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IDC Stuff > GI MDT Glacken > Flashcards

GI MDT Glacken Flashcards

1
Q

Diarrhea can be defined as

A

More than 3 bowel movements in a day
Liquidity of feces

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2
Q

Acute diarrhea lasting less than two week is most commonly caused by

A

Bacterial toxins

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3
Q

Infectious diarrhea can be transmitted by what

A

Fecal-oral contact
Food
Water

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4
Q

What is the incubation period of infectious sources of dire health

A

12-72 hours

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5
Q

Most common cause of acute gastroenteritis

A

Infectious agents

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6
Q

How is acute gastroenteritis as a diarrheal disease defined

A

3 pre more BM a day or at least 200g of stool a day

Rapid onset lasting less than 2 weeks and may be accompanied by nausea, vomiting, fever or abdominal pain

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7
Q

What are common findings on examination in patients with acute viral gastroenteritis

A

Mild diffuse abdominal tenderness on palpation

Abdomen is soft, but may be guarding

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8
Q

What is the treatment for viral gastroenteritis

A

Usually self limiting and supportive measures (fluid repletion)

No antivirals needed

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9
Q

What is the mechanisms for infectious gastroenteritis

A

Adherence
Mucosal invasion
Enterotoxin/cytotoxin production

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10
Q

Acute gastroenteritis as a diarrheal disease can lead to what

A

Dehydration and loss of electrolytes and nutrients

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11
Q

A diagnosis of gastritis requires what

A

Histopathologic evidence of inflammation

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12
Q

Gastritis only involves what

A

The stomach

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13
Q

What are the most common causes of gastritis

A

Chronic NSAID use
Chronic alcohol use
Trauma

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14
Q

If gastritis does not resolve with conservative management, refer for what

A

Endoscopy and H. Pylori testing

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15
Q

Chronic diarrheal diseases may be classified as

A

Osmotic
Inflammatory
Secretory
Chronic infections
Malabsorption syndromes
Motility disorders

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16
Q

What can cause osmotic diarrhea

A

Medications
Zollinger-Ellison syndrome

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17
Q

Inflammatory diarrhea occurs when

A

Mucosal lining of the intestine is inflamed

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18
Q

What is happening during Secretory diarrhea

A

Increase in secretory activity

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19
Q

Chronic infections if diarrhea can be caused by

A

Parasites

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20
Q

What are some malabsorption diseases

A

Celiac disease
Whipple
Crohn disease
Lactose intolerance

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21
Q

What is an example of a motility disorder

A

Irritable bowel syndrome

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22
Q

What is the difference between inflammatory diarrhea and non inflammatory

A

Inflammatory is bloody
Non-inflammatory is just watery

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23
Q

What is a common cause of inflammatory diarrhea

A

Shigella
Salmonella
E. coli
E. Coli O157:H7

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24
Q

Community outbreaks of diarrhea usually suggest what

A

Viral etiology or food source

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25
Q

Patients with recent family illness suggest what

A

Infectious origin

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26
Q

Acute non-inflammatory diarrhea is usually milder and caused by what

A

Virus

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27
Q

Common cause of acute non-inflammatory diarrhea

A

Rotavirus
Norwalk virus

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28
Q

The term “food poisoning” usually denotes what

A

Disease caused by toxins present in consumed food

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29
Q

Preformed toxin incubation period

A

1-6 hours

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30
Q

When incubation period is longer (8-16 hours) the toxin is usually produced when

A

After being ingested

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31
Q

Non-inflammatory diarrhea illness is

A

Mild and self-limited

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32
Q

If diarrhea worsens or persists for more than 7 days, stool should be

A

Sent for leukocyte, ovum and parasite eval with bacterial culture

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33
Q

Medevac for diarrhea when

A

Signs of inflammatory with fever, bloody diarrhea, or abdominal pain

6 or more stools in 24 hours

Signs of dehydration

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34
Q

Differential for diarrhea

A

Food poisoning
Inflammatory bowel disease
Malabsorption
Medication effect
Laxative abuse

