Gastro Flashcards

Question

Nommer les critères dx d'oesophagite eosinophilique

Answer 1

Sx dysfonction oesophagienne \> 15 eosino/ch sur biopsie sx réfractaire IPP

Answer 2

Biphosphonates Fer Antibio - surtout tétracycline ASA et AINS KCl Quinidine

Answer 3

- Asthme, toux - voix rauque, mal de gorge, globus - otalgie - halithose - érosions dentaires - gingivite - hoquet - laryngospasme

Answer 4

Style de vie: perte de poids et tête de lit (2 seuls démontrés), sinon diète, exercice, éviter valsalva IPP Anti-H2 Sucralfate Misoprostol Agent prokinétique: maxeran Chx

Answer 5

Cortico PO

Answer 6

Tumeur sécrétant de la gastrine Gastrine stimule les cellules pariétales à sécréter des H+ et induit une prolifération des cellules pariétales L'hyperplasie des cellules pariétales augmentent la sécrétion d'acide et favorise les ulcères

Answer 7

Triple Therapy (10- to 14-day treatment regimen) Clarithromycin, 500 mg bid Plus Amoxicillin, 1 g bid Or Metronidazole, 500 mg bid (if penicillin-allergic) Plus A PPI Quadruple Therapy (10- to 14-day treatment regimen) Bismuth subsalicylate (Pepto-Bismol), 525 mg PO qid Plus Metronidazole, 250 mg PO qid Plus Tetracycline, 500 mg PO qid Plus PPI or ranitidine, 150 mg PO bid

Answer 8

A primary (or subdiaphragmatic) volvulus occurs when the stabilizing ligaments are too lax or are congenitally abnormal in such a way that the stomach is able to twist on itself. Approximately one-third of cases are of this type. Secondary (or supradiaphragmatic) volvulus occurs in patients with diaphragmatic defects such as a paraesophageal hiatal hernia, elevated diaphragm, gastric ulcer or carcinoma, diaphragmatic paralysis, extrinsic pressure on the stomach from other organs, or abdominal adhesions. The combination of one of these factors and ligamentous laxity makes a volvulus more likely.

Answer 9

The combination of severe epigastric pain and distention, vomiting followed by violent nonproductive retching, and inability to pass a nasogastric tube (Borchardt’s triad)

Answer 10

Hépatite D nécessite la production de HbsAg (donc Hép B chronique) Hépatite fulminante plus fréquente avec Hép B + Hép D (coinfection) AST/ALT: de 10 à 100x la normale, ALT \> AST, Direct and indirect bilirubin levels are elevated almost equal proportions. Alkaline phosphatase and lactate dehydrogenase levels may be elevated but are rarely more than 2 to 3 times normal. On a 2 semaines pour donner les immunoglobulines en cas d'exposition à hép B chez qqn non vacciné. Si vacciné, mais pas HbsAb ou HbcAb - redonner vaccin mais pas immunoglobulines.

Answer 11

Anti-HBcAg antibody generally is the best indicator of previous HBV infection, whereas anti-HBsAg antibody is the best marker for immunity to HBV. The presence of anti-HDV in conjunction with IgM antibody to HBcAg suggests coinfection with HDV and HBV. Anti-HDV in association with IgG antibody to HBcAg supports the diagnosis of superinfection.

Answer 12

Close personal contact :ISG, 0.02 mL/kg IM Day care center Employee: ISG, 0.02 mL/kg IM Attendee: ISG, 0.02 mL/kg IM School contactsNone Hospital contactsNone Workplace contactsNone Food-borne source Within 2 wk of exposure: ISG, 0.02 mL/kg IM After 2 wk of exposure: None After common source outbreaks have begun to occurNone

Answer 13

Élévation AST\> ALT, rarement supérieur à 10 x la normale Élévation bilirubine Leucocytose 10-20

Answer 14

Évaluer le score MDF (Maddrey's Discriminant Function for Alcoholic Hepatitis), Score utilise le PT et la bilirubine Si score sup 32, et absence de sgmt GI, sepsis, hépatorénal, cortico 40mg PO die. Alternative: pentoxifylline

