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GIGU Exam 1 > DSA GI Correlations - Dr. Arnce > Flashcards

DSA GI Correlations - Dr. Arnce Flashcards

1
Q

Acholic

A

White clay colored from absence of bile secreted into the GI

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2
Q

Acute Abdomen

A

Serious and acute intraabdominal condition with pain tenderness and muscular rigidity - emergency surgery

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3
Q

Cachexia

A

Profound and marked constitutional disorder, general ill health and nutrition
Cancer, chronic COPD

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4
Q

Coffee-ground emisis

A

Blood congealed and separates into coffee ground in the acidic environment in the GI

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5
Q

Colic

A

Refers to GI

Acute paroxysmal ABD pain

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6
Q

Dyspepsia

A

Indigestion
Burning, UQ pain right after eating
Postprandial epigastric discomfort

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7
Q

Dysphagia

A

Hard time swallowing

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8
Q

Esophagitis

A

Inflamed esophagus

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9
Q

ERCP

A

Endoscopic Retrograde Cholangiopancreatography

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10
Q

Gastritis

A

Inflamed stomach

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11
Q

Guarding

A

Protective response in muscles in GI form pain or fear of movement (voluntary and involuntary)

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12
Q

Hematemesis

A

Vomiting blood

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13
Q

Hematochezia

A

Bright red blood or maroon stools

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14
Q

Icterus (jaundice)

A

Yellow skin, sclera, and deeper tissues, secreted bile in plasma

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15
Q

melena

A

Dark tarry stool due to broken down hemosiderin (hemoglobin) in the bowel

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16
Q

Pneumobilia

A

Abnormal gas in the biliary system and bile ducts

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17
Q

Pneumomediastinum

A

Abnormal gas in the mediastinum
Can interfere with respiration and circulation
Spontaneous or due to trauma or pathology
Can cause pneumothorax or pneumopericardium

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18
Q

Pneumoperitonium

A

Abnormal gas or air on the peritoneal cavity

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19
Q

Ulcer

A

Local defect or excavation of surface of an organ or tissue

=Due to sloughing (shedding) or inflammation of NECROTIC tissue

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20
Q

Ureterolithiasis

A

Kidney stone goes up ureter to the bladder

Urinalysis = blood in urine(hematuria)

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21
Q

Virchow’ Node

A

Palpable mass, lymph node, on left supraclavicular node of fossa

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22
Q

What can I see from this

A

Pneumomediastium

Subcutaneous Erriphesima

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23
Q

What can I see from this

A

Air under the diaphragm

Diaphragm on top, air and then liver/spleen under

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24
Q

What can I see from this

A

Pneumobilia

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25
Q

Visceral Pain

A 
Stimulated by visceral pain fibers
From dispensation, stretching, 
Felt in middle of structure involved 
No localized
EX: Periumbilical Pain with early appendicitis
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26
Q

Parietal Pain

A

Stimulation of somatic fibers
Due to inflammation in the parietal peritoneum
Constant and severe pain
Localized
Worse with movements and coughing
EX: RLQ parietal tenderness- acute appendicitis
LLQ parietal tenderness- acute diverticulitis

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27
Q

Oropharyngeal Dysphagia

A 
Trouble initiation swallowing 
Neurologic problems 
Aspiration 
Cachetic
Metabolic disorders
Zenkers diverticulum, (structural problems)
Motility problems
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28
Q

Esophageal Dysphagia

A 
Mechanical obstruction (solid foods)- schatzki ring, peptic structure
Motility Disorder (solid and liquid)- achalasia, scleroderma,

Ask, progressive or not, and constant or intermittent

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29
Q

Lipase ordered for

A

Pancreatitis

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30
Q

Ordered for
Pt/Ptt
Fractionated bilirubin

A

Liver failure

Jaundice or liver failure

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31
Q

CBC with Diff.

A 
= HAS % and absolute differential counts for PMN, Lymph, Baso, Eos, Mono)
WBC
Hb
Hematocrit
RBC
Platelets
MCH 
MVC
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32
Q

When to order a CBC

A

For any ABD pain

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33
Q

Basic Metabolic Panel

A

All the electrolytes

With creatinine

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34
Q

Comprehensive Metabolic Panel

A 
Liver products added to it 
Albumin 
ALT/AST
Protein 
Total bilirubin 
Globulin 
Alkaline Phosphate
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35
Q

Pancreatitis what do you order

A

Lipase

Amylase

36
Q

Liver function what do you order

A

Gamma-Glutamyl transferase (GGT)
Fractionated Bilirubin
PT/INR- helps for bleeding risk before a procedure

37
Q

Zolinger Ellison what do I order

A

Fasting Gastrin Gastrinoma (elevated)

Secretin Stimulation test (elevated secretin)

38
Q

Plain Films of the ABD

Acute ABD Series

A

Single view X-ray upright and flat position
Initial screening
NOT DIAGNOSTIC
Check for free air

