GIT Flashcards
(194 cards)
1
Q
Idiopathic loss of the normal neural structure of the lower esophageal sphincter resulting in the inability to relax.
A
Achalasia
2
Q
Features of Achalasia
A
dysphagia, regurgitation, weight loss, no relationship with alcohol or smoking, maybe hx of recurrent URTIs or aspiration pneumonia
3
Q
Investigations used for Achalasia
A
Barium Swallow and Manometric Studies
4
Q
Which one is the most accurate investigation for Achalasia
A
Manometric Studies
5
Q
What is the significant finding in the Barium Swallow for Achalasia?
A
Sigmoid esophagus or the “parrot’s beak”
6
Q
2 Management use for Achalasia
A
Heller’s Operation (myotomy) and Injection of Botulinum toxin
7
Q
It is an intermittern chest pain with dysphagia and can be precipitated by cold liquids. Pain can stimulate that of the MI, but has no relation to exertion. Relieved after the ingestion of nitrates.
A
Esophageal Spasm
8
Q
What are the 2 investigations used for Esophageal Spasm
A
Manometric Study and Barium meal
9
Q
Which among the 2 investigations for the esophageal spasm is the most accurate?
A
Manometric Studies
10
Q
What is the significant finding you can find in Barium meal for Esophageal Spasm
A
Corkscrew pattern
11
Q
What is the treatment for Esophageal Spasm
A
Ca Channel blockers: Nifedipine
12
Q
Dysphagia (painless/intermittent) + IDA + Post Cricoid Esophageal web
A
Plummer Vinson
13
Q
What are the management for the Plummer Vinson
A
Iron Supplement and Dilation of the web
14
Q
It is associated with esophageal carcinoma. There is occasional dysphagia. It results from the long history of GERD. From sq. ep to columnar ep
A
Barret’s esophagus
15
Q
IDA + Esophageal Web
A
Plummer Vinson
16
Q
painful dysphagia
A
Ulcers and esophageal candidiasis
17
Q
dyspjhagia + regurgitation
A
Achalasia
18
Q
Hx of halitosis
Regurgitation of Stale food and a throat lump
Endoscopy should be avoided for fear of perforation
Barium swallow may show a residual pool of contrast within the pouch
A
Pharyngeal Pouch (Zenker’s Diverticulum)
19
Q
A long hx of GERD
Occasional Dysphagia not persistent
A
Barrett’s Esophagus
20
Q
Symptoms of cancer
A
Esophageal Carcinoma
21
Q
Dysphagia to both solids and liquids without regurgitation
Results from scarring due to:
Acid refulx
Persistent GERD (retrosternal discomfort
Ingestion of corrosives
A
Benign Esophageal Stricture
(Peptic Stricture)
22
Q
What are the medications for theBenign Esophageal Stricture
(Peptic Stricture)?
A
Biphosphonates (Alendronate)
NSAIDS
23
Q
Biphosphonates are used to treat Osteoporosis but long term use can cause this resulting in a stricture.
A
Esophagitis
24
Q
What is the most common esophageal cancer?
A
Adenocarcinoma
25
Which part of the esophagus is the esophageal ca commonly located?
lower third
26
Esophageal ca is more likely to devellop in pxs with hx of ___ and ____
GERD
Barret's
27
What is the least common type of esophageal ca and which part of the esophagus does it affect?
Squamous cell type, upper 2/3
28
What are the RIsk Factors for Esophageal ca?
SAP - BAG
Smoking
Alcohol
Plummer Vinson
Barret's
Achalasia
GERD
29
What are the 2 diagnostic tool for the esophageal ca? and which one is the first line?
Upper GI Endoscopy and biopsy- 1st line
Barium Swallow
30
What can you find in the Barium Swallow that is diagnostic for Esophageal ca?
Rat Tail appearance
Apple core appearance
Shouldering
31
Anemia
Loss of weight
Anorexia
Recent onset of progressive symptoms
Masses, melena or hematemesis
Swallowing difficulty
These are the red flags for ?
Dypepsia and H Pylori
32
What is the management for dyspepsia and H Pylori, with patients >55 yo?
Endoscopy
33
Patient with no red flags, <55yo, serum Positive for H Pylori, negative urea breath test, What is the next best management?
