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GIT > 8 Feb 25 > Flashcards

8 Feb 25 Flashcards

1
Q

Sigmoid Volvulus RF

A

Sigmoid colon redundancy
(Dilation and elongation from chronic constipation)

 Inc length of sigmoid colon compared to its mesentery causes closed loop obstruction to form

Colonic dysmotility (underlying neurologic disorder)

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2
Q

Sigmoid Volvulus CF

A

🎱Slowly pregressive Abd discomfort/distension
🎱Obstructive SS
(Nausea, emesis , obstipation)

🎱Abd distention, tympanitic to percussion

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3
Q

Sigmoid volvulus imaging

A

Xray:

      Dilated ,inverted, U shaped colon 
      (Coffee bean sign)

CT scan:

      Dilated sigmoid colon , mesenteric twisting (whirl sign)
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4
Q

How to treat sigmoid volvulus

A

🌻Endoscopic detorsion (flexible sigmoidscopy)
🌻Elective sigmoid colectomy

🌻Emergency sigmoid colectomy if perforation/peritonitis present

Peristalsis inducing laxatives are contraindicated in closed loop obstructions bcz of risk of perforation.

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5
Q

Mechanism of sigmoid volvulus formation

A

🌵Sigmoid colon twists around its mesentery forming a closed loop obstruction.

🌵With continuous gas formation by intraluminal bacteria the lumen of obstructed bowel loop gradually expands.

🌵chronic constipation causes chronic fecal overloading leading to dilation and elongation of sigmoid colon

🌵Seen on Xray as inverted U shaped loop of colon (coffee bean)

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6
Q

Angiodysplasia and aortic stenosis mechanism of bleeding

A

AS triggers bleeding from angiodysplasia due to destruction of circulating vWF multimers when they pass through damaged valve.

(vWF binds platelets to site of endothelial injury, reduced levels cause bleeding)!

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7
Q

RF for bleeding from angiodysplasia

A

ESkidney dx
Aortic stenosis

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8
Q

Mechanism of angiodysplasia formation

A

Tortuous dilated thin walled vessels lined by a layer of endothelium with or without small amount of smooth muscle.

Symptomatic angiodyspalsia form in GIT in ppl >60

Form due to recurrent intermittent obstruction of distal venules in muscularis propria leading to proximal arterial damage.

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9
Q

Incisional hernia RF

A

Develop due to Fascial closure breakdown

🔪Obesity
🔪Prior vertical / midline incision

Tobacco smoking
Poor wound healing (immunosupp, malnutrition)
Surgical site infection

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10
Q

CF of incisional hernia

A

🛖Abd mass that enlarges with valsalva
🛖Palpable fascial edges in nonobese
🛖Possible delayed presentation (months through years)

Hernias with small size have more chances of incerceration
Large hernias have mass effect and give GI symptoms.

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11
Q

Dx of IH

A

Cinical

CT scan (to see unclear anatomy or if concern for incarceration)

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12
Q

Rectus abdominis diastasis

A

Bulge between rectus muscles and linea alba
No associatedfascial defect
Not palpable on supine

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13
Q

Mild CDI features and ttt

A

Classic symptoms:
Profuse watery diarrhea
Abd pain

Tttt: Oral fidaxomicin
Oral Vancomycin
Oral Metronidazole if above are not avl

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14
Q

Severe CDI and ttt

A

Classic Symptoms plus :

Leukocytosis > 15,000
Or
Serum Cr. >1.5

Ttt:

 Oral Fidaxomicin
 Oral Vancomycin
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15
Q

Fulminant CDI and ttt

A

Severe CDI plus either :
Hypotension or shock
Ileus or. Megacolon

Ttt: Oral vancomycin and
IV metronidazole
Vancomycin enemas if ileus

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16
Q

Refractory CDI ttt

A

Fecal microbiota transplant
Surgery

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17
Q

Why does colon CS metastasize to Liver

A

Venous system of colon drains directly into portal system causing intrahepatic spread

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18
Q

Pt with colon CA spread to liver (one hepatic nodule …

A

Resect primary tumor as well as liver metastatic lesion to inc >5yr survival rate
Esp if only confined to liver.

No chemo needed unless tumor is unresectable due to size and no of metastatic liver lesions

Primary tumor is resected irrespective of stage to prevent and relief obstructive signs.

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19
Q

Use of radiation in GIT cancers.

A

Used with chemo for non operatable rectal CA.

Radiation therapy is avoided in tumors proximal to rectum due to risk of radiation enteritis.

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20
Q

IBD associated Toxic megacolon ttt

A

First line : IV steroids for its anti inf effect.

IV fluids electrolytes
Bowel rest
NG Decompression
BS AB
Surgery if no improvement

21
Q

Why does Toxic megacolon Occure in UC

A

Develops in early in dx or within 3yrs of Dx

Mucosal inf > pathologic colon dilation due to NO production > extension of mucosal inf into smooth muscle layer > muscle paralysis and subsequent colon dilation.

