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GI > Ischemic/Vascular, Gallstones/Biliary Disease > Flashcards

Ischemic/Vascular, Gallstones/Biliary Disease Flashcards

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

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

A 
peptic ulcers
gastritis and duidenitis
tumors
vascular malformation
esophagitis
varices
25
Q

Esophageal Varices

A
  • 30-50% mortality
  • predictive factors: pressure, size, color
  • treatment: endoscopic banding
26
Q

Risk of recurrent GI bleeding?

A
  • bleeding during scope 60%
  • stigmata (see vessel) 40%
  • post. wall of duodenal bowel
  • stomach

-white base-1% chance to bleed, lowest

27
Q

Gastric Varices

A

hard to treat (glue injection/TIPS)

28
Q

Mallory-Weiss Tear

A
  • tear of gastroesophageal junction
  • bleeding with vomiting
  • spontaneous resolution
29
Q

CMV ulcers

A

ischemic

30
Q

Pills induced ulcers

A

tetracycline coronary

31
Q

Acute Lower GI Bleeding

A 
-bleeding from below Ligament of Treitz
most common cause of acute bleeding
-diverticulosis & angiodysplasia
most common cause of chronic bleeding
-hemorrhoids & neoplasia
32
Q

Angiodysplasia (AVM)

A

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
Q

Bile Components

A
  1. Bile acids
  2. Phospholipid
  3. IgA & IgM
  4. Mucus
  5. Glutathione
34
Q

Bile Acids

A

solubilization of cholesterol
modulation of intestinal motility
(essential for fat absorption)

35
Q

Phospholipid

A

solubilization of cholesterol

protection of bile duct epithelium

36
Q

IgA & IgM

A

bacteriostasis

37
Q

Mucus

A

prevention of bacterial adhesion

38
Q

Glutathione

A

induction of bile flow

39
Q

Pathophysology of Cholesterol Stone Formation

A
  • Cholesterol Supersaturation
  • Accelerated Nucleation
  • Gallbladder Hypomotility
40
Q

Illeus

A

when small intestine stops moving

41
Q

Causes of Cholesterol Hypersecretion

A
  1. Obesity (hyperlipoproteinemia) increased cholesterol synthesis (inc HMG)
  2. Progesterone (oral contraceptives), inc. free cholesterol
  3. Estrogens- increased cholesterol uptake
42
Q

Causes of Cholesterol Hypersecretion

A

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
Q

Black Stones: Pigment Gallstones

A
  • hemolysis
  • advancing age
  • long term TPN
  • cirrhosis
44
Q

Brown Stones: Pigment Gallstones

A
  • bacterial infection
  • decreasing biliary secretion IgA
  • High activity of B-glucuronidase
45
Q

Cholelithiasis

A

cholelith = gallstone

gallstone disease = more than 95% of al gallbladder disease

46
Q

Incidence of Cholelithiasis

A

most common is cholesterol stones

1 million in US per year

47
Q

Clinical Manifestation: biliary colic

A

abdominal pain

48
Q

Clinical Manifestation: acute cholecystitis

A

abdominal pain, fever

49
Q

Clinical Manifestation: choledocholithiasis with cholangitis

A

abdominal pain, fever, jaundice

50
Q

Clinical Manifestation: biliary pancreatitis

A

abdominal pain, increased amylase

51
Q

Treatment of Choledocholithias

A

cholecystectomy: most common elective abdominal operation

choledocholithiasis is found in 12-15% of patients who undergo cholecystectomy

52
Q

Emphysematous Cholecystitis

A

in diabetes

53
Q

Cholestasis

A

intrahepatic: PBC, drugs, malignancy
extrahepatic: stones

54
Q

Benign causes of mechanical cholestasis

A
  • post-surgical complications
  • primary sclerosing cholangitis
  • infections
  • chronic pancreatitis
55
Q

Malignant causes of mechanical cholestasis

A
  • ampullary
  • gall-bladder
  • bile ducts
  • pancreatic malignancy
56
Q

Hemobilia

A

clot in the bowel

  • abdominal pain
  • janduance
  • melinen

GI (19 decks)

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