GI pathology Flashcards by Esther Gui

● Telescoping of SI into adjacent segment; obstruct + ischemia; < 2 yoa
● Sx: sudden colicky pain w/ vomiting, lethargy, “red currant jelly”
● PE: sausage shaped mass in RUQ, epigastric, or peri-umbilical region

Intussusception

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● Enlarged colon but NOT due to obstruction
● RFs: medications or Hirschsprung’s disease (mesenteric plexus never develops) or UC / pseudo membrane colitis
● Sx: constipation, abdominal pain, fecaloma, fever, abdominal tympany
● Complications: Chaga’s disease, colonic rupture (EMERGENT)

Megacolon

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● Twisting of GIT -> obstruction,

RFs: midgut infants, colon adults

● Etiology: chronic constipation or laxative use in adults, unknown infants
● Sx: no bowel sounds, abdominal pain & distention, vomiting, ischemia

Volvulus

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● Protrusion of abdominal contents through weakened part of wall
● Indirect (passes canal into scrotum) or direct (directly into inguinal canal), femoral (more common in females)
● RFs: males; 75% inguinal
● Sx: mass (maybe reducible), painless, heaviness
o Incarcerated: pain, enlarged, discoloured, N/V, fever, abd. distention w/ possible bowel obstruction
o Strangulated: blue/red/purple discoloration, significant abd pain, peritoneal signs  gangrene

Hernia

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● Loss of lower esophageal motility ->tight esophageal sphincter -> lumen enlarges as food accumulates / stasis
● RFs: surgery, severe erosive esophagitis –> damages mesenteric plexus, Chaga’s disease, amyloidosis (amyloid proteins deposit in tissues), cancer, AI
● Sx: dysphagia, regurgitation, chest pain, night cough, aspiration
● Complications: aspiration pneumonia, cancer

Achalasia

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● Ileum obstruction from motor dysfunction –> paralysis
● Etiology: surgery, SC injury above T5, opioids, hypothyroidism (slows GIT)
● Sx: constipation, lack of bowel sounds, N/V, dyspepsia, belching (excess)

Adynamic Ileus

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● Part of the stomach herniates through the esophageal hiatus of the diaphragm
● Two types: (1) Sliding – when esophagogastric junction is above the diaphragm (95%), and (2) Paraesophageal – junction is below diaphragm
● Etiology: female (pregnancy), age, decreased fiber, obesity, ascites

hiatal hernia

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which inflammatory disease

● Infection of appendix –> inflame, pus –> necrosis, gangrene w/ ischemia
● RFs: adolescents, < 30 yoa, low fiber diet, Abx use
● Sx: Migrating, severe pain from umbilicus to RLQ
o MANTRELS Score: 7+ = likely, 5-6 = doubtful, 3-4 = negative
▪ Migratory pain (1)
▪ Anorexia (1)
▪ Nausea (1)
▪ Tenderness (1)
▪ Rebound tenderness (1)
▪ Elevated temperature (1)
▪ Leukocytosis – high WBCs (2)
▪ Shift to the left – more immature WBCs (1)
● PE: (+) peritoneal signs (rebound tenderness, guarding, rigidity)
● Dx: abdominal x-ray, CT, U/S; REFER for surgery (untreated  gangrene)

appendicitis

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which inflammatory disease:
“-losis” = out pouch; “-itis” = out pouch + infection from bacterial release
● Results in inflame of bowel wall in sigmoid colon/rectum (75%), perforation, fistula, or abscess (25%)
● RFs: low fiber diet, obesity, sedentary lifestyle, older age
● Sx: LLQ pain, low fever, alternating constipation/diarrhea, N/V
● PE: fistulas (connection)  pneumaturia (gas in urine), feculent vaginal d/c, cutaneous or myofascial infection; abscess, perforation, peritoneal signs

DIVERTICULAR disease

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which inflammatory disease:

inflammation of small intestine; could from ischemia (arterial/venous obstruction)
● Etiology:

viral, bacterial or parasitic infection (food poisoning, stomach bug or the stomach flu).
secretory (pathogenic), exudative, osmotic, malabsorptive, deranged motility

enteritis

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which inflammatory disease:

Erosion of mucosa in the esophagus;

Etiology: H pylori, Zollinger-Ellison (severe hyper-chlorhydria causing recurrent ulcers)

● RFs: GERD, smoking, bulimia
● Sx: substernal burn after eating, difficulty swallowing solid foods, chronic cough & laryngitis, SOB, hoarseness

esophageal ulcers

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● which inflammatory disease:

Local erosion of the stomach or SI;

RFs: H. pylori  chronic gastritis, NSAIDs, stress, Zollinger-Ellison syndrome

● RFs: smoking, chronic NSAID use, cirrhosis, aspirin, COPD, low fibre, stress, corticosteroids
● Sx: burning after meals, dyspepsia, nausea, belch, melena, guarding
o Gastric wall: pain right after meals w/ NO relief from food or antacids
o Duodenum: pain 2-3 hours after meals, better w/ food & antacids
● Dx: breath test (H. pylori), gastrin, endoscopy; Tx: PPI, Abx
● Complications: high reoccurrence rate, GI bleeding, perforation, cancer

peptic ulcer disease

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●
which imflammatory disease:

Inflame entire stomach; erosive (severe) or non-erosive (metaplastic)
● Sx: pain w/ food, dyspepsia, N/V, no appetite, melena (black stool)

gastritis (acute)

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inflamation of the stomach lining

Two main types: (BOTH present with chronic dyspepsia-indigestion)
● Fundal Type A (immunologic):
o MOA: parietal cells of the fundus destroyed by CD4+ T cells  lowers gastric acid secretion  malabsorption of nutrients
o Complications: anemia, autoimmune thyroiditis, celiac, ulcer
● Antral Type B (H pylori infection): PUD, lymphoma, purpura

gastritis - chronic!

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which inflammatory disease:
● Retrograde flow of stomach acid into esophagus, bc of failure of lower esophageal sphincter
● Sx: < after meals, chronic cough, wheeze sore throat, globus
● Dx: based on clinical sx; endoscopy, biopsy (rare); Tx: HPI or PPIs

GERD

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● GERD damages esophagus leads to inflammation & disrupted peristalsis
● RFs: obesity, hiatal hernia, lying down after meals, restrictive clothing around the waist, hypo- or hyper-chlorhydria
● Sx: substernal burning after meals, chest pain, cough, laryngitis
● Complications: Barrett’s esophagus

esophagitis

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which inflammatory disease:

due to GERD

tissue that is similar to the lining of your intestine replaces the tissue lining your esophagus

● simple squamous to INTESETINAL epithelium; esophageal structures develop
● RFs: long-standing untreated GERD; Sx: chronic retrosternal/epi pain
● Dx: endoscopy, biopsy; cannot be diagnosed clinically
● Complications: esophageal cancer from dysplasia

Barret Esophagus

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which inflammatory disease

● Chronic inflammation of ONLY the descending colon & rectum; NO skip/granulomas

continuous rectal lesions

● RFs: NSAIDs or Jewish
● Sx: bloody, mucoid diarrhea, wax/wane, fever, fatigue, arthralgia
● Complications: arthritis, ankylosing spondylitis (fused spine, from HLA B27 gene), uveitis, CRC, toxic megacolon, osteoporosis

IBD-UC

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which inflammatory disease

● Chronic inflammation of ileum & colon w/ skip lesions & granulomas
● Can occur anywhere in GIT; inflammation present btwn wax/wane attacks
● RFs: AI, smoking, Jewish, FHx, stress, low fiber, NSAID, lack of breastfeed
● Sx: pain, diarrhea, fatigue, anal fistulae, adhesions, adhesions, strictures
● Complications: anemia (B12, folate, iron malabsorption), uveitis, arthritis, adhesions, CRC, urolithiasis

