Gastrointestinal/nutritonal Flashcards
(204 cards)
1
Q
Esophagitis cause
A
infectious (Candida sp, CMV, HSV, TB, HIV, EBV, mycobacterium avium intracellulare) in immunocompromised, medications, corrosion
2
Q
Esophagitis s/s
A
odynophagia (painful swallowing); dysphagia, fever, LAD, rashes
3
Q
Esophagitis dx
A
endoscopy w/ culture - large deep ulcers (CMV, HIV), shallow ulcers (HSV), white plaques (candida)
4
Q
Esophagitis tx
A
treat infection - fluconazole/ketoconazole (candida), acyclovir (HSV), IV ganciclovir (CMV)
5
Q
GERD cause
A
weakness or abnormal relaxation of the esophageal sphincter, medications (tetracycline, NSAIDs, CCB, anticholinergics)
6
Q
GERD s/s
A
burning sensation in chest, throat, and mouth; difficulty swallowing, dry cough, regurgitation, hoarseness/sore throat, lump in throat; worse when lying flat and after meals, relief w/ antacids
7
Q
GERD dx
A
clinical; endoscopy w/ biopsy (esp >45 yo w/ new onset); acid (pH) probe tests for 24 hours, barium swallow, esophageal motility testing (manometry)
8
Q
GERD tx
A
lifestyle modifications (stop smoking, avoid eating large meals and at bedtime, food choice); antacids (Maalox, mylanta), H2 blockers (ranitidine), PPIs (omeprazole) education: can cause esophagitis or Barrett’s esophagus (precancerous columnar cells)
9
Q
Neurogenic Dysphagia (Esophageal Motor Disorder) cause
A
injury or disease of the brain stem or CN IX and X; difficult peristalsis
10
Q
Neurogenic Dysphagia (Esophageal Motor Disorder) s/s
A
dysphagia; difficulty with solids and liquids
11
Q
Neurogenic Dysphagia (Esophageal Motor Disorder) dx
A
barium swallow; endoscopy and biopsy; esophageal manometry (strength and coordination of peristalsis)
12
Q
Neurogenic Dysphagia (Esophageal Motor Disorder) tx
A
treat underlying disease
13
Q
Zenker Diverticulum (Esophageal Motor Disorder) cause
A
outpouching of posterior hypopharynx; blockage
14
Q
Zenker Diverticulum (Esophageal Motor Disorder) s/s
A
dysphagia; regurgitation of undigested solids and liquids several hours after eating
15
Q
Zenker Diverticulum (Esophageal Motor Disorder) dx
A
barium swallow (diverticulum visible); endoscopy and biopsy
16
Q
Zenker Diverticulum (Esophageal Motor Disorder) tx
A
endoscopic dilation and resection
17
Q
Esophageal Stenosis (Esophageal Motor Disorder/Strictures) cause
A
narrowing of esophagus; blocking and peristalsis malfunction
18
Q
Esophageal Stenosis (Esophageal Motor Disorder/Strictures) s/s
A
dysphagia; difficulty with solids; slow progression (webs and rings); rapid progression (malignancy)
19
Q
Esophageal Stenosis (Esophageal Motor Disorder/Strictures) dx
A
barium swallow (webs and rings); endoscopy and biopsy; esophageal manometry (strength and coordination of peristalsis)
20
Q
Esophageal Stenosis (Esophageal Motor Disorder/Strictures) tx
A
endoscopic dilation and resection
21
Q
Achalasia (Esophageal Motor Disorder) cause
A
peristalsis is decreased and lower esophageal sphincter tone is increased
22
Q
Achalasia (Esophageal Motor Disorder) s/s
A
slow, progressive dysphagia; episodic regurgitation and chest pain
23
Q
Achalasia (Esophageal Motor Disorder) dx
A
barium swallow (birds beak); endoscopy and biopsy; esophageal manometry (strength and coordination of peristalsis)
24
Q
Achalasia (Esophageal Motor Disorder) tx
A
