EM - GI Flashcards
etiology of appendicitis
fecalith
s/s of appendicitis
-colicky abdominal pain
-originates in the peri-umbilical region and localizes in the RLQ
-McBurneys point tenderness
-Rosvings
-psoas
-obturator
-heel slap
diagnosis of appendicitis
CT
treatment of appendicitis
-consult surgery
-cefoxitin or unasyn
etiology of cholecystitis
stones
s/s of cholecystitis
-RUQ pain
-epigastric or shoulder blade pain
-precipitated by fatty meals
-murphy sign
diagnosis of cholecystitis
-US
-HIDA if US in inconclusive
treatment of cholecystitis
-lap chole
Roout of transmission for something idk I messed up the card sawy
fecal oral route
s/s of hep A
-n/v
-mild, constant RUQ pain
-low grade fever
-distaste for smoking
-jaundice
diagnosis of Hep A
-anti HAV
-ALT>AST
treatment of Hep A
supportive
etiology of Hep B
bodily fluids
s/s of hep B
-malaise
-mild RUQ pain
-jaundice
-low grade fever
-distaste for smoking
diagnosis of Hep B
-serologic markers
first serologic marker to elevate in Hep B
HBsAG (surface antigen)
appearance of _____ and decline in ____ indicates recovery of acute infection and non-infectivity
anti-HBs; HBsAG
____ indicates a declining acute hep b
anti-HBc
t/f IgG anti-HBc persists indefinitely
true
_____ indicates viral replication and infectivity
HBeAG
treatment of hep B
-immune globulin within 7 days
-initiation of vaccine series
etiology of hep c
IV drug use
s/s of hep c
fatigue
myalgias
jaundice
diagnosis of hep c
-anti-HCV
-HCV RNA
____ indicated current infection of hep C
HCV RNA
treatment of hep c
interferon and ribavirin
Hep D is always a co-infection with _____________.
Hep B
diagnosis of Hep D
anti-HDV
treatment of hep d
supportive
etiology of acute pancreatitis
gallstones
alcohol
presentation of acute pancreatitis
-epigastric pain radiating to the back
-improves with leaning forward
-n/v
-cullen’s and grey turner sign
diagnosis of acute pancreatitis
elevated amylase and lipase
CT with contrast
most sensitive lab for pancreatitis
lipase
treatment of pancreatitis
-NPO
-fluid
-demerol
-complete bowel rest
Also Oxygen
etiology of anal fissure
trauma during defecation
s/s of anal fissure
tearing pain with defecation
bleeding
treatment of anal fissure
proper toileting
s/s of perianal abscess
-throbbing
-pain
-swelling
-fluctuant
treatment of perianal abscess
I&D
s/s of perianal fistula
purulent discharge that may lead to itching, tenderness, and pain
treatment of perianal fistula
surgical excision
etiology of cholangitis
EColi obstruction of common bile duct
Cholodocho but with infection
s/s of acute cholangitis
-RUQ pain
-fever
-jaundice
(Charcot’s Triad)
diagnosis of cholangitis
ERCP
treatment of cholangitis
-fluids
-pain control
-NPO
-stone extraction
etiology of cirrhosis
alcohol and chronic hep c
s/s of cirrhosis
-n/v/abd pain
-esophageal varicies
-spider angiomas
-fatigue
-jaundice
-ascites/peripheral edema
-HSM
diagnosis of cirrhosis
-first line US
-definitive biopsy
treatment of cirrhosis
-avoid alcohol
-liver transplant
mc location of diverticular disease?
