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Pance Re-Up > GI Re-Up #1 > Flashcards

GI Re-Up #1 Flashcards

1
Q

What is cholelithiasis? What is the MC type?

Name 5 risk factors for this condition (think F’s)

A

-Gallstones in the biliary tract WITHOUT inflammation
-Cholesterol is the MC type
-Female, Fat, Forty, Fertile, Fair: OCPs, IBD, rapid weight loss, Native American, increased TG’s

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2
Q

Although most patients with cholelithiasis are asymptomatic, what are some symptoms they CAN have?

A

-Biliary colic: episodic, abrupt RUQ pain, resolves slowly, lasting 30 minutes to hours.
-Nausea
-Precipitated by fatty foods or large meals

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3
Q

Initial test of choice for cholelithiasis

What is the treatment? Observation can be used if asymptomatic, but there is a medication that can dissolve the stones.

A

US

Ursodeoxycholic acid used to dissolve the stones (takes about 6-9 months)

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4
Q

Cholelithiasis can progress to _______ which is inflammation and infection of the gallbladder due to obstruction of the cystic duct by gallstones.

What is the MCC of this infection?

A

Acute cholecystitis

E. Coli

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5
Q

What are symptoms and physical exam findings of a patient with acute cholecystitis?

A

-Continuous RUQ or epigastric pain, precipitated by fatty foods or large meals
-N/v, Anorexia, Guarding
-Fever, Enlarged Palpable Gallbladder
-Murphy’s Sign: RUQ pain or inspiratory arrest with palpation of gallbladder
-Boas Sign: referred pain to right shoulder or sub scapular area

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6
Q

Back to Boas Sign; Explain why this occurs

A

-Phrenic Nerve Irritation

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7
Q

-Initial test of choice for cholecystitis
-What do labs show?
-Most accurate test for this.

A

-US initial
-Labs: Increased WBC’s (Leukocytosis)
-Accurate: HIDA (Cholescintigraphy)

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8
Q

Treatment for acute cholecystitis

A

-NPO, IVF, ABX (Ceftriaxone + Metronidazole) followed by cholecystectomy

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9
Q

On the same note, what is acute acalculous cholecystitis?

Explain why this occurs

A

-Acute inflammatory disease of gallbladder NOT due to gallstones

-Gallbladder stasis and ischemia leads to concentration of bile salts, distention, infection, perforation, or necrosis of gallbladder tissue

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10
Q

Who is at increased risk for acute acalculous cholecystitis specifically?

What is the treatment, because imaging studies are the same as cholecystitis.

A

-Current hospitalization, critically ill patients

-Treatment: Supportive care (IVF, bowel rest, pain control, lytes correction, ABX)

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11
Q

What is choledocolithiasis?

What are symptoms of this condition?

A

-Gallstones in the common bile duct (leads to cholestasis due to blockage)

-Prolonged biliary colic (longer than cholecystitis), RUQ pain, jaundice

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12
Q

Initial imaging study for choledocolithiasis?

What do labs show (there is a specific one for cholestasis)

Diagnostic test of choice (because it can be therapeutic as well)

A

-US initially
-Labs: elevated AST and ALT. Increased Alkaline phosphatase and GGT (cholestasis)

-ERCP can allow for extraction of the stone as well

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13
Q

Choledocolithiasis can progress to ________, which is a biliary tract infection secondary to obstruction of the common bile duct from gallstones or malignancy.

What is the MCC of this condition?

Name symptoms (think of the triad and pentad)

A

-Acute ascending cholangitis

-E. Coli

-Charcot’s Triad: fever + RUQ pain + jaundice
-Reynold’s Pentad: add hypotension/shock + AMS

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14
Q

Initial imaging study of choice for cholangitis

What do labs show (think of cholestasis again)

Most accurate imaging study?

Gold standard imaging study

A

-US initially

-Labs: Leukocytosis, Increased alkaline phosphatase and GGT (cholestasis), increased bilirubin

-Accurate: MRCP

-Gold: Cholangiography via ERCP or PTC (percutaneous transhepatic cholangiography) once stable for 48 hours after IV ABX

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15
Q

Initial management for acute cholangitis

A

-IV ABX followed by CBD decompression and stone extraction via ERCP

-ABX used: Ampicillin/Sulbactam, Piperacillin/Tazobactam, Ceftriaxone + Metronidazole

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16
Q

The ERCP for cholangitis is done when the patient has been _______ for ______ hours and after IV ABX.