nifedipine (CCB); endoscopic dilation and resection
25
Diffuse Esophageal Spasm (Esophageal Motor Disorder) cause
spasm of esophageal peristalsis
26
Diffuse Esophageal Spasm (Esophageal Motor Disorder) s/s
dysphagia; intermittent chest pain, may or may not be associated w/ eating
27
Diffuse Esophageal Spasm (Esophageal Motor Disorder) dx
barium swallow; endoscopy and biopsy; esophageal manometry (strength and coordination of peristalsis)
28
Diffuse Esophageal Spasm (Esophageal Motor Disorder) tx
endoscopic dilation and resection
29
Scleroderma (Esophageal Motor Disorder) cause
decreased esophageal sphincter tone and peristalsis
30
Scleroderma (Esophageal Motor Disorder) s/s
dysphagia; reflux esophagitis
31
Scleroderma (Esophageal Motor Disorder) dx
barium swallow; endoscopy and biopsy; esophageal manometry (strength and coordination of peristalsis); Hx of scleroderma (CREST)
32
Scleroderma (Esophageal Motor Disorder) tx
endoscopic dilation and resection; treat underlying disease
33
Mallory-Weiss Tear cause
linear tear in mucosal lining of esophagus due to forceful vomiting/retching; alcohol use
34
Mallory-Weiss Tear s/s
hematemesis; powerful/persistent vomiting/retching
35
Mallory-Weiss Tear dx
endoscopy
36
Mallory-Weiss Tear tx
PPI (if no active bleeding); endoscopic injection of epinephrine or thermal coagulation
37
Esophageal Neoplasms cause
smoking, alcohol, poor hygiene, HPV; squamous cell in proximal 2/3s, adenocarcinomas (barrett esophagitis) in distal 1/3s
38
Esophageal Neoplasms s/s
progressive dysphagia for solid food w/ weight loss; heartburn, vomiting, hoarseness
39
Esophageal Neoplasms dx
biphasic barium esophagram (initial test); endoscopy w/ brushing biopsy (diagnosis); endoscopic sonography/CT (staging)
40
Esophageal Varices causes
portal hypertension, cirrhosis, alcohol, chronic viral hepatitis, NSAIDs, Budd-Chiari syndrome
41
Esophageal Varices s/s
vomiting w/ hematochezia; black, tarry, or bloody stools; lightheadedness, LOC
42
Esophageal Varices dx
upper GI endoscopy; CT and doppler US; capsule endoscopy
43
Esophageal Varices tx
propranolol (reduce portal vein pressure); esophageal band ligation, shunts; octreotide (slow blood flow to portal vein)
44
Gastritis cause
weakness in mucous barrier in stomach; autoimmune, Helicobacter pylori; NSAIDs, stress, alcohol
45
Gastritis s/s
gnawing, burning ache or pain in upper abdomen; dyspepsia; better or worse after eating; N/V; feeling full after eating
46
Gastritis dx
endoscopy w/ biopsy; H. pylori stool/breath test; barium swallow/upper GI series Xray
47
Gastritis tx
treat underlying cause (remove NSAIDs and EtOH); clarithromycin + amoxicillin/Flagyl + PPI x 10-14 days (H. pylori), PPIs (omeprazole), acid blockers/H2 blockers (ranitidine, cimetidine), antacids
48
Zollinger-Ellison Syndrome cause
gastrinomas -> increase gastric acid secretion -> PUD
49
Zollinger-Ellison Syndrome s/s
abdominal pain w/ secretory diarrhea, frank bleeding; better with H2 blockers (ranitidine, cimetidine) or PPIs (omeprazole); multiple refractory peptic ulcers ("kissing ulcers"); most common in duodenal wall and pancreas
50
Zollinger-Ellison Syndrome dx
secretin test -> increase gastrin release (rather than decrease); fasting gastrin level >150; endoscopy/CT/MRI
51
Zollinger-Ellison Syndrome tx
PPIs, surgical resection
52
Gastric Adenocarcinoma cause
