Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
GI Pathology
USMLE GI pathology
| Question | Answer |
|---|---|
| Giardia Lamblia | MC in children 0-5 yrs from drinking stream/lake water, food/hands, ingest cysts, trophozoits GI tract; incubation 1-2 wks; CP-diarrhea, cramps, bloating, flatulence, anorexia, steatorrhea. lasting >1wk; no fever/hematochezia; disrupt brush border |
| Cryptosporidium | ingest cysts, sporozoites invade cell membrane, asexual trophozoites. resistant to chlorine, so swimming pool, cattle resevoirs. AIDs more susceptible. incubation 1wk; CP- watery diarrhea, malabsorption, terminal ileum, proximal colon, lasts 5-10 days. |
| Cryptosporidium (AIDs complications and Dx) | AIDs complication w/ chronic diarrhea, disseminate to luns, cholangitis, or pancreatitis. Dx- stool cysts w/ modified acid-fast stain, auramine, immunofluorescence; antigen detection |
| Microsporidium | Spores ingested, inject sporoplasm through polar tube in host cell, develop meronts, multiply, form spore. pigs/dogs/ chickens/ rabbits/primates/ water-borne. AIDs associated. CP-watery diarrhea, fever, ab pain, distal duodenum, proximal jejunum |
| Microsporidium (AIDs complications and Dx) | AIDs disseminate to liver, brain, and other organs. Dx-giemsa and chromotrope 2R biopsy stain |
| Isospora belli | sporulated oocysts ingested, release sporozoites penetrate epithelial cells, trophozoites, more oocysts. incubation 1wk. CP-non-bloody watery diarrhea, last 2-3wks. AIDs associated. Dx-oocysts in stool w/ acid-fast & autofluorescence |
| Cyclospora cayetanensis | ingest sporulated oocysts, form sporozoites invade epithelial cells, gametes release oocysts passed in stool, 1wk sporulate in environment latin america. CP-1wk incubation, watery diarrhea 6wks, N&V, low fever. Dx-acid fast, autofluorescence, UV light |
| Entamoeba histolytica | ingest cysts, penetrate GI wall, trophozoites, cysts in feces in latin america. CP-1wk incubation, amebic dysentery 1-3wks, colon deep ulcers. C-toxic megacolon, clonic perforation, liver abscess, hemophagous |
| Enterobius vermicularis (pinworm) | not fecal oral, MC in young children w/ eggs on hands and clothing ingested, larvae GI 1 month. no intermediate hosts. CP-perianal itching, dead adults on anus in morning. Dx-scotch tape |
| Ascaris Lumbricoides | fecal-oral ingested eggs, larvae in GI reach blood, autoinfection, adult worms 5-12 inches long in GI. incubation 2wks warm, 6wks cold. MC in children. CP- pass worm, ab pain/destintion, jaundice. C-abdominal/biliary/ pancreatic obstruction. Dx-ova stool |
| Hookworm (ancylostoma duodenale & necator americanus) | larvae penetrate skin from soil, migrate to lung, autoinfect, mature in GI to 7-13mm w/ biting plates. CP-maculopapular rash at point of penetration, Fe deficiency anemia, hemoatochezia, dyspnea during migration, eosinophilia. Dx-Ova in stool |
| Taenia solium | human definitive host; pigs intermediate host. ingest cysts in undercooked pork, Adult in GI 2-8 m, 10-20yrs, ingest eggs, cysticercosis w/ brain/spinal cord spread. CP- focal seizures, meningitis, psychosis. Dx- Ts-Ab in serum. |
| Schistosomiasis | cercariae penetrate skin, mature in lung/liver, adults live in venules of intestine and bladder. equator region. snail intermediate host. CP-hematuria, portal vein hypertension, esophageal varices bleeding, dermatitis. Dx- ova in stool. |
| staphylococcus aureus | gram (+) grapelike cocci that is (+) coagulase/B-hemolysis/mannitolfermenter/ catalase. produces heat-stable SEA that binds neural receptors in upper GI-> area prostrema. energy rich,salty,creamy foods. CP-2-3 hrs post ingestion N&V, abd pain, +/-diarrhea |
| Bacillus Cereus (emetic form) | Gram (+) sporeforming aerobic bacillus, catalase(+). starchy foods. CP-1-6 hrs in vitro heat-stable cereulide is superantigen & binds 5-HTR on vagus and/or forms ion channels in membranes, lasts <24hr w/ V&N, abd pain. |
| Bacillus Cereus (diarrheal form) | Gram (+) sporeforming aerobic bacillus, catalase(+). meats, vegetables, dried beans, fried rice. Ingest veg cells make heat-labile enterotoxin-> activates adenylate cyclase in GI. CP-8-16hr p.e., profuse diarrhea, abd pain, nausea, <24hr |
| Clostridium perfringens | Gram (+) sporeforming anaerobic bacillus, catalase (-). 6-24hr incubation. meat/gravy, deli meats. heat-labile enterotoxin damages brush borders in SI(ileum) of GI. CP-watery diarrhea ~24hrs, abd cramps |
| Clostridium botulinum | Gram (+) sporeforming anaerobic bacillus, catalase (-). 18-36 hr incubation. preformed heat-labile exotoxin (A-G) (-) Ach at NMJ=flaccid paralysis. foodborne, infant, inhalational, wound. CP-dysarthria, dysphagia, dysphonia, diplopia, descending paralysis |
| Vibrio Cholerae | Gram (-) comma-shaped rod oxidase (+), O1 and non-O1 serogroups.ingest fecal(+) water or raw crabs/oysters.16-72hr incubation.heat-labile enterotoxin activates GI adenylate cyclase, TCP, ToxR. CP-watery diarrhea w/ mucus flecs, death in 4-12hrs w/o tx. |
| Vibrio Cholera (Dx) | yellow-gold colonies in alkaline pH (8.6), NACL on TCBS agua. O1 serogroups- classic in asia; El Tor in Indonesia. non-O1 serogroups- O139 in Bangladesh india. |
| Enterotoxigenic E. coli (ETEC) | most common cause of traveler's diarrhea.24-48hr incubation, 3-4 days duration of watery diarrhea. Heat-stable ST toxin increases cGMP, Heat-labile LT toxin increases cAMP. Tx-based on presentation; ciprofloxacin & azithromycin |
| Enteropathogenic E. Coli (EPEC) | Most common cause of neonatal nursery diarrhea. (-) toxin, but bundle-forming pili, attachment and effacement lesions=disruption of normal microvillus and malabsorption. CP-watery diarrhea |
| enteroaggregative E. Coli (EAEC) | persistent, wks long, watery diarrhea in children <6y/o and AIDs pts. autoagglutinate, biofilm, & cytotoxin |
| Enterohemorrhagic E. Coli (EHEC) | 0157:H7 shiga-toxin producing gram (-) facultative anaerobe, mcKonkey agar sorbitol fermenter associated w/ HUS. incubation 16-72hr, intimin, SLT. CP- H2O diarrhea w/ blood, renal failure, thrombocytopenia, hemolytic anemia. Tx-plasmopheresis, No abx. |
| enteroinvasive E. Coli (EIEC) | direct invasion w/ fecal leukocytes present affecting colon and distal SI. uncommon cause of fever and mucoid/bloody diarrhea. |
