Unit 3 Module 1: Gastrointestinal Flashcards
Liver failure: hyper or hypoalbumin
hypoalbumin
Pre or intrahepatic or obstructive: hemolysis
prehepatic
Most common segment affected in Crohn’s
terminal ilium
cholecystitis
inflammation of the gallbladder
t/f: Pancreatitis is a common disorder that is easily treated with bowel rest, fluids and pain medication.
false, can be fatal
Hepatitis A etiology
food handlers – fecal-oral route, shellfish
Local diverticulitis symptoms
LLQ pain, blood in stool, constipation
Crohn’s or UC: colon cancer
UC
Asterixis
Encephalopathy sign
Mechanisms of injury in viral hepatitits
direct cellular injury
induction of an immune response
Crohn’s or UC: malnutrition
both
Pre or intrahepatic or obstructive: jaundice, urine and stool changes
obstructive and intrahepatic
Crohn’s or UC: tenesmus
UC - urgent need to go to the bathroom, but can’t go
How much blood from the intestines flows into the liver per minute
1 L
t/f: Pancreatitic cancer incidences are on the rise
true
t/f: Pancreatic cancer is typically dxed early when patients present with jaundice
false
The head of the pancreas is involved in 60% of cases. Because of it’s proximity to the CBD, patients often don’t present until they are jaundiced. It is often too late by that time and it has metastasized by then. The incidence of pancreatic cancer has tripled. 5% survival rate at 5 years.
Risk factors of colon cancer
age, family/genetics, diet, ulcerative colitis
Crohn’s or UC: pinpoint mucosal hemorrhages
UC
Causes of paralytic ileus
This is nonmechanical obstruction. Pain meds, ICU, surgery
Is appendicitis a problem of youth or aging?
youth
Types of intestinal obstructions
complete
incomplete
mechanical - something outside the bowel (tumor or adhesions) or in lumen of bowel
nonmechanical - slowing or stopping of peristalsis
Gallstone pancreatitis occurs because there is a stone located in the
pancreatic duct
Liver failure: low or high blood pressure
low (third spacing instead of intravascular)
Sequelae of appendicitis
gangrene/necrosis
peritonitis
wall off infection –> abcess formation
septicemia
Borborygmi
Hyperactive bowel sounds above obstruction and no sounds below
Primary affected region in ulcerative colitis
begins in rectum and proceeds to cecum
Which has a chronic state: SATAAAAA pancreatic cancer cholecystitis gastritis pancreatitis
chronic cholecystitis: GB becomes fibrotic and contracted.
Chronic pancreatitis: usually from chronic alcoholism. Very painful situation and often malnourished.
Chronic gastritis: bringing this forward from the other section.
There is not a chronic pancreatic cancer—patients usually die within 6 months to 1 year of diagnosis.
NASH
Nonalcoholic steatohepatitis: fatty liver disease.
Connected to type 2 diabetes, hyperlipidemia, metabolic syndrome
What is Laënnec cirrhosis?
Alcoholic cirrhosis
Most common location of diverticulitis
sigmoid colon
Etiology of mechanical obstruction
adhesions, tumors, hernia, fecal impactions, strictures, volvulus (twisting) and intusseption (folding over), vascular disorders
Diverticulosis vs. diverticulitis
osis: outpouchings
itis: inflamed outpouching
Name conditions that can cause fistulas
Crohn’s, ulcerative colitis, diverticulitis
Stages of viral hepatitis
- prodromal (exposure to jaundice, about 2 weeks)
- icteric (2-6 weeks with jaundice, dark urine, clay stools, enlarged liver)
- recovery (resolution of jaundice)
Hep C’s three C’s
chronic, cirrhosis, cancer
fulminant hepatitis
rapid progression from onset of symptoms to encephalopathy within 2-3 weeks - plurality from hep A and B
Crohn’s or UC: skip lesions
Crohn’s
Hepatorenal syndrome
blood redistributed and kidneys don’t get enough blood
Systemic symptoms of appendicitis
temp, WBC > 10k, N/V, bowel changes
Is jaundice an early or late symptom of cirrhosis?
late
t/f: pancreatitis Stimulates the exocrine function of the pancreas leading to overproduction of pancreatic enzymes.
false
Pre or intrahepatic or obstructive: jaundice, normal urine and stool
prehepatic
Pre or intrahepatic or obstructive: liver can’t conjugate or excrete
intrahepatic
cholangitis
inflammation of the common bile duct
When should colonoscopy vs. Cologuard be performed?
> 45 years, colonoscopy every 10 years and higher risk, Cologuard for lower risk
Skin changes with liver disease
petiecchiae, ecchymosis, pruritis, spider angiomas, peripheral edema, jaundice
cholelithiasis
gallstones
t/f: Pancreatitis causes right upper quadrant pain associated with meals high in fat.
false, this is gallstones
Is there a chronic state of Hep A?
