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Ischemic/Vascular, Gallstones/Biliary Disease Flashcards

(56 cards)

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1
Q

Ischemic Diseases of the GI tract

A
  1. Ischemic colitis
  2. Acute Mesenteric Ischemia
  3. Chronic Mesenteric Ischemia
  4. Venous Mesenteric Ischemia
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2
Q

Ischemic Colitis: Presentation

A

hematochezia, diarrhea, abdominal pain

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3
Q

Ischemic Colitis: Physical Exam

A

abdominal tenderness

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4
Q

Ischemic Colitis: Diagnosis

A

Abdominal CT, colonoscopy

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5
Q

Ischemic Colitis: Treatment

A

conservative

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6
Q

Ischemic Colitis: Outcome

A

normally benign

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7
Q

Acute Mesenteric Ischemica

A

medical/surgical emergency

delay in diagnosis

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8
Q

Acute Mesenteric Ischemica: Presentation

A
  • Early abdominal pain without ileus
  • Peritoneal signs only in advanced disease
  • Not always blood
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9
Q

Acute Mesenteric Ischemica: Diagnosis

A

X-ray, CT (thickened bowel wall, ileus and portal vein gas), MRI
-Angiography: sen 70-100%, spec 100%

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10
Q

Acute Mesenteric Ischemica: Treatment

A

ICU management, vasodilators by angiography, surgery

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11
Q

Acute Mesenteric Ischemica: Outcome

A

poor

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12
Q

Distinguishing Features of Ischemic Colitis

A
  • 90% over 60
  • acute cause is rare
  • mild pain
  • tenderness
  • bleeding
  • colonoscopy
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13
Q

Distinguishing Features of Acute Mesenteric Ischemia

A
  • age varies
  • acute cause is typical
  • severe pain
  • tenderness is not prominent early
  • bleeding uncommon
  • angiography
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14
Q

Chronic Mesenteric Ischemia

A
  • abdominal pain after eating

- at least 2 of 3 splanchnic arteries usually have significant occlusive disease

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15
Q

Chronic Mesenteric Ischemia: Diagnosis

A

CT, MRI, ultrasonography, angiography

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16
Q

Chronic Mesenteric Ischemia: Treatment

A

angioplasty, stent placement, surgery

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17
Q

Venous Mesenteric Ischemia

A
  • presentation in several days

- associated with hyper-coagulability state

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18
Q

Venous Mesenteric Ischemia: Diagnosis

A

abdominal CT, MRI, angiography

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19
Q

Venous Mesenteric Ischemia: Treatment

A

stent, surgery, anticoagulation

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20
Q

Melena

A

upper 90% of time
black, tarry, loose or sticky, malodorous stool caused by degraded blood in intestine and generally indicates an upper GI source, although it may originate in the right colon

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21
Q

Hematochezia

A

lower 90% of time

  • bright red blood from rectum, may be mixed with stools and usually indicates a lower GI lesions
  • if upper GI source, its a massive hemorrhage
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22
Q

GI bleeding Classification

A
  • upper or lower

- obscure overt bleeding, obscure occult bleeding

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23
Q

Acute Upper GI Bleeding: Epidemiology

Study These Flashcards
A
  • most frequent
  • men and elderly
  • 80% is self-limited
  • mortality depends on cause
  • continued or recurrent bleeding have mortality rates of 25-30%
24
Q

Upper GI bleeding

Study These Flashcards
A 
peptic ulcers
gastritis and duidenitis
tumors
vascular malformation
esophagitis
varices
25
Esophageal Varices
- 30-50% mortality - predictive factors: pressure, size, color - treatment: endoscopic banding
26
Risk of recurrent GI bleeding?
- bleeding during scope 60% - stigmata (see vessel) 40% - post. wall of duodenal bowel - stomach -white base-1% chance to bleed, lowest
27
Gastric Varices
hard to treat (glue injection/TIPS)
28
Mallory-Weiss Tear
- tear of gastroesophageal junction - bleeding with vomiting - spontaneous resolution
29
CMV ulcers
ischemic
30
Pills induced ulcers
tetracycline coronary
31
Acute Lower GI Bleeding
``` -bleeding from below Ligament of Treitz most common cause of acute bleeding -diverticulosis & angiodysplasia most common cause of chronic bleeding -hemorrhoids & neoplasia ```
32
Angiodysplasia (AVM)
advanced age (2/3 >70) chronic renal failure Osler-Weber-Rendu-autosomal dominant, multiple in muscosa & skin Prior radiation therapy Watermelon Stomach (GAVE-gastric anteriovascular explasia) -slow intermittent blood loss -primary cecum and right side colon
33
Bile Components
1. Bile acids 2. Phospholipid 3. IgA & IgM 4. Mucus 5. Glutathione
34
Bile Acids
solubilization of cholesterol modulation of intestinal motility (essential for fat absorption)
35
Phospholipid
solubilization of cholesterol | protection of bile duct epithelium
36
IgA & IgM
bacteriostasis
37
Mucus
prevention of bacterial adhesion
38
Glutathione
induction of bile flow
39
Pathophysology of Cholesterol Stone Formation
- Cholesterol Supersaturation - Accelerated Nucleation - Gallbladder Hypomotility
40
Illeus
when small intestine stops moving
41
Causes of Cholesterol Hypersecretion
1. Obesity (hyperlipoproteinemia) increased cholesterol synthesis (inc HMG) 2. Progesterone (oral contraceptives), inc. free cholesterol 3. Estrogens- increased cholesterol uptake
42
Causes of Cholesterol Hypersecretion
age: decrease in 7 alpha hydroxylase marked weight reduction: mobilization of tissue cholesterol ileal disease, bypass, resection: impaired bile acid absorption or excessive losses
43
Black Stones: Pigment Gallstones
- hemolysis - advancing age - long term TPN - cirrhosis
44
Brown Stones: Pigment Gallstones
- bacterial infection - decreasing biliary secretion IgA - High activity of B-glucuronidase
45
Cholelithiasis
cholelith = gallstone | gallstone disease = more than 95% of al gallbladder disease
46
Incidence of Cholelithiasis
most common is cholesterol stones | 1 million in US per year
47
Clinical Manifestation: biliary colic
abdominal pain
48
Clinical Manifestation: acute cholecystitis
abdominal pain, fever
49
Clinical Manifestation: choledocholithiasis with cholangitis
abdominal pain, fever, jaundice
50
Clinical Manifestation: biliary pancreatitis
abdominal pain, increased amylase
51
Treatment of Choledocholithias
cholecystectomy: most common elective abdominal operation | choledocholithiasis is found in 12-15% of patients who undergo cholecystectomy
52
Emphysematous Cholecystitis
in diabetes
53
Cholestasis
intrahepatic: PBC, drugs, malignancy extrahepatic: stones
54
Benign causes of mechanical cholestasis
- post-surgical complications - primary sclerosing cholangitis - infections - chronic pancreatitis
55
Malignant causes of mechanical cholestasis
- ampullary - gall-bladder - bile ducts - pancreatic malignancy
56
Hemobilia
clot in the bowel - abdominal pain - janduance - melinen

GI (19 decks)

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