GI Part 3 Flashcards
(116 cards)
1
Q
What are the two main causes of Acute Mesenteric Ischemia?
A
- diminished bowel perfusion due to low CO (CHF, drugs or, most commonly, shock)
- occlusive disease of the vascular supply of the bowel (thrombosis or embolism)
2
Q
SSX: Acute Mesenteric Ischemia
A
sever abdominal pain with minimal physical finding
sudden onset = arterial embolism
gradual onset = venous thrombosis
abd tenderness, guarding, absent bowel sounds with necrosis
3
Q
When should Acute Mesenteric Ischemia be suspected?
A
pt > 50 with predisposing conditions and sudden onset of sever abdominal pain
4
Q
T/F. Acute Mesenteric Ischemia is considered an emergency.
A
true
5
Q
Imaging: Acute Mesenteric Ischemia
A
mesenteric angiography
abd plain film or ct
6
Q
How is ischemic colitis different than Acute Mesenteric Ischemia?
A
episodic and transient from small vessel atherosclerosis
milder, slower onset sx: LLQ pain and rectal bleeding
not as emergent
7
Q
When is a hernia of the abdominal wall an emergency?
A
when strangulated
8
Q
When does hernia of the abdominal wall have sxs?
A
when strangulated
9
Q
How is intestinal obstruction classified?
A
complete/partial
simple/strangulated
location
onset: acute/gradual
10
Q
Name 5 causes of intestinal obstruction.
A
adhesions hernia tumor diverticulities foregin body volvulus intussusception fecal impation
11
Q
SSX: intestinal obstruction (small intestine)
A
sudden onset periumbilical/epigastric cramping
vomiting
non-tender abdomen (w/o strangulation)
maybe dilated loops of bowel
12
Q
What are ssx complete small intestinal obstruction?
A
obstipation
13
Q
What are ssx partial small intestinal obstruction?
A
diarrhea
14
Q
SSX: intestinal obstruction (colon)
A
gradual onset of pain obstipation vomiting abd. distension non-tender borborygmi
15
Q
5 Causes of ileus
A
post-surgical appendicitis diverticulitis perforation AAA hypokalemia drugs MI
16
Q
SSX: ileus
A
distention vomiting abdominal discomfort colicky pain watery stool
17
Q
PE: ileus
A
absent bowel sounds
non-tender abdomen
18
Q
Imaging: ileus
A
xray/ct: free air seen in colon
19
Q
What some causes of acute intestinal perforation in the SI?
A
duodenal ulcer
corrosives
strangulation of bowel
acute appendicitis
20
Q
What some causes of acute intestinal perforation in the colon?
A
obstruction
diverticulities
IBD
toxic megacolon
21
Q
SSX: acute intestinal perforation
A
sudden and catastrophic severe generalized abd pain tenderness signs of shock n/v anorexia
22
Q
PE: acute intestinal perforation
A
quiet to absent bowel sounds
peritoneal signs: guarding, rigidity
23
Q
Imaging: acute intestinal perforation
A
xray/CT: free air seen in small intestine
24
Q
What history questions do you want to ask specifically for gastroenteritis?
A
ingestion of potentially contaminated food or water, travel, contact with similarly ill person, medication use
25
General sxs: gastroenteritis
```
sudden onset nausea
vomiting
anorexia
abd. cramps
diarrhea
maybe malaise, myalgia
```
26
What work-up do you want to do if for gastroenteritis?
stool testing- hemoccult, fecal, WBC, O&P, culture
rapid enzyme assays: viral antigens, shiga toxin
CBC, CMP
27
What is the most common cause of diarrhea worldwide?
Rotavirus
28
Compare Rotavirus and Norovirus in terms of presentation.
Rotavirus: vomiting, fever >102, sxs last 5-7 days
Norovirus: abd. cramps, diarrhea, HA, lasts 1-2 days
29
What part of the year does Rotavirus incidence peak?
winter months
30
Who's most affected by enteric adenovirus and what is the pt. picture?
kids < 2 yo
| diarrhea for 1-2 wks, mild vomiting
31
What sx does all viral gastroenteritis illnesses have?
vomiting
32
What is the most common food poisoning and what foods are associated with it?
staphylococcus aureus
| custard, milk products, potato salad, salad dressing, coleslaw, processed meat/fish
33
Compare SSX of S. aureus and C. perfringens
```
S. aureus:
sudden abrupt severe vomiting 2-6 hr. after ingesting
explosive diarrhea, abd. cramps
sxs last 3-6 hrs.
