GI Flashcards
(103 cards)
1
Q
What are the dimensions over which a FB is unlikely to pass through the GI tract spontaneously?
A
2.5 x 6 cm
2
Q
Sudden inability or refusal to eat in a child is suspicious for what pathology?
A
FB
3
Q
How much time do you have to retrieve a button battery from the esophagus?
A
6 hours
4
Q
What are the three major measures that are used in esophageal food bolus impactions?
A
- Glucagon
- carbonated drinks
- Endoscopy
5
Q
After how many hours is an endoscopy indicated for a food bolus that has not passed?
A
12 hours
6
Q
What kind of necrosis occurs with acidic and alkali ingestions respectively?
A
Acidic = coagulative Alkali = liquefactive
7
Q
What is the treatment for HF acid ingestion?
A
Mag citrate
8
Q
Endoscopy is indicated within what timeframe after a caustic substance ingestion?
A
less than 12 hours
9
Q
What is the most common cause of esophageal perforations?
A
Iatrogenic
10
Q
What is the most common location in the esophagus for Boerhaave’s syndrome to occur?
A
Left posterior distal esophagus
11
Q
What anatomic structure defines upper and lower GI?
A
Ligament of treitz
12
Q
What is the prognosis for mallory-weiss tears?
A
Usually self limiting
13
Q
What is the pressor that can be used with esophageal variceal rupture?
A
Vasopressin
14
Q
What is the most common cause of lower GI bleeds?
A
Diverticulosis
15
Q
What is the toxicity caused by amanita phalloides? What does this mushroom look like? What is the treatment?
A
- Liver failure
- Like mario mushroom
- NAC
16
Q
When can the immune globulin be given for hepatitis A exposure? Hep B?
A
2 weeks d/t incubation period for both
17
Q
Does Hep A progress to chronic hepatitis? What is the treatment for hep A?
A
- Negative
- Symptomatic treatment
18
Q
When is a booster hep B vaccine indicated in exposures?
A
If never had or if ab titers are low
19
Q
Which surface antigen is needed for Hep D to infect someone?
A
Hep B (no B no D!)
20
Q
Rising creatinine in a patient with cirrhosis or liver failure is concerning for what complication?
A
Hepatorenal syndrome
21
Q
What is the survival rate of patients who develop hepatorenal syndrome?
A
Bad
22
Q
Any patient with a history of ascites and what complaint should be assumed to have SBP? (4)
A
- GI bleed
- Encephalopathy
- Fever
- Abd pain
23
Q
How many WBC and PMNs in an ascites aspirate is diagnostic of SBP?
A
More than 1000 WBCs or 250 PMNs
24
Q
What are the four major precipitants of hepatic encephalopathy?
A
- infx
- GI bleed (from reabsorb)
- Electrolytes
- Medication non-adherence
25
What are the components of the SHiNE SKiS mnemonic for
Strep pneumonia
Haemophilus influenza
Neisseria meningitidis
E. coli
Salmonella
Klebsiella
GBS
26
What is post splenectomy syndrome, and why do you care?
flu-like-illness after splenectomy, that rapidly progresses to fulminant sepsis and death
27
What are the abx of choice for splenectomy sepsis? (2)
Ceftriaxone
| Vanco
28
When does post splenectomy syndrome occur? Why don't we see this more often?
Within 1-2 years after splenectomy
| -Vaccinations (pneumovax, meningitis, hib vaccine)
29
What are the components of the SPLEEN mnemonic for causes of splenomegaly?
- Sequestration
- Proliferation
- Lipid deposition
- Endowment
- Engorgement
- Neoplasm
30
Why is there splenomegaly with cirrhosis?
portal HTN, backs up blood into spleen
31
How long should someone with splenomegaly 2/2 EBV not participate in contact sports?
3 weeks
32
What are the diagnostic criteria for SCD splenic sequestration?
- Splenomegaly
- Drop in Hb by more than 2 g/dL
- Thrombocytopenia
- Reticulocytosis
33
What is the treatment for SCD sequestration?
- resus
- half pRBCs
- Admit with hematology consult
34
What are the two types of general types of malignancy that can cause splenomegaly?
- Myeloproliferative
| - Lymphoproliferative
35
What is erythromelalgia?
vascular congestion in the hand and feet that occurs several times a day
-can be seen primarily, or 2/2 other diseases (polycythemia vera)
36
What are the causes of splenic infarction?
- hematologic malignancy
- septic emboli
- thrombosis/embolus
37
What is the diagnostic modality for splenic infarction?
CT
38
What are the 4 basic mechanisms of diarrhea?
- Decreased absorption
- Increased secretions
- Increased osmotic load
- Abnormal motility
39
What is the mechanism of bacteria that causes bloody vs non-bloody diarrhea?
```
Bloody = invasive
Non-bloody = toxin secretion (noninvasive)
```
40
What is the vector and treatment for enteroinvasive e.coli?
Raw, ground beef
| Supportive
41
What is the vector and treatment for campylobacter?
- Raw poultry, milk
| - cipro or azithro
42
What is the vector and treatment for salmonella?
Eggs, poultry, dairy
| -Cipro
43
What is the vector and treatment for shigella?
Contaminated food or water
| Cipro
44
What is the vector and treatment for vibrio vulnificus?
undercooked/raw shellfish
| cipro
45
What is the vector and treatment for vibrio parahaemolyticus?
Undercooked/raw shellfish
| Cipro
46
What is the vector and treatment for yersinia enterocolitica?
Undercooked pork/tofu
| Supportive`
47
Rose patches/salmon patches + diarrhea = ?
Salmonella
48
What is the bacteria that causes a diarrheal illness that can mimic appendicitis?
Yersinia enterocolitica
49
What is the vector and treatment for staph aureus diarrhea?
dairy, eggs
| Supportive care
50
What is the vector and treatment for bacillus cereus?
fried rice
| supportive
51
What is the vector and treatment for clostridium perfringens?
Meats
| Supportive
52
What is the vector and treatment for enterotoxigenic e.coli?
contaminated water
| bactrim cipro
53
What is the vector and treatment for vibrio cholerae?
Contaminated water
| Cipro, hydration
54
What is the vector and treatment for listeria?
Deli meats, fresh soft cheeses
| Bactrim
55
What is the vector and treatment for scromboid? HOw does this present?
- unrefrigerated fish-heat stable toxin
- Histamine-like rxn within 30 minutes
- H1 and H2 blockers
56
What is the vector and treatment for ciguatera?
- Reef fish contaminated with gambierdiscus toxicus
- n/v/d within a few hours
- Paresthesias, heat/cold reversal, muscle weakness for years
- brady/hypotension
- Mannitol for severe cases
57
What is the treatment for giardia?
Flagyl
58
What are the s/sx and treatment for entamoeba histolytica? Vector?
- Diarrhea +/- blood and extraintestinal symptoms
- From contaminated water
- Flagyl
59
What are the s/sx and treatment for cryptosporidium ? Vector?
- Watery diarrhea x1 week
- contaminated water
- Common in AIDS pts. Treatment with azithromycin and paramomycin
60
What is the most common area affected with crohn's disease?
Ileum
61
Does crohn's disease have bloody or nonbloody diarrhea? Ulcerative colitis?
```
Crohn's = non
UC = bloody
```
62
How much is GI CA risk increased with Crohn's disease? UC?
```
CD = 3x increase
UC = 30x
```
63
What is the treatment for crohn's?
- Steroids
- Sulfasalazine
- Antidiarrheals
64
What is the treatment for perianal Crohn's disease?
abx
65
What is the treatment for ulcerative colitis?
- Steroids
| - Oral and topical mesalamine
66
Why should you avoid antidiarrheals with ulcerative colitis?
Toxic megacolon
67
What is the treatment for toxic megacolon?
