Gastrointestinal System Flashcards

Question

Esophagogastroduodenoscopy (ECG)

Answer 1

1. Indicated for Upper GI bleed 2. Hemostatic intervention (cauterization, epinephrine injection) 3. Severe hemorrhagic secondary to PUD = IV PPI &blood transfusions

Answer 2

Tarry bowel movements and abdominal pain are consistent with upper GI bleeding (UGIB), likely arising as a complication of peptic ulcer disease (PUD) from NSAID use. Hypotension and tachycardia indicate the development of hypovolemic shock.

Answer 3

This patient's right upper quadrant (RUQ) abdominal pain and fever in combination with a hypoechoic lesion in the right hepatic lobe are suggestive of a liver abscess.

Answer 4

patient presents with chest pain, tachycardia, tachypnea, and crepitus over the chest (mediastinal emphysema) one day after an endoscopic procedure.

Answer 5

1. Metronidazole (or tinidazole) is considered the first-line treatment to eradicate invasive trophozoites in patients with symptomatic intestinal amebiasis (amebic dysentery) and extraintestinal amebiasis (e.g., amebic liver abscess). Following treatment with metronidazole or tinidazole, patients should also receive an intraluminal amebicide (e.g., paromomycin) to eradicate intestinal cysts and prevent relapse. In travelers with asymptomatic infection, treatment with luminal agents is usually sufficient. Individuals from endemic areas with asymptomatic infection do not require treatment 2. Metronidazole is indicated for giardiasis and is common in Southeast Asia. However, the incubation period is 7–14 days.

Answer 6

Erythromycin is a macrolide antibiotic that may be considered for the treatment of fluoroquinolone-resistant Campylobacter jejuni. Infections with Campylobacter cause inflammatory diarrhea with blood-tinged stools and fever.

Answer 7

Iron supplementation can result in dark stools, which may be mistaken for melena. Melena (black, tarry stools) occurs as a result of upper gastrointestinal bleeding. Since this patient has stools that are blood-tinged rather than tar-like, the site of blood loss is most likely the lower GI tract.

Answer 8

Albendazole is used to treat nematode infections and certain cestode infections (e.g., cysticercosis, echinococcosis). Although patients with intestinal helminthic infections can present with abdominal pain and/or blood in stools. Albendazole is not effective against protozoa such as Entamoeba histolytica.

Answer 9

Praziquantel is used to treat most trematode infections (e.g., schistosomiasis, clonorchiasis) and certain cestode infections (e.g., taeniasis). Intestinal taeniasis, clonorchiasis, and certain forms of schistosomiasis (Schistosoma japonicum, Schistosoma mansoni) are diagnosed by the presence of eggs in feces.

Answer 10

Doxycycline is the treatment of choice for diarrhea due to cholera. However, patients with cholera have frequent, voluminous “rice water” stools, are often severely dehydrated, and are usually febrile.

Answer 11

1. TMP-SMX is not the treatment of choice for intestinal amebiasis. Instead, it is used in the treatment of diarrhea due to cyclosporiasis. Diarrhea in patients with cyclosporiasis is typically watery and nonbloody, and stool microscopy reveals acid-fast oocysts instead of hematogenous trophozoites. 2. TMP-SMX is used to treat Whipple's disease, which has a highly variable presentation but commonly manifests with diarrhea and gastrointestinal symptoms. Whipple's disease, however, typically involves extraintestinal symptoms such as arthritis and is not associated with a positive IgA TTGA.

Answer 12

Def: 1. A small hole or tunnel in the skin at the top of the buttocks (where they divide). 2. Does not cause symptoms (maybe, discomfort and irritation around the tailbone), but can lead to infection (infection—> abscess —> draining pus through the sinus) if left untreated. 3. The abscess leads to pain, foul smell, & drainage 4. Treatment: abscess drainage or sinus removal.

