Gastrointestinal Flashcards
List the structures of upper and lower GI tract:
Upper:
Mouth, esophagus, cardiac sphincter, stomach, pyloric sphincter, duodenum. Ligament of Treitz.
Lower:
Jejunum, ileum, caecum, ascending -> transverse -> descending -> sigmoid colon, rectum, anus.
Signs of ESLD:
Jaundice, ascites, spider angiomas (do not blanche), palmar erythema, asterixis, caput medusae, umbilical herniation.
When performing an abdominal exam, what does rebound tenderness signify?
That the peritoneum of the affected organ is also inflamed. This has a worse prognosis and indicates a progression of the pathology.
What are signs of pancreatitis?
"Sharp" postprandial, epigastric pain Lipase count > 3 x normal Cullen sign (discoloured umbilicus) Grey-turner sign (discoloured flanks) Hypo/hyperglycaemia *May also have elevated GGT/ALP
What is an “acute abdomen?”
A serious undifferentiated diagnosis indicating severe peritoneal inflammation that requires prompt surgical consult.
Patients will be unassessable due to significant abdominal tenderness.
How do you assess for appendicitis?
Pain on palpating at McBurney’s point (1/3 of the way between the right anterior iliac crest and the umbilicus).
Rovsing’s sign: Pain in the LRQ as the left abdomen is being firmly palpated.
Identify the difference between cirrhosis and hepatitis on radiological imaging:
Hepatitis will present with hepatomegaly while cirrhosis will be much smaller due to the scarring.
Costovertibral Angle (CVA) tenderness is indicative of what?
Pyelonephritis. Likely, from a severe bacterial infection of the kidneys.
What are your tranamynase enzymes and what do elevations in their count represent?
AST and ALT
They represent direct hepatocyte damage since they leak out of ischemic/damaged liver cells. In acute liver failure, levels might be normal if the patient has a long Hx of ESDL and the liver is no longer capable of producing enough of them.
*AST:ALT > 2:1 = EtOH
How do you tell if the liver failure is from an EtOH based etiology?
The AST will be at least twice as much as the ALT. Elevated GGT might also be present.
What do elevated levels of AST and ALT indicate?
Acute, undifferentiated hepatitis. Could be from toxins, trauma, infection or drugs.
What are cholestatic enzymes and what do they represent?
ALP and GGT
When downstream pressure in the bile duct backs up into biliary tree these endothelial enzymes are released into the circulation. They represent biliary obstruction.
What are the three most important liver function tests?
- Albumin
- INR (vitamin K dependant clotting factors of the extrinsic pathway)
- Bilirubin
- Lactate
Where is unconjugated bilirubin found?
In the pre-hepatic blood stream. An elevated level most often indicates hemolysis or liver failure.
What is the difference between amylase and lipase?
Lipase is produced only in the pancreas while amylase is also produced in the saliva.
*A pleural effusion with a positive amylase indicates esophageal rupture.
Will a GI bleed have a high or a low BUN?
High. Blood is reabsorbed, digested and the protein then elevates the BUN.
Signs of an upper GI bleed:
Hemoptysis
Coffee ground emesis
Melena
*Can also have bright, red rectal blood if it is brisk. These patients are unstable!
Variceal causes of UGIB:
Portal HTN
Portal vein thrombosis
Gastric varices
Non-variceal causes of UGIB:
- Peptic/duodenal ulcer (NSAIDs, prev PUD, H. Pylori, steroids)
- Boerhaave (+/- vomiting)
- Gastritis/esophagitis (EtOH)
Tx of non-variceal UGIB:
Transfuse, if necessary, and correct coagulopathies (PRBCs, FFP, Plex, Cryo, Vit K, Ca++)
PPI (80mg Pantaloc)
Antiemetics
TXA
Tx of variceal UGIB
Transfuse and correct coagulopathies Octreotide and/or vasopressin TXA ABx Blakemore or Minnesota
Discuss the insertion of a Blakemore:
- Lube it up and insert it approx 50cm
- Partially inflate it, pull back until resistance and check X-ray
- Fully inflate gastric balloon to tamponade vessels, apply 1kg traction
- If still bleeding, inflate esophageal balloon
- Consider using saline to inflate balloons for flight