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Emed > #5: GI > Flashcards

#5: GI Flashcards

1
Q

pt presents w/ neck tenderness, fullness, abrupt onset of dysphagia w/inability to swallow saliva after eating heavy meal containing meat. Pt tried to vomit to relieve Sxs but didn’t work. Pt has h/o achalasia.

Dx?

A

Dx = esophageal FB

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2
Q

Dx of Esophageal FB

  1. need XRs of (3 things)
  2. what is seen w/ perforation
  3. why is food often not seen on XR
A

Dx of Esophageal FB

  1. need XRs of neck, chest, abd
  2. perforation –> see air
  3. food often not seen on XR b/c many not radiopaque
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3
Q

Tx of Esophageal FB

  1. what med used to relax esophagus + facilitate passage
  2. what tool used to push FB into stomach
  3. what type of FB must be removed ASAP
  4. what size FB needs endoscope or surgery to remove it
A

Tx of Esophageal FB

  1. med used to relax esophagus + facilitate passage = IV glucagon
  2. tool used to push FB into stomach = endoscope
  3. FB must be removed ASAP = button battery
  4. > 5 cm FB needs endoscope or surgery to remove it
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4
Q

What substance ingested causes 2nd MC reason for liver transplants

A

2nd MC reason for liver transplants = ingestion of acetaminophen

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5
Q

Phases of Acetaminophen Ingestion (1-4)

  1. which a/w RUQ pain, N/V and decr UO
  2. which a/w liver regeneration
  3. which a/w tender liver margin, jaundice, coagulopathy
  4. which a/w no Sxs
A

Phases of Acetaminophen Ingestion (1-4)

  1. Phase 2 a/w RUQ pain, N/V and decr UO
  2. Phase 4 a/w liver regeneration
  3. Phase 3 a/w tender liver margin, jaundice, coagulopathy
  4. Phase 1 a/w no Sxs
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6
Q

Dx/Tx of Acetaminophen Ingestion

  1. what is used to determine Tx
  2. main med given for ingestion (form given)
A

Dx/Tx of Acetaminophen Ingestion

  1. rumak-matthew norogram used to determine Tx
  2. main tx = N-acetylcysteine IV
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7
Q

Tx for Ingestion of substances

  1. Opiates –>
  2. BZs –>
  3. Tricyclics –>
  4. CCBs –>
  5. B-blocker–>
  6. Methanol –>
  7. Digoxin –>
  8. Iron –>

Other activated charcoal
- given by drinking or NG tube

A

Tx for Ingestion of substances

  1. Opiates –> Narcan
  2. BZs –> Flumazenil
  3. Tricyclics –> Bicarb
  4. CCBs –> Calcium
  5. B-blocker–> Glucagon
  6. Methanol –> ethanol
  7. Digoxin –> Digibind
  8. Iron –> Deferoxamine
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8
Q

Gastroenteritis (viral vs Bacterial): Hx

  1. 2 common viral viruses
  2. 2 common bacterial causes
  3. which type a/w undercooked food, international travel
  4. which type a/w seasons and sick contacts
A

Gastroenteritis: Hx

  1. 2 common viral viruses = norovirus (adults), rotavirus (kids)
  2. 2 common bacterial causes = salmonella, shigella
  3. bacterial = a/w undercooked food, international travel
  4. viral = a/w seasons and sick contacts
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9
Q

Gastroenteritis (viral vs Bacterial): Presentation

  1. 2 common Sxs and their order in both types
  2. which type a/w TTP in epigastrium, low grade fever
  3. which type a/w crampy, lower abd pain, borborygmi
A

Gastroenteritis (viral vs Bacterial): Presentation

  1. 2 common Sxs = vomiting—> diarrhea
  2. viral = TTP in epigastrium, low grade fever
  3. bacterial = crampy, lower abd pain, borborygmi
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10
Q

Gastroenteritis: Dx for Bacterial

  1. what 2 labs to get
  2. what type of cultures to get
  3. what type of leukocytes to get

viral: no labs

A

Gastroenteritis: Dx for Bacterial

  1. what 2 labs to get = CBC, CMP
  2. stool cultures
  3. fecal leukocytes

viral: no labs

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11
Q

Gastroenteritis (viral vs Bacterial): Tx

  1. mainstay for both
  2. which is ABX, diaper cream
  3. which is anti-emetics, avoid fatty/fried/dairy foods
A

Gastroenteritis (viral vs Bacterial): Tx

  1. mainstay for both = rehydration
  2. bacterial tx = ABX, diaper cream
  3. viral tx = anti-emetics, avoid fatty/fried/dairy foods

Both: probiotics, BRAT

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12
Q

Pancreatitis

  1. MC cause
  2. 2nd MC cause
A

Pancreatitis

  1. MC cause= biliary tract dz
  2. 2nd MC cause = EtOH use/abuse
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13
Q

Pt presents w/ acute onset of epigastric pain that is boring and radiates to back. Pain was intermittent and is now severe and constant but is improved w/ lying down. Pt is an alcoholic. Vitals: T 101, HR 110, BP 90/58. On exam he has epigastric guarding and looks toxic.

