvaccine.
D;Attenuated vaccines. E.TBscreen.
D
127
14.patients with long-standing active extensive disease should start surveillance
colonoscopy after howmany years:
A .15.
B .5 .
C .7 .
D .20.
E.8
E
128
• 15important differential diagnosis of Microscopic colitis include:
A .UC.
B .IBS.
C.Celiac disease.
D.Crohns disease.
E .B,C,D .
E
129
16.Common extra-intestinal features of IBD involves the following organs except:
A .Skin.
B .Eve.
C.Hepatobiliarysystem.
D.heart.
E.Joints
D
130
Aggressive factors for peptic ulcer are
Aggressive factors,
such
a ms NSAIDs, H pylori infection, alcohol, bile salts, acid, and pepsin
131
Happen more in males and relived by eating
*type of peptic ulcer
Duodenal ulcer
132
Happen more in female and aggravate by eating
*type of peptic ulcer
Gastric ulcer
133
Most common organic causes of dyspepsia are
Peptic ulcer
GERD
Gastric cancer
Medications(NSAIDs)
134
H.pylori treatment
Lansoprazole 30mg/d
Clarithromycin 500mg/day
Amoxicillin(metronidazole)1000mg/day
For 7 days
135
Bariatric surgery is the branch of surgery involving manip-
ulation of the stomach and/or small bowel to aid weight loss. Severe and complex obesity is a phrase commonly used for
patients with ?
body mass index (BMI) "35 and obesity-related disease, or BMI "40 by itself
136
The main cause of death after bariatric surgery is now
DVT/PE
137
minor salivary gland tumours are more likely to be
Malignant
138
Several major structures enter and pass through or pass just deep to the parotid gland. These include
1. The facial nerve [VII].
2. The external carotid artery and its branches.
3. The retromandibular vein and its tributaries.
139
exits the skull from the stylomastoid foramen
Facial nerve
140
The five terminal groups of branches of the facial nerve [VII] are
1. Temporal,
2. Zygomatic,
3. Buccal,
4. Marginal mandibular,
5. Cervical
141
is the most common VIRAL cause of acute painful parotid swelling and predominantly affects children.
It is spread via airborne droplets of infected saliva.
Mumps
142
Acute ascending ? is described in dehydrated elderly patients following major surgery.
bacterial sialadenitis
143
More commonly acute bacterial parotitis associated with a
salivary calculus
144
It is characterised by rapid swelling of one or both parotid glands, in which the symptoms are made worse by chewing and eating.
Recurrent parotitis of childhood
145
are common in the parotid gland and are responsible for about 20% of obstructive cases.
Stricture
146
is the most common site for salivary tumours
Parotid gland
147
Among primary parotid malignant tumours, ? is the most common, followed by?
mucoepidermoid carcinoma
adenocystic carcinoma.
148
are paired salivary glands that lie below the mandible on either side.
The submandibular glands
149
The most common cause of obstruction within the submandibular gland is
2nd is ?
stone formation
Stricture
150
Three cranial nerves (CNs) are at risk during removal of the submandibular gland
1 the marginal mandibular branch of the facial nerve;
2 the lingual nerve;
3 the hypoglossal nerve.
151
The most common malignant tumour in submandibular gland is
152
is an autoimmune condition causing progressive destruction of salivary and lacrimal glands
Sjögren’s syndrome
153
refers to the sensation of oral dryness, which can result from diminished saliva production
Xerostomia
154
is the unintentional loss of saliva from the mouth
Drooling (Sialorrhoea)
155
are the second largest salivary gland
The submandibular glands
156
Parotid duct is called
Stensen
157
Parotid duct opens in………
Buccal mucosa next to 2nd maxillary molar
158
Symptoms of viral infection of parotid gland by mump need ……… days to appear and ……… to resolve
1-2,
5-10
159
Most common organism cause bacterial infection of parotid gland are ………………&…………
Streptococcal + staphylococcus
160
Bacterial infection of the parotid gland most commonly effect…………. Pole of the gland
Lower
161
The characteristic feature that is similar to snowstorm in recurrent parotitis of childhood is called
Punctate sialectasis
162
Parotid stones are …………on radiographs
Radiolucent
163
The submandibular duct called
Whartons duct
164
Malabsorption hallmark is
Steatorrhea
165
In luminal phase the problem maybe ? which is happened by Pancreatic enzymes insufficiency
impaired nutrient hydrolysis
166
Gastric cancer is ………… most common type of cancer
5th
167
Gastric cancer is more common in people with…………… blood group.
A
168
is the most common form of disaccharidase deficiency
Lactase deficiency
169
Most common immunoglobulin deficiency is
IgA deficiency
170
is an autosomal recessive disease with selective inability to absorb zinc, leading to villous atrophy and acral dermatitis.
Acrodermatitis enteropathica
171
Painful, bloody, small-volume diarrhea is known as
Dysentery
172
Gold standard test for steatorrhea is
72hours stool fat collection
>6gm/day is pathological
>20gm/day is steatorrhea
173
What is schilling test
A test used to determine the cause of (B12)malabsorption
174
used to asses proximal s.gut mucosal function.
