Ou Tulsa Pa Gi Presentation

Front 1

Classic - diarrhea w/ bulky and foul smelling stool, steatorrhea, flatulence

Children = failure to thrive

Dermatitis Herpataformis

Back 1

Celiac Disease

Front 2

Anemia and Abnormal Digestive function

Diarrhea, loss of appetite, weight loss, sore tongue, weakness, HA, palpitations, irritability

Back 2

Folate Deficiency (Folic Acid, Vit. B9)

Front 3

Diarrhea, abdominal discomfort, cramping, bloating, flatulence after ingesting dairy

Child may have vomiting and frothy stool

Back 3

Lactose intolerance

Front 4

Early: anorexia, weakness, mouth sores, glossitis, stomatitis

Late: Pellegra Triad = Dermatitis, Dementia, Diarrhea

Back 4

Niacin Deficiency (Vit B3)

Front 5

Insidious onset
HALLMARK = intellectual disability
"mousy" odor to body and urine
abnormal gait, stance, and sitting posture

Back 5

Phenylketonuria (PKU)

Front 6

Oral mucosa: Angular stomatitis/cheilosis, glossitis
Seborrheic dermatitis
Normocyctic anemia

Back 6

Riboflavin Deficiency (vit b2)

Front 7

Irritability, Muscle Cramp, Anorexia, Paresthesias

Wet Beriberi = Cardiovascular symptoms w/ extreme exertion

Dry beriberi = PNS and CNS symptoms

Back 7

Thiamine Deficiency (Vit. B1)

Front 8

nystagmus, ophthalmoplegia, truncal ataxia, confusion

(seen w/ Thiamine deficiency)

Back 8

Wernicke's encephalopathy

Front 9

Thiamine deficiency with amnesia, impaired learning and short-term memory, hallucinations, confabulation

(seen w/ Thiamine deficiency)

Back 9

Korsakoff syndrome

Front 10

Looks like alcohol abuse, mental confusion, memory loss, nystagmus, and ataxia

(seen w/ Thiamine deficiency)

Back 10

Wernicke-Korsakoff syndrom

Front 11

Early: 1st sign = night blindness
xerosis, Ritot's spots, poor wood healing

Late: keratomalacia, endophthalmitis, blindness

children: growth deficiency, anemia

Back 11

Vitamin A deficiency (retinol)

Front 12

Tired/decreased mental work capacity, irritability, depression, memory loss, confusion/disorientation, anorexia, diarrhea, glossitis = "beefy red tongue"

Neurological symptoms = paresthesias, disturbed coordination, difficulty w/ balance, dementia, ataxia

Back 12

Vitamin B12 deficiency
(Cobalamin, cyanocobalamin)

Front 13

Early: nonspecific
Late: perifollicular hemorrhages, petechiae, purpura, splinter hemorrhages, bleeding gums

Terminal symptoms: edema, oliguria, neuropathy, intracranial hemorrhage

Back 13

Vitamin C (ascorbic acid)

Front 14

Mild: poor appetite, insomnia, vision problems, burning sensation in mouth and throat

Severe: periodontal disease, rickets, osteomalacia
(bony bumps on ribs = "rachitic rosary", bowed legs/arms, Knock knee, osteomalacia)

Back 14

Vitamin D Deficiency

Front 15

Excessive hemorrhage
Infants (Hemolytic disease of newborn)
Symptoms w/in 5-14 days of birth
Bleeding from circumcision cite, GI tract, skin, nose
Intracranial Hemorrhage

Back 15

Vitamin K deficiency (phylloquinone)

Front 16

Heartburn
Dysphagia
Odynophagia
Anemia
HX of caustic digestion

Back 16

Esophagitis

Front 17

Hx of allergies
Adults: hx of dysphagia for solids, episodes of impaction, heartburn

Child: abdominal pain, vomiting, chest pain, failure to thrive

Back 17

Eosinophilic Esophagitis

Front 18

Sudden onset of retrosternal pain (mild or severe)

Back 18

Pill induced esophagitis

Front 19

Hematemesis following vomiting, straining or coughing
Bright red blood (generally mild/self limiting)
May have chest pain

Back 19

Mallory-Weiss Tear

Front 20

Insidious development over years
Dysphagia
Regurgitation
Halitosis

Back 20

Zenker Diverticulum

Front 21

> 90% have solid food dysphagia
Weight loss common
Sometimes odynophagia

Back 21

Esophageal Neoplasm

Front 22

Asymptomatic until rupture
Rupture = painless, massive hematemesis of dark brown blood, pallor, tachycardia, orthostasis

Physical signs of cirrhosis of liver

Back 22

Varices

Front 23

- Disordered peristalsis (Diffuse)
- Motility disorder w/ increased pressure during peristalsis (Nutcracker)
- Increased Lower Esophageal Sphincter pressure (Hypertensive)
Achalasia

