Gastroenterology and Nutrition Flashcards
1
Q
What is pancreatitis?
A
inflammation of the pancreas
-it happens when digestive enzymes start digesting the pancreas itself
2
Q
What are the causes of pancreatitis?
A
- pancreatitis may start suddenly and last for days, or it can occur over many years
- symptoms include upper abdominal pain radiating to the back, nausea, and vomiting
- it has many causes, including gallstones and chronic, heavy alcohol use
- the mnemonic GET SMASHED is useful in recalling the most common causes: Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune disease, Scorpion sting, Hypercalcemia, Hyperlipidemia, ERCP, and Drugs
3
Q
How is pancreatitis dx?
A
clinical and elevated lipase and amylase
- abdominal CT is the diagnostic test of choice - required to differentiate from necrotic pancreatitis
- ERCP is the most sensitive for chronic pancreatitis
4
Q
What are the signs of pancreatitis?
A
Grey Turner’s sign (flank bruising), Cullen’s sign (bruising near umbilicus)
5
Q
What is Ranson’s criteria for poor prognosis?
A
At admit: -age >55 -leukocyte: > 16,000 -glucose > 200 -LDH >350 -AST >250 At 48 hrs: -arterial PO2 <60 -HCO3 <20 -Calcium <8.0 -BUN increase by 1.8+ -Hematocrit decrease by 10% -Fluid sequestration >6 L
6
Q
What is the tx of pancreatitis?
A
IV fluids (best), analgesics, bowel rest -complication: pancreatic pseudocyst (a circumscribed collection of fluid rich in pancreatic enzymes, blood, and necrotic tissue)
7
Q
What is chronic pancreatitis?
A
the classic triad of pancreatic calcification (plain abdominal x-ray), steatorrhea (high fecal fat), and diabetes mellitus
- alcohol abuse
- treatment: no alcohol, low-fat diet
8
Q
What is an anorectal fistula?
A
an open tract between two epithelium-lines areas and is associated with deeper anorectal abscesses
-fistulae will produce anal discharge and pain when the tract becomes occluded
9
Q
How is anorectal fistula tx?
A
must be treated surgically
10
Q
What is an anal fissure?
A
tearing rectal pain bleeding which occurs with or shortly after defecation, bright red blood on toilet paper
- superficial laceration (paper cut like)
- pain lasts for several hours and subsides until the next bowel movement
11
Q
What is the tx for anal fissure?
A
- sitz baths, increase dietary fiber, and water intake, stool softeners or laxatives
- usually heals in 6 weeks
- botulinum toxin A injection (if failed conservative treatment)
12
Q
What is anorectal cancer?
A
rectal bleeding + tenesmus ( a feeling of incomplete emptying after a bowel movement), the most common anorectal cancer is adenocarcinoma
- primarily adenocarcinomas
- typically colonoscopy is done: whenever rectal bleeding occurs, even in patients with obvious hemorrhoids or known diverticular disease, coexisting cancer must be ruled out
- treated with wide local surgical excision, radiation with chemotherapy for large tumors with metastases
13
Q
What is colon cancer?
A
painless rectal bleeding and a change in bowel habits in a patient 50-80 years of age
-apple core lesion on barium enema, adenoma most common type
14
Q
What are the screening recommendations for colonscopy?
A
begins at 50 then every 10 years until 75
- fecal occult blood testing - annually after age 50
- flexible sigmoidoscopy - every 5 years with FOB testing
- colonoscopy - every 10 years
- CT colonography - every 5 years
15
Q
What are the tumor marker for colon cancer?
A
CEA
- more likely to be malignant: sessile, > 1 cm, villous
- less likely to be malignant: pedunculated, < 1 cm, tubular
16
Q
What is the tx for colon cancer?
A
resect tumors and adjuvant chemotherapy
17
Q
What is esophageal neoplasms?
A
progressive dysphagia to solid foods along with weight loss, reflux, and hematemesis
-squamous cell m/c worldwide and adenocarcinoma common in the US
18
Q
What is an adenocarcinoma?
A
complication of Barrett’s esophagus (screen Barrett’s patients every 3-5 years with endoscopy), affects distal (lower) 1/3rd of the esophagus
19
Q
What is squamous cell?
