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GI Flashcards

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1
Q

Primary sclerosing cholangitis

A

Progressive hepatic disorder in which inflammation in the liver and gallbladder causes scarring of the bile ducts

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2
Q

primary sclerosing cholangitis: labs, clinical findings

A

Labs:
-elevated alk phos
-hyperbilirubinemia

Clinical findings:
-jaundice
-pruritis
-hepatomegaly
-cirrhosis

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3
Q

Primary sclerosing cholangitis: increased risk for..

A

cholangiocarcinoma (bile duct cancer)
Hepatocellular carcinoma
gallbladder cancer
colon cancer

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4
Q

primary sclerosing cholangitis is strongly associated with which disorders?

A

IBD
ulcerative colitis

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5
Q

What is the only definitive treatment for primary sclerosing cholangitis:

A

Liver transplant
- Indicated for recurrent episodes of cholangitis, cirrhosis, complications of portal hypertension, HCC, hisar cholangiocarcinoma

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6
Q

Peptic ulcer disease: S/Sx

A

gnawing epigastric pain

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7
Q

Peptic ulcer disease: common causes

A

H. pylori – most common cause
NSAIDs

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8
Q

H. Pylori treatment

A

Two ABx:
- clarithromycin
- amoxicillin
- metronidazole
- tetracycline

PLUS

PPI: esomeprazole (20mg/day, can be given IV gtt)

+/- bismuth subsalicylate

x10-14 days

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9
Q

duodenal ulcers: presentation

A

common in ages 30-55
relief of pain with eating

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10
Q

Most common pathogens causing grossly bloody diarrhea

A

enterohermorrhagic E. coli

Also common:
- shigella
- salmonella
- campylobacter

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11
Q

Zollinger Ellison syndrome

A

Syndrome of gastric acid hypersecretion that results in severe peptic ulcer disease and diarrhea

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12
Q

Zollinger Ellison syndrome: cause

A

Excess secretion of gastrin by a gastrinoma stimulates gastric acid secretion by the parietal cells

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13
Q

Zollinger Ellison syndrome: S/Sx

A

abdominal pain and chronic diarrhea

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14
Q

NSAID-induced peptic ulcer disease: treatment

A

misoprostol

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15
Q

gastric ulcers: S/Sx

A

common in ages 55-65
pain worsens with eating

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16
Q

perforation: S/Sx

A

severe epigastric pain
rigidity, “board-like” abdomen
quiet bowel sounds

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17
Q

peptic ulcer disease: labs/Dx

A

anemia
consider endoscopy after 8-12 weeks of treatment
consider H. pylori testing

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18
Q

treatment for PUD, dyspepsia

A

acid anti-secretory agents
- PUD: start PPI first
- Dyspepsia: Start H2 reactor antagonists first

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19
Q

dyspepsia

A

recurrent indigestion or epigastric pain with no obvious cause

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20
Q

mucosal protective agents

A

Give 2 hours apart from other medications

Sucralfate
- avoid antacids and H2 blockers

Bismuth subsalicylate
- direct antibacterial action against H. pylori

Antacids
- immediate relief
- do not reduce the amount of gastric acidity

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21
Q

GERD: diagnostics

A

consider EGD

rule out:
-cancer
-Barrett’s esophagus (if GERD x5 years)
-peptic ulcer disease

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22
Q

GERD: management

A

antacids PRN
H2 blockers in high doses
PPI if H2 blockers are ineffective

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23
Q

hepatitis: types

A

Viral: A, B, C, D, E G
Autoimmune
Alcoholic

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24
Q

Hepatitis A: transmission

A

fecal-oral
-Common source outbreaks result from contaminated water and food (e.g. shellfish, hurricane-stricken areas with poor sewage)
-sexual contact

