GI Flashcards
(240 cards)
1
Q
what is the most common finding in patients with GERD
A
Hiatal hernia
2
Q
what food decrease LES tone and cause GERD
A
tobacco, coffee, spicy foods,alcohol, fatty foods, chocolate
3
Q
what are the clinical features of GERD
A
heart burn after eating retrosternal chest pain regurgitation odynophagia cough, hoarsness, hiccuping worse when lying down after meals
4
Q
what is the gold standard for diagnosing GERD
A
24 hour pH monitoring
5
Q
what is the test of choice for GERD
A
endoscopy with biopsy not necessary for typical uncomplicated cased
mostly used in refractory to treatment or dysphagia or GI bleeding
6
Q
what complications can occur from GERD
A
Erosive esophagitis peptic stricture Esophageal ulcer Barretts esophagus Recurrent pneumonia dental erosions
7
Q
what is the initial treatment for GERD
A
behavior modification
-Diet avoid fatty foods, coffee, alcohol, orange juice, chocolate, large meal before bed
Antacids after meals (Ca, Al, Mg)
8
Q
what should you used after behavior modification
A
add an H2 blocker which can be used instead of or in addition to antacids
H2 blockers stop acid production
9
Q
what should you use after failed H2 blocker
A
PPI like omperazole
PPI’s work by inhibiting H+/K+ ATPase enzyme of the gastric parietal cells
10
Q
what should be added if a PPI does not work
A
a promotility ages such as metoclopramide
11
Q
if a pro-motility agent doesn’t work then what
A
add combo therapy of H2 plus promotility agent
or PPI and promotility
12
Q
what surgery is done for resistant cases of GERD
A
nissen fundoplication
13
Q
who gets infectious esophagitis?
A
immunocompromised patients
14
Q
how do you work up patients with infectious esophagitis?
A
H&P with EGD
15
Q
what is the treatment for candida
A
fluconazole
16
Q
what is the treatment for deep esophageal ulcers
A
acyclovir to treat HSV
17
Q
How do you treat shallow ulcers in the esophagus
A
ganciclovir for CMV treatment
18
Q
what are the two types of esophageal neoplasms
A
squamous cell carcinoma
adenocarcinoma
19
Q
squamous cell carinoma of the esophagus is common in what ethnicity
A
African Americans
occurs in mid to upper third of esophagus
20
Q
what are risk factors for squamous cell cancer
A
tobacco and alcohol use, betel nuts, ingestion of hot foods and beverages
HPV, achalasia
21
Q
adenocarcinoma of the esophagus is common in what ethnicity
A
caucasians
occurs in the distal third of esophagus
22
Q
what is the risk factors for adenocarcinmoa
A
GERD, Barrett’s esophagus, alcohol and tobacco
23
Q
what are symptoms of esophageal cancer
A
dysphagia intially solids only then progression to liquids weight loss anorexia odynophagia hematemesis aspiration pneumonia chest pain
24
Q
how is esophageal cancer diagnosed?
