GIT important

🟩🟩🟩🟩🟩🟩🟩 ALL GIT 🟩🟩🟩🟩🟩🟩🟩🟩

🔷🔷সব পূণ Investigation লা একসা থ 🔷🔷
💥💥💥 ত িরিভশন িদ য় িদ বন 💥💥💥
#GIT

1.First step management of upper GIT bleeding?? Ans: IV acsses

2.late features of diseminated malignancy?? Ans : weight loss

3.Malabsorption +weight loss

investigation choice>> faecal elastase

4.Investigation of persistent constipation??

Ans: barium enema/CT colonography

5.Which is the most common causes of recurrent oral ulcer and its conformatory test??
Ans: Bechet's oesophagus, Pathergy test
★ Recurrent oral ulcer +recurrent meningitis +migratory thrombophlebitis>> bechet
oesophagus.

7.Most common metabolic causes of dyspepsia?? Ans: hypercalcemia

8.Rx of oeshophageal stricture??

Ans: Endoscopic ballon dilation

9.Most important oesophageal irritant??

Ans: Gastric acid

10.50y pt presented e sudden onset of chet pain vomiting e dysphagia.Ecg revals normal
x-ray showing air bubble on the chest.Dx: gastric volvulus

11.Inv. choice of GERD>>> Endoscopy

12. Gold standar investigation of GERD??

Ans: 24 hours PH monitoring

13.Inv. choice of oesophageal stricture??

Ans: Endoscopy

14.Rare complication of IDA??

Ans: post- cricoid wab

15.Most common causes of oeshophagitis in children?? Ans: Eosinophillic

16.Antibody reduced in coeliac disease⇨IgA & blind loop stndrome⇨ IgA & IgM

17. 60 yrs old pt presented e haematemesis nd melena after proper resuscitation,ot

undergone to endoscopy,endoscopy showing large ulcer on the lesser curvature of
stomach.which artery is liable to bleeding?? Ans: left gastric ulcer.

18.which carcinoma arises from cardia of stomach: Adenocarcinoma

19.highly specific and sensitivity test of h.pylori infection: 13Urea breath test

20.most common carcinoma of oeshophagus: Adenocarcinoma

21.painless progressive dysphagia to solid e chest pain : ca oesophagus

22.most common site of acute clonic ischaemia: watershed area of colon

23. #physiology
Propulsive movement of Large intestine also called -?
Ans: Mass movement.

24.Pacemaker of gut?
Ans: Interstitial cells of cajal

25.What is the most useful in the diagnosis of suspected perforation?

Ans: chest X-ray (erect posture)
But practically & commonly used..
*Plain Xray abdomen A/P in erect posture including both dome of diaphragm.

26."Thumb-printing " sign on the plain abdominal X-ray found in -

Acute small bowel ischemia &
ulcerative colitis

27. Between 20-60% of patients with Zollinger-Ellison syndrome have which type of MEN?
Ans: MEN-1

28.Which method is 'Gold standard' for the dx of H.pylori infection?

Ans: microbiological culture

30.Somatostatin is used to treat which of the following condition?

Ans: Gastrinoma
31.
✪✪✪✪✪✪
*Most common cause of upper GIT bleeding- Peptic ulcer disease(35-50)%

*most common cause of lower GIT bleeding- Diverticular disease

*most common cause of chronic/ relapsing diarrhoea - Irritable bowel syndrome(IBS)

* cardinal feature of malabsorption- steatorrhoea

*most common benign tumor of oesophagus- Leiomyoma

*most common congenital anomaly of GIT- meckel's diverticulum

*most commonly affected site of abdominal TB- ileocaecal region

*autosomal recessive disease in GIT- abetalipoproteinaemia

*most common extra intestinal menifestation of FAP- congenital hypertrophy of retinal

pigment epithelium(70-80)%

* artery responsible for acute small bowel ischaemia- superior mesenteric artery(40-50)%

*most common site of acute colonic ischaemia- splenic flexure

*most common cause of chronic occult gastrointestinal bleeding- colorectal cancer

especially Carcinoma caecum

* 90% pancreatic neoplasm are adenocarcinoma that arise from the pancreatic ducts.
60% tumor arise from the head of pancrease.

32.# pacemaker of the Respiration:

pre botzinger complex( VGR).
#Pacemaker of the gut:
Interstitial cells of cajal.
# pacemaker of heart : SA node

33.pt present e rt upper quardant pain e pyrexa e heapatic rub

dx: Fitz-Hugh-curtis syndrome

34.Gastric cancer may be inherited by mutation of which gene??

Ans: E-cadherin (CDH-1)
35.Alcoholic patient of of 48 years is complaining abdominal pain after 20 minutes of a
meal. He got steatorrhea for 10 years. Diagnosis?
Ans: chronic pancreatitis

36. Severe peptic ulceration + gastric acid hypersecretion + Gastrinoma.

Dx: ZES
Treatment of choice: IV PPI+ Octreotide

37.Benign osteoma + Epidermoid cyst + Dental abnormality

Dx: gardener syndrome

38.40y old pt presented e diarrhoea e episode of flushing on chest auscultation systolic

murmur was found on the tricuspid area.
dx:carcinoid syndrome
conformatory test: 5HIAA(urine)

39.Dysphagia+IDA+Oeshophageal web
dx: Plummer vinson/Paterson-kelly syndrome

40.How long it takes to pancreatic pseudocysts to form?

