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Side A ------ Side B Fat, forty, female, fertile w/ RUQ pain ------ Cholelithiasis or Cholecystitis Fever, RUQ pain, radiation to back ------ Cholecystitis Elevated Alkaline phosphatase, urinary bilirubin ------ Cholecystitis F, RUQ pain, Jaundice, gallstones & dilated common duct on US ------ Ascending cholangitis (Charcot’s triad) Hx IBD, progressive RUQ pain, wt loss, F, jaundice & pruritis. Elevated bilrubin & alkaline phosphate. ERCP with bile duct stenosis, dilatation ------ Primary sclerosing cholangitis (diffuse intra- and extrahepatic duct sclerosing and dilatation) Elevated AST, ALT, indirect bilirubin ------ hepatitis Isolated elevated indirect bilirubin ------ Gilbert’s syndrome Elevated indirect bilirubin w/ defective glucuronyl transferase ------ Crigler-Najjar Dz Photosensitivity, abd pain w/ neurologic dysfunction, erythema or skin fragility ------ porphyria H.pylori gastritis ------ 2antibiotics & PPI Chronic cough, bitter taste in mouth or throat, dyspepsia ------ GERD Multiple or constant GI ulcer pain despite medications ------ Zollinger-Ellison Syndrome Peri-umbilical or flank ecchymosis ------ Acute pancreatitis (Cullen & Grey Turner’s Sign) N/V, epigastric abdominal pain, worse supine, caused by alcohol ingestion, or following fatty meals ------ Acute pancreatitis Abdominal distension, bloating, intermittent, colicky pain, high-pitched rushes & tinkles ------ SBO Air fluid levels on upright abd plain film ------ SBO Air under diaphragm, rigid board-like abdomen ------ Perforated viscus, perforated ulcer >60yo F, LLQ pain ------ Diverticulitis. IV Abx, fluids, NPO. Elderly, Hx atherosclerosis. Dull crampy periumbilical pain post-prandial ------ Mesenteric ischemia Neonate w/ projectile vomiting. Olive sized mass. ------ Pyloric stenosis Choking, cyanosis, respiratory distress, increased secretions in 1st hours of life ------ Tracheoesophageal fistula Painless rectal bleeding in pediatrics ------ Meckel’s diverticulum Alcoholic with massive hemoptysis ------ Esophageal varicies (Tx w/ octreotide) Female with recurrent abdominal pain, alternating diarrhea, constipation. Pain relieved with defecation. ------ IBS. TCA’s (nortriptyline) good if diarrhea predominant symptom Bloody Diarrhea ------ Ulcerative colitis Supraclavicular LAD (L > R) ------ Virchow’s node – metastatic abdominal cancer Hard periumbilical nodule ------ Sister mary Joseph nodule = indicates metastatic gastric and pancreatic cancers PUD, Pernicious anemia (Type A Gastritis), H. pylori ------ Gastric Ca Apple core lesion ------ Colon Cancer Elderly with positive hemmocult. ------ Colon Cancer – get colonoscopy CEA ------ Colon Carcinoma Family history of young age colon cancer, multiple polyps found on colonoscopy ------ Familial adenomatous polyposis (Gardner’s syndrome) AFP ------ Hepatocellular carcinoma, testicular seminoma (germ cell tumor) CA 19-9 ------ Pancreatic Ca CA-125 ------ Ovarian Carcinoma Chemotherapy induced N&V ------ Treat with Ondansetron (Zofran) (5-HT3 blockers) Traveler’s Diarrhea ------ E. coli is cause. Hydration & Cipro to treat Greasy, foul smelling, floating stools. Pear-shaped flagellated protozoan w/ 2 “eyes”. Water, travel, camping history ------ Giardia Afebrile, watery or loose stool. No blood or mucus ------ Viral Gastroenteritis Abdominal pain, diarrhea after picnic/party. Eaten ham, cream, custards, mayonnaise ------ Staphylococcus aureus infectious diarrhea Acute bacterial diarrhea w/ prodrome of HA, F, then crampy abd pain & diarrhea ------ Campylobacter jejuni – most common cause of acute bacterial diarrhea Painless rectal bleeding. Bulging perianal mass w/ straining ------ Internal hemorrhoids Pediatric with perianal pruritis esp. at PM. Positive cellophane tape test ------ Pruritis ani – Pinworms (enterobiasis). Tx is Mebendazole Weight loss, recurrent greasy stools (steatorrhea) mixed with diarrhea after certain foods ------ Celiac Sprue Anti-endomysial antibodies ------ Celiac Sprue Beriberi ------ Thiamine; Alcoholics, Neuro Sx Pellagra ------ Niacin (4D’s dermatitis, diarrhea, dementia, death), bright red tongue Scurvy ------ Vit C (easy bleeding, bruising, hair & tooth loss, joint pain & swelling) Rickets ------ Vit D (Osteomalacia) Night blindness ------ Vit A deficiency Magenta tongue ------ Riboflavin deficiency (B2) s/p gastric bypass surgery or gastric surgery. N, abd cramping, dizziness after eating. No masses, bleeding ------ Dumping syndrome crampy abdominal pain, increased high pitched bowel sounds, gas only in the small intestine ------ Small bowel obstruction gas with obstipation and failure to pass flatus ------ Paralytic ileus hypocalcemia in ESRD ------ deficiency of vitamin D somatostatin receptor scintography ------ ze study of choice Two top causes of hypercalcemia ------ Primary hyperparathyroidism and malignancy account for 90% of all cases of hypercalcemia. Ten to twenty percent of patients with cancer develop hypercalcemia, most commonly because of breast, lung, kidney, head and neck carcinomas, and multiple myeloma and lymphoma. soft tissue thickening of the pericolic fat, diverticula, and thickening of the bowel wall ------ CT findings consistent with diverticulitis haustral markings ------ haustral markings= LARGE BOWEL. cause of LBO ------ cancer, diverticulum, volvulus causes of SBO ------ adhesions, hernia Rx indicated for prevention of NSAID ulcers ------ omeprazole Trx systemic htn/ascites ------ start sprinolactone. if refractory can do paracentesis or tips the best visualization of an esopahgeal web or ring. ------ barium esophagram Barium studies contraindication ------ patients with a possible perforation acute performation ------ perform hartmann procedure, if scheduled colectomy and primary anastomosis is considered. PUD imaging ------ upper endoscopy absence of ganglion cells in the colon and typically presents early in life with failure to pass meconium, followed by vomiting and abdominal distension. ------ Hirschsprung disease pyloric stenosis imaging ------ upper GI with barium inner tube or coffee bean on imaging ------ volvulus The treatment of choice for diarrhea caused by Giardia ------ metronidazole 250 to 750 mg po three times per day. cholera DOC ------ doxycycline or tetracycline drug used to treat Campylobacter. ------ Erythromycin drug used to treat cholera and shigellosis. ------ Quinolones at what size do cecal obstructions require surgery ------ >12cm require surgical intervention d/c what drug prior to fecal and urea breath testing. ------ no PPI 1-2 weeks prior to fecal and urea breath testing. increased serum ammonia ------ asterixis; consider hepatic encephalopathy- give lactulose autoimmune heptatitis ------ corticosteroids Celiac diet (abstain from eating) ------ BROW: Barley Rye Oats Wheat lead pipe colon, thumbprinting, loss of haustral markings ------ ulcerative colitis Double bubble on Xray ------ represents duodenal atresia (related to Down Syndrome) most common complication associated with acute pancreatitis. ------ Pancreatic pseudocysts suspected for a patient who has continued abdominal pain, the development of an abdominal mass, and continued elevations of amylase or lipase levels following an episode of acute pancreatitis. alendronate (fosamax), which is known to cause what ADR ------ esophagitis hypochloremic alkalosis with potassium depletion. ------ pyloric stenosis hallmark of peptic ulcer disease ------ Dyspepsia (epigastric pain) variceal hemorrhage prophylaxis ------ Beta blocker affects women typically between ages 40 and 60. It is often discovered incidentally when the serum alkaline phosphatase level is found to be elevated. ------ Primary biliary cirrhosis Calcification of the gall bladder, frequently referred to as a porcelain