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Residency > ABD > Flashcards

ABD Flashcards

1
Q

causes of ascites

A

malignancy
portal HTN
hypoalbunemia
ESRD

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2
Q

complications of ascites

A

resp compromise due to pushing on diaphragm

SBP - nml gut flora translocates into periotneum

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3
Q

dx of SBP

A

WBC >1000
neut >250
low glucose
high protein

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4
Q

tx of SBP

A

cefotaxime 1st line

admit

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5
Q

ogilvie syndrome

A

large bowel obstruction with no distal colonic obstruction

recent sx, neuor disorder, chronic illness,

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6
Q

tx of cdiff

A

oral vanc
oral fidaxomicin
oral metro

fulminant is oral vanc and parenteral metro

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7
Q

scrombroid toxin

A 
tuna/mackeral fish 
histamine like toxin 
peppery fish 
metallic taste
facial flushing HA cramps

tx antihistamines

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8
Q

ciguatera toxin

A 
grouper/snapper/barrucuda
muscle weakness 
reversed temp sensation 
neuro symptoms - parasthesisas
v/d

tx supportive

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9
Q

dieulafoy lesions

A

abberant artery of GI tract that protrudes through the submucosa

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10
Q

spigelian hernia

A

between rectus abdominus and semilunate line

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11
Q

direct hernia

A

medial to inf epigastric vessels

bulge through
weakened fascia

behind superficial inguinal ring

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12
Q

indirect hernia

A

mc
lateral to inf epigastric vessels
enter inguinal canal at deep inguinal ring
can go into scrotum or labia majora

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13
Q

management of incarcerates or strangulated hernias or bowel obstructed hernias

A

consult sx

do not try to reduce due to risk of reducing necrotic bowel back into abdomen

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14
Q

types of hiatal hernia

A

sliding - displacement of GE junction above diaphragm

paraesophageal - displacement of gastric fundus above diaphgraphm (GERD pts)

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15
Q

gold standard for dx of infectious esophagitis

A

upper endoscopy visualization

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16
Q

eosinophilic esophagitis

A

most common
men 20-30s GERD
strictures, associated with asthma and eczema

dysphagia (MC), food impaction

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17
Q

tx of eosinophilic esophagitis

A

antacids

ppi trial

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18
Q

concerning signs in GERD

A

dysphagia
bleeding
weight loss

gold standard is pH monitoring

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19
Q

risk of PPIs

A

increased risk of osteoporosis
PNA
C diff

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20
Q

caustic agents

A

acids - superficial, strictures due to coagulation necrosis

alkali - severe injury, liquefactive necrosis, perf, mediastinitis, peritonitis, death (bleach)

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21
Q

achalasia

A

loss of esophageal peristalsis with failure of LES to relax

progressive dysphagia

dilated esophagus with beak like narrowing

barium

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22
Q

mcc of boerhaaves syndromes

A

iatrogenic post endocospy

late symptoms- fever sepsis, shock due to mediastinitis

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23
Q

management of boerhaaves

A

dx early due to mortality

broad spec abx: vanc, pip/tazo and metro
thoracic sx consult

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24
Q

management of adult food FBs

A

Glucagon (1st line)
carbonated bevs
nitro
nifedipine

endoscopy definitive

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25
Q

radiographs for peds trach vs esophagus

A

Esophagus

  • AP - circle
  • lateral - sliver

Trachea

  • AP - sliver
  • Lateral - circle
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26
Q

management of Peds FB

A

<5cm x 2cm likely to pass

require immediate endoscope if:
- in esophagus, sharp, too long, caustic, magnetic

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27
Q

button battery management

A

<1hr witness + asymptomatic –> 10ml honey or sucalfate water to get into stomach

if in esophagus = emergent endoscope for removal

symptomatic - pip/tazo or amp/sulf

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28
Q

dx of SBP

A

wbcs >1000
neut >250
low glucose
high protein

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29
Q

management of SBP

A

early paracentesis (delays increase mortality)

abx (cefotaime or ceftriaxone 2gIV)

admit

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30
Q

management of hepatic encephalopathy

A

lactulose - titrated to 2-3 loose stools/day

rifaximin or neomycin to decrease bacterial production of ammonia and other toxins