| Clostridium Difficile (gram + anaerobic sporeforming bacillus) | presents 5-10 days after abx therapy w/ bloody H2O diarrhea, fever, and abd tenderness. severe form causes pseudomembranous colitis. Dx- enterotoxin (TA) & cytotoxin (TB) in stool. Tx-metronidazole. MCC nosocomial diarrhea. cause- PPI usage, Abx, hospital |
| Salmonella Typhi | causes typhoid fever characterized by rose spots on the abdomen, fever, headache, and diarrhea (+/- blood). Can remain in gallbladder and cause carrier state. found only in humans, flagella, HS (+)XLD agar, (-)lactose, (+) monocytic response, Abx bad |
| Shigella flexneri | Bacillary dysentary caused by mucosa invasion, PMN infiltration. (-)lactose fermenter/HS/ flagella, cell-cell transmission w/o hematogenous spread, Abx shorten fecal excretion, very low ID50, toxin cleaves host rRNA up cytokine release-> HUS |
| Campylobacter Jejuni | Bloody diarrhea cause by enteric microaerophile gram (-), oxidase (+) Comma- or S-shaped rod grows @ 42 C. 6-48hr incubation. ass- guillain-barre syndrome, reactive arthritis, HUS. Fs-raw milk, poultry. Dx-skirrow medium |
| Yersinia entercolitica | Blood diarrhea associated w/ day-care outbreaks and pseudoappendicitis. |
| Rotavirus | Watery diarrhea virus associated w/ children. |
| Norovirus | Watery diarrhea virus associated w/ adults. |
| Clastridium perfringens | watery diarrhea bacteria associated w/ gas gangrene |
| Shigella flexneri | Cp-abdominal pain, high fever, blood diarrhea. non-motile gram (-) facultative anaerobe, (-) lactose. produces toxin that cleaves rRNA which promotes cytokine response. May lead to HUS. common in male homosexuals. |
| entamoeba histolytica | protozoan pathogen transmitted fecal-oral causes dysentery, liver abscesses, and RUQ pain. Ova and parasitic form found in stool culture. |
| Salmonella enteritidis | dysentery after ingestion of poultry or eggs or turtles. Flagella (+), disseminates hematogenously, HS (+), Abx prolong fecal excretion, causes monocytic response, non-lactose fermenting. |
| Aphthous ulcer | painful, superficial ulceration on oral mucosa. arises w/ onset of stress, but resolves spontaneously, though often recurs. has grayish base sourned by erythema w/ graish base representing granulation tissue. |
| Behcet syndrome | recurrent apthous ulcers, genital ulcers, and uveitis due to immune complex vasculitis involving small vessels. unknown etiology, possibly viral. |
| Oral herpes | shallow, painful, red ulcer resulting in rupture of vesicles in oral mucosa usually due to HSV-1 w/ primary infection occuring in childhood, dormant HSV-1 in trigeminal ganglion nerve, recurs w/ stress/sunlight. |
| Squamous cell carcinoma | malignant neoplasm of squamous cells. tobacco and alchol are major risk factors w/ floor of the mouth MC region. precurser lesion is leukoplakia followed by erythroplakia. |
| Mumps | virus that classically infects parotid glands w/ bilateral inflammation, orchitis, pancreatitis, and aseptic meningitis. |
| sialadenitis | inflammation of the salivary gland. MC associated w/ sialolithiasis complicated w/ S. Auerus infection. usually unilateral. |
| pleomorphic adenoma | Benign tumor composed of stromal (cartilage) and epithelial tissue (glands). biphasic tumor that is MC tumor of salivary glands and usually arises from parotids as painless, mobile, circumbscribed mass at angle of jaw. high recurrence rate, rare CA cause |
| Warthin Tumor | Benign cystic tumor w/ abundant lymphocytes at germinal centers. 2nd most common salivary gland tumor. MC arise from parotid due to parotid being last gland to seperate from stromal tissue embryologically. |
| Mucoepidermoid carcinoma | Malignant salivary tumor composed of mucinous & squamous cells. MC arises from parotid and often involves facial nerve pathology. |
| Tracheo-esophageal fistula | congenital defect-> connection b/w trachea & esophagus. MC variant is atretic esophagus proximal to trachea/esophagus connection. Cp-vomiting, polyhydramnios, abdominal extension, aspiration of gastric acid to trachea. |
| Esophageal web | thin protrusion of esophageal mucoasa MC in proximal esophagus. CP- dysphagia of poorly chewed foods. C- increased risk of esophageal squamous cell carcinoma |
| Plummer vinson syndrome | Cp- severe iron deficiency anemia, esophaeal webs, and beefy red tongue due to atrophic glossitis. |
| Zenker diverticulum | outpouching of pharyngeal mucosa due to acquired defect (abnormal swallowing pressure) in muscular wall. arises above UES @ esophagus/pharynx junction. CP- dysphagia, obstruction, halitosis, feeling something in back of throat. false diverticulum. |
| Mallory-Weiss syndrome | Longitudinal laceration of GI mucosa @ GE junction caused by severe vomiting, alcholism/ bulimia. CP- painful hematemesis. risk of boerhaave syndrome=rupture, air in mediastinum, SC emphysema |
| Achalasia | inability to relax LES due to damage of ganglion cells of myenteric plexus/auerbachs. CP- dysphagia liquids/solids, bird-beak barrium swallow, halitosis (putrid), high LES pressure. due to idiopathic or Chagas disease. risk esophageal squamous cell CA |
| GERD | Decrease LES tone w/ acid reflux. CP- heart burn, asthma/cough, damage to teeth enamel. C- ulceration w/ stricture from fibrosis->dysphagia, barretts esophagus-> adenocarcinoma. risk- alcohol, tobacco, obesity, caffeine, high-fat diets, hiatal hernia. |
| Esophageal adenocarcinoma | Malignant proliferation of glands w/ preceeding barretts esophagus in lower 1/3=MC in west. Men > Women; Whites > blacks; >40 y/o. |
| Squamous cell carcinoma of esophagus | Malignant proliferation of squamous cells arising in middle or upper 1/3 of esophagus |
| Hiatal hernia | protrussion of stomach past the diaphragm. Risk-age, obesity, tobacco. C- reflux esophagitis, ulcerations, bleeding, performations. |
| Esophagitis | CP- dysphagia, odynophagia. causes- HSV-1 in immunocompromised and Tsank prep (+), CMV w/ inclusion bodies beneath mucosa, Candida w/ Abx use or immunocompromised and PAS (+), Eosinophilic MC from food allergies w/ esophageal rings & high eosinophils. |