rarely fever
```
C. perfringens:
watery diarrhea, smelly, crampy adb. pain, 8-16 hrs after ingestion
resolves in 24-36 hrs
34
What are the most common sources of Bacillus cereus?
contaminated rice or meat
35
SSX: Bacillus cereus
emesis (2-6 hours after eating)
diarrhea (8-16 hours): smelly, profuse, nausea
resolves in 12-24 hours
36
What are the most common sources of Clostridium perfringens?
beef and poultry
| foods not adequately cooked and then reheated
37
Which bacteria produce exotoxin?
s. aureus
b. cereus
c. perfringens
c. botulinum
38
What is the most common source of Clostridium botulinum?
home-canned goods
39
SSX: Clostridium botulinum
incubation 4-8 hrs after ingesting
phase 1: vague
phase 2: visual
phase 3: neurological
40
What is the course of a clostridium botulinum infection?
65% mortality
| 2-9 days following ingestion
41
SSX: cholera
sudden, painless, profuse large volume, water diarrhea
no blood/mucus
no fever, abd. pain, vomiting or tenesmus
cold
hypotension, tachycardia
recovery in 7-10 days with adequate rehydration
42
SSx: Enterotoxigenic E. coli
profuse watery diarrhea for 3-5 days
| incubation 1-3 days
43
Common causes of C. diff.
nosocomial or iatrogenic (antibx use)
44
SSX: C. diff
water diarrhea
cramping
abd. pain
no n/v usually
45
Complication of C. diff
TOXIC MEGACOLON
46
SSX: toxic megacolon
dilated colon
fever
abd. pain
tachycardia
47
PE: toxic megacolon
tender abd.
| absent bowel sounds
48
Work up: toxic megacolon
elevated WBCs
distended bowel seen on xray
don't do a colonoscopy!
49
Causes of Salmonella poisoning.
undercooked chicken or eggs
unpasteurized milk
reptiles
50
Compare salmonella and c. jejuni in terms of presentation
```
salmonella: water diarrhea, maybe bloody
HA
malaise
N/V
abd. pain 6-48 hr after ingestion
maybe fever
sxs usually last 1 week
```
```
c. jejuni: prodrome of HA
myalgia
malaise for 12-24 hrs
then, severe abd. pain, high fever, profuse water diarrhea
then, bloody diarrhea
sxs usually last 7-10 days
```
51
What is the most common bacterial cause of bloody diarrhea in the US?
Campylobacter jejuni
52
Sources of Campylobacter jejuni
pork, lamb, beef, milk products, water, infected pets
53
Which bacteria use mucosal invasion?
```
salmonella
c. jejuni
shigella
enterohemorrhagic e. coli
y. enterocolitica
```
54
Who most commonly gets Shigella?
children 6mo-5 years
55
SSX: Shigella
lower abd. pain
diarrhea
fever (50%)
maybe biphasic: first presents with above sxs, then develops rectal burning, tenesmus, bloody
56
Which other virus presents like Rotavirus?
astrovirus
57
Which bacteria produce enterotoxins?
cholera (vibrio)
enterotoxigenic e. coli
c. diff
58
What the the main source for E. coli 0157:H7?
undercooked beef or unpasteurized milk
| also fecal-oral (mostly with toddlers)
59
How does enterohemorrhagic e. coli present?
acute onset of abd. cramps
watery diarrhea > 16 hrs after ingestion
becomes blood within 24 hours
60
Complications of enterohemorrhagic e. coli
HUS: hemolytic anemia, thrombocytopenia, acute renal failure
TTP: HUS, fever, neurological deficits
61
What are the main sources of Y. enterocolitica infection?
undercooked pork, unpasteurized milk, contaminated water
62
SSX: Y. enterocolitica
watery/bloody diarrhea and fever
| may look like appendicitis if in terminal ileum
63
Compare Giardia lamblia and Crytosporidium parvum in terms of presentation.
giardia: incubation 7 days
maybe asx or watery diarrhea, abd. bloating, cramps, flatulence for 1-3 wks. stools bulky, foul smelling
could be self limiting or recurrent
c. parvum:
profuse, watery diarrhea, anorexia, low-grade fever 5 days after ingestion. self-limiting ~2 weeks
64
What does c. parvum look like in an immunocompromised pt.?
chronic watery diarrhea up to 17 days
65
What are the ssx of severe entamoeba histolytica infection?
