Gastroenterology

• Common in Pt w liver cirrhosis fin hepatitis or alcohol.
• P/E: ascites, +/- fever and diffuse abd pain

• 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

• Infection: of CBD
• P/w: Reynold's Pentad: Charcot's triad (RUQ pain, jaundice, fever), /> in mental status, and shock

• Ans: inflam of gallbladder, often d/t gallstones.
• Sx: RUQ pain and have signs of infection.  LFTs NOT elevated

• 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

• 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

• 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 PCR. Best 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:

• 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

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

• 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

• Vit D: ---> hypocalcemia, osteporosis
• Vit K: ---> bleeding, easy bruising
• Vit B12: ---> Anemia, hypersegmented neutrophils, neuropathy