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Emergency EOR > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

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1
Q

Complications of GERD

A
  1. Esophagitis
  2. Stricture
  3. Barrett’s esophagus
  4. Esophageal adenocarcinoma
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2
Q

Esophageal squamous epithelium replaced by precancerous metaplastic columnar cells from the cardiac of the stomach

A

Barrett’s Esophagus

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3
Q

Atypical symptoms of GERD

A 
Hoarseness
Aspiration pneumonia
"Asthma"
Noncardiac chest pain
Weight loss
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4
Q

Alarm symptoms of GERD

A
  1. Dysphagia
  2. Odynophagia
  3. Weight loss
  4. Bleeding (suspect malignancy)
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5
Q

Diagnosis of GERD

A
  1. Clinical diagnosis
  2. Endoscopy (used first)
  3. Esophageal manometry
  4. 24 hours ambulatory pH monitoring (gold standard)
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6
Q

Management of GERD

A
  1. Lifestyle modifications
  2. H2 blockers, PPIs, antacids
  3. Nissen fundoplication if refractory
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7
Q

Yellowing of the skin, nail beds, and sclera by tissue bilirubin deposition as a consequence of hyperbilirubinemia. Not a disease but a sign of a disease

A

Jaundice

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8
Q

Jaundice occurs when bilirubin is > _____

A

2.5 mg/dL

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9
Q

DDX for hematemesis

A 
Esophageal varices
Mallory-Weiss tear
Esophageal neoplasms
Gastritis
Peptic ulcer disease
Gastric carcinoma
Caustic (corrosive) esophagitis
Boerhaave syndrome
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10
Q

DDX for melena

A 
Esophageal varices
Gastritis
Mallory-Weiss tear
Peptic ulcer disease
Gastric carcinoma
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11
Q

DDX for BRBPR

A

Hemorrhoids
Anal fissures
Intussusception
Colon CA

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12
Q

Most common cause of esophagitis

A

GERD

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13
Q

Risk factors for esophagitis

A 
Pregnancy
Smoking
obesity
EtOH use
Chocolate
Spicy foods
Medications
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14
Q

Signs/Symptoms of esophagitis

A
  1. Odynophagia
  2. Dysphagia
  3. Retrosternal chest pain
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15
Q

Diagnosis of esophagitis

A

Endoscopy

Double-contrast esophagram

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16
Q

Management of esophagitis

A

Treat underlying cause

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17
Q

Most common causes of infectious esophagitis

A

Candida
HSV - small, deep ulcers
CMV - large superficial shallow ulcers

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18
Q

Allergic, inflammatory infiltration of the esophageal epithelium

A

Eosinophilic esophagitis

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19
Q

Eosinophilic esophagitis is most commonly associated with:

A

Atopic disease - food/non food allergies, asthma, eczema

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20
Q

Endoscopy of eosinophilic esophagitis will show:

A

Multiple corrugated rings on esophagus, +/- white exudates

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21
Q

How might esophinophilic esophagitis present in children?

A

Difficulty feeding or reflux

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22
Q

Most commonly due to prolonged pill contact with the esophagus, prolonged supination after pill ingestion

A

Pill-induced esophagitis

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23
Q

Pill-induced esophagitis is most commonly seen with:

A
  1. NSAIDs
  2. Bisphosphonates (-dronate)
  3. Potassium chloride
  4. Iron pills
  5. Vitamin C
  6. Beta blockers
  7. Calcium channel blockers
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24
Q

Management of pill-induced esophagitis

A

Take pills with at least 4 ounces of water, avoid recumbency for at least 30-60 minutes after pill ingestion

