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12) GI (Part 2) Flashcards

1
Q

Acute pancreatitis most common causes/pathology

A
  • Leakage of pancreatic enzymes into the interstitial space –> edema and inflammation
  • Alcohol (inflammation)
  • Gallstones/Biliary Pancreatitis (obstruction)
  • Hypertriglyceridemia (> 1000 mg/dl)
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2
Q

Acute pancreatitis signs/symptoms

A
  • Epigastric pain radiating to the back
  • Cullen’s sign & Grey-Turner sign are consistent with severe necrotizing pancreatitis
  • Elevated Amylase and Lipase (Lipase remains elevated longer)
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3
Q

Acute pancreatitis Tx

A
  • IV FLUIDS, NPO
  • Analgesics (Demerol does not constrict the sphincter of Oddi like morphine)
  • Bowel rest
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4
Q

Most cases of chronic pancreatitis are due to

A
  • ETOH
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5
Q

Chronic pancreatitis pathology

A
  • Inflammation
  • Fibrosis
  • Irreversible loss of pancreatic cell function
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6
Q

Chronic pancreatitis signs/smyptoms

A
  • Chronic abdominal pain
  • Diarrhea
  • Weight loss
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7
Q

Chronic pancreatitis diagnosis

A
  • Amylase/lipase may be elevated or normal

- KUB: pancreatic calcifications

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8
Q

Chronic pancreatitis Tx

A
  • Symptomatic with pancreatic enzyme replacement
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9
Q

Chronic pancreatitis complications

A
  • Malabsorption, steatorrhea

- Diabetes may develop

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10
Q

Pancreatic cancer

A
  • Most are adenocarcinoma
  • Prognosis is poor as most have locally advanced or metastatic disease at Dx
  • Biggest risk factor is cigarette smoking
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11
Q

Pancreatic cancer signs/symptoms

A
  • Non-specific sxs
  • “painless jaundice” (obstruction)
  • Systemic pruritus
  • Nausea, abd discomfort
  • Weight loss
  • Courvoisier’s sign (palpable GB in the presence of painless jaundice)
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12
Q

Pancreatic cancer diagnosis

A
  • CT guided biopsy or EUS w/ biopsy
  • Pancreatectomy (Whipple’s)
  • Appropriate for only 10-20% of pts
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13
Q

Diverticulitis complications

A
  • Acute Diverticulitis

- Diverticular Bleeds

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14
Q

Diverticulitis signs/symptoms

A
  • Often elderly patients
  • LLQ pain & tenderness
  • Low grade fever
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15
Q

Diverticulitis diagnosis

A
  • Often treated empirically
  • CBC w/ elevated WBCs
  • CT w/ contrast – most accurate
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16
Q

Diverticulitis Tx

A
  • Ciprofloxacin + metronidazole (mild disease)
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17
Q

Irritable bowel syndrome pathology

A
  • Related to gut-brain interaction

- Not due to structural or biochemical abnormalities

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18
Q

IBS signs/symptoms

A
  • Abd pain and distension - worse after eating and relieved after BM*
  • No weight loss or fever
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19
Q

IBS types (3)

A
  • Constipation (IBS-C)
  • Diarrhea (IBS-D)
  • Constipation alternating with diarrhea (IBS-M)
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20
Q

IBS Tx

A
  • Pain: antispasmodics, rifaximin, tricyclic antidepressants, probiotics
  • Constipation: fiber/ psyllium, PEG, Lactulose, Lubiprostone, Linaclotide
  • Diarrhea: loperamide, eluxadone, bile acid sequestrants, alosetron
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21
Q

Celiac disease pathology

A
  • Gluten exposure causes formation of IgA antibodies directed against gliadin and tissue transglutaminase
  • Causes atrophy and blunting of the villi in the small intestines –> malabsorption
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22
Q

Celiac disease signs/symptoms

A
  • Chronic diarrhea, steatorrhea
  • Weight loss
  • Abd distension
  • Dermatitis herpetiformis
  • B12 deficiency
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23
Q

Celiac disease diagnosis

A
  • Serologic Tests: + IgA Endomysial antibodies & tissue transglutaminase (tTG) antibodies (Antigliadin antibodies: lower sensitivity and specificity)
  • Small bowel biopsy confirms Dx
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24
Q

