GIT 3 Flashcards
(100 cards)
1
Q
acute pancreatitis cause?
A
Alcohol
Gall stone
Drugs
Hypertriglyceridemia(>1000)
2
Q
Drug?
A
Diuretics(lasix and HCT)
A drug used for IBD(5-ASA and sulfasalazine)
Immunosuppressive agent(azathioprine, corticosteroid)
HIV related medication(Didanosine and pentamidine)
Antibiotics(Metronidazol,Isoniazide,CTM and didanosine)
antiepiliptic(VA and Carbamazepine)
Ace inhibitors
3
Q
CM?
A
Nausea
Vomiting
persistent Abdominal pain radiating to the back
4
Q
Lab?
A
Elevated amylase and lipase
5
Q
CT scan?
A
enlarged pancreas
peripancreatic fluid
fat around pancreas
6
Q
management?
A
supportive fluid and electrolyte
drug-induced one mainly resoles
7
Q
endoscopic ligation indication in VB?
A
active bleeding varices
no C/I for VBL
8
Q
diuretics and Acute pancreatitis mechanism?
A
direct toxicity as sulpha drug
pancreatic ischemia
increase fluid viscosity
9
Q
what is INR, and its normal value?
A
An INR test measures the time for the blood to clot. It is also known as prothrombin time, or PT.
In healthy people an INR of 1.1 or below
An INR range of 2.0 to 3.0 is generally an effective therapeutic range for people taking warfarin
10
Q
Wilson disease future?
A
Rare
Autosomal recessive
Affect mainly liver and brain
Kayseri-fleisur ring in slit-lamp examination
11
Q
Pathogenesis?
A
Defective copper excretion by liver-coper accumulate in serum, brain(basal ganglia and, and liver)
12
Q
Liver damage CM?
A
Chronic hepatitis
Cirrhosis
ALF
13
Q
Neurologic symptom?
A
Gait disturbance
Parkinsonism
Dysarthria
14
Q
Psychiatric CM?
A
Depression
Personality change
Psychosis
15
Q
Dysarthria?
A
is a motor speech disorder in which the muscles that are used to produce speech are damaged, paralyzed, or weakened. The person with dysarthria cannot control their tongue or voice box and may slur words.
16
Q
Laboratory?
A
Decrease serum ceruloplasmin
Increase urinary copper
Increase copper content in liver biopsy
17
Q
treatment?
A
chelasion
zink
transplnt
18
Q
chelation?
A
D-Penisilamin
Trientine
19
Q
Zink?
A
Decrease Cu absorbtion
20
Q
Liver transplantation?
A
Curative
Drug-resistant one
Fulminant failure
21
Q
Whipple disease cause?
A
an infectious disease caused by Trophyrema whippelli
22
Q
CM?
A
weight loss common in white men 4-6 age of life GI manifestations Cardiac menifestation Migratory polyarthrophaty Chronic cough Intermittent low-grade fever hyperpigmentation Lymphadenopathy
23
Q
GI manifestations?
A
Abdominal pain
Diarrha
Malabsorbtion w/o distension,flatulence and steatorhea
24
Q
Cardiac menifestation?
A
CHF
valvular regurgitation
25
Biopsy?
The PAS-positive lesion in biopsy
26
CNS involvement?
later stage
dementia
myoclonus
supranuclear ophthalmoplegia
27
Symptom of pellagra?
Dermatitis
Dementia
Diharoa
28
Dermatitis Cxs?
rough, hyperpigmented scaly lesion on sun exposed area
29
Dementia Cxs?
memory loss
affective symptome
psychosis
30
Risk factors?
```
Undernutrision(corn diet)
Malnutrition e.g in alcoholic
Carcinoid syndrome
Hertnub disease
Prolonged isoniazid treatment
```
31
Non-Alcoholic fatty liver definition?
Hepatic steatosis on imaging and biopsy
Exclusion of alcohol usage
Exclusion of other cause of fatty liver
32
Clinical future?
```
Mostly asymptomatic
Metabolic syndrome
Mild TA elevation with AST/ALT ratio <1(unlike ALD)
Mild ALP increment
The hyperechoic texture on U/S
Albumin and bilirubin is normal
```
33
management?
diet and exercise
| bariatric surgery if BMI >35
34
positive anti-HBC-Ab indicates?
IgM--Acute infection and the window period
| IgG-Chronic infection and recovery
35
a common cause of cirrhosis in the USA?
Viral hepatitis
Chronic alcoholism
Non-Alcoholic fatty liver
Hemochromatosis
36
Colonic polyp?
Malignant potential and non-malignant potensial
| Growths of tissue within the colon
37
Malignant potential?
Malignant potential
Adenomatous polyp
Serrated polyp
38
adenomatous one?
Neoplastic
| via chromosomal instability pathway with mutations in APC and KRAS
39
Faucher, that indicate adenomatous polyp have more malignant potential?
Villous
size >1 cm
more than 3 concourent polyp
40
Serrated polyp?
Neoplastic.
Characterized by CpG island methylator phenotype (CIMP; cytosine base followed by guanine, linked by a phosphodiester bond).
Defect may silence MMR gene (DNA mismatch
repair) expression.
Mutations lead to microsatellite instability and mutations in BRAF. “Sawtooth” pattern of crypts on biopsy.
Up to 20% of cases of sporadic CRC.
41
perforated PUD sign?
```
abdominal pain
nausea
vomiting
guaiac positive stool
chemical peritonitis
```
42
Diagnosis?
Plain chest and abdominal X-ray
| IF negative and strong clinical suspicion- do a CT scan with IV contrast.
43
Gilbert syndrome CM?
more common in male
most common inherited disorder of glucuronidation defect
AD/AR
increase UB
Intermittent jaundice precipitated by stress
44
lab?
Increase UB
| Normal liver enzyme and AP
45
management?
conservative
46
esophageal stricture future in barium swallow?
symmetric, circumferential narrowing
47
Risk?
radiation
GERD
acoustic ingestion
48
CM?
the difficulty of swallowing solid food
| if develop after GEDR-Gerd symptom will resolve due to the fibrosis prevent reflux
49
vascular ring?
aortic vessel incircle trachea or esophagus
children--inspiratory distress
Adult dysphagia
50
Hepatic encephalopathy precipitating factor?
```
Drug(alcohol,narcotics)
Hypovolemia
Electrolyte disturbance
Increase nitrogen load
Infection
Portosystemic shunt
```
51
CM?
Sleep disturbance
Asterixis
Ataxia
Altered mental status
52
Treatment?
Correct precipitating cause
| Decreased blood ammonia concentration(Rifaximin and lactulose)
53
Hypokalemia and HE?
Hypokalemia-Increase NH3 production in renal tubular cell
54
Metabolic alkalosis and HE?
Increase conversion of NH4 to NH3
55
Acute cholangitis etiology?
ascending gram-negative infection
56
CM?
Charcot triad
| Raynoud pentad
57
Charcot triad?
fever, jaundice, and RUQ pain
58
Raynaud pentad?
CT + hypotension and AMS change
59
Diagnosis?
increase DB and ALP
mild increase TA
Common Biliary duct dilation on U/S
Anion gap metabollic acidosis due to sepsis
60
management?
Enteric bacteria covering antibiotic
| ERCP drainage within 24-48Hr
61
Is the patient present with hepatosplenomegaly, mediastinal fullnes, lung opacification, and hypercalcemia? Diagnosis?
sarcoidosis
62
liver and sarcoidosis?
Hepatomegaly
abnormal cholestasis sign followed by hepatocellular damage.
Granuloma in parenchyma
63
UGI bleeding pathophysiologic relation to urea/cr ratio?
Hemoglobin metabolized to urea in intestine--Elevated BUN
| Jypovolumia increase BUN absorbtion in intestine
64
Infectious and iatrogenic cause of A.Pancrititis?
```
CMV
Legionella
Aspergillosis
Post ERCP
Ischemia(MI) and thrombosis
Post vascular procedure(Coronary stent)
```
65
when there is Post vascular procedure(Coronary stent)?
Due to cholesterol emboli
| There will be livedo reticularis, AKI, and mesenteric ischemia
66
AP diagnostic algorithm?
diagnosis requires 2 things from 3 criterion
67
The three criteria?
