GASTROENTEROLOGY

GASTROENTEROLOGY

1. Vitamin A Night blindness, conjunctival dryness, corneal keratinization

2. Vitamin D Ricketts - kids, long bone bowing; Osteomalacia-adults, demineralization

3. Vitamin K Clotting deficiency with prolonged PT

4. Thiamine (B1) Beriberi - peripheral neuropathy, Cardiomyopathy - dry or wet (high output failure)
5. Wernicke-Korsakoff - Alcoholics, confabulation, nystagmus, confusion

6. Niacin Pellagra - Diarrhea, dermatitis, dementia, death

7. Pyroxidone (B6) Rare, neuropathy, Cheilosis (swollen cracked bright red lips)

8. Cobalamin (B12) Macrocytosis, Pernicious Anemia- megaloblastic, neuro chg. ataxia, Schilling test , more in Strict Vegitarian.

9. Folate Macrocytosis, megaloblastic anemia w/o neuro chgs., common in alcoholics

10. Vitamin C Scurvy, bleeding gums, Connective Tissue problems, Can manifest 1 yr post defic.

11. Failure to Thrive Org.= decr. wt gain w/ other disease; Nonorg.=growth failure due to neglect ßstimulation
12. < 80% wt for Ht

13. Obesity mild 20-40%, moderate 41-100, severe <101%; age, black women, low income
14. BMI= body wt (kg)/Ht (mm2) Normal 20-25
15. Pickwickian Syndrome = obesity, dyspnea, hypovent, CO2 retention, hypoxia

16. Boerhaave's Syndrome esophageal rupture due to forceful vomit; Gastromediastinal fistula, dyspnea w/o hemetemesis, + Hammonds sign = pneumomediastinum, L lung effusion

17. Dysphagia Obstructive - solids 1st; Motor -solids = liquids

18. Infectious Esophagitis Candida (thrush), HSV, CMV, immunocomp, diabetics, Dysphagia & odynophagia

19. Esophageal Atresia Proximal esophagus, blind pouch

20. Trachesoph Fistula Congenital defect, distal esoph, coughing & cyanosis when feeding, abd distention

21. Achalasia Dysphagia for solids & liquids, nocturnal cough, aspiration; Absent peristalsis & tight LES, "Beak" esoph on x-ray, 20-40 yrs old

22. Esophageal Cancer squamous 90% Dysphagia solids 1st, Cough & hoarse = laryngeal nerve, constricting bands = annular lesion, Risk factors= smoking, alcohol, GERD, Barretts Esoph = adeno CA

23. Gastritis Antral Creep=fundal tissue replaced by antral mucosa, Not preCA,
24. Risk Factors = NSAIDS, Alcohol, H.Pylori

25. PUD Gastric = NSAIDS, eating no help, COPD,blood type A; 25%
26. Duodenal = H.Pylori, better w/ food, Liver cirrhosis, Blood type O ; 75%

27. Cullen's Sign Periumbilical cyanosis d/t hemoperitoneum = hemorrhagic pancreatitis, ruptured ectopic, ruptured spleen

28. Zollinger-Ellison Synd. Gastrinoma ( incr. gastrin); recurrent ulcers, ½ are malignant

29. Gastric CA Adeno, H.Pylori gastritis, Virchow's Nodes, Types = ulcerating (shallow edges); polyploid (intraluminal late mets); superficial (early CA) ; Linitus Plastica (all layers decr. elasticity) Mets to ovary = Krukenberg Tumor

30. Diarrhea Osmotic = incr. H2O lumen incr. solutes in bowel; Secretory = electrolytes & H2O secreted not absorbed; Malabsorption; Exudative secretion of blood plasma & mucus (mucosal inflammation); decr. transit time (short bowel); incr. transit (bact. Proliferation)

31. Ischemic Colitis Vascular compromise (atherosclerotic or embolic); abrupt abd pain after eating, bloody diarrhea, systemic sx.; Barium X-Ray - Thumbprint = pseudo tumor

32. Irritable Bowel Synd. Dx of exclusion (psych?); Tx: bulk supp, anticholinergics, antidiarrheals, TCA

33. Colonic Polyps villous>tubular ; sessile>pedunculated for being CA; familial adeno polyps autodom.

34. Lactose Intolerance Lactase deficiency, bloating & explosive diarrhea after milk; Ages 10-20

35. Celiac Sprue Gluten sensitivity (wheat, rye, barley); amenorrhea 1st sx girls, Infants = FTT, abnormal stool, bloating, Adults = malabsorption, vit deficiency; X-ray - dilated loops of bowel with thin mucosal folds; most common cause of malbsorption

