GI/Nutrition Flashcards
(357 cards)
1
Q
causes of RUQ pain
A
biliary colic
acute cholecystitis
acute cholangitis
sphincter of oddi dysfxn
acute hepatitis
perihepatitis (fitz hugh curtis)
liver abscess
budd-chiari
portal vein thrombosis
2
Q
acute cholangitis triad
A
fever
jaundice
RUQ pain
3
Q
intense, dull discomfort in RUQ or epigastrum - n/v, diaphoresis - lasts 30 min, plateaus w.in 1 hr - benign PE
A
biliary colic
4
Q
> 4-6 hr RUQ or epigastric pain, fever - abdominal guarding and murphy’s sign
A
acute cholecystitis
5
Q
RUQ pain w. fatigue, malaise, n/v, anorexia - +/- jaundice, dark urine, light colored stools
A
acute hepatitis
6
Q
RUQ pain with pleuritic component - pain may radiate to right shoulder
A
fitz hugh curtiz syndrome
7
Q
2 mc sx of liver abscess
A
fever
abdominal pain
8
Q
fever, abd pain w. distension, lower extremity edema, jaundice, GI bleeding, +/- hepatic encephalopathy
A
budd chiari syndrome
9
Q
3 symptoms of portal vein thrombosis
A
abd pain
dyspepsia
GI bleed
10
Q
causes of epigastric abd pain
A
acute MI
acute/chronic pancreatitis
PUD
GERD
gastritis/gastropathy
functional dyspepsia
gastroparesis
11
Q
acute onset persistent upper abd pain radiating to the back
A
acute pancreatitis
12
Q
mc sx of PUD
A
epigastric pain
13
Q
epigastric pain w. heartburn, regurgitation, dysphagia
A
GERD
14
Q
epigastric pain, heartburn, nausea, vomiting, hematemesis
A
gastritis/gastropathy
15
Q
what is functional dyspepsia
A
one or more of the following:
postprandial fullness
early satiety
epigastric pain or burning
16
Q
n/v, vomiting, abd pain, early satiety, bloating
A
gastroparesis
17
Q
causes of LUQ pain
A
splenomegaly
splenic infarct
splenic abscess
splenic rupture
18
Q
pain/discomfort in LUQ, left shoulder pain, early satiety
A
splenomegaly
19
Q
severe LUQ pain
A
splenic infarct
20
Q
fever, LUQ tenderness
A
splenic abscess
21
Q
LUQ pain, left chest wall or left shoulder pain - worse w. inspiration
A
splenic rupture
22
Q
causes of lower abdominal pain
A
appendicitis
diverticulitis
nephrolithiasis
pyelonephritis
acute urinary retention
cystitis
infectious colitis
23
Q
describe appendicitis pain
A
intially periumbilical -> radiates to RLQ
plus anorexia, n/v
24
Q
describe diverticulitis pain
A
LLQ, constant for several days, +/- n/v
25
diverticulitis is mc in what pt pop
asian
26
lower quadrant pain w. dysuria, frequency, urgency, hematuria, f/c, CVA tenderness
pyelonephritis
27
mc sx of infectious colitis
diarrhea
28
what PE exam finding suggests appendicitis has spread to the peritoneum
mcburney point rebound tenderness
29
what 3 signs are associated w. appendicitis
rovsing
obturator
psoas
30
RLQ pain w. palpation of LLQ
rovsing sign
31
RLQ pain w. internal rotation of the hop
obturator sign
32
RLQ pain w. hip extension
psoas sign
33
what lab finding is suggestive of appendicitis
neutrophilia
34
gallstones w.in gallbladder
cholelithiasis
35
inflammation of the CBD, often caused by infxn or choledocholithiasis
cholangitis
36
inflammation of the gallbladder
cholecystitis
37
gallstones that have migrated from the gallbladder into the CBD
choledocholithiasis
38
3 lab findings suggestive of acute cholecystitis
elevated WBC
elevated alk phos
elevated bilirubin
39
when does pain w. cholelithasis mc occur
after eating
at night
40
what sign is associated w. cholelithiasis
boas - referred right subscapular pain
