5. Gastrointestinal Flashcards
Patients with IBD are at higher risk of developing what complication?
Toxic megacolon (total or segmental nonobstructive colonic dilation, severe bloody diarrhea, fever, tachy)
Other causes of toxic megacolon: ischemic colitis, volvulus, diverticulitis, infx (C diff)
Tx- IVF, broad-spectrum abx, bowel rest, IV corticosteroids
Middle-aged woman with fatigue, pruritus, hepatomegaly, and elevated alkaline phosphatase. Diagnosis? How can you confirm it?
Primary biliary cholangitis - intrahepatic cholestasis d/t autoimmune destruction of small bile ducts
Dx w/ serum anti-mito ab titers
Note: anti-smooth mm abs and ANA is assoc with autoimmune hepatitis.
What commonly contributes to prolonged post-op ileus (nausea, abd distension, obstipation, hypoactive bowel sounds)?
Opiates - dec GI motility
Hepatomegaly with mild elevations in liver tests in the absence of causes of secondary hepatic fat accumulation.
Nonalcoholic fatty liver disease
In what situation would a patient with celiac disease have absent IgA anti-endomysial and anti-tissue transglutaminase abs?
If there is concurrent selective IgA deficiency
Otherwise, IgA anti-endomysial and anti-tissue transglutaminase abs are highly predictive of celiac disease
What is required to make a diagnosis of acute liver failure?
Severe acute liver injury (ALT & AST >1000) Hepatic encephalopathy (confusion, asterixis) Synthetic liver dysfunction (INR >=1.5)
What is a common complication of vascular surgery, esp in older patients with extensive underlying atherosclerosis? Note: CT shows thickening of bowel wall and colonoscopy shows cyanotic mucosa and hemorrhagic ulcerations
Ischemic colitis.
Repair of a AAA is a common precipitating event as well. Prolonged aortic clamping and impaired blood flow through the IMA.
What presents with constant and gnawing epigastric pain that’s worse at night?
Pancreatic cancer - also presents with anorexia/wt loss, and jaundice d/t extraheaptic biliary obstruction
Note: peptic duodenal ulcer has periodic epigastric pain relieved by meals
What can cause hypogonadism (testicular atrophy, ED), and decreased thyroid hormones?
Cirrhosis causes hypogonadism by primary gonadal injury or hypothalamic-pituitary dysfunction. Elevated estradiol also seen –> telangiectasias, palmar erythema, testicular atrophy, gynecomastia
Dec synth of serum binding proteins –> dec synthesis of total T3 and T4
Severe retrosternal pain, dyspnea, subcutaneous emphysema (suprasternal crepitus), odynophagia, and signs of sepsis in patient with history of alcoholism and prolonged vomiting?
Spontaneous perforation of the esophagus - assoc w/Boerhaave synd
Will see pneumomediastinum
When should you screen for colon cancer (ie perform colonoscopy) in the following:
- Fhx of FAP or colorectal cancer
- IBD (UC, Crohns)
- FAP
- HNPCC (lynch)
- 40yo or 10y bf age of dx in relative. Repeat every 3-5y
- Begin 8 y post dx (12-15y if only in L colon). Colonoscopy w/bx every 1-2 y
- Begin at age 10-12. Colonoscopy every year
- Begin at age 20-25. Colonoscopy every 1-2y.
Differentiate biliary colic due to gallstones from acute cholecystitis and acute pancreatitis
Biliary colic - exacerbated by fatty meals, lasts <6h, resolves completely bw episodes. No fever, abd tenderness on palp or leukocytosis
Acute cholecystitis - similar to biliary colic but lasts >5h, have fever, leukocytosis and tenderness to palp (pos murphy’s sign)
Acute pancreatitis - constant epigastric pain radiating to back. Doesnt resolve spont
How do you definitively diagnose esophageal sx in young patient vs patient >55?
Young - barium esophagram
>55 - endoscopy with biopsy (suspect esophageal cancer).
Esophageal rupture can be due to endoscopy, severe retching, or penetrating trauma. Sx = acute chest pain, subcutaneous emphysema, L pleural effusion. How can you confirm the dx?
Contrast esophagram - water-soluble contrast is preferred bc less inflam to tissues.
Gastric outlet obstruction can be caused by many disease processes and is characterized by early satiety, nausea, nonbilious vomiting, and weight loss. In a patient with history of acid ingestion, what is the most likely cause?
Pyloric stricture.
Abdominal succussion splash may be heard - stethoscope over upper abdomen and rocking patient back and forth at hips –> splash sound = hollow viscus filled with fluid and gas
What GI abnormality is assoc with Down syndrome?
Duodenal atresia/stenosis. Presents with bilious vomiting in first 2 days of life. Abd NOT distended bc gas cant pass the duodenum. Trapped air in stomach and first part of duodenum (double bubble sign).
Note: VSD and ASD are common cardiac findings with Down synd
Presence of a triple bubble sign and gasless colon in an infant with bilious vomiting and adominal distension indicates what?
Jejunal atresia - thought to be due to a vascular accident in utero –> necrosis and reaborption of fetal intestine
RF: prenatal cocaine exposure, vasoconstrictive drugs
How can you differentiate the etiology of conjugated hyperbilirubinemia via liver enzymes?
Inherited: normal transaminases and alk phos
Intrinsic liver disease (viral hep): predominately elevated transaminases and normal alk phos
intrahepatic cholestasis or biliary obstruction: elevated alk phos out of proportion to transaminases
