First Aid GI Flashcards
etiology of acute cholecystitis?
prolonged blockage of the cystic duct by a gallstone that leads to progressive distention, inflammation, and superinfection.
what is acalculous cholecystitis?
occurs in the absence of cholelithiasis (gallstone) in pts who are chronically debilitated or critically ill
pt suspicious of cholecystitis, you do ultrasound and found nothing, what is the next step?
HIDA scan
what is the positive sign for HIDA scan for cholecystitis?
non-visualization of the gallbladder
treatment for cholecystitis?
IV antibiotics, IV fluids, and cholecystectomy
what is the imaging modality for cholelithiasis and biliary colic?
RUQ ultrasound
4 main risk factors for cholelithiasis (gallstones)?
Female, Fat, Fertile, and Forty
additional risk factors for cholelithiasis?
OCPs, rapid weight loss, chronic hemolysis, small bowel resection, and TPN
what is the treatment for asymptomatic gallstone?
no treatment required
clinical signs for cholelithiasis?
postprandial abdominal pain in RUQ that radiates to Rt. subscapular area or the epigastrium
clinical signs for acute cholecystitis?
RUQ pain, nausea, vomiting, fever, + Murphy’s sign, leukocytosis
what is choledocholithiasis?
gallstones in the common bile duct
clinical signs for choledocholithiasis?
biliary colic, jaundice, fever, pancreatitis
what are the 2 lab hallmarks for choledocholithiasis?
- inc alkaline phosphatase
2. inc total and direct bilirubin
treatment for choledocholithiasis?
ERCP (Endoscopic retrograde cholangiopancreatography) with sphincterotomy followed by cholecystectomy
define cholangitis
acute bacterial infection of the biliary tree that commonly occurs 2’ obstruction usually from gallstones (choledocholithiasis).
unique clinical signs for cholangitis?
- Charcot’s triad - RUQ pain, jaundice, fever/chills
2. Reynold’s pentad: Charcot’s triad plus septic shock and altered mental status
ERCP for cholangitis is both
diagnostic and therapeutic
treatment for acute suppurative cholangitis?
emergent bile duct decompression via ERCP/sphincterotomy
most common cause of acute lower GI bleeding in pts > 40?
diverticulosis
what should be avoided in the initial stages of diverticulitis?
sigmoidoscopy
what is the definitive diagnosis in diverticular dz?
colonoscopy
treatments for diverticulitis?
- bowel rest (NPO)
- NG tube placement
- broad spectrum antibiotics (metronidazole, fluoroquinolone, second/third generation cephalosporin)
most common cause of odynophagia in immunocompromised pts?
candidiasis
definition of oropharyngeal dysphagia?
problem with initiation of swallowing
what are the 2 types of dysphagia?
- oropharyngeal dysphagia
2. esophageal dysphagia
which dysphagia has more problems with liquids than with solids?
oropharyngeal dysphagia
causes for oropharyngeal dysphagia?
neurologic or muscular
- stroke
- Parkinson
- myasthenia gravis
- prolonged intubation
- Zenker diverticula
causes for esophageal dysphagia?
- obstructions
- strictures
- Schatzki rings
- webs
- carcinoma - motility disorder
- achalasia
- scleroderma
- esophageal spasm
esophageal web is associated with
plummer vinson syndrome (anemia, glossitis)
what is the best initial diagnostic tool for oropharyngeal dysphagia?
modified barium swallow (video fluoroscopic swallowing exam), occasionally esophagogastroduodenoscopy (EGD)
what is the best initial diagnostic tool for esophageal dysphagia?
EGD (esophagogastroduodenoscopy)
which type of hernia is more common among yound men?
indirect
best method for diagnosing IBD?
colonoscopy
1st step of management for oropharyngeal dysphagia?
video fluoroscopic swallowing exam = modified barium swallow
what is the initial test for achalasia?
Barium swallow
what is the definitive test for achalasia?
Manometry
short term treatment for achalasia?
nitrates, CCB, endoscopic injection of botulinum toxin
long term treatment for achalasia?
pneumatic balloon dilation or surgical (Heller) myotomy