41
what are the 5 f's of cholecystitis
female
fat
forty
fertile
fair
42
what sign is associated w. acute cholecystitis
murphy's
43
3 sx of cholecystitis
fever
leukocytosis
jaundice
44
preferred initial imaging for cholecystitis
US
45
3 US findings of cholecystitis
gallbladder wall > 3 mm
pericholecystic fluid
gallstones
46
gs imaging for cholecystitis when US is inconclusive
HIDA
47
3 lab findings of cholecystitis
elevated alk phos
elevated GGT
elevated conjugated bilirubin
48
porcelain gallbladder is a complication of
chronic cholecystitis
49
gs imaging for choledocholithiasis
ERCP
50
tx for cholecystitis
cholecystectomy w.in 24-48 hr
51
32 yo G2P1 female, 32 weeks gestation in ED w. severe abd pain, fatigue, nausea - profound jaundice, ttp of RUQ - just returned from india
acute hepatitis
52
6 causes of acute hepatitis
viral hepatitides (A, B, C)
parasites (toxoplasmosis)
etoh/drugs
autoimmune hepatitis
steatohepatitis
metabolic dz
53
2 history clues for acute hepatitis
recent travel
sudden jaundice
54
prodrome of acute hepatitis
flu like symptoms
55
5 PE findings of acute hepatitis
RUQ pain
jaundice
slceral icterus
hepatomegaly
splenomegaly
fever
56
initial imaging for acute hepatitis
US
57
2 US findings of acute hepatitis
hepatomegaly -> most sensitive
gallbladder wall thickening
58
3 lab findings of acute hepatitis
elevated WBC w. atypical lymphocytes
hyperbilirubinemia
very high ALT/AST (ALT higher)
59
AST:ALT > 2 makes you suspect
etoh hepatitis
60
IgM abs indicate
early infxn
61
IgG abs indicate
chronic infxn
62
(+) IgG, (-) IgM indicates
pt is immune via prior ifxn or vaccination
63
4 serology markers for hepatitis B
anti HBc IgM
anti HBc IgG
HBSAg
anti HBs
64
(+) anti HBc IgM and HBsAg
acute HBV
65
(+) HBsAg
early acute HBV infxn
66
(+) anti HBc IgG and anti HBs
resolved acute HBV
67
(+) anti HBs
HBV vaccine/immunity
68
(+) anti HBc IgG and HBsAg
chronic HBV
69
2 hepatitis C serology markers
HCV RNA
anti HCV
70
(+) HCV RNA and anti-HCV
chronic HCV
71
(+) HCV RNA +/- anti HCV
acute HCV
72
(-) HCV RNA, (+) anti HCV
resolved HCV
73
when is antiviral therapy used for hepatitis
severe hep B
74
antiviral tx for severe hep B
nucleoside analogs: entecavir
75
pharm for severe alcoholic hepatitis
pentoxifylline
steroids
76
what is this showing
grey-turner sign
flank ecchymosis -> acute pancreatitis
77
what is this showing
dilation of upper duodenum
fluid in left leural cavity
pancreatitis
78
where does pancreatitis pain radiate
back
79
causes of pancreatitis
GET SMASHED
gallstones
etoh
trauma
steroids
mumps
autoimmune
scorpion sting
hypercalcemia
hyperlipidemia
ercp
drugs
80
imaging of choice for pancreatitis
CT
81
most sensitive imaging for chronic pancreatitis
ERCP
82
what is this showing
periumbilical ecchymosis
acute pancreatitis
83
ranson's criteria for poor prognosis w. pancreatitis
**at admit**:
age > 55
leukocytes > 16,000
glucose > 200
LDH > 350
AST > 250
**at 48 hr**:
arterial PO2 < 60
HCO3 < 20
Ca < 8.0
BUN increase by 1.8+
Hct decrease by > 10%
fluid sequestration > 6 L
this is 100% one of my sacrificial lambs
84
complication of pancreatitis
**pancreatic pseudocyst:** pancreatic enzymes, blood, necrotic tissue
85
anal issues to know
fissure
fistula
abscess
86
chronic complication of anorectal abscess
anal fistula
87
t/f: fever is uncommon w. anal abscess
t!