22
Q

Toxic Megacolon Patho

A

🍁Colonic smooth muscle inf and paralysis

🍁Complication of IBD or infectious colitis

🍁Inc Risk with antimotility agents (loperamide) or opioids

23
Q

CF of TM

A

Systemic toxicity :

   Fever 
   Tachycardia 
   Hypotension

Abd pain and distension after diarrheal illness

24
Q

Dx of TM

A

Colon dialation >6cm on imaging

25
Complication of TM
Perforation (Avoid colonoscopy )
26
Abd distension after diarheal illness
C difficile toxic megacolon
27
CF if C difficile colitis
Watery diarrhea >3 in 24hrs Abd pain Low grade fever Nausea Rately Non obstructive colonic dilation (toxic megacolon)
28
C difficile TM CF
🍔Systemic toxicity Fever hypotension , tachycardia , lethargy 🍔Abd distension and pain (diarrhea ceased due to lack of colonic motility) 🍔Leukocytosis (>15,000) 🍔Large bowel dilation >6cm colon , > 9cm cecum) with loss of haustral folds
29
Hypokalemia and ileus
Mostly severe hypokalemia <2.5-3 Causes muscle weakness leading to ileus
30
Rectal prolapse RF
Women age >40 with HO vaginak deliveries/multiparity Prior pelvic surgery Chronic constipation , diarrhea , straining Stroke , dementia Pelvic floor dysfunction /anatomic defects
31
Clinical presentation of rectal prolapse
🧿Abd discomfort 🧿Straining or incomplete bowel evacuation 🧿Fecal incontinence 🧿Digital maneuvers req for defecation 🧿Erythematous mass extending thru anus with concentric rings (full thickness prolapse) or radial invaginations (non full thickness prolapse
32
Ttt of non full thickness prolapse
Medical management : Adequate fiber and fluid intake Pelvic floor muscle exercises Biofeedback therapy for fecal incontinence
33
Management of full thickness rectal prolapse
Surgery Rectopexy
34
Acute Aortic dissetion RF
Chronic HTN (strongest RF) Marfan dx Cocaine use
35
Heart dx of Turner syndrome
🥸Bicuspid Aortic Valve 🥸Aortic Coarctation 🥸12-fold inc Risk for Aortic Dissection
36
GIT Complications of Aortic Dissection
Extension of dissection into mesenteric branches of aorta 👾Intestinal ischemia 👾Dilated bowel loops 👾Mild abd tenderness out of prop to severe abd pain 👾Leukocytosis 👾Elevated amylase due to abd inflammation
37
DX of mesenteric extension of dissection
CT angio Chest and Abd
38
Acute mesenteric ischemia CF
🤖Rapid onset periumb pain (severe) 🤖Pain can wax and wane 🤖Pain out of prop to exam findings 🤖Mild diffuse abd distension and tenderness but severe pain 🤖Hematochezia (late) 🤖local ischemia can cause an urge to defecate DD AAA pain is constant radiates to flanks and back.
39
RF of acute mesenteric ischemia
😹Atherosclerosis (acute or chronic) 😹Embolic source (thrombus , cardiac vegetation) Afib patient not taking his anticoagulants 😹Hypercoagulable state ➡️mesentery is the second most common site of embolization in IE after brain vessels.
40
Lab findings of acute mesenteric ischemia
Leukocytosis Elevated Amylase and PO4 Metabolic acidosis (inc lactate)
41
Dx of acute mesenteric ischemia
CT (prefer) or MRA Mesenteric Angiography (if unclear)
42
Ttt of AMI
NG decompression IV fluids Anticoagulation BS AB Surgery (in some cases) AMI can quickly devolve into sepsis perforation and death.
43
SIBO Risk Factors
👙 anatomic abnormalities Strictures Surgery Small bowel diverticulosis 👙motility dx (DM , Scleroderma , opioids) 👙immunidef (IgA def ) 👙Chronic pancreatitis 👙Gastric hypochlorhydria , PPI use.
44
CF of SIBO
Bloating flatulence Chronic watery diarrhea Possible malabsorption Dec Vitamin B12 (bact consumption) Inc folate (bact synthesis)
45
DX of SIBO
Carbohydrate breath testing (lactulose or glucose) Endoscopy with jejunal aspirate / culture (Gold standard but invasive. Hence we do non invasive breath test to confirm dx)
46
Ttt of SIBO
Oral AB Rifaximin, Ciprofloxacin, doxycycline
47
SIBO pathophys
Normally bacterial growth in small intestine is inhibited by Gastric acid Intestinal paristalsis Immunoglobulins Ileocecal valve ( prevents colonic bacteria from entering small intestine) Hence SIBO develops in motility disorders or after ileocecal resection
48
What is carbohydrate breath test
Fermentable carbohydrate (lactulose or glucose is given. Breath samples for hydrogen and methane (produced by gut bacteria) taken at regular intervals. Normally colon bacteria ferment non absorbable substrate after 2-3hrs. In SIBO there is early rise in hydrogen breath (<1.5h) suggesting fermentation in small bowel.

GIT (20 decks)

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