A
upper endoscopy with biopsy and brush cytology
25
what is the treatment of esophageal cancer
palliation is the goal in most patients because the disease is usually advanced at presentation
Esophagectomy can be curative i patients with 0,1 or 2A
26
what is achalasia
acquired motility disorder of esophageal smooth muscle in which the lower esophageal sphincter fail to completely relax with swallowing and abnormal peristalsis
27
what is the absolute criteria for achalasia diagnosis
incomplete relaxation of the LES
| aperistalsis of esophagus
28
what are the clinical feature of achalasia
dysphagia
Equal trouble swallowing solids and liquids
Patients eat slowly and drink lots of water to wash down food
Regurgitation
Chest pain
weight loss
recurrent pulmonary aspirations
29
how is achalasia diagnosed
Manometry to confirm the diagnosis
barium swallow will show narrowing of distal esophagus (birds beak) and a large dilated esophagus proximal to narrowing
Upper GI to rule out secondary causes of achalasia
30
what is the treatment of achalasia
```
chew food to consistency of pea soup
sleep elevated
dicyclomine
sublingual nitro, CCB's
Botulism injections of esophagus
forceful dilations
```
31
what is esophageal spasm
spontaneous contraction of the esophageal body
| Nomal LES
32
how is esophageal spasm diagnosed
esophageal manometry
33
Tx for esophageal spasm
Nitrates or CCB
| possible TCA
34
what is zenkers diverticulum
outpuching of posterior hypopharynx
35
signs/sypmtoms of zenkers diverticulum
dysphagia
regurgitation
cough
halitosis
36
how is zenkers diagnosed
barium swallow
37
what is a mallory weiss tear
mucosal tear at GE junction leads to bleeding
38
what is Boerhaave's syndrome
esophageal rupture that is full thickness, patient's appear sick
happens after vomiting and there is excruciating pain
39
presentation for esophageal perforation
```
history specific
hematemesis
chest pain
dyspnea
tachypnea
```
40
what is the treatment of a mallory weiss tear
90% stop bleeding without treatment
treatment is surgery or angiographic emcolization if bleeding continues
acid suppression to promote healing
41
what is the etiology of esophageal varices
portal HTN and cirrhosis
42
what is the presentation of esophageal varicies
usually profuse hematesis which is life threatening
43
how are esophageal varices treated
hemodynamic support
IV fluids and vasopressors and immediate control of bleeding
Endoscopy and octreotide are preferred therapy
44
what is the etiology of esophageal strictures
complications of GERD, autoimmune disease, infectious, caustic ingestion, congenital, med induced, radiation
45
how does esophageal strictures present
usually progressive dysphagia of solids may progress to liquids
46
how are stricture worked up
Barium esophagram, EGD
47
what is the treatment of a stricture
dilation and stent placement
| unless malignant then it needs to be resected
48
what causes peptic ulcer disease
```
H pylori
NSAIDS
Hypersecretion states like Zollinger Ellison Syndrome
Also
Smoking
alcohol and coffee Stress
```
49
what is PUD
any ulcer of the upper digestive tract eg gastric or duodenal ulcer
50
what is the most common cause of PUD
H pylori
51
What are risk factors for gastric cancer
H pylori or gastric ulcers
52
features of PUD/Gastritis or Duodenitis
described as burning or gnawing that radiates to the back or LUQ
Hematemesis or melana
N/V
53
How will a duodenal ulcer feel when you eat food
improves with food
54
how will food affect a gastric ulcer
it typically worsens which leads to anorexia and weight loss
55
what are complications of ulcers
bleeding
perforation
Obstruction from scarring
malignancy
56
how is PUD diagnosed
Endoscopy is most accurate
essential in gastric ulcers to rule out malignancy
preferred with acute or severe bleeding
57
How is H pylori diagnosed
Biopsy is gold standard
Urease breath test is most convenient test and is 95% specific and sensitive
Serology of antibodies to H pylori
58
what is the treatment for PUD caused by H. Pylori
Amoxicillin and Clarithromycin plus PPI
or metronidazole for 14 days
OR
Bismuth subsalicylate plus tetracycline, metronidazole and PPI for 7 days
59
what is the treatment of Gastritis/duodenitis
H2 blockers or PPI
60
what causes gastritis
inflammation of gastric mucosa caused by NSAIDS/Aspirin, H pylori, alcohol
61
how is gastritis treated
empiric therapy with H2 or PPI and stopping NSAIDS
62
the majority of gastric cancer are what kind
adenocarcinomas
63
which gastric cancer has the most favorable prognosis
superficial spreading
64
what are risk factors for gastric cancer
```
atrophic gastritis
adenomatous gastric polyps
H. Pylori infection
Post antrectomy
Pernicious anemia