IBD-Crohn’s

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which congenital cdx

● Esophagus doesn’t form properly -> no connection to stomach -> fistulation of trachea
● Sx: drooling, coughing, choking, regurgitation of all food, aspiration pneumonia if there’s a tracheoesophageal fistula

esophageal atresia

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which congenital cdx

● Membrane (thin fold of tissue) obstructs esophagus; congenital if affecting lower 2/3 & acquired if upper 1/3 (iron deficiency, bullous disease, rejected graft, celiac)

● Sx: chest pain, dysphagia

Esophageal Webs & Rings

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which congenital cdx

● Outpouching of all layers of the small intestine (usually the ileum) from vitelline duct not degrading after birth;

RFs: ectopic tissue interferes

● Sx: asx or painless hematochezia (blood from anus), obstruction, volvulus

Meckel Diverticulum

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which congenital cdx:

● Hypertrophy of pylorus causing constriction / obstruction of stomach outlet
● RFs: males, Jewish, FHx
● Sx: severe vomiting in neonates, insufficient urination, hunger, dehydration, metabolic alkalosis  electrolyte imbalances

pyloric stenosis

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which abdominal cavity cdx:

● Liver cirrhosis/damage to hepatocytes -> congestion of portal venous system -> fluid buildup in peritoneal cavity

(fluid collects in spaces within your abdomen, from high pressure in certain veins of the liver (portal hypertension) and low blood levels of a protein called albumin)

● Labs: serum ascites albumin gradient (SAAG – measures albumin) is the GOLD standard indicator for ascites
o High SAAG > 1.1 = portal venous system pushing fluid out
o Low SAAG < 1.1 = inflammation or cancer

● Sx: abdominal distention, (+) fluid transmission across abdomen, shifting dullness, pressure on other abdominal organs
o High SAAG = normal glucose & low WBC (no infection/immune process)
o Low SAAG = low glucose & low pH & high WBC (bc inflame/cancer)

Ascites

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which abdominal cavity cdx ● Inflam. of peritoneum from visceral -> parietal as infected organ contacts wall o Visceral pain diffuse; parietal is better innervated / localized pain ● RFs: appendicitis, PID, trauma, puncturing foreign body, bacterial, TB ● Sx: “acute abdomen sx” pain, tenderness, rebound tenderness, guarding, N/V ● Complications: intestinal paralysis from severe inflam., shock, abscess, death

Peritonitis / Adhesions

which vascular cdx ● Engorged veins in esophagus from chronic alcoholism or portal HTN ● RFs: alcoholism; Sx: bleeding, severe epigastric pain, liver disease ● Complications: high risk of rupture & death

esophageal varices

● Dilated veins of anal canal; RFs: low fiber diet -> constipation, pregnancy ● Sx: rectal pain, bleeding, itch, rectal prolapse -> thrombotic or inflamed

hemorrhoids

necrosis due to inadequate blood supply to the affected area Two types: ● Transmural – all GI layers, causes ischemic enteritis (inflam.) ● Partial – only mucosa, incomplete occlusions of superior mesenteric artery from athero., shock, or heart failure

infarction

● Abnormal, dilated, and fragile blood vessels in the colon ● Most common vascular issue of GIT; healthy blood cells degenerate from age ● RFs: renal failure, age, CVD; Sx: bleeding, asx unless massive hemorrhage  anemia, hematochezia (anus), hematemesis (oral)

Vascular Ectasis of the Colon

which neoplasm cdx ● Squamous cell origin; RFs: Barrett’s esophagus, alcoholism, smoking, H. pylori eradication (H pylori reduces stomach acid  less reflux  less dysplasia) ● Sx: dysphagia, hoarseness from damage to recurrent laryngeal nerve, cachexia; poor prognosis

Esophageal Cancer

which neoplasm cdx Adenocarcinoma (looks like an ulcer) either diffuse or intestinal; Asia & Africa ● Etiology: diffuse (high meat/low F/V) & intestinal (high salt, gains, nitros) ● Sx: vague GI upset, fatigue, weight loss, anorexia; Dx missed unless ulcer or metastasis occurs

gastric cancer

T/F intestinal neoplasms are common , secondary to celiac or IBD

F: they are extremely rare

● Dx: serum alpha-fetoprotein (AFP) is common tumor marker ● RFs: chronic hepatitis B/C, alcoholism, aflatoxin (carcinogen); Asia & Africa ● Sx: asx until later stage or jaundice, easy bruising, ascites, cachexia

