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Flashcards in Gastroenterology and Nutrition Deck (107)
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What is pancreatitis?

inflammation of the pancreas
-it happens when digestive enzymes start digesting the pancreas itself


What are the characteristics of pancreatitis?

-pancreatitis may start suddenly and last for days, or it can occur over many years
-symptoms include upper abdominal pain radiating to the back, nausea, and vomiting
-it has many causes, including gallstones and chronic, heavy alcohol use
-the mnemonic GET SMASHED is useful in recalling the most common causes: Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune disease, Scorpion sting, Hypercalcemia, Hyperlipidemia, ERCP, and Drugs


How is pancreatitis dx?

clinical and elevated lipase and amylase
-abdominal CT is the diagnostic test of choice - required to differentiate from necrotic pancreatitis
-ERCP is the most sensitive for chronic pancreatitis


What are the signs of pancreatitis?

Grey Turner's sign (flank bruising), Cullen's sign (bruising near umbilicus)


What is Ranson's criteria for poor prognosis?

At admit:
-age >55
-leukocyte: > 16,000
-glucose > 200
-LDH >350
-AST >250
At 48 hrs:
-arterial PO2 <60
-HCO3 <20
-Calcium <8.0
-BUN increase by 1.8+
-Hematocrit decrease by 10%
-Fluid sequestration >6 L


What is the tx of pancreatitis?

IV fluids (best), analgesics, bowel rest
-complication: pancreatic pseudocyst (a circumscribed collection of fluid rich in pancreatic enzymes, blood, and necrotic tissue)


What is chronic pancreatitis?

the classic triad of pancreatic calcification (plain abdominal x-ray), steatorrhea (high fecal fat), and diabetes mellitus
-alcohol abuse
-treatment: no alcohol, low-fat diet


What is an anorectal fistula?

an open tract between two epithelium-lines areas and is associated with deeper anorectal abscesses
-fistulae will produce anal discharge and pain when the tract becomes occluded


How is anorectal fistula tx?

must be treated surgically


What is an anal fissure?

tearing rectal pain bleeding which occurs with or shortly after defecation, bright red blood on toilet paper
-superficial laceration (paper cut like)
-pain lasts for several hours and subsides until the next bowel movement


What is the tx for anal fissure?

-sitz baths, increase dietary fiber, and water intake, stool softeners or laxatives
-usually heals in 6 weeks
-botulinum toxin A injection (if failed conservative treatment)


What is anorectal cancer?

rectal bleeding + tenesmus ( a feeling of incomplete emptying after a bowel movement), the most common anorectal cancer is adenocarcinoma
-primarily adenocarcinomas
-typically colonoscopy is done: whenever rectal bleeding occurs, even in patients with obvious hemorrhoids or known diverticular disease, coexisting cancer must be ruled out
-treated with wide local surgical excision, radiation with chemotherapy for large tumors with metastases


What is colon cancer?

painless rectal bleeding and a change in bowel habits in a patient 50-80 years of age
-apple core lesion on barium enema, adenoma most common type


What are the screening recommendations for colonscopy?

begins at 50 then every 10 years until 75
-fecal occult blood testing - annually after age 50
-flexible sigmoidoscopy - every 5 years with FOB testing
-colonoscopy - every 10 years
-CT colonography - every 5 years


What are the tumor marker for colon cancer?

-more likely to be malignant: sessile, > 1 cm, villous
-less likely to be malignant: pedunculated, < 1 cm, tubular


What is the tx for colon cancer?

resect tumors and adjuvant chemotherapy


What is esophageal neoplasms?

progressive dysphagia to solid foods along with weight loss, reflux, and hematemesis
-squamous cell m/c worldwide and adenocarcinoma common in the US


What is an adenocarcinoma?

complication of Barrett's esophagus (screen Barrett's patients every 3-5 years with endoscopy), affects distal (lower) 1/3rd of the esophagus


What is squamous cell?

-associated with smoking and alcohol use
-affects proximal (upper) 2/3rds of the esophagus
-progressive dysphagia, weight loss, hoarseness
-diagnostic studies: endoscopy + biopsy
-treatment: resection


What are gastric neoplasms?

abdominal pain and unexplained weight loss are most common symptoms along with reduced appetite, anorexia, dyspepsia, early satiety, nausea and vomiting, anemia, melena, guaiac-positive stool
-gastric adenocarcinoma in most cases worldwide
-Virchow's node (supraclavicular)
-Sister Mary Joseph's node (umbilical)


How are gastric neoplasms dx?

upper endoscopy with biopsy; linitis plastica - diffuse thickening of stomach wall d/t cancer infiltration (worst type)


What is the tx of gastric neoplasms?

gastrectomy, XRT, chemo; poor prognosis


What is celiac disease?

small bowel inflammation from an allergy to gluten
-symptoms usually occur following the ingestion of gluten-containing food, also has extraintestinal manifestations
-diarrhea, steatorrhea, flatulence, weight loss, weakness, and abdominal distention
-associated with dermatitis herpetiformis (chronic, itchy skin rash on elbow, knees, butt, scalp)
-associated conditions: T1DM, autoimmune hepatitis, autoimmune thyroid DZ, down, turner, williams syndrome, increased incidence of small bowel lymphoma


How is celiac disease dx?

-IgA anti-endomysial (EMA) and anti-tissue transglutaminase (anti-TTG) antibodies
-small bowel biopsy (duodenum) is the gold standard


What is the tx for celiac disease?

lifelong gluten-free diet


What is cholangitis?

an infection of biliary tract secondary to obstruction, which leads to biliary stasis and bacterial overgrowth


What are the characteristics of cholangitis?

-characterized by pain in upper-right quadrant of the abdomen, fever, and jaundice
-choledocholithiasis accounts for 60% of cases
-other causes include pancreatic and biliary neoplasm, postoperative strictures, invasive procedures such as ERCP or PTC, and choledochal cysts
-organisms: E.coli, enterococcus, kiebsiella, enterobacter


What is the presentation of cholangitis?

-Charcot's triad: RUQ tenderness, jaundice, fever
-Reynold's pentad: Charcot's triad + altered mental status and hypotension


What are the diagnostic studies for cholangitis?

-initial imaging: ultrasound
-best: ERCP


What is the tx for cholangitis?

Cholangitis is potentially life-threatening and requires emergency treatment
-aggressive care and emergent removal of stones, Cipro + metronidazole
-antibiotics, fluids, and analgesia
-ENCP to remove stones, insert a stent, repair the sphincter
-cholecystectomy (performed post-acute)