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GI Flashcards

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1
Q

common causes of gastric outlet obstruction

A

gastric malignancy, peptic ulcer disease, Crohn disease, strictures secondary ot ingestion of causting agennts and gastric bezoars (even 6-12 months after)

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2
Q

diabetic gatroparesis - when

A

10 years after DM

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3
Q

psoas abscess - clinical presentation

A
  1. sabacute feve, abd/flank pain radiating to groin
  2. anorexia / weight loss
  3. abd pain with hip eptension (psoas sign)
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4
Q

psoas abscess - diagnosis

A

CT scan of abdomen + pelvis
leukocytosis, elevated inl markers
blood + abscess cultures

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5
Q

psoas abscess - treatment

A

drainage

broad spectrum antibiotcs

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6
Q

management of gallstones

A
  1. without symptoms: no treatment
  2. biliary colic symptoms: elevtice laparoscopic cholecystectomy
  3. complicaed gallstone diseae (acute cholecystitis, choledocholithiasis, gallstone pancreatitis: cholecystecomy within 72 hours
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7
Q

colonic iscemia - pathophysiology

A

nonocclusive watershed ischemia (splenic flexure + rectosigmoid area)
underlying atherosc disease
state of low blood flow

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8
Q

colonic ischemia - clinical features

A

moderate abd pain + tenderness
hematoschezia, diarrhea
leukocytosis, lactic acidosis

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9
Q

colonic iscemia - diagnosis

A

CT scan: colonic wall thickening, air in wall (pneumatosis), fat stranding
endoscopy: edematous + friable mucosa

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10
Q

colonic ischemia - management

A

IV fluids + bowel rest
antibiotcs wit enteric coverage
colonic resection in necrosis develop

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11
Q

diagnosis of scurvy / how long of def causes symptoms

A

plasma or leukocytes vit C

- 3 months

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12
Q

Pancreatic ca - RF

A
  1. smoking
  2. hereditary pancreatitis
  3. nonhereditary chronic pancreatitis
  4. obesity + lack of physical activity
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13
Q

pancreatic ca - clinical presentation

A
  1. systemic symptoms (weight loss, anorexia) (more than 85%)
  2. abdominal pain / back pain (80%)
  3. jaundice (56%)
  4. recent onset of atypical DM
  5. unexplained migratory superficial thrombophlebitis
  6. Hepatomegaly + ascites with metastasis
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14
Q

pancreatic ca - Labs

A
  1. cholestasis (elevated ALP + direct bilirubin)
  2. CA 19-9
  3. Abd U/S (if jaundice) or CT scan if no jaundice
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15
Q

acute mesenteric ishemia - presentation

A

rapid onset of periumbilical pain (often severe)
pain out of proportion to examination findings
hematoschezia (late)

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16
Q

acute mesenteric ishemia - RF

A

atherosclerosis (acute on chronic)
embolic source (thrombus, vegetations
hypercoagulable disorders

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17
Q

acute mesenteric ischemia - Labs

A

leukocytosis
elevated amylase + phosphate level
metab acidosis

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18
Q

acute mesenteric ischemia - diagnosis

A
  • CT (preferred) or MR angiography

- mesenteric angiography (if diagnosis unclear, gold standard)

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19
Q

anal fissures - etiolgy

A

local rauma (eg. constipation, prolonged diarrhea, anal sex)
IBD
malignancy

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20
Q

anal fissure - clinical presentation

A

pain with bowel movement
bright red blood on toilet paper or stool surface
most common at posterior anal midline
chronic fissure may have skin tag at distal end

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21
Q

anal fissure - treatment

A 
high fiber diet + fluids
stool softeners
sitz baths
topical anestetics (vasodilators (nifedipine, NO) 
- if refractory: surgical intervention
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22
Q

management of blunt abdominal trauma in hemodynamically stable patients

A

normal mental status?
NO: serial abd exams +/- CT
YES: FAST: if negative to serial abd exams (+/- CT scan), if (+) do CT

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23
Q

sphincter of Oddi dysfunction - gold standard to diagnose and treatment

A
  • Oddi manometry

- sphincterotomy (avoid opioids)