Ans: 6 wks

41. Kantor's string sing found: Corhn's dis.

42.What is High sensitive and high specific test for H. Pylori: 13c Urea breath test

43.Pepsinogen , a Gastric proenzymes, is activated by : HCL

44.Trypsinogen, a pancreatic proenzymes, is activated by : Enterokinase

45.Most vulnerable Artery in case of Duodenal ulcer : Gastroduodenal artery

46.Most common extra intestinal feature of IBD: large joint arthritis

47.40y pt peripheral oedema e low albumin endoscopy showing mucosal fold on the
body of the fundus.
dx: Ménétrier's disease

48.chronic perrectal bleeding +small bowel polyposis +melanin pigmentation on mouth

dx: PJS syndrome

49.A Gian-looking Pt of 56 yr. Complains of lower abdominal Colicky pain+Fresh P/R

bleeding.+Tenesmus+Feeling of incomplete evacuation. O/E: Anaemic + palpable
mass.DRE: blood e Mucus. Abx: Unremarkable. CT brain: a space occupying lesion near
Sella Tursica.
Dx: Ca. Colon wit Acromegaly & presence of pituitary macroadenoma

50. Patient having ileal resection + Watery diarrhoea + Oxalate calculi in kidney.
Useful non invasive marker for this condition? Ans:7@-hydroxycholestenone

51.Most common extra intestinal feature of IBD? Ans: large joint arthritis

52.Which is the gold standard test in assesing pancreatic function?

Ans: Collection of pancreatic juice following Secretin injection

53. UC> VT > Pulmonary embolism > CTPA (1st line Inv)

54. peripheral neuropathy can be caused by

Isoniazid,Cyclosporin, Metronidazole

55.coeliac disease +recurrent microscopic haematuria.dx?? Ans: IgA nephropathy

56.#Crohn's_Disease:-
Mnemonic: CHRISTMAS
C-Cobble stone
H-High temperature
R-Reduced Lumen
I-Intestinal fistula
S-Skip lession
T-Transmural ulcer(All layer)
M-Malabsorption
A-Abdominal pain,any age,Ashkenazi jews
S-Submucosal fibrosis,smoker

57.Esophageal variceal bleeding :-

Acute bleeding - Terlipressin
Most specific Rx - Banding
Prevention - Propanolol

58. ✪pancreatitis✪
Acute:
*S. Lipase is mo

* S. Amylase returned to normal within 24-48 hrs from the onset of acute pancreatitis, if
persistently raised after then that suggests pancreatic pseudocyst

* USG will confirm the diagnosis

Chronic:
* Secretin stimulation test is gold standard
* CT scan confirmatory

Pancreatic exocrine function test:

1. Faecal elastase - simple & quick
2. Pancreolauryl test

59.✪✪✪
Dysphagia:-
★Solid > Liquid = Carcinoma
★Liquid > solid + choking during meals = Neurogenic dysphagia
★ Liquid > solid + proximal muscle weakness + ptosis = Myasthenia Gravis
★ Solid & Liquid + chest pain + Aspiration pneumonia = Achalasia
★ Solid & Liquid + proximal muscle weakness + facial rash + ANA positive =
Dermatomyositis / Polymyositis
★ Solid & Liquid + halitosis + regurgitation + nocturnal cough = Pharyngeal pouch
★Solid & Liquid + dysarthria +diabetes+distal muscle weakness = Myotonic Dystrophy

✪ Fecal calprotectin Secret from?

➤ Neutrophil

✪Which minerel decrease risk of colorectal Cancer? > Calcium

✪ Drug causing oral ulcer :

NSAIDs, ACEi,ARB(losartan), Nicorandil
DMADR(methotrexate),

✪ Which one is pure stimulatory hormone?

Ans: gastrin
& pure inhibitory > somatostatin

✪ Hyperkeratosis of palm & sole.which carcinoma may be developed in this patient? Ans:
Ca of oesophagus( SCC)
also Arsenis poisoning( palmoplanter keratosis)

✪Which one is inhibited by eating?

➤Ghrelin

✪ Fecal calprotectin increase in IBS or IBD?

Ans: IBD

✪ Most common cause of GERD?

Ans: abnormal lower oesophageal sphincter tone
& Major symptoms of GERD > heartburn

✪ Which Hormones secreted in fasting condition? > Ghrelin & Motilin

✪VIP is secreted from? > nerve fibre of GIT

✪ Which hormone modulate satiety?

➤CCK, Peptide yy
& enhance satiety >>> GIP,GLP

#git

♦♦ Question ::
1.first step management of upper git bleeding??
2.late features of diseminated malignancy??
3.malabsorption +weight loss
investigation choice:
4.investigation of persistent constipation??
5.which is the most common causes of recurrent oral ulcer and its conformatory test??
6.recurrent oral ulcer +recurrent meningitis +migratory thrombophlebitis
dx
7.most common metabolic causes of dyspepsia??
8.rx of oeshophageal stricture??
9.most important oesophageal irritant??
10.50y pt presented e sudden onset of chet pain vomiting e dysphagia
Ecg revals normal x-ray showing air bubble on the chest
dx:
11.investigation choice of gerd??
12.gold standar investigation of gerd??
13.investigation choice of oesophageal stricture??
14.Rare complication of IDA??
15.most common causes of oeshophagitis in children??
16.which antibody reduced in coeliac disease nd blond loop stndrome??
17.60y old pt presented e haematemesis nd melena after proper resuscitation,ot
undergone to endoscopy,endoscopy showing large ulcer on the lesser curvature of
stomach
which artery is liable to bleeding??

