Gastritis and Ulcers
What is gastritis? What are acute and chronic gastritis? What are the causes of both?
-Gastritis is the imbalance between mucosal injury (acid) and mucosal repair
-Acute: sudden onset caused by H. pylori and medications including NSAIDs
-Chronic: presence of chronic inflammatory cells in gastric mucosa causing inflammation and/or metaplasia (TWO PHASES: non-atrophic/superficial or atrophic/deep). Caused by H. Pylori, medications including NSAIDs, corticosteroids, and autoimmune conditions.
What are some similarities between Chron's disease and ulcerative colitis?
-Both include an inappropriate immune response in the GI tract (environmental factors, genetic predisposition, and microbial imbalance in the gut)
-Symptoms include pain, fever, bleeding, altered motility, loss of appetite, and weight loss
-INTERMITTENT DISEASES (periods of remission when no symptoms are present)
What are some symptoms/manifestations of diverticular disease? What are some tests/labs used to diagnose it?
-Symptoms: sudden, constant lower quadrant abdominal pain, nausea, diarrhea, tachycardia, fever, hypotension.
-Diagnostics: Imaging for complicated cases, urinalysis to rule out other conditions, and stool sample for occult blood.
What is acute pancreatitis? What is chronic pancreatitis? What are some symptoms for both? What causes acute and chronic pancreatitis?
-Acute: inflammation or necrosis of the pancreas; caused by alcohol abuse or gallstones.
-Symptoms: pain (deep epigastric pain), abdominal distention/tenderness, fever, Cullen sign, Grey-Turner sign.
-Chronic: Long-term inflammation leads to irreversible damage; caused by alcoholism or obstruction/stricture of pancreatic duct
-Symptoms: pain is less severe- dull, constant, and located in the LUQ; alcohol induces pain.
What is hepatitis? What are the 5 major viral types of hepatitis?
Hepatitis is inflammation of the liver and can be viral, acute alcoholic, or autoimmune.
-HAV, HBV, HCV, HDV, HEV
What is peptic ulcer disease?
an imbalance between potent gastric acid and the protective mucosal barrier lining
What tests are used to diagnose inflammatory bowel diseases?
stool samples (rule out other disease processes), CRP and ESR (elevated), H&H (anemia), lower endoscopy studies and biopsies.
What are some risk factors of Cholelithiasis and Cholecystitis?
Diet high in fat and cholesterol, hyperlipidemia, sedentary lifestyle, and females are more at risk (particularly those with use of estrogen replacement, multiparous)
What are diagnostics for acute and chronic pancreatitis?
Chronic: elevated WBC, amylase, and lipase
What are the three phases of hepatitis? What are some diagnostics for Hepatitis?
-Prodromal: from 2 weeks after initial exposure until jaundice occurs. Fatigue, nausea, vomiting, low-grade fever, highly infectious.
-Icteric: Can last up to 6 weeks, starts when jaundice develops. Jaundice, clay-colored stools, liver enlarged
-Recovery/Post-icteric: starts 6-8 weeks after exposure, Jaundice starts to resolve and labs begin to improve.
-Diagnostics: positive antibodies for different types of viral hepatitis, bilirubin levels, elevated ALT and AST levels.
What are duodenal ulcers? What cause them and what are some symptoms?
typically occurs in first portion of duodenum
-Caused by H. pylori and NSAID use
-Symptoms include burning or gnawing discomfort with empty stomach and during the night.
What is Diverticula, Diverticulosis, and Diverticulitis?
-Diverticula: small outpouchings of mucosa through muscle layers of the colon wall
-Diverticulosis: no or low-grade inflammation present (stable)
-Diverticulitis: highly inflamed diverticula (unstable)
What is Cholelithiasis? What is Cholecystitis? What is Choledocholithiasis?
-Cholelithiasis: stone formation in the gall bladder; can be acute or chronic
-Cholecystitis: stones can block the ability of bile to leave the gallbladder, causing inflammation of the gallbladder; can be acute or chronic.
