Conditions of the Abdomen Flashcards
What are common causes of LLQ pain?
IBD
Diverticulitis
Ovarian cyst, tumor
PID
IBS
Colon Cancer
What are the common causes of RLQ pain?
Appendicitis
Ileo-cecal valve problems ie: Crohn’s Disease
PID
Ectopic Pregnancy
Ovarian cyst or tumor
What are the common causes of RUQ pain?
Hepatitis
Cholecystitis
Gastritis
Nephrolithiasis
What are the common causes of LUQ pain?
Splenomegaly
Gastritis
Pancreatitis
Nephrolithiasis
What are common cause of epigastric pain?
GERD
PUD
Hiatal Hernia
Esophagitis
Gastritis
Pancreatitis
What are the two (2) types of esophageal cancer and what are the risk factors for each one?
Squamous Cell Carcinoma: Smoking, Spirits, Seeds (Betel Nut, Tobacco) , Scalding (hot liquids), HPV infection
Adenocarcinoma: Barrett’s Esophagus, Smoking, Obesity due to increased reflux, GERD
What are the signs and symptoms of esophageal cancer?
Progressive dysphagia (solids to liquids), chest pain, hemoptysis, cough, weight loss, hoarseness
How is esophageal cancer diagnosed?
Barium Swallow, Endoscopy, biopsy, cytological studies
What factors lead to the development of colon cancer?
Low fiber, high fat diet
Prolonged transit time
Low intestinal flora
High nitrosamines in the diet
Cigarette Smoking
Obesity
Physical Inactivity
Age >50 years; first degree relatives with colon cancer
What are the symptoms of colon cancer?
1) Asymptomatic for years
2) Right sided: anemia, weakness, DOE, palpitations, lethargy, abdominal pain without obstructive symptoms
3) Left sided: Change in bowel habits
4) Bowel obstruction during initial phases
5) Unexplained watery diarrhea as it progresses
6) If severe or metastatic you will get systemic sxs: weight loss, anorexia, fatigue
How is colon cancer diagnosed?
Fecal Occult Blood Test: Not sensitive or specific
Sigmoidoscopy
Colonoscopy (best)
Carcinoembryonic Antigen (CEA)
*Direct imaging, colonoscopy or flexible sigmoidoscopy with biopsy
What tumor marker is used to monitor recurrence or progression of colon cancer?
Carcinoembryonic Antigen (CEA): Tumor Marker in colon cancer; 5 ng/ml have worse prognosis
What primary cancer sites metastasize to the liver?
Lung, Breast, Colon, Pancreas, Esophagus, Kidney, Stomach and skin
What viral infection is strongly related to hepatic carcinoma?
Chronic Liver Inflammation: Chronic Hepatitis B (oncogenic) and C
What are the signs and symptoms of hepatic carcinoma?
1) 33% Asymptomatic
2) Nonspecific: weight loss, anorexia, fever, anemia, nausea
3) RUQ or epigastric pain
4) Liver hard, tender and enlarged
5) Splenomegaly
6) Jaundice
7) Ascites
What lab changes would you expect from hepatic carcinoma?
1) Increased alpha-fetoprotein
2) Increased Bilirubin
3) Increase Alkaline phosphatase & GGT
4) Elevated ALT and AST
5) Elevated LDH
How is liver carcinoma diagnosed?
Liver Biopsy
What are the risk factors for developing pancreatic cancer?
Increase Age: mean age is 60
Obesity and physical inactivity
Diabetes mellitus
Chronic pancreatitis
Cigarette smoking
Diet high in saturated fats and processed meats
What are the signs and symptoms of pancreatic cancer?
1) Epigastric pain, persistent, dull pain that may radiate to the back
2) Anorexia, N/V
3) Anxiety/Depression
4) Jaundice
5) Onset DM > 55 years old
6) Weight loss
7) Loose stools
What is the prognosis for pancreatic cancer?
5 year survival rate < 5%
What imaging study would you order if you suspect pancreatic cancer?
CT scan with contrast
What’s in the DDx for pancreatic cancer?