gall bladder, and single, solitary, large, gall stone ------ gall bladder cancer A significantly elevated PT/INR as well as bilirubin > 10 mg/dl ------ indicators of severe alcoholic hepatitis and increased mortality requiring hospitalization hematemesis with severe retrosternal tearing pain ------ boerhaave's syndrome- get esophogram and emergent surgical consult esophagram with "birds beak" ------ achalasia- tx botox, myotomy smooth circumferential structure in the distal esophagus ------ schatzki ring- get esophagram dysphagia with regurgitation of food especially in the am; older patients ------ zenker's diverticulum; get barium esophagram, surgery in severe cases esophageal web may develop from what deficiency? ------ iron deficiency (plummer vinson syndrome) when to take PPIs ------ take 30 minutes before meals complication of GERD ------ barrett's esophagus (which has an increased risk adenocarcinoma); tx long term PPI serum gastrin level >150 ------ consider ZES ulcer disease- weight loss versus weight gain ------ GUS- weight loss DUS- weight gain two main causes indirect unconjugated bilirubinemia ------ hemolysis, inherited (gilbert, crigler) biliary colic, n/v, jaundice, ELEVATED LFTs ------ choledolithiasis fever, RUQ pain, jaundice ------ charcot's triad risk of pancreatitis with what procedure ------ ERCP women (40-50) with fatigue, jaundice, pruritis, hepatomegaly, elevated alk phos, AMA + ------ Primary biliary cirrhosis; treat with bile acid sequestrant, cure is transplant Gold standard dx biliary cirrhosis ------ liver biopsy womean 30-50 with fatigue, anorexia, arthralgias, +ANA, +ASMA ------ Autoimmune hepatitis, get liver biopsy fatigue, jaundice, pruritis, pain; associated with ulcerative colitis ------ primary sclerosing cholangitis nontender palpable gall bladder with hx weight loss ------ klatskin tumor/cholangiocarcionoma rx causes acute pancreatitis ------ azothioprine, pentamide, valproate, thiazides Ranson Criteria ------ At admission: "GA LAW" (Glucose 200, Age>55, LDH >350, AST>250, WBCcount>16)* At 48 hours: "C HOBBS" (as in Calvin and Hobbes): (Calcium, Hematocrit, O2, BUN, Basedeficit, Sequestration (of fluid) greater than 6 L most common cause chronic pancreatitis ------ alcohol abuse-other causes CF, hyperparathyroidism, hx acute panc. imaging of choice chronic pancreatitis ------ CT- look for calcifications most common location pancreatic cancer ------ head increased % transferrin sat ------ hemochromatosis (autosomal recessive) low serum ceruloplasmin, increased urine copper ------ wilson's disease, treat with penicillamine icterus, jaundince, malaise with ALT>AST (20x) ------ Viral hepatitis chronic hep B carriers are at risk for what? ------ HCC most common blood bourne infection ------ hepatitis C leading cause of chronic liver failure ------ hepatitis C diagnosis of hepatitis C ------ screen with EIA, if positive use RIBA to confirm hepatitis C treatment ------ interferon plus ribavirin factor that impact hep C trx ------ genotype, race (AA males less likely to respond) most common cause cirrhosis ------ alcoholic hepatitis non alcoholic versus alcoholic liver disease ------ if AST/ALT >2.0 think ALCOHOL most common metastatic cancer ------ hepatocellular cancer most common location crohn's disease ------ terminal ileum spares the rectum ------ crohn's disease skip lesions ------ crohn's disease colicky RLQ pain, diarrhea, low grade fever, weight loss ------ crohn's disease string sign ------ crohn's disease cobblestoning ------ crohn's disease what is malabsorbed with crohn's disease ------ vitamin B12 and Fat most common complication crohn's disease ------ fistula medical management crohn's disease ------ mesalamine, sulfasalazine; azathioprine; biologics (Humira) >50 y/o with hx atherosclerotic disease sudden severe abdominal pain; post prandial ------ mesenteric ischemia celiac sprue diet (CAN EAT) ------ CRAP (corn, rice, arrowroot, potatoes) dematologic manifestation celiac sprue ------ dermatitis herpetiformis (pruritic papulovesicles over extensor surfaces and trunk/neck) mucosal biopsy: villous atrophy, blunting of villi duodenum ------ findings with celiac sprue crypt abscess ------ ulcerative colitis complications ulcerative colitis ------ toxic megacolon, performation, cancer treatment ulcerative colitis ------ aminosalicylate, cortiocsteroids, immunosupperives, tnfCOLECTOMY IS CURATIVE most common cause lower GI bleed >50 y/o ------ diverticulitis acute painless large volume maroon or bright red blood in pt >50y/o ------ diverticulosis treatment diverticulitis ------ often self resolving, elderly give metronidazole and cipro x 10-14 daysif multiple attacks consider surgical consult DRE: exquisite tenderness posterior midline position; anal skin tag ------ anal fissure dilation of vascular bed above dentate line ------ internal hemorrhoids dilation of vascular bed below dentate line ------ external hemorrhoids intermittent dysphagia for solids and liquids, especially cold ------ diffuse esophageal spasm; treat with PPI dysphagia to solids first, liquids later ------ esophageal cancer affects the lower 2/3 of the esophagus ------ adenocarcinoma foul smelling breath with oral regurgitation and coughing during meals, aspiration pneumonia ------ zenker diverticulum; tx surgical repair and myotomy bloating, cramping, abdominal discomfort, diarrhea after gastrectomy ------ dumping syndromeearly: overdistention from excess carbslate: hypoglycemia sudden skin flushing, wheezing, diarrhea, plaque like fibrinous deposits on the heart ------ carcinoid syndrome; treat with octeotride recurrent crampy abdominal pain 3 day/month for the past 3 months associated with improvement with defecation, change in frequency or form of stool. ------ IBS what GI problem has high association with Hashimoto thyroiditis ------ celiac disease
Side A ------ Side B Fat, forty, female, fertile w/ RUQ pain ------ Cholelithiasis or Cholecystitis Fever, RUQ pain, radiation to back ------ Cholecystitis Elevated Alkaline phosphatase, urinary bilirubin ------ Cholecystitis F, RUQ pain, Jaundice, gallstones & dilated common duct on US ------ Ascending cholangitis (Charcot’s triad) Hx IBD, progressive RUQ pain, wt loss, F, jaundice & pruritis. Elevated bilrubin & alkaline phosphate. ERCP with bile duct stenosis, dilatation ------ Primary sclerosing cholangitis (diffuse intra- and extrahepatic duct sclerosing and dilatation) Elevated AST, ALT, indirect bilirubin ------ hepatitis Isolated elevated indirect bilirubin ------ Gilbert’s syndrome Elevated indirect bilirubin w/ defective glucuronyl transferase ------ Crigler-Najjar Dz Photosensitivity, abd pain w/ neurologic dysfunction, erythema or skin fragility ------ porphyria H.pylori gastritis ------ 2antibiotics & PPI Chronic cough, bitter taste in mouth or throat, dyspepsia ------ GERD Multiple or constant GI ulcer pain despite medications ------ Zollinger-Ellison Syndrome Peri-umbilical or flank ecchymosis ------ Acute pancreatitis (Cullen & Grey Turner’s Sign) N/V, epigastric abdominal pain, worse supine, caused by alcohol ingestion, or following fatty meals ------ Acute pancreatitis Abdominal distension, bloating, intermittent, colicky pain, high-pitched rushes & tinkles ------ SBO Air fluid levels on upright abd plain film ------ SBO Air under diaphragm, rigid board-like abdomen ------ Perforated viscus, perforated ulcer >60yo F, LLQ pain ------ Diverticulitis. IV Abx, fluids, NPO. Elderly, Hx atherosclerosis. Dull crampy periumbilical pain post-prandial ------ Mesenteric ischemia Neonate w/ projectile vomiting. Olive sized mass. ------ Pyloric stenosis Choking, cyanosis, respiratory distress, increased secretions in 1st hours of life ------ Tracheoesophageal fistula Painless rectal bleeding in pediatrics ------ Meckel’s