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Emergency EOR > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

Complications of GERD

A
  1. Esophagitis
  2. Stricture
  3. Barrett’s esophagus
  4. Esophageal adenocarcinoma
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2
Q

Esophageal squamous epithelium replaced by precancerous metaplastic columnar cells from the cardiac of the stomach

A

Barrett’s Esophagus

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3
Q

Atypical symptoms of GERD

A 
Hoarseness
Aspiration pneumonia
"Asthma"
Noncardiac chest pain
Weight loss
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4
Q

Alarm symptoms of GERD

A
  1. Dysphagia
  2. Odynophagia
  3. Weight loss
  4. Bleeding (suspect malignancy)
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5
Q

Diagnosis of GERD

A
  1. Clinical diagnosis
  2. Endoscopy (used first)
  3. Esophageal manometry
  4. 24 hours ambulatory pH monitoring (gold standard)
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6
Q

Management of GERD

A
  1. Lifestyle modifications
  2. H2 blockers, PPIs, antacids
  3. Nissen fundoplication if refractory
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7
Q

Yellowing of the skin, nail beds, and sclera by tissue bilirubin deposition as a consequence of hyperbilirubinemia. Not a disease but a sign of a disease

A

Jaundice

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8
Q

Jaundice occurs when bilirubin is > _____

A

2.5 mg/dL

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9
Q

DDX for hematemesis

A 
Esophageal varices
Mallory-Weiss tear
Esophageal neoplasms
Gastritis
Peptic ulcer disease
Gastric carcinoma
Caustic (corrosive) esophagitis
Boerhaave syndrome
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10
Q

DDX for melena

A 
Esophageal varices
Gastritis
Mallory-Weiss tear
Peptic ulcer disease
Gastric carcinoma
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11
Q

DDX for BRBPR

A

Hemorrhoids
Anal fissures
Intussusception
Colon CA

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12
Q

Most common cause of esophagitis

A

GERD

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13
Q

Risk factors for esophagitis

A 
Pregnancy
Smoking
obesity
EtOH use
Chocolate
Spicy foods
Medications
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14
Q

Signs/Symptoms of esophagitis

A
  1. Odynophagia
  2. Dysphagia
  3. Retrosternal chest pain
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15
Q

Diagnosis of esophagitis

A

Endoscopy

Double-contrast esophagram

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16
Q

Management of esophagitis

A

Treat underlying cause

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17
Q

Most common causes of infectious esophagitis

A

Candida
HSV - small, deep ulcers
CMV - large superficial shallow ulcers

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18
Q

Allergic, inflammatory infiltration of the esophageal epithelium

A

Eosinophilic esophagitis

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19
Q

Eosinophilic esophagitis is most commonly associated with:

A

Atopic disease - food/non food allergies, asthma, eczema

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20
Q

Endoscopy of eosinophilic esophagitis will show:

A

Multiple corrugated rings on esophagus, +/- white exudates

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21
Q

How might esophinophilic esophagitis present in children?

A

Difficulty feeding or reflux

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22
Q

Most commonly due to prolonged pill contact with the esophagus, prolonged supination after pill ingestion

A

Pill-induced esophagitis

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23
Q

Pill-induced esophagitis is most commonly seen with:

A
  1. NSAIDs
  2. Bisphosphonates (-dronate)
  3. Potassium chloride
  4. Iron pills
  5. Vitamin C
  6. Beta blockers
  7. Calcium channel blockers
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24
Q

Management of pill-induced esophagitis

A

Take pills with at least 4 ounces of water, avoid recumbency for at least 30-60 minutes after pill ingestion

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25
Q

Most common cause of caustic (corrosive) esophagitis

A

Ingestion of corrosive substances - alkali (drain cleaner, lye, bleach) or acids

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26
Q

Management of caustic (corrosive) esophagitis

A

Supportive
Pain meds
IV fluids

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27
Q

UGI bleeding from longitudinal mucosal lacerations at the gastroesophageal junction or the gastric cardia

A

Mallory-Weiss tear

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28
Q

Management of Mallory-Weiss tear

A

Supportive - most cases stop bleeding without intervention. Acid suppression promotes healing

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29
Q

Management of Mallory-

Weiss tear if severe

A

Epinephrine injection
Sclerosing agent
Band ligation
Hemoclipping or balloon tamponade

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30
Q

What two causes predispose a pt to peptic ulcers?