```
bloody diarrhea
abd. pain
tenesmus
fever
toxic megacolon
```
66
How do the lesions of Crohn's and UC compare?
Crohn's: transmural, skip lesion, granulomatous
can be found anywhere along the GI tract
UC: continuous lesions involving only the mucosa
restricted to the colon and rectum (always involves rectum)
67
Risk factors of Crohn's
```
unknown, possibly genetic
smoking
OCP
diet
dysbiosis
appendectomy early in life
```
68
What is the location and quality of the pain with Crohn's compared to UC?
Crohn's: RLQ, constant, no relieved by BM
| UC: cramping pain, lower abdomen, relieved by BM
69
What is the difference in stool appearance in crohn's and UC?
Crohn's: not grossly bloody
| UC: bloody
70
How does Crohn's present?
```
abd. pain localized in RLQ
occult blood common
usually formed, maybe loose
fat malabsorption
1/3 pt. with perianal dz
```
71
How does UC present?
Cramping abd. pain
series of attack of bloody diarrhea with asx intervals
increased urgency, lower abd. cramps, blood, mucus
stools become looser as more proximal colon is involved
may also have systemic sx: fever, malaise, wt. loss, anemia
72
What is the pattern of Crohn's?
1. inflammation
2. obstruction
3. diffuse jejunoileitis
4. abd. fistulas and abscesses
73
What do you find on PE with Crohn's?
RLQ tenderness with fullness/mass (no mass in UC)
abd. distension
fever
wt. loss
74
Complications of Crohn's
```
intestinal obstruction
fistula
abscess
perforation/hemorrhage
increased risk for SCC
```
75
What labs would you want to run if you suspect Crohn's?
CBC: anemia, leukocytosis
Increased ESR, elevated CRP (higher in UC)
low serum iron and b12
+ fecal lysozyme
serology: ASCA (higher in crohn's), ANCA (higher in UC)
76
Imaging for Crohn's
plain film with double contrast barium contrast
single contrast for upper GI: irregularity, stiffness, thickening of terminal ileum
CT and double contrast for small bowel
US and MRI if radiation exposure is an issue
colonoscopy: "skip areas" and "cobble stone appearance"
granulomas seen in intestinal wall in 50% pts.
77
Risk factors for UC
```
maybe AI
genetic susceptibility
environmental factors
dietary factors
NOT SMOKING (unlike crohn's)
```
78
Who's at greatest risk for developing UC?
Jewish 2-4x
caucasians
males
15-25yrs and 55-65yrs
79
Complications of UC
Hemorrhage (most common)
Toxic megacolon
increased risk of colon cancer
80
Labs for UC
CBC: anemia, platelet count >350,000
elevated ESR and C-reactive protein
CMP: hypoalbuminemia, hypokalemia, hypomagnesemia, elevated alk phos
stool analysis for organisms
81
Imaging: UC
plain film: colonic dilation (if severe)
barium enema appropriate in mild cases: narrow, tubular, short colon with loss of haustral folds, psuedopolyps, lead pipe appearance
flexible sigmoidoscopy (can dx)
colonoscopy with biopsy confirms dx
82
What extra-intestinal manifestations are seen only with Crohn's?
cholelithiasis
renal oxalate stones
vitamin b12 deficiency
aphthous ulcers
83
Name 5 other extra-intestinal manifestations that can be see with both Crohn's and UC.
```
erythema nodosum
conjunctivitis
fatty liver
hepatitis
pyelonephritis
```
84
Red Flags features of IBS
```
sx onset after age 50
severe unrelenting diarrhea
nocturnal sxs
unintentional weight loss
hematochezia
fam hx of organic GI dz
```
85
What is the Rome III criteria for dx of IBS
recurrent abdominal pain for at least 3 days/month during previous 3 months associated with 2 or more of the following:
1. relieved by defecation
2. onset associated with a change in stool frequency
3. onset associated with a change in stool form/appearance
86
clinical picture of IBS
```
crampy abd. pain
constipation/diarrhea both or alternating
increased colonic mucus production
flatulence, bloating, nausea, anorexia
anxiety/depression
stress related sx
appearance of health
```
87
PE findings IBS
diffuse abd. tenderness over colon
88
What labs would you run for IBS?
CBC, CMP, homoccult, stool examination, hydrogen breath test, celiac testing
89
How is IBS ultimately Diagnosed?
