GI Diseases Flashcards
(439 cards)
1
Q
fatigue, nausea, anorexia, fever, arthralgia, mylagia, h/a, RUQ pain
A
All Hepatitis: Symptoms
2
Q
jaundice, scleral icterus, coca-cola urine, hepatomegaly
A
All Hepatitis: Signs
3
Q
very high ALT/AST, high TP+AP, bilirubin in urine, increase IgM
A
All Hepatits: Labs
4
Q
diffuse periportal lymphocytic inflammation, hepatocellular ballooning
A
All Hepatitis: Biopsy
5
Q
Oral-fecal, asympotomatic in children
A
Hepatitis A: MOI
6
Q
ALT and symptoms peak in 1 month, IgM peaks 3 months post-infxn
A
Hep A
7
Q
Nonenveloped ssRNA virus; @2wks - excreted in stool; @4wks - increased ALT, Sx begin; @8wks - resolution
A
Hepatitis A: Pathophysiology
8
Q
Never chronic, no tx but gamma-globulin vaccine available (passive)
A
Hepatitis A: Treatment/Notes
9
Q
Horizontal (IVDU, sex) in US
A
Hepatitis B: Epi/MOI
10
Q
The only enveloped, partially double-stranded DNA virus; 6-8wk incubation, 20% serum sickness prodrome
A
Hepatitis B: Pathophysiology
11
Q
Progresses to chronic in 4%, Tx and vaccine (passive + active)
A
Hepatitis B: Treatment/Notes
12
Q
Epi: HepB coinfection/hx
A
Hepatitis D: Epi/MOI
13
Q
Delta agent, uses HBsAg protein coat, HepB must be present
A
Hepatitis D: Pathophysiology
14
Q
Pigs
A
Hepatitis E: Epi/MOI
15
Q
~HepA, waterborne, endemic in Asia, N. Africa, Mexico
A
Hepatitis E: Pathophysiology
16
Q
350M; 1M in US
A
Chronic Hepatitis B: Epi/MOI
17
Q
Labs: increased ALT+AST >6mo, (+)HBsAg, (+)HBcAb IgG; Biopsy: Ground glass
A
Chronic Hepatitis B: Signs/Symptoms/Findings
18
Q
Vertical transmission predominant in most parts of the world; can lead to HCC; see charts on Chronic Hepatitis B
A
Chronic Hepatitis B: Pathophysiology
19
Q
PEG-interferon, tenofovir / entecavir to decrease HBV DNA levels; not curative
A
Chronic Hepatitis B: Treatment/Notes
20
Q
170M; 3M in US;
A
Chronic Hepatitis C: Epi/MOI
21
Q
Labs: increased ALT+AST >6mo, (+)anti-HCV, (+)HCV RNA; Biopsy: Portal lymphoid aggregates, interface hepatitis
A
Chronic Hepatitis C: Signs/Symptoms/Findings
22
Q
Unlike chronic HepB, anti-HCV doesn’t kill virus; but also unlike HBV, HepC can be cured (in ~75%), since no virus in nucleus
A
Chronic Hepatitis C: Pathophysiology
23
Q
PEG-interferon, ribavirin, (+boceprevir/telaprevir in genotype 1); SNP encoding interferon(IFN lamba 3) = 2x change in response
A
Chronic Hepatitis C: Treatment/Notes
24
Q
Decades of alcohol use
A
Alcoholic Hepatitis / ASH (Alcoholic Steatohepatitis : Epi/MOI
25
Acute jaundice, liver failure, hepatomegaly, ascites, encephalopathy; increased AST+ALT, AST:ALT >2:1; PMNs, ballooned hepatocytes, Mallory bodies, centrilobular macrosteatosis, chicken-wire fibrosis
Alcoholic Hepatitis / ASH (Alcoholic Steatohepatitis : Signs/Symptoms/Findings
26
Acetaldehyde (toxic metabolite of alcohol) damages central hepatocytes, leads to production of TGs; some degree of fibrosis but generally not cirrhotic; can see portal HTN from hepatic swelling
Alcoholic Hepatitis / ASH (Alcoholic Steatohepatitis : Pathophysiology
27
Tx: Abstinence, banana bag, steroids (esp. if discriminant fxn >32, which = poor prognosis), pentoxifylline (anti-TNF), need 6 mo abstinence for xplant
Alcoholic Hepatitis / ASH (Alcoholic Steatohepatitis : Treatment/Notes
28
Metabolic syndrome, M>F, 40-60 yo
NAFL (Non-Alcoholic Fatty Liver)& NASH: Epi/MOI
29
Same as ASH except mixed PMNs + lymphos, AST:ALT <1; also see perivenular and sinusoidal fibrosis
NAFL (Non-Alcoholic Fatty Liver) & NASH: Signs/Symptoms/Findings
30
1st hit: increased TG's, FFA; 2nd hit: oxidative stress leads to lipid peroxidation, cytokine release, damage to cell membranes + mitos
NAFL (Non-Alcoholic Fatty Liver) & NASH: Pathophysiology
31
Less cirrhosis risk than ASH; Tx: wt loss, exercise, glycemic/lipid control, pioglitazone, vitamin E
NAFL (Non-Alcoholic Fatty Liver)& NASH: Treatment/Notes
32
Rare Steatosis
Small Droplet Steatosis: Epi/MOI
33
Small fat vacuoles, nucleus at center
Small Droplet Steatosis: Signs/Symptoms/Findings
34
Severe mitochondrial injury leads to decrease beta-FA oxidation
Small Droplet Steatosis: Pathophysiology AND Treatment/Notes
35
Normal blood bilirubin
<17microM, 1 mg/dL
36
In real life, unconjugated serum bilirubin percent
96%
37
Lab overestimates conjugated bili by up to
30%
38
bilirubin level leading to jaudince
>35 microM
39
conjugated hyperbilirubinemia always caused by
impaired secretion of BDG from hepatocytes OR biliary obstruction
40
heptocellular causes of conjugated hyperbilirubinemia
cirrhosis, acute hepatitis (drugs, viral, alcohol)
41
biliary obstruction causes of cinjugated hyperbilirubinemia
gallstones, tumors, primary biliary cirrhosis
42
Dubin-Johnson syndrome (ABCC2) & Rotor syndrome (SLCO1B1/IB3)
genetic conjugated hyperbilirubinemia
43
unconjugated hyperbilirubinemia: overproduction causes
hemolysis, bad erythropoesis
44
unconjugated hyperbilirubinemia: impaired uptake causes
fast, sepsis, drugs (probenicid)
45
unconjugated hyperbilirubinemia: impaired conjugation causes
inherited mutations/polymorphisms
46
Crigler-Najjar (UGT1 mut) & Gilbert sydrome (polymorphism)
cause impaired conjugation unconjugated hyperbilirubinemia
47
less H bonding in E diastereoisomers, makes unconj. Bili more water soluble
phototherapy in neonates with jaudice
48
metabolism produces a hepten that binds to cells, triggers T-cells and eosinophils
drug-induced hepatitis
49
M>F (due to .'s), N. Euros. Variable penetrance
Hemachromatosis: Epi/MOI
50
Bronzing diabetes, HCC, cirrhosis, cardiomyopathy; transferrin saturation (TIBC) >50% in F, >60% in M
Hemachromatosis: Signs/Symptoms/Findings
51
HFE mutation (C282Y +/+ or H63D/C282Y) results in decrease hepcidin, which is usually inhibitor of iron absorption, recycling, storage
Hemachromatosis: Pathophysiology
52
Tx: phlebotomy; liver xplant if bad; can also see iron overload due to causes other than HFE mutation. Can halt symptoms, but cannot reverse damage
Hemachromatosis: Treatment/Notes
53
AR, 1/30K, 2-40 yo
Wilson's Disease: Epi/MOI
54
Kayser-Fleischer rings, decrease ceruloplasmin, urinary Cu high, stool low (25% direct, 50% as metallothionin),low AlkP, AST+ALT > 2.2, renal dz