Answer 13

Def: 1. A small tear in the mucosa that lines the anus. Sign/symptoms: 1. Extreme pain & discomfort around the anus 2. Inability to sit 3. Inability to defecate due to extreme pain Initial treatment: (purpose: reduce anal sphincter tone & promote mucosal healing, by increasing blood flow to the anal mucosa) 1. Sitz bath 2. Topical therapy with calcium channel blockers (nifedipine, diltiazem) Refractory to conservative therapy: 1. Botulinum toxin injection (relaxes the hypertonic anal sphincter, not a first line treatment)

Answer 14

Def: 1. Abnormal tunnel under the skin that connects the anal canal in the colon to the skin of the buttocks. 2. Can be caused after a surgery or by IBD ( Crohn’s disease or ulcerative colitis) Signs: 1. Bloody stool 2. Rectal pain 3. Malodorous perianal discharge Treatment: 1. Tract curettage ( also, used in treatment of pilonidal disease and hidradenitis suppurativa )

Answer 15

Sign/symptoms: 1. Bloody stool 2. Weight loss 3. Constipation 4. Reduction in stool caliber Treatment: 1. Colonoscopy ( every 10 years, if family history is positive, or 10 years before the age of diagnosis of the fist relative)

Answer 16

Def: 1. Pus-filled cavity developed after obstruction & bacterial overgrowth. Sign/symptoms: 1. Pain on defecation 2. No bloody stool 3. Purulent perianal discharge Complication: can develop into anal fistula (chronic manifistation) Treatment: 1. Combination of Metronidazole & ciprofloxacin

Answer 17

1. Used for diagnosis of appendicitis in children & pregnant women

Answer 18

Sign/symptoms: 1. Low-grade fever 2. Elevated WBC ( leukocytosis) 3. Migrating abdominal pain 4. RLQ pain- tenderness 5. Rebound pain Finding on US: 1. Non-compressible & distended appendix (> 6-8 mm) 2. Fluid around the appendix 3. Target sign

Answer 19

Def: 1. Twisting of an intraperitoneal loop of intestine around its mesentery. Sign/symptoms: 1. Vomiting 2. Abdominal pain & distention 3. Bowel obstruction (abdominal tenderness) 4. Bloody stool in infant 5. Hemodynamic instability Diagnosis: 1. Upper GI series Treatment: 1. Surgery

Answer 20

Def: 1. Recurrent, self limited episode of vomiting (bilious or non-bilious) associated with psychological stressors Sign/symptoms: 1. Recurrent, self-limited vomiting 2. Abdominal pain (hours to days) 3. Absence of symptoms between episodes

Answer 21

Sign/symptoms: 1. Diarrhea 2. Maybe, vomiting 3. Self limited (3-7 days)

Answer 22

Def: 1. Vomiting causes dehydration (dry mucous membrane) with loss of HCl & KCl 2. Hypovolemia = secretes Aldosterone = worsen Hypokalemia = causes paradoxical aciduria = & contraction alkalosis Sign/symptoms: 1. Newborn infants (less than 6 weeks of age) 2. Non-bilious Projectile vomiting after feeding 3. Palpable abdominal mass “ olive-shaped” 4. If left untreated, will lead to dehydration, weight loss, failure to thrive Laboratory: 1. Hypokalemia 2. Hypochloremic metabolic alkalosis Initial treatment: 1. IV-fluid therapy with 0.9% NaCl (adequate rehydration & correction of electrolyte imbalance) 2. Surgery: Ramstedt pyloromyotomy

Answer 23

Sign/symptoms: 1. Common in children 2. Heartburn 3. Regurgitation

Answer 24

Sign/symptoms: 1. Life-threatening 2. Intermittent episode of abdominal pain 3. Tachycardia 4. Hypertension 5. Neuropathy 6. Red urine ( wine-like)

Answer 25

Def: 1. Acute liver inflammation 2. Acute infection Caused by: 1. History of IV-Drug use Sign/symptoms: 1. Fatigue 2. Jaundice 3. Hepatomegaly 4. History of past IV-drug use Screening: 1. Hepatitis C antibody test (positive in active, chronic or previous infection) Diagnosis: 1. PCR for hepatitis C virus RNA Complication: 1. Porphyria Cutanea Tarda (PCT): common extra-hepatic manifestation of chronic hepatitis C (shows erosions/blisters at the dorsum of hand) Treatment: (chronic HCV) 1. Combination of direct-acting antiviral ( ledipasvir & sofosbuvir)

