Gastro Flashcards
Etiology of Hepatits(4)
Tylenol MC
Drug rxns
Reyes Syndrome
Hep A-E
Hepatitis dx
Elevated ammonia
Elevated PT/INR
Hepatitis sx(4)
Asterixis
Hyperreflexia
Coagulopathy
Jaundice
Hepatits Tx
Encephalopathy -> lactulose
Protein restriction
Definitive = transplant
Hep A sx/labs
Feco-Oral, travel, day care, shellfish
Sx: fever, malaise, arthralgia, URI, ap, jaundice
Labs: IgM HAV ab
SELF LIMITING
Hepatitis E
Feco-oral
Labs IgM anti HEV
NO TXT dangerous if prego
Hep C
IV, 80% develop chronic infection
Acute: HCV RNA
Resolved: -HCV RNA
Chronic: + HCV RNA +Anti HCV
TXT pegylated interferon alpha 2b ribavirin
Hep D
Need Hep B virus in order to get it
Hep B
IV, sex, perinatal
Mostly asx
txt supportive if acute
Alpha interferon 2b if chronic
Infectious Hep B lab
+HBeAg
Hep B acute vs chronic labs
Acute: IgM
Chronic: IgG
Pancreatitis etiology(5)
Gallstones
ETOH
then meds, CA, idiopathic, etc.
Pancreatitis pathology’s
Injury to Acinar cells leads to edema, interstitial hemorrhage, coagulation and necrosis
Pancreatitis Sx
Epigastric pain: constant radiating to back, worse if supine, better with leaning forward or sitting
N/V/F
Pancreatitis PE (what signs are present)
epigastric tenderness, decreased bowel sounds, tachycardia.
Cullens: Periumbilical bruising
Grey Turner: Flank bruising
Pancreatitis Dx
Abd CT = TOC
Abd XR: sentinel loop and cutoff sign of colon, calcifications
Ranson’s Criteria for prognosis
Ransons Criteria on admission
>55yo WBC > 16k BG > 11 Ser LDH >350 Ser AST >250
Pancreatitis Tx(6)
90% recover in 5-7d w/ “rest”
Supportive: NPO, IVF, Meperdine
ABX ONLY IF NECROTIZING
ERCP ONLY IF BILIARY SEPSIS
Stop drinking
Chronic Pancreatitis Etiology
ETOH (70%)
Chronic Pancreatitis Triad
Calcifications, steatorrhea, DM
Chronic Pancreatitis Dx
Abd XR: calcified Pancreas
amylase/lipase usually not elevated
Chronic Pancreatitis management(3)
Oral Panc Enzymes, ETOH rehab, pain control
Anal Abscess w/ MC pathogen
Swelling, pain with sitting, coughing, defecation
Results from bacterial infection
MC S. Aureus, E. Coli
MC in posterior rectal wall
Anal Fistula
Open tract between 2 epithelium
Discharge and pain
I/D and WASH
Anal Fissure sx
Linear tear in distal canal d/t low fiber diet, large hard stools, trauma
Severe rectal pain w/ bright red blood
Anal fissure tx
80% resolve on own
Supportive, warm bath, analgesics, high fiber
2nd line: topical vasodilators, Nitro, Nifedipine
Colorectal CA etiology
3rd MC cause of death
Familial APC gene
Lynch Syndrome: MC cause
Age, UC, smoking, ETOH, AA
Colorectal CA sx
Iron Def Anemia, rectal bleeding, abd pain, change in BM, large bowel obstruction, ascites, abd mass
R: lesions bleed, + diarrhea
L: obstruction, hematochezia
Dx Colorectal CA
Colonoscopy TOC
Barium Enema
Elevated CEA
Colorectal CA tx
Local: surgery
Stage 3+ Chemo
Esophageal CA
MC in upper 1/3: Squamous
- Sm, ETOH, Achalasia, NSAIDS
MC in US: Adenocarcinoma
- young, obese, lower 1/3, GERD –> Barret’s
Esophageal CA sx
Dysphagia, weight loss, chest pain, anorexia, cough, reflux, hematemesis, hypercacemia
Esophageal CA Dx/Tx
Upper endoscopy w/ biopsy
TX: resection, radiation, chemo
Barretts Esophagous
Acquired premalignant condition in patients with chronic GERD
Change associated with intestinal type morphology of mucosa
Gastric CA etiology
MC: Adenocarcinoma
MC in males >40
Risk Factors: H Pylori, salted/cured/pickled foods, ETOH/Sm, Blood type A
Gastric CA sx
Dyspepsia, weight loss, early satiety, iron def anemia
Left supraclavicular/axillary/periumbilical lymph node
