GI IV Flashcards
celiac
intolerance to gliadin
HLA DQ2, DQ8
dermatitis herpetiforms - extensor surfaces
decreased bone density
blunted villi
risk of T cell lymphoma
tx - gluten free diet
distal duodenum and prox jejunum absorption problems
celiac Abs
anti endomysial
anti transglutaminase
anti gliadin
lactase deficiency
osmotic diarrhea
lactase - tips of vill - can follow injury - viral enteritis
lactose tolerance test - if
whipple disease
tripheryma whiplei - gram positive
PAS foamy macros in intestinal lamina propria
-mesenteric ndes
cardiac sx
arthralgia
neuro sx
often older men
PAS foamy macros in intestinal lamina propria with arthritis, neuro, and cardiac sx
whipple disease
crohns
often terminal ileum and colon transmural skip lesions - cobblestone noncaseting granulomas Th1 mediated stricture, fistula, perianal disease tx - corticosteroid, azathioprine, cipro, metro, infliximab, adalimumab
extraintestinal:
- migratory polyarthritis
- pyoderma gangrenosum
- kidney stones
also - aphthous ulcer, uveitis, ankylosing spondylitis, erythema nodosum
ulcerative colitis
rectal involvement continuous only submucosa and mucosa pseudopolyps crypt abscess - Th2 mediated bloody diarrhea tx - 5-aminosalicyclic prep - mesalamine
extraintstinal:
-priamry sclerosing cholangitis
also - aphthous ulcer, uveitis, ankylosing spondylitis, erythema nodosum
mesalamine
5-aminosalicyclic prep
tx of ulcerative colitis
IBS
recurrent abdominal pain
- better with defecation
- change stool frequency
- change stool appearance
middle aged women
appendictis
adult - fecalith obstruction
children - lymphoid hyperplasia
sx - periumbilical pain to mcburney point
nausea, fever
perforation - peritonitis - rovsing sign
- rebound tenderness
- psoas and obturator
rule out - pregnancy - B-hCG
true diverticulum
all 3 layers
often sigmoid colon
false diverticulum
pseudodiverticulum
only mucosa and submucosa
diverticulosis
many false diverticula of colon
-often sigmoid
increased intraluminal P - weak colon wall
with low fiber diet
diverticulitis
inflamed diverticula
LLQ pain, fever, leukocytosis
perforate - peritonitis, abscess formation
like left sided appendicitis
zenker diverticulum
pharyngoesophageal false diverticulum
herniation mucosa tissue at killian triangle
-between thyropharyngeal and cricopharyneal parts of inferior pharyngeal constrictor
dysphagia, obstruction, foul breath (halitosis)
MC elderly men
meckel diverticulum
true diverticulum
persistent vitelline duct
ectopic gastric mucosa or pancreas tissue
-tec99 scan - for gastric mucosa
rule of 2’s - 2 inches long, 2 feet from ileocecal valve, 2% population, 2yo
ladd bands
with malrotation
volvulus
twisting bowel around mesentery
midgut - infant and child
sigmoid - elderly
intussusception
telescoping - prox bowel to distal bowel
at ileocecal jxn commonly
currant jelly stools
majority in children
bulls eye on U/S
emergency
hirschsprung disease
megacolon
lack of enteric nervous plexus
mutation of RET
chronic constipation
dilated normal portion proximal to aganglionic segment
-transitionzone
tx - resection
risk of hirschspring
down syndrome
MCC small bowel obstruction
adhesions after surgery
duodenal atresia
double bubble X-ray
failure of small bowel recanalization
with down syndrome
tx of ileus
cholinergic drug - stimulate intestine motility
meconium ileus
CF - meconium plug obstruct intestine
vollous adenomatous polyp
malignant potential
hamartomatous polyp
non-neoplastic
with peutz jeghers and juvenile polyposis
serrated polyp
premalignant
CpG hypermethylation
microsatellite instability
-BRAF mutation
saw tooth crypts
familial adenomatous polyposis
chromosome 5 - APC tumor suppressor gene
-two hit hypothesis
thousand polyps after puberty
turcot syndrome
FAP and CNS tumor
gardner syndrome
FAP and bone/soft tissuetumor
peutz jeghers syndrome
auto dom
numerous hamartoma polyps
-also hyperpigmented
more colorectal, breast, stomach, small bowel cancers
lynch syndrome
auto dom
-DNA mismatch repair mutation - microsatellite instability
3 relatives, 2 generations, 1 diagnosed before 50yo
risk fx colorectal cancer
adenomatous or serrated polyp familial cancer syndrome IBD tobacco processed meat and low fiber
ascending colon cancer
iron deficient anemia, weight loss
descending colon cancer
obstruction, hematochezia
strep bovis
colon cancer
apple core lesion on X-ray
colorectal cancer
CEA marker
monitor colorectal cancer
mutations of colorectal cancer
APC/beta-catenin pathway - sporadic cancers
1 - APC
2 - KRAS
3 - p53 and DCC