88
sx of anal abscess
pain
swelling/erythema
painful defecation
fluctuance
89
tx for anal abscess
surgical drainage
warm water cleanse
analgesics
stool softener
high fiber diet
abx for high risk
90
open tract btw two epithelium lined areas - associated w. deeper anorectal abscesses
anorectal fistula
91
tx for anorectal fistula
surgery bro
92
tearing rectal pain and bleeding shortly after defecation, BRBPR - pain lasts several hours and subsides until next BM
anal fissure
93
tx for anal fissure
sitz bath
high fiber/water
stool softeners/laxatives
botox for persistent
94
how long do anal fissures take to heal
6 weeks
95
Smarty PANCE really wants us to associate anorexia w.
appendicitis
96
timeline of appendicitis progression
1. periumbilical pain (intermittent/crampy)
2. n/v
3. anorexia
4. pain migrates to RLQ (constant/intense)
97
besides appendicitis, other GI causes of anorexia
gastric/duodenal ulcers
gastric ca
lower GI bleed
gallbladder carcinoma
pancreatic carcinoma
meds
thyroid dz
98
epigastric pain, worse with food, vomiting, anorexia, nausea
gastric ulcers
99
epigastric pain, burning/aching several hr after meals, back pain, nausea, vomiting, anorexia
relieved by food
duodenal ulcers
100
sx of gastric cancer
weapon:
wt loss
emesis
anorexia
pain/epigastric discomfort
obstruction
nausea
101
hematochezia +/- pain, melena, anorexia, fatigue, syncope, SOB, shock
lower GIB
102
biliary colic, wt loss, anorexia, +/- cholecystitis
gallbladder carcinoma
103
painless jaundice, obstruction of CBD, wt loss, abd pain, back pain, weakness, pruritis, anorexia, acholic stools, dark urine, DM
pancreatic carcinoma
104
what sign is associated w. pancreatic carcinoma
courvoisier's sign: enlarged, palpable gallbladder w. jaundice
105
what meds are associated w. anorexia
sedatives
digoxin
laxatives
thiazides
narcotics
abx
106
pathologic causes of constipation/obstipation
colorectal ca
bowel obstruction
volvulus
ileus
gastroparesis
107
what is obstipation
severe/complete constipation
108
consier _ in all pt's > 50 yo w. constipation
colorectal ca
109
XR findings of bowel obstruction
air fluid levels
dilated loops of bowel
110
obstruction due to twisting/knotting of GIT - belly pain/bloating, nausea, hematochezia, constipation
volvulus
111
XR finding of volvulus
colonic distension
112
hypomobility of the GIT in absence of mechanical obstruction, absent bowel sounds
ileus
113
vomiting, abd pain, fullness after eating small amounts, associated w. DM
gastroparesis
114
causes of diarrhea
infectious
toxic
diet
GI dz
115
bloody diarrhea indicates (2)
invasive organism
IBD
116
infxn of biliary tract 2/2 obstruction - leads to biliary stasis and bacterial overgrowth
cholangitis
117
_ accounts for 60% of cholangitis
choledocholithiasis
118
besides choledocholithiasis, other causes of cholangitis
pancreatic/biliary neoplasm
post op strictures
ERCP/PTC
choledochal cysts
119
4 organisms associated w. cholangitis
e. coli
enterococcus
klebsiella
enterobacter
120
what is charcot's triad
RUQ tenderness
jaundice
fever
**cholangitis**
121
what is reynold's pentad
charcot's triad
PLUS
AMS
hypotension
**septic/ascending cholangitis**
122
initial and gs imaging for cholangitis
initial: US
gs: ERCP
123
tx for cholangitis
stone removal (ercp)
cipro + metro
fluids
analgesia
cholecystectomy (post acute)
124
2 sx of primary sclerosing cholangitis
jaundice
pruritis
125
primary sclerosing cholangitis is associated w. what 4 diseases
IBD
cholangiocarcinoma
pancreatic ca
colorectal ca
126
what is primary sclerosing cholangitis
inflammation of bile ducts -> scarring -> narrowing -> liver dysfxn
127
2 mc cause of cirrhosis
1. etoh