Answer 26

Triad of: 1. Fatigue 2. Jaundice 3. Hepatomegaly

Answer 27

1. Common cause of abdominal pain in children (who begin toilet training or those who start going to school) 2. Treatment: 1st: Oral osmotic laxative (poly-ethyelene glycol) 2nd: enema 3. Early treatment prevents fecal impaction (seen with U/S)

Answer 28

1. Common in children less than 2 years of age 2. Happens when the ileum folds into the cecum 2. Signs: * Colicky abdominal pain lasts 15-20 min * non-bilious vomiting * currant jelly stool (reddish mucoid stool) * palpable mass at RLQ * U/S shows: target sign at site of intussusception * ** “grabs his abdomen & draws up his legs”*** * mechanical bowel obstruction (constipation & hyperactive bowel sounds) 3. Treat with: barium enema (perform air enema on the infant)

Answer 29

Indicated in case of: 1. Acute appendicitis (RLQ pain, N/V, fever, leukocytosis, U/S dilated non-compressible appendicitis, peri-appendiceal fluid collection) 2. Acute dysentery ( blood in stool & diarrhea) (caused by shigella or entaemoba histolytica)

Answer 30

Signs: 1. Extremely ill patient 2. Hypoactive bowel sound 3. Usually lie still ( not restless) 4. Rebound tenderness & guarding 5. Tachycardia 6. Hypotension

Answer 31

1. Vibrio cholera 2. Vibro parahaemolyticus (fever, abdominal cramps, vomiting, watery diarrhea within 12-52 hours) 3. Hepatitis A virus 4. Hepatitis E virus 5. Norovirus 6. Paragonimus

Answer 32

Signs: 1. Can occur following antibiotic use 1. Watery, foul smelling stool, occasionally streaked with blood 2. Leukocytosis 3. Mild diffused tenderness through Lower abdominal quadrants (inflamed colon) Diagnosis: 1. Stool toxin test: PCR is used to detect C.difficile toxin gene in stool sample 2. Enzyme immunoassay (EIA): detect glutamate dehydrogenase (GDH), toxin A, or Toxin B.

Answer 33

1. Presence of blood-tinged stool & mucus in new born baby 2. No sign of obstruction (vomiting, diarrhea, fever, hypotension) 3. Treat: continue breastfeeding & advise mother to avoid diary & soy products 4. Rectal bleeding resolve within 3 days of removal of offending food antigen 5. The baby will be able to tolerate the offending antigen if introduced again when they are 1 year old

Answer 34

Def: 1. Can manifest in infancy, but usually 8-12 months of age (2-3 months after introduction of gluten to the diet) Sign/symptoms: 1. Steatorrhea 2. Signs of Malabsorption (vitamin deficiency, anemia, failure to thrive) 3. No GI bleeding 4. Pruritic vesicles in both elbow & knee (dermatitis herpetiformis) Diagnose: 1. IgA anti-tissue Transglutaminase antibody

Answer 35

1. Detected by stool antigen immunoassay 2. Associated with peptic ulcer disease, manifest later in life with: abdominal pain worsen with eating, GI bleeding, vomiting.

Answer 36

Sign: (in preterm-premature infants) 1. Abdominal distention 2. Blood-tinged stool 3. Systemic signs of illness (vomiting, diarrhea, fever, hypotension) 4. Feeding intolerance Diagnosis: 1. Abdominal X-ray shows: Pneumatosis intestinalis (gas within the wall of intestine) Treatment: 1. Administer a broad-spectrum parental antibiotics (combination of ampicillin, tobramycin, & metronidazole) Note: 1. preterm infant presents with poor feeding, vomiting, lethargy, peritonitis on examination, thrombocytopenia, and metabolic acidosis, all of which are consistent with the diagnosis of severe necrotizing enterocolitis (NEC). An x-ray showing bubbles of gas within intestinal wall (pneumatosis intestinalis) confirms the diagnosis. 2. Surgical intervention (Exploratory laparotomy) for NEC is warranted when there is evidence of peritonitis (concerning for gangrenous bowel), perforation (pneumoperitoneum on x-ray), metabolic acidosis, elevated lactate, and/or portal venous gas on x-ray. The severity of this patient's symptoms warrants emergency exploratory laparotomy and will likely include removal of necrotic portions of the bowel.

