1
Q
Infectious esophagitis etiology
A
Candidiasis (most common) (fungal)
Cytomegalovirus
HSV1 and HSV2
Usually in immunocompromised or broad spectrum abx use
2
Q
Infectious esophagitis clinical findings
A
Odynophagia, dysphagia, retrosternal chest pain
Abd pain, diarrhea
Thrush, oral ulcers (HSV), colon or retina infection (CMV)
3
Q
INfectious esophagitis diagnostic test
A
Upper endoscopy with biopsy
4
Q
Candidiasis esophagitis presentation
A
Yellow/white plaques
5
Q
HSV esophagitis presentation
A
Punched out ulcers
Multinecleated giant cells
Eosinophilic intranuclear inclusions (Cowdry bodies)
6
Q
Cytomegalovirus esophagitis presentation
A
Punched out ulvers
Eosinophilic intranuclear inclusions
Basophillic intracytoplasmic inclusion with peripheral halo (owl’s eye)
Screen for retinitis
7
Q
Candidiasis esophagitis treatment
A
Fluconazole
8
Q
HSV esophagitis treatment
A
Acyclovir
9
Q
CMV esophagitis treatment
A
IV gaciclovir
Can switch to oral once it can be tolerated
10
Q
Pill-induced esophagitis causes
A
Taking pills with not enough water
Laying down after taking pill
11
Q
Pill-enduced esophagitis clinical findings
A
Sudden onset retrosternal chest pain, odynophagia, dysphagia
Onset several hours after taking pill
Pain persists for days or months
Older pts can be asymptomatic
12
Q
Pill-enduced esophagitis prevention
A
4 oz of water and remain upright for 30 mins
Avoid offensive agents
13
Q
Pill-enduced esophagitis diagnostic test
A
Endoscopy showing well-defined ulcers of varying depths
14
Q
Pill-enduced esophagitis treatment
A
Discontinue med and usually fixes in 7-10 days
Maybe use liquid med.
15
Q
Eosinophilic esophagitis etiology
A
Antigen sensitization with inflammatory response
Food/environmental allergies
Chronic inflammation
16
Q
Eosinophilic esophagitis risk factors
A
Hx of asthma, ezema, hay fever
17
Q
Eosinophilic esophagitis clinical findings
A
Odynophagia
Dysphagia solid foods
Food impaction
Heartburn
Chest pain
Atopic history
Abd pain, vomiting, food aversion, in chlildren
18
Q
Eosinophilic esophagitis diagnostic test
A
Endoscopy showing corrugated (stacked) ringed structures (trachealization)
Exudates
Furrows (vertical lines)
Biopsy showing eosinophilia
19
Q
Eosinophilic esophagitis treatment
A
PPI (-prazole)
20
Q
What does GERD stand for
A
Gastroesophageal reflux disease
21
Q
GERD etiology
A
Reflux of stomach contents into esophagus
Dysfunction of lower esophageal sphincter
Hiatal hernia
Abnormal esophageal clearance
Delayed gastric emptying
Fam hx
22
Q
GERD clinical findigns
A
Heartburn (pyrosis)
REgurgitation
Dyspepsia
Dysphagia
Chest pain
Hoarseness
Cough
Infrequent nausea
Sore throat
23
Q
GERD diagnostic test
A
Clinical diagnosis
Upper endoscopy with erostions,, ulcerations, esophagitisodynophagia, dysphagia, wieght loss, GI bleeding, Iron-deficient anemia
Reflux testing of pH<4.0 most accurate but usally not necessary
24
Q
GERD complications
A
Stricture
Barrett esophagus
Adenocarcinoma
25
GERD management
Eat smaller meals
Eat less acidic foods
Smoking cessation
Weight loss
Avoid tight clothing
Sleep more upright (wedge pillow)
26
GERD treatment
Antacids (TUMS, Pepsid)
PPI if 2 or more episodes/week
Surgery if refractory
27
Cautions with PPI use
Infectious gastroenteritis
Micronutrient deficiency
28
Barrett esophagus
Chronic reflux-induced injury causes metaplasia
Common in obese independent of GERD
Orange gastric epithelium
Diagnosis confirmed through biopsy
Endoscopic therapy for treatment or long term PPI to reduce cancer risk
29
What is the most serious complication of Barrett esophagus
Esopageal adenocarcinoma
30
Peptic stricture
Progressive dysphagia over months-years
Endoscopy and biopsy used to differentiate from adenocarcinoma
Treat with dilation (endoscopic or fluoroscopic), long term PPI to prevent recurrence, Endoscopic triamcinolone injection for refractory
31
Most common esophageal cancer
Squamous cell carcinoma
32
Esophageal cancer clinical findings
Solid food dysphagia progressive over weeks to months
Weight loss
Anemia
Chest pain
Odynophagia
Hoarseness
33
Esophaeal cancer diagnostic tests
Barium swallow studies
Uppe endoscopy
34
Esophageal cancer management
Staging with CT of chest, abd, and pelvis, PET scan
Evaluate for HER2 tumor
Endoscopic mucosal resection
Esophagectomy
Neoadjuvant chemo (carboplatin, paclitaxel, nivolumab)
Chemo/radiation to prolong life in uncurable
35
Zenker diverticulum etiology
Protrusion of pharyngeal mucosa at pharyngoesophageal junction
Between inferior pharyngeal constrictor and cricopharyngeus
Herniation of mucosa and submucosa thorugh muscula layer of esophagus
36
Zinker diverticulum pathophys
Loss of elasticity of upper esophageal sphincter
Restricted opening during swallowing
Results in increased intraluminal pressure
Occurs in proximal 1/3 of esophagus
37
Zinker diverticulum clinical findings
Indisious onset of orpharyngeal dysphagia over years
Regurgitation of undigested food
Halitosis (bad breath)
38
Zenker diverticulum diagnostic testing
Video esophagram (modified barium swallow)
39
Zenker diverticulum management
Observation for <1cm
Cricopharyngeal myotomy for >1cm
Diverticulectomy for large
40
Zenker diverticulum complications
Aspiration pneumonia
Bronchiectasis
Lung access
41
Esophageal webs etiology
Eosinophilic esophagitis, pemphigoid, pemphigus vulgaris
Plummer vinson syndrome (iron deficiency, dysphagia, cervical esophagela web, middle age woman, atrophic glossitis)
Hiatal hernia
42
Schatzki ring etiology
Hiatal hernia and GERD
43
Esophageal web
Thin membrane of squamous mucosa
Occurs in mid or upper 1/3 of esophagus
44
Schatzki ring
Circumferential, thin mucosal structure
Lumen diameter <13mm
Occur in distal esophagus at squamocolumnar junction
45
Esophageal webs and rings clinical findings
Episodic dysphagia to solids (steakhouse syndrome)
Intermittent food impaction
Dysphagia improves with drinking liquids
46
Esophageal webs and rings diagnostic studies
Barium esophagram showing full esophageal distention
47
Esophageal webs and rings management
Endoscopic bougie or balloon dilation
Endoscopic electrosurgical incision
Long term PPIs for pts with GERD and repeated dilations
48
Achalasia etiology
Loss of ganglion cels in esophageal mysenteric plexus
Autoimmune (HSV1 and genetic)
Loss of peristalsis in distal 2/3 of esophagus
Impaired relaxation of LES
49
Achalasia pathophys
Inhibitory neurons mediate LES relaxation and peristalsis
Absence of inhibitory neurons lead to impaired LES relaxation and peristalsis
Impaired relaxation leads to dilation of esophagus with sigmoid deformity
Hypertrophy of LES
50
Achalasia clinical findings
Dysphagia (gradual over months to years
Regurgitation of undigested food
Heartburn
Retrosternal chest pain (squeezing pressure radiating to neck, arms, jaw, back)
Weight loss
May eat slowly and lift neck throwing shoulder back to swallow
51
Achalasia diagnostic study
Esophageal manometry BEST
Barium esophargram with beak-like appearance
52
Achalasia nonoperative treatment
LES pressure reductino with nitrates, botulinum toxin
53
Achalasia operative management
Pneumatic dilation
Myotomy
54
Achalasia complications
Aspiration
Stasis esophagitis leading to esophageal squamous cell cancer
55
Diffuse esophageal spasm etiology
Disorder of deglutitive inhibition
Cause unknown
56
Diffuse esophageal spasm pathophys
Spastic contraction of muscle in esophageal wall or abnormal contractions
Normal lower esophageal relaxation
Impairment of inhibitory mysenteric plexus neurons
57
Diffuse esophageal spasm clinical findings
Episodic substernal chest pain
Dysphagia
Worse with hot, cold, or carbonated beverages
Presents like angina but not exertional
58
Diffuse esophageal spasm diagnostic studies
Barium esophagram with corkscrew esophagus
59
Diffuse esophageal spasm nonoperative manaement
Slower eating
Trial of PPI
Muscle relaxants, nitrates, CCB, Botulinium toxin injection
60
Diffuse esophageal spasm operative management
Peroral endoscopic myotomy (rarely needed) just in pts that can't tolerate oral intake or with bad pain
61
Hypercontractile esophagus etiology
INcreased pressure during peristalsis
Smooth muscle contractionsin normal sequence but at high amplitudes
62
Hypercontractile esophagus clinical findings
Chest pain
Dysphagia to both liquids and solids
63
Hypercontractile esophagus diagnosis
Manometry with increased pressure during peristalsis or duration of contraction >7.5 seconds
64
Hyeprcontractile esophagus treatment
Anticholinergic drugs
Muscle relaxants (nitrates)
Botulinium injections
65
Mallory Weiss tear
Tear at gastroesophageal junction (incomplete)
Forceful vomiting and coughing
Mucosa and submucosal involvement
5% of upper GI bleeds
66
Mallory Weiss tear presentation
Bright red hematemesis
67
Boerhaave syndrome
Spontaneous Full thickness, transmural tear of esophagus and gastroesophageal junction from forceful fomiting and coughing
Latrogenic during endoscopy
High morbidity and mortality if not treated
68
Boerhaave syndrome presentation
Hypotensive
Tachycardic
Crepitus on chest auscultatio or palpation (crackle with each heartbeat) (Hamman's sign)
69
Mallory-Weiss Tear Diagnostic studies
Upper endoscopy with linear mucosal tear at gastroespohageal junction
70
Boerhaave syndrome diagnostic studies
CT with water soluble contrast showing pneumomediasynum
71
