|
|
| Line 9: |
Line 9: |
| {{Cirrhosis}} | | {{Cirrhosis}} |
| {{CMG}} {{AE}} | | {{CMG}} {{AE}} |
| ==Table 1==
| |
| * '''The table below differentiates gastritis from other conditions:'''<ref name="pmid6710074">{{cite journal| author=Sugimachi K, Inokuchi K, Kuwano H, Ooiwa T| title=Acute gastritis clinically classified in accordance with data from both upper GI series and endoscopy. | journal=Scand J Gastroenterol | year= 1984 | volume= 19 | issue= 1 | pages= 31-7 | pmid=6710074 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6710074 }} </ref><ref name="pmid25901896">{{cite journal| author=Sipponen P, Maaroos HI| title=Chronic gastritis. | journal=Scand J Gastroenterol | year= 2015 | volume= 50 | issue= 6 | pages= 657-67 | pmid=25901896 | doi=10.3109/00365521.2015.1019918 | pmc=4673514 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25901896 }} </ref><ref name="pmid16819502">{{cite journal| author=Sartor RB| title=Mechanisms of disease: pathogenesis of Crohn's disease and ulcerative colitis. | journal=Nat Clin Pract Gastroenterol Hepatol | year= 2006 | volume= 3 | issue= 7 | pages= 390-407 | pmid=16819502 | doi=10.1038/ncpgasthep0528 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16819502 }} </ref><ref name="pmid2789799">{{cite journal| author=Sipponen P| title=Atrophic gastritis as a premalignant condition. | journal=Ann Med | year= 1989 | volume= 21 | issue= 4 | pages= 287-90 | pmid=2789799 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2789799 }} </ref><ref name="pmid25133039">{{cite journal| author=Badillo R, Francis D| title=Diagnosis and treatment of gastroesophageal reflux disease. | journal=World J Gastrointest Pharmacol Ther | year= 2014 | volume= 5 | issue= 3 | pages= 105-12 | pmid=25133039 | doi=10.4292/wjgpt.v5.i3.105 | pmc=4133436 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25133039 }} </ref><ref name="pmid17956071">{{cite journal| author=Ramakrishnan K, Salinas RC| title=Peptic ulcer disease. | journal=Am Fam Physician | year= 2007 | volume= 76 | issue= 7 | pages= 1005-12 | pmid=17956071 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17956071 }} </ref><ref name="pmid17985090">{{cite journal| author=Banasch M, Schmitz F| title=Diagnosis and treatment of gastrinoma in the era of proton pump inhibitors. | journal=Wien Klin Wochenschr | year= 2007 | volume= 119 | issue= 19-20 | pages= 573-8 | pmid=17985090 | doi=10.1007/s00508-007-0884-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17985090 }} </ref><ref name="pmid15621988">{{cite journal| author=Dicken BJ, Bigam DL, Cass C, Mackey JR, Joy AA, Hamilton SM| title=Gastric adenocarcinoma: review and considerations for future directions. | journal=Ann Surg | year= 2005 | volume= 241 | issue= 1 | pages= 27-39 | pmid=15621988 | doi= | pmc=1356843 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15621988 }} </ref><ref name="pmid21390139">{{cite journal| author=Ghimire P, Wu GY, Zhu L| title=Primary gastrointestinal lymphoma. | journal=World J Gastroenterol | year= 2011 | volume= 17 | issue= 6 | pages= 697-707 | pmid=21390139 | doi=10.3748/wjg.v17.i6.697 | pmc=3042647 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21390139 }} </ref>
| |
|
| |
| {| class="wikitable" style="border: 0px; font-size: 90%; margin: 3px;" align="center"
| |
| | colspan="13" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|'''Differential Diagnosis'''}}