- IVFs
- abx
- steroids
- surgery
68
How much dilation is diagnostic of toxic megacolon?
6+ cm
69
What is an amyand hernia? De Garengeot?
- Amyand = Appendix herniates through an indirect inguinal hernia
- De Garengeot = femoral hernia with appendix
70
Why are hernias caused by ascites more concerning than other types?
Increased risk of strangulation and death
71
What is a spigelian hernia?
Lateral ventral hernia that arises lateral to the rectus muscle
72
What is an obturator hernia, and how does it present?
Herniation of bowel contents through the obturator foramen, worse with internal rotation of the thigh, causing medial thigh pain. Usually presents as a bowel obstruction
73
What is a Richter hernia?
- Only part of the bowel wall has herniated through--lumen still patent
- Increased risk of strangulation/gangrene
74
What is the management for reducible, incarcerated, and strangulated hernias?
- Reducible = reduce, refer
- Incarcerated = reduce, call surgery if cannot
- Strangulated - do NOT reduce (sepsis), call surgery and get IV abx
75
What happens to the appendix with pregnancy? What is the clinical relevance of this?
Shifts up--can cause RUQ pain
76
What is the role of CRP/ESR with appendicitis?
not sensitive nor specific
77
Why can you have WBCs in urine with appendicitis?
Proximity of ureter to appendix
78
Appendix of more than how many mm in width is diagnostic of appendicitis?
6 mm
79
What imaging modality can be used to diagnose appendicitis in pregnant patients, if US is nondiagnostic?
MRI w/o contrast
80
What is stump appendicitis?
Infection/inflammation of the stump of the appendix after appendectomy
81
How does an ileus present?
Dull, poorly localized abdominal pain with distension, decreased flatus
82
How does an x-ray appear with an ileus?
Dilated loops of fluid filled bowel, that involves the ENTIRE bowel
83
What is the treatment for an ileus?
NPO
IVF
Metoclopromide
84
What is the second most common cause of a SBO?
incarcerated inguinal hernia
85
How can you differentiate where an obstruction is (proximal vs distal) with an SBO, based on the emesis?
- Bilious emesis = proximal
| - Feculent = distal
86
Dilated loops of bowel + air fluid levels on abd xr = ?
SBO
87
What is the "classic" physical exam finding for sigmoid volvulus?
Empty LLQ
88
What is the classic x-ray finding for sigmoid volvulus?
Bent inner tube or Coffee bean appearance
89
What is the treatment for sigmoid volvulus?
- Surgery if septic
| - endoscopic if not
90
What is the treatment for a cecal volvulus?
Fluid restriction, OR
91
What is the CT finding associated with a cecal volvulus?
Bird beak and whirl sign
92
Is elevated lactate a late or early finding of mesenteric ischemia?
Late
93
What are the three general etiologies for mesenteric ischemia?
- Artery occluded (embolic)
- Vein occluded (thrombolic, hypercoagulable)
- Low flow (CHF, dialysis)
94
What are the components of the WASH regimen for perianal abscess care?
- Wash (sitz baths)
- Anesthetic
- Stool softeners
- High fiber
95
When are perianal abscesses not amenable to I+D?
- If septic
- If DM, old, immunocompromised
- Have abd pain
96
What is the treatment for a perirectal abscess?
OR
97
What are the causes of proctitis?
- GC/Chlamydia
- Radiation
- Vasculitis, ischemia
98
Where are most anal fissures located?
Posterior midline
99
What is the treatment for anal fissures?
- WASH regimen
| - Topical NTG, hydrocortisone
100
Anal fissures lasting longer than how long are an indication for surgical referral?
6 weeks
101
When are external hemorrhoids painful? Internal?
```
External = When thrombosed
Internal = when strangulated
```
102
Within how long of onset is an external hemorrhoid amenable to I+D?
within 72 hours of symptom onset
103
What is the treatment for a strangulated or incarcerated hemorrhoid?
OR