Celiac disease Tx

A
  • Gluten-free diet (reverses pathologic changes in the intestinal villi)
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25
Acute mesenteric ischemia
- Acute onset of small intestinal hypoperfusion
26
Acute mesenteric ischemia pathology
- Embolic or thrombotic arterial or venous occlusion - Nonocclusive processes (vasospasm or low cardiac output) - Most commonly in those with atherosclerosis, A fib - Associated with high mortality
27
Acute mesenteric ischemia signs/symptoms
- Acute severe abdominal pain “out of proportion”
28
Acute mesenteric ischemia diagnosis
- CT scan, MRI | - Doppler ultrasound
29
Acute mesenteric ischemia Tx
- O2, NPO, NG tube, IVF, analgesia | - STAT surgical or endovascular consult & Rx
30
Ischemic colitis
- Usually seen in elderly patients | - Diabetes mellitus, CAD, and PAD
31
Ischemic colitis pathology
- Same as AMI (hypoperfusion) | - Most prominent at the “watershed” area of colon
32
Ischemic colitis diagnosis
- Abd CT scan | - Colonoscopy (CT or MRI may assist in the diagnosis)
33
Ischemic colitis Tx
- Usually responds to conservative Rx - NPO; IV fluids; correct electrolyte abnormalities, Abx - Anti-embolic therapy - Surgery is uncommon
34
Volvulus
- Higher incidence in elderly pts with other comorbidities
35
Volvulus pathology
- Sudden, twisting of the bowel on itself --> obstruction and ischemia - Gangrene, necrosis and perforation can occur - Associated with high morbidity and mortality
36
Volvulus signs/symptoms
- Abd pain, bloating, vomiting | - Bloody stool
37
Volvulus diagnosis
- Plain abd x-ray or KUB – “coffee bean” sign
38
Volvulus Tx
- Endoscopic reduction | - Surgery
39
Small bowel obstruction causes
- Surgical Adhesions (most common cause), hernias
40
Large bowel obstruction causes
- Colon CA – most common cause
41
Bowel obstruction signs/symptoms
- Abdominal pain - Nausea, vomiting - Constipation (with complete obstruction)
42
Bowel obstruction diagnosis
- KUB – air fluid levels, dilated bowel loops | - Abd Ct scan
43
Bowel obstruction Tx
- Decompression (NG tube), surgery
44
Toxic megacolon
- Rare, emergency case
45
Toxic megacolon pathology
- Non-obstructive widening of the large intestine (> 6 cm, loss of haustra)
46
Toxic megacolon etiologies
- UC - C-diff colitis - Colonic ischemia
47
Toxic megacolon signs/symptoms
- Abd distension - Hypotension, tachycardia - Fever - Leukocytosis - Altered mental status --> shock
48
Toxic megacolon diagnosis
- Abd X-ray - dilated colon >6cm | - Abd CT scan
49
Toxic megacolon Tx
- Bowel rest: IVF, NG tube/suction, NPO - Steroids, Abx - GI and Surgical Consult (partial or total colectomy)
50
Inflammatory bowel diseases (IBD)
- Crohn's Disease | - Ulcerative Colitis
51
Crohn's Disease
- Most commonly involves terminal ileum and adjacent colon | - Transmural (whole thickness of the colon) involvement with skip lesions
52
Ulcerative Colitis
- Most commonly involves the rectosigmoid colon - Involves the mucosa and submucosa only - Diffuse involvement (no skip lesions)
53
Crohn's Disease (IBD) common presentation
- Diarrhea (usually non-bloody) - RLQ pain - Low grade fever - Weight loss - Perianal disease with fistula and abscess - Almost never involves the Rectum
54
Ulcerative Colitis (IBD) common presentation
- Intermittent bloody diarrhea (lesions are friable) - Tenesmus, Urgency - Lower abdominal cramping - Almost always involves the Rectum
55
Crohn's Disease (IBD) lab tests and diagnostic studies
- + ASCA (antisaccharomyces cervisiae antibody) - Small bowel follow through: ulceration, fistulas, skip lesions - Biopsy – Granulomatous lesions; focal ulcerations; acute and chronic inflammation.
56
Ulcerative Colitis (IBD) lab tests and diagnostic studies
- + p-ANCA** (anti- neutrophil cytoplasmic antibody) | - Biopsy – crypt abscesses, crypt branching, shortening and disarray, and crypt atrophy
57
IBD treatment options
- 5-ASAs – PO, enema or suppository (sulfasalazine, mesalamine, etc.) - PO antibiotics - PO corticosteroids to decrease flare, sxs - Immunomodulator drugs - Biologic Therapy - Surgery
58
PO antibiotics used to treat IBD
- Metronidazole & ciprofloxacin (if secondary infection is present)
59
Immunomodulator drugs used to treat IBD
- azathioprine (Imuran, Azasan) - 6-MP, Purinethol - cyclosporine A (Sandimmune, Neoral) - tacrolimus (Prograf) - Methotrexate
60
Biologic therapy used to treat IBD
- Infliximab (Remicade)
61
Surgeries to treat IBD
- UC - colectomy is curative | - Crohn’s disease – reserve ONLY for complications