Upper GI Endoscopy
34
What are the treatments for H pylori eradication?
PPIs
Clarithromycin
Amoxicillin or Metronidazole
35
How is the H. Pylori antibody tested?
Carbon 13 Urea Breath Test
Stool Antigen Test
Serum Antibody Testing
36
if the patient is taking PPIS, it should be stop for how many days prior to performing urea breath test or stool antigen test?
14 days
37
How many days should there have a break after the eradication with antibiotics prior to testing?
28 days
38
Dilated sub-mucosal veins in the lower 1/3 of the esophagus
Often severe and life-threatening
Hx of chronic liver disease - portal hypertension ->
Esophageal varices
39
What are the features of Esophageal varices
Hematemesis and melena
Signs of chronic liver disease
40
Investigative tool for Esophageal varices at an early stage
Endoscopy
41
Acute management of variceal bleeding?
ABC,
Clotting - FFP and Vit K
TIPSS
42
Acute management of variceal bleeding that is offered to patients with suspected variceal bleeding at presentation
Terlipressin
43
Acute management of variceal bleeding that reduces mortality in patients with upper GI bleeding in association with the chronic liver disease
Antibiotic Prophylaxis
44
Acute management of variceal bleeding, if the endoscopic variceal band ligation is not available
Sclerotherapy
45
Acute management of variceal bleeding, if there is uncontrolled hemorrhage
Sengstaken-Blakemore tube
46
What is the prophylaxis of variceal hemorrhage given at discharge to reduce the portal pressure in order to decrease the risk of repeat bleeding
Propanolol
47
Severe sudden localized epigastric pain
May worsen with coughing or moving
May radiate to the shoulder tip
Perforated Peptic Ulcer
48
What are the investigative tools for the Perforated Peptic Ulcer?
Erect X ray
CT Scan
49
What are the examination features of a Perforated Peptic Ulcer?
Absent bowel sounds
Shock
Generalized Peritonitis
50
What are the management for the Perforated Peptic Ulcer
IV analgesics
Antiemetic (Metoclopramide 10mg)
Resuscitate with IV 0.9% Saline
Iv Antibiotics
51
For bleeding peptic ulcer without perforation
Endoscopy or IV PPIs
52
Bowel disease that forms ulcer in the
colon and rectum only
Ulcerative Colitis - Lt
53
Bowel disease that forms anywhere in the GIT mostly in the
ileum and colon
Crohn's Disease - Rt
54
BD, that only affects the mucosa and the submucosa
Ulcerative Colitis
55
BD that extends to the serosa
Crohn's Disease - Rt
56
BD that is autoimmune and bloody diarrhea is more prominent
Ulcerative Colitis
57
BD where weight loss is more prominent
then there is steatorrhea (fats in the poop)
Crohn's disease
58
BD , Pain in LLQ (rectum)
LI: Bloody diarrhea more common
Ulcerative Colitis
59
BD , Pain in RLQ (rectum)
LI: Bloody diarrhea not bloody
SI: Malabsorption
Crohn's disease
60
Transmural/deep ulcers
Skip lesions (cobblestone appearance)
on endoscopy
Peri-anal fistulas
Kantor-s string sign
Rose thorn ulcers
Crohn's disease
61
Circumferential, Continuous, Crypt Abscesses, 1ry sclerosing cholangitis
Aphtous oral ulcers
Ulcerative Colitis
62
Colonoscopy
Barium enema (loss of haustration, drain pipe colon)
CT/MRI
Decreased goblet cells on histology
In children -> P-ANCA positive
Ulcerative Colitis
63
Barium swallow
CT
Increased goblet cells + Granuloma on histology
Crohn's disease
64
Treatment for inducing remission in Ulcerative Colitis
1st line - Topical Aminosalicylates
eg Rectal Mesalazine
If not responding - Oral Mesalazine (5-ASA)
Still not responding or motions 5/day - PREDNISOLONE
65
Treatment for inducing remission in Crohn's disease
1st line - PREDNISOLONE
2nd line - BUDESONIDE
3rd line - MESALAZINE (5-ASA)
66
Treatment for severe colitis in children with
1. > 6 bowel movements
2. Visible blood in a large amount
3. pyrexia >37.8 C
4. Tachycardia
5. Anemic
6. ESR > 30
IV steroids, INFLIXIMAB
67
What is the treatment for Crohn's disease for maintaining remission after surgery?
