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GI from PANCE Pearls Flashcards

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1
Q

What are common causes of Esophagitis

A

GERD is #1

Infections, particularly in immunocompromised (Candida, CMV, HSV)

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2
Q

Sx of Esophagitis

A

Odynophagia (pain with swallowing)
Dysphagia (difficulty swallowing)
Retrosternal Chest Pain

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3
Q

Dx of Esophagitis

A

Upper Endoscopy

Esophagram

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4
Q

Tx of Esophagitis

A

Tx underlying cause

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5
Q

What is Infectious Esophagitis

A

Usually seen in immunocompromised

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6
Q

What are 3 most common types of Infectious Esophagitis

A

Candida
CMV
HSV

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7
Q

Sx of 3 most common types of Infectious Esophagitis

A

Candida: Linear Yellow White Plaques
CMV: Large, Superficial Shallow Ulcers
HSV: Small, Deep Ulcers

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8
Q

Tx of 3 most common types of Infectious Esophagitis

A

Candida: Fluconazole
CMV: Ganciclovir
HSV: Acyclovir

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9
Q

What is Eosinophilic Esophagitis

A

Allergic, Inflammatory Esophageal Inflammation

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10
Q

What else is typically seen with Eosinophilic Esophagitis

A

Atopic Disease

Allergies, Asthma, Eczema

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11
Q

Sx of Eosinophilic Esophagitis

A

Dysphagia

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12
Q

Dx of Eosinophilic Esophagitis

Tx of Eosinophilic Esophagitis

A

Endoscopy: See normal with multiple corrugated rings

Steroids

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13
Q

What is GERD

A

Transient relaxation of LES leads to gastric acid reflux which in turn leads to esophageal mucosal injury

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14
Q

What are complications of GERD

A

Esophagitis, Stricture, Barrett’s Esophagus, Esophageal Adenocarcinoma

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15
Q

Sx of GERD

A

Heartburn (Pyrosis), retrosternal chest pain often post prandial, regurgitation, Dysphagia, Cough
Atypical Sx: Hoarseness, Aspiration pneumonia, Asthma

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16
Q

Dx of GERD
1st line
Gold Standard
Others

A

Clinical Dx
Endoscopy is 1st line
24 hour Ambulatory pH Monitoring is Gold Standard
Esophageal Manometry

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17
Q

Tx of GERD

A

Lifestyle Modifications (avoid fatty/spicy meals), avoid recumbency for 3 hours after eating
H2 Blockers 1st
PPI
Nissen Fundoplication if refractory

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18
Q

What is Achalasia

A

Loss of Auerbach’s Plexus that leads to increased LES pressure

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19
Q

What leads to Achalasia

A

Failure of LES to relax which leads to obstruction of peristalsis

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20
Q

Sx of Achalasia

A 
Dysphagia to solids and liquids
Malnutrition
Weight Loss
Dehydration
Regurgitation
Chest Pain, Cough
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21
Q

Dx of Achalasia
Gold Standard
Others

A

Esophageal Monometry is Gold Standard

Double-Contrast Esophagram: Bird’s Beak Appearance, shows LES narrowing

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22
Q

Tx of Achalasia

A

Goal is to decrease LES pressure
Botulinum Toxin Injection (lasts 6-12 months)
Nitrates, CCB, Pneumatic Dilation

