GI/Nutrition 2 Flashcards
(205 cards)
1
Q
complication of gallstones 2/2 to infected obstruction of the cbd
A
cholangitis
2
Q
mcc of cholangitis
A
e. coli
3
Q
charcot’s triad
A
ruq pain
jaundice
fever
4
Q
reynold’s pentad
A
charcot’s triad
PLUS
hypotn
AMS
5
Q
besides reynold’s pentad, 2 additional sx of cholangitis
A
light colored stool
tea colored urine
6
Q
pruritis + jaundice =
A
primary sclerosing cholangitis
7
Q
chronic liver dz involving inflammation/fibrosis of the intrahepatic and extrahepatic ducts
A
primary sclerosing cholangitis
8
Q
what pt pop makes you think of primary sclerosing cholangitis
A
ulcerative colitis
9
Q
cholangiography finding of PSC
A
fibrosis of bile ducts
10
Q
imaging for cholangitis: initial vs gs
A
initial: US
gs: ERCP
11
Q
indication to skip US and proceed directly to ERCP w. suspected cholangitis
A
charcot’s triad + abnl LFTs
12
Q
management of cholangitis
A
empiric abx
ercp w. stent
post acute cholecystectomy
13
Q
all causes of cholangitis (6)
A
cholelithiasis
post op choledocholithiasis stricture
neoplasm (ampullary carcinoma)
pancreatic pseudocyst/pancreatitis
ERCP/PTC
biliary stent
14
Q
lab elevations associated w. cholangitis
A
elevated: WBC, bilirubin, ALP
positive blood cultures
15
Q
what is supporative cholangitis
A
severe infxn w. sepsis
“pus under pressure”
16
Q
tx for supporative cholangitis
A
IVF
abx
decompression: ERCP w. papillotomy vs PTC w. catheter drainage vs laparotomy w. T-tube
17
Q
cystic collection of tissue, fluid, and necrotic debris surrounding the pancreas
A
pancreatic pseudocyst
18
Q
2 conditions associated w. pancreatic pseudocyst
A
pancreatic (chronic > acute)
trauma to chest (ex steering wheel)
19
Q
pancreatic pseudocysts generally occur how long after acute pancreatitis
A
2-3 weeks
20
Q
characteristic appearance of pancreatic pseudocyst
A
fibrous capsuel w. no epithelial lining
21
Q
PE finding of pancreatic pseudocyst
A
abdominal mass
22
Q
indication for surgical intervention w. pseudocyst
A
if persists past 4-6 weeks:
percutaneous drainage vs pancreaticogastrostomy
23
Q
complications of pancreatic pseudocyst (7)
A
infxn -> pertonitis
bleeding
fistula
pancreatic ascites
gastric outlet obstruction
SBO
biliary obstruction
24
Q
mcc of pancreatic pseudocyst
A
chronic alcoholic pancreatitis
25
tumor marker associated w. liver ca
AFP
26
3 rf for hepatic carcinoma
hepatitis B and C
hemochromatosis
cirrhosis
27
benign liver lesions
cavernous hemagioma
hepatocellular adenoma
infantile hemangioendothelioma
28
imaging guidelines for liver lesions
< 1 cm: contrast MRI w. f/u US q 3 mo
29
guidelines for HCC screening
+/- pt's w. cirrhosis and chronic hep B
screen w. periodic AFP and US
30
tx for HCC
-transplant: single tumors < 5 cm OR
31
epigastric pain that radiates to the back + wt loss, jaundice, pruritis
pancreatic ca
32
most clearly established rf for pancreatic ca
smoking
33
mc location for pancreatic ca
head of the pancreas
34
tx for pancreatic ca
pancreaticoduodenectomy (whipple)
35
tumor marker for pancreatic ca
CA-19-9
36
what is courvoisier's sign
nontender, palpable gallbladder
37
mc type of pancreatic ca
ductal adenocarcinoma at the head of the pancreas
38
5 rf for pancreatic ca
cigs
etoh
pancreatitis
dm
obesity
39
what is virchow's node