Wilson's Disease: Signs/Symptoms/Findings
55
ATP7B on chr17 encodes metal-transporting ATPase, mutation results in excessive copper in liver and brain
Wilson's Disease: Pathophysiology
56
Chelation (penicillamine), zinc (prevents absorbtion), transplant if bad (always fatal without tx)
Wilson's Disease: Treatment/Notes
57
Biopsy: (+)PAS granules; Labs: decrease alpha 1AT;Chronic hepatitis, cirrhosis
Alpha-1-Antitrypsin Deficiency: Signs/Symptoms/Findings
58
SERPINA ZZ, some ZS, rarely SS leads to alpha 1AT getting trapped within ER of hepatocytes, leads to fibrosis, cirrhosis, HCC
Alpha-1-Antitrypsin Deficiency: Pathophysiology
59
Serpina Pi null-null
no a1t, severe lung disease, no liver dz
60
Tx: smoking cessation, abstinence, pneumovax, alpha 1AT, manage chronic liver dz, augementum for lungs, only xplant cures liver
Alpha-1-Antitrypsin Deficiency: Treatment/Notes
61
F>M 4:1, dx by exclusion, biopsy
Autoimmune Hepatitis (AIH), overlap syndromes: Epi/MOI
62
Acute hepatitis (30%), occ fulminant, 34% asympt; increased ALT + AST, IgG, gamma-globulin ; plasma cell infiltrate + interface hepatitis
Autoimmune Hepatitis (AIH), overlap syndromes: Signs/Symptoms/Findings
63
97% are Type 1: anti-smooth muscle Ab (SMA) and/or ANA, age 16-30; Type 2: anti-ILKM1, affects kids 2-14yo; type III looks like one, adults 30-50
Autoimmune Hepatitis (AIH): Pathophysiology
64
Tx: Prednisone + azathioprine, 10yr survival 90% but 3yr relapse 90%; long-term Tx usually necessary; xplant
Autoimmune Hepatitis (AIH), overlap syndromes: Treatment/Notes
65
AIH + (PBC or PSC)
Overlap Syndromes: Pathophysiology
66
F>M, other AI diseases
Primary Biliary Cirrhosis (PBC): Epi/MOI
67
(+)AMA, increased AlkP and gamma-globulin, fatigue, pruritus, cirrhotic Sx, chronic cholangitis
Primary Biliary Cirrhosis (PBC): Signs/Symptoms/Findings
68
AMA (anti-mitochondrial Ab) vs. small intrahepatic bile ducts
Primary Biliary Cirrhosis (PBC): Pathophysiology
69
Tx: Ursodeoxycholic acid; cholestyramine for pruritus
Primary Biliary Cirrhosis (PBC): Treatment/Notes
70
M>F 3:1, 20s-30s, 80% IBD (mostly UC)
Primary Sclerosing Cholangitis (PSC): Epi/MOI
71
increased increased AlkPhos+TB, increased ALT+AST, gamma-globulin, (+)pANCA, ANA, SMA, (-)AMA; Onion-skin fibrosis on biopsy, Beads-on-a-string on ERCP
Primary Sclerosing Cholangitis (PSC): Signs/Symptoms/Findings
72
ANCA>ANA>SMA vs. both intrahepatic and extrahepatic bile ducts
Primary Sclerosing Cholangitis (PSC): Pathophysiology
73
Median survival 12 yrs; transplant is only way to improve; watch for colon cancer, cholangiocarcinoma, gallbladder dz, IBD, metabolic bone disorder
Primary Sclerosing Cholangitis (PSC): Treatment/Notes
74
Cholestasis: increased direct bili, pruritus, jaundice, xanthomas, fibrosis, ADEK deficiency, fat malabsorption, hepatocellular injury, acholic stool (grey/white)
Infectious Hepatitis, TPN-associated cholestasis, galactosemia, tyrosemia, idiopathic neonate hepatitis: Signs/Symptoms/Findings
75
ToRCHeS - Toxo, Rubella, CMV, HSV, Syphilis; Coxsackie; Echovirus
Infectious Hepatitis: Pathophysiology AND Treatment/Notes
76
Premies
TPN-Associated Cholestasis: Epi/MOI
77
Lipids in TPN worsens underlying dz
TPN-Associated Cholestasis: Pathophysiology
78
Tx: feed, cycle or stop TPN
TPN-Associated Cholestasis: Treatment/Notes
79
AR pediatric liver diseases
Galactosemia, Tyrosemia, PFIC, Congential Hepatic fibrosis: Epi/MOI
80
Galactose-1-phosphate-uridyl transferase mutation leads to fatty liver
Galactosemia: Pathophysiology
81
Tx: galactose/lactose-free formula
Galactosemia: Treatment/Notes
82
Fumaryl acetoacetate hydrolase deficiencylead to increased succinyl acetone
Tyrosinemia: Pathophysiology
83
Dx: urinary succinyl acetone; Tx: transplant curative
Tyrosinemia: Treatment/Notes
84
Jaundice in 1st week of life, fulminant in 30% (giant cell hepatitis, necrosis)
Idiopathic Neonatal Hepatitis: Pathophysiology
85
Also increased indirect bili; 30-40% of neonatal cholestasis;
Idiopathic Neonatal Hepatitis: Treatment/Notes
86
1/10K, 1wk old, acholic stools,
Biliary Atresia : Epi/MOI
87
Biopsy: swirly, neuron-like ductule cells with bile plugs
Dx: abd USG to r/o other causes, HIDA w/ phenobarb, increased direct bili
Biliary Atresia : Signs/Symptoms/Findings
88
Idiopathic proliferation of bile ductules with bile plugs leading to blockage of bile ducts; cause of 50-60% of liver transplants in kids
Biliary Atresia : Pathophysiology
89
Kasai hepatic porto-enterostomy to delay progression to biliary cirrhosis and transplant
Biliary Atresia : Treatment/Notes
90
Abdominal ultrasound shows cysts, dilation (in children)
Choledochal Cyst: Signs/Symptoms/Findings
91
Congenital weakness in wall of common bile ductlead to dilation, cyst
Choledochal Cyst: Pathophysiology
92
Resection due to malignancy potential
Choledochal Cyst: Treatment/Notes
93
AD, variable penet. Pediatric liver dz
Alagille Syndrome: Epi/MOI
94
Triangular facies, ocular / CV / vertebral anomalies, decrease growth, pruritus, xanthomas
Alagille Syndrome: Signs/Symptoms/Findings
95
JAG1 mutation results in dysfunctional Notch signaling, malformation and paucity of intrahepatic bile ducts, arteriohepatic dysplasia
Alagille Syndrome: Pathophysiology
96
Prolonged survival good but defective spermatogenesis
Alagille Syndrome: Treatment/Notes
97
increased AlkPhos, pruritus, normal GGT; biliary paucity, giant cells
Progressive Familial Intrahepatic Cholestasis (PFIC): Signs/Symptoms/Findings
98
Defect in ATP8B1 (type 1: ATPase) or BSEP (2: salt pump) leads to bile transport problems
Progressive Familial Intrahepatic Cholestasis (PFIC): Pathophysiology
99
External biliary diversion, esp. in type 1; transplant
Progressive Familial Intrahepatic Cholestasis (PFIC): Treatment/Notes
100
Abd pain, cholangitis, varices; ductular cells, no cirrhosis (in children)
Congenital Hepatic Fibrosis: Signs/Symptoms/Findings
101
Malformation of embryonic ductal plate leads to fibrosis, ARPKD
Congenital Hepatic Fibrosis: Pathophysiology
102
Comorbid with Caroli's
Congenital Hepatic Fibrosis: Treatment/Notes