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23
Q

What is Nutcracker Esophagus

A

Excessive Contractions during Peristalsis

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24
Q

Sx of Nutcracker Esophagus

A

Dysphagia to liquids and solids, Chest Pain

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25
Dx of Nutcracker Esophagus
Monometry: Shows increased pressure during peristalsis
26
Tx of Nutcracker Esophagus
Goal is to lower esophageal pressure | CCB, Nitrates, Botox, Sildenafil
27
What is Zenker's Diverticulum
``` Pharyngoesophageal Pouch (False Diverticulum) It only involves the Mucosa ```
28
Where is a Zenker's Diverticulum located
At the junction of the pharynx and esophagus
29
Sx of Zenker's Diverticulum
Dysphagia Regurgitation Cough Lump in neck
30
Dx of Zenker's Diverticulum
Barium Swallow | See a collection of dye behind esophagus
31
Tx of Zenker's Diverticulum
Diverticulectomy, Cricopharyngeal Myotomy
32
What is Boerhaave's Syndrome
A full thickness rupture of the distal esophagus | It's assocaited with repeated, forceful vomiting (Bulimia)
33
Sx of Boerhaave's Syndrome
Retrosternal Chest pain worse with deep breathing and swallowing PE: Crepitus on chest auscultation due to Pneumomediastinum (air in mediastinum)
34
Dx of Boerhaave's Syndrome
CT
35
Tx of Boerhaave's Syndrome
Surgery
36
What is a Mallory-Weiss Tear
UGI bleed due to longitudinal mucosal lacerations at the GE junction or gastric cardia
37
What leads to a Mallory-Weiss Tear
Sudden rise in intragastric pressure or gastric prolpase into esophagus, such as through persistent retching/vomiting after an alcohol binge or bulimic vomiting
38
Sx of Mallory-Weiss Tear
Retching/Vomiting which leads to hematemesis after an alcohol binge Melena Hematochezia, Syncope, Abdominal Pain, Hydrophobia
39
Dx of Mallory-Weiss Tear
Upper Endoscopy: See superficial longitudinal mucosal erosions
40
Tx of Mallory-Weiss Tear
Supportive if no active bleeding | If active bleeding, give epinephrine injection, sclerosing agent, band ligation, hemo-clipping or balloon tamponade
41
What is an Esophageal Web
Thin membranes in the mid-upper esophagus
42
What is Plummer-Vision Syndrome
Dysphagia + Esophageal Webs + Iron Deficiency Anemia
43
What is Esophageal Rings
Mucosa Lower-Esophageal Constrictions at Squamocolumnar Junction
44
Sx Esophageal Rings
Dysphagia especially with solids
45
Dx of Esophageal Rings
Barium Swallow, especially with solids
46
Tx of Esophageal Rings
Endoscopic Dilation of the Areas
47
What is an Esophageal Varices | What is this the result of
Dilation of gastroesophageal collateral, submucosal veins | This is a result of portal vein hypertension
48
Risk Factors for Esophageal Varices
Cirrhosis
49
Sx of Esophageal Varices
Upper GI Bleed (Hematemesis, Melena, Hematochezia_
50
Dx of Esophageal Varices
Upper Endoscopy: See Enlarged Veins | May see red wale markings and cherry red spots
51
Tx of Acute Active Bleeding Esophogeal Varices
Endoscopic Ligation is first Pharmacologic Vasocontrictors: Octreotide, Vasopressin Balloon Tamponade Surgical Decompression: TIPS (Trans Jugular Intrahepatic Portosystemic Shunt
52
Tx to Prevent Rebleeds in Esophageal Varices
Non-Selective Beta Blockers (Propranolol, nadolol) Isosorbide (Long acting Nitrate) Abx Prophylaxis: Fluorquinolones (Norfloxacin)
53
What is a Hiatal Hernia
Portrusion of the upper portion of the stomach into the chest cavity due to diaphragm tear or weakness
54
What is a Type I Hiatal Hernia | Tx
Sliding Hernia GE Junction and stomach slid into the mediastinum Tx as GERD
55
What is a Type II Hiatal Hernia | Tx
Rolling Hernia Fundus of stomach portrudes through diaphragm with the GE junction remaining its its anatomic location Tx: Surgical Repair
56
What is the most common type of Esophageal Neoplasms
Squamous Cell
57
What causes Esophageal Neoplasms
Smoking and Alcohol Reduced fruits and vegetables Hot beverages Ingestion
58
Where is the most common site for a squamous cell Esophageal Neoplasms and who is most at risk
Upper 1/3 of the esophagus | African Americans
59
What is the second most common type of Esophageal Neoplasm
Adenocarcinma
60
Who typically gets Adenocarcinoma of the Esophagus
Younger patients | Complication of GERD/Barrett's Esophagus
61
Where is the most common site for adenocarcinoma Esophageal Neoplasm
Lower 1/3 of Esophagus
62
Sx of Esophageal Neoplasm
Solid food Dysphagia, with eventual liquid dysphagia Weight Loss, Chest Pain, Anorexia Hypercalcemia
63
Dx of Esophageal Neoplasm
Endoscopy with biopsy
64
Tx of Esophageal Neoplasm
Resection, Radiation, Chemo (5-FU)
65
What is Gastritis
Superficial Inflammation/Irritation of the stomach mucosa with mucosal injury
66
What is Gastropathy
Mucosal Injury without evidence of inflammation
67
What causes Gastritis
Imbalance between increased aggressive and decreased protective mechanisms of gastric mucosa 1. H.Pylori 2. NSAIDS/ASA use 3. Acute Sress
68
Sx of of Gastritis
Asymptomatic Upper GI bleeds Epigastri Pain N/V
69
Dx of Gastritis
Endoscopy | H.Pylori Testing
70
Tx of Gasritis
If H.Pylori Positive: Triple Therapy (Clarithromycin + PPI + Amoxicillin) If H. Pylori Negative: PPI, Anatacids, H2 blockers
71
What leads to a Gastric Ulcer
Decrease in mucosal protective factors | Mucus, Bicarbonate, Prostaglandins, Blood Flow
72
What leads to Duodenal Ulcer
Increase in damaging factors | Acids, Pepsin
73
What is more common, Gastric Ulcers or Duodenal Ulcers
Duodenal Ulcers
74
What leads to ulcers
H.Pylori Infections NSAIDS/ASA use Zollinger-Ellison Syndrome (Gastrinoma)
75
Sx of Ulcers
