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EOR Exam - Emergency Medicine > GI and Nutritional > Flashcards

GI and Nutritional Flashcards

1
Q

Describe the most common clinical presentation of appendicitis.

A

Umbilical pain migrating to the RLQ. Fever, nausea, vomiting, anorexia.

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2
Q

Describe three PE tests used to evaluate for appendicitis.

A

Rovsing’s: RLQ pain elicited by palp of LLQ
Obturator: hip internally rotated with knee and hip in flexion
Psoas: Pt supine –> flex right hip with leg straight. Pt on left side –> extend right hip with leg straight

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3
Q

What imaging is most useful in the diagnosis of appendicitis?

A

US initial, CT with contrast more sensitive.

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4
Q

What antibiotic is best in the management of appendicitis?

A

3rd generation cephalosporin

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5
Q

Define cholecystitis.

A

Inflammation and/or infection of gallbladder s/p cystic duct obstruction.

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6
Q

What is the most common causative agent in infective cholecystitis?

A

E. Coli

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7
Q

What clinical findings are most associated with cholecystitis?

A

Colicky RUQ pain worse after fatty meal, fever, nausea, vomiting, hypoactive bowel sounds (indicates perforation).

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8
Q

What imaging tests are used in the diagnosis of cholecystitis?

A

US initial
HIDA scan gold standard
ERCP diagnostic and therapeutic

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9
Q

What pharmacologic agent is most commonly used to manage pain in cholecystitis?

A

Meperidine (Demerol)

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10
Q

Differentiate cholelithiasis from choledocholithiasis.

A

Cholelithiasis: gallstones
Choledocholithiasis: obstruction of biliary tree s/p stone

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11
Q

What is the treatment of choledocholithiasis?

A

Stone removal via ERCP

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12
Q

Define primary sclerosing cholangitis.

A

Autoimmune, progressive cholestasis with diffuse fibrosis of intrahepatic and extrahepatic ducts. Usually associated with inflammatory bowel disease.

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13
Q

What clinical findings are associated with primary sclerosing cholangitis?

A

progressive jaundice, pruritus, RUQ pain, hepatosplenomegaly, inc ALP (very high), GGT, ALT, AST, and total bilirubin.

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14
Q

Define ascending cholangitis.

A

Biliary tract infection s/p obstruction by gallstone

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15
Q

Describe Charcot’s triad.

A

Fever, RUQ pain, jaundice - indicate ascending cholangitis. Add shock and AMS for Reynold’s pentad.

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16
Q

What is the treatment of ascending cholangitis?

A

Abx: PCN (Zosyn) and aminoglycoside (gentamicin)

ERCP for stone removal

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17
Q

Differentiate between the types of hepatitis.

A 
A: fecal-oral transmission
B: IVDU, STI (most common)
C: STI, IVDU (most common)
D: Requires co-infection with HBV
E: fecal-oral transmission, waterborne outbreaks --> high infant mortality if mom has HEV
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18
Q

Describe the findings of antigen and antibody testing for HBV.

A

A

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19
Q

What are the most common causes of acute and chronic pancreatitis?

A

Acute: cholelithiasis –> hypertriglyceridemia
Chronic: alcohol use disorder

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20
Q

Describe the clinical findings most commonly associated with pancreatitis.

A

Epigastric pain radiating to back - improves when patient leans forward, N/V, fever, leukocytosis

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21
Q

Describe the triad of chronic pancreatitis.

A

Calcifications, steatorrhea, diabetes mellitus

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22
Q

Which lab finding is most sensitive in diagnosis of pancreatitis?

A

lipase

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23
Q

What is the treatment of pancreatitis?

A
  • Fluid resus and stop PO intake –> 90% resolve
  • ERCP if biliary sepsis/obstruction suspected
  • Alcohol use cessation
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24
Q

What is the most common location of an anal fissure.

A

Posterior midline

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25
Q

What clinical S/S are most commonly associated with anal fissure?

A

Hematochezia, tearing pain on defecation, constipation s/p BM being too painful, skin tags in chronic

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26
Q

What is the treatment of anal fissure?

A

80% resolve spontaneously,
1st line: Sitz bath, increased fluid and bulking agents to reduce straining
2nd line: topical NTG, topical nifedipine, topical silver nitrate
Maintenance/Prevention: high fiber diet

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27
Q

What are the most common causative agents of anorectal abscess and what is the treatment?

A

Cause: Staph aureus or E. Coli
Tx: I&D –> no antibiotics

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28
Q

Define obstipation.

A

Severe or complete constipation

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29
Q

What are the most common causes of bowel obstruction?

A

Post-op adhesions or ischemia

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30
Q

What clinical S/S are most commonly associated with bowel obstruction?

A

Cramping, abdominal distention, tenderness, hyperactive high pitched bowel sounds, visible peristalsis

31
Q

What x-ray finding is consistent with bowel obstruction?

A

Air-fluid levels and dilated loops of bowel

32
Q

Differentiate common clinical presentation of small bowel obstruction from large bowel obstruction.

A

SBO: colicky pain, bilious vomiting, hyperactive bowel sounds (early), hypoactive (late)
LBO: gradually increasing pain with longer intervals between episodes, less vomiting, more common in elderly

33
Q

What is the common clinical presentation of small bowel intussusception?

A

Sudden onset significant, colicky abdominal pain that recurs every 15-20 min, often after vomiting.

34
Q

What patients are most often affected by small bowel intussusception?

A

Kids after viral infection

Adults with cancer

35
Q

What are the 2 most common PE findings associated with small bowel intussusception?

A

Currant jelly stool and sausage-like mass on palpation

36
Q

What role does barium enema play in the management of small bowel intussusception?

A

Both diagnostic and therapeutic.

