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[h] Gastrointestinal System Flashcards

[i] Master this session in just 5 minutes.

[q] What is the most likely diagnosis?

14 years old patient presenting with mild unconjugated hyperbilirubinemia thought to be provoked by fasting, physical exertion with no apparent liver disease and without overt hemolysis but there is decrease in UDP glucuronyl transferases activity?

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R2lsYmVydCBzeW5kcm9tZSBpcyBhIGNvbW1vbiBmYW1pbGlhbCBkaXNvcmRlciBvZiBiaWxpcnViaW4gZ2x1Y3Vyb25pZGF0aW9uIGluIHdoaWNoIHRoZSBwcm9kdWN0aW9uIG9mIFVEUCBnbHVjdXJvbnlsIHRyYW5zZmVyYXNlcyAoZW56eW1lcyB0aGF0IG1lZGlhdGUgZ2x1Y3Vyb25pZGF0aW9uIG9mIHZhcmlvdXMgc3Vic3RhbmNlcykgaXMgcmVkdWNlZCBhbmQgaW1wYWlyZWQgYmlsaXJ1YmluIHVwdGFrZS4=

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[q] What is the most likely diagnosis?

A newborn child presenting with bilirubin encephalopathy and neurological impairment + Indirect bilirubin level 25 mg/dl with Absent UDP-glucuronosyltransferase?

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[q] …….. is characterized by a defect in the hepatic excretion of bilirubin glucuronides across the canalicular membrane, predominantly conjugated chronic hyperbilirubinemia. Grossly, the liver is strikingly black (Dark).

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[q] ……..  is similar to dubin johnson syndrome, but milder in presentation without black (Regular) liver.

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[q] Heme oxygenase converts heme to……., a pigment that causes the greenish color to develop in bruises several days after an injury.

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[q] ……… is the most common indication for pediatric liver transplantation?

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[f]IEJpbGlhcnkgYXRyZXNpYS4=[Qq]

 

[q] What is the most likely diagnosis?

A newborn child presenting with conjugated hyperbilirubinemia, acholic (light) stools and dark urine, and hepatomegaly + Laboratory findings include increased levels of direct bilirubin, alkaline phosphatase, and gamma-glutamyl transferase + Liver biopsy shows Marked intrahepatic bile ductule proliferation, Portal tract edema and fibrosis, Parenchymal cholestasis?

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SWYgYmlsaWFyeSBkcmFpbmFnZSBpcyBub3QgcmVzdG9yZWQgc3VyZ2ljYWxseSwgYmlsZSBzdGFzaXMgd2lsbCBjYXVzZSBkZXZlbG9wbWVudCBvZiBiaWxpYXJ5IGNpcnJob3NpcyBieSA2IG1vbnRocyBvZiBsaWZlLg==

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[q] …….. is the most common type (90%), especially in the U.S. Usually radiolucent (10% are radiopaque due to associated calcium).

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[q] ……… increases cholesterol synthesis by upregulating hepatic HMG-CoA reductase activity, which causes the bile to become supersaturated with cholesterol.

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[q]…….. reduces bile acid secretion and slows gallbladder emptying. When the gallbladder is hypomotile or there is more cholesterol than bile salts, the cholesterol precipitates into insoluble crystals that eventually form to make gallstones.

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[q] Suppression of ………. activity (through fibrate medications such as bezafibrate, fenofibrate, and ciprofibrate) reduces the conversion of cholesterol into bile acids, resulting in an increased concentration of cholesterol within the bile.

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[q] ……. is gallstones that is composed of bilirubin. Usually radiopaque. Risk factors include extravascular hemolysis (increased bilirubin in bile) and biliary tract infection (E coli, Ascaris lumbricoides, and Clonorchis sinensis).

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[q]……… pigment stones typically arise secondary to infection of the biliary tract, which results in the release of β-glucuronidase by injured hepatocytes and bacteria.

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[q] A prolonged course of total parenteral nutrition (TPN) is often complicated by the formation of gallstones. The pathogenesis of TPN-induced gallstones is thought to be due to Biliary stasis from absent enteral stimulation secondary to decreased ……. release.