Hepatocellular Carcinoma/liver cancer

● Squamous cell origin; RFs: chewing tobacco, smoking, alcohol, HPV ● Sx: any mouth sore that does not heal within 14 days should be considered ● Leukoplakia are white benign patches; Erythroplakia reddish, precancerous

oral (Leukoplakia)

For pancreatic cancer. what type of tumor? Starts in the _________ epithelium in the pancreatic head causing blockage of the __________________

Adenocarcinoma that starts in the ductal epithelium in the pancreatic head causing blockage of the common bile duct

● Neoplastic change in pancreatic head; ductal adenocarcinoma (80%); unrelated to gallstones & GB ● RFs: smoking, African descent, diet/alcohol ● Sx: vague epigastric pain + weight loss + jaundice  ASSUME PC ● PE: Courvoisier’s sign – non-tender, palpable GB + mild jaundice ● Dx: CT, MRCP; Prognosis: poor , 5YR survival ratio

Pancreatic Cancer

● 3rd most common cancer; adenocarcinomas; screening begins at 50 yoa ● RFs: chronic UC, high fat low fiber diet, polyps, strong FHx ● Sx: depending on location (polyp  bleed  detect on FOBT) o R: systemic sx  fatigue, weight loss, iron deficiency, RLQ mass o L: constipation, abd pain, reduced stool caliber, rectal bleeding o Rectum (70%): obstruction, tenesmus, rectal bleed, mass on DRE ● Labs: CBC for microcytic anemia; Dx: FOBT (+), colonoscopy ● Spread will go to the liver (hepatomegaly) & lungs; 5YR survival

colorectal cancer

what kind of tumor is colorectal cancer commonly? On which side does it cause obstruction? (left or right)

Commonly adenocarcinoma of the rectal or colonic epithelium Left sided tumors = obstruction Right sided tumors = NO obstruction

which infectious disease ● Inflam. of SI & colon; Types: Abx associated, pseudo membrane colitis, ulcerative ● Sx: diarrhea, N/V, abdominal pain, fever, chills

Enterocolitis

esophagitis microbes

candida or HSV

● Inflammation of the gums o Gingivitis: -calculus causes inflammation of gingival tissues o Periodontitis: inflammation in periodontal ligament, alveolar bone, cementum of teeth ● RFs: Poor oral hygiene, acute stress, aging, infection, mouth breathing ● Acute necrotizing ulcerative gingivitis/Vinvent’s angina/Trench mouth: o Severe form in patients with decreased resistance to infection o mixed infx Borrelia vincentii & Fusobacterium o Young adults, poor hygiene, not contagious

Gingivitis / Periodontitis

● Oral inflammation; Microbe: Candida albicans; RFs: Abx, children, elderly ● Sx: local white membranous lesion

ORAL THRUSH

what condition? White patches (ESP. on tongue) that BLEED when scraped off , inflamed base, bad breath, dry mouth

ORAL THRUSH

● Severe oral inflammation from HSV 1; Sx: cold sore, fever

Herpetic Stomatitis:

● Also called “canker sores”; RFs: food allergies, Crohn’s, celiac, iron & B vitamin deficiencies, or idiopathic

Aphthous Stomatitis:

● Diffuse hepatic inflammation cause by specific hepatotropic viruses (< 6 mo)

viral hepatitis

which infectious disease has these phases Sx: (two phases) o Viral prodrome: anorexia, N/V, malaise, low fever, dull RUQ pain o Icteric phase: jaundice, dark urine, acolic stool, hepatomegaly, splenomegaly, cervical lymphadenopathy (complication  fulminant hepatic failure) Chronic: vague abdominal pain, fatigue, depression, headache, rarely jaundice

