GI/Nutrition Flashcards
(206 cards)
1
Q
epigastric pain that radiates to right subscapula
A
cholecystitis
2
Q
7 causes of epigastric pain
A
PUD
gastritis
MI
pancreatitis
biliary colic
gastric volvulus
mallory-weiss tear
3
Q
mcc of llq pain
A
diverticulitis
4
Q
mcc of rlq pain
A
appendicitis
5
Q
RUQ pain + fever + leukocytosis
A
cholecystitis
6
Q
5 f’s of cholecystitis
A
female
fat
forty
fertile
fair
7
Q
preferred imaging vs gs imaging for cholecystitis
A
preferred: US
gold standard: HIDA
8
Q
3 US findings of cholecystitis
A
gallbladder wall > 3 mm
pericholecystic fluid
gallstones (duh)
9
Q
complication of chronic cholecystitis
A
porecelain gallbladder
10
Q
epigastric pain that radiates to the back + n/v
A
pancreatitis
11
Q
2 etiologies of pancreatitis that Smarty PANCE wants us to know
A
cholelithiasis
etoh
12
Q
gs imaging for pancreatitis
A
CT
13
Q
what is this sign
A
grey turner’s -> pancreatitis
14
Q
what is this sign
A
cullen’s -> pancreatitis
15
Q
ranson’s criteria for poor prognosis w. pancreatitis
A
at admit:
age > 55
leukocytosis > 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
16
Q
what is this showing
A
pancreatic pseudocyst: circumscribed collection of fluid rich in pancreatic enzymes, blood, necrotic tissue
complication of pancreatitis
17
Q
chronic pancreatitis triad
A
pancreatic calcification
steatorrhea
DM
18
Q
3 anal topics to know
A
fissure
abscess
fistula
19
Q
hallmark sx of anal fissure
A
blood on outside of stool or in toilet following BM
20
Q
anal fissures are extremely common in what pt pop
A
infants
21
Q
mc type of anal fissure
A
vertical
22
Q
horizontal anal fissures make you think of (2)
A
crohn’s
HIV
23
Q
tx for anal fissures (3)
A
most self resolve
stool softeners
pteroleum jelly
24
Q
complication of anal fissure
A
anal abscess
25
2 mcc of anorectal abscess
STDs
blocked anal glands
26
2 mcc of deep rectal abscesses
crohn's
diverticulitis
27
tx for anorectal abscess (4)
I&D
sitz bath
pain control
abx
28
complication of deep anorectal abscess
anorectal fistula
29
Smarty PANCE wants you to think about _ w. anorexia
appendicitis
30
classic progression of appendicitis
periumbilical -> n/v -> anorexia -> RLQ pain
over 24 hr
31
besides appendicitis, what other conditions does anorexia make you think of (5)
ulcers
lower GI bleed
GI cancers
thyroid dz
meds
32
mnemonic for sx of gastric ca
**weapon:**
weight loss
emesis
anorexia
pain
obstruction
nausea
33
6 sx of lower GI bleed
brbpr
anorexia
fatigue
syncope
SOB
shock
34
sx of pancreatic carcinoma
painless jaundice
wt loss
abd pain
back pain weak
pruritis
acholic stool
dark urine
DM
35
6 meds associated w. anorexia
sedatives
digoxin
laxatives
thiazides
narcotics
abx
36
4 PE signs associated w. appenditicis
mcburney's point: rebound tenderness
rovsing: RLQ pain w. palpation of LLQ
obturator: RLQ pain w. internal hip rotation
psoas: RLQ pain w. hip extension
37
CBC finding of appendicitis
neutrophilia
38
mcc of pancreatitis: acute vs chronic
acute: gallstones
chronic: etoh
39
1/3 of pancreatic ca can be attributed to (2)
smoking
etoh
40
tumor marker present in 80% of pancreatic ca
CA 19-9
41
what is PONV
post op nausea/vomiting
42
3 emotogenic drugs commonly used in anesthesia
nitrous oxide (N2O)
opioids
phyostigmine
43
3 surgeries mc associated w. PONV
cholecystectomy
gynecologic
laparoscopic
44
least emetogenic general anesthetic
propofol
45
dx for PONV
**PONV scale:**
female
nonsmoker
hx of motion sickness/prev PONV
expected use of postop opioids
score of 0,1, 2 ,3 ,4 = 10-80% risk respectively
46
tx for PONV (2)
preoperative fasting x 2-6 hr
antiemetics
47
name 5 antiemetics
scopolamine patch
dexamethasone
ondansetron
prochlorperazine
droperidol
48
name 2 rescue antiemetics administered in PACU
prochlorperazine
droperidol
49
sx of upper GI bleed
coffee ground hematemesis
+/- melena
50
