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GI Flashcards

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1
Q

The RUQ contains

A

Liver, gallbladder, ascending colon, kidney and pancreas (sm. amt)

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2
Q

The LUQ contains

A

Stomach, pancreas, descending colon, kidney

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3
Q

The RLQ contains

A

Appendix, ileum, cecum, ovary

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4
Q

The LLQ contains

A

sigmoid colon, ovary

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5
Q

What is a + psoas sign

A

RLQ pain is produced when pt raises their right leg against resistance of pressure from the practitioners hand or when they lie on their left side and extend the right leg from the hip

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6
Q

What does a + psoas sign indicate

A

Peritoneal irritation/peritonitis

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7
Q

What is a + obturator sign

A

Inward rotation of the hip causes RLQ pain

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8
Q

What does a + obturator sign suggest

A

Peritonitis

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9
Q

What is a + Rosvigs Sign

A

Deep palpation of the LLQ produces pain in the RLQ

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10
Q

What does a + Rosvigs sign suggest

A

Peritonitis

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11
Q

What is McBurney’s Point

A

the area between the superior iliac crest and umbilicus in the RLQ

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12
Q

What does tenderness at McBurney’s Point suggest?

A

Appendicitis

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13
Q

What is a + Markle’s Jar Test

A

Pt raises heels and drops them suddenly which produces pain, also positive if pt refuses to do this r/t pain

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14
Q

What is rebound tenderness

A

Worsening abdominal pain when hand is released after abdominal palpation compared with pain on deep palpation

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15
Q

What is Murphy’s sign

A

Press deeply on the RUQ under the costal margin during inspiration. Midinspiratory arrest is a + Murphy’s

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16
Q

What does a + Murphy’s sign suggest?

A

Cholecystitis

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17
Q

What is Carnett’s Sign

A

Pt does an abdominal crunch if this worsens pain then the source is the abdominal wall

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18
Q

Sx of Appendicitis

A

Acute onset of periumbilical pain, pain at McBurney’s pint, anorexia, low grade fever, RLQ, rebound tenderness, guarding

+Psosa, obturator, heel jar, Rosvigs, Rebound tenderness

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19
Q

What is the modality of imaging for appendicitis

A

CT

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20
Q

Sx of Cholecystitis

A

RUQ pain or epigastric pain that worsens within 1 hr after a fatty meal, nausea, vomiting and anorexia

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21
Q

What is the imaging modality for cholecystitis

A

Ultrasound

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22
Q

If U/S is inconclusive for cholecystitis what would you order

A

HIDA scan

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23
Q

What condition produces an elevation in bilirubin but normal LFTs

A

Gilbert’s syndrome

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24
Q

What are symptoms of colon cancer

A

Vague GI sx, may have IDA, changes in bowel habits/stools, bloody stools (heme +), dark tarry stools, mass on abdominal palpation