diverticulum Alcoholic with massive hemoptysis ------ Esophageal varicies (Tx w/ octreotide) Female with recurrent abdominal pain, alternating diarrhea, constipation. Pain relieved with defecation. ------ IBS. TCA’s (nortriptyline) good if diarrhea predominant symptom Bloody Diarrhea ------ Ulcerative colitis Supraclavicular LAD (L > R) ------ Virchow’s node – metastatic abdominal cancer Hard periumbilical nodule ------ Sister mary Joseph nodule = indicates metastatic gastric and pancreatic cancers PUD, Pernicious anemia (Type A Gastritis), H. pylori ------ Gastric Ca Apple core lesion ------ Colon Cancer Elderly with positive hemmocult. ------ Colon Cancer – get colonoscopy CEA ------ Colon Carcinoma Family history of young age colon cancer, multiple polyps found on colonoscopy ------ Familial adenomatous polyposis (Gardner’s syndrome) AFP ------ Hepatocellular carcinoma, testicular seminoma (germ cell tumor) CA 19-9 ------ Pancreatic Ca CA-125 ------ Ovarian Carcinoma Chemotherapy induced N&V ------ Treat with Ondansetron (Zofran) (5-HT3 blockers) Traveler’s Diarrhea ------ E. coli is cause. Hydration & Cipro to treat Greasy, foul smelling, floating stools. Pear-shaped flagellated protozoan w/ 2 “eyes”. Water, travel, camping history ------ Giardia Afebrile, watery or loose stool. No blood or mucus ------ Viral Gastroenteritis Abdominal pain, diarrhea after picnic/party. Eaten ham, cream, custards, mayonnaise ------ Staphylococcus aureus infectious diarrhea Acute bacterial diarrhea w/ prodrome of HA, F, then crampy abd pain & diarrhea ------ Campylobacter jejuni – most common cause of acute bacterial diarrhea Painless rectal bleeding. Bulging perianal mass w/ straining ------ Internal hemorrhoids Pediatric with perianal pruritis esp. at PM. Positive cellophane tape test ------ Pruritis ani – Pinworms (enterobiasis). Tx is Mebendazole Weight loss, recurrent greasy stools (steatorrhea) mixed with diarrhea after certain foods ------ Celiac Sprue Anti-endomysial antibodies ------ Celiac Sprue Beriberi ------ Thiamine; Alcoholics, Neuro Sx Pellagra ------ Niacin (4D’s dermatitis, diarrhea, dementia, death), bright red tongue Scurvy ------ Vit C (easy bleeding, bruising, hair & tooth loss, joint pain & swelling) Rickets ------ Vit D (Osteomalacia) Night blindness ------ Vit A deficiency Magenta tongue ------ Riboflavin deficiency (B2) s/p gastric bypass surgery or gastric surgery. N, abd cramping, dizziness after eating. No masses, bleeding ------ Dumping syndrome crampy abdominal pain, increased high pitched bowel sounds, gas only in the small intestine ------ Small bowel obstruction gas with obstipation and failure to pass flatus ------ Paralytic ileus hypocalcemia in ESRD ------ deficiency of vitamin D somatostatin receptor scintography ------ ze study of choice Two top causes of hypercalcemia ------ Primary hyperparathyroidism and malignancy account for 90% of all cases of hypercalcemia. Ten to twenty percent of patients with cancer develop hypercalcemia, most commonly because of breast, lung, kidney, head and neck carcinomas, and multiple myeloma and lymphoma. soft tissue thickening of the pericolic fat, diverticula, and thickening of the bowel wall ------ CT findings consistent with diverticulitis haustral markings ------ haustral markings= LARGE BOWEL. cause of LBO ------ cancer, diverticulum, volvulus causes of SBO ------ adhesions, hernia Rx indicated for prevention of NSAID ulcers ------ omeprazole Trx systemic htn/ascites ------ start sprinolactone. if refractory can do paracentesis or tips the best visualization of an esopahgeal web or ring. ------ barium esophagram Barium studies contraindication ------ patients with a possible perforation acute performation ------ perform hartmann procedure, if scheduled colectomy and primary anastomosis is considered. PUD imaging ------ upper endoscopy absence of ganglion cells in the colon and typically