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Internal Medicine > 12) GI (Part 2) > Flashcards

12) GI (Part 2) Flashcards

1
Q

Acute pancreatitis most common causes/pathology

A
  • Leakage of pancreatic enzymes into the interstitial space –> edema and inflammation
  • Alcohol (inflammation)
  • Gallstones/Biliary Pancreatitis (obstruction)
  • Hypertriglyceridemia (> 1000 mg/dl)
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2
Q

Acute pancreatitis signs/symptoms

A
  • Epigastric pain radiating to the back
  • Cullen’s sign & Grey-Turner sign are consistent with severe necrotizing pancreatitis
  • Elevated Amylase and Lipase (Lipase remains elevated longer)
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3
Q

Acute pancreatitis Tx

A
  • IV FLUIDS, NPO
  • Analgesics (Demerol does not constrict the sphincter of Oddi like morphine)
  • Bowel rest
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4
Q

Most cases of chronic pancreatitis are due to

A
  • ETOH
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5
Q

Chronic pancreatitis pathology

A
  • Inflammation
  • Fibrosis
  • Irreversible loss of pancreatic cell function
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6
Q

Chronic pancreatitis signs/smyptoms

A
  • Chronic abdominal pain
  • Diarrhea
  • Weight loss
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7
Q

Chronic pancreatitis diagnosis

A
  • Amylase/lipase may be elevated or normal

- KUB: pancreatic calcifications

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8
Q

Chronic pancreatitis Tx

A
  • Symptomatic with pancreatic enzyme replacement
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9
Q

Chronic pancreatitis complications

A
  • Malabsorption, steatorrhea

- Diabetes may develop

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10
Q

Pancreatic cancer

A
  • Most are adenocarcinoma
  • Prognosis is poor as most have locally advanced or metastatic disease at Dx
  • Biggest risk factor is cigarette smoking
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11
Q

Pancreatic cancer signs/symptoms

A
  • Non-specific sxs
  • “painless jaundice” (obstruction)
  • Systemic pruritus
  • Nausea, abd discomfort
  • Weight loss
  • Courvoisier’s sign (palpable GB in the presence of painless jaundice)
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12
Q

Pancreatic cancer diagnosis

A
  • CT guided biopsy or EUS w/ biopsy
  • Pancreatectomy (Whipple’s)
  • Appropriate for only 10-20% of pts
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13
Q

Diverticulitis complications

A
  • Acute Diverticulitis

- Diverticular Bleeds

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14
Q

Diverticulitis signs/symptoms

A
  • Often elderly patients
  • LLQ pain & tenderness
  • Low grade fever
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15
Q

Diverticulitis diagnosis

A
  • Often treated empirically
  • CBC w/ elevated WBCs
  • CT w/ contrast – most accurate
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16
Q

Diverticulitis Tx

A
  • Ciprofloxacin + metronidazole (mild disease)
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17
Q

Irritable bowel syndrome pathology

A
  • Related to gut-brain interaction

- Not due to structural or biochemical abnormalities

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18
Q

IBS signs/symptoms

A
  • Abd pain and distension - worse after eating and relieved after BM*
  • No weight loss or fever
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19
Q

IBS types (3)

A
  • Constipation (IBS-C)
  • Diarrhea (IBS-D)
  • Constipation alternating with diarrhea (IBS-M)
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20
Q

IBS Tx

A
  • Pain: antispasmodics, rifaximin, tricyclic antidepressants, probiotics
  • Constipation: fiber/ psyllium, PEG, Lactulose, Lubiprostone, Linaclotide
  • Diarrhea: loperamide, eluxadone, bile acid sequestrants, alosetron
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21
Q

Celiac disease pathology

A
  • Gluten exposure causes formation of IgA antibodies directed against gliadin and tissue transglutaminase
  • Causes atrophy and blunting of the villi in the small intestines –> malabsorption
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22
Q

Celiac disease signs/symptoms

A
  • Chronic diarrhea, steatorrhea
  • Weight loss
  • Abd distension
  • Dermatitis herpetiformis
  • B12 deficiency
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23
Q