first consideration in eval of upper GI bleed
evaluate hemodynamic stability
51
5 symptoms that suggest severe upper GIB
orthostatic hypotn
confusion
angina
palpitations
cold/clammy extremities
52
5 causes of upper GIB
peptic ulcer
esophageal ulcer
mallory-weiss tear
variceal hemorrhage
malignancy
53
sx of blood loss based on severity: 15% loss - 40% loss
15%: resting tachy
15-39%: orthostatic hypotn
>/= 40%: supine hypotn
54
define orthostatic hypotn
decrease in systolic bp > 20 mmHg and/or increase in HR of 20 bpm moving from sitting to standing
55
management of upper GIB (2)
IVF asap
transfusion
56
indications for transfusion (5)
hemodynamically unstable despite IVF
Hgb < 9 in high risk pt
Hgb < 7 in low risk pt (most pt's)
active bleeding + PLT < 50,000
INR > 2.0 not due to cirrhosis
57
appendicitis is unlikely if the patient is _
hungry
58
what is obstipation
severe or complete constipation
59
2 XR findings of bowel obstruction
air fluid levels
dilated loops of bowel
60
2 types of bowel obstruction
small
large
61
5 sx of SBO
colicky abd pain
nausea w. bilious vomiting
obstipation
abd distension
high pitched BS -> hypoactive BS
62
5 sx of LBO
gradually increasing abd pain
longer intervals btw pain
abd distension
obstipation
less vomiting than SBO
63
3 hallmark sx of bowel obstruction
vomiting partially digested food
svere abd distension
hyperactive BS -> hypoactive BS
64
what is this showing
dilated loops of bowel
air fluid levels
little/no gas in colon
**bowel obstruction**
65
management of bowel obstruction (3)
NGT
hemodynamic monitoring
laparotomy
66
indication for surgery w. bowel obstruction
no resolution w. 24-48 hr of conservative managment
67
sudden onset of significant, colicky abd pain that recurs q 15-20 min w. vomiting
small bowel intussusception
68
3 pt pops that make you consider intussusception
post GI op
kiddos after viral infxn
adults w. cancer
69
90% of intussusception involves what part of the bowel
ileocecal junction
70
2 hallmark sx of intussusception
currant jelly stool
sausage like mass in abd
71
3 imaging findings of intussusception
crescent sign
bull's eye/target sign
coiled spring lesion
72
what is this showing
target sign -> intussusception
73
what is this showing
meniscus/crescent sign -> intussusception
74
dx AND tx for intussusception in kiddos
barium enema
75
general management of intussusception (5)
-NPO
-NGT
-IVF
-barium enema
-manual reduction/resection w. anastomosis
76
clinical definition of post op adynamic ileus/paralytic ileus
ileus that persists > 3 days post op
77
what is an ileus
hypomotility of GIT in absence of mechanical bowel obstruction
78
hallmark sx of ileus
absent bowel sounds
79
gs imaging for ileus
CT w. gastrografin
80
management of ileus
mc self resolves x 2-3 days
81
condition that affects stomach muscles and prevents proper stomach emptying
gastroparesis
82
mcc of gastroparesis
DM
83
all causes of gastroparesis (6)
dm
anorexia
bulimia
scleroderma
ehlers-danlos
abd surgery
84
2 hallmark sx of gastroparesis
nausea
early satiety
85
dx for gastroparesis (3)
**gs: gastric emptying scan**
KUB
manometry
86
management of gastroparesis (3)
low fiber/low residue diet/low fat diet
small, frequent meals
metoclopramide (reglan)
87
moa for reglan
d2 receptor antagonist -> increases contractility/resting tone in GIT
88
inflammation of the colon caused by cdiff
pseudomembranous colitis
89
3 abx mc associated w. pseudomembranous colitis
pcn
cephalosporins
broad spectrum abx
90
what pt pop should you think about w. pseudomembranous colitis
elderly hospitalized
91
pseudomembranous colitis relies on the secretion of what 2 toxins, which dusrupt normal colinic flora
A - enterotoxin
B- cytotoxin
92
hallmark sx of pseudomembranous colitis
mild foul-smelling watery diarrhea
>3 but < 20/day
93
t/f: pseudomembranous colitis is commonly associated w. fever
t!
