Peptic Ulcer and Celiac Disease Overview

Peptic Ulcer Disease

• Chronic ulcers in the esophagus, stomach, or duodenum
• Symptoms include epigastric pain (upper abdomen), indigestion (dyspepsia), gastric bleeding, coffee-ground-like vomit, melena (black stools), and anemia
• Diagnosis involves upper GI X-ray, endoscopy (EGD) with biopsy, stool samples, antibody testing, and urea breath test
• Treatment includes acid-suppressing drugs like Proton Pump Inhibitors (PPI) and Histamine 2 receptor antagonists (H2RA), antibiotics for H.pylori infection, and lifestyle changes such as reducing NSAID use and stress

Celiac Disease

• Autoimmune disorder triggered by gluten, leading to intestinal damage
• Symptoms include diarrhea, abdominal pain, bloating, nutrient deficiencies (iron, vitamins), and dermatitis herpetiformis (skin rash)
• Diagnosis involves blood test for elevated transglutaminase or endomysial IgA, small bowel biopsy, and endoscopy (EGD)
• Treatment involves a strict gluten-free diet and nutritional counseling

Familial Adenomatous Polyposis (FAP)

• Genetic condition causing colon polyps, often leading to colon cancer by age 50
• Symptoms include rectal bleeding, diarrhea, anemia, and often asymptomatic
• Diagnosis involves genetic testing and colonoscopy with biopsy
• Treatment involves annual colonoscopies, prophylactic colectomy, and genetic counseling for family.

Ulcerative Colitis (UC)

• Autoimmune inflammation affecting the colon's lining
• Symptoms include diarrhea (sometimes bloody), abdominal pain, fever, rectal pain, bloating, and weight loss
• Diagnosis involves colonoscopy and blood tests such as CBC, low iron levels, and elevated CRP/ESR
• Treatment includes steroids, sulfasalazine, immunosuppressants, and surgery in severe cases

Crohn’s Disease

• Autoimmune inflammation that affects any part of the GI tract, mainly the small intestine and colon
• Symptoms include the same as UC, plus vomiting, fistulas, pneumaturia (air in urine), pernicious anemia, and vitamin deficiencies
• Diagnosis involves colonoscopy, EGD for upper symptoms, CBC, vitamin deficiency tests, and imaging (X-ray, CT)
• Treatment includes steroids, immunosuppressants, monoclonal antibodies, and surgery for severe cases

Pancreatitis

• Inflammation of the pancreas, either acute or chronic
• Symptoms include abdominal pain radiating to the back, nausea, vomiting, fever, steatorrhea (fatty stool), and distention
• Diagnosis involves elevated serum lipase/amylase levels, CT scan, and CBC showing high WBC
• Treatment involves hospitalization with NPO (nothing by mouth) protocol, IV fluids, and pain management

Iron Deficiency Anemia

• Low iron levels causing decreased hemoglobin production and oxygen transport
• Symptoms include fatigue, weakness, difficulty swallowing, and cardiovascular strain
• Diagnosis involves serum ferritin, serum iron, total iron binding capacity (TIBC), and blood smear showing microcytic red blood cells
• Treatment involves iron supplementation (oral or IV), dietary changes, and monitoring ferritin and hemoglobin levels

Vitamin B12 Deficiency (Pernicious Anemia)

• Autoimmune destruction of gastric parietal cells or malabsorption, leading to B12 deficiency
• Symptoms include anemia, fatigue, neurological issues: memory loss, gait disturbances, and visual field defects (Centrocecal VF)
• Diagnosis involves blood smear showing macrocytic red blood cells, hypersegmented neutrophils, low serum B12, elevated homocysteine and methylmalonic acid, and anti-intrinsic factor antibodies present in autoimmune pernicious anemia
• Treatment involves B12 supplementation (oral or intramuscular), addressing underlying autoimmune issues if present, and monitoring neurological symptoms

Pancytopenia (due to B12 Deficiency)

• A reduction in red blood cells, white blood cells, and platelets, often linked to vitamin B12 deficiency
• Symptoms include generalized weakness, bruising, infections, pale skin, and shortness of breath
• Diagnosis involves blood count showing low levels of all types of blood cells and bone marrow biopsy if severe
• Treatment involves B12 supplementation, monitoring blood counts regularly, and addressing any associated autoimmune conditions

Cancer Basics

• Uncontrolled cell division, genetic or environmental causes
• Symptoms vary by cancer type but involve abnormal growths, fatigue, and weight loss
• Diagnosis involves clinical exams, imaging, biopsy, and TNM staging to assess severity and prognosis
• Treatment includes surgery, radiation, chemotherapy, targeted therapies, immunotherapy, and hormonal therapy

Radiation Retinopathy

• A complication of radiation treatment, affecting retinal blood vessels
• Symptoms include microaneurysms, hemorrhages, telangiectasias, macular edema, cotton-wool spots, neovascularization, and retinal detachment
• Diagnosis involves OCT-A, Fluorescein Angiography (FA), and Fundus Autofluorescence (FAF)
• Treatment includes anti-VEGF injections, laser photocoagulation, and prevention by using lower radiation doses, hyper-fractionation, and eye protection

