Gastrology Flashcards
cholelithiasis. Ethiopathogenesis
Stone in gallbladder. Cholesterol stones (yellow-greenm associated with the following): obesity, hyperlipidemia, DM, CF, Cirrohosi, OCP, multiple pregnancies. advanced age.
Pigmented stones: Black: hemolysis, or alaoholic cirrhosis.
Mixed stones = MOST COMMON
Cholelithiasis. Clinical + complications
Asymptomatic, biliary colic (RUQ pain radiating to back. pain after fatty meal and at night) due to gallbladder contracting against obstruction of cystic duct due to stone.
Complication: Cholecytitis, choledocolithiasis, gallstone ileus, malignancy.
Dx cholelithiasis.
USG, CT, MRI
Tx cholelithiasis.
asymptomatic: no treatment
recurrent biliary colic = cholcystectomy.
Acute pancreatitis: def
Inflammation of pancreas resulting from prematurely activated pancreatic digestive enzymes causing autodigestion. Mild types is the most common, responding well to supportive care. Severe: necrotizing pancreatitis: significant morality and morbidity.
Acute pancreatitis
causes
Alcohol, gallstones, past ercp, viral infections: mumps, coxachievirus B, drugs, post op complications. Trauma is the MCC in children, pancreatic cancer.
Clinical: Acute pancreatitis
epigastric pain, radiating to back. steady, dull pain, worse when supine and after meals. N/V/anorexia. Signs: Low grade fever. tachycardia, hypotension, leukocytosis, abdominal distention. Hemorrhagic pancreatitis: Grey Turner sign: flank ecchymosis, cullen sign: periumbilical.
Dx Acute pancreatitis
Amylase, lipase (more specific). LFT (if pancreatitis is due to gallstones), hyperglycemia, cbc. CT, USG to look for gallstones, ERCP.
Tx Acute pancreatitis
mild: NPO, IV fluids and correct electrolytes, pain control (fentanyl and meperdine), NG tube.
Severe: ICU, prophylactic AB (imipenem) if > 30 % is necrotized.
Chronic pancreatitis Def
persistent or continuing inflammation of the pancreas with fibrotic tissue replacing pancreatic parenchyma and alteration of pancreatic duct, eventually leads to irreversible destruction of pancreas.
Causes of Chronic pancreatitis
chronic alcoholism= MCC
hereditary pancreatitis, idiopathic chronic pancreatitis.
clinical features of Chronic pancreatitis
severe pain in epigastrium: recurrent or persistent, radiating to back . N/V. weight loss due to malabsorption
dx Chronic pancreatitis
CT scan + abdominal radiographs (look for calcifications). ERCP = gold standard. Note that amylase and lipase are NOT elevated.
Tx Chronic pancreatitis
narcotic analgesia, NPO, pancreatic enzymes and H2 blockers, insulin, alco abstinence, frequent small meals with low fat. Surgeru: Pancreaticojejunostomy, wipple procedure.
Gastritis vs PUD
Gastritis: inflammation of stomach mucose. non erosive = asymptomativ, erosive: cause bleeding but usually not pain (pain = ulcer). PUD: focal defect in the mucosa that penetrate muscularis mucosa layer results in scarring. Kan be gastric ulcer (DO BIOPSY) or duodenal ulcer (Hunger pain)
Etiology of PUD
h. pylori, NSAIS, physiologic stress, ZE syndrome, idiopathic.
6 classic features of duodenal PUD
epigastric pain, 1-3 hours after meals, relieved by eating and antacides, interrups sleep, periodicity.
Diagnosis
Endoscopy (most accurate), H.pylori test: urea breath test, serology, stool antigen, histolgy = gold standard. Fasting serum gastrin measurment if ZE syndrome suspected.
symptoms of pud
Dyspepsia. can present with complications = bleeding, perforation, gastric outlet obstruction.
Tripple therapy H pylori
Clarithromycin + amoxicillin + PPI, or clarithromycin + metronidazole + PPi fo 10-14 days
Quadruple therapy H pylori: when failed therapies
PPI, bismuth salt + metronidazole + tetracycline
Presentation of NSAID induced ulcer
Most present with complications: bleeding perforation, obstruction. Gastric ulcer more common than duodenal ulcer.
Stomach cancer: types
intestinal type: 90 %!!! lesser curvature with ulcer with heaped up margins + sister mary joseph nodes. Diffuse type/linitis plastica: NOT associated with H. pylori .
RF for Stomach cancer
H. pylori HNPCC smoking alcohol Nitrosamines Pernicious anemia polyps previous partial gastrectomy blood type A
Clinical features of Stomach cancer
suspicion: ulcer failt to heal, lesion on the GREATER curvature. Insicious or late onset of symptoms: postprandial abdominal fullness, vague epigastric pain, anorexia, weight loss. N/V, dyspepsia, dysphagia. Hepatomegaly, epigastric mass. Hematemesis. IDA.
Stomach cancer metatasis
lung liver brain, peritoneum
Dx Stomach cancer
gastroscopy + biopsy + EUS
chest/abdomen/pelvis CT
Tx Stomach cancer
gastrectomy.
CRC ethiopathogenesis
Genetic: FAP + HNPCC + FHx
adenomatous polyp: > 1 cm villous, UC. Diet: fat red meat, dec fiber, smoking. Age >50. DM + acromegaly ?
CRC clinical
ofen ASYMPTOMATIC. hematochezia/melena, abd pain, change in bowel habits, anemia, weight loss, obstruction, weakness. most CRC are diagnosed at stage 3
Diagnosis CRC
colonoscopy + histopathology - other investigations: CBC, urinalysis, liver enzymes, CEA; for staging: CT chest abdomen and pelvis. + Bone scan.
TX CRC
surgery + chemo for colon cancer. rectal caner: radio + surgery + chemo(?)
Irritable bowel syndrome
Functional bowel disease. > 12 weeks in the past 12 months of abdominal discomfort with 2 of the 3 following: releived by defecation, change in frequency, change in consistency.
