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Hepatitis A Fecal-Oral. Acute only.
Hepatitis B Parenteral/Sex/IV, 6mo+ HBs-> +/- Chronic->heptatocelluar Carcinoma. HBe & HBV DNA correlate w/viremia.
Hepatitis C Parenteral, Transfusion. +/- Chronic ->Hepatocellular Carcinoma
Hepatitis D Co-infx w/ HVB. +/- Chronic.
Hepatitis E Fecal-oral. Pregnancy-> increased mortality
Gilbert Syndrome Reduced UDP glucuronyl transferase. High unconjugated bilirubin. Asymptomatic
Crigler-Najjar Syndrome No UDP glucuronyl transferase. Jaundice, kernicterus (depositin in brain), high unconj. bilirubin. Type1: Lethal. Type2: Tx w/ phenobarbital.
Dubin-Johnson & Rotor Syndromes No bilirubin excretion from liver. D-J:->black liver. Both are benign.
Microvesicular Fatty Liver: Reye's Syndrome: Microvesicular fatty liver, Encephalopathy & coma. Assoc. w/ Aspirin in kids w/ viral infx. Pregnancy: During 3rd trimester, High mortality. Tetracycline: Hypersensitivity Rx.
Hemachromatosis DM, Cirrhosis, Skin pigmentation. HLA-A3 associated OR Achronic transfusions (beta thalassemia), chrom 6. Elevated serum FE
Wilson's Disease Ceruloplasmin deficiency (a marker, not causal). Hepatitis/cirrhosis, Basal ganglia [parkinsonian]. Renal tubule)
Budd-Chiari Syndrome Thrombosis of hepatic vein->jaundice, hepatomegaly, ascites. Assoc. w/poycythemia vera, hepatocellular carcinoma/other abdominal neoplasms, pregnancy.
Pancreatic Adenocarcinoma #1:Head-> obstructive jaundice. #2:Tail->Secondary DM
Abdominal layers Skin, Superficial fascia, External->internal Oblique,Transversus abdominus, Transversalis fascia, Extraperitoneal tissue, Peritoneum.
Celiac A. Foregut. Vagus. T12/L1: Stomach, prox duodenum, liver & gallbladder, pancreas.
Superior Mesenteric A. Midgut. Vagus. L1. Dist. Duodenum, Proximal 2/3 of Transverse colon
Inferior Mesenteric A. Hindgut. Pelvic. L3. Distal 1/3 of Transverse verse colon, upper rectum.
Myenteric (Auerbach's) Motility. Between inner(circular) & outer(longitudinal) smooth muscle layers.
Submucosal (Meissner's) Secretion, blood flow, absorption. In submucosa between mucosa & inner smooth muscle layer of muscularis externa.
Cholecystokinin I cells (Duodenum&Jejunum). Pancreatic & Gall secretions. Inhibits Gastric emptying. Fat & protein stimulates it-> Cholelithiasis exacerbated by fatty meal.
Gastrin G Cells (Antrum). Increase Acid, motility, mucosa growth. Stimulated by stomach distention, protein (esp. phenylalanine & tryptophan), vagus. Inhibited by low pH. ZE syndrome.
Secretin S Cells (Duodenum) Increase bicarb & bile, decrease H+. Increased by acid, fat. Higher pH permits pancreatic enzymes.
Somatostatin D Cells. (Pancreas, Mucosa). Slows everything. Stimulated by acid, inhibited by vagus. Tx for VIPoma, carcinoid
GIP K Cells. (Duodenum & Jejunum). Reduce acid, increase insulin. Stimulated by food.
VIP Parasympathetics (sphincters, gallbladder, small intestine). Increase H2O, SM relaxation. Stimulated by distention, inhibited by sympathetics. VIPoma: pancreatic tumor-> diarrhea.
NO SM relaxation. LOF-> achalasia.
Motilin Small intestine. Migrating motor complexes. Stimulated by fasting state.
SGLT1 Glucose/Galactoe-Na Co-transporter
GLUT-5 Fructose transporter.
GLUT-2 Nonspecific monosaccharide xporter to blood.
Boerhaave Syndrome Esophageal rupture b/c retching (as opposed to mallory-weiss tear, which is painful lacerations to GE-jct)
Whipple'S Disease Malabsorption, migratory arthritis, CNS, Cardiac. T. whipplei bacteria (G+ bacillus). PAS+ macrophages
Celiac Sprue Blunted villi, lymphatic infiltrati. Jejunum. Assoc w/ Dermatitis Herpetiformis, T-Cell Lymphomas.
Menetrier's Disease Gastric hypertrophy -> thick ruggae. Mucinous cells overrun parietal cells -> low H+ output -> protein malabsorption.
