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Sophin Rai 775 class preparation > Gastrointestinal disease > Flashcards

Gastrointestinal disease Flashcards

1
Q

Cirhosis? defination

A

Progressive hepatic fibrosis

Irreversible

Normal fibrous liver ts replaced by injured scare ts

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2
Q

Most common cause of cirhosis

A

Alcohol

Hepatitis C

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3
Q

Other causes of Cirhosis of liver

A

Other causes
Medications
Inherited or idiopathic cause
Primary and secondary biliary cirrhosis
Infections
Viruses
Hemochromatosis
Polycystic liver disease
Right-sided heart failure
Autoimmune hepatitis
Nonalcoholic steatohepatitis (NASH

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4
Q

what are the early symptoms of cirhosis of liver

A

Symptoms can be insidious
Patients can be asymptomatic
Earliest symptoms include:
Pruritus
Weight loss
Fatigue
Weakness
Malaise
Dark urine
Pale stools

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5
Q

what are symtpoms of advanced cirhosis of liver

A

Anorexia
Nausea
Vomiting
Hematemesis
Abdominal pain
Chest pain
Menstrual abnormalities
Impotence
Sterility
Neuropsychiatric symptoms (difficulty concentrating, irritability, and confusion)
Late-stage: Jaundice
Jaundice
Spider angiomata
Gynecomastia
Ascites
Anorexia
RUQ pain
Nodular firm enlarged or shrunken liver (late-stage)
Splenomegaly
Fluid wave
Increased abd girth (+)ascites
Venous hum (portal HTN)
Rectal/esophageal varice
Peripheral edema (feet, legs, and hands)
Delirium, lethargy, and coma (late-stage)
Weight loss
Tremors
Cheilosis or glossitis
Spider angiomas on the face, chest, and abdomen
Palmar erythema
Dupuytren’s contracture
Horizontal white bands on nail beds (Muehrcke nails)
Whitening of the proximal two thirds and reddening of the remainder (Terry nails)
Digital clubbing
Gynecomastia
Testicular atrophy
Changes in body hair distribution in asterixis, or liver flap, severe cases of liver failure

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6
Q

Diagnosis of Cirhosis of liver

A

No early screening diagnostic or single diagnostic biochemical marker
Patients present in advanced stage when laboratory abnormalities of liver dysfunction are found:
Elevated liver enzymes: AST and ALT all indicate hepatocellular inflammation or injury
Alkaline phosphatase and gamma-glutamyl transpeptidase levels are also often elevated
Hypoalbuminuremia
Elevated serum protein, hyperbilirubinemia
MELD Score
Liver Bx, US, CT scan, MRE

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7
Q

Differential diagnosis of Cirhosis of liver

A

Idiopathic
Primary biliary cirrhosis
Secondary biliary cirrhosis
Hepatocellular carcinoma
Hemochromatosis
NASH
Primary sclerosing cholangitis
Parasitic infection (e.g., Schistosoma mansoni)

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8
Q

Management for Cirhosis of liver

Variceal bleed

Ascities

A

Management

•Immunizations•Pneumococcal•Annual influenza•Hepatitis A and B•As indicated:•

Variceal bleeds•

Nonselective beta- blocker therapy (prevention of esophageal varix rupture, by reduction of portal pressure and collateral blood flow)

  • Endoscopic variceal ligation
  • Ascites

•Diagnostic paracentesis

  • Dietary sodium restriction of 1 to 2 g/day
  • Spironolactone (diuresis)
  • Furosemide
  • Monitor electrolytes, BUN, and creatinine level•Procedural-focused as indicated•Co-manage with specialists (hepatology)
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9
Q

Dysphagia defination

A
  • A swallowing disorder that involves dysfunction of one or more stages in the normal sequence of swallowing
  • Involves oral, pharyngeal, and laryngeal structures
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10
Q

Types of dysphagia

A

oropharyngeal

esophageal

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11
Q

What are the causes of dysphagia?