♦♦Answer ::
1.iv access
2.wt loss
3.facal elastase
4.barrium enema or ct colonography
5.bechet oeshophagus pathergy test
6.bechet oeshophagus
7.hypercalcaemia 8.endoscopic ballon dilation
9.gastric acid
10.gastric vulvulas
11.endoscopy
12.24h ph
13.endoscopy
14.post cricoid web
15.eiosinophilic
16.igAnd iga,igm
17.left gastric artery

#Git
Scenario -
Crohn's disease -
Oral ulcer ( any part of git)+ Diarrhoea + abdominal pain + wt loss +H/O cigarette
smoking

Ulcerative colitis - Bloody diarrhoea + Abdominal pain + wt loss.

1) Appendicectomy সা থ স কযু কান ??

2) Female দর বিশ হয় কান ??

3) Granuloma কান র Histology ত পা বন?

4) loss of Goblet cell কান ত পা বন?

5) Typical finding of ulcerative colitis ?

6) Ulcerative colitis ত কান টম বাংলা দ শর ডা ার কতৃ ক তির যা crhon's

disease এ নাই??

Unrecognised coeliac disease is associated with mild (under) nutrition and

osteoporosis.
Davidson page :806

SBA

The Most common type of inherited colorectal Cancer???

Heriditary Non-polyposis colorectal carcinoma

Gastrin secretion mainly antrum teke

#git
50Y old patient sudden onset chest pain, vomiting dysphagia but Ecg normal & chest
X-ray show air bubble on chest
Dx???

Gastric volvulus

1) Accumulation of Lipofuscin pigment. Dx- melanosis coli

2) Endoscopy : Narrow Calibre Oesophagus. Dx- esinophilic oesophagitis

3) Endoscopy : Enlarged,Nodule & Coarse Fold. Dx- Menetrier's Disease

4) Whipple’s disease:
5) ~Small bowel ( jejunal biopsy) shows deposition of macrophages containing
periodic acid schiff ( PAS) granules
6) ~presence of T whippelei DNA in tissue PCR

Confirmatory inv for

1. Acute Pancreatitis. Usg and s lipase
2. Chronic Pancreatitis. Ct

#GIT

***Whipple's disease :

💥Infiltration of small intestinal mucosa by Foamy macrophage.

💥Periodic acid-schiff reagent Positive----
1)Whipple's disease
2)Alpha-1 antitrypsin deficiency
3)ALL

💥Gram-positive bacillus organism(Tropheryma whipplei)

💥C/F
⬆Middle aged men are most frequently affected
⬆Most common symptom is Weight loss ★★★
⬆Low grade fever and diarrhoea
⬆ large-joint arthralgia
⬆CNS involvement
⬆Hyperpigmentation and photosensitivity

💥Inv:
1)Confirmatory test : Duodenal / Jejunal biopsy.
Finding : deposition of macrophage containing PAS.

2)CT scan of abdomen : Found in mesenteric lymphadenopathy.

💥Treatment:
1st line treatment : I/V Ceftriaxone for 2weeks followed by oral Co-trimoxazole for at
least 1 year.

#GIT

SBA Practice

1. Investigation of choice for H. Pylori Detection?

Ans:Urea breath test

2. Gold standard test for H. Pylori infection?

Ans:Microbiological culture

3. Gold standard Test for GERD?

Ans:24 hours pH monitoring

4. First line investigation in Small bowel bacterial overgrowth?

Ans:Hydrogen breath test

5. Gold standard test in coeliac disease?

Ans:Endoscopic small bowel biopsy

6. Gold standard test in food allergry?

Ans:Double blind placebo controlled food challenges

7. Investigation of choice in case of Bile acid diarrhoea?

Ans:SeHCAT

8. Best screening Test of Z- E syndrome?

Ans:Serum gastrin level

9. Confirmatory Test in Z-E syndrome?

Ans:Secretin stimulation test

10. Investigation of choice in Colon cancer?

Ans:Colonoscopy

11. Confirmatory test for evaluation of pancreatic exocrine function?

Ans:Secretin stimulation test

12. most common site of UC?

Ans:Rectum

13. most common site of crohn's disease?

Ans:Terminal Ileum

14. Diarrhoea + on biopsy : Lipid laden macrophage found.

Dx:Laxative abuse

15. Diarrhoea + on biopsy :

foamy macrophage.

Dx:Whipple's disease

16. Gold standard test for achalasia cardia?

Ans:Oesophageal manometry

#GIT

***Bile acid diarrhoea :

♦Cause of chronic diarrhoea
♦It can lead to steatorrhea
♦Malabsorption of Vit-A,D,E,K
♦The most common scenario is in patients with crohn's disease.
♦Other secondary causes include :
1)Cholecystectomy
2)Coeliac disease
3)Small bowel bacterial overgrowth

♦Inv:
1)Inv.of choice : SeHCAT test

2)Serum 7-alpha hydroxycholestenone:

⬆Elevated
⬆Non-invasive marker.

