 Epigastric pain and heartburn after eating in 50y.

o + mass in epigastric region,

investigation  endoscopy and biopsy

 Most common presentation of acute gastritis  epigastric pain

 Raised ALP in liver enzyme test, other test to confirm liver disorder  GGT
 30y.o + 2w of diarrhea, no blood or mucous + aphthous ulcers + lost 12kg in last 4y +
several erythematous tender nodules over shin  crohn’s disease

 Persistent vomiting  hypochloremic metabolic alkalosis

 Inheritance of Wilson disease  autosomal recessive
 34y.o, intermittent epigastric pain for 3w + worse with food, helped by some tablets he
ordered from pharmacy, he had similar episode 3y ago, dr gave him a course of 3types
of tablets, next dx  urea breath test

 Abdominal pain with diarrhea + mass per abdomen + dr ordered 5-hydrozindoleacetoc

acid in urine, cell responsible  enterochromaffin cell “carcinoid syndrome”

 AFP is an important tumor marker in  hepatocellular carcinoma “be careful cuz

ovarian is in choices, for ovarian= CA125”

 Can cause apthus ulcer  celiac disease

 Tumor marker of pancreatic cancer  ca 19
 NSAIDS & bloody vomiting  peptic disease
 Best rx for h.pylori  triple therapy (h.pylori regimen)
 Sudden severe generalized pain in patient with a. fib  mesenteric ischemia
 Mechanism of diarrhea in giardiasis  decrease fluid absorption
 Another q  reduction of absorption
 Bird beak on barium meal  achalasia cardia
 Patient on atorvastatin, what will you order  LFT “should be checked every year, when
patient has muscle aches= confirm with creatinine kinase”

 Most common site for crohn’s disease  ileocecal junction

 Brunner’s glands  duodenum
 Excessive gastrin producing tumor produces a syndrome called  Zollinger Ellison
syndrome

 Constipation + mass in lower abdomen, colonoscopy= 2 polyps with high grade

hyperplasia, when to do colonoscopy again  after 1y (they referenced Toronto but I’m
not sure)

 Rx for fungal infection in patient with end stage liver disease  capsofungin
 Barrett’s esophagus at high risk of  adenocarcinoma
 Most common to have mets to stomach in primary cancer  lung
 Bloody diarrhea, abdominal cramps, skip lesions  crohn’s disease
 What condition usually cause upper epigastric pain and fever  cholangitis
 s/e of ribavirin  anemia
 large bowel obstruction vs. small bowel obstruction  late onset vomiting
 chronic diarrhea with mucous + abdominal pain, sigmoidoscopy= inflammation of
sigmoid with rectal sparing and many fissures, dx  crohn’s disease

 53y.o + post-meal periumbilical pain, mucous and bloody diarrhea, also back pain,
aphthous ulcer, and sometimes redness of eye  crohn’s disease

 nOT have direct hyperbilirubinemia  (biliary obstruction, hepatitis, cirrhosis,

hemolytic anemia)

 specific for dx of chronic pancreatitis  fecal fat

 reduce both spontaneous and contact induced acid secretion in stomach  PPI
 49y.o complains of RUQ and yellowish coloration of urine + was diagnosed with cirrhosis
due to hemochromatosis 5y back ago, 1st line dx  abdominal US

 Most common sx of hepatitis c  loss of appetite**

 Oral ulcer for 12d + ulcer was whitish and at edge of tongue, he took miconazole but
didn’t relieve it, he’s alcoholic and smoker  oral hairy leukoplakia

 31y.o + jaundice, tremor, abdominal swelling, altered sleep pattern, hx of Wilson. He’s
disoriented and has slurred speech, abdominal veins are distended and fluid thrill is
positive, imaging and labs compatible with hepatic failure, mainstay of rx  liver
transplant

 Joint pain involving large joint of legs, frequently accompanied by diarrhea  ulcerative
colitis

 Alcoholic present with diarrhea, general weakness, 9lb weight loss + difficulty driving at
night, episodic upper abdominal pain not relieved with antacids and ppi, ca 3.5 (low),
prolonged PT & PTT  chronic pancreatitis

 Woman hx of Sjogren syndrome + has fatigue over 6m + pruritus and lost 4 pounds, afeb
and mild icteric sclera, excoriation on limbs and trunk and back, high ALP and bilirubin
 primary biliary cirrhosis

 All useful in acute but  fecal fat “in chronic”

 Most common cause of chronic pancreatitis  alcohol
 Most common cause of acute pancreatitis  gallstones
 Jewish 25y.o with post-meal diarrhea, exam= fistula, nodular lesion on tibia
 Hep a sx  anti-HAV IgM
 Highest con of potassium is found in  duodenum
 Low HDL and slightly high other lipids in 52y.o man  advise brisk walking
 Man with FAP syndrome, total colectomy was done, most suitable screening for other
family members  endoscopy
 Gastric glands with numerous large strongly acidophilic cells with numerous apical
canaliculi, type of cell  parietal cells

 Hx of peptic ulcer, pain now is more at back rather than epigastrium, organ affected 
pancreas

 Alcoholic with hepatic cirrhosis, admitted with porto-systemic encephalopathy, drug to

eliminate toxic products  lactulose

 Ass/ with crohn’s  fistula formation

 Peptic ulcer on therapy for 3m + noticed change in bowel, headaches, dizziness, skin
rash, loss of libido, gynecomastia  cimetidine

 Most common cause of acute mesenteric ischemia  embolic occlusion “in MSA”
 Enzyme will be produced in inadequate amount after total gastrectomy  pepsin
 Most common and serious complication of peptic ulcer  hemorrhage
 Difficulty swallowing SOLID food and recently fluid for 4m + wt loss + hx of GERD + heavy
smoker for 20y  esophageal cancer

