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GI Flashcards

1
Q

What is a palpable spleen indicative of?

A

mono, sickle cell anemia

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2
Q

What are signs of an Acute Abdomen?

A 
Involuntary guarding
Abdominal Wall Rigidity
Rebound tenderness
Progressive severe abdominal pain
Bile stained or feculent vomitus
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3
Q

What are the + signs indicative of acute appendiciits?

A

Psoas Sign
Obturator Sign
Rovsings Sign

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4
Q

Psoas Sign

A

RLQ pain on passive leg extension

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5
Q

Obturator Sign

A

Internal rotation of right hip causes RLQ pain

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6
Q

Rovsing’s sign

A

Palpation of LLQ will caused referred pain in RLQ

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7
Q

Markle Test

A

Heel Jar
Pelvic/ abdominal pain when pt drops heel on floor

or when pt jumps up and down

+ = PID, or acute Appendicitis

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8
Q

McBurney’s Point

A

the landing point of pain with a person with appendicits,

its is midway btw right anterior iliac crest and umbilicus

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9
Q

Presentation of Acute Cholecystitis / Biliary Dx

A

recurrent Colicky pain located in the RUQ
attacks come after a fatty meal
pain may radiate to Right shoulder or under scapula

+ murphy sign

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10
Q

what are gallstones called

A

cholelithiasis

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11
Q

For Acute Cholecystitis / Biliary Dx what is the imaging and labd

A

transabdominal US / Liver gallbladder US

elevated bili, and ALK phos

should refer to surgeon

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12
Q

who is in the high risk group for gallbladder dx

A 
Mexicans, Pima Tribe, NA
Ages 40-60
Females, Obese, 
Preg, DM,
OC
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13
Q

Presentation of Acute Pancreatitis and PE and signs

A

LUQ pain, hx of alcohol abuse, acute onset of mid-epigastric boring abdomial pain that radiates to the back

PE: tenderness to palpation, mid-epigastric w/ guarding and rigidity, decreased bowel sounds

+ cullen’s sign = periumbical brusing, discoloration
+ Grey-turner sign = bruising on flank

sensitive tests for pancreatisis:
- amylase and lipase

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14
Q

Acute Colonic Diverticulitis presentation, risks, labs

A

LLQ pain
older/adult w/ sudden onset of mild to moderate abdominal pain and a mass on LLQ. Will have fever and anorexia

Risks: Low fiber / age 40 or older / western society

Labs : elevated WBC, nuetrophils, and bands

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15
Q

Complication of diverticulalitis

A

infected - abscess - perforation and bleeding

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16
Q

what is diverticula?

A

sac-like herniations on the colonic wall ( not infected)

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17
Q

Management for diverticulsis

A

MILD cases only
Clear liquids only, close follow up 2-3 days

Mild = not toxic, no peritoneal signs

Cipro po BID + Metronidazole po BID x 7-10 days

Augmentin

Bactrim

moderate/severe - ED

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18
Q

Peptic Ulcer Duondenal ulcer DX presentation, TX, bacteria

A

recurrent episodes of gnawing and buring epigastic pain within 2-5 hours after meals

pain present when stomach is empty or hungry

feels better after eating and relief w/ antiacids

90% are positive for H.pylori ( most common type of ulcer)

TX: OTC antacids, H2 Blockers, or PPI’s

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19
Q

Gastic Ulcers presentation

A

epigastric pain with worsens with eating, postprandial belching, earlu saitety, nausea, pain may radiate to back

higher risk of cancer with these ulcers

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20
Q

Who can you tx in a PCP?

A

under 55 yrs old
no alarming symtpoms (no early satiety, dysphagia, anorexia, weight loss, anemia, blood in stools)

older people and high risk should go to GI for upper endosocopy

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21
Q

Who should be tested for H.pylori infections

A

Active PUD
Hx of PUD ( w/o hx of previous H.pylori )
On chronic ASA or NSAID therapy

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22
Q

Labs for PUD

A

H.plyori
CBC (iron deficiency anemia means bleeding)
Fecal Occult blood test

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23
Q

When to use H.pylori Titer test

A

For testing of dx
IgM and IgG will be + if active infection
IgG will stay + for years

Urea Breath Test or stool antigen test is very specific as well

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24
Q

How do you confirm eradication of H.pylori?