Asymptomatic Dyspepsia (Epigastric Pain/burning/gnawing) GI Bleed
76
Sx of Duodenal Ulcer
Relief with food, antacids Worse before meals Nocturnal sx
77
Sx of Gastric Ulcer
Pain after a meal | Weight Loss
78
Dx of PUD
Endoscopy with Biopsy to r/u malignancy GOLD STANDARD | Upper GI Series
79
Dx of H.Pylori
``` Endoscopy with Biopsy Urea breath test (if endoscopy can't be done) H.Pylori Stool Antigen (used to confirm eradication) Serologic Antibodies (used to confirm infection only, not eradication) ```
80
Tx of PUD
H.Pylori Positive: Triple Therapy (Clarithormycin + PPI + Amoxicillin) H.Pylori Negative: H2 blockers, PPI, Antacids Parietal cell Vagotomy if refractory
81
What is Zollinger Ellison Syndrome
Gastrinoma that results in gastric acid hypersecretion and eventually leads to PUD
82
Where is the most common site for Zollinger Ellison Syndrome
Duodenal Wall followed by Pancreas
83
Sx of Zollinger Ellison Syndrome
Multiple Peptic Ulcers Refractory Ulcers "kissing" ulcers: stacked side to side, touching each other Abdominal pain, diarrhea
84
Dx of Zollinger Ellison Syndrome
Fasting Gastrin Level: Increased levels, best screening Positive Secretin Test (gastrin released in response to secretin in gastrinomas), normally gastrin is inhibited by secretin Increased Basal Acid Output Somatostatin Receptor Scintography
85
Tx of Zollinger Ellison Syndrome
Surgical resection of tumor | If mets: PPI, surgical resection if liver involved
86
What is the most common type of Gastric Carcinoma
Adenocarcinoma
87
What are Risk Factors for Gastric Carcinoma
H. Pylori Salted, cured, smoked, pickled foods containing nitrites Pernicious Anemia
88
Sx of Gastric Carcinoma
Indigestion Weight loss, early satiety, abdominal pain/fullness, N/V Supraclavicular LN, Umbilical LN
89
Dx of Gastric Carcinoma
Upper endoscopy with biopsy See Linitis Plastica a type of gastric cancer (diffuse thickening of stomach wall due to cancer infiltration) Adenocarcinoma
90
Tx of Gastric Carcinoma
Gastrectomy | Radiation, Chemo
91
What is Pyloric Stenosis
Hypertrophy and Hyperplasia of muscular layers of pylorus
92
When is the common age to have Pyloric Stenosis
3-12 weeks old
93
Sx of Pyloric Stenosis
Nonbilious projectile vomiting Emesis after feeding Dehydration, malnutrition Olive Shaped mass: nontender, mobile, firm to right of umbilicus
94
Dx of Pyloric Stenosis
Ultrasound | Upper GI Contrast: See String Sign
95
What is 2 common reasons for Hepatic Vein Obstruction
Primary: Hepatic vein thrombosis Secondary: Hepatic Vein Occlusion
96
What are risk factors for Hepatic Vein Obstruction
Idiopathic | Hypercoagulable state
97
What is the pathophysiology with Hepatic Vein Obstruction
Hepatic vein Thrombosis or Occlusion leads to decreased liver drainage, portal HTN, and Cirrhosis
98
What are sx of Hepatic Vein Obstruction
Tried of Ascites, Hepatomegaly, RUQ pain | Jaundice, Hepatosplenomegaly
99
Dx of Hepatic Vein Obstruction
Ultrasound
100
Tx of Hepatic Vein Obstruction
Shunts (TIPS) Angioplasty with stent Anticoagulation, Thrombolysis Diuretics, low sodium diet, large volume paracentesis
101
What is Cholelithiasis
Gallstones in the gall bladder
102
What makes up gallstones | Dx of Gallstones
Cholesterol | Ultrasound
103
What are risk factors for cholelithiasis
5 F's Fat, Fertile, Forty, Female, Fair OCP
104
Sx of Cholelithiasis
Asymptomatic, usually incidental finding on ultrasound Biliary Colic: Episodic epigastric pain beginning abruptly, continuous in duration, resolves slowly, lasts 30mints-hours, Precipitated by fatty foods
105
Tx of Cholelithiasis
If Asymptomatic: Observe | Cholecystectomy
106
What is Choledocholithiasis
Gallstones in the biliary tree (common bile duct)
107
What is Cholangitis
Infection of biliary tree secondary to stone obstruction As opposed to Cholecystitis which is with the gall bladder itself. This has to deal with the actual biliary system (the ducts)
108
Sx of Cholangitis
Charcot's Triad: Fevers/Chills, RUQ pain, Jaundice | Reynold's Pentad: Above + Shock, AMX
109
Tx of Cholangitis
Antibiotics (PCN +Aminoglycoside) | Decompression of biliary tree via ERCP stone extraction
110
What is Acute Cholecystitis
Gall bladder (cystic duct) obstruction by gallstone which leads to inflammation/infection
111
Sx of Acute Cholecystitis
Biliary Colic Fever, N/V Positive Murphy's Sign (palpable Gallbladder): RUQ pain with insiratory arrest with gallbladder palpation
112
Dx of Acute Cholecystitis First choice Gold Standard
Ultrasound is 1st choice: see thickened GB, distended GB, slude, gallstones HIDA scan is Gold Standard: Nonvisulatization of gallbladder Labs: Increased WBC, Increased bili
113
Tx of Acute Cholecystitis
Conservative: NPO, IV fluids, Abx (3rd gen cephalosporin +Metronidazole) Cholecystectomy within 72 hours
114
What labs are seen with Alcoholic Hepatitis
AST:ALT >2
115
What labs are seen with Viral Hepatitis
AST/ALT >1,000
116
What labs are seen with Biliary Obstruction or Intrahepatic Cholestasis
Increased ALP | If ALP is increased and GGT is increased, it suggests a hepatic source or biliary obstruction
117
What labs are seen with Autoimmune Hepatitis
ALT>1,000 Positive ANA Positive Smooth Muscle Antibodies
118
What is Fulminant Hepatitis
Acute Hepatic Failure | Rapid Liver Failure with Hepatic Encephalopathy
119
What is Reye's Syndrome and what is it associated with
Fulminant hepatitis in children | Usually associated with ASA use or during viral infection
120
Sx of Reye's Syndrome
``` Rash on hands and feet Intractable Vomiting Liver damage and encephalopathy Dilated pupils with minimal response to light Multi-organ failure ```
