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416 Cards in this Set
- Front
- Back
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Average Weight: >20% =>
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obese
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Average Weight:
Females: medium and large frames |
5:ft: 100lb. + 5lb/in
Medium Frame: + 15lb Large Frame: + 30lb |
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Average Weight: Males
medium and large frames |
5ft: 106lb + 6lb/in
Medium Frame: + 15lb Large Frame: + 30lb |
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Foregut
where does it begin and end? blood supply ligament |
lips to duodenum (ligament of Treitz) <~ celiac artery
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Midgut
start and end important feature blood supply |
duodenum to transverse colon (splenic flexure) <~SMA
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Hindgut
start and end blood supply |
transverse colon to rectum <~ IMA
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what CN is the sensory input of the Cephalic Phase?
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CN10 = sensory input
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function of the limbic and cerebrum
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Limbic System: controls urges
Cerebrum: can override the limbic system |
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Pineal Gland: function and what hormone does it respond to?
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tells you what time of day it is; responds to 5-HT (made ofTrp)
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why does warm milk, turkey: make you fall asleep?
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Warm milk, turkey: Trp => Melatonin
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describe the melatonin levels during day and night.
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increase melatonin at night, decrease during day due to bright light
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Rhythms of the Day: what happens during these hours:
• 1st 8 hours • 2nd 8 hours • 3rd 8 hours |
• 1st 8 hours: Catabolism => exercise in the morning to burn most fat
• 2nd 8 hours: Mixture of catabolism and anabolism • 3rd 8 hours: Anabolism, melatonin is high |
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BMI:
weight (kg)/ surface area(nl) <18: >25: >30: >40: |
BMI:
weight (kg)/ surface area(nl) <18: underweight >25: overweight >30: obese >40: gastric bypass surgery |
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how does progesterone increase hunger
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Progesterone: similar to the amino acid sequence of
testosterone = > increases hunger |
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how does sympathetics affect hunger
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Sympathetics => can't eat "GI Signs of Dating"
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where is the Hunger center located?
what stimulates it? |
>>lateral nucleus of the hypothalamus
>>Low glucose/ sight of food => increased firing of hunger center |
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what happens when there is a lesion
to the lateral nucleus of the hypothalamus and Tx: |
Anorexia Nervosa (20% below normal weight)
Tx: Amitriptyline |
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what neurotransmitter and hormone does stimulates the hunger
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NE and 5-HT stimulate this center 20% of the time
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where is the saiety center located
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medial nucleus of the hypothalamus
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what happens if there is a lesion to the saiety center?
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>>Bulimia=> knuckle abrasion
loss of teeth enamel, metabolic alkalosis, hypokalemia >>Prader-Willi =>hyperphagia |
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why does gastric bypass and stomach cancer produce early siety?
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High glucose/ gastric stretch -=> increased-firing of satiety center
Ex: Gastric bypass => stomach stretches sooner to produce satiety • Ex: CA on stomach wall stretches it resulting in weight loss |
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what NT and hormones stimulate the satiety center.
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NE and 5-HT stimulate this center 80% of the time
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How Saliva is made:
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1° saliva: take up isotonic plasma (salivary duct is impermeable to water)
2° saliva: hypotonic, more K (Na/K pump), more HC03- (Cl/HC03 pump) |
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Solid Dysphagia:
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• Schatzki's rings
• cancer |
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Saliva Components: (4) and describe its functions
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• Lysozyme: detergent to impair adhesion to teeth
• IgA: protection against encapsulated bacteria • Salivary amylase: carbohydrate digestion • Bicarb: neutralizes acidic food |
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Solid+ Liquid Dysphagia: (3)
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• Esophageal spasm (DES)
• Scleroderma • Achalasia |
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Teeth:
10 mo: 15 mo: 18 mo: |
10 mo: Incisors ~> cut (2 bottom, 2 top)
15 mo: Bicuspids ~> chop (4 top, 4 bottom) 18 mo: Molars ~>grind (4 top, 4 bottom) |
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Teeth
28 mo: 8 y/o: and what do they need for maintenance 20 y/o: |
28 mo: Decidiua done
8 y/o: Permanent teeth - need fluoride and calcium 20 y/o: 3rd Molars "wisdom teeth" |
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Muscles of mastication: brachial arch and CN
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from 1st brachial arch, CN 5
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Masseter: function
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closes mouth, moves cheek
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Temporalis: function
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closes mouth, moves jaw back and forth
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• Medial pterygoids: function
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closes mouth
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• Lateral pterygoids: function
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Lowers jaw=> opens mouth
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• Buccinator: function
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slides food sideways (not mastication)
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Corkscrew:
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Esophageal spasm
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Apple core:
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cancer
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Stacked coin:
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intusucception
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Thumbprint:
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Toxic megacolon
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Abrupt cutoff:
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Volvulus
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Barium clumping:
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Celiac sprue
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what CN is responsible for sensory (somatic) the front and back of the tongue
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Front: CN V3
Back: CN 9 |
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what CN is responsible for sensory (taste) the front, middle and back of the tongue
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Sensory (taste):
Front: CN 7 Middle: CN 9 Back: CN 10 |
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how do we swallow
what CN are responsible upper pharynx pain lower pharynx pain |
Tip of tongue goes up
• Side of tongue forms gutter • Tongue tip goes up to hard palate to let gravity start rolling bolus down • Epiglottis closes off glottis to protect trachea=> don't talk while eating o CN9 - upper pharynx pain o CN10 - lower pharynx pain • Bolus goes over epiglottis to posterior pharynx to esophagus • Post pharynx comes down and medial • Soft palate lifts via LVP = > opens UES • UES relaxes and bolus rolls down |
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String sign:
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Pyloric stenosis
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Bird's beak:
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Achalasia
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where is the esophagus located?
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esophagus is located slightly on left side
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describe the muscles of the ff areas of the esophagus?
Upper 1/3: Middle 1/3: Lower 1/3: |
Upper 1/3: Skeletal muscle (stratified squamous epithelium)
Middle 1/3: Mixed Lower 1/3: SM (tall columnar) |
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UES: nucleus, what happens when it is lesioned?
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UES:
Nucleus ambiguous (gag) lesion this => NPO (will aspirate food~> feeding tube) |
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UES: what muscles and CN are in it
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• Stylopharyngeus muscle - CN9
• Pharyngeal constrictors - CN10 |
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LES: CN, nucleus, what happens when it is lesioned?
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CN 10 dorsal motor nucleus (peristalsis)
lesion this => can feed by mouth (via Ca-Calmodulin) |
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describe the UES primary and secondary peristalsis.
