Professional Documents
Culture Documents
Diagnostic Test
Measures
Breakdown product of
serotonin
Amylase
Lipase
Liver Function
Tests
Indications
Result
Carcinoid Syndrome
Test Interpretation
Parameters
Normal
2 - 9 mg
Carcinoid
Syndrome
50 - 500 mg
Acute pancreatitis
Pancreatic pseudocyst
Pancreatic cancer
Mumps
Salivary gland
inflammation
Pancreatic cancer
Acute pancreatitis
Moderately HIGH
Pancreatic pseudocyst
Pancreatic disease
HIGH
Total protein
Albumin
ALT
AST
Alkaline phosphatase
Total bilirubin
Conjugated bilirubin
Moderately HIGH
HIGH
Cholangitis
Normal
Hepatitis
Pregnancy
Excessive IV fluid
Cirrhosis
Liver disease
Chronic alcoholism
Heart failure
Nephrotic syndrome
Burns
Dehydration
Waldenstrm's
macroglobulinemia
Multiple myeloma
Hyperglobulinemia
Granulomatous diseases
Some tropical disease
LOW
Total Serum
Protein
Nutritional status
Liver function
HIGH
Normal
Albumin
Major protein
component of blood
Liver disease
Liver damage
LOW
Pancreatic cancer
Mumps
Salivary gland
inflammation
Acute cholecystitis
Perforated peptic ulcer
Acute pancreatitis
Pancreatic pseudocyst
Pancreatic cancer
Serum sample
Acute cholecystitis
Acute pancreatitis
Pancreatic pseudocyst
HIGH
Other
Hepatitis
Acute hepatocellular
dysfunction
Cirrhosis
Diagnostic Methods
Diagnostic Test
Alanine
Aminotransferase
(ALT)
Measures
Test Interpretation
Result
Parameters
Normal
10 - 60 U/L
Indications
Moderately HIGH
Hepatocellular enzyme
Liver damage
Aspartate
Aminotransferase
(AST)
Acute cholecystitis
HIGH
MI
PE
Skeletal muscle trauma
Alcholoic cirrhosis
Viral hepatitis
Cirrhosis
Drug-induced hepatitis
Cell necrosis
Heart
Important enzyme in
amino acid metabolism
Effectiveness of the
extrinsic pathway of
coagulation
Hepatic
Function Panel
Group of assays
concerning the function
of the liver
-Glutamyltransferase
(GGT)
Moderately HIGH
HIGH
Prothrombin
Time
Alkaline
Phosphatase
(ALP)
Normal
Liver damage
Severe muscle injury
Hepatitis
Cirrhosis
Hemolysis
10 - 60 U/L
Liver inflammation
Liver
RBCs
Warfarin therapy
Liver disease
Vitamin K deficiency
Sodium
Chloride
Glucose
Creatinine
Albumin
Potassium
Carbon dioxide
Urea
Calcium
Phosphorus
Normal
Acute cholecystitis
Other
Liver disease
Cholestasis
Biliary obstruction
Liver damage
Hepatocellular disease
Hepatobillary disease
Biliary stasis
HIGH
HIGH
30 - 135 U/L
Active bone formation
Pregnancy
Some intestinal
disorders
Cirrhosis
Bile duct destruction
Alcohol-induced hepatic
changes
Hepatocellular disease
Hepatobillary disease
Hepatitis
(can be normal)
Cirrhosis
(can be normal)
Diagnostic Methods
Diagnostic Test
Measures
Indications
Result
Test Interpretation
Parameters
ALP
5'-Nucleotidase
Hepatic enzyme
Cholestasis
Liver metastases
Normal
Moderately HIGH
Gallbladder disease
Other
Hepatocellular function
Total Bilirubin
Gilbert syndrome
Neonatal jaundice
Severe Crigler-Najjar
syndrome
Alcoholic hepatitis
Infectious hepatitis
Autoimmune conditions
Intrahepatic obstruction
Extrahepatic obstruction
Conjugated
Bilirubin
Unconjugated
Bilirubin
Diagnostic
Peritoneal Lavage
Intrahepatic cholestasis
Hepatocellular damage
Extrahepatic biliary
obstruction
Acclerated RBC
hemolysis
Total bilirubin
Hepatitis
Drugs
Abdominal trauma
Intraperitoneal
hemorrhage
Ruptured intestine
Ruptured organs
Diagnostic Methods
Diagnostic Test
Measures
Indications
Ascites
Paracentesis
Cell counts
Procedure to obtain
peritoneal fluid for
diagnosis or therapeutics
Cytology
Testing
Gram stain
Chemical testing
Non-Liver Targeting
Pathogens
Hepatitis
Inflammation / infection
of the liver
Liver Targeting
Pathogens
Test Interpretation
Parameters
WBC
Bacterial
Neutrophils
Peritonitis
(+) Culture
Pancreatic Ascites
Amylase
Malignant
Blood fluid
Peritonitis
(nontraumatic tap)
Cirrhosis
CHF
HIGH SAAG
Alcoholic hepatitis
( 1.1)
Myxedema
Portal vein thrombosis
Bacterial peritonitis
Malignancy
LOW SAAG
Nephrotic syndrome
(< 1.1)
Pancreatitis
TB
Peritonitis
WBC
Normal or low
AST
Striking
ALT
Striking
Follows AST and ALT
Total Bilirubin
elevations
Alkaline
Parallels bilirubin
Phosphatase
Result
Epstein-Barr virus
Cyctomegalovirus
Herpes simplex virus
Yellow fever
Mumps
Rubella
Hepatitis A
Hepatitis B
Hepatitis C
Hepatitis D
Hepatitis E
Hepatitis G
Antigens and
Antibodies
Urine
IgM
Anti-HAV
Hepatitis A
Traveling to endemic
areas
IgG
Other
Pathogen-specific
Mild proteinuria
Bilirubinuria
Acute infection
Previous exposure
Noninfectivity
Immunity
Diagnostic Methods
Diagnostic Test
Measures
HBsAg
Indications
Hepatitis B
Anti-HBs
Anti-HBc
HBeAg
Anti-HBe
HBV DNA
Hepatitis B
Hepatitis B
Test Interpretation
Parameters
First evidence of
infection
POSITIVE
Infection with HBV
Implies infectivity
Recovery from HBV
infection
POSITIVE
Noninfectivity
Vaccination
Immunity
Appears soon after
HBsAg but before
IgM
anti-HBs
Acute hepatitis B
Persists 3 - 6 months
Persists beyond IgM
IgG
Immunity
Viral replication
POSITIVE
Infectivity
Less viral replication
POSITIVE
Less infectivity
Result
LOW
Post-recovery from
acute hepatitis B in
serum and liver
Frequent cause of
cyroglobulinemia
HCV RNA
Anti-HCV RIBA
Antibody Levels
Hepatitis D
Hepatitis E
Acute Hepatitis
Panel
Parallels HBeAg
More sensitive and precise marker of
viral replication and infectivity
Often silently progressive
Anti-HCV by ELISA
Hepatitis C
Other
Diagnostic
Rise slowly
Anti-HDV
Worsening hepatitis B
POSITIVE
Pregnancy
(10 - 20% mortality rate)
Anti-HEV
POSITIVE
Diagnostic Methods
Diagnostic Test
Measures
Radiograph
Fluoroscopy with
Barium
Gastrointestinal
Endoscopy
Indications
Calcifications
Foreign bodies
Free air
Obstruction
Transit times
Mucosal abnormalities
Any GI disease
Risks
Dysphagia
Refractory GERD
PUD
Esophagogastroduodenenoscopy
Direct visualization of
esophagus, stomach, and
duodenum
Result
Malabsorption
Dilation of esophageal
strictures
Removal of polyps /
neoplasms
Test Interpretation
Parameters
Other
Enteroscopy
"Push" endoscopy of small bowel
Perforation
Bleeding
Infection
Cardiopulmonary
complications 2 to
sedation
Death
Odynophagia
Screening for Barrett's
esophagus
Upper GI bleeding
Treatment of varices /
bleeding
Rupture of esophageal
webs
Stent placement
Radiofrequency ablation
Flexible
Sigmoidoscopy
Visualization descending
colon, sigmoid colon, and
rectum
Colonoscopy
Inflammatory diarrhea
Colorectal cancer
screening
Anemia evaluation
Bleeding
Assesment of IBD
Requires sedation
Diagnostic Methods
Diagnostic Test
Measures
Indications
Pancreatic cancer
Endoscopic
Retrograde
Cholangiopancreatography
Endoscopic
Ultrasound
Ultrasound on an
endoscope
Video Capsule
Endoscopy
High-Resolution
Endoscopy
Magnifiable endoscopy
Chromoendoscopy
Narrow Band
Imaging
Enhances mucosal
morphology and vascularity
Test Interpretation
Parameters
Other
Choledocholithiasis
Obscure bleeding
Survey in polyposis
syndromes
Refractory
malabsorption
syndromes
Double Balloon
Endoscopy
Result
Varices
GERD complications
Esophagitis
Flat lesions
Barrett's esophagus
Occult lesions
Neoplasia
Adenoma
Diagnostic Methods
