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Flashcards in GI Deck (45)
1

appendicitis

chronic or acute inflammation of vermiform appendix - obstruction by fecalith, foreign body, neoplasm

MOST COMMON ABD SURG EMERGENCY

2

appendicitis s/s

McBurney's
Rovsing: RLQ pain intensified by LLQ palp

Markle: heel jar
Obturator: inward rotation of hip = kick
Psoas: lifting thigh against resistance = pain

moderate leukocytosis (10-18)

3

appendicitis tx

NO PAIN MED UNTIL SURGICAL EVAL

cefoxitin

4

cholecystitis

inflammation of gallbladder - 90% d/t gallstones impacted in cystic duct (inflammation behind obstruction)

acute can dev r/t infection, ex: CMV

5

cholecystitis s/s

murphy sign: abrupt cessation of inspiration upon palpation of RUQ

referred pain to R shoulder

rebound pain, elevated WBC/AST/ALT

6

cholecystitis tx

NPO, IVF, abx (2/3g ceph)

pain: morphine
NEVER DEMEROL

laparoscopic chole

monitor for gallbladder gangrene, post-op ileus

7

pancreatitis

inflammation of gal bladder - assoc w dysfxn of exocrine fxn - autodigestion!

8

most common abd surgical emergency

appendicitis

9

pancreatitis s/s

- supine: panc makes soup out of your insides = hurts when supine (sitting = relief)
- shock
- chvostek's: cheek spasm
- trousseau: BP cuff spasm
- cullen (bluish periumbilical)
- grey turner: bluish flanks
- pleural effusion

10

pancreatitis diagnostics

abd xray: colon cutoff sign (gas filled transverse abruptly cut off d/t inflamed pancreas)

CT scan: DIAGNOSTIC! enlarged pancreas or pseudocyst

11

diagnostic for pancreatitis

CT scan! enlarged or pseudocyst

12

pancreatitis labs

↑ amylase (4x nl suggests panc)
↑ lipase (more dxic but slower)
↑ HCT (d/t hemoconcentration)
↑ PT, INR
↑ WBC 10-30
proteinuria, glycosuria, hyperglycemia
↓ serum Ca s/t ↓ albumin (3rd spacing d/t autodigestion)

13

pancreatitis Ca significance

↓ serum Ca s/t ↓ albumin (3rd spacing d/t autodigestion)

14

ischemic bowel syndrome

chronic: *atherosclerosis sup or inf mesenteric arts, celiac → ↓ intestinal blood flow

acute: d/t abrupt ↓ blood flow:
* shock
* embolus
* sm bowel obstruction
- trauma
- CHF (drastically diuresed)
- colon resection w reanastomosis

SURGICAL EMEGENCY

15

ischemic bowel s/s

steady epigastric pain
elevated WBC
bloody diarrhea
abd distension
METABOLIC ACIDOSIS
hypotension

16

GI surgical emergencies

appendicitis (most common)

ischemic bowel

17

ischemic bowel tx

surgical emergency!!!!!!

ampicillin, aminoglycoside, clindamycin

monitor for sepsis, MODS, extension of ischemia/infarct

18

2 out of 3 buys you a ticket to the OR

+ history
+ physical exam
+ labs, imaging

DON'T LET THE SUN RISE OR SET ON A COMPLETE SMALL BOWEL OBSTRUCTION

19

GERD

constellation of sx r/t repeated exposure of esophageal mucosa to gastric contents → breakdown of mucosal barrier

RELAXATION OF ESOPHAGEAL SPHINCTER

20

GERD mgmt

lifestyle modification, Nissen fundoplication

* PPI: -prazoles, Protonix, Prevacid, Nexium etc

* eliminate/reduce sx

21

peptic ulcer disease

gastric & duodenal ulcers - break in surface mucosa of stomach/duodenum → exposes tissue to damaging effects of acid & pepsin
usually consider an area > 5mm

H. PYLORI IS A BIGGY! NSAIDS, syndromes

22

PUD sx both v gastric v duodenal

both: burning/gnawing pain, epigastric region dyspepsia, sx clusters/free periods

gastric - eating may ↑ pain

duodenal - ↓ pain after eating, ⅔ nocturnal pain

23

PUD tx

sx controlled, assess for GIB

24

dumping syndrome

20% PUD - hyperosmolar chyme (CHO) enters sm int, ↑ osmotic gradient & pulling fluid into the gut

GI discomfort, n, v, d, cramps

vasomotor response: diaphoresis, palpitations, flushing

25

diverticulitis

inflammatory changes w/in diverticular mucosa - diverticuli in DESCENDING & SIGMOID

pouch-like protrusions of intestinal mucosa in descending & sigmoid colon

MOST ASX!! / sxatic if: inflamed, bleed, perforate

26

diverticulitis presentation

mild LLQ tenderness, rebound tenderness, + stool guaiac!!!

older folks

MILD MILD MILD

27

diverticulitis dx

CT scan: diverticuli or fistula

colonoscopy: not definitive but can r/o other causes

28

diverticulitis tx

abx: keflex, flagyl, cipro, bactrim

spasms: bentyl, buspar

pain relief: avoid morphine (increased intraluminal pressure in colon can lead to perf)

29

avoid morphine in diverticulitis why?

increased intraluminal pressure in colon can lead to perf

30

ulcerative colitis

colon(ly) - diffuse mucosal inflamation aka regional enteritis

31

clinical hallmark of ulcerative colitis

BLOODY DIARRHEA! may present with urgency

32

UC work up

colonoscopy with biopsy or sigmoidoscopy

33

UC dx based on

hx blood diarrhea!
lower abd cramps w urgency
microcytic anemia
↓ serum albumin
- stool cultures
+ colonoscopy or sigmoidoscopy

34

UC tx

prednisone!! avoid prolonged
sulfasalazine (also anti-inflammatory)

35

beware toxic megacolon

UC & Crohn's

36

Crohn's disease

bow-all. any or all layers of the bowel, not just the colon - transmural

37

Crohn's visualization

- mucosal inflammation
ulceration (peyer’s patches)
- x-ray “cobblestone appearance”
- develop strictures & subsequent obstrctn
narrowing of lumen, loops adhering to each other
- high risk for bowel obstruction (50% dx req surgery)

38

Crohn's clinical presentation

RLQ pain/mass
semiliquid stool/diarrhea, fistulas, flatulence

39

Crohn's labs

CBC, CMP
- anemia (iron or B12) which also presents as neuropathy
- hypoalbuminemia
- leukocytosis

40

IBS

3mo+ lower abd sx & bowel complaints (Δ freq or characteristics)
may be continuous or intermittent

also called “spastic colon”

POO'D = GOOD

41

IBS H&P shows no

fever, bloody diarrhea, leukocytosis

42

IBS tx

antispasmodic: bentyl

lomotil, imodium

assess for relief of sx

43

C Diff

abx associated colitis: FACC'd up bowels
fluoroquinolone
ampicillin
cephs
clindamycin

44

difficult to differentiate until OR...

Crohn's & UC

45

C Diff tx

Flagyl (metronidazole), vanc, colectomy, hand washing!!!