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Gastrointestinal Flashcards

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1
Q

Acute appendicitis pain can start and radiate to

A

periumbilical to McBurney’s point

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2
Q

Rupture of appendix symptoms

A
  • acute abdomen
  • involuntary guarding
  • rebound tenderness
  • board-like abdomen
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3
Q

Another term for rebound tenderness

A

Blumberg’s sign

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4
Q

Typical presentation of acute cholecystitis

A
  • overweight female
  • ate a fatty meal within 1 hour or more
  • Severe RUQ or epigastric pain
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5
Q

Where can acute cholecystitis pain radiate to

A

right shoulder

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6
Q

Acute diverticulitis presentation

A
  • acute onset of high fever
  • anorexia
  • N/V
  • LLQ pain
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7
Q

Positive Rovsing’s sign

A

Pain in RLQ with palpation of LLQ

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8
Q

Acute pancreatitis presentation

A
  • acute onset fever
  • N/V
  • rapid abdominal pain
  • radiates to midback
  • located in epigastric region
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9
Q

Common causes of acute pancreatitis

A
  • drugs
  • biliary factors
  • alcohol abuse
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10
Q

Positive Cullen’s sign

A
  • blue discoloration around umbilicus

- indicative of acute pancreatitis

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11
Q

Positive Grey-Turner’s Sign

A
  • blue discoloration on the flanks

- indicative of acute pancreatitis

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12
Q

C.diff presentation

A
  • severe watery diarrhea
  • 10-15 stools a day
  • lower abdominal pain
  • cramping
  • fever
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13
Q

Antibiotics implicated with C.diff

A
  • Clindamycin
  • fluroquinolones
  • cephalosporins
  • PCNs
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14
Q

When to suspect colon cancer

A
  • older patient with vague GI symptoms
  • bloody stools
  • history of multiple polyps or IBD
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15
Q

Crohn’s disease pathology

A

-inflammation of any part of the GI tract

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16
Q

Crohn’s disease relapse

A
  • fever
  • anorexia
  • weight loss
  • dehydration
  • fatigue with periumbilical to RLQ abdominal pain
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17
Q

Crohn’s disease is at higher risk for

A

toxic megacolon
colon CA
lymphoma (especially if treated with azathioprine)

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18
Q

Ulcerative colitis pathology

A

-inflammation of colon/rectum

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19
Q

Ulcerative colitis presentation

A
  • bloody diarrhea with mucus (hematochezia)
  • squeezing cramping pain in LLQ
  • bloating and gas with food
  • arthralgias and arthritis
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20
Q

Ulcerative colitis is at higher risk for

A

toxic megacolon

colon CA

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21
Q

Zollinger-Ellison syndrome

A
  • gastrinoma (tumor) on pancreas or stomach
  • secretes gastrin to produce high levels of acid in stomach
  • results in multiple and severe ulcers in stomach and duodenum
  • epigastric to midabdominal pain
  • tarry stools
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22
Q

Zollinger-Ellison syndrome screening

A

serum fasting gastrin level

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23
Q

Possible causes of acute abdomen

A
  • appendicitis
  • cholecystitis
  • pancreatitis
  • diverticulitis
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24
Q