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1° peristalsis' UES
• Contract: CN10 (IP3 / DAG) • Release: Auerbach's plexus (VIP inhibits CN 10) 2° peristalsis: entire esophagus (Ca/Calmodulin- SM contraction by distension) |
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what syndromes show Double Bubble sign (2)
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• Duodenal Atresia
• Annular Pancreas |
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Stratified Squamous Epithelium: (6)
function which parts of the body has it? |
protects against abrasion
• Skin • Upper esophagus • Rectum/ Anus • Aorta • Urethra • Upper Vagina |
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Esophagus Diseases:
Test Approach: |
1)Esophography
2)Endoscopy |
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what is Achalasia?
presentation |
lose Auerbach's plexus in LES
=> increase esophageal tone (choke on solid food) |
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achalasia: barium swallow
what would be seen (3) |
"bird's beak"
"string sign" "up-side-down-ace-of-spades" |
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common cause of achalasia in adults and children
presentation in children? |
Kids: congenital
(choke w/ feeding at 4 mo) Adults: chaga's (it eats ganglia) |
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test and tx for achalasia
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Test: Manometry
• Tx: NGN, local Botox, sphincterotomy |
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barret's esophagus:
describe associated cancer |
chronic acid causes metaplasia
(squamous =>tall columnar) have increased risk of Adeno Carcinoma |
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Boerhaave's
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perforate all layers of esophagus =>L pleural cavity => acid eats lungs
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Boerhaave's presentation
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Vomit => sudden left chest pain
• Left pleural effusion, left pneumothorax "bores into lungs" • Hamman's sign: subcutaneous emphysema => air escaping under skin (crunching sound) |
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diagnosis of Boerhaave's
what would be see in pleurocentesis? |
Dx: Gastrographin swallow (water soluble)
Pleurocentesis: low pH, high amylase |
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Choanal atresia:
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membrane b/w nostrils and pharynx
=> blue when fed, pink when cry. |
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Cloaca (persistant):
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one opening for rectum/bladder/vagina
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what is a diverticula?
how is it made? how is it diagnosed? |
Diverticula: pouch => cough undigested food, malodorous halitosis
• Mechanism: uncoordinated swallow • Dx: Barium swallow |
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Zencker's Diverticulum: what are the three types
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above UES
Traction Diverticulum Epiphrenic Diverticulum |
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Traction Diverticulum:
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mid-esophagus (only true diverticulum)
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Epiphrenic Diverticulum:
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above LES
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above UES diverticulum tx:
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(Tx: Excise+ Cricopharyngeal myotomy)
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Choanal Atresia: when are they cyanotic
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• blue when fed
• pink when cry |
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Tetrology of Fallot: presentation
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• blue when cry
• pink when stop |
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Duodenal atresia
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billious vomiting after 1st feeding
double bubble sign Down's syndrome |
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Esophageal atresia w / TE fistula
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blind pouch esophagus, vomit first feeding, gastric bubble
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esophageal spasm
pathogenesis, x-ray and tx |
hypoactive neurons, "corkscrew" barium swallow
Tx: NGN, anticholinergics |
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Esophageal varices: define and Tx
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vomit blood everywhere, portal HTN
• Tx: Band ligation or Sclerotherapy (more complications) |
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Gastroesophageal Reflux Disease "GERD": define and tx
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heartburn
• Tx: Elevate head of bed, H2 blockers, PPI's |
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Hirschsprung's:
pathogenesis presentation |
lose Auerbach's in rectum
= > constipation (narrowed segment is involved) |
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Mallory-Weiss:
describe risk factors increase risk of having what? |
tear mucosa of LES at GE junction
(vomiters: EtOH, bulimia) increase hiatal hernia |
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Plummer-Vinson syndrome:
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upper esophageal webs, spoon nails, Fe-def. anemia
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Schatzki rings
what causes it to bleed? |
lower esophageal webs
(hot food causes it to bleed) |
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Tracheoesophageal fistula
presentation |
milk drips into trachea, cough and choke with each feeding
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scleroderma: peristalsis and LES
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decrease peristalsis and LES pressure
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achalasia: peristalsis and LES pressure
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decrease peristalsis and increase LES pressure
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esophageal spasm: peristalsis and LES pressure
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peristalsis and LES pressure are both increased
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what is the Gl pH of each:
Stomach: Duodenum: Early Jejunum: Late Jejunum: ileum: |
Gl pH:
Stomach: pH = 1-2 Duodenum: pH = 3-4 Early Jejunum: pH= 5-6 Late Jejunum: pH = 7-8 ileum: pH> 9 |
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Stomach: function
Peristalsis: what are the cells in each area: Antrum: Body: |
Stomach: pH=1-2 => kills all bacteria (except H. pylori due to urease)
Peristalsis: begins in middle of stomach body Antrum: G cells (stim by high pH) = >gastrin Body: Parietal cells (stim by gastrin) => IF, H+ (via carbonic anhydrase) Body: Chief cells. Pepsinogen => Pepsin to digest protein via H+ |
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what are the 3 things that GI has for protection Against Acid·
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1) Goblet cells=> mucus
2) Alkaline tide=> bicarb by-product from parietal cells 3) PGs =>mucus release |
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how does NSAIDs and prednisone cause ulcers?
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decreases mucus thickness
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Stomach Diseases:Bezoar:
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mass of hair and vegetables => gastric antrum obstruction
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Chronic Gastritis: common presentation and 2 types
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upper GI bleeding, pain less w / antacids, vomiting
type A type B |
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how are Stress Ulcers formed?
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Parasympathetics: increase H+
Sympathetics: vasocontrict => decrease blood flow |
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Type A gastritis: fundus (3)
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• Anti-parietal cell Ab
• Atrophic gastritis • Adenocarcinoma risk |
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Type B gastritis
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in stomach anthrum (more benign)
• Related to meds, spicy foods, H. pylori |
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RUQ olive mass:
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Pyloric stenosis
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RLQ sausage mass:
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Intussuseption
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Hiatal hernia:
pathogenesis two types |
>>due to obesity (increased abdominal pressure) or restrictive lung disease
>>sliding and rolling haital hernia |
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Sliding type Hiatal hernia: define and Tx
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(90%): fundus slides from esophageal hiatus to thorax => sucks acid into thorax
• Tx: weight loss, H2 blockers, Nissen Fundoplication =>lose ability to belch |
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Rolling type Hiatal hernia: define and Tx
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(10%): fundus through diaphragm hole, strangulates bowel
"rolls through a hole" • Tx: surgery |
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Menetrier's disease:
describe Tx |
lose protein, thick rugal folds (stomach)
Tx: H2 blockers/ Anticholinergics |
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Peptic Ulcer Disease of the Gastric (antrum):
define and management |
protection barrier broken down
=> PPI's will relieve sx, but not fix problem |
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Peptic Ulcer Disease of the Gastric (antrum):
when is the pain worse |
Pain is worse during a meal (increased acid production)
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Peptic Ulcer Disease of the Gastric (antrum):
blood type and drug induced |
type A blood, NSAID or steroid induced
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Peptic Ulcer Disease of the Gastric (antrum):
associations and syndromes tx. and CI to tx |
• Pseudolymphoma: lymphocyte infiltration
• 20%: predisposed to cancer • Tx: Misoprostol (PG-E analog) => causes abortions |
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Peptic Ulcer Disease of the Gastric (antrum):
80% is due to and tx. |
80%: due to H. Pylori=> MALT lymphoma
(Tx: Antibiotics, not surgery!) |
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Duodenal (2nd part): etiology and pathogen
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>>too much acid; perforation=> pancreatitis, free air under diaphragm
>>100%: due to H. pylori=> urease (breaks down mucus) |
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Duodenal (2nd part): presentation
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Pain is worse: changing pattern of pain=> perforation, pain relieved by food
o 30 min after meal (takes that long to get to duodenum) o at night (no food to buffer acid at night) |
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Duodenal (2nd part):
blood type and risk of malignancy |
Type O blood; no risk of malignancy
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Duodenal (2nd part):
what is affected when it is perforated? |
Perforation: guiac +, erodes into gastroduodenal artery
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Duodenal (2nd part): how is it diagnosed
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• Dx: UGI series w / Gastrograffin (water-soluble contrast)
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Duodenal (2nd part): tx
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Tx: H2 blockers or PPI
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Helicobacter Pylori: test
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• Dx: Urease breath test (eat *C-urea => *CO2 in breath)
or fecal Ag test |
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Helicobacter Pylori: tx
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• General Tx: 2Abx + PPI (can add bismuth to suffocate bacteria)
• Tx: Omeprazole + Amoxicillin + Clarithromycin or • Tx: Ranitidine + Metronidazole+ Tetracycline+ Bismuth "4 drugs for 4wks" |
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Malabsorption DDx: (4)
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Pancreatitis
Celiac sprue Whipple's dz Lactase deficiency |
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Indications for Ulcer Surgery:
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"IHOP"
Intractable pain (meds don't help) hemorrage Obstruction from scarring perforation |
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Peptic Ulcer Surgery: Bilroth I:
define and complication |
antrectomy / hook stomach to duodenum => G cells hyperplasia => more ulcers
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Peptic Ulcer Surgery: Bilroth II:
6 complications and tx |
antrectomy + hook stomach to jejunum
1) Dumping syndrome: 2) Blind Pouch syndrome 3) Afferent Loop 4) Reactive hypoglycemia 5) Pernicious anemia 6) steatorrhea Tx: eat small high fat meals to slow it down (fat takes longest to digest) |
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Dumping syndrome: define and tx
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Biliroth II complication
palpitations after eating Tx: small fatty meals |
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Blind Pouch syndrome
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Biliroth II complication
1ft of duodenum has nothing causing bacterial overgrowth |
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Afferent Loop syndrome
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Biliroth II complication
eating causes cramps, vomit brown stuff |
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Reactive hypoglycemia
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Biliroth II complication
increased GIP => decrease glucose |
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other complications of Biliroth II and treatment
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Pernicious anemia and steatorrhea
Tx: eat small high fat meals to slow it down (fat takes longest to digest) |
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which of the peptic ulcer surgeries has the least symptoms?
