GI

1
Lecture 3: Jaundice/Cholestasis
BTAP LFT
- Bilirubin
- Total protein
- Albumin
- PT/INR prob earliest

LDH elevation = CLIT. Compare LDH to AST
- Choledocholithiasis
- LDH
- Ischemia (Actually necrosis = LDH, not necessarily ischemia)
- Tylenol (acetaminophen)

Lecture 6: Pancreas/Hepatobiliary
- S cells: aSid and Secretin to release bicarb/water from biliary/pancreatic duct epithelium.

Acute Cholecystis FACTS
- Fluid (pericholecystic fluid)
- Acute
- Cholecystitis
- Thickened Gallbladder wall
- Stone (95%)

Acute Pancreatitis ALL HACK
- Amylase
- Lipase
- Leukocytosis
- Hypoxemia
- Anemia
- Calcium is low because calcium is used up in fat saponification (lipase)
- Kidney

Acute Pancreatitis Management OPERATE
- Oxygen monitoring
- Pee Urine monitor
- Electrolytes and LFT
- Replete volume with IV
- Analgesics (Pain killers) and Antibiotics (imipenem) if necrosis Hct <40 ok (not infection)
- Tube (Nasogastric tube) reminder not to feed patient by mouth. NJ tube > TPN
- Anti-Emetics

Most common causes of acute pancreatitis: GET SMASHED and youll get acute pancreatitis
- Gallstones
- Ethanol
- Trauma
- Steroids
- Mutations (PRSS1 and SPINK) and Mumps (MOPED)
- Autoimmune (PAN vasculitis)
- Scorpion stings
- Hyperlipidemia and Hypercalcemia. Too much fat/too much calcium = acute pancreatitis
- ERCP
- Drugs



In case of Retroperitoneal hemorrhage in acute pancreatitis. Note: Prognosis bad if Hct>44 because it means volume depletion upon
admission into hospital.
- Cullens umbiliCUs blood tracking
- Grey Turners TURN onto side lateral abdominal wall blood tracking.

Local complications of acute pancreatitis local FAPpiNG is complicated.
- Fistula
- Ascites
- Pancreatic Pseudocyst
- Necrosis
- GI bleeding

GI
2
Ascending Cholangitis
- CHArcots Triad
- Color (Jaundice)
- High temperature (Fever)
- Abdominal pain (RUQ)
- Reynolds Pentad - SHACK
- Shock
- High temperature (Fever)
- Abdominal Pain
- Color (Jaundice)
- Krazy (Altered mental status)

- STAPLED ascending cholangitis
- Septic appearing
- Triad (CHArcots) Jaundice, Fever, Abdominal Pain
- Abdominal pain (RUQ)
- Pentad (Reynolds SHACK)
- Leukocytosis and Liver enzymes AST/ALT > 500; ALK >100
- Elevated bilirubin (Total and Direct)
- Dilated biliary system in 75% and also D for Direct bilirubin
- AVID treatment for Ascending Cholangitis
- Antibiotics
- Volume repletion
- I is nothing
- D is for decompression with ERCP


Six Fs of Gallstones (Mixed cholesterol Gallbladder must be present)
- Forty
- Female
- Fat
- Fertile (Obesity)
- Family History native American
- Fasting rapid weight loss

Pancreatic Ductal Carcinoma Risks HAS P.D.C (has pancreatic ductal carcinoma)
- Hereditary Pancreatitis
- Adult onset diabetes
- Smoking 70% increase in risk
- Peutz-Jegher (STK11/LBK1) 132X fold risk
- Diabetes (harbinger adult onset)
- CA19-9 > 250 and Chronic hepatitis

Lecture 7: Acute Liver Failure
Liver Function Measures: ALT/AST/GGT/ALK are inflammatory signals
- BTAP
- Bilirubin
- Total Protein
- Albumin will be low in fulminant hepatitis
- PT/INR first thing to change in centrilobular necrosis (acetaminophen)
ALK PHOS is not specific BLIP
- Bone
- Liver
- Intestines
- Placenta