Answer 37

1. The combination of recurrent episodes of abdominal pain with varying location and intensity that are exacerbated by emotional stress, altered bowel habits (change in stool frequency and form), and normal physical examination and laboratory studies (e.g., hemoglobin, ESR) are suggestive of irritable bowel syndrome (IBS), which is most commonly seen in individuals aged 20–39 years. 2. Relief of abdominal pain after defecation is often seen in patients with IBS, which is a common chronic gastrointestinal disease with an unknown underlying pathophysiology. In some patients, pain may increase upon defecation or remain unchanged. In the absence of red flag symptoms (e.g., nighttime pain, blood in the stool, weight loss, fever), diagnosis of IBS is based on the Rome IV criteria. Treatment includes regular consultations and reassurance that the disease, although chronic, is benign; dietary adjustments (e.g., avoidance of gas‑producing foods); physical activity; stress management; and possibly psychological therapy. 3. In patients with suspected IBS and the predominant symptom of diarrhea, additional testing should be considered, e.g., fecal calprotectin or fecal lactoferrin, stool antigen test for Giardia lamblia, serological celiac disease testing, and CRP levels.

Answer 38

1. classic symptoms associated with either Crohn's disease (abdominal pain due to perianal abscesses/fistulas) or ulcerative colitis (bloody stool). Diagnosed by: 1. Fecal calprotectin concentration: (neutrophil secretes calprotectin after migration to acute inflammatory site; concentration correspond to severity of inflammation) 2. Fecal lactoferrin concentration (secreted by active neutrophil in response to acute inflammation; concentration correspond to severity of inflammation) Treat with: 1. Sulfasalazine is a first-line therapy for inflammatory bowel disease (IBD).

Answer 39

1. Not specific | 2. Increases about 6–12 hours after the inflammatory process begins.

Answer 40

epigastric abdominal pain especially at night, GI bleeding, vomiting, dyspepsia, anemia, pain relieved by eating.

Answer 41

Associated with: 1. Increased CRP & cytokines (IL-6) Signs: 1. Fever 2. Drenching Night sweat 3. Weight loss (> 10% over 6 months)

Answer 42

Associated with: 1. Celiac disease (anemia, steatorrhea, positive IgA tissue transglutaminase antibody test) 2. Peptic ulcer disease (PUD) ( dyspepsia, anemia, pain typically worsened by eating) 3. IBD (crohn’s disease or ulcerative colitis) (elevated ESR, extra-intestinal manifistation)

Answer 43

1. An outpouching of the ileal bowel wall that results from a remnant of the embryological omphalomesenteric duct (vitelline duct). 2. Common in males 3. Rule of 2: 2% of population, 2 feet away from ileocecal, presents at 2 years of age. Signs: 1. Asymptomatic 2. Symptomatic: * hematochezia (bright-red blood in stool) Complication: 1. Intussusception 2. Ulceration 3. Hemorrhage 4. Intestinal obstruction Diagnosis: 1. Technetium-99m pertechnetate scan