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Selective Parietal Cell Vagotomy
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what causes microsteatosis:
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• Pregnancy
• Reye's syndrome • Acetaminophen O/D |
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Macrosteatosis:
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EtOH
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Pyloric Stenosis: pathogenesis, presentation (2), Dx and tx
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pathogenesis: thickening of the pyloric muscle
Presentations: projectile vomiting (3-4 wk old) and Olive sign: feel an "olive mass" in RUQ Dx: string (barium trickling down) Tx: pyloric myotomy (split the muscle fibers) |
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Most common cause of Small Bowel Obstruction:
what would be seen on an xray? |
adhesions (x-ray: multiple fluid levels)
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GI Hormones: Secretin
what stimulates it and function |
(stim by low pH) =>
Pancreas: secrete bicarb, tighten pyloric sphincter, and decreased gastric emptying |
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CCK
stimulation function |
(stim by fatty food) => squeeze Pancreas/Gallbladder => enzymes/bile
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Motilin
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peristalsis
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Motilin: what is primary and secondary peristalsis
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1°: Segmentation
2°: MMC (Migrating-Motor complex), squeezes every 90 mins |
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GIP
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enhances insulin stimulated by glucose => reactive hypoglycemia
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Enterokinase
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activates the first trypsin => activates everybody else
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SS
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inhibits secretin, motilin, CCK
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VIP
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inhibits secretin, motilin, CCK, relax SM
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Amylase: define and name the types of sugars
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breaks down carbs
• Lactose => glucose + galactose • Sucrose => glucose + fructose • Maltose: 2 glucoses w/ α-1,4 branching • α-dextrin: 2 glucoses w/ α -1,6 branching |
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where does Carb digestion occurs
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Mouth (amylase)
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where does protein digestion occurs
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Stomach (pepsin)
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where does fat digestion occurs
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Small intestine (lipase)
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what pathogen causes bloody Diarrhea?
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"CASES"
Campylobacter Amoeba (E. Histolytica) Shigella E. coli salmonella |
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where do most absorption occur?
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jejunum
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where is iron absorbed?
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duodenum
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where is fat absorbed?
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jejunum
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where is Vit A,D,E,K,B12, bile salts absorbed?
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ileum
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Small Intestine Diseases:
Osmotic Gap (equation) |
stool osmolarity - 2(stool Na +K) = <50
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Small Intestine Diseases:
Constipation |
< 3 bowel movements/ wk
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Small Intestine Diseases:
Diarrhea |
>200g/ day poop
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Osmotic diarrhea:
define MOA osmotic gap examples (3) |
watery diarrhea
• Cl- excretion causes H20 to leave • Increased osmotic gap • Ex: Celiac sprue, lactose intolerance, sorbitol |
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Secretory diarrhea:
what is it caused by? MOA osmotic gap examples |
MOA: Increased osmolarity =>increased water => dilutes Na =>can't pump
caused by laxatives, non-invasive microbes Normal osmotic gap Ex: ZE syndrome, carcinoid syndrome, cholera |
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Inflammatory diarrhea:
presentation and examples |
blood, pus in the stool
Ex: UC, Crohn's, dysentery |
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syndromes that will give non-infectious diarrhea? (4)
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Pellagra
Carcinoid VIPoma (watery diarrhea) Glucagonoma |
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diseases that can cause Steatorrhea: (5)
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• Cystic Fibrosis
• Celiac Sprue • Zollinger-Ellison • SSoma • Gallbladder cancer |
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DapsoneTx: (4)
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Dermatitis Herpetiformis
Leprosy Toxoplasmosis brown recluse spider bite |
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anti-body for celiac sprue and tx.
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Anti-gliadin Ab
Anti-reticulin AB Anti-endomysial Ab Tx: Gluten-free diet (no wheat, rye, barley) |
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Celiac Sprue: describe and its associations
allery, biopsy, surgery stones, malabsorption, tumor, deficiencies, autoimmune |
• wheat allergy, Jejunum, villous atrophy, unmasked by gastric bypass
• Oxalate stones, osmotic diarrhea, incr. T-cell lymphoma • Fe-deficiency anemia, dec. Vit D, vitiligo |
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Celiac Sprue: associated with what rash and tx.
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•Dermatitis hetpetiformis (Tx: Dapsone)
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Tropical Sprue: describe and tx
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ileum celiac sprue
(Tx: Erythromycin) |
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Mesenteric Ischemia: pathogenesis, Dx
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plugged blood supply, pain out of proportion to exam
Dx: Angiography, spiral CT |
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Liver: normal size and describe
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(normal= 6-12 cm ): fenestrated endothelial cells => free flow of serum across
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functions of the liver
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Functions:
• Synthesis of plasma proteins, bile acid, coagulation factors, lipids (Ito cells) • Stores vitamins • Detoxification |
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Cirrhosis Diet: early and late
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Early: high protein
Late: low protein (avoid encephalopathy) |
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2 Hep B Association:
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• polyarteritis Nodosa
• Membranous Glomerulonephritis |
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liver zones:
which one contains the P450 system |
Zone 1: Periportal
Zone 2: Intermediate Zone 3: Central - contains P450 system |
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what does this Liver Enzyme indicate:
PT: |
acute liver injury
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what 4 things does this Liver Enzyme indicate:
LDH: |
hemolysis, MI, PE, tumor
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what does this Liver Enzyme indicate:
ALT: |
viral hepatitis or MI
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what does this Liver Enzyme indicate:
AST: |
alcoholic hepatitis "A Scotch & Tonic"
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what does this Liver Enzyme indicate:
GGT: |
alcoholic hepatitis
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what does this Liver Enzyme indicate:
Alkaline Phosphatase: |
made by bone, liver, placenta
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what does this Liver Enzyme indicate:
Bilirubin: |
increased production, decreased excretion, or the liver ain't doing its job ...