blood and stool are infectious during the 2-6 week incubation period

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25
Hepatitis B: transmission
blood, blood products sexual activity perinatally mother-fetus
26
Hepatitis C: transmission
traditionally associated with blood transfusion IVDU
27
hepatitis: S/Sx
Pre-icteric -fatigue -malaise -anorexia -N/V -headache -aversion to smoking and alcohol Icteric: -weight loss -jaundice -pruritis -RUQ pain -clay colored stool -dark urine -fever may be present -hepatosplenomegaly may be present
28
hepatitis: labs/Dx
WBC low to normal UA: proteinuria, bilirubinuria AST, ALT elevated LDH, bilirubin, alk phos, PT: normal or slightly elevated
29
Active Hepatitis A: serology
Anti-HAV IgM
30
Recovered Hepatitis A: serology
Anti-HAV IgG
31
Active Hepatitis B: serology
HBsAg HBeAg Anti-HBc IgM
32
Chronic Hepatitis B: serology
HBsAg Anti-HBc Anti-HBe IgM IgG
33
Recovered Hepatitis B: serology
Anti-HBc Anti-HBs
34
Acute Hepatitis C: serology
Anti-HCV HCV RNA
35
Chronic Hepatitis C: serology
Anti-HCV HCV RNA
36
hepatitis: management
Supportive care Increase fluids to 3000-4000 ml/day No/low protein diet (byproduct of protein metabolism is ammonia) Oxazepam if sedation is necessary Vitamin K for prolonged PT (>15 sec) Lactulose Antiviral drugs
37
diverticulitis: incidence
more common in women higher incidence in those with low dietary fiber
38
diverticulitis: S/Sx
**mild to moderate LLQ aching abdominal pain** constipation or loose stools may be present N/V low grade fever
39
diverticulitis: labs/Dx
leukocytosis ESR: elevated stool heme + in 25% of cases sigmoidoscopy: inflamed mucosa may consider CT to evaluate abscess x-ray to look for evidence of free air (pneumoperitoneum) - air under the diaphragm requires ex-lap and evacuation
40
mild diverticulitis: management
aspirin high fiver diet possible ABx therapy
41
diverticulitis: inpatient management
NPO for bowel rest IV fluids Manage GIB Surgery if indicated
42
cholecystitis: S/Sx
often precipitated by a large or fatty meal sudden appearance of steady, severe colicky pain in epigastrium or right hypochondriac (RUQ) vomiting with relief Can radiate to the back Murphy's sign RUQ tender to palpation; gallbladder may be palpable muscle guarding and rebound pain fever
43
murphy's sign
deep pain on inspiration while fingers are placed under the right rib cage
44
cholecystitis: labs/Dx/imaging
leukocytosis bilirubin: elevated ALT, AST, LDH, AP: elevated amylase may be elevated **Ultrasound: gold standard** XRays may show gallstones HIDA scan ERCP -complications: pancreatitis, perforation, hemorrhage, acute cholangitis
45
cholecystitis: management
pain management NGT for gastric decompression NPO crystalloids surgical consult for lap cholecystectomy
46
acute pancreatitis: causes/incidence
GETSMASHED G: Gallstones E: Ethanol, alcohol T: Trauma S: Steroids M: Mass (pancreatic cancer), Mumps A: Autoimmune pancreatitis S: Scorpion sting H: HLD, hypercalcemia E: ERCP complications D: Drugs (Depakote, Metformin, Trulicity, sulfonamides, thiazides, lasix, estrogen, azathioprine) Most common causes: gallstones, ethanol
47
acute pancreatitis: S/Sx
Abrupt onset of steady, severe epigastric pain worsened by walking and lying supine, improved by sitting and leaning forward Pain usually radiates to the back but may radiate elsewhere N/V Weakness, sweating, anxiety Fever Tachycardia Exam: -Pallor, cool skin -Mild jaundice common -Upper abdomen tender to palpation usually without guarding, rigidity, or rebound -Abdominal distention -Absent bowel sounds if paralytic ileus present If hemorrhagic: Grey Turner's sign, Cullen's sign
48
Grey Turner's sign
Flank discoloration sign of hemorrhagic pancreatitis
49
Cullen's sign
Umbilical discoloration sign of hemorrhagic pancreatitis
50
acute pancreatitis: labs/Dx
leukocytosis hyperglycemia LDH, AST elevated amylase, lipase elevated BUN elevated coagulation values elevated hypocalcemia -watch for Chvostek's sign and/or Trousseau's sign -can lead to Torsades CRP elevated suggests pancreatic necrosis **Contrast enhanced CT is the most reliable imaging - can identify the type of pancreatitis and any concurrent complications** Ultrasound & MRI also options but not as reliable
51
Ranson's criteria
5-6 factors = 40% mortality >7 factors = 100% mortality *Geroge Washington Got Lazy After He Broke C-A-B-E* Prognostic signs at admission -**G**reater than 55 years of age -**W**BCs >16,000 -**G**lucose >200 -**L**DH >350 -**A**ST >250 Prognostic signs during the first 48 hours -**H**ct drop of >10 -**B**UN increases >5 -**C**alcium <8 -**A**rterial O2 <60 -**B**ase deficit >4 -**E**stimated fluid sequestration >6000 ml
52
acute pancreatitis: management
bed rest NPO aggressive IV fluids NG suction pain control start clear diet once pain free and +bowel sounds
53
bowel obstruction: causes
adhesions hernia volvulus tumors fecal impaction ileus
54
bowel obstruction: S/Sx
Cramping periumbilical pain initially; later becomes constant and diffuse Minimal or no fever Mild tenderness but no peritoneal findings High pitched, tinkling bowel sounds Late sign: Unable to pass stool/gas Vomiting -proximal: within minutes of pain -distal: within 2 hours of pain Abdominal distention: -proximal: minimal -distal: pronounced
55
bowel obstruction: labs/Dx
late: leukocytosis, dehydration KUB: dilated loops of bowel and air fluid levels -SBO: horizontal staircase pattern -LBO: frame pattern
56