A
- associated with smoking and alcohol use
- affects proximal (upper) 2/3rds of the esophagus
- progressive dysphagia, weight loss, hoarseness
- diagnostic studies: endoscopy + biopsy
- treatment: resection
20
Q
What are gastric neoplasms?
A
abdominal pain and unexplained weight loss are most common symptoms along with reduced appetite, anorexia, dyspepsia, early satiety, nausea and vomiting, anemia, melena, guaiac-positive stool
- gastric adenocarcinoma in most cases worldwide
- Virchow’s node (supraclavicular)
- Sister Mary Joseph’s node (umbilical)
21
Q
How are gastric neoplasms dx?
A
upper endoscopy with biopsy; linitis plastica - diffuse thickening of stomach wall d/t cancer infiltration (worst type)
22
Q
What is the tx of gastric neoplasms?
A
gastrectomy, XRT, chemo; poor prognosis
23
Q
What is celiac disease?
A
small bowel inflammation from an allergy to gluten
- symptoms usually occur following the ingestion of gluten-containing food, also has extraintestinal manifestations
- diarrhea, steatorrhea, flatulence, weight loss, weakness, and abdominal distention
- associated with dermatitis herpetiformis (chronic, itchy skin rash on elbow, knees, butt, scalp)
- associated conditions: T1DM, autoimmune hepatitis, autoimmune thyroid DZ, down, turner, williams syndrome, increased incidence of small bowel lymphoma
24
Q
How is celiac disease dx?
A
- IgA anti-endomysial (EMA) and anti-tissue transglutaminase (anti-TTG) antibodies
- small bowel biopsy (duodenum) is the gold standard
25
What is the tx for celiac disease?
lifelong gluten-free diet
26
What is cholangitis?
an infection of biliary tract secondary to obstruction, which leads to biliary stasis and bacterial overgrowth
27
What are the characteristics of cholangitis?
- characterized by pain in upper-right quadrant of the abdomen, fever, and jaundice
- choledocholithiasis accounts for 60% of cases
- other causes include pancreatic and biliary neoplasm, postoperative strictures, invasive procedures such as ERCP or PTC, and choledochal cysts
- organisms: E.coli, enterococcus, kiebsiella, enterobacter
28
What is the presentation of cholangitis?
- Charcot's triad: RUQ tenderness, jaundice, fever
| - Reynold's pentad: Charcot's triad + altered mental status and hypotension
29
What are the diagnostic studies for cholangitis?
- initial imaging: ultrasound
| - best: ERCP
30
What is the tx for cholangitis?
Cholangitis is potentially life-threatening and requires emergency treatment
- aggressive care and emergent removal of stones, Cipro + metronidazole
- antibiotics, fluids, and analgesia
- ENCP to remove stones, insert a stent, repair the sphincter
- cholecystectomy (performed post-acute)
31
What is primary sclerosing cholangitis?
- jaundice and pruritus
| - associated with IBD, cholangiocarcinoma, pancreatic cancer, colorectal cancer
32
What is cholecystitis?
inflammation of the gallbladder; usually associated with gallstones
33
What is the presentation of cholecystitis?
- 5 Fs: female, fat, forty, fertile, fair
- (+) Murphy's sign (RUQ pain with GB palpation on inspiration)
- RUQ pain after a high-fat meal
- low-grade fever, leukocytosis, jaundice
34
How is cholecystitis dx?
- ultrasound is the preferred initial imaging - gallbladder wall > 3 mm, pericholecystic fluid, gallstones
- HIDA is the best test (gold standard) - when ultrasound is inconclusive
- CT scan - alternative, more sensitive for perforation, abscess, pancreatitis
- labs: increased ALK phos and increased GGT, increased conjugated bilirubin
- porcelain gallbladder = chronic cholecystitis
- choledocholithiasis = stones in common bile duct - diagnosed with ERCP (gold standard)
35
What is the tx for cholecystitis?
cholecystectomy (first 24-48 hours)
36
What is cholelithiasis?
a precursor to cholecystitis - stones in the gallbladder, pain secondary to contraction of gall against the obstructed cystic duct
37
What are the characteristics of cholelithiasis?
