Colorectal Cancer Assessment
- 3rd Most Common Cancer
- Change in Bowel Habits
- Bowel Obstruction
- Rectal Bleeding
- Anemia
- Weight Loss
- Ascites
- Colonoscopy
- FOBT and FIT
Irritable Bowel Syndrome (IBS) Assessment
- Abdominal Pain
- Relieved by Defecation
- Alternating Diarrhea and Constipation
- Fatigue
- Excessive Flatulence
- Sensation of Incomplete Evacuation
- Stressors
- Food Intolerances
- More Common in Women
- Rule Out Other Disorders
Irritable Bowel Syndrome (IBS) Interventions
- Identify Triggers
- Increase Fiber Intake
- Probiotics
- Anticholinergics
- Tricyclic Antidepressants (TCAs)
- Loperamide
- Linaclotide
- Tegaserod (Zelnorm)
- Lubiprostone (Amitiza)
- Alosetron (Lotronex)
Types of Hernias
- Hiatal
- Gastroesophageal Reflux Disease (GERD)
- Inguinal
- Men
- Femoral
- Women
- Incisional
- Umbilical
- Strangulation
Hernia Interventions
- Reduce Intra Abdominal Pressure
- Avoid Straining and Lifting
- Open Mouth Sneezing
- Excision
- Herniorrhaphy
- Hernioplasty
- Scrotal Support
Types of Intestinal Obstruction
- Adhesions
- Hernia
- Volvulus
- Intussusception
- Tumor
- Mesenteric Artery Occlusion
- Spinal Injury
- Paralytic Ileus
Intestinal Obstruction
- Severe Abdominal Pain
- Vomiting
- High Pitched Bowel Sounds
- Abdominal Distention
- Increased Peristalsis
- Absent Bowel Sounds
- Paralytic Ileus
Celiac Disease Characteristics
- European Descent
- HLA-DQ2
- HLA-DQ8
- Autoimmune-mediated Intolerance of Gliadin
- Dermatitis Herpetiformis
- Weight Loss
- Failure to Thrive
- Decreased Bone Density
- Steatorrhea
- Anemia
Celiac Disease Diagnosis and Treatment
- Blunting of Intestinal Villi
- Lymphocytes in Lamina Propria
- Anti-gliadin Antibodies (IgA)
- Anti-endomysial Antibodies (IgA)
- Anti-tissue Transglutaminase Antibodies (IgA)
- Gluten-Free Diet
- Corticosteroids
- Dapsone
- Intestinal Lymphoma
Crohn's Disease Assessment
- Diarrhea
- 5-6 per day
- Cramping Abdominal Pain
- Fever
- Weight Loss
- Malabsorption
- Anemia
- Obstruction
- Fistulas
Crohn's Disease Characteristics
- Terminal Ileum and Colon
- Rectal Sparing
- Transmural Inflammation
- Granulomas
- Skip Lesions
- Cobblestone Mucosa
- Fissures
- Fistulas
- Perianal Disease
- Creeping Fat
- Lymphoid Aggregates
- String Sign on Barium Swallow
Crohn's Symptoms and Associations
- Diarrhea
- Malabsorption
- Bile-Wasting
- Pigment Gallstones
- Oxalate Kidney Stones
- Ankylosing Spondylitis
- Erythema Nodosum
- Uveitis
- Migratory Polyarthritis
Ulcerative Colitis Characteristics
- Autoimmune
- Mucosal and Submucosal Only
- Rectal Involvement
- Stepwise Lesions
- Friable Pseudopolyp
- Crypt Abscess
- Loss of Haustra
- Lead Pipe Appearance
- Bloody Diarrhea
Ulcerative Colitis Associations
- Toxic Megacolon
- Colorectal Carcinoma
- Anterior Uveitis
- Pyoderma Gangrenosum
- Ankylosing Spondylitis
- Primary Sclerosing Cholangitis
- P-ANCA
Appendicitis
- Fecalith leading to obstruction and infection
- Most commonly affects teenagers
- Initial peri-umbilical visceral pain
- Subsequent somatic right lower quadrant pain
- Rebound tenderness
- Positive psoas sign
- Pain at McBurney's point
- Leukocytosis
- Fever
- Appendectomy
Acute Appendicitis Treatment
- CT Scan
- Immediate Appendectomy
- NPO
- IV Fluids
- Antibiotics
- Tertiary Intention
- Antibiotics Until Afebrile
Diverticulosis and Diverticulitis Assessment
- Outpouching
- Inflamed Diverticula
- Abdominal Pain
- Abdominal Distention
- Flatulence
- Fever
- Rectal Bleeding
- Alternating Constipation and Diarrhea
- Peritonitis
Diverticulosis and Diverticulitis Interventions
- High Fiber Diet
- Reduce Intra-abdominal Pressure
- Stool Softeners
- Exercise
- Anticholinergics
- Antibiotics
- Bowel Resection
Wilson's Disease Pathophysiology
- Autosomal Recessive
- Mutation in ATP7B gene
- Chromosome 13
- Decrease in Ceruloplasmin