Dx?

A

Dx = Pancreatitis

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14
Q

Dx of Pancreatitis

  1. what levels elevated (2)
  2. very ill what 2 labs should you get
  3. suspect biliary cause what test used to dx
  4. other dx test for mod-severe
A

Dx of Pancreatitis

  1. what levels elevated = lipase, amylase
  2. very ill –> ABG, LDH
  3. suspect biliary –> US
  4. other dx test for mod-severe = CT
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15
Q

Pain control, NPO, aggressive IVF, dont give ABXs even if febrile (usu) = Tx for

A

Pain control, NPO, aggressive IVF, dont give ABXs even if febrile (usu) = Tx for pancreatitis

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16
Q

3 Tools for Prognosis of Pancreatitis

A

Tools for Prognosis of Pancreatitis

  1. Ranson Criteria
  2. Glasgow
  3. APACHE II
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17
Q

Gallbladder Dz (Acute Cholecystitis)

RFs (5 F’s)

Others:

  • rapid wt loss
  • DM T2
  • Mexican or Native Am
  • CF
  • pancreatitis
  • TPN feeding
A

Gallbladder Dz (Acute Cholecystitis)

RFs (5 F’s)

  1. Female
  2. Fat
  3. Fair
  4. Fertile
  5. Forty
18
Q

Pt presents w/ constant severe RUQ pain that radiates to R shoulder. Pain is worse after eating fatty meal. Vitals: T 101, HR 110. On exam pt has guarding in RUQ and + Murphy’s sign

Dx?
Imaging used to Dx?

A

Dx = Gallbladder Dz (Acute Cholecystitis)

- w/ US

19
Q

Dx of Gallbladder Dz (Acute Cholecystitis)

  1. what 2 things seen on US
  2. if US not definitive what test is done next
A

Dx of Gallbladder Dz (Acute Cholecystitis)

  1. 2 things seen on US
    - thickened gallbaldder wall
    - sonographic murphy’s sign
  2. US not definitive –> HIDA scan
20
Q

Tx for Dx of Gallbladder Dz (Acute Cholecystitis)

  1. GI rest… what to do
  2. other 2 things done
  3. fever, leukocytosis, or s/s of ascending infxn –>
A

Tx for Dx of Gallbladder Dz (Acute Cholecystitis)

  1. GI rest –> NPO
  2. IV pain meds, hydration
  3. fever, leukocytosis, or s/s of ascending infxn –> ABXs
21
Q

_____ causes introduction of bacteria into peritoneal space and leads to sepsis if untreated

A

Perforated viscus causes introduction of bacteria into peritoneal space and leads to sepsis if untreated

22
Q

Perforated viscus

  1. indicates perforation happened (2 things a/w pain)
  2. what is a sign of peritonitis
  3. main way to dx (gen)
  4. what is elevated on labs
  5. only way to tx
A

Perforated viscus

  1. indicates perforation happened (2 things a/w pain)
    - abrupt onset of pain
    - abrupt relief of pain
  2. rigid abd = sign of peritonitis
  3. main way to dx (gen) = XR
  4. labs –> leukocytosis
  5. tx = surg
23
Q

Pt presents w/ low grade fever, anorexia, N/VD and abd pain that was initially diffuse but has now localized to the RLQ. On exam there is + Mcburney’s point tenderness, Rovsing, Psoas, and Obturator signs

Dx?
best test for Dx?

A

Dx = Appendicitis

- CT scan w/contrast

24
Q

Tx of Appendicitis

  1. main tx
  2. reason to use IV ABXs
  3. Tx for ruptured appendix (2 things)
A

Tx of Appendicitis

  1. main tx = appendectomy
  2. reason to use IV ABXs = cant do surg or its delayed
  3. Tx for ruptured appendix = IV ABX + appendectomy
25
Q

MC cause of Mesenteric Ischemia

A

MC cause of Mesenteric Ischemia = arterial emboli

26
Q

Pt presents w/ severe, poorly localized abd pain that seems out of proportion to exam findings. Labs show incr lactate and heme + stool. CT used for imaging.