Diagnostic Test
Measures
Autofluorescence
Transabdominal
Ultrasound
Radionuclide
Imaging
Cholescintigraphy
Biliary disease
Use of contrast to
distend small bowel
Computer-assisted high-resolution
two-dimensional image of abdomen /
pelvis generated by spiral CT
Histologic analysis of
hepatic tissue
Other
Pediatric appendicitis
Magnetic Resonance
Imaging
Test Interpretation
Parameters
Liver disease
Gastrointestinal bleed
Computer-processed x-rays
produce tomographic images
of specific areas in an object
Liver Biopsy
Result
Computerized
Topography
CT / MR
Enterography
Virtual
Colonoscopy
Indications
Trauma
Infectious /
inflammatory lesions
Obstruction
Unexplained pain
Pancreatitis
Liver malignancies
Pancreas malignancies
Liver lesions
Mucosal abnormalities
Abnormal LFTs
Suspected neoplasm
Confirmation of
diagnosis /
prognostication
Evaluation of
granulomatous disease
Unexplained jaundice or
suspected drug reaction
Diagnostic Methods
Diagnostic Test
Measures
Fecal Occult
Blood Testing
Qualitiative method of
determine the presence
of blood in stool
Hemoccult Sensa
Screening
Hemoccult
Sensa Testing
Indications
Cancer
Test Interpretation
Parameters
GI bleeding
False Positives
Red meats
Aspirin
NSAIDs
Alcohol in excess
Other drugs
Iodine preparation
False Negatives
Ascorbic acid
Citrus fruit / juice
> 250 mg/day
intake
Iron supplements
Microorganism
overgrowth
Other
The oxidation of guaiac by hydrogen
perioxide causes blue color when
exposed to "heme" found in stool
Sensa FOBT
Enhancer that allows greater
sensitivity and ease of interpretation
Bowel infection
Fecal
Leukocytes
Result
NEGATIVE
WBCs in stool
Variable
Norovirus
Rotavirus
CMV*
ETEC
EHEC
Giardia lamblia
Entamoeba histolytica*
Crytosporidium
S. aureus
C. perfringens
Salmonella
Yersinia
Vibrio parahemo.
C. difficile
Aeromonas
Shigella
Camplyobacter
EIEC
Ulceraive colitis
Crohn's disease
Radiation colitis
Ischemic colitis
Diagnostic Methods
Diagnostic Test
Measures
Clostridium
Difficile Toxin
Predominant causative
enterotoxin for
pseudomembranous colitis
Tissue Culture
Indications
Result
Identification of bacteria
in stool
Other
93 - 100% specific
Diarrhea
ELISA
63 - 99% specific
Rarely performed
Pseudomemberanous colitis
Salmonella
Bacterial Stool
Cultures
Test Interpretation
Parameters
Shigella
Acceptable
Campylobacter
Require a Special
Request for
Indentification
Vibrio
Aeromonas
Yersinia
E. coli O157:H7
Animal contact
Children at daycare
Fecal Acid-Fast
Stain
Giardia lamblia
H. Pylori Serologic
Enzyme-Linked
Immunoassay
Urea Breath
Test
H. pylori infection
Rotavirus EIA
Detection of rotavirus
Gastroenteritis
Norovirus PCR
Immunocompromised
Preserved in Cary-Blair
medium < 96 hours
Rejected
"Ghost" Cells
Cyclospora oocytes
Cryptosporidium parvum
Gastritis
Peptic ulcers
93%
Specificity
96%
Nursing homes
Long-term care facilities
Cruise ships
Diagnostic Methods
Diagnostic Test
Fecal Fat
Measures
Indications
Malabsorption disorders
Whipple's disease
Zolinger-Ellison
syndrome
Crohn's disease
Result
Test Interpretation
Parameters
Other
Quantitative Stool Fat Test
Gold-standard
Fat diet for 2 days before and
during collection
Qualitative Stool Fat Test
Sudan stain of stool sample and
microscopic evaluation
Clinical Medicine
Condition / Disease
Functional
Abdominal
Disorders
Cause
Common GI disorders
without discernable
cause
Laboratory
Result
Treatment
Medications
IBS
Dyspepsia
Diverticulitis
Diarrhea
Constipation
Bleeding
Dysphagia
Early satiety
Anorectal symptoms
Visceral Abdominal Pain
Poorly localized
Produced by dermatome
Somatic Abdominal Pain
Well localized
Initiated by pain receptors in parietal
peritoneum
Referred Abdominal Pain
Poorly localized
Felt in areas that may be remote
from disease site
Acute Etiologies
Abdominal
Pain
Acute pancreatitis
Acute appendicities
Intestinal ischemia
Bowel obstruction
Incarcerated hernia
Acute cholecystitis
Diverticulitis
PUD
Infectious diarrhea
Gynecological causes
Chronic Etiologies
GERD
IBS
Chronic pancreatitis
Other
Causes
Altered gut motility
Exaggerated visceral responses to
noxious stimuli
Altered processing of visceral stimuli
Diagnoses of exclusion
Dyspepsia
Abdominal Pain
Gastrointestinal
Disease
Test
Non-ulcer dyspepsia
IBD
Infectious diarrhea
Only patients with chronic symptoms
require management
Dyspepsia
Diverticular
Disease
Diverticulitis
Constipation
Painful, difficult, or
disturbed digestion
Inflammation of colonic
diverticula
Functional defecation
disorder due to slowed
transit through the colon,
obstruction, or irritable
bowel syndrome
Pain
Discomfort
Diverticulosis
Diverticulitis
LLQ pain
palpable mass
Suprapubic pain
"Left-sided" appendicitis
Fever
Constipation
Nausea
Dysuria
Infrequent stools
Sense of incomplete
Abdominal distention
evacuation
Bloating
Pain
Etiologies
Functional
Drugs
Endocrine / metabolic
Neurologic
Structural lesions
Endoscopy
Non-Endoscopic
Indicated Patients
CBC
CT
X-Ray
CBC
TSH
BMP
Colon Transit
Study
Anorectal
Manometry
Colonoscopy
Leukocytosis with
left shift
Gold-standard
Assess disease
severity
Free air
Ileus
Obstruction
Evaluation
Clear liquids
7 - 10 days of antibotics
Close follow-up
Surgical consult
(if not improved in 72 hours)
R/O Underlying causes
Laxatives
Medical therapy
Fiber diet ( 30 g / day)
Adequate hydration
Regular exercise
Bowel training
Digital disimpaction
Ciprofloxacin +
Metronidazole
Clinical Medicine
Condition / Disease
Nausea and
Vomiting
Cause
Dysphagia
Difficult swallowing
Odynophagia
Pyrosis
Exposure of esophageal
epithelium to gastric acid
causes a burning
sensation
Test
Laboratory
Result
Treatment
Medications
Other
Acute Etiologies
Appendicitis
Cholecystitis
Pancreatitis
Peritonitis
Small or large bowel obstruction
Chronic Etiologies
Esophageal disorders
Gastric malignancy
PUD
Difficulty swallowing
Motility Disorders
both liquids and solids
Difficulty swallowing
Mechanical Disorders
solids
Etiologies
Pill-induced esophagitis
AIDS
Infection
Immunosuppressive
disease
Ingestion of caustic substances
Doxycycline
Medications
Tetracycline
EGD
Early Satiety
Pruritus Ani
Decreased appetite
Heartburn
Barium
Studies
Esophageal
Manometry
24 Hour
Esophageal
Probes
Diagnostic
Exquisite hygiene
Xylocaine
Remove offending agents
Mild topical steroids
(1% hydrocortisone)
Antihistamines
Pramoxine
Antipruritics
Clinical Medicine
Condition / Disease
Cause
Anal Fissure
External
Hemorrhoid
Diarrhea
Infectious
Diarrhea
Diarrhea caused by a
pathogen
Pain
Large or hard-to-pass
stools
Trauma (rarely)
Inflammation of the
gastrointestinal tract due
to viral infection
Painful
Hopsitalized patients /
recent antibiotic use
Noroviruses / Norwalk
Virus
Rotaviruses
Adenovirus
Stool Anion
Gap
Dehydration
Duration
Inflammation
Warning Signs
Diarrhea
Viral
Gastroenteritis
Laboratory
Result
Bleed easily
Etiologies
Internal
Hemorrhoid
Test
Abdominal pain
Familial outbreaks
Nursing homes
Cruise ships
Highly contagious
Vaccine available
Year-round
Stool Studies
Indications
Fecal
Leukocytes in
Inflam.