Answer 44

Caused by: 1. Ingestion of Echinococcosis (shed in feces of dogs) 2. Affects liver & lungs Symptoms: 1. RUQ pain, N/V, close contact with a dog, eosinophilia, and focal cyst within the liver. 2. The contents of a hydatid cyst are highly antigenic. Treatment: 1. Oral albendazole (for 1-6 months) (CBC should be performed before treatment, and every 2-weeks to avoid leukopenia) 2. Cysts larger than 5 cm requires surgery-excision or CT-guided PAIR ( Puncture, aspiration, injection, re-aspiration) + medical therapy. *** PAIR can lead to anaphylaxis ( tachycardia, hypotension, decrease O2 saturation, & severe bronchospasm) due to leakage of highly antigenic cystic fluid into blood or peritoneal cavity *** PAIR = percutaneous draining of a hepatic cyst. Signs: 1. Intermittent abdominal pain & fullness 2. Pain extends from epigastrium to RUQ 3. Episode lasts 2 hours 4. Not worsen by food 5. Severe N/V (multiple episodes of vomiting) for few days 6. Works with animals (shelters) 7. Smooth & palpable mass below right costal margin 8. X-ray shows: unilocular cyst 4 cm in diameter with daughter cysts within the liver 9. Absent of fever & leukocytosis

Answer 45

Pyogenic liver abscess 1. Older patients 2. Affect both male/female 3. Left shift on WBC count 4. Elevated bilirubin 5. History of diabetes & gallstones 6. Caused by anaerobic bacteria (bacteroids) 7. Symptoms: RUQ pain, fever, leukocytosis, & a cystic lesion on U/S 8. Treat with: IV clindamycin amebic liver abscess 1. Younger patients 2. Affects male 3. Absent of left shift of WBC count 3. Normal bilirubin 4. History of traveling to endemic area

Answer 46

1. Occurs in people with chronic liver disease 2. Signs: hepatomegaly, RUQ pain, N/V, presence of cystic lesion within the liver 3. Treat with: IV- doxorubicin

Answer 47

To diagnose: 1. Choledocholithiasis 2. Cholangitis * presence of dilated biliary tree

Answer 48

Signs of celiac disease: 1. Diarrhea 2. Abdominal bloating 3. Sign of iron deficiency anemia ( fatigue, pale conjunctivae, angular stomatitis) 4. Positive IgA tissue transglutaminase antibody Treat with: 1. Gluten-free diet (1st) 2. Biopsy (2nd)

Answer 49

1. infectious disease caused by the bacterium Tropheryma whipplei 2. Difficult to diagnose 3. Signs: * Early (weight loss & migratory/non-deforming arthritis) * Late (chronic malabsorption diarrhea) 4. Treat with: Trimethoprim-sulfamethaxazole therapy (TMP-SMX)

Answer 50

Sign: 1. Tachycardia 2. Hypotension 3. Decrease oxygen saturation 4. Severe bronchospasm (sudden decrease in end-tidal CO2 & absent of breath sounds) Treat with: 1. Epinephrine

Answer 51

1. Loss of negative pressure between visceral and parietal pleural membranes that occurs when air abnormally enters the pleural space. Sign: 1. pleuritic chest pain, dyspnea (SOB), tachycardia, and reduced breath sounds on the ipsilateral side.

Answer 52

1. Shortness of breath and pleuritic chest pain may suggest pulmonary embolism, pneumonia, or pneumothorax. 2. Pleuritic chest pain that is worse when the person is lying on their back compared with when they are upright may indicate pericarditis.

Answer 53

1. The presence of blood in the pleural cavity. 2. Presents with diminished breath sounds and hyporesonant chest percussion. 3. Usually the result of chest trauma

Answer 54

1. present with hypoxemia, tachycardia, and decreased breath sounds on the ipsilateral side 2. Use chest tube insertion (4th intercostal anterior axillary - skin incision 1 ICS below)

Answer 55

4th intercostal anterior axillary (skin incision 1 ICS. Below)

Answer 56

1. An obstruction of the pulmonary artery and/or one of its branches by a thrombus that most commonly originates from the deep vein system in the legs or pelvis and embolizes to the lungs via the inferior vena cava. 2. Less commonly, the cause of obstruction is a fat or air embolus. 3. Risk factors include stasis (e.g., immobility, surgery), hypercoagulable states (e.g., pregnancy and the puerperium), and endothelial dysfunction (e.g., trauma). 4. Sign: tachycardia, hypotension, decrease in end tidal CO2 (breath sound is not affected) 5. Treat with: Norepinephrine ( inotropic support for patient with cardiogenic shock)

Answer 57

An excess of amniotic fluid (> 1.5 to 2 L) during gestation, as a result of either increased production or decreased resorption. Can be due to fetal gastrointestinal abnormalities (e.g., esophageal or duodenal atresia), impaired swallowing (e.g., anencephaly), or associated with maternal factors such as diabetes mellitus, infection, or Rh incompatibility.

Answer 58

Abbreviation: AFI 1. A semi-quantitative estimate of amniotic fluid volume measured antenatally via ultrasonography of a pregnant uterus. 2. It is part of the biophysical profile. An AFI between 8-18 = normal, AFI ≤5 cm = oligohydramnios, AFI ≥24 cm = polyhydramnios.

Answer 59

An excess of amniotic fluid (> 1.5 to 2 L) during gestation, as a result of either increased production or decreased resorption. Can be due to fetal gastrointestinal abnormalities (e.g., esophageal or duodenal atresia), impaired swallowing (e.g., anencephaly), or associated with maternal factors such as diabetes mellitus, infection, or Rh incompatibility.

Answer 60

Sign: 1. Unable to swallow during prenatal period (explains polyhydramnios) 2. Coughing spells 3. Drooling 4. Foaming at the mouth 5. Episode of cyanosis ( at lips & mucosa) that does not resolve when the infant cries !!

Answer 61

1. Esophageal stenosis (narrowing) Sign: 1. usually not apparent at birth and only becomes apparent through dysphagia and regurgitation once the infant begins feeding with solid foods (i.e. around the weaning period). 2. t does not affect the airways and does not cause cyanotic attacks.

Answer 62

1. Achalasia is very rare in infants and occurs most commonly in middle-aged individuals. 2. It causes dysphagia and regurgitation. Moreover, because it does not primarily affect the airways, it does not cause cyanosis. 3. Patients with achalasia are prone to developing respiratory symptoms if aspiration pneumonia develops as a sequela.

Answer 63

1. commonly presents with cyanosis in newborns, but it does not cause coughing spells or drooling and it is associated with oligohydramnios, not polyhydramnios.

Answer 64

Types: 1. Internal hemorrhoids: originate above dentate line & causes bleeding 2. External hemorrhoids: originate below dentate line and causes pain Treatment: 1st: conservative treatment ( grade 1/2 internal & external hemorrhoids) 1. Stool softeners (docusate & topical/suppository lidocaine if painful) 2. Sitz baths & lifestyle modification (weight loss, exercise, high fiber diet, avoid fatty & spicy food) 2nd: rubber band ligation (placed at apex of grade 1/2 internal H to stimulate inflammatory & fibrosis) 3rd: infrared coagulation ( used for grade 3 internal H. Or grade 1/2 internal hemorrhoids that failed conservative treatment) 4th: hemorrhoidectomy (for grade IV internal H. That cant be reduced & acutely thrombosed external H. That is paiful) Types of internal hemorrhoids : Grade 1: not prolapsed Grade 2: reduced at rest (spontaneous) Grade 3: prolapse when straining + manual reduction Grade 4: cannot be reduced manually or spontaneously

Answer 65

Antineutrophil cytoplasmic antibodies (ANCA) are found in several vasculitic conditions, including granulomatosis with polyangiitis, microscopic polyangiitis, and Churg-Strauss syndrome.

Answer 66

1. A condition of elevated total cholesterol (> 200 mg/dL). 2. Can be acquired and/or as a result of inherited conditions (e.g., familial hypercholesterolemia). Treat with: 1. Atorvastatin 2. Cholestyramine

Answer 67

1. A progressive chronic inflammation of both the intrahepatic and extrahepatic bile ducts 2. Associated with Ulcerative colitis (IBD) Signs: 1. Fatigue 2. Pruritus 3. History of inflammatory bowel disease (Ulcerative colitis) Diagnosed by: 1. ERCP 2. MRCP

Answer 68

1. Inflammation of intra-hepatic bile duct, which may lead to fibrosis & cirrhosis 2. Females (30-50) 3. Often asymptomatic; pruritus, fatigue, abdominal pain, jaundice after years 4. 4. Lab: cholestatic picture with elevated bilirubin, alkaline phosphatase, & gamma-GT 4. Positive Anti-mitochondrial antibody (AMA) 5. Associated conditions: Sjogren’s syndrome, rheumatoid arthritis, systemic sclerosis 6. Complication: Cirrhosis 7. Treatment: * choletyramine: for pruritus * ursodeoxycholic acid: improves survival & delay transplantation * liver transplantation

Answer 69

1. Inflammation of both intra- & extra-hepatic bile duct 2. Most common: male 3. Sign: fatigue, pruritus, cholangitis 4. Lab: cholestatic picture with elevated bilirubin, alkaline phosphatase, & gamma-GT 5. Investigation: ERCP/MRCP shows beaded appearance of bile duct 6. Associated condition: ulcerative colitis 7. Complication: increase risk of cholangio & colorectal carcinoma / cirrhosis 8. Treatment: * choletyramine for pruritus * ursodeoxycholic acid: may imrove LFT, but does not improve survival * liver transplantation

Answer 70

Caused by: 1. Bowel obstruction 2. Severe hypothyroidism 3. Diabetes 4. Fecal impaction 5. Volvulus

Answer 71

1. An interruption in the normal passage of contents of the small bowel due to a structural barrier/strictures. 2. Most commonly caused by adhesions (e.g., from prior abdominal surgery) and incarcerated hernias. 3. Manifestations include colicky abdominal pain, constipation, abdominal distention, and early-onset vomiting 4. any abdominal surgical procedure should focus on bowel preservation and minimize further complications (e.g., short bowel syndrome, postoperative adhesions and fistulas).

Answer 72

1. A terminal feature of abdominal cancers (commonly of the ovary, appendix, or the colon) characterized by seeding of the tumor to the peritoneum. 2. Treat with: Discontinue surgery and start palliative care

Answer 73

1. indicated to remove a diseased part of the small intestine in patients with cancer, a bleeding ulcer, or Meckel diverticulum.

Answer 74

1. Atherosclerotic occlusion of lower extremities artery 2. Most common “superficial femoral artery” occlusion in Hunter’s canal Symptoms: 1. Intermittent claudication (painful leg cramping that occurs with exercise and is relieved by rest or just standing) 2. Rest pain (pain in the foot at the distal metatarsal; pain arise at rest; pain starts at night/ awaken patient from sleep) (resolve with hanging foot over side of bed/ standing/ effect of gravity) 3. Erectile dysfunction 4. Sensorimotor impairment 5. Tissue loss Signs: 1. Absent pulses 2. Bruits 3. Muscular atrophy 4. Decreased hair growth 5. Thickened toenails 6. Tissue necrosis, ulceration, infection (ulcer starts at toes/foot vs. venous stasis ulcer that starts at the medial malleolus/ankle) (painful foot ulcer in PAD vs. painless foot ulcer in diabetes) Diagnosis: 1. Ankle-Brachial Index (ABI): normal (> 1.0) ; claudicators (<0.6); rest pain/gangrene (<0.4) * ** false positive reading can occur in patients with calcified arteries/diabetics (monkeberg sclerosis) 2. Pulse-volume recording (PVR): records volume of blood per heart beat down the legs (large waveform=good collateral blood flow) Investigation: 1. A-gram (arteriogram= dye in vessels + X-ray) Treatment: 1. Conservative therapy for claudication (exercise, stop smoking, control HTN, aspirin, oentoxifylline) 2. Angioplasty (ballon dilation) 3. Surgical graft-bypass (autolologous vein graft or Gortex) 4. Endarterectomy (removal of atherosclerotic plaque/intima/media) Post-operation: 1. Sheep skin 2. Foot cradle 3. Lotion: to prevent fissure that later forms ulcer 4. Check cardiac status & MI: most pt. With PVD have CAD & AAA 5. patients with PAD are at significantly increased risk for myocardial infarction and stroke. 6. In patients with Critical limb ischemia (rest pain, ulcer & gangrene) , urgent revascularization therapy is indicated to prevent limb-threatening arterial occlusion. Notes: 1. Aspirin/clopidogrel/ticagrelor: inhibits platelets formation 2. Pentoxifylline/cilostazol: increase RBC flexibility

Answer 75

1. Dry necrotic tissue without sign of infection (mummified tissue) 2. Common lower limbs 3. Common arterial occlusion 4. Organ is dry, shrunken, & black 5. Line of demarcation presents between gangrenous & healthy part 6. Bacteria fail to survive 7. Better prognosis due to little septicemia

Answer 76

1. Moist necrotic tissue with sign of infection 2. Common in bowel 3. Common venous occlusion 4. Moist, soft, swollen & dark 5. No line of demarcation 6. Numerous bacteria is present 7. Poor prognosis due to profound toxemia emergency amputation and debridement of infected and necrotic tissue are indicated.

Answer 77

1. Intermittent painful blue toes (or fingers) | 2. Due to micro-emboli from proximal arterial plaque

Answer 78

1. Acute occlusion of an artery by embolization or thrombosis Source of emboli: 1. Heart (A.fib, clot forming on dead muscle after MI, endocarditis, myxoma) 2. Aneurysms 3. Atheromatous plaque (embolism) Sign/symptoms (6-P’s): * acute onset * 1. Pain 2. Pallor (paleness) 3. Paralysis 4. Paresthesia 5. Polar (Poikilothermia) (cold sensation) 6. Pulselessness Immediate treatment: 1. IV-anticoagulation with heparin 2. A-gram

Answer 79

Peripheral artery disease at the level of the aortic bifurcation or bilateral occlusion of the iliac arteries that leads to the classic triad of bilateral buttock, hip, or thigh claudication; erectile dysfunction; and absent/diminished femoral pulses. PAD vs. AID: 1. PAD shows femoral pulse are palpable, but pedal pulse are absent. 2. AID: absent of femoral pulse

Answer 80

1. Muscle cramp/pain with standing & improves with walking 2. Occurs when your leg veins don't allow blood to flow back up to your heart. Signs: 1. Pain 2. Bleeding 3. Ulcer 4. Hyperpigmentation Treatment: 1. Compression stocking 2. Endo-venous thermal ablation (Laser or high-frequency radio waves are applied to the affected vein to seal it off and prevent further blood flow through it. Blood can then be diverted to veins with proper valve functioning.)

Answer 81

Lead to: 1. Compartment syndrome (tissue swelling from reperfusion causes increase intra-compartmental pressure) 2. Hyperkalemia 3. MI 4. Renal failure due to myoglobinuria

Answer 82

1. Occurs due to reperfusion injury 2. increased pressure leads to impaired perfusion Signs: 1. Pallor 2. Paresthesia 3. Paralysis 4. Presence of pulses 5. Pain with passive extension/flexion of the foot Note: pale, cool skin, weak peripheral pulses, as well as increased capillary refill time and a positive stretch test (pain in the calf muscle on passively dorsiflexing the foot) Treatment: 1. Fasciotomy: within 6 hours of the onset of clinical symptoms (to prevent necrosis) & followed up with open wound management.

Answer 83

Ischemic features (e.g., pallor, pulselessness, increased capillary refill time, poikilothermia, paralysis) are usually late findin

Answer 84

1. Complication of cardiac catheterization 2. Causes hemodynamic instability + back & flank pain 3. Diagnosed with non-contrast CT scan of abdomen & pelvis OR abdominal U/S 4. Treatment: bed rest, intensive monitoring, IV fluid & blood transfusion

Answer 85

Signs: 1. Amaurosis fugax (transient loss of vision in 1 or 2 eyes) 2. Transient ischemic attack 3. Reversible ischemic neurologic deficit 4. Cerebrovascular accident (stroke) Diagnose it: 1. A-gram (invasive) 2. Carotid U/S or Doppler (non-invasive)—> stenosis of carotid (50%) 3. Head CT Treatment: 1. Carotid endarterectomy (CEA) 2. Aspirin Death after surgery—> due to MI