Abdominal pain radiating to back
Increase amylase and lipase > 3x
Imaging fetcher
68
Management?
NPO(except important medication)
IV fluid and antibiotic
Antipain
69
Biliary pancreatitis suggesting fetcher?
ALT>150
70
when to consider antibiotics in the case of AP?
Necrotizing pancreatitis with evidence of infection
71
Facal impaction CM?
A patient who is at risk
Constipation
Bowel distension
Fecal incontinence
72
A patient who is at risk?
Defective mobility
Decrease fluid and fiber intake
Chronic constipation
Decrease rectal sensation due to spinal cord injury or dementia
73
Diagnosis?
Digital rectal examination
74
Management?
Manual disimpaction followed by enema
| Then advice on dietary alteration and laxative
75
Loperamide?
C/I
| It may exacerbate the incontinence
76
Sign in cirrhosis due to hyperestrogenism?
```
Gynecomastia
palmar erythema
Testicular atrophy
spider angioma
Decrease body hair in male
```
77
Ischemic hepatic injury/shock liver futeure?
```
Diffuse liver injury
ALT/AST>25-250x
Mild increase ALP/bilirubin
Return to normal within 1-2 wk if the inciting event resolved
The cause can shock/HF
```
78
Autoimmune metaplastic atrophic gastritis feucher?
non radiating epigatric pain
mild epigastric tendernes
Common in female
Another autoimmune disease like hypothyroidism and T1DM
Megaloblastic anemia due to IF deficiency
IDA due to hypochloremia
79
Pill-induced esophagitis fetcher?
Acute retrosternal pain with odynophagia and epigastric burning
Occur in MID esophagus(Due to aortic arch compression)
Circumflesial ulcer with normal mucosa
80
Risk factor?
```
Tetracyclin(Direct acid injury)
NSAID(decrease mucosal injury)
Potassium Chloride(osmotic damage)
Biphosphonate
Iron
```
81
Packed red blood cell indication?
Hg<7 mg/dl
Hg<9 mg/dl in ACS
Acute bleeding with hypovolemia(HCT may not indicate exact mechanism)
82
Fresh frozen plasma?
Clotting factor and plasma protein in one pack of blood
83
platelet transfusion indication?
PLT<10,0000
| PLT<50,000 with bleeding
84
Whole blood transfusion?
RBC + plasma
| Used in severe acute bleeding in case of severe trauma to aid in volume expansion.
85
Pathophysiology for NALD?
Insulin resistance--Increase FFA release from periphery and uptake by the liver--Oxidative stress --Inflammatory cytokine release--fibrosis and cirhosis
86
sign of hepatic metastasis?
Hepatomegaly
P.Effusion(Left side)-Right side in cirrhosis
prominent ALP elevation with mild TA elevation
Common from Colon
87
eosinophilic esophagitis feucher?
Chronic immune-mediated esophageal inflammation.
88
CM?
Common in young
Epigastric /upper abdominal pain does not respond to PPI
Intermitent solid food dysphagia
Food impaction
Associated atopy
History of food impaction lately: Due to esophageal stricture
89
Diagnosis?
```
Esophageal biopsy(>15 eosinophils per HPF
Endoscopy(Linear furrow and ring)
```
90
treatment?
Dietary modification
| Topical glucocorticoid
91
Bright minimal Lower GI bleeding approach?
DEpend on age and presence of the red flag
92
red flag?
```
Family history of colonic ca
Abdominal Pain
Change in bowel habit
Weight loss
IDA
```
93
Age?
<40
40-50
>=50
94
<40 w/o red flags?
Anoscopy and if nothing detected sigmoidoscopy and colonoscopy.
95
40-49 w/o red flag?
sigmoidoscopy/colonoscopy
96
>50/red flag?
colonoscopy
97
cause of bright rectal bleeding?
Hemorrhoid
Anal fissure
Colonic polyp/ca
PProctitis
98
anemia dut to hypothyroidism fetcher?
Mild
| Not usually visible on laboratory
99
Normal lipase and amylase level?
A-23-85 U/L (some lab results go up to 140 U/L)
| L-0-160 U/L
100
a common cause of SBP?
E.Coli
Klepsela
Streptococi