Mallory-Weiss tear management
Usually stop bleeding on its own
Fluid resuscitation
Blood transfusion maybe
Epinephrine, electrocautery
Antiemetics
72
Boerhaave syndrome management
Obvious perforation means emergent surgery is needed
IV broad spectrum abx
IV PPIs
Nasogastric suction
Conservative for small and stable perforation
73
Esophageal varices etiology
Dilated submucosal veins develop with underlying portal HTN
Cirrhosis is most common
74
Esophageal varices pathophys
Portal HTN (10-12 between portal vein and inferior vena cava
75
Normal pressure between hepatic veins
1-5 mmHg
76
Esophageal varices clinical findings
Coffee ground emesis
Acute upper GI bleeed
Hypovolemia
Hematamesis
Melena
Hematochezia
77
Esophageal varices diagnostic studies
Upper Endoscopy (urgent)
diagnostic and therapeutic
78
Esophageal varices nonoperative management
Abx prophylaxis (3rd gen ceph)
Octreotide (somatostatin analog as vasoactive)
79
Esophageal varices operative management
Emergent endoscopy with band ligation
Balloon tube tamponade
Decompressive procedures (transvenous intrahepatic portosystemic shunt)
80
Esophageal varices prevention of rebleeding
Beta bocker
Band ligation
81
Esophagela varices prevention
Screening endoscopy in pts with cirrhosis
Nonselective beta blockers
Manage cirrhosis
82
Caustic (corrosive) esophageal injury etiology
Accidental or deliberate ingestion of alkaline or acidic liquid
83
Caustic (corrosive esophageal injury presentation
Severe burning
Chest pain
Gagging
Dysphagia
Drooling
Possible aspiration (striding or wheezing)
84
Caustic (corrosive) esophageal injury diagnostic test
Laryngoscopy to see airway patency
Abd and chest radiograph for free perofration or pneumonitis
Endoscopy in first 12-24 hrs
85
Caustic (corrosive) esophageal injury treatment
ICU admission unless low likelihood of esophageal injury
IV fluids
IV PPIs
Analgesics
86
Nitric oxide affect on GI tract
Smooth muscle relaxation
87
Vasoactie intestinal peptide (VIP) affect on GI tract
Smooth muscle relaxer
Increases secretions
88
Gastrin affect on GI tract
Increase HCL
89
Serotonin affect on GI tract
Increased in diarrhea
Decreased in constipation
90
Glucagon affect on GI tract
Slows motility
91
Incretins (amylin, GIP, GLP-1) affect on GI tract
Slow motility
92
Somatostatin affect on GI tract
INhibit secretion and slow motility
93
Hiatal hernia
Movement of lower esophageal sphincter above the diaphragm
94
Hiatal hernia etiology
Dysfunction of LES reflux barrier
95
Hiatal hernia causes
Genetics
Increased intrabdominal pressure
Preg
Obesity
Cough
Constipation
Vomiting
96
Hiatal hernia presentation
Often asymptomatic
GERD
Dysphagia
Belching SOB
Chest pain
Early satiety
Vomiting
97
Hiatal hernia diagnostic studies
CXR
UGI study (barium)
Endoscopy
Esophageal manometry
pH probe
98
Hiatal hernia treatment
Weight loss
Small meals
Avoid acidic or fried foods and caffeine
Don't eat around bedtime
Elevate head of bed
Treat GERD
Surgery (toupet, nissen)
99
Dyspepsia symptoms
Epigastric pain lasting > 1month
Early satiety
Epigastric pain/burning
Post-prandial fullness
Bloating
NV
Heartburn
100
Dyspepsia subtypes
Postprandial distress syndrome (fullness and satiation)
Epigastric pain syndrome
101
Dyspepsia treatment
Exercise
Avoid NSAIDs
Small meals
Limit alcohol and caffeine
Treat H. pylori if its there
102
Peptic ulcer disease
Break in gastric or duodenal mucosa
Extend through mucularis mucoasae
Vary in size from 5mm to several cm
103
Peptic ulcer disease pathophys
Decrease in protective factors (mucus and bicarbonate)
Increase in aggressive factors (H. pylori, NSAIDs, ASA, tobacco)
104
Peptic ulcer disease most common causes
H. pylori
NSAIDs
Idiopathic
105
Peptic ulcer disease presentation
Epigastric pain
Early satiety
Nausea
Anorexia
106
Peptic disease alarming symptoms
Melena
Hematemesis
Guiac-positive stools
Anemia
Early satiety
Persistent vomiting
107
Difference between gastric and duodenal ulcers
Gastric ulcer pain worse after meals
Duodenal ulcers worse at night
108
Peptic ulcer disease workup
Check for H. pylori (ureas breath test or stool
Chest/abd Xray
CT abdomen
CBC, LFT, Amylase/lipase
ECG
Cardiac enzymes
109
H. pylori diagnostic tests
Urea breath test
Stool antigen test
endoscopy
110
Peptic ulcer disease complications
GI hemorrhage
Perforation or penetration
Gastric outlet obstruction
111
Peptic ulcer disease treatment
Treat H. pylori
Stop agitators
PPI (-prazole)
Competitive potassium acid blocker (vonoprazan)
Antihistamine H2 blockers (-tidine)
112
What anti-inflammatory should be used in pts with peptic ulcer disease
Cox-2 (NOT NSAIDs) (-coxib)
113
H. Pylori treatment
Bismuth Based Quad therapy
1. PPI
2. 2 ABx (metronidazol, tinidazole,, teetracycline, amoxicillin, clarithromycin, levofloxacin)
3. Bismuth (rifabutin if can't have bismuth)
PPI (prazole), metronidazole, tetracycline, bismuth (please make tummy better)
114
What abx are associated with H. pylori resistance
Metronidazole
Clarithromycin
Levofloxacin
115
Zollinger-Ellison syndrome
Acid hypersecetion from too much gastrin resulting in gastric and duodenal ulcers.
Commonly seen with peptic ulcer disease
116
Zollinger-Ellison syndrome diagnostics
pH <2.0
Gastrin >1000 (normal is <180)
117
Zollinger-Ellison treatment
Surgery if no MEN 1
High dose PPi or CPAB
Somatostatin analogs (octreotide, lanreotide)
118
Gastropathy
Epithellial or endothelial damage without inflammation
119
Gastritis
Inflammation of stomach
120
Erosive gastritis causes
NSAIDs
Alcohol
Stress
Portal HTN
121
Erosive gastritis symptoms
Anorexia
Epigastric pain
NV
UGI bleed
Hematemesis
Melena
122
Erosive gastritis treatment
PPI prophylaxis
PPI, sucralfate, beta blockade to reduceportal HTN
Remove irritating agents like NSAIDs and alcohol
123
Nonerosive gastritis types
Atrophic
Eosinophilic
Lymphocytic
124
Atrophic gastritis etiollgy
H. Pylori
Could be autoimmune
Achlorhydria can cause iron/B12 deficiency
125
Atrophic gastritis treatment
Prevent anemias
Surveillance of gastric neoplasm
126
Eosinophilic gastritis etiology
Allergic process
Eosinophilia of the stomach
Parasitic infections
Allergic vasculitis
Scleroderma
127
Eosinophilic gastritis treatment
Avoid food allergens
Use elemental diets
Glucocorticoids
128
Lymphocytic gastritis etiology
Celiac disease (MAIN)
HIV
Crohn
H. pylori
Vommon variable immunodeficiency
129
Chronic upper GI bleed etiology
Neoplasm
Vascular abnormality
Acid-peptic lesions
Infections
Meds
130
Chronic upper GI bleed diagnostic studies
EGD
Capsule endoscopy
Meckel scan
CT angiography
131
Chronic upper GI bleed treatment
Cauterization
Removal of polyps
PPI if gastritis or small ulcers
132
Acute upper GI bleed etiology
Peptic ulcer disease
Portal HTN
Gastroesophageal laceration
Angiodysplasia
Gastric neoplasm
133
Acute upper GI bleed treatment
Blood transfusion if needed
Acid inhibitory threrapy
Erythromycin
Octreotide
134
Nausea/Vomiting diagnosis
History good enough usually
BMP to see electrolytes (CO2 marker of pH)
CT abdomen if suspect bowel obstruction
EGD if suspect gastric obstruction
135
Nausea/vomiting treatment
Antiemetics
136
Chronic nausea vomiting syndrome presentation
Bothersome nausea occurring at least 1 day/week
Criteria fulfilled for at least 3 months with some symptoms at least 6 months prior
137
Cyclic vomiting syndrome presentations
Sterotypical episodes of vomiting for less than one week
History of migraine headaches
Criteria fulfilled for at least 3 months with some symptoms at least 6 months prior
138
Cannabinoid hyperemesis syndrome presentation
Stereotypical episodic vomiting
Resolution of symptoms after period of abstinence from cannabis.
Prolonged hot baths/showers
Criteria fulfilled for at least 3 months with some symptoms at least 6 months prior
139
Rumination syndrome
Persistent or recurrent regurgitation of recently ingested food with subsequent spitting, remastication, and swallowing
Effortless regurgitation not preceded by nausea
Stops when regurgitated material is acidic
Criteria fulfilled for at least 3 months with some symptoms at least 6 months prior
140
Gastroparesis
Delayed gastric emptying not associate dwith precence of obstruction
141
Causes of gastroparesis
Idiopathic (maybe viral)
Diabetes (1 or 2)
Surgery/trauma (gastrectomy)
Opioids, anticholinergics, noninsulin diabetes meds, CCB, TCAs
142
Gastroparesis presentation
Postprandial nausea
Vomiting
Abd pain
Early satiety
Bloating
reflux
Weight loss
Dry mouth
Dental issues
143
Gastroparesis diagnostic studies
EGD to rule out obstruction
Gastric scintigraphy used to assess motility
144
Gastroparesis nonpharm treatment
Hydration, electrolytes, vitamins
Small meals, low fiber, low fat
Acupunture, CBT
145
Gastroparesis pharm treatment
Control sugar
Stop GLP-1
Stop offending meds
Antiemetics (promethazine, ondansetron)
Prokinetic therapy (Metoclopramide, erythromycin)
146
Most common gastric polyp
Fundic gland polyp
147
What size hyperplastic polyp should be resected
>1cm
148
GI stromal tumor presentation
Bleeding
Abd pain
149
GI stromal tumor diagnostic test
Endoscopic ultrasound
150
GI stromal tumor treatment
SUrgical excision if high risk or symptomatic
Annual endoscopic surveillance
151
Gastric adenocarcinoma types
Intestinal (most common, related to H. pylori, pernicious anemia, gastric surgery, smo,kng, diets high in nitrates and salt, low in vitamin C.