A

H pylori

NSAIDs

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31
Q

Symptoms of peptic ulcers

A

Duodenal ulcers: improve with meals

Gastric ulcers: worsen with meals

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32
Q

Diagnostic modality for peptic ulcers

A

Endoscopy

Upper GI series if unwilling to do endoscopy

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33
Q

Treatmet tfor peptic ulcers

A

Treat underlying cause and start PPI

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34
Q

H pylori testing

A

Endoscopy with biopsy gold standard + rapid urease test
+ urea breath test
+ h. pylori stool antigen
+ serologic antibodies

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35
Q

Treatment for H pylori

A

Two weeks of:
BID PPI
BID Clarithromycin
BID Amoxicillin (or metronidazole if PCN allergic)

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36
Q

Second line treatment for H pylori

A

BID PPI
QID Bismuth
BID Metronidazole
BID Tetracycline

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37
Q

Most common bacterial etiologies of acute cholecystitis

A

E. coli

Klebsiella

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38
Q

Diagnosis of cholecystitis

A
  1. Ultrasound
  2. CT scan
  3. Labs: leukocytosis w/ left shift, high bilirubin, high LFTs
  4. HIDA scan: gold standard
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39
Q

Management of cholecystitis

A
  1. NPO, IV fluids, abx
  2. Cholecystectomy
  3. Pain control with NSAIDs or narcotics
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40
Q

Bacterial infection of the biliary tract from obstruction

A

Cholangitis

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41
Q

Most common causes of cholangitis

A

Choledocholithiasis (MC)
Neoplasm
Stricture

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42
Q

Most common organisms in cholangitis

A

E. coli (MC)

Klebsiella

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43
Q

Charcot’s Triad

A

Seen in cholangitis

  1. RUQ pain
  2. Fever
  3. Jaundice
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44
Q

Reynold’s Pentad

A

Seen in cholangitis
1,2,3 Charcot’s triad
4. Shock/Sepsis
5. AMS

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45
Q

Diagnostic modalities for cholangitis

A
  1. Labs: leukocytosis, high bili, high ALT, AST
  2. US, CT scan
  3. cholangiography - gold standard via ERCP
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46
Q

Management of cholangitis

A 
ABX:
1. Ampicillin/sulbactam or Piperacillin/tazobactam
OR
2. Ceftriaxone + metronidazole
OR
3. fluoroquinolone + metronidazole

stone extraction via ERCP

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47
Q

Inflammation of the liver caused by 5 different viruses

A

Viral hepatitis

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48
Q

Hepatitis __, __, and __ are transmitted through bodily fluids, while __ and __ are transmitted through the fecal-oral route

A

BCD

AE

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49
Q

Hepatitis __ requires co-infection with hepatitis __

A

D

B

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50
Q

Currently, the CDC suggests that all pts born between _____ and _____ have a one-time Hepatitis C screening

A

1945-1965

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51
Q

Signs/symptoms of viral hepatitis

A
  1. Fever, fatigue
  2. N/V
  3. abd pain
  4. dark discolored urine (secondary to conjugated hyperbilirubinemia)
  5. jaundice
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52
Q

Hepatitis __ and __ will usually be asymptomatic

A

B and C

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53
Q

Diagnosis of Hepatitis

A
  1. Elevated LFTs
  2. Elevated PT (if developed cirrhosis)
  3. Antibody testing (IgM and IgG)
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54
Q

In hepatitis testing, ___ is for acute infection, and ___ is for chronic infection

A

IgM
IgG
This does not apply to Hep B and C

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55
Q

Test to check for active Hepatitis C infection

A

Hep C virus RNA

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56
Q

If there is positive Hep C antibody, but negative RNA

A

Pt has cleared Hep C infection

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57
Q

If there is positive Hep C antibody and positive Hep C RNA

A

Pt has active Hep C infection

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58
Q

Hepatitis B screening:

  1. HbsAg (-)
  2. anti-HBc (-)
  3. anti-HBs (-)
A

Hepatitis B susceptible

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59
Q

Hepatitis B screening:

  1. HBsAg (-)
  2. anti-HBc (-)
  3. anti-HBs (+)
A

Immune due to natural infection

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60
Q

Hepatitis B Screening
HBsAg negative
anti-HBc negative
anti-HBs positive

A

Immune due to vaccination

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61
Q 
Hepatitis B screening:
HbsAg positive
anti-HBc positive
IgM anti-HBc positive
anti-HBs negative
A

Acutely infected

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62
Q 
Hepatitis B screening:
HbsAg positive
anti-HBc positive
IgM anti-HBc negative
anti-HBs negative
A

Chronically infected

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63
Q

Treatment for Hepatitis A and E

A

Self-resolve, are not associated with chronic liver disease

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64
Q

Treatment for acute hepatitis B

A

Supportive Care

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65
Q

Treatment for chronic Hepatitis B or positive e-antigen

A

Interferon or Nucleoside analogs (entecavir, tenofovir, lamivudine, adefovir, telvibudine)

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66
Q

Treatment for hepatitis pts with cirrhosis

A

Require transplant

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67
Q

Treatment for hepatitis C

A

Ledipasvir-sofosbuvir OR

Sofosbuvir and velpatasvir

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68
Q

Most common etiologies for acute pancreatitis

A
  1. Gallstones (MC)
  2. EtOH (MC)
  3. Malignancy
  4. Scorpion bites
  5. Mumps in children
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69
Q

Intracellular activation of pancreatic enzymes that causes autodigestion of the pancreas

A

Acute pancreatitis

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70
Q

Pain exacerbated if supine, eating or walking. Relieved if leaning forward or sitting.

A

Acute pancreatitis

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71
Q

Signs/symptoms of acute pancreatitis

A
  1. Epigastric pain (radiates to back)
  2. N/V and fever
  3. Epigastric tenderness and tachycardia
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72
Q

Cullen’s sign and grey turner sign

A

Acute pancreatitis if necrotizing/hemorrhagic
Cullen’s periumbilical ecchymosis
Grey turner: flank ecchymosis

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73
Q

Diagnostic studies for pancreatitis

A
  1. Leukocytosis, lipase, amylase, high glucose
  2. CT: diagnostic test of choice
  3. Ultrasound
  4. XR - colon cutoff sign
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74
Q

Colon cutoff sign

A

Abrupt collapse of the colon near the pancreas

Acute pancreatitis

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75
Q

Management of pancreatitis

A

90% recover without complications in 3-7 days

  1. Supportive - NPO, IV fluid resuscitation, analgesia with meperidine/Demerol
  2. Abx not commonly used
  3. If necrotizing pancreatitis - imipenem
  4. ERCP - only effective for obstructive jaundice
76
Q

Ranson’s Criteria

A

Used to determine prognosis for pancreatitis
Glucose, Age, LDH, AST, WBC
Calcium, Hematocrit fall, Oxygen, BUN, Base deficit, Sequestration of fluid

77
Q

Causes of appendicitis

A

Obstruction of the appendix MC due to:

  1. Fecalith
  2. Inflammation
  3. Malignancy
  4. Foreign body
78
Q

Vomiting usually occurs _______ pain in appendicitis

79
Q

Diagnosis of appendicitis

A
  1. Leukocytosis
  2. CT scan
  3. Ultrasound
80
Q

Management of appendicitis

A

Appendectomy

81
Q

Most common area of diverticular disease due to intraluminal pressure

A

Sigmoid colon

82
Q

Diverticulosis is associated with: (3)

A
  1. Low fiber diet
  2. Constipation
  3. Obesity
83
Q

Most common cause of acute lower GI bleeding

A

Diverticulosis

84
Q

Sign/Symptoms of diverticulitis

A

Fever
LLQ abdominal pain
N/V/D/C

85
Q

Diagnosis of diverticulitis

A

CT is test of choice

Labs: WBCs increased, + guiac

86
Q

Management of diverticulitis

A

Clear liquid diet

ABX (cipro or Bactrim + metronidazole)

87
Q

Sudden decrease of mesenteric blood supply to the bowel leading to inadequate perfusion especially at splenic flexure

A

Acute mesenteric ischemia

88
Q

Most common cause of acute mesenteric ischemia

A

Occlusion - embolus (AFib, MI)

Also: thrombus (atherosclerosis)

89
Q

Nonocclusive causes of acute mesenteric ischemia

A

Shock (decreased blood flow)
Cocaine (vasospasms)
Venous thrombosis

90
Q

Severe abdominal pain out of proportion to physical findings. Usually poorly localized pain with n/v/d, possible peritonitis