| Gastroschisis | Congenital malformation of abdominal wall leading to exposure of abdominal contents |
| Omphalocele | Persistent herniation of bowel into umbilical cord due to failure of herniated intestines to return to body cavity during development. covered w/ peritoneum and amnion of umbilical cord. |
| Pyloric stenosis | Cp- 2-3 wks after birth w/ projectile nonbilious vomiting, olive like mass in epigastric area. Tx- myotomy surgery. |
| Acute Gastritis | acidic damage to mucosa due to imbalance of mucosal protection & acidic environment. Causes- severe burn=curling ulcer; NSAID dyspepsia, heavy alcohol, chemotherapy, encephalitis=cushing ulcer, shock. Cp-superficial inflammation, erosion, ulcer. |
| Chronic gastritis | Cp-epigastic abdominal pain, high risk of ulceration/gastic adenocarcinoma, MALT lymphoma marginal lymphoma. cause-autoimmune parietal cell destruction, helicobacter pylori gastritis. |
| Autoimmune parietal cell destruction | chronic gastritis w/ fundus/body parietal cell destruction due either to anti-parietal cell Ab or anti-IF Ab. Cp- atrophy of fundus/body mucosa, achlorhydria, high gastrin/secretin, antral G-cell hyperplasia, megaloblastic anemia. C-adenoCA, carcinoid |
| Helicobacter pylori gastritis | MC cause of acute/chronic gastritis. infects antrum. (+) urease, CagA, Mucinase, flagella, vacuolating toxin. Gram (-) microaerophile. Dx-urea breath test, serum Ab's, fecal Ag's. Cp- epigastic pain. risk- gastric adenocarcinoma, MALT marginal lymphoma |
| Helicobacter pylori treatment | Resolve gastritis/ulcer w/ omeprazole, decrease urea breath test and fecal Ag's w/ amoxicillin and clarithromycin. |
| duodenal ulcer | solitary mucosal ulcer involving duodenum. Cause- H. pylori > zollinger-ellison gastrin secreting tumor. Cp- epigastric pain improves w/ meals. C-rupture/ bleeding, acute pancreatitis. rarely biopsy. |
| Gastric ulcer | Cp- epigastric pain that worsens upon eating & at night. caused H. pylori > NSAID/bile reflux. MC on lesser curvature of antrum. C- rupture cuasing L gastric artery bleeding. always biopsy |
| Intestinal type Gastric adenocarcinoma | intestinal epithelial cell neoplasia w/ large, irregular ulcer w/ heaped up margins MC on lesser curvature of antrum. risk- intestinal metaplasia, nitrosamines, blood type A. |
| Diffuse Type Gastric adenocarcinoma | signet ring cells that infiltrate gastric wall due to desmoplasia leding to thickening of stomack wall=linitis plastica. metastisis to bilateral ovaries=krukenburg tumor. |
| Gastric Carcinoma | Cp- weight loss, abdominal pain, anemia, early satiety, rarely w/ anathosis nigricans & leser-trelat sign. LN spread to L supraclavicular=virchow node. metastisis to liver, periumbilical region, bilateral ovaries. Hpylori>tobacco> PA > Etol > nitrate |
| Bezoars, pyloric stenosis, paralytic ileus (post abdominal surgery) | Causes of Gastric dilatation |
| Hyperplastic (inflammatory) polyps | mucosal masses w/ enlarged foveolar glands/smooth muscle. associated w/ gastritis. May lead to dysplasia w/ increased size, but does not typically lead to malignancy. |
| Fundic gland polyps | dilated fundic glands w/ cheif & parietal cells. increased incidence w/ PPI use due to increased pH, gastrin, and hypertrophic cheif & parietal cells. |
| Gastric marginal zone lymphoma | low grade (indolent) MALT lymphoma associated w/ H. pylori. Tx- get rid of H. pylori. Risk- diffuse large B cell lymphoma whcih infiltrates glands, is CD20 (+) causing lymphoepithelial lesions or plasmocytoids. fish flesh, LCA (+), cytokeratin (-) |
| Gastric carcinoid tumors | well differentiated neuroendocrine carcinoma caused by autoimmune gastritis or zollinger-ellison syndrome. Resection usually cures. Chromagranin A and synaptophysin (+) w/ EM showing neurosecretory granules. |
| Gastrointestinal stromal tumors | MC mesenchymal tumor of stomach w/ intestitial cell of cajal (peristaltic pacemaker cells) spindle cell composition. fish flesh appearance w/ cKIT/CD117 (+). Tx- imatinib |
| Duodenal atresia | congenital failure of small bowel to canalize w/ duodenum ending in blind loop. associated w/ downs syndrome. Cp- polyhydromnios, distension of stomach and duodenum=double bubble sign, bilious vomiting. |
| Meckel diverticulum | Outpouching of 3 layers of the bowel wall arising from failure of vitelline duct to involute. Cp-mass in umbilical area, 2% of population, 2 inches long, 2ft proximal ileocecal valve. Risk-bleeding, volvulus, intussusception, or obstruction <2y/o. |
| volvulus | twisting of bowel along mesentery-> bowel obstruction, ischmia/infarct. MC sigmoid colon -> elderly; cecum -> young adults. Cp- range of abdominal pain and duration, obstipation. |
| Intussusception | telescoping of proximal bowel into distal segment. often associated w/ ischemia and current jelly stools. children w/ lymphoid hyperplasia-> terminal ileum to cecum; adult MC cause is tumor. |
| Transmural small bowel infarction | thrombosis/embolism of superior mesenteric artery due to A-fib thrombosis or vasculitis (polyarteritis nodosa). or due to thrombosis of mesentery vein due to polycythemia vera or lupus antigoagulant. |
| Mucosal small bowel infarction | Marked hypotension may cause and lead to abdominal pain, bloody diarrhea and decreased bowel sounds |
| Lactose intolerance | decreased functioning brush border enterocyte lactase enzyme. Cp- abdominal distention & diarrhea w/ consumption of milk products. May be due to congential (rare) or acquired (age or viral) causes. |
| Celiac disease | Immune mediated destruction of small bowel villi w/ gluten exposure. HLA-DQ2 & DQ8 associated. gliadin deaminated by tissue transglutaminase (tTG)->deaminated gliadin APC MHC-II->HT-cell response. CP- ab distention, diarrhea. Dx- ab-endomysium/gliaden/tTG |
| Celiac disease (complications) | Associated w/ dermatitis herpetiformis, flattening of villi, hyperplasia of crypts, increased intraepithelial lymphocytes. damages duodenum > jejunum > Ileum. C- small bowel carcinoma, T-cell lymphoma=enteropathy associated T-cell lymphoma (EATL). |
| Dermatitis Herpetiformis | IgA deposition causes dermal papillae that resolve upon cessation of gluten containing diet. Associated w/ celiac disease. |
