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
With diarrhea, what is vomiting usually from?
Imbalance of serotonin, acetylcholine, dopamine, and histamine
Side effects of Pepto-Bismol (Bismuth-Subsalicylate)
-Dark colored stools, darkening of tongue
DO NOT GIVE TO CHILDREN WITH VIRAL ILLNESS: RISK OF REYE SYNDROME
What are important side effects of Metoclopramide?
-Extrapyramidal effects: rigidity, bradykinesia, tremor, akathisia (restlessness)
If the patient is having extrapyramidal side effects from Metoclopramide, what is the treatment?
-Diphenhydramine IV
What is the MC overall cause of gastroenteritis in adults in North America and MCC of viral gastroenteritis worldwide?
Norovirus Gastroenteritis
Transmission of Norovirus
- Fecal-oral route
- Contaminated food and water
-Outbreaks (cruise ships, hospitals, restaurants)
Symptoms of Norovirus Gastroenteritis
- Vomiting is predominant symptom
- Nausea
- Non-bloody diarrhea that lacks mucus
- Generalized symptoms
Treatment for Norovirus Gastroenteritis
-Fluid replacement (oral preferred)
Rotavirus gastroenteritis is MC seen in what population?
-Young, unimmunized children between 6 months and 2 years of age
To diagnose Rotavirus, you can do which test?
PCR testing
Treatment for rotavirus gastroenteritis
-Oral rehydration
Explain what Staph-A gastroenteritis is
-Infection due to heat-stable enterotoxin B
What is the incubation period for Staph-A gastroenteritis
-Short: within 6 hours
Source of Staph-A gastroenteritis
- Food contamination (dairy products, mayo, meats, eggs, salads) especially at room temperature
- Common at picnics
Sources of bacillus cereus gastroenteritis
- Contaminated food (such as fried rice)
- Enterotoxin that can survive reheating
What is the MCC of traveler’s diarrhea?
Enterotoxigenic E. Coli
Transmission of enterotoxigenic E. coli
-Contaminated food and water (includes unpeeled fruits washed in the water)
Symptoms of Enterotoxigenic E. Coli
-Abrupt onset of watery, non-bloody diarrhea, abdominal cramping, vomiting
Vibrio Cholerae is what shape? How is it transmitted?
- Gram-negative, comma shaped rod
- Contaminated food and water
Outbreaks of Vibrio Cholerae occur where?
-During poor sanitation and overcrowding conditions (especially abroad)
What is the pathophysiology of vibrio cholerae?
Exotoxin causes secretory diarrhea (inhibition of water, sodium, and chloride absorption) which may cause profound dehydration and hypovolemia
Symptoms of vibrio cholerae diarrhea
- Vomiting
- Abdominal pain
- Copious watery diarrhea (rice water stools) that have grey flecks of mucous and may have a fishy odor but no fecal odor, blood, or pus
Treatment for vibrio cholerae?
- Oral rehydration therapy mainstay
- Tetracyclines if needed (Tetra, Doxy, Mino)
Prevention of vibrio cholerae in areas where it is endemic
- Use bottled water
- Wash hands often with soap
- Use chemical toilets
- Cook food thoroughly
How are vibrio parahaemolyticus and vulnificus transmitted?
-Raw or undercooked shellfish consumption and seawater especially during summer months
Vibrio parahaemolyticus causes gastroenteritis primarily; however, what does vibrio vulnificus cause?
Gastroenteritis, necrotizing fasciitis, cellulitis
Vibrio Vulnificus is the MCC of
death from seafood consumption in the US
Risk factors for bacteremia with vibrio parahaemolyticus and vibrio vulnificus?
Underlying liver disease (alcoholism, cirrhosis, hemachromatosis)
Immunocompromised (DM)
Cellulitis from vibrio vulnificus occurs due to
wound exposure to seawater
For cellulitis associated with vibrio vulnificus, what is the treatment?
Tetracyclines (Tetra, Mino, Doxy)
For necrotizing fasciitis associated with vibrio vulnificus, what is the treatment?
Emergent surgical debridement + broad spectrum ABX