Most common causes of Acute Liver Failure VITAL! Ammonia usually means acute and severe
- Viruses (AST/ALT and PT/INR change at same time, but slowly)
- Ischemia (LDH)
- Tylenol (PT/INR change quickly then AST/ALT later)
- Autoimmune
- Liver failing fast must get PT/INR





GI
3
Acute liver failure, but good prognosis PITA
- Pregnancy
- Ischemia
- Tylenol (dose dependent)
- A Hepatitis A is only acute

Ammonia sources BiG DAM (ammonia)
- Bacteria metabolism
- GI bleeding
- Diet/food proteins


Lecture 8: Lover your liver Fatty liver
Never, Healing, But Chronic, Repair
1. Necrosis inflammation, oxidative damage
2. Healing Stellate cells activation (TGF-!) to become myofibroblast cells.
3. a. Basement membrane degradation
b. Collagen synthesis
4. Repair New sinusoidal/interstitial collagen (Extra-cellular matrix)

Primary* Most important? (slides) Causes of NAFLD is FLD + Insulin resistance
- Fat (Obesity)
- Lipid
- Diabetes Mellitus
Note: NAFLD is the most common cause for elevated liver enzymes.

BITCH
- Bile backed up = ITCH (pruritus). PBC/PSC

Microvesicular Steatosis (No inflammation) Little kids and babies
- Acute fatty liver of pregnancy
- Reye syndrome viral + aspirin

AH, A Cute White Person Calls Home Mallory body most common causes (prioritized). Ubiquitin.
- Alcoholic Hepatitis Steatohepatitis
- Alcoholic Cirrhosis
- Wilson Disease
- Primary Biliary Cirrhosis
- Cirrhosis (Non-alcoholic)
- Hepatocellular carcinoma

Hepatic Function Punk Ass Bitch. PAB.
- PT/INR earliest sign
- Albumin
- Biliary BITCH

Alcoholic Liver Disease BaD SHAPE none are pathognomonic, diagnosis of exclusion not Very Helpful Auto Workers Paint
- Boobs - Gynecomastia
- Dupuytrens contractures fingers cant extend
- Spider Nevi (near SVC)
- Hypoalbunemia (Secondary lunules)
- Atrophy of testicles direct action of alcohol vs depositing of Fe in pituitary in hemochromatosis
- Palmar erythema
- Enlargement of Parotids

Treatable Liver Diseases IV CAP
- Iron overload
- Viral hepatitis B and C
- Copper overload (Wilson) total Cu low, but free copper high.
- Autoimmune
- Primary biliary cirrhosis - AMA

Alcohol
- GGT elevation alcohol Gotta Get Trashed; alcohol induces it.
- AST > ALT due to mitochondrial
- Leukocytosis > 50,000 in alcoholic hepatitis
- Bone Marrow Suppression Thrombocytopenia
GI
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Non-invasive procedures for Fibrosis/Cirrhosis TV CoMmercialS should be non-invasive.
- Thrombocytopenia/leukopenia from hypersplenism
- Varices on esophageal studies
- Collaterals on US
- Markers for fibrosis never mentioned which.
- Splenomegaly

Treatments for Hemochromatosis/Wilson Ph for Fe and CUP

Hemochromatosis I (iron) HAD CHD (Cirrhosis, Heart [cardiomyopathy], Diabetes mellitus)
- Hypogonadotropic hypogonadism
- Arthritis (CPPD)
- Darker skin (Pigmentation)
- Cirrhosis
- Heart
- Diabetes Mellitus
Triad Brown Diabetes Hepatosplenomegaly, Diabetes, Skin pigementation.

FAT DAd Secondary Hemachromatosis vs. Primary: HFE C282Y; H63D (D = Asp)
- Food (Diet)
- Anemia
- Transfusions
- Drugs
- Advanced liver disease low hepcidin

Iron-mediated injuries SIGH, LAD phlebotomy: ferritin takes 2 months; SAT% takes 10 months
- Skin pigmentation
- Iron overload
- Gonad (hypogonadotropic, hypogonadism) do not reverse with phlebotomy.
- Heart (cardiomyopathy)
- Liver (cirrhosis)
- Arthritis (CPPD) do not reverse with phlebotomy.
- Diabetes Mellitus

Early signs of Hemochromatosis FAST
- Fatigue
- Arthragia
- Skin pigmentation
- T - dermaTitis

Wilson Hepatolenticular Degeneration; Lenticular nucleus is in the Basal Ganglia
- Hepatic first before Parkinsonian symptoms.