presents early in life with failure to pass meconium, followed by vomiting and abdominal distension. ------ Hirschsprung disease pyloric stenosis imaging ------ upper GI with barium inner tube or coffee bean on imaging ------ volvulus The treatment of choice for diarrhea caused by Giardia ------ metronidazole 250 to 750 mg po three times per day. cholera DOC ------ doxycycline or tetracycline drug used to treat Campylobacter. ------ Erythromycin drug used to treat cholera and shigellosis. ------ Quinolones at what size do cecal obstructions require surgery ------ >12cm require surgical intervention d/c what drug prior to fecal and urea breath testing. ------ no PPI 1-2 weeks prior to fecal and urea breath testing. increased serum ammonia ------ asterixis; consider hepatic encephalopathy- give lactulose autoimmune heptatitis ------ corticosteroids Celiac diet (abstain from eating) ------ BROW: Barley Rye Oats Wheat lead pipe colon, thumbprinting, loss of haustral markings ------ ulcerative colitis Double bubble on Xray ------ represents duodenal atresia (related to Down Syndrome) most common complication associated with acute pancreatitis. ------ Pancreatic pseudocysts suspected for a patient who has continued abdominal pain, the development of an abdominal mass, and continued elevations of amylase or lipase levels following an episode of acute pancreatitis. alendronate (fosamax), which is known to cause what ADR ------ esophagitis hypochloremic alkalosis with potassium depletion. ------ pyloric stenosis hallmark of peptic ulcer disease ------ Dyspepsia (epigastric pain) variceal hemorrhage prophylaxis ------ Beta blocker affects women typically between ages 40 and 60. It is often discovered incidentally when the serum alkaline phosphatase level is found to be elevated. ------ Primary biliary cirrhosis Calcification of the gall bladder, frequently referred to as a porcelain gall bladder, and single, solitary, large, gall stone ------ gall bladder cancer A significantly elevated PT/INR as well as bilirubin > 10 mg/dl ------ indicators of severe alcoholic hepatitis and increased mortality requiring hospitalization hematemesis with severe retrosternal tearing pain ------ boerhaave's syndrome- get esophogram and emergent surgical consult esophagram with "birds beak" ------ achalasia- tx botox, myotomy smooth circumferential structure in the distal esophagus ------ schatzki ring- get esophagram dysphagia with regurgitation of food especially in the am; older patients ------ zenker's diverticulum; get barium esophagram, surgery in severe cases esophageal web may develop from what deficiency? ------ iron deficiency (plummer vinson syndrome) when to take PPIs ------ take 30 minutes before meals complication of GERD ------ barrett's esophagus (which has an increased risk adenocarcinoma); tx long term PPI serum gastrin level >150 ------ consider ZES ulcer disease- weight loss versus weight gain ------ GUS- weight loss DUS- weight gain two main causes indirect unconjugated bilirubinemia ------ hemolysis, inherited (gilbert, crigler) biliary colic, n/v, jaundice, ELEVATED LFTs ------ choledolithiasis fever, RUQ pain, jaundice ------ charcot's triad risk of pancreatitis with what procedure ------ ERCP women (40-50) with fatigue, jaundice, pruritis, hepatomegaly, elevated alk phos, AMA + ------ Primary biliary cirrhosis; treat with bile acid sequestrant, cure is transplant Gold standard dx biliary cirrhosis ------ liver biopsy womean 30-50 with fatigue, anorexia, arthralgias, +ANA, +ASMA ------ Autoimmune hepatitis, get liver biopsy fatigue, jaundice, pruritis, pain; associated with ulcerative colitis ------ primary sclerosing cholangitis nontender palpable gall bladder with hx weight loss ------ klatskin tumor/cholangiocarcionoma rx causes acute pancreatitis ------ azothioprine, pentamide, valproate, thiazides Ranson Criteria ------ At admission: "GA LAW" (Glucose 