Hepatitis Flashcards
Identify the Councilman Bodies
What symptoms/findings would differentiate Yellow Feveor from Hepatitis?
Yellow Fevor:
black vomitus and very high fevor
A 2-year-old boy is brought to the emergency department (ED) episodic abdominal pain, blood in his diaper, and a recent diarrheal illness. A diagnosis is made using ultrasonography.
The tissue that served as lead point for this patient’s intussusception is the site for what immunologic process?
This patient presents with eTaken together, these symptoms suggest a diagnosis of small bowel intussusception after a recent GI infection. GI infections cause reactive hyperplasia of Peyer patches, which can then serve as the lead point for intussusception.
Peyer patches are small masses of lymphatic tissue whose function is to survey intestinal bacterial populations, and arm the body against overgrowth of pathogenic bacteria. M cells contained within Peyer patches take up antigens and present them to B cells, which then form germinal centers. Following CD40L stimulation from T cells, the B cells class switch to IgA, and differentiate into plasma cells.
Ultrasonography of the abdomen in patients with intussusception classically shows a “bullseye” or “target” sign, which represents the infolding of the small intestine.
The ability to develop memory B cells would take longer than the duration from this patient’s diarrheal illness to intussusception. Activating the complement cascade would occur in an acute response to the primary infection (diarrheal illness), not the intussusception. The ability to distinguish between self and foreign antigens refers to an autoimmune process that does not involve Peyer patches.
Treatment for Ulcerative colitis
Treatment of UC varies by severity of the disease. This patient’s condition is not associated with anemia or cardiovascular effects (signs of severe disease), so she should be treated with a first-line medication: mesalamineor sulfasalazine (a mesalamine prodrug). These anti-inflammatory agents are most effective at inducing remission when applied in the form of suppositories or enemas. However, less effective oral medications are also an option. Their adverse effects include malaise, nausea, sulfonamide toxicity, and reversible oligospermia.
Although infliximab can be used to treat severe UC with accompanying anemia, this patient is not anemic and is not experiencing cardiovascular changes. Similarly, colectomy is reserved for cases of severe and uncontrollable UC (after infliximab failure), colorectal cancer, or toxic megacolon. Diet modification for gluten avoidance would be a treatment for celiac disease. Omeprazole and sucralfate are treatments for peptic ulcers, which can lead to blood in the stool, but not usually arthralgias, fevers, or erythema nodosum.