viral hepatitis

● which infectious disease Labs: CBC, liver enzymes, LFTs, viral serology o High AST, 20x higher ALT, mildly high bilirubin + ALP o Viral Abs: IgM anti-HAV, HBsAg (surface), IgM anti-HBs, anti-HCV Tx: supportive UNLESS red flags! encephalopathy (high NH4+ in brain  cognitive changes), prolonged INR (slow clotting), severe vomiting, hypoglycemia (LV can’t convert to glucose  imbalance elevates insulin) ● 5 types of viral hepatitis: o HAV: acute, contaminated food/water, fecal/oral o HBV: acute or chronic, seafood or contaminated food/water, fecal/oral, HBsAg in serum indicates an active infection o HCV: acute or chronic, unprotected sex or childbirth, HCV IgG Ab ▪ More likely to lead to autoimmune conditions o HDV: acute or chronic, infection with HBV (higher susceptibility) o HEV: fecal/oral, more common in underdeveloped countries

viral hepatitis

● Inflammation of parotid gland; usually related to mumps or S aureus ● Sx: bilateral, submaxillary / sublingual swelling, tenderness, fever (24-72 hrs

Parotitis

● Sudden inflame of pancrease + hemorrhage due to auto-digestion by enzymes & hemorrhagic fat necrosis ● RFs: I GET SMASHED o Idiopathic, Gallstones, Ethanol, Trauma, Steroids, Mumps/Malignancy, Autoimmune, Scorpion Sting, HyperTGs/Ca2+, ERCP, Drugs ● Sx: severe, constant epigastric pain; radiates to the back; N/V, sit up/forward, fever (toxic metabolites), abdominal distention ● PE: Cullen’s sign (umbilical ecchymosis), Grey Turner’s (flank ecchymosis), guarding & reduced bowel sounds ● Labs:** elevated serum amylase & lipase (enzyme) **– almost always !!!!! ● REFER to ICU; prognosis usually good but could develop abscess

Acute Pancreatitis

● Long-standing inflammation w/ irreversible morphological changes of pancreas ● RFs: alcohol & idiopathic ● Labs: may or may not have elevated amylase and lipase ● Sx: persistent/intermittent epigastric pain; late stages -> steatorrhea (fat in stool) & diabetes mellitus d/t decreased endocrine/exocrine function/v patho

Chronic Pancreatitis

what type of pancreatitis: ● Alcohol dehydrates  less fluid  enzymes can’t move  precipitate  pressure builds  blocked enzymes digest pancreas  inflame, edema, hemorrhage

Alcohol Induced Pancreatitis

what type of GB cdx ● Gallstones in the GB and ducts; 80% asymptomatic ● 85% cholesterol stones, others are pigment stones (bilirubin or alcohol mix calcium) - hardened deposits of digestive fluid ● RFs: fat/fasting, fertile, forty, family history, First Nations ● Sx: Dull ache, biliary colic in RUQ, if asymptomatic, no treatment

Cholelithiasis

● what type of GB cdx Inflammation of GB from obstruction of **cystic duct** (immune response); reoccurrence; consider if symptoms > 12 hrs ● RFs: bacterial, exogenous estrogen exposure ● Sx: severe RUQ pain (hours, days), **radiates to R shoulder,** fever (low), N/V, anorexia, **Charcot’s triad** (fever, RUQ pain, jaundice) REFER for surgery ● PE: (+) Murphy’s Sign: sharp inhale w/ palpation of GB 🡪 Most predictive!! ● Complications: cholangitis (lethal) or cholelithiasis stones obstruct duct

cholecystitis

what type of GB cdx 1 or more stones in the** common bile duct**; risk of impacting pancreas ● Bile can’t leave -> begins to compromise LV function -> jaundice fluctuates ● Sx: RUQ pain – colicky or constant, fever, N/V, loss of appetite o Fluctuating jaundice – duct blocks and unblocks o Acholic stool – light, no bile ● PE: (+) Murphy’s Sign

