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61 Cards in this Set
- Front
- Back
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Nausea and Vomiting • Leads to
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– tears and rupture,
– fluid and electrolyte imbalance, – nutritional deficiencies, – aspiration pneumonia – enamel erosion |
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Causes of Vomiting
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• Stimulation of the back of the throat
• Irritation or Distention of the stomach or duodenum • Increased Intracranial pressure • Motion sickness • Chemical Agent • Psychogenic • Pregnancy • Unsettling sights, smells, or thoughts |
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Causes of upper GI bleed
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• Esophagitis
• Esophageal Cancer • Gastritis • Gastric Cancer • PUD • Gastric Cancer • Varices • Mallory Weiss Tear |
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Lower Gastrointestional Bleed
(Hematochezia) |
• Colonic diverticulosis
• Neoplasm • Ischemic colitis l • 91% • 20% • 19% • Acute colitis • Hemorrhoids (fissures) • Post polypectomy • Angiodysplasia • Chrohn’s • Other • unknown |
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causes of esophagitis
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• Acid Reflux
• Infection – Candida – HSV • Caustic • Eosinophilic • Medication |
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Achalasia
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• Most common esophageal motor disorder
• 10 per 100,000 • Degeneration of the nerves in Auerbach plexis • Lack of peristalsis leading to esophageal retention • Symptoms – Dysphagia for solids and liquids – Regurgitation • Diagnosis with Barium Swallow |
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GERD
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• Reflux of acid due to
weakness of the LES • Causes numerous symptoms • Can lead to Barrett’s esophagus or adenocarcenoma • PPI are mainstay of treatment with lifestyle changes • 24 hr ambulatory pH study |
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Barrett’s Esophagus
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• Squamous cells of
esophagus become columnar cells with intestional characteristics • Develops into adenocarcenoma • EGD q 2 years with biopsy |
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Esophageal Varices
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• Esophageal varices
develop when normal blood flow to your liver is blocked. The blood • Treatment‐ • Hemodynamic care then backs up into B d li ti smaller, more fragile blood vessels in your esophagus • Mortality rate‐ 50% • Band ligation • Sclerotherapy • Somatostatin or Octreotide • Vasopressin |
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Function of the Stomach
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Acid Production‐ pH 1‐2
• Chief Cells produce Pepsinogen • Parietal cells produce intrinsic factor • Absorbs ETOH, ASA and Caffiene |
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Gastroparesis
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• Found in 60% of diabetic patients
• Patients c/o anorexia, early satiety, N/V, bloating • r/o structural abnormalities • Gastric Emptying scan • Treatment: – Avoid‐ narcotics, anticholinergics and tricyclic – Limit solids and high fat, high fiber foods – Metoclopramide, erythromycin or J‐ tube |
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Gastritis
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• Non specific inflammation of the mucosa of
the stomach • Causes: – H. Pylori – NSAID – Stress‐ during critical illness |
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Function of the Pancreas
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• Exocrine Gland
– Pancreatic Acini • Digestive Enzymes • Endocrine Gland – Islet Cells • Insulin • Glucagon • Somatostatin • Pancreatic Polypeptide |
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Acute Pancreatitis
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Inflammation of the Pancreas
• Symptoms – Abdominal Pain – Nausea and vomiting – Elevation of Serum Amylase and Lipase • Treatment – Fluids – Pancreas Rest • Complications – Pseudocyst |
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Gastroparesis
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• Found in 60% of diabetic patients
• Patients c/o anorexia, early satiety, N/V, bloating • r/o structural abnormalities • Gastric Emptying scan • Treatment: – Avoid‐ narcotics, anticholinergics and tricyclic – Limit solids and high fat, high fiber foods – Metoclopramide, erythromycin or J‐ tube |
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cause of Pancreatitis
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GET SMASHED
– Gallstones – Ethanol – Trauma – Steroids – Mumps – Autoimmune causes – Scorpion venom – Hyperlipidemias – ERCP – Drugs |
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Gastritis