| Tropical Sprue | damage to small bowel villi due to unknown organism leading to malabsorption. occurs in tropical areas after diarrhea infection & responds to Abx. Damage to jejunum > Ileum > duodenum. decreased folic acid & Vit B12. |
| Whipple Disease | Systemic tissue damage w/ macrophage lysosome tropheryma whippelii. stain PAS (+). involves lamina propria of SBoGI. foamy macrophages crowd lacteals (-) chylomicron absorption. CP- steatorrhea, arthritis, cardiac valve pathology, LAD, and CNS pathology |
| Abetalipoproteinemia | AR decrease of apolipoptein B48 & B100. B48-> make chylomicron=fat malabsorption. B100-> make VLDL/LDL= low serum VLDL/LDL. CP- failure to thrive, acanthocytosis, steatorrhea, ataxia, retinitis pigmentosa, fatty GI enterocytes. Vit A/D/E/K deficiencies. |
| Carcinoid tumor | low-grade malignancy of neuroendocrine cells-> chromogranin (+), filled w/ neurosecretory granules. SBoGI MC site-> grows as submucosal polyps often secrete 5-HT. CP-bronchospasm, diarrhea, flushing of skin; tricuspid regurge & PV stenosis b/c fibrosis. |
| Carcinoid tumor (presentation) | chromogranin & synaptophysin (+) tumor often metastasize to liver secreting 5-HT into systemic blood. Dx- 5HIAA in urine. symptoms triggered by alcohol or emotional distress. will not lead to L heart fibrosis b/c lung has MOA to convert 5HT->5HIAA |
| Inflammatory bowel disease | Chronic/relapsing inflammation of bowel due to abnormal immune response to enteric flora. CP- young (teens-30 y/o) woman w/ recurrent bouts of blood diarrhea, ab pain. more prevelant in west in caucasions & eastern European jews. Dx- exclusion of all else |
| Ulcerative colitis | mucosal/submucosal ulcers from anus->cecum. CP- LLQ abd pain, bloody diarrhea, crypt abscesses w/ neutrophils, pseudopolyps w/o haustra (lead pipe sign). C-toxic megacolon, carcinoma (>10 yrs), primary sclerosing cholangitis. P-ANCA (+). smoking prevents |
| Crohns disease | Full-thickness inflammation w/ knife-like fissures from mouth->anus w/ skip lesions. MC terminal ileum, LC rectum. CP-RLQ abd pain w/ non-bloody diarrhea, lymphoid aggregates w/ granulomas(40%), cobblestone appearance, creeping fat, strictures. |
| Crohns disease (complications) | malabsorption w/ nutritional deficiency, calcium oxalate nephrolithiasis, fistula formation, carcinoma (if colonic). Associated w/ ankylosing spondylitis, sacroilitis, migratory polyarthritis, erythema nodosum, uveitis. Smoking increases risk. |
| Acute Appendicitis | MC cause of acute abdominal pain caused by inflammation of appendix related to obstruction by lymphoid hyperplasia (children) or facalith (adults) CP- periumbilical pain, fever, nausea, pain localizes RLQ. C-rupture-> peritonitis, periappendiceal abscess. |
| Hirschsprung disease | Defective relaxation of peristalsis of rectum and distal sigmoid colon. associated w/ downs syndrome. Congenital failure of neural creast derived ganglion cells to descend & reside in bowel wall. |
| Hirschsprung disease (presentation) | CP- obstruction, failure to pass merconium, empty rectal vault on DRE, massive dilation of bowel proximal to obstruction w/ risk to rupture. Dx- rectal suction biopsy (-) ganglion cells. Tx- resect of of involved bowel. |
| Colonic diverticula | Outpouchings of mucosa & submucosa through muscularis propia=pseudodiverticulum. related to wall stress associated w/ constipation & low fiber diet. commonly seen in older adults. MC location=sigmoid colon. C- hematochezia, diverticulitis, fistula. |
| angiodysplasion | acquired mutation of mucosal and submucosal capillary beds. arises in cecum due to high wall tension. CP- hematochezia in older adults. |
| Hereditary hemorrhagic telangiectasia | AD disorder of diluted thin walled blood vessels arising in nasopharynx & GI tract. rupture presents w/ bleeding |
| Ischemic colitis | Ischemic damage to colon usually at the splenic flexture MC caused by atherosclerosis of SMA. CP- postprandial pain, weight loss, pain, bloody-diarrhea. |
| Irritable Bowel Syndrome | relapsing abdominal pain w/ bloating, flatulence, & change in bowel habits (constipation or diarrhea). improves w/ defecation. MC in middle aged females & related to disturbed intestinal motility w/ fiber improving symptoms. No biopsy findings. |
| Hyperplastic colonic polyp | hyperplasia of glands w/ serrated appearance on bipsy and MC arising on L colon rectosigmoid. benign w/o malignant potential. |
| Adenomatous colonic polyp | 2nd MC type of colonic polyp being neoplastic glandular proliferation & premalignant. APC -> KRAS -> P53 mutation & increased COX (aspirin prevents). risk- size >2cm, sessile growth, & villous > tubular histology. FAP, gardners syndrome, turcot syndrome. |
| familial adenomatous polyposis | caused by KO of APC on chromosome 15 leading to many polyps in rectum. Tx-remove colon and rectum or develop CA by 40 y/o. |
| Gardner syndrome | FAP + fibromatosis + osteomas |
| Turcot syndrome | FAP + CNS tumors including medulla blastomas & glia tumors. |
| Juvenile Polyps | sporadic hamartomatous (benign) polyp arising in children <5 y/o. CP- solitary rectal polyp that may prolapse and bleed. the more polyps= increased CA risk. |
| Peutz-Jeghers syndrome | hamartomatous polyps throughout GI tract w/ mucocutaneous hyperpigmentation on lips, oral mucosa, & genital skin. AD disorder that increases risk of colorectal, breast, and gynecological malignancies |
| Colorectal carcinoma | Arising from colonic rectal mucosa w/ peak incidence at 60-70 y/o MC arising from adenocarcinoma sequence (80%), microsatellite instability pathway. risk- streptococcus bovis endocarditis. Staging T=depth of invasion; N=LN spread; M=metastasis. CEA marker |
| Left sided colorectal carcinoma | grows as napkin-ring lesions. CP- decreased stool caliber, LLQ abd pain, blood streaked stools. Adenocarcinoma sequence L > R. |
| Right sided colorectal carcinoma | Grows as raised lesion. CP- iron deficiency anemia due to small bleeding over long time, vague pain. microsatellite instability pathway R > L. |
| Acute pancreatitis | inflammation & hemorrhage of pancrease due to autodigestion of parenchyma by enzymes starting w/ trypsin. liquifactive/fat necosis, sopanification. Risk-alcohol, gallstones, trauma, hypercalcemia, hyperlipidemia, scorpion sting, mumps, ulcer rupture. |