Diarrhea
< 50
(secretory)
> 125
(osmotic)
Persistent or
recurring
History of fever or
tenesmus
Other warning
signs exist
Treatment
BRAT Diet
73% sensitive
84% specificity
Medications
Stool softeners
Protective ointments
Sitz baths
Topical steroids
Nitroglycerin 2% ointment
Botulinum toxin
Surgical referral
(if fissure fails to heal)
Pain treatment
Topical steroids
Rubber band
ligation
For Prolapse
Infrared
coagulation
Sitz baths
Topical steroids
Stool softeners
Removal of clot (if thrombosed)
3.5 g NaCl
1.5 g KCl
20 g glucose
Oral Rehydration
Solution
Optional 2.5 g
sodium bicarb
1 L water
Bananas
Rice
Applesause
Toast
Other
Posterior anal fissures are the more
common form, followed by anterior.
Bismuth
Subsalicylate
Lomotil
Avoid milk products
Diarrheal medications
(except with Shigella, C. difficilie, and
E. coli O157)
Antibiotic therapy
Transmission
Fecal-oral
Person-to-person
Contaminated foods
Most common in the US during the
winter months
Clinical Medicine
Condition / Disease
Giardia
Lamblia
Entamoeba
Histolytica
Cause
Flagellated protozoa
associated water
transmission in
contaminated streams, day
care centers, or well water
Vibrio
Parahaemolyticus
Vibrio Cholera
E. Coli
O157:H7
Traveler's
Diarrhea
Microbial contamination of
food and water usually by
enter-toxigenic E. coli
Samonella
Typhi
Shigella
Test
Laboratory
Result
Foul-smelling watery
diarrhea
Cyclospora
Isospora
Cryptosporidium
Microsporidia
Watery diarrhea
Abdominal cramping
Symptoms no more than 3 days after seafood or
contaminated water ingestion
Wound infection
Abdominal cramping
Rice-water stools
Hypotension
(< 2 hours due to severe diarrhea)
Mild or severe
Hemorrhagic colitis
symptoms
Treatment
Medications
POSITIVE
Metronidazole treatment
More common in tropical and
subtropical regions
Metronidazole treatment
(even if asymptomatic)
Albendazole
< 100
Antiprotozoal treatment
No fever (usually)
Hemolytic Uremic Syndrome
Microangiopathic
Acute renal failure
hemolytic anemia
Thrombocytopenia
Watery diarrhea
History of travel in
less-developed areas
Diarrhea
(maybe bloody)
Abdominal cramping
Fever
Myalgia
Headache
Septicemia / bacteremia
(2 - 14%)
Osteomyelitis
(10%)
Endocarditis
(10%)
Pulse-temperature
discordance
Fever
Arthritis
(10%)
10 - 14 days after
ingestion
Headaches
Myalgia
Malaise
No treatment necessary
Deoxycycline
Floroquinolone
Diarrhea
Fever
Tenesmus
Single-dose fluoroquinilone /
doxycycline
Incubation is dependent on whether
the organism is toxin-producing or
not.
Associated with warm weather
20,000 cases / year in US
No anti-motility medications
Supportative care
Antibiotic therapy
(may decrease the duration of illness)
Cirpofloxacin
Rifaximin
Associations
Incidence is higher in children < 5
years old and adults > 60 years old.
Diseases is worse in old, young, and
immunosuppressed.
Anorexia
Lower abdominal
cramps
TMP / SMX
Bloody diarrhea
Other
20,000 cases / year in US
Nausea
Cramps
Flatulence
Giardia
Life Cycles
Antigen Stool
Cysts are ingested
Testing
Gastric acid releases trophozoites into duodenum
and jejunum
Attachment to villi
Abdominal pain
Cramping
Anaerobic parastic protozoan that
Diarrhea
Colitis
causes necrosis of the large
(may be bloody)
intestine
Travelers
Homosexual
Salmonella
Floroquinolone
Antibiotic therapy
TMP/SMX
Clinical Medicine
Condition / Disease
Yersinia
Enterocolitica
Cause
Clostridium
Difficile
Fever
Symptoms for
Abdominal pain
1 - 2 weeks
Chronic form can
Can mimic
last months
Crohn's disease
Lymphadenopathy
Bacteremia
Transmission
Bacillus Cereus
Clostridium
Perfringens
Antibiotic-Induced
Intestinal metaplasia of
the esophagus
Medications
Clindamycin
Fluoroquinolones
PCN
Cephalosporins
Other
Systemic disease with high mortality.
