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GI Pathology

USMLE GI pathology

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



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