General GI 4
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the most common infectious agents in the U.S. for diarrhea.
Salmonella, Campylobacter, Shigella, Shigatoxin E. coli, Cryptosporidia.
Fever, rose spots, ileitis
achlorrhydria and sickle cell disease pre dispose
diarrhea that causes ileitis/ileocolitis. usually not bloody, carried by reptiles.
non typhoidal gastroenteritis.
bacterial cause of dysentery
treat all cases
In contaminated poultry
associated with Gullian Barre
E.coli- multiple types of e. coli diarrhea
- STEC (shiga toxin e coli)
- common cause of HUS
avoid antibiotics and antidiarrheals
S. boulardii has been shown to be effective in treatment of this bad daddy
Non C.diff cause of antibiotic associated diarrhea.
gram negative bug
often confused with acute appendicitis
Terminal ileitis and mesenteric adenitis
2 species that can cause chronic colonic infections
can be found in shellfish
Teddy has never heard of these
Aeromonas and Plesiomonas
high mortality in cirrhotics
on spp can be associated with a giant rash.
high fetal loss
Gastric biopsies with > 25 lymphocytes/high power field
CD8 T lymphocyte expansion
- Lymphocytic gastritis.
- treat H pylori
significant abdominal pain followed by bloody significnat bloody diarrhea in a patient with a vascular history
Acute mesenteric ischemia
portal hypertension, eosinophilia, normal lft large spleen
- treat with praziquantal
Bleeding after liver biopsy
- treat with angoigraphy
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.
HCV, + RA, renal insuff, low C4, rash, paresthesias
cobblestone appearance of tongue,
papillary thyroid cancer
fever, microscopic hematuria, elevated alk phos but normal GGT, flank pain
renal cell carcinoma
headache, elevated alk phos and elevated gtt. with normal other lft and no history of liver disease +/_ visual changes
Type I achalasia
incomplete les relaxation and minimal esophageal pressurization
Type II achalasia
incomplete les relaxation with esophageal pressurization
This is the subtype that responds best to treatment
Type III achalasia
- spastic achalasia - lumen obliterating spasm
- failure of les to relax
etiology of achalasia
unknown. tissue lacks nitric oxide synthase.
chagas disease- secondary achalasia
This cancer is increased in achalasia
squmous cell carcnoma.
Diffuse esophageal spasm
simultaneous contrctions in more than 30% of swallows, prolonged duration of the wave, and normal LES relaxation.
wave amplitude greator than 220mmHG and normal propagation and LES relaxation.
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)
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
What drug given to patients with pseudo-obstruction can lower SIBO if given in low doses at night
if given at meals, this can prolong gastric emptying and exacerbate symptoms.
- chagas diseas
- Reduviid bug. 10-30 % of infected people will develop chronic disease
Middle aged smoker with sudden onset nausea, vomiting and/or feeding intollerance
paraneoplastic visceral neuropathy
This catagory of cancer is often associated with a paraneoplastic disorder that causes CIPO
small cell lung cancer
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
occularmasticory and oculofacial myorhythmia
recurrent pain, fever and sx precipitated by estrogens and etoh
- auto autosoma dominant diseae.
- Inappropriate ADH- hyponatremia
Treatment of AIP
location of vascular lesions in HHT
stomach . bleeding is in upper GI tract.
the mutation that leeds to multiple colon polyps in patients with HHT
papules on hands with marked umbilication, that show angiomatosis on bx
- bacillary angiomatosis,
- found on skin and liver in peliosis hepatitis
what is it
what are most common causes
MULTIPLE BLOOD FILLED CYSTIC SPACES IN THE LIVER PARENCHYMA.
- BARTONELLA HENSELAE INFECTION,
active metabolite of aza
hepatotoxic product of 6mp affected by tpmt enzyme
villous blunting in small bowel
oatmeal like stool
travel to puerto Rico, Cuba, or the Hati/DR. also middle east or india
treat with tetracycline and folate for 6-12 months.
heart failure and malabsorption
- intestinal lymphangiectasia.
- white spots on endoscopy, show dilated lacteals.
anti-diarrheal that causes sevear peumonitis
drug causes of macrovesicular steatosis
tylenol, cisplatin, steroids and tamoxifen
drugs that cause ischemic colitis
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
diarrhea and saddle paresthesias
flask shaped ulcers
etamoeba histolytica colitis.
treatment for familial editerranean fever.
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