Back 23

Esophageal Spasm (motility disorder)

Front 24

HALLMARK = Heartburn
Regurgitation
Dysphagia

Atypical findings: asthma symptoms, chronic cough, chronic laryngitis, sore throat, non-cardia chest pain

Back 24

GERD - Gastroesophageal Reflux Disease

Front 25

Most are asymptomatic
MC = intermittent dysphagia to solid foods, reflux with rings

Back 25

Esophageal Webs and Rings

Front 26

Erosive: Upper GI bleed, Hematemesis (coffee grounds) usually asymptomatic, possible anorexia, epigastric pain, N/V

non-erosive = nonspecific

Back 26

Gastritis

Front 27

Usually silent until late
Nonspecific symptoms: dyspepsia, vague epigastric pain, anorexia, early satiety, weight loss

Ulcerated lesions may bleed leading to hematemesis and or melena

Back 27

Gastric Neoplasms

Front 28

HALLMARK = Dyspepsia
Nonspecific epigastric pain (gnawing, dull, aching, "hunger like"
Nausea and Anorexia

Back 28

Peptic Ulcer Disease

Front 29

Progressive, non bilous projectile vomiting --> children remain hungry

weight loss, dehydration, olive-shaped mass felt to the right of the umbilicus (esp. shortly after vomit)

Back 29

Pyloric stenosis

Front 30

90% of pts develop peptic ulcer
Mimic peptic ulcer disease
GERD is common
1/3 have diarrhea
RED FLAGS: Ulcers refractory to tx, multiple giant ulcers, ulcers w/ hypercalcemia, H. pylori negative

Back 30

Zollinger-Ellison Syndrome

Front 31

Mild fever to severe (septic shock)
Hepatomegaly
Charcots triad: RUQ pain, Fever (chills), Jaundice

Reynold's Pentad: Charcot's triad, Altered mental status, Hypotension

Back 31

Cholangitis

Front 32

Hx of biliary colic (gallstones)
Radiating paint to the neck or back
N/V, Fever, TTP/pain in RUQ
(+) murphy sign, (+) rebound, guarding
peritoneal signs

Back 32

Cholecystitis

Front 33

Frequently asymptomatic
Dull pain RUQ lasts 1-4 hrs
Worse pain after fatty meal
N/V
Pruritus/excoriations, jaundice, light colored stool, Tea colored urine
Restless pain, low blood pressure

Back 33

Cholelithiasis

Front 34

Frequently recurring attacks of severe RUQ pain that lasts several hours
Chills, Fever, Jaundice associated w/ pain

Charcot's triad, Reynolds Triad, Hepatomegaly

Back 34

Choledocholithiasis

Front 35

Classic: epigastric tenderness and abdominal distention
Decreased or absent bowel sounds
Tachycardia, pallor, hypotension, shock
Cullen's sign = blush discoloration of the skin around the umbilicus
Grey Turner's sign = ecchymotic discoloration of the flanks

Back 35

Acute pancreatitis

Front 36

Classic Triad: pancreatic calcification, steatorrhea, DM
During attack = tenderness of pancreas, mild muscle guarding, ileus

Chronic epigastric pain radiating to the back, anorexia, n/v, constipation, flatulence, weight loss, steatorrhea

Back 36

Chronic Pancreatitis

Front 37

Abdominal pain - diffuse in LUQ, radiation is common, Sister Mary Joseph nodule = hard periumbilical nodule that is palpable

Jaundice - courvoisier's sign (jaundice and palpable gallbladder)
Diarrhea = early symptom
Weight loss = late symptom

Back 37

Pancreatic Cancer

Front 38

Abdominal distension, cramping, vomiting,
Later = obstipation

SBO = acute symptoms, pain around umbilicus/epigastrium
LBO = milder symptoms that develop gradually, constipation, pain in hypogastic region
Volvulus = abrupt onset, continuous pain, superimposed waves of colicky pain

Back 38

Acute intestinal obstruction

Front 39

Early periumbilical pain
w/in 12 hrs pain shift to RUQ
Steady ache worsened by coughing or walking
Nausea w/ 1-2 episodes of vomiting,
Feeling of constipation, low grade fever
Local tenderness w/ guarding over LRQ, percussion elicits pain
Rupture = temporary pain relief and peritoneal signs

Back 39

Appendicitis

Front 40

Change in bowel habits/stool consistency
Patterns of rectal bleeding
Pain/straining
Hard pellet stools = slow transit
Straining and feeling incomplete evacuation = Cardinal signs of pelvic floor dysfunction

