Gastrointestinal Disorders Flashcards
food poisoning as a result of mayonnaise sitting out too long
staph aureus
rice-water stools
vibrio cholera
diarrhea transmitted from pet feces
yersinia enterocolitica
food poisoning resulting from reheated rice
bacillus cereus
most common cause of traveler’s diarrhea
enterotoxigenic e. coli
diarrhea after a course of antibiotics
c. diff
diarrhea after recent ingestion of water from a stream
giardia lamblia or less commonly entamoeba
mild intestinal infection that can become neurocysticerosis
taenia solium
food poisoning from undercooked hamburger
EHEC
diarrhea from seafood
vibrio cholera/vulnificus/paerahemolyticus
bloody diarrhea from poultry
campylobacter or salmonella
bloody diarrhea with liver abscess
entamoeba histolytica
diarrhea in an AIDS patient
cryptosporidium or isospora (less commonly)
dehydrated child with greenish diarrhea in winter months
rotavirus
treatment for hepatitis B
IFN-alpha
lamivudine, adefovir, entecavir, telbivudine
treatment for hepatitis C
IFN-alpha and ribavirin
what does a barium swallow allow you to visualize
esophagus, LES, and stomach
what does a gastric emptying study allow you to visualize
stomach, pyloric sphincter, duodenum
what does a small bowel follow through allow you to visualize
stomach to terminal ileum
what does a barium enema allow you to visualize
colon and appendix
different types of esophageal diverticulum
zenker: upper esophagus
traction: middle esophagus
epiphrenic: lower esophagus
treatment for entamoeba histolytica diarrhea
metronidazole
treatment for giardia lamblia
metronidazole
treatment for salmonella
none unless immunocompromised (cipro)
treatment for salmonella
none unless severe (cipro TMP-SMX)
treatment for campylobacter
erithromycin
Hep BsAg negative
Hep BsAB negative
Hep BcAb positive
window period of Hep B infection
Hep BsAg positive
Hep BsAb negative
Hep BcAb positive
chronic Hep B infection
Hep BsAg negative
Hep BsAB positive
Hep BcAb negative
Hep B vaccinated status
Hep BsAg negative
Hep BsAB positive
Hep BcAb positive
past Hep B exposure
next step in patient complaining of dysphagia
barium swallow followed by EGD
EGD reveals gastric cancer, what is the next step
CT scan to stage
next step in management of patient with recurrent duodenal ulcers on multiple EGDs
serum gastrin level to rule out ZES
most effective treatment for duodenal ulcers not due to ZES
triple therapy for h. pylori
chem 7 lab abnormality often elevated in patients with an upper GI bleed
BUN
bacteria in gut breakdown hemoglobin with is reabsorbed increasing BUN
tumor markers for pancreatic cancer
CEA and CA19-9
tumor marker for gastric cancer
CEA
regimen for h. pylori treatment
PPI + clarithromycin + amoxicillin/metronidazole
treatment for gastric cancer
distal third: subtotal gastrectomy
initial two-thirds: total gastrectomy
treatment for pancreatic cancer in the head of the pancreas
whipple if localized
most sensitive and specific lab test for chronic pancreatitis
decreased fecal elastase
treatment for chronic pancreatitis
alcohol cessation, enzyme replacement
management for patient that comes to ER with abdominal pain and AXR shows free air in abdomen
laparotomy
cuban immigrant with malabsorption and megaloblastic anemia
tropical sprue
time-frame for post-operative ileus resolution in the different parts of the gut
stomach: 24 hours
small bowel: 2-3 days
large bowel: 3-5 days
diagnosis and management: AXR reveals two distinct but sequential portions of bowel in sigmoid colon distended
sigmoid volvulus, colonic decompression, resection as needed
most common cause of small bowel obstruction
adhesions or secondly hernias
classic characteristic of acute mesenteric ischemia
pain out of proportion to the exam
tumors that can cause secretory diarrhea
VIPoma, gastrinoma, carcinoid, and medullary thyroid
most likely cause of malabsoprtion in patient with + sudan stain and normal D-xylose test
pancreatic insufficiency
treatment for whipple disease
antibiotics (TMP-SMX or ceftriaxone) x 12 months
serum antibodies seen in celiac sprue
anti-gliadin, anti-endomysial, anti-transglutaminase
serum lab findings distinguishing crohn’s from UC
crohn’s ASCA positive, UC P-ANCA positive
next step in management of patient younger than 50 w/minimal BRBPR
anoscopy looking for hemorrhoids
most likely cause of acute pain and swelling of midlien sacrococcygeal skin and subcutaneous tissues
pilonidal cyst
most likely cause of recurrent LLQ abdominal pain improving after defecation
diverticulosis
patient at risk for acalculous cholecystitis