Chemotherapy-Associated Ocular Toxicity

• Eye toxicity from systemic chemotherapy
• Symptoms include keratitis, corneal deposits, conjunctivitis, uveitis, retinal toxicity, and optic nerve toxicity
• Diagnosis varies based on symptoms
• Treatment depends on specific ocular toxicities

Metastatic Orbital Tumors

• Tumors metastasizing to the eye, most commonly from breast, lung, or prostate cancer
• Symptoms include sudden pain, diplopia, vision loss, mass on palpation, optic nerve edema, and ophthalmoplegia
• Diagnosis involves MRI for orbital mass
• Treatment involves oncology referral, surgery, radiation, or chemotherapy based on cancer stage

Paraneoplastic Ocular Syndromes

• Autoimmune reaction to cancer affecting the eyes (e.g., melanoma-associated retinopathy, cancer-associated retinopathy)
• Symptoms include vision loss, nyctalopia, dyschromatopsia (color vision issues), uveitis, macular edema, and retinal vasculitis
• Diagnosis involves OCT, ERG (electroretinogram) showing dysfunction, and blood tests for autoantibodies
• Treatment involves systemic steroids, immunotherapy, and referral to oncology if no cancer diagnosis is present

Giant Cell Arteritis (GCA)

• Inflammation of the temporal arteries, often affecting vision
• Symptoms include headache, scalp tenderness, jaw claudication, and visual disturbances or sudden vision loss (arteritic anterior ischemic optic neuropathy - AAION)
• Diagnosis involves elevated ESR (≥50 mm/hr), often >100 mm/hr, temporal artery biopsy (TAB) showing vasculitis, and CRP levels
• Treatment involves high-dose steroids, taper over months to years, and biologics or DMARDs for those contraindicated for long-term steroids

Systemic Lupus Erythematosus (SLE)

• A systemic autoimmune disorder affecting multiple organs
• Symptoms include butterfly rash, joint pain, kidney issues, and visual changes (lupus retinopathy)
• Diagnosis involves positive ANA, Anti-dsDNA, Anti-Smith antibodies, elevated ESR, and CRP
• Treatment involves immunosuppressive drugs, regular eye exams for lupus retinopathy, and systemic management for organ involvement

Rheumatoid Arthritis (RA)

• Chronic autoimmune arthritis affecting the joints
• Symptoms include joint pain, swelling, stiffness, and ocular complications: dry eye, scleritis
• Diagnosis involves rheumatoid factor (RF), Anti-CCP antibodies, elevated CRP, and ESR
• Treatment involves DMARDs (e.g., methotrexate), biologics, and managing ocular symptoms with artificial tears and anti-inflammatory treatments

Sjögren’s Syndrome (SS)

• Autoimmune disorder affecting moisture-producing glands
• Symptoms include dry eyes, dry mouth, joint pain, and fatigue
• Diagnosis involves positive Anti-SSA/Ro, Anti-SSB/La, Schirmer's test (≤5mm in 5 minutes), and ocular staining score
• Treatment involves artificial tears, saliva substitutes, and hydroxychloroquine for systemic symptoms

Ankylosing Spondylitis (AS)

• A type of spondyloarthropathy primarily affecting the spine
• Symptoms include chronic back pain, stiffness, and uveitis
• Diagnosis involves HLA-B27 positive and X-rays showing sacroiliac joint changes
• Treatment involves NSAIDs, biologics (e.g., TNF inhibitors), and management of uveitis with corticosteroids

Rosacea

• Chronic inflammatory skin condition, often on the face
• Symptoms include erythema (redness), telangiectasia, papules, pustules, and ocular symptoms: pain, dryness, tearing, conjunctival injection
• Diagnosis involves clinical examination
• Treatment includes topical treatments, oral antibiotics, and laser surgery for telangiectasia or phymatous changes

Stevens-Johnson Syndrome (SJS)

• Severe, life-threatening mucocutaneous reaction, often medication-induced
• Symptoms include skin desquamation, mucositis, fever, respiratory symptoms, and ocular effects: conjunctivitis, corneal erosions, neovascularization
• Diagnosis involves history of medication use or infection and clinical exam
• Treatment involves discontinuing offending medication, supportive care, and ocular management

Xanthoma/Xanthelasma

• Lipid-laden plaques, often related to abnormal lipid levels
• Symptoms include yellowish plaques on skin or around eyes (xanthelasma)
• Diagnosis involves lipid profile to assess cholesterol and triglyceride levels
• Treatment involves surgical removal of plaques and managing underlying lipid disorders

Basal Cell Carcinoma (BCC)

• Skin cancer affecting keratinocytes in the basal layer of the epidermis
• Symptoms include nodular: translucent nodule with telangiectasias, rolled border, pigmented or morpheaform subtypes possible
• Diagnosis involves clinical exam, dermoscopy, and biopsy
• Treatment involves surgical excision (Mohs surgery for high-risk cases), cryotherapy, radiation, and 5-fluorouracil cream