Dx?

A

Dx = mesenteric Ischemia

27
Q

Dx/Tx of Mesenteric Ischemia

  1. gold std for Dx
  2. what must be done immed as Tx (2 things)
  3. if pt has known thrombus –>
A

Dx/Tx of Mesenteric Ischemia

  1. gold std for Dx = angiography
  2. immed Tx –> IVF fluids, surg consult
  3. if pt has known thrombus –> heparin
28
Q

Pt presents w/ diffuse, crampy abd pain, abd distension, vomiting, and complains they havent been able to have BM for the past 4 days. On exam you hear high pitched bowel sounds and abd feels rigid. You order upright and supine XRs that are pending.

Dx?

A

Dx= SBO

29
Q

SBO

  1. Major RF
  2. sign on XR
  3. sign on XR indicating perforation
A

SBO

  1. Major RF = adhesions from prior surgery
  2. sign on XR = air fluid levels
  3. sign on XR indicating perforation = air under diaphragm
30
Q

Tx of SBO

  1. what gets inserted and pt becomes _____
  2. when is surg needed
A

Tx of SBO

  1. NG tube inserted and pt becomes NPO
  2. dont always need surg - only if no improvement in 12-24 hrs

IVF also given

31
Q

GI bleeds

  1. location of UGI vs LGI
  2. which has incr incid in elderly d/t anticoag and antiplt meds
A

GI bleeds

  1. location of UGI vs LGI
    - UGI = PROXIMAL to ligament of trietz
    - LGI = DISTAL to ligament of trietz
  2. UGI = incr incid in elderly
32
Q

Etiology of UGI vs LGIs - which a/w

  1. PUD
  2. alcoholism
  3. Gastric CA
  4. mallory-Weiss tear
  5. post op bleed
  6. smoking exacerbates
A

Etiology of UGI bleeds

  1. PUD
  2. alcoholism
  3. Gastric CA
  4. mallory-Weiss tear
  5. post op bleed
  6. smoking exacerbates
33
Q

Etiology of UGI vs LGIs - which a/w

  1. bleed diverticulae
  2. angiodysplasia
  3. hemorrhoids
  4. IBD
  5. colon CA
A

Etiology of LGIs

  1. bleed diverticulae
  2. angiodysplasia
  3. hemorrhoids
  4. IBD
  5. colon CA
34
Q

Pt presents w/ bright red blood w/ vomiting and vomit looks coffee grounds. Performed rectal exam and found heme + stool

dx?

A

Dx = UGI bleed

35
Q

Pt presents w/ bright red blood in stools. Performed rectal exam and found heme + stool

A

Dx = LGI bleed

36
Q

Dx of UGI

  1. what test can be done w/ NG or OG tube
  2. what is for Dx AND Tx
A

Dx of UGI

  1. Gastric lavage done w/ NG or OG tube
  2. endoscopy = for Dx AND Tx
37
Q

Dx of LGI

  1. what test can be used to determine etiology
  2. what procedure will eventually be needed
A

Dx of LGI

  1. test used to determine etiology = CT
  2. procedure eventually needed = endoscopy
38
Q
  1. CBC w/serial HCT, Hgb
  2. INR/PT/PTT
  3. Type and screen/cross
  4. Hemooccult/gastrooccult test
  5. CMP

workup for _______

A

workup for GI bleeds

  1. CBC w/serial HCT, Hgb
  2. INR/PT/PTT
  3. Type and screen/cross
  4. Hemooccult/gastrooccult test
  5. CMP
39
Q
  1. 2 large bore IVs
  2. immed/aggressive IVF
  3. O2 w/ nasal cannula
  4. consider early transfusion (FFP if coagulopathy)
  5. consult w/ ICU and GI

Tx for ________

A

Tx for GI bleeds

  1. 2 large bore IVs
  2. immed/aggressive IVF
  3. O2 w/ nasal cannula
  4. consider early transfusion (FFP if coagulopathy)
  5. consult w/ ICU and GI
40
Q

Tx for UGI

  1. what gets inserted
  2. what med is given (IV)
  3. med given for pts w/liver dz
  4. bleeding from varices –> insert what?
A

Tx for UGI

  1. NG tube inserted
  2. IV PPI
  3. w/liver dz –> otreotide
  4. bleeding from varices –> insert Blakemore tube

Emed (10 decks)

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