signal node in the left supraclavicular fossa
40
the pain of pancreatitis/pancreatic ca is relieved by
sitting and leaning forward
41
labs of pancreatic ca
-elevated: amylase, direct bilirubin, CEA, CA19-9
-glucose intolerance
42
what happens in a whipple procedure
removal of: antrum, part of duodenum, head of pancreas, gallbladder
results in:
-choledochojejunostomy: bile flow
-gastrojejunostomy: passage of food
-pancreaticojejunostomy: pancreatic juice flow
43
2 types of hiatal hernia
**type 1: sliding -> mc**
type 2: paraesophageal
44
describe hiatal hernia
both gastroesophageal junction AND portion of the stomach herniate into the thorax -> **gastroesophageal junction is above the diaphragm**
45
describe paraesophageal hiatal hernia
gastroesophageal junction remains below the diaphragm
46
which type of hiatal hernia is high risk for strangulation
paraesophageal
47
hiatal hernias are mc asymptomatic, but what are 3 possible sx
heartburn
chest pain
dysphagia
48
complications of sliding hiatal hernia
reflux esophagitis
barrett's/esophageal ca
aspiration
49
3 complications of paraesophageal hiatal hernia
obstruction
hemorrhage
incarceration/strangulation
50
dx for hiatal hernia
barium upper GI studies
upper endo
51
tx for hiatal hernia - type 1 vs type 2
type 1: antacids, lifestyle, +/- nissen fundoplication
type 2: nissen fundoplication
52
what part of the GIT is usually spared w. crohn's
rectum
*if rectum is involved, think UC*
53
pattern of involvement w. crohn's vs UC
crohn's: skip lesions
UC: continuous
54
which type of IBD involves bloody diarrhea
UC
55
which type of IBD involves severe abd pain
crohn's
56
what type of IBD is associated w. perianal dz
crohn's
57
which type of IBD involves fistulas
crohn's
58
ulcers associated w. crohn's vs UC
crohn's: aphtoid/deep ulcers, cobblestoning
UC: erythematous/friable/superficial ulcers
59
what is this showing
deep ulcers -> crohn's
60
what is this showing
cobblestoning -> crohn's
61
4 radiographic findings of crohn's
string sign
RLQ mass
fistula
abscesses
62
radiographic finding of UC
tubular lead pipe appearance
63
what is this showing
string sign of terminal ileum -> crohn's
64
what is this showing
lead pipe apperance -> UC
65
histologic features of crohn's vs UC
crohn's: transmural, non caseating granulomas
UC: mucosa-only crypt abscesses
66
association of smoking: crohn's vs UC
crohn's: worsens
UC: protective
67
serology associated w. crohn's vs UC
crohn's: ASCA
UC: p-ANCA
68
common presentation of UC (4)
bloody pussy diarrhea
rectal/lower quadrant pain
fever
urgency
69
mc site for UC
rectum
70
lab findings of UC
elevated: WBC, ESR
anemia
71
2 complications of UC
toxic megacolon
colorectal ca
72
4 systemic sx of crohn's
oral/aphtous ulcers
severe anemia
polyarthralgia
fatigue
73
mc site for crohn's
terminal ileum
74
4 complication of crohn's
strictures
obstruction
abscess
fistula
75
work up for IBD (3)
upper GI series
colonoscopy w. bx
serology
76
most valuable dx test for IBD
colonoscopy
77
consider _ over colonoscopy in UC to reduce risk of bowel perf
flex sigmoidoscopy
78
complication of UC
toxic megacolon
79
mainstay of pharm for IBD
5-aminosalicylic acid drugs (ex sulfasalazine)
80
t/f: UC is more common in smokers and ex smokers
t!