Ulcerative Colitis Autoimmune. Rectum +. (Sub)Mucosa involvement. Always bloody. Assoc w/Pyoderma gangrenosum, colorectal carcinoma & primary sclerosing cholangitis. Tx: Sulfasalazine.
Crohn's Disease Post-infx. Terminal ileum, Colon - rectum. Transmural inflammation, skips, cobblestone. Granulomatous. Tx: corticosteroids.
Diverticulosis v. Diverticulitis Diverticulosis: Elderly, low-fiber diet, Sigmoid colon. Diverticulitis: Inflammation, LLQ pain, fever, leukocytosis -> peritonitis, abscess.
Meckel's Diverticulum Ectopic gastric/pancreatic tissue. Terminal ileum. Assoc w/volvulus, intussusception, obstruction.
Turcot's Syndrome FAP + Glioblastomas
Peutz-Jeghers Syndrome Hamartomatous benign polyps on small intestine/colon. High risk of Colorectal cancer, others.
AST>ALT Alcoholic hepatitis (>1.5)
ALT>AST Viral hepatitis
Reye's Syndrome ASA tx for pediatric viral infx. Microvesicular fatty liver, hypoglycemia, coma.
Mallory Bodies Hyalination. Alcoholic hepatitis marker.
Hepatocellular Carcinoma Hep B&C, Wilson's, Hemochromatosis, alpha1-antitrypsin, alcohol, aflatoxin. Alpha-fetoprotein.
Hyperbilirubinemia HEPATOCELLULAR: Conj & Unconj, High urine bilirubin, normal urobilinogen. CHOLESTATIC/OBSTRUCTIVE: Conj, high urine bilirubin, low urobilinogen. HEMOLYTIC: Unconjugated. No urine bilirubin, elevated urine urobilinogen.
Acute Pancreatitis GET SMASHeD: Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune dz, Scorpion sting, Hypercalcemia/Hyperlipidemia, Drugs (sulfa)
Retroperitoneal GI Structures Distal duodenum, Ascending & Descending Colon, Pancreas
GI Collateral Circulation (Aorta Blocked) Subclavian -> Internal Thoracic/Mammary -> Sup. Epigastric -> Inf. Epigastric -> Ext. Iliac -> Int. Iliac -> 1) Middle Rectal -> Inf. Mesenteric -> Sup. Mesenteric -> Thoracic Aorta 2) Common Iliac -> Thoracic Aorta. Then supplies Celiac, SMA, IMA
Portosystemic Vein Anastamoses 1)Umbilicus (Inf & Sup Epigastric <-> Paraumbilical ). 2) Esophagus (L. Gastric <-> Esophageal Veins). 3) Rectum (Superior Rectal <-> Middle/Inferior Rectal Veins) 4)Surgical: Splenic <-> Renal
Brunner's Glands Alkaline mucus secretions from duodenal submucosa. Hypertrophied in peptic ulcer disease.
Enteropeptidase/Enterokinase Activates Trypsinogen -> Trypsin in duodenum.
Glut5, SGLT1 Glut5: GI passive fructose absorption. SGLT1: Na-dependent Glucose & Galactose importer
Esophageal Cancer (Risk factors, Type) ABCDEF: Alcohol/Achalasia, Barrett's, Cigarettes, Diverticuli, Esophageal Web (P-V Synd)/Esophagitis, Familial. SCC>Adeno.
Misoprostol PGE1 Analog. Supports gastric mucous, inhibits acid secretion. NSAID-induced peptic ulcers, maintain PDAs, induce labor, abortion
H Pylori Tx Metronidazole, Amoxocillin/Tetra, Bismuth, +/- PPI
Pirenzepine M1, M3 Antagonist -> Lowers Acid & Histamine secretion. Tx: Peptic ulcers. SE: Tachycardia, dry mouth, blurry vision.
AlOH, MgOH,CaCO3 HYPOKALEMIA Aluminum: Constipation, hypoPO4. Magnesium:Diarrhea, hyporeflexia, HypoTN & Cardiac arrest. Calcium:hyperCa, rebound acid.
Infliximab Anti-TNF antibody. Tx: Crohn's Disease, Rheumatoid Arthritis. SE: Fever, Respiratory Infx, HypoTN
Sulfasalazine Sulfapyridine(antibiotic) + Mesalamine(anti-inflammatory). Tx:UC, Crohn's. SE:Malaise, Nausea, Sulfa toxicity, oligospermia.
Onadestron 5-HT3 antagonist. Tx: Anti-emetic. SE: Headache, constipation.
Created by: Kyle Tiemeier