@marimphil wrote:
GASTROENTEROLOGY
Vitamin A Night blindness, conjunctival dryness, corneal keratinization
Vitamin D Ricketts - kids, long bone bowing; Osteomalacia-adults, demineralization
Vitamin K Clotting deficiency with prolonged PT
Thiamine (B1) Beriberi - peripheral neuropathy, Cardiomyopathy - dry or wet (high output failure)
Wernicke-Korsakoff - Alcoholics, confabulation, nystagmus, confusion
Niacin Pellagra - Diarrhea, dermatitis, dementia, death
Pyroxidone (B6) Rare, neuropathy, Cheilosis (swollen cracked bright red lips)
Cobalamin (B12) Macrocytosis, Pernicious Anemia- megaloblastic, neuro chg. ataxia, Schilling test , more in Strict Vegitarian.
Folate Macrocytosis, megaloblastic anemia w/o neuro chgs., common in alcoholics
Vitamin C Scurvy, bleeding gums, Connective Tissue problems, Can manifest 1 yr post defic.
Failure to Thrive Org.= decr. wt gain w/ other disease; Nonorg.=growth failure due to neglect ßstimulation
< 80% wt for Ht
Obesity mild 20-40%, moderate 41-100, severe <101%; age, black women, low income
BMI= body wt (kg)/Ht (mm2) Normal 20-25
Pickwickian Syndrome = obesity, dyspnea, hypovent, CO2 retention, hypoxia
Boerhaave's Syndrome esophageal rupture due to forceful vomit; Gastromediastinal fistula, dyspnea w/o hemetemesis, + Hammonds sign = pneumomediastinum, L lung effusion
Dysphagia Obstructive - solids 1st; Motor -solids = liquids
Infectious Esophagitis Candida (thrush), HSV, CMV, immunocomp, diabetics, Dysphagia & odynophagia
Esophageal Atresia Proximal esophagus, blind pouch
Trachesoph Fistula Congenital defect, distal esoph, coughing & cyanosis when feeding, abd distention
Achalasia Dysphagia for solids & liquids, nocturnal cough, aspiration; Absent peristalsis & tight LES, "Beak" esoph on x-ray, 20-40 yrs old
Esophageal Cancer squamous 90% Dysphagia solids 1st, Cough & hoarse = laryngeal nerve, constricting bands = annular lesion, Risk factors= smoking, alcohol, GERD, Barretts Esoph = adeno CA
Gastritis Antral Creep=fundal tissue replaced by antral mucosa, Not preCA,
Risk Factors = NSAIDS, Alcohol, H.Pylori
PUD Gastric = NSAIDS, eating no help, COPD,blood type A; 25%
Duodenal = H.Pylori, better w/ food, Liver cirrhosis, Blood type O ; 75%
Cullen's Sign Periumbilical cyanosis d/t hemoperitoneum = hemorrhagic pancreatitis, ruptured ectopic, ruptured spleen
Zollinger-Ellison Synd. Gastrinoma ( incr. gastrin); recurrent ulcers, ½ are malignant
Gastric CA Adeno, H.Pylori gastritis, Virchow's Nodes, Types = ulcerating (shallow edges); polyploid (intraluminal late mets); superficial (early CA) ; Linitus Plastica (all layers decr. elasticity) Mets to ovary = Krukenberg Tumor
Diarrhea Osmotic = incr. H2O lumen incr. solutes in bowel; Secretory = electrolytes & H2O secreted not absorbed; Malabsorption; Exudative secretion of blood plasma & mucus (mucosal inflammation); decr. transit time (short bowel); incr. transit (bact. Proliferation)
Ischemic Colitis Vascular compromise (atherosclerotic or embolic); abrupt abd pain after eating, bloody diarrhea, systemic sx.; Barium X-Ray - Thumbprint = pseudo tumor
Irritable Bowel Synd. Dx of exclusion (psych?); Tx: bulk supp, anticholinergics, antidiarrheals, TCA
Colonic Polyps villous>tubular ; sessile>pedunculated for being CA; familial adeno polyps autodom.