Diffuse (younger people, CDH1 mutation, prophylactic gastrectomy)
152
What part of GI tract is iron most absorbed
Duodenum
153
Where is B12 absorbed in GI
Ileum (need intrinsic factor from the stomach)
154
Where are femoral hernias
Below inguinal ligament
155
Where is a direct inguinal hernia
Posterior wall of inguinal canal
156
Where is indirect inguinal hernia
Through deep inguinal ring (most common inguinal hernia)
157
Hernia presentation
Paingul bulge or pain without bulge or bulge without pain
NV
Bowel obstruction (constipation)
Bloating
Burning
158
Hernia diagnostic studies
CT is best study but not generally needed
159
Hernia complications
Strangulation effects blood supply (surgical emergency)
Incarceration ( stuck and can't be reduced)
160
Hernia treatment
Optional if asymptomatic
Bely bands, jock straps
Strengthen muscles
Surgery is definitive (open or laprascopic with or without mesh)
161
Hernia post-op reccomendation
Restricted activity for 4-6 weeks
No lifting >10lbs in first two weeks
No straining to poop
Hold pillow on abdomen when coughing
Use stool softeners
162
Most common small bowell neoplasm
Neuroendocrine (MEN1)
163
Intussusception
Part of bowel slides into another part of bowel (like a telescope folding up)
164
Adenocarcinoma presentation
Abd pain
Nausea
Jaundice
165
Lymphoma presentation
Weight loss
N/V
Distension
Anemia
Occult blood in stools
Protein losing enteropathy
166
Gastroenteropancreatic neuroendocrine tumors (carcinoid) presentation
Bowel obstruction/ischemia
Bleeding
Facial flushing
Head and neck edema
Telangiectasia
167
Sarcoma presentation
Usually asymptomatic
168
Small bowel polyps/neoplasm diagnostic studies
Capsule endoscopy
CT or MRI with contrast
Barium small bowel series
biopsy
169
Gastroenteropancreatic neuroendocrine tumors (carcinoid) diagnostic studies
Serotonin, gastrin, substance P elevated
Serum chromogranin A most sensitive
Urine 5-HIAA more specific
Gallium 68 DOTATE PET scan instead of octreotide for staging
170
Small bowel polyps/neoplasm treatment
Surgical resectoin
Octreotide (gastropancreatic NETs
Oncology referal for chemo and radiation
171
ileus
Neurogenic failure of peristalsis in instestine without obstruction
172
What causes ileus
Intra-abd process such as surgery or peritoneal irritation
Severe medicinal illness
Meds
Infections
173
Ileus presentation
Mild, diffuse abd discomfort
NV
Abd distension
Diminished bowel sounds
174
Ileus diagnostic studies
Electrolytes to rule out other stuff
Upright xray of abd
CT to rule out bowel obstruction
175
Ileus treatment
Restrict oral intake (bowel rest)
NG suction if severe or prolonged
IV fluids
Avimopan can reverse opioid induced ileus
176
Small bowel obstruction presentation
Abd pain
Abd distension
HIGH PITCHED TINKLING SOUND at place of obstruction
Post-prandial bloating
Loud borborygmi
177
Most common cause of small bowel obstruction
Surgical adhesions
178
Small bowel obstruction diagnostic studies
X ray initial showing string of beads
CT with contrast shows site and cause
CBC and CMP
179
Protein-losing enteropathies
Loss of serum proteins in GI tract (usually albumin and alpha-1-antitrypsin)
180
Protein losing enteropathies causes
Mucosal disease
Lymphatic obstruction
Idiopathic
181
Protein losing enteropathies diagnostic studies
Alpha-1-antitrypsin clearance elevated in stool studies
Serum protein electrophoresis
Lymphocyte counts low
Small bowel capsule endoscopy with biopsy
182
Protein losing enteropathies treatment
Treat heart/liver infection
High protein adn low fat diet with trigyceride supplementation
Spironolactone, octreotide, dopamine
Anti-coagulation bc lack of antithrombin
183
Small intestinal bacterial overgrowth diagnostic studies
Carbohydrate breath test
Test for H, CO2, CH4
184
Small intestinal bacterial overgrowth causes
Impaired motility
Stricture
Blind loops
Gastric hypochlorhydria
185
Small intestinal bacterial overgrowth symptoms
Gas
Cramping
Malabsorption
Steatorrhea
Weight loss
Vitamin deficiencies
186
Small intestinal bacterial overgrowth treatment
Antibiotics
187
Short bowel syndreom
Small intestinal length (<200cm) with loss of absorptive area (normal is 600)
188
Short bowel syndrome presentation
Maldigestion
Malabsorption
Malnutrition
189
Short bowel syndrome causes
Strangulated bowel
Crohn disease
Ischemia
Trauma
Weight loss/bariatric
190
Short bowel syndrome treatment
IV fluids
Need B12 if no ileum
Antimotility and antisecretory agents (tedgultide, octreotide)
191
Dumping syndrome
Alterations in small bowel motility resulting in rapid transit of ingested foods
192
Dumping syndrome presentation
Diarrhea, nausea, light headed within 30 mins after meal
Hypoglycemia, weakness, sweating, dizziness 1-3 hours after meal
193
Dumping syndrome causes
Post-vagotomy
Bariatric surgery
Short bowel syndrome
IBS
Diabetic enteropathy
Carcinoid syndrome
194
Dumping syndrome diagnostic tests
Dual phase gastric scintigraphy
Carb hydrogen breath test
Small mowel manometry
195
Dumpiing syndrome treatme t
Minimize simple sugars
Loperamide
Verapamil
Octreotide
196
Diarrhea definition
Liquid or ununiformed stools >3 in 24 hrs
Acute <2 weeks
Persistent 14-30 days
Chronic >4 weeks
197
Constipation definition
Fewer than three bowel movements per week
198
Inflammatory diarrhea presentation
Tissue damage
Bloody diarrhea
Small volume
LLQ cramps
Urgency
Tenesmus
Positive fecal leukocytes
Positive fecal lactoferrin
199
Non-inflammatory diarrhea presentation
Small bowel source
Watery
Lots of shit
No blood
Periumbilical cramps
Bloating
NV
Negative fecal leukocytes
200
Noninflammatory diarrhea complications
Dehydration
Hypokalemia
Metabolic acidosis
201
Prevention of travelers diarrrhea
Bismuth subsalicylate (pepto bismol)
Cholera vaccination
ABx in unhealthy pts
202
Common pathogens of acute inflammatory diarrhea
Shigella
Salmonella
Campylobacter jejuni
Enterohemorrhagic E. coli
Yersinia
Listeria
Clostridioids Difficle
Entamoeba
203
Shigellosis presentation
Incubation 24-48 hrs
Duration >1week
Dysentery (watery, bloody, mucoid diarrhea)
Tenesmus
Hedache, malaise, vomiting
204
Salmonellosis sources
Food borne and reptiles and birds
205
Salmonellosis pathophys
Acid sensitive
INvade intestinal epithelium
Enters macrophages
O (somatic) and H (flagellar) antigens
206
Salmonellosis presentation
Incubation 12-72 hrs
Lasts 7 days
Fever, abd cramping, NV
Enteric fever - Fever, HA, bradycardia, abd pain, splenomegaly, leukopenia
207
Salmonelosis complications
Recurrent in AIDS
Osteomyelitis
Sickle cell
208
Typhoid fever pathophys
Salmonella enterica - typhi
Carrier contact with food/water
Mucosal invasion
209
Typhoid fever presentation
Pea soupd diarrhea
Fever, sore throat, cough, headache, constipation prodrome
210
Typhoid fever complications
intestinal hemorrhage
211
Typhoid fever prevention
Vaccination for travelers going to endemic areas
212
Campylobacter pathophys
Need body temp to grow (leaving food out on the counter)
Food borne
Acid sensitive
INvade intestinal epithelium
213
Campylobacter presentation
Prodrome of fever and malaise
Severe abd pain and diarrhea
Incubation 2-5 days
Duration 5-9 days
214
Campylobacter complications
Guillain Barre syndrome
215
Enterohemorrhagic E.coli pathophys
Undercooked BEEF
Shiga toxin
216
Enterohemorrhagic E. coli presentation
FEVER USUALLY ABSENT
Watery diarrhea progressive to bloody
Incubation 1-8 days
Duration days-weeks
217
Yersinia pathophys
Undercooked PORK or direct contact with pigs
Lymphatic spread
218
Yersinia presentation
Incubation 24-48 hrs
duration 2 weeks
Enterocoloits causing pain and bloody diarrhea
219
Listeriosis pathophys
Deli meats and cheeses
Preg women common (causes miscarriages through placental invation)
Invades intestinal epithelium
220
Listeriosis presentation
Incubation 3-90 days usually 7-14
Duration 1-3 days
Malaise, fever, diarrhea
Muscle aches, nausea
Flu-like in preg
221
C diff cause
Clindamycin, penicillin, fluorwuinolones, ceph
222
C diff presentation
7-10 days after abx initiation
abd pain
Smelly diarrhea
223
What makes c diff hard to kill
It makes spores
224
Amebiasis pathogen
Entamoeba histolytica
225
Amebiasis pathophys
Poor sanitation
Sex
Trophozoites bind epithelial surface
Clonic mucosal invasion
226
Amebiasis presentation
Incubation days to years usually 2-4 weeks
Mild diarrhea PROGRESSES to dysenteric stool
227
Amebiasis complications
Liver abscess
Toxic megacolon
228
Pathogens of acute noninflammatory diarrhea
Cholera
E. coli
Staph aureus
Bacillus cereus
Giardia
229
Cholera pathophys
From vibrio cholorae or vibrio parahaemolyticus
Food and water
Shellfish
Acid sensitive
Adhere to intestinal epithelium and release toxins that induce electrolyte and water secretion
230
Cholera presentation
Rice water stool
24-72 hours
Fever is uncommon
231
What reduces mortality in cholera
Fluid replacement
232
Most common cause of Travelers diarrhea
Enterotoxigenic E. coli
233
Enterotoxigenic E. coli pathophsy
Contaminated food and water
Heat-labile toxin and heat stable roxin
reduced Na absorption
Enhanced chloride and water secretion
234
Enterotoxigenic E. coli prevention
Vaccine for travelers
235
Staph aureus food poisoning pathophys
Enterotoxin B
Heat-stable
236
Staph aureus food poisoning presentatoin
Incubation 8 hours
Duration n24 hours
NV more than diarrhea
Abd cramps
237
Bacillus food poisoning pathophys
Fried rice
Improperly stored breast milk
Spore forming
Enterotoxin
238
Bacillus food poisoning presentation
Incubation <8hrs
Duration <24hrs
NV more than diarrhea
abd cramping
Fever, headache
239
Giardiasis pathophys
Drinking water from unfiltered stream, lake, pond
Protozoan
Ingest cysts
Trophozoites in small intestine
Adhere to intestinal epithelium
240
Giardiasis presentation
Incubation 1-14 days
Diarrhea, flatulence, nausea
Malabsorption, steatorrhea, weight loss
Abd pain
241
Giardiasis complications
Most get chronic infection
242
When to do stool culture
Severe dehydration
Fever>102
Dysenteric stools
Fecal leukocytes present
243
What can be identified in stool culture
Salmonella
Shigella
Campylobacter
244
When to check stool for parasites
Persistent diarrhea >2 weeks
History of travel
Exposure to children at daycares
Immunosuppression
245
What does Elisa antigen assay identify in stool
Giardiasis
Amebiasis
246
First step in diagnosis of C. diff
Clostridioides enyme immunoassay
247
Gold standard C diff diagnostic tool
C diff toxin test
248
Rapid diagnosis of C diff
Sigmoidoscopy showing pseudomembranous lesions
249
When are abx contraindicatied in diarrhea
Enterohemorrhagic E. coli
Can cause release of Shiga toxin
250
When to give abx for diarrhea
Fever>102
Dysenteric stools
Severe travelrs diarrhes
SEvere dehydratoin
Diarrhea > 1 week
251
Good diet to manage diarrhea
Bananas
Rice
Apple sauce
Toast
252
Osmotic diarrhea
Chronic
Ceases with fasting
253
Causes of osmotic diarrhea
Osmotic laxaties
Lactase deficiency
Nonabsorbable carbs
Gluten and FODMAP intolerance
254
Secretory diarrhea
Chronic
Persists with fasting
255
Dysmotility
Diarrhea
Rapid intestinal transit
Reduced time to absorb nutrients
Senen in IBS, Visceral neuromyopathies, hyperthyroidism, prokinetic drugs
256
Steatorrhea
Fatty stool
257
What is a result of steatorrhea
Nutritional deficiencies
Weight loss
258
Noninflammatory steatorrhea causes
Mucosal malabsorption
Bacterial overgrowth
Pancreatic insufficiency
259
Inflammatory steatorrhea causes
Inflammatory bowel disease
Food allergies
Radiation injury
Gastorintestinal malignancies
260
What organisms cause chronic diarrhea
Giardiasis
Entamoeba histolytics
261
Neuroendocrine tumor chronic diarrhea presentation
Persists during fasting (secretory)
Normal osmotic gap
Watery diarrhea
262
Chroni cdiarrhea management
Antidarrheal (loperamide, codeine, clonidine, octreotide)
263
Primary constipation
Slow colonic transit (>72hrs)
enteric nervous system dysfunction
Impaire drelaxation or paradoxical contration of anal sphincter
264
Secondary constipation
Systemic disease
Neurologic, electrolyte, or endocrine disorders)
265
Most common cause of constipatoin
Dietary (indadequate fiber and fluid intake)
266
Constipation evaluation
Digital rectal exam
267
Alarming symptoms of constipation
Weight loss
Hematochezia
anemia
268
Constipation diagnostic study
Anorectal manometry (balloon expulsion test( to rule out pelvic flood disorders.