2. hep C/B
128
what is the LFT ratio for cirrhosis
AST > ALT
129
complication of cirrhosis that occurs in 10-25% of pt's
hepatocellular carcinoma
130
lab to monitor for HCC in cirrhotic pt's
AFP
131
hepatic vein thrombosis is same same
budd chiari syndrome
132
budd chiari syndrome triad
abd pain
ascites
hepatomegaly
133
7 complications of cirrhosis
potal HTN
ascites
peripheral edema
esophageal varices
hepatorenal syndrome
hepatic encephalopathy
HCC
134
portal htn leads to (4)
ascites
peripheral edema
splenomegaly
varicosity of veins
135
2 causes of ascites
portal htn
hypoalbuminemia
136
mc complication of cirrhosis
ascites
137
work up for ascites
US
diagnostic paracentesis
serum albumin gradient
138
tx for ascites
Na restriction
furosemide/spironolactone
paracentesis
139
3 indications for paracentesis w. ascites
tense ascites
SOB
early satiety
140
5 sx of esophageal varices
dilated submucosal veins
retching
dyspepsia
hypotension
tachycardia
141
3 sx of hepatorenal syndrome
azotemia
oliguria
hypotension
142
pathology behind hepatorenal syndrome
renal hypoperfusion
143
pathology behind hepatic encephalopathy
ammonia accumulates -> travels to brain -> decreased mental fxn
144
PE findings of hepatic encephalopathy
asterixis
dysarthria
delirium
coma
145
what is asterixis
flapping tremor
*have pt flex hands*
146
lab finding indicative of severe cirrhosis
prolonged PT/PTT -> tx is fresh frozen plasma
147
skin/nail changes associated w. cirrhosis
terry's nails
spider angiomata
palmar erythema
jaundice
slceral icterus
caput medusa
hyperpigmentation
148
what is this
spider angioma -> cirrhosis
149
what does this make you think
palmar erythema -> cirrhosis
150
what is this
caput medusa -> cirrhosis
151
what is this
terry's nails -> cirrhosis
152
HCC screening recs
US q 6-12 months for pt's w. cirrhosis
153
dx for HCC
CT guided bx
154
constipation is defined as
< 3 BM/week
155
rome III criteria for functional constipation
any 2 of the following x 3 months w. symptom onset 6 months prior to dx :
straining
lumpy hard stools
incomplete evacuation
digital maneuvers
sensation of obstruction/blockage
decrease in stool frequency (<3/week)
156
secondary causes of constipation
opioids
DM
hypothyroidism
dehydration
MS
157
work up for constipation should include
DRE
imaging not really recommended in geriatrics
158
tx for constipation
**first line: bulk forming laxatives**
osmotic laxatives
stimulant laxatives
stool softeners/suppositories
159
what are the bulk forming laxatives
psyllium seed (metamucil)
methylcellulos (citrucel)
Ca polycarbophil (FiberCon)
wheat dextrin (benefiber)
160
name a osmotic laxatives
polyethylene glycol (PEG)
161
what are the stimulant laxatives
bisacodyl
senna
sodium picosulfate
162
when should you do work up for constipation
after 2 weeks of refractory
163
infectious diarrhea assocaited w. daycare centers
**rotavirus**
cryptosporidium
giardia
shigella
164
if you see daycare center, think
rotavirus
165
infectious diarrhea assocaited w. composed salads (ex egg salad)
s. aureus
166
infectious diarrhea assocaited w. seafood/shellfish
vibrio cholerae
vibrio parahaemollyticus
167
infectious diarrhea associated w. raw ground beef or sprouts
e.coli 0157
168
infectious diarrhea associated w. poultry/pork
salmonella
169
infectious diarrhea associated w. undercooked beef/pork/poultry
s. aureus
clostridium perfringens
salmonella
listeria
e.coli 0157 (shiga producing)
b.cereus
yersinia
campylobacter
170
which pathogen is associated w. travelers diarrhea
enterotoxigenic e.coli (ETEC)
171
infectious diarrhea from poorly canned home foods
c perfingens
172
infectious diarrhea from fried rice
