Im git ,half neuro

What does bloody diarrhea typically indicate?

Colitis → abdominal pain, cramping, stools with blood & mucus (not specific to cause).

What are the major causes of bloody diarrhea?

Infectious colitis, drug-induced colitis (NSAIDs), inflammatory bowel disease (UC, Crohn's), ischemic colitis, antibiotic-associated colitis (C. difficile).

initial investigations in bloody diarrhea include Stool ….., ……toxin assay, stool ……. exam, abdominal …. (ischemia/complications), ………….. if non-infectious suspected.

culture

C. difficile

ova & parasite

ct

colonoscopy with biopsy

What is the pathology of Shigella or invasive E. coli colitis?

Superficial, intense, exudative inflammation of colonic mucosa.

What is the pathology of Entamoeba histolytica colitis?

Flask-shaped ulcers with undermined edges.

What is the cornerstone of infectious colitis management?

Hydration & electrolyte correction.

When are empiric antibiotics indicated in infectious colitis?

Severe features in immunocompetent, sepsis, moderate-severe traveler's diarrhea.

What empiric antibiotics are recommended for adults with infectious colitis?

Fluoroquinolones (e.g., ciprofloxacin).

What should be done if a specific pathogen is identified in infectious colitis?

Provide pathogen-specific therapy.

What are the two major types of inflammatory bowel disease (IBD)?

Crohn's disease (CD) and Ulcerative colitis (UC).

What are the peak ages of IBD onset?

15-35 years (main peak); 10% before 18 years; smaller peak after 50 years.

How does sex distribution differ between UC and Crohn's?

UC → slightly more in males; Crohn's → more in females.

Which ethnic group has highest risk of IBD?

Ashkenazi Jews (also higher in Caucasians).

What are the prevalence ranges of Crohn's and UC?

Crohn's: 26-199/100,000 (\~201/100,000 adults); UC: 37-246/100,000 (\~238/100,000 adults).

What gene is strongly linked to Crohn's disease?

NOD2 gene (discovered 2001).

How does family history affect IBD risk?

10× higher if family history; 30× higher if sibling affected.

What environmental factors are linked to IBD?

Smoking (↑ Crohn's, ↓ UC), urban > rural, developed countries, westernized lifestyle, reduced sunlight, industrial pollution, possible: diet, OCPs, perinatal infections, atypical mycobacteria (not proven).

What parts of GI tract can Crohn's affect?

Any from mouth to anus; most common = terminal ileum + colon; rectal sparing typical.

What is the characteristic inflammation pattern in Crohn's?

Transmural, patchy "skip lesions."

What are common GI symptoms of Crohn's?

Chronic/intermittent diarrhea (± blood), nocturnal diarrhea, RLQ/central abdominal pain, perianal disease.

What systemic symptoms can Crohn's present with?

Fever, weight loss.

What are extraintestinal features of Crohn's?

Mouth ulcers, arthritis, uveitis/episcleritis, erythema nodosum, pyoderma gangrenosum.

What labs and imaging are used for Crohn's diagnosis?

CBC, ESR/CRP, fecal calprotectin, CT/MR enterography, capsule endoscopy.

What is the gold standard for Crohn's diagnosis?

Colonoscopy with biopsy (including terminal ileum).

How is remission induced in mild-moderate Crohn's?

Budesonide (controlled ileal release).

How is remission induced in moderate-severe Crohn's?

Systemic corticosteroids.

What agents are used for Crohn's maintenance?

Azathioprine, methotrexate, anti-TNF biologics (infliximab, adalimumab, certolizumab).

What is the management of severe fulminant Crohn's?

Hospitalization, IV corticosteroids, consider anti-TNF therapy.

Where does UC occur?

Colon only, always involves rectum, continuous proximal spread.

What layer of bowel wall is affected in UC?

Mucosa only (not transmural).

What are classic GI symptoms of UC?

Bloody diarrhea, rectal urgency, tenesmus.

What are systemic/extraintestinal features of UC?

Arthritis, erythema nodosum, pyoderma gangrenosum, episcleritis, uveitis, primary sclerosing cholangitis, fever, weight loss.

What scoring systems assess UC severity?

Truelove & Witts criteria, Mayo score.

What is used for induction & maintenance in mild-moderate UC?

5-ASA drugs (sulfasalazine, mesalamine).

How is moderate-severe UC treated?

Corticosteroids for induction; maintenance with 5-ASA, thiopurines, or anti-TNF biologics.

How do Crohn's and UC differ in bowel involvement?

Crohn's = any GI tract, rectal sparing; UC = colon only, rectum always involved.

How do Crohn's and UC differ in inflammation depth?

Crohn's = transmural; UC = mucosal only.

How do Crohn's and UC differ in distribution?

Crohn's = patchy skip lesions; UC = continuous.

What is the definition of diarrhea ….bowel movements/day, stool weight ….., stool water is ….

≥3

>250 g/day

70-95%

What is acute diarrhea?

Diarrhea lasting <14 days

What is chronic diarrhea?

Diarrhea persisting >1 month

What is dysentery?

Low-volume, painful, bloody stool

What is true diarrhea vs pseudodiarrhea?

True = ↑stool weight/frequency/fluidity; Pseudodiarrhea = urgency/tenesmus without ↑weight

What are the types of acute infectious diarrhea?

Inflammatory (colon, dysentery, fecal WBCs, bloody stool, systemic symptoms) and Non-inflammatory (ileum, watery stool, no fecal WBCs)

What are the main features of colonic chronic diarrhea?

Blood + mucus in stool, cramping lower abdominal pain, weight loss, nutritional deficiencies

What are the main features of small bowel chronic diarrhea?

Steatorrhea, large-volume watery stool, undigested food, bloating, mid-abdominal pain

What are colonic causes of chronic diarrhea?

IBD, neoplasia, ischemia, IBS, NSAIDs, SSRIs, aminosalicylates

What are small bowel causes of chronic diarrhea?

Celiac disease, tropical sprue, lymphoma, CF, chronic pancreatitis, pancreatic cancer

What are infectious causes of chronic diarrhea?

Giardia, Cryptosporidium, Cyclospora

What are endocrine causes of chronic diarrhea?

VIPoma, Zollinger-Ellison syndrome, hyperthyroidism, Addison's disease

What are drug-induced causes of diarrhea?

Antibiotics, alcohol, antacids, laxatives

What is the simplified 5-step approach to diarrhea?

1. Confirm true diarrhea, 2. Exclude drug-induced, 3. Acute vs chronic, 4. Inflammatory/fatty/watery, 5. Consider factitious or functional

What is osmotic diarrhea?

Diarrhea due to poorly absorbed solutes drawing water into lumen

What are causes of osmotic diarrhea?

Carbs (lactose intolerance, fructose, sorbitol, mannitol, lactulose), divalent ions (Mg antacids, Na phosphate), drugs (antibiotics, alcohol, colchicine, antacids)

What are features of osmotic diarrhea?

Stops with fasting, no fat/RBC/WBC in stool, stool osmotic gap >50 mOsm/kg

What is secretory diarrhea?

Diarrhea due to ↑secretion and ↓absorption of ions/water

What are features of secretory diarrhea?

Watery large-volume (>1 L/day), persists with fasting, osmotic gap <50, fluid/electrolyte depletion

What are causes of secretory diarrhea?

Enterotoxins (cholera, E. coli), hormones (VIPoma, carcinoid, medullary thyroid carcinoma), endocrine (hyperthyroidism, Addison's), laxatives (senna, aloe, bisacodyl), bile salt malabsorption

What is inflammatory diarrhea?

Diarrhea with blood, pus, fecal WBCs

What are causes of inflammatory diarrhea?

Infections (C. diff, TB, amoeba, strongyloides, CMV), IBD (UC, Crohn's), ischemic colitis, neoplasia (colon cancer, lymphoma), radiation colitis

What are key investigations in diarrhea?

Stool studies (volume, fat, WBCs, osmotic gap), colonoscopy/biopsy, duodenal biopsy, US/CT/MRCP/barium, hormonal assays for secretory causes

What is malabsorption syndrome?

Impaired absorption of macronutrients and micronutrients due to maldigestion (luminal) or mucosal malabsorption

What are the 3 phases of malabsorption?

Luminal (enzyme/bile deficiency, bacterial overgrowth), Mucosal (brush border defect, mucosal injury), Postabsorptive (lymphatic obstruction)

What are causes of fat malabsorption?

Pancreatic insufficiency, bile salt deficiency, bacterial overgrowth, enterocyte defects

What are causes of carbohydrate malabsorption?

Lactase deficiency, mucosal disease, pancreatic insufficiency

What are causes of protein malabsorption?

Pancreatic insufficiency, mucosal disease, protein-losing enteropathy

What are clinical features of malabsorption?

Diarrhea, steatorrhea, weight loss, bloating, gas, anorexia/hyperphagia, N/V, muscle atrophy, edema, anemia, osteoporosis, dermatitis

What are investigations for malabsorption?

Blood tests for deficiencies, quantitative fecal fat (72h >7 g/day = abnormal, gold standard), qualitative fecal fat (Sudan stain, acid steatocrit), endoscopy/biopsy, breath tests (lactose, D-xylose), Schilling test, CCK/secretin test

What is celiac disease?

Chronic immune-mediated enteropathy triggered by gluten → malabsorption, nutrient deficiency, complications

What are types of celiac disease?