Cutaneous Squamous Cell Carcinoma (cSCC)

• Cancer of squamous cells, typically in sun-exposed areas
• Symptoms include scaly, firm papules, or plaques, ulceration possible, itching, pain, or altered sensation
• Diagnosis involves biopsy and clinical examination
• Treatment involves surgical excision, Mohs surgery for high-risk areas, and epidermal growth factor inhibitors for advanced cases

Cutaneous Melanoma

• Melanoma, a cancer of melanocytes, often fatal if untreated
• Symptoms include irregular moles (asymmetry, border irregularity, color variation) and changes in size, color, or shape of moles
• Diagnosis involves biopsy, dermoscopy, and sentinel lymph node biopsy
• Treatment involves surgical excision with margins, monoclonal antibodies for metastasis, and regular skin exams and follow-up

Sinusitis

• Inflammation of the sinus epithelium, often bacterial
• Symptoms include unilateral facial pain, headache, eye pain, toothache, post-nasal discharge, cough, inflamed nasal mucosa
• Diagnosis involves clinical exam and imaging for severe or recurrent cases
• Treatment involves OTC analgesia, decongestants, and antibiotics for infections lasting longer than 10 days

Cellulitis

• Bacterial infection of the dermis and subcutaneous fat, often from Staph or Strep species
• Symptoms include red, warm skin, localized edema, fever, chills, and can spread to deeper tissues like muscle
• Diagnosis involves clinical exam, culture if severe
• Treatment involves oral or IV antibiotics, surgical drainage in severe cases

Impetigo

• Superficial bacterial infection of the skin, often in children
• Symptoms include non-bullous: honey-colored pustules, bullous: thin-walled vesicles in warm, moist areas
• Diagnosis is clinical
• Treatment involves cleaning lesions, topical antibiotics, and oral antibiotics for extensive cases

Tuberculosis (TB)

• Mycobacterium tuberculosis infection, primarily affecting the lungs
• Symptoms include fever, fatigue, weight loss, persistent cough, pleuritic chest pain, and can spread to kidneys, spine, adrenal glands
• Diagnosis involves tuberculin skin test (TST) or IGRA blood test, and chest X-ray to differentiate latent vs.active TB
• Treatment involves multi-drug regimen for active TB, isoniiazid monotherapy for latent TB, and systemic TB treatment and care for eye complications for ocular TB

Cat-Scratch Disease

• Infection from Bartonella henselae, transmitted by cat bites or scratches
• Symptoms include vesicular lesion, unilateral lymphadenopathy, low-grade fever, muscle/joint pain
• Diagnosis involves history of cat interaction, and serology for Bartonella antibodies
• Treatment involves supportive care, antibiotics for severe cases, and antibiotics for ocular involvement

Lyme Disease

• Tick-borne bacterial infection from Borrelia burgdorferi
• Symptoms include erythema migrans (bullseye rash), headache, arthralgia, fatigue, and can progress to systemic complications
• Diagnosis involves clinical history, ELISA, and Western blot for confirmation
• Treatment involves doxycycline for early disease, doxycycline for disseminated disease, and IV antibiotics for severe cases

Herpes Zoster (Shingles)

• Reactivation of varicella zoster virus (VZV), often affecting a specific dermatome
• Symptoms include unilateral vesicular rash, severe pain, itching, malaise, facial nerve palsy, abdominal pain if visceral involvement
• Diagnosis is clinical based on rash and history of VZV infection
• Treatment involves oral antivirals within 72 hours, antibacterial ointments for skin lesions, and vaccination for prevention

Histoplasmosis

• Fungal infection caused by Histoplasma capsulatum, associated with bird/bat droppings
• Symptoms include flu-like symptoms, respiratory distress, hypoxia, and presumed ocular histoplasmosis: punched-out "histo" spots, choroidal neovascularization
• Diagnosis involves antigen/antibody testing, biopsy for confirmation
• Treatment involves oral/IV antifungals for systemic infection, and anti-VEGF injections and laser photocoagulation for ocular involvement

Mucocutaneous Candidiasis

• Yeast infection from Candida albicans, affecting mouth (thrush), esophagus, or genitals
• Symptoms include white plaques, itching, redness, discomfort
• Diagnosis involves surface scraping, culture, or biopsy
• Treatment involves oral/IV antifungals and treating underlying conditions

Toxoplasmosis

• Parasitic infection caused by Toxoplasma gondii, transmitted through cat feces or undercooked meat
• Symptoms include acquired: headache, myalgia, lymphadenopathy, congenital: hydrocephalus, brain calcifications, retinochoroiditis
• Diagnosis involves serology for IgG/IgM antibodies, PCR for severe cases
• Treatment involves no treatment needed for immunocompetent, pyrimethamine, sulfadiazine, leucovorin for immunocompromised, and systemic and intravitreal therapy for severe cases for ocular involvement