Gastroenterology

Irritable Bowel Syndrome

Etiology Idiopathic Women 20-30y Psychiatric disorder Presentation Abdominal Pain → 3d in 3m Relieved by a bowel movement Less at night Relieved by change in bowel habit Diarrhea, Constipation OR Both NO weight loss NO malabsorption Diagnosis Diagnosis of exclusion NO blood/WBC in stool Treatment Fiber in diet Antispasmodic...

Read more

Diarrhea

Stool Osmotic Gap 290 – 2(Na+K) Normal = 50-100 Diarrhea Classification Acute Invasive → RBC/WBC IBD C. diff Campylobacter Salmonella Shigella EHEC Entamoeba histolitica Vibrio parahemolyticus Yersinia Non-invasive → No RBC/WBC Medication Viral Parasite Giardia Cryptosporidium ETEC Bacillus cereus Staph Chronic Secretory → Normal OG Gastrinoma VIPoma Carcinoid C....

Read more

GI Bleeding

Etiology Upper GI Bleeding PUD → Most common Gastritis Esophagitis Duodenitis Cancer Varices Lower GI bleeding Diverticulosis → Most common Angiodysplasia (AVM) → Related to Aortic Stenosis Polyps Cancer IBD Hemorrhoids Upper GI bleeding with rapid transit time Presentation Blood loss 15-20% → Orthostasis → ↑PR >10 OR ↓SBP >20 30% → PR>100...

Read more

Gastric Disorders

Gastritis Gastropathy → Inflammation/erosion of gastric lining Etiology Acute Gastritis Alcohol NSAIDs H. pylori Portal hypertension Stress Burn → Curling ulcer Brain injury → Cushing ulcer Trauma Sepsis Multiorgan failure → Uremia Chronic Gastritis Type A → Fundus → Parietal cell Ab → Pernicious Anemia Type B → Antrum → NSAIDs, H. pylori → PUD Presentation History of NSAIDs,...

Read more

Epigastric Pain

Etiology Most common → Non-ulcer dyspepsia Presentation Gastric ulcer → Pain Greater with food, Weight loss Duodenal ulcer → Pain Decreases with food Cancer → Weight loss Pancreatitis → Tenderness GERD → Bad taste, Cough, Hoarseness Gastroparesis → Diabetes, Bloating Non-ulcer dyspepsia → No other associated symptom Diagnosis Most accurate...

Read more

Esophageal Disorders

When to do endoscopy Dysphagia/Odynophagia + Weight loss + Blood in stool + Anemia When to do manometry Motility dysphagia (Non-progressive) Achalasia Spasm Scleroderma Esophagitis Etiology Infectious → AIDS/↓Immune Candidiasis → 90% CMV HSV HIV Pill esophagitis NSAIDs Antibiotics Doxycycline Bisphosphonates Alendronate HAART KCL Eosinophilic Children with asthma, eczema, odynophagia Caustic Presentation...

Read more

Amebiasis

Etiology Entamoeba histolytica Travel to developing country Presentation Up to 3m incubation period Bloody diarrhea Severe abdominal pain Fever Chronic form Mimics IBD Liver abscess Lung abscess Diagnosis Fecal sample Oocyte/Trophozoit → Carrier Trophozoit with RBC inside → Active disease Serology Colonoscopy → Flask-shaped ulcers CT scan → Abscess Complications Steroid ⇒ Fatal...

Read more