D-xylose test
175
Pathological findings of celiac disease is
Short or absent villi, MNC infiltration,crypt hypertrophy, Epithelial cell damage.
176
is an immune-mediated dis. That primarily affects the s. gut in response to dietary GLUTEN and only in those who are genetically predisposed.
Celiac disease
177
The genetic factors of celiac disease are
HLA DQ2 or DQ8 as well as non HLA genes
178
Most common symptom of celiac disease is
Diarrhea
179
The extra features of celiac disease are
Arthritis
Alopecia
Hyposplenism
Osteoporosis
Epilepsy
Recurrent abortion
Depression
Infertility
Polyneuropathy
Elevated liver enzyme
180
A systematic disease cause by tropheryma whipplie and occurs mainly in farmers and associated with HLA-B27
Whipple disease
181
Whipple disease treatment
Ceftriaxone or meropenium
Sulphmethaxaze and trimethoprim o prevent relapse
182
It is a GI condition that affects the s. gut and causes MA. The exact cause is un- known & likely infectious in nature . It occurs in inhabitants of trop. areas OR who have traveled to trop. areas
TROPICAL SPRUE
183
TROPICAL SPRUE treatment
Vit B12 and folate
Tetracycline
184
is the inability to absorb lactose, caused by lactase deficiency. in which you have digestive symptoms—such as bloating, diarrhea, and gas
Lactose intolerance
185
Appedix surgical incision types are
Grid iron
Lanz
Paramedian
Rutherford
186
Blumberg sign is
Rebound tenderness in appendicitis
187
Pelvic abscess present with ……………die to irritation of sigmoid colon
Diarrhea
188
A type of Minimal access surgery where there is no requirement for gas insufflation as the operating space is held open by the rigidity of the thoracic cavity.
Thoracoscopy
189
Flexible or rigid endoscopes are introduced into hollow organs or systems, such as the urinary tract, upper or lower gastrointestinal tract, and respiratory and vascular systems
Endoluminal endoscopy
190
Advantages of minimal access surgery
Decrease in wound size Reduction in wound infection, dehiscence, bleeding, herniation and nerve entrapment
Decrease in wound pain Improved mobility
Decreased wound trauma Decreased heat loss
Improved vision
191
Limitations of minimal access surgery
Reliance on remote vision
Loss of tactile feedback Dependence on hand–eye coordination
Difficulty with haemostasis Reliance on new techniques Extraction of large specimens
192
Minimal access surgery contraindications
Compromised cardiac status Peritonitis
Multiple Abdominal Surgeries Bleeding Disorders
Morbid Obesity
Third Trimester Pregnancy Portal Hypertension
193
Why using co2 in MIS
Because it’s
Cheap-available-easily absorbed-released via respiration-highly diffusion coefficient
194
Cells invade basement membrane using
collagenases and hydrolases
Invasive cancer
clumped chromatin, have not invaded basement membrane
195
Most common gi cancer
Colorectal 3rd
Gastric 5th
Liver 6th
Esophagus 8th
Pancreas 12th
196
Most mortality in gi cancers
Colorctal 2nd
Liver 3rd
Stomach 4th
Esophagus 6th
Pancreas 7th
197
The esophagus disease like diverticula, acalasia and gerd are causing which type of esophagealcancer?
Gerd and diverticula causing adenocarcinoma(M 15=1 F)
Acalasia causing squamous carcinoma (M 3=1 F)
198
The classic finding of an apple core lesion is
in patients with esophageal cancer
199
The diagnosis of esophageal cancer is best made from
an endoscopic biopsy
200
is the most critical component of esophageal cancer staging
Endoscopic ultrasound
201
of the chest and abdomen is important to assess the length of the tumor, thickness of the esophagus and stomach
Also may identify fistula
CT scan
202
Male to female ratio of gastric cancer
M 1.8 = 1 F
203
is the most common predisposing condition for CCA in developed countries, with the lifetime incidence ranging 5–10%.
Primary sclerosing cholangitis
204
What is saint traid
Gall stone hiatus hernia colon diverticulosis
205
Gallstones Classified by their cholesterol content
According to its chemical composition
Cholesterol stones
Pigment stones
1-Cholesterol
2-Mixed stones
3-Pigments stones
206
Pain at Rt.UQ, epigastric area, back, interscapular area or to chest -A, N, V, febrile, reluctant to move and murphy sign is positive
Acute cholecystitis
207
Duo to obstruction of cystic duct causing GB distention& increasing tension
Chronic cholecystitis
208
is the most common acute abdominal disorder encountered in daily practice. It occurs in 7– 12% of the population; peak incidence is in the second to third decade of life
Acute appendicitis
209
The most prevalent theory regarding etiology of acute appendicitis is
appendiceal luminal obstruction
210
Vomiting after pain is common in
acute appendicitis
211
The most common flora associated with appendicitis are
Gram-negative aerobic and anaerobic enteric flora
212
1-Palpation in the RLQ elicits tenderness ()
2-palpation in the LLQ elicits pain in the RLQ
3-Hyperextension of the flexed right extremity when in the left lateral decubitus position elicits right-sided pain
4-Medial and lateral rotation of the thigh elicits hypogastric pain
5-Rebound tenderness after pressing and taking the hand away from right iliac fossa
1-McBurney’s sign
2- rovsing sing
3-iliopsoas sign
4-obturator sign
5-Blumberg’s (release) sign
213
Free perforation leads to
contained perforation may lead to
generalized peritonitis
phlegmon and/or abscess.
