Gastrointestinal disease Flashcards
Cirhosis? defination
Progressive hepatic fibrosis
Irreversible
Normal fibrous liver ts replaced by injured scare ts
Most common cause of cirhosis
Alcohol
Hepatitis C
Other causes of Cirhosis of liver
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
what are the early symptoms of cirhosis of liver
Symptoms can be insidious
Patients can be asymptomatic
Earliest symptoms include:
Pruritus
Weight loss
Fatigue
Weakness
Malaise
Dark urine
Pale stools
what are symtpoms of advanced cirhosis of liver
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
Diagnosis of Cirhosis of liver
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
Differential diagnosis of Cirhosis of liver
Idiopathic
Primary biliary cirrhosis
Secondary biliary cirrhosis
Hepatocellular carcinoma
Hemochromatosis
NASH
Primary sclerosing cholangitis
Parasitic infection (e.g., Schistosoma mansoni)
Management for Cirhosis of liver
Variceal bleed
Ascities
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)
Dysphagia defination
- A swallowing disorder that involves dysfunction of one or more stages in the normal sequence of swallowing
- Involves oral, pharyngeal, and laryngeal structures
Types of dysphagia
oropharyngeal
esophageal
What are the causes of dysphagia?
•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)
Clinical presentation of dysphagia?
Patients may initially seen with malnutrition
•Weight loss•Dehydration•Coughing•Choking with eating•Pneumonia
Physical examination result in dysphagia?
Xerostoma (dry mouth)
globus (sensation of something stock in the mouth
Diagnostic test of dysphagia
swol-qol tool
Management of Dysphagia
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.
what is hepatitis
•Inflammation and damage to the hepatocytes leading to fibrosis and scarring with isolated hepatocyte injury and focal necrosis can develop
Causes of hepatitis?
•Viruses•Alcohol•Medications•Autoimmune disease•Metabolic defects•Chronic liver inflammation >6 months (risks of cirrhosis and hepatocellular carcinoma)
Types of Hepatitis?
- Viral Hepatitis
- Alcoholic Hepatitis
- Non-Alcoholic Fatty Liver
- Drug-Induced Liver Injury
- Autoimmune Hepatitis
What do you fine in Physical examination of Hepatitis?
•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
Diagnosis of Hepatitis
CBCLFTsBilirubinPlateletPTAlbumin levelHepatitis panelImmunoglobulin M (IgM) anti-HAVLiver BxUltrasoundCT
Management of Hepatitis
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
Symptoms of pancreatitis
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.
Main cause of pancretitis?
Frequent causes include drugs (approximately 90% of cases of acute pancreatitis),
biliary factors
alcohol abuse.
elevated triglycerdie ( more than 800 mg/dl).
Management of pancreatitis
Hydration
pain management
surgical removal
Which test is sensitive to rule pancreatitis
amylase and lipase
Sign of diverticulitis
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).
Risk factor for diverticulitis
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.
Complication of diverticulities
Complications include abscess, sepsis, ileus, small bowel obstruction, hemorrhage, perforation, fistula, and phlegmon stricture. May be life-threatening.
Diverticulitis management
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.
Cholecystitis sign
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.
Complication of cholecystitis
If left untreated, may develop gangrene of the gallbladder (20%). May require hospitalization.
.
Colon cancer risk factor
Hx inflammatory of colon- crohns ds, inflammatory bowel syndrome
who take azathioprine
Age 50 years of age
Sign and symptoms of Colon CA?
Dark tarry stool
iron def anemia
mass on abdominal palpation,
Crohns disorder
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
Ulcerative colitis
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.
Abdomen content location
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
Which is more sensitive to liver damage
ALT
ALT and ALT is normal in which liver disease?
Chronic liver ds such as cirhosis
AST and ALT is elevated in which disease?
Acute liver disease sucha as pancreatitis
hepatitis C is the main risk factor for________
Cirhosis and LiveR Ca
Hepatiis D occur in presence of Hepatitis B
Helper b cell is required to replicate
No vaccine for Hep D, but hep b will help
Which ulcer is more common? Duodenum or gastric?
Duodenal
___ulcer are at high risk of malignancy?
Gastric ulcer
Peptic ulcer sign
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