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• Non specific inflammation of the mucosa of
the stomach • Causes: – H. Pylori – NSAID – Stress‐ during critical illness |
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Pancreatic Cancer
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• Poor Prognosis
– 1 Year survival is 20% – 5 Year survival is 5% • Symptoms – Weight Loss – Jaundice • Types – Adenocarcenoma – cystadenocarcenoma |
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Function of the Pancreas
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• Exocrine Gland
– Pancreatic Acini • Digestive Enzymes • Endocrine Gland – Islet Cells • Insulin • Glucagon • Somatostatin • Pancreatic Polypeptide |
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Celiac Disease
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• Gluten damages mucosa of small intestine
• Malabsorption Develops • Associated with Alleles HLA DQ2 and DQ8 • Symptoms: • Neuropathy • Miscarriage • Delayed menses • IBS • Anemia • Osteoporosis |
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Acute Pancreatitis
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Inflammation of the Pancreas
• Symptoms – Abdominal Pain – Nausea and vomiting – Elevation of Serum Amylase and Lipase • Treatment – Fluids – Pancreas Rest • Complications – Pseudocyst |
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Irritable Bowel Disease
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• 20% population
• Symptoms of abdominal Pain, bloating, Constipation and/or diarrhea • ? Etiology • Associated with Stress • Foods may play a part such as Caffeine, Stress, gluten, chocolate |
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cause of Pancreatitis
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GET SMASHED
– Gallstones – Ethanol – Trauma – Steroids – Mumps – Autoimmune causes – Scorpion venom – Hyperlipidemias – ERCP – Drugs |
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Ulcerative colitis
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• Inflammation of the ileum and the large
intestines due to abnormal activation of the immune system • Abdominal pain and bloody diarrhea • Increased risk of colon cancer • Treatment: Steroids, Topical 5 ASA compounds, immunodilutors |
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Pancreatic Cancer
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• Poor Prognosis
– 1 Year survival is 20% – 5 Year survival is 5% • Symptoms – Weight Loss – Jaundice • Types – Adenocarcenoma – cystadenocarcenoma |
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Crohn’s Disease
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• Inflammatory Bowel Problem
• Associated with abdominal Pain and bloody diarrhea • Dx at age 15 to 30 • Involves skip lesions of small intestine and large intestine • complications: obstruction, fistula, abscess, perforation • Tx: steroids, 5 ASA compounds • Mutation of the CARD 15 gene |
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Celiac Disease
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• Gluten damages mucosa of small intestine
• Malabsorption Develops • Associated with Alleles HLA DQ2 and DQ8 • Symptoms: • Neuropathy • Miscarriage • Delayed menses • IBS • Anemia • Osteoporosis |
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Irritable Bowel Disease
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• 20% population
• Symptoms of abdominal Pain, bloating, Constipation and/or diarrhea • ? Etiology • Associated with Stress • Foods may play a part such as Caffeine, Stress, gluten, chocolate |
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Ulcerative colitis
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• Inflammation of the ileum and the large
intestines due to abnormal activation of the immune system • Abdominal pain and bloody diarrhea • Increased risk of colon cancer • Treatment: Steroids, Topical 5 ASA compounds, immunodilutors |
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Crohn’s Disease
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• Inflammatory Bowel Problem
• Associated with abdominal Pain and bloody diarrhea • Dx at age 15 to 30 • Involves skip lesions of small intestine and large intestine • complications: obstruction, fistula, abscess, perforation • Tx: steroids, 5 ASA compounds • Mutation of the CARD 15 gene |
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Gastroparesis
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• Found in 60% of diabetic patients
• Patients c/o anorexia, early satiety, N/V, bloating • r/o structural abnormalities • Gastric Emptying scan • Treatment: – Avoid‐ narcotics, anticholinergics and tricyclic – Limit solids and high fat, high fiber foods – Metoclopramide, erythromycin or J‐ tube |
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Gastritis
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• Non specific inflammation of the mucosa of
the stomach • Causes: – H. Pylori – NSAID – Stress‐ during critical illness |