Gastric CA Dx/ Tx
Upper edo w/ biopsy
CT chest/abd
LFTs
Tx; gastrectomy, radiation/chemo
BAD PROGNOSIS
Hepatocellular Carcinoma
Risk? (4)
Primary Liver Neoplasm
Rsk: chronic Hep B/C/D cirrhosis
Hepatocellular carcinoma sx/dx/tx
sx: malaise, weight loss, jaundice
dx: US/CT/MRI
Increased alpha fetoprotein (needle biopsy AVOIDED)
Tx: Resection
Celiac Disease Path
small bowel autoimmune 2/2 alpha gliadin to gluten
leads to loss of villi and absorptive area
MC in females
Celiac Disease SX
Diarrhea, steatorrhea, abd pain, distention
Dermatitis Herpetiformis: pruritic, papulovesicular rash on extensor surfaces/neck/scalp
Celiac DX
Endomysial IgA Ab and Transglutaminase Ab
DEFINITIVE: SMALL BOWEL BIOPSY
Celiac TX
Gluten Free Diet
Acute Cholangitis and organisms associated with it
Biliary tract infection 2/2 obstruction
MC d/t gram negative enteric organisms E. Coli, Klebsiella
Acute Cholecystitis etiology
Acute: gall bladder obstruction
Chronic: gall stones
Cholecystitis sx
RUQ/epi pain, continuous
+N
May be precipitated by food
PE: +F, enlarged gallbladder, MURPHYS SIGN, BOAS SIGN: referred pain to right shoulder
Cholecysitis DX/Tx
DX: US, CT scan, HIDA=GOLD STANDARD
Elevated WBCs, Bili, Alk Phos, LFTs
Tx: NPO, IVF, Abx, Cholecystectomy within 72 hours
Chronic Cholecystitis; what will the GB look like
Strawberry gallbladder
Porcelain GB = premalignant
Cholelithiasis
Gallstones in GB
Black: hemolysis or ETOH
Brown: prastatic/bacterial
5 Fs: fat female forty fertile flatulent
Cholelithiasis sx
MC asx
Biliary colic: episodic, abrupt RUQ pain, resolves slowly
Cholelithiasis Dx/Tx
US = TOC
TX:
if asx –> obs and use ursodeoxycholic acid
+ sx –> surgery
Cirrhosis
Mostly irreversible fibrosis with nodular regeneration
Increase in portal pressure
Cirrhosis etiology
ETOH = MC
chronic hep, NAFLD, Hemochromatosis
Cirrhosis Sx (ie. skin manifestations)
Fever, Malaise, Weakness, Weight loss, Cramps
Ascites, Spider angioma, Gynecomastia, Caput medusa
Hepatic encephalopathy, confusion, lethargy, asterixis
Esophageal varices
Portal HTN
Cirrhosis Dx/ Tx
US, liver biopsy
Tx: Lactulose for encephalopathy
Ascites: Na restriction/ diuretics
Pruritis: cholestyramine
UC etiology / marker
Diffuse mucosal inflam in CONTINUOUS pattern
pANCA = marker
UC sx/ features
bloody diarrhea
Diffuse mucosal involvement/ulceration
RARE strictires
COMMON rectal involvement
UC tx
Mesalamine for maintenance
Flare: prednisone
Refractory: methotrexate
Last line: anti-TNF alpha
Cure: surgery Colostomy
Crohn’s Disease etiology
+ marker
Transmural inflammation in DISCONTINUOUS pattern occurring anywhere from mouth to anus
Marker: ASCA
Crohn’s sx/features
RECTUM SPARING, cobblestoning, common strictures
sx: abd pain, mass, obstruction, perianal disease, systemic sx
Crohn’s tx
Flares: steroids
Mild: mesalamine
Moderate: Immunomodulators
Severe: Anti-TNF/Abx
NO CURE
Diverticular Dz Etiology
MC in sigmoid
Weak muscle at vascularture entry point
Diverticula: outpouching due to herniation of mucosa into colon
Diverticula etiology / dx
LACK OF FIBER
CT = TOC
elevated WBCs and Guiac+
Diverticulosis:
MC cause?
Sx?
Tx?
Uninflamed diverticula a/w low fiber diet, obesity, constipation
MC cause of lower GI bleed
Painless rectal bleeding
Tx w/ high fiber diet
Acute diverticulitis
Inlamm response to stool in neck of divertic with bacterial proliferation
Sx: pain, fever, tachycardic, left iliac fossa tenderness, leukocytosis, elevated ESR
TX: bed rest, clear liquid, ABX broad (cipro/ bactrim / flagyl combo)
Chronic Diverticulitis
sx?
Dx?
Tx?
