gastro Flashcards
crackling with every heartbeat. Nombre del signo y que significant?
Hamman sign
indicating mediastinal emphysema
Couvosier sign que es y que indica?
painless obstructive jaundice+palpable, nontender gallbladder
Indica:
obstructive pancreatic, periampullary, or biliary malignancy until proven otherwise.
Baby >2 weeks of age+jaundice+ direct hiperbilirrubinemia +hepatomegalia
que diagnostico y como se diagnostica y tx?
Biliary atresia
Intraoperative cholangiography
tx: Kasai procedure, which attaches the distal duodenum to the liver
Murphy sign + dx?
colecistitis aguda
factores de riesgo: female, fat, forty, fertile (multipara)
masa debajo de linea dentada de canal anal? dx y tx?
carcinoma celulas escamosas
tx: radioquimioterapia
pruritus + bile acids increased
dx and tx?
colestasis of pregnancy
elevated bile acid (the most sensitive and specific measure of intrahepatic cholestasis of pregnancy)
tx: ursodeoxycholic acid
What is the likely diagnosis in an insulin-dependent patient with diabetes with anorexia, nausea/vomiting, early satiety, and post-prandial hypoglycemia without heartburn or epigastric pain?
Diabetic gastroparesis
Pneumatosis intestinalis
dx?
necrotizing enterocolitis
Chrons disease histology+colonoscopia?
q tipo de diarrea
Histologia
-transmural inflammation
-non caseating granuloma
Colonoscopia:
skips lesions > cobblestone mucosa + creeping fat
Watery diarrhea
ulcerative colitis histologia? que tipo de diarrea?
inflammation only in mucosa
crypt abscess
bloody diarrea
saccular or fusiform dilations of the biliary tree or as dilated masses that communicate with the biliary tree +palpable right upper quadrant mass
dx? poblacion a la q se asocia?
biliary cyst
associated to asian descent
watery diarrhea+hipokalemia+acloridia dx?
VIPoma
causes of acute pancreatitis?
I GET SMASHED
Idipathic
Gallstones
Ethanol
Trauma
Scorpion sting
Mumps (paperas)
Autoimmune
Steroids
Hipertrigliceridemia / hipercalcemia
ERPC (Colangiopancreatografía retrógrada endoscópica)
Drugs
acute mesenteric ischemia
pain out of proportion to physical findings
risk factores for thromboembolism (atrial fibrillation..)
Elevated LDH
name most common complication of chronic untreated reflux esophagitis?
name most severe complication of chronic reflux esophagitis?
most COMMON: esophageal stricture
most severe: adenocarcinoma of esofago (<1% lo desarrolla)
esofagitis eosinofilica
sintomas y findings en endoscopia?
Sintomas:
- disfagia para solidos
-food impactation
-persona atopica
endoscopia:
Circumferential mucosal lesions+ Longitudinal furrows
treatment for chronic hepatitis C infection of genotypes 1, 4, 5, 6?
Sofosbuvir + Ledipasvir (genotipos 1, 4, 5, 6)
Sofosbuvir + velpatasvir (all 6 genotypes)
Glecaprevir + pibrentasvir (all 6 genotypes)
soto lina, soto valeria, gleca pribre
Acute and chronic HCV are treated with the same antiviral regimens.
Administer hepatitis A and B vaccines (prevent further liver damage)
lesiones lineares en colonoscopia + inclusiones en biopsia
hiv+
dx?
citomegalovirus colitis
tx: foscarnet, ganciclovir, and cidofovir.
PAS-positive foamy macrophages. Dx? Tx?
Whipples disease
tx: Ceftriaxona IV 2 semanas + TMP SMX 1 año VO
floating, fatty, foul-smelling steatorrhea. Parasito? tx?
giardia lambia
tx: tinidazole
White plaques on oral mucosa that CAN scraped off. dx?
candidiasis
may bleed when scraped off
White plaques on oral mucosa that CANT scraped off.
leukoplakia
nombra las hiperbilirrubinemias hereditarias que presentan elevaciones en indirect bilirrubin
Gilbert sd:
^indirect bilirrubin <3mg. transient neonatal jaudince
worse during fasting/stress
AST, ALT, and GGT values are normal.
