Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PANCE > Gastrointestinal - 9% > Flashcards

Gastrointestinal - 9% Flashcards

1
Q

Achalasia

A

Ineffected - 1. parastalsis, 2. swallowed induced relaxation of L esophageal sphinctor

Sxs

  • Dysphagia for solids & mostly liquids
  • progressive
  • regurgitation of undigested food

Dx

  • Esophagram - bird’s beak of distal esophagus
  • Esophageal manometry - gold confirmatory

Tx

  • Limited - botox
  • Surgical myotomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Acute and Chronic Pancreatitis

dx

A

Dx:

  • Serum Amylase x5 ULN (non spec)
  • Serum Lipase x3 ULN specific
  • CT scan - gold standard
  • +/- jaundice
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Ranson’s Criteria

A

At admission:

  • Age > 55
  • Glucose > 200
  • AST > 250
  • LDH > 350
  • WBC > 16,000

48 hrs after admission

  • Hematocrit fall > 10%
  • BUN Rise > 5mg/dl
  • Ca < 8 mg/dl
  • PO2 < 60 mmHG
  • Base deficit > 4 mEq/L
  • Fluid sequestration > 6L
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Acute Pancreatitis

eti, sxs

A

MC gallstones, 2/2 ETOH N/V

Sxs:

  • Epigastric abd pain
  • r-> back worse supine and
  • post prandial
  • hemorrhagic
    • Grey Turner - flank ecchymosis
    • Cullen - periumb ecchymosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Acute Pancreatitis

tx

A

Mild - bowel rest NPO Pain control Severe - ICU

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Anal Abscess and Fistula

Dx, tx

A

Clinical

I&D followed by WASH

  • Warm water
  • Cleansing
  • Analgesics
  • Sitz Bath
  • High fiber diet
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Anal Abscess

eti, sxs

A

Bacterial infx of perianal ducts/glands - MC S Aureus

MC posterior rectal wall

Sxs:

  • Painful defecation
  • Rectal pain worse with sitting, coughing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Anal Fissures

dx and tx

A
  • clinical
  • Sigmoidoscopy if < 50 yo to r/o FH of colon ca
  • Analgesics
  • High fiber diet
  • Stool softener, laxatives, mineral oils
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Anal Fissures

eti, sxs

A

Painful, linear tear/crack low fiber diet

MC in posterior midline

2/2 Crohn’s and Granulomatous (TB or sarcoid)

Sxs:

  • Severe, tearing pain with defecation
  • Pt afraid of BM —> Constipation and
  • BRBPR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Anal Fistula

eti, sxs

A

open tract btwn two epithelial-lined areas

MC with Crohn’s

Sxs:

  • Perirectal/anal swelling
  • painful defecation
  • Malodorous drainage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Anorexia Ddx

A

Appendicitis

  • Periumbi pain, N/V, anorexia, RLQ

Gastric Ulcers

  • epigastric pain, N/V, anorexia

Duodenal Ulcers

  • Epigastric pain - burning aching, anorexia, decr appetite

Gastric Cancer

  • WEAPON

Lower GI Bleed

  • abd pain, melena, anorexia, fatigue, syncope

Carcinoma of GB

  • biliary colic, wt loss, anorexia, asymp til late

Pancreatic carcinoma

  • painless jaundice from CBD obstruction; wt loss, abd pain -> back, weakness, pruritus from bile salts, anorexia, courvoisier’s sign, acholic stool, dark urine, DM
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Appendicitis

A

Obstruction of appendix,

MC d/t fecalith, malignancy, inflammation, foreign body

Sxs:

  • 10-30 yo
  • anorexia, N/V, leukocytosis
  • periumbilical pain -> RLQ pain

Dx

  • PE signs
    • Rovsing sign - RLQ pain w/ LLQ palp
    • Obturator sign - pain with internal/external hip rotation w/ flexed knee
    • Psoas sign - RLQ pain w/ hip flexion/extension against resistance
    • McBurney’s point of tenderness- 1/3 of distance from ant sup iliac spine and navel
  • Abd US - initial test
  • CT - non contrast - gold

Tx

  • appendectomy
  • IV Abx - Cipro + Metronidazole
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Bariatric Surgery

complications

A

Early complications

  • anastomostic leak
    • presents with hemodynamic instability
  • DVT/PE
  • bleeding
  • infx
  • Splenic injury