1) Acute cholangitis
2) Chronic pancreatitis
3) Hepatitis
4) Cirrhosis
5) Liver Malignancy
What antigen is associated with pancreatic cancer?
CA -19-9
What might contribute to gallbladder cancer?
1) Primary sclerosing cholangitis
2) Hx of gallstones
4) Occupational carcinogen exposure
5) Chronic infection
6) Smoking Tobacco
What organism may be associated with gastric carcinoma?
H.pylori
What are the predisposing factors for developing gastric cancer?
1) Achlorhydria
2) Increase nitrate ingestion and salt composition
3) Hx of gastric ulcers
4) Chronic gastritis
5) Pernicious anemia cause achlorhydria and chronic atrophic gastritis
What age group is more likely to develop gastric cancer?
Men > 50 year old, special affiliation with blood type A
What are the signs and symptoms of gastric cancer?
1) Early stage is non-specific
2) Epigastric pain
3) N/V
4) Anorexia, early satiety
5) Dysphagia
6) Weight Loss
7) Change in bowel habits
8) Jaundice
- Ulcer that fails to heal
What is seen on PE with gastric cancer?
1) Palpable mass in advanced disease
2) Hepatomegaly
3) Abdominal Tenderness
4) Weight Loss
5) LAO: Supraclavicular or axillary
6) Ascites
How is gastric cancer diagnosed?
Esophagogastro-duodenoscopy and biopsy
What is acute pancreatitis?
Alcohol abuse and gallstones are the most common causes
Acute inflammation associated with pancreatic edema, swelling, autodigestion, necrosis and hemorrhage
What are the risk factors for developing acute pancreatitis?
Alcoholism 30%
Cholelithiasis with pancreatic duct blockage 30-75%
Hypertriglyceridemia with serum >1000 mg/dL
Medication side effect
What are some of the medications that can lead to acute pancreatitis?
1) Aminosalicylates
2) Sulfonamides
3) Valproic Acid
4) Tetracycline
5) GLP-1 agonists
What are the signs and symptoms of acute pancreatitis?
Fever, nausea, vomiting
Severe, knife-like pain in the mid-epigastric area; may radiate to back
Tender, rigid abdomen
Hypovolemic shock
Jaundice caused by compression/obstruction of bile duct
Hypoxemia: pancreatic phospholipase circulates destory surfactant in the lungs –> ARDS
Cullen’s Sign (periumbilical hemorrhage)
Grey- Turners sign (Flank hemorrhage)
Disseminated intravascular coagulation
Tetant Coma
What labs are elevated in acute pancreatitis?
Serum amylase/lipase is increased 3x the upper limit
Increased ALT and AST
GGT may also be elevated
What are the risk factors of chronic pancreatitis?
Alcohol Abuse > 150 g daily for at least 5 years
Cigarrette smoking
Recurrent episodes of acute pancreatitis
What are the signs and symptoms of chronic pancreatitis?
1) Epigastric or diffuse abdominal pain
2) May radiate through to the back
3) Insulin dependent diabetes mellitus
4) Weight loss and loss of appetite
5) Nausea/ Vomiting
6) Steatorrhea
Which pancreatic enzyme rises first and which one stays elevated the longest?
Amylase will typically rise and return to normal first
Lipase is elevated several days after onset
How is chronic pancreatitis diagnosed?
Pancreatic calcification seen on abdominal x-ray is considered pathognomonic for chronic pancreatitis
What causes peritonitis?
Acute inflammation of the visceral and parietal peritoneum
Secondary to other ill:
Appendicitis
Pelvic Inflammatory Disease
Ruptured Ectopic Pregnancy
Perforated Peptic Ulcer
Cholecystitis
Diverticulitis
Ascites
Trauma
What are the signs and symptoms of peritonitis?
Sudden onset of acute abdominal pain, tenderness, rigidity
Nausea, vomiting, *high fever, dyspnea
Abdominal distention; absent bowel sounds (Hypoactive)
How is peritonitis diagnosed?
