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GIT steep 2 > GIT1 > Flashcards

GIT1 Flashcards

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1
Q

angiodysplesia CM?

A

episodic painless lower GI bleeding
Commonage >60
IDA

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2
Q

Associated disease?

A

AS
ESRD
VWD

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3
Q

Diagnosis?

A

Endoscopy

Frequently missed B/C inadequate bowel preparation and valves

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4
Q

Management?

A

Conservative if they are asymptomatic

Band ligation if symptomatic(anemia/GI bleeding)

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5
Q

pathophysiology?

A

Dilation of submucosal veins and AV malformation

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6
Q

clinical future of carcinoid?

A 
SKIN
GI
Cardiac
Pulmonary
Miscellaneous
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7
Q

SKIN?

A

Flushing
Telangiectasia
Cyanosis

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8
Q

GI?

A

Diarrhea

cramping

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9
Q

cardiac?

A

valvular(more at right)

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10
Q

pulmonary?

A

Bronchospasm

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11
Q

Miscellaneous?

A

Niacin deficiency (diharoa, dermatitis, and dementia)

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12
Q

diagnosis?

A

Elevated 24 Hr 5-HIAA
CT/MRI–detect metastasis
Osteoscan to detect metastasis
Echocardiogram

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13
Q

treatment?

A

Octreotide before surgery and anesthesia

Liver surgery for metastasis

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14
Q

common location?

A

Distal small bowl
Proximal colon
Lung

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15
Q

spontaneous bacterial peritonitis risk?

A

Temperature >37.8
altered mental status
Abdominal discomfort/tenderness
Hypotension/Hypothermia in severe infection

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16
Q

Diagnosis?

A

PMN>250g/dL
A positive culture(G-ve) for peritoneal fluid
Protein <1g/dl
SAAG>=1.1g/dl

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17
Q

Treatment?

A

3rd generation cephalosporin for Tx

Floroquinilol for prophlaxix

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18
Q

Future of Dubin Jhonson S and Rotor syndrome?

A

chronic relapsing and remitting jaundice
Bilirubin in urine(B/C of unecreted CB)
Normal AST/ALT and ALP
IN DJS-Dark liver due to lysosomal storage

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19
Q

trigger?

A

Acute illness
Pregnancy
OCP

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20
Q

pathophysiology?

A

Defect in CB excresion

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21
Q

ACute erosive gastropathy?

A

Severe hemorrhagic lesion after exposure to substance that damage gastric mucosa.

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22
Q

factors?

A

NSAID-Decrease PG secretion
Cocaine-vasoconstriction
Alcohol-direct injury to the mucosa

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23
Q

pathogenesis?

A

Mucosal injury–Acid/Bile acid/Protease enter to lamina propira–vascular injury

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24
Q

CM?