121
What causes Fulminant Hepatitis
Acetaminophen Drug Reactions Viral Hepatitis
122
Sx of Fulminant Hepatitis
Ecephalopathy: Vomiting, Coma, AMS, Seizures, Asterixis, Hyperreflexia, Cerebral Edema Coagulopathy: Due to decreased hepatic production of coagulation factors Hepatomegaly, Jaundice
123
Dx of Fulminant Hepatitis
Increased Ammonia Increased PT/INR Hypoglycemia
124
Tx of Fulminant Hepatitis
Encephalopathy: Lactulose, Neomycin, Protein Restriction | Liver Transplant
125
What is the definitive tx for Fulminant Hepatitis
Liver Transplant
126
What are sx of Viral Hepatitis
Prodromal: Malaise, Arthralgia, Fatigue, URI | Icteric Phase: Jaundice
127
What defines Chronic Hepatitis and what can it lead to
More than 6 months | May lead to end stage liver disease or Hepatocellular Carcinoma
128
What types of Hepatitis are associated with Fecal-Oral Routes
Hepatitis A and Hepatitis E
129
What types of Hepatitis are associated with Blood, Sex, Drugs
Hepatitis B, C, and D
130
Sx of Hepatitis A and Hepatitis E
Malaise, Arthrlagias, Fatigue, URI sx, Jaundice
131
Dx of Hepatitis A
Positive IgM
132
What will present if someone has been previously exposed to Hepatitis A
Positive IgG | Negative IgM
133
Tx of Hepatitis A
Self-Limiting, recovery in weeks | HAV immune globulin for close contacts
134
Dx of Hepatitis B | -Acute Infection, Past Infection, Chronic Infection
Acute: Positive HCV RNA Past: Negative HCV RNA Chronic: Positive HCV RNA + Positive Anti-HCV
135
Tx of Chronic Hepatitis B
Pegylated Interferon Alpha-2b + Ribavirin
136
How do you screen of hepatocellular carcinoma
Serum Alpha-Fetoprotein and Ultrasound
137
What is the first evidence of Hepatitis B infection
HBsAg (arrives before sx)
138
What signifies a resolved Hepatitis B infection or immunization
HbsAb
139
What indicates an acute Hepatitis B infection
HbcAb IgM
140
What indicates a chronic Hepatitis B infection (or resolved)
HbcAb IgG
141
What indicates increased Hepatitis B replication and increased inectivity
HbeAg
142
What indicates a waning Hepatitis B infection
HbeAb
143
Tx of Hepatitis B
Acute: Supportive Chronic: Alpha-Interferon 2b, Lamivudine, Adefovir
144
What is a contraindication of Hepatitis B vaccine
Baker's Yeast
145
What is needed for a Hepatitis D infection
HBV (HbsAg)
146
What is Cirrhosis
Irreversible liver fibrosis with nodular regeneration
147
What causes Cirrhosis
Alcohol Chronic Viral Hepatitis Nonalcoholic Fatty Liver Disease Hemochromatosis
148
Sx of Cirrhosis
Fatigue, Weakness, Weight loss Spider Angioma, Caput Medusa, Muscle Wasting, Bleeds, Hepatosplenomegaly, Palmar Erythema, Jaundice Hepatic Encephalopathy: Confusion, Lethargy, Asterixis Esophageal Varices: Due to portal HTN Ascites, Gynecomastia
149
Dx of Cirrhosis
Ultrasound | Liver Biopsy
150
Tx of Cirrhosis
Encephalopathy: Lactulose, Neomycin, Protein Restriction (all 3 keep the ammonia levels down) Lactulose: Keeps ammonia in the gut Neomycin: Kills bacteria making the ammonia Protein Restriction: Stop the source of the ammonia Ascites: Sodium Restriction, Paracentesis, Diuretics (Spironolactone) Pruritis: Cholestyramine (Questran) Liver Transplant
151
How do you screen for Hepatocellular Carcinoma
Ultrasound + Increased Alpha-Fetoprotein and Biopsy
152
What is Primary Biliary Cirrhosis
Autoimmune disorder of intrahepatic small bile ducts which leads to decreased bile salt excretion, cirrhosis and ESLD
153
Sx of Primary Biliary Cirrhosis
Asymptomatic | Fatigue, Jaundice, RUQ discomfort, Hepatomegaly
154
Dx of Primary Biliary Cirrhosis
Positive Anti-Mitochondrial Antibody | Increased ALP with Increased GGT
155
Tx of Primary Biliary Cirrhosis
Ursodeoxycholic Acid | Cholestyramine and UV light for Pruritis
156
What is Primary Sclerosing Cholangitis
Autoimmune Progressive Cholestasis with diffuse fibrosis of intrahepatic and extra hepatic ducts
157
What is Primary Sclerosing Cholangitis most commonly associated with
Ulcerative Colitis
158
Sx of Primary Sclerosing Cholangitis
Progressive Jaundice, Pruritis, RUQ pain, Hepatomegaly, Splenomegaly
159
Dx of Primary Sclerosing Cholangitis
Increased ALP + Increased GGT Positive P-ANCA ERCP is gold standard
160
Tx of Primary Sclerosing Cholangitis
Liver Transplant
161
What is Wilson's Disease
Hepatolenticlar Degeneration Free copper accumulation in the liver, brain, kidney, cornea Due to autosomal recessie disorder that leads to inadequate bile excretion of copper with increased small intestine absorption of copper
162
Sx of Wilson's Disease
CNS copper deposits: Basal Ganglia Deposition leads to Parkinson-like sx (bradykinesia, tremor, rigidity), dementia Liver Disease: Hepatitis, Hepatosplenomegaly, Cirrhosis, Hemolytic Anemia Corneal Copper Deposits: Kayser-Fleischer Rings (Brown or green pigment in cornea)
163
Dx of Wilson's Disease
``` Increased Urinary Copper Excretion Decreased Ceruloplasmin (carrier molecule for copper) ```
164
Tx of Wilson's Disease
Ammonium Tetrathiomolybdate (binds to copper for urinary excretion) Pencillamine: Chelates Copper, must give Vitamin B6 alone with this Zinc: Enhances urinary copper excretion
165
What is Acute Pancreatitis
Acinar Injury leads to intracellular activation of enzymes which leads to auto-ingestion of pancreas
166
What are common causes of Acute Pancreatitis
Alcohol and Gallstones | Mumps in kids
167
Sx of Acute Pancreatitis
Epigastric pain that on constant, radiates to back, relieved with leaning forward, sitting, fetal position N/V, Fever Cullen's Sign: Periumbilical Ecchymosis Grey Turner's Sign: Flak Ecchymosis
168
Dx of Acute Pancreatitis
CT is test of choice Labs: Lipase, Amylase >3x, ALT >3x suggests gallstones, Hypocalcemia Leukocytosis, Increased Bilirubin, Increased Triglycerides
169
Tx of Acute Pancreatitis
Supportive: NPO, IV Fluids, Analgesics with Meperidine (Demerol) Broad Spectrum Antibiotics (Imipinim) ERCP if biliary sepsis suspected
170
What is part of Ranson's Criteria for Acute Pancreatitis
``` Glucose>200 Age>55yrs LDH>350 AST>250 WBC>16,000 Calcium10% Oxygen5 Base Deficit>4 If score >3 = Severe Pancreatitis likely If score ```
171
What is Chronic Pancreatitis
Chronic Inflammation causing parenchymal destruction, fibrosis and calcification resulting in loss of exocrine and sometimes endocrine function
172
What are the most common causes of Chronic Pancreatitis
Alcohol Abuse Idiopathic CF in kids
173
Sx of Chronic Pancreatitis
Calcifications + Steatorrhea + Diabetes Mellitus | Weight loss, epigastric/back pain
174
Dx of Chronic Pancreatitis
Abdominal Xray: Calcified Pancreas
175
Tx of Chronic Pancreatitis
Oral Pancreatic enzyme replacement Avoid Alcohol Pain Control
176
What are risk factors for Pancreatic Cancer
Smoking, age>60yrs, Chronic Pancreatitis, DDT exposure, Alcohol, DM, Males, Obesity
177
What is the most common form of Pancreatic Cancer and where is it found
Adenocarcinoma Head of Pancreas Ampullary and Duodenal Carcinoma
178
Sx of Pancreatic Carcinoma
Painless Jaundice, Weight Loss Abdominal Pain that radiates to the back Pruritis Courvoisier's Sign: Palpable, non-tender, distended gallbladder associated with jaundice
179
Dx of Pancreatic Cancer
CT scan is test of choice | Labs: Increased Tumor Marker: CEA, CA 19-9
180
Tx of Pancreatic Cancer
Whipple Procedure: Radical Pancreaticoduodenal Resection. Done if confined to head or duodenal area ERCP with stent is palliative tx
181
What is Meckel's Diverticulum
Persistent portion of embryonic vitteline duct (yolk sac) Rule of 2's: 2% of population, 2 feet from ileocecal valve, 2% symptomatic, 2 inches in length, 2 types of ectopic tissue (gastric or pancreatic), 2 years is most common age, 2x more likely in boys
182
Sx of Meckel's Diverticulum
Asymptomatic | Painless Rectal Bleeding or Ulceration
183
Dx of Meckel's Diverticulum
Meckel's Scan
184
Tx of Meckel's Diverticulum
Excision
185
What is the Small Bowel Obstruction
Post-Surgical adhesion
186
What are the most common surgeries leading to small bowel obstruction
Hernias | Crohn's disease
187
Sx of Small Bowel Obstruction
Crampy Abdominal Pain Vomiting, Diarrhea, Obstipation High pitched tinkles on auscultation and visible peristalsis
188
Dx of Small Bowel Obstruction
Abdominal XRay: Air fluid levels in step ladder pattern | Dilated bowel loops
189
Tx of Small Bowel Obstruction
NPO, IV Fluids Bowel Decompression (NG tube suction) Surgical if strangulated
190
What is Intussusception
When the intestinal segment invaginates "telescopes" into adjoining intestinal lumen Can lead to owel obstruction
191
Sx of Intussusception
Triad: Vomiting, Abdominal Pain, Passage of Blood per Rectum "currant jelly stools" Pain is colicky, lethargy Dance's Sign: Sausage-Shaped Mass in RUQ or hypochondrium and emptiness in RLQ
192
Dx of Intussusception
Barium Contrast Enema | X-Ray, CT
193
Tx of Intussuscpetion
Barium or Air Insufflation Enema | Surgical Resection if refractory
194
What is Celiac Disease
A small bowel autoimmune iflammation secondary to alpha-gliadin in gluten Loss of villi and absorptive areas that leads to impaired fat absorption
195
Sx of Celiac Disease
Malabsoprtion: Diarrhea, Abdominal Pain/Distention, Bloating, Steatorrhea, Weight Loss Dermatitis Herpetiformis: Pruritic, Papulovesicular rash on extensor surfaces, neck, trunk and scalp
196
Dx of Celiac Disease
Positive IgA Antibody and Transglutaminase Antibody | Small Bowel Biopsy is definitive
197
Tx of Celiac Disease
Gluten Free Diet (avoid wheat, barley and rye) | Oats, Rice, and Corn are fine
198
What is Lactose Intolerance
Inability to digest lactose due to low levels of lactase enzyme
199
Sx of Lactose Intolerance
Loose Stools, Abdominal Pain, Flatulence after ingestion of milk or milk-containing products
200
Dx of Lactose Intolerance
Hydrogen Breath Test | Hydrogen produced by undigested lactose being fermented by colonic bacteria
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Tx of Lactose Intolerance
Lactase enzyme preparations Lactaid (prehydrolyzed milk) Lactose free diet
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What are Diverticula
Small mucosal herniations protruding through intestinal and smooth muscle layer along natural openings of the asa recta of the COLON
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What part of the colon is most commonly affected by Diverticula
Sigmoid Colon due to high intraluminal pressure
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What is Diverticulosis
Non-inflamed diverticula associated with low fiber diet, constipation and obesity Lower GI Bleed
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What is Diverticulitis
Inflamed diverticula secondary to obstruction/infection (fecalith) that leads to distention
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Sx of Diverticulitis
Fever, LLQ pain, N/V, Diarrhea, Constipation, Flatulence and Bloating
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Dx of Diverticulitis/Diverticulosis
CT scan Barium Enema, though not done in acute phase Increased WBC Positive Guaiac
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Tx for Diverticulosis
High Fiber Diet Diber Supplements Bleeding usually stops on its own but if it doesn't use vasopressin