No treatment is indicated
Doxycycline
Antibiotic treatment (if severly ill)
Azithromycin
Antibiotic treatment
Contaminated food,
water, or milk
Animal contact
( from chickens)
Associations
Guillain-Barre Syndrome
(ascending paralysis)
Reactive arthritis
Up to 1 week incubation period
Fluoroquinolone
75% sensitivity
EIA Testing for Need 3 (-) tests to
Toxins A and B
rule out
Highly specific
> 99% sensitivity
PCR
Highly specific
Flagyl
Oral vancomycin
(severe disease or refractory)
Fidaxomicin
Barrett's
Esophagus
Treatment
Pre-formed toxin
Staphococcus
Aureus
Laboratory
Result
Diarrhea
Dysentery
Campylobacter
Jejuni
Test
Heat Labile
Toxin
POSITIVE
55 years old
(at diagnosis)
Pathogenesis
Chronic gastroesophageal reflux
Reflux esophagitis
Squamous epithelial injury
Intestinal metaplasia
Diagnostic
2:1
Whites > hispanics
Clinical Medicine
Condition / Disease
Cause
Sour brash
Dysphagia
Gastroesophageal
Reflux Disease
Chronic symptom of
mucosal damage caused
by stomach acid coming
up from the stomach into
the esophagus
Cough
Laryngitis
Hoarseness
Laboratory
Treatment
Result
Type and extent of
PPI (empirical)
tissue damage
Upper
Normal in cases
Endoscopy
Does not detect Lifestyle modifications
mild disease
Detects strictures,
Prokinetics
ulceration, and
H2RA
Barium
abnormal folds
Medical
Antacids
Radiography Reveals abnormal
Treatment
Mucosal
motility or
protectants
clearance
TLESR inhibitors
Ambulatory Detects pathologic
pH Testing
acid reflux
Nissen fundoplication
Test
Infectious
Esophagitis
Inflammation of the
esophagus due to
infection
Schatzki's Ring
Weight loss
Hematemesis
Melena
Zenker's
Diverticulum
Outpouching of the
upper esophagus
Symptoms > 10
years
Barrett's
Screening EGD
Age > 50
White
Common Etiologies
Candida
CMV
Herpes simplex
HIV idiopathic ulceration
Odynophagia
Dysphagia
EGD with
Biopsies
Diagnostic
Chest pain
Internal diameter < 13 mm
Dilation
GERD symptoms
PPIs
Cervical web
Dysphagia
Iron-deficient anemia
Etiologies
Congenital
Bullous pephigoid
Epidermolysis bullosa
Pemphigus vulgaris
Post-Barrett's ablation
GVHD
Post-perforation
Post-surgical
Regurgitation
Dysphagia
Halitosis
> 60 years old
Eosinophilic infiltration of
the esophagus from
allergic or idiopathic
etiology
Eosinophilic
Esophagitis
Manometry
Other
Symptom onset in ages > 50 warrants
further investigation
Etiologies
Incompetent lower esophageal
sphincter
TLESR
Irritant effects of refluxate
Delayed gastric emptying
Abnormal esophageal clearance
Scleroderma
Plummer-Vinson
Syndrome
Esophageal
Web
Peptic Strictures
Dysphagia
Function of
esophageal
muscle
contractions and
esophageal
sphincters
Medications
Food impaction
"Reflux"
Strictures
Mucosal rings
Linear furrowing
Ulceration
"Feline" esophagus
Eosinophilic abscess
Esophageal polyps
Barium
Swallow
Abnormal
Acid suppression
PPIs
Dilation
H2RA
PPIs
Swallowed fluticasone
Leukotriene inhibitors
Mast cell inhibitors / antihistamines
Histology
Endoscopic dilation
> 15 eosinophils
Elimination diets
/ HPF
Viscous budesonide suspension
Systemic steroids
Associations
Asthma
Allergic rhinitis
Urticaria
Hay fever
Atopic dermatitis
Food allergy
Medicine allergy
Higher concern for perforation with
dilation
Clinical Medicine
Condition / Disease
Achalasia
Cause
Gradual, progressive
dysphagia
Disease of unknown etiology
Ages 25 - 60
characterized by the absence of
Weight loss
esophageal smooth muscle
Substernal discomfort /
peristalsis with increased tonus of
fullness after eating
Regurgitation of
undigested foods
Symptoms are chronic
Chest pain
Poor esophageal
emptying
Test
Laboratory
Result
Only method
conclusively for
diagnosis
Manometry
Nocturnal regurgitation
Diffuse
Esophageal
Spasm
Simultaneous,
nonperistaltic
contractions of the
esophagus
Nutcracker
Esophagus
Scleroderma
Esophagus
Esophageal
Cancer
Intermittent dysphagia
Barisum
Esophagography
Manometry
Chest pain
Manometry
Dysphagia
Manometry
Strictures
Erosion
Barium
Swallow
Weight loss
50 - 70 years old
Neoplasm of the
esophagus
Hoarsness
Surgery
Polypoid,
infiltrative, or
ulcerative lesion
Radiation
Nitrates
CCBs
Cisplatin / 5 FU
Assessment
Staging
20 - 50% 5-year
survival
Unresectable
disease for
palliation
Cisplatin / 5 FU
21% 5-year
survival
Pneumonia
Malnutrition
Botox
Markedly dilated,
flaccid esophagus
Endoscopic
Ultrasound
Nitrates
Low amplitude
Botulinum toxin injection
waves
Simultaneous cork
screw
contractions
"Rosary bead"
appearance
Intermittent,
Symptom reduction and reassurance
simultaneous
contractions of
high amplitdue
along with periods
of normal
peristalsis
Intermittent high
pressure
Strong
contractions
or absent LES
pressure
Markedly
diminished
Lung or bony
metastases
Chest CT
Other
Nifedipine
Pneumatic dilation
Complete absence
of peristalsis
Surigcal myotomy
Mediastinal
widening
Barium
Esophogram
Medications
Medical treatment
CXR
Complications
Treatment
Endoscopic
Treatment
Life expectancy
to 33 weeks from
27 weeks
Stenting for
palliation
Photodynamic
therapy
ChemoRad
Staging
Tis - Carcinoma in situ
T1 - Invades lamina propria or
submucosa
T2 - Invades muscularis propria
T3 - Invades adventitia
T4 - Invades adjacent structures
Nx - Cannot be assessed
N0 - No regional nodal metastases
N1 - Regional nodal metastases
M0 - No distant metastases
M1 - Distant metastases
Stage Groupings
I - T1 N0 M0
IIA - T2-3 N0 M0
IIB - T1-2 N1 M0
III - T3 N1 M0, T4 any N M0
IV - Any T Any N M1
IVA - Any T Any N M1a
IVB - Any T Any N M1b
Clinical Medicine
Condition / Disease
Cause
Test
Laboratory
Result
Bloody emesis
Hematemesis
Hematochezia
Hematocrit
Stabilize patient
Correlates with
severity of bleed
at initial
evaluation
Determine Source
of Bleeding
Medications
EGD
Colonoscopy
NG lavage
Radionuclide
imaging
Angiography
Gastrointestinal
Bleeding
Melena
Foul, unforgettable smell
Upper GI Bleed
Above the ligament of Treitz
Lower GI Bleed
Below the ligament of Treitz
Gastrointestinal
Ulcers
Treatment
Discontinuity or break in
the epithelium of the GI
tract
Resting tachycardia
(10% volume loss)
Orthostasis
(10 - 20% volume loss)
Shock
(20 - 40% volume loss)
NSAIDs
Steriods in the setting of
NSAIDs
Associated Medications
Warfarin
Heparin
Plavix
Pradaxa
Bleeding
(erosion into a vessel)
NSAIDs
Helicobacter pylori
Acid
Risk Factors
Steroids with NSAIDs
Anti-coagulation
Ethanol
Fluid resuscitation
MCV
Other
100 new cases / 100k
Etiologies of Upper GI Bleed
Peptic ulcer disease
Varices
Arteriovenous malformation
Mallory Weiss tear
Tumors and erosions
Dieulafoy's lesion
Esophagitis
Aorto-enteric fistula
Etiologies of Lower GI Bleeding
Diverticular disease
Neoplastic disease
Colitis
Unknown
Angiodysplasia
Hemorrhoids / fissures
BUN
Rise out of
proportion to
creatinine level
Octreotide drip
Protonix drip
Antibiotics
Platelets (for renal disease or Plavix
patients)
Variceal Bleeds
PPIs
Eradication of H. pylori (if present)
Endoscopic therapy
If endoscopic
therapy fails
Angiogram
Surgery
Airway management
Esophageal or
Gastric Varices
Medical
Treatment
Massive upper GI bleed with hemodynamic
instability
Intervetions
Octreotide
Antibiotics
(for cirrhotics)
EGD with
endoscopic
banding
Compression with
Minnesota tube
TIPS
Dieulafoy's Lesion
Mallory-Weiss
Tear
Diverticular
Bleeding
Clinical Medicine
Condition / Disease
Cause
Group of inflammatory
conditions of the colon
and small intestines
Laboratory
Result
Diarrhea
(nocturnal or bloody)
Fatigue
CBC
Weight loss
Fever
CMP
Anorexia
Nausea / vomiting
SED / CRP
Abdominal pain
Arthralgias
Erythema nodosum
Episcleritis
Uveitis
Pyoderma gangrenosum
TSH with
Reflex T4
Celiac
Serologies
Worrisome Signs
Inflammatory
Bowel Disease
Test
Frequent UTIs /
pneumaturia
Nausea / vomiting
Obstruction
Small Bowel
FollowThrough
CT / MR
Enterography
Crohn's Disease
Can affect any portion of
the GI tract
Transmural
Stricturing
Fistulizing
Ulcerative Colitis
Limited to the colon
Stool Studies
Usually continuous
More superficial disease
