Lecture 1 Flashcards
where does gallbaldder pain refer?
right shoulder or subscapular region
liver are and back
where does pancreas pain refer?
Left mid back
and epigastrium
vomit bile w/I 15 minutes of eating; believed by be cause by reflux of bile into stomach
Bilious vomiting
Foreceful emesis w/o prior nausea or retching. Found often in increased ICP, but can be seen in other conditions
Projectile vomiting
Vomiting of food eaten more than 6 hours previously
Gastric retention
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
Greater than 1 Liter per day of diarrhea
decreased absorption of Na/Cl
includes fatty acid induced diarrhea
Secretory diarrhea
Diarrhea stops when patients fasts. Elevated osmotic gap on stool analysis. Can be due to laxatives with magnesium
Osmotic diarrhea
2 causes of inflammatory diarrhea?
Ulcerative colitis
Parasites
Motility disorders that can cause diarrhea?
IBS Hyperthyroid Carcinoid Scleroderma Diabetes
Abdominal distention, diarrhea, postprandial abdominal distention. Hypomotility leads to bacterial overgrowth. WIll have watery diarrhea or steatorrhea.
Scleroderma
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
Left lower quadrant pain
tenderness, fever, and leukocytosis. Tender mass is noted frequently
Diverticulitis
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
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
tx of achalsaia
open LES with balloon dilation
Botox injections
surgical myotomy
Type of scleroderma calcinosis Reynards phenomenon esophageal dysmotility sclerodacytyl telangiectasia
CREST syndrome
non-progressive dysphagia liquids and solids affected substernal chest pain can appear like angina Will have periods normal peristalsis
Diffuse esophageal spasm
high amplitude contractions in distal esophagus
Principal symptom is chest pain
Non-progressive
Liquids and solids
Nut cracker esophagus
Tx of diffuse esophageal spasm
nitrate/ calcium channel blockers
Dx of diffuse esophageal spasm and nutcrack esophagus
esophageal manometry
Tx of nutcracker esophagus
calcium channel blockers
nitrates
Anxiety disorder. Say they have problem swallowing but they don’t
globus hystericus
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
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