36. Tropical Sprue nutritional defic, small bowel mucosal abnormal; Acquired - Caribbean, India, SE Asia; Megaloblastic Anemia, glossitis, diarrhea, wt loss Tx Folic Acid & Tetracycline

37. Whipple's Disease Infectious; middle aged men; multi-organ; Thickened mucosal folds, Foamy macrophage with rod shaped bacilli that stain w/periodic acid (Schiff's Reagent)

38. Intestinal Lymphangiectasia Children & young adults; cong or acquired telangiectasia of intramucosal lymphatic
39. Massive extremity edema w/ diarrhea, N/V; Tx: low fat w/ triglyceride supplement

40. Toxic Megacolon Dilation > 6cm, Adults preceded by IBD (UC or Crohn's) Kids preceded by Hirschsprungs Ds; Sx: severely ill, incr. temp, abd pain, rebound, leukocytosis; X-ray - intraluminal gas along continuous seg of dilated bowel; Tx: NPO, IV fluids & electrolytes, Antibiotics & Steroids, Rectal tube may alleviate but can cause perforation

41. Inguinal Hernia Indirect = infants, persistent processus vaginalis, protrudes thru ring, lateral Inf Epig.
42. Direct = Adults, medial to ing ring & inf epig artery, Weakness in Hesselbach's

43. Ulcerative Colitis Colon & Terminal Ileum w/o skip lesions, w/ rectal bleeding, "lead Pipe" on X-ray (shortened, narrowed, loses haustrations) Tx: Sulfasalazine, steroids, Immunosuppresents; Complications=perf, hemorrhage, Toxic Megacolon, Colon CA

44. Diverticular Disease Diverticulosis = false diverticulae, pearl sign on xray
45. Diverticulitis = infection, acute abd pain usually on left, may form fistulas to bladder, vagina or skin, CT w/ water soluble contrast during acute attack

46. Crohn's Disease Granulomatous colitis; No bloody stools, 1st in terminal ileum, transmural, skip lesions, cobblestoning: Complications=small bowel abscess, obstruction, perianal disease, malabsorption, toxic megacolo, Colon CA. Surgery is not curative

47. Colon CA Right Sided=napkin ring, anemia Left Sided=Apple core, pencil stools; Genetic; Annual rectal>40, Annual Guaiac >50; Flex Sig q3-5y >50; Rectal CA-hematochezia

48. Volvulus Rotation of Bowel; Newborns & elderly; Double Bubble; Birds Beak on Barium Enema, Tx: Left Sided = decompression; Rt sided & kids = surgery

49. Intussusception Telescoping of large bowel into an adjacent section; most common cause of obstruction in kids under 2; Episodic Abd pain 1-2 min. Reflex = early vomit; Obstructive = omit late; Currant Jelly Stool; Small Infants = Pallor, sweating, and vomiting. Leukocytosis with hemoconcentration, BE to reduce x 2 before surgery

50. Necrotizing Enterocolitis Premature, decr. birth weight, older infants with malnutrition; bilious vomit, abd distention, bloody stool, lethargy; Thrombocytopenia; Small Bowel Distention; pneumatosis (air in bowel wall) TX; NG, TPN, IV antibiotics, surgical Rx necrotic part

51. Cholera Fecal - Oral, Rice Water Stools, Vibro Cholera; Endemic gulfcoast, Asia, Africa, Mid East; Severe dehydration, Metabolic Acidosis, Tx: Tetracycline or Doxycycline

52. Shigella Dysentery Small bact dose needed, Blood & mucous, Kids worse than adults, Fluid Replacement & Ciprofloxacin

53. Staph Enteritis Onset 3-6 hrs; "Church Picnic epidemic; N/V/D, HA, fever recovery w/in 24 hrs

54. Salmonella Enteritis Undercooked Poultry; nausea & cramps => watery &/or bloody diarrhea; No antibiotics prolongs excretion of the organism

55. Viral Enteritis Norwalk = yr round, Rota (kids) = winter; Coxsackie A1; echo, adeno

56. Botulism Clostridium Botulinum, neuromuscular; onset 12-36 hrs; N/V/D, cranial nerve palsy, fixed dilated pupils, resp failure, no fever, Wound induced = neuro w/o gi sx
57. Infants constipation 1st=> cranial nerve sx => cranial nerve Sx => Neuromuscular

58. Hemorrhagic Colitis E coli 157, cramps, => watery diarrhea => bloody diarrhea Complications= Hemolytic-Uremic Syndrome, thrombotic thrombocytopenic pupura

59. Pseudomembraneous Colitis Antibiotic induced (clindamycin, ampicillin, cephalosporin) C. Diff; mail -> severe bloody diarrhea; Tx: stop antibiotics, oral metronidazole in severe cases

