Gastroenterology Flashcards
Duodenal ulcer vs. Gastric ulcer
Which improves with food?
Gastric ulcer -> worsens with food
Duodenal ulcer -> improves with food
Major causes for duodenal ulcers include:
1.
2.
- Helicobacter pylori
2. NSAID drugs
Treatment:
H. Pylori
- Acid suppression (omperazole, pantoprazole)
- Antibiotics (amoxicillin, clarithromycin)
- Vagotomy: reserved for refractory cases
What are the hallmarks of secretory diarrhea?
- Large daily stools >1L/day
- Diarrhea occurring during fasting or sleep
- Reduced stool osmotic gap
How do you calculate the stool osmotic gap (SOG)?
SOG= plasma osmolality - 2 x (stool sodium + stool potassium
Use this to distinguish osmotic from secretory diarrhea.
What are the hallmarks of osmotic diarrhea?
- Elevated osmotic gap (SOG >125 mOsm/kg)
What is the main difference between osmotic and secretory diarrhea?
Osmotic diarrhea= high SOG; >125 mOsm/kg
Secretory diarrhea= low SOG; <50 mOsm/kg
Signs and symptoms:
Inflammatory diarrhea
- Grossly bloody stools, or positive FOBT
- Fatigue
- Fever
Signs and symptoms:
Intestinal dysmotility (i.e. psuedo-obstruction, IBS)
- Fatigue
- Nausea
- Vomiting
How does factitious diarrhea affect the stool osmolality gap (SOG)?
It can either be elevated (eg, lactulose) or decreased (eg, sulfate-containing laxatives)
Diagnosis:
- Chronic dysphagia to solids and liquids
- Regurgitation
- Difficulty belching
- Heartburn
- Weight loss
Achalasia
Pathophysiology:
Achalasia
- Impaired peristalsis of the distal esophagus
2. Failure of the lower esophageal sphincter to relax when a food bolus reaches it
What is the key diagnostic tool use to diagnose Achalasia?
Manometry:
- Increased LES resting pressure
- Incomplete LES relaxation
- Decreased peristalsis of the distal esophagus
- Also, Barium Esophagram:
1. Bird beak narrowing at gastroesophageal junction*
Management:
Achalasia
- Upper endoscopy to rule out malignancy
- Definitive TX: laparoscopic myotomy or pneumatic balloon dilation
- Temporary TX: Botulinum toxin injection, CCB, nitrates
Who is most likely to develop acute acalculous cholecystitis?
Hospitalized and critically ill patients
What are the risk factors for developing acalculous cholecystitis?
- Severe trauma or recent surgery
- Prolonged fasting or TPN
- Critical illness (sepsis, ICU)
Signs and symptoms:
Acalculous cholecystitis
- Fever
- Leukocytosis
- Increased LFTs
- RUQ pain
* Less common: Jaundice & RUQ pain*
Diagnose:
Acalculous cholecystitis
- Abdominal ultrasound
- HIDA (if needed)
- CT (if needed)
Signs and symptoms:
Crohn Disease
GI:
- Abdominal pain
- Nonbloody diarrhea
- Oral ulcers
- Weight loss
- Malabsorption
- Fistula/abscess formation
Extraintestinal:
- Arthritis
- Uveitis
- Scleritis
- Episcleritis
- Erythema nodosum
- Pyoderma gangrenosum
Diagnosis:
Crohn Disease with
- Blood labs:
- Endoscopy:
- Radiography:
- Leukocytosis, iron deficiency anemia, increased inflammatory markers
- Focal ulcerations next to normal mucosa (cobblestoning) and skip areas of disease
- Strictures, bowel wall thickening
Treatment:
Crohn Disease
- 5-ASA
- Corticosteroids
- Antibiotics
- Azathioprine
- Anti-TNF
How can you differentiate IBS from Crohn Disease?
IBS is NOT associated with weight loss, anemia, leukocytosis, or elevated inflammatory markers
Crohn disease vs. Ulcerative colitis
Which presents with bloody stools?
Ulcerative colitis
Crohn Disease vs. Ulcerative colitis
Which is associated with oral lesions
Crohn Disease
What is Boerhaave Syndrome?
Spontaneous rupture of the esophagus
MA: severe retching and vomiting
Diagnose:
Boerhaave Syndrome on CXR
- Pneumomediastinum
- Pleural effusion
- Subcutaneous emphysema
- Widened mediastinum
- Pneumothorax (sometimes)
Diagnose:
Pleural fluid from a suspected Boerhaave effusion
- Exudative, low pH
2. Very high amylase content: from saliva in esophagus
How do you confirm the diagnosis of suspected Boerhaave syndrome?
- CT w/ gastrogaffin
2. Contrast esophagography w/ gastrogaffin