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25
What is the gold standard screening for colorectal cancer?
Colonoscopy q10 years | Can also do FIT annually
26
What are the differences between Crohn's and Colitis
Crohn occurs from mouth to anus, sx depends on affected area (watery diarrhea, bloody diarrhea, fever, anorexia, wt loss, dehydration, fatigue, periumbilical pain, fistuale, perianal disease UC: Occurs in the colon/rectum -sx: bloody diarrhea with mucus, cramps, bloating, gas, fever, anorexia, wt loss, fatigue, arthralgias, arthritis, IDA or anemia of chronic disease
27
Crohn's and UC increase the risk of:
Colon cancer | Toxic Megacolon
28
What is GERD
acidic contents regurgitate from stomach into esophagus related to inappropriate LES relaxation
29
Food triggers for GERD
-chocolate, mints, caffeine, ETOH, carbonated drinks, tomatoes, citrus, fatty foods, spice
30
Med triggers for GERD
CCB, NSAIDs, nitrates, anticholinergics, iron, bisphosphonates, quinidines, theophylline, alpha adrenergic receptor agonists
31
Sx of GERD
- chronic heartburn - associated with fatty or large meals - worsens when supine - acidic/sour taste in mouth - thinning enamel - chronic sore throat/cough
32
What is a complication of GERD
Barrett's esophagus
33
What is the treatment of GERD
First Line: Lifestyle changes avoid large/fat meals, 3-4 hrs pre bedtime, avoid triggers, weight loss, smoking cessation Pharm: Antacid H2 antagonist PPI
34
What are longterm risks of PPI use?
Risk of osteoprosis, interstital nephritis, low magnesium, C. Diff, decreased iron absorption
35
When should you refer a patient with GERD
- No relief after 4-8 weeks after PPI use | - Sx associated with weight loss, difficulty swallowing, bleeding
36
C. Diff Diarrhea Risk Factors
- Prior or current antibiotic therapy - Advanced age - Hospitalization - Chemo
37
What Abx are most likely to cause C. Diff
-Clindamycin, fluroquinolones, cephalosporin, penicillin
38
What are sx of C. Diff
-watery diarrhea, cramps, anorexia, nausea, low grade fever
39
What is the 1st line treatment for C. Diff
Vancomycin 125mg PO QID x 10 days
40
What is irritable bowel syndrome
A chronic functional disorder of the colon can be diarrhea or constipation dominant
41
What are treatments for IBS
- increase dietary fiber - avoid gassy foods (ie. beans, onions, cabbage, high fructose corn syrup) - antispasmodics (Dicylomine or hyoscyamine) - Decrease anxiety and stress
42
Red Flags Diarrhea
- Bleeding - Abdominal pain - Weight loss - Anemia - Elevated inflammatory markers - lyte disturbances
43
Risk factors for Colorectal cancer
- any polyps or hx of colorectal cancer - IBD - Family hx of CRC or polyps
44
What are RED FLAGS in Peptic Ulcer Disease
- Early satiety - Anorexia - Anemia - Recurrent Vomiting - Hematemesis - Weight loss
45
What are sx of PUD
- recurrent epigastric pain - Burning, gnawing ache - Pain that is relieved by antacids or food - Black tarry stools - Blood in stools - Coffee ground emesis - IDA
46
What labs are indicated in PUD
- CBC - FOBT - H. Pylori (urea breath test) - Upper endoscopy + Biopsy
47
What is the gold standard test for PUD
Upper endoscopy and biopsy
48
If a patient has multiple ulcers or are resistant to treatment, what should you test and what are you looking for?
- Gastrin levels | - Zollinger-Ellison Syndrome
49
What is the treatment for a Negative H. Pylori Ulcer
- smoking and ETOH cessation - stop NSAIDs - Combo lifestyle changes with PPI/H2 antagonist - If no response x4-8 weeks refer
50
What is the treatment of a +H. Pylori Ulcer
- Quad Therapy | - Triple Therapy
51
Quad therapy consists of
1. Bismuth 600mg QID 2. Metronidazole 250mg QID 3. Tetracycline 500mg QID 4. PPI standard dose
52
Triple therapy consists of
1. Clarithromycin 500mg BID 2. Amoxicillin 1g BID or Metronidazole 500mg BID 3. PPI standard dose
53
What is the difference in pain presentation between a gastric ulcer and a duodenal ulcer
- Gastic ulcers pain recurs shortly post meals | - Duodenal ulcers pain occurs 2-4hrs post meal
54
What are diverticula
Small pouch like herniations on the external surface of the colon, secondary to chronic fiber insufficiency
55
What is diverticulitis
Infection of diverticula (the small pouch like herniation on the external surface of the colon)
56
What are sx of diverticulitits
- LLQ pain - fever - If obstruction occurs, may have nausea +/- vomiting +/- ileus
57
What are labs are indicated in suspected diverticulitits
- CBC (will see left shift) | - FOBT (+)
58
What is the gold standard for dx diverticulitis
CT
59
What is the outpatient management of diverticulitis
- only outpatient in uncomplicated cases - Liquid Diet - Amox/Clav or Cipro & Flagyl
60
What is acute pancreatitis
Inflammation of the pancreas secondary to: - ETOH - Elevated triglycerides - Gallstones - Infections
61
A triglyceride level of ____ will cause a high risk of acute pancreatitis
800mg/dL
62
Sx of acute pancreatitis include:
- Fever - N/V - Abdominal pain with radiation to midback - guarding - tenderness - Cullens - Grey-Turner's Signs
63
What is Cullen's Sign
Bluish discoloration around the umbilicus
64
What is grey turner's sign
Bluish discoloration around the flanks
65
What does IgM mean regarding immunity
Think "minute" as in you are recently infected
66
What does IgG mean regarding immunity
Thing "gone" as in you have immunity
67
Acute Hep A infection is indicated by:
IgM Anti-HAV
68
The presence of Hep A immunity is indicated by the following lab test:
IgG Anti- HAV
69
What does a + HBsAg mean
The patient has the virus and is currently infected
70
What does a + Anti-HBs mean
Patient is immune
71
What does HBeAg mean
Chronic Hep B infection
72
What does Anti-Hbc mean
- This appears at onset of Hep B infection and stays for life * Can help you see whether immunity is from infection or vaccination
73
What is the screening test for Hep C
Anti HCV
74
If the Anti HCV is + what should you order
HCV RNA
75
If ALT and AST are elevated but ALT > AST think:
L- Liver | Likely hepatitis
76
If ALT and AST are elevated but AST > ALT think:
AST- Acetaminophen, statins, tequila aka drugs, statins and ETOH
77
What ration of AST:ALT make ETOH the most likely cause?
2
78
An elevation of AST ALT with a ratio of <1 is likely:
NAFLD
79
When is an elevation in ALP normal?
- In pregnancy | - Adolescents
80
Where is ALP found
Bones and liver
81
What is the gold standard for colorectal cancer screening?
Colonoscopy q10 years
82
What is NAFLD
- Hepatic steatosis without 2ndary cause | - Can progress to cirrhosis
83
What abdominal conditions warrant an X-ray
Ileus, obstruction, perforation
84
What abdominal conditions warrant an U/S
Gallbladder, pelvic organs, appendix*, liver
85
What abdominal conditions warrant a CT
Appendix, diverticulitis, acute abdomen
86
What abdominal conditions warrant an MRI
Hepatocellular carcinoma | Metastatic Disease
87
If an ultrasound is inconclusive for cholecystitis what is another test you can order to confirm
HIDA

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