Fecal leukocytes
or fecal
calprotectin
Tenesmus
Fecal urgency
Primary
Sclerosing
Cholangitis
Asymptomatic
Hematochezia
Itching
Treatment
Medications
Ulcerative Colitis
Corticosteroids
5-ASA
Immunomodulators
TNF- inhibitors
Leukocyte trafficking inhibitors
Workup for
Janus kinase inhibitors
diarrhea
Crohn's Disease
Corticosteroids
Immunomodulators
5-ASA
TNF- inhibitors
Leukocyte trafficking inhibitors
Dysplasia
Malignancy
UC Surgical
Toxic colitis
Differentiate CD
Indications
Hemorrhage
and UC
Intractable
symptoms
Fibrotic strictures
CD Surgical
Obstruction
Indications
Fistulae
Avoid if possible
Stool culture
DEXA
Lifestyle
modifications
Osteoporosis
Clostridium
Vitamin D and
Prevention
difficile
calcium
Minimize steriods
Biphosphonates
Mesalamine
Sulfasalazine
6-MP
Azathioprine
Adalimumab
Other
Descriptions of UC by Extent of
Involvement
proctitis - anus / rectum
proctosigmoiditis - to sigmoid colon
left-sided colitis - to splenic flexure
pancolitis / universal colitis - total
colon
Descriptions of CD by Extent of
Involvement
ileitis - ileal
ileocolitis - ileal and colonic
colitis - colon only
perianal - worse prognosis
Use as little steroid as possible
Risk for Colon Cancer in IBD
Colitis
Concomitant PSC
Family history of colon cacer
Time and degree of inflammation
Infliximab
Golimumab
Vedolizumab
Routine labs
Follow-up
5-ASA (UC) or
budesonide (CD)
Tofacitinib
Methotrexate
Anti-TNF
Alkaline
Phosphate
LFTs
p-ANCA
MRCP / ERCP
HIGH
Diagnostic
Hepatologist referral
Clinical Medicine
Condition / Disease
Cause
Pain in non-radiating
Nighttime awakenings
from pain
Asymptomatic
(30 - 40% of NSAID users
with ulcers)
COPD
Test
Laboratory
Result
H. Pylori
Serology False
Negatives
EGD
Cirrhosis
Peptic Ulcer
Disease
Associations
Systemic mastocytosis
Uremia
Age > 65
Higher dose NSAIDs
Corticosteroids
Anticoagulants
H. pylori infection
Indications for
EGD
PPIs
Antibiotics
Treatment
Odynophagia
Dysphagia
Iron deficiency
Perforation
Age > 55
ZollingerEllison
Syndrome
Multiple ulcers
Gastric Cancer
Ulcers in distal
duodenum and jejunum
Stress-Induced
Ulcers
Diarrhea
Ulcer resistant to
medical treatment
Unexplained diarrhea
Hypercalcemia
Secretin
Stimulation
Test
Most sensitive
(94%) and specific
(100%)
Misoprostol
PPI
High-dose H2
blockers
Mucosal
Protection
High-dose PPI
Fasting Serum
Gastrin
Endoscopic
Ultrasound
and
Somatostatin
Receptor
Other
500k new cases / year
4 million recurrences / year
> 80% prev. in developed nations
Bismuth
Confirmation of eradication
Allows
characterization of
May require retreatment in 20%
the lesion and
biopsy
Antacids
GI bleeding
H2 blockers
Unintended
weight loss
PPIs
Family Hx of GI
Gastrectomy
Surgery (rare)
malignancy
Vagotomy
Complications
Hemorrhage
Medications
H. pylori Eradication
PPI
Triple Therapy for
Clarithromycin
2 Weeks
Amoxicillin
Surgical resection
(if not metastatic)
Vagotomy
Metastatic
Disease
Successful in 90%
Somatostatin
analogs
Interferon
Cytotoxic
chemotherapy
Surgical resection
Chemoembolization
Histamine-2 blockers
PPIs
Critically Ill
Histology
EGD
EUS
Barium
Swallow
CT / MRI
Adenocarcinoma
(95%)
Surgical resection
Carcinoid,
squamous cell
Lymphoma
Safe, easy, and Neoadjuvant chemotherapy and
able to obtain radiation therapy
tissue
Able to obtain
5-FU
tissue and good
for staging
Adjuvant
Doxorubicin
Chemotherapy
Diagnostic
Cisplatin
Clinical Medicine
Condition / Disease
Cause
Gallstone
Types of Stones
Cholesterol Stones
5 F's
(gallbladder)
Drugs
Black Pigment Stones
Cirrhosis
(gallbladder)
Chronic hemolysis
Brown Pigment Stones
Bile duct infection
(bile ducts)
Fever
Cholecystitis
Nausea
Vomiting
Cholecystitis in the
absence of gallstones
Critically ill
Emphysematous
Cholecystitis
Choledocholithiasis
Ascending
Cholangitis
Sphincter of Oddi
Dysfunction
Stenosis or dyskinesia of
the sphincter of Oddi
Malignant
Biliary
Obstruction
Ideally after 8
hour fast
Cholecystectomy
WBC
AST
AP
Gallbladder
Ultrasound
HIDA
HIGH
HIGH
HIGH or Normal
Reynold's Pentad
NPO
Supportative Care
Other
10% of general population
Risk Factors (5 F's, 2 C's, 2 D's)
Female, fat, fertile, age > 40, and
family history
Crohn's disease or cirrhosis
Diabetes or Drugs
IV fluids
Charcot's Triad
Medications
Gold-standard
Complications
Treatment
Gallbladder
Ultrasound
CT / MRI
Acalculous
Cholecystitis
Laboratory
Result
Asymptomatic
Cholelithiasis
Test
Cholangitis
Pancreatitis
Fever
RUQ pain
Jaundice
Charcot's triad
Hypotension
AMS
AP
HIGH
Gallbladder
Ultrasound
Bubbles in
gallbladder wall
Alkaline
Phosphatase
Gallbladder
Ultrasound
CT / MRI
MRCP
WBC
Direct
Bilirubin
AP
Blood Cultures
LFTs
Gallbladder
Ultrasound
HIDA
AP
Direct
Bilirubin
HIGH
Percutaneous cholecystostomy
(if too ill for surgery)
Emergent surgery
Stone dilated
ducts proximal of
Cholecystectomy after ERCP
stome
HIGH
HIGH
HIGH
Can be (+)
IV antibiotics
IV fluids
ERCP
Cholecystectomy after ERCP
(if stones)
ERCP with manometry
Diagnostic
Sphincterotomy
HIGH
HIGH
Poor prognosis
Surgery
Clinical Medicine
Condition / Disease
Cause
Malabsorption
Abnormality in the
absorption of nutrients
Celiac Disease
Laboratory
Treatment
Test
Result
Change in bowel
CBC
Weight loss
movements
CMP
Bacterial overgrowth
PT / INR
Helpful in
Mucosal disease
TSH
Steatorrhea
determining
Pancreatic insufficiency
Folate
severity
Fat absorption issue
B12
Pale Skin
Anemia
Lipid Panel
Qualitative
Petechiae
Vitamin K
Stool Fat Test
Vitamin deficiency
Mouth Changes
Quantitative
Dental changes
Gold-standard
Stool Fat Test
Peripheral Neuropathy
Vitamin B12
Identifies mucosal
D-Xylose Test
Muscle Wasting /
malabsorption
Protein malabsorption
Edema
in SI
Carbohydrate
Most useful for
Abdominal Distention
Breath Test diagnosing lactase
malabsorption
Associated Clinical Syndromes
deficiency
Distinguishes
Lactase deficiency
Giardiasis
Schilling Test
causes of B12
Celiac disease
Tropical sprue
deficiency
Amyloidosis
Lymphoma
Hypoparathyroidism
Hyperthyroidism
CT / MRI /
Helpful in
Whipple's disease
Lymphoma
ERCP
diagnosis
Bacterial overgrowth
Short gut syndrome
Adrenal insufficiency
Carcinoid syndrome
Diarrhea with
AntiWeight loss
steatorrhea
Endomysial
Most specific
IgA
Bloating
Nutritional deficiencies
Serology test of Gluten-Free Diet
Chronic diarrhea
choice
Flatulence
Lactose intolerance
Anti-tTGA
> 90% sensitivity
Nutrient deficiencies
Borborygmi
> 95 specificity
Persistent diarrhea resembling traveler's diarrhea
IgA or IgG
Less sensitive
Extra-Intestinal Manifestations
Antigliadin
Malignancy
Short stature
Fatigue
May be indicated
Total IgA
Amenorrhea
Fertility
if IgA deficient
Iron deficiency anemia
Arthropathy
Folate / vitamin K
Osteopenia /
DQ2 / DQ8
Not fully
deficiency
osteoporosis
Genetic
Other
necessary
Screen
autoimmune
Muscle atrophy
Neurologic symptoms
Dental enamel
Autoimmune
diseases
Gold-standard
hypoplasia
myocarditis
Villous atrophy
Complications
Definite Associated Conditions
Autoimmune thyroid
Dermatitis herpetiformis
Lymphocytic
Nutritional
disease
infiltration of
deficiencies
Mucosal
Type 1 DM
RA
lamina propria
Biopsy
Sjgren's syndrome
Down's syndrome
Probable Associated Conditions
Crypt hyperplasia
Musculoskeletal
Sarcoidosis
Congenital heart disease
injuries and
Cystic fibrosis
Intraepithelial
deformities
IBD
Autoimmune hepatitis
lymphocytes
Myasthenia gravis
Signs and Symptoms
Medications
Other
Luminal Phase
Nutrients are hydrolyzed and
solubilized
Mucosal Phase
Futher processing takes place at the
brush border of the epithelial cell
with transfer into the cell
Transport Phase
Nutrients are moved from the
epithelium to the portal venous or
lymphatic circulation
Associated Drugs and Foods
Cholestyramine
Fiber diets
Tetracycline
Antacids
Sorbitol
Fructose
Xenical
Metformin
Colchicine
Methotrexate
Sulfasalazine
Phenytoin
Common in Middle East and India
Rare in Japan and China
10% of US American
Gluten is found in wheat, rye, barley,
and any foods made with these
grains.