- asymptomatic (most), symptoms only last few hours
- biliary colic - RUQ pain or epigastric
- pain after eating and at night
- Boas sign - referred right subscapular pain
- RUQ ultrasound - high sensitivity and specificity if > 2mm, CT scan and MRI
38
What is the tx for cholelithiasis?
asymptomatic - no treatment necessary
| -elective cholecystectomy for recurrent bouts
39
What is cirrhosis?
a chronic liver disease characterized by fibrosis, disruption of the liver architecture, and widespread nodules in the liver
40
What are the characteristics of cirrhosis?
- the most common cause is alcoholic liver disease
- second most common cause: hepatitis B and C infections
- labs: typically AST > ALT
- increase risk for hepatocellular carcinoma - 10-25% of patients with cirrhosis - monitor AFP
- hepatic vein thrombosis (Budd Chiari Syndrome): a triad of abdominal pain, ascites, and hepatomegaly
41
What are the causes of distortion of liver anatomy?
- portal HTN: decreased blood flow through the liver - hypertension in portal circulation; causes ascites, peripheral edema, splenomegaly, varicosity of veins
- ascites - accumulation of fluid in the peritoneal cavity due to portal HTN and hypoalbuminemia
- the most common complication of cirrhosis
- abdominal distension, shifting fluid dullness, fluid wave
- abdominal ultrasound, diagnostic paracentesis - measure serum albumin gradient
- salt restriction and diuretics (furosemide and spironolactone)
- paracentesis if tense ascites, SOB, or early satiety
- esophageal variceal rupture - dilated submucosal veins, retching or dyspepsia, hypovolemia, hypotension, and tachycardia
- hepatorenal syndrome: progressive renal failure in ESLD, secondary to renal hypoperfusion from vasoconstriction - azotemia (elevated BUN), oliguria (low urine output, and hypotension
- hepatic encephalopathy: ammonia accumulates and reaches the brain causing decreased mental function, confusion, poor concentration
- asterixis (flapping tremor) - have patient flex hands
- dysarthria, delirium, and coma
- hepatocellular failure - decreases albumin synthesis and clotting factor synthesis
- prolonged PT - PTT in severe disease - tx with fresh frozen plasma
42
What is the presentation of cirrhosis?
- ascites, pulmonary edema/effusion, esophageal varices, Terry's nails (white nail beds)
- skin changes: spider angiomata, palmar erythema, jaundice, scleral icterus, ecchymoses, caput medusae, hyperpigmentation
43
What is the tx of cirrhosis?(3)
avoid alcohol, restrict salt, transplant
- monitoring: periodic lab values every 3-4 months (CBC, renal function, electrolytes, LFT, coagulation panel), perform endoscopy for varices
- abdominal ultrasound every 6-12 months to screen for hepatocellular carcinoma
- CT-guided biopsy for hepatocellular carcinoma
44
What is Crohn disease?
an inflammatory bowel disease (IBD) that causes chronic inflammation of the gastrointestinal tract from mouth to anus
45
What is the etiology of Crohn disease?
idiopathic (most likely immune reaction to GI tract flora); MC in Caucasians 15-35 y
46
How does Crohn disease present?
abdominal pain, weight loss, diarrhea, and oral mucosal aphthous ulcers
-longer standing disease may have severe anemia, polyarthralgia, and fatigue
47
What is the most common site of Crohn disease?
terminal ileum
48
What is the distribution from mouth to anus for Crohn disease?
mouth to anus and will commonly present with thickened bowel wall, cobblestone and "skip" lesions
- linear fissures and cobblestone appearance
- tends to be transmural while UC is limited to the mucosa and submucosa
- complications include stricture identified by a STRING sign on barium study
- obstruction, abscess, fistula, and sinus tracts are common
- 1-3% cancer risk (low)
49
How is Crohn disease dx?
the diagnosis of Crohn's disease can sometimes be challenging, and a number of tests are often required to assist in making the diagnosis
- even with a full battery of tests, it may not be possible to diagnose Crohn's with complete certainty
- rectal exam, stool exam, and culture, CBC, electrolytes, TSH, CT-abdomen
- Upper GI series with small bowel follow-through
- increased ESR, anemia, nutritional and electrolyte imbalance during exacerbation
- colonoscopy is most valuable tool for establishing diagnosis/determining extent/guiding treatment
- colonoscopy is approximately 70% effective in diagnosing the disease, with further tests being less effective
- a biopsy will show involvement of the entire bowel wall; granulomas are frequent
- + anti-saccharomyces cerevisiae antibodies (ASCA) and perinuclear antineutrophil cytoplasmic antibody may distinguish Crohn and UC
50
What is the tx for Crohn's disease?
