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21 Cards in this Set

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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

Gastroenteritis

- 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

Appendicitis

- 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

Hemorrhoids

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



-

Cholelithiasis

Gallstones


- 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


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