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PANCE/EOC > GI #1 > Flashcards

GI #1 Flashcards

(52 cards)

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1
Q

Diagnostics for cholecystitis

A
  • US: initial test

- HIDA: most accurate

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2
Q

Treatment for Cholecystitis

A
  • NPO, IVF

- ABX (Ceftriaxone + Metro) then Cholecystectomy

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3
Q

MCC of Acute Cholecystitis

A

E. Coli

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4
Q

Symptoms of Cholangitis

A
  • Charcot’s Triad: Fever, chills, RUQ pain

- Reynold’s Pentad: AMS, Hypotension

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5
Q

What is the cause of Cholangitis

A

Biliary tract infection secondary to obstruction of the common bile duct (gallstones, E. Coli, Malignancy)

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6
Q

Diagnostics for Cholangitis

A
  • Labs: Leukocytosis, Increased Alk Phos & GGT, increased bilirubin
  • US: Initial
  • Cholangiography: via ERCP (Gold standard)
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7
Q

Treatment for Cholangitis

A
  • IV ABX (Ceftriaxone + Metro, Unasyn)

- ERCP

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8
Q

MC of cholelithiasis

A

Cholesterol

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9
Q

Risk Factors for Cholelithiasis

A

-Female, Fat, Forty, Fertile, Fair

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10
Q

Symptoms of cholelithiasis

A

-Biliary colic: episodic abrupt RUQ lasting 30 min - hours after fatty or large meals

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11
Q

Gallstones in the common bile duct

A

Choledocolithiasis

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12
Q

Physiologic jaundice presents on days _____ of life

A

3-5

Bilirubin levels fall in about 50% of neonates during first week of life

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13
Q

jaundice is associated with bilirubin levels > _____ mg/dL

A

> 5.0 mg/dL

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14
Q

Kernicterus, which is _________ and due to bilirubin in the brain tissue, is associated with bilirubin levels > ______

A

Cerebral dysfunction and encephalopathy

> 20 mg/dL

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15
Q

Treatment for neonatal jaundice

A
  • Phototherapy initial management of choice.
  • -Done if > 12 at 24 hours of life, > 15 at 48 hours or > 18 at 72 hours of life
  • Exchange transfusion in severe cases (hemolysis, Rh immunization)
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16
Q

Symptoms of Gilbert’s Syndrome

A

-Transient episodes of jaundice during periods of stress, fasting, alcohol, or illness

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17
Q

How to diagnose Gilbert’s Syndrome

A
  • Increase in isolated indirect bilirubin level with otherwise normal LFT’s
  • No treatment needed (mild, benign disease)
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18
Q

Treatment options for fecal impaction

A
  • Digital disimpaction followed by warm water enema with mineral oil
  • Polyethylene Glycol
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19
Q

Anorectal Abscess and Fistula MCC

A

-Staph A

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20
Q

MC location for anorectal abscess and Fistula

A

Posterior wall

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21
Q

Symptoms of anorectal abscess or Fistula

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A
  • Swelling, pain that is worse with sitting/coughing/defecation
  • Febrile
  • Focal edema, induration, and fluctuance on eam
22
Q

Treatment for anorectal abscess and Fistula

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A
  • Incision and drainage

- WASH: warm water cleansing, analgesics, sitz baths, high fiber diet

23
Q

Symptoms of an Anal fissure

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A
  • BRBPR
  • Pain with bowel movements
  • Longitudinal tear in posterior midline
  • Skin tags seen in chronic fissures
24
Q

