Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Acute Care 2 > GI > Flashcards

GI Flashcards

1
Q

bowel obstruction definition

A

Blockage of the lumen of small bowel; can perforate if necrosis present

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

bowel obstruction causes and risk factors

A

-Adhesions from prior surgery
-Strictures from Crohns, XRT or ischemia
-Hernia
-Hematoma
-Volvus/intussusception
-LBO
-Tumor, foreign body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

bowel obstruction presentation and workup

A

Leukocytosis, dehydration

KUB: ladder-like pattern w/ air fluid levels on upright. Thickening of abd wall (thumbprinting)

CT w/ oral contrast w/ follow through

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

bowel obstruction treatment

A

Surgical consult

NGT to LIWS
IV fluids
Pain control

ABX IF: strangulation/necrosis suspected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

cholecystitis definition

A

Inflammation of gallbladder

Cholelithiasis= stones in gallbladder
Choledocholithiasis = stones in CBD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

cholecystitis causes and risk factors

A

-Cholelithiasis, Acalculous cholecystitis
-Bacteria
-Neoplasm
-Ischemia, torsion, strictures
-Obesity, pregnancy

4 Fs = female, fat, 40, fertile
-Female, advanced age, rapid wt loss, fad diets, high cholesterol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

cholecystitis presentation

A

NV, bloating, gas, belching, previous episodes, RUQ pain, radiating pain to shoulder and scapula, Fever, jaundice
(+) Murphy’s sign

Mild leukocytosis, mild bili elevation, LFTs elevated (ALK PHOS)
Amylase > 500 consider pancreatitis also

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

cholecystitis diagnostic imaging

A

RUQ US = visualize stones
EKG = r/o cards issues
HIDA/PIPIDA scan = how well gallbladder is squeezing

ERCP: invasive but can place stent/remove stones and look at bili and pancr ducts
MRCP = non-invasive but non interventional

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

cholecystitis surgical and medical treatment

A

-NPO/NGT if severe NV
IV fluids
-Pain control including antispasmodics (Robinul)
-antiemetics
-ABX if infection suspected
-Sx or GI consult

Medical Tx if Sx not an option
-ursodiol for 12-24 months
-chenodeoxycholic acid
-dissolve stones w/ an ether placed directly into the gallbladder via percutaneous route

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Crohns definition

A

Chronic inflammatory disease of bowel and digestive system that can effect any level of digestive systems

-transmural process (all layers) r/I ABD pain, perforations, abscess and strictures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Crohns presentation and workup

A

Labs: anemia d/t micro blood loss, B12 deficiency, inflammatory markers high, poor nutritional markers

(-) stool studies

Biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Crohns management

A

-STOP SMOKING
-Nutritional support: maybe TPN
-Surgical consult
-ABX: flagyl, cipro, rifaximin

Steroids: IV initial then PO
-Entocort (for 1 yr)
-Pred is better but want to avoid systemic

Immunomodulating drugs: azathioprine, mercaptopurine, MTX
-Anti TNF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

UC definition

A

Unknown etiology but characterized by intermittent bouts of inflammation of the mucosa in part of or the entire colon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

UC presentation

A

S/s: bloody diarrhea, fever, ABD pain, wt loss, cramping

Extra colon s/s: arthralgias, ocular complications, skin disorders, liver disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

UC workup

A

Labs: leukocytosis, anemia, lytes d/t diarrhea, elevated LFTs, stool Cx (-)

KUB: r/o or confirm megacolon; can help w/ disease severity by looking for feces in colon

Sigmoidoscopy/ colonoscopy w/ Bx for Dx

Can do barium enema but not as good and can’t be done during a flair

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

UC treatment

A

5-ASA: sulfasalazine, mesalamine, balsalazide
-sulfasalazine: wean on for acute flair up to 4-6 gm/day and then wean down to 2 gm/day for maintenance dosing
-supplement w/ folate

Step up to hydrocortisone
-foam enemas first
-step up to oral steroids Pred 20-30 BID taper slowly over 4-8 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

UC: when to hospitalize and hospital management

A

-NPO
-NGT if obstruction or toxic megacolon
-IV fluids
-Lytes
-TPN if wasting
-Stool sample for infection, leukocytes, occult blood
-KUB for toxic megacolon, free air and stool in colon
-SM 48-60 md/day
-ACTH 120 unit/day if not responding to SM
-cyclosporine is no response
-Surgery for removal and to cure disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Celiacs defintion