Lab Findings of Wilson Disease CLUE
- Ceruloplasmin low (95% of serum) free copper up, but total low
- Liver copper high (part of Dx + chelation (D-penicillamine) response)
- Urine copper high
- Elevated bilirubin and low HAPTAGLOBIN

MELD BIC 16/22
- Bilirubin
- INR
- Creatinine
16 minimum; 22 HCC


Lecture 10: Blood and Guts

A BIG PIGHEAD head encephalopathy and precipitating events/factors
- Alkalosis (hypokalemic)
- Benzodiazepines, Sedatives, Narcotics (Normal ammonia levels)
- Protein excess in diet
- Infection
- GI bleed
- HEAD for encephalopathy


GI
5
SAAG
- H, H, H Heart failure
- High SAAG, High Protein, Heart Failure
- Metastatic cancer (carcinomatosis) makes proteins Low SAAG (high ascitic proteins) and high total protein


Lecture 13: GI Radiology

KUB KOARSE
- Obstruction (Supine/upright is best)
- Abdominal Pain
- Renal Stones
- Swallowed Foreign Body
- Enteric tube placement

KUB variations
- Acute Abdomen (+ CXR) = perforation

Barium Swallow c** goes down CGD
- Chest pain (non-cardiact)
- GERD
- Dysphagia

UGI series HUMP UG(L)I
- Hiatal hernia
- Ulcers (classic UGI)
- Masses
- Pain

SBFT (Small Bowel Follow Through) IM a DOG so follow me
- IBD Crohns is classic remember location can be anywhere in GI.
- Masses of Small Bowel
- Diarrhea/Malabsorption
- Obstruction of small bowel
- GI bleeding chronically without source

Barium Enema SOLIDD Colon
- Stool with blood
- Obstruction of large bowel
- Left lower quadrant pain
- Inflammatory Bowel Disease Ulcerative colitis
- Diarrhea
- Diverticulosis/diverticulitis
- Constipation

Barium Enema classic findings D-CUP
- Diverticulosis/Diverticulitis
- Colon cancer apple core
- Ulcerative colitis
- Polyps

Ultrasound indications Make RLY High Sounds
- Masses of Liver
- RUQ pain best for gallbladder
- LFTs up biliary obstruction/liver problems
- Yellow jaundice
- Hepatomegaly
- Splenomegaly

Acute GI bleeding must be actively bleeding
- FAST: Angiography 0.5 1.0 ml/min
- SLOW: RBC nuclear 0.2 ml/min hemangiomas greater than 1.0 cm (most common benign liver tumor)
- Liver hemangioma, Acute active bleed
- < 2.0 ml/min: Endoscopy; If bleeding is too slow go to RBC nuclear tag.



GI
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Abdominal CT liver mass/solids masses are hypodense (darker)
- IV contrast: LIVer and Pancreas
- Oral: Bowel
- Renal colic CT
- M&M: Multiple is Metastatic
- Tumor staging

Abdominal MRI last test
- HTWOO = T2; bright.

Abdominal Angiography A.A. to GMAT
- GI bleeding (acute/chronic) fast
- Mesenteric ischemia
- Abdominal Aortic Aneurysm
- Trauma to vasculature

Extraintestinal manifestations of IBD A PIE SAC
- Aphthous ulcers
- Pyoderma gangrenosum
- Iritis (Uveitis)
- Erythema nodosum
- Sclerosing cholangitis (UC)
- Arthritis
- Clubbing of Fingertips


Hepatic Encephalopathy Precipitating Factors - HEPATICS
Hemorrhage in GIT/ Hyperkalemia
Excess protein in diet
Paracentesis
Acidosis/ Anemia
Trauma
Infection
Colon surgery
Sedatives

Ulcerative colitis: complications "PAST Colitis":
Pyoderma gangrenosum
Ankylosing spondylitis
Sclerosing pericholangitis
Toxic megacolon
Colon carcinoma

Pathology
4 Ms of Herpes epithelial cells.
- Multinucleate
- Molding of Nuclei
- Muddy nuclear chromatin
- Margination of nuclear chromatin

CMV biopsy = Center at the base because it affects endothelial cells.