Responsive; Unresponsive/Refractory (Type I = normal IELs; Type II = clonal IELs, risk of lymphoma)

What are GI features of celiac?

Diarrhea, steatorrhea, bloating, dyspepsia

What are extra-intestinal features of celiac?

Weight loss, osteoporosis, fractures, anemia, infertility, dermatitis herpetiformis

What are diagnostic tests for celiac?

Serology: anti-TTG IgA (test of choice), total IgA, EMA, anti-DGP; Endoscopy: villous atrophy + crypt hyperplasia; Genetics: HLA-DQ2/DQ8

What is the treatment for celiac?

Lifelong gluten-free diet (<100 mg gluten/day); refractory → steroids, immunosuppressants (azathioprine, methotrexate)

What are complications of celiac?

Refractory celiac (Type II → lymphoma), enteropathy-associated T-cell lymphoma, jejunal adenocarcinoma, osteoporosis, fractures, growth/puberty delay in children

epigastric pain causes

PUD, GERD, MI, AAA, pancreatic pain, gallbladder obstruction

RUQ pain causes

Acute cholecystitis, hepatitis, hepatomegaly , perforated du , herpes zoster, myocardial ischemia, pneumonia.

LUQ pain causes

Acute pancreatitis, gastric ulcer, gastritis, splenicr upture, myocardial ischemia, pneumonia.

RLQ pain causes

Appendicitis, enteritis, bowel obstruction, ectopic pregnancy, PID, ovarian cyst, ureteral stones, hernia

LLQ pain causes

Diverticulitis, ectopic pregnancy, PID, ovarian cyst, ureteral stones, hernia, regional enteritis.

Periumbilical pain causes

Transverse colon disease, gastroenteritis, appendicitis, early bowel obstruction

diffuse abdominal pain causes

Peritonitis, pancreatitis, sickle cell crisis, mesenteric thrombosis, gastroenteritis, metabolic issues, ruptured aneurysm, intestinal obstruction, psychogenic causes

referred abd pain causes

Pneumonia, inferior MI, pulmonary infarction

types of abd pain

Visceral: From organs, dull/crampy.

Colic: Crampy.

Parietal: From parietal peritoneum irritation, sharp.

Referred:Pain felt distant from pathology site

organic vs functional abd pain

Organic: Acute, localized, worsens with time, associated systemic signs.

Functional: Less localized, multiple sites, often linked to psychological stress, no systemic signs

systemic causes of abdominal pain

Diabetes ketoacidosis, uremia, sickle cell, porphyria, lupus, vasculitis, hyperthyroidism, toxic exposures, thoracic and genitourinary causes.

common acute syndromes

Appendicitis, diverticulitis, cholecystitis, pancreatitis, ulcer perforation, obstruction, ruptured AAA, pelvic disorders

which is more common site of PUD

deodenal more than gastric

peptic ulcer perforation

Sudden severe epigastric pain, rebound tenderness, rigidity.

Diagnosed by X-ray showing air under diaphragm.

Surgical emergency.

pelvic pain causes

Ectopic pregnancy, PID, UTI, ovarian cysts.

chronic pain syndromes

IBS, chronic pancreatitis, diverticulosis, GERD, inflammatory bowel disease, gastric/duodenal ulcers.

give account on IBS

Functional disorder, common in young adults.

symptoms of IBS

Crampy lower abdominal pain relieved by bowel movement, worsens post meals, stress-related, no nocturnal symptoms

diagnosis of IBS

: Rome criteria (≥3 months symptoms with stool changes)

rome criteria

3 month minimum of following symptoms in continuous or recurrent pattern Abdominal pain or discomfort relieved by BM & associated with either: Change in frequency of stools and/or Change in consistency of stools

Two or more of following symptoms on 25% of occasions/days: Altered stool frequency >3 BMs daily or <3BMs/week Altered stool form Lumpy/hard or loose/watery Altered stool passage Straining, urgency, or feeling of incomplete evacuation Passage of mucus Feeling of bloating or abdominal distention

management of IBS

: Supportive, diet changes, meds, reassurance

alarm signs of IBS

Age >50, anemia, rectal bleeding, weight loss, nocturnal symptoms, family cancer history , noctornal sym, male

diverticulosis

Common in elderly, often asymptomatic.

Symptoms: Irregular bowel habits, intermittent pain, bloating.

Diagnosis: CBC, occult blood, imaging.

Management: High fiber diet (gradual increase), avoid seeds, nuts, popcorn.

acute hep def

Inflammation of liver parenchyma lasting less than 6 months.

infectious causes of hep

Viral hepatotropic (HAV, HBV, HCV, HDV, HEV)

Viral non-hepatotropic (CMV, EBV, HSV)

Non-viral infections (some bacterial, parasitic)