Late complications

  • Malnutrition + nutritional probs
  • Marginal Ulcers, anastomastic stricturs
  • Internal Hernia
  • Band slippage
  • Band erosion
  • esophogeal dilatation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Bariatric Surgery

types

A

Indications

  • BMI > 40 or BMI >35 + medical problem related to morbid obesity
  • individuals must have failed other non-surgical wt loss program
  • Psychologicall stable - follow post op orders
  • No caused by medical disease

Restrictive procedures - less extensive but less wt loss +decr in morbidity

  • Adjustable Gastric banding
    • band slippage can cause vomiting/regurgitation, inability to keep food down
  • Vertical Banded Gastroplasty
  • Sleeve Gastrectomy

Malabsorptive procedures - more wt loss, but probs with malnutrition

  • Biliopancreatic diversion
  • Biliopancreatic diversion w/ or w/o Duodenal Switch

Combination of restrictive and Malabsorptive procedures

  • Roux-en-Y Bypass - mean wt loss 50% of excess weight
    • MC type used
    • proximal gastric pouch - Roux-en-Y gastrojejunostomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Large Bowel Obstruction

A

Causes - volvulus, adhesions, hernias, colon cancer (MCC in elderly ppl)

Sxs:

  • Constipation, obstipation, high pitched BS
  • N/V
  • gradually increasing distention and pain (longer eps btwn pain)

Dx:

  • KUB/abd Xray - distended proximal colon w/ haustra, air fluid levels, no gas in rectum

Tx:

  • NPO
  • NG suction
  • IV fluids
  • monitoring pain
  • Surgery if mechanical obstruction w/in 48 hrs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Small Bowel Obstruction

A

MCC - adhesions d/t previous abd surgeries

Sxs:

  • Colicky abd pain, obstipation
  • N, bilious vomiting
  • Abd distention, rigid or firm
  • hyperactive BS => hypoactive BS

Dx

  • KUB - air fluid level on upright

Tx

  • NG tube
  • Bowel rest
  • Surgery if unresolved
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Volvulus

Bowel Obstruction

A

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

MC Sigmoid Colon & cecum

Sxs - obstruction

  • abd pain, distention
  • N/V
  • Fever
  • tachycardia

Dx - KUB series

Tx -

  • endoscopic decompression - initial TOC
  • Surgical correction - 2nd line
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Cholangiocarcinoma

Neoplasms

A

Rare biliary tumor, MC adenocarcinoma

RF - PSC, parasitic infx

Klatskin tumor - hilar cholangiocarcinoma (MC at junction of R and L main hepatic ducts)

Sxs

  • non tender palpable GB w/ hx of wt loss

Dx - usu found late

Tx - improved prognosis if complete resection of tumor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Cholangitis

dx, tx

A

Dx:

  • 1st - RUQ US or CT gold -
  • ERCP for cholangiography after afebrile for 48 hrs
  • ERCP for decompression
  • PTC if can’t do ERCP

Tx with Abx - Ceft + Metro - Zosyn (pip/tazo)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Cholangitis

eti, sxs

A

info of biliary tract 2/2 to obstruction - gallstones

MC Ecoli or Kleb

Charcot’s Triad

  1. RUQ pain
  2. Jaundice
  3. Fever

Reynold’s Pentad

  1. above + AMS & Sepsis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Cholecystitis

dx & tx

A

Dx with RUQ US >3mm

HIDA scan (gold std)

Tx:

NPO IV fluids Abx (ceft + metron) Definitive - cholecystectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Cholecystitis

eti, sxs

A

Inflammation of GB

MC gall stones

Sxs:

  • RUQ/epigastric pain
  • N/V/Anorexia
  • R-> R shoulder/scapular - Boas’s sign
  • Inspiratory halt during deep palpi = Murphy’s sign
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Choledocholithiasis

dx, tx

A

Trans abd US gold - ERCP extraction tx

cholecystectomy definitive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Choledocholithiasis

eti, sxs

A

GS in Common Bile Duct

1ry - formation of gs in CBD

2ry - passage of gs from GB to CBD

Sxs:

asymp 50%

Biliary colic w/ RUQ tenderness +/- jaundice

may lead to shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Cholelithiasis

dx, tx

A

Gold - RUQ US > 2mm

3 types deps on color (yellow for cholesterol

black - hemolysis, ETOH, cirrhosis

brown - biliary tract infx observation if asymp

Tx - Urseodeoxycholic acide to dissolve GS Elective cholecystectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Cholelithiasis eti, sxs