A

Malabsorptive disease 2nd to intolerance of gluten that affects the small intestinal mucosa

1:100 people

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Celiacs presentation and workup

A

s/s: stunted growth and s/s of malnutrition

IgA endomysial antibody
IgA tTG antibody tests
>90% sens and 95% specific screening

EGD w/ Bx for official Dx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Celiacs management

A

Remove all wheat, rye and barley products from diet

Can be refractory = very poor prognosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

PUD definition

A

Chronic disorder w/ lifelong tendency

Loss of enteric surface epithelium that extends deeply enough to penetrate muscularis mucosa (common duodenum and stomach)

Natural defense: mucosal barrier, good blood supply, competent sphincters

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

PUD risk factors

A

Gastric acid, pepsin, bile acids, decreased blood flow, incompetent sphincters, NSAIDS, ASA, steroids, smoking, tumors, stress, alcohol, low bicarb, H. pylori

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

PUD labs and results

A

-CBC: anemia, macrocytosis, leukocytosis if perf
-CMP: looking for liver disease, hypercalcemia, elevated BUN, dehydration
-Lipase and amylase
-Serum gastrin levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

PUD diagnostic tests

A

-H pylori testing: biopsy from EGD, serum test can show acute or past infection, breath test is better but cannot have ABX/antacids/pepto for 4 weeks AND no PPI for 2 weeks before test. Can do fecal test to check for cure

-CXR check for: asp PNA, effusions, eso or vicus perforation, ileus
-CT abd check for: fistula, inflammatory changes, cholecystitis, free air, liver disease

