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21 Cards in this Set

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  • Back
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GERD Gastroesophageal Reflux Disease

- reflux of gastric juice due to incompetent LES

- heartburn, belching, gagging, cough, nausea

- esophageal hiatus hernia

- Barrett esophagus (cellular change due to chronic inflammation)

- radiography w swallowed barium

- H2 antagonists: cimetidine, ranitidine, famotidine, nizatidine

- proton pump inhibitors: omeprazole, lansoprazole

- prokinetic drugs (improve sphincter function & gastric motility): bethanechol, metoclopramide, cisapride)

Peptic Ulcer Disease (PUD) & Gastritis

- Inflammation , ulceration of stomach, duodenum

- burning pain stimulated by certain food intakes; hematemesis, melena, early satiety, weight loss

- Helicobacter pylori lowers stomach pH prompting higher acid secretion

- bismuth subsalicylate with tetracycline/amoxicillin + metronidazole/clarithromycin


- Stomach, intestine inflammation

- pain, vomiting, diarrhea, cramping, fever; hematemesis, melena, dehydration

- viral: adenovirus, echovirus, coxsackievirus, rotavirus

- bacterial: Escherichia coli, Campylobacter, Yersinia, Salmonella, Shigella, Clostridium

- protozoal: Entamoeba histolytica, Guardia lamblia

- fungal: Candida Albicans

- other: poisonous plants, chemicals, foods medicines

- pseudomembranous enterocolitis: a fatal Clostridium difficile infection usu after unrelated antibiotic Rx

- stool testing

- Rx symptomatic, supportive except in specific cases


- obstruction of appendiceal lumen by fecalith (stone like hardened fecal mass)

- or, swelling by infection / neoplasm

- inflammation, ischemia, necrosis, rupture

- generalized pain severing, localizing in right lower quadrant

- tenderness, rebound tenderness over McBurney point (1/3 BTW r anterior superior iliac spine & umbilicus)

- perforation within 12-36 hrs, peritonitis, vascular collapse

- radiography w rectal injection of barium

- appendectomy

Irritable Bowel Syndrome

- Chronic/recurring abdominal distress & bowel dysfunction

- no demonstrable organicity

- alternate diarrhea & constipation

- barium enema & colonoscopy

- antispasmodics to reduce motility and cramping

- alosetron and tegaserod for women

Crohn Disease (Regional Enteritis/Ileitis)

- chronic inflammation anywhere in the bowel

- pain, tenderness, nausea, diarrhea, steatorrhea, hematochezia (bright stool blood), weight loss, fever

- may lead to intestinal obstruction, abscess, fistula formation, wall perforation

- string sign: barium enema shows regional lumen narrowing

- sigmoidoscopy, colonoscopy

- skip areas: intermittent normal areas

- all bowel layers involved

- specific antibiotics: azathioprine, sulfasalazine, olsalazine

- surgery for fistula / perforation

- segmental bowel resection

- colectomy with ileostomy

Ulcerative Colitis

Chronic inflammation of esp. left colon

- superficial ulceration

- cramps, fever, tenderness, bloody diarrhea, tenesmus, anorexia, hemorrhoids/anal fissures

- later: colonic hemorrhage, perforation, toxic dilatation, polyp formation (w progression to carcinoma), arthritis, spondylitis (of ligaments beneath spine), iritis, oral ulcers

- 20+ bowel motions per day

- sulfasalazine, mesalamine, corticosteroids

- IV alimentation, fluid replacement

- colectomy w ileostomy

Diverticulosis w Diverticulitis

Blister/bubble -like out-pouching of (a hollow/tubular organ) the colon and its infection/inflammation

- more common in upper age ranges

- diverticulosis usu w/out symptoms

- diverticulitis : pain, nausea, emesis, constipation, fever, stool blood

- tenderness and sensation of a mass (in sigmoid colon)

- thorough evaluation must to rule out malignancy

- metronidazole, ciprofloxacin, trimethoprim-sulfamethoxazole

- surgery to drain abscess / resect a bad segment

Intestinal Obstruction

Blockage of digestive fluids through the intestine

- cramps, nausea, emesis, obstipation (no stool / flatulence)

- distension, borborygmi (gurgling sounds), peristaltic rushes (urgent squeaking/gurgling w peristalsis)

- causes: surgical adhesions, hernia, neoplasms, gallstones, volvulus (intestinal twisting), intussusception (passage of an intestinal segment into a distal portion), foreign body, fecal impaction

- strangulation (ischemia of the involved portion)

- x-rays, barium enema

- nasogastric suction to decompress bowel near the obstruction

- IV fluids for support

- surgery for relief and resection of strangulated portion

Adynamic Ileus

Bowel atony / paralysis disrupting digestive flow

- due to surgery, peritonitis, mesenteric ischemia / infarction, drugs

- nausea, emesis, obstipation, distension

- x-ray study

- nasogastric suction, IV fluids


Dilated veins just above/below anus

- anorectal pain, swelling, protrusion, bleeding

- mild, intermittent

- stool softeners, suppositories

- excision / cryosurgery for external hemorrhoids

Acute Peritonitis

- Infection from wounds, surgery, dialysis, spread from other sources

- abrupt onset of severe local/general pain

- nausea, vomiting, fever

- high temp & pulse

- boardlike rigidity, tenderness, rebound tenderness

- septicemia, vascular collapse within hrs of onset

- hospitalization: NPO (nothing by mouth), suction to decompress, IV fluids, narcotics, antibiotics, surgery re underlying cause