A

Gallstones + pain when GB compresses on GS

Fat Forty Fertile Female Flatulence

Sxs:

  • MC asymp Biliary colic
  • episodic RUQ/epig pain —> resolves in 30-1h
  • post prandial pain + at night
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Chronic Pancreatitis

tx

A

Pancreaticojejunostomy -> Whipple PO

Pancreatic enzyme replacement

ETOH abstinence

Pain control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Colorectal Carcinoma (CRC)

dx

A

Colonoscopy with bx - gold

barium enema - apple core lesion

+ CEA - marker

CBC - anemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Colorectal Carcinoma (CRC)

eti

A

3rd MC Cancer in US Genetics

Familial Adenomatous Polyposis (APC gene - develop colon cancer by 40yo —> prophylactic colectomy

RFs

  • age > 50yo -
  • UC > Crohn’s -
  • Low fiber diet -
  • smoking -
  • etoh -
  • AAs -
  • fam hx of CRC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Colorectal Carcinoma (CRC)

Screening

A

average risk

  • start at 50 yo
  • FOBT q 1 year
  • Colonoscopy q 10y or Flex sig q 5 y

1st degree Relative or high RFs

  • FOBT q1y
  • starting at 40y or 10 yrs younger than earliest dx age Colo - q 5y

Highest risk

  • UC or Crohn’s >8yrs,
  • FAP
  • FOBT any age
  • Colonoscopy q5y
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Colorectal Carcinoma (CRC)

sxs

A

MCC large bowel obstruction in adults

Painless rectal bleeding; changes in bowel habits

Right sided - ascending colon

  • proximal - lesions tend to bleed
    • occult blood loss = anemia/+ FOBT
    • non-spec sxs - fatigue, wt loss

Left sided - descending colon

  • changes in bowel habits - constipation
  • sxs of obstructions; present later
    • abd pain, N/V, distention
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Colorectal Carcinoma (CRC)

tx

A

localized (stage 1 to 3) - resection

Stage 3 to Mets - chemotherapy with 5FU/Fluorouracil

33
Q

Diarrhea

Pseudomembranous colitis

A

Inflammation of colon d/t C. Diff 2/2 abx penicillin, cephalosporins, FQ

disrupts normal colonic flora

Sxs

  • Mild watery foul smelling diarrhea (>3 but < 20 stools/d)
  • Fever
  • Abd pain, gen constitutional sxs

Dx

  • PCR - C diff toxin- Toxin B (clinically important)
  • Stool culture
  • Leukocytosis

Tx

  • IV metronidazole, or PO Vanc
  • Strict hand washing
  • Complications - bowel perf/ toxic megacolon
34
Q

Diverticulitis

dx, tx

A

gold - CT scan

FOBT + CBC Leuks

Tx:

  • Abx - Cipro/Bactrim + MNZ
  • Clear liquid diet
  • colonoscopy in 6 wks to r/o cancer
35
Q

Diverticulitis

eti, sxs

A

Infection and inflammation of outpouchings d/t fecalith

Sxs:

  • LLQ abd pain
  • Fever N/V/D
  • Constipation
  • bowel changes and bloating
36
Q

Diverticulosis

dx, tx

A

CT - TOC***

  • avoid barium enema

Tx:

  • high fiber diet
  • psyllium - fiber supplement
37
Q

Diverticulosis

eti, sxs

A

Outpouchings d/t intestinal mucosa herniation

Sxs:

  • MCC BRBPR
  • Low fiber diet
  • LLQ discomfort
  • fever, chills
38
Q

Adenocarcinoma

eti, sxs

Esophageal Carcinoma

A

MCC esophageal ca in US - White Males

a/w Barrett’s esophagus and GERD; lower 1/3 of esophagus

Sxs:

  • progressive dysphagia solids -> fluids odynophagia
  • chest pain not related to eating
  • reflux hoarseness

Dx - Endoscopy with Bx - gold Barium; esophagram CT for staging

Tx - Esophageal resection chemo 5FU

39
Q

Squamous Cell Carcinoma

Esophageal Carcinoma

A

MCC Esophageal worldwide; 50-70yo; a/w smoking/etoh

upper 2/3 of esophagus

Dx - Endoscopy w/ bx and diagnosis

Chemo or radiation or resection

40
Q

Esophageal Strictures

A

Strictures - scarring from healing process of ulcerative esophagitis

Schatzki Ring - diaphragm mucosal ring that causes sxs if is too small.

