~Easy Mode GI~ Flashcards
contagious for 28 days of incubation, and one week following onset of jaundice
Hepatitis A
bruising around umbilicus
pancreatitis
Cullen’s sign
outpatient treatment = ceftriazone + doxycycline
Pelvic Inflammatory Disease
abrupt onset of RUQ pain, fever/malaise, anorexia, jaundice, hepatomegaly
Hepatitis A
85% are STI related
Pelvic Inflammatory Disease
monitor for sepsis- blood cultures x2 before antibiotic treatment
Cholangitis
complications = obstruction, paralytic ileus, edema, compression of colon
diverticulitis
typically results from endocarditis or seeding from another site
Splenic abscess
rigid proctoscopy or flex sig evaluation after treatment
rectal foreign body
SEVERE pain in anal area
no fever
no findings on DRE
perianal abscess
splenic artery occluded my embolus, clot, or infection
Splenic infarct
positive Courvoisier’s sign
Choldecholithiasis
ascending bacterial infection due to obstruction of the biliary ducts
Cholangitis
LUQ pain referred pain to the left shoulder
Splenic rupture
hyperactive bowel sounds/high pitch
diverticulitis - obstruction
treatment for uncomplicated = monitor + analgesics
treatment for complicated = splenectomy
Splenic infarct
acute presentation can be a malignant effusion or small bowel obstruction
Ovarian cancer
can be caused by an infection such as mononucleosis, CMV, HIV
Splenic rupture
urinary urgency, frequency, dysuria low grade fever change in bowel habits abd distention N/V LLQ pain
diverticulitis
ultrasound = abscesses, bowel wall thickening, diverticula, fistulas
diverticulitis
blood cultures x 2 if admitting
Pelvic Inflammatory Disease
gallstones in the bile or pancreatic duct
gall stone pancreatitis
anorectal or abdominal pain
blood per rectum
mucus discharge
rectal foreign body
obstipation
small bowel obstruction
gallbladder wall thickening, sonographic “murphy’s sign”, gallstones or sludge, pericholecystic fluid
acute cholecystitis
foul smelling vaginal discharge (lochia)
Post-Partum Endometritis
d-dimer (GI disorders)
acute mesenteric ischemia
IV steroids
Toxic megacolon
gallstones within the common bile duct
Choldecholithiasis
treatment = anesthetize area, open wound, evacuate pus, irrigate well
no packing
sitz bath
perianal abscess
treatment = IV clindamycin + IV gentamycin
Post-Partum Endometritis
elevation of serum lipase or amylase to 3 times greater than normal limit
pancreatitis
adhesions from prior abdominal/pelvic surgery can cause
small bowel obstruction
complications include acute pancreatitis and acute cholangitis
Choldecholithiasis
vaginal bleeding with pain, typically 6-8 weeks after last menses
ectopic pregnancy
high mortality intestinal emergency
acute mesenteric ischemia
left side pain (tender mass) on rectal exam
diverticulitis
colicky biliary type pain RUQ
radiates to epigastric
Choldecholithiasis
traumatic and atraumatic etiologies
Splenic rupture
x-ray = dilated colon fever > 38 C HR > 120 neutrophilic leukocytosis > 10500 microliters anemia dehydration altered mental status electrolyte disturbance hypotension
Toxic megacolon
toxic appearing patient, fever
altered mental status
bloody diarrhea
Toxic megacolon
cefoxin/cefazolin + metronidazole
analgesia
appendicitis
Shortness of breath and cough especially when lying flat
peptic ulcer disease
dark urine + pale stools
Hepatitis A
antibiotic triple therapy (ampicillin/gentamycin/metronidazole)
Toxic megacolon
hypoactive bowel sounds/ absent (diverticulitis)
peritonitis
LLQ deep, steady, constant pain
diverticulitis
rebound tenderness
appendicitis
free air or dead bowel on x-ray = yes = laparotomy
acute mesenteric ischemia
ultrasound with duplex for blood flow
Ovarian torsion
inpatient treatment = cefoxitin + doxycycline
Pelvic Inflammatory Disease
LUQ pain, fever
+/- splenomegaly
+/- left side pleural effusion
Splenic abscess
RLQ pain
N/V, anorexia
fever = late finding
rigidity, guarding, pain on rectal exam
appendicitis
CT with contrast = localized bowel thickening, colonic diverticula, abscesses, fistula, dilated loops of bowel
diverticulitis
soft uterus +/- excessive uterine bleeding
Post-Partum Endometritis
pain increases with fatty food intake
acute cholecystitis
leukocytosis with bands, elevated CRP, normal liver labs
acute cholecystitis
Grey Turner sign
pancreatitis `
severe, constant RUQ pain > 6 hours that radiates to the epigastric and right shoulder
acute cholecystitis
RLQ pain - starts periumbilical and migrates
appendicitis
consult patient to increase fluids and fiber in diet
hemorrhoid
x-ray = dilated loops of bowel with air-fluid levels
small bowel obstruction