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31
Q

risk factors for liver abscess

A

mcc peritonitis
diabetes
liver transplant
ppi use

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32
Q

conjugated bilirubin is associated with

A

liver and biliary pathology

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33
Q

unconjugated bilirubin is associated with

A

extrahepatic pathology

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34
Q

when should N-acetylcystein be given

A

within 8 hrs of ingestion if acetaminophen level above Rumack matthew nomogram

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35
Q

risk factors for acalculous cholecystitis

A

immunosuppresion
diabetes
renal failure

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36
Q

cholangitis

A 
fever 
abd pain 
jaundice 
confusion 
hypotension
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37
Q

tx of cholangitis

A

pip/tazo
or
fluroquinolone and metro

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38
Q

drugs that cause pancreatitis

A

tetracycline
valproic acid
metro

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39
Q

markers for severe pancreatitis

A

age
symptoms of ARDS
elevated WBC, LDK, AST
elevated glucose

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40
Q

imaging for pancreatitis

A

CT not for stable pts
CT mod -sev
US abdomen r/o gallstones

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41
Q

pancreatitis mortality score

A 
BISAP 
B- BUN >25
I - impaired mental 
S- SIRS crit >1
A-age >60 
P-pleaural effusion
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42
Q

complications of pancreatitis

A 
pancreatic necrosis 
pseudocyst 
hyperglycemia 
ARDS
Renal Failure 
Death
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43
Q

causes of abd compartment syndrome

A 
trauma 
burns w/ aggressive fluid resuscitation
liver transplant 
acute pancreatitis 
ruptured AAA
sepsis
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44
Q

dx and tx of abd compartment syndrome

A

dx - measure abd pressure via bladder pressure

tx support, bladder decompression, ascites removal

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45
Q

tx of gastritits

A 
r/o dangerous things
topical antacids 
histamine 2 blockers (famotadine) 
or 
PPI
46
Q

tx of Peptic ulcer dz (PUD)

A

uncomplicated PUD

  • sucralfate
  • topical antacids
  • H2 blockers or PPI

perf
ceft, metro
emerg sx consult

47
Q

pyloric stenosis presentation

A

nonbilious forceful projectile vomit in baby 2-10wks

dehydration, lethargy, poor perfusions, sunken fontanelle, olive like mass in epigastric

48
Q

dx and tx of pyloric stenosis

A

dx hypokalemic hypochloremic met alkalosis (late) + US preferred study

tx IVF, sx consult

49
Q

gastroparesis

A

delayed gastric emptying, diabetes complication (some norwalk virus)

50
Q

medication induced gastroparesis

A

CCBs
clonidine
TCAs

post sx

51
Q

tx of gastroparesis

A

IVF
metoclopramide and erythromycin (prokinetics)

optimize glucose control
haloperidol for severe

52
Q

mcc of Upper GI bleed

A

peptic ulcers

53
Q

lab signs of upper GI bleed

A

elevated BUN due to digestion of blood

54
Q

management of upper GI bleed

A

transfusion (prn)
PPI IV
(if variceal = octreotide and if refractory vasopressin)

ceftriaxone (if pt cirrhotic to prevent sbp)
sengstaken-blakemore

55
Q

tx of etec

A

cipro
bactrim
if preg azithromycin

56
Q

tx of campylobacter diarrhea

A

azithro
or
cipro

57
Q

tx of cryptosporidium

A

azithromycin or parmomycin

hiv/immunocompromised individual

58
Q

causes of SBO

A 
post op adhesions 
hernias
malignancy 
crohns disease 
volvulus 
bezoar 
gallstones
59
Q

dx of SBO

A

metabolic acidosis
abd tympany
tachycardia
dehydration

US - >2.5cm diamter of loops of bowel over collapsed bowel with absent peristalsis activity

60
Q

aortoenteric fistula

types and RFs

A 
native aorta (1) 
secondary (prior sx or intervention on aorta)

RF: stent migration, post op complications, bowel injury

61
Q

presentation of aortenteric fistula

A

GI bleeding occasionally a herald bleed precedes massive GI bleed
abd pain
weakness
LE ischemia

62
Q

management of aortenteric fistula

A

ceftriaxone and metro

emergent stabilization

63
Q

malrotation

A 
1st year
BILIOUS vomiting
hematochezia (painless) 
peritonitis 
hemodynamic instability
64
Q

dx of malrotation

A

gold standard is upper GI series - corkscrew or duodenal beak appearance due to obstruction

65
Q

meckels presentations

A

rule of 2’s
mcc of Lower GI bleed
stools can bright red or tarry
intussusception and obstruction

66
Q

meckels workup and tx

A

cbc for anemia
normal radiograph

meckels scan (gold)

tx IVF, r/o volvulus, enteritis, intuss

67
Q

dx of fulminant c diff colitis

A

elevated WBCs
lactic acidosis
elevated Cr
hyponatremia

large bowel dilation >7cm or >12cm in cecum

68
Q

complication of c diff

A

toxic megacolon can lead to bowel perf

69
Q

obturator sign

A

pain on flexion and internal rotation of right hip

70
Q

iliopsoas sign

A

pain on extension of right hip

71
Q

management of appendicitis non ruptured

A

abx (cefoxitin or ceftriaxone) + metro
sx (lap)

abx only in some stable pts w/out evidence of perf (30% require future appy)