Crigler-Najjar sd:
tipo 1: persistent neonaal jaudice ^ indirectament bilirrubin (20-50)
tipo 2: ^indirecr bilirrubina <20
tx fenobarbital
nombra las hiperbilirrubinemias hereditarias que presentan elevaciones en direct bilirrubin
Dubin Johnson: worse during contraception/pregnancy
Rotor sd
increased urinary coproporphyrin and normal liver histology on biopsy.
serologia en celiac disease?
IgA tissue transglutaminase antibody
^ α-fetoprotein + oligohydramnios + embarazada
gastrosquisis
fetal ultrasound will show free-floating bowel without a membranous sac
^α-fetoprotein + abdominal mass
hepatocellular carcinoma
occur due to failure of >lateral< fold closure of the anterior abdominal wall en bb
gastronquisis (protrusion of the abdominal contents NOT covered with peritoneum). no cromosomal association
onfalocele (protrusion of the abdominal contents covered with peritoneum). commonly associated with other congenital diseases, including trisomy 13, trisomy 18, and Beckwith-Wiedemann syndrome,
gastritis + enlargement of the mucosal folds
dx?
Menetrier disease: prominent gastric rugae + atrophic parietal cells + gastritis sx
-massive enlargement of the mucosal folds
-Increased mucus production → loss of protein → hypoalbuminemia and peripheral edema
-Atrophy of parietal cells → decreased gastric acid production
-Hyperplasia of gastric rugae
peptic ulcers: gastric vs duodenal. como les afecta la comida?
gastric empeora con comida y duodenal mejora
pain is Greater with Gatric
liver biopsy: balloning of hepatocytes + inflammatory infiltrates. dx? labs?
Nonalcoholic steatohepatitis
hydrogen breath test se usa para diagnosticar?
lactose intolerance and SIBO
steatorrhea+pain after meals+chronic alcohol use.
dx? y metodo diagnostico?
pancreatitis cronica
tac con contraste: string-of-beads (areas de estenosis alternadas)
lab that indicates poor prognosis in acute apendicitis
1)Blood urea nitrogen
2) hematocrit
In patients with acute pancreatitis, the release of inflammatory cytokines and vascular injury by pancreatic enzymes leads to vasodilation and increased vascular permeability, which can result in significant third-space fluid loss and hemoconcentration. Patients with significant third-space fluid loss usually have a more severe disease course and a worse prognosis. Blood urea nitrogen (BUN) and hematocrit are indicators of the severity of third-space fluid loss and an increase in these is associated with a poor prognosis. Several scoring systems (e.g., Ranson criteria, BISAP) use these indicators to assess the severity and prognosis of patients with acute pancreatitis.
herpes esofagitis endoscopia findings?
Multiple round/oval well-circumscribed, confluent ulcers in mid-distal esophagus + vesicles
Intranuclear, eosinophilic Cowdry A inclusions
obliteration of the psoas outline on x-ray. dx?
Ileo paralitico
otra cosa en x rays: uniforme distribution of gas
grey turner sign que significa?
indica hemorragia retroperitoneal
usualemnte asociado a pancreatitis
cual es el surveillance de un pt con riesgo de desarrollar carcinoma hepatocelular? y cuando hay sospecha de malignidad?
US cada 6 m + medir alfa-fetoproteina cada 6 meses?
cuando hay sospecha de malignidad?
lesion ≥10 mm o AFP ≥ 20 ng/mL
que metodo se utiliza para evaluar la erradicación de H pylori después de tx? y cuando se hace?
- prueba de aliento de urea
- antigeno en heces
4-6 semanas depsues de terminar el tx
Left lower quadrant pain+fever+older pt.
diagnostico, metodo dx, tx?
diverticulitis
TAC con contraste primer paso
tx: metronidazole+fluoroquinolona // 2-3 gen cefalósporina
diarrea de aspecto grasiento después de tomar de una corriente de agua dx?
giardiasis
tx: tinidazole
clinica de ileo paralitico?
abdomen distendido, timpanico, absent bowel sounds
CHARGE asociation que significa cada letra?
Coloboma
Heart defect,
Atresia of the choanae
Retardation of growth
Genital abnormalities
Ear anomalies.
VACTERL asociacion que significa cada letra?