214
pain arises in cases of pelvic appendicitis
pain arises in cases of retrocecal appendicitis
Cope’s obturator test
Psoas test and baldwing test
215
score is a clinical scoring system used in the diagnosis of appendicitis
The Alvarado
MANTRELS ;
Migration to the right iliac fossa Anorexia Nausea Vomiting Tenderness in the right iliac fossa (2)
Rebound pain
Elevated temperature(fever) Leukocytosis (2)
Shift of leukocytes to the left
216
sudden severe central colicky pain ,central distention and early vomiting with late constipation (usually small bowel )
Acute onset of IO
217
lower abd.pain with constipation followed by distention of long duration (usually large bowel ).
Chronic presentation of IO
218
Most common cause of IO
Adhesion
Hernia
Tumor
219
Gas in the intestine is duo to
1. Swallowed air
2. Bacterial over growth
3. Diffusion from blood
220
Fluids in intestine come from
1. Ingested fluids
2. Saliva 500 mL
3. Gastric 1000 mL and intestinal juice
4. Bile 500 mL and pancreatic secretion 500 mL
221
Clinical pictures of strangulation
Colicky pain changed to constant and severe.
An increase in serum potassium, amylase or LDH
leucocytosis or leucopenia.
Fever
Tenderness with rigidity peritonism
Shock
222
Postoperative adhesions giving rise to intestinal obstruction usually involve and almost never ?.
the lower small bowel
involve the large bowel.
223
This occurs when one portion of the gut invaginates into an immediately adjacent segment; almost invariably, it is the proximal into the distal.
Acute intussusception
224
An intussusception is composed of three parts
● the entering or inner tube (intussusceptum);
● the returning or middle tube;
● the sheath or outer tube (intussuscipiens).
225
firm mass of undigested hair ball
firm mass of fruit or vegetable
They’re cause of bolus obstruction as well as?
trichobezoar
phytobezoar
Food,gallstones,stercolith,worm
226
Late manifestations of intestinal obstruction include
Dehydration: dry tongue and skin ,sunken eyes and poor venous filling
Oliguria,
Hypovolemic shock
Pyrexia,
Septicemia,
Respiratory embarrassment
Peritonism
227
The pain of IO
In small bowel is
In large bowel is
In strangulation is
In paralaytic ileus
is central and colicky
is dull and peripheral or lower abdomen
is continuous and severe
is absent
228
Time of onset of vomiting
Early,Late,Delayed and absent
Nature of vomitus
Clear,bilious,feculent
high small bowel obstruction
low small bowel obstruction
large bowel obstruction
Clear gastric :pyloric obstruction Bilious: high small bowel obstruction Feculent: low small bowel obstruction
229
Absolute constipation is a cardinal feature of
complete intestinal obstruction
230
Intractable diarrhoea with impaired absorption of nutrients following resection or bypass of the small intestine, ultimately leading to progressive malnutrition, is referred to as
Short bowel syndrome (SBS)
231
skin condition that causes a dark discoloration in body folds and crease
Arcanthosis nigrans
232
Features of short bowel syndrome usually appear when there is less than ? of small bowel
Norma length?
200 cm
The small intestine of the neonate is about 250 cm in length, 750 cm in
adult
233
Most common cause of SBS
Crohn disease
234
Manifestations of SBS
Malabsorption
Diarrhoea
Steatorrhea
Fluid and electrolyte disturbance
Cholelithiasis
Bone disease
Gastric acid hypersecrtion
Liver disease
235
greatest proportion of digestive enzymes are
concentrated in
villi of jejunum
236
Loss of physiological GI feedback mechanisms –result in
rapid gastric emptying
237
Loss of ileocecal valve
Small bowel dilation and slower motility
Increased risk of bacterial overgrowth
238
occurs 24-48 hrs after massive bowel resection.
The adaptation phase generally begins 2-4 days after bowel resection and may last up to 12-18months
•During this phase ,up to 90% of the bowel adaptation may occur.
Acute phase
Adaptation phase
239
Lesion in lining of mucosa of the gi tract by action of pepsin and gastric acid
Peptic ulcer
240
Lead pipe sign on barium enema is indicative of
Ulcerative collitis
241
are used to reduce the amount of acid produced by the stomach.
PPI
242
Which one is more common duodenal ulcer or gastric ulcer
duodenal ulcer
And also it’s never malignant so no need for biopsy
