3 Feb 24 Flashcards
Autoimmune metaplastic atrophic gastritis mechanism
Antibodies against parietal cells
(Causing atrophy and metaplasia of gastric corpus , hypochlorhydria , unchecked gastrin production)
Antibodies towards intrinsic factor
(B12 def)
Female autoimmune history gastric features macrocytic anemia
Think about AMAG
Autoimmune metaplastic atrophic gastritis.
CF of autoimmune metaplastic atrophic gastritis
Post prandial abd pain
Bloating
Nausea
Heartburn
Regurg
Elevated serum gastrin
Dec stomach acid 👉🏼reduced Fe bioav
Iron def anemia
Complications of AMAG
Inc risk for gastric adenocarcinoma
(Routine endoscopy needed)
Cause of inc BUN and Cr in Upper GIT bleed
Inc urea production from intestinal breakdown of Hb and inc urea reabsorption in proximal tubule due to associated hypovolemia.
Inc BUN/Cr ratio
Criteria of transfusion in pts with UGIB
Stable pts <7 Hb
Unstable Acute coronary pts <9 Hb
Active bleed pts with Hypovolemia give pack cells as Hb levels drop massively if crystalloid solutions are given
Whole blood is given for massive hemorrhage eg trauma.
Angiodysplasia of colon CF
🎱Episodic painless GI bleed
🎱Dilated submucosal veins and AV malformations
🎱Inc incidence after 60y
🎱Can occur anywhere in GIT mainly Rt colon
🎱Easily missed on colonoscopy
🎱Associated with advanced CKD and vWD
🎱Also common with Aortic stenosis due to acquired vW factor def (disruption of vWmultimers as they traverse the turbulent valve space induced by AS )
🎱Bleeding remits after valve replacement.
Angiodysplasia ttt and dx
Dx : endoscopy/colonoscopy
Ttt: No ttt req in A/S cases
Anemics or those with gross occult
Bleed are treated with endoscopy and cautery
Benefit of octreotide in UGIB
Somatostatin analogue (octreotide ) inhibits release if vasodilator hormones causing splanchnic vasoconstriction and decrease portal flow.
Alternate: terlipressin (vasopressin analogue)
Criteria to transfuse blood in GIbleed pt
Keep Hb >7 in stable pts
Hb>9 in pts with acute coronary dx
Duodenal ulcer vs gastric ulcer
DU pain worse on empty stomach and improves with food (due to alkaline fluid secretion in duodenum)
Gastric ulcer pain is worse after eating (increased acid secretion)
Cause of duodenal ulcer
Hpylori
NSAIDS
Ttt of duodenal ulcer due to Hpylori
🛖antisecretory therapy = PPI
🛖Amoxicillin plus clarithromycin
Achalasis in an old patient with significant weight loss
Pseudoachalasia
Due to cancer
Primary achalasia vs pseudoachalasia
Primary achalasia:
Younger pt 20-50y
Insiduous onset
Mild weight loss
Endoscopy shows normal mucosa with dilated esophagus
Closed LES which is easily traversed by scope
Psudoachalasia :
Age >60
Rapid onset <6mo
Sig weight loss
Mucosal lesions on endoscopy
LES is not traversed by a scope as it is obstructed by tumor.
RF of pseudoachalasia
🏀Tobacco use
🏀Presence of alarm features
🏀Wide mediastinum due to tumor mets (lymph nodes) or local tumor invasion.
Dx
Endoscopy
Zenker diverticulum and pneumonia
Regurgitation of undigested food or medications several hours after eating leads to aspiration and recurrent aspiration pneumonia
Mallory weiss syndrome etiology and CF
Etiology:
Forceful retching
Mucosal tear
Submucosal venous or arterial plexus bleeding
CF :
Epigastric /back pain
Hematemesis (bright red or coffee ground )
Possible hypovolemia
DX and ttt of MW syndrome
Dx : Upper GI endoscopy
Ttt: Acid suppression
Most heal spontaneously
For persistent bleed ttt with endoscopic electrocoagulation or local injection of epinenephrine
Boerhaave syndrome etiology and CF
Etiology :
Forceful retching
Transmural tear
Spillage of esophageal air /fluid
CF :
Chest /back/ epigastric pain
Crepitus , crunching sound (hamman sign)
Odynophagia , dyspnea, fever , sepsis
Workup for boerhaave and ttt
Dx: CXRay (pnemothorax , pneumomediastinum, pleural effusion)
Esophagography or CT with water soluble contrast.
Ttt:
Acid suppression , Antibiotics , NPO
Emergency surgical consult
MW tear RF
Alcohol use disorder
Hiatal hernia
Gastroschisis complication s
FGR :
Nutrition loss across exposed bowel
Oligohydramnios :
Blood and nutrients are shunted away from kidneys to vital organs (brain) causing dec fetal urine production and hence oligo .
Polyhydramnios:
Continuous exp of intestines to Amniotic fluid causes chronic inflammation and edema causing intestinal thickening and reduced bowel motility . And even bowel obstruction. Resulting in polyhydramnios.
Pyloric stenosis initial management
Babies who present with hypochloremic hypokalemic metabolic alkalosis due to prologed vomiting should have
IV rehydration and electrolyte replacement prior to pyloromyotomy to decrease risk of post operative apnea