39
Q

Definite Diagnostic of ABD is

A

CT scan or endoscopy

40
Q

Plain Films of the ABD

KUB (kidney, ureter, bladder)

A

Single flat supine x-ray of ABD

Limited diagnostic ability

41
Q

Barium Swallow X-ray

Barium Esophagraphy

A

Mechanical lesions vs motility disorders from DYSPHAGIA

Esophageal narrowing due to rings, achalasia, or proximal lesions, Zenkers Diverticulum

42
Q 
Upper Endoscopy (Esophagogastroduodenoscopy)
EGD
A

Persistent heartburn, peptic ulcer disease, food getting stuck
Dysphagia
Odynophagia
Barium swallow shows structural deformity
DIAGNOSTIC and THERAPEUTIC
Allows biopsy of mucosa and dilation or structures

43
Q

Colonoscopy

A

To see the lower GI
For LGIB
Undifferentiated LAP

44
Q

Ultrasound

A

Images fluid filled structures
-Gallbladder (stones), Bladder, Kidney, Aorta, Heart
Fast for trauma
Limited by air and fat

45
Q

ERCP Endoscope Retrograde Cholangiopancreatography

A

Look at hepatobiliary and pancreatic ducts
DIAGNOSTIC and THERAPEUTIC
EX: stone in common bile duct

46
Q

MRCP

A

Similar to ERCP however ONLY DIAGNOSTIC

47
Q

HIDA Hepatobiliary Iminiodiacetic Acid Scan

A

Check gallbladder ejection fraction (LOW= biliary dyskinesia)
Check for a dysfunctional gallbladder - not secreting bile like it should
Tx: remove gallbladder

48
Q

CT SCAN

A

Most information given
MOST DEFINITIVE DIAGNOSTIC
For IV and Oral contrast
Order pelvic/ABD together

49
Q

GERD/ Gastritis/ PUD

A

Can all progress to GI BLEEDING

50
Q

GERD

A

10-20% of population
Reflux or gastric contents come through the lower esophageal sphincter
Injury esophageal tissue
Sx: heartburn (PYROSIS) and regurgitation/reflux(food come back up to mouth)

51
Q

GERD with

What for EGD to be a must

A 
Older then 60yo
GI Bleed
Anemia
Anorexia
Dysphagia 
Odynophagia 
Vomiting 
Cancer GI in relatives
52
Q

GERD TX:

Know somewhat he said —-> more interested in SX and what to order

A

Weight loss if obese
Avoid food that increase it, Alcohol and smoking
Elevate head of bed

CA+2 carbonate (TUMS), aluminum hydroxide
Surface agents (sucrafate)
H2 BLOCKERS (blocks Gastrin parietal cell receptors from release in acid) EX: Zantac
PROTON PUMP Inhibitors

53
Q

Peptic Ulcer Disease (PUD)

A

Defected gastric or duodenal mucosa
Risks: H Pylori and NSAIDs (non-steroidal anti-inflammatory)
SX: asymptotic, Upper ABD pain= RUQ + epigastric +LUQ
See first sometimes as a GI Bleed: 50% UGIBs
PE: mild-moderate epigastric pain

54
Q

Gastric Ulcer

A

H Pylori
NSAID is a risk factor also
Lesser curvature of stomach
Lowered ACID SECRETION = loss of protective barrier

DO EGD Tx: H2 blocker

55
Q

Duodenal Ulcer

A

H pylori, stress, smoking
Proximal duodenum, if many in the lower distal part = ZES
DO EGD Tx: H2 blocker

56
Q

H Pylori is associated with what

KNOW THIS

A
  1. PUD
  2. Chronic Gastritis
  3. Gastric adenocarcinoma
  4. Gastric mucosa associated lymph tissue (MALT)
    5 duodenal ulcers
57
Q

H Pylori facts

A

Most common 50% many assymptomatic

Risk: Poverty, overcrowding, limited education, ethnicity, birth outside US
Transmission = unknown: fecal to oral or oral to oral

58
Q

How does H pylori survive in the stomach

WHAT ARE SIGNS

A

Converts urea to ammonia to neutralize the acid
So then it can penetrate the gastric mucus layer
High Gastric acid secretion
Immune response
Gastric metaplasia
Breath for ammonia
Mucosal defense mechanisms

59
Q

HOW TO test for H Pylori

A

Urea Breath test
Fecal Ag Test
Upper endoscopy
* patient needs to stop H2 Pump blocker (PPI) for 14 days before the test

60
Q

What is the division of UGI and LGI

A

The Ligament of Treitz
UGI: Esophagus, Stomach, duodenum
LGI: Jejunum, Ileum, colon, rectum

61
Q

What can cause UGIB

A

HTN, tachycardia, syncope, SOB, weakness, confusion,
Hematemesis, Melena, coffee ground emesis
ASK: PMH, liver disease, abusive alcohol- varcies
H pylori, NSAIDS, Aortic stenosis

62
Q

What can cause GI Bleeds

A 
Blood thinners
Glucocorticoid 
NSAIDs
Anticoagulants
Beta blockers
63
Q

Watch out for what when blood in stool from pt.

