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Jaundice
Jaundice Pre-Hepatic → Isolated ↑Bilirubin Unconjugated ↑ Production Hemolysis Hemorrhage ↑ Enterohepatic circulation Breastfeeding J. → <7d → Poor feeding → Feed more Breast milk J. → >7d → No gut bacteria → Feed formula Pyloric stenosis Intra-Hepatic → Isolated ↑Bilirubin Unconjugated Uptake/Conjugation defect Physiologic J. Gilbert → Stress → Phenobarbital Craigler-Najjar Type 1...
Read moreCirrhosis Complications
Cirrhosis → Chronic liver injury ⇒ Bridging fibrosis + Nodular regeneration Presentations and Treatments ↓Albumin Edema Coagulopathy (Except factor 8) FFP/Platelet → In bleeding Vitamin K is WRONG! Ammonia increase Asterixis → Liver flap Hepatic Encephalopathy Lactulose Rifaximin Estrogen metabolism problems Gynecomastia Spider angiomata Palmar erythema Portal hypertension ↓PLT → Splenic sequestration Ascites SAAG >1.1...
Read moreMalabsorption
Malabsorption Etiology Celiac disease → Gluten-sensitive enteropathy IgA mediated Whipple disease → Treponema whippli Tropical sprue → Infection Lactose intolerance Chronic pancreatitis Presentation Steatorrhea Fat malabsorption → Weight loss ADEK deficiency D → ↓Ca, Osteoporosis K → Bleeding, Easy bruising B12 deficiency → Anemia, Hypersegmentd PMN, Neuropathy Celiac Dermatitis herpetiformis (10%) Iron deficiency Osteoporosis Whipple...
Read moreGI Cancers
Esophageal Cancer Etiology SCC Most common worldwide Upper/Middle third Alcohol Tobacco Nitrosamines Adenocarcinoma Most common in US Lower third GERD Barrett Esophagus Presentation >50y PROGRESSIVE dysphagia → From solid to liquid ↓Weight GI bleeding Vomiting Diagnosis Best initial → Barium esophagram (might be) Asymmetric stricture Most accurate → Endoscopy and...
Read moreGallbladder
RUQ pain Jaundice Fever Best Initial Most Accurate Cholelithiasis ✓ ✖︎ ✖︎ U/S U/S Cholecystitis ✓ ✖︎ ✓ U/S HIDA scan Choleducolithiasis ✓ ✓ ✖︎ U/S MRCP Cholangitis ✓ ✓ ✓ U/S ERCP Cholelithiasis Etiology Cholesterol stone → Radiolucent Pigmented stone Black → Hemolysis Brown → Infection Presentation Fat...
Read moreGastriesophageal Reflux Disease
GERD Etiology Inappropriate relaxation of LES Worsened by Nicotine Alcohol Caffeine Chocolate Peppermint Late-night meals Obesity Scleroderma Gasteroparesis Hiatal hernia Presentation Heartburn Epigastric burning pain 30-90m after meals Radiate → Up into chest Worsened by → Reclining Improved by → Sitting, standing, antacids Sore throat → Water brash Bad metallic...
Read moreCirrhosis Causes
VW Happens Viral Hepatitis (Chronic) Presentation Cirrhosis Liver cancer PAN Diagnosis Hep B → ⨁ Surface Ag (DNA PCR) >6m Biopsy has no significance Only treat if ⨁ E-Ag OR DNA polymerase Hep C → PCR RNA viral load Treat anyone with ↑ RCR RNA viral load Treat anyone...
Read morePancreas Disorders
Insulinoma MEN 1 Whipple triad Hypoglycemia on blood test Associated symptoms Sweating Palpitation Anxiety Tremor Headache Confusion Resolution of symptoms with correction glucose Best initial test → Fasting insulin + C-peptide Most accurate → 72-hour fasting test Localize tumor and resect VIPoma VIP-producing malignant tumor Presentation Classic triad Watery...
Read moreColon Cancer
Colon Cancer Second cause of cancer mortality in US Etiology Polyps >2 cm Sessile > Pedunculated Villous > Tubular Presentation Right-sided Anemia → Chronic blood loss ↓ Weight Anorexia Diarrhea Vague abdominal pain Left-sided Obstruction → Apple-core Bowel habit change Constipation ↓ Caliber Blood-streaked stool Rectal Bright red blood...
Read moreDiverticular Disorders
Diverticulosis Etiology False diverticula Meat diet Low fiber High fat Presentation Asymptomatic Constipation Bleeding Anemia Diagnosis Best initial → CT scan Most accurate → Colonoscopy Barium studies → Acceptable but not as accurate Complications Diverticular hemorrhage Diverticulitis Treatment Bran Psyllium Methylcellulose ↑ Dietary fiber Diverticulitis Etiology Diverticular infection Fecalith Presentation Old age...
Read moreInflammatory Bowel Disease (IBD)
Crohn Ulcerative Colitis Skip lesion Continuous Transmural Mucosal Perianal disease Rectum always Fistula Pseudopolyp Noncaseting granuloma No granuloma ASCA Ab pANCA Crohn Disease Etiology Idiopathic Presentation Diarrhea Blood in stool Weight loss Fever Extraintestinal Arthralgia Anemia Aphthous stomatitis Eye Uveitis Iritis Episcleritis Skin Erythema nodosum → Indicator of disease activity...
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