Colon transit studies using radiopaque markers or wireless capsule
269
Indications for anorectal manometry
Refractory constipation not responding to meds
270
Indications for colon transit study
After refecatory disorders are excluded
271
Colonic inertia
Nerves and/or muscles working too slowly to move food through colon
Can lead to severe constipation
272
Colonic inertia treatment
More fiber and fluids
Med changes
Colonectomy or ileostomy
273
First line meds for constipation
Osmotic laxatives (polyetylene glycol, magnesium stuff, Carbohydrate containing - lactulose, sorbitol)
Stimulant laxatives
274
When to refer pts with constipation
Alarm symptoms and >45-50yo
New onset and suspicious of obstruction
Refractory constipation not responsive to therapy
275
Fecal impaction risk factors
Opioids
Psychiatric disease
Prolonged bedrest
Neurogenic colonic disorders
Spinal cord issues
276
Fecal impaction presentation
Decreased apetite
NV
Abd pain
Encopresis (liquid stool leaking around impaction)
Firm feces
277
Fecal impaction treatment
Enemas
Digital disimpaction (finger up the ass)
278
Fecal incontinence risk factors
Old
Diarrhea
Fecal urgency
Urinary incontinence
Diabetes mellitus
Hormone therapy
279
Fecal incontinence treatment
Avoid food/activity that triggers (fructose, lactose, caffeine)
Improve perianal hygiene (barrier cream)
Regular bathroom schedule
Bulking agents (psyllium, methylcellulose)
Loperamide, bismuth subsalicylate, bile acid binders (cholestyramine) for diarrhea
Prevent impaction
Enemas for neurogenic bowel dysfunction
280
Toxic megacolon clinical findings
Abd pain
bloody diarrhea
Malaise
Abd distension
AMS
Fever, tachy, hypotension
Abd tenderness
Peritoneal signs
281
Toxic megacolon diagnosis
RADIOGRAPH SHOWS DILATATOIN >6cm
At least three:
Fever
HR>120
Neutrophilic leukocytosis
Anemia
Plus at least one:
Dehydration
Altered sense
Electrolyte disturbances
Hypotension
282
Toxic megacolon non-pharm treatment
ICU admission
Fluids
COMPLETE bowel rest
NG tube
Knee-elbow positioning
283
Toxic megacolon pharm treatment
Broad abx
Glucocorticoids of IBD related or infliximab if no improvement
Oral vancomycin if C diff
Steroids for ulcerative colitis
284
What percent of pts with toxic megacolon need surgery
50%
If no improvement after three days of infliximab
Immediate if perforation, bleeding, necrosis, ischemia, peritonitis, organ failure, or abd compartment syndrome
Total colectomy or subtotal colectomy with ileostomy
285
What cause of toxic megacolon has worst prognosis
C diff
286
Irritable bowel syndroem presentation
Recurrent abd pain
Change in bowel habits (freq and form)
287
IBS nonpharm treatment
CBT
Relaxation
Exercise (yoga)
Hypnotherapy
288
IBS pharm treatment
Antispasmodics, neuromodulators, and peppermint for discomfort
Fiber
osmotic laxatives (polyethylene glycol)
Secretagogues
Ion channel blocker
Antidiarrheal (loperamide)
Gut flora modulator (rifaximin)
Bile acid sequestrant (cholestyramine
Opioid receptor modulator
5-HT3 receptor antagonist
289
Main types of inflammatory bowel disease
Ulcerative colitis
Crohn's Disease
Both lifelong
290
Crohn's disease characteristics
Can involve any part of GI from mouth to anus
Pattern of inflammation is patchy (SKIP LESIONS)
TRANSMURAL - effects all layers
Non-caseating granulomas
291
Ulcerative colitis characteristics
INvolves only rectum and large intestine
Inflammation is continuous
Affects only mucosa and submucosa
Crypt abscesses
292
Goblet cells
Make mucous
293
M-cells
Sample antigen of lumen allowing appropriate response
294
Panneth cells
Secrete antimicrobila peptides to control microbes in gut
295
IBD pathophy
Intestinal epithelial cell dysfunction
Impaired barrier function
Dysfunctional immune response for genetic or environmental factors
Microbial products inappropriately infiltrating barriers and activating immune cells
296
What immune cells are affected in Crohn's disease
TH1 adn TH17 actibated and increase cytokies and interleukins causing transmural damag
297
What immune cells are affected in ulcerative oclitis
TH2 incerease cytokines and interleukins
Also neutrophils keeping damage only to mucosa and submucosa
298
IBD risk factors
Fam hx
Western diat
Stress
NSAIDs
Smoking (but protective for ulcerative colitis)
Abx use
299
What mutation causes Crohn's disease
NOD2 affect apneth cells
300
What mutation causes Ulcerative colitis
Certain HLA alleles allow natural killer clels to destroy intestinal epithelial cells
301
Chron's disease complications
FIstulas
Strictures
Perianal disease
Oral apthous ulcers
Abd abscess formation
Small bowel cancer
B12/D/Folate deficiency
302
Ulcerative colitis complications
Toxic megacolon
Fulminant colitis
Colorectal cancser
Primary sclerosing cholangitis
Osteoporosis
Iron deficiency anemia
Folate deficiency
Venous thromboembolism
303
Crohn's disease presentation
Usually chronic
Diarrhea
Abd pain (RLQ)
Fatige Weight loss
Perianal disease
Esophageal involvement
Fistulase
Abscess formation
Nutritional deficiency
304
Ulcerative colitis presentation
Bloody diarrhea
Abd pain (LLQ)
Tenesmus
Iron deficiency from lood loss
305
Tenesmus
Feeling the need to pass stool when rectum is empty
306
Extraintestinal symptoms in IBD
Not usally present at diagnosis but seen later on
Pyoderma gangrenosum and erythema nodosum
Peripheral arthritis, ankylosing spondylitis, sacroiliitis
Uveitis, episleceritis
Hepatitis
Oral aphthous ulcers (only in Crohn's)
Primary sclerosing cholangitis causing liver disease (only in ulcerative colitis)
307
Antibodies asociated with ulcerative colitis
Anti-neutrophl cytoplasm antibodies (p-ANCA)
308
Antibodies associated with chron's disease
Anti-saccaromyces cervisiae antibodies (ASCA)
309
Ulcerative colitis diagnostic studies
Barium enema shows lead pipe or stove pipe appearance and pseudopolyps
Continuous inflammation starting at rectum
Colonoscopy is diagnostic
Biopsy with crypt abscesses and mucosal involvement
310
Crohn's disease diagnostic studies
Barium enema shows skip leaseiona, apthous ulcers, string sign, cobblestone appearance
Colonoscopy look like cobblestone
Biopsy with granulomas and transmural involvement
311
Ulcerative proctitis
Limited to rectum
312
Ulcerative proctosigmoiditis
Limited to rectum and sigmoid
313
Left sided or distal ulcerative colitis
Extends from rectum up to splenic flexure
314
Extensive ulcerative colitis
Extending from rectum through transverse colon
315
Pancolitis
Extends from rectum to cecum
316
Fulminant ulceractiv ecolitis
Life threatening
317
Mild ulcerative colitis
<5 stools per day
No toxicity symptoms
ESR normal
Cramping pain
318
Moderate ulcerative colitis
>4 bloody stools per day
Mild anemia
Mild to moderate abd pain
Minimal signs of toxicity
319
Severe ulcerative colitis
>5 loose, bloody stools per day
Severe cramps
systemic toxicity (fever, tachy, anemia or elevated ESR)
Rapid weight loss
320
Ulcerative colitis pharm first line treatment
Aminosalicylates (mesalamine, sulfaslazine)
Oral steroids for nonlifethreatening
321
What med is used to induve remission in moderate-sever crohn's disease
CCS
322
Meds used in Crohn's disease and ulcerative colitis for remission maintencnac
Immunomodulators (azathioprine, 6-mercaptopurine, cyclosporine, methotrexate)
323
Meds used for mod-severe ulcerative colitis and Crohn's disease
ANti -TNF (infliximab, adalimumab)
Anti-integrin (vedolizumab)
Jack inhibitors (tofacitinib)
324
Meds used for ulcerative colitis pouchitis and Crohn's disease perianal disease
Ciprofloxacin
Metronidazole
325
Meds for mild-moderate Crohn's disease
Budesonide
Aminosalicylates
326
Nonpharm treatment for Crohn's disease
Low fiber diet during flares
SMoking cessation
Stress management
Physical activity
327
Nonpharm treatment for ulcerative colitis
Low residue diet during flares to reduce stool volume
328
Ulcerative colitis surgery
Proctocolectomy with ileal pouch-anal anastomosis or with ileostomy
Remove rectum and entire colon
Indicated if other stuff doesn't work or really bad
329
Diverticulosis
Large outpouching (diverticulum) in mucosa of colon
Occurs with sigmoid colon
330
DIverticulosis risk factors
Red meat, low fiber
Sedentary
Constipation
Obsesity
Smoking
331
Diverticulosis presentation
Asymptomatic
Diverticular bleed (painless rectal bleeding with bloating and cramping)
332
Diverticulosis diagnostic studies
Colonoscopy for non-acute
333
Diverticulosis treatment
Low residue diet for 6 weeks (BRAT), supportive care, increase fiber
334
Most common cause of acute lower GI bleed (hematochezia)
Diverticulosis
335
Diverticulitis
Inflammation of diverticula by obstructive matter
336
Diverticulitis presentation
Sudden abd pain usually LLQ
Altered bowel movements (colicky pain releaved with BM)
Fever
LLQ tenderness
337
Diverticulitis diagnostic studies
Blood in stool
Leukocytosis
Elevated CRP
Plain film to rule out free air
CT showing thickened bowel wall (>4mm) and diverticulum
Colonoscopy
338
How to rule out cancer in colon
Colonoscopy
339
Diverticulitis treatment outpatient
Bowel rest 73 hrs
Ciprofloxacin and metronidazole
Or augmentin
340
Diverticulitis treatment inpatient
Bowel rest
Abx if abscess <3cm
Percutaneuous drainage if abscess >3cm
Get colonoscopy
Colonoscopy 6-8 weeks after flare unless had one in last year
