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the most common infectious agents in the U.S. for diarrhea.
Salmonella, Campylobacter, Shigella, Shigatoxin E. coli, Cryptosporidia.
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Fever, rose spots, ileitis
s. typhi
achlorrhydria and sickle cell disease pre dispose
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diarrhea that causes ileitis/ileocolitis. usually not bloody, carried by reptiles.
non typhoidal gastroenteritis.
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low inoculum.
bacterial cause of dysentery
treat all cases
shigella
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In contaminated poultry
associated with Gullian Barre
bloody
Camphylobacter
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E.coli- multiple types of e. coli diarrhea
most importantly
- STEC (shiga toxin e coli)
- common cause of HUS
avoid antibiotics and antidiarrheals
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S. boulardii has been shown to be effective in treatment of this bad daddy
C.diff
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Non C.diff cause of antibiotic associated diarrhea.
gram negative bug
klebsiella oxytoca
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often confused with acute appendicitis
pork intestines
Terminal ileitis and mesenteric adenitis
Yersinia
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2 species that can cause chronic colonic infections
can be found in shellfish
Teddy has never heard of these
Aeromonas and Plesiomonas
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high mortality in cirrhotics
on spp can be associated with a giant rash.
non-cholera vibrios
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lunch meat
high fetal loss
lysteria
think cantolupo
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Gastric biopsies with > 25 lymphocytes/high power field
CD8 T lymphocyte expansion
- Lymphocytic gastritis.
- treat H pylori
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significant abdominal pain followed by bloody significnat bloody diarrhea in a patient with a vascular history
Acute mesenteric ischemia
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abdominal pain
RUQ mass
jaundice
choledochal cyst
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portal hypertension, eosinophilia, normal lft large spleen
- Schistosomiasis
- treat with praziquantal
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Bleeding after liver biopsy
- hemobilia
- treat with angoigraphy
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neutropenia , and imaging showing inflammaiton in the ileum and cecum.
neutorpenic enterocolitis or more commonly typhlitis.
tx is supportive, emperic abx and avoid scoping because of the risk of perforation.
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HCV, + RA, renal insuff, low C4, rash, paresthesias
mixed cryoglobulinemia
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cobblestone appearance of tongue,
papillary thyroid cancer
breast Ca
gi hammartomas
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fever, microscopic hematuria, elevated alk phos but normal GGT, flank pain
renal cell carcinoma
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headache, elevated alk phos and elevated gtt. with normal other lft and no history of liver disease +/_ visual changes
temporal arteritis
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Type I achalasia
incomplete les relaxation and minimal esophageal pressurization
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Type II achalasia
incomplete les relaxation with esophageal pressurization
This is the subtype that responds best to treatment
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Type III achalasia
- spastic achalasia - lumen obliterating spasm
- failure of les to relax
Worst subtype
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etiology of achalasia
unknown. tissue lacks nitric oxide synthase.
chagas disease- secondary achalasia
tumor- pseudoachalasia
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This cancer is increased in achalasia
squmous cell carcnoma.
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Diffuse esophageal spasm
simultaneous contrctions in more than 30% of swallows, prolonged duration of the wave, and normal LES relaxation.
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Nutcracker esophagus
wave amplitude greator than 220mmHG and normal propagation and LES relaxation.
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Familial visceral neuropathy vs. myopathy
- in the neuropathy the muscle contractions are normal but not co-ordinated
- type I (autosomal dominant)
- type II (autosomal recessive)
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type 2 FVM (familial visceral myopathy)
under the microscope
this is a mitochondrial disorder
- bx shows "ragged red fibers"
- this condition has multiple extraintestinal manifestations
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What drug given to patients with pseudo-obstruction can lower SIBO if given in low doses at night
octreotide
if given at meals, this can prolong gastric emptying and exacerbate symptoms.
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Trypanosoma cruzi
- chagas diseas
- Reduviid bug. 10-30 % of infected people will develop chronic disease
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Middle aged smoker with sudden onset nausea, vomiting and/or feeding intollerance
paraneoplastic visceral neuropathy
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This catagory of cancer is often associated with a paraneoplastic disorder that causes CIPO
small cell lung cancer
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state the Rome III criteria for IBS
- Recurrent ab pain for at least 3 days in past 3 months with 2 or more of:
- -improvement with defecation
- -onset associted wth change in stool frequency
- -onset associated with change in stool form
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occularmasticory and oculofacial myorhythmia
whipple disease
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recurrent pain, fever and sx precipitated by estrogens and etoh
- AIP
- auto autosoma dominant diseae.
- Inappropriate ADH- hyponatremia
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Treatment of AIP
oral glucose
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location of vascular lesions in HHT
stomach . bleeding is in upper GI tract.
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the mutation that leeds to multiple colon polyps in patients with HHT
SMAD4
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papules on hands with marked umbilication, that show angiomatosis on bx
- bacillary angiomatosis,
- found on skin and liver in peliosis hepatitis
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Peliosis hepatis
what is it
what are most common causes
MULTIPLE BLOOD FILLED CYSTIC SPACES IN THE LIVER PARENCHYMA.
- hiv
- BARTONELLA HENSELAE INFECTION,
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active metabolite of aza
6-TG
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hepatotoxic product of 6mp affected by tpmt enzyme
6mmp
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villous blunting in small bowel
oatmeal like stool
travel to puerto Rico, Cuba, or the Hati/DR. also middle east or india
Tropical sprue.
treat with tetracycline and folate for 6-12 months.
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heart failure and malabsorption
- intestinal lymphangiectasia.
- white spots on endoscopy, show dilated lacteals.
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anti-diarrheal that causes sevear peumonitis
mineral oit
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drug causes of macrovesicular steatosis
tylenol, cisplatin, steroids and tamoxifen
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drugs that cause ischemic colitis
- alosetron
- carboplatinin
- docaine
- digitalis
- diuretics
- estrogen
- nsaids
- tegaserod
- paclitaxel
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what is the thereshold for treatment of colonic pseudoobstruction
cecal diameter of 12cm. or flailure of condition to resolve ater 24-48 hrs with conservative therapy
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diarrhea and saddle paresthesias
HSV proctitis-
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flask shaped ulcers
etamoeba histolytica colitis.
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charcot-leyden crystals
isospora -
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treatment for familial editerranean fever.
colchicine
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