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Flashcards in GI Deck (60)
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1

common causes of gastric outlet obstruction

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

2

diabetic gatroparesis - when

10 years after DM

3

psoas abscess - clinical presentation

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

4

psoas abscess - diagnosis

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

5

psoas abscess - treatment

drainage
broad spectrum antibiotcs

6

management of gallstones

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

7

colonic iscemia - pathophysiology

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

8

colonic ischemia - clinical features

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

9

colonic iscemia - diagnosis

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

10

colonic ischemia - management

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

11

diagnosis of scurvy / how long of def causes symptoms

plasma or leukocytes vit C
- 3 months

12

Pancreatic ca - RF

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

13

pancreatic ca - clinical presentation

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

14

pancreatic ca - Labs

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

15

acute mesenteric ishemia - presentation

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

16

acute mesenteric ishemia - RF

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

17

acute mesenteric ischemia - Labs

leukocytosis
elevated amylase + phosphate level
metab acidosis

18

acute mesenteric ischemia - diagnosis

- CT (preferred) or MR angiography
- mesenteric angiography (if diagnosis unclear, gold standard)

19

anal fissures - etiolgy

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

20

anal fissure - clinical presentation

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

21

anal fissure - treatment

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

22

management of blunt abdominal trauma in hemodynamically stable patients

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

23

sphincter of Oddi dysfunction - gold standard to diagnose and treatment

- Oddi manometry
- sphincterotomy (avoid opioids)

24

small bowel obstruction - clinical presentation

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

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