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Tx for Diverticulitis
Clear liquid diet | Broad Spectrum Antibiotics (Cipro or Bactrim) + Metronidazole
210
What is a Volvulus
Twisting of any part of the bowel in itself
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Where is the most common site for a volvulus
Sigmoid Colon | Cecum
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Sx of Volvulus
Obstructive Sx such as abdominal pain, distension, N/V, fever, tachycardia
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Tx of Volvulus
Endoscopic Decompression Initially | Surgery if endoscopy doesn't work
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What is Appendicitis
Obstruction of the appendix usually due to a fecalith
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Sx of Appendicitis
Anorexia Periumbilica/Epigastric pain followed by RLQ pain N/V Rebound Tenderness, Rigidity and Guarding
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What is Rovsign Sign
RLQ pain with LLQ palpation
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What is Obturator Sign
RLQ pain with internal and external hip rotation with bent knee
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What is Psoa's Sign
RLQ pain with right hip flexion/Extension (raise leg vs. resistance)
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What is McBurney's Point Tenderness
The point 1/3 the distance from the anterior superior iliac spine and navel
220
Dx of Appendicits
CT scan Ultrasound Leukocytosis
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Tx of Appendicits
Appendectomy
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What is Irritable Bowel Syndrome
Chronic, Functional Idiopathic Disorder with no organic cause
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Sx of Irritable Bowel Syndrome
Abdominal pain associated with altered defecation/bowel habits Diarrhea, Constipation or Alternations between thw two
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What are common causes of IBS
Abnormal Motility Visceral Hypersensitivity Psychosocial Interactions
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Dx of IBS
Abdominal Pain or discomfort with 2 of 3 features for at least 12 weeks Relief with Defecation, Change in stool frequency, Change in stool formation
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Tx of IBS
Lifestyle Changes Diarrhea: Anticholincergics/Spasms (Dicyclomine), Antidiarrheal (Loperamide) Constipation: Prokinetics, bulk-forming laxatives, saline TCA (Amitriptyline) and SSRI for pain
227
What is Acute Mesenteric Ischemia
Ischemic Bowel Disease: Sudden decrease of mesenterial blood supply to the bowel leads to inadequate perfusion
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What causes Acute Mesenteric Ischemia
Occlusion, Embolus, Thrombus, Nonocclusive Cause (shock)
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Sx of Acute Mesenteric Ischemia
Severe abdominal pain out of proportion to physical findings | N/V, Diarrhea
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Dx of Acute Mesenteric Ischemia
Angiogram Colonoscopy: See patchy necrotic areas Increased WBC, Lactic Acidosis
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Tx of Acute Mesenteric Ischemia
Revascularization via angioplasty with stenting or bypass | Surgical Resection if bowel not salvageable
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What is Chronic Mesenteric Ischemia
Ischemic bowel disease
233
What causes Chronic Mesenteric Ischemia
Mesenteric Atherosclerosis of the GI tract leads to inadequate perfusion especially during the post-prandial state at the splenic flexure
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Sx of Chronic Mesenteric Ischemia
Chronic dull abdominal pain worse after peals | Anorexia (weight loss)
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Dx of Chronic Mesenteric Ischemia
Colonoscopy: SEe mucosal atrophy with loss of villi
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Tx of Chronic Mesenteric Ischemia
Bowel Rest | Revascularization (Angioplasty with stenting or bypass)
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What is Ischemic Colitis
LLQ pain with tenderness | Bloody Diarrhea
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Dx of Ischemic Colitis
Colonoscopy: See segmental ischemic changes in areas of low perfusion such as splenic flexure
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Tx of Ischemic Colitis
Restore perfusion and observe for sigs of performation
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What is Toxic Megacolon
Nonobstructive, severe colon dilation >6cm + Signs of systemic toxicity
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What are common causes of Toxic Megacolon
Ulcerative Colitis, Crohn's, Pseudmembranous Colitis, Infectious, Iscehmic, Hirschsprung
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Sx of Toxic Megacolon
Abdominal Pain, diarrhea, N/V, Rectal Bleeding or Tenesmus, Fever, Electrolyte derangements
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Dx of Toxic Megacolon
Abdominal Xray: See dilated colon >6cm
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Tx of Toxic Megacolon
Bowel Decompression | Bowel Rest, NG Tube, Broad Spectrum Abx, Colostomy in refractory cases
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What are the 2 categories under Inflammatory Bowel Disease
Ulcerative Colitis | Crohn's Disease
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What is Ulcerative Colitis