♦Treatment:
Bile acid sequestrants: Cholestyramine/ Colesevelam.

#GIT
Peutz-Jeghers syndrome :

💥Autosomal dominant disorder

💥Responsible gene encodes serine-threonine kinase (LKB1 or STK11)
💥Most cases are asymptomatic.
⬆Chronic bleeding
⬆Anaemia or intussuception can occur.

💥Diagnosis : Two of the three following features --

⬆Small bowel polyposis
⬆Mucocutaneous pigmentation
⬆Positive family history
💥Screening by--- Colonoscopy
💥Confirmed by--genetic testing
#GIT
Ulcerative colitis :

♦Any age group

♦Male female equally affected
♦More common in non smoker
♦Most commonly involved in rectum
♦Bloody diarrhoea
♦ Histology: Inflammation limited to mucosa, crypt distortion,cryptitis,crypt abscess,
loss of goblet cells.
♦Found in pseudo-polyp
♦Chance of malignant transformation
♦pANCA positive
♦Typical features is crypt abscess
♦Cardinal symptom : Rectal bleeding.
♦Life-threatening complication : Toxic megacolon
♦Inv.of choice : Colonoscopy
#GIT
Crohn's disease :

💥Any age group

💥Slight female predominance
💥Genetics factor:defective innate immunity and autophagy
💥More common in smokers
💥Most commonly involved in terminal ileum, rectum spare.
💥Skip lesion
💥Watery diarrhoea
💥Histology:
1)Submucosal or transmural inflammation common 2deep fissuring ulcer,fistulae,patchy
changes 3)non-cesating granuloma

💥Cobblestone appearance
💥ASCA positive
💥Barrium follow-through showing:characteristics rose thorn ulcers.
💥Inv.of choice :Colonoscopy
#GIT
Ischaemic colitis /acute colonic ischemia :

♦Elderly patients
♦The splenic flexure is most commonly affected site
♦Most commonly affects watershed areas
♦ Presents with sudden onset of cramping, left-sided,lower abdominal pain and rectal
bleeding.

♦Arterial thromboembolism is usually responsible. But colonic ischemia can also follow
---
⬆Severe hypotension
⬆Colonic volvulus
⬆Strangulated hernia
⬆Systemic vasculitis
⬆Hypercoagulable states.

♦ Ischaemia of the descending and sigmoid colon is also a complication of abdominal

aortic aneurysm surgery.

♦X-ray of abdomen showing thumb printing.

♦Inv.of choice : Colonoscopy.
#GIT
Irritable bowel syndrome :

♦Young women are affected 2-3 times more often then men.
♦Coexisting conditions associated:
⬆Non-ulcer dyspepsia
⬆Chronic fatigue syndrome
⬆Dysmenorrhea
⬆Fibromyalgia

♦Most Common presentation : recurrent abdominal discomfort

♦Most patients alternate between episodes of diarrhoea and constipation.
♦Inv:Clinical with rome criteria
♦Alarm features :
FAN and WAR
F-Family history of colon cancer
A-Age>50yrs, male gender
N-Nocturnal symptoms
W-Weight loss
A-Anaemia
R-Rectal bleeding

♦Features supporting a diagnosis of IBS:

⬆presence of symptoms for more than 6months
⬆Frequent consultations for non-GIT problems
⬆previous medically unexplained symptoms
⬆Worsening of symptoms by stress.

♦Colonoscopy: in older patients >40 years to exclude colorectal cancer.

♦Treatment: reassurance
⬆diarrhoea predominant :

Low-FODMAP or gluten free diet-->symptoms persist--> anti- diarrheal

drugs(loperamide)--> symptoms persist-->TCA(Amitriptyline)

⬆Constipation predominant :

High-roughage diet--> symptoms persist-->Ispaghula/lactulose->

Symptoms persist-->prucalopride/linaclotide-->symptoms persist-->SSRI(Duloxetine)

⬆Pain and bloating :

Low-FODMAP/gluten free diet-->

Symptoms persist-->spasmodic drugs(Mebeverine)

#GIT
Acute small bowel ischemia :

💥Superior mesenteric artery is responsible for 40-50% cases

💥patients usually have evidence of cardiac disease and arrhythmia
💥Abdominal pain,sudden onset,distended abdomen.
💥Diminished bowel sounds
💥Inv.finding :
⬆Leucocytosis
⬆Metabolic acidosis
⬆Hyperphosphataemia
⬆Hyperamylasaemia

💥Plain X-ray showing :

Thumb printing.

💥Inv.of choice : mesenteric or CT-angiography.

#GIT
Chronic mesenteric ischemia :

♦ Typical presentation :Severe mid or upper abdominal pain which is dull aching in
nature.

♦Pain developing about 30 minutes after eating.

♦Weight loss is common because patients are reluctant to eat.
♦Inv.of choice : mesenteric or CT angiography
♦Treatment: vascular reconstruction or percutaneous angioplasty.
All 'Gold standard's mentioned in the Gastroenterology chapter of the Davidson 24th
edition.