H. pylori, genetic factors, cigarette smoking
53
Gastric Adenocarcinoma s/s
dyspepsia, weight loss associated w/ anemia and occult GI bleeding; >40yo; progressive dysphagia, postprandial vomiting; Virchow node (left supraclavicular LAD) and Sister Mary Joseph nodule (umbilical nodule) sign of metastatic spread
54
Gastric Adenocarcinoma dx
endoscopy; iron deficiency anemia, elevated LFTs (w/ hepatic mets); CT abd extent of disease
55
Gastric Adenocarcinoma tx
curative/palliative resection, chemo, radiation
56
Carcinoid Tumors cause
hypergastrinemia; RARE
57
Carcinoid Tumors s/s
benign, abd. pain, diarrhea, N/V, rectal bleeding/pain, flushing
58
Carcinoid Tumors dx
endoscopy w/ biopsy
59
Carcinoid Tumors tx
self-limiting
60
Gastric Lymphoma cause
greater risk w/ H. pylori; MC extranodal site for non-Hodgkin lymphoma
61
Gastric Lymphoma s/s
dyspepsia, weight loss associated w/ anemia and occult GI bleeding; >40yo; progressive dysphagia, postprandial vomiting
62
Gastric Lymphoma dx
endoscopy w/ biopsy
63
Gastric Lymphoma tx
resection, radiation/chemo prn
64
Peptic Ulcer Disease cause
H. pylori, use of NSAIDs/ASA, NSAIDs + steroids, anticoags, SSRIs
65
Peptic Ulcer Disease s/s
burning stomach pain, bloating/belching, fatty food intolerance, heartburn, N/V, appetite changes, hematochezia, trouble breathing
66
Peptic Ulcer disease dx
H. pylori stool/breath test; endoscopy w/ biopsy; upper GI
67
Peptic Ulcer Disease tx
remove NSAIDs and EtOH; clarithromycin + amoxicillin/Flagyl + PPI x 10-14 days (H. pylori), PPIs (omeprazole), acid blockers/H2 blockers (ranitidine, cimetidine), antacids; sucralfate or misoprostol (protect stomach lining)
68
Cholelithiasis cause
calcification in GB; fat, female, forty, fertile, fair
69
Cholelithiasis s/s
RUQ pain
70
Cholelithiasis dx
ultrasound
71
Cholelithiasis tx
supportive; cholecystectomy prn
72
Choledocholithiasis cause
obstruction of common bile duct by stone
73
Choledocholithiasis s/s
RUQ pain; N/V, jaundice, fever
74
Choledocholithiasis dx
ERCP, US, HIDA; increased bilirubin
75
Choledocholithiasis tx
ERCP and sphincterotomy; cholecystectomy
76
Cholecystitis cause
obstruction of bile duct by stones or bacteria
77
Cholecystitis s/s
colicky epigastric/RUQ pain after high fat meal; pain radiates to right shoulder, subscapula, back; N/V, fever, constipation
78
Cholecystitis dx
increase in bilirubin in 24 hours, leukocytosis; US, HIDA scan (gold standard), ERCP
79
Cholecystitis tx
cholecystectomy, NPO, antibiotics (ceftriaxone, metronidazole, zosyn), meperidine
80
Acute Hepatitis cause
Hepatitis A, B, C, D, E
81
Acute Hepatitis s/s
sudden onset; flu-like illness to fatal liver failure; poor appetite, N/V, fever, RUQ pain, jaundice, hepatic encephalopathy
82
Acute Hepatitis dx
LFTs (elevated AST/ALT); liver biopsy; antibody/antigen testing
83
Acute Hepatitis tx
remove alcohol/harmful substance, antiviral drugs; Hep A/E self limiting
84
Chronic Hepatitis cause
hepatitis B, C (sometimes E); alcoholic hepatitis, fatty liver disease, a1-antitryspin deficiency, Wilson disease; drugs (isoniazid, methyldopa, macrobid, NSAIDs)
85
Chronic Hepatitis s/s
vague, gradual onset, >6 months; malaise, poor appetite, fatigue, jaundice, low-grade fever, upper abdominal discomfort; enlarged spleen, spider angiomas, ascites
86
