Gastroenterology Flashcards Preview

MKSAP - Internal > Gastroenterology > Flashcards

Flashcards in Gastroenterology Deck (101)
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1

gold standard for dx. kidney stones in someone who presents with unilateral flank pain

non-contrast helical CT scan

2

acute abdomen

sudden and severe abdominal pain less than 24 hours in duration

3

next best step in pt presenting with acute abdomen

chest XR
supine and upright abdominal radiographs - to exclude bowel obstruction or perforation

4

what is definitive diagnostic test for acute abdominal pain?

abdominal CT scan

5

elderly man presents with severe back pain with syncope followed by abdominal discomfort - dx?

ruptured aortic aneurysm
- medical emergency

6

what diagnostic test should be performed in someone suspected of having ruptured aortic aneurysm

CT scan followed by surgery

7

patient presents with fever, crampy abdominal pain (LLQ) and an associated change in bowel habits; labs show leukocytosis - dx?

diverticulitis

8

Rome III criteria

atleast two of:
- pain releived with defecation
- onset assoc. w/ change in stool frequency
- onset assoc. w/ change in consistency of stool

9

alarm symptoms

older age
male sex
nocturnal awakening
rectal bleeding
weight loss
family history of colon cancer

10

tx. of constipation-predom IBS in a pt whom fibre supplements did not work

reassurance and polyethylene glycol

11

an elderly patient with known atherosclerotic disease presents with rapid onset, severe abdominal pain or tenderness; she also notes bright red rectal bleeding and diarrhea - what test should you do? what will you find? and what is diagnosis?

do CT scan abdomen
dx. ischemic colitis
- will show segmental thickening of bowel wall

12

how do you establish diagnosis of ischemic colitis?

colonscopy - patchy segmental ulcerations (in pt with compatible history)

13

patient presents with signs/symptoms of acute diverticulitis - what imaging/diagnostic test should you do?

contrast-enhanced CT scan of abdomen and pelvis
- confirms diagnosis as well as evaluates for any complications

14

what two tests should be avoided in suspected acute diverticulitis?

colonscopy
barium enema
- both pose risk of perforation with air insufflation

15

complications of diverticulitis

obstruction
perforation
abscess
fistulas

16

chronic alcoholic patient presents with chronic upper abdominal pain radiating to the back, diabetes and steatorrhea - what do you consider?

chronic pancreatitis

17

how do you confirm dx of chronic pancreatitis?

calcififcations on plain films or CT scan

18

patient presents with pain, fever and jaundice; there is also elevation of pancreatic enzymes in the setting of biliary obstruction...

acute cholangitis

19

diagnostic criteria of HUS

thrombocytopenia
microangiopathic hemolytic anemia (schistocytes, elevated reticulocytes, elevated LDH)

20

tx. of HUS

supportive with fluids and monitoring of electrolytes and blood counts
- packed RBC is anemia is severe
- antibiotics and platelets are not recommeneded

21

patient presents with diarrhea and tenesmus; she recently underwent chemotherapy and radiation for rectal cancer - dx?

radiation proctitis
- develops within 6 weeks after tx and resolves on its own usually

22

how do you diagnose radiation proctitis?

flexible sigmoidoscopy
- mucosal telengiectasias
- submucosal fibrosis
- arteriole endarteritis

23

when does stool osmolality test come in handy?

when you want to distinguish osmotic diarrhea from secretory diarrhea - ie. in pts having factitious diarrhea (low stool osmolality)

24

how does malabsorption present in chronic pancreatitis?

diarrhea, steatorrhea
weight loss
deficiency in fat soluble vitamins

25

definitive diagnostic test for chronic pancreatitis

abdominal CT scan

26

tx. of severe CDI with colitis

oral vancomycin
IV metronidazole

27

Tx. of ischemic colitis

IV fluids and bowel rest
- symptoms resolve w/in 48 hrs

28

what patients with salmonella gastroenteritis should receive antibiotic therapy?

1. pts < 2y yo or > 50 yo
2. pts with severe illness - toxicity/bacteremia
3. pts with atherosclerotic plaques, endovascular or bone prosthesis - seeding
4. immunocompromised pts

29

what drugs should be avoided in pts with infectious diarrhea (fever, bloody stools, systemic toxicity)

bowel paralytics such as loperamide

30

how do you diagnose hepatocellular injury?

elevation of ALT (more specific )and AST
direct (CB) hyperbilirubinemia > 50%