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RRPA Clinical Med II > Ross GI study guide - Exam 3 > Flashcards

Ross GI study guide - Exam 3 Flashcards

1
Q

What patient population presenting with abd pain is at high risk for serious pathology?

A

Elderly population

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2
Q

Patients with bowel obstructions present with what type of pain?

A

Diffuse colicky pain

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3
Q

Patients with mesenteric ischemia present with what type of pain?

A

Pain out of proportion to exam

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4
Q

Patients with pancreatitis present with what type of pain?

A

Epigastric pain radiating to back left shoulderblade

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5
Q

Patients with appendicitis present with what type of pain?

A

periumbilical to RLQ pain

Children can have rectal pain

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6
Q

CT is useful to determine what abd conditions?

A

Perforation, abscess, obstruction, or mass.

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7
Q

Patients over age 65 have a ____ threshold to CT scan?

A

Low

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8
Q

What bacteria is related to peptic ulcer disease?

A

Helicobacter pylori

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9
Q

Other than H. pylori, what are some common causes of peptic ulcer disease?

A

NSAIDs, alcohol use, stress

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10
Q

Patients negative for H. pylori who do not use NSAIDs or alcohol should be worked up for _____.

A

Gastric carinoma

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11
Q

What other signs and symptoms are suggestive of gastric carcinoma?

A

Weight loss, no response to PPI.

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12
Q

Other than ulcers, what condition can be caused by H. pylori?

A

Gastric carcinoma

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13
Q

What tests can be done for H. pylori?

Which is best?

A

Serum antibody, stool antigen, or urea breath test.

Urea breath test is best

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14
Q

What is the treatment for patients with suspected PUD who do not use NSAIDs or alcohol?

A

PPI, clarithromycin, amoxicillin

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15
Q

What test is indicated in patients over 50 presenting with PUD symptoms or dyspepsia?

A

Endoscopy to R/O gastric carcinoma

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16
Q

Any time you see _____ on XR, it is a surgical emergency.

A

Free air

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17
Q

Signs/Symptoms of perforated ulcer?

A

Intense pain, peritoneal signs, vomiting, abnormal vital signs

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18
Q

What imaging study should be ordered when a perforated ulcer is suspected?

A

KUB checking for free air

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19
Q

Acute appendicitis typical patient age?

A

Teens and early 20s

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20
Q

Classic presentation of appedicitis?

A

Umbilical pain the migrates to the RLQ over hours. Pain precedes vomiting.

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21
Q

Treatment for appendicits?

A

Surgical

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22
Q

How might symptoms of appendicitis change in a pregnant patient?

A

May have RUQ pain due to upward shifting of the appendix.

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23
Q

Atypical pain for appendicitis is back pain. Patients who have this have a ____ appendix.

A

Retrocecal appendix

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24
Q

Typical exam findings of appendicitis?

A

Psoas, obturator, Rovsing’s are typically positive.

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25
Q

You examine a patient and find a positive psoas, obturator, and Rovsing sign. They have typical appendicitis symptoms. What should you do next.

A

CT with contrast.

Physical exam findings not specific enough to call surgery.

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26
Q

What imaging study should be considered in peds you suspect for appendicitis?

A

US of RLQ

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27
Q

Patients with appendicitis should get what meds pre-op?

A

Antibiotics and pain management

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28
Q

What are common causes of mesenteric ischemia?

A

Arterial emboli or thrombus

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29
Q

Less common cause of mesenteric ischemia?

A

Hypotension

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30
Q

Lab findings in mesenteric ischemia?

A

Leukocytosis and metabolic acidosis

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31
Q

Imaging study of choice for suspected mesenteric ischemia?

A

Abdominal CT with contrast

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32
Q

Treatment for mesenteric ischemia?

A

Aggressive fluid resuscitation, antibiotics, and early surgical evaluation

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33
Q

What are the types of bowel obstruction?

A

Non-Mechanical

Mechanical

34
Q

Non-mechanical obstructions are caused by an ileus. What is an ileus?

A

A section of paralyzed intestine where the bowel does not have paristalsis.

35
Q

What are the causes of an ileus?

A

Electrolyte imbalance, infections, spinal cord injury, and bowel surgery.

36
Q

Physical exam findings of an ileus?

A

Hypoactive bowel sounds and mild tenderness

37
Q

What are common causes of mechanical bowel obstructions?

A

Adhesions, hernias, and cancers.

38
Q

Exam findings of mechanical bowel obstructions?

A

Diffuse abdominal pain, distension, and sometimes vomitting.

39
Q

Can patients with mechanical bowel obstructions pass gas or feces?

A

No

40
Q

Auscultation of a mechanical bowel obstruction would reveal _______.

A

High pitched hyperactive tinkling.

41
Q

Common cause of large bowel obstructions?

A

Cancer or volvulus.

42
Q

Imaging studies for bowel obstruction?

A

XR can be helpful but CT more sensitive.