GERD Triad PEBto
- Papillae elongation (2/3 of epithelium)
- Eosinophilia infiltration
- Basal zone hyhperplasia (epithelium)

Ten % rule of Barrett Esophagus 10% of GERD patients have BE. 30-100X ACA risk.
- Must have goblet cells on histology.

ANTS love PY H. pylori most common diffuse antral gastritis vs. Multifocal atrophic gastritis

BMT therapy for H. pylori
- Bismuth
- Metronidazole
- Tetracycline

GI
7
Agents of H. pylori VAPor UP
- VacA cytotoxin
- Adhesins
- Proteases
- Urease
- Phospholipases

Stress Ulcers Many BITES
- Multiple
- Brain trauma increased intracranial pressure Cushing. Acidity increases.
- Irritants NSAIDs, Corticosteroids
- Trauma
- Extensive Burns Curling (iron)
- Stomach and shallow (not past musc. propria)

Chronic Active Ulcer Layers FIGS
- Fibrinoid necrosis debris
- Inflammation (acute/chronic) mixed
- Granulation tissue
- Scars and Fibrosis

Ulcers DINGo PLay
- Duodenal Increase Acid (G cells make more gastrin) into pancreas
- Gastric No acid increase (Atrophic) into liver (left lobe)

Diffuse type Gastric Adenocarcinoma REFUND
- Ring (signet ring)
- E-cadherin mutation
- Females, younger
- Umbilical mets Sister Mary Joseph; Ovary Krukenberg
- New De-Novo
- Diffuse Type Gastric ACA

HIVA for Bowel Obstruction
- Hernia
- Intussusception
- Volvulus (most important for small bowel)
- Adhesions (most common cause of SBO post surgery)

DaMaGe
- Duodenual, Malabsorptive Diarrhea, Giardia Steatorrhea that goes away with fasting.


Celiac Disease is a disease of 2 and 8; Most often IBS, not CD
- HLA- DQ-Two ; ATA (T is transglutaminase, Two)
- HLA- DQ- Eight ; EMA (E is endomysial, Eight)

Whipples PASs 27 cans of foamy whipped cream. 1 year TMP/SMX. Vs. acid fast MAC avium
- HLA-B27 seronegative spondylpathies AS, arthritis, encephalopathy
- PAS positive
- Foamy Macrophages white men
- Gram positive

Celiac Disease
CD4+ mediated and Crypt hyperplasia
European descent
Lymphocytes in Lamina propria/ Lymphoma risk
Intolerance of gluten (wheat)
Atrophy of villi in small intestine/ Abnormal D-xylose test
Childhood presentation failure to thrive, anemia.
Short villi






GI
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Crohn's disease: GREAT CHRISTMAS, Dr. Sven Nod2 DeFour, Smoke 17 cigars
Granulomas lymphocytic infiltration
Roaming - anywhere
Edema
Adipose tissue infiltration
Thick wall

Cobblestones - Serpiginous mucosal ulcer
High temperature - Fever
Reduced lumen (Stricture)
Intestinal fistulae
Skip lesions
Transmural (all layers, may ulcerate)
Malabsorption
Abdominal pain
Submucosal fibrosis

Extraintestinal manifestations of IBD A PIE SAC
- Aphthous ulcers and Arthritis
- Pyoderma gangrenosum painful ulcerations on leg
- Iritis (Uveitis)
- Erythema nodosum
- Sclerosing cholangitis (UC)
- Arthritis
- Clubbing of Fingertips

Ulcerative colitis (UC) features
ULCERATIVE ABDomen
Ulcers (mucosal and submucosal SUPERFICIAL)
Large intestine (rectum always)
Crypt distortion
Extra-intestinal manifestations (e.g.Erythema nodosum)
Remnants of old ulcers (pseudopolyps granulation tissue)
Architectural changes crypts, glands drop
Toxic megacolon
Inflammatory cells - Neutrophils
Vacant no HOUSE-tra
Eosinophils

Abscesses in crypts
Bloody diarrhea
DRB1 (HLA-DRB1)