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Function of the Pancreas
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• Exocrine Gland
– Pancreatic Acini • Digestive Enzymes • Endocrine Gland – Islet Cells • Insulin • Glucagon • Somatostatin • Pancreatic Polypeptide |
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Acute Pancreatitis
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Inflammation of the Pancreas
• Symptoms – Abdominal Pain – Nausea and vomiting – Elevation of Serum Amylase and Lipase • Treatment – Fluids – Pancreas Rest • Complications – Pseudocyst |
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cause of Pancreatitis
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GET SMASHED
– Gallstones – Ethanol – Trauma – Steroids – Mumps – Autoimmune causes – Scorpion venom – Hyperlipidemias – ERCP – Drugs |
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Pancreatic Cancer
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• Poor Prognosis
– 1 Year survival is 20% – 5 Year survival is 5% • Symptoms – Weight Loss – Jaundice • Types – Adenocarcenoma – cystadenocarcenoma |
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Celiac Disease
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• Gluten damages mucosa of small intestine
• Malabsorption Develops • Associated with Alleles HLA DQ2 and DQ8 • Symptoms: • Neuropathy • Miscarriage • Delayed menses • IBS • Anemia • Osteoporosis |
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Irritable Bowel Disease
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• 20% population
• Symptoms of abdominal Pain, bloating, Constipation and/or diarrhea • ? Etiology • Associated with Stress • Foods may play a part such as Caffeine, Stress, gluten, chocolate |
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Ulcerative colitis
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• Inflammation of the ileum and the large
intestines due to abnormal activation of the immune system • Abdominal pain and bloody diarrhea • Increased risk of colon cancer • Treatment: Steroids, Topical 5 ASA compounds, immunodilutors |
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Crohn’s Disease
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• Inflammatory Bowel Problem
• Associated with abdominal Pain and bloody diarrhea • Dx at age 15 to 30 • Involves skip lesions of small intestine and large intestine • complications: obstruction, fistula, abscess, perforation • Tx: steroids, 5 ASA compounds • Mutation of the CARD 15 gene |
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compare ulcerative colitis w/ chrohn's disease
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Ulcerative colitis
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Bowel Obstruction
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• Mechanical blockage
prevents flow in small bowel or large bowel • Causes: neoplasm, adhesions, inflammatory bowel syndromes • Symptoms: abdominal pain, constipation, vomiting |
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Diverticulosis
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• Outpouchings which occur at
the weak point in wall of colon – where small feeding blood vessels enter the circular muscular layer. • Assoc. with low fiber and high fat diet • 2/3 of people >85 • 15 to 20% of people develop diverticulitis |
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Diverticulitis
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• Inflammation of out pouches
of the colon • broad‐spectrum antibiotics which cover anaerobic bacteria and gram – negative rods • LLQ Abdomen ( 5% RLQ) • Can cause perforation and abscess • Abdominal CT with contrast‐ – 98% Specificity – 95% sensitivity |
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Gall Bladder
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• Storage area
• Concentrates bile • Secretes bile when fat is eaten • Stimulates duodenum to secrete cholecystokinin for fat digestion and appetite supression |
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Cholecystitis
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Cholecystitisdistention,
edema,inflammation,ischemia of GB due to obstruction of the cystic duct which can lead to infection, gangrene and perforation • 90% Gallstones – Increased WBC Most people have surgery within 24 to 48 hours. – Hx biliary colic – Pain RUQ – N & V • 10% acalculous – Bile stasis – Ischemia |
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Biliary Colic
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• “chronic cholecystitis”
• Associate with chronic pain in the RUQ to epigastrum to scapula • Gall Stones may be present |
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Gall Bladder Cancer
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• Cell dysplasia in the GB & bile duct
• Rare ‐ 9, 520 new cases per year. • Symptoms – N and V – Jaundice – Intense itch – Occasional pain • Risks – Obesity – Stones – ETOH – Genetic Predisposition |