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Hep C Association: (3)
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• Lichen planus
• Cryoglobulinemia • porphyria cutanea tarda |
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Total Bilirubin:
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direct (liver) + Indirect (hemolysis)
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what is Child-Pugh:
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prognosis of cirrhosis of the liver
Labs: Albumin, Bilirubin, INR Exam: .Ascites, Encephalopathy |
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1° Biliary Cirrhosis: define and presentation
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autoimmune destruction of bile ductules in liver,
Xanthelasma, no jaundice, pruritis at night |
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1° Biliary Cirrhosis: ab and tx (4)
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• Anti-mitochondrial Ab
• Tx: Cholestyramine, Ursodeoxycholic acid, Phenobarbital, Terfenadine |
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1° Sclerosing Cholangitis:
define test and what would be seen associations |
bile duct inflammation
• US "beading", "onion skinning" • Assoc w / Ulcerative Colitis |
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1° Sclerosing Cholangitis: staging and diagnosis
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• Staging: liver biopsy (bad prognosis if Alk Phos > 125)
• Diagnosis: ERCP or PTC |
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1° Sclerosing Cholangitis: tx
|
• Tx: Cholestyramine, Ursodeoxycholic acid (Sjogrens, dark skin, pruritis), Abx
|
|
|
Ascending Cholangitis: def and tx
|
common duct stone gets infected=> dilated ducts w/ pus
• Tx: Emergency decompression |
|
|
Budd-Chiari: define and levels of ascites
|
hepatic vein thrombosis (poor prognosis) ~> fetor hepaticus (NH4 breath)
• increased Ascitic protein |
|
|
Cirrhosis: define and Sx
|
hepatocyte destruction; regeneration causes fibrosis
Sx: jaundice, fluid wave, asterixis |
|
|
Alcoholic cirrhois Sx and Dx
|
spider angioma, palmar erythema, Dupuytren's contractions, gynecomastia
Dx: high bilirubin |
|
|
Albumin (serum -ascites):
<1.1 >1.1 |
Albumin (serum -ascites):
<1.1: TB, tumor, inflammation >1.1 portal HTN |
|
|
Ascites Tx:
|
1) Paracentesis (replace albumin)
2) Spironolactone |
|
|
name 7 diseases that can cause Cirrhosis Etiology:
|
1) EtOH:
2) Hep B,C: 3) Biliary: xanthomas, xanthelasmas, anti-mitochondrial Ab 4) Hemochromatosis 5) Wilson's dz 6) alpha 1 anti-trypsin 7) CHF |
|
|
EtOH
|
AST > ALT "Scotch and Tonic"
|
|
|
Hep B,C
|
ALT > AST
|
|
|
Biliary:
|
xanthomas, xanthelasmas, anti-mitochondrial Ab
|
|
|
Hemochromatosis
|
bronze skin, DM, arthritis
|
|
|
Wilson's dz
|
copper deposits, KF rings, decrease ceruloplasmin
|
|
|
α1-AT deficiency
|
~> emphysema
|
|
|
CHF
|
nutmeg liver
|
|
|
Cirrhosis Tx:
|
Glucocorticoids
colchicine (decrease inflammation) Spironolactone (decrease ascites) |
|
|
Hepatic Adenoma: define and tx
|
due to oral contraceptives
Tx: embolize/resection |
|
|
Hepatic Encephalopathy:
presentation |
confusion ~> coma, asterixis, fetor hepaticus
|
|
|
tx: for hepatic encephalopathy
|
1) protein-free diet
2) lactulose (traps NH3 ~> NH+~> in colon ~> enema 3) Neomycin (kills NH3-producing bacteria) |
|
|
Hep A:
how is it acquired who are most risk |
Fecal-oral (Pregnant, Asians, Shellfish)
|
|
|
Hep B:
how is it acquired type of virus |
Needles (DNA virus, Mom ~> baby)
|
|
|
Hep C:
how is it acquired complications |
Blood (2° Hemosiderosis)
|
|
|
what is Hepatorenal Syndrome?
presentation (4) precipitated by (5) effect on kidneys tx |
pt w / liver dz ~> liver toxins ~> renal failure
• Sx: azotemia (⇧BUN/Cr), Na retention, oliguria (urine Na <10), hypotension • Precipitated by diuresis, paracentesis, dye, GI bleeding, aminoglycosides • Kidneys are still viable for transplantation • Tx: volume |
|
|
what is the effect of furosemide to patients with cirrhosis and tx.
|
Furosemide to cirrhosis pts ~> no pee for 3 days
(Tx: Stop diuretic, then volume load) |
|
|
Portal Hypertension:
describe causes (3) general tx tx for bleeding |
⇧portal vascular resistance (>12mm Hg)
• Caused by cirrhosis, portal vein obstruction, hepatic vein thrombosis • Tx: Propanolol, TIPS (hook up hepatic and portal veins) • Tx: Vasopressin or Octreotide for bleeding |
|
|
AVM Complications and tx
|
Tx: Coils to clot around
• Sequester platelets ~> bleed • Rupture~> bleed • Sequester blood ~> heart failure |
|
|
Spontaneous Bacterial Peritonitis:
presentation who is at increased risk Dx Tx |
• Fever, chills, rebound
tenderness, altered mental status • inc. Risk with nephrotic syndrome • Dx: Paracentesis has >250 PMNs/μl • Tx: Cefotaxime +Albumin (for renal perfusion pressure) |
|
|
Gall Bladder: what leads to jaundice
what are the tx for • Bilary tract pain: • Diarrhea s/p cholecystectomy (due to bile salts): |
Bilirubin >2 =>yellow eyes
• Bilary tract pain Tx: Demerol (does not ⇧CCK.) • Diarrhea s/ p cholecystectomy (due to bile salts) Tx: Cholestyramine |
|
|
Ascending Cholangitis: define and what is charcot's triad and Reynald's pentad.
