Toxic daily threshold of alcohol consumption is 40-80 g for males and 20-40 g for females for 10-12 years.
Signs of alcohol abuse and hepatic injury include malnutrition and muscle wasting, cutaneous telangiectasia, palmar erythema, finger clubbing, Dupuytren's contracture, peripheral neuropathy, parotid gland enlargement and signs of gynecomastia and hypogonadism may also be present.
Most fissures are seen by separating the buttocks with opposing traction of the thumbs.
Majority of fissures are located in the posterior midline of the anus.
Acute fissures are simple splits or cracks in the anoderm while chronic fissures may show secondary changes eg sentinel tag, hypertrophied anal papilla, rolled edges, fibrosis of the edges or deep ulceration with exposure of the underlying internal sphincter muscle.
It is considered a premalignant metaplastic condition that usually involves the distal esophagus.
It is postulated that exposure of the esophageal epithelium to acid damages the lining resulting in chronic esophagitis and its healing involves metaplastic process.
Symptoms usually start on days 4-9 of antibiotic treatment, but may also occur up to 8-10 weeks after discontinuation of antibiotics.
Discontinuation of antibiotics may be the only measure needed for patients with only mild diarrhea, no fever, no abdominal pain nor a high WBC count.
Cessation of antibiotics allows for reconstitution of the normal colonic microflora and markedly reduces risk of relapse.
It is the 2nd most common cancer in women and third most common cancer in male worldwide. It commonly arises from adenomatous polyps.
It is strongly linked to age with 83% occurring in people ≥60 years old.
Rectal cancer is defined as cancerous lesions located within 12 cm of the anal verge.
Difficult stool passage may include straining, feeling of difficulty in passing stool, incomplete evacuation, lumpy/hard stools, prolonged time to defecate, need for manual maneuver to pass stool, abdominal discomfort and feeling of anorectal blockade.
Chronic constipation is considered when symptoms of constipation have existed ≥3 months.
Symptoms of chronic constipation may be due to dysfunction of intestinal motility, visceral sensitivity, anorectal musculature or the enteric nervous system.
The definition of chronic diarrhea based on symptoms alone will lead to an overlap with functional bowel disorders eg irritable bowel syndrome.
Diarrhea that is continuous or nocturnal and lasting <3 months is more likely due to an organic disease.
The absence of abdominal pain during defecation and presence of weight loss are points against the diagnosis of functional bowel syndrome eg irritable bowel syndrome.
Infectious diarrhea is diarrhea of infectious origin (bacteria, virus, protozoal) and is usually associated with symptoms of nausea and vomiting and abdominal cramps.
Dysentery (invasive diarrhea) has the presence of visible blood in diarrheic stool.
Abdominal pain is usually localized to the left lower quadrant, is abrupt, steady, severe and worsens over time.
Other signs and symptoms are fever, anorexia, nausea, vomiting, and altered bowel movements especially constipation but may also present with diarrhea or tenesmus.
Dyspepsia is having any one of the following: disturbing postprandial fullness, early satiation, epigastric pain and/or burning felt predominantly in the upper abdomen.
It is considered a symptom complex rather than a specific diagnosis.
Acid suppression is the recommended initial therapy.
Most of gastric cancers are adenocarcinomas, subdivided according to histological appearances into diffuse (undifferentiated) and intestinal (well differentiated) types.
It is the 4th most common cancer and the 2nd most common cause of cancer-related deaths worldwide.
Most common sites of gastric cancer are the proximal lesser curvature, cardia and esophagogastric junction.
It is produced by various mechanisms such as frequent occurrence of transient relaxation of the lower esophageal sphincter or pressure abnormalities in the lower esophageal sphincter (which can be caused by hormonal and neural mediators, food, drugs and patient lifestyle).
Typical symptoms are acid regurgitation and heartburn.
Regurgitation is the perception of flow of refluxed gastric contents into the mouth or hypopharynx.
Heartburn is defined as burning sensation in the retrosternal region.
Signs and symptoms of gastrointestinal tumor include presence of abdominal mass (which may be an incidental finding in endoscopy), gastrointestinal bleeding, hemoperitoneum, anemia and gastrointestinal perforation.
Infection is strongly associated with the development of gastric epithelial and lymphoid malignancies.
Acute infection is mostly asymptomatic and is acquired through human-to-human contact via gastro-oral and fecal-oral routes.
Adaptability in gastric conditions and production of urease allow it to colonize the stomach.
External hemorrhoids are located closer to the anal verge and are covered with squamous epithelium. It produces symptoms only when thrombosed or when they give rise to large skin tags which make hygiene difficult. Common symptoms are anal pain of acute onset and a palpable lump in the perianal area.
Internal hemorrhoids originate above the dentate line and are covered with rectal or transitional mucosa. It does not cause cutaneous pain. Prolapse of internal hemorrhoids may cause bleeding, mucus discharge, fecal soiling and anal pruritus.
Hepatitis A generally causes minor illness in childhood with >80% of infections being asymptomatic but more likely to produce clinical symptoms in adults.
Hepatitis B, C, & D may also be asymptomatic.