No. self limiting, usually not fatal. Usually highly symptomatic and body clears it.
DNA or RNA? Hep A, B, C
RNA: A, C
DNA: B
Liver failure: low or high cholesterol
low
Most colon cancer arises from…
Polyps
Which type of obstruction requires a lysis of adhesions?
mechanical
Complications of bowel obstruction
perforation, peritonitis, fluid and electrolyte imbalance, acid/base disturbances, hypovolemic shock
Top 5 complications of ulcerative colitis
Hemorrhage, perforation, nutritional deficiency, colon cancer, toxic megacolon
(also abscess, peritonitis, fistulas)
Pre or intrahepatic or obstructive: ^^ both conjugated and unconjugated bilirubin
intrahepatic
Diagnostic tools for obstruction
X ray and CT
How does liver failure cause encephalopathy?
Impaired conversion of ammonia to urea
process of Inflammation of the liver
inflammatory cells, edema (hepatomegaly), chronic –> necrosis
Pre or intrahepatic or obstructive: ^^ conjugated bilirubin
obstructive
What is HBsAg
The marker that you have Hep B
Hep C etiology
needles and blood transfusions
Which hepatitis can cause chronic hepatitis
B, C, D (C is most common)
IBD etiology
Unknown, believed to be autoimmune
Pain pattern of appendicitis
epigastric or periumbilical pain with 1-2 episodes of nausea
increasing pain localizes to RLQ
pain with palpation and rebound tenderness
pinpoint area of pain
Which hepatitis has vaccines?
- A (endemic regions, surfers/swimmers, MSM)
- B (broad, esp healthcare workers and exposure to blood) - offers some protection for D
- not for C
If an obstruction pt has bowel movements, describe
watery or ribbonlike
Pre or intrahepatic or obstructive: ^^ unconjugated bilirubin
prehepatic
Crohn’s or UC: colectomy with ileostomy
UC
Hepatitis specific symptoms
jaundice, RUQ pain
What benefit is there for testing stool for DNA over testing just for occult blood?
Stool DNA testing can pick up on precancerous DNA mutations which is superior to looking for hidden blood which is a symptom of colon cancer. The procedure is similar to occult blood testing as both take a sample of stool for testing. Both can be done at home and then sent into the lab.
Hep G details
sparse
Which of the 5 F’s is not supported by science
Fair – Native Americans have a higher risk
Pre or intrahepatic or obstructive: bilirubinuria
intrahepatic and obstructive (only conjugated is water soluble)
t/f: Patients with cholecystitis always have gallstones
false
Cholecystitis can be caused by gallstone or by “acalculous” where no stones are found. Acalculous cholecystits can be caused by trauma, DM, fasting, dehydration, opioid use, or hormone replacement therapy.
t/f: Pancreatitis can result in the release of pancreatitc enzymes into the peritoneal cavity or into the general circulation.
true
Portal hypertension
blood backs up in the portal vein (valveless) – causes collateral circulation in GI tract, rectum, esophagus
Liver failure: impaired [fat or protein] absorption
fat - bile salts are responsible for fat absorption. Steatorrhea - floating stool.
4 extraintestinal symptoms of systemic IBD
SEAL: stones (gall and kidney), eye inflammation, arthritis, lesions (skin and mouth)
Hepatitis causes
viral (alphabet), drugs/toxins/alcohol, fatty, autoimmune
3 reasons liver failure causes clotting issues
- poor absorption of fat soluble vitamins (like K)
- splenomegaly hoardes/destroys platelets
- decreased coagulation factors
Liver failure: hyper or hypoglycemic
hypoglycemic
t/f: The head of the pancreas is most often involved in pancreatic cancer
true
choledocholithiasis
stones in the common bile duct
Dx of appendicitis
physical exam, ultrasound, CT scan
Hep E is similar to which other hepatitis?
A. Waterborne, fecal-oral, no chronic form
Crohn’s or UC: cobblestoning
Crohn’s
Most colon cancer occurs in…
rectum and sigmoid colon. Can be ascending colon and cecum – harder to dx/screen.
Crohn’s or UC: bloody diarrhea
UC
Hep D is paired with which other hepatitis?
B. It can also be chronic
t/f: There’s a 4-5% 5 year survival for pancreatic cancer
true
Causes of diverticulosis
age, lack of fiber, lack of physical activity, neglecting urge to defecate, constipation
Hepatitis B etiology
transmitted by blood and body fluids
Crohn’s or UC: weight loss
Crohn’s
Crohn’s or UC: extraintestinal symptoms
both
Crohn’s or UC: weight loss
both
Hepatitis nonspecific symptoms
nausea, fatigue, anorexia, arthralgia, myalgia, pruritus
Hepatitis nonspecific symptoms
nausea, fatigue, anorexia, arthralgia, myalgia, pruritus
Systemic diverticulitis symptoms
n/v, temperature, elevated wbc