A

urea breath test 4 or more weeks post treatment

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25
What is the gold standard for dx of H.pylori?
upper endoscopy w/ biopsies and H. pylori testing
26
what is the #1 tx for H.pyloir
Think " BMT" + PPI " QUAD THERAPY" | Bismuth (pepto-bismol) + Metronidazole (flagyl) + tetracyline QID + PPI 10-14 days
27
what is the #2 rx for H.pylori?
Clarithromycin , Amox + PPI x 14 days ( may have some resistance)
28
What are examples of PPI"s
Omeprazole Prilosec Esomeprazole Nexium Lansoprazole Prevacid
29
Zollinger-Ellison Syndrome
TRAID: high level of gastric secretion, PUD and gastrinoma can be benign or related to multiple endocrine neoplasia symptom may be multiple ulcers TX: PPI's Labs : fasting gastrin level increased ( hold PPI for 7 days prior to test)
30
Ulcer Perforation
acute onset of mid-epigastric pain that radiates to the right shoulder Vomits frank blood to cofee-ground emesis tachy, clammy, shock
31
What organs do NSAIDS effect?
GI tract, Kidneys, the CV system
32
What is the effect on GI system?what NSAID highest problem rate?
Blocks prostaglandins which regulates flow of GI tract most compliactions with indomethacin, then naproxen, then diclofenac
33
Ways to decrease NSAID toxicity?
combine NSAID w/ PPI, Stop use of NSAID's, can also combine with misoprostol
34
What is the Key with toradol?
max number of days per " episode" is 5 and you can give first dose IM or IV. Do not combine with other NSAID's, anitcoagulants, ASA
35
GERD presentation
middle-age adult c/o of daily episode of epigastic to mid-sternal pain( heartburn). symptoms of sour taste, chronic sore throat, dry cough, esophageal erosion
36
what is a red flag sign in GERD
Barett's esophagus : precurser to esophageal cancer and it is dx by Biopsy
37
when to refer people to GI specialist?
chronic (years) hx of GERD to r/o Barretts Esophagus
38
GERD management first line
1. lifestyle and dietary changes ( lose weight, stop eating 3-4 hours prior to bedtime, elevate HOB. Avoid aggrevating foods, alchol, smoking
39
Food to avoid with GERD
mints/gum (relaxes esopheageal sphincter), alcohol, coffee
40
GERD management medication
1. Antacids PRN ( see effect in 30/60 min) Maalox, Roliads, Tums 2. H2 recepter antagonists ( ranitidine, famitidine) if no releif stop and add 3. PPI's for up to 8 weeks omeprazole, esomeprazole, lansoprazole
41
What are the averse effects of PPI's
headache, diarrhea, abd pain reduced absoption of mg, iron, vit b12 increased fractures ( reduced ca absoption) c.diff pneumonia cv disease renal disease ( stimulates immune response)
42
IBS in adults
RLQ pain functional disorder ( no change in colon) Acute/recurrent abdominal pain w/ changes in stool and pain related to defecation adult women there are multiple types ( IBS w/ constipation, w/ diarrhea, w/ mixed) **does not increase colon cancer risk**
43
Alarm features of IBS
``` older than 50 weight loss abdominal mass, melana nocturnal adominal pain iron-def anemia fam hx of colon cancer ```
44
what is the dx criteria for IBS
``` recurrent abdominal pain w/ 1 day/wk (previous 3 months) w at least two of following - pain w/ defacation - change in # of stools - change in stool form / appearance ```
45
IBS tx
life style - fiber supplementation - Psyllium can increase stool bulk - Food diary for triggers - Low FODMAP diet - Avoid high FODMAP: wheat, onion, garlic, fruits - stress reduction pain - hypocyamine for spasms sublingual 5HT-3 antagonist - Lotronex for severe diarrhea IBS who have failed other tx. must have specific degree to tx
46
Giardiasis presentation, labs and tx
sudden onset of foul-smelling fatty stools w/ explosive diarrhea w/ abdominal cramping, flatuence, and malaise. chronic infection may have malabsorption and weight loss labs: c/s for parasites tx; Tinidazole or Falgy
47
what does low caliber stools indicate?
thin and narrow stools may be caused by colon ca, diarrhea, ibs refer to GI
48
when can celiac dx erupt? presentation
any age or after a viral URI, preg recurrent hc of abdominal pain, bloating/gas, fatigue, migraine, HA's, anemia, joint pain weight loss
49
What to avoid in celiac dx
gluten, wheat, barely, rye, kamut, spelt, titracale
50
UC keys
colon and rectum only (always rectum), rectal bleeding and more common to see gross blood in feces ** DX : Colonoscopy
51
Chrons keys
most common in ileum, strictures, fissues, skip lesions, not so much in rectum. May involve mouth , small intestine. If distal ileum is involved : crampy RLQ abdominal pain Dx. colonosopy
52
UC and Chrons sympts
fatigue, weight loss, prolonged diarrhea w/ abdominal pain, fever, gross bleeding non GI sympt : arthtitis, anklyosing spondilitis (back pain), (eye)uveitis, (skin)erythema nodosum, (lung) chronic bronchitis
53
Hemmoriods presentation and tx
recurrent right red blood from anal area. Hx of constipation, may have anal itching or pain during flare will see soft bulging ble verins in anal area OTC remedies, sitz bath, increase fiber, dont sit on toilet too long
54
AST
liver function test, elevated after acute MI | will see it in lever, cardiac, skeletal muscle, kidney and lung
55
ALT
most specific for liver dx | present in heart and liver
56
AlK Phos
bone - growing children, teens, healing fractures | liver, gallbladder, kidneys, placenta
57
GGT
lone elevation in alcoholic | if elevated w/ alk phos helps determine if it from lever or bone
58
Alcoholic Hepatitis
will see elevated GGT and a 2:1 ration with AST to ALT = alochol abuse
59
when do you see acute hepatitis s/s, labs , avoid
2-6 weeks after exposure. fever, fatigue, loss of apetit jaundice, dark urine, clay-colored stools labs ALT and AST will be normal ( if high it is indicative of viral hep) Bili= normal to high Avoid heptaotoxic things: statins, tylenol, alcohol
60
Hepatitis A
Spread: fecal - oral route post exposure prop - admin vaccine screening test: IgM anti HAV
61
Havrix
hep A vaccine dose : two ( 0-6 months after) give to MSM, international travel (mexico, central and south america, middle east, africa, SE asia
62
Hep B
spread: semen, vaginal secretions, saliva, blood products LFT's will be elevated
63
HBsAG
surface antigen = infected or infectious, acute or chronic | if + = they have it
64
Anti-HBs
surface antibody = indicates immunity ( either recovered from infection or hep B vaccine)
65
IgM anti-HBc
Hep B core antigen = recent infection ( is pt infectious)
66
HbeAg
hep B envelop antigen = virus replication and high levels of hep B virus
67
Where is Hep B most endemic?
Africa, southeast asia, western pacific, central and south america and carribean
68
Hep C
spread: IVDU, blood products to baby boomers ( 1945-1965). screening : anti- HCV if + = order a HCV RNA by PCR if both + then pt has dx Antiviral tx is - 96-99% effective
69
Hep D
must be infected B to get D

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