Gastrointestinal Flashcards
A patient presents with sudden onset of severe, diffuse adominal pain. Examination reveals peitoneal signs and abdominal radiograph reveals free air under the diaphragm. Management?
Emergent laparatomy to repair a perforated viscus.
The most likely cause of acute lower GI bleeding in patients > 40 years of age.
Diverticulosis
Risk factors for cholelithiasis
Fat, female ,fertile, forty, flatulent
Inspiratory arrest during palpation of the RUQ
Murphy sign, seen in acute cholecystitis
The most common caurse of small-bowel obstruction (SBQ) in patients with no history of abdominal surgery
Hernia
The most common cause of SBQ in patients with a history of abdominal surgery
Adhesions
Identify key organisms causing diarrhea: Most common bacterial organism Recent antibiotic use TRaveler's diarrhea Poultry/eggs Raw seafood
Campylobacter Clostridium difficile Enterotoxigenic Escherichia Coli (ETEC) Salmonella Vibrio, hepatitis A (HAV)
A 25-year old Jewish man presents with pain and watery diarrhea after meals. Examination shouws fistulas between the bowel and skin and nodular lesions on his tibias
Crohn disease
Inflammatory disease of the colo with a raised risk of colon cancer
Ulcerative colitis (greater risk than Crohn)
Extraintestinal manifestations of IBD
Uveitis, ankylosing spondylitis, pyoderma gangrenosum,erythema nodosum, 1° sclerosing cholangitis
Difference betwwen Mallory-Weiss and Boerhaave tears
Mallory - Weiss__ superficial tear in the esophageal mucosa; Boerhaave ___ full-thickness esophadeal rupture
Charcot triad
RUQ pain, jaundice, and fever/chills
Reynolds pentad
Charcot triad plus shock and mental status changes
Medical treatment for hepatic encephalopathy
Lowered protein intake, lactulose, rifaximin
The first step in the management of a paitent with an acute GI bleeding episode
Manage ABCs
A 4-year old child presents with oliguria, petechiae, and jaundice following an illness with bloody diarrhea. Most likely diagnosis and cause?
Hemolytic-uremic syndrome (HUS° due to E Coli Q157:H7
Treatment after exposure to hepatitis B virus (HBV)
HBV immunoglobin
Classic cause of drug-induced hepatitis
TB medications (INH, rifampicine, pyrazinamide) acetaminophen, and tetracycline
A 40-year old obese woman with elevated alkaline phosphatase, elevated bilirubin, pruritus, dark urine and clay-lolored stools
Biliary tract obstruction
Hernia with highest risk of incarceration – indirect, direct, or femoral?
Femoral hernia
Severe abdominal pain out of proportion to the examination
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 . Management?
Confirm the diagnosis of acute pandreatitis with elevated amylase and lipase. Make the patient NPO and give IV fluids, Oé, analgesia, and “tincture of time”
Colon cancer region based on symptoms:
- Anemia from chronic disiase, occult blood loss, vague abdominal pain.
- Obstructive symptoms, change in bowel movements
Right sided: rare to have an obstriction
Left- sided : “apple-core” lesion
Presents with watery diarrhea, dehydration, muscle weakness, and flushing
VIPoma (replace fluids and elctrolytes, may need to surgically resect tumor, or use octreotide)
Presents with palpable nontender gallbladder
Courvoisier sign (suggests pancreatic cancer)
