Clinical Correlation Lecture (TEST 2) Flashcards
Testing for H. pylori
1) HISTOLOGIC EXAM:
- EDG WITH BIOPSY (Hematoxylin and Eosin Stain or Warthog-Starry Stain) or RAPID CLO (Clofazimine Test)
- Could be INACCURATE if patient recently treated with PPI (Proton Pump Inhibitor)
2) SEROLOGY
- Serum HELICOBACTER PYLORI ANTIBODIES, IGA!!!!!!!!!!
- Not helpful to show eradication (takes 6 to 24 months for Antibodies to Decrease to Undetectable Levels)
3) STOOL H. pylori ANTIGEN
4) CARBON 13 or CARBON 14 UREA BREATH TEST
- Detects H. pylori UREASE ACTIVITY
- Becomes NEGATIVE as soon as treatment for H. pylori si started
Melena
- Passage of dark-colored, tarry stools, due to the presence of blood altered by the intestinal juices.
Hematochezia
- Passage of bloody stools, in contradistinction to melena, or tarry stools
Coffee-ground Emesis
- Coffee ground vomitus refers to a particular appearance of vomit. Blood contains iron within heme molecules in red blood cells. When this iron has been exposed to gastric acid for some time, it becomes oxidized. This reaction causes the vomitus to look like ground coffee.
- Coffee-ground vomitus is a classic sign of upper gastro-intestinal bleeding.
- A peptic ulcer, for example, may bleed into the stomach and produce coffee-ground vomitus.
- There are many causes that can result in this reaction, with use of NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) being particularly common.
- These drugs can interfere with the stomach’s natural defenses against the strongly acidic environment, causing damage to the mucosa that can result in bleeding.
Hematemesis
- Hematemesis or haematemesis is the vomiting of blood. The source is generally the upper gastrointestinal tract.
Peptic Ulcer Disease
- Associated with H. pylori 75% OF THE TIME!!!!!!
- Typically in LESSER CURVATURE OF THE ANTRUM OF STOMACH!!!!!!!!!!!!
- BURNING EPIGASTRIC PAIN!!!!
- WORSENS within 30 MIN AFTER EATING!!!!!!!!
DIAGNOSIS:
- Esophagoduodenoscopy (EDG) +/- H. pylori
- A person can be colonized with H. pylori and NOT have an Ulcer
- Can have an Ulcer and be (-) for H pylori
TREATMENT:
- H2 Blocker (Cimetidine), PROTON PUMP INHIBITOR (Omeprazole), ERADICATE H pylori (Amoxicillin and Clarithromycin)
Duodenal Ulcer
- 95% SECONDARY to H. pylori
- Presents as GNAWING PAIN!!!!!
- 1 to 3 Hours AFTER EATING
- RELIEVED BY FOOD/ EATING
- Anterior wall of PROXIMAL DUODENUM
- H pylori + Stress + Smoking = INCREASED RISK
- NSAIDS/ Steroid fall into the other 5% for Risk Factors
H pylori
- Curbed GRAM NEGATIVE RODS that produce UREASE (MICROAEROPHILIC Spiral Bacilli with FLAGELLA)
- Cause CHRONIC GASTRITIS, DUODENAL ULCERS, and MALT!!!!!!!!!!!!
Multiple Endocrine Neoplasia
- The term multiple endocrine neoplasia (MEN) encompasses several distinct syndromes featuring tumors of endocrine glands, each with its own characteristic pattern.
- When tumor of the Pancreas leads to Ulcers of the Stomach and Duodenum and then also has symptoms of ELEVATED CALCIUM and GALACTORRHEA (Milky Discharge from Nipple)!!!!!!
Multiple Endocrine Neoplasia 1
- Pituitary Adenoma
- Parathyroid Hyperplasia
- Pancreatic Tumor
Multiple Endocrine Neoplasia 2A
- Parathyroid Hyperplasia
- Medullary Thyroid Carcinoma
- Pheochromocytoma
Multiple Endocrine Neoplasia 2B
- Mucosal Neuromas
- Marfanoid Body Habitus
- Medullary Thyroid Carcinoma
- Pheochromocytoma
Gastric Ulcer
- Within 30 MINS of EATING pain is WORSE!!!!!
- Epigastric or RUQ Pain
- Typically SHAPR BURNING PAIN!!!!!!
- NSAID/ Alcohol/ Smoking
- 75% H pylori
Duodenal Ulcer
- BETTER WITH EATING
- Pain WORST 1 to 3 HOURS AFTER EATING!!!!!
- “GNAWING” PAIN
- RUQ or Epigastric Pain
- 95% SECONDARY to H pylori
Arches Senilis
- May be present at Birth
- Typically over age 50
- May INDICATE FAMILIAL HYPERLIPIDEMIA
- It is LIPID DEPOSIT in the CORNEA!!!!!!!
Acalculous Cholecystitis
- Inflammation of the Gallbladder WITHOUT STONES
Calculous Cholecystitis
- Inflammation of Gallbladder WITH STONES
Choledocholithiasis
- Stone in the COMMON BILE DUCT
Ascending Cholagitis
- Infection that is ASCENDING from the Duodenum into the Biliary tree. A Stone usually leads to this!!!
Biliary Dyskinesia
- Malfunction of the Gallbladder where it is NOT EJECTING the Bile out Properly
- These people may come in complaining of Biliary Colic
** Use a test to show LOW EJECTION FRACTION of the Gallbladder. The EF will be LESS THAN 40%!!!!!!
HIDA Scan
- A cholescintigraphy scan, also known as: Hepatobiliary Iminodiacetic Acid (HIDA), is a NUCLEAR IMAGING procedure to evaluate the HEALTH and FUNCTION of the GALLBLADDER.
- A RADIOACTIVE TRACER is injected through any accessible vein, then allowed to circulate to the liver, where it is excreted into the biliary system and stored by the gallbladder and biliary system.
- In the ABSENCE of disease, the gallbladder is visualized within 1 hour of the injection of the radioactive tracer. If the gallbladder is not visualized within 4 hours after the injection, this indicates either CHOLECYSTITIS or CYSTIC DUCT OBSTRUCTION
KUB
- X ray of the Kidneys, Ureters, and Bladder
Treatment for Gallbladder Stones and Inflammation
- Start Antibiotics
- INTRAVENOUS FLUID
- Consult GI for ERCP (ENDOSCOPIC RETROGRRADE COLONIC PANCREATOGRAPHY)
- CONSULT FOR SURGER FOR CHOLECYSTECTOMY!!!!!!!!
- Restart medication for DM2: likely initially Insulin in the Hospital, maybe METFORMIN on Discharge +/- other meds
- Monitor Blood Pressure, may need treatment if does then ACEI is good Choice for DM2
- Start a CHOLESTEROL MEDICATION: STATIN!!!!!!!!
Gallbladder Disease/ Gallstone Risk Factors
4 F’s:
1) Female
2) Fat
3) Fertile
4) Forty
Modifiable Factors:
- RAPID WEIGHT LOSS
- LOW FIBER, HIGH CALORIE DIET
- HYPERTRIGLYCERIDEMIA, Low HDL
- OBESE Family History
- Bariatric Surgery
Need 2/3 to Diagnosis Pancreatitis
1) Epigastric Pain
2) CT Imaging of Pancreatitis
3) Lipase 3x Upper Normal Limit