```
65
what is Virchows node
metastsis to superclavicular node
66
what is sister mary josephs node
metastasis to the periumbilical lymph node
67
what are the clinical features of gastric cancer
abdominal pain and unexplained weight loss
reduced appetite, anorexia, dyspepsia,
N/V, anemia, melena guaiac positive
68
how is gastric cancer diagnosed
endoscopy with multiple biopsies
69
what is the treatment for gastric cancer
surgical resection with wide margins and extended lymph node dissection
70
what is zollinger-Ellison syndrome
is a condition which one or more tumors form in your pancreas or upper part of small intestines
The gastrinomas secrete large amount of gastrin which causes excessive acid production which leads to PUD
71
how is zollinger ellison syndrome diagnosed
blood is analyzed to see whether you have elevated gastrin levels
they can do a secretin injection test
EGD
72
treatment of zollinger ellison syndrome
PPI and possible surgical resection
73
what is the most common extra-nodal site for non-hodgkins lymphoma
the stomach lymph nodes
74
who get pyloric stenosis
infants
| male more than females
75
what is pyloric stenosis
hypertrophy of the pyloric muscle
76
what are the symptoms of pyloric stenosis
projectile nonbilious vomiting
| weight loss and dehydration
77
what will you find on exam in a patient with pyloric stenosis
olive shaped mass in epigastrum
78
what is the treatment for pyloric stenosis
pylorotomy
79
how is pyloric stenosis diagnosed
barium swallow will show delayed emptying and string of pearls
or ultrasonography
80
what is cholelithiasis
stones in the gallbladder
81
what are the three types of stones
cholesterol stones most common which are yellow to green
pigment stones associated with hemolysis and sickle cell or alcoholic cirrhosis
mixed
82
what is a common symptom of cholecystitis
Pain in typically located in RUQ or epigastrium
Pain happens usually after eating and at night
radiates to subscapular
N/V anorexia
Murphys signs is pathognomonic
low grade fever and hypoactive bowel sounds
83
how is cholecystitis diagnosed
RUQ ultrasound will show thickened gallbladder wall, pericholecystic fluid, distended gallbladder and stones
Use HIDA scan when ultrasound is inconclusive
84
what does a positive HIDA scan mean
gallbladder was not visualized
| if its not visualized after 4 hours diagnosis of acute cholecystits
85
what is the treatment
| for acute cholecystitis
IV fluids, Bowel Rest, analgesics and correct electrolyte abnormalities
Cholecystectomy for pts with symptomatic stones
86
what is biliary colic
when stones in the gallbladder block the cystic duct and the gall bladder contracts and it usually only lasts a few minutes
87
what is acute cholecystitis
obstruction of the cystic duct (not infection) causes inflammation of the gallbladder wall
88
what are signs of biliary tract obstruction
```
elevated alkaline phosphatases (ALP) increased GGT
Elevated conjugated bilirubin
Jaundice
pruitis
clay colored stool and dark urine
```
89
what is choledocholithiasis
stone in the CBD
90
what are clinical features of choledocholithiasis
RUQ or epigastric pain, and jaundice
91
what labs will be abnormal
total direct and indirect are elevated as well as ALK-P
92
What does a RUQ ultrasound show with choledocholithiasis
usually the initial study but not as sensitive for choledocholithiasis
93
what is the gold standard for diagnosis for choledocolithiasis
ERCP
94
what is the treatment of choledocolithiasis
ERCP with sphincterotomy, stone extraction and stent placement
95
what is cholangitis
infection of biliary tract secondary to obstruction which leads to biliary stasis and bacterial over growth
96
what types of obstructions cause cholangitis
60% of the time its due to choledocholithiaisis can also be due to neoplasms, post op strictures
97
what are the clinical features of cholangitis
Charcot's triad
Fever, RUQ pain, jaundice
Renoylds pentad is
Fever, RUQ pain, jaundice, altered mental status and shock
98
what should you do for patients who have cholangitis
Blood cultures
IV fluids
IV Abx and decompress CBD when pt is stable
99
What are Lab findings with Cholangitis
hyperbilirubinemia, leukocytosis and elevated transaminases
100
what is used to make definitive diagnosis of cholangitis
ERCP or PTC
101
what is cirrhosis
liver disease characterized by fibrosis, disruption of the liver architecture and widespread nodules in the liver
102
what does the destruction of the liver due to cirrhosis cause
decreased blood flow through the liver causing portal HTN
| Hepatocellular failure which leads to decreased albumin synthesis and clotting factors
103
what is the most common cause of cirrhosis?