Answer 15

Cirrhose de Laennec - alcoolique - processus diffus, atteinte des lobules en entier Cirhose post nécrotique - non homogène, zones saines et zones atteintes - infectieux/ métabo/ Rx Cirhose biliaire - 2nd atteinte obstructive des canaux intra hépatiques/canaux biliaires Cirrhose cryptogénique - stéatose hépatique devient une cause de + en + importante

Answer 16

Ascites Alcohol cessation in patients with alcohol-induced liver disease Baclofen, 5–10 mg tid, for management of alcohol cravings Diagnostic paracentesis in patients with new-onset ascites Hepatology follow up within 1 wk of hospital or ED discharge Sodium-restricted diet Diuretic use—spironolactone Spot urine sodium/potassium ratio to monitor sodium restriction Fluid restriction for sodium level \< 125 mmol/L Caution in pressure lowering agents: ACE inhibitors and ARBs Avoid nonsteroidal antiinflammatory drugs (NSAIDS) Consider liver transplantation referral. Refractory ascites Oral midodrine, 7.5 mg tid for refractory or recurrent ascites Caution with beta blockers, such as propranolol Serial paracentesis Postparacentesis albumin infusion (6–8 g/L removed) for large-volume paracentesis (removal of \>5 L) Consider referral for transjugular intrahepatic portasystemic shunt stent or surgical shunt placement. Immediate referral for liver transplantation Spontaneous bacterial peritonitis Paracentesis with fluid PMN count \< 250 cells/mm3 and infectious signs and symptoms requires parenteral cefotaxime, 2 g q8hr Paracentesis with fluid PMN count \> 250 cells/mm3 requires parenteral ceftriaxone, 2 g die (cefotaxime supérieur à ceftriaxone selon uptodate) Signs of secondary peritonitis—obtain ascitic fluid for total protein, glucose, Gram stain, LDH, carcinoembryonic antigen (CEA) and alkaline phosphatase testing. Obtain CT scan. Repeat paracentesis for for patients at increased risk due to nosocomial or recent antibiotic exposure. Albumin, 1 g/kg body weight in the setting of PMN \>250 cells/mm3, renal insufficiency (blood urea nitrogen \> 30 mg/dL or creatinine \> 1 mg/dL) Hepatorenal syndrome (HRS) Obtain urinary neutrophil gelatinase-associated lipocalin to aid in the diagnosis Albumin infusion plus vasoactive midodrine or octreotide for type I HRSa Albumin infusion plus norepinephrine for type I HRSa in the intensive care setting Urgent referral for liver transplantation for type I or II HRSa

Answer 17

- Sgmt GI - Infection - SBP - Iléus- constipation - déshydratation, hypovolémie - sédations - IRA - thrombose veineuse - désordres électrolytiques

Answer 18

Tx condition sous-jacente Éviter sédatifs LActulose 30-60 g / jour ad 3-4 selles/jour Antibio : rifaximin ou neomycine ou flagyl ou vanco PO glycerol phenylbutyrate Dialyse à l'albumine nutritional intake of 25 to 40 kcal/kg/day with dietary modification of protein. Protein intake should be approximately 1 to 1.5 g/kg/day.

Answer 19

dialysate WBC more than 100 cells/mm3 and confirmed by culture. In patients with symptoms suggesting peritonitis, dialysate should be collected for analysis and culture, and treatment should be initiated. Consideration of catheter removal is also warranted. Antibio, favoriser intrapéritonéal \> IV sauf si pt septique Intrapéritonéal: en continu vs intermittent dans l'échange le plus long (min 6 heures) vancomycin or cefazolin, plus cefepime/ceftazidime/genta or aztreonam.

Answer 20

symptomatique Vitamine K

Answer 21

Noir: associé à l'hémolyse, contenu élevé en bilirubine de calcium Brun: associé à des infections bactériennes \> parasites, contenu aussi élevé en calcium

Answer 22

E.Coli Klebsiella Clostridium perfringens

Answer 23

E coli Klebsiella Enterococcus Bacterioides

Answer 24

Dlr HCD Fièvre Ictère Hypotension AEC

Answer 25

Tazo Ceftri/flagyl Cipro/flagyl Levaquin/flagyl Mero

Answer 26

CMV Microsporidia Mycobacterium avium complex -MAC Cryptosporidium

Answer 27

Cefotaxime + metronidazole Ampicillin + gentamycin + metronidazole Ciprofloxacin or levofloxacin or moxifloxacin + metronidazole Piperacillin-tazobactam Impinem or meropenem, or doripenem or ertapenem Drainage si plus de 3 cm Si amibe: flagyl 750 mg IV TID x 7-10 jours