BRiMS Salmonella culture
- Blood
- Rose spots
- Marrow (bone)
- Stool

Liver
Staining CRIP
- Copper Rhodanin
- Iron Prussian-Blue

Collagen
- Portal is PRIME
- I - 1
- III 3
- V - 5
- XI 11
- In space of Disse
- Type IV collagen

Hemochromatosis
- Secondary = Sinusoids and Kupffer cells
- Primary = hepatocytes

GI
9
Neonatal Jaundice after a week CHASE BAZ
- Choledochal cysts biliary tree dilation
- Hepatitis idiopathic, viral
- Atresia of biliary tree 1/10,000 most common cause of infant liver transplant
- Sepsis
- Entities BAZ - # of ducts are just low.
- Byler
- Alagille
- Zellweger
FITPIG causes for adenocarcinoma of gallbladder and extrahepatic cholangiocarcinoma
- Fibrocystic disease of the bile ducts
- Inflammatory Bowel Disease
- Thorotrast (HCC, cholangiocarcinoma, angiosarcoma)
- Primary Sclerosing Cholangitis
- Infection of the biliary tract
- Gallstones 60-90% of carcinomas
* Extrahepatic biliary tract tumors cause jaundice faster than pancreatic ductal carcinoma

6 Fs of Cholelithiasis
Fat (obse)
Female
Family history (Native American)
Fasting rapid weight loss
Forty
Fertile (multiple pregnancy)

Acalculous cholecystitis rare ischemia or vasculitis (PAN)


Pancreas Protective Mechanisms BAG of ICe to put the fire (enzymes out) amylase/lipase active.
- Bicarbonate fluid from pancreas
- Acinar cells are inherently resistant
- Granules zymogens are stuffed into granules
- Inhibitors like SPINK1 or PRSS1 of trypsin
- Cleaves self-cleavage site if trypsin gets too high.

Acute Pancreatitis precipitating events F-HIP
- Fat necrosis (lipase, phospholipase)
- Hemorrhage (elastase)
- Inflammation/edema
- Proteolysis (proteases)

Acute pancreas complications HypoCalcemia and SOAPED
- Hypocalcemia
- Carcinoma
- Shock
- Organ failure
- Abscesses
- Pseudocysts
- Electrolyte imbalance
- DIC/Diabetes

HAS P.D.C. Pancreatic Ductal Adenocarcinoma risk
- Hereditary Pancreatitis
- 130 fold: STK11/LBK1 Peutz-Jegher
- PRSS1
- CFTR chronic
- p16 mutation familial multiple mole melanoma
- BRCA2
- HNPCC/FAP MSH2/MLH1 mutations
- Adult onset diabetes
- Smoking (70%)
- Peutz-Jegher Syndrome (130 fold)
- Diabetes again is a big harbinger
- CA19-9 is the pancreatic ductal adenocarcinoma marker


GI
10
Straight Memorize Pancreatic Ductal Adenocarcinoma
- Telomerase shortening
- K-Ras
- p16 PanIN-2
- SMAD4/BRCA2 PanIN-3
- DPC4
- p53


GI
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Infections
- EHEC culture negative for sorbital fermentation and O157 positive. Farm, beef reservoir.
- EAEC A is for AIDS
- EPEC Type III injection system to change cytoskeleton like" Salmonella typhi (Type III = Typhi)
- EIEC M cells like Shigella
- ETEC LT and ST; LT is exactly like Cholera. Constitutive activation of AC to make cAMP. LT, ST, and fimbriae for attach.

Enteric opportunists
- Klebsiella alcoholic, mucoid
- Serratia red
- Proteus UTI; renal stones
- Enterobacter IV lines


- Shigella and Salmonella suck at fermenting lactose
- Salmonella do swim like salmon into macrophages they do have flagella. Typhi is only humans Vi antigen.
- Shigella dont swim like salmon dont have flagella use M cells to get into macrophages. Most contagious is Shigella
- BRiMS + Media
- Blood/Bone Marrow
- Rose spots on trunks PUNCH biopsy
- Media MacConkey + Hektoen
- Stool
- 3 CATS eating salmon. 3
rd
gen ceph, amox/ampi, TMP-SMX
- Shigella ACT Amp, Cipro, TMP-SMX. Also it is limited. Super infective person to person * remember UPS guy and the
pen
- Typhoid fever also uses Type III (Typhi is Type III) change enterocyte cytoskeleton

