Gastro Flashcards
Indicators for severe DCI
Leukoctyosus at >=15000
Crea >= 1.5 mg/dl
Fulminant CDI
Severe CDI + hypotension, shock, ileus, megalcolon
High risk for recurrent CDI
Age >65 yo
Immunocompromised
Severe CDI on presentation
Prior ep of CDI in the past 6months
Suggestive findings on CT of Appendicitis
> Dilatation >6 mm with wall thickening
A lumen that does not fill with enteric contrast
Fatty tissue stranding or air surrounding the appendix (inflammation)
Ultrasounf findings suggestive of appendicitis:
Wall thickening
Increased appendiceal diameter
Presence of free fluid
Etiology of travelers diarrhea associated with cruise ships
Norovirus
Single most important agent in travelers diarrhea
ETEC
Major cause of dysentery in travelers diarrhea
Shigella
Travelers diarrhea
- etiology in hikers and campers who drinks from freshwater streams
Giardia lamblia
Travelers diarrhea
Etiology resistant to chlorin
Cryptosporidium
Most common cause of intestinal obstruction
Post op adhesions
Most common site of volvolus
Sigmoid
Xray: coffee bean shaped dilated shadow
Volvolus
Risk factors for volvolus
Institutionalization
Neuropsychiatric conditions requiring psychotropic medication
Chronic constipation
Aging (70s or 80s)
Ct scan findings of cecal volvlus
Whorl deformity
Birds beak
C looo
Surgical decompression (laparotomy/laparoscopy)
Most common site of GI TB
Ileocecal
Abdominal xray: staircasing” pattern of dilated air and fluid-filled small-bowel loops >2.5 cm in diameter with little or no air seen in the colon
SBO
• Mesenteric venous gas
• Pneumatosis intestinalis
• Pneumoperitoneum
Late findings (presence of bowel necrosis): Intestinal ischemia
Most specific early finding of Intestinal Ischemia
Altered bowel wall enhancement
True or False
Rectum is usually spared in colonic diverticula
True
> most common affecting the colon is pseudodiverticula
most common cause of hematochezia in patients >60 years
Diverticula
Onlr 20% will have bleeding
Factors for increased risk of bleeding:
> Hypertension
> Presence of atherosclerosis
> Patients with regular use of antithrombotic therapy
> Regular use of NSAIDS
> Obesity
• Diabetes mellitus
• Sigmoid diverticula
• Thickened colonic wall >4 mm
• Inflammation within the pericolic fat with or without the collection of contrast material or fluid
CT findings of Diverticulitis (confirming colon infection + inflammation)
Mgt Bowel rest
Antibiotics if Symptomatic Uncomplicated DD no difference
Hinchey classification of Diverticulitis
I
II
III
IV
Confined abscess
Distant abscess
Noncommunication
Free communication with the peritoneum
Causes of Mesenteri. vascular Insufficiency
Chronic:
Acute
Venous
Non occlusive
Chronic: atherosclerotic
Acute thrombosis and embolism
Venous hypercoagulable
Non occlusive acute hemodynamic instability
part of colon at risk for colonic ischemia)
descending and sigmoid colon (Sudeck’s point:
Markers if poor prognosis in hepatitis
Initial presenting features such as ascites, peripheral edema, and hepatic encephalopathy
Lab features
prolonged PT
low serum albumin level
hypoglycemia, and
very high serum bilirubin