Vertebral anomaly
Anal atresia
Cardiac anomaly
Tracheoesophageal fistula
Esophageal atresia
Renal anomaly (including agenesis)
Limb malformation
Esophageal atresia with TEF to the distal esophageal segment is the most common type of esophageal atresia, accounting for > 75% of cases. A fetus with esophageal atresia is unable to swallow amniotic fluid, resulting in polyhydramnios, which can lead to premature rupture of membranes and premature labor,
que problema de embriogenesis genera esophageal atresia+tracheoesophageal fistula?
mesodermal differentiation causes Esophageal atresia with TEF
paciente es diagnosticado con cirrosis por alcohol, cuales son los screenings que se deben hacer?
- gastroscopia al momento del dx para evaluar si hay varices esofágicas, dependiendo del riesgo de las varices cada 1-3 anos, si hay varices de alto riesgo (grandes, high wall pressure) se hace profilaxis con B bloq (propanolol o nodolol) o ligacion endoscopica
- cada 6 meses US abdominal+medicion alfa fetoproteina para screen for hepatic carcinoma
- cada 3 meses labs para calcular child pugh: bilirrubina, inr, protrombina, grado de ascitis y encefalopatía
IgA tissue transglutaminase antibody
presente en?
celiac disease
patogeno en travelers diarrhea ? que tipo de diarrea es? tx?
EnteroTOXIGENIC E. coli
watery diarrhea
supportive
paciente que hace semanas tuvo una colecistectomia y semanas después empezo con diarrea acuosa, dx y tx?
Postcholecystectomy diarrhea: type of secretory diarrhea. Because the gall bladder is a reservoir for bile, its removal results in constant drainage of bile acids into the bowel
tx: Bile acid resins (e.g., cholestyramine)
a quien se le hace screening para hepatitis c?
todos los adultos >18 anos por lo menos una vez en la vida
mas frecuente en los pt de alto riesgo:
Injection drug use
HIV infection.
solid-organ transplantation
long-term hemodialysis
adulto mayor con urea breath test positivo y masa CD20+ con infiltracion de linfocitos
dx? tx?
MALT linfoma gastrico asociado a h pylori
tx: Omeprazole, bismuth, tetracycline, and metronidazole x 14 d
Because of the strong association between MALT lymphomas and H. pylori infection, eradication therapy should be performed even if the patient tests negative. In 60–80% of patients with H. pylori-associated gastric MALT lymphoma, eradication therapy results in complete regression of the tumor.
A urea breath test or stool antigen test, as well as an endoscopic biopsy, should be performed three months after therapy to confirm H. pylori eradication and histological response. If there is no or only a partial histological response, radiotherapy or chemotherapy should be initiated
diangostico de pancreatitis aguda? (imagen)
US abdomen porq la caausa #1 de pancreatitis es gallstones
sino queda claro tac con contraste, pero primero us abdomen
nino <2 anos + hematoquecia/melena
diagnostico y dx?
diverticulo de meckel
dx: tecnecio 99 pertecnetato
autoimmune hepatitis anticuerpo?
Anti-smooth muscle antibody
colangitis esclerósante primaria anticuerpos? y complicación?
antimitochondrial antibodies.
complicacion: osteóporosis, hepatocelular carcinoma
cuando se hace proctocolectomia y cuando hemicolectomia?
proctocolectomia se hace si hay cancer colorectal Y colitis ulcerativa
hemicolectomia se hace si le persona tiene solo cancer colorectal
bb <2 meses + ictericia + direct hiperbilirrubinemia + fosfatasa alcalina
biliary atresia
Antiendomysial antibodies
Anti-tissue transglutaminase antibodies
enfermedad?
celiac disease
Anti-Saccharomyces cerevisiae antibodies
enfermedad?
chron disease
epigastric pain that iproves with food
dx? complicaciones?
