GI Flashcards
Celiac Disease: What is it? Which 3 proteins? What is the toxin called? Patho?
Gluten intolerance
Wheat, barley and rye gluten proteins elicit an immune response in genetically predisposed individuals
In Celiac disease
-Leaky junctions= Gluten can reach lamina propria
-Genetic predisposition = Abnormally heightened immune response
-Protected transport of toxic gliadins = Transcytosis of IgA/gliadin immune complexes to lamina propria without degradation- Immune complexes present to
APC and trigger activation of local T-cells
Cytokine production – intestinal tissue damage
§ Villous atrophy
§ Crypt hyperplasia
Celiac Disease: Symptoms and Complications
Symptoms § Diarrhea § Abdominal pain § Malabsorption § Cramping § Bloating § Dermatitis herpetiformis
Complications
§ T-cell lymphomas
§ GI carcinomas
Celiac Disease: Diagnosis
Diagnosis:
Biopsy of duodenal specimen
§ Mucosal damage
§ Villous atrophy
Serology testing
§ IgA transglutaminase (tTG) antibodies and IgA endomysial antibodies
Positive response to gluten free diet
Celiac Disease: Treatment
- Strict, lifelong avoidance of gluten
- Treatment of nutritional deficiencies
Diverticular disease: What is it? Where is it? Patho?
Diverticula = “colonic pouches”
§ Acquired deformity- Consumption of refined foods with little fiber
§ Occur in the colon- Descending and sigmoid
§ Mucosa and submucosa herniate through the muscularis externa
§ Increased intraluminal pressure causes outpouching through weakened areas of colon
§ These pouches can become inflamed and infected from passing fecal matter (diverticulitis)
Diverticular disease: Symptoms and Complications
Symptoms -Inactive disease (Diverticulosis) § Chronic constipation § Straining during defecation § Otherwise patients asymptomatic -Active disease (Diverticulitis) § Intense lower abdominal pain § Fever § Elevated WBC -Complications § Perforation § Diverticular Bleeding
Diverticular Disease: Diagnosis
Diverticulosis
§ Routine colonoscopy
Diverticulitis
§ Clinical symptoms
§ CT findings
Diverticular disease: Treatment
Diverticulosis § High fiber and increased liquids Diverticulitis § Antibiotics § Bowel rest (IV fluids)
Ischemic Bowel: What is it? Patho?
Insufficient blood flow to intestines = Causing ischemia
Likelihood of ischemia based on
§ Collateral adequacy
§ # and size of splanchnic vessels affected
§ Duration of insult
Occlusive or non-occlusive
§ Occlusive: Arterial or venous, SMA most common, Embolic disease = Dislodged from L side of the heart
Thrombotic disease = Atherosclerotic plaque rupture
§ Non-occlusive: Splanchnic vasoconstriction- Low cardiac output, Hypotension
Ischemic Bowel: Symptoms and Risk factors
Symptoms
§ Acute, severe abdominal pain
§ N/V, diarrhea, bloody stools
Risk factors
§ Atrial fibrillation
§ Recent MI
§ Valvular heart disease: Particularly a recent valve replacement
Ischemic Bowel: Diagnosis & Treatement
Clinical suspicion
§ Risk factors present
§ Labs: Cardiac enzymes, Lactic acid
§ Imaging: Abdominal x-ray, CT scan
§ IV and PO contrast
§ Laparotomy (Surgery): Also the treatment
-Vascular bypass, Endovascular stenting, Resection of areas of necrosis
CHOLELITHIASIS: Risk factors
Risk factors § Female § Obese § Middle age § Pregnancy § High dietary fat consumption § Oral contraceptive use § Rapid weight loss
CHOLELITHIASIS: What is it? Patho?
Gall Bladder stones
-Increased biliary secretion of cholesterol
§ Cholesterol solubility in bile exceeded
§ large, small, sludge all possible
§ Sludge is a precursor
-Gall bladder motility/contraction also plays a role
CHOLELITHIASIS: Diagnosis
§ Abdominal ultrasound
§ CT
§ ERCP
§ HIDA scan
CHOLELITHIASIS: Symptoms and Complications
Symptoms:
-Stones in gallbladder
§ Asymptomatic
§ Can be found on routine imaging
-Migration into cystic duct or CBD (choledocholithiasis)
§ Biliary colic
§ Severe, steady ache in RUQ or epigastric region
§ Can radiate into the scapula and shoulder
Complications:
§ Choledocholithiasis
§ Cholecystitis
§ Cholangitis
Cholelithiasis : Treatment
- Cholecystectomy (Laparoscopic)
- ERCP
CHOLECYSTITIS: What is it? Patho? Acute, Acalculous vs Chronic
Inflammation of the gallbladder
Acute
§ Usually the result of obstruction from a stone
§ Increased pressure within the gallbladder - distention and ischemia within the gallbladder mucosa and wall
§ Release of local inflammatory tissue factors
§ Bacterial inflammation
Acalculous cholecystitis § >50% no cause is found § Biliary sludge may be responsible § More common in -Burn or trauma -Postpartum after prolonged labor -Prolonged TPN use
Chronic inflammation of gallbladder
- Almost always associated with gallstones
- Repeated acute cholecystitis episodes
- Bacteria may be present in the bile
- Can be asymptomatic for years
- Can present with acute cholecystitis after being chronic
- Can present with a complication
Cholecystitis: Symptoms & Complications (Acute vs Chronic)
Symptoms: ¡ Typically starts with biliary colic that doesn’t remit and progressively gets worse ¡ N/V ¡ Not eating ¡ +/-Fever
Complications: § Empyema § Hydrops § Gangrene § Jaundice § Perforation § Fistula formation
Diagnosis: Cholecystitis
¡ Clinically
- Physical Exam findings: RUQ tender to palpation
- Labs: White blood cell count, Bilirubin and alkaline phosphatase
- Vitals: Fever
Same as cholelithiasis
¡ Ultrasound
¡ ERCP
¡ HIDA
Cholecystitis: Treatment
§ Bowel rest- IV fluids
§ Antibiotics (If indicated)
§ Pain medications
§ Cholecystectomy