bacillus cereus
173
infectious diarrhea from raw milk
salmonella
campylobacter
e.coli 0157
listeria
174
infectious diarrhea associated w. camping
giardia
175
incubation period and sx of girardia
incubation: 1-3 weeks
sx: foul smelling, bulky stool, may wax/wane for weeks
176
infectious diarrhea associated w. receptive anal intercourse
HSV
chlamydia
gonorrhea
syphilis
177
infectious diarrhea in HIV/immuncompromised pt's
cryptosporidium
microsporidia
isospora
CMV
mycobacterium
listeria
178
rice water scools
v. cholerae
179
bloody stools
salmonella
shigella
campylobacter
e.coli 0157
c.diff
entamoeba
yersinia
180
afebrile abd pain w. bloody stools
e.coli 0157
181
67 yo M, chronic constipation presents w. steadly LLQ pain, low grade fever, abd distension - stool guiac negative - CBC shows absolute neutrophilic leukocytosis w. left shift
diverticulitis
182
63 yo M w. painless BRBPR x 2 hr and LLQ pain
diverticulosis
183
inflammation of an abnormal pouch (diverticulum) in the intestinal wall - mc large intestines
diverticular dz
184
the presence of diverticulum is called
diverticulosis
185
inflammation of diverticulum is called
diverticulitis
186
mc location for diverticular dz
sigmoid colon
187
sx of diverticulitis
f/c
n/v
LLQ pain
188
dx for diverticulitis
-CT w. oral/rectal/IV contrast
-colonoscopy 1-3 months after episode
189
CT findings of diverticulitis (2)
fat stranding
bowel wall thickening
190
tx for diverticulitis
pain control
liquid diet x 2-3 days followed by high fiber diet
+/- abx
+/- US guided drainage/surgical resection
191
indications for colon resection w. diverticular dz
recurrent attacks
perforation
fistula
abscess
192
54 yo F w. odynophagia, dysphagia, retrosternal CP
esophagitis
193
2 types of esophagitis
non infectious
infectious
194
5 types of non infectious esophagitis
reflux
medication-induced
eosinophilic
radiation
corrosive
195
2 meds associated w. esophagitis
NSAIDs
bisposphanates
196
asthma sx and GERD not responsive to antacids
eosinophilic esophagitis
197
dx for eosinophilic esophagitis
bx
198
barium swallow findings of eosinophilic esophagitis
ribbed esophagus
multiple corrugated rings
199
4 radiosensitizing drugs associated w. esophagitis
doxorubicin
bleomycin
cyclophosphamide
cisplatin
200
t/f: dysphagia can lasts months after xrt therapy
t!
201
corrosive esophagitis is associated w.
medication attempted suicide
202
hallmark sign of infectious esophagitis
pain while swallowing food/liquids
203
pt pop mc affected by infectious esophagitis
immune compromised
204
pathogens associated w. infectious esophagitis
candida albicans
HSV
CMV
205
linear yellow-white plaques w. odynophagia or pain w. swallowing
candidal esophagitis
206
tx for candidal esophagitis
daily PO fluconazole
207
shallow punched out lesions on EGD
HSV esophagitis
208
tx for HSV esophagitis
acyclovir
209
large solitary ulcers or erosions on EGD
CMV esophagitis
210
tx for CMV esophagitis
ganciclovir
211
other pathogens associated w. infectious esophagitis
EBV
myobacterium tuberculosis
myobacterium avium
212
dx for infectious esophagitis
endoscopy/bx
double contrast esophagram
culture
213
tx for corrosive esophagitis
steroids
214
tx for eosinophilic esophagitis
remove triggers
ICS
215
3 causes of gastritis
**h.pylori** -> mc
inflammation of stomach lining
autoimmune or hypersensitivity
216
location of h.pylori gastritis
antrum
body
217
dx for h pylori
urea breath
fecal antigen
218
2 causes of inflammation related gastritis
NSAIDs
etoh
219
how do NSAIDs cause gastritis
they diminish local PG production in stomach and duodenum
220
you sould associate autoimmune/hypersensitivity gastritis w.