72
Q

management of ruptured appendicits

A

broad spec abx (pip/tazo and metro)

septic or unstable = emergent lap

stable = IR drainage of abscess with delayed appy

73
Q

complications of crohns

A

fistula
perf
abscess
sepsis

multiple sx –> short gut syndrome

74
Q

hirschsprungs dz

A

aganglionic colon
failure to pass meconium

abd distension
BILIOUS emesis

75
Q

dx of hirschsprungs dz

A

barium contrast enema in ED

rectal bx is gold standard

76
Q

NEC presentation

A

preterm/low birth weight

sudden changes: decreased feeding, abd distensions, BILIOUS vomiting, diarrhea, hematochezia

sepsis, lethargy, apnea, hypotension

77
Q

dx of NEC

A

abd x-ray pneumatosis intestinalis

US abd fluid and changes in bowel motility

78
Q

management of NECt

A

supportive
bowel rest
gastric decompression

broad spec abx (vanc, gentamicin + metro)
emerg sx consult

79
Q

radiation colitis pathophys

A

radiation can injure vessel –> ischemia, ulceration, stricture, fibrosis

80
Q

radiation colitis presentation and dx

A

n/v/abd pain
post 3 months

dx: exam, CT segmental inflam bowel thickening, mesenteric stranding

81
Q

management of radiation colitis

A

symptomatic

antidiarrheal agents and abx if bacterial overgrowth present

82
Q

diverticulosis vs diverticulitis

A

diverticulosis - painless hematochezia

diverticulitis - F, LLQ pain, ttp on exam

83
Q

management of diverticulosis and diverticulitis

A

supportive
transfuse
abx for diverticulitis - augmentin or cipro + metro

84
Q

volvulus

A

sigmoid: older pts, bedbound, constipation
cecal: congenital deefect, mcc of bowel obstruction in preg pts

85
Q

presentation of volvulus

A

abd pain
distension
progressive obstipation (aka severe constipation)

poss pain due to ischemia

86
Q

dx of volvulus

A

x-ray (first line)
sigmoid = coffee bean appearance

cecal = birds beak deformity

87
Q

management of sigmoid and cecal volvulus

A

cecal = sx consult

sigmoid = sigmoidoscopy with decompression

88
Q

complication of HSP

A

intussusception

89
Q

presentation of intussusception

A

colicky abd pain
vomiting
currant jelly stools (late sign)

crying, pulling legs up

sausage like mass

90
Q

dx of intussusception

A

barium enema (gold standard for dx and therapy

US donut sign or target sign

91
Q

tx of intussusception

A

IVF
r/o meckels inguinal hernia and malrotation

air contrast or barium enema

92
Q

GI bleed with elevated BUN suggests

A

upper GI bleed since blood is being digested

93
Q

causes of anorectal abscesses

A

obstruction of anal crypt glands

IBD
TB
Lymphogranuloma venereum
trauma

94
Q

perianal abscess

A

involves superficial tissues of the anus

95
Q

perirectal abscess

A

involves deep tissue space of the pelvis

96
Q

when to drain an anorectal abscess

A

stable well localized perianal abscess that does NOT extend into perirectal space

tx = I and D

97
Q

management of a pilonidal cyst

A

I and D

abx for skin flora and MRSA coverage –> doxy OR cephalexin + TMP-SMX(bactrim)

98
Q

management of anal fissures

A 
fiber (psyllium) 
colace 
promotility agents (senna) 
sitz bath 
topical nifedipine and nitro
99
Q

when to excise a hemorrhoid

A

thrombosed hemorrhoids <48hrs (hard to palpation)

make elliptical incision

100
Q

management of rectal prolapse

A

apply sugar to reduce edema

manual reduction
post reduction: fiver (psyllium) colace and senna

101
Q

rectal FB removal

A

if palpable on DRE attempt removal in D with analgesia

(NO procedural sed it inhibits pt ability to valsalva)

foley placement beyond object then inflate balloon to help relived vacuum effect

102
Q

tx of HPV genital warts

A

podophyllotoxin
imiquimod
trichloracetic acid
(usually not prescribed from ed)

103
Q

etiologies of splenomegaly

A

hemolytic anemia (hereditary spherocytosi)
portal HTN
infection (EBV, lupus, malaria, endocarditis)
splenic sequestration due to sickle cell

104
Q

causes of pancreatitis in children

A

CF

HUS

105
Q

diameter of a nml gallbladder wall

A

<3mm

106
Q

false elevations in amylase

A

preg

renal failure

107
Q

transfusing in Upper GI bled

A

stable transfuse if Hgb <7

commorbidities Hgb <9

108
Q

SBO bowel sounds

A

high pitched
hypoactive bowel sounds

distended loops of bowel

109
Q

typhilitis

A

neutropenic pts
ileocecal region
HIV/Heme cancers

fever abd pain distension paralytic ileus
ANC<500

110
Q

typhilitis dx and tx

A

dx CT abd pelvis with IV and oral contrast (avoid rectum)

tx- bowel rest, ng suction, pip/tazo or cefepime + metro

Residency (19 decks)

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