Abdominal Films: Free air in peritoneal cavity or CT contrast
What predisposes to Barrett’s esophagus?
Chronic exposure to stomach acid
Male
>50 years of age
Caucasian
Smokers
Overweight w/ Hx of GERD
What type of cancer does chronic GERD cause?
Esophageal adenocarcinoma
What is eosinophilic esophagitis?
Prominence of eosinophils from esophagus biopsy due to chronic immune/antigen-mediated disease causing chronic esophageal inflammation
What are the common signs and symptoms of eosinophilic esophagitis?
GERD-like symptoms (Heartburn)
Dysphagia when eating solids: history dates back to childhood
ER presentation: ER with food bolus impaction
N/V
What should be evaluated in patient with eosinophilic esophagitis?
Food Allergies
What are the most common types of food allergies in patients with eosinophilic esophagitis?
Dairy, wheat, soy, egg, nuts, and fish
What are the 3 main types of esophageal motility disorders?
1) Diffuse (distal) esophageal spasm (DES)
2) Hypertensive peristalis (NutcracKer esophagus)
3) Hypertension lower esophageal sphincter (LES)
What are the common signs/symptoms of esophageal motility disorders?
1) Dysphagia for solids and liquids
2) Difficulty swallowing several seconds after initiating the swallow
3) Sensation of food getting stuck in esophagus
4) Occasionally retrosternal chest pain
5) Some patient experience GERD
How are esophageal motility disorders diagnosed?
1) Upper Endoscopy and biopsy to rule out structural disorders
3) Esophageal manometry
What are some underlying conditions that can result in esophageal motility disorders?
1) Scleroderma
2) Diabetes Mellitus
What is the main pharmacologic treatment for esophageal motility disorders?
Calcium Channel Blockers: Diltiazen and nifedipine
What are the common signs and symptoms of GERD?
1) Burning retrosternal chest pain- worse after meals
2) Aggravated by lying down
3) Acid regurgitation
4) Dry cough
5) Belching
What are the main pharmacologic treatments of GERD?
Proton Pump Inhibitor are most effective therapy
-Esomeprazole (Nexium)
-Ranitidine (Zantac)
Antiacids or H2 blockers
What lifestyle modifications are indicated for patients with GERD?
Avoidance of individual food intolerances:
Avoid alcohol, coffee and other acidic foods, do not eat 3 hours before lying down
Food substances that Aggravate GERD Symptoms:
Alcohol
Caffeine
Tobacco
Fatty/Fried Foods
Chocolate
Peppermint
Spicy Foods
Citrus fruit juices
What herbs can be used to soothe GERD?
Demulcent Herbs:
Aloe Vera
Glycyrrhiza glabra
Ulmus Fulva
What is the etiology for peptic ulcer disease?
PUD is most often caused by H. Pylori (90%)
NASIDs use (7% of duodenal ulcers, 35% for gastric ulcers)
Physiologic stress-induced
Strong association with smoking, alcohol abuse or cocaine use
What are the 2 types of peptic ulcers?
Gastric or Duodenal Ulcers
What are the general symptoms of peptic ulcers?
Nagging, gnawing, or burning epigastric or retrosternal pain, weight loss, N/V, halitosis
What are symptoms of gastric ulcers?
-Epigastric pain worse by eating, starts shortly after eating
-Nausea is frequent
-Bleeding is frequent
-Pain is not alleviated by food
What are the symptoms of duodenal ulcers?
-Pain relived with eating, starts several hours after eating
-Substernal heatburn
-Pain awakens them at night
-Pain is relieved by food but returns several hours later
How are peptic ulcers diagnosed?
Endoscopy
What are the complications of peptic ulcer disease?
Bleeding
Duodenal Perforation
Obstruction
Where are gastric ulcers most commonly located?
Gastric ulcers are more common along the lesser curvature of the stomach
Which herbs are indicated for treating ulcers?
Aloe Vera
Glycyrrhiza glabra
Ulmus Fulva
Ulcers may be a side effect of the use of what drugs?
NSAIDs: ibuprofen, aspirin, naproxen
What amino acid is indicated for ulcers?