Choledocholithiasis

what type of liver cdx impairment in excretion of bile **Bile stops moving & builds up in liver** -> damages hepatocytes ● Etiology: gallstones, tumors, metabolic dysregulation (no secretions), drugs, primary biliary sclerosis, primary sclerosing cholangitis (“fit liver” picture) ● RFs: mixing medications ● Sx: **ITCH** (pruritus), jaundice, fatigue – vagueness makes Dx difficult ● Complications: intrahepatic cholestasis of pregnancy  stillbirth, prematurity, abnormal clotting

Cholestasis

● Sclerosing or fibrosis replaces hepatocytes; > 75%  liver failure ● RFs: chronic hepatitis B or C, alcohol ● Sx: fatigue, **hard, shrunken liver,** jaundice

Cirrhosis

● Severe and rapid hepatocellular injury (< 8 wks); from viral (HBV) or drugs ● Sx: malaise, low fever, urticaria, pruritis, hepatomegaly, RUQ pain, hepatic encephalopathy (confusion, altered consciousness, coma) ● Labs: CBC, high liver enzymes, LFTs (high bilirubin, INR), LDH (lactate dehydrogenase)

Fulminant Hepatic Failure (ACUTE)

**● Decompensation of liver; inability to regenerate; complete loss of function **● Areas of decompensation: o Encephalopathy: cognitive decline  drowsiness, tremors (Asterixis: wrist quiver), disoriented  stupor, hyperactive reflexes  coma o Excretory dysfunction: can’t conjugate bilirubin  buildup  jaundice o Coagulopathy: decreased clotting + easy bruising o Hypoalbuminemia: edema + portal HTN from… ▪ Caput medusa: dilated superficial veins of abdomen (shunt) ▪ Ascites: low albumin  alters pressure to push fluid out  increases blood volume  fluid accumulates (PE: shifting dullness) o Hormones: abnormal catabolism of hormones leaves ADH, aldosterone & estrogen to buildup in blood  gynecomastia, testicular atrophy ● Labs: high (or normal) AST + ALT, PT/INR, **low albumin**, LDH o Acute failure: high LE, Chronic: mild or high, Acute/Chronic: high bilirubin

Hepatic Failure (CHRONIC)

**an autosomal recessive disorder of bilirubin metabolism within the liver ET: decreased UDP-glucuronosyltransferase activity and impaired uptake of bilirubin **● Sx: jaundice; Labs: elevated unconjugated bilirubin

Gilbert Syndrome

● Liver damage from alcohol consumption; cholestasis buildup damages hepatocytes  fibrosis around central vein  venous obstruct  cirrhosis ● Related to steatosis (fat deposits) as fatty acids are made with alcohol conversion ● Sx: fever, hypotension, jaundice, tachycardia, malnourishment ● PE: palpable, tender liver (ALWAYS tender in cirrhosis, NOT hepatomegaly), ascites ● Labs:*** AST: ALT > 2:1*** (ONLY time, B6 def) & elevated enzymes + LFTs o High bilirubin & leukocytes ● Prognosis: Reversible if alcohol is avoided, but cirrhosis is not reversible

Alcohol-Related Liver Disease

● Inflammation of liver from medication (**acetaminophen**, OCP, Abx); can’t clear metabolites  buildup & damage hepatocytes ● Excess dosing 10-15g/day or 4-6g/day in epilepsy & alcoholics ● RFs: any disease that caused liver injury ● Sx: N/V, jaundice, hepatic encephalopathy, acute renal failure, death ● Labs: CBC, liver enzymes (all high), LFTs (high bilirubin + INR) ● Dx: EMERGENT, gastric lavage/oral charcoal; prognosis based on blood [ ]

Drug-Induced Hepatitis

what type of liver cdx Inflammation + damage from **fat buildup **unrelated to alcohol; metabolic ● RFs: obesity, insulin resistance, dyslipidemia, metabolic syndrome, weight loss ● Sx: fatigue, malaise, mild RUQ pain, hepatomegaly, unexplained splenomegaly, portal HTN (could cause fluid buildup in spleen) ● Complications: cirrhosis, hepatocellular carcinoma, liver failure, encephalopathy