Answer 28

**Toxico-métabolique** Alcool Hypercalcémie Hypertriglycéridémie Urémie Médication : sulfa, acide valproique, cortico, salicylates... Venin scorpion **Obstruction** Pancréas divisum - malformation congénitale Tumeur Biliaire Post-trauma Post-ERCP Dysfonction ampoule Diverticule duodenum **Infectieux** EBC, CMV, VIH, oreillons, cocsackie, varicelle TB, Salmonella, Campylobacter, Legionella, Mycoplasma Ascaris **Vasculaire** Hypoperfusion Vasculite Embolie Hypercoagulabilité **Autres** Db - Acidocétose Idiopathique Héréditaire Auto-immun

Answer 29

Interstitial Edematous Pancreatitis • Acute peripancreatic fluid collection—homogeneous fluid collection adjacent to pancreas; seen within 4 wk of symptom onset • Pancreatic pseudocyst—homogeneous fluid collection with well-defined wall; seen \>4 wk from symptom onset Necrotizing Pancreatitis • Acute necrotic collection—heterogeneous collection of fluid and necrosis; intrapancreatic and/or extrapancreatic • Walled-off necrosis—heterogeneous collection of fluid and necrosis with well-defined wall; intrapancreatic and/or extrapancreatic; seen \>4 wk from symptom onset Autres bowel necrosis, splenic or portal vein thrombosis, gastrointestinal bleeding, or gastric outlet obstruction.

Answer 30

Atteinte hépatique Atteinte salivaire Trauma Brûlures Néoplasie VIH Cholécystite IRA

Answer 31

CT is only recommended in the following circumstances: (1) in cases of diagnostic uncertainty—for example atypical abdominal pain—or normal pancreatic enzyme levels in the setting of high clinical suspicion; (2) to rule out other suspected intra-abdominal pathology—for example, bowel obstruction or aortic aneurysm; (3) to assess for complications in patients who fail to respond to appropriate therapy after at least 48 hours

Answer 32

Légère: peu ou pas d'atteinte d'organe Modérée: dysfonction d'organes transitoires ( à 48hr), complications locales ou systémiques Sévère: dysfonction d'organes persistante

Answer 33

**At Admission** Age \> 55 yr WBC \> 16,000/mm3 Glucose \> 11 AST \> 250 IU/L LDH \> 350 IU/L **At Admission (if biliary cause)** Age \> 70 yr WBC \> 18,000/mm3 Glucose \> 12 AST \> 250 IU/L LDH \> 400 IU/L **At 48 Hours** Hematocrit drop \> 10% BUN rise \> 2 mmol/L Calcium \< 2 mmol/l PO2 \< 60 mm Hg Base deficit \> 4 mEq/L Fluid sequestration \> 6 L **At 48 Hours (if biliary cause)** Hematocrit drop \> 10% BUN rise \> 0.8 mmol/L Calcium \< 2 mmol/L Base deficit \> 5 mEq/L Fluid sequestration \> 4 L **The bedside index for severity in acute pancreatitis, BISAP**, urée, AEC, SRIS, age, ép. pleuraux Compared to other scoring systems, it has lower sensitivity and similar specificity. **Harmless Acute Pancreatitis Score (HAPS)**, in patients with no peritonitis (no rebound or guarding) and normal hematocrit and creatinine levels, there is a very low risk of mortality, necrosis, or need for hemodialysis or ventilatory support.

Answer 34

Tx support Tx hypocalcémie si calcium ionisé bas Remplacer hypoMg peut corriger HypoCa Pas d'indication de NPO

Answer 35

Toxico-métabolique Obstructif Auto-immun Génétique Post-nécrotique, post pancréatite récurrente Idiopathique

Answer 36

The initial diagnosis of chronic pancreatitis is made by one of several imaging modalities, including CT, MRCP, or EUS

Answer 37

Tabac +++ Alcool Diabète Pancréatite chronique Obésité Approximately 85% of cases are adenocarcinoma. About 10% are neuroendocrine tumors such as gastrinomas (Zollinger-Ellison syndrome), insulinomas, and glucagonomas.

