GIT 2 Flashcards by bailey craig

a. T-cell mediated autoimmune disease
b. Triggered by prolamin (protein present in gluten)
c. Small bowel, villous atrophy and malabsorption

celiac

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d. Hx: female, age, fatty diarrhea, abdo pain, bloating, nausea, vomiting, weight loss, mouth ulcers

celiac

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i. Bloods: CBC, folate, calcium, vitamin D, Antibodies (α-gliadin, transglutaminase, anti-endomysial

celiac

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a. Malabsorption disease found in tropical areas
b. abnormal flattening of villi and inflammation
c. Hx: fatty diarrhea, weight loss

tropical sprue

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a. Tropheryma whippelii infection
i. Gram positive bacillus
ii. Contaminated soil/animals/sewage

whipples

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b. Hx: Men, middle age, peripheral joint pain and inflammation, weight loss, fatty diarrhea, abdominal pain, fever
c. Exam: skin hyperpigmentation

whipples

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d. Comp: Endocarditis, dementia (reversible), ophthalmoplegia

whipples

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a. Chronic, progressive inflammation- Fibrosis, calcification, dilated pancreatic duct

chronic pancreatitis

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Hx:

i. Epigastric pain ‘bores’ through to the back, relieved by sitting forwards, bloating, fatty diarrhea, weight loss
ii. PMH – diabetes
iii. SH – alcohol

chronic pancreatitis

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Causes: alcohol and gallstones

chronic pancreatitis

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d. Invest: CT – pancreatic inflammation, calcifications

chronic pancreatitis

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a. Asymptomatic

b. May precede colorectal cancer – benign hyperplasia

colorectal polyps

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i. Genetic cancer syndrome: colorectal, endometrial, ovarian, gastric
ii. Mainly right sided
iii. Younger – 40s

HNPCC

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a. Adenocarcinoma
b. 50-75 yo
i. Age, altered bowel habit, bleeding (fresh/melaena), mucus, weight loss, abdo pain, obstruction
ii. PMH: bowel polyps, IBD, HNPCC, low fiber diet
iii. SH: smoking

CRC

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Weight loss, malaise, tiredness, abdo pain, tends to present later and bleeding

right CRC

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Bleeding, mucus, altered bowel habit, tenesmus (mass effect)

left CRC

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Presence of diverticular outpouchings of bowel; asymptomatic

diverticulosis

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location of diverticular dz

sigmoid

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Acute inflammation of diverticular outpouchings

i. Hx: Altered bowel habit, abdominal pain relieved by defecation, nausea, fever, generally unwell, blood/pus

diverticulitis

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a. Acute interruption of blood flow: arterial thrombosis (MC) & venous thrombosis
b. Usually small bowel

acute mesenteric ischemic

c. Classic triad
i. Acute severe abdominal pain: central or RIF, constant
ii. No abdominal signs on examination (no tenderness)
iii. Rapid hypovolemia leading to circulatory shock

acute mesenteric ischemic

d. Invest:
i. AXR: ‘gasless’ bowel
ii. Consider arteriography
iii. Surgery: diagnosis confirmed by necrotic bowel

acute mesenteric ischemic

e. Comp: Septic peritonitis, overwhelming sepsis, death

acute mesenteric ischemic

a. Large bowel; transient, non-occlusive ischemia
b. Hx:
- Sudden cramping, mild, left lower abdominal pain, tenesmus, rectal passage of blood – fresh/old/bloody diarrhea
- Symptom resolution within 2-3 days; healing 1-2 weeks
c. Thumb printing on AXR – not receiving oxygen
d. Metabolic acidosis

acute ischemic colitis

a. Adhesion – adults b. Crohns strictures c. Volvulus: cecal, sigmoid d. Hx: i. Acute vomiting, colicky pain, constipation, distention ii. Vomit: feculent: fermented bowel contents or small bowel contents e. Sound: hyper tink @ beginning; nothing at the end

bowel obstruction

a. Prolapse of abdominal contents through weakness in abdominal wall b. Inguinal, Femoral, periumbilical, incisional, Spigelian (lateral edge of rectus sheath- below and lateral to umbilicus

hernias

a. Less than 30 b. Infection and inflammation of appendix wall c. Hx: Periumbilical pain – moves to RIF, anorexia, vomiting, increased pain with coughing/movement d. Exam: Low grade fever, tachycardic, lying still, guarding, rebound, tenderness RIF, Rovsing’s sign (rebound tenderness)