341
What diet to order for someone with diverticulitis
High fiber
No tobacco
Decrease red meat
342
When is surgery indicated in diverticulitis
Refractory to treatment
Increasing episodes
FIstula
Abscess
Obstruction
Intolerance
343
When to never do colonoscopy or barium enema
Current abd pain (don't want to blow anything up)
344
Diverticulitis complications and treatments for them
Abscess (drainage if >3cm)
Peritonitis (surgery)
Perforatoin (surgery)
Fistula (surgery when cooled off)
Bowel obstruction
345
Peritoneal signs
Regidity
Guarding
Bad abd pain
High fever
Tachy
Hypotensive
346
Intra-abdominal abscess
Colllection of pus/infected fluid causing inflammation
347
Intra-abdominal abscess risk factors
Infalmmatory bowel disease
Diabetes
Surgery
348
Intra-abdominal abscess presentation
Fever
Abd pain
Decreased appetite
NV
Change in bowel movements
349
Intra-abdominal abscess treatment
Abx
Percutaneous drainage
Surgical drainage
350
Chronic mesenteric ischemia presentation
Postprandial abd pain
Anorexia
Weight loss
351
Chronic mesenteric ischemia diagnostic studies
CT angiogram showing calcifications in large vessels , plaques, stenosis, SMA, not filling defects
352
Chronic mesenteric ischemia treatment
Statin
Asparin
RF mods
Revasccularization with interventional radiology
353
Acute mesenteric ischemia risk factors
Afib
ASCVD
Abd malignancy
Vlavular disease
354
Acute mesenteric ischemia presentation
Acute severe abd pain disproportionate to exam
NVD
Peritoneal signs maybe
Blood in stool
355
Acute mesenteric eschemia pathophys
Occlusion from emboli (afib)
Thrombus (ASCVD)
Hypoperfusion form shock/vasopressors
Cocaine (spasm)
356
Acute mesenteric ischemia diagnostic studies
CTA without oral contrast is GOLD
Leukocytosis and elevated lactate
Abd x-ray upright to rule out free air
357
Acute mesenteric ischemia treatment
NPO
Close monitoring
Broad abx (ceftriaxone and metronidazole
ANticoagulation if occlusive ischemia
surgery
358
Most common places for colonic ischemia
Splenic flexure and rectosigmoid junction
Referred to as watershed areas (Griffith's and Sudek's points)
359
Colonic ischemia risk factors
>60
Female
ASCVD
Hypotension
CHF
REcent surgery
Hx constipation, HTN
360
Colonic ischemia presentation
LLQ pain
Blood diarrhea
Dull post-prandial abd pain
LLQ tenderness
Absent/hypoactive bowel signs
361
Colonic ischemia diagnostic studies
CTA or MRA showing thumbprinting (segmental bowel wall thickening)
Colonoscopy showing ischemic changes to mucosa (GOLD) but not done if perforation suspected
362
Colonic volvulus
Life-threatening
Colon twists creating obstruction or vascular compromise
363
Clonic volvulus risk factors
Elderly
Bedridden
Constipation
Ovarian or pelvic masss
Preg
Dementia
Hx of previous volvulus
364
Colonic volvulus presentation
Avute colicky abd pain
Abd distention
Obstipation
NV
Very distended abd
365
Colonic volvulus diagnostic studies
Leukocytosis
Xray showing U shaped U sigmoid and coffee bean sign
CT showing dilated sigmoid colon with bird beak appearance
366
Sigmoid volvulus treatment
Decompression vis sigmoidoscopy then consider surgery
367
Cecal volvulus treatment
Straight to surgery (higher risk for perforation and ischemia)
368
Coonic volvulus with peritonitis or ischemic bowel treatmetn
IV fluids
Anadlgesia
Abx
Surgical resection if life threatening
369
Bowel obstruction risk factors
Adhesion
Hernias
Neoplasma
Strictures
Volvulus
Intusssusception
Fecal impaction
Meds (GLP-1)
370
Bowel obstruction presentation
Crampy abd pain
Distension
Vomiting (obstipation - puking poop)
high pitched bowel sounds
Fever
Tachy
Shock
Dehydration
Electrolytes abdnormal
Fecal smelling breath
371
Bowel obstruction diagnostic studies
Urpight xray showing distended colon and air-fluid levels
CT with contrast
372
Bowel obstruction treatment
NPO
NG tube
Fluids and monitor
Pain management
Surgery if imaging shows strangulated bowel
DO NOT give laxatives
373
Fistula
one tract betweeen two epithelium lined areas that aren't supposed to be connected
374
Fistula treatment
Abx
Anti-inflammatory
Surgical repair
Wound care
375
Colorectal cancer test of choice
Colonoscopy
376
What types of polyps are worst
Serrated (sessile, sawtooth appearance, larger)
Adenomatous (tubular, tubulovillous vlllous most common)
377
Colon polyps presentation
Usually asymptomatic
Bloody stools
Constipation
Abd pain
Chronic blood loss
Iron deficiency anemia
378
Colon polyp diagnostic studies
Colorectal cancer screening every 10 years if clean
Follow ups every 3-5 years after abnormal test
379
Familial adenomatous polyposis (FAP) cause
Mutation in polyposis coli gene
380
FAP pathophys
Turns into colorectal cancer by 35-40 years old if not treated
381
FAP diagnostic studies
Colonoscopy with >100 polyps
Colorectal screening at 10-12 years old
Yearly thyroid ultrasoind
382
FAP presentation
Asymptomatic until cancer
383
FAP treatment
Prophylactic colectomy by age 20
384
Peutz-Jeghers Hemartomatous polyposis syndrome
Cancer of small bowel with hyperpigmentation of lips, oral mucosa, hands
Benign polyps in large bowel
385
COwden disease hemartomatous polyposis
Screen if <5yoa and CRC for fam members
386
Lynch syndrome
Hereditary nonpolyposis colon cancer
387
Most common cause of hereditary colon cancer
Lynch syndrome
388
Lynch syndrome treatmetn
Colonoscopy every 1-2 years at 25 or 5 years younger than youngest diagnosis in family
Prophylactic hysterectomy to prevent ovacrian cancer
Gastric cancer screening
389
Rightsided CRC presenetation
BLEEDS
Weight loss
Iron deficient anemia
Palpable mass
Sessiel
390
Left sided CRC presentation
BLOCKS
Melena
Change in bowel habbits
Usually pedunculated
391
Rectal cancer presentation
Deep red blood on surface of stool
Abd pain
tenesmus
Sensation of incomplete evacuation
392
Colon cancer follow up
Physical exam with digital rectal exam and CEA every 3-6 months for 3 years
CT 6-12 months for 3 years
PET if CEA rising
393
Rectal cancer followup
Physical exam with digital exam and CRE everey 3-6 months for 3 years
CT scan every 6-12 months for 5 years
Sigmoidoscopy every 6 months for 4 years if no radiation to pelvis
394
CRC treatment
Healthy BMI
Routine activity
Healthy diet
Asparin
395
Hemorrhoid risk factors
Constipation
Low fiber
Multiparity
Vaginal birth
Straining
Prolonged sitting
396
Hemorrhoid presentation
Discomfort
itching
bleeding on toilet paper
397
Most common cause of painless rectal bleeding in adults >50
Hemorrhoids
398
Hemorrhoid diagnostic studies
DIgital rectal exam
Anoscopy if can't feel on rectal exam
399
Hemorrhoid treatment
Increase fiber
Stool softener
SItz bath
Cream
Laser ablatoin
Banding
Surgical excision
400
External hemorrhoid treatment
Nifedipine ointment
Lidocaine cream
Proctozone
Proctosol
401
Thrombosed external hemorrhoid etiology
Compromised blood flow to tissue
Commonly caused by coughing, heavy lifting, straininig
402
Thrombosed external hemorroid presentation
Acute pain
Tense and tender blueish perianal nodule
403
Thrombosed external hemorrhoid treatment
Remove clot with local lidocaine if in first 48 hrs
Skin tag may remain
Daily sitz bath
404
Anal abscess presentation
Pain
REdness/swellng
Fever, chills
Drainage/discharge
Odor
405
Anal abscess diagnostic studies
Left lateral decubitis with knee pulled to chest
CT
406
Anal abscess treatment
Drainage
Abx if needed
407
Anorectal abscess risk factors
Crohn's disease
Diabetes
Chronic corticosteroid use
408
Anorectal absess presentation
Dull achy pain in rectum
Odor
Drainage
Worssens prior to BM and gets better after
409
Anorectal abscess diagnostic studies
CT
410
Anorectal abscess treatment
Surgical drainage and abx
411
Pilonadal disease etiology
Ass hair clogs pore and causes infection
412
Pilonidal disease risk factor
Sedentary
Deep gluteal cleft
Localized trauma
INcreaesd hair
Fam hx
413
Pilonidal disease presentation
Pain
odor
Purulent drainage
Fluctuance
414
Pilonidal disease treatment
Hair removal
Radiofrequency ablation
Abx
Surgical incision
Surgical I&D if abscess and excise pilonidal sinus
415
Anal fistula presentation
Painful swelling and defecation
Tract becomes occluded causing prurulent anal discharge and pain
Localized tenderness, erythema, swelling, fluctuance
416
Anal fistula treatment
Fistulotomy
maybe abx
417
Anal fissure
Small teear in lining of anus
418
Anal fissure risk factors
Constipation
Hard stools
Anal intercourse
419
Anal fissure presentation
Pain with defecation (pooping razor blades)
420
Anal fissure diagnostic tests
Anoscopy
Sigmoidoscopy
Colonoscopy
All very painful for pt
421
Anal fissure treatmet
Stool softener
Increase fiber and water
Sitz bath
Topical nitroglycerin, lidocaine
Botox
Surgery
422
Rectal prolapse diagnostic studies
barium enema or colonoscopy to see rest of colon
423
Rectal prolapse treatment
Surgery
Pelvic floor exercises if surgery not possible
424
Most common rectal neoplasm
Adenocarcinoma
Polyploid shape
425
Rectal neoplasm presentation
Rectal bleeding
Stool changes
abd pain
Iron deficiency anemia
Often asymptomatic
426
Rectal neoplasm diagnostic studies
Colonoscopy with biopsy for staging
CT scan
CEA baseline level
427
Rectal neoplasm treatmetn
Local resection/excision
Bowel resection with chemo/radiation id ndes or distal involvement