 Food sticking in throat and halitosis  zenker diverticulum

 Patch over tongue, cannot be scraped, hx of smoking  leukoplakia
 14y.o + swelling on floor of mouth, non-tender and is under tongue  ranula
 Obstipation and vomiting… blab la  SBO
 20y.o severe abdominal pain for 2h, n/v, fever, ,mild tenderness in right lower quad,
wbc 18  acute appendicitis

 Nonsmoker, fx of cirrhosis, cxr- panlobular emphysema  alpha 1-antityrpsin def

 Most common cause of superior vena cava obstruction  malignancy
 Most controllable risk factor for crohn’s disease  smoking
 Coffee bean sign  sigmoid volvulus
 Cramping nausea, small cell lung cancer, hyponatremia  fluid restriction
 Drug of choice for traveler’s diarrhea  ciprofloxacin
 True about ranula  translucent swelling in floor of mouth
 Repetitive forceful vomiting and retching, blood in vomit, he binge drinks, he’s 20  
Mallory Weiss tears

 Most common cause of SBO in industrialized countries  adhesions

 Chronic epigastric pain + malabsorption + wt loss  chronic pancreatitis
 MVA. Anterior injury to pancreas, leakage of fluid will collect in  anterior pararenal
space

 New
 Ass/ with celiac disease  dermatitis herpetiformis
 Most common presentation of acute gastritis  pain
 2m hx of diarrhea no blood or mucous, oral aphthous ulcer, wt loss, very large ulcer in
leg  crohn’s disease

 Peptic ulcer, on metro and PPI, what to add  clarithromycin

 Rx for c. difficile  vancomycin
 Diarrhea w/ blood, wt loss, arthritis, anemia, skip lesions  crohn’s disease “crohn skips
school”

 Hep vaccine available  hep b & a

 Liver zone most affected by hypoxia  perivenous zone “zone III”
 MVA, ALP high, femur fracture, what would confirm this elevation is not hepatic in origin
 GGT**
 Daily use of alcohol, AST-ALT ration > 2:1  alcoholic hepatitis
 Severe diarrhea and vomiting, unable to took, bp 80/60 standing, 120/80 sitting, what
cause of fluid loss  decrease extracellular fluid “orthostatic hypotension, in case of
decrease intercellular fluid= tachycardia”

 Max NORMAL 2h postprandial glucose  8 “<140, impaired 140-200, DM >200”

 Vomiting, dry mucous, capillary refill 2s, cries with tears  mild and treat with ORS
 MOST ACCURATE for primary biliary cirrhosis (PBC)  antimitochondrial ab
 Confirmatory for primary biliary cirrhosis (PBC)  percutaneous liver biopsy
 Etiology of primary biliary cirrhosis (PBC)  T lymphocyte-mediated attack on bile duct
epithelial cells

 Conjugated hyperbilirubinemia  rotor syndrome

 Common feature of IBS  altered bowel habit
 Gastritis, hb=9  oral iron
 Most ass/ RF for crohn  +ve family hx
 HBV surface antigen |HBsAg|, is positive, asymp  acute hep**
 Genes related to celiac disease  HLA-DQ2 “MOQ2”
 Most common sx of perforated duodenal ulcer  peritonitis
 UC complicated by infection, he was given ceftriaxone but no improvement, organism is
 pseudomona*******

 Liver biopsy in  seventh intercostal space in midaxillary line

 Specific for acute hepatitis B  IgM anti-HBcAg
 Peptic ulcer med cause ED & decrease libido  cimetidine
 Celiac disease  proximal small intestine
 Pain control doesn’t cause gastric irritation  (celecoxib, profen, indomethacin, aspirin)
 24y.o, eye sometimes yellow only, indirect bilirubin= 1.1, direct= 0.3, ALT=12, ALP= 55
 gilbert syndrome

 Kwashiorkor  low protein intake only

 HBV  enveloped DNA
 Most likely cause of crohn’s disease  unknown cause
 Liver cirrhosis and ascites, wt loss, next  US
 Enteric fever, 1 w, best modality to reach dx  blood culture
st

 Safe in celiac  rice

 Bla bla peptic ulcer sx, on NSAIDS for years  PPI “triple therapy= h. pylori”
 Cause increase in AST  alcohol
 Travel & bloody diarrhea  Entamoeba
 1 sign of portal HTN  splenomegaly/ GI bleeding????
st

 Mild-moderate IBD  immunomodulator

 Orlistat  inhibit lipase
 Confirm rotavirus  stool antigen
 How to know if someone improved with triple therapy w h. pylori  urea breath test
 T. Whipple infection “chronic diarrhea, ataxia, abnormal movement” needs  long-
term abs “1-2 y”
 Anemia, high bilirubin, +ve direct and indirect coombs, with peripheral smear with
random blood cells  autoimmune hemolytic anemia

 Female with jaundice, disoriented and tremor, husband has hep b, +HBsAb, liver enzyme
slightly elevated  order ceruloplasmin “she’s immune to hep b, suspect Wilson”

 Recurrent oral and genital aphthous ulcer  Bechet disease

 Retrosternal pain, barium swallow= esophageal corkscrew appearance  diffuse
esophageal spasm

 Cells secrete defensins  Paneth cells

 Chronic diarrhea with blood, low fever, lost wt, edematous rectal mucosa  ulcerative
colitis

 AAA screening  65 male left smoking for 10y “most imp he ever smoked and 65-75”
 Sign of acute hepatic failure  hepatic encephalopathy
 Young, jaundice, hx of flu sx, high indirect, everything else normal, gene mutation 
CD59 “indirect hyperbilirubinemia”

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