A

Stable/Afebrile for 48 hours

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17
Q

Appendicitis is obstruction of the lumen of the appendix resulting in inflammation and bacterial overgrowth. What is the MCC of this condition?

True or False: Appendicitis is the MCC of acute abdomen in children 12-18 years old?

A

Fecalith and lymphoid hyperplasia

True

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18
Q

Symptoms of appendicitis

There are also 4 specific exam tests that can be done for this. Name and explain them.

A

-Anorexia and periumbilical of epigastric pain followed by RLQ pain, nausea, and vomiting

-Rovsing Sign: RLQ pain with LLQ palpation
-Obturator Sign: RLQ pain with hip rotation w/ flexed knee
-Psoas Sign: RLQ pain with right hip flexion/extension (raise leg against resistance)
-McBurney’s Point Tenderness: 1/3 distance from anterior superior iliac spine and navel

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19
Q

Appendiceal inflammation stimulates nerve fibers around ___- _____, causing vague periumbilical pain.

A

T8-T10

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20
Q

What is the preferred imaging study of choice for appendicitis in adults?

What is preferred if the patient is pregnant or a child?

A

-CT scan

-US and MRI for radiosensitive populations

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21
Q

Treatment for appendicitis

A

-Appendectomy (Laparoscopic preferred)

22
Q

Hirschsprung Disease is what?

Where is it MC?

What are some risk factors?

A

-Congenital megacolon due to absence of ganglion cells (Auerbach and Meissner plexuses)

-MC in distal colon and rectum

-Males, Down Syndrome, MEN II

23
Q

Symptoms of Hirschsprung Disease

A

-Neonatal meconium ileus (failure to pass > 48 hours)
-Bilious vomiting
-Abdominal distention
-Failure to thrive

24
Q

What is seen on contrast enema in Hirschsprung Disease?

What is the definitive diagnostic?

Treatment?

A

-Enema: Transition zone between normal and affected bowel

-Definitive: Rectal biopsy

Treatment: Resection of affected bowel segment

25
Q

What is the pathophysiology of pyloric stenosis?

What are two risk factors for this condition?

A

Hypertrophy and hyperplasia of pyloric muscles, causing functional gastric outlet obstruction

-MC in first 3-12 weeks of life
-Erythromycin use (within the first two weeks of life)

26
Q

Symptoms of pyloric stenosis

What is the initial diagnostic of choice?

A

-Nonbilious projectile vomiting (after feeding)
-Palpable pylorus (olive shaped, nontender, mobile hard mass to right of epigastrium)

Abdominal US: elongated, thickened pylorus

27
Q

What is seen on upper GI series for pyloric stenosis?

How about labs?

A

-Upper GI series: String sign (thin column of barium through narrowed pyloric channel), delayed gastric emptying. Railroad track sign (excess mucosa in pylorus resulting in 2 columns of barium)

Labs: Hypokalemia and hypochloremic metabolic alkalosis from vomiting

28
Q

Treatment for pyloric stenosis

A

-Rehydration (IVF) and Potassium Replacement
-Definitive: Pyloromyotomy

29
Q

What is intussusception?

True or False: This is the MCC of bowel obstruction in children 6 months - 4 years of age.

A

Telescoping (invagination) of an intestinal segment into adjoining distal intestinal lumen, leading to bowel obstruction.

True

30
Q

Where does intussusception MC occur?

What is the MCC?

A

Ileocolic junction

Idiopathic MCC; others: hyperplasia of Peyer’s Patches, tumors, foreign body

31
Q

Symptoms of intussusception (triad)

Physical exam findings

A

-Vomiting + abdominal pain + passage of blood per rectum (currant jelly stools - stool mixed with blood and mucus). Abdominal pain colicky in nature, pulls knees to chest due to pain

-Sausage-shaped mass in RUQ or emptiness in the RLQ (Dance’s Sign) due to telescoping of bowel

32
Q

Best initial diagnostic for intussusception and what is seen?

What is the diagnostic that can also be therapeutic?

A

US initial: Donut or Target Sign

Air or contrast enema

33
Q

Management for intussusception

A

-Fluid and electrolyte replacement (initial steps)
-Then, NG decompression with pneumatic (air) or hydrostatic (saline or contrast)
-Admit for observation (10% recurrence rate within 24 hours)

34
Q

What is dumping syndrome and what is it often a complication of?