Chronic Hepatitis dx
liver biopsy; tests for hepatitis infection; elevated LFTs
87
Chronic Hepatitis tx
entecavir, tenofovir (hepatitis B); ribavirin, sofosbuvir, telaprevir (hepatitis C); prednisone, azathioprine (autoimmune); liver transplant
88
Cirrhosis cause
chronic alcohol abuse, hepatitis B or C; fatty liver, cystic fibrosis, Wilson’s disease, autoimmune, biliary dysfunction, medications (NSAIDs)
89
Cirrhosis s/s
upper abdominal pain, jaundice, ascites, easy bleeding/bruising, swelling in legs, loss of appetite, weight loss, nausea, spider like blood vessels; encephalopathy, esophageal varices
90
Cirrhosis dx
elevated LFTs (bilirubin, AST, Alk Phos), CBC (low platelets, anemia), poor kidney function, PT/INR, liver biopsy
91
Cirrhosis tx
stop EtOH use, weight loss, antivirals, low sodium diet, medications to control portal hypertension, liver transplant
92
Liver Neoplasms cause
common site for metastasis (breast, lung); cavernous hemangioma, hepatocellular adenoma, infantile hemangioendothelioma (benign); hepatocellular carcinoma (Hep B&C, aflatoxin B2 exposure, Aspergillus spp, cirrhosis, Malignant)
93
Liver Neoplasms s/s
malaise, weight loss, abdominal swelling, weakness, jaundice, upper abdominal pain (usually late in disease); hepatomegaly, splenomegaly, hepatic bruit, ascites, jaundice, wasting, fever
94
Liver Neoplasms dx
elevated a-fetoprotein (HCC, chronic hep C, cirrhosis); US/CT/MRI/hepatic angiography (no needle biopsy -> fear of seeding)
95
Liver Neoplasms tx
surgical resection, liver transplant, treat primary lesion (poor prognosis)
96
Acute Pancreatitis cause
cholelithiasis, alcohol abuse, hypertriglyceridemia, PUD, drugs (antiretroviral)
97
Acute Pancreatitis s/s
epigastric pain radiating to back; better leaning forward; N/V, fever, peritonitis symptoms, hypovolemia, tachycardia, Grey Turner Sign/Cullen Sign (hemorrhagic pancreatitis)
98
Acute Pancreatitis dx
elevated amylase, lipase (x3), WBC, hyperbilirubinemia, bilirubinuria, hyperglycemia, hypocalcemia; US; Ransom Criteria poor prognosis (leukocyte >16K, glucose >200, LDH >350, AST >250, arterial PO2 <60, base deficit >4, falling Ca, rising BUN)
99
Acute Pancreatitis tx
NPO, IV fluids, opioid pain control, antibiotics (zosyn); no ETOH, monitor
100
Chronic Pancreatitis cause
alcohol abuse, cholelithiasis, PUD, hyperparathyroidism, hyperlipidemia
101
Chronic Pancreatitis s/s
calcification, steatorrhea, diabetes mellitus (classic triad); epigastric pain radiating to back; better leaning forward; N/V; fat malabsorption
102
Chronic Pancreatitis dx
elevated amylase early but will decrease, abdominal xray (calcifications)
103
Chronic Pancreatitis tx
treat acutely; low-fat diet, remove ETOH; partial removal of pancreas
104
Pancreatic Neoplasms cause
age, obesity, tobacco, chronic pancreatitis, abdominal radiation, family hx
105
Pancreatic Neoplasms s/s
radiating abdominal pain, jaundice, palpable gallbladder (Courvoisier's sign)
106
Pancreatic Neoplasms dx
CT angiography to search for mets and vascular invasion
107
Pancreatic Neoplasms tx
surgical resection (Whipple procedure); radiation/chemo (poor prognosis)
108
Constipation cause
age, opioid medications, dehydration, IBS, excess fiber
109
Constipation s/s
decreased stool volume, increase stool firmness, straining w/ BM; abdominal pain/distension