Non-Alcohol Steatohepatitis (NASH)

liver disease when immune system is attacking the liver Unknown cause; RFs: other AI conditions, viral infection, medications ● Sx: (similar to acute hepatitis) weight loss, fatigue, behavioural changes, epistaxis (sign of upper GI hemorrhage from poor clotting), easy bruising ● Complications: liver failure, chronic liver disease, anemia (from bleed)

Autoimmune Hepatitis

what type of liver cdx From elevated pressure in portal venous system, originating from: o Pre-hepatic: portal vein thrombosis, congenital abnormality o Intra-hepatic: from liver cirrhosis o Post-hepatic: CHF, hepatic vein thrombosis, IVC pathology, constrictive pericarditis ● Sx: hepatic encephalopathy, ascites, splenomegaly, mild pancytopenia (trapped blood in the spleen), varicose veins, caput medusae, jaundice ● Complications: renal failure, variceal rupture (esophagus), bacterial peritonitis

portal HTN

what type of liver cdx Bilirubin accumulates in extrahepatic tissues -> yellow skin coloration ● Accumulation of o Unconjugated (indirect) bilirubin from hemolytic anemia / hemorrhage o Conjugated (direct) bilirubin from obstruction (stones), hepatitis, cirrhosis, drugs, or pregnancy

jaundice

what def./reabsorption cdx: ● Low/no HCl acid in stomach; RFs: aging, drugs, pernicious (B12) anemia ● Sx: asx or dyspepsia, gastric upset ● Complications: infection (easier to colonize), nutrient malabsorption (B12), dysbiosis, gastric cancer

achlorhydria

what type of def/reabsorption cdx: Gluten (gliadin) intolerance; immune cells attach gliadin on villi of jejunum  flattens microvilli  decreased absorption  osmosis pulls fluid in ● Sx: (unmanaged) **bulky, frothy, greasy, yellow, or gray stools;** nutrient malabsorption  weight loss, borborygmi, flatus, muscle wasting, fatigue ● Complications: autoimmunity (IBD, thyroiditis), anemia, osteoporosis (from chronic inflammation), intestinal lymphoma, dermatitis herpetiformis (rash) ● Dx: endoscopy to observe microvilli (gold standard)

Celiac disease

● Malabsorption of lactose from lactase enzyme deficiency; remains in gut ● Sx: gas, bloating, diarrhea, diffuse abdominal pain

Lactase Deficiency

name the enzyme deficiencies 1. ● Deficiency of hexosaminidase A; needed to breakdown toxins in brain/SC  buildup & degrade CNS  severe mental/motor impairment ● RFs: Ashkenazic Jews 2. ● Deficiency of alpha-L iduronidase (IDUA)  accumulation of heparan sulfate & dermatan sulfate in the heart, brain, liver & other organs ● Sx: progressive mental deterioration, dwarfism, stubby fingers, cloudy cornea 3. ● Deficiency of lysosomal alpha glucosidase  glycogen accumulates in the liver, heart & skeletal muscle ● Sx: fatal from cardiorespiratory failure

1. Tay Sach's 2. Hurler's disease 3. Pompe's disease

● Viral infection 12hr-3days, oral-fecal route, viruses-> epithelium damage-> osmotic diarrhea, vomiting ● Microbes: Salmonella, E. coli, Campylobacter jejuni, Shigella, Yersinia enterocolitica (“Gastroenteritis is SECSY”) o Secretory: cholera o Bloody: enterohemorrhagic E. coli (EHEC)

Gastroenteritis

● RFs: Antacid drugs or hypochloridria, immunosuppression, exposure to infected person or contaminated food, lack of breast feeding, children, elderly, immunocompromised ● Sx: Diarrhea, sometimes cramping/pain, presence of blood and/or pus, systemic symptoms (fever, arthralgias, myalgias), highly frequent or unremitting bowel movements ● Complications: o Blood or pus, recurrent diarrhea, signs of serious electrolyte disturbances including hypotension, dizziness, sunken fontanelles, severe dehydration lack of urination or tear production and/or skin tenting. o Dysentery can lead to sepsis and death. o Hemolytic uremic syndrome is life-threatening complication of EHEC. o Viral diarrhea is leading

Gastroenteritis