Preferred imaging for appendicitis

A

CT

US in peds

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25
Preferred imaging for cholecystitis
- US | - HIDA if US inconclusive
26
Preferred imaging for diverticulitis
CT
27
Preferred imaging for pancreatitis
CT | abdominal US
28
Organs in RUQ
- liver - gallbladder - ascending colon - right kidney
29
Organs in LUQ
- stomach - pancreas - descending colon - left kidney
30
Organs in RLQ
- appendix - ileum - cecum - right ovary
31
Organs in LLQ
- sigmoid colon | - left ovary
32
Organs in suprapubic area
- bladder - uterus - rectum
33
Psoas/iliopsoas sign maneuver
- (+): RLQ abdominal pain - supine, raise right leg against pressure of hand resistance - patient on left side, extend right leg from hip
34
Obturator sign maneuver
- (+) if inward rotation of hip causes RLQ pain - rotate right hip through full ROM - pain with movement or flexion of hip
35
McBurney's point
-between superior iliac crest and umbilicus in RLQ
36
Markle test
- aka heel jar - raise heels and drop suddenly - or ask to jump in place - positive if pain elicited or patient refuses to perform due to pain
37
Involuntary guarding
-with palpation, abdominal muscles reflexively become tense or board-like
38
Murphy's sign
- deep palpation of RUQ under costal margin during inspiration - (+) midinspiratory arrest
39
Positive Murphy's sign is indicative for
Cholecystitis
40
Complication of GERD
Barrett's esophagitis (precancer) | increased risk of SCC
41
GERD objective findigns
- acidic or sour odor to breath - reflux of sour acidic stomach contents - thinning tooth enamel - chronic sore red throat - chronic coughing
42
First line treatment for GERD
- lifestyle modifications - avoid large and/or high fat meals - avoid eating 3-4 hours before bedtime - avoid ASA - avoid mints, chocolate, alcohol, caffiene, NSAIDs, carbonated beverages, other aggravating foods - smoking cessation
43
Medications with GERD side effects
- BB - CCB - alpha 1 or alpha 2 adrenergic receptor agonists
44
3 mechanisms of GERD
- reduction in LES tone - irritation of esophageal mucosa - increased gastric acid secretion
45
Examples of antacids
- Maalox - Mylanta - Rolaids - Tums
46
Antacids mechanism
- increase pH for about 20-30 minutes | - fastest relief
47
H2 receptor antagonist examples
- Cimetidine (Tagamet) - Famotidine (Pepcid) *** - Nizatidine (Axid)
48
H2 receptor antagonist mechanism
- decrease acid production for 6-12 hours | - relief in 60 minutes
49
PPI examples
- omeprazole (Prilosec) - Lansoprazole (Prevacid) - Esomeprazole (Nexium) - Pantoprazole (Protonix)
50
PPI mechanism
- reduce gastric acid secretion - relief in 1-3 days - Rx for 4-8 weeks
51
Gold standard treatment for GERD
PPI
52
GERD diagnosis
- presumptive: heartburn, dysphagia, regurgitation | - empiric treatment with PPI
53
PPI long-term therapy associated with
- hip fractures - PNA - C.diff
54
PPI discontinuation
- needs taper | - can cause rebound symptoms
55
Patient with GERD not responding to therapy in 4-8 weeks
- high risk for Barrett's | - refer to GI for upper endoscopy/biopsy
56
Worrisome symptoms of GERD
- progressive dysphagia - iron-deficiency anemia - weight loss - Hemoccult positive
57
What do Cullen's sign and Grey-Turner's sign indicate
-retroperitoneal bleeding
58
How does smoking effect GERD
increases stomach acid | -lowers esophageal sphincter pressure
59
IBS pathology
- chronic functional disorder of colon - exacerbations and spontaneous remissions - common exacerbation by stress - diarrhea or constipation, can be both
60
IBS treatment plan
- increase dietary fiber - supplement with psyllium (Metamucil) - avoid gassy foods: beans, onion, cabbage, high-fructose corn syrup - decrease stress
61
IBS with constipation treatment
-fiber supplement
62
IBS with diarrhea treatment
-loperamide (Imodium) before meals
63
Infectious causes of diarrhea
- usually viral - Salmonella, Shigella, Campylobacter - Giardia, etc.
64
Diarrhea red flags
- rectal bleeding - nocturnal or progressive abdominal pain - weight loss - anemia - elevated inflammatory markers - electrolyte disturbance
65
Hematochezia
blood in stool
66
Which ulcer has a higher risk of malignancy
Gastric ulcers
67
Which ulcers are mostly benign
Duodenal
68
Most common cause of both duodenal and gastric ulcers
H.pylori
69
Etiology of PUD
- H.pylori - Chronic NSAID use --> reduction of GI blood flow and reduction of protective mucosal layer - Tobacoo - alcohol - stress after acute illness - bisphosphonates
70
PUD labs
- CBC - FOBT - H.pylori testing - If (+) for H.pylori --> gastroenterology referral
71
Gold standard for diagnosing PUD
-upper endoscopy and biopsy
72
Testing for H.pylori
- Serology (titers): IgG elevated, not used to document eradication - Urea breath test: active H.pylori, can be used to document eradication - Stool antigen: screening and eradication documentation.
73
H.pylori negative PUD treatment
- Stop NSID use - H2 blockers at bedtime - PPI for 4-8 weeks daily
74
H.pylori triple therapy
- Clarithromycin (Biaxin) - Amoxicillin or metronidazole (PCN allergy) - PPI 4-8 weeks