sigmoid colon
s/s of diverticulosis
-asymptomatic
-may see mild LLQ pain
treatment of diverticulosis
high fiber diet
s/s of diverticulitis
-LLQ pain
-palpable mass
-low grade fever
-bowel changes
diagnosis of diverticulitis
CT
treatment of diverticulitis outpatient
-clear liquid diet
-cipro + flagyl or augmentin
treatment of diverticulitis inpatient
-NPO with IV fluids
-pip/taz
treatment of diverticular bleed
-may resolve on own
-colonoscopy with cauterization of bleed
etiologies of erosive gastritis
-meds
-alcohol
-stress
s/s of gastritis
-anorexia
-epigastric pain
-n/v
-hematemesis
diagnosis of gastritis
EGD
treatment of gastritis
PPI
treatment of h.pylori
-clarithromycin
-omeprazole
-amoxicillin
diagnosis of hpylori
-urea breath test
-EGD
s/s of viral gastroenteritis
watery stool
no blood or mucus
dehydration
management of viral gastroenteritis
oral fluid challenge
zofran
antidiarrheal
presentation of bacterial gastroenteritis
-bloody mucopurulent diarrhea
-cramping
-fever
management of bacterial gastroenteritis
-fluids
-can use pepto bismol if needed
-empiric abx in adults only
presentation of GI bleed
-hematemesis
-melena
-hematochezia
PE of GI bleed
-hyperactive bowel sounds (UGI)
-tenderness
-hyperactive bowel sounds (UGI)
-tenderness
-stable: consult surgery for endoscopy
-unstable: fluids, transfusion if needed, reverse anticoagulation if needed, PPI
management of GI bleed if variceal
octreotide
presentation of giardiasis
-watery diarrhea
-dehydration
-no vomiting
-afebrile
diagnosis of giardiasis
stool sample
treatment of giardiasis
-azole
etiology of GERD
-relaxation of lower esophageal sphincter
s/s of GERD
-heartburn
-worse after meals
-regurgitation
-dysphagia
diagnosis of GERD
-clinical for mild
-EGD
treatment of GERD
-lifestyle modification
-H2 blockers
-antacids
-PPI
etiology of hemorrhoids
increase in venous pressure
s/s of hemorrhoids
-mostly asx
-may have bleeding or prolapse
diagnosis of hemorrhoids
inspection via DRE
treatment of hemorrhoids
-proper toileting
-banding
-hemorrhoidectomy
management of external thrombosed hemorrhoid
evacuation of clot
presentation of incarcerated/strangulated hernia
-firm
-tender
-redness or discoloration of overlying skin
treatment of hernia
surgery
mc area of chrons disease
terminal ileum
s/s of chrons disease
-RLQ pain
-non-bloody diarrhea
-steatorrhea
-erythema nodosum
-pyoderma gangrenosum
diagnosis of chrons disease
-cobblestoning on colonoscopy
-skip lesions
management of chrons disease
-steroids
-TNF blockers + azathioprine
mc area for ulcerative colitis
rectum and sigmoid colon
s/s of ulcerative colitis
-bloody diarrhea
-crampy abdominal pain
diagnosis of ulcerative colitis
sigmoidoscopy
management of ulcerative colitis
mesalamine
steroids
curative: total proctocolectomy
S/S of toxic megacolon
-severe bloody diarrhea
-abd pain and distention
-vomtiing
in which IBD is toxic megacolon seen?
ulcerative colitis
diagnosis of toxic megacolon
CT
treatment of toxic megacolon
-steroids
-surgical consult
S/S of mesenteric ischemia
-abd pain out of proportion to PE
-mild distention
-absent bowel sounds
-occult blood in stool
diagnosis of mesenteric ischemia
mesenteric arteriography
treatment of mesenteric ischemia
pain control
-abx
-anticoagulation
-NTG
cause of jaundice
accumulation of bilirubin
pre-hepatic vs hepatic vs post-hepatic jaundice
-prehepatic: unconjugated bilirubin
-hepatic: conjugated and unconjugated
-posthepatic: conjugated
clinical findings associated with unconjugated hyperbilirubinermia
-normal stool and urine
-mild jaundice
clinical findings associated with conjugated hyperbilirubinermia
-light colored stools
-dark urine
-hepatomegaly
-jaundice
etiology of mallory weiss tear
retching, vomiting, or lifting
s/s of mallory weiss tear
-hematemesis
-epigastric pain
-hx of vomiting
diagnosis of mallory weiss tear
egd
treatment of mallory weiss tear
-fluids and blood
-stop bleeding
-PPI
mc type of volvulus
sigmoid
pathophys of volvulus
sigmoid colon twists around the mesentery
s/s of volvulus
-slow onset of abd pain
-nausea
-distention
-constipation
-tympanic
diagnosis of sigmoid volvulus
CT (whirl pattern)
management of sigmoid volvulus
-endoscopic decompression with rigid sigmoidoscope
diagnosis of cecal volvulus
-radiography (coffee bean sign, comma sign)
-CT (whirl pattern)
management of cecal volvulus
-stable without compromise: open surgical detorsion and ileocecal resection
-unstable without compromise: cecopexy
-stable with compromise: ileocecal resection and right colectomy
-unstable with compromise: resection of compromised bowel and ileostomy
treatment of bowel obstruction
NG suction
Diagnosis of bowel obstruction
Xray, CT