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35
Q

Labs for diarrhea

A

CBC w diff
Fecal leukocyte
Fecal O/P
Stool culture

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36
Q

Initial care for diarrhea

A

Treat symptomatically

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37
Q

What are the categories of gastritis

A

Erosive and hemorrhagic
No erosive and non specific
Specific type

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38
Q

Uncommon causes of gastritis

A

Caustic ingestion and radiation

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39
Q

Symptoms of gastritis

A

Epigastric pain
Nausea vomiting
Upper GI bleed with “coffee ground” vom

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40
Q

Most sensitive method of diagnosis for gastritis

A

Endoscopy

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41
Q

Treatment for NSAID caused gastritis

A

D/C NSAIDs.
Proton pump inhibitor 2-4 weeks (omeprazole 20-40mg)

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42
Q

Treatment for alcohol caused gastritis

A

No alcohol
H2 receptor agonists
PPI

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43
Q

Disposition for gastritis

A

Medevac

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44
Q

Non erosive, non specific causes of gastritis

A

H. Pylori
Pernicious anemia
Eosinophil gastritis

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45
Q

Causes of constipation

A

Decrease in fiber intake with decrease fluid intake

Medications
Structural abnormalities
Slow colonic transport
IBS
Hirschsprung disease

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46
Q

How will getting an upright chest film for a patient who is constipated help

A

Detect the presence or absence of an obstruction

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47
Q

First line treatment for constipation

A

Strict diet changes
Increase water
Fiber supplementation (Metamucil)

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48
Q

Second line treatment for constipation

A

Emollients - colace 100mg 1-2x a day
Stimulants - bisacodyl 5-15mg PO daily
Saline laxative - milk of mag
Hyperosmolar agents - sorbitol

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49
Q

Third line treatment for constipation includes

A

Suppositories or enemas

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50
Q

If uncomplicated constipation disposition is what

A

Retain on board

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51
Q

Complicated or chronic cases of constipation disposition is

A

Refer to gastroenterologist

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52
Q

Stage I hemorrhoids are

A

Internal and confined to the anal canal

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53
Q

Stage II hemorrhoids defined

A

Gradually enlarge and protrude from anal opening

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54
Q

Stage III hemorrhoids

A

Require manual reduction after bowel movements

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55
Q

Stage IV hemorrhoids

A

Remain chronically protruding and unresponsive to manual reduction

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56
Q

What is the definitive care for internal hemorrhoids

A

Surgical banding or band ligation

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57
Q

Describe external hemorrhoids

A

Tense bluish nodule covered with skin.

Few centimeters in size

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58
Q

Type of diet for hemorrhoids

A

High fiber diet increase water intake

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59
Q

Treatment for external hemorrhoids

A

Warm sitz bath
Anesthetize skin with 1% lido, 30g needle
Eclipse of skin excised and clot evacuated

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60
Q

Describe what anal fissures look like

A

Linear or rocket shaped ulcers, usually < 5mm in length

61
Q

Causes of anal fissures

A

Trauma from Straining, constipation, high internal sphincter tone

62
Q

Symptoms of anal fissures

A

Sever, tearing pain during defecation
Bright Blood may be present

63
Q

Difference is appearance between chronic and acute anal fissures

A

Acute looks like cracks in the epithelium

Chronic results in fibrosis and development of skin tags at outermost edge

64
Q

Differential for anal fissures

A

Perianal abcess
Hemorrhoids
Skin tag
Crohn disease

65
Q

Treatment for anal fissures

A

Fiber supplements and sitz baths
Topical anesthetics
Oral analgesics (Tylenol or NSAID)

66
Q

Initial care for anal fissures

A

Consider stool softeners
Inform patient on importance of keeping clean

67
Q

What is an obstruction of an anal gland that opens in the base of an anal crypt that drains into the anal canal

A

Anorectal abcess

68
Q

Anorectal abscesses almost always begin with the involvement of?

A

An anal crypt and it’s gland

69
Q

Most common space Anorectal abcesses occur

A

Perianal

70
Q

Least common place Anorectal abcesses occur

A

Supralevator

71
Q

As rectoanal abcesses persist what may happen

A

Fistula formation

72
Q

Who is commonly affected by Anorectal abscesses

A

Young middle aged males

73
Q

Symptoms of Anorectal abscesses

A

Dull, aching, throbbing pain immediately before defecation, lessened after defecation, persists between bowel movements

Aggravated by straining

Interfere with walking or sitting

74
Q

Differential for Anorectal abscesses

A

Pilonidal cyst
Hemorrhoid
Anorectal fistula

75
Q

Treatment for Anorectal abscesses

A

Surgical as soon as diagnosis is made
Packed with gauze (not required)

76
Q

Patients with abscesses and fever should be give ?

A

Broad spectrum antibiotics (cephalexin (keflex), doxy)

77
Q

Initial care for rectoanal abscesses

A

I&D
If more complicated refer to surgery

78
Q

Anal crypts allow for secretion of

A

Excess mucus otherwise found in rectum and anus

79
Q

Anal crypts become problematic when?

A

Obstruction occurs

80
Q

An epithelialized track that can form to connect an abscess in the anus or rectum with perirectal skin

A

Anorectal fistula

81
Q

Anorectal fistulas can be the result of?

A

Non-healing Anorectal abscess following drainage

82
Q

Symptoms of Anorectal fistulas

A

Chronic purulent drainage
Pustule lesion in Perianal or buttock area
Rectal pain while pooping or sitting
Malodorous drainage

83
Q

Disposition of Anorectal fistulas

A

If unstable medevac

84
Q

Anatomy of pilonidal disease

A

Pilonidal sinus
Sacrum
Coccyx

85
Q

Asymptomatic hair-containing cysts or abscess on the sacrococcygeal region that have tendency to recur

A

Pilonidal disease

86
Q

Pilonidal abscess may occur in the presence of?

A

Staphylococcus aureus which invade through openings caused by ingrown hairs

87
Q

Where do Pilonidal sinuses or cysts occur

A

Midline in upper part of the natal cleft overlaying the lower sacrum and coccyx

88
Q

Symptoms of Pilonidal disease

A

Swelling, pain, discharge
Tender mass

89
Q

Examination for Pilonidal disease genially reveals what?

A

Area of inflammation in midline gluteal crease with one or more sinus openings

90
Q

Most common finding in Pilonidal disease

A

Single opening with protruding hair

91
Q

Treatment for Pilonidal disease

A

Surgical treatment is treatment of choice

92
Q

Acute Pilonidal abscess treatment

A

I&D, recurrence is common

93
Q

Definitive treatment for persistent or complicated Pilonidal abscess

A

Surgical excision

94
Q

Pilonidal abscess should be packed with what type of gauze

A

Moistened (wet to dry) changed daily

95
Q

Disposition for Pilonidal disease

A

Retain for uncomplicated cases, refer to general surgery for definitive management

Med advice

96
Q

Inflammatory bowel disease encompasses what disease processes

A

Ulcerative colitis
Crohn disease

97
Q

In IBD what is happening with the immune response

A

It disrupts the intestinal mucosa leading to chronic inflammation

98
Q

Hallmarks of ulcerative colitis

A

Limited to colonic mucosa
Pseudo polyps

99
Q

Hallmarks of Crohn disease

A

Any segment from mouth to anus
Skip lesions
Transmural inflammation

100
Q

Crohn disease may be associated with

A

Oral ulcers
Anorectal diseases

101
Q

What is mucosal inflammation

A

Involves only the mucosal layer of bowel wall

Ulcerative colitis

102
Q

What is transmural inflammation

A

Inflammation/ulceration of all layers of bowel wall

Crohn disease

103
Q

Most common portion of GI tract affected by Crohn disease

A

Terminal ilium resulting in malabsorption of food, B12, bile salts and calcium

104
Q

B12 deficiency causes

A

Macrocyclic anemia

Crohn disease

105
Q

Common symptoms of macrocytic anemia

A

Numbness and tingling in distal aspects of upper and lower extremities

106
Q

Crohn disease is a chronic and ______ disease

A

Recurrent

107
Q

Intestinal cobble stoning is a finding of

A

Crohn disease

108
Q

Pertinent history for Crohn disease

A

Fevers
General well being
Weight loss
Abdominal pain
Number of liquid BM a day
Surgical history/hospitalization

109
Q

Symptoms of Crohn disease

A

Ileitis/ileo-colitis (most common)
Fistulas to bladder (UTI)
“Peeing out air”
Anal fissures
Perianal diseases
Oral aphthous lesions

110
Q

Type of imaging useful for crohn disease

A

Endoscopy (not when inflamed)
Colonoscopy (not when inflamed)
CT

111
Q

Crohn disease is a chronic lifelong illness characterized by

A

Exacerbations and periods of remission

112
Q

Treatment for Crohn disease

A

Treat symptomatically toward improvement and controlling disease

113
Q

Available therapies for Crohn disease

A

5-aminosalicylic acid derivatives (5-ASA)
Corticosteroids
Immuno-modulating and biological agents