Alcoholic liver disease
104
what is the second most common cause of cirrhosis
Hep B and C infections
105
what are other causes of cirrhosis
```
Drugs- acetaminophen
Autoimmune hepatitis
Primary biliary cirrhosis
Hemachromatosis
Alpha1 antitrypsin deficiency
```
106
what are features of cirrhosis
```
Portal HTN
Varicies esophageal or gastric (caput medusa)
Ascities
gynecomastia
hemorrhoids
hematemesis, melena
Palmar erythema
hypoalbuminemia
```
107
what is primary sclerosing cholangitis
chronic thickening of bile duct walls unknown etiology
| Associated with IBD and UC
108
what is primary sclerosing cholangitis associated with for cancers?
cholangiocarcinoma
109
what are the features of PSC
fatigue, maliase,jaundice, pruritis and weight loss
110
what is the treatment of PSC
Urosdiol
| Liver transplant
111
what is the treatment of cirrhosis
bed rest, low sodium diet and diuretics (furosemide and sprionolactone)
beta blockers
therapeutic paracentesis if tense ascities
TIPS transjugular intrahepatic portosystemic shunt
112
what is hepatic encephalopathy
toxic metabolites mainly ammonia is thought to be the main one accumulate in the brain
113
clinical features of hepatic encephalopathy
decreased mental function, poor concentration and stupor or coma
Asterixis
rigidity and hyperreflexia
musty breath
114
what is the treatment for hepatic encephalopathy
Lactulose
Neomycin
Limit protein to 30-40 g/day
115
what is hepatorenal syndrome
indicates endstage liver disease
| progressive renal failure in advance liver disease secondary to renal hypoperfusion
116
what are the clinical features of hepatorenal syndrome
azotemia, olgiouria, hyponatermia, hypotension
117
what is the treatment for hepatorenal syndrome
liver transplant is the only cure
118
what is spontaneous bacterial peritonitis?
infected ascitic fluid
| occurs in patients with ascities by end stage liver disease
119
what bacterial are responsible for SBP
e. coli
Klebsiella
Streptococcus pneumoniae
120
what are symptoms of spontaneous bacterial peritonitis
abdominal pain, fever, vomiting, rebound tenderness,
121
How is SBP diagnoes
paracentesis and examining fluid for WBC especially PMN
WBC>500
PMN>250
122
what is the treatment for SBP
Abx
123
how is cirrhosis treated
abstinence from alcohol and interferon for hep B and C
Avoid acetaminophen
Once cirrhosis develops goal is to manage complications
Liver transplant is the only cure
124
what is primary biliary cirrhosis
cholestatic liver disease characterized by destruction of intrahepatic bile ducts
125
what is the etiology of PBC
autoimmune and affects middle aged women
126
what are the clinical features of PBC
fatigue, jaundice, pruritus, RUQ pain, xanthomata, Osteoporosis
Portal HTN
127
how is PBC diagnosed
LFT's and elevated ALK-p
| positive AMA and a liver biopsy confirms diagnosis
128
what is the most common benign liver tumor
cavernous hemangioma
129
hepatocellular carcinoma accounts for what percent of liver cancer
80% althought they are rare in the US account for most deaths due to cancer world wide
High risk areas include africa and asia
130
what type of hepatocellular carcinoma is associated with Hep B and C
nonfibrolamellar most common
131
what are risk factors for hepatocelluar carcinoma
```
cirrhosis especially in association with alcohol or hepatitis
Alpha 1 antitrypsyn deficiecny
hemochromatosis, wilsons disease
Schistosomiasis
hepatic adenoma
cigarette smoking
```
132
features of hepatocelluar carcinoma
abdominal pain
weight loss, anorexia, fatigue,
portal hypertension, jaundice
paraneoplastic syndromes- erythrocytosis, hypercalcemia, carinod syndrome
133
how is hepatocellular carcinoma diagnosed
liver biopsy
Hep B&C serology, LFT and coags
US,CT,MRI is surgery is an option
Tumor marker elevation (AFP)
134
what is the treatment for hepatocellular carcinoma
liver resection or liver transplant
135
what is NASH
symiliar to alcoholic liver disease but patients have not history of alcohol use
136
NASH is associated with
obesity, hyperlipidemia, DM
137
what is the most common cause of hepatitis
viral
138
what is the second most common cause of hepatitis
toxins
| Alcohol
139
chronic hepatitis most often results from which hepatitis's
B,C,D
but is often inherited disorders wilsons disease, alpha 1 antitrypsin deficiency
140
How are hepatitis A&E transmitted
Fecal-Oral
141
how are hepatitis B,C,D transmitted
blood or mucous membrane contact
142
Clinical features of hepatitis
fatigue, malaise, nausea, abdominal discomfort
143
what is the prognosis of Hep A&E
self limited and mild without long term sequalae
144
when does a person get Hep D
only seen in patients with Heb B and associated with a more severe course
145
Igm to Anti-HAV indicates what?