fever/ chills mucopurulent vaginal discharge intermenstrual bleeding cervical friability pelvic TTP
Pelvic Inflammatory Disease
treatment = methotrexate
ectopic pregnancy
CT with contrast shows inflammation, fat stranding, fluid collection
appendicitis
anal pruritus, prolapse
hemorrhoid
percutaneous drainage
acute cholecystitis - unstable patient
RUQ pain relieved by leaning forward, hypoactive bowel sounds, fever, tachypnea, hypotension, N/V, bloating
pancreatitis
defect in gastric of duodenal mucosa
peptic ulcer disease
IV contrast CT is very important, oral not as important for detecting ischemia associated with
small bowel obstruction
early satiety, dyspepsia, “heart burn”
peptic ulcer disease
Rovsings
appendicitis
ecchymotic discoloration due to retroperitoneal bleeding
pancreatitis
grey turner sign
treatment is splenectomy and blood transfusion
Splenic rupture
leukocytosis with elevated liver labs (alk phos, GGT, bilirubin, transaminases) +/- elevated amylase with pancreatic involvement
Cholangitis
ALT > AST
Hepatitis A
tumor markers CA 125
Ovarian cancer
fever/chills + uterine tenderness
Post-Partum Endometritis
treatment = transanal removal with IV sedation or surgical removal
rectal foreign body
ceftriaxone + metronidazole
+/- systemic anticoagulation
acute mesenteric ischemia
no anti-motility medications or opioids
Toxic megacolon
WBCs on saline microscopy
elevated ESR and CRP
Pelvic Inflammatory Disease
Most commonly caused by Choldecholithiasis
Cholangitis
x-ray = transverse/ right colon dilated up to 15 cm +/- air fluid levels
Toxic megacolon
elevated LDH, leukocytosis
Splenic infarct
Appears ill, lies still, + positive murphy’s sign
acute cholecystitis
RUQ pain, slower progression, persistent, severe, boring acute pain, radiates to back
pancreatitis
non-gallstone because slower progression
fever/ chills, RUQ pain, jaundice
Cholangitis (Charcot’s triad)
NG tube + antiemetics
small bowel obstruction
severe, bloody diarrhea
Toxic megacolon
decreased of no perfusion to section of colon- obstructive arterial or venous process
acute mesenteric ischemia
fever/ chills, RUQ pain, jaundice, altered mental status, hypotension
Cholangitis (Reynold’s pentad)
\+/- leukocytosis \+/- metabolic acidosis hemoconcentration (third spacing) increased lactate increased LDH
acute mesenteric ischemia
Splenic emergency that is diagnosed by ultra sound and not CT with contrast like the other splenic emergencies
Splenic rupture
epigastric pain that radiates to the mid thoracic region
peptic ulcer disease
LUQ pain and FULLNESS
Splenic rupture
lead point of the bowel is pulled forward by normal peristalsis, telescoping or prolapsing the affected segment of bowel into another segment of bowel
intussusception
high risk patients = ERCP then elective cholecystectomy
low risk = cholecystectomy
Choldecholithiasis
if thrombosed, incise overlying skin, evacuate clot = immediate relief
hemorrhoid
Cullen’s sign
pancreatitis
bright red, copious rectal bleeding
hemorrhoid
order a KUB and CXR to check for free air
peptic ulcer disease
acute perianal pain, “lump” due to thrombosis
hemorrhoid
usually caused by enterococci
Cholangitis
free air of dead bowel on x-ray = no = abdominal CT angiography with IV contrast
acute mesenteric ischemia
localized pain to the RUQ, RAPID ONSET**, radiates to back
gall stone pancreatitis
treatment = salpingo-oophrectomy
Ovarian torsion - post-menopausal
partial or complete rotation of ovary, often results in ischemia
Ovarian torsion
“possible forceful bowel evacuation”
post-prandial pain
acute mesenteric ischemia
air-filled loop of the sigmoid colon twists about its mesentery
volvulus
blockage of appendix with stool, appendicolith, tumor with secondary infection
appendicitis
+ obturator sign
pelvic appendicitis
rapid onset, severe periumbilical pain out of proportion to physical exam
acute mesenteric ischemia
UA = pyuria
diverticulitis
inflammation due to microperforation of a diverticulum
diverticulitis
+ psoas sign
retroceccal appendicitis
can be caused by a neoplasm from leukemia or lymphoma
Splenic rupture
acute onset of pain
N/V
adnexal mass
pain radiates to back/flank/groin
Ovarian torsion
treatment for uncomplicated = cipro + metronidazole at home
diverticulitis
treatment if suspected tubal rupture or hemodynamically unstable = oophorectomy
ectopic pregnancy
treatment = laproscopic detorsion
Ovarian torsion - pre-menopausal
LIFE-THREATENING hemorrhage is ruptured
ectopic pregnancy
cramping***, abdominal pain, periumbilical
small bowel obstruction
adnexal mass abd distention bloating early satiety weight loss
Ovarian cancer
positive stool guaiac
diverticulitis