pernicious anemia
221
location of pernicious anemia related gastritis
body of fundus
222
triad of pernicious anemia
positive schilling test
decreased intrinsic factor
parietal cell abs
223
tx/dx for gastritis
1. stop NSAIDs
2. PPI x 4-8 weeks
3. if no response -> upper GI endo w. bx and US
4. test for h.pylori
224
triple and quadruple therapy for h. pylori
**triple:** clarithromycin, amoxicillin, omeprazole +/- metro
**quadruple:**: tetracycline, omeprazole, metro, bismuth
225
upper GI bleeding originates where
proximal to the ligament of treitz
226
vomiting of blood or coffee ground emesis
hematemesis
227
black tarry stool
melena
228
ddx for hypotn, tachycardia, abd tenderness
peptic ulcer
esophageal ulcer
mallory weiss tear
esophageal varices
malignancy
severe erosive esophagitis
229
emesis, retching, coughing prior to hematemesis
mallory weiss tear
230
odynophagia, dysphagia, retrosternal CP
severe erosive esophagitis
231
tx for upper GIB
NPO, IV, O2
isotonic crystalloids
IV PPI
+/- transfusion
+/- surgery
232
indications for transfusion: high risk vs low risk pt
high risk (elderly, CAD): Hgb < 9
low risk: Hgb < 7
233
passage of BRPBP
hematochezia
234
ddx for hematochezia
hemorrhoids
anal fissure
proctitis
polyps
colorectal ca
diverticulosis
235
painless bleeding w. blood on toilet paper
hemorrhoids
236
severe rectal pain w. defecation
anal fissure
237
rectal bleeding PLUS abd pain
proctitis
238
large volume of BRBPR
diverticulosis
239
what are the parasitic GI infxns
(besides my least favorite topic)
giardia
pinworm
tapeworm
hookworm
roundworm
amebiasis
schistosomiasis
240
diarrhea 1-3 weeks after a camping trip
waxing/waning foul smelling bulky stool
giardia
241
tx for giardia
1st line: tinidazole
alt: metro
242
perianal pruritis that is worst at night
pinworm (enterobios vermicularis)
243
dx for pinworm
sctoch tape test early in the AM
eggs under microscopy
244
tx for pinworm
mebendazole
245
-transmission from raw or undercooked meat
-B12 deficiency
-GI sx PLUS wt loss
tapeworm
246
dx for tapeworm
tape test for diphyllobothrium latum
stool sample for eggs
247
tx for tapeworm
praziquantel
248
-cough, wt loss, anemia, eosinophilia, recent travel
-larvae invade the skin -> travel to lung -> cough/swallow -> reside in intestines
hookworm
249
dx for hookworm
stool sample -> adult worms
250
tx for hookworm
mebendazole or pyrantel
251
mc intestinal helminth worldwide
contaminated soil
roundworm
252
small roundworm load can be asymptomatic, what are the sx of a large roundworm load
pancreatic duct/CBD/bowel obstruction
253
dx for roundworm
stool sample -> eggs vs adult worms
254
tx for roundworm
albendazole
mebendazole
pyrantel pamoate
255
-fecal/oral, contaminated water/food
-bloody diarrhea, tenesmus, abd pain, liver abscess
amebiasis (entamoeba histolytica)
256
dx for amebiasis
stool sample -> trophozoites
257
tx for amebiasis
iodoquinol or paromycin
if liver abscess: add metro
258
-parasitic flatworms
-aka snail fever or bilharzia
-contaminated freshwater -> penetrate skin -> migrate to liver/intestines -> rash, abd pain, bloody diarrhea, hematuria
schistosomiasis
259
dx for schistosomiasis
eggs in urine or feces
260
tx for schistosomiasis
praziquantel
261
when is heartburn worst
night
lying down
262
causes of heartburn
GERD
food intolerance
esophagitis
gastritis
hiatal hernia
PUD
263
heartburn frequency that indicates GERD
more than twice weekly
264
emergency sx of esophagitis
food stuck in esophagus
prolonged chest pain
265
part of. thestomach pushes up thru the diaphragm
hiatal hernia
266
-post prandial burning abd pain, n/v, bloating
-hx PPI/H2 blocker
-not associated w. wt loss
-hx h.pylori and/or chronic NSAIDs
PUD
267
who should undergo work up for heartburn
-longstanding or atypical sx: wheezing/cough/hoarseness
-refractory to max dose PPI/H2 blocker
268
standard work up prior to surgical antireflux procedure (4)
endoscopy w. bx
manometry
24 hr ambulatory pH testing
barium esophagography
269
gs dx for GERD/heartburn stuff
endoscopy w. bx