```
identify typical symptoms
complete physical examination
exclude alarm features
r/o celiac
colonoscopy in pts. >50yo to r/o CA
```
90
Causes of SIBO
anatomical anomalies
insufficient enzymes
abnormal motility
abnormal communication btw sm. and large bowel
immunocompromise, alcholism. cirrhosis, pancreatitis
91
What hx findings would make you think SIBO?
sxs improve after a antibiotic use
worsening of IBS with probiotic/prebiotic use
worsening of IBS with increased fiber intake
92
SSX: SIBO
abd. pain, cramping, borborygmus, erctation, flatulence, bloating, watery diarrhea may alternate with constipation
vomiting, heartburn, wt. loss, steatorrhea, systemic sxs
93
PE finding for SIBO
abd. distension
| succussion splash
94
Work-up SIBO
CBC: anemia
Glucose breath hydrogen analysis
[14C]-d-xylose breath test (methane)
Jejunal aspirate during endoscopy
95
What causes diverticulitis?
```
low fiber diet
high refined carbohydrates
genetic
aging
meds
colonic segmentation
defects in colonic wall strength
```
96
SSX: diverticulosis
asx
maybe chronic LLQ abdominal pain, constipation
maybe rectal bleeding
97
Complications of diverticulitis
obstruction
| dangerous perforation
98
SSX: diverticulitis
abd. pain: LLQ, steady, deep
fever/chills
colick and diffuse abd. pain with flatulence
altered bowel habits
n/v
rectal bleeding: bright red or wine colored
99
Concomintant sxs of diverticulitis
dysuria
pyuria
urinary frequency
100
What are some SSX of complications of diverticulitis
pneumaturia or recurrent UTI
feculent vaginal d/c
severe and generalized abd. pain, absent bowel sounds, fever
back or lower extremity pain
101
What are expected PE findings of diverticulitis?
```
localized abd. tenderness
rebound tenderness, maybe mass
low-grade fever
DRE shows tenderness, stool color changes and extent of GI bleeding
proctoscopic exam may show mass
```
102
Imaging: diverticulitis
sigmoidoscopy: narrowing and inflammation
| NO BARIUM X-RAY
103
SSX lactose intolerance
varies from minor abd. discomfort and bloating to severe diarrhea
watery diarrhea, abd. bloating and pain, flatulence, nausea
104
Labs: lactose intolerance
hydrogen breath test
| dietary elimination
105
SSX: tropical sprue
acute phase: diarrhea with fever and malaise
| chronic: diarrhea, nausea, vomiting, abd. cramps....
106
PE: tropical sprue
vitamin deficiency signs
| glossitis, stomatitis, cheilosis, cutaneous hyperpigmentation...
107
Work-up: tropical sprue
no definitive markers exist
| 60% pt.s have megaloblastic anemia
108
Where is prevalence of celiac dz highest?
people with GI sxs and a first degree relative with celiac
any age
females
109
Who might you consider to screen for celiac dz?
those with unexplained iron deficiency, early onset osteopenia, unexplained epilepsy, failure to thrive, poor glucose control, chronic diarrhea, infertility, miscarriage, elevated liver enzymes
110
Classic celiac sxs
diarrhea, steatorrhea, bloating, flatulence, vit/min deficiencies
111
How might infants present with celiac disease beyond the classic sxs?
```
failure to thrive
anorexia
vomiting
psychomotor impairment
hypoproteinemia
acidosis
```
112
What atypical sxs may present with celiac dz in adulthood?
```
aphthous ulcers
dyspepsia
fatigue
infertility
neuropsychiatric
bone pain
weakness
dermatitis
```
113
Work-up: celiac disease
```
CBC
CMP
Serology: Serum IgA quantitation, Serum IgA anti-endomysial Abs
IgA tissue transglutaminase Abs
Deamidated gliadin peptide IgA and IgA
```
114
Procedures for celiac dz
small bowel biopsy is confirmatory
115
4 DDX for celiac dz
```
crohn's
giardia
HIV
IBS
intestinal lymphoma
```
116
What are some differences in sxs of IgE and non-IgE mediated food allergies
IgE: variable, dermatologic, ophthalmologic, GI, CV (multisystem) n/v, cramping, diarrhea, pruritis, edema
non-IgE: chronic vomiting, diarrhea, reflux, failure to thrive, atopic derm