There is a higher incidence of
lymphoma associated with celiac
disease.
Clinical Medicine
Condition / Disease
Cause
Oral (rare)
Gastrointestinal
Tropical Sprue
Inflammatory disease of
small bowel secondary to
overgrowth of coliforms
Laboratory
Result
Multiple intensely
pruritic papules and
vesicles that occur in
groups
Vesicles
Erosions
Erythematous macules
Abdominal bloating
Cramping
Pain
Diarrhea
Constipation
Skin
Dermatitis
Herpetiformis
Test
Dapsone therapy
Megaloblastic anemia
Folate / B12 supplementation
Lipase
(+) Gray Turner's sign
BUN
Hct
Gallstones (35%)
Alcohol (30%)
Obstruction
Medications
Ultrasound
Infections
Metabolic
Toxins
Vascular
Trauma
Post-ERCP
Inherited
Idiopathic
Ranson Criteria
Admission
Age > 55
Glucose > 200
CT
Abdominal pain
Abdominal pressure
Infection
Rupture
"Sentinel loop
of SB"
"Colon cut-off
sign"
Enlarged
hypoechoic
pancreas
Gallstones
Biliary ductal
dilation
IV fluids
Pain medications
MRCP
ERECP
Pancreatic
enlargement
Peripancreatic
edema
Necrosis
Extrapancreatic
fluid
Assesses
complications
Evaluate biliary
tree and
pancreatic duct
Evaluate biliary
tree and
pancreatic duct
Monitor in ICU
Modality of choice
for pancreatic
parenchyma
WBC > 16
LDH > 350
Pancreatic
Pseudocyst
HIGH
HIGH
More specific
> 25
> 44
Etiologies
Other
Abdominal pain
Inappropriate activation
of trypsinogen causing
inflammation
Medications
Life-long condition
Amylase
Acute
Pancreatitis
Treatment
Abdominal CT in
72 hours to assess
necrosis /
complications
Severe
Pancreatitis
Prophylatic
antibiotics if
> 30% necrosis
Jejunal feeds
early
Clinical Medicine
Condition / Disease
Cause
Test
Laboratory
Result
Amylase
Persistent / recurrent episodes of epigastsric and
LUQ pain
Lipase
Usually not
elevated
Treatment
Abstince from alcohol
Pancreatic
enzymes
replacement + H2
blocker / PPI +
fat diet
Fecal Fat
Pain with no radiologic
evidence
Steatorrhea
Fecal Elastase
Narcotics
Diagnostic
Pain
Chronic
Pancreatitis
Secretin
Stimulation
Test
Diabetes
Chronic inflammatory
process leading to
irreversible fibrosis of
pancreas
Abdominal
X-Ray
Etiologies
ERCP with
sphincterotomy or
stent placement
Other
Most acute pancreatitis does not go
to chronic pancreatitis.
Tropical Chronic Pancreatitis
Due to childhood malnutrition in
underdeveloped countries
Chronic Obstruction of Pancreatic
Duct
Pancreatic duct strictures
Pancreatic tumor
Papillary stenosis
There are no blood tests to diagnose
chronic pancreatits.
Celiac plexus or
splanchnic nerve
block
Surgery
Pancreatic
calcifications
Pancreatic
calcifications
Medications
CT
Chronic alcohol use
(70%)
Chronic obstruction of
pancreatic duct
Tropical chronic
pancreatitis
Autoimmune
pancreatitis
Genetic
Idiopathic
(20%)
Jaundice
Weight loss
Painless
(in pancreatic head)
Abdominal pain
(in pancr. body / tail)
Atrophied
pancreas
MRCP / ERCP
"Chain of lakes"
(areas of dilation
and stenosis along
pancreatic duct)
Bilirubin
Pancreatic
Adenocarcinoma
Supraclavicular LN
Lungs
Peritoneum
Liver
Bone
Risk Factors
Tobacco use
Chronic pancreatitis
Exposure to Bnaphthylamine or
benzidine
Non-insulin dependent
DM arising in nonobese
person > 50 years old
Hereditary chronic
pancreatitis
Peutz-Jeghers
BRCA 2 mutation
CT
MRI
Assessment
Endoscopic
Ultrasound
If no lesion seen
on CT / MRI and
still have high
suspicion
Puestow
procedures
Subtotal
pancreatectomy
Total
pancreatectomy
( autologous islet
cell
transplantation)
Whipple
procedure
(if in head)
Diagnostic
Surgery
Alkaline
Phosphatase
CA 19-9
(+) Courvoisier's sign
Insulin therapy
Resection
(no vascular
invasion,
lymphatic
involvement, or
metastasis)
Distal
pancreatectomy +
splenectomy
(if in tail)
5-FU chemoradiation
Not always
(if locally advanced and not
needed if imaging resectable)
is convincing
Tissue
Diagnosis
ERCP with
brushing +
intraductal biopsy
CT-guided biopsy
(risk of seeding)
EU with FNA
(best option)
Gemcitabine
Metastatic
Pain control
Palliative stents
Clinical Medicine
Condition / Disease
Cause
Abdominal pain
(44%)
Hematochezia / melena
(40%)
Weakness
(20%)
Weight loss
(6%)
Test
Laboratory
Result
Colonsopy
Gold-standard
Abdominal
and Pelvis CT
Staging
CXR
Diagnostic
Needle Biopsy
If suspected to be
metastatic disease
Unusual Presentations
Local invasion or
malignant fistula
Fever of unknown origin
formation into adjacent
Intra-abdominal or retroperitoneal abscesses
Colorectal
Cancer
Streptococcus bovis
bacteremia
Clostridium septicum
sepsis
Risk Factors
Age
Carcinoid
Rare neuroendocrine
tumor that arise at
several body sites
Inherited syndromes
Type II diabetes
Metabolic syndrome
Ethnicity
Inflammatory bowel
disease
Physcial inactivity
Obesity
Smoking
Familial adeomatous
polyposis
Abdominal pain
Intermittent
obstruction
Locations in GI Tract
(most common first)
Ileum
Rectum
Appendix
Colon
Stomach
CMP
PET
24 Hour Urine
HIAA
Chromogranin
A, B, and C
Biopsy
Imaging
If suspected to be
metastatic disease
Diagnostic
Treatment
Medications
Other
Clinical Medicine
Condition / Disease
Jaundice
Cause
Hyperbilirubinemia
Test
RUQ pain
Nausea / vomiting
Jaundice
Hepatitis A
Transmission
Incubation Period
Complications
Chronic Sequelae
Transmission
Fecal-oral
Average = 30 days
15 - 30 days
Fulminant hepatitis
Cholestatic hepatitis
None
Parenteral
Blood
Body fluids
Laboratory
Result
Bilirubin
HIGH
ALT
AST
Hepatitis A
IgM Antibody
HIGH
HIGH
Hepatitis A
IgG Antibody
Hepatitis B
HbSAg
HbSAb
HbCAb
Premature Mortality
from Chronic Liver
Disease
2 - 10% teenagers /
adults
HbEAg
HbEAb
15 - 25%
Risk Factors
Travelers to intermediate and
HAV-endemic countries
Homo- / bisexual
Drug users
Chronic liver disease
Rate communities (Alaska natives
and Amercian Indians)
Acute infection
Vaccination
Infection
Prior infection
Vaccination
