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  2. Spontaneous Bacterial Peritonitis
    • Common in Pt w liver cirrhosis fin hepatitis or alcohol.
    • P/E: ascites, +/- fever and diffuse abd pain
  3. Choledocolithoiasis
    • Ans: gallstone in the common bile duct
    • Sx and PE: Abd pain, jaundice, N/V, pruritis
    • When evidence of infection is apparent: Dx is then Cholangitis
  4. Cholangitis
    • Infection: of CBD
    • P/w: Reynold's Pentad: Charcot's triad (RUQ pain, jaundice, fever), /> in mental status, and shock
  5. Cholecystitis
    • Ans: inflam of gallbladder, often d/t gallstones.
    • Sx: RUQ pain and have signs of infection.  LFTs NOT elevated
  6. Budd-Chiari Syndrome
    • Ans: Occlusion of hepatic veins or IVC that is common in myoproliferative disorders (e.g. polycythemia vera, tumors, and hypercoagulable states.
    • P/E: ascites, and fever (not as common as in cholangitis)
    • Pt won't have positive blood cultures
  7. Epigastric Pain
    How to ans "What is the most likely (M.L.) Dx?"
    • If this is in the Hx: The M.L. Dx is:
    • Pain worse with food --> Gastric Ulcer
    • Pain better with food --> Duodenal Ulcer
    • Weight Loss --> CA, Gastric Ulcer
    • Tenderness --> Pancreatitis
    • Bad Taste, cough, hoarse --> Acid reflux
    • Diabetes, bloating --> Gastroparesis
    • Nothing --> Non-ulcer dyspepsia
  8. Diarrhea
    • ABx assoc: C. difficile, caused by any ABx; blood+WBC found in stool; usu presents days-wks after abx.  Best Test= stool C.diff toxin test or PCRBest Tx= Metronidazole (2ndLine: PO vanco (never IV since it won't reach intestines) or fidaxomicin)
    • Malabsorption: (Celiac; rare Tropical sprue and Whipple Dz)
    • Chronic Pancreatitis:
    • Carcinoid Syndrome:
    • Lactose Intolerance:
  9. Malabsorption
    • nothing clinically to distinguish tropical sprue from celiac (gluten-sens enteropathy)
    • Celiac: dermatitis herpetiformis in 10% of cases.
    • B12 absorption needs: intact bowel wall & pancreatic enz
    • Whipple Dz also p/w: arthralgias, ocular findings, neurologic abnormalities (dementia, seizures), fever, lymphadenopathy, treat with ceftriaxone followed by TMP/SMX
  10. Malabsorption
    Dx tests
    Distinction of Chr Pancreatitis and Gluten-sens Enteropathy: presence of Iron Deficiency (Fe needs intact bowel wall, but doesn't need pancreatic enz.

    • Unique Tests: !
    • Celiac: !
    • 1st test: Anti-tissue transglutaminase
    • Others: Antiendomysial Ab, IgA antigliadin Ab
    • Gold Standard: Duodenal Bx

    Pro Tip: Bowel Bx necessary with Celiac to exclude Lymphoma
  11. Diarrhea
    • Disease:  -->   Specific Tx
    • Chronic Pancreatitis: ---> Enzyme Replacement
    • Celiac Dz: ---> Gluten-free diet (no wheat, oats, rye, barley)
    • Whipple Dz: ---> Ceftriaxone, TMP/SMX
    • Tropical Sprue: ---> TMP/SMX, and tetracycline
  12. Deficiencies  --->  Manifestations
    • Vit D: ---> hypocalcemia, osteporosis
    • Vit K: ---> bleeding, easy bruising
    • Vit B12: ---> Anemia, hypersegmented neutrophils, neuropathy
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