GI Packet 3

What is Diverticulosis?

When there are small marble sized pouches that protrude through the colon wall

Where do diverticula occur?

They develop in naturally weak areas in the colon that gives to pressure

What is a Diverticulum?

single pouch

What is diverticulitis?

Inflammation of one or many diverticulum

What is meckel's diverticulum?

an outpouching or bulge in the lower part of the small intestine

Pathophysiology of diverticulitis?

-Usually, multiple diverticula are present

-usually less than 10mm in size

-Most commonly found in the descending and sigmoid colon (except for the Asian population where it is primarily found in the ascending colon)

What is the chances someone over 60 has diverticulosis?

Approximately 1 out of every 2

Risk factors for diverticulitis?

-Aging

-Family History

-Too little fiber

-Lack of exercise

-obesity

-smoking

Signs/Symptoms of Diverticulitis

-LLQ pain - Can be severe, usually related with bowel movement, Worse with eating, Associated with bloating/constipation

-Fever- may be present if there is an infection

-N / V

-Palpable mass

DDx for Diverticulitis

Ovarian cyst

Bowel obstruction

Left utterer

ectopic pregnancy

hernia

tumor

Test of choice for Diagnosing Diverticulitis?

CT of abdomen

Treatment for Diverticulitis if there are mild symptoms?

Can tolerate liquids

-Outpatient antibiotics and only intake clear liquids - usually improve on their own

Treatment for significant symptoms/imflammation

Admit

Complete bowel rest

IV antibiotics

What do you do for diverticulitis if they dont get better?

Surgical Treatment - bowel resection (will depend upon the amount of inflammation)

Lifestyle recommendations for patients to avoid diverticulitis?

-20-30g of Fiber a day - helps reduce pressure

-Increase fluids - 6-8 glasses

-Patient responds to bowel movement

-Exercise everyday 30 min

What is IBS?

Irritable bowel syndrome - Syndrome of the gut sensitivity and motility. It can affect any section of the GI track

Signs/Symptoms of IBS

- Diarrhea, constipation or alternating with abdominal pain and cramping

- Bloating

Possible causes of IBS?

Altered GI motility

Luminal irritation

Possible hormonal changes

Some triggers for IBS?

Food

Stress

Other illnesses

Testing/Diagnosis for IBS

Process of elimination

Criteria for diagnosis for IBS?

Abdominal pain and discomfort lasting 12 weeks (not consecutive) plus 2 of the following:

1. changes in frequency and consistency of stool

2. Urgency

3.Incomplete empty

4. Lots of mucus in stool

5. Bloating or distention

Red Flags for additional testing

-Weight Loss

-Onset after 50

-High fever

Additional testing for IBS?

- flexible sigmoidoscopy

- colonoscopy

- CT of abdomen

- stool studies

Treatment for IBS?

Most cases can be controlled by learning to manage stress along with diet and lifestyle changes

-Fiber supplementation

-Antidiarrheals

-probiotics

-Small meals - limit milk and cheese

-Antibiotics as last resort

-avoid caffine

Medical treatment for IBS-C?

Lubiprostone (Amitiza)

Medical Treatment for IBS-D?

Alosetron Hydrochloride (Lotronex)

Prevention/Treatment for IBS?

-Counseling

-Regular exercise, yoga, massage

-Deep breathing

-acupuncture

-Ginger

-Hypnosis

What does the liver do?

Creates Bile

Detoxes drugs/alcohol

Produces cholesterol

Converts glucose to glycogen for storage

Regulates Clotting

Bilirubin removal

Anatomy of Liver?

4 lobed organ

-Right, Left, Caudate, and quadrate lobe

3 pounds

can lose 3/4 of its cells before it stops functioning

What is Hepatitis?

Inflammation of the liver, usually caused by exposure to an infectious agent, a toxin, or a drug

What are the types of hepatitis?

Hepatitis A, B, C, D, E, G (all viral)

Autoimmune Hepatitis

Toxic Hepatitis

What is Hepatitis A caused by?

Caused by contamination of fecal, water, or personal contact

Contagious infection

Symptoms of Hepatitis A?

-None

-Fatigue

-N / V

-Abdominal Pain, esp. RUQ

-Loss of appetite

-Low grade fever

-Dark urine

-Muscle pain

-Jaundice

-enlarged tender liver

Transmission of Hep A?

-Fecal oral route

-Drinking contaminated water

-Eating raw shellfish from polluted water

-Can be transmitted via intercourse or needle sharing

Testing/Diagnosis of Hep A?

Blood test can detect presence of hepatitis by mesuring:

-Bilirubin - nonspecific

-Enzyme levels

Special blood test is done to identify the exact type of hepatitis (radioimmunoassay) IGM-anti hep A antibody - specific

Treatment for Hep A?

No specific treatment exists

The main focus is on adequate nutrition and the prevention of permanent liver damage

Recover in 6 weeks

Hepatitis B info?

Caused by hep B virus

-can become chronic leading to liver failure, liver cirrhosis, or liver cancer

-Most adults do fully recover

Vaccine is avalible

Can be pasted from mom to baby

Can be transmitted w/o Sx

Symptoms of Hep B?

-None

-Fatigue

-N / V

-Abdominal Pain, esp. RUQ

-Loss of appetite

-Low grade fever

-Dark urine

-Joint Pain

-Jaundice

Transmission of Hep B?

Contact with blood or other bodily fluids

Intercourse, needles

Birth, razor sharing, toothbrushes

Transmission does not occur through casual contact, telephone or toilet

Testing/Diagnosis

Labs

1. Hepatitis B surface antigen (HBsAg) - if a pt tests positive for this antigen means the pt can pass it on to someone else

2. Antibody to Hep B surface antigen (anti-HBs) - positive (antibodies present) due to vaccine or prior infection

How do you treat acute hepatitis B?

Acute Hep B clears on its own. But still rest, proper nutrition, plenty of fluids and close monitoring while your body fights the infection.

How to treat chronic hepatitis b?

-Antiviral medications - slow down or stop viruses from replicating

-Liver transplantation (if damage to liver is severe)

-Immunomodulators

Hepatitis C Vaccine?

no vaccine

How does Hepatitis C spread?

blood or other body fluids -Sharing Needles, IV drugs

Unstreral tattoo equipment

Mother to Baby

usually not sexual contact

What happens the the majority of patients with Hep C

Most of patients do progress to chronic disease

Testing/diagnosis for hepatitis C?

Hep C antibody test

Treatment for hepatitis C?

Avoid alcohol

Antiviral drugs - Sofosbuvir

What is the duration of treatment for hepatitis C?

-9-12 weeks for antiviral medication

->90% can be cured

-Test viral load - quantity of virus in blood (before and after treatment)

-Sustain Viral Responses The hepatitis C virus is not detected in the blood 12 weeks or more after completing treatment

Prevention recommendations for hep C?

educate about hep c

avoid needle sharing, unsafe tattooing

avoid alcohol

Who should be tested for hep C?

Anyone born b/t 1945 - 1965

Elevated ALT (or AST)

Hx of illicit drug use or intranasal cocaine

Needle stick or mucosal exposure to blood

Blood Transfusion prior to 1992

Known exposure

Known HIV

signs and symptoms of Hep C

Children born to moms with hep C

What is a LFT you order?

Total Protein

Albumin

Bilirubin

Liver Enzymes - AST, ALT, Alkaline Phosphatase