Gastroenterology Notes
Hepatitis
| A | B(D) | C | E(preg) |
| -HAV-IgM(+) -.. IgG(R) | -Hb-S Ag-..E Ag(inf-M)(+,both)-IgM anti-HBC(6 M) | -Anti HCV-HCV-RNA | -HEVIgM(+)-..IgG(R) |
| I-Supp:No Oh good dietII-Pegy IFN/ Interferon alphaIII-AntiViral:LamuvidineAdefovirEntercavirTranplant | I-Non X:No OHHBV +D vaccinII-X:inerferon alpha+Ribaviri(1&4>1&3)III-Transplant |
INF-M = Infectivlity marker
A,B,D VaccineC+E , No Vaccine
Autoimmune
| AutoImm:-Chronic-Gamma G (High)-IgG >1.5 (N)Dx:type I:ANA(+) ,Anti-SMA(+)Type II:Anti-LKM III: Anti SLA/LPIgG>1.5Tx:Predni 40-60mg..10md/dy+Azathio 50-100 mg/day 2-4 Y |
Esophageal Cancer
| ^^Dx:Barium—>EGD&Biop—>CT/MRI |
| ^^Tx:I,IIa: Pre chem &resectionIIb,III: ,,, ,,,,IV :Chemo/Radio/lazer/Stent-Gasttro.]/jenunostom-post Op :zEGD: 6Mo-3 |
Upper GI Bleeding
| Ulcer Bleed | Esophagela varacies |
| PPT ↑Hb ↓I-Inject: NE/OHCoagulationII-PPI 80 mgII:ClipsAngiolembolziation | PPT (-)Hb (-)I-Supp:-IV Fluids-Plasma-Vit K-Transfusion-Ax(Cefrtiaxine)II-Endo:-EVL,Ligation-SclerothrapyII-P HBP:-TIPS-Shunt-Transplant |
Liver Disease
| OH | Ascites |
| I-mild:asbstainII-Mod:-pentxy..400mg-Prednisolon 30-60mg-inflixmab(antiTNF)III-Tx complication | -Mild: (-) SaltII-Mod:SpirolactoneFuresmidIII-Severe:-Paracentis( albumin IV saline)-Furesmid+ spri(160-400mg) |
| SBP( P-HBP)-Ceftriaxone-Cephalosponr750/,g or TMP(prophylaxis) |
^^DILI:I-Acute heptic Damage:1-Dose Ind: Anti TB, Halothan,Anticonvulasion2-Dose Dep : Paracetamol/Amiodaronemethotraxate
II-(+)Hepatitis: Isoniazid/NitrofurationIII-Cirhossi: MethotrexateIV-Tumours:Anabolic steroidV-Cholestasis:DR:Anabolics steroin,azath,Estogennot DR: Carbimazole, Erythromycin , PhenothiazineVI-Gallston: Clofibrate,estrogen!
Pancreatitis
| A-Pan | C |
| -amylase (3x):urine and serum-Lipase(+)-CRP-WBC(+)-Ca(-) | To less Degree-Glucoe(+)-OH reduces Pain-Secretenin(+) Test-IgG4 (+) |
| 3-7 daysNO FOOD,PE-Analesgis: Mepridine!! | I-Enzyme replacementII-Low Fat & No OH |
Hepatic Encephalopathy
| 0: |
| 1:some lack of awarnessEuphoriaShort AttentionAction Fail |
| 2:Lethargy/apathyDsorientation( min(personality change |
| 3:Somnolence semistuporconfusionDisoretation(High) |
| 4 Coma |
^^ALARM Sx:-Weight Loss-Anemia-Persistant Vommiting-Heme +ve Stool – dysphagia-Long Standing GERD)-Sx >5 Years-PPI Dont Work!
^^Johnson (Gastric Ulcer):I:Lesser curve(NO hypersection)II;BOdy+ Incisura(YES…)III:Prepyrloic(YES)IV:High Near Cardia/ GE junction(NO)V: anywhere NSAID induced!