Answer 38

1,2,3, Adhérences, tumeurs, hernies Extrinsèque: Néoplasie, volvulus, hernie, adhérences Paroi: Néoplasie, hématome, strictures (MII), radiation Intraluminal: CE, infectieux (ascaris), bezoars, lithiase, intussusception TDM avec contraste IV sans contraste PO (plus cher, inefficace, entraine retard dx, inconfort, peut induire vo et aspiration)

Answer 39

Si non candidat à la chirurgie TNG Cortico Octreotide 200-900 mcg / jour divisé TID

Answer 40

These become the celiac trunk, superior mesenteric artery (SMA), and inferior mesenteric artery (IMA), respectively. The celiac trunk arises from the anterior aspect of the abdominal aorta and branches into the common hepatic, splenic, and left gastric arteries. These vessels supply the distal esophagus to the duodenum at the entrance of the bile duct. The SMA normally arises 1 cm below the celiac trunk and runs toward the cecum, terminating as the ileocolic artery. The SMA supplies the distal half of the duodenum to the proximal two-thirds of the transverse colon. The IMA originates approximately 6 to 7 cm below the SMA and gives rise to the left colic artery, sigmoid arteries, and hemorrhoidal arteries. Anatomically, this vessel provides blood flow to the distal third of the transverse colon to the rectum.

Answer 41

Thrombophilie: surtout V Leiden, aussi antithrombine, déficit prot C et S Polycythémie vraie, thrombocytose essentielle Hypertension portale, insuffisance cardiaque, insuffisance rénale Inflammation locale: pancréatite, MII, néoplasie Contraceptifs oraux Trauma, post splénectomie

Answer 42

Pneumatose intestinale Thumbprinting Air a/n système porte

Answer 43

Présence fécalith Tumeur Abcès Collection liquide péri appendicite Appendicite \> 1.1 cm

Answer 44

one of four mechanisms—ingestion of preformed toxins, adherence of the infectious pathogens to the intestinal cell walls, invasion of mucosal cell walls, and production of enterotoxins and cytotoxins.

Answer 45

Stool cultures should be sent for patients with severe illness, fever of 38.5° C (101°F) or higher, dysentery, persistent diarrhea for 14 days or longer and for patients who are immunocompromised or who have been recently hospitalized or placed on antibiotics.