Repeat attacks of inflammation
Irregular bowel habits, passage of mucus
Dx: barium enema
Tx: conservative at first, Resection of affected colon
Hinchey Classificaion
Abscess Calssificaiton I: localized II: pelvic III: purulent peritonitis IV: feculent peritonitis
Up to III you may treat with washout/abx
Esophageal Strictures etiology
Chronic reflux, radiation therapy, eosin esoph
Esophageal Stricture dx/ tx
Barium esophagram,
Tx: Stricture dilation/
Achalasia etiology
Idiopathic proximal loss of plexus
INCREASED LES –> fails to relax
Achalasia sx
dysphagia to solids and liquids, malnutrition, weight loss, dehydration, regug, chest pain, cough
Achalsia Dx/Tx
CXR: air fluid level
Endoscopy: dilated esophagus
Manometry: HIGH resting LES
Barium: birds beak
Tx: botox, nitrates, CCBs, balloon dilation, Hellers operation
Hellers operation
Vertical division of LES muscle
- preserves underlying mucosa
- combine with fundoplication to ppx GERD
Esophageal Web
thin membrane in mid upper esophagus
Plummer Vinson Syndrome: Dysphagia, webs, iron def anemia
Schatski Ring:
what is it?
MCC?
DX?
TX?
Lower esophageal web/constriction @ squamous junction
MC a/w sliding hiatal hernia
dx: barium esophogram
Tx: edoscopic dilation if +sx w/out reflux
Esoph Varices
Gastroesophageal dilation d/t portal HTN
Risk: Cirrhosis MC, portal thrombosis
Varices sx/dx
Upper GI bleed
DX: upper endoscopy: enlarged veins
Varices Tx
Ligation = TOC
Octreotide: RX for acute bleeding
Vasopression, balloon tamponade, surgical decompression
Long term
- BB: propanolol and nadolol
- isosorbide
Esophagitis etiolgoy
MC: GERD
Radiation, meds, infectious
Esophagitis sx/ dx/ tx
Dysphagia/reflux or feeding difficulty in children
Dx: upper endo
Double contrast esophagram
Tx underlying cause
Gastritis etiology
superficial inflammation/irritation of stomach mucosa
H. Pylori = MC
NSAIDS = 2nd MC
Stress, ETOH, refulx, meds, radiation, trauma
Gastritis Sx/ Dx
Epigastric pain, n/v, anorexia, upper GI bleed
DX: endoscopy = GOLD STANDARD
or H. Pylori testing
Gastritis Tx
H. Pylori +
H. Pylori -
+H Pylori: Clarythromycin, Amoxcillin, and PPI
-H Pylori: Acid suppression, PPO, H2 blocker, Antacids
GERD Etiology
Transient relaxation of LES –> reflux –> injury
can present w/ hiatal hernia/ delayed gastric emptying
Complications of GERD
esophagitis, stricture, Barrett’s, adenocarcinoma
GERD Sx/ Dx
Heartburn worse supine, dysphagia, cough at night
ALARM SX: dysphagia, odophagia, weight loss, bleeding
DX: endoscopy
THEN manometry
GOLD STANDARD: 24 hour ambulatory pH monitorig
Hemorrhoids etiology
Engorgement of venous plexus originating from: Superior Hem vein or Infer Hem vein
Risk: increased venous pressure, straining, preg, obesity, cirrhosis
Hemorrhoids classification
I. does not prolapse, may bleed
II. prolapses with straining but spont reduces
II. prolapses with strainign requires manual reduction
IV. Irreducible and may strangulate
Sx of Hemorrhoids
Internal: rectal bleesing, hematochezia, rectal itching, mucus, pain
External: perianal, worse with defecation, tender mass, skin tags, thrombosisd/t cough/lifting
Hemorrhoid Dx/Tx
Visual inspection, DRE, Fecul occult test
Tx: high fiber diet, increased fluids, sitz bath, topical corticosteroid
Procedures: rubber band ligation
Hiatal Hernia Type I
“Sliding” MC
GE junction and stomach slide into mediastinum
tx is similar to GERD
Hiatal Hernia Type II
“Rolling” paraesophageal
Fundus of stomach protrudes through diaphragm
Surgical repair to avoid complications
Gastroenteritis Sx
CAUSES MC:
DIARRHEA AND VOMITING
MC: Norovirus, rotavirus
rapid onset, lasts less than 1 week
Non viral etiologies: persistent fever, dehydration, blood/pus in stool
Gastroenteritis Dx
Self limiting, tx sx, stay hydrated
IBS Etiology
Chronic funcitonal disorder
Abd pain a/w altered defecation. Pain relieved with defecation
Abn motility
Visceral hypersensitivity
Psychosocial interactions
IBS Dx
ROME IV CRITERIA
- recurrent abd pain at least 1day/week in the last 3 months a/w:
- defecation
- change in stool frequency
- stool form
IBS Tx
Lifestyle changes: smoking cessation, diet, sleep. exercise
Dicyclomine: antidiarrheal
Constipation: bulk laxatives
TCA amitriptyline for intractable pain
Mallory Weiss Tear Etiology
UGI bleed from longitudinal mucosal laceration of GE junction
Sudden rise in pressure or gastric prolapse
PERSISTENT vomiting after ETOH or Bulimia
Mallory Weiss Tear Sx/Dx/Tx
Retching/vomiting followed by hematemesis
Dx: upper endoscopy TOC
Tx: supportive, if severe then EPI injection/ligation/clipping