| |
| |+
| |
| | rowspan="3" style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Disease'''}}
| |
| | rowspan="3" style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Cause'''}}
| |
| | colspan="9" style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Symptoms'''}}
| |
| | style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Diagnosis'''}}
| |
| | rowspan="3" style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Other findings'''}}
| |
| |-
| |
| | colspan="3" style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Pain'''}}
| |
| | rowspan="2" style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Nausea & Vomiting'''}}
| |
| | rowspan="2" style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Heartburn'''}}
| |
| | rowspan="2" style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Belching or Bloating'''}}
| |
| | rowspan="2" style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Weight loss'''}}
| |
| | rowspan="2" style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Loss of Appetite'''}}
| |
| | rowspan="2" style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Stools'''}}
| |
| | rowspan="2" style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Endoscopy findings'''}}
| |
| |-
| |
| | rowspan="1" style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Location'''}}
| |
| | rowspan="1" style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Aggravating Factors'''}}
| |
| | rowspan="1" style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Alleviating Factors'''}}
| |
| |-
| |
| | style="padding: 5px 5px; background: #DCDCDC;"| Gastric outlet obstruction (GOO)
| |
| |
| |
| * [[Peptic ulcer|PUD]]: 5% cases (most commonly affecting [[pylorus]] and initial part of the [[duodenum]])
| |
| * [[Polyps|Gastric polyps]]
| |
| * [[Caustic|Caustic ingestion]]
| |
| * [[Stenosis|Duodenal stricture]]
| |
| * Systemic [[amyloidosis]] of the [[gastrointestinal tract]]
| |
| * Eosinophillic [[gastroenteritis]]
| |
| * [[Obstruction]] by [[Gallstone disease|gallstones]] (Bouveret syndrome)
| |
| * Complication of [[acute pancreatitis]]: [[pancreatic pseudocyst]] formation
| |
|
| |
| * [[Chronic pancreatitis]]
| |
|
| |
| * [[Bezoar|Bezoars]]
| |
| * [[Crohn's disease]] involving the [[duodenum]]
| |
| * [[Stomach|Gastro]]-[[Duodenum|duodenal]] [[tuberculosis]]
| |
| * Pyloric stenosis
| |
| |[[Abdominal pain|Epigastric pain]]
| |
| |[[Food]]
| |
| | -
| |
| |✔
| |
| |✔
| |
| |✔
| |
| |✔
| |
| |✔
| |
| |[[Melena|Black stools]] in case of [[Peptic ulcer|Peptic Ulcer Disease(PUD)]]
| |
| |
| |
| * Helps in the determination of site of [[obstruction]]
| |
| * Helps in the visualization of the [[Stomach|gastric]] silhouette:
| |
| * Helps note the following:
| |
| ** [[Stomach|Gastric]] [[dilation]]
| |
| ** Narrowing of the [[pylorus]]
| |
| ** Presence of [[Ulcer|ulcers]]
| |
| ** [[Tumor|Tumors]]
| |
| ** Differentiation of GOO from [[gastroparesis]] where gastric [[dilation]] is not associated with the narrowing of the [[pylorus]]
| |
| |
| |
| ==== Sodium chloride load test ====
| |
| * Procedure: [[Patient]] is infused with 750 mL of [[sodium chloride]] solution into the [[stomach]] via a [[Nasogastric tube|nasogastric tube (NGT)]].
| |
| * In case > 400 mL is left in the [[stomach]] after half an hour, the diagnosis of GOO may be made.
