By Jason M. Guardino DO MSEd
Designed for fast, effortless point-of-care reference in the course of sanatorium rounds and within the outpatient sanatorium, this notebook offers clinically proper details on over a hundred gastrointestinal, pancreatic, and hepatic difficulties and significant endoscopy subject matters. each one subject is gifted in easy-to-scan bullet lists and tables on interfacing pages, with headings that come with definition, epidemiology, etiology, pathophysiology, scientific manifestations, actual exam, laboratory reports, diagnostic stories, remedies, issues, and diagnosis. the newest nationwide remedy directions are awarded on the best of the web page. while acceptable, themes are cross-referenced to every other.
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Additional info for Primo Gastro: The Pocket GI/Liver Companion
Miralax); may be related to a functional bowel problem ■ CT needed to rule out malignancy/paraneoplastic? e. g. S. e. e. Billroth I or II) » Bile acid binders (cholestyramine), Bile analog (ursodiol), Prokinetics, Surgery (Roux-en-Y) • Granulomatous gastritis » Crohn’s disease, Sarcoid, TB, Syphilis, Histoplasmosis, Parasites; Treat specifically • Portal HTN gastropathy » If blood loss, then BB, Nitrates, PPI • Collagenous gastritis » No known effective therapy ■ Nonspecific Gastritis • Nonerosive gastritis: Type A, Type B; See Chronic Antral & Fundal Gastritis on page 35 • Erosive gastritis: • H.
Pylori infection (80% of cases) • Characterized by: surface degeneration, foveolar hyperplasia, hyperemia with lamina propria edema, neutrophilic infiltration Clinical Manifestations/Physical Exam: ■ Most asymptomatic ■ Most patients who have non-ulcer dyspepsia (NUD) do not have H. 21) For H. Pylori testing Diagnostic Studies: ■ EGD: more intense inflammation located in antrum (termed: gastropathy) Treatments: ■ H. Pylori treatment ■ PPI, H2 blocker Complications: ■ Can progress to atrophic gastritis with c risk of gastric adenocarcinoma CHRONIC FUNDAL GASTRITIS (TYPE A, ATROPHIC): Definition: Type A ϭ Anemia, Antibodies, Atrophic ■ Chronic inflammation of the stomach, especially mucosal (Gastritis is a histological diagnosis) Etiologies: ■ Autoantibodies against intrinsic factor and parietal cells, leading to loss of intrinsic factor and achlorhydria Clinical Manifestations/Physical Exam: ■ Atrophic gastritis, achlorhydria, hypergastrinemia; pernicious anemia ■ Often associated with other autoimmune diseases: • Hashimoto’s thyroiditis, Thyrotoxicosis, Myxedema, Addison’s disease, Diabetes mellitus, Sjogren’s syndrome, Vitiligo ■ Pernicious anemia (B12 deficiency/malabsorption): • DDX of low B12: • Gastric: pernicious anemia, gastrectomy; Pancreases (insufficiency); Diet: vegan • Small Bowel: ileal resection, Crohn’s, blind loop, malabsorption states; Meds: neomycin, metformin, PPI Laboratory Studies: ■ Low B12 and Iron ■ Autoantibodies against intrinsic factor are more sensitive/specific than antibodies to parietal cells (anti-parietal cell antibodies) ■ Schilling’s test (labeled B12 and follow urinary excretion)–rarely used in clinical practice Diagnostic Studies: ■ EGD: chronic inflammation located in corpus-fundal mucosa (termed: gastropathy) ■ Colonoscopy (with TI intubation) Treatments: ■ B12 injections 1–3 times/month, ?
12 7/16/07 8:53 PM Page 30 GASTROPARESIS & DUMPING SYNDROME (Gastroenterology 2004;127:1589–91 & 1592–1622. Neurogastroenterol Motil 2006;18:263–83) GASTROPARESIS Definition: ■ Motility disorder of the stomach, often associated with other intestinal motility disorders; Results from impairment of normal gastric emptying ■ Factors of gastric motility and emptying: 1. e. fat empties slow) 2. Neuroregulators: Neural innervation is complex but largely involves the vagus (innervates stomach to right colon) 3.