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25
Most common cause of caustic (corrosive) esophagitis
Ingestion of corrosive substances - alkali (drain cleaner, lye, bleach) or acids
26
Management of caustic (corrosive) esophagitis
Supportive Pain meds IV fluids
27
UGI bleeding from longitudinal mucosal lacerations at the gastroesophageal junction or the gastric cardia
Mallory-Weiss tear
28
Management of Mallory-Weiss tear
Supportive - most cases stop bleeding without intervention. Acid suppression promotes healing
29
Management of Mallory- | Weiss tear if severe
Epinephrine injection Sclerosing agent Band ligation Hemoclipping or balloon tamponade
30
What two causes predispose a pt to peptic ulcers?
H pylori | NSAIDs
31
Symptoms of peptic ulcers
Duodenal ulcers: improve with meals | Gastric ulcers: worsen with meals
32
Diagnostic modality for peptic ulcers
Endoscopy | Upper GI series if unwilling to do endoscopy
33
Treatmet tfor peptic ulcers
Treat underlying cause and start PPI
34
H pylori testing
Endoscopy with biopsy gold standard + rapid urease test + urea breath test + h. pylori stool antigen + serologic antibodies
35
Treatment for H pylori
Two weeks of: BID PPI BID Clarithromycin BID Amoxicillin (or metronidazole if PCN allergic)
36
Second line treatment for H pylori
BID PPI QID Bismuth BID Metronidazole BID Tetracycline
37
Most common bacterial etiologies of acute cholecystitis
E. coli | Klebsiella
38
Diagnosis of cholecystitis
1. Ultrasound 2. CT scan 3. Labs: leukocytosis w/ left shift, high bilirubin, high LFTs 4. HIDA scan: gold standard
39
Management of cholecystitis
1. NPO, IV fluids, abx 2. Cholecystectomy 3. Pain control with NSAIDs or narcotics
40
Bacterial infection of the biliary tract from obstruction
Cholangitis
41
Most common causes of cholangitis
Choledocholithiasis (MC) Neoplasm Stricture
42
Most common organisms in cholangitis
E. coli (MC) | Klebsiella
43
Charcot's Triad
Seen in cholangitis 1. RUQ pain 2. Fever 3. Jaundice
44
Reynold's Pentad
Seen in cholangitis 1,2,3 Charcot's triad 4. Shock/Sepsis 5. AMS
45
Diagnostic modalities for cholangitis
1. Labs: leukocytosis, high bili, high ALT, AST 2. US, CT scan 3. cholangiography - gold standard via ERCP
46
Management of cholangitis
``` ABX: 1. Ampicillin/sulbactam or Piperacillin/tazobactam OR 2. Ceftriaxone + metronidazole OR 3. fluoroquinolone + metronidazole ``` stone extraction via ERCP
47
Inflammation of the liver caused by 5 different viruses
Viral hepatitis
48
Hepatitis __, __, and __ are transmitted through bodily fluids, while __ and __ are transmitted through the fecal-oral route
BCD | AE
49
Hepatitis __ requires co-infection with hepatitis __
D | B
50
Currently, the CDC suggests that all pts born between _____ and _____ have a one-time Hepatitis C screening
1945-1965
51
Signs/symptoms of viral hepatitis
1. Fever, fatigue 2. N/V 3. abd pain 4. dark discolored urine (secondary to conjugated hyperbilirubinemia) 5. jaundice
52
Hepatitis __ and __ will usually be asymptomatic
B and C
53
Diagnosis of Hepatitis
1. Elevated LFTs 2. Elevated PT (if developed cirrhosis) 3. Antibody testing (IgM and IgG)
54
In hepatitis testing, ___ is for acute infection, and ___ is for chronic infection
IgM IgG This does not apply to Hep B and C
55
Test to check for active Hepatitis C infection
Hep C virus RNA
56
If there is positive Hep C antibody, but negative RNA
Pt has cleared Hep C infection
57
If there is positive Hep C antibody and positive Hep C RNA
Pt has active Hep C infection
58
Hepatitis B screening: 1. HbsAg (-) 2. anti-HBc (-) 3. anti-HBs (-)