- Inadequate copper excretion
- Liver
- Brain
- Kidney
- Cornea
- Joints
- Treat with Penicillamine
Wilson's Disease Symptoms
- Cirrhosis
- Hepatocellular Carcinoma
- Basal Ganglia Degeneration
- Dementia
- Dyskinesia
- Asterixis
- Kayser-Fleischer Rings
- Slit Lamp Exam
- Hemolytic Anemia
Mesenteric Ischemia
- Severe Abdominal Pain
- Bloody Diarrhea
- Metabolic Acidosis
- Increased WBC
- Increased Lactate (Lactic Acid)
- X-ray
- Air Within Bowel Wall
- CT Angiography
- Bowel Wall Edema
- Antibiotics
- Emergent Surgical Intervention
Meckel's Diverticulum
- True Diverticulum
- Vitelline Duct
- Yolk Stalk
- Contain Ectopic Tissue
- Pancreatic And Gastric Mucosa
- Hemorrhage
- Intussusceptions
- Volvulus
- 2 Feet From Ileocecal Valve
- 2 Inches Long
- 2% Population
- First 2 Years Of Life
- Pertechnetate T99
Lynch Syndrome (Hereditary Nonpolyposis Colorectal Cancer)
- Autosomal Dominant
- Defective DNA Mismatch Repair
- 80% Risk of Colon Cancer Development
- Proximal (Right) Colon
- Type II associated with Endometrial, Ovarian and Skin Cancers
- 3 Relatives with Colon Cancer
- Occurs Across 2 Generations
- 1 Relative Diagnosed < 50 Years Old
- Frequent Screening
- Colectomy
Hirschsprung Disease
- Failure of Neural Crest Cell Migration
- Involves Rectum
- Lack of Auerbach and Meissner Plexus
- Chronic Constipation
- Failure to Pass Meconium
- Congenital Megacolon
- Increased Risk with Down Syndrome
- RET Mutations
Hemochromatosis Pathophysiology
- Hemosiderin Deposition
- Autosomal Recessive
- HLA-A3
- Secondary to Transfusion Therapy
- Increase Iron
- Increase Ferritin
- Increased Transferrin Saturation
Hemochromatosis Signs and Symptoms
- Micronodular Cirrhosis
- Hepatocellular Carcinoma
- Diabetes
- Bronze Skin Coloring
- CHF
- Arthropathy
- Testicular Atrophy
- Impotence
Fistula Causes
- FRIEND Mnemonic
- Foreign Body
- Radiation
- Inflammation or Infection
- Epithelialization
- Neoplasm
- Distal Obstruction
Carcinoid Syndrome
- Neuroendocrine Cells
- Serotonin
- Appendix
- Chromogranin A
- Neuron Specific Enolase
- Dense Core Bodies on EM
- Symptoms When Metastasize to Liver
- Flushing
- Wheezing
- Right Heart Murmur
- Diarrhea
Peutz-Jeghers Syndrome
- Symptomatic Age: 10-30 Years
- LKB1/STK11 Gene Mutation
- Autosomal Dominant
- Benign GI Hamartomatous Polyps
- Mucocutaneous Hyperpigmentation
- Positive Family History
- Increased Risk of Colorectal Carcinoma
Gallstones (Part 1/2)
- Cholelithiasis
- Increased Bilirubin
- Increased Cholesterol
- Stasis
- Decreased Bile Salts
- Cholesterol Stones are the Most Common Type
- Fat, Female, Fertile, Forty, Fair Complexion
- Crohn's Disease
- Rapid Weight Loss
- Estrogen Therapy
- Native American
- Ultrasound
- Cholecystectomy
Porcelain Gallbladder
- Associated with Chronic Cholecystitis or Cholelithiasis
- Increased Risk of Gallbladder Adenocarcinoma
- RUQ Pain
- Usually Asymptomatic
- Often Found Incidentally
- Confirm with CT or Ultrasound
- Prophylactic Cholecystectomy
Lactose Intolerance
- Lactase Deficiency
- Decreased Lactose Absorption
- Increased Osmotic Load
- Abdominal Pain
- Flatulence
- Diarrhea
- Positive Hydrogen Breath Test
- Decreased Stool pH
- Avoid Dairy
- Lactase Supplementation
Gardner Syndrome
- Familial Adenomatous Polyposis (FAP) + Extraintestinal Benign Tumors
- Autosomal Dominant
- APC Gene Mutation
- Desmoid Tumors
- Nasal Angiofibromas
- Osteomas
- Congenital Hypertrophy of Retinal Pigment Epithelium
- Dental Abnormalities
- Cutaneous Lesions
- Adrenal Adenomas
- Thyroid Cancer
- Duodenal / Periampullary Cancer
- Pancreatic Cancer
- Hepatoblastoma
Turcot Syndrome
- Autosomal Dominant or Autosomal Recessive
- Colonic Polyposis + CNS Tumor
- Increased Risk of Colorectal Cancer
- Increased Risk of Brain Cancer
- Lynch Syndrome
- Glioblastoma Multiforme
- Familial Adenomatous Polyposis (FAP)
- Medulloblastoma