detects the onset of Hep A
146
HAV IgG represents what
resolved hep A
147
what does HBsAg mean
| Hepatitis B surface antigen
current infection with HBV acute or chronic
148
what does anti-HBs
| anti-hepatitis B surface antigen
marker of immunity with HBV
149
what does anti-HBc mean
| Hep B core antibody
present between the disappearance of HBsAG and the appearance of anti-HBs indicating acute hepatitis
150
what does HBeAg mean
| Hepatitis B envelope antigen
indicates highly contagious HBV infection but anti-HBe antibodies indicate lower level of infection
151
how can you tell when hep C is present
anti-HCV antibodies
152
how is hep D detected
only happens when hep b and detected by anti-HDV antibodies
153
how to tell if a person is Hep B carrier or is chronic infection
Both have positive HBsAg but in chronic infection there is elevated AST and ALT
hepatocelluar damage on biopsy
154
his is hep A&E treated
supportive
155
how is chronic HBV treated
Interferon
156
how is chronic HCV treated
interferon and ribavirin
157
what is pancreatitis
inflammation of the pancreas resulting from prematurely activated pancreatic digestive enzymes that induce autodigestion
158
which type of pancreatitis will respond to supportive treatment
mild acute pancreatitis
159
what are the most common causes of pancreatitis
alcohol or gallstones
can also be caused by post ERCP
Viral infection
post op
scorpion bites
160
what are the clinical features of acute pancreatitis
```
epigastric pain radiating to the back
N/V
leukocytosis
Fever/Peritonitis
severe hypovolemia, ARDS
```
161
What labs will be abnormal in acute pancreatitis
serum amylase is the most common test but many condition cause hyperamylasemia
Levels need to be more than 5 times upper limits of normal
Serum lipase is more specific
LFT- to identify cause
Hyperglycemia,hypoxemia and leukocytosis
162
how is pancreatitis diagnosed
CT scan
ERCP is used in severe gallstone pancreatitis with biliary obstruction
163
what is the admission criteria for pancreatitis
```
GA LAW
Glucose >200
Age>55
LDH>350
AST>250
WBC>16,000
falling Calcium
BUN Rising
```
164
what is the treatment for acute pancreatitis
NPO-bowel rest
IV fluids
correct electrolyte abnormalities
Pain control
165
what is cullens sign
periumbilical eccymoses from hemorrhagic pancreatitis
166
what is grey turner sign
flank ecchymoses hemorrhagic pancreatitis
167
what is fox's sign
eccyhymosis of inguinal ligaments from hemorrhagic pancreatitis
168
what is chronic pancreatitis
persistent or chronic inflammation of the pancreas with fibrotic tissue replacing pancreatic parenchyma and alteration of pancreatic ducts
169
what is the most common cause of chronic pancreatitis
alcoholism
170
what are the features of chronic pancreatitis
severe pain in epigastrium recurrent or persistent
N/V
aggravated by drinking episode
171
how is chronic pancreatitis diagnosed
CT scan will show calcifications
ERCP is the gold standard
Lab studies not helpful
172
treatment for chronic pancreatitis
```
narcotics for pain management
NPO
Pancreatic enzymes and H2 blockers
Insulin
alcohol abstinence
surgery-whipple procedure
```
173
what is the classic triad for pancreatic calcifications
steatorrhea, pancreatic calcifications, DM
| Elevated fecal fat
174
who gets pancreatic cancer
mostly elderly patients 75% >60yrs old
| more common in african americans
175
where is the most common location of pancreatic cancer
75% occur in the head
176
what are risk factors for pancreatic cancer
```
Smoking is most clearly established
chronic pancreatitis
DM
alcohol use
exposure to benzidine and b-naptthlamine
```
177
what are clinical features of pancreatic cancer
```
abdominal pain
jaundice
weight loss, anorexia
glucose intolerance
depression, fatigue
courvoisiers sign
```
178
how is pancreatic cancer diagnosed
CT is the preferred test for diagnosis
Tumor markers CA19-9
CEA
179
what is the treatment for pancreatic cancer
whipple procedure
180
what is appendicitis?