Hepatitis B susceptible
59
Hepatitis B screening: 1. HBsAg (-) 2. anti-HBc (-) 3. anti-HBs (+)
Immune due to natural infection
60
Hepatitis B Screening HBsAg negative anti-HBc negative anti-HBs positive
Immune due to vaccination
61
``` Hepatitis B screening: HbsAg positive anti-HBc positive IgM anti-HBc positive anti-HBs negative ```
Acutely infected
62
``` Hepatitis B screening: HbsAg positive anti-HBc positive IgM anti-HBc negative anti-HBs negative ```
Chronically infected
63
Treatment for Hepatitis A and E
Self-resolve, are not associated with chronic liver disease
64
Treatment for acute hepatitis B
Supportive Care
65
Treatment for chronic Hepatitis B or positive e-antigen
Interferon or Nucleoside analogs (entecavir, tenofovir, lamivudine, adefovir, telvibudine)
66
Treatment for hepatitis pts with cirrhosis
Require transplant
67
Treatment for hepatitis C
Ledipasvir-sofosbuvir OR | Sofosbuvir and velpatasvir
68
Most common etiologies for acute pancreatitis
1. Gallstones (MC) 2. EtOH (MC) 3. Malignancy 4. Scorpion bites 5. Mumps in children
69
Intracellular activation of pancreatic enzymes that causes autodigestion of the pancreas
Acute pancreatitis
70
Pain exacerbated if supine, eating or walking. Relieved if leaning forward or sitting.
Acute pancreatitis
71
Signs/symptoms of acute pancreatitis
1. Epigastric pain (radiates to back) 2. N/V and fever 3. Epigastric tenderness and tachycardia
72
Cullen's sign and grey turner sign
Acute pancreatitis if necrotizing/hemorrhagic Cullen's periumbilical ecchymosis Grey turner: flank ecchymosis
73
Diagnostic studies for pancreatitis
1. Leukocytosis, lipase, amylase, high glucose 2. CT: diagnostic test of choice 3. Ultrasound 4. XR - colon cutoff sign
74
Colon cutoff sign
Abrupt collapse of the colon near the pancreas | Acute pancreatitis
75
Management of pancreatitis
90% recover without complications in 3-7 days 1. Supportive - NPO, IV fluid resuscitation, analgesia with meperidine/Demerol 2. Abx not commonly used 3. If necrotizing pancreatitis - imipenem 4. ERCP - only effective for obstructive jaundice
76
Ranson's Criteria
Used to determine prognosis for pancreatitis Glucose, Age, LDH, AST, WBC Calcium, Hematocrit fall, Oxygen, BUN, Base deficit, Sequestration of fluid
77
Causes of appendicitis
Obstruction of the appendix MC due to: 1. Fecalith 2. Inflammation 3. Malignancy 4. Foreign body
78
Vomiting usually occurs _______ pain in appendicitis
After
79
Diagnosis of appendicitis
1. Leukocytosis 2. CT scan 3. Ultrasound
80
Management of appendicitis
Appendectomy
81
Most common area of diverticular disease due to intraluminal pressure
Sigmoid colon
82
Diverticulosis is associated with: (3)
1. Low fiber diet 2. Constipation 3. Obesity
83
Most common cause of acute lower GI bleeding
Diverticulosis
84
Sign/Symptoms of diverticulitis
Fever LLQ abdominal pain N/V/D/C
85
Diagnosis of diverticulitis
CT is test of choice | Labs: WBCs increased, + guiac
86
Management of diverticulitis
Clear liquid diet | ABX (cipro or Bactrim + metronidazole)
87
Sudden decrease of mesenteric blood supply to the bowel leading to inadequate perfusion especially at splenic flexure
Acute mesenteric ischemia
88
Most common cause of acute mesenteric ischemia
Occlusion - embolus (AFib, MI) | Also: thrombus (atherosclerosis)
89
Nonocclusive causes of acute mesenteric ischemia
Shock (decreased blood flow) Cocaine (vasospasms) Venous thrombosis
90
Severe abdominal pain out of proportion to physical findings. Usually poorly localized pain with n/v/d, possible peritonitis
Acute mesenteric ischemia
91