A

•Neurologic•Neuromuscular•Metabolic•Pharmacologic•Infectious•Psychiatric•Environmental,•Structural (more common is esophageal cause)•Trauma or surgery•Tumor,•Webs•Strictures or stenoses,•Diverticula•Infection•Cervical osteophytes (or cricopharyngeal bars)

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12
Q

Clinical presentation of dysphagia?

A

Patients may initially seen with malnutrition

•Weight loss•Dehydration•Coughing•Choking with eating•Pneumonia

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13
Q

Physical examination result in dysphagia?

A

Xerostoma (dry mouth)

globus (sensation of something stock in the mouth

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14
Q

Diagnostic test of dysphagia

A

swol-qol tool

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15
Q

Management of Dysphagia

A

Management

•Treatment is based on dysphagia functional etiology

Structural causes (e.g., such as tumors, strictures, webs, and diverticula)

•Surgery or dilation•Chemotherapy or radiation therapy may be used for tumors•Diet changes•Medications

Cough-based dysphagia

  • Aspiration and Nonoral therapy
  • Swallowing Strategies and Therapies
  • Gastrostomy tube placement may be necessary and appropriate for some patients.
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16
Q

what is hepatitis

A

•Inflammation and damage to the hepatocytes leading to fibrosis and scarring with isolated hepatocyte injury and focal necrosis can develop

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17
Q

Causes of hepatitis?

A

•Viruses•Alcohol•Medications•Autoimmune disease•Metabolic defects•Chronic liver inflammation >6 months (risks of cirrhosis and hepatocellular carcinoma)

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18
Q

Types of Hepatitis?

A
  • Viral Hepatitis
  • Alcoholic Hepatitis
  • Non-Alcoholic Fatty Liver
  • Drug-Induced Liver Injury
  • Autoimmune Hepatitis
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19
Q

What do you fine in Physical examination of Hepatitis?

A

•Acute Hepatitis

•Low-grade fever•

Symptomatic/chronic hepatitis•Jaundice•Hepatomegaly•Splenomegaly

•Alcoholic Hepatitis•Fever•Jaundice•Leukocytosis•Rashes

•Tender hepatomegaly•Splenomegaly•Ascites•Encephalopathy (ranging from asterixis to coma)•Signs of malnutrition•Hepatic bruit•Spider telangiectasia•Parotid enlargement•Gynecomastia•Palmar erythema

20
Q

Diagnosis of Hepatitis

A

˜CBC˜LFTs˜Bilirubin˜Platelet˜PT˜Albumin level˜Hepatitis panel˜Immunoglobulin M (IgM) anti-HAV˜Liver Bx˜Ultrasound˜CT

21
Q

Management of Hepatitis

A

Management

•Acute HAV and HBV•Palliative, rest•HBV•Monitor LFTs until normalized•

Chronic HBV and HCV•Manage with meds as indicated•Alcoholic hepatitis•Alcoholic abstinence•Monitor bilirubin level•Medications as indicated•Transplant

  • Drug-induced hepatitis
  • Remove toxic drug/substance•Treat antidote pharm for overdose•Transplant•Supportive management•

NAFLD and NASH•Weight loss with diet and exercise

Health Promotion

•Alcohol and substance abuse avoidance, safe sexual practices, vaccinations, and regular checkups that include monitoring of LFTs

22
Q

Symptoms of pancreatitis

A

onset of fever, nausea, and vomiting that is associated with rapid onset of abdominal pain that radiates to the midback (“boring”) located in the epigastric region.

Abdominal exam reveals guarding and tenderness over the epigastric area or the upper abdomen.

Positive Cullen’s sign (blue discoloration around umbilicus) Grey–Turner’s sign (blue discoloration on the flanks).

The patient may have an ileus, may show signs and symptoms of shock. Refer to ED.

23
Q

Main cause of pancretitis?

A

Frequent causes include drugs (approximately 90% of cases of acute pancreatitis),

biliary factors

alcohol abuse.

elevated triglycerdie ( more than 800 mg/dl).