43
Q

Treatment for SBO?

A

Replace electrolytes and fluids. Decompress stomach (controversial).
Admission and surgical consult.

44
Q

Describe the pain of diverticulitis.

A

Slow onset over 1-2 days. Diffuse and non-specific, migrating to LLQ.

45
Q

Symptoms of diverticulitis?

A

Fever, vomiting, decreased appetite, abd pain.

46
Q

Most common anatomical location for diverticulitis?

A

Descending and sigmoid colon

47
Q

Imaging of choice for suspected diverticulitis?

A

CT with contrast for first presentation. Not necessary for repeated episodes, but should be repeated for suspected perf or abscess.

48
Q

Treatment for simple diverticulitis?

A

PO antibiotics and pain management.

49
Q

Treatment of complicated diverticulitis?

A

IVF, antibiotics, bowel rest.

+/- admission depending on comorbidities

50
Q

What anatomical structure differentiates upper GI bleeds from lower GI bleeds?

A

Ligament of Treitz

51
Q

Symptoms suggestive of upper GI bleed?

A

Vomiting blood or coffee ground emesis, melena.

52
Q

Common causes of upper GI bleeds?

A

PUD with perf, esophageal varices, Mallory Weiss tear

53
Q

What could help differentiate between Mallory Weiss tear and serious causes of upper GI bleeding?

A

CBC, orthostatic vitals, stool guaiac

54
Q

You are called into a room with a patient actively vomiting blood. What is your first intervention?

A

2 large bore IVs - fluid resuscitation

55
Q

What procedure done by GI is diagnostic and therapeutic for upper GI bleeds?

A

esophagogastroduodenoscopy

56
Q

You are concerned your patient has an upper GI bleed. No orthostatic changes, stool guaiac is negative, NG tube shows no blood. PT may have PUD but it is not a bleeding ulcer. Can this patient be discharged?

A

Yes, with GI follow up

57
Q

Common sign of lower GI bleeds?

A

Hematochezia

58
Q

Common causes of lower GI bleeds?

A

Diverticulitis, polyps, cancer, IBD, infectious diarrhea, colitis, hemorrhoids

59
Q

What MUST you do for a patient with hematochezia?

A

Directly visualize anus for hemorrhoids, consider anoscopy.

60
Q

Most common cause of lower GI bleed?

A

Hemorrhoids

61
Q

Internal hemorrhoids vs external hemorroids?

A

Internal arise above dentate line

External arise below dentate line.

62
Q

Treatment for hemorrhoids?

A

Stool softeners, high fiber diet, topical anesthetics.

63
Q

Most reliable lab in evaluation of pancreatisis?

A

Lipase

64
Q

Describe the symptoms associated with pancreatitis?

A

Sharp, severe, persistent pain with nausea and vomiting

65
Q

MCC of pancreatitis in men? In women?

A

Men: alcohol abuse
Women: gallstones

66
Q

Patients with severe pancreatitis may show what signs?

A

Cullen’s and Grey-Turner’s signs

67
Q

What criteria is used to access severity of pancreatitis ?

How often should it be done?

A

Ranson’s criteria.

Used at initial evaluation and every 24 hours after

68
Q

What is the best procedure to remove foreign bodies of the esophagus?

A

endoscopy

69
Q

Where can esophageal foreign bodies occur?

A

At any narrowing. Examples include stricture, carcinoma, lower esophageal ring

70
Q

What are some pharmacologic interventions for an impacted food bolus?

A

Glucagon and nitroglycerin

They are smooth muscle relaxers

71
Q

If a hernia is not reducible, what types could it be?

A

Incarcerated or strangulated

72
Q

What is the difference between incarcerated and strangulated hernias?

A

Strangulated hernias has no blood supply, and will become nectrotic.

73
Q

How can you differentiate between incarcerated and strangulated hernias?

A

Strangulated typically very tender, have peritoneal signs, high lactate.

74
Q

Imaging study of choice for strangulated hernia?

A

CT abdomen with contrast

75
Q

What locations can a patient have hernias?

A

Ventral, umbilical, femoral, inguinal

76
Q

4 year old patient presents with crying, currant jelly stool, and a sausage mass mid abdomen. What is the likely diagnosis?

A

Intussusception

77
Q

________ is both diagnostic and therapeutic for intussusception.

A

Barium air enema

78
Q

Vomiting, weight loss, an olive shape mass mid epigastrium, and peristalic waves in an infant are suggestive of _______.

A

Pyloric stenosis

79
Q

Pyloric stenosis is usually diagnosed by what age?

A

5 months

80
Q

Diagnosis and treatment of pyloric stenosis?

A

Diagnose via US

Treatment is surgical repair.

81
Q

What causes of abdominal pain should you be sure not to miss?

A

MI, AAA, mesenteric ischemia, ectopic pregnancy, bowel obstruction, perforation.

RRPA Clinical Med II (45 decks)

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