1st line - AZATHIOPRINE, MERCAPTOPURINE or 5-ASA
68
IN severe cases, this tool would be appropriate in the setting to look for features suggestive of toxic megacolon
ABDOMINAL EXRAY
69
What is the treatment for Ulcerative Colitis for maintaining remission?
Mesalazine
If not well maintained -> Oral Azathioprine or Mercaptopurine
70
IBD or infective colitis characterized by total or segmental non-obstructive colonic dilatation + systemic toxicity
Presentation:
Severe Abdominal Pain
Marked toxicity (weakness, lethargy, confusion)
Toxic Megacolon
71
What is the diagnostic tool for the toxic megacolon?
Abdominal Xray
72
What is the management of the Toxic Megacolon?
Admission to ITU, IV fluids
IV steroids in case of IBD
IV antibiotics in case of infectious cases
Possible surgical resection (high risk of perforation and death)
If a rupture colon is suspected - Urgent laparotomy
73
Gastrinoma (tumours found in pancreas or duodenum) -> secretes gastrin - increase gastric acid - peptic ulcers at usual sites, such as 2nd part of duodenum or jejunum
Ulcers may occur after adequate surgery
Zollinger Ellison
74
What are the investigations used for Zollinger Ellison?
Fasting Gastrin levels
Secretin Stimulation test (gastrin goes up after secretin in case of Gastrinoma)
75
ZES is suspected when
1. Multiple ulcers that are resistant to drugs
2. Associated with diarrhea and steatorrhea
3. Family history of peptic ulcers
76
Management for the hard stool
Stool softeners + high fiber (residue) diet
77
Management for soft stool
Senna then lactulose
78
Management for impacted stool
Phosphate enema
79
Management for constipation in pregnancy
Lactulose then Senna
80
What is the best diagnostic investigation for Colorectal ca
Colonoscopy
81
What is the gold standard for Colorectal ca
biopsy
82
What are the alternative diagnostic tool for Colorectal Ca
Barium enema and Ct angiography
83
CEA antigen is not used for diagnosis or staging but rather for
monitoring relapses
84
85
It is presented with change in bowel habits, abdominal pain, anemia and weight loss
Colorectal Carcinoma
86
3 loose or watery stool/ day
Diarrhea
87
acute <14 days of diarrhea,nxt mgt?
Microscopy, culture and sensitivity
88
chronic >14 days of diarrhea, nxt mgt?
Colonoscopy
89
MC adenoma causing electrolytes disturbances
Villous Adenoma
89
MC electrolyte imbalance in diarrhea
Hypokalemia
90
Acid-base imbalance in diarrhea
Non-anion gap metabolic acidosis
91
MC cause of bloody diarrhea
Campylobacter ( a prdrome of headache, myalgia and fever)
92
Second MC cause of bloody diarrhea
Shigella - Salmonella
93
Diarrhea after camping
Giardia
94
MC cause of travelers diarrhea (in less than 72 hrs)
E coli
95
Traveler' diarrhea lasting > 1 week and associated with steatorrhea and weight loss
Giadia
96
MC cause of diarrhea in pediatrics
Viral (Rotavirus)
97
Diarrhea followed by weakness and reflexia (Ascending paralysis)
GBS
98
It is presented with change in bowel habits, abdominal pain, anemia and weight loss
Colorectal Carcinoma
99
Diarrhea followed by renail impairment
HUS (HEmolytic Uremic Syndrome)
100
Bloody diarrhea followed by RUQ pain
Ameba - Amebic Liver abscess
101
Chronic bloody diarrhea in young male
IBO
102
Diarrhea after long term antibiotics
Clostridium Difficile
103
MC Antibiotic causing Clostridium difficile
Clindamycin
Cephalosporin
Co-Amoxiclav
104
TTT of clostridium difficile
Metronidazole
Vancomycin- for severe cases
failure to respond - Metronidazole
105
Diarrhea after eggs or chicken
Salmonella - Ciprofloxacin
106
Diarrhea / vomiting just hours after meal
Staph toxin
107
Diarrhea in bed ridden with constipation
Fecal impaction
108
Main TTT of diarrhea
Fluid
109
TTT of traveler diarrhea
Fluid only
110
TTT of staph toxin
FLuid only
111
TTT of shigella or campylobacter
Antibiotics
112
TTT of ameba or giardia
Metronizadole
113
ist line of choice for acute diarrhea < 14 days
Stool C and M
114
HIV + watery diarrhea
Cryptosporidium Parvum
115
HIV + bloody diarrhea
CMV
116
Non-bloody/watery/steatorrhea in long standing diarrhea after recent travel
Giardiasis (1st- stool microscopy then stool PCR and ELISA)
117
bloody long-standing diarrhea after recent travel
Campylobacter jejuni
(curved bacilli)
118
What is the treatment of C. jejuni?
Erythromycin
/
Clarithromycin or Azithromycin
if macrolides are not tolerated -> Ciprofloxacin
119
this disease is caused by the protein gluten (exacerbated by consumption of wheat)
Repeated exposure leads to villous atrophy which in turn causes malabsorption - buttock atrophy in children
Celiac Disease
120
What are the signs and symptoms of Celiac Disease
diarrhea (chronic or intermittent)
Stinking stools, difficult to flush
Steatorhhea
Persistent GI symptoms
Fatigue
Recurrent abdominal pain
Sudden or unexpected weight loss
unexplained iron, folate or Vitamin B12 deficiency anemia
121
What are the complications of Celiac Disease
1.Osteoporosis
2.T cell lymphoma of SI (rare)
3.Dermatitis herpetiform (presented as red raised patches, often with blisters and severe itching, treated with Dapsone)
122
What are the complications of Celiac Disease
Osteoporosis
T cell lymphoma of SI
Dermatitis herpetiform (presented raised patches often with blisters and severe itching treated with Dapsone)
123
What is the MC presentation of Celiac Disease
Iron Deficiency Anemia
124
This deficiency in this mineral is more common than Vitamin B12 deficiency in Celiac Disease
Folate
125
Celiac Disease is also associated in this disease
DM type 1
126
Any patient with confirmed celiac disease who experience recurrence of the symptoms despite a gluten-free diet +/- weight loss until proven otherwise
Intestinal Lymphoma
127
What are the investigations of Celiac Disease
Specific Auto-antibodies
Jejunal/duodenal biopsy
127
It is presented with change in bowel habits, abdominal pain, anemia and weight loss
Colorectal Carcinoma
128
Jejunal/duodenal biopsy
Villous atrophy
Crypt hyperplasia
increase in intraepithelial lymphocytes
129
What is the management for the Celiac Disease
Gluten free diet
130
Clostridium difficile is detected in stool, presented with watery diarrhea (could be bloody), abdominal pain, raised WBCs and fever
Pseudomembranous colitis
131
What is the most common antibiotic that can cause the Pseudomembranous colitis
Clindamycin
132
What is the management for the Pseudomembranous colitis?
Stop the antibiotic cause'
1st line - Oral Metronidazole
If severe or not responding - Oral Vancomycin
133
It is presented with change in bowel habits, abdominal pain, anemia and weight loss
Colorectal Carcinoma
134
What are the other antibiotics that can cause the Pseudomembranous Colitis?
Cephalosporin
Co-Amoxiclav
Quinolones
Aminopenicillins
135
Prehepatic jaundice
with increased unconjugated hyperbilirubinemia
increase heme breakdown
Hemolysis
G6PD Deficiency
Malaria
136
Intrahepatic jaundice
inability to conjugate
Increase hyperbilirubinemia
Gilbert's Syndrome
137
Intrahepatic jaundice
inability to excrete
Increase conjugated hyperbilirubinemia
Dubin JOhnson
138
Posthepatc jaundice / obstructive
Gallstones
Cholangitis
139
Autoimmune, idiopathic
Associated with Sjogren Syndrome and RA
Pruritus
Increase ALP
Positive AMA (Antimicrondiral Antibodies)
Primary Biliary Cholangitis / Cirrhosis
140
Autoimmune, idiopathic
fibrosis at some areas of bile ducts "beaded appearance"
Associated with IBD
Pruritus with increased ALP
Primary Sclerosing Cholangitis
141
What are the treatments for Primary Biliary Cholangitis / Cirrhosis
Urodeoxycholic Acid
Cholestyramine
142
What are the treatments for Primary Primary Sclerosing Cholangitis
Urodeoxycholic Acid
Cholestyramine
143
What is the most specific tool for Primary Sclerosing Cholangitis
ERCP
144
What are the M rule for Primary Biliary Cholangitis (PBC)
igM
AMA
Middle aged female
145
This is due to ascending bacterial infection (E. Coli) as a result of choledocholithiasis
It is presented by the Charcot's triad
fever, RUQ pain and jaundice
Ascending Cholangitis
146
What is the confirmatory test for Ascending Cholangitis?
US gallbladder and biliary ducts
147
What are the complications of Ascending Cholangitis?
Reynold triad
= Charcot's triad + hypotension + confusion
148
What is the management for the Ascending Cholangitis
Emergency ERCP
Rehydration
Antibiotics
149
Chronic disease of unknown cause characterized by continuiung hepatocellular inflammation and necrosis which tends to progress to cirrhosis.
Often seen with autoimmune diseases (autoimmune thyroid disorder, Addison's or vitiligo)
Middle-aged women
Autoimmune Hepatitis (AIH)
150
What are the features of Autoimmune hepatitis
Fever, malaise
Rash, polyarthritis
Pulmonary infiltration, pleurisy
Glomerulonephritis
Liver enzyme are usually elevated
Amenorrhea is common and disease tends to attenuate in pregnancy
151
What are the investigations for the Autoimmune hapatitis
ANA/SMA/LKMI antibodies
Raised IgG levels
Liver biopsy - inflammation extending beyond limiting plate "piecemeal necrosis, bridging necrosis
152
Pre-eclampsia
First pregnancies
Multiple pregnancies
Begins after 30 wks of gestation, may also appear immediately after delivery
Presents with:
Nausea, vomiting, abdominal pain
fever, headache, jaundice, pruritus
Acute fatty liver of pregnancy
153
Investigations of Acute fatty liver of pregnancy
Elevated LFTs
Raised Bilirubin
Hypoglycemia and ammonia
Prolonged PT
Liver biopsy - diagnostic
154
What is the management for the Acute fatty liver of pregnancy?
Treat hypoglycemia
Correct clotting disorders
N-acetylcysteine (NAC)
Consider early delivery
155
HELLP + hypoglycemia + ammonia
Acute fatty liver of pregnancy
156
Causes of elevated liver enzymes in the postpartum period
Pregnancy-related liver disease
Obstetric Cholestasis - severe pruritus due to high bile acids ? x20 ALT
Pre=eclampsia/Eclampsia
HELLP Syndrome
Acute Fatty Liver of pregnancy
157
Causes of elevated liver enzymes in postpartum period
Liver diseases unrelated to pregnancy
Viral hepatitis
Autoimmune liver disease
Budd Chiari S
Acute Cholecystitis
Drug-induced Hepatotoxicity
158
Autosomal recessive condition in which increased intestinal absorption of iron causes iron accumulation in tissues especially the liver which may lead to cirrhosis and HCC (hepatoma)
iron is accumulated mainly in the peripheral hepatocytes
Hemochromatosis
159
iron is accumulated mainly in the Kuppfer cells and more in central than in peripheral hepatocytes
Hemosiderosis
160
Hemochromatosis can lead to ___ and can prediscpose to _____
Cardiomyopathhy; HCC
161
What is the triad of symptoms in Hemochromatosis
Diabetes
Hepatomegaly
Bronze pigmentation
162
Presentation of Hemochromatosis
Asymptomatic
40-60s
symptoms vague and not specific
Iron overload - arthropathy and gynecomastia
may include cardiac arrhythmias or cardiomyopathy or neurological/psychiatric symptoms
163
What are the main causes of acute pancreatitis
alcohol and gallstones
164
Acute Pancreatitis
GET SMASHED
Gallstones
Ethanol
Trauma
Steroids
Mumps
Alcohol, autoimmune
Scorpion venom
Hypertriglyceridemia, increase Calcium, hypothermia
ERCP
Drugs ( Azathioprine, Bendroflumethiazide, didanosine, pentamidine, sodium valproate)
165
What are the features of Acute Pancreatitis?