A

-Symptoms due to rapid gastric emptying and rapid fluid shifts when large amounts of carbs are ingested

Often a complication of bariatric surgery

35
Q

Symptoms of dumping syndrome

What tests can be done to confirm rapid gastric emptying?

A

-Bloating, flatus, diarrhea, abdominal pain, nausea, dizziness, tachycardia, flushing (within 15 minutes)

-Barium fluoroscopy and radionuclide scintigraphy

36
Q

Treatment for dumping syndrome

A

-Decreased carbohydrate intake
-Eat more frequently with smaller meals
-Separating solids from liquid intake by 30 minutes

37
Q

Celiac Disease is autoimmune-mediated inflammation of the small bowel due to reaction with _______ in gluten-containing foods. What are some foods that have gluten in it?

Explain the pathophysiology behind this condition

What are some common symptoms of this (think of the skin as well)

A

-Alpha-Gliadin

-Foods: wheat, rye, barley

-Patho: Autoimmune damage leads to loss of villi with subsequent malabsorption

-Symptoms: Malabsorption (diarrhea, distention, bloating, steatorrhea). Growth delays.
–Dermatitis herpetiformis: pruritic, papulovesicular rash on extensor surfaces, neck, trunk, and scalp.

38
Q

Screening test for celiac disease

Definitive and confirmatory diagnostic for celiac disease

A

-Screening: Transglutaminase IgA antibodies (Endomysial IgA antibodies)

-Confirmatory: small bowel biopsy –atrophy of the villi

39
Q

Management for Celiac Disease

A

-Gluten Free Diet: avoid wheat, rye, barley.
-Vitamin Supplementation

40
Q

Diagnostic test of choice for lactose intolerance

A

-Hydrogen breath test: hydrogen produced when colonic bacteria ferment the undigested lactose.

41
Q

Peanut and Tree Nut Allergies are mostly IgE mediated. What are some risk factors for this condition?

What is the management of an acute attack?

A

-Risks: Genetics, Family History. Delayed introduction of nuts until > 3 years of age.

Antihistamines if mild, Epinephrine if severe

42
Q

What exactly are diverticula?

Where do they MC occur? Where do they MC bleed?

Risk Factors for diverticulosis?

A

-Outpouchings due to herniation of mucosa into the wall of the colon

-MC occur in left colon, right colon MC site for bleeding

-RF: low fiber diet, constipation, obesity

43
Q

Symptoms of diverticulosis

Remember, diverticulosis is the MCC of acute lower GI bleeding

A

-Usually asymptomatic, incidental finding
-Lower GI Bleeding (painless hematochezia) in adults

44
Q

Test of choice for diverticulosis

If bleeding not visualized on this diagnostic, what can be done?

A

-Colonoscopy

-radionuclide imaging (technetium-99 tagged RBC scan)

45
Q

In most cases, the bleeding with diverticulosis stops spontaneously. However, what can be done to stop the bleeding if needed?

A

Resuscitation (2 large bore IVs, correction of coagulopathies)

Epinephrine injection, tamponade

46
Q

What recommendation do you have for a patient with asymptomatic diverticulosis?

A

-High fiber diet, use of Bran, or psyllium

47
Q

On the other hand, diverticulitis is ….

Where is the MC area for this?

A

Microscopic perforation of a diverticulum that leads to inflammation and focal necrosis.

Sigmoid colon

48
Q

Symptoms of diverticulitis

A

-LLQ pain
-Low grade fever
-N/v, Constipation, diarrhea, bloating, flatulence, change in bowel habits

49
Q

Initial imaging study of choice for diverticulitis (why should you NOT use colonoscopy?)

What do labs show?

A

CT scan. Do not use colonoscopy due to perforation risk.

Labs: leukocytosis

50
Q

Management for uncomplicated diverticulitis

A

-Outpatient treatment with oral ABX (Metronidazole + Ciprofloxacin or Levofloxacin) for 7-10 days and clear liquid diet

-Surgery: if refractory, recurrent, perforation, or stricture

51
Q

When should you admit a patient with diverticulitis?

A

-Perforation, abscess, stricture, obstruction, fistula.
-High risk: High fever > 102, sepsis, immunosuppression, increased age, unable to tolerate oral intake, etc.

Pance Re-Up (76 decks)

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