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GI (50%) Flashcards

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1
Q

Features of High Risk Abdominal Pain

A 
> 65 yo
Immunocompromised
CVD
Major comorbidities (cancer, IBD, pancreatitis, renal failure)
Recent GI surgery
Early pregnancy (ectopic)
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2
Q

High Risk Abd Exam findings

A
  • Tense or rigid abdomen
  • Involuntary guarding
  • Signs of shock (pallor, tachycardia, tachypnea, diaphoresis, AMS)
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3
Q

Acute Hepatitis signs / symptoms

A
  • RUQ pain + fatigue
  • N/V
  • Anorexia
  • Jaunidce
  • clay colored stools
  • dark urine
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4
Q

Hepatitis A

A

Fecal-oral transmission
Dx = serum IgM anti-HA
Tx: self-limited

Prophylaxis for family members bc contagious 1st week of jaundice –> IV-IGG

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5
Q

Hepatitis B transmission & Symptoms

A

Bodily fluids
-Needles, sex, close contact, mother-to-baby

Flu-like symptoms + jaundice…may progress to liver failure

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6
Q

Hep B labs:

  • Acute infxn
  • Early acute infxn
  • Chromic infxn
  • Resolved acute HBV
  • Hep B vaccine
A

Acute Hep B = + IgM & + HBsAG

Early acute = only HBsAG +

Chronic Hep B infxn

  • Anti-HBc IgG +
  • HBsAG +

Resolved acute HBV

  • Anti-HB’s +
  • Anti-HBc IgG +

Hep B vaccine
-Only anti-HB’s +

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7
Q

Hepatitis C infxn

A

Blood-to-blood contact
IV drug users

85% develop chronic infxn

Increased risk of hepatocellular carcinoma

Dx= Anti-HCV +

Tx: Sofosbuvir, Grazoprevir, Declatasvir

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8
Q

Hepatitis D

A

Only occurs w/ hep B

Leads to more severe hepatitis & faster progression to cirrhosis

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9
Q

Hepatitis E

A

Fecal-oral transmission
-waterborne outbreaks

Self-limited infection

Dx = anti-HEV IgM

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10
Q

Pilonidal Cyst ABX

A

Indicated if significant cellulitis

Cefazolin + Metronidazole
OR Augmentin

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11
Q

MC type of Colon Cancer

A

Adenocarcinoma

Most precarious lesion –> adenomatous polyp

3rd leading cause of cancer death in US

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12
Q

Risk Factors for colon cancer

A
  • Elderly
  • Smoker + ETOH
  • Obesity
  • Low Fiber, High animal fat
  • 1st degree relative
  • Crohn’s Dz
  • Ulcerative colitis
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13
Q

Colonoscopy Guidelines

A

Average risk person w/o symptoms–> start getting at 50 yo & repeat q 10 years

Increased risk factors (adenomatous polyp or 1st degree relative) –> Start at age 40 or 10 years younger than diagnosis of family member

High Risk (Crohn’s or UC >8 years; Genetic disorder) –> Colonoscopy at any age

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14
Q

Tumor marker for colon cancer

A

CEA = carcinoembryonic antigen

Valuable for following after treatment

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15
Q

Hesselbach’s Triangle

A
  • Rectus abdominis
  • Inferior Epigastric vessels
  • Inguinal ligament

**Direct hernia passes through triangle

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16
Q

Anorectal abscess formation

A

Obstructed anal crypt gland

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17
Q

Where do anorectal abscesses usually occur?

A

within 3 cm of the anal margin

Intersphincteric & transphincteric are most common

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18
Q

Pectinate/Dentate line epithelium? Vessels? Lymph nodes? Innervation?

A

Above = columnar epithelium

  • superior rectal vessels
  • Internal iliac lymph nodes
  • Inferior hypogastric plexus

Below = squamous epithelium

  • Inferior rectal vessels
  • Superficial inguinal lymph nodes
  • Pudendal nerve
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19
Q

MC location for an anal fissure

A

Posterior midline = 90%

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20
Q

What is a sentinel pile?

A

thickened mucosa due to fissure – usually seen below fissure

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21
Q

Tx for anal fissures

A

Topical nitroglycerine or nifedipine

Stool softeners

Sitz baths

Surgery = Lateral internal sphincterotomy

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22
Q

What percentage of anorectal abscesses will result in a fistula?

A

50%

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23
Q

What is a positive Boas sign?

A

Right subscapular pain due to phrenic nerve irritation from cholecystitis

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24
Q

What is the Gold Standard test for cholecystitis?