A

Acute mesenteric ischemia

91
Q

Diagnosis of acute mesenteric ischemia

A
  1. Angiogram definitive
  2. Colonoscopy - patchy, necrotic areas
  3. WBC high, lactic acidosis
92
Q

Management of acute mesenteric ischemia

A 
Surgical revascularization (angioplasty or stenting with bypass)
Surgical resection if bowel is not salvageable
93
Q

Increased risk of CA in both when there is colonic involvement

A

Inflammatory bowel disease - UC and Crohn’s

94
Q

Signs/Symptoms of inflammatory bowel disease

A
  1. Abd pain
  2. Weight loss
  3. Bloody diarrhea
  4. Fever
95
Q

Extraintestinal manifestations of IBD

A
  1. Erythema nodosum
  2. Arthritis
  3. Uveitits
  4. Pyoderma gangrenosum
  5. Primary sclerosing cholangitis
96
Q

Characteristics of ulcerative colitis

A

Involves colon
Continuous involvement
pANCA positive

97
Q

Characteristics of crohn’s disease

A 
Skip lesions
Entire GI tract involvement (mouth to anus)
Transmural inflammation
Cobblestone appearance
Fistulas may be seen
ASCA positive
98
Q

Treatment for inflammatory bowel disease

A
  1. Steroids for acute exacerbations
  2. Sulfasalazine or mesalamine
  3. If no response to sulfa or mesalamine, ABX are used for crohn’s only
  4. Colectomy or proctocolectomy is offered to those with extensive dz refractory to medications
99
Q

Etiologies of toxic megacolon

A

UC
Crohn’s
Pseudomembranous colitis
Infectious

100
Q

Signs/symptoms of toxic megacolon

A 
Fever
Abd pain
N/V/D
Rectal bleeding
Tenesmus (cramping rectal pain)
Electrolyte disorders
101
Q

Physical exam findings for toxic megacolon

A 
Abd tenderness
Rigidity
Tachycardia
Dehydration
Hypotension
AMS
102
Q

Diagnosis of toxic megacolon

A
  1. AXR: large dilated colon > 6 cm
103
Q

Management of toxic megacolon

A 
Bowel decompression
Bowel rest
NG tube
Broad-spectrum abx
Electrolyte repletion
104
Q

Most common cause of large bowel obstruction in adults

A

Colorectal cancer

105
Q

Most common causes of small bowel obstruction

A
  1. Adhesions
  2. Incarcerated hernia
  3. Crohn’s dz
  4. Malignancy
106
Q

Signs/Symptoms of small bowel obstruction

A 
CAVO
Cramping abd pain
Abdominal distention
Vomiting - may be bilious if proximal
Obstipation (late finding) - diarrhea early
107
Q

Physical exam for SBO

A

Abdominal distention
Hyperactive bowel sounds in early obstruction
Hypoactive bowel sounds in late obstruction

108
Q

Diagnosis of small bowel obstruction

A
  1. AXR - air fluid levels in step ladder pattern, dilated bowel loops
109
Q

Management of small bowel obstruction

A

Nonstrangulated: NPO, IV fluids, NG tube
Strangulated: surgical intervention

110
Q

Twisting of any part of the bowel at its mesenteric attachment site

111
Q

Most common area of volvulus occurrence

A

Sigmoid colon and cecum

112
Q

Signs/Symptoms of volvulus

A 
Obstructive symptoms
Abd pain
Distention
N/V
Fever, tachycardia
113
Q

Management of volvulus

A

Endoscopic decompression initial treatment of choice

Surgical correction is second line

114
Q

Causes of anal fissures

A

Low fiber diets
Passage of large, hard stools
Other anal trauma

115
Q

Signs/symptoms of anal fissure

A

Severe rectal pain
Painful bowel movements causing pt to refrain from having BM
Leads to constipation
BRBPR

116
Q

Where is the most common location of anal fissures

A

90% posterior midline

117
Q

Treatment for anal fissures

A 
80% resolve spontaneously
Supportive measure: warm sitz baths 
High fiber diet
Analgesic
Increased water intake
Stool softeners
118
Q

