Gastrointestinal Flashcards
porcelain gallbladder
calcification of gallbladder on CT
Bluish brittle consistency when gallbladder removed
Pathogenesis: maybe due to increase bile salt deposition
Increase risk of gallbladder adenocarcinoma
Requires cholescytectomy
severe retrosternal pain, SOB, subcutaneous emphysema , odynophagia and sign of sepsis
think boerhaave syndrome
- due to esophageal rupture
normal d-xylose test - what is dx then?
celiac disease
if normal - pancreatic disease
cause of zener diverticulum
motor dysfunction
prolonged isoniazid treatment can cause what skin condition?
pellagra ( roughen skin)
- due to nicin deficiency - dermatitis, diarrhea, dementia
acute intermittent porphyria clinical
abdo pain
vomitting
diarrhea
neurological symptoms ( agitation, parenthesis, confusion)
abdo pain, micocytic anemia, positive FOB, heapatomegly with hard edge on liver palpation with small pleural effusion on left
colon cancer with mets to liver
the pleural effusion - might be due to malignancy as well
how does TPN cause gallstones
gallbladder stasis
chronic abdo pain , diarrhea, WL and elevated ESR
chrons disase
labs for alcoholic hepatitis
AST : ALT > 2
AST and ALT > 300
elevated GGT, bilirubin and INR
Decrease albumin
Leucocytosis
most common cause of bleeding painless PR in elderly with a history of constipation
diverticulosis
why do you get malabsorption in zollinger ellison syndrome
patients get inactivation of pancreatic enzymes by increase production of stomach acid may lead to malabsorption
why does cirrhosis cause hypogonadism
due to primary gonadal injury or hypothalamic pituitary dysfunction
what kind of anemia can NSAIDS cause
iro n deficiency anemia - through blood loss in GI tract
painless jaundice and a patient with elevated CB and markedly elevated ALP - raise suspicion for?
biliary obstruction due to pancreas or billiary cancer
difference b/w biliary obstruction from cancer VS acute choledocholithiasis
bother will have elevate ALP, elevated CB
Acute choledocholithiasis - usually have acute onset of right upper quadrant or epigastric pain
If malignant obstruction - usually have painless jaundice
septic shock and then one day later develops elevation in AST and ALT (>1000) - what is that cause
ischemic hepatic injury or shock liver
Halmark: rapid and massive increase in transaminase with modest elevation in bile and alk phosphatase
ischemic hepatic injury - treatment
if the patient durvies the underlying cause of hypotension ( septic shock, heart failure)
liver enzymes will normally return to normal within one to two weeks
WL , jaundice and non tender distended gallbladder on exam
think pancreatic head tumour
what is recommended in acute GI bleed in patients with hg < 7
packed red blood cell transfusion
when do you get FFP
DDP - contains all clotting factors and plasma proteins from one unit of blood - given in severe coagulopathy ( liver disease ,DIC) when patient is actively bleeding
give INR > 1.6
how do you elicit a succussion splash for gastric outlet obstruction
patient places stethoscope over the upper abdomen and rocks the patient back and forth at the hips
patient with weeks of lower abode pain, bloody diarrhea, fecal urgency
who suddenly develops worsening fever, abode distention, leukocytosis , hypotension , tachycardia
what is happening
the patient most likely has undiagnosed IBD
then second presentation is suggestive of toxic megacolon - get abode x-ray
Treatment
– bowl rest
ng tube
antibitoics
- surgery - only if not responsive
foul smelling bulky stools and Wl over last 6 months with small bowel biopsy showing villous atrophy - what does this suggest?
celiac disease
