Gastrointestinal and Nutrition Flashcards
dumping syndrome symptoms and timing
15-30 minutes post-meal
N/D/abd cramps
Vasomotor (palpitaitons, diaphoresis, hypotension)
Dizziness/confusion, fatigue, diaphoresis
dumping syndrome pathogenesis
rapid emptying of hypertonic gastric contents into duodenum due to loss of normal action of PYLORIC SPHINCTER POST-GASTRECTOMY
treatment of dumping syndrome
diet modification - frequent, smaller meals, avoid simple sugar, increase fiber and protein, fluids between meals
Blunt abdominal trauma and 24-36hrs later, epigastric pain and vomiting. Esp in children
Duodenal Hematoma - obstruction due to blood b/w submucosal and muscular layers of duodenum
Mgmt of duodenal hematoma
NG tube decompression.
Surgery and drainage if nonoperative management fails
RUQ pain, intraperitoneal free fluid, hemodynamic stability, abnormal blood counts
MCC of this is right eight or ninth rib fracture (seat belt sign)
liver LAC - one of MC complications of BAT
BAT and days to weeks later develop N/V/wt loss, palpable abdominal mass.
pancreatic pseudocyst (or prior pancreatitis)
1mo old with N/V/poor feeding.
pyloric stenosis
Fever, RUQP, N/V. CREPITUS in abdominal wall adjacent to gallbladder.
Unconjucgated hyperBr, mildly elevated aminotransferases.
Dx and MCC
A form of acute cholecystitis - emphysematous cholecystitis due to infection with gas-forming bacteria (clostridium or E coli)
will see air fluid levels in GB, gas in GB wall
Three risk factors for emphysematous cholecystitis
DM, vascular compromise, immunosuppression
Following a vascular procedure (i.e. AAA repair), a 65yo M presents with mild pain and abdominal tenderness, hematochazia, diarrhea, and metabolic (lactic) acidosis).
CT scan: THICKENED BOWEL WALL, double halo sign, pneumatosis coli
Colonoscopy: mucosal pallor, cyanosis, petechia, hemorrhage
ischemic colitis
Opacity in right upper lobe. Foamy sputum with BRB. Wheezing on right side.
Dx and initial management
tuberculosis
respiratory isolation
TB patient is in respiratory isolation and needs to be intubated. Fresh blood fills the endotracheal tube. Best next step in management
bronchoscopy
define “massive” hemoptysis, which requires immediate treatment of bleeding
> 600 mL/24h OR >100ml/h
Gilbert syndrome has increased what kind of Br? Clinical findings
increased unconjugated Br
decreased UDP-glucuronosyltransferase
mild jaundice provoked by stress.
discuss the evaluation of blunt genitourinary trauma in a hemodynamically stable patient with hematuria
UA
contrast CT of abdomen and pelvis
discuss evaluation of hemodynamically unstable patient with evidence of renal trauma
Intravenous pyelography prior to surgical evaluation
define acute mesenteric ischemia
Rapid onset of often severe periumbilical pain out of proportion with physical exa, Hematochezia is a late complication.
Urge to defecate.
three lab findings in acute mesenteric ischemia
leukocytosis
elevated amylase and phosphate
METABOLIC ACIDOSIS (elevated LACTATE)
nausea, vomiting, epigastric pain radiating to back
acute pancreatitis
Recurrent, episodic pain in RUQ or epigastric region, corresponding elevations in aminotransferases and alkaline phosphatase. Opioids (morphine) can worsen/precipitate symptoms.
What is this and what is seen upon visualization of the common bile duct?
sphincter of oddi dysfunction
CBD is dilated in the absence of stones.
gold standard for dx of sphincter of oddi dysfunction
sphincter of oddi manometry
treatment of anal fissures
fiber, fluids, sitz bath, stool softeners, topical anesthetics and vasodilators (nitroglycerin and nifedipine)
recommendation for diverticulitis with abscess formation (i.e “5cm ring enhancing perisigmoid fluid collection”)
CT guided percutaneous drainage
Subacute fever, abdominal/flank pain radiating to groin. Anorexia and weight loss. Abdominal pain with hip extension.
May be associated iwth appendicitis.
This is a psoas abscess
Abdominal pain with hip extension is the PSOAS SIGN
stehoscope placed over upper abdomen and patient’s hips rocked back and forth. retained gastric material >3h postprandial will generate splash sound and indicates presence of hollow viscus filled with fluids/gas
what is this called and what does it indicate?
called abdominal succussion splash
indicates gastric outlet obstructin
BAT followed by left sided abdominal pain with radiation to shoulder, fever, vomiting.
splenic INFARCT (but LAC is more common)
patient presents with appendicitis for >5d after onset of symptoms. high incidence of what? manage how?
perforation with abscess formation
manage with IV hydration ,antibiotics, bowel rest, and interval appendectomy
Dx: fever, severe abdominal pain, tachycardia, peritonitis (guarding, rigidity, reduced bowel sounds, rebound tenderness) presenting after a penetrating abdominal wound.
perforated viscus
the two MC locations of ischemic colitis
splenic flexure and rectosigmoid flexure
child with:
midline abdominal defect covered by peritoneum. multiple abdominal organs contained. umbilical cord and APEX of defect
omphalocele
child with:
defect to right of cord insertion not covered by membrane or skin. contains bowel. umbilical cord inserts next to defect
gastroschisis
child with:
defect at linea alba covered by skin. sometimes contains bowel . umbilical cord inserts at apex of defect
umbilical hernia
ALT>__ is 95% PPV for gallstone pancreatitis.
150
NExt best step: gallstone pancreatitis with cholangitis, visible CBD dilation/obstruction, increasing liver enzymes.
ERCP
epigastric pain/tenderness and weight loss in setting of nonspecific systemic symptoms and significant SMOKING history.
increased alkphos and direct Br
pancreatic adenocarcinoma.