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[q] ……..  improve cholesterol solubility by reducing the amount of cholesterol secreted into the bile and increasing biliary bile acid concentration.

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[f]IEh5ZHJvcGhpbGljIGJpbGUgYWNpZHMgKHVyc29kZW94eWNob2xpYyBhY2lkKS4=[Qq]

[q] What is the most likely diagnosis?

34 years old female presenting with colicky pain in the right upper quadrant radiating to the right shoulder and back, often triggered by ingestion of fatty food, accompanied by nausea and vomiting + symptoms usually resolve within 4 hours?

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[q] What is the most likely diagnosis?

34 years old female presenting with right upper quadrant pain and tenderness, fever, vomiting, and leukocytosis. During abdominal examination there is worsening of right upper quadrant pain with inspiration that sometimes causes the patient to suddenly hold his breath + U/S shows gallstones, thick-walled gallbladder, and pericholecystic fluid.

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[q] What is the most likely diagnosis?

It is crucial to have a high index of suspicion for acalculous cholecystitis when managing those patients at increased risk, as an insidious presentation is linked to higher rates of ……. and ……..?

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TW9ydGFsaXR5IHJhdGVzIHJhbmdlIHdpZGVseSBmcm9tIDEwLTkwJSwgZGVwZW5kaW5nIG9uIHBhdGllbnQgY29uZGl0aW9uIGFuZCBob3cgcXVpY2tseSB0aGUgZGlhZ25vc2lzIGlzIGVzdGFibGlzaGVkLg==[Qq]

[q] What is the most likely diagnosis?

34 years old female presenting with long history of gallstones presenting with abdominal pain/distension, nausea/vomiting, high- pitched (tinkling) bowel sounds, and tenderness to palpation + Abdominal x-ray shows dilated loops of bowel with air-fluid levels and gas in the biliary tree (pneumobilia)?

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[q] …….. is recommended for those with porcelain gallbladders because 11-33% of this patient population will eventually develop gallbladder carcinoma.

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[Qq]Porcelain gallbladder is a term used to describe the calcium-laden gallbladder wall with bluish color and brittle consistency often associated with chronic cholecystitis.

[q] What is the most likely diagnosis?

34 years old female presenting with long history of gallstones presenting with Fever, jaundice, and right upper quadrant abdominal pain, Confusion and hypotension + Laboratory results usually show leukocytosis and neutrophilia in addition to elevations in alkaline phosphatase, gamma-glutamyl transpeptidase, and direct bilirubin?

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[q] Administration of mu opioid analgesics, such as morphine, can cause ……. of smooth muscle cells in the sphincter of Oddi, leading to spasm and an increase in common bile duct pressures.

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[q] What is the most likely diagnosis?

25 years old patient presenting with history of ulcerative colitis pruritus, jaundice with elevated conjugated bilirubin, dark urine, light-colored stool, hepatosplenomegaly + onion skin” bile duct fibrosis → alternating strictures and dilation with “beading” of intra- and extrahepatic bile ducts on magnetic resonance cholangiopancreatography (MRCP) + p-ANCA ⊕, ↑ IgM.

 

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[q] What is the most likely diagnosis?

25 years old patient presenting with history of Hashimoto thyroiditis pruritus, jaundice with elevated conjugated bilirubin, dark urine, light-colored stool, hepatosplenomegaly + lymphocytic infiltrate + granulomas → destruction of the intrahepatic bile ducts and cholestasis + Anti-mitochondrial antibody ⊕, ↑ IgM?

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UHJldmlvdXNseSBrbm93biBhcyBwcmltYXJ5IGJpbGlhcnkgY2lycmhvc2lzLg==

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[q] What is the most likely diagnosis?

21 years old patient presenting with longitudinal tears in the anal canal distal to the dentate line at the posterior midline + chronic constipation with high anal pressures and passage of hard stools, There is exquisite pain with defecation and blood streaks covering the stools?

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