Back 40

Constipation

Front 41

Chance in consistency, frequency, quantity, color, odor, melanic(bloody/black) of stool
Watery = Small bowel
Blood and mucus = colon

Fever, HA, anorexia, vomiting, altered mental status, abdominal pain/distention, malaise, myalgia

Back 41

Acute Diarrhea

Front 42

Chance in consistency, frequency, quantity, color, odor, melanic(bloody/black) of stool BUT lasts OVER 4 weeks
Tenesmus, Flatus, steatorrhea

Back 42

Chronic Diarrhea

Front 43

MC = low grade fever, malaise, weight loss, decreased energy
NON-bloody diarrhea
Postprandial bloating, cramping, and borborygmi
RLQ focal tenderness
Fistula and sinus tracts

Back 43

Crohn's disease

Front 44

HALLMARK = Blood diarrhea
Invariably involves the rectum, but DOES NOT spread
Characterized by periods of symptomatic flare-ups and remission
Mild, Moderate, and Severe cases

Back 44

Ulcerative Colitis

Front 45

Symptoms persist for at least 3 months, usually intermittent
Lower abdominal crampy pain
Mucus is common in stool
DOES NOT interrupt sleep
Onset associated w/ change in form and/or frequency

Back 45

Irritable Bowel Disease

Front 46

Impairment of blood supply and necrosis of bowel segment
Episodic colicky pain and vomiting
Sausage shaped mass in hepatic flexure
Fever/Dehydration signs
"CURRANT JELLY" stools

Back 46

Intussuseption

Front 47

Acute mesenteric Ischemia: sudden onset of severe abdominal pain out of proportion to exam findings

Chronic mesenteric Ischemia: abdominal angina occurring 10-30 minutes after eating that is relieved by squatting or lying down

LLQ pain/tenderness

Back 47

Ischemic Bowel Disease

Front 48

Very ill appearing, "toxic vitals"
Fever, abdominal pain/distension, diarrhea
Dehydration/ electrolyte imbalance

Rapid progression of symptoms over 1-2 weeks

Back 48

Toxic Megacolon (Hirschsprungs Disease)

Front 49

*Occult Blood* (elderly)
Crampy LLQ abdominal pain
Worse w/ movement, cough, strain
Palpable mass
Low grade fever, N/V
Abdominal distension
Chronic constipation w/ episodes of diarrhea

Back 49

Diverticulitis

Front 50

Type 3 is most common (Ileum)
Abdominal distension
Vomiting in first 24-48 hrs after birth
Jaundice

Back 50

Intestinal Atresia

Front 51

Ampullary = jaundice due to bile duct obstruction or bleeding

Non-ampullary = peak incidence in 6th decade, symptoms of obstruction, acute or chronic bleeding, weight loss, majority have metastasized

Back 51

Adenocarcinoma

Front 52

Abdominal pain, weight loss, N/V, distension, anemia, occult blood in stool

MC in Distal Small Bowel

Back 52

Lymphoma

Front 53

90% w/ syndrome have hepatic metastases, facial flushing, edema of the head and neck, abdominal cramps and diarrhea, bronchospasm, cardiac lesions

Back 53

Carcinoid Tumors

Front 54

Lesions may be present anywhere in the intestinal tract
Visceral involvement usually associated w/ cutaneous disease
Most lesions are silent
Large lesions may be symptomatic

Back 54

Small intestine Sarcoma

Front 55

Fever, malaise, N/V
Dark urine
Jaundice
Normal to low WBC
Elevated aminotransferases (AST/ALT)

Back 55

Hepatitis A

Front 56

MOST PT are asymptomatic
Average time from exposure 4-12 weeks
Fatigue, abdominal pain, anorexia, jaundice

Slow progression, 75-80% become carriers

Back 56

Hepatitis C

Front 57

50% of adults are asymptomatic
Pre-icteric (prodromal): 1-3 wks; malaise anorexia, N/V, RUQ pain fever HA dark urine

Icteric phase: 1-3 wks; jaundice, acholic stools, hepatic tenderness, hepatomegaly

Convalescence: sx resolve

Back 57

Hepatitis B

Front 58

Hep B titre:
1st evidence of infection, and persists throughout the clinical illness. If it persists more than 6months the disease is chronic

Back 58

HBsAg

Front 59

Hep B titre:
Antibody to HBsAg appears after clearance of HBsAg. Appears in successful RECOVERY of infection and immunization

Back 59

Anti-HBs

Front 60

Hep B titre:
Antibody indicates acute HEP B infection

Back 60

Anti-HBc
IgM

Front 61

Hep B titre:
Appears during acute HEP B infection, but persists indefinitely whether the pt recovers or is chronic