-EGD is best since it’s most accurate and can do interventions to fix condition
-UGI barium: if positive will likely still need EGD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
PUD medical management
Medical Management -IV PPI and wean to oral PPI -can do antacids and antimetics -H2 -carafate if not using H2 blockers -eradicate h. pylori H pylori regimens -3 ABX: Clarithromycin, Amoxicillin, Metronidazole -PPI: omeprazole -Regimens: MOC, MOA, COA Regimen w/ Bismuth -QID dosing -Bismuth, metronidazole, omeprazole, tetracycline -Regimen: BMT or TOMB
26
PUD follow up care
Follow up Care -duodenal ulcer no f/u if asymptomatic after 8 weeks of therapy -gastric ulcer: repeat EGD in 4-6 weeks. -Partially healed and no evidence of cancer = 6 more weeks therapy then rescope -Partially healed and CA = surgery -Partially healed < 50% = surgery consult
27
PUD complications (3) and the management
Complications UGI bleed -stabilize fluids, RBC, PLT, fibrinogen, PPI gtt 80 mg bolus then 8mg/hr for 48-72 hrs, NGT to empty stomach and protect airway -sandostatin can be used until EGD is done and varicies are r/o -vasopressin for vasoconstriction. Do not use in coronary or PAD Perforation -pain, rigid abd, shock, leukocytosis, amylase elevated maybe, KUB w/ free air -UGI w/ water soluble contrast only -Sx and GI consult -Abx: Gastric outlet obstruction -d/t edema or narrowing of pylorus or duodenal bulb -NV, anorexia, early satiety, wt loss -UGI barium, gastric emptying study -NGT to allow edema to improve (this may be all you need to do) -possible EGD for Dx and dilation -TPN if NPO for a while, or can do DH tube
28
Peritonitis definition and types
Acute inflammation of visceral and parietal peritoneum Primary = SBP. Complication of cirrhosis, ascites, PD. Causes: e.coli, kleb, pneumococcus, entero Secondary = trauma (abd sx, ruptured appy, PUD, panc rupture ) or perforation Ascites = cirrhosis, portal HTN, renal failure, low albumin, PD, panc cyst rupture, CHF
29
peritonitis risk factors
Cirrhosis, trauma involving abd cavity PD Bowel perforation TB Familial Mediterranean fever
30
peritonitis s/s and labs
s/s: gen abd pain, rigid abd, distention, low bowel sounds, hyperresonance, NV, fever Labs: leukocytosis -Check: CBC, CMP, CRP -May do: UA, BNP
31
peritonitis imaging and diagnostics. SBP vs 2ndBP
Imaging -KUB: free air, dilation -CXR: elevated diaphragm -CT/US: ascites, intra abd mass Peritoneal fluid = order protein, cell count, stain, C&S, lactic acid, glucose, LDH SBP lab results -polys cell count > 500 -Grm stain = bacteria -C&S GN usually -Lactic acid > 32 -glucose > 50 (opp in 2ndary peritonitis) -LDH < 225 (opposite) -protein > 1 (opposite) Sec. SBP results -leukocytosis > 10k -LDH > 225 -Protein < 1 -Glucose < 1
32
peritonitis management
Infectious workup and management -IV fluids, ABX, pan culture -ABX: cefotaxime, ceftriaxone, ampicillin or Unasyn. Possible aminoglycosides + metronidazole for anaerobic coverage. Ceftazidime for pseudomonas Surgical consult
33
hepatitis defintion and types
Inflammation of the liver caused by viral, bacterial, fungal, parasitic infections or alcohol, drugs, autoimmune disease or metabolic diseases Viral ABCDEG
34
hepatitis presentation and workup
s/s: fatigue, fever, low appetite, NV, clay stools, dark urine, joint pain, jaundice -surface antigen: current infection and able to infect. -surface antibody: immune to hep infection and cannot pass on to other -total antibody to core antigen: has or has had Hep infection now or sometime in the past. Includes IgM and IgG -IgM: current or recent acute infection. “miserable” -IgG: has had hep but “gone”
35
hepatitis general management
Bed rest until jaundice is gone No heavy lifting or strenuous activity High calorie, high carb, low protein, low fat NO ALCOHOL Antiemetics Review and dose meds HOSPITALIZE IF: encephalopathy or dehydration
36
Diverticulitis definition
Inflammation or localized perforation of diverticulum w/ abscess formation Can rupture and cause peritonitis. Can bleed w/o rupture
37
diverticulitis risk factors
Weakness in bowel wall, constipation, low fiber diet, change in diet
38
diverticulitis presentation and workup
s/s: LLQ pain, fever, constipation, NV, cramping, hypoactive BS, rectal bleeding Labs -CBC: leukocytosis, anemia -CMP: lyte issues d/t NV -sepsis/inflamm: ESR, CRP, procal, lactate -UA to r/o pyelo or UTI -Beta hCg for all females Dx -CT: free air = rupture -flexsig: usually outpt -colonoscopy/BE: usually outpt also -angiography to locate bleeding vessel
39
diverticulitis management
Can be managed outpatient Mild: home w/ bowel rest; low residue or CL diet 24-48 hours, no laxatives/enemas Hospital management -NPO -ABX (sometimes): Zosyn, ertapenem, impipenem, merrem, ticarcillin clavulanate -pain control: No ASA or NSAIDS -Sx consult if no improvement w/in 72 hours or decompensation, free air, abscess on CT, peritonitis -Possible reversible colostomy
40
appendicitis definition
Acute inflammation 2nd to occlusion of the lumen from fecaliths, inflammation, foreign bodes, worms, strictures, tumors
41
appendicitis presentation and workup
s/s: RLQ pain, + Psoas sign, + obtutator sign, + Rovsings sign, + McBurneys point, periumbilical pain, fever, constipation, diarrhea, NV Labs -UA: looking hematuria, pyuria, albuminuria -leukocytosis Dx -US: can Dx but painful -CT: BEST
42
appendicitis management
Sx is still mainstay IV fluids/ABX (GN, anaerobic) -Cefoxitin if not ruptured -rupture/gangrenous: Unasyn, gentamycin, clindamycin, flagyl, imipenem/cilastatin -Pain control Rupture: leave wound open, pack it and let close by secondary intention
43
pancreatitis definition
Acute, inflammatory autodigestive process of the pancreas
44
pancreatitis risk factors
Alcoholism, biliary tract disease, hyperlipidemia, cancer, hypercalcemia, ABD trauma/surgery, ERCP, viral infections, ischemia, PUD, pregnancy Congenital: pancrease divisum Drugs: Monjaro, Victoza
45
pancreatitis presentation and staging
2 of the following: amylase/lipase 3 x normal, radiographic evidence, characteristic abd pain Staging -Mild (80%): interstitial edema pancreas w/o organ failure -Moderately severe = w/ transient organ failure (failure last < 48 hrs & pancreatitis resolves w/in 1 week) -Severe = organ failure > 48 hrs s/s: NV, fever, sweating, anxiety, low bowel sounds, jaundice, steatorrhea, ascites, pl. eff, tachypnea, sharp shooting to back pain in epigastric area
46
pancreatitis labs and imaging
Labs -CBC: WBC > 10, Hct elevated d/t dehydration -CMP: hypocalcemia, high or low K, low albumin -Lipase/amylase: lipase more specific. P-amylase is more specific than amylase -Lactate, LDH, CRP, procal -Trigs -High glucose d/t islet cell damage -AST/LDH elevated if tissue necrosis -Bili and Alk phos = CBD obstruction Imaging -KUB: gallstones, calcif of pancreas, ileus, free air -US: gallstones, panc pseudocyst -CT w/ contrast: better than US but c/f renal damage in severe ill pts -MRCP
47
pancreatitis management
Treat the cause May need lap/choley to prevent recurrence Pain control Fluids: NS or LR (better) NGT if uncontrolled NV. Resume diet slowly; enteral feeds preferred over parenteral Glucose management: get A1c on admit Trend labs for improvement ERCP is not routinely recommended ABX if severe: GN and anaerobic coverage (zosyn, merrem) CT guided aspiration for fluid to get C&S if not getting any better Prognostic indicators -Atlanta revised criteria is preferred
48
Mesenteric ischemia definition
Failure of blood supply to mesentery to carry enough oxygen to meet intestinal needs 1/3: arterial embolism (moving) 1/3: arterial thrombus (stationary) 1/3: low flow states (shock, pressors etc)
49
mesenteric ischemia risk factors
PAD surgical accidents ABD trauma Tumor TTP, DIC SLE polyarteritis nodosa
50
mesenteric presentation and workup
s/s: cramping, abd pain, possible rectal bleed -HOTN and abd distention signals infarct Labs -leukocytosis -lactic acidosis Imaging -US w/ doppler -mesenteric arteriography -BE: thumbprinting or xray -MRA w contrast -CT w contrast
51
mesenteric ischemia management
Vascular or general Sx consult: stent, bypass. May need colon resection Increase blood flow, increase oxygenation Declot: surgery or drugs
52
GIB risk factors for UGI and LGI bleed
UGI: esophagus, stomach or duodenum -varices, Mallory Weiss tear or PUD LGI: diverticulitis, hemorrhoids, cancer, ischemic colitis, inflammatory colitis, post XRT injuries
53
GIB presentation and workup
Labs -CBC w/ serial H&H -PT/INR -CMP -EKG INR/PT/PTT: if INR 1.5-2 can consider endoscopy. INR > 2.5 and on anticoag then reversal agents
54
GIB general management
General Treatment -IV fluids -Consider O2 -GI consult -Hgb > 9 if massive bleeding, significant comorbities, delay in treatment. Otherwise Hgb > 7 -PLT and plasma transfusion consider in pts getting massive RBC -4 factor prothrombin complex concentrate > FFP Consider reversal agent and hold anticoagulants initially -Vit K and FFP for coumadin -idarucizumab = dabigatran -andexanet alfa = apixaban/rivaroxaban ASA for high-risk CV pts should be restarted ASAP or w/in 7 days. PTs w/ ACS in last 90 days, or stent in last 30 days should not DC anticoag No NSAIDS
55
Basics of Hepatitis A
A = acute fecal/oral transmission from food/water, restaurants, shellfish. VERY CONTAGIOUS. IG shot for temporary immunity for 2-3 mo Vaccine (Havrix, VAQTA) for high risk travel and after exposure. Combo w/ hep B. 2 shots.
56
Hep B basics
B = BAD -percutaneous/mucosal contact w/ virus through blood, semen or vaginal secretions. -90 day incubation -Vaccine: recombivax, engerix for 3 does. -No cure just remission. Can cause cirrhosis and liver Ca -Worse if combo infxn w HDV -Tx: interferon, lamivudine, adefovir, tenofovir, entecavir, telbivudine
57
Hep C basics
C = cure -blood or tissue contact Worse if also have HBV or HIV -20-30 yrs for serious damange -70% cure w/ protease inhibitors, interferon, ribavirin
58
Hep D basics
need Hep B to replicate Can be prevented w/ vaccine
59
Hep E basics
fecal/oral route not common in US, check if recent travel
60

Acute Care 2 (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions