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
HLA-B27 Associations
- PAIR Acronym
- Psoriatic Arthritis
- Ankylosing Spondylitis
- Inflammatory Bowel Disease
- Reactive Arthritis
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
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
Peptic Ulcer Disease Assessment
- Helicobacter Pylori
- NSAIDs
- Increased Stomach Acid
- Abdominal Pain
- Heartburn (Pyrosis)
- Melena
- Weight Changes
- GI Distress
- Most Commonly in Duodenum
- Duodenal: Pain Relieved by Eating
- Gastric: Pain Caused by Eating
Peptic Ulcer Disease Interventions
- Combination Drug Therapy
- Two Antibiotics
- Proton Pump Inhibitor (PPI)
- Decrease Acid Secretion
- Avoid NSAIDs
- Diet and Lifestyle Changes
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
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
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
Colorectal Cancer Assessment
- 3rd Most Common Cancer
- Change in Bowel Habits
- Bowel Obstruction
- Rectal Bleeding
- Anemia
- Weight Loss
- Ascites
- Colonoscopy
- FOBT and FIT
Colorectal Cancer Interventions
- Surgical Colon Resection
- Radiation
- Chemotherapy
- Bowel Cleansing
- Screening
- Colostomy
- Dietary Consult
- Body Image
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
Intestinal Obstruction
- Severe Abdominal Pain
- Vomiting
- High Pitched Bowel Sounds
- Abdominal Distention
- Increased Peristalsis
- Absent Bowel Sounds
- Paralytic Ileus
Types of Intestinal Obstruction
- Adhesions
- Hernia
- Volvulus
- Intussusception
- Tumor
- Mesenteric Artery Occlusion
- Spinal Injury
- Paralytic Ileus
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
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
Intussusception
- Telescoping of Bowel Segments
- Lead Point
- Episodic Abdominal Pain
- Diarrhea
- Sausage-Shaped Mass
- Red Currant Jelly Stools
- Ultrasound/CT
- Target Sign
- More Common in Children
- Rotavirus Vaccine Contraindicated
- Air or Hydrostatic Enema
- Surgical Reduction
Imperforate Anus
- Congenital Anorectal Malformation
- No Anal Opening
- Absence of Meconium
- Gradual Increase in Abdominal Distention
- Surgical Repair
- Bowel Management
Whipple's Disease
- Tropheryma Whipplei
- Gram-Positive
- Middle-aged, Caucasian men and Farmers
- Malabsorption
- Mesenteric Nodes
- Arthralgias
- Cardiac Symptoms
- Neurologic Symptoms
- PAS-positive Foamy Macrophages
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
Fistula Causes
- FRIEND Mnemonic
- Foreign Body
- Radiation
- Inflammation or Infection
- Epithelialization
- Neoplasm
- Distal Obstruction
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
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
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)
Clostridioides difficile (Clostridium difficile)
- Gram-Positive
- Bacillus
- Anaerobe
- Clindamycin and Ampicillin
- Toxin A Enterotoxin
- Damages Brush Border of Gut
- Toxin B Cytotoxin
- Damages Cytoskeletal Structure
- Diarrhea
- Pseudomembranous Colitis
- Toxic Megacolon
- Detect Toxins in Stool
- Metronidazole
- Vancomycin
Clostridium difficile (Clostridioides difficile) Treatments
- Oral Vancomycin
- Fidaxomicin
- Metronidazole
- Stool Transplant
Selective IgA Deficiency
- Defect in Class Switching
- Decreased IgA
- Often Asymptomatic
- Increase in Atopic & Autoimmune Diseases
- Sinopulmonary Infections
- Increased Risk Giardia Lamblia Infections
- Inflammatory Bowel Disease
- Celiac Disease
- Anaphylaxis From IgA Containing Blood Products
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
Volvulus Characteristics and Presentation
- Bowel Torsion
- Bowel Infarction
- Sigmoid Colon and Cecum
- Small Bowel Obstruction
- Abdominal Pain
- Unstable Vital Signs
- Peritonitis
Volvulus Diagnosis and Management
- Abdominal X-ray
- Coffee Bean Sign
- Kidney Bean Sign
- Abdominal CT Scan
- Whirl Sign
- Barium Enema
- Bird's Beak Sign
- Fluid Resuscitation
- Surgery
- Consider Antibiotics
Necrotizing Enterocolitis Diagnosis and Management
- Complete Blood Count (CBC)
- Blood Cultures
- Pneumatosis Intestinalis
- Increased Bowel Wall Thickness
- NPO with NG Tube to Suction
- Broad Spectrum Antibiotics
- Surgery
Necrotizing Enterocolitis Characteristics and Clinical Features
- Bowel Wall Inflammation
- Prematurity
- Failure to Thrive
- Vomiting
- Rectal Bleeding
- GI Perforation
- Peritonitis
- Sepsis and Shock
Familial Adenomatous Polyposis
- Autosomal Dominant
- Mutation in Chromosome 5
- APC Gene Mutation
- Overexpression of Beta-catenin
- Two-Hit Hypothesis
- Change in Bowel Habits
- Colonic Polyps
- Colonoscopy
- Prophylactic Surgery
- Progresses to Colorectal Carcinoma
Juvenile Polyposis Syndrome
- Autosomal Dominant
- Children < 5 Years Old
- Hamartomatous Polyps in Gastrointestinal Tract
- GI Distress
- Anemia
- Increased Risk of Colorectal Carcinoma
Ischemia and Vulnerable Tissues
- Brain
- MCA-ACA and MCA-PCA Interface
- Heart
- Subendocardium of Left Ventricle
- Kidney
- Proximal Tubule
- Thick Ascending Limbs of the Loop of Henle
- Liver
- Central Vein
- Colon
- Splenic Flexure
- Rectosigmoid Junction
Neoplastic Colonic Polyps
- Malignant
- Adenomatous Polyps
- APC and KRAS Mutation
- Villous Type is more Malignant
- Serrated Polyps
- BRAF Mutation
- Saw-Tooth Pattern
Hemorrhoids
- Lower GI Bleeding
- Internal Hemorrhoids
- Above Pectinate Line
- Visceral Innervation
- Not Painful
- External Hemorrhoids
- Below Pectinate Line
- Somatic Innervation
- Painful
- High Fiber Intake
- Surgery