270
tx for zollinger ellison
PPI
tumor resection
271
ddx for hematemesis
PUD
esophageal varices
etoh
mallory-weiss
coagulation d.o
esophageal ca
malignany
272
tear in the lining of the stomach just above esophagus caused by violent retching or vomiting
mallory weiss syndrome
273
progressive dysphagia to solids, weight loss, reflux, hematemesis
esophageal ca
274
varicose veins of anus/rectum
hemorrhoids
275
rf for hemorrhoids
constipation/straining
pregnancy
portal HTN
obesity
prolonged sitting/standing/anal intercourse
276
indications for anoscopy w. hemorrhoids
BRBPR
suspected thrombosis
277
classifications of hemorrhoids
external
internal
278
sx of thrombosed hemorrhoid
significant pain
pruritis
no bleeding
purplish palpable perianal mass
279
what type of hemorrhoid requires excision
thrombosed external
280
tx for non thrombosed hemorrhoids
fiber
sitz bath
ice packs
bed rest
stool softeners
topical steroids
+/- rubber band ligation or hemorrhoidectomy
281
indications for rubber band ligation for hemorrhoids
protrudes w. defecation
enlargement
intermittent bleeding
282
indication for hemorrhoidectomy
permanently prolapsed
283
types of hernias
hiatal
ventral/incisional
umbilical
inguinal
*you missed her didn't you*
284
which type of hernia is generally congenital and appears at birth
umbilical
285
when should you refer to surgery for umblical hernia
persists beyond 2 yo
286
2 types of inguinal hernias
indirect -> mc
direct
287
passage of intestine thru internal inguinal ring down the inguinal canal +/- to the scrotum
indirect hernia
288
passage of intestine thru external inguinal ring at hesselbach triangle - rarely enters scrotum
direct hernia
289
complications of hernias
strangulation
obstruction
incarceration
290
irreducible hernia that does not interfere w. blood supply to bowel
obstructed hernia/incarcerated
291
hernia so occluded that it can not be reduced and blood supply to bowel is impaired
strangulated
292
what are the 2 IBD's
UC
Crohn's
293
characteristics of UC (7)
continuous lesions
mucosal surface only
hematochezia
pus filled diarrhea
fever
tenesmus
anorexia/wt loss
294
barium enema findings of UC
loss of haustral markings -> lead pipe appearance
295
tx for UC
prednisone and masalamine
colectomy
296
chracteristics of crohn's (8)
mouth to anus
transmural
skip lesions
transmural thickening
aphtous ulcers
wt loss
nonbloody diarrhea
297
what is this showing
cobblestoning -> crohn's
298
what is this showing
lead pipe appearnce -> UC
299
tx for crohn's: flares vs maintenance
flares: prednisone +/- mesalamine, metro, cipro
maintenance: mesalamine
300
t/f: surgery is curative for UC, but not for crohn's
t!
301
continuous lesions, mucosal surface, lead pipe
UC
302
transmural, skip lesions, cobblestoning, fistulas and ulcers
crohn's
303
24 yo M w. UC receives lomotil for excessive diarrhea -> develops fever, abd pain, tenderness
toxic megacolon
304
what is this showing
massively dilated colon -> toxic megacolon
305
toxic megacolon is mc w. which dz
UC
306
tx for toxic megacolon
decmpression of colon
+/- complete colonic resection
307
71 yo M, hx afib - sudden onset severe abd pain q 10 min after eating - normal PE except for minimal pain w, palpation - stool guaiac positive - leukocytosis w. elevated lactate, amylase, LDH
ischemic bowel dz
308
artery mc affected by ischemic bowel dz
superior mesenteric
309
hallmark of ischemic bowel dz
pain out of proportion to findings
310
pain w. ischemic bowel dz begins _ and is relieved by _
10-30 min after eating
relieved by lying down or squatting
311
gs imaging for ischemic bowel dz
mestenteric angiography
312
CT/XR findings of ischemic bowel dz
bowel edema
pneumotasosis intestinalis
portal venous gas
313
what is pneumatosis intestinalis
gas w.in the bowel
314
tx for ischemic bowel dz, including gold standard
bowel rest
fluids
abx
+/- resection
**gs: revascularization**
315
first sign of jaundice
scleral icterus
316
bilirubin > _ is a sign of jaundice related dz
2.5
317
causes of jaundice (lots!)