- elemental diet
- Crohn's: supplement with vitamin B12, folic acid, vitamin D
- smoking cessation
- surgery not curative in Crohn's; curative in UC
- aminosalicylates (sulfasalazine, mesalamine) = corticosteroids = immune modifying agents
- 5-aminosalicylates: anti-inflammatory agents; good for flares and remission
- oral meslamine: especially active in terminal small bowel and colon; long-acting works throughout entire small intestine and colon; best for maintenance
- topical mesalamine: rectal suppositories and enemas: topical treatment is effective in the distal colon
- sulfasalazine: works primarily in the colon; s/e: higher side effect profile with sulfasalazine (hepatitis, pancreatitis, allergic reaction, fever, rash); give folic acid with sulfasalazine
- corticosteroids: rapid-acting anti-inflammatory drugs used for acute flares only = oral and topical; long term risk = osteoporosis, increased infections, weight gain, edema, cataracts
- immune modifying drugs: 6-mercaptopurine, azathioprine, and methotrexate = steroid-sparing
- anti-TNF drugs: inhibits proinflammatory cytokines (-mab)
- initial treatment for uncomplicated Crohn's disease is immunosuppressant therapy
- if this is not effective, surgery may be required, especially for complications of perforation, hemorrhage, and toxic colitis
- the distinction between Crohn's disease and ulcerative colitis is important as chronic treatment approaches vary
- avoidance of surgery is desired in patients with Crohn's disease due to the natural history of recurrence
- indications for surgery in both Crohn's disease and ulcerative colitis include intractable or fulminant disease, massive hemorrhage, colonic obstruction, cancer prophylaxis, colon dysplasia, or cancer
- indications for surgery specific to ulcerative colitis include toxic megacolon, colonic perforation, or extracolonic disease
- indications for surgery specific to Crohn's disease include stricture and obstruction, refractory fistula, abscess, or perianal disease unresponsive to medical therapy
51
What is diverticular disease?
inflammation of an abnormal pouch (diverticulum) in the intestinal wall, usually found in the large intestine
- the presence of the pouches themselves is called diverticulosis
- when they become inflamed, the condition is known as diverticulitis
- left-sided appy
- most common locations: sigmoid colon
- fever/chills/nausea/vomiting/left-sided abdominal pain
52
How is diverticular disease dx?
abdominal/pelvic CT scan revealing fat stranding and bowel wall thickening
-the most common location cause of massive lower gastrointestinal bleeding
53
What is the tx for diverticular disease?
ciprofloxacin or augmentin/ + metronidazole (Flagyl)
- recurrent attacks or the presence of perforation, fistula or abscess require surgical removal of the involved portion of the colon
- treat by increasing the bulk in the diet with high-fiber foods and bulk additives such as Metamucil
54
What are esophageal strictures?
solid food dysphagia in a patient with a history of GERD
- esophageal web: thin membranes in the mid-upper esophagus
- may be congenital or acquired
- plummer-vinson: esophageal webs + dysphagia + iron deficiency anemia
- A schatzki ring is a diaphragm-like mucosal ring that forms at the esophagogastric junction (the B ring)
- if the lumen of this ring becomes too small, symptoms occur
55
How are esophageal strictures dx?
barium swallow
56
How do you tx esophageal strictures?
endoscopic dilation
57
What are esophageal varices?
dilated veins in the distal esophagus or proximal stomach caused by elevated pressure in the portal venous system, typically from cirrhosis
58
How do esophageal varices present?
often asymptomatic until hematemesis
59
What is the etiology of esophageal varices?
portal hypertension (from cirrhosis), Budd-Chiari syndrome (from occlusion of hepatic veins)
60
What is the tx for esophageal varices?
therapeutic endoscopy - endoscopic banding and IV octreotide, prevent with nonselective beta-blockers
61
What is esophagitis?
simply inflammation that may damage tissues of the esophagus
| -it can be divided into two types: non-infectious and infectious
62
What is reflux esophagitis?
mechanical or functional abnormality of the LES
63
What is medication-induced esophagitis?
think NSAIDs or bisphosphonates
64
What is eosinophilic esophagitis?
pt with asthma symptoms and GERD not responsive to antacids
- allergic, eosinophilic infiltration of the esophageal epithelium
- diagnosed with a biopsy
- a barium swallow will show a ribbed esophagus and multiple corrugated rings
65
What is radiation esophagitis?
radio sensitizing drugs include doxorubicin, bleomycin, cyclophosphamide, cisplatin
- dysphagia lasting weeks-months after therapy
- radiation exposure of 5000 cGy associated with increased risk for stricutre
66
What is corrosive esophagitis?
ingestion of alkali or acid from attempted suicide
67
What is infectious esophagitis? Bacteria(3)
Hallmark sign
odynophagia (pain while swallowing food or liquids) is the hallmark sign
- this occurs mainly in patients with impaired host defenses
- primary agents include Candida albicans, herpes simplex virus, and cytomegalovirus
- symptoms are odynophagia and chest pain
68
What is fungal esophagitis? bacteria?
s/s?
tx?
infectious Candida: linear yellow-white plaques with odynophagia or pain on swallowing
-tx with fluconazole 100 mg PO daily
69
What is viral esophagitis? virus + characteristics?
TX?
- HSV: shallow punched out lesions on EGD, treat with acyclovir
- CMV: large solitary ulcers or erosions on EGD, treat with ganciclovir
70
What is EBV esophagitis?
Mycobacterium tuberculosis, and Mycobacterium avium intracellular are additional infectious causes
71
How is esophagitis dx?
by endoscopy, biopsy, double-contrast esophagram, and culture
72
How is esophagitis tx?
treat with underlying culture
- Candida: treat with fluconazole 100 mg PO daily
- HSV: treat with acyclovir
- CMV: treat with ganciclovir
- Corrosive: treat with steroid
- Eosinophilic: treat by removing foods that incite allergic response, topical steroids via inhaler
- Medication: induced: to prevent bisphosphonate-related esophagitis treat by drinking pills with at least 4 ounces of water, avoid laying down for at least 30-60 minutes after ingestion
73
What is gastritis?
dyspepsia (belching, bloating, distension, and heartburn) and abdominal pain are common indicators of gastritis
74
What are the three causes of gastritis?
- infection
- inflammation
- autoimmune or hypersensitivity reaction
75
What are the characteristics of infection gastritis?
Bacteria:
Location:
Dx:
H. pylori - most common
- location: antrum and body
- studies: urea breath test or fecal antigen
76
What are the characteristics of inflammation gastritis?causes? (2)
inflammation of the stomach lining (NSAIDs and alcohol)
- NSAIDs: cause gastric injury by diminishing local prostaglandin production in the stomach and duodenum
- alcohol: a leading cause of gastritis
77
What are the characteristics of autoimmune or hypersensitivity gastritis?
Cause:
Location:
Dx:
(e. g pernicious anemia)
- location: body of the fundus
- pernicious anemia: + schilling test + decreased intrinsic factor and parietal cell antibodies
78
What is the tx and dx of gastritis?
stop NSAIDs, empiric therapy with acid suppression 4-8 wk of PPI
- if no response, consider upper GI endoscopy with biopsy and ultrasound
- test for H. pylori infection - if H. pylori (+) treat with (CAP) clarithromycin + amoxicillin +/- metronidazole + PPI (i.e omeprazole)
- quadruple therapy (PPI, Pepto and 2 antibiotics) for one week
79
What is gastroenteritis?
an inflammation of the lining of the intestines caused by a virus, bacteria, or parasites
- viral gastroenteritis is the second most common illness in the U.S
- the cause is often a norovirus infection
- salmonella infection common bacterial cause of gastroenteritis
80
What is gastroesophageal reflux disease?
retrosternal pain/burning shortly after eating worse with carbonation, greasy foods, spicy foods and laying down
81
How is gastroesophageal reflux disease dx?
- endoscopy with biopsy - the test of choice but not necessary for typical uncomplicated cases
- indicated if refractory to treatment or is accompanied by dysphagia, odynophagia, or GI bleeding
- upper GI series (barium contrast study) - this is only helpful in identifying complications of GERD (strictures/ulcerations)
- PH probe is the gold standard for diagnosis (but usually unnecessary)
82
What is the treatment for gastroesophageal reflux disease?