- V.cholerae is positive for oxidase
- TCBS Test Cholera By Science agar yellow is cholera
- A-B toxin.
- B binds to GM1 receptor
- A becomes A1 and A2
- A1: activetoxin ADP ribosylation of GTP binding protein constitutive AC activation.
- Campylobacter is bird high in the air where air pressure is low microaerophilic and high temperature
- Special high temperature agar
- When kids are about to go camping, they are so excited theyll have tremors (Guillain-Barre) and will be hyper
(hypersensitivity)
- Causes isolated cases
- Bimodal distribution: less than 1 year; 15-24 y/o
- Invades into mucosa of colon/small bowel

Dysentery = BPM blood, pus, mucus

HUS possibility: Shigella dysenteriae type I; EHEC in kids ! do not give Abx.

Viral Red Highlights

Know that rotavirus and norovirus are both resistant and non-enveloped.
Rotavirus more children than adults. Diarrhea more pronounced vs. Norovirus
- Immunocompromised people chronic diarrhea.
- Non-enveloped resistant to drying, acid, detergents, common disinfectants
- ds RNA. NSP4 causes secretory diarrhea.
- Three concentric shells and diff. proteins
- Outer is most important: VP7 surface glycoprotein; VP4 protease cleaved protein
- Super contagious infectious dose is less than 10 virions and theres a seasonal distribution.
- Fecal-oral spread nosocomial in pediatric hospitals; Daycare centers kids younger than 5 most common cause of severe,
dehydrating gasteroenteritis.
- Infect the villus tip osmotic malabsorptive diarrhea
- Treatment just rehydrate, unless
- IV therapy: Intractible vomiting*, Altered mental status, Loss of > 10% body weight
- Vaccines available transient immunity by intestinal IgA

Norovirus more adults than kids; Vomiting is more pronounced think about cruiseship. Very contagious.
- Single stranded RNA
- Vomiting more prominent abrupt onset of cramping/nausea. Fecal oral.
- No seasons all year.
Highly contagious
GI
12
- No vaccines
Abx-associated diarrhea and C. diff
- Not all antibiotic related diarrhea is due to infections.

C.diff strictly ANAEROBIC, spore forming, gram-positive rods.
- Nosocomial, nursing homes shoes, hands, clothing only bleach kills.
- Toxin is whats dangerous do assay for toxin not the bug.
- Toxin A and B B is strong, but A is what causes diarrhea as an enterotoxin.
- Inactivates GTP proteins.
- highest risk: Previous or concurrent antibiotic therapy most important risk
- FACT antibiotics highest associations. Fluoroquinolones, Amp/amox, Clindamycin, Third gen Ceph
- Pseudomembrane colitis/ Toxic megacolon (65% mortality if perforated dilation more than 6 cm)
- Elevated WBC in serum empiric therapy
- Oral metronidazole is best; Oral vancomycin if more severe. If IV, only do metro because Vanc goes out in urine.
- Oral metronidazole not for pregnant women: GET on DIFF metro
- Metronidazole contraindication:
- Pregnant women
- Lactation
- Intolerance
- Failure to respond severe gets oral vanc. never IV
- Take antibiotic off ! most important
- Stool transplant? - Wash your goddamn hands
Pseudomembrane, what is it? Mucin, fibrin, PMN, and dead enterocytes.

Adenovirus and Astrovirus = kids

Protozoal Infections
Amebiasis
- Colon: Not much fever watch out for fulminant or necrotizing colitis and perforation and toxic megacolon
- Liver abscesses: 90% fever usually doesnt happen with colitis FEVER is LIVER. CT scan.