110
Constipation dx
clinical; Abdominal Xray/CT
111
Constipation tx
increase fiber (10-20g/day), increase fluid intake (1.5-2L/day); increase exercise; enema/laxative
112
Diverticular Disease cause
low fiber diet; age
113
Diverticular Disease s/s
sudden onset LLQ or suprapubic region; fever, rectal bleeding; N/V, altered BM
114
Diverticular Disease dx
CT abd/pel with contrast; leukocytosis, occult blood
115
Diverticular Disease tx
750mg cipro BID + 500mg flagyl QID x 7-10; low-residue diet; if not improved -> admit for IV pain control and abx; colonoscopy 6 weeks later; surgical resection
116
Crohn's Disease cause
genetic predisposition; 15-35 yo, smoking
117
Crohn's Disease s/s
abdominal cramps, blood in stool, fever, fatigue; fistulas, abscess, aphthous ulcers, arthralgias, renal stones
■ Gradual onset; Mouth to anus; right sided; skip areas; transmural; diarrhea and abdominal pain; fistulas, toxic megacolon, colon cancer
118
Crohn's Disease dx
colonoscopy w/ biopsy (granulomas, cobblestoning); Mouth to anus, skip lesions, transmural
119
Crohn's Disease tx
Prednisone (acute attacks); aminosalicylates (sulfasalazine); flagyl, Cipro (complications); inflizimab (refractory); diet and mesalamine (maintenance), B12, folic acid, Vitamin D; segmental resection
120
Ulcerative Colitis cause
genetic predisposition, 15-35yo
121
Ulcerative Colitis s/s
diarrhea w/ pus and blood, some LLQ pain, weight loss, malaise, fever, tenesmus; episcleritis, arthritis, sclerosing cholangitis, erythema nodosum, pyoderma grangrenosum
■ Sudden or gradual onset; distal to proximal; continuous; mucosal surface; bloody, pus-filled diarrhea, tenesmus; toxic megacolon, colon cancer
122
Ulcerative Colitis dx
colonoscopy w/ biopsy; distal to proximal colon, continuous, mucosal surface, toxic megacolon
123
Ulcerative Colitis tx
Steroids and aminosalicylates; total proctocolectomy
124
Irritable Bowel Disease cause
stress, MCC in females
125
Irritable Bowel Disease s/s
abdominal pain, relieved with defecation; postprandial urgency; urinary urgency/frequency, dyspepsia, constipation/diarrhea; hyperresonance or palpable sigmoid colon
126
Irritable Bowel Disease Dx
labs, colonoscopy, endoscopy to r/o lactose intolerance, cholecystitis, chronic pancreatitis, interstitial obstruction, celiac disease, carcinoma
127
Irritable Bowel Disease TX
reassurance; high fiber diet, psyllium hydrophilic mucilloid (bulk laxative); antispasmodics, antidiarrheals (loperamide), antidepressants (linactolide, SSRI, TCA)
128
Noninfectious Diarrhea
```
watery, voluminous, no blood or WBCs; vomiting
staphylococcus
bacillus cereus
v. cholera
v. parahemolyticius
e. coli
c.diff
```
129
Staphylococcus Noninfectious Diarrhea
dairy products, meats, eggs
| ■ Tx: supportive
130
Bacillus cereus: Noninfectious Diarrhea
contaminated food
| ■ Tx: supportive
131
V. cholera: Noninfectious Diarrhea
food and water abroad
| ■ Tx: supportive
132
V. parahemolyticius: Noninfectious Diarrhea
Shell fish esp in gulf of mexico
| ■ Tx: supportive; Fluoroquinolones/Doxycycline (w/ fever
133
E. coli: Noninfectious Diarrhea
traveler’s diarrhea, unsanitary water
| ■ Tx: fluoroquinolone
134
C. diff: Noninfectious Diarrhea
after course of antibiotics (clindamycin)
■ striking lymphocytosis and pseudomembranous colitis
■ Tx: give metronidazole (vancomycin taper according to my preceptor)
135
infectious diarrhea
```
bloody; stomach cramps, belching, indigestion, N/V, flatulence, WBCs
Shigella
○ Yersinia enterocolitica
○ Salmonella
○ E. coli
○ Campylobacter enteritis
```
136
Shigella:infectious diarrhea
■ highly virulent; may cause neurologic manifestation esp in young children; leukemoid reaction (WB >50k)
■ Diagnostics: stool culture; Sigmoidoscopy (punctate areas of ulceration)
■ Tx: bactrim, fluoroquinolones
137
Yersinia enterocolitica:
| infectious diarrhea
■ Tx: Fluoroquinolones
138
Salmonella: infectious diarrhea
MC source in poultry products, exotic pets
■ High risk groups include immunocompromised, sickle cell disease (risk of osteomyelitis)
■ S. typhimurium - pea soup stools (watery brown green mucous diarrhea)
■ Typhoid fever - cephalic phase: headache -? Pea soup stools, fever, bradycardia, with blanching rose spots
■ Tx: fluoroquinolones
139
E. coli: infectious diarrhea
ground beef, unpasteurized milk, apple cider, day care centers
■ Watery -> bloody stools, produces enterotoxin
■ Tx: Supportive care
140
Campylobacter enteritis: infectious diarrhea
MC cause of bacteria in US. Poultry
■ MC antecedent event in post infectious Guillain barre syndrome
■ Presentation: Watery -> bloody stool
■ Dx: gram negative stool culture with “S or Seagull shaped” organisms
■ Tx: erythromycin, fluoroquinolones
141
Protozoan Infected Diarrhea
Giardia lamblia
amebiasis
cryptosporidium
142
Giardia lamblia
Contaminated water from remote streams/wells
■ Presentation: Frothy, greasy foul diarrhea
■ Dx: Trophozites cysts in stool
■ Tx: metronidazole
143
amebiasis
Traveling
■ Presentation: Gi colitis, dysentery, amebic liver abscess
■ Diagnosis: stool ova and parasites
■ Tx: metronidazole
144
Cryptosporidium
MC of chronic diarrhea in AIDS pts
145
Small/Large Bowel Obstruction cause
intestinal adhesions, colon cancer, hernias, IBS/IBC, diverticulitis, volvulus, fecal impaction
146
Small/Large Bowel Obstruction s/s
crampy, intermittent abd pain, loss of appetite, constipation, vomiting (SBO), inability to have BM or pass gas, abdominal distension
147
Small/Large Bowel Obstruction dx
PE, Xray, CT W contrast, barium enema
148
Small/Large Bowel tx
NG tube, enema, low fiber diet, surgical resection
149
Toxic Megacolon (EMERGENCY) cause
hirschsprung disease, ulcerative colitis, Crohn colitis, pseudomembranous colitis, infectious (shigella, campylobacter, c diff)
150
Toxic Megacolon (EMERGENCY) s/s
fever, prostration, severe cramps, abdominal distension, rigid abdomen and localized, diffuse, or rebound abdominal tenderness
151
Toxic Megacolon (EMERGENCY) dx
abdominal xray (colonic dilation)
152
Toxic Megacolon (EMERGENCY) tx
decompression of colon; resection/colostomy; fluid and electrolyte balance
153
Colon polyps cause
slow-growing overgrowths in colonic mucosa; <1% malignant; HNPCC, familial polyposis; diet (meats, fiber, fat, alcohol); smoking
154
Colon polyps s/s
asymptomatic; rectal bleeding, iron deficiency anemia, diarrhea, constipation; occult blood in stools, distal polyps felt on DRE
155
Colon polyps dx
stool occult blood test; flexible sigmoidoscopy; colonoscopy
156
Colon polyps tx
polypectomy; colonic resection
157
Colorectal Cancer cause/types
hereditary nonpolyposis colorectal cancer (HNPCC/Lynch Syndrome), familial polyposis
■ Types: hyperplastic (benign), adenomas (tubular, tubulovillous, villous)
158
Colorectal Cancer s/s
slow growing; abdominal pain, change in bowel habits, occult bleeding, intestinal obstruction; chronic blood loss and iron deficiency anemia (right-sided lesions); circumferential, change in bowel habits, obstructive symptoms (left-sided lesions)
159
Colorectal Cancer dx
colonoscopy/sigmoidoscopy/barium enema; occult blood in stool; CT for mets; (colonoscopy between 20-25 years, q 1-2 yrs, for HNPCC)
160
Colorectal Cancer tx
surgical resection; chemo prn, radiation for rectal lesions
161
Appendicitis cause
infection, fecolith
162
Appendicitis s/s
RLQ pain (starts periumbilical/epigastric); anorexia, fever, N/V
163
Appendicitis dx
CT abd/pel; CBC, CMP, UA, B-Hcg
164
Appendicitis tx
urgent surgical consult, antibiotics (unasyn)
165
Clostridium Difficile Colitis cause
toxins released from Clostridium difficile causing inflammation and damage; common after antibiotic treatment (clindamycin)
166
Clostridium Difficile Colitis s/s
watery diarrhea, lower abdominal pain/cramping, anorexia, malaise, dehydration, fever, rebound tenderness
167
Clostridium Difficile Colitis dx
stool culture; leukocytosis, CMP (dehydration), elevated lactate; CT abd/pel (pseudomembranous colitis)
168
Clostridium Difficile Colitis tx
Flagyl or vancomycin x 10 days
169
Malabsorption cause
pernicious anemia (B12), lactase deficiency, celiac disease, HIV/AIDS; pancreatic disease, cystic fibrosis
170
Malabsorption s/s
diarrhea, bloating, abdominal discomfort, steatorrhea; weight loss, edema, bone demineralization, tetany, bleeding, anemia
171
Malabsorption dx
72-hour fecal fat test; D-xylose test (distinguish maldigestion from pancreatic insufficiency and bile salt deficiency from malabsorption); detect underlying deficiency
172
Malabsorption tx
therapeutic trials of lactose free, gluten free diet, pancreatic enzyme replacement, antibiotics
173
Celiac Disease cause
gluten ingestion (wheat, rye, barley) leading to malnutrition
174
Celiac Disease s/s
diarrhea, steatorrhea, flatulence, weight loss, weakness, abdominal distension; iron deficiency, failure to thrive, coagulopathy, hypocalcemia
175
Celiac Disease dx
IgA antiendomysial (EMA), anti-tissue transglutaminase antibodies (anti-tTG) (screening tests); small bowel biopsy (crypt hyperplasia, villous atrophy) (diagnostic)
176
Celiac Disease tx
gluten free diet, supplementation (Fe, B12, folic acid, Ca, Vit D), prednisone (refractory)
177
Lactose Intolerance cause
small intestine doesn’t produce enough lactase to digest lactose; genetics (african, asian, hispanic); illness, injury, surgery; premature infants; autoimmune
178
Lactose Intolerance s/s
diarrhea, N/V, abdominal cramps, bloating, flatulence 30min - 2hrs after eating/drinking lactose
179
Lactose Intolerance dx
lactose tolerating test (measuring low glucose 2 hours after lactose intake); hydrogen breath test (large amounts of hydrogen exhaled); stool acidity test
180
Lactose Intolerance tx
avoid large amount of dairy products; add products to break down lactose
181
Niacin (B3) Deficiency cause
alcoholism; vegans; isoniazid usage; diarrhea; cirrhosis (found in maize)
182
Niacin (B3) Deficiency s/s
Pellagra - bilateral dermatitis, Casal's necklace, angular stomatitis, diarrhea, depression, disorientation, delirium
