GI Clues

what 2 GI diseases have a corkscrew appearance on x-ray?

esophageal spasm and vovulus

what GI dz has an apple core on xray?

colorectal cancer

what GI dz has stacked coins on xray?

intussusception

what GI dz has a thumbprint on xray?

toxic megacolon?

what GI dzs are the causes of solid and liquid dysphasia?

schatzki's rings, stricture, cancer

what GI dz has a string sign on xray?

pyloric stenosis & chron's dz

what GI dz has an abrupt cut of on xray?

volvulus

what GI disease has barium clumping on xray?

celiac sprue

what GI disease has a bird's beak on xray?

achalasia

what GI dzs are the causes of liquid dysphasia?

scleroderma and achalasia

what is barrets esophagus?

metaplasia of the lower esophagus increased risk of adenocarcinoma

what are esophageal varices?

d/t portal htn, vomit large amounts of blood when they rupture

what is mallory weiss

tearing of the lower esophageal sphincter assoc with chronic vomiting, cough up a little blood and possible visual varices

what is boerhaave syndrome?

transmural tearing of the esophagus.
left side mc
pneumonia/pain/effusion

what is achalasia?

inc LES pressure (no aeurbach's plexus)
bird beak on xray
also seen in chagas dz

what is hirschprungs disease?

failure of innervation to the rectum (no auerbach's plexus), lack of meconium passage in nb, neural crest cell migration problem

what is zenker's diverticulum?

cough up undigested food from above upper esoph sphincter, halitosis, motor dysfunction problem

what is traction diverticulum?

outpouch btwn upper and lower esoph sphincters

what is plummer-vinson syndrome?

esoph webbing at the UES, spoon nails from iron deficiency anemia

what is schatzki's ring?

esoph webs in the lower esoph
dysphasia (mucosal tissue)

what is tracheoesophageal fistula (H-type)?

chokes with each feeding and is congenital

what is esophageal atresia with TE fistula (C-type)?

baby vomits with first feeding, large gastric bubble and distended abdomen (failure of apoptosis)

what is duodenal atresia?

bilious vomiting with first feeding, double bubble sign on xray, assoc with down's syndrome

what is pyloric stenosis?

non-billious projectile vomiting (3-4 wk old) & ruq olive mass on palpation

how does choanal atresia present?

baby turns blue with feeding, pinks up when breast/bottle is removed (blocked nasal passages)

how does tet of fallot present differently from choanal atresia?

TOF babies turn blue with crying (no feeding issues),
choanal atresia\=smurf on a nipple

what makes scleroderma unique?

can have an increased OR decreased LES pressure

what makes esoph spasms unique?

increased peristalsis

what makes achalasia unique?

dec peristalsis & inc LES pressure

what GI disease has a RLQ sausage mass?

intussuseption

what is atype A gastritis?

upper GI bleed, autoimmune (antiparietal cell antibodies), atrophic/achlorhorhydria and increased risk for adenocarcoma (body & fundus region of stomach)

what is a duodenal ulcer?

pain 20-30 min after eating, relieved with food, caused by h. pylori infxn 80-90% of the time & weight gain

what is type B gastitis?

upper GI bleed, assoc with eating spicy foods, loss of barrier protection & h.pylori infections (antrum of stomach)

what is a gastric ulcer?

loss of protective barrier, pain during meal, assoc w/nsaids, h. pylori infxn & weight loss

what is a sliding hiatal hernia?

fundus of the stomach herniates through the esophageal hiatus into the thorax

what is a rolling hiatal hernia

bowel protruding through a defect in the diaphragm. this can strangulate the bowel and can cause atelectasis.

What GI disease has a right lower quadrant sausage mass

intussusception

What is a bezoar?

mass of undigestable material (like hair) causing an occlusion at the pylorus

What is the type A gastritis

upper GI bleed,
autoimmune (anti parietal cells antibodies),
atrophic /achlorhydria, increased risk for adenocarcinoma (body and fundus region of the stomach)

What is type B gastritis

If upper GI bleeding,
Associated with eating spicy foods,
Loss of barrier protection,
H. pylori infections,
antrum of the stomach

What is a duodenal ulcer

Pain 20 to 30 minutes after eating,
Relieved when food,
Caused by H. pylori infection 80 to 90% of the time and weight gain

What is menetrier's disease

Loss of protein through the rugal folds. Causes generalized edema. CMV association in children and H. pylori in adult.

