GIT Flashcards
(128 cards)
1
Q
Feeling of foreign body
Ass with nasal regurgitation
A
Mc and symptom only present in Zenkers diverticulum
If absent it is esophageal dysphagia
2
Q
Zenkers ? Type of diverticulum
A
False and pulsion type
3
Q
Zenkers diverticulum position
A
Opening at midline
Sac at left posterolateral
Between CricoPHARYNGEUS and Thyropharyngeus
4
Q
Treatment of zenkers
A
<2cm—Myotomy
>2cm—Dohlmann procedure(Endoscopic stapler)
5
Q
Mc complication of zenkers
A
Aspiration pneumonitis>Lung abscess
6
Q
Diff btw functional and structural dysphagia
A
For liquids then solids
Solids then liquids
7
Q
Barium swallow
Corkscrew
Birdbeak
A
DES
Achalasia
8
Q
IOC for Achalasia
A
High resolution manometry
9
Q
HRM findings of
DES
NC
AC
A
IRP<15mmHg
Multipeak contractions
DCI-450-8000mmHg
IRP<15mmHg
DCI>8000mmHg
IRP>15mmHg
Failed peristalsis Type 1
Panesophageal pressurisation Type 2
Premature contractions Type 3
10
Q
Initial treatment for functional dysphagia
A
CCB Nitrates
11
Q
Treatment of Achalasia
A
Hellers myotomy/
Hellers Dor fundoplication
New modality—-POEM
12
Q
Esophagus
Erosion
White plaque
Serpengious headed up margin ulcers
A
Esophagitis
GERD
Candida
CMV ulcer
Feline eosinophilic esophagitis
13
Q
Esophageal webs present in
A
Plummer vinson symdrome
Patterson kelly brown syndrome
Glossitis
Dysphagia
IDA
14
Q
Diff btw RF of sq cell ca and adeno ca of esophagus
A
Adeno ca
Obesity
GERD
Barretes esiphagus
15
Q
Wide excision of esophageal ca
A
Proximal 10 cm
Distal 5 cm
16
Q
Incisions of esophageal ca surgery
A
Upper M
Middle I
Lower O
17
Q
Conduit for esophageal ca
A
Stomach
R gastroepiploic> R gastric
Intestine Left colon
Ascending branch of L colic
18
Q
Mcc of death in esophageal ca surgery
A
Anastomotic leak
19
Q
Important cause of GERD
A
Frequent transient LES relaxation > Hypotensive LES
20
Q
IOC for GERD
Gold standard
A
Endoscopy
24hr pH monitoring
21
Q
Antireflux surgery
A
Nissens fundoplication 360
22
Q
Complications of GERD
A
Esophagitis>Barretes
23
Q
Dye used for staining metaplasia of esophagus
A
Methylene blue/ Alcian blue / Cresyl blue
24
Q
Mc complication of fundoplication
A
Gas bloat syndrome
25
IOC for hiatus hernia
CT scan with oral contrast
26
Mcc of spontaneous esophageal perforation
Barotrauma>Borhoeve (lower 1/3)
Fever
L pleural effusion
27
Crepitus in neck seen in
Cervical esophagus perforation dt flexible endoscope
Rx—Conservative
28
IOC for perforation esophagus
CT scan with oral contrast
29
Treatment of esophageal perforation
Endoscopic stenting
X
Primary buttressing / Ttube imperforation with Feeding jejunostomy
30
IOC for corrosive injury of esophagus
Gentle endoscopy
31
Mc type of Transesophageal fistula
Type C
32
Mc cause of acute abdomen pain
Acute appendicitis
33
Causes of appendicitis
Fecolith
Lymphoid hyperplasia
Enterobium vermicularis worm
Ecoli
Lymphatic obstruction
34
Mc type of appendix
Retroceacal
35
Pointing sign in appendicitis
Pain is localised
36
Cope psoas sign in appendicitis
Hyperextension of LL lead to pain in RIF
37
Rousnig sign in appendicitis
Reverse
Palpation at LIF lead to pain in RIF
38
Dunphy sign in Appendicitis
Coughing/crying leads to pain in RIF
39
Tecton sign in appendicitis
Gentle traction of R spermatic cord leads to pain in RIF
40
Treatment of Appendicular lump
Oschner Shirren regimen
Conservative
41
DD of appendicitis in Child and Adult
Mesenteric lymphadenitis due to
Yersinia enterocolitica infection
Psoas abscess(Groin swelling)
42
Mc malignant tumour of appendix
Adeno ca
Carcinoid
43
Complications of gastrectomy
Bleeding
Stump blow out
Dumping
44
Early vs Late dumping
Hypovolemia
Hypoglycemia
45
Mcc of Acute ulcer
Mc site
Stress gastritis
Fundus>Body
46
Mc site of chronic ulcer
Duodenal>Gastric(mc site—lesser curve incisura angularis Type 1)
47
Treatment of chronic duodenal ulcer
Surgery of choice
Trunkal vagotomy with Pyloroplasty(no risk of dumping)
Proximal gastric vagotomy
48
Complications of chronic ulcer
Bleeding—DU(gastroduodenal A)>GU(L gastric A)
49
Mc cause of hemetemesis
PUD > Varices