Immunity
Hepatologist referral
Active or prior
infection
Not positive with
vaccination
Active replication
of virus
Chronic infection
Antiviral therapy
No active
replication
HBV DNA in
Blood
Infection
HbCAb
Present or cleared
infection
Parental
Transmission
Very little sexual
Hepatitis C
Alcoholic Liver
Disease
Non-Alcoholic
Fatty Liver
Disease
HCV infection
2 - 26 weeks
Chronic Hepatitis
70%
Predicts response
and guides
duration
HCV Genotype
Persistent Infection
85 - 100%
RUQ pain
Nausea / vomiting
Jaundice
Asymptomatic
Obesity
ALT
Diabetes /
insulin resistance
Hyperlipidemia
AST
6 Phenotypes
2x ALT
AST
Bilirubin
INR
Lamivudine
Entacavir
Tenofovir
Pegylated
interferon- +
ribavirin
Genotype 2 / 3
HCV RNA
Interferon
Telbivudine
Average = 6 - 7 weeks
Incubation Period
Other
Immunity
Incubation Period
45 - 180 days
Medications
Prior infection
Average = 60 - 90 days
Treatment
Genotype 1
24 weeks of
treatment
Treatment difficult
to tolerate
Telaprevir
Boceprevir
Combination with
pegylated
interferon- +
ribavirin
Interferon-
Ribavirin
Prevention
Prevent perinatal HBV transmission
Routine vaccination of all infants
Vaccination of adolescents
Vaccination of high risk groups
High Risk Groups
Houshold member of HBV-infected
patients
Sexual parteners of HBV-infected
patients
Health care workers
Prisoners
Travelers to endemic areas visiting
6 months
#1 indication for liver transplant
Prevention
No vaccine
Avoid sharing needles
Use barrier protection if multiple
sexual partners
Telaprevir
Boceprevir
Neither go above
500 U/L
Prednisone pnetoxyfylline
HIGH
(if DF > 32)
HIGH
Weight loss and exercise
Mildly elevated
Clinical Medicine
Condition / Disease
Cause
Test
Laboratory
Result
Persistent / recurrent
hepatitis
Cirrhosis
Hemochromatosis
Autoimmune hepatitis
Wilson's disease
-1-antitrysin deficiency
Portal hypertension
Ascites
CBC
Platelets
Gastro-esophageal
varices
Splenomegaly
Albumin
INR
LOW
HIGH
Encephalopathy
Bilirubin
HIGH
Hematemesis
Melena
IV octreotide
-Blockers
Emergent endoscopy
Tachycardia
Ultrasound
Spontaneous
Bacterial Peritonitis
Encephalopathy
Accumulation of fluid in
the peritoneal cavity
Shifting abdominal
dullness
Fluid wave
Abdominal pain
Fever
Brain disease
Euphoria
Confusion
Asterixis
Coma
Precipitating Factors
Infection
Bleeding
Hyponatremia
Hypokalemia
Sedatives
Azotemia
Blood transfusion
TIPS
Hemangioma
Other
Replacement of a
diseased liver with a
healthy liver
Hepatitis C
Cyrptogenic / NASH
Serum
Albumin Ascities
Albumin
CBC with
Differential
Ascites
Culture
Portal
hypertension if
> 1.1
> 250 PMNs
Pathologic Diagnosis
Fibrosis
Regenerated nodules
Vascular distortion
See PowerPoints for grading of
cirrhosis.
All patients with cirrhosis should
have an upper endoscopy to look for
varices.
Spironolactone
Furosemide
TIPS for refractory ascites
Antibiotics
(3rd generation cephalosporin)
Indications
Liver
Transplantation
Medications
Medication effects
Ascites
Treatment
Other Etiologies
Chronic
Hepatitis
Bleeding Varices
Alcohol
(abstinent 6 months)
PBC
PSC
Autoimmune hepatitis
Hepatitis B
Asymptomatic
Found incidentally
Clinical Medicine
Condition / Disease
Cause
Hepatic
Adenoma
Focal Nodular
Hyperplasia
Nonneoplastic response to a
congential vascular
malformation
Hepatocellular
Carcinoma
Cancer secondary to
either viral hepatitis
infection or cirrhosis
Possible rupture
Test
Laboratory
Result
Bleeding
Treatment
Medications
Other
Resection
Asymptomatic
Must be
multphasic
Resection
Pharmacology
Drug
Generic Examples /
Brand Name
Metronidazole / PPI /
Clarithromycin
Quadruple Therapy
for Heliobacter
Eradication
Pepto Bismol /
Metronidazole /
Tetracycline /
Randitidine
Mechanism of Action
Indications
Pharmacokinetics
Maalox
Mylanta
Amphojel
GI effects
Altered taste
Disulfiram reaction
Eradication: 75 - 90%
GI effects
Metallic taste
Disulfiram reaction
Photosensitivity
Black tongue / stools
O: 5 - 15 minutes
Duration: 1 - 2 hours
Neutralize gastric
acid
Renal failure
CHF
Hypertension
GERD
Tums
cimetidine
H2 Receptor
Antagonist
Adverse Effects
Amoxicillin / PPI /
Clarithromycin
Alka-Seltzer
Antacids
Contraindications
Eradication: 70 - 85%
ranitidine
nizatidine
Block histamine
production in
parietal cells
Duodenal ulcer
Gastric ulcer
GERD
A: Oral, IV, or IM
O: 30 min
Duration: 10 hours
Fluid overload
Alkalosis
Diarrhea / constipation
Hypermagnesemia
Hypercalcemia
Aluminum neurotoxicity
Drug interactions
Headache
Nausea
Abdominal pain
Thrombocytopenia
Headache
Nausea
Abdominal pain
Diarrhea
Long-Term Effects
B12 / calcium dysabsorption
Fractures
C. difficile-associated diarrhea
Pneumonia
famotidine
Peptic ulcer disease
omeprazole
GERD
lansoprazole
Proton Pump
Inhibitors
rabeprazole
esomeprazole
Heliobacter Eradication
dexlansoprazole
Esophageal Erosion
Maintenance
pantoprazole
Sucralfate
Carafate
Forms cytoprotective
complex that covers
ulcers
DU maintenance
(lansoprazole)
Esophageal erosion
healing
Omeprazole
Omeprazole / NaHCO3
Lansoprazole
Rabepazole
Omeprazole
Omeprazole / NaHCO3
Lansoprazole
Lansoprazole
Esomeprazole
Omeprazole
Lansoprazole
Rabepazole
Esomeprazole
Omeprazole
Omeprazole / NaHCO3
Lansoprazole
Dexlansoprazole
Rabepazole
A: Oral or IV
Adminster: 30 min
before breakfast
Peak: 1 - 2 hours
(Zegerid = 30 min)
Duration: Longer
A: Oral on empty
stomach
D: 1 g QID
CYP450 inhibitors
(omeprazole, Zegerid, and
esomeprazole)
Metabolic alkalosis
(Zegerid)
Monitoring / Other
Considerations
PCN allergy
Previous antibiotic use
Pill count
Side effects
Cost
Considerations
PCN allergy
Previous antibiotic use
Pill count
Side effects
Cost
Constipation
Gastric bezoar
Aluminum accumulation
Hypophosphatemia
Drug Interactions
Warfarin
Digoxin
Quinolones
These drugs need to be
separated by 2 hours.