-Gold standard investigation for diagnosis of gastro-oesophageal reflux disease:

Endoscopy
-Gold standard investigation for diagnosis of H. Pylori infection: Microbiological culture
-Gold standard management of gastric cancer: Surgery (resection)
-Gold standard investigation for diagnosis of coeliac disease: Endoscopic small bowel
biopsy
-Gold standard investigation to assess the patient's adherence to a gluten-free diet in
case of coeliac disease: Endoscopy with duodenal biopsies
-Gold standard investigation for diagnosis of small intestinal bacterial overgrowth:
Culture of small bowel aspirate, obtained at endoscopy
-Gold standard method for screening/ secondary prevention of colorectal cancer:
Colonoscopy
-Gold standard investigation for diagnosis of acute small bowel ischaemia: CT with
contrast
-Gold standard investigation to define pancreatic function in chronic pancreatitis:
Collection of pure pancreatic juice after secretin injection
#gold_standard

#gold_standard_gastroenterology
#D24

1.peyer's patches most numerous--?

Ans-ileum

2.parietal cell receptors--?

Ans-Ach-R,H2,CCK2R

3.most common cause of chronic mesenteric ischemia?

Ans-Atherosclerotic stenisis of( coeliac axis,sup,inf mesenteric artery)

4.fructose is absorbed by--'?

Ans-Simple diffusion

5.first phase of swalloing is--involuntary/voluntary ,which muscle involved?

Ans-Voluntary,tongue

6.heart of adaptive immunity in git?

Ans-GIT mucosa(contain 25% of total lymphatic tissue of body)

7.upper gi endoscopy relative contraindications?

Ans-1.severe respiratory disease
2.atlantoaxial subluxation

8.crypt abscess is a feature of--?

Ans- UC

9.most important risk factor for gastric ca?Ans-H.pylori

10. definite modality in dx of hiatus hernia?Ans-barium meal

11.
12. #Git
13. GIT pearls 🏵
14. Bloody diarrhoea+ positive pANCA>>> UC
15.
16. Diarrhoea+ perianal fistula or skip lesions >>> Crohn's disease .
17.
18. Bloody diarrhoea + elderly with left iliac fossa pain and tenderness >>> diverticulitis .
19.
20. Bleeding per rectum+ aortic stenosis >>> angiodysplasia ( commonly affect right
colon).
21.
22. Bleeding per rectum + AF + metabolic acidosis >>> Ischemic colitis .
23.
24. Bleeding per rectum + loss of weight + history of acromegaly >>> cancer colon .
25.
26. Bleeding per rectum + perioral pigmentation>> peutz Jepgh syndrome
27.
28. Bleeding per rectum+ skull or bone osteoma , skin fibroma + family history>>>
Gardner syndrome
29.
30. Malabsorption symptoms + macrocytosis in young patient >>> coeliac disease
31.
32. Malabsorption symptoms + improve with control of diary intake + negative
endomyseal Abs>>> Lactose intolerance .
33.
34. Malabsorption + joint pain + Bradycardia in middle age>>> Whipple's disease
( positive PAS biopsy).
35.
36. Malabsorption + macrocytosis + negative endomyseal Abs and normal IgA>>> think
in tropical sprue .
37.
38. Malabsorption + recurrent epigastric pain to back + positive fecal elastase >>>
chronic pancreatitis .
39.
40. Malabsorption + symptoms of bronchiectasis >>> cystic fibrosis
41.
42. ( collected)
1.conformatory test of protein losing entheropathy??
2.conformatory test of food alergy??

3. conformatory test of abdominal tb??

1.faecal clearance of alpha 1 anti-trypsin or 51Cr labelled albumin after injection
2.double blind placebo controlled food challenge
3.Histopathology