Hepatitis A is predominantly transmitted through oral-fecal route.
Hepatitis B is transmitted through perinatal, percutaneous, or sexual routes or close person-to-person contact via open cuts and sores.
Hepatitis C infections are transmitted through perinatal, percutaneous, or sexual routes, blood transfusions, or organ transplants.
Hepatitis D's route of transmission is sexual or percutaneous, especially IV drug use.
Hepatitis E is transmitted primarily through contaminated drinking water and oral-fecal transmission.
Ulcerative colitis is a diffuse mucosal inflammation limited to the colon while Crohn's disease is a patchy, transmural inflammation that occurs in any part of the gastrointestinal tract.
The ileum and colon are the most frequently affected sites.
In the hollow viscera is where common disruptions occur, which allows intraluminal bacteria to invade and proliferate in the usually sterile area (ie peritoneal cavity or retroperitoneum).
Community-acquired intra-abdominal infection is usually secondary to gastroduodenal perforation, ascending cholangitis, cholecystitis, appendicitis, colon diverticulitis with or without perforation, or pancreatitis.
Uncomplicated IAI infectious process involves only a single organ and does not extend to the peritoneum.
Complicated IAI is when infection extends beyond the hollow viscus of origin into the peritoneal space and may be associated with peritonitis or abscess formation.
There are no identifiable physical, radiologic or lab abnormalities indicative of organic disease.
Symptoms may be exacerbated by stress, alcohol or food.
Classical presentation includes fever, jaundice, and right upper quadrant symptoms (pain, guarding, rocking and rebound tenderness).
Biliary tract disease is the most common cause of bacterial liver abscess.
Most pyogenic liver abscesses are polymicrobial (eg enteric facultative and anaerobic species).
Vomiting is a partially voluntary act of forceful expelling of stomach contents up to and out of the mouth that may or may not be preceded by nausea.
Retching or repetitive active contraction of the abdominal muscles occurs between nausea and vomiting.
Management includes correction of clinically relevant metabolic complications, pharmacological therapy and treatment of underlying cause.
They arise from cells throughout the diffuse endocrine system.
Carcinoid tumors and pancreatic neuroendocrine tumors are the most common.
Carcinoid tumors arise from the lungs & bronchi, stomach, small intestine, appendix, rectum or thymus.
Majority of the neuroendocrine tumors are sporadic but some tumors are caused by inherited genetic syndromes such as multiple endocrine neoplasia, Von-Hippel Lindau disease, tuberous sclerosis complex and neurofibromatosis.
They have the ability to store and secrete various peptides and neuroamines.
Nonalcoholic fatty liver disease is having excessive fat (in the form of triglycerides) accumulation not due to excessive alcohol consumption or other secondary causes.
It is considered as a hepatic manifestation of metabolic syndrome.
Progression of nonalcoholic fatty liver disease is variable.
It is the 13th most common cancer in the world, 10th most common in the United States, and 4th leading cause of cancer-related deaths in the United Stated and Europe.
Exocrine tumors account for 95% of malignant pancreatic disease.
It is more common in women.
The median age of occurrence is at 71 years old.
Abdominal pain is the most prominent symptom of acute pancreatitis.
It is diagnosed by at least two of the following: characteristic abdominal pain, serum amylase or lipase levels ≥3 times the upper limit of normal and characteristic abdominal imaging findings.
Mild acute pancreatitis does not have any organ failure or local or systemic complication.
Moderately severe acute pancreatitis has the presence of local or systemic complication and/or transient organ failure in <48 hours.
Severe acute pancreatitis has organ failure persistent in >48 hours.
Signs and symptoms include abdominal pain that is epigastric in location that radiates to the back and frequently occurs at night or after meals, symptoms of fat, protein & carbohydrates maldigestion that become apparent with advanced chronic pancreatitis and presence of diarrhea.
Chronic pancreatitis results in destruction of alpha and beta cells which gives rise to deficiencies of both insulin and glucagon.
It can be caused by protozoan parasites and helminths.
Host susceptibility factors in gastrointestinal parasitic infections are nutritional status, intercurrent disease, pregnancy, immunosuppressive drugs and presence of a malignancy.
Knowledge of the geographic distribution of parasites is helpful in the diagnosis of patients.
It is the principal cause of upper gastrointestinal hemorrhage.
Appropriate therapy depends on the cause of peptic ulcer disease.
Primary biliary cirrhosis is chronic, progressive, autoimmune, cholestatic liver disease more common in middle-aged women. It is characterized by destruction of small to medium bile ducts, leading to cholestasis and frequently, end-stage liver disease.
Diagnostic features are chronic biochemical cholestasis, presence of antimitochondrial antibodies and the characteristic liver biopsy findings.
At present, the diagnosis is most often made in an asymptomatic patient who presents with abnormal lab results on a routine checkup or as part of workup for an associated illness.
Approximately two-thirds of patients have sporadic ZES while the rest is part of multiple endocrine neoplasia type 1.
ZES should be considered in the differential diagnoses of patients who present with abdominal pain, malabsorption and chronic watery diarrhea.
A high index of clinical awareness is necessary to correctly diagnose ZES.