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GI/nutn 2b


3 most common causes of upper GI bleed PUD (55%); Varices (14%); AVM (6%)
3 most common causes of lower GI bleed Diverticular Dz (33%); Neoplastic Dz (Polyps, Ca; 19%); Colitis (18%)
Dieulafoy Lesion = Dilated submucosal artery erodes into mucosa with subsequent rupture of the vessel; bleeding often massive & recurrent
Diverticular bleeding = Acute, painless hematochezia; most bleeds are right sided
Colon ca: most common metastases are to: liver, then lung (colon); liver or lung (rectal ca)
Conj bili = direct; bound to gluc acid; water soluble; caused by obstruction of outflow tract or in the liver
Unconj bili = indirect; water insoluble; caused by hemolysis
Hep A incubation average 30d
Hep B incubation average 60-90d
Hep C incubation average 6-7 wk
Hep A clinical sxs 80% jaundice pts >14 yo; fulminant or cholestatic hep
Hep B clinical stuff 15-25% premature mortality; cirrhosis/hepatocell ca; Asians
Hep C clinical stuff 40% jaundice; 70% chronic; persistent; AA men in 40s; No. 1 indication for liver transplant
Most common benign liver tumor hemangioma; W>M, 20-40 (2nd most common: FNH: focal nodular hyperplasia)
IBS & post-infxn: often assoc with: Entamoeba, Salmonella and Campylobacter
No. 1 indication for liver transplant Hep C
Crohn Dz findings fistula: abscesses; more common at anus; strictures of the intestine; CRC risk increased if >1/3 colon involved; macro anemia
Primary sclerosing cholangitis (PSC) = stricture of biliary ducts; UC>CD; risk for CRC; refer to hepatologist
Erythema nodosum = raised tender red-purplish nodules; most commonly on extensor surfaces of extremities; parallels IBD activity/tx; may req steroids
Pyoderma gangrenosum = wide spectrum of necrotic inflam; IBD tx, topical tx, or poss colectomy; DO NOT Bx
IBD eye complications episcleritis; uveitis: refer to Ophtho (blindness risk)
IBD colon ca risk/surveillance CD/UC colitis >1/3 colon: colonoscopies starting 8 yrs from sx onset; q1-3 years; if comorbid PSC: immed start annual colonoscopy; FH also inc CRC risk
malabsorption: impaired digestion = ___ phase intraluminal phase
malabsorption: impaired absorption = ___ phase mucosal phase
malabsorption: impaired transit = ___ phase absorptive phase
Intensely pruritic papulovesicular rash of trunk, scalp and extremities = Dermatitis herpetiformis (think celiac dz)
Whipple dz: Dx arthralgias; GI sx; wt loss, chronic cough, low-grade fever, neuro sx (steady-state: wt loss & diarrhea); bx is confirmatory (villous atrophy, macrophage infiltration of lamina propria)
Hep B: more likely to become chronic if: young at age of infxn (or immunocompromised); 95% of pts clear the virus & develop Abs; chronic Hep B increases risk of cirrhosis & HCC
Black pigment gall stones: GB; Calcium bilirubinate; in pts with cirrhosis and chronic hemolysis (eg, sickle cell)
Brown pigment gall stones: Ducts; Calcium salt of unconjugated bilirubin; assoc w/ infection; Form denovo in the ducts
Most common stone locations 75% GB (Asx); cystic duct (20% intermittent: biliary colic; 10% impacted: cholecystitis)
Panc ca: most common sx Pain, obstructive jaundice, weight loss; BUT classic hx = painless jaundice
Diffuse intra- and extrahepatic bile duct inflammation and fibrosis: Primary sclerosing cholangitis (PSC)
Primary sclerosing cholangitis (PSC): assoc with: UC (most cases); leads to cirrhosis and portal HTN; elev alk phos, pruritus, fatigue; Cholangitis
Courvoisier sx palpable GB due to head mass compressing CBD = panc ca
Trousseau sx in panc ca 2/2: migratory thrombophlebitis
V cholera MOA stimulates adenyl cyclase in intestinal epithelial cells to overproduce cAMP => H2O & Cl- hypersecretion => diarrhea
salmonella: 3 patterns Enteric (typhoid) fever; gastroenteritis; bacteremia
Salmonella: Enteric (typhoid) fever S/S 5-14d incubation, insidious (kids abrupt); F, HA, ST, myalgia, malaise; abd pain, pea soup diarrhea; pulse-temperature discordance; freq relapse; 1-5% chronic carriers
Salmonella: gastroenteritis S/S most common salmonella type; 8-48 hr incubation; F, N/V, crampy abd pain, bloody diarrhea 3-5d; +stool cx
Salmonella: bacteremia S/S usu in immunocompromised pt; recurrent F, local infxn (bone, jt, lungs)
Created by: Adam Barnard Adam Barnard