Sxs

  • solid food dysphage w/ hx of GERD

Dx

  • Barium swallow/ esophagram
  • Endoscopy is confirmatory

Tx

  • Endoscopy and dilatation
  • sx rarely needed
41
Q

Esophageal Varices

Hematemesis

A

Dilated submucosal veisn in distal esophagus or proximal stomach

hx of portal HTN & Cirrhosis; high mortality

Sxs:

  • Hematemesis - coffee ground appearance
  • melena -black tarry stool
  • VS instability
    • hypovolemia/tachycardia
    • shock

Dx:

  • Emergent endoscopy (EGD)
  • Band ligation**** & IV Ocreotide for vasoconstriction
  • sclerotherapy
  • If fails - Balloon tamponade or TIPS (transjugular intrahepatitc portosystemic shunt)
  • Longterm - BB (propanolol), no etoh
42
Q

Gluten Intolerance

Food allergies and sensitivities

A

Inflammation of small bowel 2/2 ingestion of gluten; autoimmune disorder, hereditary

Sxs

  • Diarrhea, steatorrhea, flatulence, weight loss
  • weakness and abd distention
  • infants/children = FTT

Dx

  • IgA antiendomysial (EMA) and antitissue Transglutaminase (anti-tTG) abs
  • Endoscopic intestinal mucosal biopsy of proximal and distal duodenum- confirmatory

Tx - GF Diet

43
Q

Lactose Intolerance

Food allergies and sensitivities

A

Inability to digest lactose - predom sugar of milk, via lack of lactase

Sxs

  • abd bloating and cramps, flatulence
  • diarrhea, N, borborygmi, vomiting
  • usu 30mins to 2 hrs

Dx

  • Lactose breath hydrogen test - positive if > 20ppm
  • Stool acidity test (fecal pH test) - acidic = acid producing bacteria

Tx

  • avoid dairy product
  • lactase supplement
44
Q

Nut Allergies

Food allergies and sensitivities

A

linked to anaphylaxis

Sxs/ Dx

  • Derm - pruritis, erythema, urticaria, angioedema
  • GI manifestation - N/V, abd cramps, diarrhea
  • Anaphylactic reaction - respiratory syst and can be fatal
  • Cutaneous manifestation - angioedema, urticaria

Avoid nuts, and nut products

administer epinephrine asap

45
Q

Gastric Carcinoma

A

MC adenocarcinoma; can be lymphoma (rarer, a/w Non Hodgkin Lymphoma)

RFs:

  • H pylori*** salted, cured, pickled food
  • Etoh, Smoking
  • Blood type A

WEAPONS

  • Weight loss + Fe deficiency Anemia
  • Emesis
  • Anorexia
  • Pain/abd discomfort
  • Obstruction
  • Nausea

Dx

  • Endoscopy with Biopsy - Linitis plastica - thickening of gastric wall

Tx - poor prognosis- resection

46
Q

Abdominal Carcinoma

signs of metastasis

A

Virchow’s Node - Left supraclavicular LN

Sister Mary Joseph’s Nodule - umbilical LN

47
Q

GERD

A

Relaxation of LES

Sxs:

  • Heartburn* w/ meals, wt gain, N, recumbency
  • Throat irritation and cough

Tx - symptom relief w/ PPO and H2 Blockers

  • PPI - sx relief + promote healing
  • Tx empircally on PPI x 4 wks (failed H2blockers w/ mod-severe GERD)

Dx

  • Endoscopy - if failed empirical tx on PPI OR
    • GI bleeding/anemia
    • Dysphagia/odynophagia
    • unintentional wt loss
    • H/o heavy NSAIDs
    • Risk of UGI cancers
48
Q

H. pylori

Peptic Ulcer Disase

A

Dx

  • Urea Breath test * gold - needs to be off PPI, bismuth and abx
    • active infection
    • urea as byproduct of metabolism
  • Stool antigen
  • Endoscopy bx

