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GIT steep 2 > GIT 4 > Flashcards

GIT 4 Flashcards

(84 cards)

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1
Q

Clostridium difficile infection fetcher?

A 
A patient who has risk
Abdominal pain
Voluminous watery diharrha(rarely bloody)
Low-grade fever
Leukocytosis
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2
Q

Risk factor?

A

1) Recent broad-spectrum antibiotic use(Dis. Normal F)
2) Gastric acid suppression(Dis. Normal F)
3) Hospitalization(severely ill)
4) Age >65(immunodeficiency and have risk of above 3-factor exposure)

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3
Q

Pathogenesis?

A

Disruption of normal flora—CD overgrowth—release enterotoxin A and cytotoxin B—pass EC–epithelial cell loss TJ and apoptosis–diarrhea.

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4
Q

diagnosis?

A

Stool PCR for CD toxin

Stool EIA for CDT and Glutamate DHG antigen

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5
Q

complication?

A

fulmitant colitis

Toxic megacolon

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6
Q

fulminant colitis?

A
  • Most severe form of uncomplicated acute colitis, with intense symptoms, high fever, and some- times colectasia.
  • Is also used synonymously with that of acute severe colitis
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7
Q

Toxic megacolon?

A

An acute form of colonic distension.
It is characterized by a very dilated colon (megacolon), accompanied by abdominal distension (bloating), and sometimes fever, abdominal pain, or shock.
Risk factors: Chronic bowel disease
Complications: Septic shock, perforation of the …
Other names: Megacolon toxicum
Prognosis: Fatal without treatment

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8
Q

Treatment of TM?

A

Antibiotic
Colectomy if have peritonitis and not respond to Ab
Not do a procedure that increases the risk of perforation(endoscopy and enema)

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9
Q

Management?

A

Oral vancomycin/fidaxomicin

Infection control

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10
Q

Infection control?

A

Hand hygiene with soap and water

Contact precaution

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11
Q

Nocturnal dharrha Indicates?

A

Secretory diarrhea(develop during fasting)

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12
Q

cause?

A

Chronic GI infection
Microscopic colitis
Bile salt diarrhea
Hormonal increament(VIP/Gastrine)

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13
Q

Symptom of celiac disease?

A 
Bulky, foul-smelling stool
fatigue, loss of muscle, and SCF?
anemia
bone pain and #
easy bruising(K deficiency)
hyperkeratosis(A deficiency)
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14
Q

Diagnosis?

A

Villous atrophy, crypt hyperplasia, and submucosal LC
IGA-anti endomysial, tissue glutaminase
serum IgA level and IgG if negative IgA Ab if strong suspicion(B/C IgA deficiency is common)

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15
Q

Collagenous colitis?

A

Chronic diarrhea

Normal mucosa with supepitelial collagen deposition

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16
Q

UGI bleeding secondary to varices TX?

A

Fluid resuscitation
Prophylactic Ab(decrease infn, recurrence and mortality)
Endoscopic ligation(repeat after 1-2 wk)should be done within 12 Hr
Octreotide
Secondary prophylaxis with beta-blocker after ligation
Balloon tamponade (uncontrolled bleeding until definitive management(TIPS or shunt) done.
Serial HCT if HGB>9 and transfuse if it is less than this.

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17
Q

Patient with ascitis and rise ascitic bilirubin level indicate?

A

Biliary tract or bowel perforation
Abdominal pain and sign of peritonitis
brown(bilious ascitis

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18
Q

ascitis secondary to PH color?

A

straw-yellow color

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19
Q

low glucose and high LDH in AF?

A

Infection
Malignancy
Bowel perforation

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20
Q

In pancriatic ascitis?

A

Increase amylase

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21
Q

increase TG?

A

chylous ascitis

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22
Q

Diverticular bleeding?

A

massive bright red bleeding(b/C arterial)

no pain

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23
Q

How to D/T with heamoroid?

A

Hemorrhoid has minimal bleeding and has irritation symptoms like frequency.

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24
Q

Management of DB?

A

mostly resolve

endoscopic or surgical intervention.