A

Hematemisis

Abdominal pain

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25
Aorticoenteric fistula?
Life-threatening GI hemorrhage
26
RISK factor?
Older age Previous aneurysm Prior GI surgery Malignancy
27
esophageal varicess?
Occurs in 30-60% of patients The major cause of morbidity and mortality in cirrhosis Screening endoscopy is recomended in all Pt with cirhosis
28
when to check ammonia level in cirrhosis?
symptom of hepatic encephalopathy | also, asses risk factor when HE present
29
Management(survilance)?
Liver U/S and alpha-fetoprotein every 6 month | EGD scopy
30
primary prophylaxis for VB indication?
small with bleeding risk | medium and large varices
31
what to do?
Endoscopic variceal ligation | Non-selective beta blocker
32
EVL Indication?
patient preference | large varices
33
NSBB drug and mechanism?
Propranolol/nadolol beta blockage--inhibit adrenergic vasodilation in mesenteric arterioles and unopposed alpha effect--vasoconstriction-decrease blood flow
34
ascitic fluid protein level how determine the cause?
protein > =or <2.5 mg/dl
35
protein > =2.5 mg/dl?
``` Constrictive pericarditis CHF Budd Chiari peritoneal carcinomatosis TB Fungal infection ```
36
protein <2.5 mg/dl?
Cirrhosis | Nephrotic syndrome
37
How SAAG?
>=/< 1.1 mg/dl
38
>=1.1 mg/dl(portal HTN)?
cardiac cirrhosis BCS
39
< 1.1 mg/dl(Non portal HTN)?
TB Pancreatic ascitis Nephrotic S peritoneal carcinomatosis
40
D-Xylulose test?
Give xylulose and assess urinary excretion | Help to D/T from enzyme deficiency and intestinal wall disease?
41
enzyme deficiency?
Normal
42
intestinal wall disease(e.g celiac disease)?
decrease
43
what can give a false positive D-Xylulose test?
Delayed gastric emptying Abnormal GFR Small intestine bacterial overgrowth(metabolize xylulose0
44
how to r/o this?
asses GFR | repeat test after 4-week rifaximin tx
45
Lynch syndrome pathogenesis?
``` mismatch repair gene defect autosomal dominant microsatellite instablity serrated polyp pathway usually, right-side colon affected ```
46
associated cancer risk in LS?
colon endometrial ovarian
47
things to do after LS made?
colonoscopy at time of diagnosis endometrial biopsy start at age 30-35 anualy bilateral salphingnoopherectomy at 40 or earlier if reproduction completed
48
pheripherial neuropathy and antiacid?
loss of position and vibration Gastric acid-detach animal protein-bound to B12 and maker protein secreted by salivary gland attach to B-12-aids absorption
49
HIV neuropathy?
pain predominate | all sensory modality affected
50
Multiple myeloma neuropathy?
another finding will be there pain predominate all sensory and motor will be affected
51
cryoglobulinemia neuropathy?
Hep C positive rash/purpura arthralgia
52
gastric MALT lymphoma?
B-cell clonal proliferation Associated with H.PYlori common in the gastric body ALL patients should be tested for H.Pylori
53
management?
low grade with positive H.Pylori-eradication therapy | High grade/negative H.Pylori test-radiotherapy/imunotherapy/
54
Test to be done in suspicion of acute HBV infn?
HBS Ag and anti core Mab -
55
Which appear first?
HBsAg
56
When HBC AB positive and why should be done?
When symptom starts | B/C patient may be in window period and HBsAg negative
57
use of testing HBV DNA?
For chronic infection To assess a candidate for antiviral Tx To follow up after Tx
58
chronic giardiasis CM?
malabsorption weight loss Persistent GI distress
59
management?
metronidazole for symptomatoc patient
60
diagnosis?
Stool AG Microscopy NAAT
61
Why ALT is more specific than AST?
AST present in skeletal muscle. heart and kidney
62
primary sclerosis cholangitis CM?
Asymptomatic fatigue and pruritis associated with IBD(mainly UC)
63
laboratory?
increase ALP and bilirubin | normal/mildly elevated TA
64
diagnosis?
MRI(cholangiopancreatography) endoscopic retrograde cholangiopancreatography-If have C/I to MRI Liver biopsy-uncertain diagnosis-only 25% positive for biopsy
65
complication?
biliary stricture cholangitis cholangiocarcinoma,colonic and biliary ca cholestasis(fat malabsorption)
66
future in MRI and BIOPSY?
Fibrosis both intra and extrahepatic bile duct | Narrowing and dilation in BD-Beads in string
67
CM of pancreatitis?
abdominal pain worsens with meal nausea vomiting ascitis
68
asccitis future in pancratitis?
``` high total protein high amylase(>1000) High total protein(>2.5 mg/dl) Low SAAG serosanguinous color ```
69
approach to dysphgia?
differ whether oropharyngeal or esophageal
70
oropharyngeal future?
Difficulty in initiating swallowing chocking, cough, and nasal congestion during swallowing food stuck in throat recurent aspiration pnumonia
71
Risk factor?
dementia stroke oropharyngeal ca motor dysfunction(MG)
72
the first test in this case?
videofluoroscopic modified barium swallow
73
if esophageal?
No difficulty in initiating swallowing No chocking, cough, and nasal congestion during swallowing food stuck in the esophagus dysphagia occurs after few seconds of swallowing
74
test to do in this case?
If both solid and liquid dysphagia occur simultaneously-barium swallow followed by manometry--esophageal motility disorder progressive dysphagia--if have a risk for ca(Upper endoscopy) but if not barium swallow followed by endoscopy--suspect mechanical one
75
risk for Ca?
radiation complex stricture caustic injury the previous laryngeal ca/esophageal ca
76
Roux-en-Y procedure?
Do gastric poch---anastosis with jujnum and make other jujuno jujunostomy used for wt loss
77
Complication?
Anastomosis site stenosis(at GJ site)
78
CM?
progressive dyspagia
79
diagnosis?
esophagogastrododinoscopy
80
diverticular disease etiology?
Diverticulitis Diverticular bleeding Diverticulosis
81
Diverticulosis?
Increase intraluminal pressure causing herniation of bowl through weakness(vasa recta penetration) no symptom
82
Diverticular bleeding?
Injury to exposed vasa recta | Hematocasia
83
Diverticulitis?
traped food particles and increase intraluminal pressure and result in perforation. LLQ pain, tenderness, fever, and vomiting
84
Risk factor DD?
high fat, red meat, and low fiber | obesity, physical inactivity, and smoking

GIT steep 2 (4 decks)

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