Diagnosis of acute mesenteric ischemia
1. Angiogram definitive 2. Colonoscopy - patchy, necrotic areas 3. WBC high, lactic acidosis
92
Management of acute mesenteric ischemia
``` Surgical revascularization (angioplasty or stenting with bypass) Surgical resection if bowel is not salvageable ```
93
Increased risk of CA in both when there is colonic involvement
Inflammatory bowel disease - UC and Crohn's
94
Signs/Symptoms of inflammatory bowel disease
1. Abd pain 2. Weight loss 3. Bloody diarrhea 4. Fever
95
Extraintestinal manifestations of IBD
1. Erythema nodosum 2. Arthritis 3. Uveitits 4. Pyoderma gangrenosum 5. Primary sclerosing cholangitis
96
Characteristics of ulcerative colitis
Involves colon Continuous involvement pANCA positive
97
Characteristics of crohn's disease
``` Skip lesions Entire GI tract involvement (mouth to anus) Transmural inflammation Cobblestone appearance Fistulas may be seen ASCA positive ```
98
Treatment for inflammatory bowel disease
1. Steroids for acute exacerbations 2. Sulfasalazine or mesalamine 3. If no response to sulfa or mesalamine, ABX are used for crohn's only 4. Colectomy or proctocolectomy is offered to those with extensive dz refractory to medications
99
Etiologies of toxic megacolon
UC Crohn's Pseudomembranous colitis Infectious
100
Signs/symptoms of toxic megacolon
``` Fever Abd pain N/V/D Rectal bleeding Tenesmus (cramping rectal pain) Electrolyte disorders ```
101
Physical exam findings for toxic megacolon
``` Abd tenderness Rigidity Tachycardia Dehydration Hypotension AMS ```
102
Diagnosis of toxic megacolon
1. AXR: large dilated colon > 6 cm
103
Management of toxic megacolon
``` Bowel decompression Bowel rest NG tube Broad-spectrum abx Electrolyte repletion ```
104
Most common cause of large bowel obstruction in adults
Colorectal cancer
105
Most common causes of small bowel obstruction
1. Adhesions 2. Incarcerated hernia 3. Crohn's dz 4. Malignancy
106
Signs/Symptoms of small bowel obstruction
``` CAVO Cramping abd pain Abdominal distention Vomiting - may be bilious if proximal Obstipation (late finding) - diarrhea early ```
107
Physical exam for SBO
Abdominal distention Hyperactive bowel sounds in early obstruction Hypoactive bowel sounds in late obstruction
108
Diagnosis of small bowel obstruction
1. AXR - air fluid levels in step ladder pattern, dilated bowel loops
109
Management of small bowel obstruction
Nonstrangulated: NPO, IV fluids, NG tube Strangulated: surgical intervention
110
Twisting of any part of the bowel at its mesenteric attachment site
Volvulus
111
Most common area of volvulus occurrence
Sigmoid colon and cecum
112
Signs/Symptoms of volvulus
``` Obstructive symptoms Abd pain Distention N/V Fever, tachycardia ```
113
Management of volvulus
Endoscopic decompression initial treatment of choice | Surgical correction is second line
114
Causes of anal fissures
Low fiber diets Passage of large, hard stools Other anal trauma
115
Signs/symptoms of anal fissure
Severe rectal pain Painful bowel movements causing pt to refrain from having BM Leads to constipation BRBPR
116
Where is the most common location of anal fissures
90% posterior midline
117
Treatment for anal fissures
``` 80% resolve spontaneously Supportive measure: warm sitz baths High fiber diet Analgesic Increased water intake Stool softeners ```
118
Second line treatment for anal fissures
Topical vasodilators: nitroglycerin
119
Surgical procedure for anal fissures
Lateral internal sphincterotomy
120
Most common bacterial etiologies of anorectal abscesses
Staph aureus | E coli
121
Most common location of anorectal abscesses