Colonoscopy and CT scan 1 year after treatment with repeat every 3-5 years
Annual DRE and CEA
428
Anal cancer type
Non-keratinized squamous cell
429
Anal cancer risk factors
HPV
HIV
Autoimmune disease
Anal sex
Smoking
430
Anal cancer presentation
Asymptomatic
Rectal bleeding
Anal pain
Anal mass
Itching
431
Anal cancer diagnostic studies
DRE
Anoscopy
Pap smear
Anal canal ultrasound
CT
MRI
Biopsy
432
Anal cancer treatment
Chemotherapy (5-FU + mitomycin C + radiation)
Surgery possibly
433
Appendicitis cause
Most commmonly lymphoid hyperplasia
Fecalith
Foreign body
Carcinoid diverticulum
Cancer
IBD
434
Appendicitis presentation
Early on can be vague (malaise, anorexia, periumbilical abd pain, NV, fever)
Later (RLQ pain, tendernesss, guarding, malaise, NV, Flank pain, elevated WBC and or high fever suggestions perferation)
McBurney's point tenderness
pain with hip extension (psoas)
Pain with rotation f hip with knee flexed (obturator)
Rovsing sign
435
Appendicitis diagnostic studies
Compression ultrasoind on preg and children
CT of abd/pelvis (GOLD)
436
Appendicitis treatment
NPO
IV fluids
Analgesic
Abx (cef + metronidazole)
Appendectomy
437
Cholelithiasis
Gallstones
438
Cholelithiasis risk factors
Age
Females
Preg
Diabetes
Dyslipedemia
Obesity
Rapid weight loss
Fibrates
Sickle cell
439
Cholesterol stones
Gallstones
Form in individuals with genetic or environmental predisposition ot bile that is supersaturated with cholesterol
75% of all stones
440
Black pigment stones
Gallstones
Results from hemolytic states like sickle cell, cirrhosis, hemolytic anemias
441
Brown pigment stone
Gallstones
Contain cytoskeletons of bacteria associate with bacterial or parasitic infections of biliary system
442
Cholelithiasis pathphys
Excess cholesterol or bilirubin
Gallbladder doesn't empty correctly
443
Cholelithiasis presentation
Asymptomatic
Biliary colic
RUQ abd pain that waxes and wanes worse after fatty meal
Can radiate to the back
N/V
444
Cholelithiasis diagnostic imaging
RUQ ultrasound shows stone in gallbladder
445
Symptomatic cholelithiasis treatment
NSAIDs
Opioids if NSAIDs no work
Elective cholecystectomy
446
Asymptomatic cholelithiasis treatmetn
None needed
447
Ursodeoxycholic acid
Medical therapy in gallstone disease and for biliary sludge
Prevent gallstones in certain pts
448
Complications and recommendations after gallblader surgery
Diarrhea
Need to eat smaller and more frequent meals
Low fat diet
Increase fiber intake
449
Cholecystitis
Inflammation of the gallbladder
450
Cholecystitis pathophys
Cystic duct obstruction (gallstone) MOST COMMON
Bile stasis
Inflammation from prostaglandins or infection of bile
451
Cholecystitis presentation
RUQ abd pain that may radiate to shoulder or back
Can be post-prandia
Fever, nausea, vomitin, anorexia possible
452
Cholecystitis labs
Leukocytosis
Elevation of bilirubin and alkaline phosphatase
Get blood cultures and preg test
453
Cholecystitis diagnostic studies
Ultrasoind looking for gallstones, gallbladder wall thickening (double wall sign), Murphy's sign, edema, pericholecystic fluid
CT could be useful
HIDA scan + if failure to fill the gallbladder
454
Hida scan
Contrast goes straight to gallbladder
455
Cholecystitis treatment
Cholecystectomy preferred over supportive
Pain control,NPO, abx that cover gram negative
456
Nonsurgery cholecystitis treatmtn
Percutaneous cholecysostomy (drains the gallbladder)
457
Acalculous cholecystitis cause
Gallbladder stasis adn ischemia causing inflammatory response
458
What patients commonly get acalculous cholecystitis
Hospitaliized
459
Acalculous cholecystitis treatment
IV fluids
Electrolytes
Bowel rest
pain control
IV abx
Cholecystectomy
Gallbladder drainage
Percutaneous cholecystectomy
460
Chronic cholecystitis cause
Result of irritation or recurrent attacks of acute cholecystitis leading to fibrosis and thickening of gallbaldder
461
Chronic cholecystitis
Ranges from biliary colic intractable abd pain
462
Chronic cholecystitis diagnostic studies
HIDA scan with CCK showing delayed biliary transit
463
Chronic cholecystitis treatment
Cholecystectomy
464
Choledocholithiasis
Gallstones in common bile duct
465
Primary choledocolithiasis
Stoned formed in the common bile duct itself
466
Secondary choedocholithiasis
Passage from stone to gallbladder into common bile duct
467
What percent of people with symptomatic gallstones also have gallstones in common bile duct
10%
15% if have cholecystitis
468
Choledocholithiasis causes
Bile stasis
Older adults with large bile ducts
Recurrent or persistent bile duct stones and infectoins
Ischemia due to hepatic artery injury
469
Choledocholithiasis presentation
Biliary colic pain
NV
could be asymptomatic
RUQ or epigastric tenserness
Murphy's sign
jaundice
Courvoisier sign
470
Choledochoithiasis diagnostic studies
Ultrasoind
Endoscopic retrograde choleangiopancreatography can be diagnostic and therapeutic
471
Choledocholithiasis labs
Elevated bilrubin, alkaline phosphatase, ALT/AST
472
Choledocholithiasis treatment
Endoscopic retrograde choleangiopnacreatography
473
Cholangitis pathophys
Develops due to stasis and infection of biliary tract from biliary calculi, biliary strictures, malignancy, ERCP, Bacteria (E. coli)
474
Cholangitis presentation
Charcots triad (fever, abd pain, jaundice)
Reynalds pentad (fever, abd pain, jaundie, hypotension, AMS)
475
Cholangitis diagnostic studies
Ultrasound best initial
MRCP
ERCP best test and can be therapeutic
476
Cholangitis labs
Leukocytosis
Possibel increased ALT/AST, alkaline phosphatase, and bilirubin
477
Cholangitis treatment
Supportive care
Abx with gram negative coverage
ERCP FIRST LINE
478
Acute pancreatitis cause
Gallstones (MC)
Alcohol intake
Biliary sludge
Biliary crystals
Hypertriglyceridemia
ERCP
meds
479
Pancreatitis pathgenesis
Intrapanceatic diagestive enzyme activation and acinar cell injury
Activation (inflammatory rxn)
Cell injury and death
480
meds that can cause acute pancreatitis
Valproic acid
Opiates
Estrogen preparations
Bactrim
Tetracycline
Corticosteroids
Furosemide
DPP-4 inhibitors
Isoniazid
Metronidazole
Tamoxifen
Thiazides
Simvastatin
Methyldopa
481
Acute pancreatitis presentation
Steady epigastric abd pain
Nausea
Vomiting
Dyspnea
Epigastric tenderness to palpation
JMabe distentino, hypoactive bowel sounds, jaundice
Severe has fever, tachycardia, hypoxemia, hypotension
482
Hemorrhagic pancreatitis signs
Cullen sign (around umbilicus)
Grey turner sign (on flank)
483
Acute pancreatitis labs
Serum lipase and amylase elevation >3x upper limit of normal
Hypertriglyceridemia
Leukocytosis
Proteinuria
Granular casts
Hyperglycemia
Elevated serum bilirubin
Elevated UN
Elevated alkaline phosphatase
484
Acute pacreatitis diagnostic imaging
CT with contrast showing edema, enlargement, and necrosis
485
Acute pancreatitis Diagnostic critearia
2/3:
1. Acute onst of severe epigastric pain
2. Elevation of lipase or amylase 3x upper limit of normal
3. Characteristic findings on CT
486
Acute pancreatitis treatment
Most subside on their own
NPO
IV fluids
IV analgesics (meperidine or morphine)
Start back with low fat, soft diet
487
Acute pancreatitis complications
Peripancreatic fluid collection
Plncreatic pseudocysts
Necrosis
Abd compartment syndrome
Organ failure
Pancreatic cancer
488
Chronic pancreatitis pathogenesis
Stellate cell activation leads to cytokine expression and productoin of extracellular matrix proteins that contribute to acute and chronic inflammation and collage deposition in pancreas
489
Chronic pancreatitis causes
Alcohol
Genetics
Tobacco
hyperparathyroidism
Cystic fibrosis most frequent cause in children
490
Chronic pancreatitis presentation
Epigastric and LUQ pain
Can be severe and intermittent
Pain may not correlate with imaging
NV
Anorexia
Steatorrhea
Chronic diarrhea
Weight loss (bc eating is painful)
491
Chronic pancreatitis labs
Amylase/lipase normal low or mildly elevated
Fat soluble vitamins (ADEK) deficiency
492
Chronic pancreatitis diagnostic imaging
Xray shows pancreatic calcifications
Ultrasound shows increase in echogenicity
Abd CT/MRI/MRCP BEST looking for atrophy, ductal dilation, parenchymal , intraductal calcifications
493
Chronic pancreatitis treatmetn
AVOID opioids
Acetaminophin or NSAIDs for pain
Pancreatic enzyme replacement if steatorrhea
Endoscopic treatmetn
494
Chronic pancreatitis complications
Vitamin D deficiency
Diabetes
Opioid dependency
Pseudocyst formations
495
Exocrine pancreatic insufficiency presentation
Steatorrhea
Diarrhea
Bloating
Increased flatulence
Hypocalcemia
Vitamin B12 deficiency
Weight loss
496
Exocrine pancreatic insufficiency diagnostic studies
Random fecal elastase 1
497
Pancreatic pseudocyst
Collection of leaked pancreatic fluids next to pancreas
Encapsulated with little to no necrosis
498
pancreatic pseudocyst pathophys
Forms with pancreatic cells become inflamed or injured and pancreatic enzymes start to leak
More common in chronic pancreatitis
499
Pancreati pseudocyst risk factors
Acute/chronic pancreatitis
Gallstones
Alcohol abuse
500
Pnacreatic psudocyst presentation
Maybe asymptomatic
Abd pain
Ascites
NV
Weight loss
Early satiety
Jaundice
501
Pancreatic pseudocysts diagnostic studies
Not seen until 4 weeks after onset.