A

HIDA scan

-Ordered when ultrasound is equivocal + high suspicion

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25
What are some ultrasound findings for acute cholecystitis?
- Stones - Thickened gallbladder wall >3 mm - Pericholecystic fluid - Distended GB - Sonographic Murphy's sign
26
Cholelithiasis definition
Gallstones in the gallbladder (no inflammation) Stones -90% = cholesterol 10% = pigmented
27
Which ABX is a major cause of biliary sludge?
Ceftriaxone
28
Charcot's Triad & Reynold's Pentad
Cholangitis Triad - RUQ pain - Fever - Jaundice Pentad + confusion +hypotension
29
Sliding Hiatal Hernia vs. Paraesophageal Hiatal Hernia
Sliding = MC! 90% - displaced gastroesophageal junction - GERD symptoms Paraesophageal - displacement of stomach fundus through defect...does not include GE junction - can become strangulated!
30
Treatment of Type I Hiatal Hernia vs. Type II
Type I = Sliding - GERD treatment - 15% require Nissen Fundoplication Type II = Paraesophageal -Nissen fundoplication
31
Drugs that can cause GERD
- Anticholinergics - Antihistamines - Tricyclic antidepressants - CCBs - Progesterone - Nitrates
32
Complications of GERD
- Esophagitis - Strictures - Barrett's
33
GERD Treatment
1. H2 blockers / PPI 2. If not medically managed order Endoscopy 3. pH probe = GOLD STANDARD 4. Consider Nissen Fundoplication for refractory pts
34
Barrett's esophagus
Complication of chronic GERD Normal stratisfied squamous epithelium of esophagus is replaced with columnar epithelium --> increased risk of esophageal adenocarcinoma Once identified screen pts q 3-5 years with upper endoscopy
35
Esophagitis - Infectious vs. Noninfectious
Infection --> painful swallowing! - Candida albicans - Herpes simplex - CMV * *immunocompromised pts** Non-Infectious - REflux - Meds --> NSAIDs, bisphosphonates - Radiation - Corrosive agents -- attempted suicide
36
Symptoms & Dx of Esophagitis
Symptoms - Painful, difficult swallowing - Chest pain when eating Dx: -Endoscopy + biopsy
37
Gastritis - Acute vs. Chronic
Inflammation of stomach lining Acute --> gastric antrum - NSAIDs - ETOH - Stress - H. pylori infxn - CMV Chronic --> risk for gastric carcinoma
38
Gastritis symptoms
- Epigastric pain - N/V - Worsened by eating
39
Gastritis Dx & Tx
Dx= endoscopy + biopsy -H. pylori testing Tx = treat underlying condition
40
H. pylori triple therapy
"CAP" - Clarithromycin - Amoxicillin - PPI
41
Peptic Ulcer Disease
Ulcer of the upper GI tract mucosa- involving stomach & proximal duodenum ``` Duodenum = 90% Gastric = 10% ```
42
MCC of non-hemorrhagic GI bleed leading to melena?
PUD
43
MCC & MC site of Duodenal ulcer vs. Gastric Ulcer
Duodenal - H. pylori - Anterior duodenum Gastric - H. pylori - LESSER curvature of antrum
44
Duodenal Ulcer Symptoms vs. Gastric Ulcer Symptoms
Duodenal - Better w/ meals - Post-prandial pain 1-2 hours later - Awakens pt at night Gastric - Worse with meals - Early satiety - Better a few hours later
45
Treatment of PUD
High dose PPI -- 20-40mg omeprazole for x4-8 weeks If H. pylori is present - Clarithormycin - Amoxicillin - PPI
46
MCC of acute vs. chronic pancreatitis
Acute = gallstones Chronic = ETOH
47
Diagnosis of pancreatitis requires 2/3 of which criteria?
1. Lipase >3x normal limit 2. Abdominal pain 3. Finding on CT or MRI
48
S/S pancreatitis
* Epigastric pain with N/V * Mild jaundice * Fatty stools * Low grade fever * Abdominal pain that is decreased by sitting up & leaning forward
49
Cullen's sign vs. Grey Turner's sign
Dx for pancreatitis Cullens = bruising around umbilicus Grey-Turner's = flank bruising
50
Diagnosis of Pancreatitis
- Lipase & amylase - Abdominal CT scan Can see sentinel loops on Xray from inflammation of pancreas
51
Ranson's Criteria for predicting ______ severity
Pancreatitis...3 or > = more severe course At admission - > 55 - Leukocytes > 16 - Glucose > 200 - LDH > 350 - AST > 250
52
Tx for pancreatitis
- NPO - fluids - analgesics - antiemetics - bowel rest - **ABX not typically used** Address underlying problem if chronic pancreatitis --> ETOH + low fat diet
53
Potential Causes of Hematemesis
Peptic Ulcer - Upper abdominal pain Esophageal ulcer - Odynophagia (pain) - GERD - Dysphagia (difficulty) Mallory-Weiss tear - Emesis, retching or coughing prior to hematemesis ``` Variceal hemorrhage - Ascites • Malignancy - Dysphagia - Early satiety - Involuntary weight loss Due to portal hypertension - Jaundice ```