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24
Q

small bowel obstruction - clinical presentation

A
  1. colicky abd pain, vomiting
  2. inability to pass flatus or stool if compete
  3. hyperactive and then absent bowel sounds
  4. distended + tympanic abdomen
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25
small bowel obstruction - diagnosis
dilated loops of bowel with air-fluid levels on plain film or CT partial air in colon complete: transition point, no air in colon
26
small bowel obstruction - complications
ischemia/necrosis | bowel perforation
27
small bowel obstruction - management
bowel rest, nasogastric tube, IV fluids | if signs of complication or unstable surgical exploration
28
pilonidal disease?
males 15-30, esp obese, with sedentary lifestyles or occupations, and those with deep gluteal clefts - pain, fluctuant mass 4-5 cm *mucoid, purulent or bloody drainage) - despite longer healing times, open closure is preferred due to decrease recurrence rate
29
paralytic ileus - etiology
1. abd surgery 2. retroperitoneal/abd hemorrhage or inflammation 3. intestinal ischemia 4. electrolyte abnormalities 5. morphine
30
Suspected esophageal variceal hemorrhage --> ...
place 2 large-bore IV catheters --> give fluids, octreotide, antibiotics --> Urgent endoscopic therapy: A. No further bleeding --> 2ry prophylaxis: β-blockers, endoscopic ligation 1-2 wks later B. continued bleeding --> balloon tamponade --> TIPS or shunt surgery C. early rebleeding --> repeat endoscopic therapy --> reccurent hemor --> TIPS or shunt surgery
31
lab associated with gallstone pancreatitis
ALT more than 150
32
Dumping syndrome - symptoms
1. abd pain, diarrhea, nausea 2. HYPOTENSION/TACHYCARDIA 3. dizziness, confusion, fatique, diaphoresis
33
Dumping syndrome - onset / pathogenesis
15-30 mins after meal | rapid emptying of hypertonic gastric contents
34
Dumping syndrome - management
1. small/frequent meals 2. replace simplesugars with complex carbo 3. incorporate (add) high fiber + protein rich foods 4. if refractory: octreotide or reconstructive surgery
35
congenital umbilical hernia - pathophysiology
incomplete closure of abd muscles
36
congenital umbilical hernia - clinical features
1. soft nontender bulge at umbilicus 2. protrudes with increased abd pressure 3. typically reducible
37
congenital umb hernia - management
observe (for spontaneous closure) elective surgery at age 5 less likely to close if larger than 1.5 in diameter or other underlying medical problems
38
umbilical granuloma
umbilical cord has separated with a oist, red, pedunculated, friable umbilical mass treatment: silver nitrate
39
emphysematous cholecystitis - RF
1. DM 2. Vascular compromise 3. immunosprression
40
emphysematous cholecystitis - clinical presentation
1. fever, RUQ pain, nausea, vomiting | 2. crepitusn abd wall
41
emphysematous cholecystitis - diagnosis
1. air fluid levels in gallbladder, gas in wall 2. cultures with gas forming Clostiridium, E.coli 3. uncongugated hyperbilirub (clostiridium induced hemolysis), mildly elebated aminotranferases
42
emphysematous cholecystitis - treatment
emergent cholecystectomy | broad spectrum antibiotcs with Clostiridium coverage (eg. ampicillin-sulbactam)
43
emergent surgery in patients on warfarin
fresh frozen plasma pre-operatively
44
duodenal hematomas
MC in paediatric - following blant abd trauma epigastric pain and vomiting 24-26 h after initial injury managemet: gastric decompression + parental nutition
45
evaluation of blunt genitourinary trauna
urinalysis --> if hematuria: - stable: Contrast CT - unstable: IV pyelography --> surgical evaluation
46
pancreatic pseudocysts - treatment
- expectant management is preferred iniitally in patients with minimal or no symptoms and without complications - endoscopic drainage is typically reerved for patients with significant symptoms, infected, or evidence of pseudoaneurysm
47
uncomplicated diverticulitis - treatment
- outpatient with bowel rest, oral antibiotcs, observation | - ihospitalization in elderly, immunosuppressed, high fever, significant leukocytosis, cormobitities
48
complicated diverticulitis - treatment
abscess smaller than 3 cm --> iv antibiotcs and observation --> worsening symptoms --> surgery larger than 3 cm --> CT-guided perctuaneous drainage --> if not controlled in 5 days --> surgical drainage and debridement fistula, perforation, obstraction, recurrent attacks --> resection
49
appendicitis management
it is a clinical diagnosis --> immediate appendectomy (Imaging only if nonclassic symptoms, or delayed presentation
50
appendicitis - when to go consevatively
symptoms more than 5 days usually have a phlegmn with an abscess that was walled off (delayed appendectomy) PSOAS SIGN POSITIVE
51
acalculous cholecystitis
in critically ill patients similar presentation image: wall thickening and distention + pericholecystic fluid - antibiotcs + percutaneous chocystostomy, followed by cholecystectomy when medical condition stabilize
52
Surgery and hemorophilia A
Give desmopresin before
53
how to prevent paralytic ileus
1. epidural anesethesia 2. minimally invasive surgery judicious perioperative use of IV fluids (to minimise GI edema)
54
adenoca in GERD if more than .... years
20
55
esoph stricture vs ca
ca is asymmetric narrowing of the lumen | stricture: symmetric, circumferential narrowing on barium swallow
56
gastric outlet obstruction clinical examination
abdominal succussion splash which is elicited by placing the stethoscope over the upper abdomen and rocking the patient back + forth at the hips
57
Scurvy - manifestation
cutaneous: petechiae, follicular hemorrhage, bruising, coiled hairs 2. gingivical: bleeding/receding gums + dental carries 3. constitutional: arthralgias, weakness, malaise, depression 4. impaired wound healing 5. vasomotor insttability (if severe/prolonged)
58
perforate viscus (eg. air under the diaphragm) - next step
urgent laparo
59
RFs for psas abscess
1. HIV 2. IV drug use 3. DM 4. Crohn
60
torus palatinus?
young individuals with fleshy immobile mass on the midline hard palate --> no medical or surgical therapy unless growth becomes symptomatic or interferes with speech or eating

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