Answer 46

**Shigella (sonnei, flexneri, dysenteria)** Pas de tx si non sévère, sauf si S dysentérie. Ciprofloxacin, 750 mg daily for 3 days; azithromycin, 500 mg daily for 3 days Complications: SHU, Reiter, convulsions, encéphalopathie **Salmonella (typhimurium, enteritidis, typhi)** Entérite bactérienne la + fréquente Nontyphoid : pas de tx sauf severe colitis and for infants younger than 3 months, adults older than 50 years, and those at risk for severe disease, including those who are immunocompromised, with sickle cell disease, and with prosthetic grafts For severe cases (fever, bloody diarrhea, bacteremia)— levofloxacin (Levaquin) ou Cipro, 500 mg daily for 7–10 days Azithro 1g puis 500 die x 6 jours Associé au syndrome de Reiter dans 2% des cas Typhoid Fluoroquinolone daily for 7 days; ou si hospit, ceftriaxone IV , 1–2 g for 7 days **Campylobacter( jejuni, coli)** : pas de tx empirique si HD stable, attendre culture. Azithromycin/ Erythro, 500 mg daily for 3 days ou Cipro (mais résistance ad 20%) Induit Guillain-Barré 1/1000 **Vibrio cholerae et non colera spp** The difference between cholera and noncholera Vibrio spp. versus V. parahaemolyticuslies in the mechanism of pathogenesis. V. parahaemolyticus produces disease via toxins that cause intestinal mucosal destruction, whereas cholera and noncholera Vibrio strains produce an enterotoxin in vivo that stimulates enterocyte adenylate cyclase, disrupting mucosal fluid absorption and leading to a secretory diarrhea. Vibrio vulnificus, associé fruits de mer, induit septicémie, cause de mortalité importante. Doxy + ceftazidime, ou levaquin ou cipro Dose unique Cipro 1 g, Azithro 1g ou Doxycycline, 7 mg/kg up to 300 mg once **Vibrio—noncholera - Vibrio parahaemolyticus** Associé au fruits de mer/poisson cru, eaux salées Majorité de requièrent pas de tx, tx seulement si prolongé/sévère Ciprofloxacin, 750 mg daily for 3 days; azithromycin, 500 mg daily for 3 days Ceftriaxone **Enterotoxigenic Escherichia coli:** Ciprofloxacin, 750 mg daily for 3 days, rifaximin 200 mg tid for 3 days; azithromycin, 1 g once **Shiga toxin–producing E. coli; E. coli O157:H7** No treatment, supportive care only; antibiotics increase risk for HUS **Yersinia enterocolitica**: Supportive care; in severe cases, TMP-SMX (Bactrim) 1 co DS BID Doxy + aminoglycoside ou fluoroquinolones Peut mimer appendicite Manifestations immunes fréquentes: arthrite, Reiter, érythème noueux **Clostridium difficile** : Metronidazole, 500 mg tid for 10 days; vancomycin, 125 mg PO qid for 10 days **Staphylococcus aureus**: Supportive care **Clostridium perfringens**: Detection of spores in stool; production d'entérotoxine, Supportive care **Bacillus cereus;** Food may be cultured, produits spores 2 types d'entérotoxines (1 émétisante et l'autre diarrhée) Supportive care; for severe cases—vancomycin, 125 mg qid; or clindamycin, 500 mg tid for 7–10 days

Answer 47

Giardia lamblia: Stool microscopy for ova and parasite; Tinidazole—2 g PO single dose Metronidazole—500 mg PO bid or 250 mg tid for 5–7 days Nitazoxanide—500 mg bid for 3 days Alternative agents Albendazole—400 mg once daily for 5 days Mebendazole—200 mg PO tid for 5 days Quinacrine—100 mg PO tid for 5 days Paromomycin—10 mg/kg PO tid day for 5–10 days Entamoeba histolytica: Stool microscopy, culture, immunoassay Metronidazole—500–750 mg PO tid for 7–10 days; Tinidazole—2 g PO once a day for 3 days; Nitazoxanide—500 mg PO bid for 3 days Intraluminal infection Paromomycin—25–30 mg/kg PO tid for 7 days Diiodohydroxyquin—650 mg PO tid for 20 days for adults Diloxanide furoate—500 mg PO tid for 10 days for adults Cryptosporidium: Stool microscopy, culture, immunoassay Nitazoxanide—500 mg PO bid for 3 days Cyclospora cayetanensis: Stool microscopy, stool culture, acid-fast stain, fluorescence microscopy Trimethoprim—trimethoprim-sulfamethoxazole (TMP-SMX), one double-strength 160/800 mg tablet PO bid for 7–10 days

Answer 48

Poissons les + fréquemment impliqués: mahi mahi, thon, tassergal (blue fish) Scombroid fish poisoning results from the ingestion of heat-stable toxins produced by bacterial action on the histidine present in the dark meat of the fish. The bacteria responsible are normal constituents of the surface marine flora, rather than contaminants. The histidine decarboxylase activity of these organisms produces histamine and histamine-like substances, which cause the symptoms of scombroid fish poisoning. High levels of histamine in the fish correlate directly with the occurrence of the illness. In general, the problem is caused by improper refrigeration by the supplier rather than being the fault of the restaurant serving the fish While eating the fish, the patient may note a metallic, bitter, or peppery taste, although many affected fish do not have an abnormal odor or taste. Symptoms usually develop abruptly within 20 to 30 minutes and consist of facial flushing, diarrhea, severe and throbbing headache, palpitations, and abdominal cramps. Other manifestations may include dizziness, dry mouth, nausea and vomiting, and urticaria Tx: diphenhydramine, 50 mg IM or IV, or cimetidine, 300 mg IM or IV, usually relieve all symptoms promptly

