GI Flashcards
GERD sequelae
Adenocarcinoma of the esophagus, esophageal strictures
Esophageal Strictures
Symmetric circumferential narrowing on barrium swallow. Caused by GERD. May improve GERD symptoms. Biopsy is necessary to rule out Adenocarcinoma. Dilation is the tx.
Meconium Ileus
Commonly seen in Cystic Fibrosis. Obstruction at Ileum and early colon. Thick, inspissated meconium. Microcolon. Dx: Xray for pneumoperitoneum (surgery) then contrast enema (in a stable patient) to determine level of obstruction.
Dubin-Johnson Syndrome
Rare, benign, hereditary condition with chronic or fluctuating conjugated hyperbilirubinemia due to a hepatocyte excretion defect.
Jaundice typically triggered by illness, pregnancy, or OCPs. Urine will appear dark due to the presence of conjugated bilirubin that is usually degraded. The presence of urobilinogen (as in other diseases) in the urine usually indicates elevated unconjugated bilirubin.
Labs: Elevated total and conjugated bili, other liver labs will be normal.
Factious Diarrhea
Female more common, often healthcare workers, history of multiple hospitalizations.
Usually taking laxatives that will cause profuse watery diarrhea, hypokalemia, metabolic ALKAlosis.
Colonoscopy will show brown pigments in the bowel wall, melanosis coli.
Dx: Stool laxative testing.
Glucagonoma
Presents with weight loss, possible diarrhea, constipation. Patients will often have mild DM, possible neuropsychiatric symptoms, DVTs.
Necrolytic Migratory Erythema: papules or plaques with central clearing, crusting, erosion on borders that occur on face, limbs, perineum,
Patients will be anemia due to anemia of chronic disease or glucagons effect on erythropoesis.
Abdominal imaging to find tumor.
Mild Constipation
Constipation without severe pain and vomiting. Does not require abdominal xray. May begin laxatives.
Chronic Hepatitis C
Asymptomatic or nonspecific symptoms: fatigue, nausea, anorexia, myalgia, arthralgia, weight loss.
Transaminases increased in 2/3rds of patients, 20% will progress to cirrhosis
Types of watery diarrhea
Secretory: >1L/day, often happens during sleep, stool osmotic gap low
Osmotic: Increased stool osmotic gap
Functional:
Stool osmotic gap = plasma osmolality - 2x (stool Na + Stool K) normal is around 125
Food protein induced allergic protocolitis
young infant with painless bloody stools +/- spit up. FMH of eczema, asthma, or allergies. Maternal ingestion of milk or soy products that causes a non IgE allergic reaction in infants.
Eliminate offending agent from maternal diet or hydrolyzed formula. Will resolve by 1 year old.
Chemistries on a person who has been vomiting
Hypochloremic, hypokalemic, increased bicarb. Metabolic alkalosis (relative loss of H+ and loss of fluid causes retention of bicarb)
Chronic Pancreatitis
Etiology: alcohol, obstruction, autoimmune, CF
Presentation: Chronic epigastric pain, malabsorption, DM
Labs/Imaging: Amylase/lipase often normal, CT or MRCP can show calcification, dilation of ducts, and an enlarged pancreas.
Toxic Megacolon
Abdominal pain, bloody diarrhea, fever, abdominal distention, peritonitis.
Xray: marked colonic distention
Risks: Inflammatory Bowel Disease, C diff
Tx: Bowel rest, NG suction, abx, steroids if associated with IBD. If refractory then you proceed to surgery.
Hepatic Hydrothorax
Small defects in the diaphragm that allow transudative fluids into the thorax. More common on the right because the right hemidiaphragm is less muscular.
Tx: Salt restriction, thoracentesis
Tests following diagnosis of GERD
EGD w/ biopsy,
If EGD negative, consider 24 hr pH.
Carcinoid Syndrome Presentation
Skin: Flushing, telangiectasia, cyanosis
GI: diarrhea
Cardio: Right-sided valvular lesions (occasionally left)
Pulm: Bronchospasm
Niacin deficiency (dermatitis, diarrhea, dementia)
Necrotizing Enterocolitis
Risks: Low birth weight, enteral feedings, prematurity
Features: Poor vitals, lethargy, bilious emesis, bloody BMs, abdominal distension.
Xray: Gas patterns, portal venous gas, pneumoperitoneum
Tx: Bowel rest, parenteral feedings, broadspectrum abx, +/- surgery
Mild Non-bleeding esophageal varices
Beta blocker
HbsAg
First serologic marker of HepB
igM anti HBc
appears shortly after HbsAg
HbeAg
Indicator of infectivity
Chronic HepC extrahepatic findings
Mixed cryoglobulinemia, membranoproliferative glomerulonephritis, lichen planus, porphyria cutanea tarda
Acalculous cholecystitis
seen in severely ill patients with poor perfusion to the gallbladder.