94
dx for pseudomembranous colitis
PCR
95
which cdiff toxin is clinically important
toxin b
96
tx for pseudomembranous colitis
IV metro
vs
PO vanco
97
2 complications of pseudomembranous colitis
bowel perf
toxic megacolon
98
only proven method to reduce and maintain wt loss and reduce obesity related morbidities/mortalities
bariatric surgery
99
NIH guidelines for indications for bariatric surgery (5)
BMI > 40
BMI > 35 + obesity related problem
failed non surgical wt. loss programs
psychologically stable to follow post op care
obesity NOT due to medical dz (ex endocrine)
100
3 mechanisms that bariatric surgery uses to reduce energy intake in obese pt's
restrictive
malabsorptive
combo: restrictive + malabsorptive
101
3 types of restrictive bariatric surgery procedures
adjustable gastric banding (AGB)
vertical banded gastroplasty (VBG)
sleeve gastrectomy (SG)
102
2 types of bariatric malabsorptive procedures
-biliopancreatic diversion (BPD)
-biliopancreatic diversion w/w.o duodenoal switch (BPD/DS)
103
combo malabsorptive/restrictive bariatric surgery procedure
roux-en-y gastric bypass (RNYGB)
104
4 mc bariatric procedures used in the US
RNYGB
AGB
VSG
BPD/DS
105
describe roux-en-y
-bypass: stomach, duodenum, 100-150 cm of SI
-creates a restrictive pouch
-roux limb (gastrojejunostomy): limits absorption
106
2 complications of RYGB that Smarty PANCE stresses
dumping syndrome
mortality 1/500
107
what gastric bypass procedures is restrictive and hormonal
VSG
108
describe VSG
-resection stomach along greater curvature, including fundus ->
-reduces stomach to < 25% volume
-decreased ghrelin due to removal of fundus
109
what type of bariatric surgery is restrictive only
ABG
110
ideal candidate for ABG
**volume eater**
*trains pt to eat and chew slower*
111
downsides of ABG (4)
regurgitation
annual barium swallow study
less wt loss
hiatal hernias must be repaired first
112
3 complications of ABG
band slippage
**prolapse**
dilation
113
mc bariatric surgery for tx of severe obesity in US
RNYGB
114
what type of bariatric surgery leaves the pylorus and stomach innervation intact
SG
115
what types of bariatric surgeries are not commonly used due to complications and malnutrition
BPD
DS
116
5 early complications of bariatric surgery
anastomitic leak
DVT/PE
bleeding
infxn
splenic injury
117
8 late complications of bariatric surgery
malnutrition
ulcer
anastomotic strictures
internal hernia
cholelithiasis
band slippage
band erosion
esophageal dilatation
118
mcc of esophageal stricture
GERD
119
2 PMH clues for esophageal stricture
solid food dysphagia
GERD
120
infectious esophagitis causes what type of esophageal stricture (2)
proximal
mid
*NOT distal*
121
schatzki ring is mc associated w. what condition
hiatal hernia
122
triad of plummer-vinson syndrome
dysphagia
esophageal webs
IDA
123
thin membrane in mid-upper esophagus that is congenital vs acquired
esophageal web
124
esophageal strictures are often due to
healing process of ulcerative esophagitis
125
diaphragm like mucosal ring that forms at the esophagogastric junction (B ring)
schatzki ring
126
when do sx usually occur w. schatzki ring based on size
> 20 mm: few sx
< 13 mm: severe/chronic sx
127
schatzki rings are found in 6-15% of pt's who have undergone
barium swallow study
128
typical presentation of schatzki ring
intermittent/nonprogressive dysphagia for solids **after consuming heavy meal w. meat that was wolfed down**