75
H.pylori quad therapy
- Bismuth subsalicylate tab - Metronidazole tab - Tetracycline - PPI 4-8 weeks
76
Treatment duration for H.pylor ulcers
14 days
77
Colorectal cancer screening starts at
age 50
78
Gold standard for colon CA screening
colonoscopy q10 years
79
Cause of diverticula
- pouch-like herniations due to poor diet and lack of fiber | - higher incidence in Western societies
80
Diverticulitis presentation
- older adult - acute fever - LLQ pain - anorexia - N/V - hematochezia
81
Diverticulitis treatment plan
- uncomplicated cases can be treated outpatient - routine antibiotic treatment controversial - Ciprofloxacin and Flagyl x 19-14 days - probiotics - increased fiber intake not recommended until resolved - follow up in 2-3 days, go to ED if no improvement
82
Chronic therapy for diverticulosis
-high fiber diet with supplementation
83
Causes of acute pancreatitis
- alcohol abuse - gallstones - elevated TG - infections
84
Pathology of pancreatitis
-pancreatic enzymes activate and autodigest
85
TG levels for pancreatitis risk
->800
86
Where can acute pancreatitis pain refer to
midback
87
Complications of acute pancreatitis
- ileus - sepsis, shock, multiorgan failure - diabetes
88
C.diff labs
- PCR - CBC with leukocytosis - stool assay - testing and treating asymptomatic patients not recommended
89
C.diff treatment
``` -Oral Vancomycin most effective Flagyl 10-14 days used if Vancomycin not available for some reason -avoid antimotility agents -probiotic use controversial -increase fluid intake ```
90
IgG anti-HAV positive
- Immune | - previous HAV infection or immunized
91
IgM anti-HAV positve
- acute infection | - still contagious
92
HBsAg
- screening for HBV | - (+) acute infection or chronic infection
93
Anti-HBs
- (+) immune | - from past infection or immunization
94
HbeAg
- active viral replication | - persistent e: chronic HBV
95
alk phos is found in
``` liver bone GI kidneys placenta ```
96
causes of elevated alk phos
- age (growth spurt) - pregnancy - recent healing fracture - hyperthryoidism - bone metastasis - overdose with acetaminophen
97
Anti-HBc
current or previous infection
98
Anti-HCV indication
screening for hep C does not always mean patient recovered from infection -may indicated current infection -carrier
99
Next step with + anti-HCV
- HCV RNA or HCV PCR to r/o chronic infection | - if positive, refer to GI for biopsy
100
what does hepatitis D require for infection
-current hepatitis B infection
101
Risk of concurrent hep B and hep D infection
- increases risk of - fulminant hepatitis - cirrhosis - severe liver damage - low prevalence in US
102
HBsAg (-) Anti-HBc (-) Anti-HBs (-)
not immune no current infection need vaccination
103
HBsAg (-) anti-HBc (+) anti-HBs (+)
immune from previous infection
104
HBsAg (-) anti-HBc (-) anti-HBs (+)
immune from immunization
105
HBsAg (+) anti-HBc (+) IgM anti-HBc (+) anti-HBs (-)
acute infection
106
HBsAg (+) anti-HBc (+) IgM anti-HBc (-) anti-HBs (-)
chronically infected
107
HBsAg (-) anti-HBc (+) anti-HBs (-)
unclear
108
Normal AST
0-45
109
Where is AST found
``` liver heart skeletal muscle kidney lung ```
110
Normal ALT
0-40
111
Where is ALT found
primarily in liver
112
Can hepatitis A be chronic
no
113
Hepatitis A transmission
fecal oral
114
Food workers with active hepatitis A
avoid work for 1 week after onset of infection
115
Hepatitis B transmission
-sexual activity blood vertical transmission
116
Hepatitis B treatment
- pegylated interferon alfa - entecavir - tenofovir disoproxil fumarate
117
Hepatitis C transmission
- needle sharing - blood transfusions before 1992 - vertical transmission - needle stick injuries - sexual contact
118
Most common cause for liver cancer and transplant in US
hepatitis C
119
Hepatitis C management
refer to GI | -biopsy to stage
120
acute hepatitis presentation
- fatigue - nausea - dark colored urine for several days - new sexual partner - jaundice - liver tenderness
121
acute hepatitis labs
-AST/ALT: elevated 10x during acute phase
122
Which lab value is usually elevated during growth spurts
alk phos
123
LFT's may be normal in chronic liver disease
true
124
Labs for acute pancreatitis
amylase and lipase
125
HIDA scan is used for...
rule out cholecystitis
126
Bloody traveler's diarrhea may be caused by
Campylobacter jejuni
127
Watery traveler's diarrhea may be caused by
salmonella or e.coli
128
Best antibiotic to treat traveler's diarrhea
Cipro
129
Foods that contain gluten
- wheat - barley - rye - Rice is OKAY
130
How to differentiate between intra and extra abdominal mass
- instruct patient to lift head off table while tensing her ab muscles to visualize any mass and palpate the abdominal wall. - if intra: will be pressed down by muscles and be less obvious
131
Statin plus high dose B complex can cause what
drug induced hepatitis
132
What is high dose B complex
Niacin
133
First line treatment for mild C.diff
-Flagyl 500 mg PO TID x 10-14 days
134
Treatment for severe C.diff
-Vancomycin

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