GI Step Up

Salivary gland disorders

-may be caused by

-Sxs

-Tx

-Obstructive pathology vs neuromuscular pathology for dysphasia

Dysphagia

-sxs

-Workup

-Radiology

-Treatment

Next Step: If a patient presents with dysphagia then

perform a barium swallow BEFORE an EGD because of the lower associated risks of the former

Achalasia

-defined by

-Epidemiology and cause

-Sxs

-Workup

-Radiology

-Treatment

Secondary causes of achlasia include

Chagas disease

Neoplasm

scleroderma

Complications of Achlasia tx

myotomy can cause GERD

____ relieve pain from diffuse esophageal spasm but worsen symptoms of _____

nitrates

GERD

Diffuse Esophageal Spasm

-defined by

-Sxs

-Workup

-Radiology

-Treatment

Esophageal Hiatal Hernias

-Types

Mallory Weiss Syndrome

-Defined by

-RF

-Sxs

-Tx

Zenker Diverticulum

-Definition

-Sxs

-Radiology

-Tx

-Complications

GERD

-Pathophysiology

-RF

-sxs can worsen with

-SXS

-workup

-Radiology

-Tx

-Complications

Symptoms of GERD can resemble those of

asthma or MI

Esophageal Cancer

-Types and where comon

-Preceded by

-RF

-Sxs

-Workup

-Radiology

-Tx

-Complications

Viral Gastroenteritis

-progression

-common agents include

-sxs

-Labs

-Treatment

Bacillus Cereus

-Source

-SXS

-Tx

Campyylobacter jejuni

-Source

-SXS

-Tx

Clostridium botulinum

-Source

-SXS

-Tx

Clostridium difficile

-Source

-SXS

-Tx

ETEC

-Source

-SXS

-Tx

EHEC

-Source

-SXS

-Tx

Stapylococcus aureus

-Source

-SXS

-Tx

Salmonella species

Shigella species

Vibrio cholerae

Vibrio parahaemolyticus

Yersnia Enterocolitica

-Source

-SXS

-Tx

Giardia lamblia

-Source

-SXS

-Tx

Entamoeba histolytica

-Source

-SXS

-Tx

Cryptosprodium parvum

-Source

-SXS

-Tx

Trichinella spiralis

-Source

-SXS

-Tx

Taenia solium (intestinal taeniasis)

-Source

-SXS

-Tx

Taenia solium (cysticercosis)

Hepatitis

-Defined by

-Acute hepatitis is ___, chronic is

-RF

Defined by: inflammatory dz of the liver is most commonly caused by viral infection but can also result from alcohol or toxins

acute hepatitis is initial disease

chronic form is disease lasting >6 months

RF:

• IV drug abuse

• alcoholism

• travel to developing nations

• poor sanitation

Trends of viral hepatitis serology Graph/Diagram

HAV

-Virus type

-Spread

-Treatment

-Prevention

-Complications

HBV

-Virus type

-Spread

-Treatment

-Prevention

-Complications

HCV

-Virus type

-Spread

-Treatment

-Prevention

-Complications

HDV

-Virus type

-Spread

-Treatment

-Prevention

-Complications

HEV

-Virus type

-Spread

-Treatment

-Prevention

-Complications

Viral hepatitis

-SXS

SXS

• possibly asymptomatic

• malaise

• arthralgias

• fatigue

• n/v

• RUQ pain

• jaundice

• scleral icterus

• tender hepatomegly

• splenomegaly

• LAD

Viral hepatitis: Workup

c. Hep c: anti-HCV abs and positive HCV PCR indicates infection

Viral hepatitis: Treatment

Serologies seen in various diseases state of HBV infection table:

Course of disease:

• Acute infection (4-12 week postexposure)

• Acute infection window period (12-20 week postexposure)

• Chronic infection, active viral replication

• Chronic infection, lesser viral replication (good prognosis)

• Past infection (recovered)

• Vaccination

Postive or negative for:

HBV surface antigen (HBsAg)

HBVeAg

HBC core antibody (Anti-HBc)

HUS is a complication of __________

and is characterized by __________

Acute resolving HCV Diagram

Chronic HCV Diagram

Hiatal Hernia

-Defined by

-Types

-Sxs

-Radiology

-Treatment

-Complications

Gastritis

-defined by

-types

-Acute gastritis is characterized by

In pernicious anemia, ABs destroy

Characteristics of Type A and B chronic Gastritis

Gastritis

-chronic gastritis can occur in

-Sxs

-Workup

-Radiology

-Treatment

Ulcers can also develop secondary to

Next Step: in refractory cases of PUD

PUD

-defined by

-What is involved in pathology

-RF

PUD

-SXS

-Workup

-Radiology

PUD Treatment and Complications

Distinguishing between gastric and duodenal ulcers

Zollinger-Ellison Syndrome

-Defined by

-Assoicated with

-Sxs

-Workup

-Radiology

-Treatment

-Complications

Gastric Cancer

-Most common, and most rare

-Type

-RF

-Sxs

-Workup

-Radiology

-Treatment

-Complications

Barium swallow findings that suggest the presence of malignant lesion assoicated with an ulcer include

• abnormal appearing mucosal folds in the region of the ulcer

• presence of a mass near the ulcer

  • irregular filling defects in the base of the ulcer

Next Step: Workup for patients < 40 yo in whom concern exists for PUD can frequently be cone with

noninvasive testing

older patients or those with previous ulcer should have EGD performed

Next Step: Give what meds for patietns with PUD who require NSAID therapy

COX-2 selective NSAIDS

PPI must be stopped before

gastrin level testing to collect an accurate measurment

Difference between celiac and tropical sprue

Celiac Disease

-defidne by

-immune mediated process with

-Sxs

-Workup

-Treatment

Tropical Sprue

-Defined by

-Acquired disorder in patients who

-Sxs

-Workup

-Treatment

Location of absorption of vitamins, minerals, and nutrients throughout the GI tract

Diagnostic pathway for suspected malbsorption syndrome

Lactose Intolerance

-Defined by

-Lactose not metabolised in

-Sxs

-Workup

-Treatment

Whipple Disease

-defined by

-RF

-Workup

-Treatment

-Complications

Diarrhea

-Defined by

-RF

-Acute diarrhea duration and cause

Acute diarrhea pathway

Rotavirus is most common cause of

acute diarrhea in children

Chronic diarrhhea

-duration and results from

-types

Pediatric diarrhea is commonly caused by

Diarrhea treatment

Chronic Diarrhea pathway

Rome III critera for diagnosis of IBS

IBS

-defined by

-begins during

-SXS

-Workup

-Radiology

-Treatment

Half of patients with IBS have

comorbid psychiatric disorders

IBD

-defined by

-Types

-RF

defined by:

• dz of small and large bowel, with a constellation of sxs assoicated with inflammatory bowel processes, AI reactions, extraintestinal manifestaions, and multiple complications

Types: Chrons and UC

RF: Ashkenazi jews, Whites> blacks, presents in teens or early 20s

Crohn Disease

-site of involvement

-SXS

-PE

-Extraintestinal manifestations

-Labs

-Radiology

-Treatment

-Complications

UC

-site of involvement

-SXS

-PE

-Extraintestinal manifestations

-Labs

-Radiology

-Treatment

-Complications

Bowel obstruction

-defined by

-most common cause

• mechanical obstruction of small or large bowel that can lead to vascular compromise

• most common cause of obstruction are adhesions, hernias and neoplasms

Small bowel obstruction most commonly results from vs. large bowel obstruction…

adhesion formation

vs. large bowel obstruction is most commonly caused by neoplasms

Ischemic Colitis

-Defined by

-caused by

-RF

-Sxs

-Workup

-Radiology

-Tx

-Complications

The Left side of the colon is the most common area involved in vs the rectum

ischemic colitis.

the rectum is frequently spared because of collateral circulation

abdominal pain for iscemic colitis is less severe than

small bowl ichemia which is significant and OUT OF PROPORTION to examination

Appendicitis

-defined by

-caused by

-sxs

Appendicitis

-Workup

-Radiology

-Tx

-Complications

Next Step: Always get in a women with abdominal pain and of child bearing age to rule out ….

BHCG, pregnancy

Comparison of small bowel obstruction vs large bowel obstruction

• Causes

• symptoms

• PE

• Radiology

• Treatment

Ileus

-defined by

-caused by

-sxs

-radiology

-treatment

Next Step: high clinical suspicion of appendicitis

go right to surgery

do NOT wait for radiological examiniation

Volvulus

-defined by

-tends to occur in

-sxs

-radiology

-treatment

Post op ileus typically lasts _____

small bowel recovers in _____

stomach in _______

large bowel in _______

< 5 days

24 hours

48-72 hours

3-5 days

Diverticulosis

-defined by

-RF

-SXS

-Workup

-Radiology

-Tx

-Complications

Diverticular disease most frequently occurs in ______

and is the most common cause of __________ in patients over 40 yo