Lactose Intolerance Lactase deficiency, bloating & explosive diarrhea after milk; Ages 10-20
Celiac Sprue Gluten sensitivity (wheat, rye, barley); amenorrhea 1st sx girls, Infants = FTT, abnormal stool, bloating, Adults = malabsorption, vit deficiency; X-ray - dilated loops of bowel with thin mucosal folds; most common cause of malbsorption
Tropical Sprue nutritional defic, small bowel mucosal abnormal; Acquired - Caribbean, India, SE Asia; Megaloblastic Anemia, glossitis, diarrhea, wt loss Tx Folic Acid & Tetracycline
Whipple's Disease Infectious; middle aged men; multi-organ; Thickened mucosal folds, Foamy macrophage with rod shaped bacilli that stain w/periodic acid (Schiff's Reagent)
Intestinal Lymphangiectasia Children & young adults; cong or acquired telangiectasia of intramucosal lymphatic
Massive extremity edema w/ diarrhea, N/V; Tx: low fat w/ triglyceride supplement
Toxic Megacolon Dilation > 6cm, Adults preceded by IBD (UC or Crohn's) Kids preceded by Hirschsprungs Ds; Sx: severely ill, incr. temp, abd pain, rebound, leukocytosis; X-ray - intraluminal gas along continuous seg of dilated bowel; Tx: NPO, IV fluids & electrolytes, Antibiotics & Steroids, Rectal tube may alleviate but can cause perforation
Inguinal Hernia Indirect = infants, persistent processus vaginalis, protrudes thru ring, lateral Inf Epig.
Direct = Adults, medial to ing ring & inf epig artery, Weakness in Hesselbach's
Ulcerative Colitis Colon & Terminal Ileum w/o skip lesions, w/ rectal bleeding, "lead Pipe" on X-ray (shortened, narrowed, loses haustrations) Tx: Sulfasalazine, steroids, Immunosuppresents; Complications=perf, hemorrhage, Toxic Megacolon, Colon CA
Diverticular Disease Diverticulosis = false diverticulae, pearl sign on xray
Diverticulitis = infection, acute abd pain usually on left, may form fistulas to bladder, vagina or skin, CT w/ water soluble contrast during acute attack
Crohn's Disease Granulomatous colitis; No bloody stools, 1st in terminal ileum, transmural, skip lesions, cobblestoning: Complications=small bowel abscess, obstruction, perianal disease, malabsorption, toxic megacolo, Colon CA. Surgery is not curative
Colon CA Right Sided=napkin ring, anemia Left Sided=Apple core, pencil stools; Genetic; Annual rectal>40, Annual Guaiac >50; Flex Sig q3-5y >50; Rectal CA-hematochezia
Volvulus Rotation of Bowel; Newborns & elderly; Double Bubble; Birds Beak on Barium Enema, Tx: Left Sided = decompression; Rt sided & kids = surgery
Intussusception Telescoping of large bowel into an adjacent section; most common cause of obstruction in kids under 2; Episodic Abd pain 1-2 min. Reflex = early vomit; Obstructive = omit late; Currant Jelly Stool; Small Infants = Pallor, sweating, and vomiting. Leukocytosis with hemoconcentration, BE to reduce x 2 before surgery
Necrotizing Enterocolitis Premature, decr. birth weight, older infants with malnutrition; bilious vomit, abd distention, bloody stool, lethargy; Thrombocytopenia; Small Bowel Distention; pneumatosis (air in bowel wall) TX; NG, TPN, IV antibiotics, surgical Rx necrotic part
Cholera Fecal - Oral, Rice Water Stools, Vibro Cholera; Endemic gulfcoast, Asia, Africa, Mid East; Severe dehydration, Metabolic Acidosis, Tx: Tetracycline or Doxycycline
Shigella Dysentery Small bact dose needed, Blood & mucous, Kids worse than adults, Fluid Replacement & Ciprofloxacin
Staph Enteritis Onset 3-6 hrs; "Church Picnic epidemic; N/V/D, HA, fever recovery w/in 24 hrs
Salmonella Enteritis Undercooked Poultry; nausea & cramps => watery &/or bloody diarrhea; No antibiotics prolongs excretion of the organism
Viral Enteritis Norwalk = yr round, Rota (kids) = winter; Coxsackie A1; echo, adeno
Botulism Clostridium Botulinum, neuromuscular; onset 12-36 hrs; N/V/D, cranial nerve palsy, fixed dilated pupils, resp failure, no fever, Wound induced = neuro w/o gi sx
Infants constipation 1st=> cranial nerve sx => cranial nerve Sx => Neuromuscular
Hemorrhagic Colitis E coli 157, cramps, => watery diarrhea => bloody diarrhea Complications= Hemolytic-Uremic Syndrome, thrombotic thrombocytopenic pupura
Pseudomembraneous Colitis Antibiotic induced (clindamycin, ampicillin, cephalosporin) C. Diff; mail -> severe bloody diarrhea; Tx: stop antibiotics, oral metronidazole in severe cases
Acute Pancreatitis Pain radiates to back w/ N/V; Grey Turner's Sign (blue flank) Cullen's Sign (blue at umbilicus; Amylase & Lipase incr. ;
Ranson's Criteria: 3 or more = incr mortality
Admission: >55, gluc>200, LDH >350, AST >250 WBC > 16000
Within 48 hrs: Hct decr. 10%, BUN incr. >5, Ca< 8, PaO2 < 60, Base Def > 4, Fluid Seq>6L
Chronic Pancreatitis ERCP to Dx; Alcoholics, Malabsorption & diabetes are results
Hepatitis Hep A = Fecal oral, shedding before Sx; IG to travelers & contact with HAV infected
Heb B= Blood & STD; HbsAg early if persists = carrier; HbcIGM then HbcIgG for life
HBIG for needle sticks and infants born to + moms; assoc w/ hepatocell CA
Hep C Most common post transfusion hepatitis
Hep D = Co infection with B; Hep E = fecal oral
Cholelithiasis Female, fertile, fat, forty; Ultrasound, RUQ pain after fatty meals, Calcified = preCA
Cholangitis Charcot's Triad = Biliary Colic, Jaundice, Fever; Leukocytosis, incr. Alk Phos
Hepatocellular CA Mets 2x more than primary CA (breast, lung, colon), Budd Chari-thrombosis hep V.