Posterior rectal wall
122
Open tract between two epithelial-lined areas
Fistula | Seen commonly with anorectal abscesses
123
Symptoms of anorectal abscess
Swelling Rectal pain that is worse with sitting, coughing, and defecation May have anal discharge if fistula present
124
Management of anorectal abscesses
``` I&D followed by wash Warm water cleaning Analgesics Sitz baths High-fiber diets ```
125
Internal hemorrhoids result from engorgement of which venous plexus
Superior hemorrhoidal vein
126
External hemorrhoids result from engorgement of which venous plexus
Inferior hemorrhoidal vein
127
Risk factors for hemorrhoids
``` Increased venous pressure Straining during defecation (constipation) Pregnancy Obesity Prolonged sitting Cirrhosis with portal hypertension ```
128
Symptoms of internal hemorrhoids
``` Rectal bleeding (intermittent) Hematochezia Rectal itching and fullness Mucous discharge Rectal pain suggests complications ```
129
Symptoms of external hemorrhoids
Perianal pain - aggravated with defecation | +/- tender palpable mass
130
Diagnosis of hemorrhoids
``` visual inspection digital rectal exam fecal occult blood testing proctosigmoidoscopy colonoscopy in pts with hematochezia to r/o proximal sigmoid disease ```
131
Management of hemorrhoids
conservative tx - high fiber diet, increased fluids, warm sitz bath, topical rectal corticosteroids for pruritus and discomfort if failed conservative therapy or debilitating pain: Rubber band ligation Sclerotherapy Infrared coagulation Hemorrhoidectomy (for all stage IV)
132
Hernia that occurs lateral to the inferior epigastric artery
Indirect inguinal hernia
133
Indirect hernias are often congenital and occur due to a __________ ___________ __________ ___________
Persistent patent process vaginalis
134
Most common overall type of hernias in men and women
Indirect inguinal hernia
135
Hernia that occurs medial to the inferior epigastric arteries within Hesselbach's triangle
Direct inguinal hernia
136
Borders of Hesselbach's Triangle
RIP Rectus abdominis Inferior epigastric arteries Poupart's Ligament
137
Signs/Symptoms of a strangulated hernia
Incarcerated hernia with systemic toxicity Compromised blood supply-ischemic Severe painful bowel movement
138
Management of inguinal hernias
Often require surgical repair | Strangulated are surgical emergencies
139
Hernia that is most commonly seen in women
Femoral hernia
140
Often become incarcerated or strangulated compared to an inguinal hernia so surgical repair is often done
Femoral hernia
141
Management of umbilical hernias
Observation, will usually resolve by 2 years old | Surgical repair if still persistent in children > 5 y/o
142
Incision hernias occur most commonly with __________ and in ___________
Vertical incisions | Obese patients
143
Most common causes of gastritis
``` H pylori infection Autoimmune causes (pernicious anemia) ```
144
Most common causes of gastropathy
NSAIDs Alcohol Bile reflux
145
Treatment for gastritis
Treat underlying cause and give PPPI
146
Acute diarrhea is defined as being less than _________ in duration
2 weeks
147
C. diff is commonly associated with __________, however, any abx can lead to c diff
Clindamycin
148
C. diff diarrhea will present __________ following abx therapy, and will present as excessive (_________)
days to weeks | over 10x daily
149
Signs/symptoms of c. diff infxn
Watery diarrhea Abdominal pain Fever Leukocytosis
150
Treatment for c. diff
Metronidazole is best initial therapy | If no response, follow with vancomycin
151