Abdominal Hernia

Localized weakness in musculoaponeurotic wall of abdomen causing partial protrusion of organs

- tender bulge in abdominal wall, enlarges straining; palpable defect

- leads to obstruction, severe pain, emesis, weakness, shock, collapse

- umbilical: mostly congenital, self-resolves

- direct inguinal: aging, thinning abdominal wall,

- femoral: into femoral canal , where femoral bl vessels pass through pelvis into the thigh

- strangulation, incarceration (inability to reduce hernia), bowel obstruction

- surgical repair, implantation of reinforcing mesh

Hepatitis A

Liver infection by Hepatitis A virus

- anorexia, respiratory / flu like symptoms, vomiting, joint pain, diarrhea/constipation

- jaundice, liver enlargement & tenderness, splenomegaly, cervical lymph adenopathy

- serum bilirubin, LFT, atypical lymphocytes, Anti-HAV (IgM) antibody,

- lasting IgG antibody after recovery

- self-resolution

- supportive/symptomatic Rx

Hepatitis B

- by Hepatitis B virus

- transmits: by blood, maternally

- anorexia, fever, emesis, joint pain n swelling, rash, pain, bowel irregularities

- jaundice, liver enlargement + tenderness, splenomegaly, cervical lymph node adenopathy

- serum bilirubin, LFT, atypical lymphocytes, Hepatitis B surface antigen (HBsAg)

- Antibody to the antigen, AntiHBs, after recovery

- 6-12 wks incubation period, acute illness up to 16 wks

- carried and transmitted for years after recovery

- chronic persistent hepatitis: mild, usu asymptomatic

- chronic active hepatitis: liver deterioration, cirrhosis, risk of hepatocellular carcinoma

- mostly supportive Rx

- interferon alfa-2b, lamivudine for chronic cases

Hepatitis C (HCV)

Mild/asymptomatic infection by sharing needles / bid transfusion

- chronic

- leads to cirrhosis

- serologic testing to screen carriers

- interferon Alfa / ribavirin

- liver transplantation

Cirrhosis (Portal, regular, Laennec)

Inflammation of liver's secretory cells, then nodular regeneration n fibrosis

- due to chronic alcohol abuse, hepatitis C, others

- anorexia, nausea, vomiting, ascites, swelling, amenorrhea, male impotence

- pleural effusion, peripheral edema

- gynecomastia in men (due to high estrogen)

- spider nevi (spider angiomas) on face, upper trunk

- palmar erythema

- asterixis (flapping tremors), delirium, BC of hepatic failure

- high amino transferase, lactic dehydrogenase (LDH), & alkaline phosphate (c of liver damage)

- liver biopsy

- radioactive liver scans

- esophagoscopy

- progressive hepatic failure

- fibrosis causes shutting of portal circulation branches, increases portal hypertension; other vessels: varicose / tortuous

- hemorrhage from bleeding esophageal varices

- paracentesis for ascites

- portacaval shunt (surgical bypass of portal vein over liver directly into vena cava




- 90% incidence in pts. w cholecystitis

- silent: asymptomatic gallstones

- blockage of: common bile duct (w obstructive jaundice), cystic duct (w cholecystitis)- gallstone ileus: bowel obstruction due to stone's passage- laparoscopy: for surgical removal w gallbladder- oral bile salts for dissolving: Chenodeoxycholic acid, ursodeoxycholic acid- ESWL: extracorporeal shock wave lithotripsy


Acute Cholecystitis

Acute gallbladder inflammation

- usu due to cholelithiasis, w ischemia, abscess formation, perforation

- acute severe epigastric n r upper quadrant pain, nausea, emesis

- involuntary guarding: abdominal muscles spasms on palpitation

- bilirubin, serum enzymes showing hepatic damage

- ascending cholangitis: spread up into liver via biliary tract

- gangrene: tissue death due to ischemia

- laparoscopic decompression (drainage) for perforation

- cholecystectomy

Acute Pancreatitis

- usu due to alcoholism / chronic biliary tract disease, b/c of bile back flow / pancreatic tract obstruction w edema

- intense inflammation, necrosis, hemorrhage

- also due to hypercalcemia, hypertriglyceridemia, abdominal trauma/surgery, medicines, viral infections e.g. mumps

- abrupt onset severe pain, radiates to flanks, back

- emesis, sweating, prostration

- Turner (Greg Turner) sign: bluish skin discoloration in pancreatic hemorrhage

- ascites / left pleural effusion

- shows leukocytosis, hyperglycemia, anemia, hypocalcemia, high lipase n amylase

- left atelectasis: partial l lung collapse by shallow breathing at site of pain

- high mortality n recurrence rates

- leads to abscess, splenic vein thrombosis, ileus, shock, renal failure, adult respiratory distress syndrome, severe hypocalcemia w tetany, pseudocysts (pockets of inflammatory fluid, debris b/w pancreas n other tissues), chronicity


Adenocarcinoma of Colon n Rectum

Malignant neoplasm from large intestine's glandular epithelium

- usu by malignancy in benign polyps (adenomas)

- cramps pain, bloody stool, fatigue

- palpable mass

- carcinembryonic antigen (CEA) titer high in serum

- surgical resection

- abdominoperineal resection (entire lower bowel removed, w anus) in rectal carcinoma, with sigmoid colostomy

- simple anastomosis of normal bowel above and below the site of tumors higher in the colon

- usu by malignancy in being polyps (adenomas)

- cramps, pain, bloody stool, fatigue

- palpable mass

- carcinoembryonic antigen (CEA) titer high in serum