Glutamine
What causes gastritis?
Helicobacter pylori infection
Drugs: Aspirin/NSIADs
Alcohol
Physiological-Stress related mucosal changes
What are the signs and symptoms of gastritis?
Epigastric pain: burning, gnawing
Dyspepsia, N/V
Bloating, belching
Loss of appetite
Erosive: Bleeding, Melena, Iron Deficiency
How is gastritis diagnosed?
Biopsy during endoscopy showing red, inflamed and irritated mucosa
What causes cirrhosis of the liver?
Alcoholic liver disease (85%)
NASH
Biliary cirrhosis or sclerosing cholangitis
Chronic viral hepatitis (B, B+D, C; but never A or E)
Autoimmune diseases
Metabolic Diseases
-Hemochromatosis
-Wilson’s Disease (rare)
What are the signs and symptoms of cirrhosis?
1) Well compensated people may not have any symptoms
2) Systemic: weight loss, fever, weakness, anorexia
3) Palmar erythema
4) Caput Medusea: Dilated abdominal veins radiating out from umbilicus
5) Hepatomegaly
6) Spider telangiectasias
7) Hepatic Encephalopathy
8) Coagulopathy
Pruritis (20-70%)
Painful Hepatosplenomegaly
Jaundice (60%)- Late finding
Inflammatory Arthropathy
What values on a liver function test will be affected by cirrhosis of the liver?
AST/ALT >1 in alcoholic cirrhosis
Elevated Bilirubin
Decreased Albumin
BUN will be increased in renal involvement
What factors contribute to the anemia seen in liver cirrhosis?
1) Acute and chronic GI blood loss
2) Folate Deficiency
3) Direct Toxicity due to alcohol
4) Hypersplenism
5) Bone Marrow Suppression ( aplastic anemia)
6) Anemia or chronic disease (Inflammation)
What herbs are indicated for cirrhosis?
Curcuma longa
Silybum Marianum
Cynara Scolymus
Leptandra Virginia
Taraxacum officinalis root
Ceanothus virginicus
What is the accumulation of excess fluid in the peritoneum called?
Ascites
What are the major causes of ascites?
-Portal hypertension: Cirrhosis, CHF
-Hypoalbuminemia
-Malignancy
-Peritoneal Disease
What diuretic medication is used to help treat ascites?
Furosemide
What are the causes of jaundice?
Prehepatic: (unconjugated) Hemolytic anemia, Gilbert’s Syndrome
Hepatic causes: (conjugated) Hepatitis, alcohol-induced, NASH, hemochromatosis
Posthepatic: Obstructive jaundice, gallstones, pancreatitis
What effect does obstructive jaundice have on urobilinogen?
It will be normal. No bile may be excreted so no urobilinogen may be reabsorbed
In which cause of jaundice will you NOT see a rise in unconjugated bilirubin?
Gilbert’s Syndrome: Liver doesn’t properly process bilirubin
What are the different causes of hepatitis?
Viral, autoimmune, Alcohol, NASH, medication, toxins
Hepatitis A: Fecal-oral
Hepatitis B: Parenteral, oral, sexual, vertical (pregnancy) transmission
Hepatitis C: Parenteral or sexual transmission
What are the signs and symptoms of acute hepatitis?
Prodrome: Flu-like symptoms with malaise, fatigue, anorexia, N/V, myalgia, HA and mild fever, Smokers may be disgusted by smell of cigarettes
Icteric phase: Jaundice, abdominal pain, hepatomegaly and/or dark urine
What would you see on labs with hepatitis?
Elevated enzymes
ALT > AST
AST: ALT < 1 with viral hepatitis
AST: ALT >2 with alcoholic hepatitis
Hyperbilirubinemia
Bilirubinuria
Slight elevated alkaline phosphate
What’s the incubation period for HAV?
2 to 6 weeks (WB) ; 4- 6 weeks
What is the incubation period for HBV?
1 to 6 months
What’s the incubation period for HCV?
2 weeks to 6 months
How is hepatitis A dignosed?
(+) Anti-HAV IgM indicates active infection; Anti-HAV IgG indicated recovery or vaccination
How is acute hepatitis B diagnosed?
(+) HBsAg , (+) HBeAg, followed by (+) HBcAg IgM
What antigen is associated with high infectivity of HBV?
HBe antigen
What antigen is a sign of HBV infection?
HB core antibody
What are complications of hepatitis?
Chronic B,C, or B/D hepatitis
What color stool will you often see in patients with hepatitis?
Tan/gray color
What would be the following tell you about hepatitis B? HBsAg(-), HBcAB (+), HBsAB(IgG)(+)
Immune due to previous infection
What would the following tell you about hepatitis B? HBsAg (-), HBcAB (-), HBsAB (IgG) (+)
Immune due to vaccination
What would the following tell you about hepatitis B? HBsAg (-), HBcAB (-), HBsAB (IgG) (-)
Suceptible to infection
What would the following tell you about hepatitis B? HBsAg (+), HBeAg(+), HBcAB (+), HBsAB (IgG) (-), HBeAB (-)
Chronic Hepatitis B
What would the following tell you about hepatitis B? HBsAg (+), HBeAg (+), HBcAB (+), HBsAB (IgG) (-), HBeAB (-)
Acute Hepatitis B
The presence of HBV serological marker indicates convalescence and recovery?
HBeAb(IgG)
What is the schedule of pediatric HBV vaccination?
3 doses: Birth, 1-2 months, 6 months
How is HAV and HEV transmitted?
Fecal-oral
How is HCV and HBV transmitted?
Blood and Bodily Fluids
How is HDV transmitted?
Blood and body fluids concomitant with hepatitis B
What herbs are indicated for hepatitis?
Curcuma longa
Silybum Marianum
Taraxacum officinalis root
Leptnadra virginica
Glycrrhiza glabra
Silybum marianum
Arctium Lappa
Cynara scolymus
What are the predisposing factors for the development of non-alcoholic steatohepatitis (NASH)?
Obesity, DM, Hyperlipidemia
What is the best treatment for NASH?
Weight loss, Tx of DM and hyperlipidemia
What is the term for a stone on the common dile duct?
Choledocholithiasis
What are the predisposing factors for cholelithiaisis?
Fair, fat, female, forty, fertile
Obesity
Rapid Weight Loss
Use of OCP’s or estrogen replacement therapy
Hypertriglyceridemia
What are the symptoms of cholelithiasis?
1) Usually asymptomatic or may present with signs of biliary colic
2) Pain getting progressively worse over 1-5 hours and then remitting
3) N/V is common
4) Intermittent episodes
5) May be aggravated by fatty foods
What diagnostic imaging techniques are used to help diagnose cholelithiasis?
Abdominal ultrasound; biliary tree
What herbs are indicate for cholelithiasis?
Chionanthis virginicus
Collinsonia Canadensis
Curcuma Longa
Mentha piperita
Silybum Marianum
Chelidonium majus- caution
Gentiana lutea- caution
What is the major cause of cholecystitis?
Gallstone obstructing cystic duct
What are the signs and symptoms of cholecystitis?
Biliary colic
Vomiting
Severe constant epigastric RUQ pain longer than 6 hours , anorexia, nausea, low grade fever
Murphy sign
Jaundice
Palpable gall bladder
Aggravated by Fatty Foods
What is seen on labs with cholecystitis?
Neutrophilic leukocytosis, left shift ( due to bacterial invasion of gallbladder wall)
Increased WBC
Increase Bilirubin ( indicates stone in bile duct)
Elevates ALT/AST
Elevate ALk phos
How is cholecystitis diagnosed?
Ultrasound (98% sensitive), CT or HIDA scan
What nutrient can be helpful in preventing gallstone formation?
Lecithin
What are the symptoms of appendicitis?
-Persistent, steady, diffuse abdominal pain
-Radiates to RLQ
-Followed by nausea and vomiting
-Mild Fever
-Anorexia
What would you find on PE with appendicitis?