ICU patient or patient on TPN
charcot’s triad
fever, RUQ pain, and jaundice
reynold’s pentad
fever, RUQ pain, jaundice, altered mental status, hypotension
next step for patient found to have calcified gallbladder
biopsy
treatment of cholecystitis v. cholangitis
cholecystitis go right to cholecystectomy
cholangitis perform endoscopic drainage followed by delayed cholecystectomy
patient with colon cancer has local lymph node involvement without distant mets
stage III
will require chemotherapy
patient undergoes colonoscopy and is found to have 3 small tubular adenomas, when should he undergo his next colonscopy
5 years
man tells you his father was diagnosed with colon cancer at age 55, when should his first colonoscopy be
45
antibiotic combination to treat diverticulitis as an outpatient
metronidazole + TMP-SMX/augmentin/fluoroquinolone
how are anal fissures managed
stool softeners, topical nitroglycerin, anti-spasmotics
refractory cases may receive partial sphincterotomy (risk of incontinence)
most common causes of upper GI bleeds
peptic ulcer disease, esophagitis, variceal bleeds, gastritis, mallory-wise tears
most common causes of lower GI bleeds
upper GI bleeds, diverticulosis, AV malformations, colorectal cancer, mesenteric ischemia, meckel’s diverticulum
how is volume status assessed in patient with GI bleed
blood pressure, heart rate, urine output
antibiotic contraindicated in neonates with hyperbilirubinemia
ceftriaxone
deep palpation of RUQ causes arrest of inspiration and pain
murphy’s sign, cholecystitis
RLQ pain on passive extension of hip
psoas sign, appendicitis
RLQ pain on passive internal rotation of the flexed hip
obturator sign, appendicitis
LUQ pain and referred left shoulder pain
kehr’s sign, splenic rupture
ecchymosis of the skin overlying the flank
grey-turner sign, pancreatitis
ecchymosis of the skin overlying the periumbilical area
cullen’s sign, pancreatitis
treatment for hepatic encephalopathy
lactulose and rifaximin (or neomycin)
protein restriction
symptoms of budd-chiari syndrome
ascites, hepatomegaly, jaundice
most widely used screening test for hemochromatosis
serum ferritin
treatment for hemochromatosis
phlebotomy and deferoxamine
primary biliary cirrhosis v. primary sclerosing cholangitis
PBC: female, intrahepatic ducts only, anti-mitochondrial antibodies, anti-ANA
PSC: male, intrahepatic and extrahepatic ducts, P-ANCA, ERCP shows beads on a string
treatment for primary biliary cirrhosis
urodeoxycholic acid +/- colchicine
eventual liver transplant
most common type of TE fistula
blind upper esophageal pouch, lower esophagus is connected to the trachea
hepatitis virus types
A: picornavirus, single-stranded RNA B: hepadnavirus, double-stranded DNA C: flavivirus, single-stranded RNA D: delta agent, incomplete single-stranded RNA E: calicivirus, single-stranded RNA
statistics for progression to chronic hepatitis
5% adults progress to chronic hepatitis B
90% children progress to chronic hepatitis B
80% adults progress to chronic hepatitis C
increased LES pressure, incomplete LES relaxation, decreased peristalsis
achalasia
see “birds beak” sign on CXR
management of a duodenal hematoma
most resolve in 1-2 weeks
treat conservatively with NG tube and TPN
polyps that are not pre-malignant
peutz-jaghers, hyperplastic, inflammatory, and juvenile
treatment for acute diverticulitis
NPO, IV fluids, antibitoics
elective surgery for those who have had > 2 attacks
treatment for sigmoid volvulus
proctosigmoidoscopic exam, leave rectal tube in
elective sigmoid resection
treatment for pyogenic liver abscess
diagnose with U/S or CT scan
percutaneous drainage required
treatment for amebic liver abscess
seldom require drainage, metronidazole will suffice
large, thin, distended gallbladder with obstructive jaundice picture
likely malignancy causing obstruction
malignant obstructive jaundice, anemia, blood in stools
cancer of the ampulla bleeding into the lumen
severe peptic ulcers, watery diarrhea
zollinger-ellison syndrome (gastrinoma)
treatment: measure serum gastrin, surgically resect
devastating hypoglycemia in newborns that results in 95% pancreatectomy
nesidioblastosis
mild diabetes, anemia, glossitis, stomatitis, and severe migratory necrolytic dermatitis
glucagonoma
treatment: surgically resect, somatostatin or streptozocin for metastatic disease
diagnostic method for meconium ileus
gastrografin enema (also therapeutic)
management of pyloric stenosis
correct metabolic abnormalities and follow with surgery
management of intussusception
barium enema is both diagnostic and therapeutic