So not misdiagnosed

A

FE+3 pills, peptobismol

RED Koolaid, beets

64
Q

Huge risk factor for GIBs

A

Alcohol

65
Q

Esophageal and Gastric Varices

What is this

A

Dilated submucosal veins due to portal HTN
MOST common result from alcohol liver disease
Some small % UGIBs
Can cause UGIB and PUD

66
Q

Cholelithiasis and Cholecystitis (Gallstones)

A

6% men, 9% women
Asymptotic usually
BILIARY COLIC = sign (pain especially after eating greasy foods, RUQ pain)

67
Q

Gallstones future complications

A

Pancreatitis….

68
Q

Cholelithiasis

A

Gallstones (stones in the gallbladder)

69
Q

Cholecystitis

A

Inflammation of gallbladder due to stone in neck of GB or the cystic duct, Bile can still drained by LIVER, not GB
= NORMAL LFTs

70
Q

Choledocholithiasis

A

Stone in Common Bile Duct (CBD)
LIVER and GB can’t drain Bile
= HIGH LFTs

71
Q

Ascending Cholangitis

A

Biliary tree inflamed from air (bacteria) or stone in the common bile duct
Very sick patients

72
Q

Gallstone Pancreatitis

A

Gallstones stuck in the pancreatic duct = HIGH LFTs and HIGH Pancreatic Enzymes:Lipase and Amylase

73
Q

Dysfunctional GB

How to Dx:

A

No stones
GB can’t empty - biliary colic symptoms
Use HIDA scan

74
Q

Pancreatitis
What
Risk

A

Inflammatory condition of pancreas- ABD pain and HIGH Pancreatic Enzymes in blood
RISK= Gallstones, alcohol abuse….

75
Q

Pancreatitis
Sx:
What to order
Tx:

A

Acute persistent epigastric pain, radiating to back, N,V, tenderness when palpating epigastric
CBC, CMP, Lipase, UA, Preg test,
CT to image (pelvis/ABD) IV and oral contrast
US to image gallbladder, Kidney, pancreas

To: IV fluids, pain medication, NPO (no food)

76
Q

Acute Appendicitis

A

Acute ABD pain
RLQ , anorexia, N, V, F
Starts visceral pain ——-> parietal pain

CBC, CMP,Preg test, UA
CT and US

Tx: NPO, fluids, surgery

77
Q

McBurney’s Point

A

RLQ pain = Appendicitis

78
Q

Diverticulosis/ Diverticulitis

A

outpatching/when inflamed
Outpatching of the colon (diverticulum) that get inflamed
Starts at Visceral pain ——> parietal pain
ABD Pain in LLQ
N,V,F

Tx: Abs, surgery

79
Q

Achalasia

A

Degeneration of ganglionic cells of the myenteric plexus in esophagus wall= LES can’t relax = NO peristalsis in distal esophagus (food is stuck in the esophagus)
Primary: unknown cause
Secondary: motor abnormalities

80
Q

Primary achalasia

A

NO producing neurons in the myenteric plexus in the esophagus is lost= X peristalsis and unrelated LES
REGURGITATION and PROGRESSION
Barium test= bird beak appearance
Esophageal Manometry can confirm also
TX: dilation, botulinum injection, surgery

81
Q

Chagas Disease

Secondary to what

A

Secondary to ACHALASIA
Patients from central and South America
Bitten by kissing bug - Trypanosoma Cruzi

Causes: achalasia , megaesophagus, megacolon, Chagoma (swelling)
Romana Sign (infection periorbital tissue swelling)
82
Q

Zollinger Ellison Syndrome

A

Gastrin secretion from tumor in pancreas or duodenum
* associated with MEN1 (multiple endocrine Neoplasia)- gastrimoma, hyperparathyroidism[high Ca+2], pituitary neoplasm

HIGH GASTRIC ACID, severe PUD, diarrhea
POSITIVE SECRETIN STIMULATION TEST

83
Q

Upper parasympathetic goes to

A 
Esophagus ——> transverse colon
Vagus N (OA,AA)
84
Q

Lower Parasympathetic goes to

A

Descending colon, Sigmoid, Rectum

Pelvic Splanchnic N (S2-S4)

85
Q 
Sympathetic level for 
Appendix
Esophagus 
Stomach
Liver
Gallbladder
Small intestine 
Colon
Pancreas
A 
T12
T2-T8
T5-T9
T6-T9
T6-T9
T5-T9, T9-T12
T9-L2
T5-T11

GIGU Exam 1 (19 decks)

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