NRE Step 1: GIT Made Simple – Pass with Precision – Bilalmd

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Digestive System (GIT)

  • Esophagus: This is your food pipe, about 25 cm long.
    • The strongest layer is called the submucosa.
    • If someone has a weak immune system and trouble swallowing, it might be a fungal infection in the esophagus, called fungal esophagitis.
    • If you feel like food is stuck early when swallowing, it could be a “corkscrew esophagus” or diffuse esophageal spasm.
      • Doctors check this with a test called manometry or barium swallow.
    • Esophageal Cancer:
      • 2 out of 3 cases are squamous cell cancer, often linked to smoking.
      • 1 out of 3 cases are adenocarcinoma, which can come from something called “Barrett’s esophagus”.
        • Barrett’s esophagus is when the normal cells in the esophagus change to look like intestinal cells.
    • Achalasia Cardia: This is when the lower part of the esophagus doesn’t open well, making it hard for food to pass. On X-ray, it looks like a “rat tail” or “bird beak”.
  • Stomach:
    • The stomach is J-shaped.
    • It has cells that make pepsinogen, which turns into pepsin.
    • It also makes something called “intrinsic factor” (IF) which helps absorb Vitamin B12.
    • Ulcers:
      • Duodenal ulcer: Pain higher up in the stomach area.
      • Gastric ulcer: Pain lower in the stomach area.
    • H. pylori: A type of bacteria that can cause stomach problems.
      • Doctors can test for it using blood, stool, or a breath test.
      • Treatment involves antibiotics (like clarithromycin) and acid-reducing medicine (PPI).
    • Stomach Issues & Symptoms:
      • Epigastric pain: Pain in the upper belly that can go to the back, with nausea, vomiting, or indigestion.
      • Chest heaviness: Can be from GERD (acid reflux) or acute pancreatitis.
  • Stomach Cancer (Gastric Adenocarcinoma):
    • Risk factors include eating spicy food, smoking, and H. pylori infection.
    • Symptoms can be no symptoms, indigestion, or weight loss.
    • Spread (Metastasis):
      • Virchow node: Cancer spread to a lymph node above the left collarbone.
      • Sister Mary Joseph nodule: Cancer spread around the belly button.
      • Krukenberg tumor: Cancer spread to the ovaries.
  • Acute Appendicitis:
    • Pain in the lower right side of the belly that moves towards the belly button.
    • Other symptoms: nausea, vomiting, fever, and a high white blood cell count.
    • McBurney point: A specific spot on the lower right belly that is painful when pressed.
    • The appendix can be in different positions, like behind the large intestine.
    • Signs:
      • Rovsing sign: Pain in the lower right belly when pressing on the lower left belly.
      • Psoas sign: Pain when moving the leg.
      • Obturator sign: Pain when rotating the hip.
    • If someone has symptoms for 4-7 days, it’s likely appendicitis.
    • Doctors often use ultrasound for diagnosis.
  • Acute Mesenteric Ischemia:
    • Sudden, very bad belly pain (10/10) with nausea and vomiting.
    • Causes: Hardening of arteries (atherosclerosis), inflammation of blood vessels (polyarteritis nodosa).
    • Treatment: Surgery to fix blood vessels or remove part of the bowel.
  • Diverticulitis:
    • A 60-year-old person with bleeding from the rectum and changes in bowel habits might have diverticulitis.
    • Symptoms: High white blood cell count. Diagnosis with CT scan of the belly. Treatment: Surgery.
  • Heyde Syndrome: A group of problems including a heart valve issue (aortic stenosis) and abnormal blood vessels in the colon (angiodysplasia).
  • Colon Polyps: Growths in the colon.
    • Hyperplastic polyp: Not cancerous.
    • Adenomatous polyp: Can turn into cancer.
    • Familial Adenomatous Polyposis (FAP): A family condition where many polyps grow in the colon due to a faulty APC gene on chromosome 5.
      • Turcot Syndrome: FAP with a brain tumor.
      • Gardner Syndrome: FAP with bone growths (osteoma).
  • Colon Cancer:
    • Risk factors: Smoking, family history, and low fiber diet.
    • Hint: An older person with iron deficiency anemia might have colon cancer.
    • Right colon cancer: Often causes bleeding and iron deficiency anemia.
    • Left colon cancer: Often causes blockage.
    • CEA: A marker used to check how treatment is working and if cancer is coming back.
    • Diagnosis: Colonoscopy and biopsy.
  • Tumor Markers: Substances in the body that can indicate cancer.
    • CA 15-3: Breast cancer.
    • CA 19-9: Pancreatic cancer.
    • AFP: Liver cancer, testicular cancer.
    • Calcitonin: Medullary thyroid cancer.
    • LDH: Seminoma (testicular cancer).
    • HCG: Testicular cancer.
    • Gastrin: Zollinger-Ellison syndrome.
    • CA 125: Ovarian cancer.
    • PSA: Prostate cancer.
    • 5HIAA: Carcinoid syndrome.

Liver and Gallbladder (Hepato Biliary Pathologies)

  • Gallstones: Lumps that form in the gallbladder.
    • Types:
      • Cholesterol stones: Most common (90%), often in “4Fs” (Female, Fertile, Forty, Fatty).
      • Pigmented stones: Less common (10%), made of bile components.
    • Cholecystitis: Gallbladder inflammation, often caused by a stone.
      • Symptoms: Upper right belly pain after eating fatty food, nausea, tenderness.
      • Diagnosis: Ultrasound.
      • Treatment: Surgery to remove the gallbladder (cholecystectomy).
    • Cholelithiasis: Stones in the gallbladder, often with E. coli bacteria.
    • Choledocholithiasis: Stone stuck in the main bile duct.
    • Cholangitis: Inflammation of the main bile duct.
      • Symptoms: Upper right belly pain, yellow skin/eyes (jaundice), fever/chills (Charcot’s triad). In severe cases, confusion and shock (Reynold’s pentad).
  • Porcelain Gallbladder: A hardened, scarred gallbladder.

Pancreas Problems

  • Pancreatic Cancer:
    • Pain in the upper belly that goes to the back.
    • Can cause yellow skin/eyes (jaundice) if it’s in the head of the pancreas.
    • Can cause fatty stools (steatorrhea) and weight loss.
    • Marker: CA 19-9.
    • Courvoisier sign: A big, non-painful gallbladder can be a sign of pancreatic cancer.
  • Acute Pancreatitis:
    • Very severe pain (10/10) in the upper belly that goes to the back.
    • Symptoms: Sweating, nausea, vomiting, high levels of amylase and lipase in blood.
    • Necrosis: The pancreas can digest itself (liquefactive necrosis) or get damaged from injury (fat necrosis).
  • Chronic Pancreatitis:
    • Repeated mild to intense upper belly pain.
    • Can cause maldigestion and fatty stools (steatorrhea).
    • Can lead to a pancreatic pseudocyst.

Anal Problems

  • Anal Fissure: A tear in the skin around the anus.
    • Symptoms: Intense pain during and after pooping, a streak of blood. Often linked to constipation.
    • Treatment: Diet changes, drinking fluids, pain medicine, and medicine to relax the area.
  • Anal Abscess: A collection of pus near the anus.
    • Symptoms: Pain, fever, chills.
    • Treatment: Draining the pus.
  • Hemorrhoids (Piles): Swollen veins in the rectum.
    • Causes: Chronic constipation, high blood pressure in the portal vein (portal hypertension), liver disease, obesity.
    • Symptoms: Painless bleeding when pooping, a drop of blood on stool, or a mass coming out.
    • Types:
      • Internal hemorrhoids: Above the dentate line (inside), usually painless, come from the endoderm.
        • Graded 1-4 based on how much they stick out.
      • External hemorrhoids: Below the dentate line (outside), painful, come from the ectoderm.
    • Treatment:
      • Mild cases: Diet changes, fluids.
      • More severe: Banding or sclerotherapy (injecting medicine).
      • Worst cases: Surgery (hemorrhoidectomy).
  • Pilonidal Sinus: A small hole or tunnel in the skin, usually at the bottom of the spine (tailbone), often with hair inside.
    • Symptoms: Discharge, pain, a lump, or hair sticking out.
    • Treatment: Surgery.
  • Perianal Fistula: A tunnel that forms between the anal canal and the skin near the anus.
    • Symptoms: Persistent pain and discharge in the anal area, itching.
    • Diagnosis: MRI.
    • Treatment: Surgery (fistulectomy).

Kidney Stones (Renal Stones)

  • Symptoms: Kidney pain that often goes to the groin, blood in urine (hematuria), peeing less (oliguria), tenderness in the kidney area.
  • Types:
    • Calcium stones: Most common (70-80%), either calcium phosphate or oxalate.
    • MAP (Struvite) stones: Second most common, linked to infections and can cause kidney swelling (hydronephrosis).
    • Uric acid stones: Not visible on X-ray.
    • Cysteine stones: Rare, but more common in children; hexagonal shape.
  • Diagnosis: CT scan without contrast is the best way to confirm.
  • Stone Size and Treatment:
    • Less than 0.5 cm (5 mm): Can pass on their own.
    • More than 0.5 cm (5 mm): May need a procedure.

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