Celiac disease diagnosis

A
  • Serologic Tests: + IgA Endomysial antibodies & tissue transglutaminase (tTG) antibodies (Antigliadin antibodies: lower sensitivity and specificity)
  • Small bowel biopsy confirms Dx
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24
Q

Celiac disease Tx

A
  • Gluten-free diet (reverses pathologic changes in the intestinal villi)
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25
Q

Acute mesenteric ischemia

A
  • Acute onset of small intestinal hypoperfusion
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26
Q

Acute mesenteric ischemia pathology

A
  • Embolic or thrombotic arterial or venous occlusion
  • Nonocclusive processes (vasospasm or low cardiac output)
  • Most commonly in those with atherosclerosis, A fib
  • Associated with high mortality
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27
Q

Acute mesenteric ischemia signs/symptoms

A
  • Acute severe abdominal pain “out of proportion”
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28
Q

Acute mesenteric ischemia diagnosis

A
  • CT scan, MRI

- Doppler ultrasound

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29
Q

Acute mesenteric ischemia Tx

A
  • O2, NPO, NG tube, IVF, analgesia

- STAT surgical or endovascular consult & Rx

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30
Q

Ischemic colitis

A
  • Usually seen in elderly patients

- Diabetes mellitus, CAD, and PAD

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31
Q

Ischemic colitis pathology

A
  • Same as AMI (hypoperfusion)

- Most prominent at the “watershed” area of colon

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32
Q

Ischemic colitis diagnosis

A
  • Abd CT scan

- Colonoscopy (CT or MRI may assist in the diagnosis)

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33
Q

Ischemic colitis Tx

A
  • Usually responds to conservative Rx
  • NPO; IV fluids; correct electrolyte abnormalities, Abx
  • Anti-embolic therapy
  • Surgery is uncommon
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34
Q

Volvulus

A
  • Higher incidence in elderly pts with other comorbidities
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35
Q

Volvulus pathology

A
  • Sudden, twisting of the bowel on itself –> obstruction and ischemia
  • Gangrene, necrosis and perforation can occur
  • Associated with high morbidity and mortality
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36
Q

Volvulus signs/symptoms

A
  • Abd pain, bloating, vomiting

- Bloody stool

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37
Q

Volvulus diagnosis

A
  • Plain abd x-ray or KUB – “coffee bean” sign
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38
Q

Volvulus Tx

A
  • Endoscopic reduction

- Surgery

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39
Q

Small bowel obstruction causes

A
  • Surgical Adhesions (most common cause), hernias
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40
Q

Large bowel obstruction causes

A
  • Colon CA – most common cause
41
Q

Bowel obstruction signs/symptoms

A
  • Abdominal pain
  • Nausea, vomiting
  • Constipation (with complete obstruction)
42
Q

Bowel obstruction diagnosis

A
  • KUB – air fluid levels, dilated bowel loops

- Abd Ct scan

43
Q

Bowel obstruction Tx

A
  • Decompression (NG tube), surgery
44
Q

Toxic megacolon

A
  • Rare, emergency case
45
Q

Toxic megacolon pathology

A
  • Non-obstructive widening of the large intestine (> 6 cm, loss of haustra)
46
Q

Toxic megacolon etiologies

A
  • UC
  • C-diff colitis
  • Colonic ischemia
47
Q

Toxic megacolon signs/symptoms

A
  • Abd distension
  • Hypotension, tachycardia
  • Fever
  • Leukocytosis
  • Altered mental status –> shock
48
Q

Toxic megacolon diagnosis

A
  • Abd X-ray - dilated colon >6cm

- Abd CT scan

49
Q

Toxic megacolon Tx

A
  • Bowel rest: IVF, NG tube/suction, NPO
  • Steroids, Abx
  • GI and Surgical Consult (partial or total colectomy)
50
Q

Inflammatory bowel diseases (IBD)