114
Q

Disposition for Crohn disease

A

DC tobacco
Consult to GI
Medevac

115
Q

Complication of Crohn disease

A

Intra abdominal abscess
Small bowel obstruction
Fistulas
Fissures, skin tags
Bleeding
Increase colon carcinoma risk

116
Q

Screening colonoscopy to detect dysplasia or cancer for patients with Crohn disease frequency

A

Patients with history of 8 or more years after initial diagnosis

117
Q

Ulcerative colitis is a chronic and _____ disease

A

Recurrent

118
Q

Ulcerative colitis is limited to what part of the GI tract

A

Large intestine

119
Q

Inflammation of the mucosa of the colon can cause

A

Ulceration
Edema
Bleeding
Fluid and electrolyte loss

120
Q

Ulcerative colitis manifests in periods of

A

Flare ups and remission

121
Q

Ulcerative colitis is common in what demographic

A

Non smokers and former smokers

122
Q

Appendectomy before the age of 20 is an increased risk of developing

A

Ulcerative colitis

123
Q

Pertinent history for ulcerative colitis

A

Stool frequency and character
Rectal bleeding
Abdominal pain
Fecal urgency
Tenesmus (the feeling of needing to poop)

124
Q

Hallmark of ulcerative colitis

A

Bloody diarrhea
Lower abdominal pain
Anemia
Negative stool culture

125
Q

Mild Ulcerative colitis symptoms

A

Infrequent diarrhea (less than 5 a day)
Formed or loose consistency
Tenesmus
LLQ pain

126
Q

Moderate ulcerative colitis symptoms

A

Severe diarrhea with frequent bleeding
Fever, anemia

127
Q

Severe ulcerative colitis symptoms

A

More than six to ten BM per day
Severe anemia
Hypovolemia
Impaired nutrition
Abdominal pain

128
Q

Initial assessment for patient with ulcerative colitis should focus on

A

Volume status by orthostatic BP, HR, urine output and mental status

Nutritional status

129
Q

DRE of patient with ulcerative colitis may have

A

Red blood on DRE

130
Q

Labs for ulcerative colitis

A

Blood, serology, stool culture
Degree of abnormality in HCT and albumin reflects severity

131
Q

Colonoscopy screening for ulcerative colitis

A

8 years post initial diagnosis

132
Q

Patients with ulcerative colitis have _______ risk of colon cancer than general population and Crohn disease

A

Greater

133
Q

What are the two main treatments for ulcerative colitis

A

Terminate the acute attack
Prevent recurrent attacks

134
Q

Medication options for ulcerative colitis

A

Mesalamine
Corticosteroids
5-ASA
Antidiarrheal agents if negative for Cdiff

135
Q

What is the surgery called for ulcerative colitis

A

Total proctocolectomy

Taking out the large intestine (curative)

136
Q

Mild to moderate ulcerative colitis should be referred to

A

GI or general surgery

137
Q

Severe ulcerative colitis initial treatment

A

Hospitalize
DC oral intake for 24-48 hours
Serial abdominal exams

138
Q

Disposition for ulcerative colitis

A

Medevac

139
Q

Can ulcerative colitis be diagnosed in an outpatient setting

A

No, needs a biopsy

140
Q

How is irritable bowel syndrome defined

A

Chronic disease (more than 3 months) with abdominal pain associated with altered bowel habits

141
Q

IBS usually begins at what stage in life

A

Late teens to early twenties

142
Q

Hallmark of IBS

A

Abdominal discomfort relieved immediately after defecation with a normal physical exam

143
Q

What is needed to diagnose IBS

A

Two of three:
Relieved with defecation
Onset of change in frequency of stool
Onset with change in stool form

144
Q

3 major categories of IBS

A

C - constipation
D - diarrhea
M - mix constipation and diarrhea

145
Q

Rule out other diagnosis before concluding IBS in patients with these symptoms

A

Acute onset
40-50 years old
Nocturnal diarrhea
Severe constipation
Hematochezia
Weight loss
Fever
Family history of cancer

146
Q

Physical exam for IBS are usually

A

Normal

147
Q

Differential for IBS

A

Colonic neoplasia
IBD
Hypo/hyperthyroidism
Parasites
Malabsorption
Psych

148
Q

What is definitive treatment for IBS

A

No definitive treatment
Adjust diet

149
Q

Can antidepressants (TCA) be used in treatment of IBS

A

Yes

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