Second line treatment for anal fissures

A

Topical vasodilators: nitroglycerin

119
Q

Surgical procedure for anal fissures

A

Lateral internal sphincterotomy

120
Q

Most common bacterial etiologies of anorectal abscesses

A

Staph aureus

E coli

121
Q

Most common location of anorectal abscesses

A

Posterior rectal wall

122
Q

Open tract between two epithelial-lined areas

A

Fistula

Seen commonly with anorectal abscesses

123
Q

Symptoms of anorectal abscess

A

Swelling
Rectal pain that is worse with sitting, coughing, and defecation
May have anal discharge if fistula present

124
Q

Management of anorectal abscesses

A 
I&D followed by wash
Warm water cleaning
Analgesics
Sitz baths
High-fiber diets
125
Q

Internal hemorrhoids result from engorgement of which venous plexus

A

Superior hemorrhoidal vein

126
Q

External hemorrhoids result from engorgement of which venous plexus

A

Inferior hemorrhoidal vein

127
Q

Risk factors for hemorrhoids

A 
Increased venous pressure 
Straining during defecation (constipation)
Pregnancy
Obesity
Prolonged sitting
Cirrhosis with portal hypertension
128
Q

Symptoms of internal hemorrhoids

A 
Rectal bleeding (intermittent)
Hematochezia
Rectal itching and fullness
Mucous discharge
Rectal pain suggests complications
129
Q

Symptoms of external hemorrhoids

A

Perianal pain - aggravated with defecation

+/- tender palpable mass

130
Q

Diagnosis of hemorrhoids

A 
visual inspection
digital rectal exam
fecal occult blood testing
proctosigmoidoscopy
colonoscopy in pts with hematochezia to r/o proximal sigmoid disease
131
Q

Management of hemorrhoids

A

conservative tx - high fiber diet, increased fluids, warm sitz bath, topical rectal corticosteroids for pruritus and discomfort
if failed conservative therapy or debilitating pain:
Rubber band ligation
Sclerotherapy
Infrared coagulation
Hemorrhoidectomy (for all stage IV)

132
Q

Hernia that occurs lateral to the inferior epigastric artery

A

Indirect inguinal hernia

133
Q

Indirect hernias are often congenital and occur due to a __________ ___________ __________ ___________

A

Persistent patent process vaginalis

134
Q

Most common overall type of hernias in men and women

A

Indirect inguinal hernia

135
Q

Hernia that occurs medial to the inferior epigastric arteries within Hesselbach’s triangle

A

Direct inguinal hernia

136
Q

Borders of Hesselbach’s Triangle

A

RIP
Rectus abdominis
Inferior epigastric arteries
Poupart’s Ligament

137
Q

Signs/Symptoms of a strangulated hernia

A

Incarcerated hernia with systemic toxicity
Compromised blood supply-ischemic
Severe painful bowel movement

138
Q

Management of inguinal hernias

A

Often require surgical repair

Strangulated are surgical emergencies

139
Q

Hernia that is most commonly seen in women

A

Femoral hernia

140
Q

Often become incarcerated or strangulated compared to an inguinal hernia so surgical repair is often done

A

Femoral hernia

141
Q

Management of umbilical hernias

A

Observation, will usually resolve by 2 years old

Surgical repair if still persistent in children > 5 y/o

142
Q

Incision hernias occur most commonly with __________ and in ___________

A

Vertical incisions

Obese patients

143
Q

Most common causes of gastritis

A 
H pylori infection
Autoimmune causes (pernicious anemia)
144
Q

Most common causes of gastropathy

A

NSAIDs
Alcohol
Bile reflux

145
Q

Treatment for gastritis

A

Treat underlying cause and give PPPI

146
Q

Acute diarrhea is defined as being less than _________ in duration

147
Q

C. diff is commonly associated with __________, however, any abx can lead to c diff

A

Clindamycin

148
Q

C. diff diarrhea will present __________ following abx therapy, and will present as excessive (_________)

A

days to weeks

over 10x daily

149
Q

Signs/symptoms of c. diff infxn

A

Watery diarrhea
Abdominal pain
Fever
Leukocytosis

150
Q

Treatment for c. diff

A

Metronidazole is best initial therapy

If no response, follow with vancomycin

151
Q

Infectious diarrhea can be divided into: ________ and _________

A

Inflammatory (blood or WBC in stool)