#git

🟩 Drug causing oral ulcer : MAN-PC

mtx
acei + losartan
nsaids
nicorandil
penicillamine
cytotoxic drugs

*Budd-Chiari syndrome is most likely due to a thrombophilia

*Wilson's disease - serum caeruloplasmin is decreased
*24hr oesophageal pH monitoring is gold standard investigation in GORD
*H. pylori eradication:
PPI + amoxicillin + clarithromycin, or
PPI + metronidazole + clarithromycin
*A combination of liver and neurological disease points towards Wilson's disease
*A non-cardioselective B-blocker (NSBB) is used for the prophylaxis of oesophageal
bleeding
*A recurrent episode of C. difficile within 12 weeks of symptom resolution should be
treated with oral fidaxomicin
*A severe flare of ulcerative colitis should be treated in hospital with IV corticosteroids
*Acute pancreatitis is the most common complication of ERCP
*Acute respiratory distress syndrome is a recognised complication of acute pancreatitis
*Amylase: breaks starch down to sugars
*An isolated rise in bilirubin in response to physiological stress is typical of Gilbert's
syndrome
*Angiodysplasia is associated with aortic stenosis
*Antibiotic prophylaxis reduces mortality in cirrhotic patients with gastrointestinal
bleeding
*Bezlotoxumab is a monoclonal antibody which targets C. difficile toxin B
*Brush border enzymes:
maltase: glucose + glucose
sucrase: glucose + fructose
lactase: glucose + galactose
*Budd – Chiari syndrome - ultrasound with Doppler flow studies is very sensitive and
should be the initial radiological investigation
*Carcinoid syndrome can affect the right side of the heart. The valvular effects are
tricuspid insufficiency and pulmonary stenosis
*Causes of villous atrophy (other than coeliacs): tropical sprue, Whipple's, lymphoma,
hypogammaglobulinaemia
*CCK - I cells in upper small intestine
*Cessation of smoking may trigger an ulcerative colitis flare
*Charcot's cholangitis triad: fever, jaundice and right upper quadrant pain
*Chronic anal fissure - topical glyceryl trinitrate
*Clindamycin treatment is associated with a high risk of C. difficile
*Co-amoxiclav is a well recognised cause of cholestasis
*Co-danthramer is genotoxic and should only be prescribed to palliative patients due to
its carcinogenic potential
*Coeliac disease - tissue transglutaminase antibodies are the first-line test
*Coeliac disease has a strong association with HLA-DQ2 (present in 95% of patients)
*Colorectal cancer screening - PPV of FOB = 5 - 15%
*Constipation can be a trigger for liver decompensation in cirrhotic patients
*Corticosteroids are used in the management of severe alcoholic hepatitis
*Courvoisier's sign - a palpable gallbladder in the presence of painless jaundice is unlikely
to be gallstones
*CT pancreas is the preferred diagnostic test for chronic pancreatitis - looking for
pancreatic calcification
*Diarrhoea + hypokalaemia → villous adenoma
*Diarrhoea - biospy shows pigment laden macrophages = laxative abuse
*Diarrhoea, weight, arthralgia, lymphadenopathy, ophthalmoplegia ?Whipple's disease
*Dietary modification and topical steroids are used in the management of eosinophilic
oesophagitis
*Dysphagia affecting both solids and liquids from the start - think achalasia
*Dysphagia, aspiration pneumonia, halitosis → ?pharyngeal pouch
*Eosinophilic esophagitis typically presents in young men with symptoms of dysphagia
and in patients with a history of food allergy, eczema and asthma
*ERCP/MRCP are the investigations of choice in primary sclerosing cholangitis
*Faecal elastase is a useful test of exocrine function in chronic pancreatits
*Familial adenomatous polyposis is due to a mutation in a tumour suppressor gene
called adenomatous polyposis coli gene (APC)
*FAST scans can be used to assess the presence of fluid in the abdomen and thorax
*Ferritin and transferrin saturation are used to monitor treatment in haemochromatosis
*Flucloxacillin is a well recognised cause of cholestasis
*Flushing, diarrhoea, bronchospasm, tricuspid stenosis, pellagra → carcinoid with liver
mets - diagnosis: urinary 5-HIAA
*Gastric adenocarcinoma - signet ring cells
*Gastric MALT lymphoma - eradicate H. pylori
*Gastrin - increases gastric motility
*Gastrin increases H+ secretion by gastric parietal cells
*Gastrin increases HCL production and gastrointestinal motility
*Gastrin is produced by the G cells in the antrum of the stomach
*Give 50% of normal energy intake in starved patients (> 5 days) to avoid refeeding
syndrome
*GORD is the single strongest risk factor for the development of Barrett's oesophagus
*Haemochromatosis is autosomal recessive
*Haemochromatosis is more common than cystic fibrosis
*HBsAg negative, anti-HBs positive, IgG anti-HBc negative - previous immunisation
*HBsAg negative, anti-HBs positive, IgG anti-HBc positive - previous infection, not a
carrier
*Hepatocellular carcinoma
hepatitis B most common cause worldwide
hepatitis C most common cause in Europe
*Hepatorenal syndrome is primarily caused by splanchnic vasodilation
*High urea levels can indicate an upper GI bleed versus lower GI bleed
*High-resolution CT scanning is the diagnostic investigation of choice for pancreatic
cancer
*HPV infection is the strongest risk factor for anal cancer
*Hydrogen breath testing is an appropriate first line test for diagnosis of small bowel
overgrowth syndrome
*Hypophosphataemia is a characteristic biochemical sign in patients at risk of refeeding
syndrome
*If C. difficile does not respond to first-line vancomycin , oral fidaxomicin should be used
next, except in life-threatening infections
*If a first episode of C. difficile doesn't respond to either vancomycin or fidaxomicin then
oral vancomycin +/- IV metronidazole should be tried
*If a mild-moderate flare of ulcerative colitis does not respond to topical or oral
aminosalicylates then oral corticosteroids are added
*If a patient with ulcerative colitis has had a severe relapse or >=2 exacerbations in the
past year they should be given either oral azathioprine or oral mercaptopurine to maintain