acute appendicitis

a. RNA virus, fecal oral spread, 2-6 wk incubation b. Hx: fever, malaise, nausea, jaundice c. Invest: Hep A IgM

hep A

a. DNA virus; spread: blood, sexual, vertical; 1-6-month incubation b. Hx: same as hep A plus itching, joint pain, RUQ pain c. Exam: Jaundice, RUQ tenderness, hepatomegaly, splenomegaly d. Invest: HBsAg (early), HBeAg (infectivity), HBcAg (previous infection) e. Comp: cirrhosis; PAN

hep B

a. RNA virus, spread: blood sexual | b. Comp: hepatocellular carcinoma

hep C

a. Hx: anorexia, diarrhea, vomiting, jaundice, easy bruising b. Exam: jaundice, hepatomegaly, ascites c. Invest: Blood – LFTs, clotting, urea

alcoholic hepatitis

a. Type 1: adults/children, anti SMA in 80%, ANA in 1% b. Exam: jaundice, hepatomegaly c. Invest: liver biopsy – mononuclear infiltrate d. Young female

alcoholic hepatitis

a. Genetic: toxic copper accumulation b. Hx: i. Liver: Chronic hepatitis, cirrhosis, ii. Eye: Kayser-Fleischer rings iii. CNS: Movement, coordination, cognitive or mood disorders (weird gait/bad balance) c. Invest: urine – increased copper excretion

chronic liver dz - wilson's

a. Young pt b. Hyperpigmentation c. Bronze diabetes d. Invest: serum ferritin e. Comp: cirrhosis, cardiac failure, hypogonadism

hemochromatosis

a. Exam: Leukonychia, Terry’s nails, clubbing, palmar erythema, Dupytren’s contracture, spider naevi, hepatomegaly, ascites

cirrhosis

a. Stones formed from bile i. Pigment stones – small, friable, irregular ii. Cholesterol – large, often just one iii. Mixed

gallstones

females, forty, fat, fertile

gallstones

Leads to i. Infection – cholecystitis, ascending cholangitis ii. Obstruction – colic, pancreatitis, obstructive jaundice

gallstones

Hx: RUQ pain radiating to the back, vomiting; +/- obstructive jaundice (pale stools, dark urine), fatty meal Exam: Jaundice, RUQ/epigastric tenderness

gallstones

i. Hx: continuous epigastric/RUQ pain, vomiting, fever ii. Exam: Raised temperature, peritonism, tender gall bladder mass, Murphy’s sign iii. Invest: USS – thick walled gall bladder, sludge, stone

cholecystitis

i. Ascending infection from bile stasis – leads to biliary sepsis ii. Hx: Charcot’s triad: fever, RUQ pain, pale stools/dark urine

ascending cholangitis

a. Inflammatory disorder of gallbladder - Assoc with IBD b. Hx: Asymptomatic (incidental), fluctuating, jaundice, itching, abdominal pain, fatigue c. Exam: Jaundice, hepatomegaly, caput medusae

primary sclerosis cholangitis

primary sclerosis cholangitis investigations

i. Autoantibodies: ANA, ANCA+ ERCP – beaded appearance – multiple strictures Liver biopsy

a. Chronic inflammation i. Damage to interlobular bile ducts (portion in liver) ii. Cholestasis, portal hypertension iii. Associated with: RA, Sjogren’s, systemic sclerosis

primary biliary cirrhosis

b. Invest: liver biopsy – granulomas around bile ducts | c. Comp: Osteoporosis (vit D), coagulopathy (vit K), portal hypertension

primary biliary cirrhosis

a. Slow growing b. Poor prognosis – 5-month survival c. Hx: fever, abdominal pain, malaise, jaundice, weight loss, itching d. Exam: weight loss, jaundice, ascites, hepatomegaly

cholangiosarcoma

alcohol and gallstones i. SEVERE epigastric pain, radiating to back, relieved by sitting forwards, precipitating event (e.g. alcohol binge/scorpion bite), jaundice

acute pancreatitis

b. Exam: Unwell, fever, raised HR, jaundice, guarding, Cullen’s sign, Grey-Turner’s sign c. Invest: CBC, amylase, lipase, ABG d. Comp: renal failure, pancreatic necrosis, abscess, pseudocyst

acute pancreatitis

i. Female, > 60 yo, smoking, alcohol, diabetes ii. Metastasize early – mean survival 6 months iii. Hx: painless jaundice iv. Exam: jaundice, Courvoisier’s sign 1. Cancer of the head of the pancreas, palpable painless gallbladder

pancreatic cancer