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GIT > 10 Feb 2024 > Flashcards

10 Feb 2024 Flashcards

1
Q

Erythema Nodosum CF

A

👩🏻‍🦰Tender , indurated , erythematous nodules
👩🏻‍🦰
Most common anterior legs

Mirrors IBD activity , worsens during IBD flares and resolves as flares improve.

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2
Q

Pathogenesis of erythema Nodosum

A

🧠Delayed hypersensitivity reaction
🧠Septal panniculitis without Vasculitis

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3
Q

Erythema Nodosum Associated Dx

A

🫂Infections ( streptoccocus)

🫂Inflammatory disorders (IBD , sarcoidosis)

🫂Medications (eg AB , OCPs)

🫂Pregnancy

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4
Q

Management if EN

A

Evaluation ;

CBC , ESR , Streptococcus testing, chest radiograph , tuberculin skin test

Symptomatic Ttt:

NSAIDs , KI , Corticosteroids (if refractory)

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5
Q

Colon ischemia pathophys

A

👮🏻‍♀️ usually watershed non occlusive ischemia
👮🏻‍♀️ underlying atherosclerotic dx
👮🏻‍♀️ state of low blood flow (hypovolemia)

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6
Q

CF of colonic ischemia

A

Moderate abd pain and tenderness
Hematochezia and diarrhea
Leukocytosis and lactic acidosis

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7
Q

Dx of colonic ischemia

A

CT scan with IV contrast :

     Colon wall thickening , fat stranding

Endoscopy :

     Edematous and friable mucosa
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8
Q

Ttt of colonic ischemia

A

IV fluids and bowel rest

AB with enteric coverage

Colonic resection if necrosis develops.

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9
Q

Watershed areas of colon

A

Splenic flexure :
Btwn SMA and IMA territory

Rectosigmoid junction:
Between sigmoid artery and super rectal artery

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10
Q

RF for severe dx in Crohns

A

👐Young age <30 at dx
👐Extensive anatomical involvement
👐Perianal dx
👐Deep ulceration
👐Strictures
👐Fistulization
👐Prior intestinal surgery

👶🏾Smoking is only Major modifiable RF that can affect severity and progresssion
Strongly ass with need for hopitalization and surgery plus failure of biologic agents

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11
Q

Severe Crohn dx ttt

A

Smoking cessation
Biologic agents (TNF alpha inhibitors)
Immunomodulators (azathioprine, 6-MP)

Close endoscopic surveillance

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12
Q

Pathophys of Bile Acid diarrhea

A

Unresorbed bile acids spill in colon causing mucosal irritation

  🤖 bile acid enters terminal ileum too rapidly and overwhelms resorptive capacity (post cholecystectomy) 

  🤖 ileal dx impairs bile absorption (crohn dx , abd radiation damage)
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13
Q

CF of Bile acid diarrhea

A

Secretory diarrhea
(Happens during fasting and at night)

Unremarkable blood and stool studies

Bloating and abd cramps

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14
Q

Ttt of Bile acid diarrhea

A

Bile acid binding resins

Cholestyramine
Cholestipol

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15
Q

Mechanism of bile acid diarrhea

A

Gall bladder act as reservoir for bile.
Cholecystectomy causes bile acid to enter intestines more rapidly overwhelming ileal resorptive capacity.
Unresorbed bile causes irritation in colon causing secretory diarrhea.

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16
Q

Pt with constipation and mild L Abd pain upto date on colonoscopy
No change in diet.

A

Do colonoscopy for CA despite being up to date on colonoscopy due to:

Unexplained new constipation
Persistent change in bowel habits >4M
Significant change in bowel habits
<1 bowelmovement per week
Age >50
Weight loss
Hematochezia
Fe def anemia
Severe/worsening abd pain in high risk
New concerning SS

17
Q

Pt with crohn dx have SS of SBO

A

Fibrotic stricture

18
Q

Crohn dx and fibrotic strictures

A

Indications of worsening inflammation in crohn

Age <30
Strictures
Smoking

Ttt :surgery

19
Q

Fibrotic stricture CF

A

Those of SBO

Bilious emesis
Abd pain
N V
Partial obs (cant pass stool but can pas gas)
Complete obs (obstipation)
Abd distension
High ptched bowel sounds

20
Q

19yo Pt with watery diarrhea , blood in stools , abd pain , anemia , elevated CRP
Neg for C.difficile

A

IBD

Do colonoscopy
(To diff btw UC and crohn)

21
Q

Pt with prev bowel surgery now has peritonitis cause

A

SBO and Perforation due to adhesion formation.

22
Q

Opioid induced constipation ttt

A

Non pharm :
Inc fluids
Inc dietary fibre
Inc exercise
Early ambulation (post op)

Pharm:

      👿Osmotic laxatives (polyethylene glycol , lactulose ) 
      😈Contact cathartics or stimulant laxatives (senna bisacodyl) 
      😈Hard stools ; softeners (docusate) 
      😈Refractory :   Methylnaltrexone , lubiprostone
23
Q

First line for opioid constipation

A

Osmotic and stimulant laxatives

(Mostly no testing required)

24
Q

Abd pain , bloody diarrhea after AAA repair

A

Ischemic colitis

25
Q

Ischemic colitis colonoscopy

A

Ulcerations and cyanotic mucosa with sharp transition from affected to unaffected mucosa.

26
Q

Ttt of ischemic colitis

A

Uncomplicated
Conservative ttt;

    IV fkuids 
    Bowel rest 
    AB

Perforation / gangrene : surgery

27
Q

Biliary atresia labs

A

⬆️ direct bilirubin
⬆️ GGT
⬆️ ALP
⬆️ to normal LFTs
Normal ret count (no hemolysis)

28
Q

Gold standard for dx of biliary atresia

A

Intraoperative cholangiography
(Biliary obstruction)

Liver biopsy

29
Q

Pyogenic liver abscess CF

A

Fever
RUQ pain
Leukocytosis
Inc LFTs

30
Q

Pyogenic liver abscess cause

A

Direct extension from
biliary infections ,
penetrating trauma , hematogenous spread from IE or intrabd infection (diverticulitis)

31
Q

Pyogenic liver abscess Dx

A

CT scan
(Well defined hypoattenuating round lesion surrounded by peripherally enhanced abscess memb)

32
Q

Ttt of pyogenic liver abscess

A

⏺Percutaneous drainage

⏺Surgical drainage (if percut intervention fails)

33
Q

PSC complications

A

Biliary stricture

Cholangitis / cholelithiasis

Cholangiocarcinoma

Colon Ca , biliary CA

Cholestasis (fat soluble vit def , osteoporosis)

34
Q

What is renold pentad

A

RUQ pain
Fever
Jaundice
Hypotension
AMS

35
Q

Young pt with renold pentad , hematochezia

A

Young pt with recurrent acute cholangitis is due to biliary stricture from PSC.
And associated UC

36
Q

PSC etiology

A

Fibrosis and stricturing of medium and large intra and extra hepatic bile ducts causes cholestasis.
This predisposes pts to bacterial invasion of normally sterile biliary tree.
(Acute cholangitis)

USG is normal as Intrahepatic bile ducts arent easily visible initially.

37
Q

DX of PSC

A

Normal USG

MRCP

38
Q

Ttt of PSC

A

Endoscopy for strictures
Ttt of UC
AB for acute cholangitis
Urso

GIT (20 decks)

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