Tx

  • Clarithromycin 500 mg BID
  • Amoxicillin 1g BID
  • PPI BID
    • Metronidazole 500 mg if pcn allergic
  • Follow up with urea breath test 1 mo post tx to ensure eradication
49
Q

Heartburn and Dyspepsia

ddx

A

Burning pain or discomfort - after eating at night, worsen when lying down

GERD

  • Acid reflux + HB > 2x/wk = GERD

Food Intolerance

Esophagitis

  • painful, difficulty swallowing + CP w/ eating

Gastritis

  • H. pylori or NSAIDs, or etoh

Hiatal hernia

  • no sxs but can be a/w HB and abd discomfort

PUD

  • burning abd pain, N/V, bloating
50
Q

Hemorrhoids

A

varicose vein of anus and rectum

RFs - constipation/straining, pregnancy, portal HTN

Dx - Anoscopy if BRBPR or suspected thrombosis

External

  • lower 1/3 of anus
  • thrombosed
    • significant pain, pruritis, NO bleeding
    • palpable perianal mass w/ purplish hue
  • Tx - excision

Internal

  • upper 1/3 of anus
  • BRBPR, pruritis, rectal discomfort
  • Tx - Fiber, sitz bath, ice packs, stool softeners
    • Rubber band ligation - if +protrudes, enlargement and intmt bleeding
    • Hemorrhoidectomy if prolapse
51
Q

Hepatocellular Carcinoma

dx, tx

A

Alpha fetoprotein (AFP) marker esp in pst with hep C or cirrhosis

Ultrasound, MRI lesions >/= 1cm

Liver transplant for

  • single lesion < 5cm or
  • = 3 lesions that are all = 3cm

Surgical resection - cancer can recur

52
Q

Hepatocellular Carcinoma

eti, sxs

A

Primary Cancer - HCC

2/2 to mets from lungs and breast Ca (MC)

RFs:

  • Hepatitis B, C, D
  • Cirrhosis
  • Aflatoxin B1 exposure (Aspergillus spp)

Sxs

  • Malaise, wt loss
  • Jaundice, ascites, Hepatosplenomegaly
53
Q

Hernia (incarcerated/strangulated)

A

Protrusion of organ/structure through abd wall

Inguinal hernias

  • MC - through internal ring down the inguinal canal (into scrotum)

Direct inguinal hernias

  • passage of intestines through external inguinal ring at Hesselbach’s triangle

Sxs:

  • Reducible bulge when patient coughs or strains
  • Usu painless unless
  1. Incarcerated - can’t be reduced
  2. Obstructed - irreducible hernia but no interference w/ blood flow
  3. Strangulated - blood supply cut off - bowel ischemia, necrosis perforation

Tx - Open repair or lap w/ mesh reinforcement

54
Q

Femoral, Incisional

Hernia

A

Femoral - into groin at the top of inner thigh

Incisional - a/w vertical incisions - esp with obesity

55
Q

Hiatal Hernia

A

Sliding hernia (type 1) - >90% cases, GE junction and portion of stomach herniates into thorax through esophageal hiatus (GE junction above diaphragm)

Paraesophageal Hiatal Hernia (type 2) - <5% cases . Stomach herniates into thorax through esophageal hiatus, but GE junciton does not. Remains below diaphragm.

  • can become strangulated

Sxs

  • heartburn, chest pain, dysphagia

Dx

  • Upper GI series, endoscopy

Tx

  • Type 1 - antacid, small meals, ele of head after meal - can do Nissen fundoplication
  • Type 2 - elective surgery
56
Q

Crohn’s Disease

IBD

A

Genetic +environmental factors; peaks at 15-35 yo

Mouth to anus - transmural, “Skip lesions”

Sxs:

  • Colicky RLQ pain
  • Diarrhea/ malabsorption
  • Low grade fever
  • Wt loss
  • a/w anal fistulas, aphthous ulcers

Dx:

  • Colonoscopy - gold
    • cobblestoning
    • skip lesions
  • small bowel films
    • string sign - barium study
  • Lab - CBC, ESR, CRP, B-12, stool culture
  • +ASCA
57
Q