CT, ultrasound, or MRI shows well circumscribed fluid collection
Endoscopic ultrasound with needle aspiration
502
Pancreatic pseudocyst treatment
Observation an dsupportive cae
PPI
Endoscopic drainage if over 6cm
503
Pancreatic cancer risk factors
SMOKING
Alcohol
Chronic pancreatitis
Diet
Diabetes
Obesity
504
Pancreatic cancer presentation
Asymptomatic
Most common: painless jaundice, abd pain, weight loss
Asthenia
Pruritis
NV Diarrhea
Steatorrhea
RUQ mass
Cuorvoiser's sign
Cachexia
Hepatomegaly
Migratory superficia thrombophlebitis
505
Pancreatic cancer diagnostic imaging
Abd CT with contrast best first test
506
Pancreatic cancer diagnostic criteria
Abd pain, weight loss, jaundice, new-onset diabetes
CT/MRI sees extent
Serum markers
507
What is commonly elevated in pancreatic cancer
Carbohydrate antigen
508
Pancreatic cancer treatment
Refer to oncology
Surgical resection with pancreatectomy or pancreaticoduodenectomy (WHIPPLE)
Chemo
Surgery + Chemo
509
Hepatocytes
80% of liver mass
Produce bile
Synthesize proteins
Metabolize COOHs, lipids, drugs
Detoxify substances
Vitamin, mineral, glycogen storage
510
Sinusoids
Specialized capillaries of liver
Have Kupffer cells (macrophages)
Filter blood, do stuff in immune system
Ito cells store vitamin A
511
Liver jobs
Detoxification of drugs, alcohol, ammonia
Bile synthesis
Bilirubin metabolism (unconjugated/indirect into conjugated/direct)
512
Albumin
Most abundant plasma protein
Maintains oncotic pressure
Transports substances in blood
513
Proteins made by liver
Albumin
Clotting factors
Transport proteins
Acute phase proteins
Complement
Binding proteins
Enzymes
514
Most common symptom related to liver dysfunction
Afternoon fatigue
515
GI symptoms related to liver dysfunction
Nausea provoked by smelling food or eating fatty acids
Poor apetite and weight loss
RUQ pain and tenderness
Steatorrhea in severe jaundice
Pale stools
516
When is jaundice detectable
Bili > 2.5
517
Ascites
Accumulation of fluid in peritoneal cavity
Common in in chronic liver disease and cirrhosis bc of fibrosis, splanchnic vasodilation triggering RAS and ADH, hypoalbuminemia, and lymphatic obstruction
518
Liver dysfunction skin findings
Spider telangiectasisas
Xanthomas around eyes
519
Types of liver disease
Hepatocellular
Cholestatic
Mixed
520
Alanine aminotransferase (ALT)
Primarily in hepatocytes
Released into bloodstream in hepatocyte injury
521
Aspartate aminotrasferase (AST)
In hepatocytes and other tissues
Released into bloodstream in hepatic injury and heart/muscle injury
522
Alkaline phosphatase (ALP)
Increased concentration in bile ducts, liver, bones, and placenta
INcreased level show bile duct damage (cholestasis), liver damage, or bone damage
523
How can you tell if ALP elevation is from liver damage
If ALP and GGT both elevated, its probably from liver
524
Cholestasis
Reduction or stop of bile flow
525
What causes bilirubin to be increased
Unable to excrete from liver
526
What tests test liver function
Albumin
Bilirubin
PT/INR
527
Liver dysfunction first line imaging
Ultrasound
528
Best imaging to identify liver lesions
MRI
529
Best imaging to see liver cancer
CT
530
Gold standard test to diagnose liver disease
Liver biopsy (transjugular approach for those with coagulopathy)
531
Liver enzymes for different types of liver disease
Hepatocellular: ALT and AST elevated, ALP norm
Cholestatic: ALT/AST elevated or normal, ALP and GGT elevated
Mixed: ALT/AST and ALP elevated
532
Liver disease cardiovascular symptoms
Widened pulse pressure
533
Liver disease lung findings
Hydrothorax
Hepatopulmonary syndrome (hypoxemia due to shunting
534
Liver disease eye symptoms
Icterus
Kayser-Fleischer rings
535
Normal bilirubin
0.1-1.0
536
What is bilirubin
Breakdown product of heme
537
What type of bilirubin is water soluble and excreted by kidney
Conjugated (direct)
538
Gilbert's syndrome
Isolated and mild elevation of unconjugated bilirubin
Negative DAT and Coomb's test
Normal liver enzymes
539
Crigler-Najjar syndrome
Sybstantially elevated unconjugated bilirubin
Normal liver enxyymes
Negatie hemolysis
Associated with kernicterus and encephalopathy
540
Hepatitis A transmission
Fecal-oral
Contaminated food or water
No chronic carrier
541
Hepatitis A presentation
Mild to asymptomatic usually
Fever, fatigue, nausea, jaundice
542
Hepatitis A lab diagnostics
AST/ALT and bilirubin elevated
Anti HAV IgM in accute infection
Anti HAV IgG is chronic
543
Hepatitis A treatment
Support, rest, fluids
Avoid alcohol and hepatotoxic meds (acetominophen)
544
Hepatitis B transmisssion
Blood
Sex
Mother to child
545
Hepatitis B presentation
Fever, nausea, vomiting, malaise
Jaudice (icteric phase)
546
Hepatitis B treatment
Acute: supportive
Chronic: nucleoside/ncleotide analogs (tenofovir, entecavir)
547
First evidence of Hepatitis B infection
Surface antigen
548
Hepatitis B marker of immunity
Surface antibody
549
Hepatitis B Prevention
Vaccine given at birth
550
Hepatitis C transmission
Blood (usually IV drug use)
551
Hepatitis C presentation
Most asymptomatic
Malaise, anorexia, myalgia, jaundice, clay stools, dark urine
Elevation of ALT and maybe AST
552
hepatitis C initial diagnostic tests
Anti-HCV antibodies initial
HCV RNA PCR confirms
RNA genotyping guides treatment
553
Hepatitis C treatment
DIrect acting antivirals
Ledipasvir and sofosbuvir (6 weeks)
95% cured
554
Hepatitis C prevention
No vaccine
Needle exchange programs
555
What percent Hep C becomes chronic
85%
556
Hepatitis D transmission
Blood/body fluid
557
What do you have to have before acquiring hepatitis D
Hepatitis B
558
Hepatitis D diagnostic studies
Anti-HDV
HDVV RNA to confirm
559
Hepatitis D treatment
Supportie if asymptomatic
Pegylated interferon alpha if symptomatic or increased ALT
560
Hepatitis D prevention
Hep B vaccine
561
Hepatitis E transmission
Fecal-oral
562
Hepatitis E presentation
Mostly asymptomatic
563
Hepatitis E diagnostic tests
Anti-HEV IgM
564
Hepatitis E prevention
Improve sanitation and water quality
565
Hepatitis E treatment
Supportive
Pregnancy needs transplant
566
Autoimmune hepatitis etiology
HLA-DR3, HLA-DR4 genes
Infections, meds, hormones (more common in females)
Low coffee consumption
567
Autoimmune hepatits extrahepatic features
Arthritis
Sjogren syndrome
Thyroiditis
Nephritis
Ulcerative colitis
AIHIA
Striae
Acne
Hirsutism
568
Autoimmune hepatitis lab findings
ALT and AST high
Bilirubin high
Low albumin maybe (poorer prognosis)
569
Autoimmune hepatitis diagnostic testing
Increased IgG
+ANA
+SMA
+SLA
570
Autoimmune hepatitis treatment
Prednisone + azathioprine only for those with symptoms.