| Acute pancreatitis (CP) | epigastic pain that radiates to back, nausea, vomiting, periumbilical and flank hemorrhage (necrosis spread to other vessels), elevations of lipase/amylase, hypocalcemia (poor prognosis). |
| Acute pancreatitis (complications) | shock (hemorrhage, bradykinin), DIC (enzyme clotting factors degredation), pancreatic pseudocyst (fibrosis surrounding liquifactive necrosis), pancreatic abscess (E. coli-abd pain, fever, high amylase after AP tx), ARDS (alveolar capillary degradation) |
| Chronic pancreatitis | fibrosis of pancreatic parenchyma after recurrent acute attacks. Cp-epigastric abd pain radiating to back, pancreatic insufficiency, dystrophic calcification, secondary diabetes mellitus. Risk-pancreatic carcinoma. Cause- alcoholism & cystic fibrosis |
| Pancreatic carcinoma | adenocarcinoma arising from pancreatic ducts seen in elderly (70 y/o). R-smoking, chronic pancreatitis. Cp- epigastric abd pain & weight loss, obstructive juandice (head)/stale stools/palpable gallbladder, DMII (body/tail). Dx-CA-19-9. Tx-whipple. 10% 1yr |
| Pancreatic carcinoma (CP) | CP- pancreatitis w/o elevated lipase/amylase-> pancreatic insufficeincy; migratory thrombophlebitis, elevated CA-19-9 marker. 1 yr survival <10%. |
| Biliary atresia | failure to form or early destruction of extrahepatic biliary tree (lumen). Cp- biliary obstructuion w/in 3m of life, juandice, high CB, progresses to cirrhosis. |
| Cholelithiasis | Solid, round stones in gallbladder due to precepitation of cholesterol or bilirubin in bile. R-supersaturation, low phospholipids/ bile acids (lecithin;cholestiramin), stasis. CP- biliary colic, acute cholecystits, RUQ pain radiates to scapula, fever, N&V |
| Cholelithiasis (CP) | CP- biliary colic=waxing & waining RUQ pain, acute cholecystits=inflammation of GB-> dilation/pressure ischemia, RUQ pain radiates to scapula, fever, high WBC/ALP, N&V. may lead to rupture if left untreated. |
| Bilirubin Gallbladder stone | radioopaque on x-ray. R-extravascular hemolysis, biliary tract infection (E. coli, Ascaris lumbricoides, & clonorchis sinesis) |
| Cholesterol Gallbladder stone | MC GB stone; usually readiolucent; yellow. R- fat, fertile, female, forty y/o, clofibrate, native american decent, crohns disease (ileum damage), cirrhosis. |
| Chronic Cholycystitis | chronic inflammation of the GB due to chemical irritation from long-standing cholelithiasis. Cp-vague RUQ pain especially after eating, porcelain GB (late). Tx-cholecystectomy w/ risk of GB CA. |
| Ascending cholangitis | Bacterial infection of biliary ducts usually due to ascending infection w/ enteric gram (-) bacteria. CP- sepsis, jaundice, abdominal pain. C- cholelithiasis. |
| Gallstone Ileus | Gallstone obstructing the small bowel due to cholecystitis caused fistula formation b/w gallbladder and small bowel. |
| Gallbladder carcinoma | Adenocarcinoma arising from glandular epithelium that lines gallbladder wall. Risk- gallstones, porcelain gallbladder. CP- presents as cholecystitis in elderly woman. Poor prognosis. |
| Jaundice | Yellowish discoloration w/ earliest sign being sclera icterus. due to elevated serum bilirubin usually > 2.5 mg/dL. |
| Extravascular hemolysis or ineffective erythropoesis jaundice | elevated UCB overwhelms conjugating ability of liver. CP- dark urine w/ high urobilinogen. Risk- hyperpigmented bilirubin stones |
| Jaundice of newborn | elevated UCB due to decreased UDP glucoronyl transferase activity. Tx- phototherapy makes UCB soluble, preventing kernicterus. |
| Gilbert syndrome | AR caused elevated UCB due to mild UDP glucoronyl transferase activity. Cp- asymptomatic unless jaundice during periods of stress or infection |
| Crigler-Najjar syndrome | greatly elevated UCB due to abscence or severe deficienvy of UDP glucoronyl transferase leading to kernicterus and eventual death. |
| Dubin-Johnson syndrome | AR caused elevation of CB due to decreased bilirubin canalicular transport protein w/ dark pigmented liver. asymptomatic. |
| Rotor syndrome | AR caused elevation of CB due to decreased bilirubin canalicular transport protein w/o darkening of the liver. |
| Obstructive jaundice | High CB, low urobilinogen in urine, high ALP, & associated w/ gallstones, pancreatic carcinoma, cholangiocarcinoma, parasites, liver fluke (clonorchis sinesis). CP- dark urine, pale stools, pruritis, hypercholesterolemia-> xanthomas, fat malabsorption |
| Viral Hepatitis | High CB & UCB due to inflammation disrupting hepatocytes and small bile ductules. Cp- dark urine w/ high bilirubin, normal/low urobilinogen. HAV, HBV, HCV, HDV, HEV, EBV, CMV. |
| Hepatitis A virus | picornavirus naked (+)ssRNA w/ fecal/oral transmission often aquired by travelers/children. CP-acute hepatitis w/o chronic. relatively short incubation of 3wks. asymptomatic usually, but may-> jaundice, fever, vomiting |
| Hepatitis E virus | Calciviridae (+)ssRNA naked w/ fecal oral transmission acquired through contaminated water and undercooked seafood. No vaccine. Infection of pregnant women associated w/ fulminant hepatitis w/ 20% death. |
| Hepatitis B virus | hepadenoviridae dsDNA enveloped icosohedral w/ parental transmission (high childbirth infecction rate) w/ 3month incubation. chronic hepatitis develops in 20% of cases. |
| Hepatitis D virus | deltaviridae enveloped (-)ssRNA requires HBV to infect. superinfection (HBV before HDV) > coinfection severity & likelihood to develop fulminant infection |
| Hepatitis C virus | flaviviridae enveloped (+)ssRNA w/ parental infection (screened for in transfusion) results in acute hepatitis w/ chronic hepatitis occurring >70%. Dx- HCV-RNA. MC indication of liver transplantation. Type I MPGN & porphyria cutanea tarda associations. |
| Acute phase | HBsAG (+); HBeAB/HBV-DNA (+); HBcAB IgM (+); HBsAb (-) |
| Window phase | HBsAG (-); HBeAB/HBV-DNA (-); HBcAB IgM (+); HBsAb (-) |
| Resolved phase | HBsAG (-); HBeAB/HBV-DNA (-); HBcAB IgG (+); HBsAb IgG(+) |
| Chronic phase | HBsAG (+); HBeAB/HBV-DNA (+/-); HBcAB IgG (+); HBsAb (-) |
| Immunized phase | HBsAG (-); HBeAB/HBV-DNA (-); HBcAB (-); HBsAb IgG(+) |