Low grade fever
Rebound tenderness at McBurney’s point
Rosvig’s sign: Pain in RLQ upon palpation of LLQ
Guarding: voluntary and involuntary
Positive Psoas and obturator’s signs
What is a possible complication of appendicitis?
Perforation leading to peritonitis
If appendicitis is suspected, what diagnostic workup is ordered?
CBC with differential, Abdominal CT
Neutrophilic leukocytosis with left shift
Higher leukocyte count with perforation
B-hCG r/o ectopic pregnancy
Abnormal urinalysis: increased protein, hematuria, pyuria
What causes celiac disease?
Inappropriate immune response to gliadin, a component of gluten found in grains (barely, kamut, oat, rye, spelt, wheat)
T cell and IgA mediated response against gluten
Damage to intestinal mucosa via immune response to gliadin
What elements on a chemistry screen and CBC will be affected by celiac disease?
Decreased Hct, Hgb, MCV, hypoalbuminemia, electrolyte imbalances
How does celiac disease affect the instestines?
Flattened jejunal mucosa resulting in defective absorption of fat, protein and carbohydrates, iron, water and fat soluble vitamins.
What are some of the gluten-containing foods?
Wheat, rye, triticale, barely, spelt, kamut. Oats may be tolerated by some but must be cautious for cross contamination
What are the classic symptoms of celiac disease?
Diarrhea (foul, bulky, greasy) , bloating, gas, steatorrhea
Weight loss; anemia
Vitamin/Mineral Deficiency
How is celiac disease diagnosed?
Positive gliadin IgA, IgG (older test, not used much anymore)
Small bowel biopsy, Fecal Fat > 7%, Malabsorption, Bloodwork
Whats in the DDx for celiac disease?
Crohn’s Disease
Ulcerative Colitis
Giardiasis
Lactose Intolerance
Irritable Bowel Disease
What are the clinical findings of fecal impaction?
Rectal pain, tenesmus, repeated attempts to defecate, abdominal cramps, serous fluid may flow around mass, palpable lump on digital exam
What is an outpouching of the colonic mucosa called?
Diverticulosis
What can predispose to diverticulosis?
Low-fiber diet
Constipation
What are the common signs and symptoms of diverticulosis?
-Usually asymptomatic
-Episodic LLQ abdominal pain, bloating flatulence, constipation, diarrhea
-Normal temperature
-Poorly localized LLQ tenderness
Palpable inflammatory mass
How is diverticulosis diagnosed?
Sigmoidoscopy
Would a sigmoidoscopy be performed during an acute attack of diverticulitis?
No, its contraindicated
What dietary advice would you give someone in the acute phase of diverticulosis?
High Fiber diet to prevent constipation
Bowel Rest
Liquid Diet
Hydration
Would you approve colon hydrotherpy in a patient with diverticulosis?
Yes
What is seen on colonoscopy with ulcerative colitis (UC)?
Pseudopolyps and ulceration in the colon, limited to the mucosa
UC: inflammation from rectum to cecum of large intestine
What are the local GI symptoms of UC?
Recurrent left-sided abdominal cramping with *bloody diarrhea and *mucus
Pre-defecatory urgency
Fever, tenesmus, weight loss, fatigue
What are some of the extra-intestinal symptoms of UC?
General: weight loss, fever, nutrient deficiencies
Ankylosing spondylitis: migratory arthritis
Skin: Erythema nodosum
Primary sclerosing cholangitis
Ocular: episcleritis, uveitis, iritis, conjunctivitis
What is seen on barium enema with UC?
“Lead pipe sign” on X-ray
What lab antibody test is more specific for ulcerative colitis over chron’s disease?
P-ANCA
Is colon hydrotherapy indicated for inactive UC?
Yes, but not while active
What are the signs and symptoms of Chron’s disease?
Chronic intermittent diarrhea, usually not bloody
Abdominal pain on right side
Anorexia
RLQ mass or fullness
Systemic: Fever, fatigue, lethargy, weight loss
Apthous ulcers in mouth
What is seen on colonoscopy in Chron’s Disease?