|
infection of obstructed CBD
>>Charcot's Triad (RUQ pain, fever, jaundice) >>Reynald's Pentad (ShocK, altered mental status) => 50% mortality |
|
|
Biliary Colic:
|
stone stuck in cystic duct or CBD
|
|
|
what bug can cause Cholangiocarcinoma:
|
Clinorchis Sinensis in biliary tract
|
|
|
Cholecystitis:
presentation general tx management for acalculous cholecystitis |
inflammation of galbladder
Murphy's sign (press gallbladder => pt stops breathing) • Tx: Ampicillin + Sulbactam + Gentamycin • Tx: urgent transhepatic drainage tube (if acalulous) |
|
|
Cholelithiasis:
|
gallstone
RUQ colic, US shadow sign |
|
|
Choledocholithiasis: presention and tx
|
gallstone obstructs bile duct
• Tx: emergent ERCP |
|
|
Cholestasis:
|
bile can't get from liver to duodenum
• Pruritis, ⇧ alkaline phosphatase |
|
|
Gallstone ileus
|
small bowel obstruction caused by gallstone erosion into duodenum
|
|
|
Klatskin tumor:
|
R/L hepatic junction tumor
|
|
|
Mirizzi's fistula:
|
compression of CBD by an impacted cystic duct
|
|
|
DDX: Post-Cholecystectomy Pain:
|
• Functional pain
• Sphincter of Oddi contract. • Common bile duct obstruct |
|
|
Liver's role in the bile cholesterol relationship
|
conjugates bile acid-albumin w/ glucuronyl transferase
(add Gly/taurin ) => "bile salts" |
|
|
MP role in the bile cholesterol relationship
|
eat old RBC ->break down heme-> biliverdin -> bilirubin-> bile acids
|
|
|
Small intestine role in the bile cholesterol relationship
|
deconjugates bile salt bound to cholesterol
• 80% reabsorbed in ileum (urobilinogen => yellow pee) ~>kidney ~>recycle bile salts ~> liver • 20% excreted (stercobilinogen=> brown poop) |
|
|
Gall bladder role in the bile cholesterol relationship
what are the 2 types of bile? describe each |
stimulated by CCK to release bile
• Conjugated: "direct" (water soluble) • Unconjugated: "indirect" (fat soluble) |
|
|
when and how is the Bile salt made? 3 steps
|
occurs in between meals
1) Forms micelle: Lecithin+ Fat+ Bile salts 2) Lipase chops it all up = > • short chain FA - have lacteals ("lymphatics" for fats), CM • medium chain FA- transported by albumin to liver (tx steatorrhea in infants) • long chain FA - have lacteals, CM |
|
|
what are Gallstones?
where do they get stuck? |
high cholesterol, low bile (most get stuck in the cystic duct)
|
|
|
most common gallstones
most at risk? |
80% gallstones: made of Cholesterol => can't see it on x-ray
"Female, Fat, 40, Futile, Flatulent" |
|
|
the 20% of gallstone are made of what?
when do you see this? management? |
20% gallstones: made of Ca-bilirubinate
(w/ anemia) = > see w/ x-ray |
|
|
Brown CBD stones:
Dx tx |
Dx: Asian, infection
Tx: Dissolve w/ Ursodeoxycholic acid or do cholecystectomy |
|
|
Black CBD stones
Tx: Dx: |
Dx: Gallbladder stones due to cirrhosis or hemolysis
Tx:Dissolve w/ Ursodeoxycholic acid or do cholecystectomy |
|
|
Gallstone tests: what would you see on these test?
Labs: 2) X-rays: 3) US: 4) HIDA scan: |
1) Labs: ⇧alk phos, ⇧direct bilirubin
2) X-rays: see 20% of gallstones 3) US: see obstruction 4) HIDA scan: inject dye into veins ⇨ cystic duct ⇨ dye can't enter gall bladder ⇨ obstruction |
|
|
Cholesterol Diseases:
Hyperlipidemias:Type 1: |
Bad Liver LL (CM)
|
|
|
Cholesterol Diseases:
Hyperlipidemias:Type 2a: |
Bad LDL or B-100 receptors:
trapped in ER (LDL only) <~ Familial |
|
|
which of the Hyperlipidemias is familial and has a ( + ) thompson test?
|
Type 2a: (+) Thompson test due to Achilles tendon rupture. (can't stand on toes)
|
|
|
hyperlipedemia Type 2b
|
Less LDL/VLDL receptors
(LDL/VLDL) downregulation of receptors due to obesity |
|
|
hyperlipedemia Type 3:
|
Bad Apo E (IDL/VLDL)
|
|
|
hyperlipedemia Type 4:
|
Bad Adipose LL (VLDL only)
|
|
|
hyperlipedemia Type 5:
|
Bad C2 (VLDL/ CM)
b/ c C2 stimulates LL.. |
|
|
Xanthoma
|
cholesterol (elbow)
|
|
|
Xanthelasma
|
TG (under eye)
|
|
|
Hypercholesterolemia
|
type 2 (LDL carries cholesterol)
|
|
|
HyperTGemia:
what do they carry? |
not type 2 (they carry TG)
|
|
|
A-betalipoproteinemia:
|
no B48 tags => no CM
|
|
|
hyperlipedemia type 3
|
Dysbetalipoproteinemia
|
|
|
what are the uncojugated bilirubin diseases?
|
Its an enzyme problem
Crigler-Najjar (AR): Type I and II Gilbert's |
|
|
Crigler-Najjar (AR): type I
|
unconjugated bilirubin, usually in infants "Conjugation defect"
Type I- complete glucuronyl transferase deficiency=> kernicterus |
|
|
Crigler-Najjar (AR): Type II and Tx
|
partial glucuronyl transferase deficiency
(Tx: Phenobarbital) |
|
|
Gilbert's syndrome
|
unconjugated hyperbilirubinemia,
glucuronyl transferase is saturated => stress unconjug bilirubin tx: hydration |
|
|
what are the Conjugated hyperbilirubinemia?
|
It is a transport problem
Rotor' s Dubin-Johnson Common Bile Duct obstruction Gallstone ileus |
|
|
Rotor' s syndrome
|
bad bilirubin storage=> conjugated bilirubin
"Release defecit" |
|
|
Dubin-Johnson
|
bad bilirubin excretion=> conjugated bilirubin, black liver "Departure defect"
|
|
|
Common Bile Duct obstruction
levels of conjugated bilirubin, alk phos presentation (2) |
increased conjugated bilirubin, alk phos,
jaundice, itching |
|
|
3 most common bile duct obstruction in a Newborn:
|
Choledochal cyst
biliary atresia annular pancreas (ventral bud went wrong way) |
|
|
Gallstone ileus:
type of bilirubenemia what happend |
conjugated bilirubinimia.
gallstone eroded through gallbladder wall and fell into duodenum |
|
|
most common cause of bile duct obstruction in Kid:
|
gallstones
|
|
|
most common cause of bile duct obstruction in the elderly
|
pancreatic cancer
|
|
|
what is the spleen? what are the red and white pulp?
|
Spleen: the blood's lymph node, easily crushed
White pulp:T and B cells Red pulp: venous system |
|
|
management of splenectomy
|
Spleen removal=> ⇧encapsulated infections=> pnemnonia vaccine
|
|
|
Pancreas function
|
secretes enzymes
|
|
|
what do most pancreatic Diseases do?
|
autodigestion by proteolytic enzymes causes inflammation
|
|
|
Annular pancreas
|
=> ventral pancreatic bud encircles the 2nd part of duodenum, double bubble sign
|
|
|
Phlegmon: define and complicaitons
|
=> bowel wraps around inflamed pancreas to
prevent inflamm. from spreading => ileus |
|
|
describe pancreatitis
|
severe mid-epigastric pain boring to the back
malabsorption DM |
|
|
common cause of pancreatitis in children?
|
Tauma, Infection and genetic diseases (Coxsackie B, EBV, CMV, cystic fibrosis)
|
|
|
most common cause of pancreatitis in Adults: Tx:
|
Chronic EtOH, Acute gallstones
(Tx: hook pancreatic duct to jejunum) |
|
|
Default Colors:
Stool Urine what compound adds color to it? |
Default Colors:
bilirubin adds normal color Stool: clay Urine: tea |
|
|
Cullen's sign:
|
Hemorrhagic Pancreatitis:
bleeding around umbilicus |
|
|
Turner's sign:
|
bleeding into flank. Hemorrhagic Pancreatitis:
|
|
|
Pancreatitis Etiology:
|
"PANCREATITIS"
• Peptic ulcer perforation • Alcohol • Neoplasm • Cholelithiasis • Renal disease • ERCP • Anorexia • Trauma • Infection: CMV, TB • Toxins: HIV drugs, ACE-I, Salicyliates Incinerations (burns) • Scorpion bite |
|
|
Pancreatitis Tests:
|
• Amylase - sensitive, breaks down carbs (also in mouth)
• Lipase - specific, breaks down TG's |
|
|
Ranson's Critera (at presentation):
|
"GA LAW" => poor prognosis
• WBC: > 16K/ flL (infection) • Age: >55 (usually have multiple illnesses) • Glucose: >200 mg/ dL (islet cells are fried) • LDH: >350 IU/L (cell death) • AST: >250 IU/L (cell death) |
|
|
which part of the bowel has the highest risk of ischemic bowel and why?