103
75% M
Caroli's Disease: Epi/MOI
104
Abd pain, hepatomegaly, Gm- sepsis, CBD normal
Caroli's Disease: Signs/Symptoms/Findings
105
Multiple saccular dilatations of intrahepatic ducts (~choledochal cyst)
Caroli's Disease: Pathophysiology
106
Stenting, Abx, pain meds, transplant curative
Caroli's Disease: Treatment/Notes
107
CT: lumpy-bumpy, enlarged liver; Biopsy: collagen; increased TB (Tx: see PBC), increased PT/INR
Cirrhosis: Epi/MOI AND Signs/Symptoms/Findings
108
Chronic inflammationlead to fibrosis from stellate cells, regenerative nodules, distortion of liver parenchyma; etiologies = HepB/C, EtOH, autoimmune, congenital, toxins
Cirrhosis: Pathophysiology
109
Pro-oncogenic environment (1-5% / yr progress to cancer); prognosis: compensated 8.9 yrs, decompensated 1.6 yrs
Cirrhosis: Treatment/Notes
110
Other sequelae include hepatic hydrothorax (Tx: ~ascites), hyponatremia (Tx: decrease fluids, vaptans), hepatoencephalopathy, varices, portopulmonary syndrome
Portal Hypertension: Epi/MOI AND Signs/Symptoms/Findings
111
Portal pressure increased >7mm Hg (>10 is "significant") from increased outflow resistance (fibrosis or vasoconstriction) + increased inflow; Tx: beta blockers, octreotide
Portal Hypertension: Pathophysiology AND Treatment/Notes
112
SAAG >1.1, nl glucose, low LDH, low protein+amylase
Ascites: Signs/Symptoms/Findings
113
>10mmHglead to fluid in peritoneal cavity from lymphatic backflow
Ascites: Pathophysiology
114
Tx: Low Na+ diet, diuretics, LVP, TIPS
Ascites: Treatment/Notes
115
increased WBC (>500, or >250 with more than half polys), (+)culture (klebsiella, e.coli, entercoccus, pneumococcus)
Spontaneous Bacterial Peritonitis (SBP): Signs/Symptoms/Findings
116
Ascites fluid infected by bacteria or fungi w/o gut perforation
Spontaneous Bacterial Peritonitis (SBP): Pathophysiology
117
Tx: 3G cephalosporin x 5d
Spontaneous Bacterial Peritonitis (SBP): Treatment/Notes
118
Serum Cr >1.5, despite volume expansion, d/c diuretics
Hepatorenal Syndrome: Signs/Symptoms/Findings
119
Renal insufficiency with cirrhosis and ascites; Type 1 worse than Type 2
Hepatorenal Syndrome: Pathophysiology
120
Tx: Albumin, midodrine, octreotide, TIPS, liver xplant
Hepatorenal Syndrome: Treatment/Notes
121
Platypnea-orthodeoxia, clubbing, cyanosis
Hepatopulmonary Syndrome: Signs/Symptoms/Findings
122
V-Q mismatch from vasodilation in lung due to NO from portal HTN
Hepatopulmonary Syndrome: Pathophysiology
123
Tx: O2, liver transplant
Hepatopulmonary Syndrome: Treatment/Notes
124
Gross: "Nutmeg liver" Biopsy: congestion near central vein
Centrilobular Congestion: Signs/Symptoms/Findings
125
Right-sided heart failure (or biventricular heart failure)
Centrilobular Congestion: Pathophysiology AND Treatment/Notes
126
Biopsy: necrosis near central vein
Centrilobular Necrosis: Signs/Symptoms/Findings
127
Left-sided heart failure
Centrilobular Necrosis: Pathophysiology
128
Ascites & increased coag state
Budd-Chiari Syndrome: Signs/Symptoms/Findings
129
Liver (cont'd)
Budd-Chiari Syndrome: Cat
130
Thrombi/tumor invade hepatic vein/IVC; liver blocked, congested
Budd-Chiari Syndrome: Pathophysiology
131
50% due to Tylenol
Acute Liver Failure (ALF): Epi/MOI
132
Acute, change MS, coagulopathy (increased INR), no cirrhosis; coagulative necrosis
Acute Liver Failure (ALF): Signs/Symptoms/Findings
133
Drugs, viruses, toxins, metabolic dz, ischemia, etc. leads to liver damage; can lead to encephalopathy, infection, cerebral edema, renal failure, SIRS
Acute Liver Failure (ALF): Pathophysiology
134
ICU, IV N-acetylcysteine if acetaminophen, early liver transplantation (other organs usually recover)
Acute Liver Failure (ALF): Treatment/Notes
135
28% Tylenol, 52% indeterminate (probably viral)
Pediatric Acute Liver Failure: Epi/MOI AND Signs/Symptoms/Findings
136
Acetaminophen better prognosis than viral/indeterminant
Pediatric Acute Liver Failure: Pathophysiology
137
OLT (King's college criteria)
Pediatric Acute Liver Failure: Treatment/Notes
138
Asterixis, stupor, coma, change LOC
Hepatic Encephalopathy: Signs/Symptoms/Findings
139
Gut neurotoxin (e.g. NH3) bypass liver due to portal-systemic shunt
Hepatic Encephalopathy: Pathophysiology AND Treatment/Notes
140
1M die / yr
Hepatocellular Carcinoma: Epi/MOI
141
Screen with liver USG q6mo in at-risk pts, vaccinate for HBV
Hepatocellular Carcinoma: Signs/Symptoms/Findings
142
Screen ALF pts every 6 mos
for Hepatocellular Carcinoma
143
Chemo, RF ablation
Hepatocellular Carcinoma: Treatment/Notes
144
hepatic failure + iron deposition
gestational alloimmune liver disease
145
complement cascade activates, intrauterine onset. Anti-human C5B9 complex
gestational alloimmune liver disease
146
IVIg, exchange transfusion, OLT
gestational alloimmune liver disease
147
PT prolongs within
one day of liver dysfunction
148
marked ALT/AST elevation
hepatocellular
149
marked AlkP, TB elevation
cholestatic
150
marked AlkP only
infiltrative
151
normal albumin
3.5-5.3
152
normal AST
six-40
153
normal Alk-P
30-120
154
normal TB
0.1-1
155
normal direct B
0.1-0.4
156
normal GGT
0-42
157
normal INR (PT ratio)
1
158
dx biliary obstruction
MRCP (costly)
159
test to access cirrhosis
liver-spleen scan (medium)
160
will not evaluate liver function, can't detect fibrosis, rarely reveals etiology
CT, MRI/MRCP
161
mild elevation
<5x normal
162
severe elevation
>15x normal
163
decreases UGT1 activity, increased bili production, bad erthropoesis and decreased RBC survival
why babies be jaundiced
164
female, advanced age, DM, obese, chronic viral disease, alcohol, decreased renal fxn, nutritional deprivation
factors associated with drug-related liver damage
165
acetominophen, after P450, produced
toxic NAPQ1
166
tylenol and beer both
deplete glutathione, leading to mercapturic acid conjugates and mitochondrial dysfunction
167
picornaviridal hepatovirus
hep A
168
hepandaviridae
hepB
169
flaviveridal hepacivirus
hep C
170
unclassified viroid, delta virus
hep D
171
unclassified, toga- and alphavirus-like
hep E
172
mono, lymphadenopathy, splenomegaly and hepatitis
EBV
173
immunocompromised with hepatitis
CMV?