What defines constipation

Less than three bowel movements per week

What defines diarrhea

Greater than 200 g of stool per day

What is osmotic diarrhea

High osmolality in the bowel pulling water into the lumen

What is secretory diarrhea

Water pushed from cells into the gastric lumen (increased cAMP)

What is inflammatory diarrhea

Diarrhea with blood and Pus

What is celiac sprue

Founded in the jejunum
Wheat allergy
villous atrophy
Anti-gluten/gliadin antibodies

what is tropical sprue

found in the distal ileum
Caused by bacterial or viral, ameoba or parasitic infection
villous atrophy

What is mesenteric ischemia

Abdominal pain out of proportion to physical exam

What bugs cause bloody diarrhea

" cases": campylobacter, amoeba (entamoeba histolytica), shigella, E coli and salmonella

What is primary biliary cirrhosis

Anti Mitochondrial antibody
Bile ducts are destroyed
xanthelasmas
Pruritus

What is primary sclerosing cholangitis

Anti smooth muscle antibody
Bile ducts are scarred from inflammation
There is a beading and onion skinning
Associated with ulcerate of colitis and p-anca if if

What is ascending cholangitis

Common bile duct infection due to stones

What are the physical signs of alcoholic cirrhosis

Spider angioma
palmar erythema
gynecomastia
dupuytren's contracture

What is hepatorenal syndrome

Build up liver toxins that cause renal failure

What is cholangitis

Inflamed bile duct

What is cholecystitis

Inflammation of the gallbaladder

What is cholelithiasis

Formation of gallstones

What is Choledocholilithiasis?

gallstone obstructs the bile duct

what is cholestasis

obstructed bile duct
high alkaline phosphatase (if in common bile duct)

what is conjugated bilirubin

water soluble and direct bilirubin

what is unconjugated bilirubin

fat soluble and indirect bilirubin

what is the mcc gallstones

cholesterol stone (not seen on xray)

what type of gallstone can be seen on xray

calcium billirubinate stones

what is xanthoma

cholesteril build up (common at elbow or achilles tendon)

what is a xanthelasma

triglyceride buildup, and is seen under the eyes (xanthome subtype)

what can high cholesterol cause

atherosclerosis

what can high triglycerides cause

pancreatitis

what is type 1 hyperlipidemia

defective liver lipoprotein lipase (chilomicrons are elevated)

what is type 2A hyperlipidemia

defective LDL-clathrin pit or B-100 (LDL are elevated)

what is type 2B hyperlipidemia

deficiency of adipose receptors and LDL receptors (increased LDL & VLDL)

what is type 3 hyperlipidemia

defective ApoE (elevated IDL)

what is type 4 hyperlipidemia

defective adipose lipoprotien lipase (elevated VLDL)

what is type 5 hyperlipidemia

defective enzyme and receptor (C-II), elevated VLDL and chilomicrons, assoc with DM

what do chilomicrons do

take triglycerides from GI to liver and endothelium

what does VLDL do

takes triglycerides from liver to adipose

what does IDL do

takes triglycerides from adipose to tissue

what does LDL do

carries cholesterol (only one that does this)

what are the breakdown products of VLDL

IDL & LDL

what is the treatment for hypercholesterolemia

statins

what is the only statin to undergo renal excretion

pravastatin

what blood level should be monitored in pts taking statins

liver enzymes every 3 months and serum Cr

what is the MOA of statins

inhibits HMG CoA reductase

what is crigler-najjar type I

unconjugated bilirubin buildup, nb or infants, no UDP-GT, phenobarbitol yeilds no change

what is gilberts syndrome

stress induced elevated unconjugated bilirubin, increased load saturates glucoronyl transferase

what is rotor's

defective bilirubin storage and elevated conjugated bilirubun

what is dubin johnson

defective bilirubin storage, black liver, increased conjugated bilirubin

what is cullen's sign

bruising around umbilicus caused by hemorrhagic pancreatitis (late sign)

what is turners sign

bleed into flanks and caused by hemorrhagic pancreatitis (early sign)

what tests are used to follow pancreatitis

amylase (sensitive) breaks down carbs and lipase (specific) breaks down triglycerides

what will ranson's criteria tell you and what will you see at 48 hours

prognosis of pancreatitis pts, BUN \>5 (decreased RBF), Calcium

what is the triad for carcinoid syndrome

diarrhea, flushing, wheezing

what is peutx jegher syndrome

hyper-pigmented lower lip, pts have dark gums and vagina, and small bowel polyps

what produces currant jelly sputum

klebsiella

what produces currant jelly stool

intussusseption

what is turcot's syndrome

familial polyposis w/brain tumors

what is gardener's syndrome

familial poyposis w/bone tumors

what is familial polyposis

100% risk of colon cancer, APC gene defect and annual colonoscopy starting at 5 yo

what is ulcerative colitis

starts at rectum and ascends, skip lesion mucosa, 1%/year risk for CA, IBD w/pseudopolyps, hematochezia, lead pipe colon and toxic megacolon