| |
|
| |
| ==== Needle-guided biopsy ====
| |
| * Helps in the evaluation of [[Patient|patients]] for [[metastasis]]
| |
| |-
| |
| | style="padding: 5px 5px; background: #DCDCDC;" |[[Acute gastritis|'''Acute gastritis''']]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * ''[[H. pylori]]''
| |
| * [[NSAIDS]]
| |
| * [[Corticosteroids]]
| |
| * [[Alcohol]]
| |
| * Spicy food
| |
| * [[Viral infections]]
| |
| * [[Crohn's disease]]
| |
| * [[Autoimmune diseases]]
| |
| * Bile reflux
| |
| * [[Cocaine]] use
| |
| * Breathing machine or ventilator
| |
| * Ingestion of [[corrosive|corrosives]]
| |
| |
| |
| * [[Epigastric pain]]
| |
| |Food
| |
| |[[Antacids]]
| |
| |✔
| |
| |✔
| |
| |✔
| |
| |<nowiki>-</nowiki>
| |
| |✔
| |
| |[[Melena|Black stools]]
| |
| |
| |
| * [[Pangastritis]] or antral [[gastritis]]
| |
| * [[Gastric erosion|Erosive]] (Superficial, deep, hemorrhagic)
| |
| * Nonerosive (''[[H. pylori]]'')
| |
| |<nowiki>-</nowiki>
| |
| |-
| |
| | style="padding: 5px 5px; background: #DCDCDC;" |[[Gastritis|'''Chronic gastritis''']]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * ''[[H. pylori]]''
| |
| * [[Alcohol]]
| |
| * Medications
| |
| * [[Autoimmune diseases]]
| |
| * Chronic stress
| |
| |
| |
| * [[Epigastric pain]]
| |
| |Food
| |
| |[[Antacids]]
| |
| |✔
| |
| |✔
| |
| |✔
| |
| |✔
| |
| |✔
| |
| |<nowiki>-</nowiki>
| |
| |''[[H. pylori]] [[gastritis]]''
| |
| * [[Atrophy]]
| |
| * Intestinal [[metaplasia]]
| |
| Lymphocytic gastritis
| |
| * Enlarged folds
| |
| * Aphthoid erosions
| |
| |<nowiki>-</nowiki>
| |
| |-
| |
| | style="padding: 5px 5px; background: #DCDCDC;" |[[Atrophic gastritis|'''Atrophic gastritis''']]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * ''[[H. pylori]]''
| |
| * [[Autoimmune disease]]
| |
| |
| |
| *[[Epigastric pain]]
| |
| |<nowiki>-</nowiki>
| |
| |<nowiki>-</nowiki>
| |
| |✔
| |
| |<nowiki>-</nowiki>
| |
| |
| |
| |✔
| |
| |✔
| |
| |<nowiki>-</nowiki>
| |
| |''[[H. pylori]]''
| |
| * Mucosal [[atrophy]]
| |
| [[Autoimmune]]
| |
| * Mucosal [[atrophy]]
| |
| |
| |
| * [[Iron deficiency anemia]]
| |
| *Autoimmune gastritis diagnosis includes:
| |
| **Antiparietal and anti-IF antibodies
| |
| **[[Achlorhydria]] and hypergastrinemia
| |
| **Low serum [[vitamin B12|cobalamine]]
| |
| |-
| |
| | style="padding: 5px 5px; background: #DCDCDC;" |[[Crohn's disease|'''Crohn's disease''']]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * [[Autoimmune disease]]
| |
| |
| |
| * [[Abdominal pain]]
| |
| |<nowiki>-</nowiki>
| |
| |<nowiki>-</nowiki>
| |
| |<nowiki>-</nowiki>
| |
| |<nowiki>-</nowiki>
| |
| |<nowiki>-</nowiki>
| |
| |✔
| |
| |✔
| |
| |
| |
| * Chronic [[diarrhea]] often bloody with [[pus]] or [[mucus]]
| |
| * [[Rectal bleeding]]
| |
| |
| |
| * Mucosal nodularity with cobblestoning
| |
| * Multiple [[aphthous ulcers]]
| |
| * Linier or serpiginous ulcerations
| |
| * Thickened antral folds
| |
| * Antral narrowing
| |
| * Hypoperistalsis
| |
| * Duodenal strictures
| |
| |
| |
| * [[Fever]]
| |
| * [[Fatigue]]
| |
| * [[Anemia]] ([[pernicious anemia]])
| |
| |-
| |
| | style="padding: 5px 5px; background: #DCDCDC;" |[[GERD|'''GERD''']]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Lower esophageal sphincter abnormalities
