Gastrointestinal Flashcards
Most likely cause of acute LGIB in pts >40 yo
Diverticulosis
Dxic modality when U/S is equivocal for cholecystitis
HIDA scan
RFs for cholelithiasis
Fat, female, fertile, forty, flatulent
Inspiratory arrest during palpation of the RUQ
Murphy’s sign, seen in acute cholecystitis
MCC of SBO in pts with no h/o abdominal surgery
Hernia
MCC of SBO in pts with a h/o abdominal surgery
Adhesions
Diarrhea: MC organism
Campylobacter
Diarrhea: recent abx use
Clostridium difficile
Diarrhea: camping
Giardia
Diarrhea: traveler’s diarrhea
ETEC
Diarrhea: church picnics/mayo
S. aureus
Diarrhea: uncooked hamburgers
E. coli O157:H7
Diarrhea: fried rice
Bacillus cereus
Diarrhea: poultry/eggs
Salmonella
Diarrhea: raw seafood
Vibrio, HAV
Diarrhea: AIDS
Isospora, Cryptosporidium, Mycobacterium avium complex (MAC)
Diarrhea: pseudoappendicitis
Yersinia
25 yo Jewish M presents with pain and watery diarrhea after meals
Exam: fistulas btwn the bowel and skin, nodular lesions on tibias
Crohn’s dz
Inflammatory dz of the colon with increased risk of colon CA
Ulcerative colitis (greater risk than Crohn’s)
Extraintestinal manifestations of IBD
Uveitis, ankylosing spondylitis, pyoderma gangrenosum, erythema nodosum, 1˚ sclerosing cholangitis
Medical tx for IBD
5-ASA agents and steroids during acute exacerbations
Difference btwn Mallory-Weiss and Boerhaave tears
- Mallory-Weiss: superficial tear in the esophageal mucosa
- Boerhaave: full-thickness esophageal rupture
Charcot’s triad
RUQ pain, jaundice, and fever/chills in the setting of ascending cholangitis
Reynolds’ pentad
Charcot’s triad (RUQ pain, jaundice, fever) + shock + mental status ∆s, with suppurative ascending cholangitis
Medical tx for hepatic encephalopathy (HE)
- Decrease protein intake
- Lactulose
- Rifaximin
1st step in managing a pt with an acute GIB
Establish the ABCs
4 yo presents with oliguria, petechiae, and jaundice following an illness with bloody diarrhea. Most likely dx and cause?
Hemolytic uremic syndrome (HUS) d/t E. coli O157:H7
Post-HBV exposure tx
HBV immunoglobulin
Classic causes of drug-induced hepatitis
- TB meds (INH, rifampin, pyrazinamide)
- Acetaminophen
- Tetracycline
40 yo obese F with elevated alk phos, elevated bili, pruritus, dark urine, and clay-colored stools
Biliary tract obstruction
Hernia with highest risk of incarceration: indirect, direct, or femoral?
Femoral hernia
50 yo M with h/o alcohol abuse presents with boring epigastric pain that radiates to the back and is relieved by sitting forward. Management?
Confirm the dx of acute pancreatitis with elevated amylase and lipase. Make sure pt is NPO. Give IVF, O2, analgesia, and “tincture of time.”
Pt presents with sudden onset of severe, diffuse abd pain
Exam: peritoneal signs
AXR: free air under the diaphragm
Management?
Emergent laparotomy to repair perforated viscus
