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Diverticular 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...
Read moreIrritable 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 moreDiarrhea
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 moreGI 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 moreGastric 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 moreEpigastric 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 moreEsophageal 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 moreOsteomyelitis
Etiology Children → Hematogenous Adults → Contiguous (nearby) Due to diabetes, vascular insufficiency Organisms Most common → Staph aureus Sickle cell → Salmonella Hip replacement → Staph epidermidis Foot puncture → Pseudomonas IVDU → Staph aureus, Pseudomonas Presentation Diabetic patient with ulcer Warmth, redness, swelling Draining sinus Afebrile Diagnosis Best initial → X-ray If Normal → Best...
Read moreSeptic Arthritis
Etiology Damaged joint DJD RA Prosthetic joint → Highest risk <3m → Perioperative → S. aureur, Pseudomonas 3-12m → Perioperative → S. epidermidis >12m → Not related to surgery → New S. aureus infection Blood spread Endocarditis IVDU Organism Staph (40%) Strep (30%) Gram ⊖ rod (20%) Staph epidermidis →...
Read moreOsteoporosis
Etiology ↓ Bone density Osteomalacia is mineralization defect due to severe ↓ Vit D Risk Factors Age Smoking Caffeine Alcohol Family history ↓ Estrogen in women Hypogonadism in men Hyperthyroidism Chronic inflammatory disease Corticosteroid Presentation Old woman Asymptomatic Spontaneous finding with routine DEXA scan in F>65y Vertebral fracture → ↓...
Read moreSeronegative Spondyloarthropathies
Ankylosing Spondylitis Etiology HLA-B27 association Can be associated with IBD → Enteropathic Spondylitis → Different from reactive arthritis Presentation Men <40y Low back pain/stiffness Worsen by rest Relieved by activity Radiate to buttocks Lumbar curvature flattening ⨁ Schober test → ↓ Spine flexion ↓ Chest expansion Enthesopathy → Achilles tendon...
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