GI Flashcards
Causes of acute pancreatitis
hyperParathyroid (hypercalcemia) Alcohol Neoplasm Cholelithiasis Rx (drugs) ERCP Abdominal surgery hyperTriglyceridemia Infection (mumps) Trauma Idiopathic Scorpion bite
Ranson Criteria on admission
increased mortality from pancreatitis (GA LAW) Glucose > 200 AST > 250 LDH > 350 Age > 55 WBC > 16000
Ranson Criteria during initial 48 h after admission
Increased mortality from pancreatitis (Calvin & HOBBS_ Ca < 8 Hct dec > 10% O2 (PaO2) < 60 BUN incr >5 Base deficit > 4 Sequestration of fluid > 6 L
Whipple triad
Seen with insulinoma
- sx of hypoglycemia while fasting
- hypoglycemia
- improvement of sx with carb load
Charcot triad
fever, jaundice, RUQ pain
*cholangitis
biopsy of liver with Reye syndrome
microvesicular steatosis
Pathogenesis of spider angiomas and palmar erythema in a patient with alcoholic cirrhosis
hyperestrinism - impaired hepatic metabolism of circulating estrogens
- estrogens affect vascular wall dilation
Osmotic vs. secretory diarrhea
Osmotic: elevated osmotic gap
Secretory: reduced osmotic gap, occurs while fasting or sleeping
SOG = plasma os - 2 x (stool Na + stool K)
9 year old with abdominal pain and difficulty swallowing that doesn’t respond to acid suppression. Patient has eczematous patches on skin. Endoscopy shows circular rings and thickened, linear furrowing of the esophagus.
eosinophilic esophagitis (>15 eosinophils per HPF)
Upper GI bleed management
volume resuscitation prophylactic antibiotics (ceftriaxone) - for cirrhotic patients somatostatin analogues (octreotide) - prevent vasodilation
22 year old presents with resting tremor, muscle rigidity, clumsy gait, slurred speech, drooling, transaminitis, increased alk phos and bilirubin.
Wilson disease
- test patient for low ceruloplasmin and slit lamp exam for Kayser-Fleischer rings
- tx: trientine or penacillamine
Female with worsening watery diarrhea, muscle weakness/cramps, hypokalemia, low BP, increased pulse. Mass detected in tail of pancreas
VIPoma - rare tumor of pancreatic cells
- VIP binds to intestinal epithelial cells to increase fluid and electrolyte secretion in the intestinal lumen
- common mets to liver
- tx: fluids, octreotide, possible hepatic resection
Complications of PBC
Malabsorption, fat-soluble vitamin deficiencies
Metabolic bone diseases (osteoporosis, osteomalacia)
Hepatocellular carcinoma
Most common cause of duodenal ulcers
H. pylori
tx: amoxicillin, clarithromycin and PPI
Rocking a patient’s hips back and forth with a stethoscope on the abdomen diagnoses
gastric outlet obstruction (succussion splash)
Pt with Chrons develops kidney stones due to increased absorption of
oxalate
- with fat malabsorption, calcium binds up fat leaving oxalate unbound and free to be absorbed in the bloodstream
Risk factors for C diff
Abx
Hospitalization
PPI
50 year old male with diarrhea, abdominal pain, and weight loss. Pt also has generalized LAD and skin hyperpigmentation. Small bowel biopsy shows villous atrophy with PAS-positive material in the lamina propria.
Whipple dz
- Tropheryma whipplei
Causes of pill induced esophagitis
tetracyclines, potassium chloride, NSAIDs, bisphosphonates
Pt with diabetes develops severe right knee pain with swelling. X-ray shows chondrocalcinosis and a moderate effusion. pt also has mild hepatomegaly
Hereditary hemochromatosis
- get iron studies
- pts commonly have diabetes and liver dz
Vitamin deficiency associated with carcinoid syndrome
Niacin
- serotonin is synthesized from tryptophan which is also used to in the production of niacin
Most common cause of liver mets
colon cancer
75 year old male with cough and low grade fever, Has been treated for PNA twice. In the past 6 months he has had difficulty swallowing and frequently regurgitates food. Has foul-smelling breath and a fluctuant mass in the left neck
Zenker’s diverticulum
- get a contrast esophagram
Pt with CLL has acute onset of abdominal pain, shock and anemia. She was in an exercise class when she had sudden onset of left-sided abdominal pain followed by syncope
Splenic rupture
Pt with tender, erythematous, and palpable cord-like veins on the left arm and upper chest. She has a 15-30 year pack hx
Trousseau’s syndrome
- migratory thrombophlebitis
- most commonly assoc with pancreatic cancer
- mucin released by tumor reacts with platelets to form platelet rich microthrombi
tx to stimulate appetite in cancer patient
Progesterone analogue (or corticosteroids)
Elevated AFP with blastic and lytic lesions of the spine
Primary testicular or hepatocellular carcinoma
Hypotension with massive, acute increase in liver enzymes
ischemic hepatic injury
Colonoscopy findings in a patient with laxative abuse
dark brown discoloration with pale patches of lymph follicles
Tests for lactose intolerance
Positive hydrogen breath test
reduced stool pH
increased stool osmotic gap
Young man with intermittent dysphagia with pork, chicken and steak. No issues with water. Episodes are increasing in frequency.
Eosiniphilic esophagitis
- dietary therapy, PPIs, topical glucocorticoids
Bisexual man with hx of chronic constipation has tender, fluctuant, erythematous perianal mass with fever and worsening pain
Perianal abscess
Colonoscopy for IBD
8-10 years after dx then repeat every 1-3 years
B1 (thiamine) def
Beriberi (peripheral neuropathy and heart failure)
Wernicke-Korsakoff
B2 (riboflavin) def
Angular chelosis, stomatitis, glossitis.
Normocytic anemia
Seborrheic dermatitis
B3 (niacin) deficiency
Pellagra (dermatitis, diarrhea, delusions/dementia, glossitis)
B6 (pyridoxine) deficiency
Chelosis, stomatitis, glossitis
irritability, confusion, depression
B9 (folate, folic acid) def
megaloblastic anemia
NTDs
B12 (cobalamin) def
megaloblastic anemia
neuro deficits
vit C def
Scurvy (punctate hemorrhage, gingivitis, corkscrew hair)
Signs of bowel obstruction with hypocalcemia and hypokalemia
Pseudo-obstruction
Ogilvie syndrome
Budd-Chiari syndrome
- hepatic venous outflow obstruction
- caused by occlusion of the hepatic veins, adjacent inferior vena cava, or both; this leads to hepatic ischemia and congestion
- ascites, jaundice, variceal bleeding, and hepatomegaly
- liver failure with no obvious cause
Electrolytes in refeeding syndrome
hypophosphatemia, hypokalemia, hypomagnesemia
pellagra
Niacin deficiency
- diarrhea, dermatitis, depression, dementia, distraction, death
Follow up for patients with liver cirrhosis
abdominal ultrasound every 6 months to evaluate for HCC
Pt with anion gap metabolic acidosis and abdominal pain, vomiting, diarrhea, hematemesis, melena
acute iron poisoning
Pt undergoes small bowel resection for chrons disease. He is very sedentary and develops generalized bone pain after surgery. X- rays of femoral neck show pseudofractures and x-raysof lumbar spine show decreasedbone mineral density
osteomalacia due to vitamin d def
- high pth, low phos, low calcium
metaclopramide and prochlorperazine
antiemetics - dopamine antagonists
- can cause extrapyramidal SE dystonia, akathisia and parkinsonism
