Lecture 1 Flashcards by Meg Dolohanty

where does gallbaldder pain refer?

right shoulder or subscapular region

liver are and back

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where does pancreas pain refer?

Left mid back

and epigastrium

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vomit bile w/I 15 minutes of eating; believed by be cause by reflux of bile into stomach

Bilious vomiting

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Foreceful emesis w/o prior nausea or retching. Found often in increased ICP, but can be seen in other conditions

Projectile vomiting

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Vomiting of food eaten more than 6 hours previously

Gastric retention

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Most common; explosive bouts of n/v in conjunction w/ watery diarrhea, cramping, abdominal pain, myalgias, HA and fever. Rapid recovery usually within 7-10 days

Viral gastroenteritis

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Greater than 1 Liter per day of diarrhea
decreased absorption of Na/Cl
includes fatty acid induced diarrhea

Secretory diarrhea

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Diarrhea stops when patients fasts. Elevated osmotic gap on stool analysis. Can be due to laxatives with magnesium

Osmotic diarrhea

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2 causes of inflammatory diarrhea?

Ulcerative colitis

Parasites

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Motility disorders that can cause diarrhea?

IBS
Hyperthyroid
Carcinoid
Scleroderma
Diabetes

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Abdominal distention, diarrhea, postprandial abdominal distention. Hypomotility leads to bacterial overgrowth. WIll have watery diarrhea or steatorrhea.

Scleroderma

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Abdominal pain; hematemesis or “coffee ground” emesis; passing melena tarry stool (stool may be frankly bloody or maroon with massive or brisk upper GI bleeding)

Upper GI bleeding

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Left lower quadrant pain

tenderness, fever, and leukocytosis. Tender mass is noted frequently

Diverticulitis

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Due to neurologic or neuromuscular dz. Have problems starting swallowing. Possibility of aspiration/ regurgitation. Common in elderly, cortical brainstem lesion. More problem with liquids than solids

Transfer dysphagia

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Most common cause of motor dysphagia. Slowly progressive motility disorder. Lack of relaxation of LES. hallmark- loss of cels in myenteric ganglia. Episodes of aperistalsis. Sensitivity to gastrin and cholinergic agents. Liquids and solid both difficult. Pain and regurg common.

achalasia

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tx of achalsaia

open LES with balloon dilation
Botox injections
surgical myotomy

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Type of scleroderma 
calcinosis 
Reynards phenomenon 
esophageal dysmotility 
sclerodacytyl 
telangiectasia

CREST syndrome

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non-progressive dysphagia
liquids and solids affected
substernal chest pain
can appear like angina 
Will have periods normal peristalsis

Diffuse esophageal spasm

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high amplitude contractions in distal esophagus
Principal symptom is chest pain
Non-progressive
Liquids and solids

Nut cracker esophagus

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Tx of diffuse esophageal spasm

nitrate/ calcium channel blockers

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Dx of diffuse esophageal spasm and nutcrack esophagus

esophageal manometry

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Tx of nutcracker esophagus

calcium channel blockers

nitrates

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Anxiety disorder. Say they have problem swallowing but they don’t

globus hystericus

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Acid stimulation of chemoreceptors
prolonged severe contractile waves
distention of stretch receptors 
common with GERD
Similar to IBS; seen in patients w/ nutcracker esophagus

Esophageal chest pain

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most common histology of esophageal cancer

squamous cell carcinoma

Only have difficulty with solid food. rapid onset

Mechanical obstruction

test of choice for transfer dysphagia

barium swallow

rings of fibrous tissue that occur in the lower esophagus and cause intermittent dysphagia to solids. Trouble with large piece of bread or meat

Esophageal rings (Schatski’s Ring)

Tx for Schatski’s Ring

balloon or bougie dilation

rings that occur in the proximal esophagus

esophageal webs

causes occasional heartburn LES is often weak and hiatal hernia can contribute Bitter regurg or water brash can have cough, asthma, horseness retrosternal burning sensation radiating upward large meals in supine position

GERD

dx of GERD

ambulatory pH study Endoscope can be done in clinic just based on S/S

tx of GERD

elevated head in bed, weight loss, avoid fatty foods Histamine 2 receptor antagonist PPI promotility therapy

Metaplasia in the esophagus can lead adenocarcinoma. Due to years of acid exposure. Seen in people with hx of GERD

Barrett's esophagus

tx of Barrett's

Endoscope every few years with biopsy PPI Resection if needed

what type diarrhea does zollinger diarrhea cause?