Leukocytosis, RUQ pain +/- mass, +/- jaundice, +/- abnormal LFTs
Basically the worst.
Dx: Ultrasound
Tx: Abx and Cholecystostomy and eventual cholecystectomy
Patient presentation of pancreatic cancer
vague epigastric pain, weight loss, cigarette smoking, recent onset DM, chronic pancreatitis
Focal Nodular Hyperplasia
Hyperdense with contrast imaging of liver
central stellate scar
generally does not require treatment
Rebound tenderness after penetrating trauma
Exploratory laparotomy
Signs and symptoms of gallbladder disease or pancreatitis in a kid under 10
Think biliary cyst
can present as a cyst within or outside the liver along the biliary tract.
FSGS
African american, mexican, obese, HIV, heroin
Membranous nephropathy
SLE, Adenocarcinoma of breast or lung, NSAIDs, HepB
Membranoproliferative glomerulonephritis
HepC and HepB Tram track appearance
Also SLE, scleroderma, RA, Sjogrens, and Celiac’s
Minimal change disease
lymphoma, NSAIDs
IgA Nephropathy cause
URTI
Celiac Disease
Iron deficiency in a young person without GI bleed. Abdominal discomfort and diarrhea.
Can see dermatitis herpetiformis
Dx: anti tissue transglutaminase (occasionally negative) and vilous bx (definitive)
Tx: Gluten free diet
Air in gallbladder wall
Surgical emergency
Acute Liver Failure
ALT AST increased (usually above 1000)
Hepatic encephalopathy
INR >1.5
Crohn’s
Mouth to anus, rectum spared, skip lesions, perianal disease, noncaseating granulomas, cobblestoning, diarrhea +/- blood, fistulas, and abscesses.
Ulcerative colitis
rectum and colon, continuous inflammation, bloody diarrhea, pseudopolyps, can have toxic megacolon.
Gastric Cancer
Asian w/ vague epigastric pain, nausea, vomiting, iron deficiency anemia. Metastasizes to the liver causing elevated LFTs and Alk phos.
DDx: Pancreatic cancer usually does not present with anemia
Pancreatic pseudocyst treatment
Asymptomatic: NPO, expectant management
Symptomatic/Infx/Pseudoaneurysm: Endoscopic drainage
Complications of Roux en Y
Early: Leak, mesenteric ischemia
Late: Stricture, Ulcer, Dumping syndrome, Cholecystitis
Cholecystitis is due to rapid weight loss and promotion of gallstone formation
Elevated alk phos in the setting of abdominal pain
Cholestasis
Acute Cholecystitis
RUQ pain, leukocytosis, fever
no other labs are necessary for diagnosis
RUQ US
Meckel’s Diverticulum
A remnant of the vitelline duct may contain ectopic gastric mucosa which secretes HCl causing ulceration and painless GI bleeds in children.
Dx: Tech99
Corkscrew appearance on upper bowel series
Midgut volvulus
Age of presentation for pyloric stenosis
3-5 weeks
Duodenal Atresia
Seen in down syndrome
Usually, Xray is diagnostic, but sometimes an upper GI series is needed.
NG tube and surgery
High-risk pediatric ingestions
Batteries, magnets, sharp objects
Should be removed
Eosinophilic esophagitis
A young man with intermittent dysphagia to solids. GERD symptoms Association with asthma and eczema >15 eosinophils per hpf glucocorticoids and diet modification
Smooth hepatic cyst with daughter cysts inside.
Echinococcus
Albendazole
large cysts may need draining.
Neonate with bilious vomiting workup
Stop feeds, IVF, NG tube decompression
Xray
-Shows free air —> surgery
-Shows dilated loops of bowel —-> contrast enema
-Gasless abdomen —> Upper GI series (malrotation)
-Double bubble —-> Duodenal atresia
HCC
Labs can be all over the place. May have high or normal LFTs. Alk phos may be elevated if there is bone involvement. AFP is markedly increased in 50% of cases.
Mets to bone are mixed blastic and lytic
Increased incidence in populations with high exposure to Hepatitis
Cyclical Vomiting Syndrome
Personal or family history of migraines
Cycles of vomiting that occur at regular intervals
Asymptomatic between cycles
New diagnosis of cirrhosis should have ___ done
EGD to check for varices
Painless GI bleed + AS
Angiodysplasia
Fever, leukocytosis, RUQ pain post chole
Probable bile leak. More likely with increased alk phos. Imaging shows normal bile duct.
UA for appendicitis
Can present with microscopic hematuria with leukocytes due to right ureteral proximity to the appendix.
Primary sclerosis cholangitis
fatigue, pruritis, and 90% will have ulcerative colitis
Cholestatic liver enzymes
Fibrous obliteration of bile ducts
Increased risk of cholangiocarcinoma and colon cancer