| Cirrhosis | End stage liver disease, disruption of hepatic parenchyma by bands of fibrosis mediated by stellate cells secreting TGF-B to mediate fibrosis-> beneath endothelial cells that line sinusoids. C- portal HTN, high serum estrogen, jaundice, low serum protein |
| Cirrhosis (Cp) | ascites, congestive splenomegaly, hepatorenal syndrome, altered mental status, asterixis, coma (ammonia), spider angiomata, palmer erythma, gynecomastia, jaundice (CB & UCB), hypoalbunemia, edema, coagulopathy (high PTT only start-> High PTT & PT end) |
| Alcoholic related liver disease | Damage to hepatic parenchyma & MC cause of liver disease in west. fatty liver --> alcoholic hepatitis w/ mallory bodies & AST > ALT (>2.5X). 10-20% develop cirrhosis w/ chronic condition. |
| Non-alcoholic fatty liver disease | fatty damage, hepatitis, may develop cirrhosis. ALT > AST & associated w/ obesity. Dx of exclusion. |
| Hemochromatosis | excess body iron leading to deposition in tissues=hemosiderosis & organ damage=hemochromatosis mediated by fenton Rx (high ROS). Primary-AR HFE C282Y-> high Fe uptake at GI enterocytes; HLA-A3. secondary- multiple transfusion. |
| Hemochromatosis (CP) | CP- late adulthood w/ cirrhosis, DMT II, bronzed skin, cardiac arrhythmia, gonadal dysfunction (testicular atrophy), impotence, High ferritin/serum iron/% saturation, low TIBC/transferin. Dx-prussian blue stain. Tx-phlebotomy. C-hepatocellular carcinoma |
| Wilsons disease | AR defect in ATP mediated hepatocyte Cu++ transport (ATP7B gene) --> low Cu++ transport to bile and incorporation to ceruloplasmin. Cu++ deposits in tissues --> high ROS. CP- childhood cirrhosis, neurologic manifestations, kayser-fleisher rings in cornea. |
| Wilsons disease (labs) | Tx- D-penicillamine. Labs- High urinary Cu++, low ceruloplasmin, high Cu++ in liver biopsy. Risk- hepatocellular carcinoma. |
| Primary biliary cirrhosis | autoimmune granulomatous destruction of intrahepatic bile ducts. classically in 40 y/o women & associated w/ other autoimmune diseases. Dx- Antimitochondrial Ab. Cp- obstructive jaundice w/ late cirrhosis. |
| Primary sclerosing cholangitis | inflammation/fibrosis of intrahepatic/extrahepatic bile ducts --> periductal fibrosis w/ onion-skin appearance creating string of pearl appearance. ass-ulcerative colitis. Dx- P-ANCA (+). Cp- obstructive jaundice w/ late cirrhosis. risk-cholangiocarcinoma |
| Reye syndrome | Fulminant liver failure w/ encephalopathy in children treated w/ Aspirin while having viral infection. related to mitochondrial damage of hepatocytes. CP- hypoglycemia, high liver enzymes, N/V, may progress to coma/death. |
| Hepatic adenoma | benign tumor of hepatocytes associated w/ oral contraceptive use that regresses upon cessation of OC. Risk-rupture and intraperitoneal hemorrhage especially during pregnancy. |
| Hepatocellular carcinoma | Cause- chronic hepatitis (HBV, HCV), cirrhosis, aflatoxin from aspergillus (P53 mutation). poor prognosis w/ late detection & symptoms masked by cirrhosis. Dx- a-fetoprotein. |
| Budd-chiari syndrome | Risk from hepatocelluar carcinoma. liver infarction secondary to hepatic vein obstruction. Cp- hepoatomegaly, ascites, may lead to death. |
| Colon, pancreas, breast, lung carcinoma | MC cause of metastisis to liver w/ multiple nodules. Cp- hepatomegaly w/ noduled edges. |
| Shigella sonnei | MC form of shigellosis in US leading to miled diarrhea. commonly acquired in day care centers, nurseries, and custodial institutions. (+)glucose, (-) lactose fermenter on MacConkey agar.1-3 day incubation. fecal oral. |
| Shigella dysenteriae type 1 | Most severe form of shigellosis. seen in developing contries. (+) glucose, (-)lactose fermenter on macConkey agar (clear), hektoen enteric agar (green). causes tenesmus. |
| Vibrio parahaemolyticus | Cp-fever, vomiting, abd pain, explosive diarrhea. incubation-16-72hr. Fs- shellfish. OC- halophilic vibrio grows in TCBS agar. |
| Yersinia enterocolitica | Cp-watery diarrhea w/ flecks of blood, low fever, diffuse abd pain. Risk-leukocytosis of terminal ileum (diff appendicitis). incubation 1-10days. Fs- milk, tofu, meat. OC- gram (-) rod |
| Listeria monocytogenes | Cp-abd pain, diarrhea, fever & myalgia. incubation 24hrs. OC- gram (-) bacillus (-)spore, (+)catalase, tumbling motility, 4 C growth, beta-hemolytic, placenta cross, listeriolysin O, 2phospholipase C. Fs-cheese, milk, deli meats, hot dogs, unwashed veges. |
| methylcellulose | indigestible, hydrophilic colloid that absorbs water. ROA-oral. E-feces. MOA-laxitive that forms bulky, emolient gell to cause distension of colon & promote peristalsis. CU-constipation. CI-bowel obstruction, appendicitis, acute abd surgery, GI ulceration |
| Docusate | enhances incorporation of water/fat into stool to soften stool. ROA-oral/enema. Cu-constipation. |
| Mineral oil | lubricates fecal material, retarding colonic absorption of fecal water. ROA-oral/enema. CU-constipation. SA-lipid pneumonitis (aspirated), Vit A/D/E/K malabsorption |
| Lactulose | synthetic nonabsorbable suguar. ROA-oral/enema. hyperosmotic agent works w/in 1-3hrs producing purgation;breakdown by enteric bacteria acidifies colon (-) ammonia absorption. CU- constipation, hepatic encephalopathy |
| polyethylene glycol & electrolytes | balanced isotonic solution containing nonabsorbable PEG sugar. ROA-oral. MOA- hyperosmotic increases fecal fluid. CU- constipation, bowel prep for GI endoscopy |
| Bisacodyl | Diphenylmethane derivative stimulant laxative acting on ENS/elecrolyte/fluid secretion. ROA-oral/enema. CU-constipation, Bowel prep w/ PEG efore colonoscopy. SA-cathartic colon, electrolyte imbalance. |
| Senna | Natural plant product stimulant laxative. ROA-oral. CU-constipation. SA-melanosis coli, finger clubbing, cathartic colon |
| Alvimopan | peripheral mu-opioid receptor antagonist laxitive w/o CNS effect. ROA-oral. CU-short term opioid use and shorten postop ileus. CI-cannot take >7days. SA-dyspepsia, anemia, hypocalemia, back pain, constipation. |
| methylmaltrexone | peripheral mu-opioid receptor antagonist laxitive w/o CNS effect. ROA-SC. CU-opioid induced constipation of palliative care. SA-hyperhidrosis, GI perforation |