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25
Hepatic hydrothorax?
Pleural effusion in cirrhosis patient common I right(passage of ascitic fluid in right b/c of muscle less in right) The patient will have dyspnea, cough, pleuritic chest pain and hypoxemia. PE in CXR
26
Management?
fluid restriction and diuretics thoracentesis if sever symptom Don't do C-TUBE--loss of fluid, protein, electrolyte, and RF risk.
27
What to investigate in patients with sepsis of clostridium skepticum and streptococcus bovis?
Colonoscopy(Both highly associated with colonic ca)
28
Chest pain relieved by nitrate differential?
ACS | Diffiuze esophagial spasm
29
CM of microscopic colitis?
``` watery diarrha fecal urgency and frequancy abdominal pain fatigu wight loss artheralgia common in older women ```
30
Trigers?
Smoking drugs like NSAID,SSRIand PPI Autoimune disease increase risk
31
pathology?
show both lymphocytic infilitrasion collaginous collitis:subepithelial collagen band thikning lymphocytic colitis:lymphocyte accumulation in lamina propria Normal mucosa
32
managment
avoid trigaseers | if diharrha persisit--bedisonide/antidiharreal like loperamide
33
benifit of alcohol abestienance in patient with A.coirrhosis?
Decrease liver inflamation Decease portal pressure increase survival Baclofen can be used for craving
34
CM of pancriatic ca?
``` abdominal pain radiate to back and worse when patient eat,lies back and night jaundice wight loss recent atypical DM hepatomegaly and ascitis migratory thrombophlebitis ```
35
lab study?
ca 19-9 (not used for screenin CT for body and tail an tumour < 3 cm Head ==U/S
36
Clinical Feucher of alcholic hepatitis?
``` Jaundice,anorexia and fever RUQ and epigastric pain Abdominal distension due to ascitis H.Encephalophaty Proximal muscle wastuing\ ```
37
Labratory?
``` AST and ALT usualy <300 and always <500 AST/ALT ratio >=2 Elevated INR/GGT,INR and biliribin Lukocytosis predominantly nethrphil Decrease albumin if malnuritiod Abdominal immaging may show fatty liver acute phase reacctant increment ```
38
SIBO managment?
oral rifaximin or neomycine
39
When we need endotrachial intubation in patient with UGIB?
If patient mental status is not normal
40
When to start cancer screening?
USPSTF:at age of 50 ACS:at 45 Both recommend start 10 year earlier inpatient with risk(family history of colon cancer)
41
modality?
FOBT and FIT anually Colonoscopy every 10 year and flexible sigmoidoscopy every 5 year Flexible sigmoidoscopy with FIT every 10 year
42
when to start screening patient with UC?
8-10 year after initia diagnosis
43
workup for dyspepsia?
Age >60 endoscopy | Age<60:Test and treat for H.pylori and endoscopy is >=1 alarming feuture
44
what are alarming feuture?
``` progresive dysphagia IDA odynophagia family history of Gi malignancy palpable mass/LDP Persistent vomiting ```
45
Non-invasive test for chronic pancreatitis?
Fecal elastase level
46
recurrent clostridium difficile managment?
``` First recurrence vancomycin PO in prolonged /taper course fidaxomicin if Vanco used in the initial episode multiple recurrences vancomycin PO followed by rifaximine fecal transplant ```
47
Fulmitant C.Difficile infection?
hypotension/shock/toxic megacolon | manage with Iv metronidazole with vancomycine/surgical evaluation
48
Is symptom consistent with GERD approach?
``` Perform endoscopy if 1-Age >50 2-Symptom >5 year 3-Cancer risk factor 4-Alarming symptom ```
49
after endoscopy how classify?
1-cancer--biopsy 2-esophagitis 3-non-esophagitis
50
if the sign of esophagitis what consider and to do next?
treat according to diagnosis
51
what the diagnosis can be?
``` Pill induced Autoimmune skin disease Zollinger Ellison syndrome Eosinophilic esophagitis Barret's esophagus ```
52
3-non-esophagitis?
``` consider further testing for the following acalasia gastroparesis nonacid reflex disease nocturnal acid breasthrogh ```
53
If have no indication for endoscopy/
