Gastroenterology Flashcards
Short gut syndrome refers to ___________________.
patients who have anatomically or functionally decreased small intestinal length; anatomically this is typically less than 1/4 over the intestines and children and less than 1/6 of the intestines in adults
Patients with short gut syndrome will require what?
TPN
Common causes of short gut syndrome include ___________________.
NEC, volvulus, and trauma
___________ is characterized by a paucity of bile ducts on liver biopsy.
Alagille syndrome
Alagille syndrome has what inheritance pattern?
Autosomal dominant w/ variable penetrance
What are the diagnostic criteria of pancreatitis?
Two of the following:
- Elevated lipase
- Imaging findings
- Epigastric pain
Start feeding on ___________ days of no appetite in acute pancreatitis.
3
Colitis comes in three categories: __________.
infectious, ischemic, and inflammatory
Ischemic colitis typically affects what area of the colon?
The watershed area between the IMA and SMA, which is the splenic flexure
What are advantages and disadvantages to G-tubes and GJ-tubes?
G-tubes have the benefit of being easy to replace (can be done at bedside) and the ability to bolus feeds, but they carry a risk of aspiration. GJ-tubes have a decreased aspiration risk and have two ports, but they require fluoroscopy and must be continuous feeds through the J.
What kinds of abdominal pain present with abrupt, sudden-onset pain?
- Torsion (both ovarian and testicular)
- Aortic dissection
- Nephrolithiasis
- Ruptured ovarian cyst
To help get the best abdominal tenderness exam, _______________.
don’t tell them you’re going to press on their abdomen; instead, tell them you’re going to listen with your stethoscope and then slowly progress to palpation
When should you get a lactate in assessing abdominal pain?
Mesenteric ischemia
True or false: for suspected pancreatic cancer (e.g., painless jaundice) the first test to order is an abdominal CT with contrast.
False
For all suspected biliary disorders, an ultrasound is still the right first test. The other reason this might be helpful is that if it shows a pancreatic head mass then the next test may be an MRCP.
What medical things can help with achalasia if someone is obstructed?
- Glucagon
- NO
GI bleed in a person who’s had a AAA repair could be _____________.
aorto-enteric fistula, usually through the duodenum which is closest to the aorta
____________ is the most common complaint in acute diverticulitis.
Constipation
Review the four categories of causes of ascites.
Portal HTN:
- Cirrhosis
- Thrombosis
Hypoalbuminemia (loss of intravascular oncotic pressure):
- Protein-losing enteropathy
- Malnutrition
Volume overload:
- ESRD
- CHF
Malignancy:
- Peritoneal metastasis
- Hepatic metastasis
- Lymph blockage
What two criteria are diagnostic of SBP?
- WBC > 1,000 cells/mL
- PNMs > 250 cells/mL
Low glucose and high protein are suggestive of infection (and should be sent with cell count and culture) but not diagnostic.
_____________ is first line for SBP.
Cefotaxime
Review the causes of constipation and bowel obstruction.
Pharmacologic:
- Anticholinergics
- Antihistamines
- Opiates
- Antipsychotics
Neurologic:
- Neuropathies
- Parkinson’s
Endocrine:
- Hypothyroidism
- Diabetes
- Hyperparathyroidism (hypercalcemia)
Metabolic:
- Hypokalemia
- Hypomagnesemia
- Hypercalcemia
Toxicologic:
- Iron
- Lead
Malignant:
- GI cancers
Functional:
- Anal fissures
- Ileus
- Ogilvie
Review the three groups of causes of acute diarrhea.
Infectious:
- Bacterial
- Viral
- Protozoal (e.g., E. histolytica, Giardia, Cryptosporidium)
Ischemic:
- Mesenteric ischemia
- Ischemic colitis
Intoxication:
- Meds (e.g., metformin, NSAIDs)
- Alcohol
True or false: never treat ETEC.
False
EHEC should not be treated with abx because of the increased likelihood of HUS. ETEC should be treated with ciprofloxacin.
What are the two antibiotics of choice for most traveler’s diarrhea (like ETEC, Campylobacter)?
Ciprofloxacin or Bactrim
What three viruses are some of the most common causes of diarrhea?
Enterovirus, Norovirus, and Rotavirus
The most common cause of hematemesis in adults is ____________.
PUD
Dieulafoy lesions typically cause what type of GI bleeding?
Brisk bright red blood
Dieulafoy are arterial lesions so they will have sudden forceful, painless bleeds of bright red blood.
What study should you order to rule out esophageal perforation?
Chest CT
CXR can show it, but it is not sensitive so if you are concerned enough that you want to rule it out then get a CT.
Which kind of IBD has transmural inflammation?
Crohn’s
UC usually just affects the mucosa and submucosa.
What are the emergency conditions that can be caused by IBD?
Toxic megacolon
Small bowel obstruction
Abscess
Perforation
C difficile
On KUB, what diagnostic criteria meets toxic megacolon?
Colon greater than 6 cm
What is your suspected workup for Mallory Weiss tears?
Maybe nothing if the patient is stable and the exam/HPI is clear, but if concerned then the following:
- CXR (r/o pneumomediastinum)
- CBC
Also, observation in the ED for f/u bleeding.
The CTA GI bleed is for _________ GI bleeding.
lower
What is the Glasgow-Blatchford score?
A score used in ED patients with suspected upper GI bleed to determine who is low risk and can be discharged. The scores range from 0-23. Any score greater than 6 warrants admission.
- It’s not often used because it has a low threshold for positivity.
In patients with cirrhosis who have GI bleeding, ___________ has been shown to reduce mortality.
ceftriaxone
When would you diagnose SBP with a lower peritoneal PMN count?
In a patient receiving peritoneal dialysis the cutoff is > 100 WBC/uL w/ 50% or more PMNs or > 100 PMNs/uL
When you see a abscess near the anus, you need to decide what?
Is this a simple perianal abscess or is this a perirectal abscess. The main way you do this is by digital rectal examination. If the abscess feels like it abuts the anus or goes deep along on the rectum then you ought to get a CT pelvis w/ IV contrast. If it is a perirectal abscess then they must see surgery for more complex I&D w/ anoscopy. If it is a simple perianal abscess then ED I&D is acceptable.
True or false: perianal abscesses should not be treated with antibiotics.
False
All abscesses should be treated with either Augmentin or ciprofloxacin/Flagyl for 4-5 days.
Why is ammonia not a helpful lab in hepatic encephalopathy?
People can have hyperammonemia without hepatic encephalopathy and can have normal ammonia while having hepatic encephalopathy.
What percent of patients with SBP will have no symptoms or signs of infection?
10-20%
The most important treatment of hepatic encephalopathy is _____________.
poop
______________ is one of the earliest signs of HE.
Mental status changes
Ask “how much money do you have if you have three nickels and a dime.”