bilirubin overproduction
hemolysis
ineffective erythropoiesis
decreased hepatic bilirubin uptake
impaired conjugation
biliary tract obstruction
viral hepatitis
physiologic jaundice. ofnewborn
gilbert syndrom
dubin johnson
318
hemolytic jaundice is _ hepatic
obstructive jaundice is _ hepatic
hepatocellular jaundice is _ hepatic
hemolytic: pre hepatic
obstructive: post hepatic
hepatocellular: intra hepatic
319
-increased indirect/unconjugated bilirubin
-mild hyperbilirubinemia
-dark urine dt hemoglobinuria, dark stool
hemolytic/prehepatic jaundice
320
-increased direct/conjugated bilirubin
-dark urine, acholic stools
osbructive/post hepatic jaundice
321
causes of obstructive/post hepatic jaundice
cholestasis
biliary obstruction
322
lab findings associated w. obstructive/post hepatic jaundice
GGT/ALP elevated
323
what are acholic stools
white stools -> biliary obstruction
324
-increased indiret AND direct bilirubin
-dark urine
hepatocellular/intrahepatic jaundice
325
lab findings of hepatocellular/intrahepatic jaundice
ALT/AST markedly elevated
326
causes of hepatocellular jaundice
etoh hepatitis
acute hepatitis
chronic hepatitis
327
AST > ALT 2:1
etoh hepatitis
328
increased ALT and AST > 1,000
ALT > AST
acute hepatitis
329
increased ALT:AST but < 500
chronic hepatitis
330
what makes you suspect gilbert's or dubin-johnson or hemolysis
bilirubin > 2.5 w.o increased LFTs
331
21 yo M brought in by gf after drinking every night last week - reports having vomited each night - tonight after vomiting he noticed blood
mallory-weiss tear
332
tear that occurs in the esophageal mucosa at the junction of the esophagus and stomach - caused by severe retching/vomiting and results in severe bleeding
mallory weiss tear
333
hx clue for mallory weiss (besides vomiting)
etoh
334
upper endo finding of mallory weiss
superficial longitudinal mucosal erosions
335
tx for mallory weiss
supportive
+/- cauterize or epi
336
BRBPR/hematochezia means what type of bleed
lower GI:
hemorrhoids
anal fissures
polyps
proctitis
diverticulitis
337
ddx for n/v
gastroenteritis
migraines
food poisoning
influenza
pyloric stenosis
PUD
hiatal hernia
common cold
338
infant w. projectile vomiting
pyloric stenosis
339
hiatal hernia sx mimic
GERD
340
name the anti emetics
scolpamine patch
dexamethasone
ondansetron
prochlorperazine
droperidol
GI cocktail
341
what are the rescue antiemetics
prochlorperazine
droperidol
342
what's in a GI cocktail
maalox
visous lidocaine
droperidol
343
4 cardinal signs of strangulated bowel
fever
tachycardia
leukocytosis
abd tenderness
344
2 types of bowel obstruction
small
large
345
colickly abd pain, nausea, bilious vomiting, obstipation, abd distension
SBO
346
bowel sounds associated w. early vs late SBO
early: hyperactive
late: hypoactive
347
mcc of SBO
**adhesions**
**hernias**
ca
IBD
volvulus
intussusception
348
what is this showing
-dilated loops of bowel
-air fluid levels
little or no gas in colon
**bowel obstruction**
349
vomiting partially digested food, severe abd distension
bowel obstruction
350
gradually increasing abd pain w. longer intervals btw episodes of pain, abd distension, obstipation, less vomiting
large bowel obstruction
351
which type of bowel obstruction is more common in elderly
large
352
mcc of large bowel obstruction
**cancer**
stritures
hernias
volvulus
fecal impaction
353
tx for bowel obstruction
bowel rest
NGT
+/- surgery
354
defect in gastric or duodenal wall that extends thru the musularis mucosa into the deeper layers of the wall
PUD
355
gs dx for PUD
endo w. bx
356
tx for NSAID associated ulcers
PPI for a minimum of 8 weeks
357
tx for ulcers that are not due to h.pylori or NSAIDs
PPI x 4-8 weeks