DUODENAL ulcer
complicaciones:
duodeno anterior: perforación
duodeno posterior: massive bleeding
Succussion splash
early satiety
dx?
gastric outlet obstruction
diarrea no sanguínolenta cronica + colonoscopia normal
dx y metodo dx?
microscopic mucosa
dx: biopsia con infiltrados linfocitos intraepitelial
PAS-positive cytoplasmic granules
dx?
whipples disease
estenosis pilorica cual es el desorden acido base y de electrolitos
alcalosis metabolica
hipocloro
hipokalemia
hiponatremia
Cl, K, Na
ulcera de curling, fisiopatologia y prevención?
fp: decreased gastric blood flow
extensive burns > hipovolemia/hipoperfusion > decreased gastric blood flow > curling ulcer
prevention: proton pump inhibitor in patients with extensive burns to prevent the formation of Curling ulcers.
congenital umbilical hernia
management?
observation because mostly have spontaneous resolution by age 5
Umbilical hernias can be seen in association with Down syndrome
Umbilical hernias are specifically due to a defect in the umbilical ring
periodic acid shift (PAS positive) macrophages in laminate propria
dx and tx?
whipples disease
tx:
ceftrixone iv 2 semanas (tx inicial) + tmp smx vo 1 año (tx mantenimiento)
“abdominal succussion splash” dx? metodo diagnostico?
:abdominal succussion splash puede indicar
- gastric outlet obstruction, dx se hace gastroscopia para ver si hay alguna obstrucción mecanica (/malignididad)
2.gastroparesia diabetica, dx gammagrafía
refractory peptic ulcer disease+multiple ulcerations+steatorrhea (foul-smelling, lightly-colored stools)
dx, a q se asocia este dx?
Zollinger-Ellison syndrome aka gastrinoma
asociado a MEN-1 (adenoma pituitario+hiperpatatiroidismo primario+endocrine pancreatic cancer)
hiperparatiroidismo: PTH incrementada+hipercalcemia
perianal fistula asociado a?
chrons
transmural inflammation leads to fistula into another organs
duodenal atresia que hay en x ray y a que enfermedad en bb se asocia?
Duodenal atresia:
-Double bubble sign in x ray
-Down sd association (25%)
jejunal atresia:
-3 bubble sign
-asociado a cystic fibrosis o mama usando vasoconstrictor (cocaina/MDMA, cigarrillo)
Intestinal atresia of any origin is suggested by a prenatal history of polyhydramnios, resulting from the inability of the fetus to ingest amniotic fluid due to intestinal obstruction.
left lower quadrant pain+hx of constipation in adulto mayor
dx? metodo dx?
diverticulitis
tac con contraste y 6-8 s DESPUES colonoscopia
factores que causan encefalopatia hepatica y tx?
- Gastrointestinal bleeding: provides gut bacteria with nitrogenous compounds (e.g., hemoglobin) that are degraded to ammonia
- hipoKalemia
- hipoNatremia
- Alcalosis metabolica
- infection
- excessive protein consumption
tx: lactulose / rifaximina
zenker diverticulum
dx and tx?
dx: Barium contrast esophagogram
tx: Cricopharyngeal myotomy
enfermedades a las que se asocia la angiodisplasia? dx?
- end stage renal disease
- aortic stenosis
- von willebrand disease
associated to older age >60 y.o
angiografia gold standard dx
se manifiesta como hematoquesia
tx definitivo de isquémia mesenterica aguda?
open embolectomy (si es x trombo)
mesenteric bypass surgery (si es x embolo)
What acid-base disturbance is associated with pyloric stenosis?
Hypokalemic, hypochloremic metabolic alkalosis (ph increased, hco3 increased)
Piloromiotomia es el tx definitivo pero SIEMPRE se corrige hidratacion, electrolito y acido base PRIMERO antes de la cx, sino hay riesgo de apnea postqx
hepatic cyst (hydatid cyst) with or without daughter cysts and eggshell calcification on ultrasonography. etiologia?
Echinococcus granulosus causes echinococcosis,
Any invasive procedure (drainage or surgery) of hydatid cysts should be performed with the utmost care to prevent spillage of cyst contents, which can cause life-threatening anaphylactic shock and/or secondary seeding of infection.
marcador tumoral mas especifico en adenocarcinoma PANCREATICO?
CA19-9
Tmabien se puede mejor CA 125 pero es MENOS especifico
odinofagia, oral pain, HEAVY SALIVATION
con que se enveneno? manejo?
causticos: potassium hydroxyde, drain and toilet cleaners
manejo:
decontamination (removal of clothing), airway management, and fluid resuscitation with upper endoscopy within 12–24 hours of ingestion.
triada de salmonella typhi y tx?
salmonella typhy
salmon rash (rose spots)
hepatomegalia
fiebre
tx
fluoroquinolona
macrolido
3 gen cefalosporina