60. Acute Pancreatitis Pain radiates to back w/ N/V; Grey Turner's Sign (blue flank) Cullen's Sign (blue at umbilicus; Amylase & Lipase incr. ;
61. Ranson's Criteria: 3 or more = incr mortality
62. Admission: >55, gluc>200, LDH >350, AST >250 WBC > 16000
63. Within 48 hrs: Hct decr. 10%, BUN incr. >5, Ca<> 4, Fluid Seq>6L

64. Chronic Pancreatitis ERCP to Dx; Alcoholics, Malabsorption & diabetes are results

65. Hepatitis Hep A = Fecal oral, shedding before Sx; IG to travelers & contact with HAV infected
66. Heb B= Blood & STD; HbsAg early if persists = carrier; HbcIGM then HbcIgG for life
67. HBIG for needle sticks and infants born to + moms; assoc w/ hepatocell CA
68. Hep C Most common post transfusion hepatitis
69. Hep D = Co infection with B; Hep E = fecal oral

70. Cholelithiasis Female, fertile, fat, forty; Ultrasound, RUQ pain after fatty meals, Calcified = preCA

71. Cholangitis Charcot's Triad = Biliary Colic, Jaundice, Fever; Leukocytosis, incr. Alk Phos

72. Hepatocellular CA Mets 2x more than primary CA (breast, lung, colon), Budd Chari-thrombosis hep V.
73. Risk Factors = HBV, HCV, Alcoholic cirrhosis, Aflatoxins (fungal metabolites)

74. Benign Hep Adenomas oral contraceptives

75. Exocrine Pancreatic CA Ductal CA, Courvoiser's Law=palpable nontender GB in a jaundiced patient is a head of Pancreas tumor. Tumor Body or Tail=splenic vein obstruction=> splenomegaly, gastritis, esoph varices

76. Insulinoma Insulin hypersecretion, hypoglycemic symptoms, Insulin levels still incr. after fasting
77. Whipple Triad: confirms hypoglycemia as source of Sx 1. Hypoglycemia, 2. Relieved with carb ingestion 3. Sx occur while fasting

78. VIPoma Makes Vasoactive peptide (VIP); Sx WDHA (watery diarrhea, hypokalemia, achlohydria; unexplained secretory diarrhea; laparoscopy for Dx

79. Glucagonoma tumor of alpha islet cells; 80% women; 80% malignant; Necrolytic Exfoliating Erythema characteristic exfoliating lesion of the extremities

80. Pompe's Disease a 1,4 glucosidase deficiency; fatal by age 2

81. VonGierke's Disease glucose-6-phosphatase def.; big liver & kidneys, growth retardation, electrolyte prob.

82. McArdles Disease musclephosphorylase is absent, muscle cramps & incr. myoglobin after exercise

83. Jaundice Prehepatic = hemolysis, gilbert's disease, Crigler Najjar; Hepatic = hepatocellular or cholestatic; Post Hepatic = Biliary obstruction, AST & LDH also incr. ;
84. incr. unconj prehepatic; incr. conj = intrahepatic cholestasis or post hepatic disease ; incr. all fractions = hepatocellular, hyperbilirubinuria = conj bili water soluble

85. ETOH Hepatic Disease Fatty liver => ETOH hepatitis => cirrhosis; AST incr. > ALT incr. ; incr. PT; decr. II, VII, IX, X Clot

86. Cirrhosis necrosis and fibrosis, decr. serum albumin, anemia incr. PT, Not curable or reversible

87. Esophageal Varices veins that expand to circumvent congested hepatic flow; Tx: vasopressin, balloon tamponade, endoscopic sclerotherapy, transjugular hepatoporto shunt (TIPS

88. Hepatic Encephalopathy altered consciousness, incr. ammonia incr. glutamine in CSF, EEG abnormal

89. Ascites Complication of hepatic disease; Paracentesis to examine ascitic fluid values should equal serum if incr. albumin = malignant; incr. LDH > 60% of serum = malig or infective;
90. incr. WBC = infection

91. GI Bleeding Upper GI = melaena (black tarry) ; Lower GI = hematochezia (bright red) decr. Lig Trietz

92. Intestinal Obstruction Vomiting common in small bowel, late in lg bowel, High pitched "tinkling" BS.
93. X-ray - prox dist = lg bowel; dilated loops of bowel with air fluid levels = sm bowel

94. Ileus Paralytic obstruction of bowel due to loss of peristalsis

95. Pyloric Stenosis Projectile vomit in neonates, visible peristaltic wave, String Sign

96. Meconium Ileus Abnormal thick Meconium with undigested protein, associated with CF

97. Hirschsprung's Disease No autonomic nerves in colon, Obstipation, late vomit, Megacolon, Toxic Enterocolitis if left untreated, BE proximal dilated & distal narrow, Colostomy