Gastrointestinal Flashcards
A patient presents with sudden onset of severe, diffuse abdominal pain. Examination reveals peritoneal signs, and abdominal radiograph reveals free air under the diaphragm. Management?
Emergent laparotomy to repair a perforated viscus
The most likely cause of acute lower GI bleeding in patients >40 years of age
Diverticulosis
Diagnostic modality used when ultrasonography is equivocal for cholecystitis
Hepatobiliary IminoDiacetic Acid (HIDA) scan
Risk factors for cholelithiasis
Fat, female, fertile, forty (or older), fair (white)
*First Aid says flatulent instead of fair, not sure where they got that from or what that is supposed to mean.
Inspiratory arrest during palpation of the RUQ. Likely diagnosis?
Murphy sign, seen in acute cholecystitis
The most common cause of small bowel obstruction (SBO) in patients with no history of abdominal surgery? With a history of abdominal surgery?
Without surgical hx: hernia
With surgical hx: adhesions
Most common bacterial organism causing diarrhea
Campylobacter
Organism causing diarrhea associated with recent antibiotic use
Clostridium difficile
Organism causing diarrhea associated with camping.
Giardia
Organism causing diarrhea associated with traveler’s diarrhea
Enterotoxigenic E. coli (ETEC)
Organism causing diarrhea associated with church picnics / mayonnaise
Staph aureus
Organism causing diarrhea associated with uncooked hamburgers
E coli. O157:HY (EHEC)
Organism causing diarrhea associated with fried rice
Bacillus cereus
Organism causing diarrhea associated with poultry/eggs
Salmonella
Organisms causing diarrhea associated with raw seafood
Vibrio, hepatitis A virus
Organisms causing diarrhea associated with AIDS
Isospora, Cryptosporidium, Mycobacterium avium complex (MAC)
Organisms causing diarrhea associated with pseudoappendicitis.
Yersinia, Campylobacter
A 25 year-old Jewish man presents with pain and water diarrhea after meals. Examination shows fistulas between the bowel and skin, and nodular lesions on his tibias. Likely diagnosis?
Crohn’s disease
Inflammatory disease of the colon with n increased risk of colon cancer
Ulcerative colitis (greater risk than Crohn’s)
Extraintestinal manifestations of IBD
Uveitis, ankylosing spondylitis, pyoderma gangrenosum, erythema nodosum, primary sclerosing cholangitis
Medical treatment for IBD
5-ASA agents and steroids during acute exacerbations
A 30 year old man with ulcerative colitis presents with fatigue, jaundice, and pruritis. Likely diagnosis?
Primary sclerosing cholangitis
Difference between Mallory-Weiss and Boerhaave tears
Mallory-Weiss: superficial tear in the esophageal mucosa
Boerhaave: full-thickness esophageal rupture
Signs of and condition indicated by Charcot triad?
Reynolds’ pentad?
Charcot: RUQ pain, jaundice, and fever/chills. Acute cholangitis.
Reynold’s: Triad plus shock and AMS. Obstructive ascending cholangitis.
Medical treatment for hepatic encephalopathy
Decreased protein intake, lactulose, rifamixin
The first step in the management of a patient with an acute GI bleeding episode
ABCs
A 4 year old child presents with oliguria, petechiae, and jaundice following an illness with bloodny diarrhea. Most likely diagnosis and cause?
Hemolytic-uremic syndrome (HUS) due to E. coli O157:H7 (or alternatively, other E. coli serotypes, Shigella, or Campylobacter)
Treatment after exposure to hepatitis B virus?
Hepatitis B Immune Globulin (HBIG)
Classic causes of drug-induced hepatitis
TB medications (isoniazid/INH, rifampin, pyrazinamide), acetaminophen, and tetracycline
A 40 year old obese woman with elevated alkaline phosphatase, elevated bilirubin, pruritis, dark urine, and clay-colored stools. Likely diagnosis?
Biliary tract obstruction
Hernia with highest risk of incarceration: indirect, direct, or femoral?
Femoral
Severe abdominal pain out of proportion to the examination suggests…?
Mesenteric ischemia
Diagnosis of ileus
Abdominal radiographs (could also perform CT scan)
A 50 year old man with a history of alcohol abuse presents with boring epigastric pain that radiates to the back and is relieved by sitting forward. Likely diagnosis? Management?
Confirm the diagnosis of pancreatitis with elevated amylase and lipase. Make the patient NPO, give IV fluids, oxygen, analgesia, and “tincture of time”
Anemia from chronic disease, occult blood loss, vague abdominal pain.
Right-sided colon cancer (rarely causes obstruction)
Obstructive symptoms and changes in bowel movements
Left-sided colon cancer: “apple-core” lesion
What presents with watery diarrhea, dehydration, muscle weakness, and flushing? Management?
VIPoma. Replace fluids and electrolytes, may need to surgically resect tumor or use octreotide
What presents with palpable, nontender gallbladder? Name of sign?
Courvoisier sign, suggests pancreatic cancer