81
GIB, fulminant colitis, toxic megacolon
UC
82
fistulas and renal stones
crohn's
83
mc type of small bowel carcinoma
adenocarcinoma in the duodenum
84
mc presenting sx of small bowel tumors
intermittent, crampy abdominal pain
85
4 rf for small bowel carcinoma
-hereditary nonpolyposis colorectal ca (HNPCC)
-cystic fibrosis
-crohn's
-etoh, refined sugar, red meat, salt/smoked foods
86
dx for small bowel ca
CT
endoscopy
fobt
87
majority of small bowel cancers are positive for what tumor marker
CEA
88
tx for small bowel ca
surgical resection
chemo
89
first sign of jaundice
slceral icterus
90
jaundice is seen w. serum bilirubin > _
2.5
91
causes of jaundice (6)
hemolysis/ineffective erythropoiesis
liver dysfxn
biliary tract obstruction
physiologic of newborn
gilbert
dubin-johnson
92
pathway of Hgb breakdown
1. Hgb is broken into: heme + globin
2. globin: broken into aa
3. heme: broken into iron and protoporphyrin
4. iron: recycled
5. protoporphyrin: convrted to unconjugated bilirubin (UCB)
93
what happens to UCB (unconjugated bilirubin)
1. transported by albumin to the liver for conjugation by uridine glucoronyl transferase (UGT) -> creates conjugated bilirubin ->
2. conjugated bilirubin is transferred to bile -> 3. bile is transferred to the gallbladder ->
4. bile is converted to urobilinogen ->
5. uriblinogen oxidized to stercobilin (stool) and uriobilin (urine)
94
labs to evaluate jaundice (4)
Tbili and unconjugated bili
ALP/ALT/AST
PT/INR
albumin
95
jaundice PLUS normal LFTs
rule out hepatic injury/biliary tract dz
96
jaundice plus predominant ALP elevation
biliary obstruction
vs
intrahepatic cholestasis
97
jaundice plus predominant AST/ALT elevation
intrinsic hepatocellular dz
98
jaundice PLUS elevated INR
obstructive jaundice
99
which type of bilirubin suggests hemolytic anemia
unconjugated
100
think of _ when you see elevated unconjugated bilirubin/hemolytic anemia (2)
drugs
gilbert syndrome
101
think _ when you see elevated conjugated bilirubin (4)
biliary obstruction
intrahepatic cholestasis
hepatocellular injury
genetic condition
102
post op jaundice should clear by week _
3
103
5 causes of PREhepatic post op jaundice
hemolysis (prosthetic valve)
resolving hematoma
transfusion rxn
post cardiopulmonary bpass
blood transufsion
104
causes of post op hepatic jaundice (lots!)
drugs
hypotn
hypoxia
sepsis
hepatitis
preexisting cirrhosis
right sided heart failure
hepatic abscess
gilbert
crigler-najjar
dubin johnson
TPN
105
causes of post op POSThepatic jaundice (lots!)