Limited to colon. It begins in the rectum and contiguously spreads proximally
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What depth is involved in Ulcerative Colitis
Mucosa and Sub Mucosa Only
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Sx of Ulcerative Colitis
LLQ pain, colicky Tenesmus, Urgency Bloody Diarrhea, Steatorrhea, Hematochezia
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What are complications that can arise with Ulcerative Colitis
Primary Sclerosing Cholangitis Colon CA Toxic Megacolon
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Dx for Ulcerative Colitis
Flexi Sigmoidoscopy in acute disease No Colonoscopy in acute disease Barium Enema: See Stovepipe Sign Colonoscopy: See Uniform Inflammation, Sandpaper appearance, Pseudo Polyps
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What labs are seen in Ulcerative Colitis
Positive P-ANCA
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What role does surgery have in Ulcerative Colitis
Surgery is curative
253
What is Crohn's Diease
Any segment of the GI tract from the mouth to the anus
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What region is most commonly affected in Crohn's Disease
Terminal Ileium (RLQ pain)
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What depth is involved in Crohn's Diease
Trasmural
256
Sx with Crohn's Disease
RLQ pain, Crampy, Weight Loss | Diarrhea with NO visible blood
257
What are complications that can result from Crohn's Diease
Perianal Disease such as fistulas, strictures, abscesses, granulomas Malabsorption, such as B12 and Iron deficiency
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Dx of Crohn's Disease
Upper GI series is used in acute disease No Colonoscopy in acute disease Barium Enema: See String Sign Colonoscopy: See Skip lesions (normal areas interspaced between inflamed areas) with cobblestone appearance
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What labs are seen with Crohn's Disease
Positive ASCA
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What role does surgery have in Crohn's Disease
Noncurative
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What are medical management options for Inflammatory Bowel Disease
Aminosalicylates are 1st line (Sulfasalazine, Mesalamine) (these are a type of immunosuppressant) Corticosteroids (for acute flares only) Immune Modifying agents (6-mercaptopurine, Azathioprine)
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How does Colorectal Cancer Progress
Starts with adenomatous polyp that turns malignant (adenocarcinoma)
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What are risk factors for Colorectal Cancer
Age >50yrs, UC/Crohn's Disease, Polyps | Low fiber diet, High red/processed meats, animal fat)
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Sx of Colorectal Cancer
Iron Deficiency Anemia, Rectal Bleeding, Abdominal Pain, change in bowel habits
265
Dx of Colorectal Cancer
Colonoscopy with biopsy Barium Enema (apple core lesion) Increased CEA
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Tx of Colorectal Cancer
5FU (Chemo) | Monitor CEA with treatment
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At what age should someone with an average risk of colorectal cancer be screened and how often should they get a colonoscopy
50 years | Colonoscopy every 10 years
268
At what age should someone with a first degree relative with colorectal cancer after the age of 60 be screened and how often should they get a colonoscopy
40 years | Colonoscopy every 10 years
269
At what age should someone with a first degree relative with colorectal cancer before the age of 60 be screened and how often should they get a colonoscopy
40 years or 10 years before the age the relative was dx | Colonoscopy every 5 years
270
At what age should someone with FAP be screened for colorectal cancer and how often should they get a colonoscopy
Start at age 10 | Yearly Colonoscopy
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At what age should someone with family hx of HNPCC be screened for colorectal cancer and how often should they get a colonoscopy
Age 20-25 years or 10 years before the youngest member was dx Colonoscopy Every 1-2 years
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At what age should someone with IBD be screened for colorectal cancer and how often should they get a colonoscopy
8 years after dx | Colonoscopy every 1-2 years
273
What is a hernia
Protrusion of the viscus from its cavity
274
What is an Indirect Hernia
Contents follow the testicle tract into the scrotum | Due to a persistent process vaginalis
275
What side is most common for an Indirect Hernia
Right Sided
276
Where are Indirect Hernias located with respect to epigastric vessels
Lateral to the inferior epigastric vessels
277
What is a Direct Hernia
Weakness in Hesselbach's Triangle | Does not reach scrotum
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Where are Direct Hernias located with respect to Epigastric Vessels
Medial to the inferior epigastric vessels
279
At what age are Umbilical Hernias reparied
If they continue to be present after 5 years of age
280
What is an Incarcerated Hernia | Sx
``` Irreducible Hernia (unable to return contents back to abdominal cavity) Usually painful ```
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What is a Strangulated Hernia | Sx
Irreducible hernia with compromised blood supply | Systemic Toxicity, Severe painful BM
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Tx of Hernias
Surgery
283
What are Hemorrhoids
Enlarged venous plexus that increased with venous pressure
284
Sx of Internal Hemorrhoids
Intermittent rectal bleeding Bright red blood per rectum Can't feel these, so not likely to be painful
285
Sx of External Hemorrhoids
Perianal Pain that is aggravated with defecation | Tender palpable mass
286
Dx of Hemorrhoids
Visual Inspection Digital Rectal Exam Fecal Occult Blood Test Proctosigmoidoscopy, Colonoscopy
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Tx of Hemorrhoids
Conservative: High Fiber Diet, Increased Fluids, Warm Sitz Baths, Topical Hydrocortisone for pruritis, Analgesics Surgery if failed conservative tx
288
What are common pathogens involved in Anorectal Abscess and Fistulas
Staph Auerus E.Coli Proteus Streptococcus
289
What is the most common site for anorectal abscess and fistulas
Posterior rectal wall
290
Sx of Anorectal Abscess and Fistulas
Throbbing rectal pain worse with sitting, coughing, defectation
291
Tx of Anorectal Abscess and Fistulas
Incision and Drainage | No Abx
292
What is an Anal Fissure
A linear tear/crack in the distal anal canal
293
Where is the most common site for an Anal Fissure
Posterior midline
294
What leads to Anal Fissures
Low Fiber Diet | Passage of large, hard stools
295
Sx of Anal Fissures
Severe painful BM Bright red blood pre rectum Rectal Pain See skin tags
296
Tx of Anal Fissures
Most resolve spontaneously with conservative tx | Sitz baths, analgesics, stool softeners, high fiber diet, increased fluid intake, laxatives
297
What is a Pilondal Cyst
Tender abscess in gluteal cleft
298
Tx of Pilodonal Cyst
Surgical Drainage + Abx
299
What results with Vitamin C deficiency
Scurvy | 3 H's: Hyerkeratosis, Hemorrhage, Hamtologic (Anemia)
300
What results with Vitamin D deficiency
Rickets | Bone softening, bowing, fractures
301
Tx for Vitamine D Deficiency
Ergocalciferol (vit. D)
302
What results in Vitamin A deficiency
Visual changes, night blindness, bitot spots (white spots on conjunctiva), Xeropthalmia
303
What is another name for Vitamin B1
Thiamine
304
What results in Vitamin B1 deficiency (3 things)
Beriberi: dry results in parastehsias, demyleination. wet results in high output failure, dilated cardiomyopathy, edema Wernicke's Ecephalopathy Triad: Ophtalmoplegai, Ataxia, Global Confusion Korsakoff's Dementia: Memory loss, Confabulation, both of which are irreversible
305
Who is most at risk for Vitamin B1 deficiency
Alcoholics
306
What is another name for Vitamin B2
Riboflavin
307
What results in Vitamin B2 deficiency
Oral-Ocular-Genital Syndrome Oral: Lesions of mouth, magenta colored tongue, angular cheilitis Ocular: Photophobia/Corneal Lesions Genital: Scrotal Dermatitis
308
What is another name for Vitamin B3
Niacin
309
What results in Vitamin B3 deficiency
Pellagra | 3 D's: Diarrhea, Dementia, Dermatitis
310
A diet rich in what typically results in Vitamin B3 deficiency
Corn
311
What is another name for Vitamin B6
Pyridoxine
312
What results in Vitamin B6 deficiency
Peripheral Neuropathy | Flaky skin, headache, anemia
313
What is another name for Vitamin B12
Cobalamine
314
What results in Vitamin B12 deficiency
Neuro: Parasthesias, gait abnormalities, memory loss, dementia Glossitis Macrocytic Anemia with hypersegmented neutrophils
315
What is Pernicious Anemia
An autoimmune destruction/loss of gastric parietal cells that secrete intrinsic factor which is needed to absorb Vitamin B12 in the gut
316
Dx for Pernicious Anemia
Schilling Test | Antiboy Tests
317
Who is at risk for B12 deficiency
String Vegans Alcoholics Malabsorption (Celiac Disease, Crohn's)
318
What defines Constipation
Infrequent BM, usually
319
Tx for Constipation
Fiber Bulk Formking Laxatives (Psyllium, Methylcellulose, Polycarbophil) Osmotic Laxatives (Miralax is a type of Polyethylene Glycol; Lactulose, Sorbitol, Milk of Magnesium) Stimulant Laxatives (Bisacodyl, Senna)
320
What is a pancreatic pseudocyst
Collection of fluid around the pancreas Fluid is usually pancreatic enzymes They are usually connected to the pancreatic duct
321
What causes Pancreatic Pseudocysts
Acute Pancreatitis or Chronic Pancreatitis | Results from increased pressure from obstruction or from necrosis related to pancreatitis
322
Sx of Pancreatic Pseudocysts
Abdominal Pain Bloating Poor Digestion
323
Dx of Pancreatic Pseudocysts
CT
324
Tx of Pancreatic Pseudocysts
Most resolve on their own | If symptomatic, removal via endoscopy or surgical removal
325
What are indications for Bariatric Surgery
BMI>40 BMI>35 with 1 comorbidity BMI>30 with 1 comorbidity or Type II DM
326
What are forms of Bariatric Surgery
Roux-en-Y: Stomach, Duodenum and proximal Jejunum is bypassed. Small stomach pouch is made Sleeve Gastrectomy: Most of stomach from greater curvature is removed leaving a "sleeve" made up of lesser curvature Gastric Band: Restrictive procedure, results in small stomach pouch at top of band restricting food quantity
327
What are common complications/complaints post-bariatric surgery
Nausea and Vomiting Cholelithiasis and Cholecystitis Constipation
328
What is Dumping syndrome Sx Associated Foods
A complication of bariatric surgery related to rapid transit of high osmotic load through small gastric pouch to jejunum Crampy abdominal pain, N/V, perspiration and diarrhea Foods: Sweets or Carbs, Fruits, Brassica Vegetables (Cabbage, Cauliflower, Asparagus, Broccoli), Bran cereal
329
Which type of Gastric Bypass Surgery has a lower risk of dumping syndrome
Vertical Sleeve compared to Roux-en-Y

Surgery (12 decks)

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