E. histolytica. Trophozoites die alone (1 nucleus); Cysts are invasive and have 4 nuclei. only pathogenic amoeba
- Trophozoites eat blood cells, mucosal cells, etc. flask shaped ulcers
- Stool O&P
- Metronidazole / DO NOT give antimotility drugs because you want to pass these despite diarrhea
+ Tetracycline if disseminated
- Trophs: CARE
- Adhesion Lectins
- Enzymes that are proteolitic
- Resistance of phagocytosis
- Complement
- Local tissue damage with cytotoxins.
- Trophozoites: Pathogenic; Cysts: Infective

Giardia the pear shaped trophozoite. Causes malabsorptive diarrhea due to villi atrophy
- Ventral sucking disk for trophozoite with 8 flagella migrate into colon and stick by lectin. DOES NOT INVADE.
- Cyst has 4 nuclei.

Dx: Include duodenal aspiration because trophozoites live in the upper small intestine
- Normal: Stool mount or stool antigen test. Microscopy is hard.
Tx: Metronidazole GET on the DIFF metro


GI
13
Helminths
- Lung migration from Small Bowel: ANALS Loefflers
- Ascaris (eaten eggs) MAP
- Nector (hookworm, skin penetration) - albendazole
- Ancyclostoma (hookworm, skin penetration) - albendazole
- Lung and Loefflers
- Strongyloides (Skin penetration) ivermectin

- EAT MAP
- Enterobius (pin)
- Ascaris
- Trichuris (whip) rectal prolapse Ol Southern Trick play pull a football out of your ass


Hookworm All-aboard (albendazole) Capt. Hook)

Ive (Ivermectin) seen strong people on steroids and rolAIDS. Autoinfection.

Cestodes Centimeters Tapeworms Taeniasis

Cysticercosis BEST eating the EGGS, not larvae
- Brain
- Eyes
- Skin stationary subcutaneous mass
- Taenia solium eggs

PATS Praziquantel/Albendazole
- Taenia saginata/solium
- Schistosoma

Japanese people think they are superior S. japonicum superior mesenteric vein. Mansoni is inferior. Hematobium is urinary plexus.
- Japonicum small bowel b/c of SMV
- Mansoni large
- Hematobium venous plexus near urinary bladder can cause portal hypertension, obstructive uropathy

* Know life cycle of Schistosoma
- Eggs in feces/urine " hatch to miracidia " penetrate snail " sporocyte/cercaria made in snail " Cercaria swim around in
the water (think Lake Victoria) " SKIN penetration while swimming " shed tail " SCHISTOSOMULAE
- Schistosomulae are after the cercariae lose their tails after penetration Swimmers Itch
- Migration through tissue " get to veins " deposite eggs in venules of portal system
* adults do not multiply they sit in the vein and keep making eggs. WTF. Eggs cause disase.

- GRANULOMAS in pre-sinusoidal areas (still intrahepatic)
Acute: Katayama 6 weeks at least after fever, cough, eosinophila, diarrhea, hepatosplenomegaly
- Basically, Katayama disease is immune complex disease against the Schistosoma eggs.
Chronic: Granulomas fibrosis portal hypertension, bladder cancer, glomerulonephritis
- T cells, macrophages, eosinophils collagen and fibrosis against Schistosoma eggs = granulomas.


GI
14
Lecture 27: GI Infections

Mechanisms of Protection A,G,E,S
- IgA antibodies
- Gut motility
- Endogenous Flora
- Stomach acid most important do not get on PPI when traveling.

EHEC, and EIEC you get In HeLL but ETEC is noninflammatory.

Non-inflammatory:
- ETEC (LT is like cholera toxins)
- Viruses
- V. cholera! (A-B)
- Parasites (except amebiasis)

Viruses = VOMIT that lasts just a few days. Rotavirus most common in kids less than 5.
- Kids, sporadic: Think rotavirus
- Adults, sporadic: Norovirus (calicivirus), then rota, then astro
- EPIDEMIC: Calicivirus, rota, astro, adeno.

Immunocompromised: CMV, EBV, HSV, adeno, astro, picorna

Routine stool culture: CRASS
- Campylobacter
- Routine stool culture
- Aeromonas
- Shigella
- Salmonella

Systemic? Think Thyphoid/enteric fever; RAPID? food poisoning; Chronic? AIDS, immunocompromised
E. histolytica can cause dysentery not a lot of fecal leukocytes because it eats it.

AIDS/immunocompromised Cryptosporidium, cyclospora, MAC, microsporidia, CMV, EBV.