62
IBD extra-intestinal manifestations
- Skin: erythema nodosum, pyoderma gangrenosum - Eye: uveitis, episcleritis - Joints: ankylosing spondylitis
63
Colon cancer (IBD complication)
- Management: Screening colonoscopy is recommended 8 yrs after Dx - Then, annual surveillance
64
Toxic megacolon (IBD complication)
- Emergency
65
Primary sclerosing cholangitis (IBD complication)
- Suspect in a patient who has unexplained elevated liver enzymes - Particularly an elevation in serum alkaline phosphatase
66
Colon polyps pathology
- Majority are adenomas - Benign adenomatous polyps can undergo dysplasia & neoplastic changes - Larger polyps & those with more villous characteristics are more likely to contain dysplasia (tubular, villous, tubulovillous)
67
Colon polyps signs/symptoms
- Are asx
68
Colon polyps diagnosis
- Found incidentally on colonoscopy or radiologic study - FHx (genetic mutation) - Sigmoidoscopy/ colonoscopy - Barium study/ CT scan
69
Colon polyps Tx
- Endoscopic resection | - F/U surveillance by colonoscopy every 2-5 yrs
70
Colorectal cancer is nearly always
- Adenocarcinoma
71
Colorectal cancer risk factors
- First degree relative with colon cancer or adenomatous polyps - Personal H/O breast, ovarian, or uterine cancer - Genetic predisposition - Ulcerative colitis > Crohn’s disease
72
Genetic predisposition to colorectal cancer
- Familial adenomatous polyposis (AKA: FAP, Gardner’s syndrome) - Peutz-Jeghers Syndrome
73
Colorectal cancer signs/symptoms
- Change in bowel habits - + FOBT - Intermittent melena or stool streaked with blood - Recurrent hematochezia
74
Colon cancer diagnosis
- Colonoscopy with biopsy – test of choice | - Stool tests
75
Stool tests to screen for colon cancer
- Fecal immunochemical test (FIT) - Multitarget stool deoxyribonucleic acid (MT-sDNA) ***+ results require a colonoscopy for definitive Dx***
76
Colon cancer Tx
- Surgical excision for early stage cancers - Adjuvant chemotherapy and/or XRT - Prognosis depends upon stage at Dx
77
Anal fissure pathology
- Split or tear in anal mucosa
78
Anal fissure signs/symptoms
- Tearing, burning, throbbing pain with defecation | - Blood streaks on stool &/or toilet paper
79
Anal fissure physical exam findings
- Crack in the epithelium | - External anal skin tag
80
Anal fissure Tx
- Sitz baths - High fiber diet - Stool softeners - Hydrocortisone supp/ cream (Anusol HC, Proctofoam-HC)
81
Anal fistulas pathology
- Communication btwn an abscess with an opening within the anal canal
82
Anal fistulas are associated with
- Crohn’s disease - Lymphogranuloma venereum - Rectal cancer
83
Anal fistula signs/symptoms
- Drainage of blood, pus, mucous, stool | - Pruritus, tenderness, pain
84
Anal fistula Tx
- Surgery - I&D (under sedation or in office) - Fistulotomy - Broad spectrum Abx - Sitz baths
85
Hemorrhoids
- Varices of the hemorrhoidal plexus
86
Hemorrhoids signs/symptoms
- Pruritus & rectal bleeding. - BRBPR - Dull, burning pain (internal rhoids) - Rectal pain (if external and thrombosed)
87
Hemorrhoids Tx
- High fiber diet - Sitz baths - Local treatment (proctofoam, Tucks medicated pads, Preparation H) - Rubber band ligation - Sclerotherapy - Surgical repair if severe
88
Hernias may present as
- Incarcerated | - Strangulated
89
Incarcerated hernia
- Reducible - a hernia that is not able to be reduced on exam - The vascular supply of the bowel is NOT compromised
90
Strangulated hernia
- Irreducible - Blood supply to the entrapped bowel has been cut off - Results in small bowel obstruction and infarction
91
Types of hernias
- Direct - Indirect (most common) - Umbilical - Incisional - Ventral - Hiatal or diaphragmatic - Femoral
92
Indirect hernia (most common)
- Passes thru the internal inguinal ring down the inguinal canal - May pass into the scrotum
93
Direct hernia
- Passes through the external inguinal ring at Hesselbach’s triangle - Rarely enters the scrotum
94
Umbilical hernia
- Most often appear at birth - Most resolve without treatment - Surgery may be indicated
95
Incisional hernia
- Most often appear after vertical incisions
96
Ventral hernia
- Weakening in the anterior abdominal wall | - May be either incisional or umbilical
97
Hiatal or diaphragmatic hernia
- Herniation of the stomach through the esophageal hiatus
98
Femoral hernia
- Passes through the femoral ring - Least common - Occur almost exclusively in females

Internal Medicine (14 decks)

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