571
Alcohol associated hepatitis labs
AST/ALT elevated (on both sides but more AST, ratio >2.0)
Bilirubin elevated
ALP elevated
Albumin low
Macrocytic anemia
572
Alcohol associated hepatitis presentation
Might have stopped drinking months ago
Jaundice, fever, nausea, anorexia, edema, RUQ pain
Ascites, variceal bleeding, and hepatic encephalopathy in severe
573
Alcohol associated hepatitis imaging
Ultrasound of RUQ looking for gallbladder disease adn portal system issues
574
Alcohol associated hepatitis treatment
Stop drinking
Prednisone
Pentoxifylline if can't do prednisone
575
Alcohol associated liver disease pathogenesis
Excessive consumption--> Steatosis--> hepatocellular injury and death--> inflammation and immune response--> stellate cell activation
576
What amount of alcohol puts people at risk for alcohol associated liver disease
Men: 4 drinks/day or 14/week
Women: 3 drinks/day 7/week
577
How much alcohol in standard drink
14g
578
Alcohol assocaited liver disease presentation
Steatosis (fatty liver) most common
Nusea, fatigue, anorexia, RUQ pain
Portal HTN leading to splenomegaly, ascites, varices, caput meduse, variceal bleed
579
Alcohol associated liver disease physical exam
Palmar erythema
Spider nevi
Dupuytren contracture
Atrophic glossitis
580
Alcohol associated liver disease lab findings
Elevated AST, ALT, and GGT
581
Alcohol associated liver disease diagnostic studies
Initial: Ultrasound showing steatosis (fatty liver), nodular liver, portosystemic collaterals, masses
CT if need further evaluation
MRI if need further
Elastography for fibrosis extent
Biopsy last result
582
Alcohol assoicated liver disease treatment
Better lifestyle
Disulfiram, naltrexone,, baclofen
Liver transplant
583
Drug and toxin induced liver injury presentation
Like other liver disease
Jaunidce
Hx shows use of hepatotoxic drugs or hepatotoxin exposure
584
Drug and toxin induced liver injury treatment
Remove offending agents
NO STEROIDS
Liver transport from mushroom antitoxin
585
Acetominophen max dose
4g/day
586
Acetaminophen toxicity clinicla findings
Shorly after ingestion
N/V but no other signs of toxicity until 24-48 hrs after
Aminotransferases increase
Fulminant hepatic necrosis with jaundice and hepatic encephalopathy in severe
587
Acetaminophen overdose treatmetnt
Activated charcoal within 1-2 hrs of indigestion
N-acetylcysteine is antidote
588
MASLD
Fatty accumulation of liver (steatosis) from metabolic dysfunction
589
MASLD pathogenesis
Insulin resistance-->
Increase lipolysis in adipoase tisssue-->
Free fatty acids-->
Increased fat accumulation in the liver
590
MASH
Steohepatitis
Inflammation caused by fatty accumulation of liver (MASLD)
591
MASLD presentation
usually asymptomatic
Fatigeu
RUQ pain
Malaise
hepatomegaly
jaundice, ascites, edema, splenomegaly, encephalopathy in MASH or cirrhosis
592
MASH pathophys
Fatty liver from MASLD-->
oxidation of fat in liver-->
Reactive O2-->
Liver injury-->
Inflammation-->
Cirrhosis
593
MASLD labs
LFTs elevated
Lipids elevated
Get fasting glucose
594
MASLD imaging
Ultrasound first line for hepatic steatosis
Fibroscan measurese liver stiffness
CT/MRI can provide more info
Liver biopsy only if needing confirmation or to rule out something
595
MASLD treatment
Lifestyle mods
Calorie and fructose restriction (mediterranean)
Exercise (aerobic)
Metformin, Vitamin E, GLP-1, Statin
Bariatric surgery when BMI > 35 and fail other attempts at weight loss
Liver transplant
596
CHronic hepatitis pathophys
Chronic inflammation causes liver to become fibrotic, nodular, and smaller in size
597
When does it become chronic Hepatitis B
6 months
598
Chronic HBV phases
Immune tolerant
Immune active
Inactive HBsAg carrier state
Reactivation
HBsAg negative phase
599
Hepatitis B immune tolerant phase
Little liver damage and normal liver enzyme levels
Positive antigens and HBV DNA (indicating viral replication)
No antiviral needed
600
Hepatitis B immune active phase
Increased risk of liver damage
Positive antigens and HBV DNA
Could progress to cirrhosis
Give antivirals
601
Hepatitis B inactive carrier state
Low viral replication
HBeAg neg
HBsAg pos
HBV DNA low
Anti-HBV pos
No antiviral needed
602
Hepatitis B reactivation phase
INcreased viral replication and liver inflammation
elevated liver enzymes and increased risk of liver damage
HBsAg pos
HBV DNA increasing
HBeAg neg
AntiHBe pos
603
HBsAg negative phase
HBC DNA undetectable but virus still in liver
Anti HBe maybe still positive
Serum transaminases normal
"functional cure"
604
Chronic HBV + HDV
Results in severe hepatitis
Can progress to cirrhosis
Anti-HDV IgG and HDV RNA positive along with HBV findings
605
Chronic HBV treatment
Antivirals (entecavir, tenofovir) or pegylated interferon-alfa with positive HBeAg and HBV DNA
606
Chronic Hep C diagnosis
HCV RNA positive 6 months after initial infection
607
Chronic Hep C diagnostic studies
AFTs
Elastogrophy to see liver stiffness
608
Chronic hep c treatment
Antivirals (pevirs, asvirs, buvirs) but expensive
Peginterferon + ribavirin (worried about side affects)
609
Parenchymal injury definition and causes
Direct injury to hepatocytes
usually drug induced
Could be viral or antibody mediated
Acute on chronic from alcohol, meds, or infection
610
Vascular related injury to liver
Ischemia
Vein clot
Vein congestion (RHF)
611
Acute liver failure presentation
RUQ pain
Icterus ICterus
Jaundice
GI sx
Encephalopathy
Very high AST/ALT/Bilirubin
Increased ICP
611
Hepatic encephalopathy treatment
Lactulose to pass amonia (causes diarrhea)
611
Hepatic encephalopathy presentation
AMS
COndusion
Comatose
Asterixis (flapping tremor)
612
Underlying causes of chronic liver disease
Chronic viral hepatitis
Alcohol associated liver disease
MASLD
Autoimmune hepatitis
INherited disorder (Wilson, hemochromatosis)
Chronic biliary disease
612
Hepatic encephaloppathy complications
Coagulopathy (prolonged PT/INR)
Hypoglycemia
Infection
613
Chronic liver failure symptoms
Jaundice
Ascites
Peripheral edema
Hepatic encephalopathy
Coagulopathy
Esophageal varices
Muscle wasting
Fatigue
Weakness
Malaise
614
Chronic liver failure complications
Portal HTN
Hepatorenal syndrome
HCC
Infections
614
Chronic liver failure treatment
Manage complications
Stop alcohol
Manage viral disorders
Liver transplant
615
Cirrhosis clinical findings
Asymptomatic
Fatigue, disturbed sleeep, muscle cramps, weight loss
Advanced: anorexia, nausea, abd pain, menstrual irregularities, ED, gynecomastia, falls, hematemesis
615
Cirrhosis
Chronic injury to liver
615
Cirrhosis causes
Alcohol
Metabolic dysfunction-associated liver disease
Chronic viral hepatitis
Drug toxicity
Autoimmune
Metabollic
Wilson's disease
Alpha-1-antitrypsin deficiency
615
Cirrhosis pathogenesis
Hepatocyte injury causing fibrosis and nodular regeneration
616
Cirrhosis complications
Portal HTN
Coagulopathy
Gastroesophageal vafrices
Ascites
Spleomegaly
Thrombocytopenia
Fibrinolysis
Factor deficiency
Acute kidney injury (hepatorenal syndrome
Hepatic encephalopaty
Malnutrition
617
Liver cirrhosis treatment
Lasix and spironolactone for ascites
3rd gen cephalosporin for apontaneous bacterial peritonitis
Banding and ligation for varices
Lactulose for encephalopathy
Paracentesis or octreotide midodrine with hepatorenal syndrome (give albumin for large paracentesis)
Hepatocellular carcinoma monitoring with ultrasound and AFT every 6 months
617
Chronic liver failure diagnostic testing
Liver biopsy GOLD STANDARD
CBC, CMP, PT/INR fibrosure test, serum markers less invasive alternative
Also could usse ultrasound or MR elastography
617
Hepatocellular carcimoma symptoms
Abd pain
weight loss
Anorexia
Nausea
Vomiting
Jaundice
Ascites
Edema
617
Most common type of primary liver cancer
Hepatocellular carcinoma (HCC)
618
Hepatocellular carcinoma
Most common primary liver cancer
Originates from hepatocytes
618
Hepatocellular carcinoma diagnostic tests
US showing nodularity and lesions
CT or MRI showing arterial enhancing lesionz with venous washout
Biopsy
Elevated AFP
619
Hepatocellular carcinoma treatment
Surgical resection if possible
Liver transplant if possible
Ablation, TACE (transarterial chemoembolization)
Treat liver dysfunction
Pain and nutrition management
VTE monitoring
619
Where is foregut pain referred
Epigastric
619
Where is midgut pain referred
Periumbilical
619
Where is hindgut pain referred
Suprapubic
619
When do you not use contrast for abdominal CT
Nephrolithiasis (Kidney Stones)
619
When to give PO contrast for abdominal CT
Suspected abscess or intestinal obstruction
619
Appendicitis presentation
Periumbilical pain migrating to RLQ
Locallized RLQ peritonitis in uncomplicated
Diffuse peritonitis in perforated
Fever
Elevated WBC shows possible rupture
619
Appendecitis treatment
Surgery or abx and observation for uncomplicated
Surgery and abx for perforateed
619
Where does gallbadder pain refer to
Right periscapular
619
Hemochromatosis pathophys
INcreaseed accumulation of iron as hemosiderin in liver, pancreas, heart, adrenals, testes, pituitary, kidney
Variant of HFE gene on chromosome 6
620
Hemochromatosis clinical findings
Fatigue
Arthralgia
Calcium pyrophosphate des
Bronze or dark grey colored skin
621
Hemochromatosis complications
Hepatomegaly
Hepatic dysfunction
Cardiomegaly
Heart failure
Diabetes mellitus
Hypogonadism
Infections
622
Hemochromatosis lab findings
Elevated serum iron
Elevated ferritin
Low iron binding capacity
HFE gene testing
623
Hemochromatosis diagnostic testing
MRI elastography alternative to biopsy to diagnose fibrosis
Liver biopsy shows extra iron as hemosiderin
Skin biopsyy shows increaseed melanin and hemosiderin
624
Hemochromatosis treatment
Avoid iron rich foods
Evaluate first degree relatives
Refer to GI and hematology
PPI decreases iron absorption
IV deferoxamine as iron chelating agent
625
Wilson disease pathophys
Excessive deposition f copper in liver and brain from increased absorption oin small intestine and decreased excretion by liver
Autosomal recessive
626
Wilson disease presentation
Psychiatric issues
Hepatitis
Portal htn
Splenomegaly
Hypersplenism
Kayser-Fleisher rings of corna
Renal calculi
Hemolytic anemia
Infertility
627
Kayser-Fleisher rings
Rings on cornea
Sign of deposition of copper in liver
628
Wilson disease treatment
Refer to Heme
Restrict dietary copper
Eat zinc with meals to block copper absorption
Copper chelation with D-penicillamine or trientine with meals
Vitamin B6
Liver transplant
629
What foods have lots of copper
Nuts
Mushrooms
Green leafy vegetables
Seafood
Dark chocolate
630
Copper deficiency causes
Zinc supplementation or malabsorption
Menkes syndrome (X-linked)
631
COpper defiicency treatment
IV and oral copper supplements
632
Lactose intolerance diagnostic testing
History
Hydrogen breath test
633
Lactose intolerance treatmetn
Avid lactose
Lactaid
634
Celiac disease pathophys
IgG mediated
HLA-DQ6 or HLA-DQ8 gene
Permanent
635
Celiac presentation
Chronic diarrhea
Flatulance
bloating
Weight loss
Dyspepsia
Fatigue
Iron deficiency
Bone loss
Dermatitis herpetiformis
636
Celiac disease diagnosis
Small bowel biopsy (GOLD STANDARD) showing increased intraepithelial lymphocytosis and villous blunting
Serologic testing shows anti-tissue transglutaminase IgA and anti-deamidated giadin peptide IgG and IgA and anti-endomysial
637
Celiac disease treatment
Gluten free diet (NOT UNTIL AFTER TESTING)
Refer to dietitino
Lifelong reatment
638
Kwashiorkor
Defficieny in protein with adequate energy (calories)
639
Kwashiorkor presentation
Skinny with protuberant abdomen
Dependent edema
Ascites
Anasarca
640
Marasmus
Not enough protein or energy (calories)
Associaed with COPD, HF, cancer
641
Marasmus presentation
Not much fat or muscle
642
Cachexia
Loss of lean body masss irrespective of adipose tissue changes
Associated with inflammation and protein catabolism
Cancer is common cause
643
Refeeding syndrome
Everything turns back on too fast causing diarrhea, malabsorption, dependent edema, HF
