GI #9 Flashcards
What is the most accurate test for nonalcoholic fatty liver disease?
Biopsy: micro vesicular fatty deposits similar to alcoholic liver disease without the history of heavy alcohol consumption
Review Primary Biliary Cirrhosis and Primary Sclerosing Cholangitis
What is Wilson’s Disease?
-Autosomal recessive disorder leading to copper accumulation in the body (liver, brain, kidney, joints, and cornea)
What is the pathophysiology of Wilson’s Disease?
-Defect in chromosome 13 leads to decreased biliary copper excretion due to decreased ceruloplasmin
Symptoms of Wilson’s Disease
- Liver: Hepatitis, cirrhosis, liver failure
- CNS: Dysarthria (MC), dystonia, tremor, rigidity, dementia, seizures, ataxia
- Psychiatric: Behavioral changes, psychosis, delusions
- Joints: arthralgias
What is unique and seen on physical exam with Wilson’s Disease?
Kayser-Fleischer rings: brown or green pigmented rings due to copper deposition in cornea
How to diagnose Wilson’s Disease?
- Decreased serum ceruloplasmin
- Liver biopsy: Definitive
- Molecular genetic testing for ATP7B
Treatment for Wilson’s Disease
-Copper-chelating agents: Trientine (less side effects) or D-Penicillamine
What is given with D-Penicillamine and why?
Pyridoxine (B6) to prevent B6 deficiency
What is also given to patient’s with Wilson’s Disease and what does it do?
Zinc supplementation because it interferes with intestinal copper absorption
Where does an indirect inguinal hernia occur?
-Lateral to inferior epigastric artery
True or False: an indirect inguinal hernia is the MC type of hernia in both sexes, young children, and young adults?
True
Indirect is the MC type
What is the pathophysiology of an indirect inguinal hernia?
- Often congenital due to a persistent patent process vaginalis
- Increase in abdominal pressure may force intestines through internal ring into inguinal canal and may follow testicle tract into scrotum
Symptoms of an indirect inguinal hernia
- Swelling or fullness at site
- Scrotal swelling
- Enlarges with standing or pressure
Symptoms of an incarcerated hernia
- Painful enlargement of an irreducible hernia
- Nausea, vomiting
Symptoms of a strangulated hernia
- Systemic toxicity (irreducible with compromised blood supply)
- Severe painful bowel movement (may refrain defecation)
How do you initially diagnose an inguinal hernia?
Groin US
Treatment for inguinal hernia?
Often require surgical intervention
-Strangulated hernias are a surgical emergency
Where do direct inguinal hernias occur?
-Medial to inferior epigastric artery within Hesselbach’s triangle
What are the components of Hesselbach’s Triangle?
-RIP
- Rectus abdominus (medial)
- Inferior epigastric (lateral)
- Poupart’s Ligament (inferior)
Femoral hernias are MC found in ______ and because the femoral ring is smaller, they often become ________
Women
Incarcerated or strangulated
Treatment for umbilical hernias
- Usually resolve by 2 years of age
- Surgical repair may be indicated if still persistent by 5 years of age to avoid strangulation or incarceration
Incisional hernias MC occur with what type of incisions and in what patients?
- Vertical incisons
- Obese patients
What are the four mainstays of treatment for diarrhea?
- Fluid repletion: oral hydration preferred (IV saline, sports drinks, Pedialyte)
- Diet: bland, low-residue diet (BRAT Bananas, Rice, Applesauce, Toast)
- Anti-Motility Agents: Bismuth-Subsalicylate, Loperamide
- Antiemetics: Ondansetron, Dolasetron, Promethazine, Metoclopramide
