Gastrointestinal Flashcards
diagnostic modality used when US is equivocal for choledystitis
HIDA scan
risk factors for cholelithasis
fat, female, fertile, forty, and flatulent
inspiratory arrest during palpation of the RUQ
murphy’s sign - seen in acute cholecytisis
most common causes of small bowel obstructions
ABCs - adhesions; bulge (hernia); cancer
IBD w/ increased risk of colon cancer
UC
extraintestional manifestions of IBD
uveitis, anklyosing spondylitis, pyoderma gangrenosum, erythema nodosum, primary sclerosing cholangitis
medical tx for IBD
5-ASA agents and steroids during acute exacerbations
difference between mallory-weiss and boerhaave tears
mallory weiss = superficial tear in the esophageal mucosa
boerhaave = full-thickness esophageal rupture
charcot’s triad - signs of ascending cholangitis
RUQ pain, jaundice, and fever/chills
reynold’s pentad - signs of suppurative ascending cholangitis
charcot’s triad plus shock (hypotension) and AMS
medical tx for hepatic encephalopathy
decreased protein intake, lactulose, and rifaximin
first step in the mgmt of a pt w/ an acute GI bleed
manage ABCs
post-HBV exposure tx
HBV immunoglobulin
classic causes of drug-induced hepatitis
TB meds (INH, rifampin, pyrazinamide), acetaminophen, and tetracycline
hernia w/ the highest risk of incarceration - indirect, direct, or femoral
femoral
most likely cause of acute lower GI bleed in pts > 40 yo
diverticulosis
describe the three distinct categories of liver function…
- synthetic (synthesis of clotting factors, cholesterol, and proteins)
- metabolic (metabolism of drugs and steroids, including detoxification)
- excretory (bile excretion)
hyperestrogenism in cirrhosis leads to…
gynecomastia, testicular atrophy, decreased body hair, spider angiomas, and palmar erythema
most common etiology of bacterial diarrhea. pt frequently presents w/ bloody diarrhea. cause? tx?
camplyobacter. tx w/ erythromycin
diarrhea associated w/ recent abx (PCN, quinolones, clindamycin) that presents w/ fever, abdominal pain, and watery diarrhea. lab? dx? tx? complications?
labs - c diff toxin assay
dx - c. diff
tx - cessation of inciting abx, tx w/ PO metronidazole or vanc; give IV metronidazole if pt cannot tolerate
complications - toxic megacolon
pt traveling to developing country (w/in 3 months) presents w/ severe abdominal pain, diarrhea, and fever. + fecal RBCs and WBCs. dx? tx?
entamoeba histolytica. tx w/ metronidazole (avoid steroid as can lead to fatal perforation)
child recently eaten meat presents w/ severe abdominal pain, low grade fever, vomiting, and diarrhea. dx? tx? complication?
e coli 0157:H7. tx w/ supportive care. avoid abx or anti-diarrhea meds as can increase complication of HUS
pt ingested poultry or eggs presents w/ prodromal HA, fever, myalgia, abdominal pain and diarrhea. dx?
salmonella
pt w/ severe diarrhea. + fecal RBCs and WBCs. spread fecal-oral route. dx? tx?
shigella. tx w/ TMP-SMX
HIV pt w/ bloody diarrhea, normal stool exam, colonoscopy shows multiple ulcers and mucosal erosions, biopsy demonstrates characteristic cells w/ inclusion bodies. dx? tx?
CMV colitis. tx of choice is ganciclovir. foscarnet is alternative.
pt returning from developing country or camping trip w/ symptoms of malabsorption (s/s including foul smelling stools, fatty stools, bloating, flatulence, nausea, malaise, and abdominal cramps). dx? tx?
giardiasis. tx w/ metronidazole.
pt w/ epigastric pain that improves upon eating? cause?
duodenal ulcer. most commonly H pylori or NSAIDs
zenker diverticulum develops due to…
due to posterior herniation between the fibers of the cricopharyngeal muscle
distinguish between crohns and UC - s/s, location, morphology, complications, tx
crohns:
s/s = diarrhea (+/- bloody) w/ IBD associated symptoms;
location = any portion of GI tract except rectum w/ skip lesions;
morph = transmural inflammation –> fistulas, cobblestoning, non-caseating granulomas
complications = strictures, fistulas
tx = corticosteroids, azathioprine, methotrexate, infliximab, adalimumab
UC:
s/s = bloody diarrhea w/ IBD associated symptoms;
location = colon, continuous, always involving the rectum;
morph = mucosal and submucosal inflammation only, loss of haustra - lead pipe appearance, ulcers
complications = increased colon cancer risk, PSC, toxic megacolon
tx = ASA preparations (sulfasalazine), 6-MP, infliximab, colectomy
pt w/ recurrent abdominal pain associated w/ 2 of more: pain improves w/ defecation, change in stool freq, change in stool appearance, alternating between loose and constipation
IBS
marked elevations in AST and ALT (> 25 x ULN). ddx?
ddx includes toxin-induced (ie tylenol), ischemic, or viral hepatitis
LFTs in alcoholic hepatitis
elevated AST and ALT (AST: ALT is 2:1) usually with levels less than 300 (def no more than 500) + increased GGT