^^OH Lab↑: Bilirubin,AS:ASLT,GGT,Ammonia(encephalo↓ : PT, Tpenia,Albumin,WBC
^^Santorini-Gallbladder :3 cmm -CD 5mm-CHD : 4mm-PD :3.5mm
Cholecystitis and Cholangitis
Acute Cholecystitis
I:FeverAnorexiaPain(RUQ)Murphy+II:WBC ↑,Bilirubin ↑4A+mylase ↑III:US:(Stone)(Wall>4mm)(Empyema)(Muphy(+)Tx:1-48-72 H/4-6WI-LaproCI: Peritnotis/Cholangitis!II-Open
Cholangitis
I:Obst JaundiceFeverPainII–RUQ USIII-ERCPTX:I-ERCP (Drain ,Remove Stone)
PSC
pANCA (+)IgGUCDAVit ABaloontransplantI-Non X:-observe bili-No OH-Fat VitII-X:-UCDA-Chlotyramin(pruritis)III-Transplnt:VaraciesAsciteEcephalonath
PBC(
↑↑:GGT,ALP↑: ALT ,ASTAMA(-)AMA(+)Cholesterol >1000
if you Suspect Bishmouth [2+ 2 or more= —>biliary drainge should be Done Percutanously!
Liver Cancer
Bm-Hemiangioma-LNona-FNH-HCAHCCcholengioCCombinedBilary CusadenomaUndiff Carcioma
Inflammatory Bowel Disease
Ulcerative Colitis
-Sero-ve arhtritis-Erthme nodosum-Pyoderma-Iritis-PSC-UvititisProctitis:Urgent defection-Blood in stool–>Steroid Topical ASALeft Sided collits:rectal irritattion/blood —>Steroid/Topical 5-ASA/SystemicPancollitis:Systemic Sx(fever/Albumin(-)/K(-)—>5ASA/OP Steroid/Iuno(-)Azathrprine/ Infliimab(anti-TNF)
Peritonitis and Diverticulitis
Peritonitis
Ax: Cefuroxin/CephalosporineOrAG’s + metronidazoleCefuroxim ( 1.5g x 3 /day and METRO 5003/day
Non Complicated Diverticulitis
1-infusion2-PAin killers3-spasmolyitc4-Ax : Genmycin+ metonidzao/ Cfeorim + metronidazol
Post-Gastrectomy Syndromes
Dumping Feeding
small Frequent MEalsFluid btwn meals not withNo Sugar , honey syrup,sorbitol-PRt rich Food(slow GI empty)-Low Fiber Grained-Canned>No Fresh Fuirts-No Greens!
Diarrhea
Diahrea >3/days:-rehydrate solution (Pedialyte)-No Artifical Sweet(-ols)-No Coffe , OH-small measl 3-4H-No Spicy Food-Watery Diahrea—> Boiled Starch and Cereal!/No Fat=Pro and Prebiotics!
Constipation
1-Lifestyl2- Fiber up (20-25g/day)(Veggies+ fruits)3-H2O ,8 cups!Diverticulosis:Fiber+ FluidAcute diverticulitits: No Solid Food!
Pancreatitis Severity
Atlanta Classification
I-Early —1W—-LateII-MILD:None —Mod :Organ failr<48 H—Severe:Organ Fail>48 hoursIII1-Edema:-peripancreatic collection (<4w)-Pseudocyst>4W2-Necrotizing:Wall of necrosis>4W
Laparotomy Indications
Indications for Laparotomy
(if you dont find Abd injury he can die)BluntPenetreating low BPFree Air ,Abd-Diaphragm Rupture-Peritonitis-Intrabd Injuries on CT-Hemodynanic unstable-Peritonitits-Evisceration(+) US-Gunshot injury
Liver Resection Terminology
http://www.radiologyassistant.nl/en/p4375bb8dc241d/anatomy-of-the-liver-segments.html
Right hepatectomy
segment V, VI, VII and VIII (± segment I).
Extended Right or right trisectionectomy
segment IV, V, VI, VII and VIII(± segment I).
Left hepatectomy
segment II, III and IV(± segment I).
Extended Left or left trisectionectomy
segment II, III, IV, V and VIII(± segment