| |
| * [[Hiatal hernia]]
| |
| * Abnormal esophageal contractions
| |
| * Prolonged emptying of [[stomach]]
| |
| * [[Gastrinoma|Gastrinomas]]
| |
| |
| |
| * [[Epigastric pain]]
| |
| |
| |
| * Spicy food
| |
| * Tight fitting clothing
| |
| |
| |
| * [[Antacids]]
| |
| * Head elevation during sleep
| |
| |✔
| |
|
| |
| (Suspect delayed gastric emptying)
| |
| |✔
| |
| |<nowiki>-</nowiki>
| |
| |<nowiki>-</nowiki>
| |
| |<nowiki>-</nowiki>
| |
| |<nowiki>-</nowiki>
| |
| |
| |
| * [[Esophagitis]]
| |
| * [[Barrette's esophagus]]
| |
| * [[Strictures]]
| |
| |Other symptoms:
| |
| * [[Dysphagia]]
| |
| * [[Regurgitation]]
| |
| * [[Cough|Nocturnal cough]]
| |
| * [[Hoarseness]]
| |
| Complications
| |
| * [[Esophagitis]]
| |
| * [[Strictures]]
| |
| * Barrette esophagus
| |
| |-
| |
| | style="padding: 5px 5px; background: #DCDCDC;" |[[Peptic ulcer disease|'''Peptic ulcer disease''']]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * ''[[H. pylori]]''
| |
| * [[Smoking]]
| |
| * [[Alcohol]]
| |
| * [[Radiation therapy]]
| |
| * Medications
| |
| * [[Zollinger-Ellison syndrome]]
| |
| |
| |
| * [[Epigastric pain]] sometimes extending to back
| |
| * [[Right upper quadrant pain]]
| |
| |
| |
| '''[[Duodenal ulcer]]'''
| |
| *Pain aggravates with empty stomach
| |
| '''[[Gastric ulcer]]'''
| |
| *Pain aggravates with food
| |
| |
| |
| * [[Antacids]]
| |
|
| |
| * [[Duodenal ulcer]]
| |
| :*Pain alleviates with food
| |
| |✔
| |
| |✔
| |
| |<nowiki>-</nowiki>
| |
| |<nowiki>-</nowiki>
| |
| |<nowiki>-</nowiki>
| |
| |
| |
| * [[Melena|Black stools]]
| |
| |'''Gastric ulcers'''
| |
| * Discrete mucosal lesions with a punched-out smooth ulcer base with whitish fibrinoid base
| |
| * Most [[ulcers]] are at the junction of [[fundus]] and antrum
| |
| * 0.5-2.5cm
| |
| '''Duodenal ulcers'''
| |
| * Well-demarcated break in the [[mucosa]] that may extend into the [[muscularis propria]] of the [[duodenum]]
| |
| * Found in the first part of [[duodenum]]
| |
| * <1cm
| |
| |'''Other diagnostic tests'''
| |
| * Serum [[gastrin]] levels
| |
| * [[Secretin]] stimulation test
| |
| * [[Biopsy]]
| |
| |-
| |
| | style="padding: 5px 5px; background: #DCDCDC;" |[[Gastrinoma|'''Gastrinoma''']]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Associated with [[MEN type 1]]
| |
| |
| |
| * [[Abdominal pain]]
| |
| |<nowiki>-</nowiki>
| |
| |<nowiki>-</nowiki>
| |
| |✔
| |
|
| |
| (suspect [[gastric outlet obstruction]])
| |
| |✔
| |
| |<nowiki>-</nowiki>
| |
| |<nowiki>-</nowiki>
| |
| |<nowiki>-</nowiki>
| |
| |
| |
| * [[Melena|Black stools]]
| |
| |Useful in collecting the tissue for [[biopsy]]
| |
| |
| |
| * May present with symptoms of [[GERD]] or [[peptic ulcer disease]]
| |
| * Associated with [[MEN type 1]]
| |
| '''Diagnostic tests'''
| |
| * Serum [[gastrin]] levels
| |
| * [[Somatostatin]] receptor [[scintigraphy]]
| |
| * [[CT]] and [[MRI]]
| |
| |-
| |
| | style="padding: 5px 5px; background: #DCDCDC;" |[[Gastric Cancer|'''Gastric Adenocarcinoma''']]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * ''[[H. pylori]]'' infection
| |