lumen of the appendix is obstructed by hyperplasia of lymphoid or a fecalith
181
what is the most common cause of appendicitis
fecalith
182
what age is the most common age for appendicitis
10-30 years of age
183
what are the symptoms of appendicitis
```
intermitten periumbilical or epigastric pain
pain at Mcburneys point
N/V, anorexia
Low grade fever
Psoas sign
```
184
how is appendicitis diagnosed
CT scan
185
what is the treatment of appendicitis
appendectomy
| Abx if perforation
186
most colon cancers arise from what type of cells
adenomas
187
what do all patients with a positive FOBT need
colonoscopy
188
what are risk factors for colon cancer
```
age over 50
adenomatous polyps
villous adenomas
larger the size or greater number of polyps higher risk of cancer
prior Hx CRC
IBD
Both UC and Chrons increase risk but UC greater risk
Fam Hx 1st Degree relatives
Familial adenomatous polyposis
Gardners syndrom
Turcots syndrome
Peutz-Jegher
Lynch Syndrome
```
189
clincial features of CRC
```
melena, hematochezia, abdominal pain, iron deficiency anemia
Abdominal pain
Bowel obstruction
weight loss
blood in stool
```
190
Signs of right sided tumors
occult blood in stool, iron deficiency anemia, melena
| Triad of anemia weakness, RLQ mass
191
signs of left sided tumor
obstruction
alternating constipation/ diarrhea
pencil stools
heamtochezia
192
rectal cancer signs
heamtochezia
tenesmus
rectal mass
193
what is the treatment of CRC
Surgery resection of tumor and regional lymphnodes
| CEA level
194
what is the surveillance for a person with CRC
stool guaiac test
annual CT scan of abdomen/pelvis and CXR up to 5 years
Colonoscopy at 1 year every 3 years
CEA levels
195
what is the most common nonneoplastic polyp
hyperplastic/(metaplastic) polyps
| hard to distinguish so often removed
196
what are the three types of adenomas
Tubular which is the most common with the smallest risk of malignancy
Tubulovillous-intermediate risk
Villous- greatest risk
197
what determines the malignant potential of a polyp
size- the larger greater risk of malignancy
histologic type
Atypia of cells
shape- sessile(more likely to be malignant) versus pedunculated on a stalk
198
what is chrons disease
it is a chronic transmural inflammatory disease that can affect any part of the GI tract
199
what is the hallmark location of chrons disease in the body
terminal ileum
200
what does the pathology of chrons disease look like
```
Skip lesions, discontinuous involvement
Fistulae
Luminal strictures
noncaseating granuloma
Transmural thickening
```
201
what are the clinical features of chrons
```
diarrhea usually without blood
malabsorption
abdominal pain in the RLQ
N/V
Fever malaise
Uveitis, Arthritis, Erythema nodosum, apthous ulcers
```
202
how is chrons diagnosed
endoscopy with biopsy
203
what are complications of chrons
```
fistulae
anorectal disease
SBO
Malignancy
Malabsorption
```
204
what is the treatment for chrons
Sulfasalazine 5-ASA
205
what is Ulcerative colitis
chronic inflammatory disease of the colon or rectal mucosa
206
where is the most common site affected by colitis
the rectum
207
what does the pathology of colitis look like
uninterrupted involvement of the rectum and colon NO SKIP lesions
PMN accru in the crypts of the colon
208
what are the clinical features of colitis
```
Blood diarrhea
abdominal pain
frequent but small bowel movenents
fever, anorexia, weight loss
tenesmus
Jaundice, arthritis
```
209
what should you include in your work up of suspected colitis
stool cultures for ova and parasites
fecal leukocytes
Colonoscopy
210
complications of UC
```
iron deficiency anemia
hemorrhage
electrolyte abnormalities
Colon cancer
Sclerosing cholangitis
```
211
what is the treatment for UC
systemic steroids for acute exacerbations
| Sulfasalazine, Mesalamine
212
what is IBS
combination of altered motility hypersensitivity to intestinal distention and psychological stress
213
who is IBS more common in?
women
214
how is IBS diagnosed
it is a diagnosis of exclusion
215
what is intussusception
is invagination of the proximal segment of the bowel into the portion just distal to it
Occurs in 95% of children usually following viral infection
In adults its caused by a neoplasm
216
clinical features of intussusception
colicky pain if stool is passed will contain blood and mucus (current jelly stools)
A sausage like mass may be felt on exam
217
lab findings for Intussusception
for kid barium or air enema may be therapeutic and diagnostic
218
how is intussusception diagnosed in adults
dont use barium
| CT is best mean of establishing the diagnosis
219
what is the treatment for intussusception
for kid barium or air enema
| adults may require surgery
220
what is diverticulosis
large outpouchings of the mucosa of in the colon
221
what are laboratory findings with diverticulosis
occult blood in the stool and moderate leukocytosis
plain film to rule out free air
CT is warranted if patient does not respond to therapy
222
what is the treatment for diverticulitis
low residue dies and broad spectrum Abx
Hospitalization for IV administration of IV Abx, bowel rest, pain meds, NG tube if ileus develops
Surgical management me be necessary in severe cases including peritonitis, large abscess
High Fiber diet
223
clinical features of CMI are
abdominal angina with pain occuring 10 to 30 minutes after eating which is relieved somewhat by squatting or laying down
224
how does AMI present
sudden angina with pain out of proportion to examination findings
225
lab findings in AMI
Colonoscopy is the optimal test to evaluate for ischemia of the colon
226
treatment for AMI
surgical revacularization
227
what is toxic megacolon
extreme dilatation and immobility of the colon and represents a true emergency
228
what causes toxic megacolon in kids
hirshsprungs disease
229
what causes toxic megacolon in adults
UC, Chrons, psedomembranous colitis and shigella, campylobacter and clostridium
230
clinical features of toxic mega colon
fever, prostration, severe cramps and abdominal distention
| rigid abdomen and localized, diffuse or rebound tenderness
231
what do the abdominal films show
colonic dilitation
232
what is the treatment for toxic megacolon
decompression of the colon is required, in some cases a colostomy or even complete colonic resection
233
what is celiac sprue
inflammation of the small bowel with the ingestion of gluten containing foods such as wheat, rye and barley leading to malabsorption
234
how does celiac sprue present
diarrhea, steatorrhea, flatulence, weightloss, weakness, abdominal distention
235
how is celiac disease diagnosed
IgA antiendomysial and antitissue transglutaminase antibodies
small bowel biopsy to confirm the diagnosis
236
what is the treament for celiac disease
gluten free diet, refer patient to a nutrionist
possibly a lactose diet
supplement of B12, Iron, folic acid and Vitamin D
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what is a volvulus
twisting of any portion of the bowel on itself most commonly the sigmoid or cecal area
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clinical features of volvulus
cramping abdominal pain and distention with nausea, vomiting, and obstipation
abdominal tympany will be found on exam along with tachycardia, and fever
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how is volvulus confirmed
abdominal plain film which show colonic distention
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what is the treatment for volvulus
endoscopic decompression
| surgical evaluation and treatment is required if volvulus fails to quickly resolve