174
HBsAg
acute or chronic hep B
175
Anti-HBc IgM
acute hep B
176
HBeAg
increased infectivity hep B
177
Anti-HBe
decreased infectivity hep B
178
Anti-HBs
hep B immunity
179
Anti-HBc IgG + HBsAg
hep B chronic infxn
180
Anti-HBc IgG + Anti-HBs
hep B resolved infxn
181
Hep C incubates for
6-8 weeks
182
Hep C becomes chronic for
80%
183
Hep C becomes cirrhotic for
20%
184
HCV RNA positive at
2 weeks post-infxn
185
Anti-HCV appears
12-24 weeks post infxn
186
AST:ALT in alcoholic hep
>2:1
187
three effects of alcohol ingestion
aldehyde adducts, increased ROS, increase NADH:NAD+ ratio
188
required abstinence for xplant
six months
189
predict progression in NAFLD
DM, high initial fibrosis, obesity
190
portal hepatic pressure gradient PV-HV
7 is normal, 10 is significant, balloon is in the HV
191
NO increases in PHTN because
shear stress activates eNOS in splanchnic beds, increased TNF and VEGF
192
spontaneous bacterial peritonitis, refractory ascites, dilutional hyponatremia, hepatorenal syndrome
prognosis in PHTN, worst to best
193
GI bleed/hypotension, advanced liver disease, prior Hx
risk factors for spontaneous bacterial perotinitis
194
All tx for end-stage liver dz, except OLT
supportive not curative
195
INR in ALF
>1.5
196
barbituates, mannitol, hyperventilation, head elevation
may prevent encephalopathy in fulminant liver failure
197
discrimination function equation
4.6*(patient's PT-control PT) + total bili
198
DF>32
alcoholic hepatitis, treat with steroids
199
pH100 and creatinine>3.5, in III/IV coma
King's College OLT criteria in acetominophen poisoning
200
PT>100, or three of these:PT>50, younger than 10 or older than 40, jaundice 7 days prior to encephalopathy, bili>17, not hep A or B
Kings College OLT criteria (not ACM)
201
associated with polysplenia, heterotaxia, intraabdominal vascular abnormalities
biliary atresis
202
alaguille's prognosis is good except defective sperms and
CNS aneurysms
203
percent of HCC due to HBV
80%!
204
HBV, HCV, alcoholic cirrhosis, NAFLD, metabolic syndrome, aflatoxin (from corn, soy, nuts), dirty water
HCC risk factors
205
Lymphocytes in islets lead to
Type I Diabetes Mellitus: Signs/Symptoms/Findings
206
Autoimmune vs. beta cells
Type I Diabetes Mellitus: Pathophysiology
207
Amyloid buildup in pancreas
Type II Diabetes Mellitus: Signs/Symptoms/Findings
208
Insulin resistance in beta cells
Type II Diabetes Mellitus: Pathophysiology
209
Hypoglycemia
Islet Cell Adenoma (Insulinoma): Signs/Symptoms/Findings
210
Benign but functional encapsulated tumor of islet cell origin
Islet Cell Adenoma (Insulinoma): Pathophysiology
211
Complete (IPF1 single nucleotide deletion) or partial lack of pancreas
Pancreatic Agenesis: Pathophysiology
212
Partial still has full function
Pancreatic Agenesis: Treatment/Notes
213
Obstructed pancreatic fluid flow, canlead to chronic pancreatitis
Pancreas Divisum: Signs/Symptoms/Findings
214
10% of the people
Pancreas Divisum: Epi/MOI
215
dx w/Ultrasound, ECRP. Think of in patients with recurrent pancreatitis
Pancreas Divisum
216
Pancreas separated, not fused together
Pancreas Divisum: Pathophysiology
217
Completely separated pancreas strangulates duodenum
Annular Pancreas: Pathophysiology
218
Surgical resection
Annular Pancreas: Treatment/Notes
219
35% alcohol use, 45% gallstones
Acute Pancreatitis: Epi/MOI
220
Epigastric abd pain rad to back, rapid onset, N/V, may have Cullen's/Grey-Turner's signs; increased Serum lipase + amylase (3x nl), liquefactive necrosis, elastase destruction of blood vesselslead to
Acute Pancreatitis: Signs/Symptoms/Findings
221
No initial abx if severe. ERCP for stones
Acute Pancreatitis
222
Dx requires 2 of: imaging, characteristic pain, amylase/lipase 3x normal
Acute Pancreatitis
223
Intracellular enzymes released, digest pancreatic fat, lobules, blood vessels; most common cause is gallstones, followed by alcohol, post-ERCP, drugs (E2, valproate, thiazide diuretics, PIs)
Acute Pancreatitis: Pathophysiology
224
Tx: IV fluids, NPO; can lead to fat necrosis, hemorrhage, ARDS, hypovolemia, hypocalcemia, coagulopathy, hyperglycemia,
Acute Pancreatitis: Treatment/Notes
225
Alcohol #1 cause
Chronic Pancreatitis: Epi/MOI
226
Calcified pancreas on XR/CT; exocrine insufficiency; large duct disease (more common in males, alcohol) vs. small duct (females, idiopathic); pain
Chronic Pancreatitis: Signs/Symptoms/Findings
227
Episodes of repeated acute pancreatitis and resultant fibrosis; EtOH increased mRNA production of degradation enzymes, blocks apical migration of lysosomes
Chronic Pancreatitis: Pathophysiology
228
Tx: abstinence, analgesics, octreotide, enzyme replacement, ERCP/neurolysis for pain, Puestow procedure. Can cause DM by destroying islets
Chronic Pancreatitis: Treatment/Notes
229
AD, 80% with mutation develop inflammation
Hereditary Pancreatitis: Epi/MOI
230
PRSS1 mutation results in increased intracellular enzymes
Hereditary Pancreatitis: Pathophysiology
231
High risk for pancreatic cancer (>40%)
Hereditary Pancreatitis: Treatment/Notes
232
Other AI disorders, plus pancreatitis
Autoimmune Pancreatitis: Epi/MOI
233
IgG deposits, especially IgG4
Autoimmune Pancreatitis: Signs/Symptoms/Findings
234
Autoantibodies results in narrowing of main pancreatic duct
Autoimmune Pancreatitis: Pathophysiology
235
Tx: steroids
Autoimmune Pancreatitis: Treatment/Notes
236
Fat, Forty, Fertile Female; 10-15% of adults, hispanic>white>black
Gallstones (Cholelithiasis): Epi/MOI
237
USG: hyperechoic with shadow
Gallstones (Cholelithiasis): Signs/Symptoms/Findings
238
Cholesterol stones (85%, radiolucent), black pigment stones (radiodense, from hemolysis), or brown pigment stones (infectious)
Gallstones (Cholelithiasis): Pathophysiology
239
Cholecystectomy
Gallstones (Cholelithiasis): Treatment/Notes
240
Steady epigastric/RUQ pain, rad to back/R shoulder
Biliary Colic: Signs/Symptoms/Findings
241
Most common complication; = pain from GB stones or CBD stones
Biliary Colic: Pathophysiology
242
Onset of pain >1hr after meals and at night
Biliary Colic: Treatment/Notes
243
Fever, leukocytosis, mild LFTs in 25%, N/V, RUQ pain rad to back, worse with movement or cough, HIDA scan, Murphy's sign, stones + thick wall on USG
Acute Cholecystitis: Signs/Symptoms/Findings
244
Inflammation of gallbladder itself; can be calculous (impaction of stone at GB necklead to inflammation, bacteria) or acalculous (immunocompromised)
Acute Cholecystitis: Pathophysiology
245
Tx: NPO, supportive care, antibiotics, surgery, cholecystectomy, endo-scopic cystic duct stenting, meperedine for pain
Acute Cholecystitis: Treatment/Notes
246
Biliary colic, obstructive jaundice, cholangitis, pancreatitis; Dx: intraductal or radial endoscopic USG
Choledocholithiasis: Signs/Symptoms/Findings
247
CBD blocked by stones (any type)
Choledocholithiasis: Pathophysiology
248
Tx: ERCP w/ cannulation, sphincterotomy, or stone retrieval; surgical biliary bypass, cholecystectomy
Choledocholithiasis: Treatment/Notes
249
Charcot's triad in 60-70% (fever, jaundice, RUQ pain); infected bile, frank pus, increased LFTs, less severe tenderness
Acute Cholangitis: Signs/Symptoms/Findings
250
stents, tumors, congenital cysts, pancreatitis, ascaris lumbroides, HIV
Acute Cholangitis: Associated Conditions
251
BD stone results in bacterial (usually Gm-, multiple agents) infection of bile ducts, usually with partial or complete cholestasis
Acute Cholangitis: Pathophysiology
252
Tx: broad spectrum antibiotics (cypro, zocin), NPO, hydration, ERCP if emergent(better than surgery)
Acute Cholangitis: Treatment/Notes
253
acini cells (84%), then ducts (5) then islets (1)
by mass, pancreas is mostly
254
cues acinar enzyme secretion
CCK via IP3
255
cues ducts to secrete water, Na and bicarb
secretin via cAMP
256
Cough, aspiration; more problems with liquids
Oropharyngeal Dysphagia: Signs/Symptoms/Findings
257
Difficulty transferring bolus out of mouth
Oropharyngeal Dysphagia: Pathophysiology
258
Caused by Zenker's diverticulum, stroke, ACS, parkinson's MS, muscular dystrophy
Oropharyngeal Dysphagia
259
Sense of bolus "sticking"
Esophageal Dysphagia: Signs/Symptoms/Findings
260
Bolus trapped in esophagus
Esophageal Dysphagia: Pathophysiology
261
Only solid food impaction (with forced regurgitation), often progressive (especially malig.)
Mechanical, Schatzki Ring, Esophageal Stricture, Esophageal Carcinoma: Signs/Symptoms/Findings
262
Can also be caused by Barrett's
Mechanical: Pathophysiology
263
Ring at squamo-columnar junction, dysphagia with large boluses of food
Schatzki Ring: Pathophysiology
264
Steakhouse syndrome
Schatzki Ring: Treatment/Notes
265
Can be asymptomatic, usually caused by acid reflux
Esophageal Stricture: Pathophysiology
266
Tx: with esophageal dilators
Esophageal Stricture: Treatment/Notes
267
Irregular stricture with lots of ulcers
Esophageal Carcinoma: Pathophysiology
268
Tx: chemotherapy, resection, radiation, stents
Esophageal Carcinoma: Treatment/Notes
269
Liquid impaction, nocturnal
Motor: Signs/Symptoms/Findings
270
Aperistalsis, LES HTN and incomplete relaxationlead to distal narrowing
Achalasia: Signs/Symptoms/Findings
271
Idiopathic or Chagas results in esophageal denervation/dilation, failure of smooth muscle relaxation
Achalasia: Pathophysiology
272
Tx: laparoscopic myotomy, Botox, pneumatic dilation
Achalasia: Treatment/Notes
273
Esophageal dysmotility, weak LES, weak contraction, LES hypotension, GERD
Scleroderma: Signs/Symptoms/Findings
274
Aka CREST syndrome, where smooth muscle becomes fibrotic
Scleroderma: Pathophysiology
275
Tx: immunosuppression
Scleroderma: Treatment/Notes
276
Heartburn, atypical sx: chest pain, ENT problems, vocal changes, asthma, cough; Biopsy: basal cell hyperplasia, mixed inflammatory cells, erosions
Gastroesophageal Reflux Disease (GERD): Signs/Symptoms/Findings
277
LES transiently relaxes, leading to esophagitis due to acid, can lead to strictures
Gastroesophageal Reflux Disease (GERD): Pathophysiology
278
Dx: 24hr pH monitoring, Bravo capsule study, etc. Tx: avoid precipitants, wt loss, PPI > H2RA
Gastroesophageal Reflux Disease (GERD): Treatment/Notes
279
most common GI referral, late complication: Barretts
GERD
280
no fatty food, alcohol, caffeine, small meals, raise bed, antacids
Mild GERD tx
281
histimine 2 receptor antagonist: Cimetidine
severe GERD tx
282
Junctional: mucinous glands; Gastric fundic: parietal cells; normal cells, just abnormal location
Barrett's Esophagus (Columnar Metaplasia): Signs/Symptoms/Findings
283
Intestinal metaplasia (i.e. esophagus looks like small intestine) due to injury to squamous mucosa and subsequent stem cell repair
Barrett's Esophagus (Columnar Metaplasia): Pathophysiology
284
Cancer risk (adenocarcinoma)
Barrett's Esophagus (Columnar Metaplasia): Treatment/Notes
285
Vomiting, reflux symptoms; >20 eos per HPF, rings, strictures, white papules, linear furrows
Eosinophilic Esophagitis (Allergic): Signs/Symptoms/Findings
286
Children/YA, M>F
Eosinophilic Esophagitis (Allergic): Epi
287
Hypersensitivity to dietary or airborne allergens
Eosinophilic Esophagitis (Allergic): Pathophysiology
288
Tx: corticosteroids, diet, avoid allergens, AA formulas. Anti-reflux drugs ineffective
Eosinophilic Esophagitis (Allergic): Treatment/Notes
289
