Gastrointestinal Flashcards
Viral Hepatitis Path: Pt: Dx: acute infection recovered immunized early marker for infection, positive in window period best marker for prior Hep B high infectivity low infectivity Tx:
Path: Hep A, E: fecal oral
Hep B infectious
Hep C: IVDA, chronic, cirrhosis, carcinoma, carrier
Hep D: dependent on Hep B co-infection
Pt: N/V, RUQ abd pain
PE-> tender enlarged liver +/- jaundice
Dx: HBsAg: acute infection Anti-HBs: recovered or immunized Anti-HBc IgM: early marker of infection, positive in window period Anti-HBc IgG: best marker for prior HBV HBeAg: high infectivity Anti-HBeAb: low infectivity
Tx: Supportive
Acute pancreatitis Path: Pt: Dx: Tx: Complications
Path: GET SMASHED
gallstones, ethanol, trauma, steroids, mumps, autoimmune, scorpion stings, HLD/hyper Ca+, ERCP, Drugs
Pt: epigastric pain radiates to back, N/V
Grey-Turner Sign
Cullen Sign
Dx: elevated lipase
RUQ U/S-> gallstone obstruction
Abd CT-> non-obstructive origin
Tx: NPO, IVF
Complications: GA-LAW >/=3 severe pancreatitis glucose >200 Age >55 LDH >350 AST >250 WBC >16k
Chronic Pancreatitis Path: Pt: Dx: Tx:
Path: ETOH most common
Pt: Glucose intolerance
Abdominal pain radiating to back
Malabsorption, steatorrhea
Dx: CT/ Abdominal XR: calcifications
Tx: small, low fat meals Pain: TCAs, narcotics NPO-> acute exacerbations Pancreatic enzymes Replace fat soluble vitamins and cyanocobalamin-> steatorrhea
Anal fissure Path: Pt: Dx: Tx:
Path:
Posterior midline-> primary
-Local trauma, constipation, diarrhea, vaginal delivery, anal sex
Lateral-> secondary
-Crohn disease, other granulomatous diseases, malignancy, communicable disease
Pt: Rectal pain and bleeding shortly after defecation
Dx:
Visual inspection: PE-> skin tags, sentinel pile, hypertrophied anal papillae
Tx:
1st-> warm situ baths, inc dietary fiber, topical anesthetics
Botulinum toxin, organic nitrate preparations and topical CCB
Lateral internal sphincterotomy (gold standard)
Esophageal cancer Path: Pt: Dx: Tx:
Path: Squamous cell -MC esophageal cancer world wide -MC upper 1/3 of esophagus -Peaks 50-70y -Risk factors: tobacco, ETOH
Adenocarcinoma
- MC type in US
- MC lower 1/3 of esophagus
- Younger pts, obese, Caucasians
- Usually a complication of GERD leading to Barrett’s esophagus
Pt: Dysphagia to solid foods-> fluids Odynophagia Weight loss, chest pain Hypercalcemia (squamous cell)
Dx: Upper endoscopy w/ bx
Tx:
Esophageal resection
Radiation
Chemo (5-FU)-> depending on stage
Stomach cancer Path: Pt: Dx: Tx:
Path: Adenocarcinoma
H pylori most important risk factor
Pt:
male, >40y
dyspepsia, weight loss, early satiety
Dx: Upper endoscopy w/ bx
Tx: Gastrectomy, radiation and chemo
Poor prognosis
Colorectal cancer Path: risk factors Pt: Dx: Tx:
Path: Progression of adenomatous polyp into malignancy (adenocarcinoma)
Risk factors-> age>50, IBD, adenomatous polyps, diet (low fiber, high red meat), ETOH, african americans, family hx CRC
-genetics: familial adenomatous polyposis (APC gene mutation), lynch syndrome, Peutz-Jehgers
Pt: Iron deficiency anemia, rectal bleeding, abd pain, change in bowel habits
Large bowel obstruction (MC cause in adults)
Dx: Colonoscopy w/ bx (GS)
Barium enema: apple core lesion classic
Inc CEA; monitored during tx
CBC-> iron deficiency anemia
Tx:
Localized (stage I-III): surgical resection
Stage III and Mets: chemo mainstay (5FU/fluorouracil)
Celiac disease Path: Pt: Dx: Tx:
Path: autoimmune IgA gluten allergy
Pt: diarrhea, bloating, weight loss, dermatitis herpetiformis( pruritic, papulovesicular rash on extensor surfaces, neck, trunk, scalp)
Dx:
1st: antibodies: Ttg (anti-tissue transglutaminase), endomysial
EGD w/ bx: blunted villi
GS-> small intestinal bx
Tx: avoid gluten 3-4
BMR for newly dx pts
Charcot’s triad
fever
RUQ abdominal pain
jaundice
(cholangitis)
Cholecystitis Path: Pt: Dx: Tx:
Path: Obstruction by a gallstone
Pt: Fat, Fertile, Female, 40s
Colicky, steadily inc RUQ/epigastric pain after eating fatty foods
PE: Fever
Murphy’s sign-> inspiratory arrest w/ palpation of gallbladder
Boas sign->referred pain R shoulder
Dx:
(GS): HIDA scan (cholescintigraphy scan)-> nonvisualization of the gallbladder
Labs-> inc WBCs, inc bilirubin, inc Alk Phos, and inc LFTs
Initial: U/S
Thickened gallbladder; distended gallbladder, sludge, gallstones, pericholecystic fluid, + sonographic Murphy’s sign
Tx:
NPO, IVF, abx-> ceftriaxone + metronidazole
Pain-> NSAIDs, narcotics
Cholecystectomy
Cholecystostomy tube (if surgery contraindicated)
Cholelithiasis Path: Pt: Dx: Tx:
Path: Gallstones in gallbladder (NO inflammation)
Pt: Fat, fair, fertile, female, 40s (TPN another risk factor)
Biliary colic: RUQ pain lasting 30 mins- few hrs precipitated by fatty foods or large meals
Dx:
U/S
CT or MRI
Tx:
Asx-> observation
Elective cholecystectomy