H2 receptor blockers, proton pump inhibitors, diet modification (avoid fatty foods, coffee, alcohol, orange juice, chocolate; avoid large meals before bedtime); sleep with trunk of body elevated; stop smoking
- Nissen fundoplication: antireflux surgery for severe or resistant cases
- Complications: stricture or Barrett's esophagus
83
What are hemorrhoids?
varicose veins of anus and rectum
- risk factor: constipation/straining, pregnancy, portal HTN, obesity, prolonged sitting or standing, anal intercourse
- Hematochezia - rectal bleeding (BRPPR), painless, fecal soilage
- dx: anoscopy if BRBPR or suspected thrombosis
84
What are external hemorrhoids?
lower 1/3 of the anus (below dentate line)
- thrombosed:
- significant pain, and pruritus but no bleeding
- palpable perianal mass with a purplish hue
- treat with excision for thrombosed external hemorrhoids
85
What are internal hemorrhoids?
upper 1/3 of the anus
- bright red blood per rectum, pruritus and rectal discomfort
- treatment: fiber, sitz bath, ice packs, bed rest, stool softeners, topical steroids
- rubber band ligation if protrude with defection, enlargement, or intermittent bleeding
- closed hemorrhoidectomy if permanently prolapsed
86
What is hepatic cancer?s/s? tumor marker?
abdominal pain, weight loss, right upper quadrant mass
- etiology: cirrhosis, hepatitis B, hepatitis C, hepatitis D, aflatoxin from aspergillus
- tumor marker: increase alpha-fetoprotein and abnormal liver imaging
87
What is the tx of hepatic cancer?
resection, transplant - poor prognosis
88
What is a hiatal hernia?
involves protrusion of the stomach through the diaphragm via the esophageal hiatus
89
What is type 1 hiatal hernia?
sliding hernia = GE junction and stomach slide into the mediastinum (MC)
-increase reflux, treat like GERD
90
What is type 2 hiatal hernia?
rolling hernia = fundus of the stomach protrudes through diaphragm with GE junction, remaining in its anatomic location
-surgical repair to avoid complications
91
How is hiatal hernia dx?
physical exam/ultrasound
92
What is the tx of hiatal hernia?
- acid suppression may suffice (type 1)
| - surgical repair can be used for more serious cases (type 2) - fundoplication
93
What is irritable bowel syndrome?
symptoms complex marked by abdominal pain and altered bowel function (typically constipation, diarrhea, or alternating constipation and diarrhea) for which no organic cause can be determined; also called spastic colon
94
How is IBS defined according to the Rome IV criteria?
defined as recurrent abdominal pain, on average, at least one day per week in the last three months, associated with two or more of the following criteria
- related to defecation
- associated with a change in stool frequency
- associated with a change in stool form (appearance)
95
How is IBS dx?
DX of exclusion
- all labs normal, no mucosal lesions: CBC, renal panel, FOBT, O&P, sed rate +/- flex sig
- colonoscopy, barium enema, ultrasound or CT
- endoscopy in patients with persistent symptoms, weight loss/anorexia, bleeding or history of other GI
96
What is the tx for IBS?
- diarrhea - diphenoxylate or loperamid (lmodium)
- constipation - colace, psyllium, cisapride
- tegaserod maleate (zelnorm) is a serotonin agonist introduced for treatment of IBS
- health maintenance: avoid dairy products and excessive caffeine, high fiber diet, physical exercise, stress management, and relaxation techniques
- comorbid: depression, anxiety, somatization
97
What is a Mallory-Weiss tear?
tear that occurs in the esophageal mucosa at the junction of the esophagus and stomach caused by severe retching and vomiting and results in severe bleeding
- presentation: history of alcohol intake and an episode of vomiting with blood
- caused by forceful vomiting, associated with alcohol use, upper endoscopy showing superficial longitudinal mucosal erosions
98
What is the tx for a Mallory-Weiss tear?
supportive, may cauterize or inject epinephrine if needed
99
What is peptic ulcer disease?
refers to painful sores or ulcers in the lining of the stomach or the first part of the small intestine, the duodenum
- etiology: H. pylori, NSAIDs, Zollinger Ellison syndrome (suspect GI malignancy in nonhealing GU-ZES and gastric cancer)
- epigastric pain, nocturnal symptoms
- duodenal ulcer (food classically relieves pain think Duodenum = decreased pain with food)
- gastric ulcer (food classically causes pain)
100
How is peptic ulcer disease dx?