*steakhouse syndrome*
129
dx and tx for schatzki ring
dx: barium swallow/endoscopy
tx: dilation via rupture
130
what is this showing
esophageal web
131
first line diagnostic study in elderly man presenting w. dysphagia
esophagoscopy
132
major risk factor for adenocarcinoma of the esophagus leading to barrett esophagus
GERD
133
adenocarcinoma of the esophagus mc occurs at what part of the esophagus
lower third
134
2 main types of esphageal ca
squamous cell carcinoma
adenocarcinoma
135
mcc of both types of esophageal ca
adenocarcinoma: GERD/barrett's
squamous cell: smoking vs etoh
136
7 sx of esophageal ca
dysphagia of solids -> liquids
regurgitation
heartburn
LAD
wt loss
hematemesis
chest pain unrelated to eating
137
dx for esophageal ca (3)
barium swallow
endoscopy/bx
MRI vs thoracic CT
138
tx of choice for esophageal ca that has NOT metastasized
surgery
139
mc type of esophageal ca worldwide vs US
worldwide: squamous
US: adeno
140
gs dx for esophageal ca
upper endoscopy w. bx
141
indication for endoscopic screening for esophageal ca
pt's w. barrett's q 3-5 years
142
90% of gallstones are:
10% are:
90%: cholesterol
10%: pigmented
143
10 rf for cholelithiasis
5 f's
ocp's
chronic hemolysis
cirrhosis
infxn
rapid wt loss
ibd
tpn
fibrates
elevated TG
144
3 complications of cholelithiasis
cholecystitis
choledocholithiasis
cholangitis
145
when should US for cholelithiasis be performed
after 8 hr of fasting
*distended/bile filled gallbladder is best to visualize stones*
146
2 types of pigmented gallstones
black: calcium bilirubinate
brown: biliary tract infxn
147
2 causes of black gallstones
cirrhosis
hemolysis
148
t/f: hypercholesterolemia is a rf for gallstones
f!
hyperlipidemia is tho
149
referred right subscapular pain of biliary colic
boas sign -> cholelithiasis
150
4 complications of lap chole
cbd injury
right hepatic duct/artery injury
cystic duct leak
biloma
151
3 indications for cholecystectomy in asymptomatic pt
ssa
porecelain gallbladder
kiddo
152
gs dx/tx for choledocholithiasis
ercp
153
what med may dissolve cholesterol gallstone
chenodeoxycholic acid (actigall)
154
screening recs for colorectal carcinoma
all adults 45-75 yo
+/- 76-85 yo
155
screening options for pt's with no rf for colorectal ca (4)
colonoscopy q 10 years
flexible sigmoidoscopy q 5 years
double contrast barium enema q 5 years
circulating tumor cells q 5 years
156
screening for colorecta cal for pt w. adenomatous polyps OR colon ca in first degree relative
colonoscopy at 40 or 10 years younger than first relative was dx
157
3 highest risk factors for colorectal ca that indicate colonoscopy at any age
IDB
hereditary non polyposis colorectal ca
familial adenomatous polyps
158
progression of adenomatous polyp into malignancy (adenocarcinoma) usually occurs w.in _ years
10-20 years
159
7 known rf for colorectal ca
age > 45
IBD
polyps
low fiber diet
high animal fat diet
smoking
etoh
160
2 hallmark sx of colorectal ca
painless rectal bleeding
change in bowel habits
161
3 stool tests for colorectal ca
guaiac based fecal occult (FOBT) annually
fecal immunochemical test (FIT) annually
FIT-DNA q 1-3 years
162
what is this showing
apple core lesion on barium enema -> colorectal adenocarcinoma
163
2 lab findings of colorectal carcinoma
elevated CEA
anemia
164
tx for colorectal carcinoma (3)
surgical resection
5 FU chemo
monitor CEA
165
what is lynch syndrome
-hnpcc: hereditary non polyposis colon ca
-autosomal dominant