Secretory diarrhea

3 things to stop before H. pylori testing

Pepto-Bismol, H2 Blockers (Zantac, Pepcid etc) Proton Pump Inhibitors (Nexium, Prilosec)

Patient presents with PUD, negative for H. Pylori and NSAIDs and has recurrent ulcers what should you suspect?

Zollinger- Ellison Syndrome

Diarrhea R lower quadrant pain diarrhea is non-bloody weight loss/ vomiting/ fever

Crohn's Dz

where does crohn's dz occur

any portion of GI transmural cobblestoning skipped lesion

what deficiency may you have with crohn's

Vit B 12 | Iron deficiency

rectum is always involved pain, bloody diarrhea, urgency, bleeding, mucus passage tenesmus, urgency

Ulcerative colitis

complications of UC?

toxic megacolon perf anemia- Fe deficiency adenocarcinoma of colon

extra-intestinal manifestations of IBD

arthritis liver complications MSK complications

ways to diagnose IBD

Labs test for inflammation/ anemia colonoscopy radiography

what are the red flag symptoms that will rule out IBS.

``` weight loss anemia nocturnal symptoms steatorrhea onset of symptoms after age 50 Fever family hx of colon cancer sudden changes in symptoms ```

Drugs to manage IBS

``` Anticholingerics acid suppression motility agents antidepressants don't put on narcotics ```

Common in child care centers; person to person (fecal-oral) transmission. Watery noninflammatory diarrhea. Rarely causes bacteremia; lasts 3-6 days.

Acute Shigellosis

From contaminated meat, dairy or poultry products, can be from spices. 2-3 days. Fever, nausea, vomiting, diarrhea

Acute salmonellosis

main cause of traveler's diarrhea. Outbreaks from foodborn transmission.

E. Coli

winter outbreaks; vomiting and diarrhea in families, nursings homes, schools.

Norovirus

Outbreaks among children; unusual and mild in adults | worldwide distribution

Rotavirus

waterborne transmission; protozoan. Day care centers. IgA deficiency.

Giardia lamblia

Common in immunocomprimised; HIV and AIDS patients. waterborn transmission, travel

cryptosporidium

causes of immunosupression disorders of the intestines

Cryptosporidium, Isospora, Cyclospora

parasitic and protozoan causes of intestinal infections

Giardia, Amoeba

what does the overgrowth of C. diff lead to?

pseudomembranous colitis

what are invasive pathogens that cause inflammatory damage?

Salmonella, Norwalk Virus., Entamoeba

Cytotoxin elaborating-destroy mucosal epithelial cells

C. Diff

Neurotoxin elaborating-one cause of food poisoning & vomiting

Staph A

what is bleeding like with diverticulur dz?

profuse and painless bleeding

Hepatitis caused by feca-oral contamination. Common in child care, NICU or sexual transmission . There is no carrier state.

HAV

Hepatitis caused by percutaneous, perinatal and sexual contact. can have vertical transmission

HBV

hepatitis that is less than 6 months.

acute hepatitis

incubation time of HAV

2-6 weeks

incubation time of HBV

1-6 months

HCV incubation time

5-10 weeks

Hepatitis that most commonly turns into chronic hepatitis?

Hep C

what make HBV different from the rest

it is DNA, rest are RNA

Similar to HEA | incubation of 2-9 weeks. Can have massive hepatitis necrosis.

Hep E

2 hepatitis that have massive hepatic necrosis

Hep D | Hep E

When do IgM levels go back to zero in Hep A?

4 months after expsoure

HbsAG will be positive when?

Hep B (acute or chronic)

When will IgM antiHBc be positive?

only with acute HBV

What types of hepatitis can be chronic

B C D

Most common cause of chronic hepatitis

NASH | Nonalcoholic Steatohepatitis

what most commonly causes the drug type of hepatitis.

Acetaminophen

what is the pathological picture of hepatitis

monocyte infiltration, cell necrosis, hyperplasia & cholestasis

how do you treat Hep B?

interferon | Lamuvidine

How do you treat Hep C?

Interferon | Ribavirin

when will you have mallory bodies in hepatitis? Fever, jaundice, and hepatomegaly and common. spider angiomas

Alcoholic hepatitis

ABCDEFs of fulminant hepatic failure

Acetaminophen Hep A autoimmune hepatitis hep B Hep C, cryptogenic Hep D, drugs Esoteric causes- Wilson's, Budd-Chiari syndrome Fatty infiltration- Reye's, acute fatty liver of pregnancy

how long do you have give N-acetylcystine before a liver starts shutting down?

17 hours