| * Smoked and salted food
| |
| |
| |
| * [[Abdominal pain]]
| |
| |<nowiki>-</nowiki>
| |
| |<nowiki>-</nowiki>
| |
| |✔
| |
| |✔
| |
| |✔
| |
| |✔
| |
| |✔
| |
| |
| |
| * [[Melena|Black stools]], or blood in stools
| |
| |'''Esophagogastroduodenoscopy'''
| |
| * Multiple biopsies are taken to establish the diagnosis
| |
| |'''Other symptoms'''
| |
| * [[Dysphagia]]
| |
| * Early [[satiety]]
| |
| * Frequent [[burping]]
| |
| |-
| |
| | style="padding: 5px 5px; background: #DCDCDC;" |[[Gastric lymphoma|'''Primary gastric lymphoma''']]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * ''[[H. pylori]]'' infection
| |
| |
| |
| * [[Abdominal pain]]
| |
| * [[Chest pain]]
| |
| |<nowiki>-</nowiki>
| |
| |<nowiki>-</nowiki>
| |
| |<nowiki>-</nowiki>
| |
| |<nowiki>-</nowiki>
| |
| |<nowiki>-</nowiki>
| |
| |✔
| |
| |<nowiki>-</nowiki>
| |
| |<nowiki>-</nowiki>
| |
| |Useful in collecting the tissue for [[biopsy]]
| |
| |'''Other symptoms'''
| |
| * Painless swollen [[lymph nodes]] in neck and armpit
| |
| * Night sweats
| |
| * [[Fatigue]]
| |
| * [[Fever]]
| |
| * [[Cough]] or trouble breathing
| |
| |}
| |
|
| |
| ==Table== | | ==Table== |
| <div style="width: 85%;"><small> | | <div style="width: 85%;"><small> |
</figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline> Recent out break of leptospirosis is reported in Bronx, New York and found 3 cases in the months January and February, 2017.
![Histopathology of a pancreatic endocrine tumor (insulinoma). Source:https://librepathology.org/wiki/Neuroendocrine_tumour_of_the_pancreas[1]](/images/2/2f/Pancreatic_insulinoma_histology_2.JPG)
Histopathology of a pancreatic endocrine tumor (insulinoma). Source:https://librepathology.org/wiki/Neuroendocrine_tumour_of_the_pancreas[1]![Histopathology of a pancreatic endocrine tumor (insulinoma). Chromogranin A immunostain. Source:https://librepathology.org/wiki/Neuroendocrine_tumour_of_the_pancreas[1]](/images/a/a3/Pancreatic_insulinoma_histopathology_3.JPG)
Histopathology of a pancreatic endocrine tumor (insulinoma). Chromogranin A immunostain. Source:https://librepathology.org/wiki/Neuroendocrine_tumour_of_the_pancreas[1]![Histopathology of a pancreatic endocrine tumor (insulinoma). Insulin immunostain. Source:https://librepathology.org/wiki/Neuroendocrine_tumour_of_the_pancreas[1]](/images/d/d5/Pancreatic_insulinoma_histology_4.JPG)
Histopathology of a pancreatic endocrine tumor (insulinoma). Insulin immunostain. Source:https://librepathology.org/wiki/Neuroendocrine_tumour_of_the_pancreas[1]![Histopathology of a pancreatic endocrine tumor (insulinoma). Source:https://librepathology.org/wiki/Neuroendocrine_tumour_of_the_pancreas[1]](/index.php/File:Pancreatic_insulinoma_histology_2.JPG)
![Histopathology of a pancreatic endocrine tumor (insulinoma). Chromogranin A immunostain. Source:https://librepathology.org/wiki/Neuroendocrine_tumour_of_the_pancreas[1]](/index.php/File:Pancreatic_insulinoma_histopathology_3.JPG)
![Histopathology of a pancreatic endocrine tumor (insulinoma). Insulin immunostain. Source:https://librepathology.org/wiki/Neuroendocrine_tumour_of_the_pancreas[1]](/index.php/File:Pancreatic_insulinoma_histology_4.JPG)