Answer 49

More than 400 fish species that frequent coral reefs have been implicated as ciguatoxin carriers, but fewer than 50 are commercially important; these include amberjack, barracuda, grouper, king mackerel, parrotfish, sea bass, snapper, sturgeon, surgeonfish, and ulua. Ciguatoxin is produced by the marine dinoflagellate Gambierdiscus toxicus, which attaches itself to marine algae and is passed up the food chain. The lipid-soluble toxin accumulates in the tissues of the larger predacious coral reef fish Ciguatoxin has anticholinesterase and cholinergic properties, but its neurotoxicity is mediated by its effect on sodium channels The GI symptoms (eg, nausea, vomiting, profuse watery diarrhea, crampy abdominal pain, diaphoresis) tend to appear first and resolve over the first 24 hours. The constellation of neurologic symptoms consists largely of dysesthesias and paresthesias around the throat and the perioral area—burning feet, which may resemble alcoholic peripheral neuropathy, loose painful teeth, and sometimes CNS changes, such as ataxia, weakness, vertigo, visual hallucinations, and even confusion and coma. Cold allodynia, defined as dysesthesia experienced on contact with cold water or cold objects, is almost pathognomonic of ciguatera poisoning and often is incorrectly referred to as cold-hot temperature reversal. Another classic feature is a return or a worsening of all the symptoms after ingestion of alcohol. Ciguatera poisoning lasts an average of 1 to 2 weeks, but at least 50% of victims are still symptomatic at 8 weeks. Pruritus may be managed with a histamine H1 receptor antagonist, such as diphenhydramine 25 mg PO qid, or cetirizine, 10 mg once daily. Amitriptyline, 25 mg bid, can bring about a dramatic reduction in the pruritus and dysesthesias, two of the most disturbing and protracted symptoms.

Answer 50

In HAART-naïve populations, Cryptosporidium and CMV infections are the two most common causes Chronic high-volume watery diarrhea often is indicative of small bowel disease from one of the coccidia, Cryptosporidium and Cystoisospora belli. CMV and MAI also produce a chronic illness in those with CD4+ counts less than 100/mm3 Microsporidia fréquent si \< 100 Salmonella infections, especially with S. typhimurium, are common in immunocompromised hosts. Patients with AIDS who acquire Salmonella enteritis are at increased risk for bacteremia and metastatic focal infection compared with normal hosts Entérite bactérienne la + fréquente: C diff Patients with a fulminating clinical course usually have a disseminated infection, such as infection with CMV or MAI complex. Massive weight loss is also associated with diarrhea caused by infection with those two organisms and the coccidia Cryptosporidium and Cystoisospora. Voluminous watery diarrhea usually is a result of one of the coccidial organisms, including Cyclospora and Isospora. Patients with a proctocolitis-like picture most often have herpes simplex virus or CMV infection Ciprofloxacin, 500 mg PO, may be empirically initiated while the evaluation is in progress. If Giardia or C. difficile is suspected, metronidazole, 500 mg PO, should be added. If CMV colitis is suspected, foscarnet, 90 mg/kg IV, should be given

Answer 51

Recurrent abdominal pain or discomfort at least 3 days/mo in the previous 3 mo associated with two or more of the following: 1. Improvement with defecation 2. Onset associated with a change in frequency of stool 3. Onset associated with a change in form (appearance) of stool Facteurs qui ne concordent pas avec dx colon irritable: onset of symptoms after the age of 50 years, unintentional weight loss, anorexia, bloody stools, nocturnal diarrhea, or family history of significant colon disease Tx: dycyclomine Loperamide / lax-a-day Rifaximine ISRS, TCA

Answer 52

Trimethoprim-sulfamethoxazole, one double-strength tablet bid, andmetronidazole, 500 mg q6h or • Ciprofloxacin, 500 mg bid, and metronidazole, 500 mg q6h, or • Amoxicillin-clavulanate, extended-release, 1000/62.5 mg, two tablets bid

Answer 53

Néoplasie colique Volvulus Diverticulite Carcinomatose péritonéale Hernie incarcérée Adhérences Pseudo obstruction Fécalome Strictures

Answer 54

CU: Arthropathies inflammatoires, cholangite sclérosante (et atteinte oculaire, dermato, osseuse) Crohn: spondyarthropathies, uvéite, stomatite aphteuse, érythème noueux