54
what is a volvulus?
Obstruction due to twisting or knotting of the GI tract - Older adults w/ constipation - Kids w/ malrotation
55
Causes of intussuseption in kids & adults?
Kids = following viral infxn Adults = neoplasm
56
X-ray findings for intussuseption
- Cresent sign | - Bull's eye sign / target sign
57
Post-op ileus
Obstipation & intolerance of oral intake due to nonmechanical factors that disrupt normal coordinated propulsive motor activity in GI tract Some degree post op is normal & self limited (0-72 hours) >3 days is termed paralytic ileus
58
S/S + physical exam findings of post-op ileus
S/S - Abdominal distention / bloating - Diffuse persistent abd pain - N/V - Delayed passage of gas / inability - Inability to tolerate oral diet Physical Exam - Absent/reduced bowel sounds - Tympany on percussion - Diffuse tenderness
59
Treatment of post-op ileus
Physiologic ileus spontaneously resolves within 2-3 days - IV fluids - Stop opioids / use sparingly - Bowel rest = allowed clear fluids - NG tube = bowel decompression - Serial abd exams
60
Common Cause & Symptoms of Gastroparesis
Cause= Diabetes! S/S - N/V - Early satiety - Belching - Upper abdominal pain out of proportion to physical exam findings
61
Diagnosis of Gastroparesis
Gastric emptying scan CT/MRI/upper endoscopy to r/o mechanical obstruction
62
Treatment of Gastroparesis
Smaller meals spaced out 2-3 hours apart...low fiber & low fat diet (harder to digest) **Metoclopramide (Reglan)
63
C. diff infection commonly occurs after...
Treatment with ABX! -Clindamycin Seen in elderly hospitalized pts
64
S/S of C. diff infection
Mild, watery foul-smelling diarrhea >3 but <20 times per day Crampy abd pain Fever
65
Dx of C. Diff
PCR identification of C. diff toxin **Tox B is clinically important* Stool culture
66
C. diff treatment
IV metronidazole OR PO vancomycin
67
Celiac Disease definition
Autoimmune disorder causing malabsorption & chronic fatty diarrhea Causes crypt hyperplasia & villous atrophy --> malabsorption
68
Celiac Dz serology antibodies
Anti-endomysial Ab Anti-tissue transglutaminase Ab
69
Other conditions/problems associated with Celiac Dz?
Dermatitis herpetiformis Osteoporosis Iron deficiency anemia
70
Esophageal webs
thin membranes in mid-upper esophagus Congenital or acquired
71
Esophageal strictures
Scarring in esophagus - GERD - infectious esophagitis
72
Diagnosis of esophageal webs & strictures
Barium swallow study
73
Esophageal cancer - MC type - MC location
MC type in US = Adenocarcinoma Worldwide MC type = squamous cell MC site = lower 1/3
74
Gastric Cancer - MC type - Risk Factors
MC type = Adenocarcinoma Risk Factors - FmHx - Gastric ulcers - H. pylori - Pernicious anemia
75
Gastric Carcinoma | -S/S
- Abdominal fullness/pain - Anemia - Melena Virchow's node Sister-Mary Joseph nodule - umbilical lesion indicating abd malignancy
76
Gastric Carcinoma Tx & prognosis
Gastrectomy is only tx option overall prognosis is poor
77
Hepatic carcinoma - MC type - Risk Factors
MC type = Hepatocellular carcinoma -aggressive Risk Factors - Hep B - Chronic hep C - Hereditary hemochromatosis - Cirrhosis
78
Lab test for hepatic carcinoma
elevated serum alpha-fetoprotein
79
Pancreatic cancer risk factors
- increased risk with age - Smoking - ETOH - Pancreatitis - Diabetes mellitus - Obesity - Men > women
80
Pancreatic cancer MC type & location
MC = ductal adenocarcinoma in head of pancreas
81
Courvoisier's sign
palpable non-tender gallbladder...associated with pancreatic cancer
82
Whipple procedure
for pancreatic cancer -- only 20% can be removed at the time of diagnosis Remove antrum of stomach + part of duodenum + head of pancreas + gallbladder
83
Ulcerative Colitis | -Antibodies test?
Only involved colon!!! Mucosa & submucosa involvement p-ANCA (antineutrophil cytoplasmic antibodies) colonoscopy = lead pipe (loss of haustra)
84
Crohn's disease | -Antibodies test?
Mouth to anus *terminal ileum & proximal colon most commonly affected Transmural involvement Colonoscopy = cobblestone + skip lesions + ASCA (anti-saccharomyces cerevisiae antibodies)
85
MCC of acute gastritis?
**H. pylori**
86
Gastritis Tx
Avoid any causative agent Eradicate H. pylori PPI Parenteral B12 --> pernicious anemia due to gastric parietal cell destruction

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