large bowel obstruction: imaging
dilated loop of bowel with air-fluid level sand a frame pattern
57
SBO: imaging
X-ray, 2 views: ladder/staircase-like pattern of dilated small-bowel loops with air-fluid levels No colonic distention
58
bowel obstruction: management
IV fluids NG suction surgical intervention in all cases of complete obstruction partial obstruction: treat medically
59
ulcerative colitis
idiopathic inflammatory condition characterized by diffuse mucosal inflammation of the colon Involves the rectum and may extend upward involving the whole colon
60
ulcerative colitis: S/Sx
bloody diarrhea
61
ulcerative colitis: imaging
mural thickening thumb printing
62
ulcerative colitis: Dx
sigmoidoscopy
63
ulcerative colitis: management
mesalamine suppositories or enemas for 3-12 weeks hydrocortisone suppositories and enemas
64
mesenteric infarct
a syndrome as a result of inadequate blood flow through the mesenteric circulation, leading to ischemia and gangrene of the bowel
65
mesenteric infarct: causes
Arterial or venous embolus or thrombus atherosclerosis smoking coagulopathy increases risk
66
mesenteric infarct: S/Sx
**Sudden onset of cramping, colicky abdominal pain (perhaps after eating) Pain out of proportion to physical exam findings** N/V Fever Guarding and tenderness Hyperactive to absent bowel sounds Peritoneal findings as state progresses Shock
67
mesenteric infarct: labs/imaging
elevated amylase leukocytosis **STAT CT angio of the abdomen** surgical consult
68
mesenteric infarct: management
immediate surgical intervention
69
appendicitis: S/Sx
Begins with vague, colicky umbilical pain that shifts to RLQ Nausea with 1-2 episodes of vomiting Pain worsened and localized with coughing RLQ rebound tenderness McBurney's point tenderness Psoas sign (iliopsoas test) Obturator sign +Rovsing's sign Local abdominal tenderness Low grade fever
70
McBurney's point tenderness
2/3 of the distance from the right anterior superior iliac spine to the umbilicus RLQ Common landmark suggestive of acute appendicitis
71
psoas sign (iliopsoas test)
pain with right thigh extension
72
obturator sign
pain with internal rotation of flexed right thigh
73
Rovsing's sign
RLQ pain when pressure is applied to the LLQ
74
appendicitis: labs/Dx
leukocytosis CT or ultrasound is diagnostic
75
IBD
Benign GI disorder Diagnosis of exclusion- no pathological problems with GI system
76
IBD: S/Sx
No weight loss No systemic symptoms No blood in the stool Alternating constipation and diarrhea with relief of abdominal pain when having a bowel movement
77
IBD: managmeent
management of diet peppermint oil antispasmodic therapy
78
Crohn's disease
Inflammatory bowel disorder in which skip lesions can occur anywhere in the GI system with a patchy distribution
79
Crohn's disease: S/Sx
abdominal pain bloody stools constipation/diarrhea bloating possible fever/chills
80
Crohn's disease: associated findings
anemia uveitis arthritis erythema nodosum skin rashes
81
Crohn's disease: management
dietary management aspirin steroids infliximab
82
Conditions associated with AST >10x normal limit
acute viral hepatitis toxins acute fulminant hepatitis tumor necrosis
83
gastroparesis is a complication of...
uncontrolled hyperglycemia
84
gastroparesis: S/Sx
abdominal pain early satiety postprandial fullness nausea hypoglycemia after meals if taking rapid-acting insulin
85
upper GI bleed: labs
hypernatremia d/t fluid loss through emesis elevated BUN elevated BUN:Cr ratio d/t digestion of blood or prerenal azotemia mild leukocytosis metabolic acidosis elevated PTT
86
upper GI bleed: management
NPO NG tube serial H/H PPI (H2 blockers ineffective)
87
preferred method of nutrition for patients who cannot eat
GI tract (enteral feeds) - least invasive, preserves integrity of GI tract -parenteral nutrition is only used if enteral nutrition is contraindicated
88
Formula for estimating daily caloric needs
calories (kcal/day) = 25-30 x wt (kg)
89
giardia lamblia: presentation
Incubation period of 7-21 days Diarrhea Abdominal pain/cramping Nausea Greasy stools
90
guardia lamblia: who is at risk?
People who drink contaminated water Travelers to countries where giardiasis is common Backpackers or campers who drink untreated water from lakes or rivers
91
3 diagnostic criteria for acute pancreatitis
Symptoms consistent with pancreatitis (e.g. epigastric pain) Elevation of serum amylase or lipase to 3x normal level Radiological features consistent with pancreatitis (e.g. CT or MRI) Diagnosis is made when 2 out of 3 criteria are met
92
GI perforation: imaging
free air under the diaphragm
93
GI perforation: presentation
abdominal pain large amount of free air on abdominal films
94
GI perforation: management
OR for immediate surgical exploration IV fluids NPO Broad spectrum ABx
95
GI perforation: most common cause
peptic ulcer disease
96
hepatorenal syndrome: management
albumin, midodrine, and octreotide to increase circulating volume and improve renal perfusion
97
Spontaneous bacterial peritonitis (SBP)
Complication of liver failure d/t translocation of enteric pathogens across the bowel mucosa and into the peritoneal fluid
98
Spontaneous bacterial peritonitis (SBP): diagnosis
diagnostic paracentesis - ascitic fluid culture
99
Spontaneous bacterial peritonitis (SBP): management
Empiric broad-spectrum ABX for proven or suspected SBP (cefoxatime) -narrowed when susceptibility results are available

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