37
Q

Define ileus.

A

Hypomotility of GI tract in absence of mechanical bowel obstruction

38
Q

What is the treatment for an ileus?

A

Spontaneously resolves in 2-3 days

Discontinue opiates

39
Q

Describe gastroporesis.

A

Slowed gut motility causing delayed gastric emptying

40
Q

Describe S/S of gastroparesis.

A

Nausea, early satiety, palpitations, heartburn, bloating, decreased appetite, GERD

41
Q

State the treatment for gastroparesis.

A

low fiber diet, restrict fat intake, smaller meals spaced 2-3 hours apart; Reglan (metoclopramide) to increase contractility

42
Q

Describe common S/S associated with C Diff.

A

Mild, watery foul-smelling diarrhea, fever, abdominal pain, constitutional S/S

43
Q

How is C Diff commonly diagnosed?

A

Stool sample culture more common than PCR

44
Q

What is the common treatment for C Diff?

A

Stop antibiotics if possible

IV metronidazole or PO vancomycin

45
Q

What is the most common concerning complication of C Diff?

A

Toxic megacolon

46
Q

What are the two most common causes of liver cirrhosis?

A

Most common: chronic hepatitis

2nd: alcohol

47
Q

Describe clinical findings associated with hepatic encephalopathy.

A

asterixis (liver flaps), dysarthria, delirium, coma

48
Q

For a patient with cirrhosis and acute fever and abdominal pain, what is at the top of the differential?

A

Spontaneous bacterial peritonitis

49
Q

Describe ongoing evaluation for hepatocellular carcinoma in a patient with cirrhosis.

A

Monitor alpha fetoprotein (AFP) –> MRI if elevated

Abdominal US q 6-12 months

50
Q

Describe common lab findings associated with cirrhosis.

A

AST > ALT, inc ALP, GGT, total and direct bilirubin, hemolytic anemia, folate deficiency, dec platelets and albumin, prolonged PT, PTT, INR

51
Q

What pharmacologic agents are used to treat hepatic encephalopathy?

A

lactulose and neomycin

52
Q

How is salmonella diarrhea usually transmitted?

A

fecal-oral from undercooked food

53
Q

What is the presentation of salmonella diarrhea and what is the treatment?

A

Diarrhea: pea-soup and rose spots
Tx: ceftriaxone, sometimes fluoroquinolone or azithromycin

54
Q

Describe diarrhea associated with shigella and state the treatment.

A

Watery diarrhea with blood, pus, or mucus. Often presents with lower abdominal cramping/
Tx: Bactrim, anti-diarrheals contraindicated

55
Q

How is shigella diarrhea usually transmitted?

A

Crowded areas –> day care

56
Q

Describe the diarrhea associated with cholera.

A

Rice water diarrhea –> life threatening illness

57
Q

Differentiate diverticulosis from diverticulitis.

A
  • osis: non-inflamed outpouchings of LI mucosa - usually in sigmoid colon. MC cause of GI bleeding
  • itis: inflamed diverticula s/p obstruction or infection
58
Q

How is the diagnosis of diverticular disease typically made?

A

CT is test of choice, WBCs elevated and Guaiac positive

59
Q

Describe the treatment of diverticulosis and diverticulitis.

A
  • osis: high fiber diet, vasopressin if bleeding doesn’t stop spontaneously (only ~ 10%)
  • itis: clear liquid diet, metronidazole + cipro or Bactrim
60
Q

What is the most common cause of esophagitis?

A

GERD

61
Q

Define odynophagia and dysphagia.

A

Odyno: painful swallowing
Dys: difficulty swallowing

62
Q

What is the most common cause of gastritis?

A

H. Pylori, NSAIDs/ASA 2nd most common

63
Q

How is H. Pylori treated?

A

Clarithromycin, Amoxicillin, PPI –< metronidazole if PCN allergy

64
Q

What is the greatest risk factor for gastric carcinoma? List others.

A

Main risk factor: H/ Pylori

Others: salted, cured, smoked, pickled foods containing nitrites

65
Q

In general, when are anit-diarrheal agents contraindicated?

A

Undifferentiated bloody diarrhea or know C. Diff or known E. Coli (produces shiga toxin)

66
Q

Define GERD.

A

transient relaxation of LES –> gastric acid reflux –> esophageal mucosal injury

67
Q

What symptoms associated with GERD are considered alarm symptoms?

A

dysphagia, odynophagia, weight loss, bleeding

68
Q

Define Barrett’s esophagus.

A

Esophageal squamous epithelium replaced by precancerous metaplastic columnar cells from the stomach.

69
Q

When is endoscopy indicated to evaluate GERD?

A

Patient older than 45 with new onset, frequently recurring symptoms, failure to respond to therapy, or alarm symptoms

70
Q

Describe pharmacological therapy indicated for GERD.

A

1st: OTC antacids or H2RAs
2nd: PPI if prescription therapy needed
Night Sx: H2RA at night + PPI daytime
Nissen fundoplication if refractory to meds

71
Q

What drugs should be avoided by patients with GERD?

A

beta agonist, alpha antagonist, nitrates, CCBs, anticholinergics, theophylline, morphine, meperidine, diazepam, barbiturates

72
Q

List some lifestyle modifications recommended for patients with GERD.

A

Elevate HoB, avoid recumbency for 3 hours after eating, eat small meals, avoid fatty/spicy, citrus, chocolate, caffeinated products, peppermint; decrease alcohol, weight loss, smoke cessation

73
Q

List risk factors for GERD.

A

Obesity, pregnancy, diabetes, hiatal hernia, connective tissue disorders.

74
Q

Resume on page 25 with hemorrhoids.

A

A

EOR Exam - Emergency Medicine (2 decks)

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