Cobblestone appearance
Skip lesions
Spares the rectum
Narrowing/Strictures
Perianal involvement
Where does the Crohn’s disease most often occur ?
Most common location: Ileum and ascending colon
What is the gold standard method of diagnosing Crohn’s Disease?
Biopsy of small ileun
Endoscopy with biopsy to visualize and diagnose; Barium studies, CT of ABD show cobblestone appearance
What amino acid is indicated for both Crohn’s and UC?
Glutamine
What does an elevated C-reactive protein indicate?
Can be used to r/o diagnosis and monitor tx response
1) Inflammatory Disease (non-specific)
2)Autoimmune Disease
3) Inflammatory Bowel Disease
4) PID
What is the main complication that arises from inguinal and umbilical hernias?
Incarceration and strangulation
What are the cause of adynamic ileus?
Recent abdominal surgery is main cause
Peritoneal infections
Drug side effect: especially opiates
What is seen on x-ray with adynamic ileus?
Copious gas dilation of the small intestine and colon
What are the signs and symptoms of adynamic ileus?
Abdominal distention
Mild Abdominal pain
N/V possible
Anorexia
What condition usually occurs with Meckel’s diverticulum?
Gastrointestinal Bleeding
Meckel’s Diverticulum vestigial remnant of the omphalomesenteric (vitellointestinal duct)
Mnemonic: 2 inches long, 2 feet from ileocecal valve, 2% of population, 2% symptomatic
What constitutes an external hemorrhoid?
Below the dentate line, inferior hemorrhoidal veins, systemic circulation
What constitutes an internal hemorrhoid?
Above the dentate line, superior hemorrhoidal veins, portal circulation
What are the most common food intolerance’s?
Gluten
Dairy (casein)
Soy
Corn
Eggs
Nuts
Gastric acid assists in the absorption of which nutrients?
Calcium, iron, and vitamin B12
What are common symptoms of intestinal dysbiosis?
Bloating
Flatulence
Abdominal Discomfort
Diarrhea
Vitamin Deficiencies
What are the signs and symptoms of irritable bowel syndrome?
Constipation alternating with diarrhea, usually one will predominate
Urgency at stool
Exacerbated by stress
Increase Mucus
Gas and bloating
Abdominal tenderness usually localized to LLQ
What is seen on colonoscopy with IBS?
Colonoscopy is normal
How is IBS diagnosed?
Diagnosed by exclusion; Rome III Criteria for Diagnosing
12 weeks in 12 months of ABD pain, you have 2 out of 3:
-relieved with defecation
-frequency stool
-change in appearance
What is the DDx for IBS?
1) Food allergy or intolerance (celiac disease, gluten intolerance, lactase intolerance)
2) Crohn’s disease or ulcerative colitis
3) Diverticulitis
4) Gastroenteritis: viral, bacterial, fungal, parasitic
5) Small bowel intestinal overgrowth
6) Colorectal malignancy
7) Gardia
What specific diet could be prescribed for IBS?
Low sugar, avoidance of dairy and gluten, consider SIBO diets
What dietary advice would you give someone in the acute phase of IBS?
Avoid common food allergens
What amino acids are indicated for IBS?
Gutamine
What are the most common causes for bacterial gastroenteritis?
Salmonella, Shigella, E.coli and Campylobacter
How is bacterial gastroenteritis transmitted?
Fecal-oral route, food and water borne
What are the common symptoms of bacterial gastroenteritis?
Acute Diarrhea, usually contain blood or pus
2) Cramping abdominal pain
3) Fever
What is the usual presentation for viral gastroenteritis?
Short prodrome followed by mild fever and vomiting, followed by 1-4 days of non-bloody watery diarrhea
What is the incubation period for giardia?
1-3 weeks
What are the symptoms of gardiasis?
Gradual onset of nausea, epigastric pain, abdominal cramps, bloating and flatus
Frequent explosive, non-bloody, watery stools
What drug is used to treat giardiasis?
Metronidazole
What is the most important consideration in a patient with acute infectious diarrhea?
Dehydration