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Diagnosis of GB Disease
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• Ultrasound 90% sensitivity and specificity
• Ct scan • ERCP |
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Cullen’s Sign
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• Bluish discoloration of the periumbilical skin
(periumbilical cyanosis and grid cyanosis) due to subcutaneous intraperitoneal haemorrhage. This may be caused by ruptured ectopic pregnancy, or, more rare, acute pancreatitis. |
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Ascites
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• Excess Peritoneal Fluid – evident on physical exam if
>500 ml • Due to excess renal sodium and water retention due to portal hypertension and splanchnic vasodilitation • Diagnosis with US • Paracentesis helps define serum ascites – albumen level and cause – >1.1g/dl can mean cirrhosis, nephrotic syndrome,myxedema • Treatment: diuretics, salt and fluid restriction, TIPS procedure |
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Portal Hypertension
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Pressure in the portal vein is 5mm > than that of
the hepatic vein causing back up. – Complications: – Esophageal Varices, – Ascites, – Spontaneous Bacterial Peritonitis • Treatment: – B‐ blockers – TIPS procedure – DSRS procedure – Transplant |
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Treatment of Esophageal Varices
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• Severe complication of portal hypertension
• 30% of people with cirrhosis • 20% of initial bleeds are fatal • Treatment to decrease pressure • Beta blockers • Sclerotherapy • Ligation/ Banding • Vasoconstriction with Vasopressin or Somatostatin i.e octreotide • Baloon Tamponade |
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Treatment of Portal Hypertension
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• Same as for Esophageal varices
• TIPS Procedure • DSRS Procedure |
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What is the DSRS
Procedure |
• Distal Spleno renal shunt
• The splenic vein is detached from the portal vein and reattached to the left Renal vein. |
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What is the TIPS Procedure?
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• Transjugular Intrahepatic
Porto Systemic Shunt • Tract made between Portal Vein and Hepatic Vein • 90% helpful |
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Spontaneous Bacterial Peritonitis
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• Infection of ascitic fluid usually with
Pneumococcus or Enterobacteriaceae • Symptoms: Fever, Abdominal Pain, tenderness • DX: evaluation of fluid • Tx: third Generation Cephalosporin • High Rate of recurrence – long term antibiotic for prophylaxis |
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Hepatic Encephalopathy
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• Neuropsychiatric abnormality assoc with advanced liver
disease • Toxins build in the blood – Serum Ammonia elevation due to inability of liver to remove nitrogenous compounds • Associated with – impaired cognition to coma – a flapping tremor‐ asterixis to hyperreflexia • Treatment to prevent ammonia absorption – Lactulose ‐ traps ammonia in the colon – Refaximin or Neomycin to kill bacteria – Flumazenil benzodiazepam antagonist – L‐ornithine‐L‐aspartate interrupts urea cycle |
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Fatty Liver
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• Most common liver disease is the US – 30% of
population • Can lead to cirrhosis and Hepatocellular carcenoma • Increased BMI associated with progression • Barriatic surgery has been associated with a good outcome |
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How do we know if
a patient has appendicitis? |
Rovsing's sign
• Deep palpation of the left iliac fossa may cause pain in the right iliac fossa. This is the Rovsing's sign, also known as the Rovsing's symptom. It is used in the diagnosis of acute appendicitis. Pressure over the descending colon causes pain in the right lower quadrant of the abdomen.[19] Psoas sign • This is right lower quadrant pain that is reproduced with the patient lying on their left side and then extending the hip. Because extension elicits pain, the patient will lie with the right hip flexed for pain relief. Obturator sign • If an inflamed appendix is in contact with the obturator internus, spasm of the muscle can be demonstrated by flexing and internally rotating the hip. This maneuver will cause pain in the hypogastrium. |
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Peutz‐ Jegher Syndrome
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• Peutz‐Jeghers syndrome is
characterized by the development of growths called hamartomatous polyps in the gastrointestinal tract (particularly the stomach and intestines), and a greatly increased risk of developing certain types of cancer. |