Risk Factors = HBV, HCV, Alcoholic cirrhosis, Aflatoxins (fungal metabolites)
Benign Hep Adenomas oral contraceptives
Exocrine Pancreatic CA Ductal CA, Courvoiser's Law=palpable nontender GB in a jaundiced patient is a head of Pancreas tumor. Tumor Body or Tail=splenic vein obstruction=> splenomegaly, gastritis, esoph varices
Insulinoma Insulin hypersecretion, hypoglycemic symptoms, Insulin levels still incr. after fasting
Whipple Triad: confirms hypoglycemia as source of Sx 1. Hypoglycemia, 2. Relieved with carb ingestion 3. Sx occur while fasting
VIPoma Makes Vasoactive peptide (VIP); Sx WDHA (watery diarrhea, hypokalemia, achlohydria; unexplained secretory diarrhea; laparoscopy for Dx
Glucagonoma tumor of alpha islet cells; 80% women; 80% malignant; Necrolytic Exfoliating Erythema characteristic exfoliating lesion of the extremities
Pompe's Disease a 1,4 glucosidase deficiency; fatal by age 2
VonGierke's Disease glucose-6-phosphatase def.; big liver & kidneys, growth retardation, electrolyte prob.
McArdles Disease musclephosphorylase is absent, muscle cramps & incr. myoglobin after exercise
Jaundice Prehepatic = hemolysis, gilbert's disease, Crigler Najjar; Hepatic = hepatocellular or cholestatic; Post Hepatic = Biliary obstruction, AST & LDH also incr. ;
incr. unconj prehepatic; incr. conj = intrahepatic cholestasis or post hepatic disease ; incr. all fractions = hepatocellular, hyperbilirubinuria = conj bili water soluble
ETOH Hepatic Disease Fatty liver => ETOH hepatitis => cirrhosis; AST incr. > ALT incr. ; incr. PT; decr. II, VII, IX, X Clot
Cirrhosis necrosis and fibrosis, decr. serum albumin, anemia incr. PT, Not curable or reversible
Esophageal Varices veins that expand to circumvent congested hepatic flow; Tx: vasopressin, balloon tamponade, endoscopic sclerotherapy, transjugular hepatoporto shunt (TIPS
Hepatic Encephalopathy altered consciousness, incr. ammonia incr. glutamine in CSF, EEG abnormal
Ascites Complication of hepatic disease; Paracentesis to examine ascitic fluid values should equal serum if incr. albumin = malignant; incr. LDH > 60% of serum = malig or infective;
incr. WBC = infection
GI Bleeding Upper GI = melaena (black tarry) ; Lower GI = hematochezia (bright red) decr. Lig Trietz
Intestinal Obstruction Vomiting common in small bowel, late in lg bowel, High pitched "tinkling" BS.
X-ray - prox dist = lg bowel; dilated loops of bowel with air fluid levels = sm bowel
Ileus Paralytic obstruction of bowel due to loss of peristalsis
Pyloric Stenosis Projectile vomit in neonates, visible peristaltic wave, String Sign
Meconium Ileus Abnormal thick Meconium with undigested protein, associated with CF
Hirschsprung's Disease No autonomic nerves in colon, Obstipation, late vomit, Megacolon, Toxic Enterocolitis if left untreated, BE proximal dilated & distal narrow, Colostomy
If it will help u guys just let me know I'll post rest of the systems
Thxn 2 eaziz
Cheers
Posts: 1
Participants: 1
Read full topic