Pharmacology
Drug
Misoprostol
Metoclopramide
Generic Examples /
Brand Name
Cytotec
Mechanism of Action
Synthetic
prostglandin E1
analog
NSAID ulcers
GERD
Diabetic gastroparesis
Domperidone
Peripherally-acting
dopamine agonist
Baclofen
Lioresal
Bulk Laxatives
methycellulose
psyllium
polycarbophil
Docusate
Sodium
PEG 3350
lactulose
Colace
Pharmacokinetics
Bisacodyl
Anthraquinones
Saline
Laxatives
Castor Oil
Adverse Effects
Pregnancy
Diarrhea
Abdominal cramping
Flatulence
Nausea
Headache
CNS effects
Diarrhea
Headache
Sedation
EPS (especially in elderly)
Chemotherapy-induced
nausea and vomiting
GERD
Monitoring / Other
Modest efficacy
GERD
Symptoms refractory to
PPIs
Constipation
A: Oral with 8 oz of
water
O: 1 - 3 days
Bowel obstruction
Stricture
Crohn's disease
Constipation
Constipation (ineffective)
Bloating / gas
Shoud be titrated
Mechanical obstruction of colon and
esophagus
Bloating
Nausea
Gas
Cramping
(lactulose > PEG 3350)
A: Oral
O: 1 - 3 days
A: Oral
Mineral Oil
Contraindications
Reglan
Motilium
Osmotic
Laxatives
Indications
Lubricant laxative
Constipation
Stimulant laxative
Constipation
Stimulant laxative
Constipation
Duclolax
Correctol
Ex-Lax
A: Oral
O: 6 - 12 hours
D: Not recommended for
daily use
A: Oral
O: 6 - 12 hours
Elderly
Children < 6 years old
Anal seepage
Pruritus
Incontinence
Malabsorption of fat-soluble vitamins
(long-term use)
Severe cramping
Diarrhea
Electrolyte imbalance
Abdominal cramping
Melanosis coli
Senokot-S
magnesium hydroxide
magnesium citrate
sodium phosphate
Stimulant laxative
Constipation
A: Oral
O: 1 - 6 hours
D: Not for daily use
A: Oral
O: 1 - 6 hours
D: Not for daily use
Elderly
Cramping
Severe diarrhea
Dehydration
Premature labor
Compiled by Drew Murphy, Duke Physician Assistant Class of 2015
Pharmacology
Drug
Enemas and
Suppositories
Lubiprostone
Generic Examples /
Brand Name
glycerin suppositories
Mechanism of Action
Indications
Pharmacokinetics
Acute constipation
Contraindications
Amitiza
Increase luminal fluid secetion
Monitoring / Other
Fecal impaction
Adverse Effects
Hyperphosphatemia
(NaPO4 enema)
Electrolyte abnormalities
A: Rectal :-(
O: 15 - 30 min
Nausea (29%)
Diarrhea (12%)
Headache (11%)
IBS constipation
Linaclotide
Linzess
Activates gyanylate
cyclase C in the
interstinal epithelium
A: Oral 30 minutes
before first meal
D: 145 g daily
Diarrhea (16%)
Abdominal pain (7%)
Dizziness
Constipation
Antimotility
Agents
Absorbents
loperamide
diphenoxylate /
atropine
paregoric
attapulgite
calcium polycarbophil
Bismuth
Subsalicylate
Pepto-Bismol
Octreotide
Sandostatin
Emetrol
Mixture of fructose,
dextrose, and
phosphoric acid
Diarrhea
Absorb toxins,
bacteria, gases, and
fluids
Diarrhea
Decrease water
secretion into the
bowel
Diarrhea
Traveler's diarrhea
Chronic idiopathic
diarrhea
Abdominal pain
Diarrhea
Dysglycemia (in diabetics)
Nausea
Unknown
Vomiting
Sedation
Anticholinergic effects
dimenhydrinate
diphenhydramine
scopolamine
prochlorperazine
Nausea
dolasteron
granisetron
ondansetron
palonosetron
Block D2 receptors
promethazine
Serotonin
Receptor (5-HT3)
Antagonist
Vomiting
Block serotonin
receptors in gut wall
Chemotheapy-induced
nausea and vomiting
Post-operative nausea
and vomiting
A: Oral or IV
Caution in
Narrow-angle glaucoma
BPH
CV disease
Seizure disorders
Motion sickness
chlopromazine
Phenothiazines
AIDS-related diarrhea
meclizine
Antihistamines /
Anticholinergics
EPS
Sedation
Anticholinergic effects
Drug interactions
Headache
Dizziness
Constipation
Asthenia
LFTs
QT prolongation (rare)
Pharmacology
Drug
Corticosteroids
Generic Examples /
Brand Name
dexamethasone
haloperidol
Butyrophenones
droperidol
Cannabinoids
Benzodiazepines
Neurokinin-1
Antagonist
dronabinol
nabilone
Mechanism of Action
Unknown
Blocks dopamine
stimulation of CTZ
Indications
Pharmacokinetics
Contraindications
Adverse Effects
Chemotheapy-induced
nausea and vomiting
Monitoring / Other
Increase the efficacy of other
antiemetics
A: Oral, IV, or IM
Post-operative nausea
and vomiting
Pallative care
Inhibits
neurotransmitter
release
Enhance GABA
Inhibits substance P /
neurokinin 1 receptors
Euphoria
Drowsiness
Hallucination
Paranoia
Anamnestic effects
A: Oral
A: Oral
alprazolam
lorazepam
aprepitant
fosaprepitant
CYP3A4 substrates
CYP2C9 inducers
Antiemetics
Class
Antihistamine
Anticholinergic
Phenothiazine
Serotonin Receptor
(5-HT3) Antagonist
Neurokinin-1 Antagonist
Generic Name
dimenhydrinate
Scopolamine
promethazine
ondansetron
granisteron
palonosetron
Brand Name
Dramamine
Antivert
Bonine
TransdermScop
Phenergan
Zofran
Kytril
Aloxi
aprepitant
Emend
meclizine
Class
Antimotility
Stimulant
Emollient
Osmotic
Chloride Channel
Activator
Guanylate Cyclase-C
Agonist
Generic Name
loperamide
Brand Name
Imodium A-D
diphenoxylate / atropine
Lomotil
bisacodyl
ducosate sodium
PEG 3350
Dulcolax
Colace
Miralax
lubiprostone
Amitiza
linaclotide
Linzess
Generic Name
esomeprazole
lansoprazole
rabeprazole
Brand Name
Nexium
Prevacid
Prilosec
Zegerid
AcipHex
pantoprazole
Protonix
PUD / GERD
Class
GI Protectant
Generic Name
cimetidine
famotidine
ranitidine
sucralfate
Brand Name
Tagament HB
Pepcid
Zantac
Carafate
Prostaglandin E1 Analog
misoprostol
Cytotec
Prokinetic Agent
metoclopramide
Reglan
Histamine H2
Antagonist
Class
omeprazole