- endoscopy is the definitive study = gold standard/most accurate diagnostic test - biopsy to r/o malignancy
- alarm sx: > 50 yo, dyspepsia, history of UG, anorexia, wt loss, anemia, dysphagia
- Upper GI series: all gastric ulcers seen on UGI series should be followed with endoscopy to r/o malignancy
- H. pylori testing:
- endoscopy with biopsy = gold standard + rapid urease test
- urea breath test to confirm eradication after therapy
- H. pylori stool antigen = >90% specific - confirm eradication after therapy
- serologic antibodies: confirm infection not eradication
101
What are the complications of peptic ulcer disease?
bleeding (melena, hematemesis, dizziness), perforation (sudden onset severe, diffuse abdominal pain, rigid abdomen, rebound tenderness), penetration (pain radiating to back), obstruction (vomiting)
102
What is the tx for peptic ulcer disease?
- D/C aspirin/NSAIDs, no alcohol, stop smoking and decrease emotional stress, avoid eating before bedtime, decrease coffee intake, weight loss
- PPI (most effective), H2 blockers
- eradicate H. pylori with "CAP" - clarithromycin,, amoxicillin and PPI
- surgery for refractory cases
103
What is ulcerative colitis?
an inflammatory bowel disease (IBD) that causes long-lasting inflammation and ulcers (sores) in the digestive tract
104
What are the characteristics of ulcerative colitis?
- BLOODY DIARRHEA
- ulcerative colitis affects the innermost lining of the large intestine (colon) and rectum
- presents with hematochezia and pus-filled diarrhea, fever, tenesmus (feeling of incomplete defecation) anorexia, weight loss
- inflammation isolated to colon and confined to mucosa and submucosa (unlike Crohn's not transmural)
- most common site is in the rectum
- continuous lesions
- mucosal surface only
105
How is ulcerative colitis dx?
diagnosis of ulcerative colitis typically requires colonoscopy to see the ulcers, and take a biopsy
- show continuous inflammation starting from rectum and extending proximally with loss of haustral markings and lumen narrowing
- may elect to limit the extent of the exam (flex sigmoidoscopy) if severe colitis is encountered to minimize the risk of perforation of the colon
106
What are the other tests used to dx ulcerative colitis?
in addition, radiological imaging may be done with the help of CT scan, MRI, a barium enema
- barium enema: lead pipe appearance (loss of haustral markings) = may cause toxic megacolon
- a radiograph may show colonic dilation
- laboratory tests should be done to screen for anemia, decreased albumin, and electrolyte abnormalities
- antibody test: antineutrophil cytoplasmic antibodies (**pANCA)**
- labs: increased WBC, increased ESR, increased CRP, and anemia
- liver function tests = elevated alkaline phosphatase and y-glutamyl transpeptidase levels in patients with major colonic involvement suggest possible primary sclerosing cholangitis
- to detect nutritional deficiencies, levels of vitamin D and B12 should be checked every 1 to 2 yr
107
What is the tx of ulcerative colitis?
- colectomy is curative
| - medications: prednisone and mesalamine
108
Etiology of Hepatits(4)
Tylenol MC
Drug rxns
Reyes Syndrome
Hep A-E
109
Hepatitis dx
Elevated ammonia
Elevated PT/INR
110
Hepatitis sx(4)
Asterixis
Hyperreflexia
Coagulopathy
Jaundice
111
Hepatits Tx
Encephalopathy -> lactulose
Protein restriction
Definitive = transplant
112
Hep A sx/labs
Feco-Oral, travel, day care, shellfish
Sx: fever, malaise, arthralgia, URI, ap, jaundice
Labs: IgM HAV ab
SELF LIMITING
113
Hepatitis E
Feco-oral
Labs IgM anti HEV
NO TXT dangerous if prego
114
Hep C
IV, 80% develop chronic infection
Acute: HCV RNA
Resolved: -HCV RNA
Chronic: + HCV RNA +Anti HCV
TXT pegylated interferon alpha 2b ribavirin
115
Hep D
Need Hep B virus in order to get it
116
Hep B
IV, sex, perinatal
Mostly asx
txt supportive if acute
Alpha interferon 2b if chronic
117
Infectious Hep B lab
+HBeAg
118
Hep B acute vs chronic labs
Acute: IgM
Chronic: IgG