Severe epigastric pain or central abdominal pain that radiates to the back and is relieved by sitting forwards
vomiting is prominent
tachycardia
fever
jaundice
shock
Right abdomen with local tenderness
periumbilical bruising (Cullen's sign)
166
What are the investigations for Acute Pancreatitis?
Serum amylase > 1000U/ml (however lipase levels are more sensitive and more specific but take more time to rise following an attack > 24 hrs)
CT with contrast
167
What are the treatments for Acute Pancreatitis?
Fluid Resuscitation , analgesia, and nutritional support
IV antibiotics (IV mipenen)
Laparoscopy - only when there's infection or necrosis
168
half-life is only 20 days and it's a good parameter for the chronic liver disease
Its main function is to regulate the oncotic pressure of blood, and it also binds to enzymes and hormones
it shifts the fluid into the intravascular compartment'
it is also useful to obtain diuresis in hypoalbuminemia patient
Albumin
169
3 main causes of Chronic Pancreatitis
alcohol
smoking
autoimmune
170
What are the features of Chronic Pancreatitis
Episodic with short periods of pain
-Pain free intervals are specific to chronic pancreaittis
-Radiates to the back
-Relieves by sitting doward
-Exacerbated by eating
Steatorrhea
Diabetes
Jaundice
171
Due to malabsorption of fats from the lack of pancreatic lipase secretion which results on weight loss
Sometimes described as "loose, offensive tools which are difficult to flush"
Steatorrhea
172
What are the investigations for the Chronic Pancreatitis
Serum amylase / lipase
US
CT with Contrast - gold standard
173
What is the management of Chronic Pancreatitis?
Pain - Analgesia
Steatorrhea or malabsorption - Pancreatic enzymes supplements and fat-soluble vitamins
Diabetes - Oral hypoglycemics and insulin
174
What are the drugs that induced the hepatitis?
Co-Amoxyclav
Flucloxacillin
Steroids
Sulphonylurea
175
Elevated bilirubin + massive increase in ALP and AST
Drug-Induced Hepatitis
176
May occur after esophageal perforation (after endoscopy)
Xray may show widened mediastinum or air in the mediastinum
Mediastinitis
177
pain located in the substernal region
Anterior Medistinitis
178
pain in the epigastric region with radiation to the interscapular region
Mediastinitis
179
It is a protein that is seen by immunostaining which is used as a clinical marker for lung adenoca
TTF-1
180
Very common in hospitals, especially with the spread of norovirus
they present with acute onset of diarrhea (sometimes with vomiting) and abdominal pain
Pain is usually central and could be epigastric
Gastroenteritis
181
infection of the intestine that leads to severe diarrhea (blood + mucosa) and abdominal pain
Dysentery
182
Courvoisier sign
(painless obstructive jaundice with a palpable mass)
Cancer head of Pancreas
183
Celiac disease is associated with
Lymphoma
184
Ulcerative Colitis and Crohn's disease are associated with
Colon cancer
185
Bloating
Constipation
Alternating with diarrhea
+ NO blood on stool
Irritable Bowel Syndrome
186
Fetal Calpoprotein (measures protein in the sool) if it is elevated? ____
IBD (Inflammatory bowel Disease)
187
Fetal Calpoprotein (measures protein in the sool) if it is normal
IBS (Irritable Bowel Syndrome)q
188
severe recurrent rectal pain in the absence of any organic disease, and may occur at night after bowel actions or after ejaculation. Anxiety could be an associated feature.
Proctalgia fugax
189
Treatment if patient has Ascites + bleeding
Terlipressin
190
Management if the patient has ascites without bleeding?
Perform ascitic fluid aspiration to detect the Neutrophil count, gram stain, culture and obtain protein level
191
It is presented with change in bowel habits, abdominal pain, anemia and weight loss
Colorectal Carcinoma
191
Elevated bilirubin + massive increase in ALP and AST
Drug-Induced Hepatitis