Red inclusion bodies, multiple nuclei per cell, molded cells, ground glass nuclei, affects squamous cells
HSV Esophagitis: Signs/Symptoms/Findings
290
Fairly common, self-limited, peripheral ulcers secondary to infxn. Relapse frequent
HSV Esophagitis: Pathophysiology
291
Cytomegaly, intranuclear inclusions, granules and pale zone, epithelium spared
CMV Esophagitis: Signs/Symptoms/Findings
292
In immunocompromised patients, enlarged stromal cells (endos, histiocytes, nerve, muscle). Dx w/ulcer base biopsy
CMV Esophagitis: Pathophysiology
293
AIDS/DM
Candida Esophagitis: Epi/MOI
294
White pseudomembranes grossly, pseudohyphae and yeasts on silver stain
Candida Esophagitis: Signs/Symptoms/Findings
295
Indicator of AIDS, must see tissue invasion
Candida Esophagitis: Pathophysiology
296
NSAIDs, tetracycline, bisphosphonates, potassium, vitamin C, iron
Pill Esophagitis
297
dx: clinic pathology, or biopsy (iron)
pill Esophagitis
298
2-3 weeks post, self-limiting, esophageal ulcers
radiation esophagitis: acute
299
3-6 months post, fibrosis, treat with stents and dilation
radiation esophagitis: chronic
300
10% lifetime prevalence, 50% have H. pylori
Peptic Ulcer Disease: Epi/MOI
301
Dyspepsia, relieved (DU) or worsened (GU) by food; majority asymptomatic; can result in upper GI bleeding; DU (right), GU (left)
Peptic Ulcer Disease: Signs/Symptoms/Findings
302
Recurrent ulcers in upper GI tract, especially near mucosal junctions; due to increased acid+pepsin and decrease PGE-related protective factors (HCO3, mucus, etc.)
Peptic Ulcer Disease: Pathophysiology
303
H. pylori classical cause, NSAIDs becoming more common (decrease PGE2 from decrease COX-1);dx: upper endoscope and biopsy; Tx: PPI + amox
Peptic Ulcer Disease: Treatment/Notes
304
Parietal cell/IF antibodies, loss of parietal and chief cells, intestinal metaplasia
Autoimmune (Type A) Chronic Atrophic Gastritis: Signs/Symptoms/Findings
305
Rarest form, associated with pernicious anemia (B12 malabsorption)
Autoimmune (Type A) Chronic Atrophic Gastritis: Pathophysiology
306
Can result in gastrin cell tumors; mostly affect body / fundus
Autoimmune (Type A) Chronic Atrophic Gastritis: Treatment/Notes
307
H. pylori seen outside cells; Dx: urea breath test / stool test
H. Pylori (Type B) Chronic Atrophic Gastritis: Signs/Symptoms/Findings
308
children with multifocal gastritis, gastric ulcer, gastric cancer
H. Pylori (Type B) Chronic Atrophic Gastritis: Signs/Symptoms/Findings
309
adults with chronic gastritis, duodenal ulceers
H. Pylori (Type B) Chronic Atrophic Gastritis: Signs/Symptoms/Findings
310
H. pylori produces urease, leading to increased ammonia; can lead to gastric adenocarcinoma
H. Pylori (Type B) Chronic Atrophic Gastritis: Pathophysiology
311
Usually affects antrum / pylorus, but can be corpus (elderly) or pangastric
H. Pylori (Type B) Chronic Atrophic Gastritis: Treatment/Notes
312
Foveolar hyperplasia, mucosal edema and fibrosis, mild chronic inflammation
Reactive Gastritis (Type C): Epi/MOI AND Signs/Symptoms/Findings
313
aka Chemical; NSAIDs (decrease COX, decrease prostaglandins, low protection and platelet inhibition), reflux, EtOH
Reactive Gastritis (Type C): Pathophysiology
314
Rare, 25% hereditary
Zollinger Ellison Epi
315
Very thick mucosa, increased gastrin, acid, PUD
Zollinger-Ellison (Gastrinoma) Syndrome : Signs/Symptoms/Findings
316
Parietal and chief cells hyperplastic, hypersecreting, due to MEN1 (25%) or islet cell tumor
Zollinger-Ellison (Gastrinoma) Syndrome : Pathophysiology
317
Surgical resection, high dose PPIs. Only cure is surgery
Zollinger-Ellison (Gastrinoma) Syndrome : Treatment/Notes
318
Large hyperplastic folds, antrum-sparing
Menetrier's Disease : Signs/Symptoms/Findings
319
Mucus cells hyperplastic
Menetrier's Disease : Pathophysiology
320
Watermelon stomach in GAVE (gastric antral vascular ectasia)
Vascular Lesions: Signs/Symptoms/Findings
321
Gastric varices, gastric hypertensive gastropathy, or GAVE
Vascular Lesions: Pathophysiology
322
Usually a complication of portal HTN
Vascular Lesions: Treatment/Notes
323
Fundic most common
Gastric Polyps: Epi/MOI
324
Hyperplastic = oddly shaped, fundic = cystically dilated
Gastric Polyps: Signs/Symptoms/Findings
325
Hyperplastic, fundic gland, adenomatous, or fibroid polyps
Gastric Polyps: Pathophysiology
326
Adenomatous has malignancy potential
Gastric Polyps: Treatment/Notes
327
C-section, early or late gluten exposure
Celiac Disease (Gluten-Sensitive Enteropathy): Epi/MOI
328
Steatorrhea, malabsorption, weight loss; Biopsy: CD3+ IELs, Inflammation, villous atrophy (<4:1 V:C ratio) Labs: anti-tTG, EMA, and gliadin
Celiac Disease (Gluten-Sensitive Enteropathy): Signs/Symptoms/Findings
329
Gliadin gets activated by tTG, presented to APCs because of HLA DQ2/8, cross-reaction with small bowel tissue; can be comorbid with lymphocytic gastritis/colitis
Celiac Disease (Gluten-Sensitive Enteropathy): Pathophysiology
330
Response to gluten-free diet is both diagnostic and primary treatment; rule out other causes of villous atrophy
Celiac Disease (Gluten-Sensitive Enteropathy): Treatment/Notes
331
common (1% prevalence) only 17% dx in US, twins is 70%
Celiac
332
H. pylori protects, best tests are tTG IgA and DGP
Celiac
333
Diarrhea in <2 yo, growth issues at all ages
Pediatric Celiac Disease: Epi/MOI AND Signs/Symptoms/Findings
334
No diarrhea, IBS, incidental, decrease Fe anemia, dermatitis herpetiformis
Silent Celiac Disease: Signs/Symptoms/Findings
335
Non-diarrheal presentations of celiac disease; oral lesions is from interaction with tTG in skin
Silent Celiac Disease: Pathophysiology
336
Can also get enamel abnormalities (dental applications!)