Answer 55

Diarrhée Rectorragies Perte de poids Paleur, fatigue Atteinte oculaire/arthrite Fistules/abcès périanaux ATCD familiaux

Answer 56

Ulcerative Colitis Mild Disease • Fewer than four stools/day • Stools may contain some blood • No systemic signs of toxicity (eg, fever, tachycardia, anemia, elevated erythrocyte sedimentation rate) Moderate Disease • More than four stools/day • Minimal signs of toxicity Severe Disease • More than six bloody stools/day • Signs of systemic toxicity Crohn’s Disease Mild to Moderate Disease • Patient ambulatory and able to eat • No dehydration • No toxicity • No significant abdominal pain or mass • Weight loss of 10% Moderate to Severe Disease—Any of the Following • Mild disease that has failed to respond to treatment • Patient may have some systemic toxicity, significant weight loss, anemia • Fever, some abdominal pain or tenderness, intermittent nausea or vomiting Severe Disease • Persistence of symptoms during corticosteroid or biologic (eg, infliximab) therapy • High fever, persistent vomiting • Intestinal obstruction • Rebound tenderness • Cachexia • Abscess

Answer 57

CT features suggestive of CI include thumbprinting, wall thickening, and luminal narrowing and inner wall hypoperfusion, the so-called double halo sign

Answer 58

Lavement avec cortico LAvement avec sucralfate water-absorbing stool softeners to reduce mucus-containing diarrhea are helpful.

Answer 59

The superior, middle, and inferior hemorrhoidal arteries provide the blood supply to the anorectum. They arise from the inferior mesenteric, internal iliac, and internal pudendal arteries, respectively. The superior hemorrhoidal veins drain into the portal system, and the inferior hemorrhoidal veins drain into the caval system. Lymphatic drainage is to the inferior mesenteric nodes above the dentate line and to the inguinal nodes from all areas of the anorectum.

Answer 60

WASH regimena • bains de siège, analgésie, stool softeners, high fiber diets Nitroglycerin ointment (0.4%) bid or tid • Nifedipine gel (0.2%) bid with lidocaine (1.5%) • Botulinum toxin (surgical consultation) • Anal dilation performed with the patient under general anesthesia • Surgical excision

Answer 61

Horseshoe Abscess A large, communicating, horseshoe-shaped abscess forms in the ischiorectal, intersphincteric, or supralevator space. Surgical management is necessary.

Answer 62

Traitement de support - éviter macération, porter linge ample, éviter trauma - tx comorbidités, contrôle glycémie, perte de poids, arrêt tabagique - clinda topique - antibio systémiques à long terme (doxy, clinda) - rétinoides - immunosuppresseurs

Answer 63

Traumatique: lésion médullaire, trauma obstétrical, lésion sphincter, lésion nerveuse post-op Neurologique: neuropathie autonome (db), lésion nerveuse post-accouchement, démence, lésion médullaires Mécanique: CE, néoplasie, fécalome, hémorroides Ped: hirschprung, encoprésie, congénital, myéloméningocèle, spina bifida Autres: diarrhée, laxatif, MII, procidence

Answer 64

Acronyme ITCH Infection: VPH, HSV, syphilis, parasites/bactéries/fongiques, gale Topique irritation: mauvaise hygiène, fissure, fistule, skin tags, hémorroides Cutané: dermatite séborrhéique, psoriasis, lichen plan, lichen scléreux, néo cutané, dermatite contact (savons, cortico) Hypersensibilité: IRC, Db, Dysthyroidies, polycythémie, déficit fer/vit A/ vit D, caffeine, tea, beer, spicy foods, citrus fruits, quinidine, intravenous hydrocortisone, colchicine, tetracycline

Answer 65

**Common Conditions** Anal fissure Abscess and fistula Hemorrhoids Pruritus ani Pilonidal disease **Common Stds** Gonorrhea Chlamydial infection Herpes Chancroid Syphilis Condyloma acuminatum Atypical Conditions **Infectious** TB, CMV infection, actinomycosis, cryptococcosis Neoplastic Lymphoma, Kaposi’s sarcoma, squamous cell carcinoma Other Idiopathic anal ulcer

Gastro Flashcards

(101 cards)