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H/P - refractory PUD, abdominal pain, nausea, vomiting, indigestion, diarrhea, steatorrhea, possible history of other endocrine abnormalities
Zollinger-Ellison syndrome
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labs - increased fasting gastrin, positive secretin-stimulating test
Zollinger-Ellison syndrome
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Treatment for Zollinger Ellison syndrome
Surgical resection for nonmetastatic disease, PPI and H2 Blockers, octreotide may help reduce symptoms in metastatic disease
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Cancer resembling sulcers seen in PUD
Ulcerating
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Cancer that are large intraluminal neuplasms
Polyploid
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Cancers that involve the mucosa and submucosa
- Superficial spreading
- best prognosis
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all layers of stomach involved, decreased stomach elasticity
- Linitis plastica
- Poor prognosis
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Risk factors for stomach cancer
H. Pylori, Family History, Japanese person living in Japan, tobacco, alcohol, vitamin C deficiency, high consumption of preserved food, male>females
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Antiendomysial and antigliadin antibodies
Celiac Sprue
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Loss of duodenal and jejunal villi
Celiac Sprue
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Acquired disorder in patient living in tropical areas
without entiendomysial and antigliadin antibodies
Tropical Sprue
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Treatment for tropical sprue
- folic acid replacement, tetracycline or sulfa 3-6 months
- removal of gluten from diet has no effect
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Testing for lactose intolerance
- lactose tolerance test (minimal increase in serum glucose following ingestion of lactose)
- lactose breath hydrgen test after lactose meal
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History of Weight loss, joint pain, abdominal pain, diarrhea, dementia, cough, bloating, steatorrhea, fever, vision abnormalities, lymphadenopathyy, new heart murmur
Whipple disease
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Etiology of Whipple disease
asociated with Tropheryma whippelii and immune deficiency
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Risk factors for Whipple disease
males with European ancestry
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Treatment for Whipple disease
TMP-SMX or ceftriaxone for 12 months
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CT showing air within bowel wall and bowel wall thickening
Ischemic colitis
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Abdominal pain out of proportion to examination
Small bowel ischemia
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Double bubble sign
proximal or distal illeus
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Painful bleeding tears in posterior wall of anus secondary to trauma
- Anal fissures
- Treat with stool softeners, topical nitroglycerin to relieve spasm, partial sphinctertomy
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Inflammation of anal crypts, internal hemrrhids, or hair follicle leading
Throbbing rectal pain, fever, tenderness on digital examination
- Anorectal abscesses
- treat with antibiotics and I&D
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Mild pain during defecatin, possible visible site of draining pus
Formation of tract between rectum and adjacent structures from unknown cause, IBD, or abscess
- Rectal fistula
- treat with fistulotomy, treat IBD
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Presence of one or more cutaneous sinus tracts in the superior midline gluteal cleft, obsturction of the tact by hair or debris leading to cyst and abscess formation
Usually asymptomatic, can be painful
I&D with surgical closure of sinus tracts
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flushing, diarrhea, bronchoconstriction, tricuspid/pulmonary valvular disease
carcinoid syndrome
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Abdminal pain, carcinoid syndrome
Carcinoid tumor of GI tract, cna be asymptomatic
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Increased 5-hydroxy-indolacetic-acid (5-HIAA) in urine
Carcinoid tumor
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Treatment for carcinoid tumor
- Tumors <2 cm should be resected
- Tumors >2 cm have a high risk of metastases and require extensive resection.
- Metastatic disease treated with IFN-alpha, octreotide, and embolization
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Carcioembryonic Antigen (CEA)
Increase in 70% of colorectal cancer
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