Back 61

Anti-HBc
IgG

Front 62

Hep B titre:
Indicates viral replication and infectivity

Back 62

HBeAg

Front 63

Hep B titre:
Detected with PCR-generally parallels the presence of HBeAg

Back 63

HBV DNA

Front 64

Portal HTN: variceal bleeding, edema, ascites, hemorrhoids
Weak, Fatigue, disturbed sleep, wt loss, muscle cramp
Skin: spider angioma, palmar erythrema, dupuytren contracture, jaundice

3 stages

Back 64

Cirrhosis

Front 65

Yellow discoloration in ocular conjuctivae, and oral mucosa
Plasma elevation of unconjugated and/or conjugated bilrubin
Pruritis, Dark urine, Light stool

Back 65

Jaundice

Front 66

Abdominal distension
Bulging flanks
Shifting Dullness
**MC complication of Cirrhosis**

Back 66

Ascites

Front 67

Fever, Abdominal Pain, Abdominal tenderness, Altered Mental Status

Some PT are Asymptomatic w/ abnormal labs
Common isolates = E.coli and pneumococci

Back 67

Peritonitis

Front 68

MC cause of GI bleeding due to portal HTN
Acute GI hemorrhage
Hypovolemia

Back 68

Esophageal Varices

Front 69

Disturbed Diurnal Sleep
Asterixis
Hyperactive tendon reflex
Stages: mild confusion, drowsiness, stupor, coma

Back 69

Hepatic Encephalopathy

Front 70

Fatigue, Pruritis, Hepatosplenomegaly
Xanthomatous lesion on skin and eyes

Advanced: Jaundice, steatorrhea, portal HTN

Orthostatic hypotension, cognitive impairment

Back 70

Primary Biliary Cirrhosis

Front 71

MC from Cirrhosis and Hep C
Cachexia (wasting syndrome)
Bloody ascites
Hepatomegaly
Bruit over tumor or friction rub

Back 71

Hepatocellular Carcinoma

Front 72

Most pts are asymptomatic
Mild RUQ pain
hepatomegaly

(common from metabolic syndromes)

Back 72

Nonalcoholic fatty liver disease

Front 73

Severe tearing pain during defecation
Thobbing discomfort
Hematochezia

Back 73

Anal Fissure

Front 74

Anal:
Throbbing continuous pain
Erythema
Fluctuance
Swelling

Back 74

Anorectal Abcess

Front 75

Anal:
Purulent discharge
Itching
Pain and tenderness

Back 75

Anorectal Fistula

Front 76

Decreased Appetite, N/V
Abdominal pain and distention
Paradoxical diarrhea due to stool leaking around the impaction

Back 76

Fecal Impaction

Front 77

Internal: Bleeding, Prolapse, Mucoid discharge
Pain uncommon until late stage

Back 77

Hemorrhoid

Front 78

Cyst, Abscess, or one or more sinus tracts in the upper part of the natal cleft

MC in Men 3rd decade (Not in PT over 45)

Back 78

Pilonidal Disease

Front 79

Non Familial: usually asymptomatic, may have occult bleeding that leads to anemia

Familial: early development of 100-1000 adenomatous polyps

Back 79

Polyps

Front 80

Right colon: blood loss, iron deficiency anemia fatigue, weakness

Left colon: obstructive sx, abd pain, change in bowel habits, "apple-core" lesion on radiograph

Rectosigmoid: hematochezia, tenesmus, narrowing of the caliber of stool

Back 80

Colorectal Cancer

Third most common cancer
Second leading cause of death due to malignancy

Front 81

Bulge in groin onto anterior thigh below the inguinal ligament
Very susceptible to incarceration and strangulation
Can be mistaken for lymph nodes or lipomas
MC = Female

Back 81

Femoral hernia

Front 82

GERD, Tightness, pain related to position, dysphagia, chronic lung infection due to aspiration, hoarse voice

100xMC

Back 82

Hiatal hernia (type 1)

Front 83

Type 2: No GERD, incarceration or strangulation of fundus may occur

Type 3: Signs of increased intrabdominal pressure, lump in chest

Back 83

Hiatal Hernia

Front 84

Bulge, pain, discomort at site, bowel obstruction

(MC from a deep wound infection)

Back 84

Incisional Hernia

Front 85

Bulge in groin
MC right side

Male < 20 yro due to increased pressure
MC type of hernia

Back 85

Indirect Inguinal Hernia

Front 86

Bulge in groin
MC in elderly men

Back 86

Direct inguinal hernia

Front 87

Generally asymptomatic
Soft protuberance at the umbilicus

Back 87

Umbilical Hernia

Front 88

MC = PT over 30
Progressive dysphagia to solid AND liquid
Regurgitation of undigested food
Nocturnal cough (due to aspiration)
Chest pain/Heartburn

Barium swallow = "Bird Beak" narrowing

Back 88

Achalasia