183
Niacin (B3) Deficiency dx
clinical; urine excretion of n-methylnicotinamide (NMN) <0.8mg/day
184
Niacin (B3) Deficiency tx
250-500mg/day nicotinamide; balanced diet with other B vitamins (riboflavin, pyridoxine)
185
Thiamine (B1) Deficiency cause
nutritional deficiency; prolonged IV feeding, GI procedures/diseases, malignancies, infections, starvation, hyperemesis gravidarum (high-refined carbs - rice, flour, sugar)
186
Thiamine (B1) Deficiency s/s
mental confusion, dysphonia, confabulation w/ impaired memory (Korsakoff's syndrome -> alcoholism); psychomotor slowing/apathy, nystagmus, ataxia, impaired consciousness (Wernicke encephalopathy); fatigue, poor appetite, depression, polyneuropathy, heart failure, angular stomatitis, edema (Beriberi)
187
Thiamine (B1) Deficiency dx
favorable response to thiamin; erythrocyte transketolase activity, 24 hour urinary thiamin excretion
188
Thiamine (B1) Deficiency tx
thiamin supplementation (IV thiamin 100mg before IV glucose)
189
Vitamin B12 (Coalamin) Deficiency cause
: vegans, breastfed babies of vegan mothers, fad diets, inflammatory bowel disease, fish tapeworm infestation, autoimmune (pernicious anemia)
190
Vitamin B12 (Coalamin) Deficiency s/s
pernicious anemia, macrocytic anemia, neurologic degeneration (weakness, hyporeflexia, spasticity, extensor plantar responses, ataxia, stocking glove distribution) paranoia, delirium, confusion, pallor
191
Vitamin B12 (Coalamin) Deficiency dx
CBC (megaloblastic anemia), B12 (<200) and folate levels; schilling test (presence of intrinsic factor)
192
Vitamin B12 (Coalamin) Deficiency tx
1000-2000mcg/day B12; 1mg IM B12 1-4/week
193
Vitamin A Deficiency cause
dietary (rice devoid of beta-carotene); celiac disease, cystic fibrosis, pancreatic insufficiency, duodenal bypass, chronic diarrhea, cirrhosis
194
Vitamin A Deficiency s/s
reduced bone growth, night blindness, xerophthalmia/xerosis, keratomalacia (cornea softens -> perforates), depressed immunity, severe drying/scaling of skin
195
Vitamin A Deficiency dx
clinical (ocular findings); serum retinol levels <28; therapeutic trial of Vit A
196
Vitamin A Deficiency tx
60K IU/day Vitamin A palmitrate
197
Vitamin D Deficiency cause
inadequate sun exposure/intake; genetic
198
Vitamin D Deficiency s/s
soft bones, enlarged joints/skull, deformed chest, spinal curvature, bowed legs (Ricket's disease); osteomalacia; tetany; muscle aches, muscle weakness, bone pain
199
Vitamin D Deficiency dx
clinical, Xrays of ulna/radius (diaphyseal ends lose sharp, clear outline, spotty/fringy, noncalcified and radiolucent); serum Calcium, Phosphorus, Alk Phos, PTH, and 25(OH)D <20
200
Vitamin D Deficiency tx
correct calcium and phosphate deficiencies; Vitamin D3 40 mcg 1600 IU/day
201
Vitamin K Deficiency cause
poor placental transmission, immature neonatal liver, low breast milk levels, sterile neonatal gut first few days of life; biliary obstruction, cystic fibrosis, resection of small intestine; use of Coumarin anticoagulants
202
Vitamin K Deficiency s/s
easy bruising, epistaxis, bleeding/hemorrhage (newborn infants, biliary tract disease)
203
Vitamin K Deficiency dx
prolonged PT; decrease in prolonged PT and elevated INR after phytonadione
204
Vitamin K Deficiency tx
phytonadione 1-20mg