remission
*Imaging is required before making a diagnosis of PBC to exclude extrahepatic biliary
obstruction
*In a mild-moderate flare of ulcerative colitis extending past the left-sided colon, oral
aminosalicylates should be added to rectal aminosalicylates, as enemas only reach so
far
*In haemochromatosis, cardiomyopathy and skin pigmentation are reversible with
treatment
*In life-threatening C. difficile infection treatment is with ORAL vancomycin and IV
metronidazole
*In patients with non-alcoholic fatty liver disease, enhanced liver fibrosis (ELF) testing is
recommended to aid diagnosis of liver fibrosis
*In suspected SBP- diagnosis is by paracentesis. Confirmed by neutrophil count >250
cells/ul
*Insoluble sources of fibre such as bran and wholemeal should be avoided in IBS
*Lactulose and rifaximin are used for the secondary prophylaxis of hepatic
encephalopathy
*Liver abscesses are generally managed with a combination of antibiotics & drainage
*Liver failure following cardiac arrest think ischaemic hepatitis
*Metabolic ketoacidosis with normal or low glucose: think alcohol
*NICE recommend avoiding lactulose in the management of IBS
*Obesity - NICE bariatric referral cut-offs
with risk factors (T2DM, BP etc): > 35 kg/m^2
no risk factors: > 40 kg/m^2
*Obesity with abnormal LFTs - ? non-alcoholic fatty liver disease
*Oesophageal adenocarcinoma is associated with GORD or Barrett's
*Oesophageal/Gastric Cancer - Endoscopic ultrasound (EUS) is better than CT or MRI in
assessing mural invasion
*Omeprazole can increase your risk of severe diarrhoea (Clostridium difficile infections)
*Ongoing diarrhoea in Crohn's patient post-resection with normal CRP →
cholestyramine
*Oral vancomycin is the first line antibiotic for use in patients with C. difficile infection
*Patients must eat gluten for at least 6 weeks before they are tested
*Patients with ascites (and protein concentration <= 15 g/L) should be given oral
ciprofloxacin or norfloxacin as prophylaxis against spontaneous bacterial peritonitis
*Patients with ascites secondary to liver cirrhosis should be given an aldosterone
antagonist
*PEG insertion is not normally recommended in advanced dementia patients
*People with coeliac disease receive the pneumococcal vaccine due to hyposplenism
*Pernicious anaemia is an autoimmune disease caused by antibodies to intrinsic factor
+/- gastric parietal cellsautoimmune destruction of gastroparietal cells
*Peutz-Jeghers syndrome - autosomal dominant
*Positive anti-HBc IgG, negative anti-HBc IgM and negative anti-HBc in the presence of
HBsAg implies chronic HBV infection
*PPIs are a cause of microscopic colitis, which can present with chronic diarrhoea,
colonoscopy and biopsy should be considered when patients present in this way and are
taking a PPI
*PPIs are a risk factor for C. difficile infection
*Primary biliary cholangitis - the M rule
IgM
anti-Mitochondrial antibodies, M2 subtype
Middle aged females
*Screening for haemochromatosis
general population: transferrin saturation > ferritin
family members: HFE genetic testing
*Secretin - S cells in upper small intestine
*Secretin increases secretion of bicarbonate-rich fluid from pancreas and hepatic duct
cells
*SeHCAT is the investigation of choice for bile acid malabsorption
*Sjogren's syndrome is common in patients with PBC
*Somatostatin is produced by D cells in the pancreas & stomach
*Speed of onset can help to differentiate the type of hepatorenal syndrome
*Spontaneous bacterial peritonitis - treatment: intravenous cefotaxime
*Spontaneous bacterial peritonitis: most common organism found on ascitic fluid culture
is E. coli
*Sulphasalazine can cause oligospermia and infertility in men
*Sulphonylureas may cause cholestasis
*Surgery is indicated in patients with ongoing acute bleeding despite repeated
endoscopic therapy
*T2DM with abnormal LFTs - ? non-alcoholic fatty liver disease
*Terlipressin - method of action = constriction of the splanchnic vessels
*The 'double duct' sign may be seen in pancreatic cancer
*The Alvarado score can be used to suggest the likelihood that a patient has acute
appendicitis
*The gold standard test for achalasia is oesophageal manometry
*The oral contraceptive pill is associated with drug-induced cholestasis
*The splenic flexure is the most likely area to be affected by ischaemic colitis
*Torsades-des-pointes secondary to hypomagnesaemia can result as a consequence of
refeeding syndrome
*TPMT activity should be assessed before offering azathioprine or mercaptopurine
therapy in Crohn's disease
*Transient elastography may be useful for diagnosing and monitoring the severity of liver
cirrhosis
*Transjugular Intrahepatic Portosystemic Shunt commonly causes an exacerbation of
hepatic encephalopathy
*Treatment for Wilson's disease is currently penicillamine
*Ulcerative colitis - depletion of goblet cells
*Ulcerative colitis - the rectum is the most common site affected
*Urea breath test - no antibiotics in past 4 weeks, no antisecretory drugs (e.g. PPI) in past
2 weeks
*Ursodeoxycholic acid is the first-line medication for primary biliary cholangitis
*USS is the first line investigation for suspected cholangitis
*Weight loss is the best first line management for NAFLD
*While amylase is an important investigation in the diagnosis of pancreatitis, it does not
offer prognostic value
*Whilst dysphagia of solids and liquids is a classic history for achalasia, certain features
such as significant weight loss are not consistent and suggest cancer - 'pseudoachalasia'
*Whilst hypercalcaemia can cause pancreatitis, hypocalcaemia is an indicator of
pancreatitis severity
*Whipple's disease: jejunal biopsy shows deposition of macrophages containing Periodic
acid-Schiff (PAS) granules
*Wilson's disease - autosomal recessive
*Wilson's disease: in the brain, most copper is deposited in the basal ganglia
*You cannot interpret TTG level in coeliac disease without looking at the IgA level
*Zollinger-Ellison syndrome: epigastric pain and diarrhoea

pass medicine

hemochromatosis venesection response kibabe monitor korben?

S. ferritin

wilson KF ring kotojon poa jai

60%
#hepatology

Joint pain+ polyuria & polydipsia + pigmentation + arrthymia + hepatomegaly

Dx??
Rx??
Hemochromatosis
Rx venesection

Gastroenterology: GERD:
Dr Ahnaf Tahmid (A-118001)
INVESTIGATION
❖ Investigation of choice >>> Endoscopy
❖ Gold standard investigation >>> 24 hours pH monitoring
Barrett’s Oesophagus:
❖ Gold standard investigation >>> Endoscopy
Oesophageal Stricture:
❖ Investigation of choice >>> Endoscopy
Gastric Volvulus:
❖ Investigation of choice >>> Chest X-ray
Ca Oesophagus:
❖ Investigation of choice >>> Upper GI endoscopy with biopsy
Perforation of oesophagus:
❖ Investigation of choice >>> Water soluble contrast swallow (But in difficult cases both
CT and careful endoscopy may required)
Pharyngeal pouch:
❖ Investigation of choice >>> Barium swallow
Achalasia cardia:
❖ Investigation of choice/1st line >>> Upper GI Endoscopy
❖ diagnostic/Initial investigation >>> Barium swallow
❖ Confirmatory/Gold standard investigation >>> Manometry
PUD:
❖ Investigation of choice >>> Upper GI endoscopy
H.Pylori infection:
❖ Rapid investigation >>> Serology
❖ Cannot differentiate current from past infection >>> Serology ❖ Good for population
studies >>> Serology

❖ Highly sensitive & specific investigation >>> 13C-urea breath test ❖ Cheap
investigations >>> Faecal antigen test & Rapid urease test ❖ Gold standard
investigation >>> Microbiological culture
Perforation of stomach/gut:
❖ Most useful investigation/ Investigation of choice >>> Chest X-ray (erect posture)
❖ Confirmatory investigation >>> Water soluble contrast swallow Zollinger-Ellison
Syndrome:
❖ Investigation of choice >>> Basal gastric pH level
❖ Single best screening test >>> Fasting gastrin levels
❖ Confirmatory investigation >>> Secretin stimulation test
Ca stomach:
❖ Investigation of choice >>> Upper GI endoscopy with biopsy
Gastric lymphoma & Carcinoid tumour: ❖ Investigation of choice >>> EUS
Coeliac disease:
❖ Gold standard investigation >>> Endoscopic small bowel biopsy
❖ Investigation of choice/1st line >>> tissue transglutaminase (TTG) antibodies ❖
Most sensitive and specific investigation >>> Anti-endomysial antibodies
Small intestinal bacterial overgrowth:
❖ Gold standard investigation >>> Culture of small bowel aspirate
❖ Non-invasive diagnostic test >>> Hydrogen breath test Whipple's disease:
❖ Diagnostic test >>> Small bowel biopsy (jejunal) Bile acid diarrhoea:
❖ Most accurate & specific investigation >>> 75SeHCAT
❖ Investigation of choice >>> 75SeHCAT
❖ Gold standard investigation >>> 75SeHCAT
❖ Useful non-invasive marker >>> Serum 7α-hydroxycholestenone
Protein-losing enteropathy:
❖ Confirmatory investigation /Investigation of choice >>> Measurement of faecal
clearance of α1-antitrypsin or 51Cr-labelled albumin.

Meckel's diverticulum:
❖ Confirmatory investigation >>> Abdomen scanning following an intravenous injection
of 99mTc-pertechnetate
Colorectal cancer:
❖ Investigation of choice >>> Colonoscopy
❖ Investigation for staging >>> CT chest,abdomen & pelvis
❖ Investigation for local staging of rectal cancer >>> Pelvic MRI or Endoanal ultrasound
❖ Investigation for monitor of recurrence >>> Serum CEA
Familial adenomatous polyposis:
❖ Investigation of choice >>> Genetic testing
Peutz-Jeghers Syndrome:
❖ Investigation of choice >>> Genetic testing
Hirschsprung's disease:
❖ Investigation of choice >>> Full-thickness biopsy
Inflammatory bowel disease:
❖ Investigation of choice >>> Colonoscopy
❖ Highly sensitive & specific investigation >>> Barium enema
❖ Investigation for monitoring >>> Serum Calprotectin or Lactoferrin ❖ Investigation
that differ IBD from IBS >>> Serum Calprotectin
❖ Useful screening test for IBD >>> Serum Calprotectin
Irritable bowel syndrome:
❖ Investigation of choice >>> Clinical diagnosis (Rome IV criteria)
Acute small bowel ischaemia:
❖ Gold standard investigation >>> Contrast CT
Acute colonic ischaemia:
❖ Investigation of choice >>> Contrast CT
Chronic mesenteric ischaemia:
❖ Investigation of choice >>> Mesenteric angiography

Acute pancreatitis:
❖ Has greater diagnostic accuracy >>> Serum lipase
❖ Confirmatory investigation >>> USG + Serum lipase Chronic pancreatitis:
❖ Investigation of choice >>> CT scan
❖ Investigation of choice prior surgery >>> MRCP
Adenocarcinoma of pancreas:
❖ Investigation of choice >>> USG/Contrast CT
❖ Confirmatory investigation >>> EUS- or CT-guided Cytology Pancreatic exocrine
function:
❖ Investigation of choice >>> Faecal elastase
❖ Gold standard investigation >>> Secretin stimulation test