treat with PPI 1 per day for 2 months if not respond 2x/change regimen per day if not respond endoscopy and gastric PH
54
CM of severe pancreatitis?
``` Fever, hypotension, and tachycardia Dyspnea, tachypnea, and basilar crackle Abdominal tenderness and distension Cullen sign gray turner sign ```
55
Cullen sign?
periumbilical bluish discoloration indicating hemoperitoneum
56
gray turner sign?
Redish discoloration around flank area indicating retroperitoneal bleeding
57
the associated factor with severity?
``` Age >75 Obesity Alcoholism C-reactive protein >150 rising BUN and Creatinin in first 48 Hr pulmonary infiltration and effusion pancreatic necrosis and extrapancreatic tissue inflammation ```
58
S.pncrititis definition and epidemiology and definition?
15-20% | pancreatitis with one organ damage
59
what test shod do?
Abdominal CT and MRCP to see pancreatic necrosis
60
pathophysiology?
entrance of pancreatic enzymes to BV--vasodilation, increase vascular permeability
61
How to differentiate ascites due to the liver and cardiac diseases like constrictive pericarditis and RSHF?
``` in cardiac cases, there will be RSHF jugular venous distension Kussmaul sign pericardial knock pulses paradoxus ```
62
approach to elevated ALP?
First cheek GGT if normal consider bone disease If raised consider liver disease
63
If raised GGT?
Do abdominal ultrasound and AMA If both normal-L.Biopsy.ERCP and observation show dilated duct--ERCP raised AMA with liver abnormality-L.biopsy
64
Ursodeoxycholic acid?
Is hydrophilic bile acid unlike natural one Increase biliary acid secretion anti-inflammatory and immunomodulatory effect
65
Were tests done for lactose intolerance?
Positive hydrogen breath test increase stool anion gap acidic stool PH Positive reducing sugar in the stool
66
stool anion gap calculation and interpretation?
290-(stool NA + K) | If >75--Indicate osmotically diarrhea
67
lactulose benefit and target?
acidifiy colon--change amonia to non absorbable form increase bowel movt-increase clearance target is to produce 2-3 x loss stool per day
68
anorexia nervosa MC?
``` osteoporosis amenorrhea lanugo, hair loss, and dry skin gastroparesis,GERD and constipation Elevated liver function enlarged parotid gland hypotension, bradycardia, and hypothermia cardiac atrophy and arrhythmia ```
69
how to D/T with hypothyroidism?
hypothyroidism Weight gain Diastolic HTN
70
feucher of secretory dihareoa?
low stool osmotic GAP,50 | Occur during fasting/night/
71
feucher of osmotic diharoa?
high SOG >125 | occur after feeding
72
factitious diarrhea cause and future?
Mainly due to laxative abuse Common in female and HCW Hyperactive bowel sound
73
colonic cancer screening indication inpatient with increase risk?
depends on the risk type indication
74
Family history of adenomatous polyp or CRC
1 first degree relative with age <60 | >=2 first degree relative at any age
75
when to do?
first screening at 40 or age <10 from the diagnosis of affected family then every 5 year
76
IBD?
UC | CD with colonic involvement
77
when to do?
8-10 year from first diagnosis and 12-15 year if only left colon affected repeat every 1-3 year
78
classic FAP?
age 10-12 | repeat annually
79
HNPCC?
age 20-25 | repeat every 1-2 year
80
drug-induced hepatitis liver histology?
``` Idiosyncratic(isoniazid)--hepatic necrosis(Like AVH) cholestasis-anabolic steroid fatty liver--Valproate toxic/fulminant--Acetaminophen granoulomatous --allopirinol ```
81
CM?
``` Hepatitis future Leukocytosis Eosinophilia Rash Arthralgia Fever idiosyncratic--short latency direct toxic drug--variable latency ```
82
pseudo achalasia future?
Is due to gastric ca Bird break appearance like achalasia in barium swallow Do endoscopy to d/t with thru achalasia
83
TNF indication in UC?
used in refractory cases.
84
cause of splenic infarction?
embolism hypercoagulable state hemoglobinopathy congestive/hypertrophic splleen

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