A
  • Crohn’s Disease

- Ulcerative Colitis

51
Q

Crohn’s Disease

A
  • Most commonly involves terminal ileum and adjacent colon

- Transmural (whole thickness of the colon) involvement with skip lesions

52
Q

Ulcerative Colitis

A
  • Most commonly involves the rectosigmoid colon
  • Involves the mucosa and submucosa only
  • Diffuse involvement (no skip lesions)
53
Q

Crohn’s Disease (IBD) common presentation

A
  • Diarrhea (usually non-bloody)
  • RLQ pain
  • Low grade fever
  • Weight loss
  • Perianal disease with fistula and abscess
  • Almost never involves the Rectum
54
Q

Ulcerative Colitis (IBD) common presentation

A
  • Intermittent bloody diarrhea (lesions are friable)
  • Tenesmus, Urgency
  • Lower abdominal cramping
  • Almost always involves the Rectum
55
Q

Crohn’s Disease (IBD) lab tests and diagnostic studies

A
    • ASCA (antisaccharomyces cervisiae antibody)
  • Small bowel follow through: ulceration, fistulas, skip lesions
  • Biopsy – Granulomatous lesions; focal ulcerations; acute and chronic inflammation.
56
Q

Ulcerative Colitis (IBD) lab tests and diagnostic studies

A
    • p-ANCA** (anti- neutrophil cytoplasmic antibody)

- Biopsy – crypt abscesses, crypt branching, shortening and disarray, and crypt atrophy

57
Q

IBD treatment options

A
  • 5-ASAs – PO, enema or suppository (sulfasalazine, mesalamine, etc.)
  • PO antibiotics
  • PO corticosteroids to decrease flare, sxs
  • Immunomodulator drugs
  • Biologic Therapy
  • Surgery
58
Q

PO antibiotics used to treat IBD

A
  • Metronidazole & ciprofloxacin (if secondary infection is present)
59
Q

Immunomodulator drugs used to treat IBD

A
  • azathioprine (Imuran, Azasan)
  • 6-MP, Purinethol
  • cyclosporine A (Sandimmune, Neoral)
  • tacrolimus (Prograf)
  • Methotrexate
60
Q

Biologic therapy used to treat IBD

A
  • Infliximab (Remicade)
61
Q

Surgeries to treat IBD

A
  • UC - colectomy is curative

- Crohn’s disease – reserve ONLY for complications

62
Q

IBD extra-intestinal manifestations

A
  • Skin: erythema nodosum, pyoderma gangrenosum
  • Eye: uveitis, episcleritis
  • Joints: ankylosing spondylitis
63
Q

Colon cancer (IBD complication)

A
  • Management: Screening colonoscopy is recommended 8 yrs after Dx
  • Then, annual surveillance
64
Q

Toxic megacolon (IBD complication)

A
  • Emergency
65
Q

Primary sclerosing cholangitis (IBD complication)

A
  • Suspect in a patient who has unexplained elevated liver enzymes
  • Particularly an elevation in serum alkaline phosphatase
66
Q

Colon polyps pathology

A
  • Majority are adenomas
  • Benign adenomatous polyps can undergo dysplasia & neoplastic changes
  • Larger polyps & those with more villous characteristics are more likely to contain dysplasia (tubular, villous, tubulovillous)
67
Q

Colon polyps signs/symptoms

A
  • Are asx
68
Q

Colon polyps diagnosis

A
  • Found incidentally on colonoscopy or radiologic study
  • FHx (genetic mutation)
  • Sigmoidoscopy/ colonoscopy
  • Barium study/ CT scan
69
Q

Colon polyps Tx

A
  • Endoscopic resection

- F/U surveillance by colonoscopy every 2-5 yrs

70
Q

Colorectal cancer is nearly always

A
  • Adenocarcinoma
71
Q

Colorectal cancer risk factors

A
  • First degree relative with colon cancer or adenomatous polyps
  • Personal H/O breast, ovarian, or uterine cancer
  • Genetic predisposition
  • Ulcerative colitis > Crohn’s disease
72
Q