| Lubiprostone | Type 2 chloride channel (CIC-2) agonist in small intestine increases chloride-rich fluid into intestine and shortens GI transit time. ROA-oral. CU=chronic idiopathic constipation, IBS (females only). SA-chest pain/discomfort, peripheral edema. |
| Diphenoxylate/Atropine | opioid receptor agonist antidiarrhetic. slow GI motility, increase fecal H2O absorption, decrease gastrocolic reflex, CNS effects (HD). ROA- oral. CU-diarrhea. SA-opioid dependence, anticholinergic effects (atropine), pancreatitis, toxic megacolon. |
| Loperamide | opioid receptor agonist w/ low CNS effect. slow GI motility, increase fecal H2O absorption, decrease gastrocolic reflex. ROA-oral. CU-diarrhea. SA-dizziness, fatigue, bullous eruptions. CI-bloody diarrhea, high fever, pseudomembrnous colitis. |
| Cholestyramine | cationic exchange resins insoluble in H2O bind bile acids in GI lumen to prevent reabsorption. ROA-oral. CU-diarrhea caused by excess fecal bile acids. SA-constipation, malabsoption of Vit A/D/E/K. CI-complete biliary obsdtruction |
| Octreotide | synthetic octapeptide somatostatin receptor agonist. ROA-SC, IM, IV. SA-GB problems, dysglycemia, hypothyroidism, bradycardia, ECG changes, pancreatitis |
| Octreotide (CU) | CU-acromegaly, carcinoid tumor, VIPoma, esophageal variceal bleeding, AIDS-related diarrhea, GI/pancreatic fistula, dumping syndrome, chemotherapy-related diarrhea, chylothorax, GI bleeding, hyperinsulinemia/hypoglycemia of infancy. |
| Alosetron | potent/selective 5-HT3 receptor antagonist (-) N/V, bloating, colonic motility. decrease colonic trnasit time. Cu-IBS severe diarrhea (adult women). SA-BLack box. CI-rectal bleeding, hx of chronic consitipation, crohns disease, toxic megacolon. |
| Dicyclomine | nonspecific muscarinic receptor antagonist blocks PNS effects on smooth muscle, secretory glands, CNS, GI tract. ROA-oral, IM. CU-IBS adults/children. SA-blurred vision, sedation, paralytic ileus, constipation, local skin irritation (IM only). |
| Ondansetron | Antiemetic 5-HT3 receptor inhibitor in area prostrema, CTZ, extinsic vagal & spinal afferent nerves. may slow colonic transit. ROA-oral, IV, IM. CU-(-) N/V from chemotherapy, postoperative, radiation; cholestatic pruritus, spinal-opioid pruritis. |
| Aprepitant | antiemetic by antagonism of brain supstance P/neurokinin 1 receptors in area prostrema. ROA-oral. CU-prevent acut/delayed N/V from surgery, chemotherapy. SA-headache, alopecia, bradycardia, hypotension, anemia, neutropenia |
| fosaprepitant | antiemetic by antagonism of brain supstance P/neurokinin 1 receptors in area prostrema. ROA-IV. CU-prevent acut/delayed N/V from surgery, chemotherapy. SA-headache, alopecia, bradycardia, hypotension, anemia, neutropenia |
| Diazepam, lorazepam | antiemetic benzodiazepines given before initiation of chemotherapy to reduce anticipatory vomiting or anxiety vomiting |
| droperidol | Butyrophenone antiemetic, antipsychotic agent blocks CNS dopaminergic circuits. |
| Dronabinol | cannabinoid THC psychoactive agent antiemetic. ROA-oral. Cu- (-) N/V in chemotherapy & (+) appetite. SA- psychoactive properties. CI-hypersensitivity to sesame oil, pregnancy category C. |
| Diphenhydramine, dimenhydrinate, meclizine, scopolamine | H1-receptor antagonist/ anticholinergic drugs used as antiemetic |
| prochlorperazine, promethazine, thiethylperazine | Phenothiazine antipsychotic drug antiemetics inhibit dopamine and muscarinic receptors. |
| metocloproamide, trimethobenzamide | Benzamide antiemetic w/ dopamine-receptor blockade ability |
| Mesalamine | 5-aminosalicylic acid (5-ASA) w/ various unique packaging. ROA-oral/rectal.COX/LOX pathways (-) pro-inflammatory cytokines, NF-kB, NK cells, mucosal lymphocytes, macrophages; scavenges ROS. risk-reye syndrome. CI-pregnancy |
| Sulfasalazine | 5-ASA bound by Azo (N=N) bond to reduce absorption of drug from SGI. flora cleave azo w/ azoreductase releasing active 5-AZA. ROA-oral.modulate COX/LOX pathways (-) pro-inflammatory cytokines, NF-kB, NK cells, mucosal lymphocytes,macrophages;scavenges ROS |
| Mesalamine (CU) | CU-1st line tx for mild --> moderate active ulcerative colitis & crohns disease in colon/distal ileum. SA-GI discomfort, exacerbation of colitis, pericarditis, cholestatic hepatitis, discolored urine |
| Sulfasalazine (CU) | CU-1st line tx for mild --> moderate active ulcerative colitis & crohns disease in colon/distal ileum, Rheumatoid arthritis, juvenile rheumatoid arthritis. risk-reye syndrome |
| Sulfasalazine (SA) | SA-GI pain/ulcerations/bleeding, tinnitus, hearing loss, hepatotoxicity, renal damage, premature hemolysis, CNS alterations, pulmonary edema, bronchospasm, interstitial lung disease. |
| Prednisone, prednisolone | MC oral or IV GCs used for moderate --> severe IBD |
| Hydrocortisone | Enema, foams, suppositories GC used to maximaize colonic tissue effect and minimize systemic absorption. preferred for IBD occuring in rectum or sigmoid colon. |
| Budesonide | potent analog of prednisolone given orally, but released in ileum/colon w/ a low bioavailability. preferred GC for mild --> moderate crohns disease of ileum & proximal colon |
| Azathioprine (17 wks) | Thiopurine analog converted to mercaptopurine activated by HGPRT to TIMP/6-TGN which (-) several enzymes in de novo purine synthesis= cytotoxic immunosuppressant . CU-ulcerative colitis, crohns disease. SA-leukopenia, infections, mutogenic |
| Mercaptopurine (17 wks) | Thiopurine analog activated by HGPRT to TIMP/6-TGN which (-) several enzymes in de novo purine synthesis= cytotoxic immunosuppressant . CU-ulcerative colitis, crohns disease. SA- elevated liver function tests, thrombocytopenia, nephrotoixic, pancreatitis. |
| methotrexate | folic acid analog DMARD (-) DHFR, cell proliferation, IL-1. (+) adenosine anti-inflammatory & Tcell apoptosis. ROA-oral, IV, IM. CU-induction/ maintanence of Crohn's disease. SA-demyelinating encephalopathy, GI perforation, renal/hepatotoxic, blackB pregX |
| Infliximab | IgG anti-TNF to (-) cytokine release, (+) apoptosis of Tcell/macrophages. ROA-IV. CU-acute/ chronic moderate --> severe crohns/ ulcerative colitis disease in 2wks. SA- anti-nuclear Abs, infection, URTI, lupus-like syndrome, sepsis, TB, malignancy |