50
Non variceal hemetemesis treatment
Stable—-PPI RL—-Endoscopic FORREST classification—-Endoscopic coagulation and adrenaline inj——Angioembolisation——Explore and oversew /underrun ulcer
Unstable——Explore and oversew/underrun
51
Treatment of Mallory weiss tear
Conservative
X
Endoscopic coagulation Branch of L gastric artery
52
Treatment of Dielfouy lesion
Submucosal A V malformation
Endoscopic coagulation
X
Angioembolisation of L gastric artery
53
Upper GI
Lower GI
point of differentiation
Ligament of Treitz
54
Most sensitive inv for Melena and GI bleed of obscure origin
Tc99 RBC scan
It is mostly small intestine bleed
Inv—Capsule endoscopy / Double balloon enteroscopy
55
MCC of gaatric outlet obstruction
Gastric ca
56
Olive in epigastric region
IHPS
57
Distant mets of Gastric ca
Tteatment
Liver
Malignant ascites
Trosiers sign
Trausseaus syndrome
Sister mary joseph nodule
Kruckenberg
Blummer shell nodularity
Palliation of symptoms and chemo
If GOO present—-RNY GJ
58
Imp prognostic factor of Gastric ca
Stage>Depth
59
Laparoscopic staging before radical surgery
Lower esophageal
Stomach
Gall bladder
Cholangio ca
Pancreatic
Colorectal
Ovarian
60
Gastric volvulus treatment
Acute——Gangrenous—Gastrectomy
Non gangrenous—-Lap closure of hiatal opening and gastropexy
Chronic ——Lap closure of hiatal opening and gastropexy
61
Xray finding in Gastric volvulus
Retrocardiac air fluid levels in chest xray
62
Cause of
Small vs large bowel obstruction
Small——Post op adhesive obstruction
Large——Cancer
63
Treatment of paralytic ileus
Treat the cause
Electrolytes
Uremia
Ureteric renal stone
Burns
Acute pancreatitis
Intra abd fluid collection
Bed ridden
64
Oglieve syndrome
Pseudoobstruction
Elderly bed ridden
Neostigmine
Serial xray
65
Proximal and Distal parts in Intussusception
Intussuspien
Intussuseptum
66
Lead points of intussusception
Meckels diverticulum
Polyp
HSP
67
Diff btw Ileocolic and Ileoileal intussusception
Sausage shape lump in RHC with empty RIF (Sign of D dance)
with Normal RIF
68
Red current jelly stool
Intussesception
69
Doughy abd
Meconium ileus
70
Xray finding of Meconium ileus
Soap bubble appearance
Groundglass appearance
71
Sequelae of Meckles diverticulum
If persist as band——Volvulus—-obstruction
If obliterated but not completely vanished———Umbilical polyp
Obliterated from ileum but remains on umbilicus———Umbilical polyp
72
Only true diverticulum of GIT
Meckels diverticulum
73
Rule of 2 of meckels diverticulum
Seen in 2%
2% asymptomatic
2feet from ileocecal junction
2 inches long
2cm wide
2x more common in males
74
Tissue present in meckels diverticulum
Heteropic tissue——Gastric mucosa>pancreatic
75
IOC for meckels diverticulum
Tc99 RBC scan
76
Mcc of acute and chronic mesenteric ischemia
Acute——Afib. SMA
Chronic—-Atherosclerosis. SMA
77
Treatment of mesenteric ischemia
Early————Fogartys embolectomy
Late————Exp lap with resection of gangrenous bowel
If chronic due to atherosclerosis——Balloon angioplasty
78
Complication of resection of bowel
Short bowel syndrome
79
Treatment of mesenteric cyst
Chylolymphatic———Enucleation
Enterogenous———Segmental resection and anastomoses
80
IOC for Hirschprung disease
Rectal biopsy
81
Treatment of Hirschprung disease
Short ———Rectal strip myectomy
Long———Pull through operation
Duhamel
Swenson
Modified Swoves
82
CT finding of Volvulus
Swirl sign
83
Diverticulosis ? Type of diverticula
False and pulsion
84
Clinical features of Diverticulitis
Left sided appendicitis
85
IOC for
Diverticulosis
Diverticulitis
Ba enema
CT
86
Rectal prolapse
Partial vs Complete
Peds
Mucosa and Submucosa
Adult
All layers
87
Rectal prolapse treatment
Partial——-Digital reposition X Sclerotherapy X Excision of redundant mucosa submucosa
Complete———
Perineal(Elderly)——-DAT
Abdominal(Young)——Wells
Repstein
Anterior rectopexy
Goldberg rectopexy
88
Colorectal ca presentation
Right side
Late
Good prognosis
Anemia
Malena
Mass
Left side
Early
Bad prognosis
Obstruction
89
Mc type of colorectal ca
Adenoca
90
RF of colorectal ca
Age
Family history
DM——but Metformin is protective
High fatty diet
FAP
HNPCC
91
IOC for colorectal ca
Colonoscopy
If not possible—-CT colonography
92
Treatment of rectal ca
Anterior resection
Low anterior resection
Abdomino perineal resection
93
Inv for LN in rectal ca
Endorectal coil MRI
94
High mobilisation
Vs
Low mobilisation
Sympathetic
Parasympathetic
95
Type of Ca above and below dentate line
Above——Columnar
Below——Squamous
96
Management of fistula in ano
Low———Fistulotomy
High———Seton
Anorectal advancement flap surgery
97
IOC for fistula in ano
MR- fistulogram
98
Primary hemorrhoids
3
7
11
All primary are internal
Internal are usually not painful
99
Grading and treatment of hemorrhoids
1–Bleeding no prolapse
2–Prolapse but goes back spontaneously
3–Manual reposition
4–Irreducible
1–laxative lifestyle modification
2–Barrens banding
34–Milligan Morgan hemorrhoidectomy
100
Ginkgo leaf sign
Xray of Esophageal perforation
Pneumomediastinum
Subcutaneous emphysema
101
Barretts treatment
Low grade—Surveillance
Intermediate—RFA- F/U
High grade—Manage as Ca
102
Ceacal bar sign
Inflammed ceacum
Areow head appearance—Inflammed appendix
103
Mcc of LGIBLEED
Diverticulosis>Angiofysplasia
104
DOC for varice bleed
Prophylaxis
Terlipressin
Beta blockers for rebleed
Ceftriaxone for SBP
105
Variceal bleed management
EBL
X
Tubes Linton Minnesota Sengstaken
X
Repeat EBL
X
TIPSS
106
Complications of TIPSS
Early—Capsular rupture and encephalopathy
Late—Stent stenosis/thrombosis
107
Nut cracker syndrome
Left renal vein compressed by SMA
If duodenum compressed it is Wilkie/Cast/SMA syndrome
108
Endoscopes length
Anoscope
Proctoscope
Rigid sigmoidoscope
Flexible sigmoidoscope
Colonoscope
10 cm
15cm
25cm
60cm
160cm
109
Short bowel syndrome
Mcc in child and adult
Management
NEC/jejunal atresia
Chrohns /mesenteric ischemia
GLP2 agonists
Lengthening procedures
Bianchi
Step
Kimura
110
Max risk of malnourishment in which type of enterocutaneous fistula
Duodenal fistula
111
Mirizzi syndrome
Gall stone ass jaundice
112
Waxing and waning jaundice
Peri ampullary ca
Double duct sign
113
Scolicidal agents in PAIR
95% Ethanol
Hypertonic saline
NOT FORMALIN
114
Sausage pancreas
Autoimmune pancreatitis
IgG4 related disease
115
Inguinal canal borders
Anterior——External abdominal oblique
Posterior——Fascia transversalis
Roof——Transverse abdominus + Internal oblique (Conjoint tendon)
116
Hasselbach triangle
Lateral——Inf epigastric vessels
Medial——Rectus abdominus
Inferior——Lacunar ligament
117
Ligaments of External oblique
LIP
Lacunar
Inguinal
Pectineal
118
Landmark of Inguinal hernia and Femoral hernia
Pubic tubercle
119
Myopectineal orifice
Superior——Int oblique/TA
Inferior——Coopers
Medial——Rectus muscle and sheath
Lateral——Ileopsoas
120
Traingle of Doom boundaries
Lateral——Gonadal vessels
Posterior——Peritoneal reflection
Medial——Vas deferense
Contents
Iliac artery
Iliac vein
Genital br of genitofemoral nerve
121
Triangle of Pain
Superomedial——Gonadal vessels
Lateral——Peritoneal reflection
Inferolateral——Iliopubic tract
Contents
Deep circumflex iliac artery and vein
Lateral cutaneous femoral nerve
Ant femoral cutaneous nerve
Femoral branch of genitofemoral nerve
Femoral nerve
122
Contents of inguinal canal
Spermatic cord
Ilioinguinal nerve
123
Spermatic cord contents
3A
Testicular A
Vas A
Cremasteric A
3V
Vas
Pampaniform plexus
Testicular lymphatics
3N
Genital br of GFN
Synpathetuc and visceral afferent
Ilioinguinal nerve
124
Types of hernia
Litter
Amyand
Gibson
Pantaloon
Sliding
Richter
Oglive
Maydle
Meckels diverticulum
Appendix
Hernia Hydrocele
Direct Indirect
Sigmoid
Hernia Diarrhoea
Congenital direct
W shaped contents(necrosis/strangulation)
125
Hernia mimicking peptic ulcer
Epigastric hernia
Linea alba
126
Infra umbilical hernia above arcuate line
Spigelian hernia
Defect in Transverse abdominus
High risk of strangulation
127
Hernia with less chances of strangulation
Umbilical hernia
Incisional hernia but In adult has high risk of strangulation
128
Structure between Direct and Indirect hernia
Inf epigastric artery