-high risk of colon ca
166
sx of colon ca: right vs left sided lesion
right: microcytic anemia, (+) FOBT, melena, postprandial discomfort, fatigue
left: change in bowel habits, colicky pain, obstruction, abd mass, BRBPR, hematemesis, constipation
167
melena is mc from what type of colorectal ca
right sided
168
hematochesia is mc w. what type of colon ca
left sisded
169
microcytic anemia is _ until proven otherwise in a man or postmenopausal woman
colorectal ca
170
3 mcc of colonic obstruction in adults
colon ca
diverticular dz
colonic valvulus
171
mc type of gastric carcinoma
adenocarcinoma
172
4 rf for gastric ca
fam hx
gastric ulcers
h pylori
prenicious anemia
173
5 sx of gastric ca
LOA
progressive dysphagia
vague feeling of abd fullness/early satiety
n/v
wt loss
174
dx for gastric carcinoma
egd w. bx
cbc
fobt
175
what type of anemia is associated w. gastric ca
microcytic hypochromic
176
only curative tx for gastric carcinoma
surgery
177
gastric carcinoma is extremely high in what 3 countries
japan
chile
iceland
178
sx that gastric ca has metastasized
virchow node
sister mary joseph nodule
179
what is this showing
sister mary joseph nodule
180
2-3 week old well fed infant who presents w. non bilious vomiting after most/every feeding
pyloric stenosis
181
common presentation of pyloric stenosis (3)
< 3 months old
projectile non bilious vomiting
olive shaped mass - pathognomonic
182
lab finding of pyloric stenosis
hypochloremic hypokalemic metabolic alkalosis
183
dx for pyloric stenosis
US vs UGI barium series
184
hallmark imaging sign of pyloric stenosis: US vs barium studies
US: double track
barium: string sign
185
what is this showing
string sign -> pyloric stenosis
186
tx for pyloric stenosis
pyloromyotomy - ramstedt procedure
187
hypertrophy of smooth muscle of pyloris -> obstruction of outflow
pyloric stenosis
188
rf pyloric stenosis
first born male
189
why is vomiting w. pyloric stenosis non bilious
obstruction is proximal to ampulla of vater
190
4 complications of pyloromyotomy
duodenal damage
bleeding
infxn
aspiration pna
191
post op feeding for pyloromyotomy
6-12 hr post op: pedialyte
24 hr: full strength formula
192
diverticulosis is mc found in the
sigmoid colon
193
s/sx of diverticulitis
f/c
n/v
left sided abd pain
194
2 hallmark imaging findings of diverticulitis
fat stranding
bowel wall thickening
195
mcc cause of lowr GIB
diverticulitis
196
abx used for diverticulitis
cipro vs augmentin
+/- flagyl
197
4 indications for colon resection w. diverticulitis
recurrent
perforation
fistula
abscess
198
lifestyle management of diverticulitis
high fiber diet
199
t/f: nuts and seeds are associated w. an increasein risk of diverticulosis, diverticulitis, or diverticular bleeding
f!!!!!!
thank you for acknowledging this Smarty PANCE!
200
the presence of what 3 factors acurately predicts acute diverticulitis
absence of vomiting
CRP > 5
tenderness limited to LLQ
201
gs dx for diverticulitis
CT w. contrast
202
what is absolutely contraindicated if you suspect diverticulitis in an acute setting
colonoscopy
*risk of bowel perf*
203
6 complications of diverticulitis
abscess
peritonitis
fistula
obstruction
perforation
stricture
204
mc fistula associated w. diverticulitis
colovesical (to bladder)
205
surgery mc performed for acute diverticulitis w. complications
hartmann's: resection w. end colostomy
206
2 mc oragnisms associated w. development of diverticulitis
e. coli
b. fragilis
