GI 3 Flashcards
Ischemic cholangiopathy
Iatrogenic, post liver transplant, cholecystectomy, radiation therapy
Sxs: Pruritis, pale stool
Primary biliary cirrhosis pt sx picture
Middle age, female, unexplained pruritis, fatigue, RUQ pain, jaundice
Ddx ascites
RCHF, portal hypertension, alcoholic hepatitis, cirrhosis, hepatovenous occlusive disorder, constrictive pericarditis
Eclampsia
Super high blood pressure during pregnancy
*can cause hepatic artery occlusion
Budd-Chiari syndrome
Obstruction of hepatic venous outflow..caused by hypercoaguable states
Portland hypertension
Cause: cirrhosis, schistosomiasis
Sxs: asx, esophageal hemorrhage–>hematemesis
PE: ascites, caput medusae, may be jaundice or spider angioma
US or CT
Portal system encephalopathy
Caused by diseased liver that cannot properly deal with drugs/toxins
Sxs: apraxia, asterixis
Labs: CMP, EEG
Apraxia
Cannot process steps or commands
Asterixis
Arms outstretched, wrists dorsiflexed…“liver flap”
Hepatocellular carcinoma
Most common primary liver cancer.
Risk factors: HBV, HCV, hemochromatosis, alcoholic cirrhosis
The work up to do for gallbladder stuff
Ultrasound!
Cholelithiasis
Common, esp cholesterol stones seen w hyperlipidemia, SAD diets, obesity, diabetes
Risk factors: female, fat, forth, fertile, family hx
Sxs: asx! May have RUQ pain, 15 min-1 hr for up to 6-12 hrs
Acute cholecystitis
Inflammation, dt stone in cystic duct
Sxs: pain like biliary colic but >6hrs
PE: right sub costal tenderness, + Murphys sign, fever
Chronic cholecystitis
Longstanding inflammation due to stones…calcification –> porcelain gallbladder
Recurrent biliary colic, upper abdominal tenderness, afebrile
Choledocholithiasis
Stones that form in the bile ducts.
May be asx, biliary colic if duct is partially obstructed
Can –> cholangitis or gallstone pancreatitis
Acute Cholangitis
Emergency! Bile duct obstruction lets bacteria ascend from duodenum
Sxs: Charcot’s triad: abdominal pain, jaundice, fever/chills
PE: RUQ tenderness, liver tender/big, confusion/hypotension=bad sign!
Recurrent pyogenic cholangitis
Intrahepatic brown stone formation –> obstruction, infection, inflammation
Under nutrition and parasites increase susceptibility
Both Choledocholithiasis and cholangitis
Labs: elev bilirubin, alk phos, ALT, GG
Acute indicated if leukocytosis, AST and ALT high (hepatic necrosis due to micro abscesses)
Sclerosing cholangitis
Assoc with IBD (ulcerative colitis). May be autoimmune.
Sxs: Progressive fatigue, pruritis, jaundice, steatorrhea
Labs: elevated alk phos and GGT, antimitochondrial Ab negative
Cholangiocarcinoma
Complication of primary scleorising cholangitis.
Sxs: pruritis, obstructive jaundice, abdominal pain, anorexia, wt loss
+Courvoisier sign
DDX RUQ
Hepatitis, cholecystitis, cholangitis, Buud-Chiari, pancreatitis
Epigastric pain DDX
GERD, gastritis, peptic ulcer dz, pancreatitis, MI, ruptured aortic aneurysm
LUQ pain DDX
Spleen infarct, gastritis, pancreatitis, hiatal hernia
Right flank pain DDX
Kidney inflammation, pyelonephritis
Periumbilical pain DDX
Early appendicitis, gastroenteritis, bowel obstruction, peritonitis
Left flank pain DDX
Kidney inflammation, pyelonephritis
RLQ pain DDX
Appendicitis, IBD, cecal diverticulitis, inguinal hernia, nephrolithiasis, ovarian cyst, ectopic pregnancy, testicular or epididymal inflammation
Suprapubic pain DDX
Cystitis, acute urinary retention, uterine cramps, PID, acute prostatitis
LLQ pain DDX
Diverticulitis, IBD, IBS, nephrolithiasis, ovarian cyst, testicular inflammation, ectopic pregnancy
Diffuse abdominal pain
Appendicitis, gastroenteritis, intestinal obstruction, mesenteric ischemia, peritonitis, IBS
Diarrhea complications
- Dehydration–number 1 cause of morbidity and mortality
- Failure to thrive/malnutrition
- Abdominal pain
- Borborygmus
- Perianal erythema
Constipation red flags
Abdominal distention, vomiting, blood in stool, weight loss, worsening sxs
Gas red flags
Weight loss, blood in stool
GI bleeding causes
Small bowel: angioma, AV malformation, tumors, Merkels diverticulum
Colon/anus: anal fissure, colitis, carcinoma, polyps, diverticular dz, IBD, hemorrhoids
Dyschezia
Difficulty evacuating. Feel urge but cannot due to discoordination. Hypotonia, prolapse.
Labs to run for lower GI
Stool examination; Ova and parasites x3; stool culture; hemoccult; comprehensive digestive stool analysis (markers for digestion, absorptiom, metabolism); salivary IgA
Procedures for lower GI
Anoscopy Sigmoidoscopy Abdominal X-ray CT and MRI Barium rectal injection