choledocholithiasis
stricture
cholangitis
cholecystitis
biliary duct injury
pancreatitis
sclerosing cholangitis
pancreatic ca
gallbladder ca
biliary stasis
ceftriaxone
106
labs suggesting hemolysis
elevated: LDH, reticulocytes, fragmented RBCs on smear
decreased: haptoglobin Hct
107
first manifestation of conjugated hyperbilirubinemia
tea colored urine
108
what is melena
black tarry stool
109
causes of melena (5)
**upper GIB**
peptic ulcer
esophageal ulcer
mallory weiss tear
variceal hemorrhage/portal HTN
malignancy
110
what is hematochezia
BRBPR
111
causes of hematochezia (4)
**lower GIB**
hemorrhoids
anal fissures
polyps
colorectal ca
112
painless bleeding w. wiping
hemorrhoids
113
severe rectal pain w. defecation
anal fissures
114
painless rectal bleeding
no red flag signs
polyps
115
type of anemia: acute GIB vs chronic GIB
acute: normocytic
chronic: microcytic
116
gs test for hematochezia
colonoscopy
117
gs test for melena
EGD
118
tx for hematochezia and melena (4)
-endoscopic thermal probe vs clips vs injection
-angiographic embolization
-endoscopic intravariceal cyanoacrylate injxn
-band ligation
119
4 cardinal signs of strangulated bowel
fever
tachy
leukocytosis
localized abd tenderness
120
5 causes of volvulus
**birth defect causing malrotation - mc**
constipation
hirschprung dz
pregnancy
abdominal adhesions
121
mc part of colon affected by volvulus
sigmoid colon
*2nd is cecum*
122
order of imaging when SBO is suspected
abdominal XR series
abdominopelvic CT w. contrast
123
XR finding of volvulus
coffee bean/kidney bean sign
aka bent inner tube sign
124
what is this showing
bird beak sign -> volvulus
125
management of volvulus
emergent surgery
126
mcc of SBO in kiddos and worldwide
hernias
127
don't forget to r.o _ with SBO
incarcerated hernia
128
define incomplete vs complete bowel obstruction
incomplete: some gas in colon
complete: no gas in colon
129
initial management w. all SBO pt's (4)
NPO
NGT
IVF
FC
130
what 2 tests can distinguish partial vs complete bowel obstruction
CT w. contrast
SBFT
131
ABCs of SBO
1. adhesions
2. bulge - hernia
3. cancer
132
tx for complete SBO
laparotomy w. lysis of adhesions
133
how to remember all causes of SBO
give bad cramps:
gallstone illeus
intussusception
volvulus
external compression SMA syndrome
bezoars
abscess
diverticulitis
crohn's
radiation
annular pancreas
meckel's diverticulum
peritoneal adhesions
stricture
134
mc indication for abd surgery in crohn's pt's
SBO due to strictures
135
cause of SBO for pt on coumadin
bowel wall hematoma
136
indications to lower threshold for surgery w. SBO
increasing leukocytosis
fever
tachycardia/tachypnea
increasing abd pain
137
absolute indication for surgery w. partial SBO
peritoneal signs -> **free air on AXR**
138
_ commonly mimics SBO
paralytic ileus -> diffuse gas distension, including colon
139
dx for anal fissures
anoscopy
140
hallmark anoscopy finding of anal fissures
thickened mucosa -> **sentinel pile** below fissure
141
dx for anal abscess
DRE
+/- CT if recurrent
142
dx for perianal fistula
exam
proctoscope
143
tx for anal fissures (5)
1. fluid/fiber
2. stool softeners
3. sitz baths
4. nitroglycerin/CCB ointments
5. botox
144
tx for anal abscess
**surgical drainage**
sitz baths
analgesics
stool softeners
high fiber diet
+/- abx if high risk
145
tx for anal fistula
fistulotomy
146
what type of anal fissure is commonly due to straining during constipation
posterior midline
147
treatment for anal fissure that does not respond to conservative management
lateral anal sphincterotomy
148
mc location for anal fissures
posterior midline
149
4 indications for abx post op for anal abscess
cellulitis
immunosuppression
DM
heart valve abnl
150
what pt pop do you think of w. anal fistula
crohn's
151
what is goodsall's rule
anterior anal fistulas: course straight and exit anteriorly
posterior anal fistulas: curved track
152
thick suture placed thru anal fistulae tract to allow slow transection of sphincter muscle
seton
153
chronic anal fissure triad
fissure
sentinel pile
hyertrophied anal papilla
154
consider what dz's w. chronic anal fissure (4)
IBD
anal ca
STIs
AIDS
155
2 types of GI ulcer to know
gastric
duodenal
156
rf for increased incidence of duodenal/gastric ulcers AND decrease in rate of healing
cigs
157
mc type of ulcer
anterior/proximal duodenal
158
pain decreases w. food
duodenal ulcer
159
mcc of PUD
h pylori
160
2 complications of posterior duodenal ulcer
gastroduodenal a bleed
acute pancreatitis
161
rare cause of PUD
zollinger ellison
162
4 causes of gastric ulcers
**h.pylori - mc**
NSAIDs
GERD
cigs
163
common presentation of gastric ulcers
-gnawing/burning pain that radiates to the back
-worse w. food
164
mc location for gastric ulcers
lesser curvature of antrum
165
mcc of non-hemorrhagic GIB
PUD
166
what type of bleeding is associated w. PUD
melena
167
gs dx for PUD
upper endo w. bx
168
managment of PUD
PPI for all
abx if h pylori
confirm eradication of h pylori
169
abx options for h pylori
metro + omeprazole + clarithro
vs
clarithro + ampicillin + ppi
170
8 rf for PUD
male
smoking
ASA/NSAIDs
uremia
ZE syndrome
h pylori
trauma
burns
171
3 indications for surgery w. bleeding duodenal ulcer
intractable hemorrhage
obstruction
perforation
172
what operation is used for ulcer hemorrhage/obstruction/perf
distal gastrectomy w. excision
173
3 types of hemorrhoids
internal
external
strangulated
174
presentation of internal hemorrhoids
**painless brbpr**
+/- mucus d.c, sensation of incomplete evacuation
175
presentation of external hemorrhoids
pain
no bleeding
176
which type of hemorrhoid is higher risk for thrombosis
external
177
dx for hemorrhoids
**anoscopy**
+/- sigmoidoscopy vs colonoscopy
178
tx for internal hemorrhoids
-stool softeners sitz baths, topical analgesics, hamamelis (witch hazel compress)
-bleeding: injection sclerotherapy (5% phenol in vegetable oil)
-larger/prolapsed/refractory: rubber band ligation
179
indication for excision of hemorrhoid
thrombosed external
180
3 hemorrhoid quadrants
left lateral
right posterior
right anterior
181
degrees of hemorroids
first: does not prolapse
second: prolapses w. defacation, self reduces
third: prolapses w. defecation/valsalva, requires manual reduction
fourth: prolapsed, not reducible
182
4 complications of hemorrhoidectomy
**exsanguination**
infxn
incontinence
stricture
183
contraindication for hemorrhoidectomy
crohn's
184
tx for protruding internal hemorrhoids
rubber band ligation
185
5 types of hernias to know
hiatal
ventral
incisional
umbilical
inguinal
186
which type of hernia is mc congenital
umbilical
187
indication for surgery w. umbilical hernia
persists past 2 yo
188
mc type of inguinal hernia
indirect
189
pathway of indirect hernia
thru internal inguinal ring -> down inguinal canal -> into scrotum
*i = internal inguinal ring*
190
pathway of direct inguinal hernia
thru external inguinal ring at hesselbach triangle
191
3 complications of hernias
obstruction
incarceration
strangulation
192
dx for hernia
exam
US
193
what type of inguinal hernia is felt on the side of the finger during exam
direct
194
what type of inguinal hernia is felt on the tip of the finger during exam
indirect
195
5 rf for ventral hernia
abd surgery
age
obesity
wound infxn
surgical drains
196
which type of inguinal hernia is congenital and generally happens before 1 yo
indirect
197
what type of hernia very rarely strangulates
ventral
198
what type of hernia has a high incidence of strangulation
femoral
199
toxic megacolon is mc a complication of
**IBD: UC > crohn's -> mc**
pseudomembranous colitis
200
4 sx of toxic megacolon
fever
distended abd
pertonitis
shock
201
imaging for toxic megacolon
KUB showing dilated colon > 6 cm
202
dx for toxic megacolon
**at least 3 of the following:**
radiographic evidence
fever > 101.5
HR > 120
neutrophilic leukocytosis
anemia
203
what is this showing
toxic megacolon
204
tx for toxic megacolon
decompression
+/- colostomy vs complete resection
205
3 radiographic findings of toxic megacolon
dilated colon > 6 cm
loss of colonic haustrations
segmental colonic parietal thinning