| Natalizumab | IgG anti-a4 of integrin (-) chemotaxis/diapedisis. CU-moderat --> severe crohns disease. SA- LR infections, UTI's, gastroenteritis, progressive multifocal leukencephalopathy (JC virus) |
| Ursodiol | urodeoxycholic acid decreases cholesterol content of bile by reducing hepatic cholesterol secretion, stabalizes hepatocyte canalicular membranes. expands bile acid pool & dissolves gallstones. CI-IBS, calcified gallstones, chronic hepatitis |
| ursodiol (CU) | CU-dissolution of small cholesterol gallstones, gallstone prevention, primary biliary cirrhosis, cystic fibrosis liver disease, intrahepatic cholestasis of pregnancy |
| Albendazole | Benzimidazole (-) helminthic microtubule synthesis. ROA-oral;better w/ fatty meal. VD-all body tissues, CSF, hydatid cysts. SA-neurocysticercosis, agranulocytosis, BMS, hepatitis, liver/renal failure. |
| Mebendazole | Benzimidazole (-) helminthic microtubule synthesis & glucose uptake. ROA-oral;better w/ fatty meal.VD-all body tissues, CSF, hydatid cysts. SA-angioedema, seizures, alopecia, neutropenia, unusual weakness. |
| Diethylcarbamazine | antihelminth w/ unknown MOA. citrate salt. The DOC- filariasis, loiasis, mansonella stretocerca, tropical eosinophilia. SA- encephalopathy, allergic response to dying microfilariae, Pregnancy X. |
| Ivermectin | antihelminthic glutamate-gated Cl- channel agonist=hyperpolarize; microfilaricidal to onchocerca volvulus. ROA- oral, topical.SA-microfilaricidal Rx 1st day, swelling & abscess 1-3wks, conjunctivitis, ocular hyperemia, eye irritation, dandruff |
| Praziquantel | (+) permeability of helminthic cell to Ca++=paraylysis, dislodgement, death. adult & immature stages. ROA-oral w/o chewing & w/ high carb meal/cimetidine. poor CNS Dist. SA- CNS RX w/neurocysticercosis.CI- CYP34A4 (+), intraocular/spinal cystocercosis |
| pyrantel pamoate | (+) Ach release & (-) cholinesterase= paralysis of worms and expulsion via peristalsis. SA- tenesmus, elevated liver function, weakness. CI- GI obstruction, hepatic disease. |
| Pyrantel pamoate (A CU) | A CU-in children & adults- Ascariasis, enterobiasis, trichostrongylus orientalis, Hookworm. |
| Doxycycline | Tricyclic Abx kills wolbachia bacteria= microfilaircidal of W. bancrofti & onchocerciasis |
| Metronidazole | antiprotazoal agent that is THE drug of choice for dracunculiasis. |
| Albendazole (THE CU) | THE CU- gnathostomiasis (2/dyX3wks), Hydatid cyst=echinococcosis (2/dyX28daysX3), capillaria philipinensis (intestinal capillariasis), microsporidial infection, neurocysticercosis (T. solium w/ corticosteroids), visceral larva migrans |
| Albendazole (A CU) | A CU- A. cantonensis infection, Ascariasis (roundworm), cutaneous larva migrans (creeping eruption), N. americanus/A. duodenale (hookworm), trichinosis (trichinella spiralis, trichuriasis (T. trichiura=whipworm) |
| Albendazole (alternative CU) | alt CU-clonorchiasis (clonorchis sinensis), enterobiasis(pin worm), Filariasis/elaphantiasis (wuchereria bancrofti/ brugia malayi), opisthochiasis (opisthorchis felineus=cat liver fluke), strongyloidiasis, trichostrongylus orientalis, tropical eosinophila |
| Mebendazole (A CU) | A CU- A. cantonensis infection, ascariasis, enterobiasis, hookworm, trichinosis, T. orientalis, trichuriasis. |
| Mebendazole (alternative CU) | Alt CU- dracunculiasis medinensis, intestinal capillariasis, taenia saginata (beef tapeworm), visceral larva migrans. |
| Diethylcarbamazine (THE CU) | THE CU- filariasis (antihistamine/GC Coadministration), loiasis Loa Loa (african eye worm), mansonella streptocerca, tropical eosinophilia |
| Ivermectin (CU) | THE CU- Strongyloidiasis (intestinal), Onchocerciasis (river blindness). Alt CU- ascariasis, filarisis, loiasis, trichuriasis, tropical eosinophilia, head lice, scabies, blapharitis (demodex folliculorum) |
| Praziquantel (THE CU) | THE CU- Clonorchiasis, hymenolepis nana (dwarf tapeworm), schistosoma haematobium/ mansoni/ japonicum (old & new world w/ GC's), opisthorchiasis, paragonimiasis (oriental lung fluke paragonimus wstermani) |
| Praziquantel ((A/alt CU) | A CU- diphyllobothrium latum (fish tapeworm), fasciolopsis buski (Large GI fluke), heterophyesX2 (small GI fluke), metagonimus yokogawai (small GI fluke), taeniasis, T. solium (adult). alt CU- neurocysticercosis |
| Albendazole, mebendazole | A. Cantonensis infection Tx |
| Albendazole, mebendazole, pyrantel pamoate < Ivermectin | Ascarias lumbricoids Roundworm infection Tx. |
| Praziquantel < Albendazole | Clonorchis sinensis oriental liver fluke Tx. |
| Albendazole, Ivermectin | Cutaneous larva migrans or creeping eruption Tx. |
| Albendazole, mebendazole, pyrantel pamoate | enterobius vermicularis or pinworm disease Tx. |
| Diethylcarbamazine > Albendazole, ivermectin | Wuchereria bancrofti or brugia malayi elephantiasis = filariasis Tx. |
| Albendazole, mebendazole, pyrantel pamoate, | Necator americanus & A. duodenale Hookworm Tx. |
| Albendazole > mebendazole | Intestinal capillaria philippinensis = capillariasis Tx. |
| Albendazole > praziquantel | T. solium pork tapeworm = neurocysticercosis Tx. |
| Praziquantel > albendazole | Opisthorchis felineus cat liver fluke opisthorchiasis Tx. |
| Ivermectin > albendazole | strongyloides stercoralis threadworm disease = strongyloidiasis Tx. |
| Albendazole, mebendazole | Trichinella spiralis trichinosis infection Tx. |
| pyrantel pamoate > albendazole | trichostrongylus orientalis infection Tx. |
| mebendazole, albednazole > ivermectin | T. trichiura whipworm disease = trichostrongylus Tx. |
| Diethylcarbamazine > Albendazole (empiric alternative Tx), ivermectin | Tropical eosinophilia Tx. |
| Albendazole > Mebendazole | Visceral larva migrans Tx. |
| Metronidazole > mebendazole | dracunculus medinensis Guinea worm dracunculiasis infection Tx. |
| Praziquantel > mebendazole | Taenia saginata Beef tapeworm taeniasis infection Tx. |
| pyrantel pamoate, mebendazole > albendazole | Trichostrongylus Orientalis infection Tx. |
| Diethylcarbazine > Ivermectin | Loa loa African eye worm loiasis infection Tx. |
| Ivermectin > Doxycycline | Onchocerca volvulus River blindness onchocerciasis infection Tx. |
Created by:
45203472
Popular USMLE sets