200, Age>55, LDH >350, AST>250, WBCcount>16)* At 48 hours: "C HOBBS" (as in Calvin and Hobbes): (Calcium, Hematocrit, O2, BUN, Basedeficit, Sequestration (of fluid) greater than 6 L most common cause chronic pancreatitis ------ alcohol abuse-other causes CF, hyperparathyroidism, hx acute panc. imaging of choice chronic pancreatitis ------ CT- look for calcifications most common location pancreatic cancer ------ head increased % transferrin sat ------ hemochromatosis (autosomal recessive) low serum ceruloplasmin, increased urine copper ------ wilson's disease, treat with penicillamine icterus, jaundince, malaise with ALT>AST (20x) ------ Viral hepatitis chronic hep B carriers are at risk for what? ------ HCC most common blood bourne infection ------ hepatitis C leading cause of chronic liver failure ------ hepatitis C diagnosis of hepatitis C ------ screen with EIA, if positive use RIBA to confirm hepatitis C treatment ------ interferon plus ribavirin factor that impact hep C trx ------ genotype, race (AA males less likely to respond) most common cause cirrhosis ------ alcoholic hepatitis non alcoholic versus alcoholic liver disease ------ if AST/ALT >2.0 think ALCOHOL most common metastatic cancer ------ hepatocellular cancer most common location crohn's disease ------ terminal ileum spares the rectum ------ crohn's disease skip lesions ------ crohn's disease colicky RLQ pain, diarrhea, low grade fever, weight loss ------ crohn's disease string sign ------ crohn's disease cobblestoning ------ crohn's disease what is malabsorbed with crohn's disease ------ vitamin B12 and Fat most common complication crohn's disease ------ fistula medical management crohn's disease ------ mesalamine, sulfasalazine; azathioprine; biologics (Humira) >50 y/o with hx atherosclerotic disease sudden severe abdominal pain; post prandial ------ mesenteric ischemia celiac sprue diet (CAN EAT) ------ CRAP (corn, rice, arrowroot, potatoes) dematologic manifestation celiac sprue ------ dermatitis herpetiformis (pruritic papulovesicles over extensor surfaces and trunk/neck) mucosal biopsy: villous atrophy, blunting of villi duodenum ------ findings with celiac sprue crypt abscess ------ ulcerative colitis complications ulcerative colitis ------ toxic megacolon, performation, cancer treatment ulcerative colitis ------ aminosalicylate, cortiocsteroids, immunosupperives, tnfCOLECTOMY IS CURATIVE most common cause lower GI bleed >50 y/o ------ diverticulitis acute painless large volume maroon or bright red blood in pt >50y/o ------ diverticulosis treatment diverticulitis ------ often self resolving, elderly give metronidazole and cipro x 10-14 daysif multiple attacks consider surgical consult DRE: exquisite tenderness posterior midline position; anal skin tag ------ anal fissure dilation of vascular bed above dentate line ------ internal hemorrhoids dilation of vascular bed below dentate line ------ external hemorrhoids intermittent dysphagia for solids and liquids, especially cold ------ diffuse esophageal spasm; treat with PPI dysphagia to solids first, liquids later ------ esophageal cancer affects the lower 2/3 of the esophagus ------ adenocarcinoma foul smelling breath with oral regurgitation and coughing during meals, aspiration pneumonia ------ zenker diverticulum; tx surgical repair and myotomy bloating, cramping, abdominal discomfort, diarrhea after gastrectomy ------ dumping syndromeearly: overdistention from excess carbslate: hypoglycemia sudden skin flushing, wheezing, diarrhea, plaque like fibrinous deposits on the heart ------ carcinoid syndrome; treat with octeotride recurrent crampy abdominal pain 3 day/month for the past 3 months associated with improvement with defecation, change in frequency or form of stool. ------ IBS what GI problem has high association with Hashimoto thyroiditis ------ celiac disease
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