Non-inflammatory

152
Q

Most accurate test for identifying bacteria

A

Stool culture

153
Q

Most common organism isolated in inflammatory diarrhea

A

Campylobacter

154
Q

Inflammatory diarrhea is treated with

A

Fluoroquinolone
(ciprofloxacin, ofloxacin, moxifloxacin)
Azithromycin is an appropriate alternative

155
Q

Non-inflammatory diarrhea is treated with:

A

Supportive therapy

Oral rehydration

156
Q

Diagnosis for giardiasis diarrhea

A

ELISA for giardia antigen

157
Q

Treatment for giardiasis diarrhea

A

Metronidazole

158
Q

Diarrhea and symptoms that begin within 6 hours suggests __________ or ____________

A

Staphylococcus

Bacillus cerus

159
Q

Diarrhea and symptoms that begin within minutes is

160
Q

Diarrhea associations: chicken and eggs

A

Salmonella

161
Q

Diarrhea associations: shellfish

162
Q

Diarrhea associations: rice water stools

163
Q

Diarrhea associations: camping and freshwater

164
Q

Diarrhea associations: canned foods

A

Clostridium

165
Q

Diarrhea associations: poultry and raw milk

A

Campylobacter

Associated with reactive arthritis and Guillain-Barre syndrome

166
Q

Diarrhea associations: daycare centers

167
Q

Diarrhea associations: spoiled fish, wheezing, flushing, vomiting, diarrhea

A

Scrombroid

168
Q

Dyssynergic defecation, slow transit, and IBS-constipation type

A

Primary causes of contipation

169
Q

DM, hypothyroid, hypercalcemia, intestinal mass, Parkinson’s disease, anal stricture, and medications

A

Secondary causes of constipation

170
Q

Alarm symptoms of constipation

A
  1. Hematochezia
  2. Weight loss
  3. Fam hx of colon CA
  4. Anemia
  5. Heme positive stool
  6. Severe persistent constipation
171
Q

Diagnosis of constipation

A
  1. Rectal exam - r/o masses, fissures, sphincter tone

2. Colonscopy if alarm sx

172
Q

Treatment of constipation

A
  1. Increase fluids, exercise, develop bowel pattern
  2. Fiber of 25 g daily
  3. Bulk/osmotic laxatives
  4. Prunes are an alternative
173
Q

Chronic GI bleeding presents as

A

Hemoccult + stools
Iron deficiency anemia
Both

174
Q

An acute upper GI bleeding is ____________ than lower GI bleed

A

3x more common

175
Q

Acute upper GI bleeding presents as:

A

Hematemesis (MC)
Melena
Hematochezia

176
Q

Most common causes of upper GI bleeds

A

Peptic Ulcers

Esophageal varices

177
Q

Most common causes of lower GI bleeding

A

Diverticular dz

Vascular malformation

178
Q

Mostly irreversible liver fibrosis with nodular regeneration secondary to chronic liver diseasee

179
Q

The nodules of cirrhosis cause

A

Increased portal pressure

180
Q

Macronodules seen in cirrhosis are associated with a high risk of:

A

Hepatocellular carcinoma

181
Q

Most common cause of cirrhosis in US

182
Q

Other causes of cirrhosis besides EtOH (4)

A
  1. Chronic viral hepatitis
  2. Nonalcoholic fatty liver disease (obesity, DM, hypertriglyceridemia)
  3. Hemochromatosis
  4. Primary biliary cirrhosis, primary sclerosing cholangitis, drug toxicity
183
Q

Signs/Symptoms of cirrhosis

A
  1. Fatigue, weakness
  2. Weight loss
  3. Muscle cramps
  4. Anorexia
184
Q

Physical exam with cirrhosis

A
  1. Ascites
  2. Hepatosplenomegaly
  3. Spider angiomas
  4. Caput medusa
  5. Palmar erythema
  6. Gynecomastia
  7. Dupuytren’s contracture
  8. Jaundice
  9. Esophageal varices
185
Q

Diagnosis of cirrhosis

A

Ultrasound - determines liver size and evaluates for HCC

Liver biopsy

186
Q

Treatment of cirrhosis

A
  1. Lactulose. Rifaximin - abx
  2. Sodium restriction - diuretics, paracentesis
  3. Cholesytramine to help with itching
187
Q

Definitive treatment of cirrhosis

A

Liver treatment

Emergency EOR (12 decks)

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