Genetic predisposition to colorectal cancer

A
  • Familial adenomatous polyposis (AKA: FAP, Gardner’s syndrome)
  • Peutz-Jeghers Syndrome
73
Q

Colorectal cancer signs/symptoms

A
  • Change in bowel habits
    • FOBT
  • Intermittent melena or stool streaked with blood
  • Recurrent hematochezia
74
Q

Colon cancer diagnosis

A
  • Colonoscopy with biopsy – test of choice

- Stool tests

75
Q

Stool tests to screen for colon cancer

A
  • Fecal immunochemical test (FIT)
  • Multitarget stool deoxyribonucleic acid (MT-sDNA)

+ results require a colonoscopy for definitive Dx

76
Q

Colon cancer Tx

A
  • Surgical excision for early stage cancers
  • Adjuvant chemotherapy and/or XRT
  • Prognosis depends upon stage at Dx
77
Q

Anal fissure pathology

A
  • Split or tear in anal mucosa
78
Q

Anal fissure signs/symptoms

A
  • Tearing, burning, throbbing pain with defecation

- Blood streaks on stool &/or toilet paper

79
Q

Anal fissure physical exam findings

A
  • Crack in the epithelium

- External anal skin tag

80
Q

Anal fissure Tx

A
  • Sitz baths
  • High fiber diet
  • Stool softeners
  • Hydrocortisone supp/ cream (Anusol HC, Proctofoam-HC)
81
Q

Anal fistulas pathology

A
  • Communication btwn an abscess with an opening within the anal canal
82
Q

Anal fistulas are associated with

A
  • Crohn’s disease
  • Lymphogranuloma venereum
  • Rectal cancer
83
Q

Anal fistula signs/symptoms

A
  • Drainage of blood, pus, mucous, stool

- Pruritus, tenderness, pain

84
Q

Anal fistula Tx

A
  • Surgery - I&D (under sedation or in office)
  • Fistulotomy
  • Broad spectrum Abx
  • Sitz baths
85
Q

Hemorrhoids

A
  • Varices of the hemorrhoidal plexus
86
Q

Hemorrhoids signs/symptoms

A
  • Pruritus & rectal bleeding.
  • BRBPR
  • Dull, burning pain (internal rhoids)
  • Rectal pain (if external and thrombosed)
87
Q

Hemorrhoids Tx

A
  • High fiber diet
  • Sitz baths
  • Local treatment (proctofoam, Tucks medicated pads, Preparation H)
  • Rubber band ligation
  • Sclerotherapy
  • Surgical repair if severe
88
Q

Hernias may present as

A
  • Incarcerated

- Strangulated

89
Q

Incarcerated hernia

A
  • Reducible - a hernia that is not able to be reduced on exam
  • The vascular supply of the bowel is NOT compromised
90
Q

Strangulated hernia

A
  • Irreducible
  • Blood supply to the entrapped bowel has been cut off
  • Results in small bowel obstruction and infarction
91
Q

Types of hernias

A
  • Direct
  • Indirect (most common)
  • Umbilical
  • Incisional
  • Ventral
  • Hiatal or diaphragmatic
  • Femoral
92
Q

Indirect hernia (most common)

A
  • Passes thru the internal inguinal ring down the inguinal canal
  • May pass into the scrotum
93
Q

Direct hernia

A
  • Passes through the external inguinal ring at Hesselbach’s triangle
  • Rarely enters the scrotum
94
Q

Umbilical hernia

A
  • Most often appear at birth
  • Most resolve without treatment
  • Surgery may be indicated
95
Q

Incisional hernia

A
  • Most often appear after vertical incisions
96
Q

Ventral hernia

A
  • Weakening in the anterior abdominal wall

- May be either incisional or umbilical

97
Q

Hiatal or diaphragmatic hernia

A
  • Herniation of the stomach through the esophageal hiatus
98
Q

Femoral hernia

A
  • Passes through the femoral ring
  • Least common
  • Occur almost exclusively in females

Internal Medicine (14 decks)

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