Silent Celiac Disease: Treatment/Notes
337
Type I: CD8+, responds to immunosuppression; Type II: refractory to immunosuppression, malignancy risk (T-cell lymphoma)
Refractory Sprue: Epi/MOI AND Signs/Symptoms/Findings
338
Celiac that doesn't respond to gluten-free diet; can be from noncompliance, wrong diagnosis
Refractory Sprue: Pathophysiology AND Treatment/Notes
339
Increased collagen in subepithelial area
Collagenous Sprue: Signs/Symptoms/Findings
340
Travel
Tropical Sprue: Epi/MOI
341
Vs. celiac: distal bowel affected more than proximal, macrocytic anemia from B12 malabsorption
Tropical Sprue: Signs/Symptoms/Findings
342
Post-infectious (e. coli, heterophilus) sprue that doesn't respond to gluten-free diet
Tropical Sprue: Pathophysiology
343
Tx: doxycycline, B vitamins
Tropical Sprue: Treatment/Notes
344
Vs. celiac: other Crohn's Sx AND No hematochezia, RLQ pain, aphthous ulcers Gross: skip areas, crypt malformation, giant cells, granulomas, pyloric metaplasia
Crohn's Disease: Signs/Symptoms/Findings
345
Vs. celiac: gastric heterotopia (duodenum looks like stomach)
Peptic Duodenitis: Signs/Symptoms/Findings
346
H. pylori infection in duodenum, gastric metaplasia
Peptic Duodenitis: Pathophysiology
347
Vs. celiac: much more eosinophils
Eosinophilic Gastroenteritis: Signs/Symptoms/Findings
348
Mucosal dominant: most common, see diarrhea, bleeding; mural: abd pain, obstruction, N/V; serosal: eosinophilic ascites
Eosinophilic Gastroenteritis: Pathophysiology AND Treatment/Notes
349
Vs. celiac: anti-enterocyte/anti-goblet cell Abs
Autoimmune Enteritis: Signs/Symptoms/Findings
350
Can affect entire gut, see virtually no goblet or Paneth cells on biopsy
Autoimmune Enteritis: Pathophysiology
351
Vs. celiac: reduced plasma cells, chronic giardiasis
Common Variable Immunodeficiency: Signs/Symptoms/Findings
352
Hypogammaglobulinemia, B lymphocytes fail to mature
Common Variable Immunodeficiency: Pathophysiology
353
Responds to steroids (not curative)
Common Variable Immunodeficiency: Treatment/Notes
354
Vs. celiac: metaphase mitoses (colchicine), increased apoptosis (mycophenolate)
Drug-Related Enteritis: Signs/Symptoms/Findings
355
NSAIDs, mycophenolate, colchicine, chemo, radiation
Drug-Related Enteritis: Pathophysiology
356
Vs. celiac: histiocytes (Whipple's), (+)acid fast (MAI), (+)silver (Histo), worms+cysts (strongy)
Infectious Enteritis: Epi/MOI AND Signs/Symptoms/Findings
357
Can be from adenovirus, CMV, calicivirus, Whipple's disease, MAI, histoplasmosis, strongyloides, AIDS
Infectious Enteritis: Pathophysiology AND Treatment/Notes
358
Rule of 2s: 2% of people, 2ft from ileocecal valve, 2cm, 1/2 heterotopic mucosa (gastric or pancreatic)
Meckel's Diverticulum: Epi/MOI AND Signs/Symptoms/Findings
359
True diverticulum from persistence of vitelline duct leads to an appendix-like lesion in terminal ileum
Meckel's Diverticulum: Pathophysiology
360
Complications: inflammation, bleeding ulcer, obstruction
Meckel's Diverticulum: Treatment/Notes
361
Intussusception (2nd to masses in adults), volvulus, herniation, adhesions
Intestinal Obstruction: Pathophysiology AND Treatment/Notes
362
reduced risk in smokers
Ulcerative Colitis
363
increased risk in smokers
Crohns
364
15-25, 50-65; M=F, Jews, FMHx, White>Black
Ulcerative Colitis: Epi/MOI
365
Bloody diarrhea, 6+ BMs/day, LLQ pain, anemia Gross: red friable mucosa, pseudopolyps Biopsy: flat ulcers, overhanging mucosa, crypt abscesses, Paneth metaplasia, crypt irregularity
Ulcerative Colitis: Signs/Symptoms/Findings
366
Environmental triggers (smoking, diet, NSAIDs, stress, etc.) + genetic predisposition + increased immune response (TNF- alpha , alpha 4beta7); complications include toxic megacolon, low-grade or high-grade dysplasia, carcinoma
Ulcerative Colitis: Pathophysiology
367
Tx: 5-ASA (mesalamine) formulation depending on location (e.g. Asacol or Lialda for ileocolitis), oral/IV steroids, infliximab (anti-TNF), 6-mercaptopurine / azathiprine, cyclosporins / tacrolimus, biologics
Ulcerative Colitis: Treatment/Notes
368
no blood in stool, RLQ pain, apthous ulcers, skip areas, cobblestoning Biopsy: fissures, transmural dz, pyloric metaplasia, non-caseating granulomas
Crohn's
369
Smoldering disease with chronic inflammation of terminal ileum, ileum+colon, colon, or upper GI tract; complications: strictures, perianal fistulae, dysplasia, colon cancer (4-20x greater risk)
Crohn's Disease: Pathophysiology
370
Tx: 5-ASA (mesalamine) formulation depending on location (e.g. Asacol or Lialda for ileocolitis), oral/IV steroids, infliximab (anti-TNF), 6-mercaptopurine / azathiprine, cyclosporins / tacrolimus, biologics
Crohn's Disease: Treatment/Notes
371
Travel, c.diff
Infectious Colitis: Epi/MOI
372
(-) stool culture in 70%, PMNs in lamina propria, crypts intact
Infectious Colitis: Signs/Symptoms/Findings
373
Acute, self-limited
Infectious Colitis: Pathophysiology
374
Resolved by Abx
Infectious Colitis: Treatment/Notes
375
Volcano lesions, membranous white plaques, PMNs in lamina propria
Pseudomembranous Colitis: Epi/MOI AND Signs/Symptoms/Findings
376
C. diff overgrowth destroys epithelium
Pseudomembranous Colitis: Pathophysiology AND Treatment/Notes
377
>70 yo, increased coag state
Ischemic Colitis: Epi/MOI
378
LLQ pain, hematochezia, urgency; crypt atrophy, fibrotic lamina propria
Ischemic Colitis: Signs/Symptoms/Findings
379
Slowly progressing, affects crypts (most O2 demand); can result in hemorrhage, ulcer, stricture, infarct
Ischemic Colitis: Pathophysiology
380
Middle age
Microscopic Colitis: Epi/MOI
381
Watery (secretory) diarrhea, grossly normal on colono/endoscopy
Microscopic Colitis: Signs/Symptoms/Findings
382