Treatment for Anal Fissures

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A
  • Most resolve spontaneously
  • Supportive measures are first line
  • Topical vasodilators, Nitroglycerin
  • Botox injections
25
Symptoms of internal hemorrhoids
- Bleed and painless - Originate above the dentate line - Intermittent rectal bleeding, Painless BRBPR - Rectal itching and fullness
26
Four grades of Internal Hemorrhoids
- 1: does not prolapse (confined to anal canal). May bleed with defecation - 2: prolapses with defecation but spontaneously reduces - 3: prolapses with defecation with requires manual reduction - 4: irreducible and may strangulate
27
Symptoms of external hemorrhoids
- Do not bleed, but are painful - Originate below the dentate line - Perianal pain worse with defecation
28
Treatment for hemorrhoids
- High fiber diet, increased fluids, warm sitz baths - Rubber band ligation (for strangulated), Sclerotherapy, Excision - Hemorrhoidectomy for Stage IV if no response to other therapies
29
MCC of acute lower GI bleeding
Diverticulosis
30
Diagnostic of choice for diverticulosis
Colonoscopy | -Radionuclide imaging if bleeding not visualized on colonoscopy
31
MC area for diverticulosis
Sigmoid area
32
Symptoms of Diverticulosis
- Usually asymptomatic (incidental finding most times) | - Painless hematochezia
33
Diagnostic for Diverticulitis
- CT scan: initial - Labs: Leukocytosis Do NOT use colonoscopy and barium enema due to risk of perforation
34
Treatment for diverticulitis
-Metronidazole + Cipro/Levofloxacin for 7-10 days
35
What is the definition of toxic megacolon?
-Colon dilation > 6 cm + signs of systemic toxicity
36
Causes of Toxic Megacolon
- Ulcerative colitis - C. Diff - Radiation - Diverticulitis
37
Symptoms of Toxic Megacolon
- Profound bloody diarrhea - Distention - Signs of toxicity: AMS, fever, tachycardia, hypotension, dehydration
38
Initial imaging of choice for toxic megacolon
Abdominal radiographs
39
Treatment for Toxic Megacolon
-Supportive is mainstay (bowel rest, bowel decompression with NG tube, Metro + Ceftriaxone)
40
What is Olgivie Syndrome?
Acute dilation of the colon in the absence of any mechanical obstruction (colonic pseudo-obstruction)
41
Causes of Olgivie Syndrome
- Postoperative state - Opiates - Hypokalemia, Hypercalcemia - Hypothyroidism - DM
42
Treatment for Olgivie Syndrome
- IVF and electrolyte repletion - Neostigmine for decompression if failed conservative therapy - Surgical decompression as a last resort if failed other treatment modalities
43
Risk Factors for IBD
- Ashkenazi Jews - 15-35 years old - Genetics - Diet - Infections - Meds: NSAIDs, OCP - Gender: CD in females, UC in males - Smoking: protective in UC
44
Extra-Intestinal Manifestations of IBD
- Rheumatologic: MSK pain, arthritis, ALS, osteoporosis - Dermatologic: Erythema Nodosum - Ocular: anterior uveitis, iritis, conjunctivitis - Hematologic: B12 and Iron Deficiency, risk of thromboembolism
45
Facts about Ulcerative Colitis
- Limited to colon (contiguous spread proximally) - Rectum always involved - Mucosa and Submucosa ONLY - LLQ pain, bloody diarrhea - Smoking protective - Uniform inflammation on colonoscopy - Stovepipe Sign (loss of haustral markings) on Barium study - P-ANCA lab - Surgery curative
46
Facts about Crohn's Disease
- Any segment of the GI tract from mouth to anus effected - MC in Terminal Ileum - Transmural - RLQ pain, non-bloody diarrhea - Fistulas, B12 deficiency, and abscesses more common - Skip lesions and cobblestone appearance on colonoscopy - string sign on barium studies - ASCA lab - Surgery is noncurative
47
Treatment for Crohn's Disease
- 5-ASA (Mesalamine) or oral Glucocorticoids | - Severe & Refractory: Azathioprine, Methotrexate, anti-TNF agents
48
Treatment for UC
-Topical 5-aminosaliyclic Acid (ASA) first line | Surgical resection in some cases
49
MC occlusion in acute mesenteric ischemia
Superior mesenteric artery
50
Symptoms of acute mesenteric ischemia
- Severe abdominal pain out of proportion to exam findings - Pain poorly localized - N/v - Diarrhea
51
Diagnostics for acute mesenteric ischemia
- CT angiography (initial) - Conventional arteriography: definitive - Labs: lactic acidosis, leukocytosis
52
Treatment for acute mesenteric ischemia
-Surgical revascularization

PANCE/EOC (63 decks)

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