-Choledocholithiasis: blockage of common bile duct
What is Glomerulonephritis? What is primary and secondary Glomerulonephritis?
Inflammation of glomeruli in kidneys: leads to deposit of antigen/antibody complexes and increased permeability which allows passage of RBCs, protein into urine.
-Primary is limited to the kidneys while secondary is the result of another disease process.
What is Cirrhosis? What are the causes and risk factors? What are diagnostics for Cirrhosis?
-Cirrhosis is late stage scarring of the liver and is caused by alcohol consumption, hepatitis, or chronic obstruction of bile ducts. Risk factors include being male or being in countries with higher alcohol consumption per capita.
Diagnostics: elevated AST, ALT, bilirubin; decreased albumin, total protein, ammonia. Increased Coagulation tests
What are gastric ulcers? What causes them and what are some symptoms?
-caused by duodenal reflux of bile, H. pylori, NSAID induced (decrease in prostaglandins leads to decrease in mucous production
-Symptoms include burning or gnawing discomfort, may be precipitated by food; nausea and weight loss frequently accompany this type of ulcer.
what are some differences between ulcerative colitis and chron's disease?
Chron's Disease: Transmural inflammation of the bowel with skip lesions; Can affect BOTH SMALL AND LARGE INTESTINE; bowel wall thickening, ulcerations; cobblestone appearance (Symptoms: nausea, vomiting, diarrhea, bowel obstructions)
What are some diagnostic tests/results used to diagnose cholelithiasis and cholecystitis?
Elevated WBC; elevated amylase and lipase if the pancreas is involved; elevated conjugated bilirubin, AST, ALT if liver is involved
-Abdominal x-ray and gallbladder scan
What are the symptoms of Glomerulonephritis? Nephritic syndrome presentation vs nephrotic syndrome presentation? Can both syndromes be present?
Nephritic Syndrome presentation: hematuria, proteinuria, RBC casts, and dysmorphic RBCs
Nephrotic Syndrome presentation: hyperlipidemia, hypoalbuminemia, edema, proteinuria, and fatty casts in urne
BOTH SYNDROMES CAN BE PRESENT
What is portal hypertension and esophageal varices? What is hepatic encephalopathy?
portal hypertension and esophageal varices: Occurs when hepatocytes are replaced by scar tissue, fibrous connective tissue leads to constriction. This forces blood out of the liver to vessels that have a lower tolerance to pressure, including vessels surrounding the esophagus and spleen.
Hepatic Encephalopathy: When the liver isn't functioning properly, ammonia accumulates in the bloodstream; impact brain function (confusion and disorientation)
What are some complications caused by ulcers? What are some labs used to diagnose ulcers?
-Complications: Upper GI bleeding, lower GI bleeding, occult bleeding; response to GI bleeding is dependent upon the amount and rate.
-Labs: WBC level, Hemoglobin (measures the protein in RBCs that binds to oxygen), Hematocrit (proportion of RBCs to total blood cell population)
What are complications of diverticular disease? Diverticula and diverticulitis?
-Complicated diverticula: with diet, stress, and other risk factors- obstuction, stasis, altered local bacteria, or ischemia and of the diverticula lead to diverticulitis.
-Complicated diverticulitis: feeder artery may become compressed or eroded, leading to perforation or bleeding
-Complicated diverticulitis: inflammation associated with formation of an abscess, fistula, obstruction, bleeding or perforation
What are some symptoms of Cholelithiasis and Cholecystitis?
Stone Formation: mild gastric distress in RUQ after fatty meal.
Blocked: severe and sudden onset of midepigastric pain (biliary colic); radiates to right shoulder blade, nausea, tachycardia, steatorrhea (dark urine), fever, and chills
What are some diagnostics for Glomerulonephritis?
-urinalysis, blood urea nitrogen (BUN), serum creatinine, albumin, and total protein.
What is Ascites? What is Jaundice?
Ascites: when liver damage stops albumin (protein) production, this increases capillary permeability; therefore, fluid leaks into interstitial spaces.
Jaundice: When there is an excessive build up of bilirubin