|
Splenic Flexure= "Watershed area" little blood supply => ischemic bowel
SMA stops before watershed area •IMA starts right after watershed area |
|
|
Ranson's Criteria (at 48 hrs):
|
"C-HOBBS"
• Ca: <8 mg/dL (saponification) • Hct: drops >10% (hemorrhage into pancreas) • p02: <60mm Hg = >fluid and protein leak out => ARDS (restrictive lung disease) • Base deficit : >4mEq/L (diarrhea=> pancreatic enzymes are dead) • BUN: increase >5mg/dL (⇩renal blood flow) • Sequester >6 L fluid => 3rd spacing (bowel swollen with water) |
|
|
Ranson's criteria percent mortality rate:
|
3 ⇨ 15% mortality
5 ⇨ 40% mortality 7 ⇨ 100% mortality |
|
|
signs of appendicitis:
|
• Psoas sign
• Rovsing sign • Obturator sign • Pain at McBurney's point |
|
|
Pancreatitis Tx:
|
• NPO (let the pancreas rest)
• NG tube (decompress air) • IV fluids (NS) • Mepiridine (pain relief, will not ⇧CCK) • Imipenum • Ampicillin+ Gentamycin +Metronidazole (if necrosis) |
|
|
Pseudocyst:
|
fluid lined with granulation tissue
|
|
|
Ruptured Pseudocyst:
|
pancreatitis + abdominal mass with bruit
|
|
|
Laplace's Law:
|
Tension = Pr
|
|
|
Lower GI Phase: what are retroperoteneally located
|
Retroperoteneal ⇨ ascending/ descending colon
|
|
|
Jejunum: on absorption or resorption
|
highest absorptive capacity
|
|
|
Ascending colon: on absorption or resorption
|
highest resorptive capacity
|
|
|
Colon:
function valves peristalsis |
Secretes K+
all valves = α1 receptors 1° peristalsis =haustration 2° peristalsis = mass involvement |
|
|
Cecum:
|
large pocket, no obstruction, most perforation
|
|
|
Ascending colon: function and hormone
|
last chance to reabsorb fluid (most Na/ K pumps controlled by Aldo)
|
|
|
Sigmoid colon:
|
stool waits to make its journey into the outside world => 90° angle of rectum to sigmoid kept by pubococcigious muscle~> keeps feces in sigmoid
|
|
|
how do we defecation
|
completely parasympathetic
1) Relax pubococcigious muscle (PC) muscle~> gravity starts moving stool down into rectum from sigmoid 2) Internal anal sphincter relaxes <~ pelvic nerve 3) Relax pelvic floor mm. (spread by specific angle to relax mm. = "toilet seat") 4) External anal sphincter contracts (voluntary control) <~ pudendal nerve |
|
|
Currant-jelly sputum:
|
Klebsiella
|
|
|
Currant-jelly stool:
|
Intussusception
|
|
|
Colon Diseases usually occurs where in adults?kids?
what stain fat? |
PAS stains fat
Adults: usually occurs in sigmoid Kids: usually occurs in ileum |
|
|
Appendicitis:
what is it caused by? presentation |
infection due to fecalith in appendix, periumbilical pain radiated to RLQ
|
|
|
Ruptured Appendicitis
presentation complication |
pain relieved, peritonitis, pyelophlebitis
(infxn of portal vein thrombosis) |
|
|
Diverticulitis: presentation, management
|
hurts ~> do CT (colonoscopy will perforate)
|
|
|
Diverticulosis: etiology
|
bleeds (fecoliths erode into arteries)
|
|
|
Intussusception:
common in what age presentation (3) Tx |
3mo -6y/o, currant-jelly stool, stacked coin enema, RLQ sausage mass
Tx: barium enema (risk of perforation) |
|
|
Volvulus:
what would you see on x-ray? barium swallow? presentation? tx? |
X-ray abrupt cutoff in bowel air
Barium swallow birds-beak sign sudden pain Tx: sigmoidoscopy with rectal tube |
|
|
what kind of polyp has a Colon CA Risk:
|
• Villous
• Sessile • >2.5 cm |
|
|
what are Adenomatous Polyps?
give 8 examples? |
Adenomatous Polyps: pre-malignant (adults)
Tubular: Villous: Gardner's syndrome hyperplastic polyps Peutz-Jegher syndrome Turcot's syndrome: Familial polyposis: Juvenile polyposis: |
|
|
Tubular:
|
stick out
|
|
|
Villous
|
flat, secrete K+ into stool
|
|
|
Gardner's syndrome:
|
familial polyposis w/ bone tumors
|
|
|
Turcot's syndrome
|
familial polyposis w / brain tumors
|
|
|
Familial polyposis:
risk of colon cancer pathogenesis management |
100% risk of colon cancer
dinucleotide repeats 5 y/o colonoscopy q yr |
|
|
Juvenile polyposis:
|
<10 y/o polyps+ intussusception
|
|
|
Hyperplastic Polyps
|
Benign (kids)
|
|
|
Hamartoma
|
hyperplastic
|
|
|
Peutz-Jegher syndrome
presentation risk for what cancers colon polyps |
hyperpigmented mucosa ⇨dark gums/vagina
• CA of breasts/ ovaries/lymphatics, benign colon polyps (no colon cancer) |
|
|
types of Familial Colon Cancer:
|
1) FAP:
2) HNPCC: |
|
|
FAP
gene location of tumors risk of colon cancer |
APC gene
left-side tumors 100% risk of colon CA |
|
|
HNPCC
gene location of tumors |
Mismatch repair gene
right-side tumors dinucleotide repeat microsattelites |
|
|
Irritable Bowel Syndrome:
presentation tx |
Alternating diarrhea and constipation, abdominal distension
• Pain relief with bowel movement, sense of incomplete evacuation, mucus in stool • Tx: lower stress, high fiber diet |
|
|
Ischemic Colitis:
presentation etiology complication |
sudden pain w / bloody diarrhea
• occurs at watershed area • Throw clot to SMA=> A Fib (ischemic tissue depolarizes) • Can lead to mesenteric ischemia: pain out of proportion to exam, life-threatening |
|
|
what is ogilvie's:
define complication presentation tx |
pseudo-obstruction
• If cecum >12cm ~>perforation • No stool in rectal vault, no obstruction on colonoscopy • Tx: Neostigmine |
|
|
Pseudomembranous Colitis:
etiology sx what would be seen in colon mucosa? xray complication |
overgrowth of C. diificile
• Sx: diarrhea, cramps, fever • Yellow plaques on colon mucosa • Can cause toxic megacolon = intense diarrhea, "thumbprint" on an xray |
|
|
Causes of Pseudomembranous Colitis:
|
1) cephalosporins
2) Clindamycin 3) Ampicillin 4) Amoxicillin |
|
|
which of the following antibiotic is prescribe
more that can cause pseudomembrenous collitis? |
cephalosporins
|
|
|
Tx: for pseudomembrenous collitis
⇨First Episode: ⇨Repeat Episode: ⇨Pregnant/ Kids: ⇨Resistant: |
⇨First Episode: Metronidazole (PO)
⇨Repeat Episode: repeat Metronidazole (PO) ⇨Pregnant/ Kids: Vancomycin (PO) ⇨Resistant: Vancomycin (enema) or Cholestyramine |
|
|
what is a Spastic colon? test and tx
|
intermittent severe cramps
• Test: inject marijuana into colon=> watch it spasm • Tx: muscle relaxants |
|
|
Whipple's disease:
etiology presentation tx |
T. whippleii destroy GI tract, then spread
• Middle age male, arthralgia, malabsorption, PAS+ MP • Tx: Bactrim |
|
|
Upper GI Obstruction:
what would be seen on an x-ray? heard on auscultation? |
x.- ray shows air/fluid levels
high pitched bowel sounds |
|
|
most common cause of upper GI Obstruction in newborns?