Infectious diarrhea can be divided into: ________ and _________
Inflammatory (blood or WBC in stool) | Non-inflammatory
152
Most accurate test for identifying bacteria
Stool culture
153
Most common organism isolated in inflammatory diarrhea
Campylobacter
154
Inflammatory diarrhea is treated with
Fluoroquinolone (ciprofloxacin, ofloxacin, moxifloxacin) Azithromycin is an appropriate alternative
155
Non-inflammatory diarrhea is treated with:
Supportive therapy | Oral rehydration
156
Diagnosis for giardiasis diarrhea
ELISA for giardia antigen
157
Treatment for giardiasis diarrhea
Metronidazole
158
Diarrhea and symptoms that begin within 6 hours suggests __________ or ____________
Staphylococcus | Bacillus cerus
159
Diarrhea and symptoms that begin within minutes is
Scombroid
160
Diarrhea associations: chicken and eggs
Salmonella
161
Diarrhea associations: shellfish
Vibrio
162
Diarrhea associations: rice water stools
Cholera
163
Diarrhea associations: camping and freshwater
Giardia
164
Diarrhea associations: canned foods
Clostridium
165
Diarrhea associations: poultry and raw milk
Campylobacter | Associated with reactive arthritis and Guillain-Barre syndrome
166
Diarrhea associations: daycare centers
Shigella
167
Diarrhea associations: spoiled fish, wheezing, flushing, vomiting, diarrhea
Scrombroid
168
Dyssynergic defecation, slow transit, and IBS-constipation type
Primary causes of contipation
169
DM, hypothyroid, hypercalcemia, intestinal mass, Parkinson's disease, anal stricture, and medications
Secondary causes of constipation
170
Alarm symptoms of constipation
1. Hematochezia 2. Weight loss 3. Fam hx of colon CA 4. Anemia 5. Heme positive stool 6. Severe persistent constipation
171
Diagnosis of constipation
1. Rectal exam - r/o masses, fissures, sphincter tone | 2. Colonscopy if alarm sx
172
Treatment of constipation
1. Increase fluids, exercise, develop bowel pattern 2. Fiber of 25 g daily 3. Bulk/osmotic laxatives 4. Prunes are an alternative
173
Chronic GI bleeding presents as
Hemoccult + stools Iron deficiency anemia Both
174
An acute upper GI bleeding is ____________ than lower GI bleed
3x more common
175
Acute upper GI bleeding presents as:
Hematemesis (MC) Melena Hematochezia
176
Most common causes of upper GI bleeds
Peptic Ulcers | Esophageal varices
177
Most common causes of lower GI bleeding
Diverticular dz | Vascular malformation
178
Mostly irreversible liver fibrosis with nodular regeneration secondary to chronic liver diseasee
Cirrhosis
179
The nodules of cirrhosis cause
Increased portal pressure
180
Macronodules seen in cirrhosis are associated with a high risk of:
Hepatocellular carcinoma
181
Most common cause of cirrhosis in US
EtOH
182
Other causes of cirrhosis besides EtOH (4)
1. Chronic viral hepatitis 2. Nonalcoholic fatty liver disease (obesity, DM, hypertriglyceridemia) 3. Hemochromatosis 4. Primary biliary cirrhosis, primary sclerosing cholangitis, drug toxicity
183
Signs/Symptoms of cirrhosis
1. Fatigue, weakness 2. Weight loss 3. Muscle cramps 4. Anorexia
184
Physical exam with cirrhosis
1. Ascites 2. Hepatosplenomegaly 3. Spider angiomas 4. Caput medusa 5. Palmar erythema 6. Gynecomastia 7. Dupuytren's contracture 8. Jaundice 9. Esophageal varices
185
Diagnosis of cirrhosis
Ultrasound - determines liver size and evaluates for HCC | Liver biopsy
186
Treatment of cirrhosis
1. Lactulose. Rifaximin - abx 2. Sodium restriction - diuretics, paracentesis 3. Cholesytramine to help with itching
187
Definitive treatment of cirrhosis
Liver treatment

Emergency EOR (12 decks)

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