24
Q

Management of pancreatitis

A

Hydration

pain management

surgical removal

25
Q

Which test is sensitive to rule pancreatitis

A

amylase and lipase

26
Q

Sign of diverticulitis

A

Elderly patient with acute onset of high fever, anorexia, nausea/vomiting, and left lower quadrant (LLQ) abdominal pain.

Signs of acute abdomen are rebound, positive Rovsing’s sign, and board-like abdomen.

CBC will show leukocytosis with neutrophilia and shift to the left.

The presence of band forms signals severe bacterial infection (bands are immature neutrophils).

27
Q

Risk factor for diverticulitis

A

Risk factors for acute diverticulitis include

increased age,

constipation,

low dietary fiber intake,

obesity, lack of exercise, and

frequent nonsteroidal anti-inflammatory drug (NSAID) use.

28
Q

Complication of diverticulities

A

Complications include abscess, sepsis, ileus, small bowel obstruction, hemorrhage, perforation, fistula, and phlegmon stricture. May be life-threatening.

29
Q

Diverticulitis management

A

Clear liquid for 2 to 3 days

metronidazole and cipro ( If symptoms does not subside- sent to ED

fiber diet not recommended

opiates should be avoided - as it increases intraluminal pressure.

30
Q

Cholecystitis sign

A

Overweight female patient complains of severe right upper quadrant (RUQ) or epigastric pain that occurs within 1 hour (or more) after eating a fatty meal. Pain may radiate to the right shoulder. Accompanied by nausea/vomiting and anorexia.

31
Q

Complication of cholecystitis

A

If left untreated, may develop gangrene of the gallbladder (20%). May require hospitalization.

.

32
Q

Colon cancer risk factor

A

Hx inflammatory of colon- crohns ds, inflammatory bowel syndrome

who take azathioprine

Age 50 years of age

33
Q

Sign and symptoms of Colon CA?

A

Dark tarry stool

iron def anemia

mass on abdominal palpation,

34
Q

Crohns disorder

A

Impact from mouth, small to large intestine, anus

pain in periumbilical to Rt lower quadrant pain

Ileum- watery diarhea

Colon- bloody diarhea with mucus

More common is ashkenazi Zews

35
Q

Ulcerative colitis

A

pain in left side of the abdomen with bloating and gas that is increased after intake of food

Relapses characterized by fever, anorexia, weight loss, and fatigue. Accompanied by arthralgias and arthritis (15%–40%) that affect large joints, sacrum, and ankylosing spondylitis.

May have iron deficiency anemia or anemia of chronic disease. Disease has remissions and relapses.

Increased risk of colon cancer.

Risk of toxic megacolon.

36
Q

Abdomen content location

A

Right upper quadrant (RUQ): Liver, gallbladder, ascending colon, kidney (right), pancreas (small portion); right kidney is lower than the left because of displacement by the liver

​Left upper quadrant (LUQ): Stomach, pancreas, descending colon, kidney (left)

​Right lower quadrant (RLQ): Appendix, ileum, cecum, ovary (right) ​

Left lower quadrant (LLQ): Sigmoid colon, ovary (left) ​Suprapubic area: Bladder, uterus, rectum

37
Q

Which is more sensitive to liver damage

A

ALT

38
Q

ALT and ALT is normal in which liver disease?

A

Chronic liver ds such as cirhosis

39
Q

AST and ALT is elevated in which disease?

A

Acute liver disease sucha as pancreatitis

40
Q

hepatitis C is the main risk factor for________

A

Cirhosis and LiveR Ca

41
Q

Hepatiis D occur in presence of Hepatitis B

A

Helper b cell is required to replicate

No vaccine for Hep D, but hep b will help

42
Q

Which ulcer is more common? Duodenum or gastric?

A

Duodenal

43
Q

___ulcer are at high risk of malignancy?

A

Gastric ulcer

44
Q

Peptic ulcer sign

A

Pain when you are hungry

Pain is relieve when the you take food

Middle aged people

C/o episodic epigastric pain, burning/gnawing pain

rectal bleeding

45
Q
A

Sophin Rai 775 class preparation (22 decks)

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