Ulcerative Colitis

IBD

A

Idiopathetic, inflammatory dz

Friable mucosa and submucosa, limited to colon = Rectum MC

bimodal distr - 15-25yo and 55-65

Sxs:

  • Bloody, pus filled diarrhea
  • LLQ pain
  • fever

Dx:

  • Barium enema - lead pipe appearance
  • coloscopy with bx - gold = loss of haustral markings and lumen narrowing
    • risk of toxic megacolon
  • pANCA
58
Q

IBD Treatment

A

Medical Management

5-Aminosalicylates ASA

  • Mesalamine
    • SE - NV, HA, rash, fever
    • replace folic acid
  • Sulfasalazine

Immunomodulators

  • Azothioprine/6-mercaptopurine
    • maintenance therapy
    • takes 3-6 mos for full effect
    • can come off 5ASA
    • check LFTs and CBC q 90 ds

Biologics

  • TNF-inhibitors (Infliximab/Remicade, Adalimumab/Humira)
    • SE - reactivate of Hep B and TB (check prior to initiation)
    • expensive

Corticosteroids

  • high dose, short course => acute exacerbations
  • Prednisone in taper 30-40mg

Abx - for fistula

  • Metronidazole
  • Cipro
  • Rifaximin
59
Q

Infectious Diarrhea

A

Causes of Diarrhea - infectious, toxic, dietary, or other GI diseases

  • Traveler’s Diarrhea - E coli
  • Picnic and egg salad - S aureus
  • Shellfish - Vibrio cholera
  • Poultry or pork - Salmonella
  • Pt post abx - C diff
  • poorly canned home foods - C perfringens
  • Breakout in a daycare center - Rotavirus
  • Cruise ship - Norovirus
  • Fresh mountain stream water - Giardia lamblia - foul smelling bulky stool
60
Q

Infectious Esophagitis

A

MC in IMC hosts;

Sxs:

  • Odynophagia* (painful swallowing) - food or liquid
  • Dysphagia (difficult swallow)
  • Chest/substernal pain/fever

Dx/Tx - EGD

  • Candida MC - linear yellow white plaques
    • Fluconazole 100 mg PO QD
  • HSV - shallow punched out lesions
    • Acyclovir
  • CMV - large solitary ulcers or erosions
    • Ganciclovir

Tx - EGD dilation

61
Q

Intussusception

A

Intestinal obstruction; part of bowel telescopes into nearby segment

MC in children 3mos to 6yo; MC a/w adenovirus

Sxs

  • Severe, colicky abd pain => lethargy
  • Abd mass - sausage shaped
  • bilious emesis, stool with mucus or blood (currant jelly)
  • decr stool if obstruction +

Dx

  • abd US** gold = telescoping

Tx

  • Air/Contrast enema
  • Surgery if + free air under diaphragm, peritonitis, hemodynamic instability
62
Q

Jaundice ddx

A

Bilirubin deposition = hyperbilirubinemia

1st sign - scleral icterus; serum bilirubin > 2.5mg/dl

pathophys

  • RBC breakdown = globin + Heme => iron + protoporphyrin
    • unconjugated bilirubin +albumin -> liver + uridine glucuronyl transferase (UGT) = conjugated bilirubin
    • Conjugated BR => bile formation in GB

Eti: Unconjugated Bilirubinemia - no acholic stools, jaundice

Extravascular hemolysis, ineffective erythropoiesis

Physiological jaundice of newborn

  • can lead to kernicterus, neuro deficits and death = tx w/ phototherapy

Gilbert Syndrome

  • mildly low UGT increases UCB = jaundice during physio stress- fasting

Crigler-Najjar Syndrome

  • RARE - toxif levels of indirect bilirubin - Jaundice at birth*
  • abs of UGT = incr UCB = kernicterus

Conjugated Bilirubinemia - Direct - usu d/t obstruction, jaundince, acolic stools

Dubin-Johnson Syndrome - opps of Gilberts

  • deficiency of bilirubin canaliculi = incr CB
  • liver is pitch dark
  • Rare benign - seen in pregnancy, etoh, OCP use
  • Jewish descent

Biliary Tract Obstruction

  • gall stones, pancreatic carcinoma, liver fluke, cholangiocarcinoma

Viral hepatitis

63
Q

Mallory Weiss Tear

Hematemesis

A

Mucosal tearing of gastroesophageal junction from vomiting

Sxs:

  • Hx of vomiting/retching or alcohol intake
  • PainLESS hematemesis

Dx - Esophagogastroduodenoscopy (EGD)

Tx - self limited, supportive

64
Q

Mesenteric Ischemia

A

Hypoperfusion to bowel vasculature

Sxs:

  • abd pain OOP to PE
  • h/x of afib, vascular dz

Dx - CT angio, treat in surgery

65
Q

G6PD Deficiency

Metabolic Disorders

A

X linked Recessive; Hemolytic anemia d/t oxidative stress = 2-4d post exposure

Sxs:

  • Patient taking antimalarials, sulfonamides, nitrofurantoin, Fava beans
  • Malarial protection

Dx

  • Peripheral blood smear - Heinz bodies
  • Results in bite cells

Tx

  • self limited, maintain hydration
  • severe anemia - iron/folic acid supp
66
Q

Paget Disease of Bone (Osteitis Deformans)

Metabolic Disorders

A

Incr in osteocastic activity, then incr in osteoblastic activity

Sxs

  • Asymp MC
  • arthritis, pain = vertebral involvement => stenosis, nerve compression
  • bone deformity, fracture

Dx

  • ele alk phos; normal Ca, Normal phosphorus
  • X-ray - bone thickening, enlarge thickened cortices**

Tx

  • Bisphosphonates
67
Q

Phenylketonuria (PKU)

Metabolic Disorders

A

MC autosomal recessive; lack of amino acid phenylalamine hydroxylase protein to convert into Tyrosine

Newborn screening 2-3 days after birth

Sxs

  • musty urine or body odor, microcephaly
  • mental or growth retardation

Dx

  • decr phenylalanine hydroxylase => incr phenylalanine and decr tyrosine

Tx

  • Avoid phenylalanine in diet = no beef, pork, chicken
  • limit carb
  • Lots of fruits and vegetables - tyrosine
  • Nutritional supplements
68
Q

Rickets

Metabolic Disorders

A

Softening and weakening of bones d/t lack of Vitamin D; defective mineralization of cartilage in epiphyseal growth plates

MCC- insufficient intestinal absorption

RFs - little sun exposure, darker pigmente skin, BF’ing w/o vit D supplementation

Sxs

  • Bowed legs, stunted growth, bone pain
  • Large forehead, trouble sleeping
  • Bone frx, muscle spasms, abn curved spine or intellectual disability

Dx

  • AP Radiographs of Knees and Wrist - Osteopenia, metaphyseal cupping, distal physis widened
  • Labs - ​↓ 25-hydroxyvitamin D,
    • ​↓ calcium, ↓ phosphate
    • ↑ alkaline phosphatase, ↑ parathyroid hormone levels

Tx

  • Vitamin D supplementation = maintain target of > 20 ng/mL
  • Breastfed infants = 400 IU or 10 mcg daily of Vit D supp, few days after birth
  • Children 1-18 yo = 600 IU or 15 mcg daily
69
Q

Non-Infectious Esophagitis

A
  1. Reflux Esophagitis
    • mechanical or functional abn from LES - refer to GERD
  2. Medication induced
    • Usu NSAIDs or bisphosphonates - drink 4oz of water, sit upright
  3. Eosinophilic - allergic eosinophilic infiltration of esophageal epithelium
    • dx w/ Barium swallow = ribbed esophagus and multiple corrugated rings
70
Q

Obstipation ddx

A

Bowel Obstruction - small and large

Small Bowel Intussusception

Ileus

Gastroparesis

  • condition that affects stomach muscles, prevents proper emptying
  • MCC - DM, anorexia/bulimia, scleroderma, Ehlers-Danlos, abd surgery
  • N, early satiety, palps, HB, bloating
  • Dx - KUB, manometry, gastric emptying scan
  • Tx - Lower fiber and low residue diet, small meals
    • Metoclopramide
71
Q

Pancreatic Carcinoma

A

MCC smoking*, chronic pancreatitis, ETOH, DM, M, obesity, AA

Adenocarcinoma - ductal, and head of pancreas MC

Sxs:

  • MC metasis at dx - regional LN or liver
  • Abd pain => back
  • painless jaundice* classic - 2/2 common bile duct obstruction
  • Wt loss
  • Pruritis - incr bile salts, acholic stools/dark urine
  • Courvoisier’s sign - palpable, NT, distended GB a/w jaundice