|
Atresias
|
|
|
most common cause of upper GI Obstruction in 4 mo ?
|
Achalasia
|
|
|
most common cause of upper GI Obstruction in 6mo-2y/o?
|
Intussusception, Hernias
|
|
|
most common cause of upper GI Obstruction in >2y/o?
|
Adhesions (from old blood)
|
|
|
what are the colon CA Risk Factors?
|
• Low fiber diet
• High fat diet (free radicals) • Polyps |
|
|
what is the most common Lower GI Obstruction in new borns?
|
Hirschsprung's
|
|
|
what is the top 4 most common Lower GI Obstruction in adults? (in order)
|
1) Adhesions
2) obstipation 3) Diverticulitis 4) Cancer |
|
|
Dx management of diverticulitis?
|
do CT. (not colonoscopy) due to rupture)
|
|
|
colon cancer:
presentation of stool xray tumor marker right side cc presentation vs. leftside cc presentation? |
Cancer => pencil thin stool
"apple core" x-ray CEA Right: present with anemia Left: obstruction |
|
|
GI Bleeds: black stool
|
upper
|
|
|
GI Bleeds: red stool
|
lower
|
|
|
presentation of an upper GI bleed
|
coffee-ground hematemesis, above ligament of Treitz, tarry stool
|
|
|
most common cause of upper GI bleed in newborns?management.
|
Swallowed maternal blood on the way out
=> do Apt test for fetal Hb (+=>baby's blood) |
|
|
most common cause of upper GI bleed in kids? and management
|
Nosepicking (nosebleed ⇨ GI ⇨vomit up)
Tx. Phenylephrine nasal spray |
|
|
2 most common cause of upper GI bleed in adult patients:
5 DDX of upper GI bleed |
Adults: Gastritis, PUD
DDx: "mallory's Vices Gave An Ulcer" • Mallory-Weiss tear • Variceal bleeding • Gastritis • AV malformation • Ulcer (peptic) |
|
|
presentation of Lower GI Bleed:
|
hematochezia
|
|
|
most common cause Lower GI Bleed of newborns and tx
|
Anal fissure from hard stool
(Tx: stool softeners) |
|
|
most common cause Lower GI Bleed of kids
|
hyperplastic polyps
|
|
|
3 most common cause Lower GI Bleed of adults >40:
name 6 DDX for lower GI Bleed in >40: |
Angiodysplasia (varicose vein), Diverticulosis, Cancer
DDx: "Can U Cure Aunt Di's Hemorrhoids?" • Colitis (Ulcerative) • Upper GI bleed • Cancer • Angiodysplasia • Diverticulosis • Hemorrhoids |
|
|
DDx: Upper+ Lower GI Bleed:
|
Duodenal-Aortic Fistula
|
|
|
Hemorrhoids Internal:
presentation tx |
no nerves fibers => no pain
(Tx: band and allow to necrose) |
|
|
Hemorrhoids: External:
presentation tx |
pain=> thrombose, ulcerate
(Tx: topical anesthetic, Sitz bath, surgical excision) |
|
|
Massive GI bleed Kids:
describe, rule of 2's test |
Meckel's diverticulum- remnant of vitelline duct
• 2" long, 2ft from IC valve (on ileum side) • 2% population • 2 y/o (peaks) • 2 types of mucosa= gastric and pancreatic Test.· Tagged RBC scan ⇨ where blood is pooling or 99Tc pertechnetate scan |
|
|
Massive GI bleed Adults: etiology, and test
|
Peptic ulcer disease (gastrin secreting)
Test.· Tagged RBC scan ⇨ where blood is pooling or 99Tc pertechnetate scan: |
|
|
Abdominal Pain Management:
|
1) NPO
2) NG tube 3) IVF 4) Meperidine 5) X-ray (abdomen) 6) CT (abdomen |
|
|
Most Common Sources of Abdominal Pain in the RUQ:
|
liver and gallbladder
|
|
|
Most Common Sources of Abdominal Pain LUQ
|
spleen
|
|
|
Most Common Sources of Abdominal Pain between the RUQ and LUQ
|
esophagus, pancreas, aorta
|
|
|
Most Common Sources of Abdominal Pain RLQ
|
appendix, kidney, ovary
|
|
|
Most Common Sources of Abdominal Pain LLQ
|
diverticulitis, kidney, ovary
|
|
|
Peristalsis Review Esophagus:
1⁰ peristalsis 2° peristalsis |
1⁰ peristalsis = CN10 (IP3/DAG)
2° peristalsis =Auerbach's plexus (VIP) |
|
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Peristalsis Review Small intestine:
1° peristalsis 2° peristalsis |
1° peristalsis = segmentation
2° peristalsis = MMC |
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Peristalsis Review Colon:
1° peristalsis 2° peristalsis |
1° peristalsis = haustration
2° peristalsis = mass movement |
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what can High Cholesterol lead to?
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atherosclerosis
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what can High TG lead to?
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pancreatitis
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hyperlipedimia criteria
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Hyperlipidema
Total cholesterol: >240 (or >200 + 1 risk factor: male, HTN, etc.) LDL:>130 (or >100 + 1 risk factor) HDL: <40. TG: >500. |
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treatment for hyperlipedemia
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Tx: Screen=Total/HDL cholesterol
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how do we raise HDL?
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• Weight loss, Exercise
• Moderate EtOH (1 glass whiskey or 1 glass wine or 2 beers/ day) |
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HMG-CoA Reductase Inhibitors
when are they most effective effects on HDL and LDL |
most active after 8pm (⇧HDL, ⇩LDL)
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name some of the statins
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• Lovastatin
• Simvastatin • Atorvastatin |
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Provastatin
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the statin that is most water soluble ''pee it out"
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Cerivastatin
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the statin that got taken off market b/c of rhabdomyolysis
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Valdestatin
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the statin that got taken off market b/c of rhabdomyolysis
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management of statins
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fat soluble, rhabdomyolysis, hepatitis ⇨ check liver enzymes every 3mo.
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Bile Acid-Binding Resins:
MOA what does it decrease? |
force liver to take out more cholesterol to make bile
(decreases LDL) |
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Bile Acid-Binding Resins: drugs
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Cholestyramine
Colestipol |
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which Bile Acid-Binding Resins drugs decreases
absorption of lipid soluble drugs? when is this contraindicated? |
Cholestyramine, therefore its bad if pt is on multiple meds
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Niacin MOA
antidote to avoid flushing decreases what factors |
inhibits VLDL prod
decreases Lipoprotein A use ASA to avoid flushing (⇩LDL) |
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what are the fibrates and its MOA?
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Fibrates: enhances LL (⇩TG)
• Clofibrate • gemfibrozil |
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which of the fibrates is associated with colon cancer?
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Clofibrate
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Tums: Ca Carbonate
class SE (2) |
antacids that can cause acid output (gastrin)
diarrhea |
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Rolaids: Al-OH
class SE |
antacids that can =>constipation
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Milk of magnesia: Mg-OH
class SE |
antacids that can =>diarrhea
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Gaviscon:
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antiacids: Al-OH and Mg carbonate
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what are the H2 blockers and MOA , SE?
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block H2 receptors on parietal cells => bloating, cramps (need H+ to digest food)
• Cimetidine "Tagamet" • Ranitidine "Zantac" • Famotidine "Pepcid" • Nizatidine "Axid" |
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Cimetidine "Tagamet"
class SE |
H2 blocker, inhibits p450 ~>gynecomastia, psychosis, ⇩CrCl
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what are Proton Pump Inhibitors MOA
SE |
reversibly inhibit H/K pump in parietal cells = >bloating, cramps
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name all PPP
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omeprazole "Prilosec II
Esomeprazole "Nexium" Lansoprazole "Prevacid" Pantoprazole "Protonix" |
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what are the Mucosal Protective Agents:
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• Misoprostol "Cytotec"
• Sucralfate "Carafate" • Bismuth "Pepto-Bismol" |
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management of miseprostol "cytotec"
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Mucosal Protective Agents that induces abortion
=> do pregnancy test in all females |
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management of Sucralfate "Carafate"
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Mucosal Protective Agents: don't take w/ antacids or acid blockers (needs acid to dissolve)
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management of Bismuth "Pepto-Bismol"
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Mucosal Protective Agents: black tongue, black stool, suffocates H. Pylori
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what are the anti-emetics:
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• Diphenhydramine (H1 anti-histamine)
• Odansetron (5-HT inhibitor) • dronabinol Prochlorperazine (DAr blocker in gut) |
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which anti-ematics used in cancer patients?
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Odansetron (5-HT inhibitor)
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what are the anti-diarrheal drugs?
what are the prokinetic drugs? |
• Loperamide "Imodium"
• Diphenoxylate "Lomotil" Prokinetics: Cisapride Metoclopramide Psyllium "Metamucil" docusate sodium "Colace |
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which of the anti-emetics has Marijuana-like -increases appetite in cancer pts?
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Dronabinol
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which of the anti-emetics is a DAr blocker in gut
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Prochlorperazine
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which of the prokinetics is a 5-HT agonist if + Erythromycin=> Torsade de Pointes)
and also causes diarrhea? |
Cisapride
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which of the prokinetics is a DAr blocker in chemotrigger zone=> Parkinson's symptoms
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Metoclopramide
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which of the prokinetics⇧stool bulk, gas, bloating, non absorbable sugar
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Psyllium "Metamucil" -
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which of the prokinetics mixes stool fat and water?
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docusate sodium "Colace"
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what are the 3 effects of Opiates:
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1) Muscle relaxation
2) CNS depressant 3) Analgesia |
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Opiates listed in the order of potency
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Fentanyl
Buprenorphine Heroin Morphine Methadone Pentazocine Hydrocodone "Vicodin" - Meperidine "Demerol" Codeine Dextromethorphan Naltrexone Naloxone Loperamide |
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which of the opiates is the most potent?
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Fentanyl - patch, most potent
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which of the opiates is the most low dependence?
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Buprenorphine
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which of the opiates is the most abused on streets?
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Heroin
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which of the opiates is the most common in hospital for severe pain,⇧ intracranial pressure
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Morphine
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which of the opiates is a heroin addict recovery tx and crosses BBB
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Methadone
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which of the opiates is the opioid agonist and antagonist that is not used in heroin addicts b/c it causes nightmares?
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Pentazocine
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which of the opiates causes moderate pain relief?
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Hydrocodone "Vicodin"
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which of the opiates is used for tx of abdominal pain and why?
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Meperidine "Demerol"
does not contract Sphincter of Oddi |
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which of the opiates is the most used as a anti-tussive, mild pain relief?
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Codeine
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which of the opiates is is used as an anti-tussive (the "DM" in cold meds)
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Dextromethorphan
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which of the opiates is an opiate antagonist, oral?
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Naltrexone
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which of the opiates is used for fast opioid antagonist, IV
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Naloxone "the shorter name acts faster'
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which of the opiates is used for cough suppression?
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Loperamide
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alias for Crohn's
Ulcerative Colitis: how often |
Crohn's: "regional enteritis"
Ulcerative Colitis: 6BM/ day x 6mo |
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Crohn's vs. Ulcerative Colitis: symptoms
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crohn's Sx: weight loss, cramps, melena
UC Sx: bloody diarrhea, rectal pain (tenesmus) |
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Crohn's vs. Ulcerative Colitis: layers of mucosa involved
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crohn's: Transmural (all 3 layers)
UC: Mucosal only |
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Crohn's vs. Ulcerative Colitis: biopsy
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CR: Non-caseating granulomas ⇨ cobblestones
UC: Pseudopolyps (2 ulcers next to each other) |
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Crohn's vs. Ulcerative Colitis: lesions
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CR: Skip lesions
UC: Continuous lesions |
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Crohn's vs. Ulcerative Colitis: location
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CR: Starts in ileum ⇨ distal (involves anus)
UC: Starts in rectum ⇨ proximal (not involve anus) |
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Crohn's vs. Ulcerative Colitis: how it looks like
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CR: Creeping Fat (due to granulomas)
UC: Lead Pipe colon |
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Crohn's vs. Ulcerative Colitis: color of stools
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CR: Melena = dark stools
UC: Hematochezia =bright red blood |
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Crohn's vs. Ulcerative Colitis: colon cancer RF and HLA association
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CR: 3% risk for colon CA, HLA-DR1
UC: 10% risk for colon CA, HLA-B27, HLA-DR2 |
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Crohn's vs. Ulcerative Colitis: give 4 complications of Crohn's and 3 for UC
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CR: Fistulas: do CT scan
• Enterocutaneous: G I to skin • Enteroenteral: GI to GI • Enterovesicular: GI to bladder "pneumaturia" • Enteroaortic: bleed through bowel, die UC: 1⁰ Sclerosing Cholangitis, Toxic Megacolon Pyoderma Gangrenosum (skin), |
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Crohn's vs. Ulcerative Colitis: associated syndromes
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CR: Associated w / uveitis, amyloidosis, mouth ulcers,
steatorrhea, kidney stones, oxalate stones UC: Associated w / ankylosing spondylitis, cholangitis |
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Crohn's vs. Ulcerative Colitis: treatments
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CR:Tx: Prednisone, Mercaptopurine, Infliximab
UC: ) Mesalamine "5-ASA" or Sulfasalazine 2) Steroids 3) Azathioprine or 6 mercaptopurine 4) Infliximab 5) Cyclosporin A |
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which of the inflammatory bowel diseases
can smoking cessation lead to flare ups? |
Ulcerative colitis
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management of fistulas in crohn's disease?
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do a CT scan
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ulcerative colitis associated antibody
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p-anca
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