Lymphocytic or collagenous colitis, only microscopically inflamed
Microscopic Colitis: Pathophysiology
383
Not improved with fasting, osmotic gap 1L, maybe blood, happens in the night
Secretory Diarrhea: Signs/Symptoms/Findings
384
Iso-osmotic fluid secreted; caused by toxins, function hormone tumors, etc. (E.coli, cholera, inflammation)
Secretory Diarrhea: Pathophysiology
385
Tx: ORS, ribosylates Gsalpha
Cholera: Signs/Symptoms/Findings
386
Vibrio cholerae toxin increased Na+ export
Cholera: Pathophysiology
387
Resolves with fasting, watery, osmotic gap >50 mOsm/kg, <1L
Osmotic Diarrhea: Signs/Symptoms/Findings
388
sorbitol, fructose intolerance, sprue, celiac
Osmotic Diarrhea causes
389
Osmotically active substance in lumen; often lactase deficiency
Osmotic Diarrhea: Pathophysiology
390
Foul-smelling, floaters, multiple flushes, increased w/ fat ingestion
Fatty Diarrhea: Signs/Symptoms/Findings
391
Fat malabsorption
Fatty Diarrhea: Pathophysiology
392
make illness 1-2 days shorter, increase salmonella populations, make c. dif and ecoli worse
Abx in Diarrhea
393
Can result in nephrolithiasis (FAs out-compete oxalate for Ca+)
Short Bowel Syndrome: Signs/Symptoms/Findings
394
After resection, <200cm SB
Short Bowel Syndrome: Pathophysiology
395
Bloody, mucus, tenesmus
Inflammatory Diarrhea: Signs/Symptoms/Findings
396
Invasive infectious result in bloody, proteinaceous, exudative diarrhea with decrease serum protein + albumin
Inflammatory Diarrhea: Pathophysiology
397
AIDS
Cryptosporidiosis: Epi/MOI
398
Blue dots on Giemsa stain
Cryptosporidiosis: Signs/Symptoms/Findings
399
Invasive infectious result in bloody, proteinaceous, exudative diarrhea with decrease serum protein + albumin
Cryptosporidiosis: Pathophysiology
400
AIDS
CMV Colitis: Epi/MOI
401
Owl's eye epithelial nucleus
CMV Colitis: Signs/Symptoms/Findings
402
Invasive infectious result in bloody, proteinaceous, exudative diarrhea with decrease serum protein + albumin
CMV Colitis: Pathophysiology
403
22%, F>M (3:1), >40yo
Irritable Bowel Syndrome: Epi/MOI
404
Abdominal pain (3d/mo for 3+ mos) relieved by defecation, change stool freq/form
Irritable Bowel Syndrome: Signs/Symptoms/Findings
405
increased Permeability leads to inflammation, activation of mast cells leads to ENS hyper-sensitivitylead to symptoms
Irritable Bowel Syndrome: Pathophysiology
406
IBS-D = diarrhea, IBS-C = constipation; 5HT and IL-10 both implicated; Tx: chart
Irritable Bowel Syndrome: Treatment/Notes
407
50% of >60, 2/3 of >80, more men than women only if 20-30
Diverticular Bleeding (Diverticulosis): Epi/MOI
408
Diverticulae common in L colon but bleeding often from R; bleeding sudden, often painless
Diverticular Bleeding (Diverticulosis): Signs/Symptoms/Findings
409
Low fiber dietlead to decrease stool volumelead to herniations of colonic mucosa through muscularis (pseudodiverticulae)
Diverticular Bleeding (Diverticulosis): Pathophysiology
410
NSAIDs or aspirin worsens risk; Tx: resuscitation, vasopressin, embolization
Diverticular Bleeding (Diverticulosis): Treatment/Notes
411
>50%
Hemorrhoidal Bleeding: Epi/MOI
412
Scant hematochezia; most common cause of LGIB
Hemorrhoidal Bleeding: Signs/Symptoms/Findings
413
Tx:increased fiber, topical anti-inflammatory, ligation, etc.
Hemorrhoidal Bleeding: Pathophysiology AND Treatment/Notes
414
Lifetime 7%, usually young adults
Appendicitis: Epi/MOI
415
Periumbilicallead to RLQ pain, nausea, Rovsing's sign, fever, increased WBC; abd CT most diagnostic
Appendicitis: Signs/Symptoms/Findings
416
Obstruction of appendiceal lumenlead to polymicrobial (e. coli, b. fragilis, etc.) bacterial overgrowth, inflammation
Appendicitis: Pathophysiology
417
Tx: appendectomy, earlier surgery = better prognosis, Abx prophylaxis
Appendicitis: Treatment/Notes
418
Self-limited and mild in some cases
Clostridium Difficile: Epi/MOI
419
Fever, diarrhea, toxicity, increased WBC, pain; Dx: tissue culture assay for cytotoxin
Clostridium Difficile: Signs/Symptoms/Findings
420
Antibiotics, esp. clindamycin; complications include toxic megacolon, colonic perforation
Clostridium Difficile: Pathophysiology
421
Tx: d/c antibiotic if possible, oral ABx or IV metronidazole (+rifampin if relapse)
Clostridium Difficile: Treatment/Notes
422
10% of diverticuli pts
Diverticulitis Epi
423
LLQ pain, change in bowel habits, fever, increased WBC, bladder fistula, peritonitis, CT with IV contrast
Diverticulitis: Signs/Symptoms/Findings
424
Gm- infect diverticulum (sigmoid) after fecalith impacts;lead to perforations; occurs in 10-25% of diverticulosis, mostly sigmoid
Diverticulitis: Pathophysiology
425
Tx: metronidazole + other Abx, colonoscopy 4-6wk later, surg after 3rd episode
Diverticulitis: Treatment/Notes
426
Abx that cover enterobacter, bacteroids, (less: pseudomonas and enterococci), 4-6 weeks, follow up with colonoscopy
Diverticulitis
427
relapse rate 10-30%
diverticulitis
428
M>F 3:1
Sigmoid Volvulus: Epi/MOI
429
Distended abd, plain films
Sigmoid Volvulus: Signs/Symptoms/Findings
430
Lengthened sigmoid gets twisted
Sigmoid Volvulus: Pathophysiology
431
Tx: Non-op decompression + surgery, resection if relapse
Sigmoid Volvulus: Treatment/Notes
432
bird's peak deformity
Sigmoid Volvulus
433
3rd world, high plant fiber diet
Sigmoid Volvulus
434
Obstipation, abd pain, distention
Large Bowel Obstruction: Signs/Symptoms/Findings
435
Any mechanic obstruction
Large Bowel Obstruction: Pathophysiology
436
Tx: surgery, enteral stents
Large Bowel Obstruction: Treatment/Notes
437
decrease BS or high-pitched; abd pain; Dx: barium enema
Ileus: Signs/Symptoms/Findings
438
Failure of peristalsis
Ileus: Pathophysiology
439
Tx: neostigmine, supportive
Ileus: Treatment/Notes