Dx

  • CT scan - initial TOC
  • CA 19-9 tumor markers

Tx

  • Whipple procedure
  • Advanced or inoperative
    • ERCP w/ palliative stent for itching
72
Q

Pancreatic Pseudocyst

A

Cystic collection of tissue, fluid, & necrotic debris surrounding the pancreas. Wall is from inflammatory fibrosis, not epithelial lining

a/w - chronic pancreatitis, occurs 2-3 wks after acute pancreatitis, trauma to chest (steering wheel trauma)

Sxs

  • Abdominal pain
  • hx of chronic pancreatitis

Dx

  • CT** - TOC
  • US
  • elevated amylase/lipase
  • Bilirubin, CBC

Tx

  • if persists 4-6 wks, or enlarges
    • Percutaneous drainage > 5cm
    • Surgical decompression - pancreaticogastrostomy
    • Cystic fluid - drained into stomach or bowel
73
Q

Peptic Ulcer Disease

eti, sxs, dx, tx

A

MCC of non hemorrhagic GI bleeds

Duodenal 5x > Gastric; MCC H pylori > NSAIDs, ETOH, smoking

Sxs:

  • Gastric Ulcers
    • abd pain worse with meals - get better after eating
    • patient refuses to eat (losing weight)
  • Duodenal Ulcers
    • Pain gets better with eating - worse after eating
    • Patient gaining weight
    • hemorrhage from gastroduodenal artery
    • MC than gastric ulcer*

Dx

  • Endoscopy* - gold

Tx

  • PPI qd-BID x 8 to 12 weeks; confirm EGD w/ gastric ulcer healing
74
Q

Pyloric Stenosis

A

Hypertrophy and hyperplasia of muscular layers of pylorus = functional outlet obstruction

Infants, first 2-3 wks of life or < 3mos

Sxs

  • projectile vomiting
  • non bilious after every feed
  • DeH2O - hypochloremic, hypokalemia, metabolic alkalosis
  • palpable olive mass in epigastric region

Dx

  • US - double track sign
  • Barium study - string sign

Tx

  • IV fluids rehydration
  • Pyloromyotomy - Ramstedt procedure
75
Q

Small Bowel Carcinoma

A

Rare, delay in dx common

MC adenocarcinoma, highest in duodenum.; RF - hereditary nonpolyposis colorectal ca, CF, Crohns

Sxs:

  • Abdominal pain - intermittent and crampy
  • N/V, wt loss, jaundice, Anemia
  • Obstruction > perforation

Dx

  • CT
  • Screen for FOBT, LFTs, CBC
  • some +CEA

Tx

  • Surgery - localized
  • Adjuvant chemo for LN+
76
Q

Toxic Megacolon

A

Non obstructive, extreme colonic dilation > 6cm + signs of systemic toxicity

Eti - Crohns, UC, infection, radiation

Sxs:

  • fever, abd pain, N/V
  • tenesmus
  • rigidity, tachycardia, dehydration, hypotension, AMS

Dx

  • Abd radiographs - large dilated colon > 6cm
  • 3 of the following
    • Fever > 101.5
    • HR > 120 bpm
    • Neutrophilic leukocytosis >10.5 x 10^9
    • Anemia

Tx

  • bowel decompression
  • Bowel Rest, NG tube, broad spectrum abx
  • Colostomy reserved for refractory cases
77
Q

Zenker’s Diverticulum

A

False outpouching in posterior hypopharynx - uncoordinated swallow/occlusive ep

Sxs

  • Dysphagia, choking, cough, halitosis**
  • aspiration, regurgitation of undigested food
  • aspiration pna or bronchiectasis

Dx

  • Barium esophagram
  • EGD - Contrast CT of neck

Tx

  • Surgical if severe
78
Q

Zollinger-Ellison Syndrome

PUD ddx

A

Gastrinoma of pancreas* or duodenum

PUD develops in 90% of pts

Consider if

  • Recurrent PUD
  • Neg H. pylori, Neg NSAID/ASA use
  • Severe abd pain, diarrhea

Dx

  • secretin test => gastrin level will rise

Tx

  • Surgical resection of gastrinoma

PANCE (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions