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GI/GU > Gastrointestinal Exam 2 > Flashcards

Gastrointestinal Exam 2 Flashcards

1
Q

Sphincter of Odi

A

Between pancreas and duodenum

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2
Q

3 exoxrin pancreatic enzymes

A

Protease (trypsin and chymotrypsin)
Lipase
Amylase

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3
Q

Pancreatic delta cells

A

Secrete somatostatin
Endocrine cells more in the tail

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4
Q

Parts of pancreas damaged more with chronic versus acute pancreatitis

A

Acute - exocrine
Chronic - endocrine

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5
Q

MCC of acute pancreatitis

A

Gallstones, Alcohol, Idiopathic 20%

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6
Q

Alcoholic pancreatitis

A

May be due to acinar cell injury or stimulated contraction of sphincter of Oti

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7
Q

Presentation of acute pancreatitis

A

Epigastric pain radiating to the back
Improves leaning forward, worse lying down
N/V, sweating

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8
Q

PE findings for acute pancreatitis- 4

A

May have absent bowel sounds, epigastric tenderness, Jaundice, Mass

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9
Q

Cullen’s sign

A

Bruising around the umbilicus d/t acute pancreatitis

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10
Q

Gray Turner sign

A

Flank bruising d/t pancreatitis

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11
Q

Acute interstitial edematous pancreatitis

A

More common acute pancreatitis - intact blood flow

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12
Q

Necrotizing acute pancreatitis

A

Blood flow not intact - more severe

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13
Q

Labs for acute pancreatitis

A

Amylase and Lipase (more sensitive) 3x upper limit is diagnostic

Leukocytosis on CBC

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14
Q

Imaging for acute pancreatitis

A

Sentinel loop or colon cutoff sign on plain X-ray
US not useful
CT may show enlarged pancreas

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15
Q

Ranson’s Criteria- 5 At Admission and 6 after 48 Hours

A

Pancreatitis Prognosis
Admission:
Age >55
BG > 200mg/dL
Serum LDH >350
AST >250
WBC >16,000

Within 48 hours
HCT decrease >10%
BUN increase >5mg/dL
Serum calcium <8mg/dL
PaO2 <60mmHg
Base deficit >4mEq/L
Estimated fluid sequestration >6L

3+ predict a severe course

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16
Q

Mortality rate for Ranson’s Criteria

A

0-2 - 1%
3-4 - 16%
5-6 - 40%
7-8 - 100%

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17
Q

BISAP criteria for acute pancreatitis

A

BUN >25mg/dL
Impaired Mental Status
Systemic inflammatory response
Age >60
Pleural effusion

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18
Q

Treatment for acute pancreatitis

A

Admit
Rest Pancreas - NPO
IV fluids - early and aggressive
NO MORPHINE, Demerol for pain
Bed rest

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19
Q

Mild acute pancreatitis treatment as symptoms improve

A

Clear liquids and low fat first
Cholecystectomy if gallstone
Monitor for return of bowel sounds

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20
Q

Tx for severe acute pancreatitis

A

ICU, Treat complication, ABX if abcess - imepenem, Fluid resicitation, CT if not improving

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21
Q

Acute pancreatic fluid collection

A

Resolves spontaneously in 7 days

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22
Q

Chronic pancreatitis presentation

A

Slow irreversible loss
MCC = Alcoholism, smoking, autoimmune
Steady pain, worse after eating, DM and steatorrhea d/t enzyme loss
Can have an acute attack

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23
Q

Labs for chronic pancreatitis

A

Slightly elevated lipase and amylase could be normal
Check of autoimmune cause

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24
Q

Imaging for chronic pancreatitis

A

Calcifications on X-ray
CT is preferred
Ultrasound - honeycombing of the pancreas

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25
Q

Management of chronic pancreatitis

A

Low fat, stop smoking, alcohol
Pain management - careful with opioids
Treat complications

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26
Q

Puestow procedure

A

Pain relief for dilated duct - attach intestines to pancreas

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27
Q

Whipple procedure

A

Resection of part of the pancreas

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28
Q

Part of pancreas easier to resect

A

Head of the pancreas

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29
Q

Risk factors for pancreatic cancers (4)

A

Over 45
Late onset diabetes
Smoking
BRACA gene

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30
Q

Clinical presentation of pancreatic cancer

A

Gnawing insidious pain like gastritis
Painless jaundice with nontender palpable gallbladder = Courvasier’s sign
Sister Mary Joseph Nodule

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31
Q

Tumor marker for pancreas

A

CA-19-9

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32
Q

Imaging for pancreatic cancer

A

CT = First line
ERCP if uncertain CT

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33
Q

Pancrease staging

A

T1 and T2 confined to pancreas, others not

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34
Q

Surgery for pancreatic cancer

A

Exploratory laparoscopy followed by whipple procedure is suitable

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35
Q

Screening for pancreatic cancer

A

If 1st degree relative - get a CT 10 years before onset in the relative

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36
Q

ERCP

A

More invasive with sedation
Diagnostic AND therapeutic

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37
Q

MRCP

A

Like an MRI, less invasive
Only diagnostic

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38
Q

Triangle of Calot

A

Medial common hepatic duct
Inferior cystic duct
Superior-inferior surface of the liver

Landmark in cholecystectomy allowing for ligation of cystic duct and artery - need to protect common bile duct

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39
Q

CCK

A

Cholecystokinin - Stimulates gall bladder contraction and sphincter of Oti relaxation

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40
Q

Causes of gallstone formation

A

High cholesterol
High Billirubin
Sedentary Gall Bladder

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41
Q

Lifestyle changes to prevent cholelithiasis

A

Low carb or mediterranean diet
Caffeinated coffee

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42
Q

Asymptomatic cholelithiasis

A

Stones stay in the bottom of gall bladder and do not cause pain by blocking the duct

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43
Q

Presentation of cholelithiasis- Pain, Timing, Appearance

A

RUQ pain to right shoulder blade
After fatty meals
Dull with nausea and sweating
Not ill-appearing

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44
Q

Lab results for cholelithiasis

A

WNL

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45
Q

Abd exam with cholelithiasis

A

No peritoneal sx, no rebounds tenderness
Pretty benign

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46
Q

Imaging for cholelithiasis

A

Abd US is procedure of choice - RUQ

Could also use CT or XR

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47
Q

Treatment for cholelithiasis

A

NSAIDS for pain
Laparoscopic cholecystectomy
Don’t need to treat if asymptomatic

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48
Q

3 reasons for a prophylactic cholecystectomy

A

Calcified gall bladder
3cm or greater stones
Native American

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49
Q

Pregnancy and cholecystectomy

A

Try to wait until 2nd trimester
Need labor and delivery and NICU there

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50
Q

Intraoperative choleangiogram

A

Xray with catheter in bile duct to help with surgeon visualization - used to check for nicking of common bile duct

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51
Q

Treatment for cholelithiasys in those not candidates for surgery- 2 Pharm options

A

Urosodiol - Ursodeoxycholic acid
Bile salt PO

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52
Q

3 types of cholecystitis

A

Acute Calculus - due to gallstones and MC
Acute acalculous - Gallbladder stasis ischemia - major surgeries
Chronic cholecystitis - Episodic billiary cholic

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53
Q

Presentation of cholecystitis

A

Appear Ill - Unlike cholic
Pain with fatty meal lasting over 6 hours!!!
Peritoneal signs

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54
Q

Murphys sign

A

Cholecystitis - Inspiration stops with pressing down in RUQ

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55
Q

Lab findings in cholecystitis

A

Leukocytosis w/ Left shift
No elevation of liver enzymes

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56
Q

Imaging for acute cholecystitis

A

Thickening of gallbladder wall
Stones
Use an US

HIDA scan if inconclusive

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57
Q

HIDA scan

A

IV contrast that travels into bile ducts - look for transit time
Non-visualized gallbladder = Cholecystitis

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58
Q

Other diagnostic test for cholecystitis

A

CCK injection
Ejection fraction of gallbladder under 35

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59
Q

Complications of acute cholecystitis

A

Gangrene of gallbladder
Gallbladder perforation
Hydrops of gallbladder - distended
Mirizzi syndrome - Jaundice from common hepatic duct compression
Percelain gallbladder - calcified

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60
Q

Management of acute cholecystitis- 4

A

Abx for E coli - Pip and Taz or 2nd or 3rd gen chep or cipro and metro
NPO w/ NG tube
Demerol or NSAID for pain
Cholecystectomy w/in 24-48 hours

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61
Q

New treatment for acute cholecystitis

A

Cholecystotomy for drainage
Alternative if they can’t handle a cholecystecomy

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62
Q

-choledo-

A

Common bile duct

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63
Q

Choledocholithiasis presentation and cause

A

Gallstone in common bile duct - uncomplicated
RUQ pain up to scapula
Jaundice
Epigastric tenderness

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64
Q

Diagnosis for choledocholithiasis

A

Elevated liver enzymes with bilirubinemia

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65
Q

Treatment for choledocholithiasis

A

ERCP with spincterotomy and stent placement
with Cholecystectomy after

MRCP used first for low risk - just cholecytectomy if no stone

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66
Q

Cholangitis

A

Bacterial infection with stone in common bile duct

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67
Q

Triad of acute cholangitis

A

Charcot triad
RUQ pain
Fever
Jaundice

Reynolds Pentad
Add - Hypotension and Mental status changes

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68
Q

Labs and imaging for acute cholangitis

A

CBC leukocytosis
Liver enzymes
Prolonged PT

ERCP is the most accurate imaging - Diagnostic procedure of choice, will likely do an US first

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69
Q

Treatment for cholangitis

A

NPO, prep for surgery, IV fluids, Pain control
ERCP for stone extraction

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70
Q

ABX for cholangitis

A

Mild/Mod - Cipro and flagyl
Severe - Zosyn(Pip and Taz) and Flagyl

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71
Q

First line imaging for most billiary diseases

A

US

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72
Q

Primary sclerosing cholangitis

A

Related to UC and IBD
No cure
Leads to obstructive symptoms - fibrosis

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73
Q

Presentation of PSC

A

Jaundice
Pruritis
Hepatosplenomegaly

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74
Q

Lab finding for PSCA

A

Elevated LFTs
Increased P-ANCA antibodies (specific to injuries of billiary tree)

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75
Q

Imaging for PSCA

A

MRCP - ERCP if inconclusive
Beads on a string seen is indicative - Segmental fibrosis

Liver biopsy with “onion skinning” if those are inconclusive

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76
Q

Treatment for PSCA

A

No cure
Cipro for episodes
Immune suppressants and Ursodeoxycholic acid are being studied
ERCP with stent
Liver transplant
Resection of carcinoma - complication

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77
Q

Most deadly gallbladder cancer

A

Choleangiocarcinoma

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78
Q

3 common coexisting conditions with gallbladder carcinoma

A

Chronic infection - Salmonella
Gallbladder polyp
Calcification of gallbladder

Often invades liver

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79
Q

MC location of choleangiocarcinoma

A

Confluence of R/L hepatic ducts

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80
Q

PE findings of biliary tract cancer

A

RUQ tenderness
Courvoisier sign
Ascites

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81
Q

Diagnostic for Carcinoma of biliary tract

A

ERCP w/ biopsy or US guided biopsy

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82
Q

Tx for biliary tree cancer

A

Resect
Roux en Y if non-resectable to bypass bile duct -bile drains fromthe liver to the duodenum

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83
Q

Porta hepatis

A

Hepatic artery, Portal vein, and hepatic duct - between the four lobes

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84
Q

Unconjugated billirubin

A

Indirect bilirubin that has NOT been processed by the liver. made from protoporphyrin
Binds to albumin, lipid soluble

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85
Q

Conjugated bilirubin

A

Made by uridine glucuronyl transferase
Water soluble - has been processed by the liver
Goes to bile ducts

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86
Q

Fates of conjugated bilirubin

A

Goes to SI, urobilinogen sent to urine, cobilin sent to feces

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87
Q

Conjugated hyperbilirubinemia

A

Pale urine and stools as opposed to unconjugated hyperbilirubinemia
Post hepatic jaundice

88
Q

3 factors not made in liver for clotting

A

III,IV, and VIII - not effected by liver disease

89
Q

Gold standard to diagnose portal hypertension

A

Insert catheter to get pressure

90
Q

ABCDE of portal hypertension

A

Ascites
Bleeding
Caput Medusae
Diminished liver function
Enlarged spleen

91
Q

Hepatorenal syndrome

A

Liver failure leads to kidney failure - portal hypertension causes poor perfusion of kidneys

92
Q

Hepatic encephalopathy

A

Due to ammonia buildup - ammonia can’t be made to urea

93
Q

3 enzymes that assess for hepatic tissue damage

A

AST, ALT, LDH
ALT is the most specific to the liver

94
Q

Elevated aminotranseferases indicating acute liver trauma

A

8-25x normal range
AST>ALT (ratio over two - chronic alcohol, under two non-alcoholic)
ALT>AST - Acute Liver Trauma

95
Q

2 Liver enxymes to measure obstruction of the billiary tre

A

Alkaline phosphatase (4x elevation is cholestasis) AND Gamma-glutamyl transpeptidase
BOTH is indicative of obstruction
Also 5’-nucleotidase specific to the liver

96
Q

Tests of hpatic synthetic function

A

Albumin levels
If other LFTs are normal consider malnutrition
PT time
See above note

97
Q

Autoimmune hepatitis

A

Insidious onset to sudden attack presentation
Precipitated by viral illness, pregnancy, drug exposure
May have a history of autoimmune - Positive ANA, pANCA, anti-SLA
Liver biopsy for diagnosis

98
Q

Treatment for autoimmune hepatitis

A

Prednisone long term
Azathioprine - second line
Liver transplant if they fail therapy

99
Q

Drugs that can induce hepatitis

A

Acetominophe
Isoniazid
Tetracyclines

100
Q

Labs and treatment for drug induced hepatitis

A

ALT > AST
May require a liver transplant

101
Q

Acetominophen toxic doses for kids and adults

A

Adults - 4g (4000mg)
Kids - 80mg/kg

102
Q

Stage one of acetominophen induced hepatitis

A

.5-24 hours - N/V, diaphoresis, pallor lethargy w/ normal labs

103
Q

Stage two of acetominophen induced hepatitis

A

24-72 hours
Symptoms resolve but labs get worse
RUQ pain
PT and billirubin elevated

104
Q

Stage three of acetominophen induced hepatitis

A

72-96
Jaundice, confusion
Elevated enzymes
Many die

105
Q

Stage 4 of acetominopheni induced hepatitis

A

4 days to 2 weeks
Recovery
May have AKI
Symptoms and lab values begin to normalize

106
Q

Diagnosis and treatment for acetominphen induced hepatitis

A

Measure acetominophen level with the blood
N-acetylcysteine (activated charcoal) if possible within 1-2 hours of ingestion - give if we don’t know when they took it

107
Q

RiskFactors for Alcoholic liver disease

A

2 drinks per day for men, 1 per day for women
Fatty liver to alcoholic hepatitis to cirrhosis
50g daily for 10 years is the threshold
Often an incidental finding of labs in the fatty liver stage

108
Q

ALT AST ratio of alcoholic liver disease

A

2:1 or greater AST to ALT ratio

109
Q

Treatment for alcoholic liver disease

A

Abstinence from alcohol
Folic acid, zinc, thiamine
Prednisone for about a month

110
Q

Glasgow alcoholic hepatitis score

A

Greater than 9 is an indication for steroid treatment

111
Q

Non-alcoholic steatohepatitis

A

Fatty liver w/o alcohol us
Can still lead to cirrhosis
Fatty liver is without inflammation
RUQ discomfort - vague symptoms
Biopsy to diagnose

112
Q

Treatment for non-alcoholic fatty liver disease- 5

A

Lifestyle modification
Hepatitis vaccines
Vitamin E, Thiazolidenediones, Metformin

113
Q

Percent of NASH patients who progress to cirrhosis

A

20%

114
Q

PE findings with cirrhosis- 7

A

Portal hypertension
Pruritis
Spider angiomas
ED,
Gyencomastia
Palmar erythemia
Jaundice - later in the disease

115
Q

Labs and diagnostics for liver cirrhosis

A

Minimal elevations in liver enzymes early in the disease cours
DDx - Liver biopsy
FL - US of Liver

116
Q

Treatment for cirrhosis- 6

A

TRANSPLANT
Avoid alcohol
Hepatitis vaccination
Spironolactose and Furosemide
TIPS - Shunt
Paracentesis

117
Q

Bacterial peritonitis related to cirrhosis
Agent and Drug of Choice

A

MC w/ E. coli
Treat with cefotaxime

118
Q

Treatment for hepatic encephalopathy

A

Reduce protein intake
Give lactulose
ABX - Rifamixin and Flagyl to reduce ammonia producing bacteria

119
Q

Tx for cirrhosis clotting factor deficiencies

A

Give FFP, Ferrou sulfate for anemia

120
Q

Tx for esophageal varices

A

Band, Ballon, Tamponade
Octreotide for bleeding
Beta blocker for maintainence

121
Q

MELD score

A

Assesses for appropriateness for liver transplant
14 or higher qualifies for a liver transplant

122
Q

Primary billiary cirrhosis

A

Chronic autoimmune destruction of the bile ducts
Common in women 40-60
Fatigue and itchiness are MC symptoms
Fat deposits in the fingers
Positive ANAD

123
Q

Diagnosis- 2 and Tx - 3 for primary billiary cirrhosis

A

Elevated ALP and cholesterol
Baseline US biopsy not needed
Ursodeoxycholic acid is tx
CHolestyramine for itching
Liver transplant is definitive

124
Q

Hepatitis A Etiology and Incubation

A

Fecal Oral route
Incubates for TWO weeks
No chronic carrier state

125
Q

Hepatitis A presentation - 6

A

More severe in adults
Distaste for smoking
N/V/D
RUQ pain gets worse with movement
Jaundice and acholic stools
Hepatomegaly

126
Q

Diagnosis of HAV

A

Jaundice with known risk for Hep A
Established by IgM anti HAV antibodies - peak during symptoms
ALT>AST
Imaging not indicated

127
Q

Treatment for HAV

A

Symptomatic treatment - fluids and rest
Avoid alcohol
Prevent via handwashing and vaccination

128
Q

3 antigens of Hepatitis B

A

HBcAg - Core antigen
HBeAg - Secreted BY the core
HBsAg - HBV surface antigen

129
Q

Risk factors for HBV

A

Bloodborne
Sexual activity, mother to baby, healthcare workers, IVDU, incarceration, previous STD

130
Q

Clinical presentationand incubation of Acute HBV

A

6 week to 6 month incubation
Recurrent fever
RUQ pain
Jaundice
Subsides in a few weeks

131
Q

HBsAg

A

First to elevate - persists throughout clinical illness - presence for >6 months indicates chronic illness

132
Q

anti-HBs

A

Indicates recovery when coupled with decline of HBsAg
Indicates vaccine response and immunity when no HBsAG is present

133
Q

IgM anti HBc

A

One month after HBsAG is detected
Indicates declining acute hepatitis B
3-6 month persistence
Acute flares of chronic disease

134
Q

IgG anti-HBC

A

Persists indefinitely
With Anti-HBs = recovery
With HBsAG = Chronic disease

135
Q

HBeAG

A

Elevated with infectivity - helps us know how infectious it is
Appearance of antibody indicates reduction in infectivity
Parallelled by HBV DNA

136
Q

Labs of acute hepatitis

A

ALT greater than AST - more marked than HAV

137
Q

Txand Prophylaxis for HBV

A

Avoid alcohol and activity
Antiviral therapy only if chronic
HBIG for prophylaxis within 7 days of exposure and newborns with HBV positive mothers

138
Q

Tx for chronic HBV

A

Can lead to hepatocellular carcinoma and cirrhosis
Nucleoside and nucleotide analogs - 1st line
Interferon treatment - 2nd line

139
Q

Hepatitis C

A

IVDU, Sexually transmitted, Healthcare, often co-infected with HIV

140
Q

Presentation and course of HCV

A

6-7 week incubation period
Often a mild presentation
Often becomes chronic
Anti-HCV antibodies - RNA indicates a CURRENT infection, only Ab’s indicate a past infection

141
Q

Prevention for hepatitis C

A

No vaccine
Safe sex and needle use

142
Q

Management for HCV

A

Harvoni - combo drug of ledipasvir/sofosbusir

143
Q

HCV protease inhibitors and polymerase inhibitos for HCV

A

8 week course
Prevent viral replication

144
Q

Hepatitis D

A

Only associated with Hepatitis B infection!!
Mainly in IVDU
Anti-HDV antibodies in serum

145
Q

Hepatitis E

A

In non-US contries more often - fecal-oral
Most severe among young pregnant women
May be spread by swine
Test for IgM anti-HEV in serum
Treat with oral ribovirin to treat

146
Q

Hemochromatosis

A

Autosomal recessive
Increased iron absorption from the duodenum and storage in the liver
Usually don’t present until older than 50
“bronze diabetes”

147
Q

Diagnosis of hemochromatosis

A

Mild LFT elevationElevated serum Iron and serum ferritin
Test first degree family members
Genetic testing available

148
Q

Treatment for hemocrhomatosis

A

Weekly phlebotomy for 2-3 years
Chelating agents if unable to tolerate phlebotomy - Defaroxamin
Liver transplant for cirrhosis

149
Q

WIlson disease

A

Autosomal recessive disorder
Presents before age 40
Excessive absorption of copper and decreased excretion by the liver leading to low ceruloplasmin
Deposition of copper in liver and brain

150
Q

Presentation of Wilson disease

A

Kayser Fleischer copper rings around iris - pathognomic
Parkinsonianism, Dysphagia
Personality changes

151
Q

Labs for Wilson disease

A

Urine copper
Low serum ceruloplasmin levels
Liver biopsy to assess chronic hepatitis/cirrhosis

152
Q

Five Treatments for Wilson disease

A

Restrict copper - nuts chocolate shellfish
Penicillamin - Drug of choice - Chelating agent and increases urinary excretion
B6 - antimetabolite of copper
Zinc promotes fecal copper excretion
Liver transplant if not caught early

153
Q

Gilbert syndrome

A

Mild unconjugated hyperbilirubinemia
Familial
Reduced activity of glucuronyl transferase
Random outbreaks of jaundice
Bilirubin above 3mg/dL
Benign, educate about flare-ups

154
Q

Crigler Najjar syndrome

A

Infantile jaundice
Glucuronyl transferase deficiency
Autosomal recessive
Rapid and severe
Does not go away after 2-3 weeks

155
Q

Crigler Najjar Types

A

Type I - 20-50mg/dL
Type II <20mg/dL
High levels definitive for diagnosis

156
Q

Treatment for crigler najjar syndrome

A

Phototherapy under fluorescent light
Plasmapheresis
Liver transplant - curative
Phenobarbital for type II

157
Q

Dubin Johnson syndrome

A

Genetic
Conjugated bilirubin not sent to bile ducts
Intermittent jaundice and fatigue
Elevated conjugated bilirubin
Black liver
Benign - can be exacerbated by illlness or pregnancy

158
Q

Rotor syndrome

A

Rare genetic disorder
Stored bilirubin leaks back into the blood stream
Inject dye for a transport study to differentiate from Dubin Johnson
Benign

159
Q

Budd-Chiari syndrome

A

Hereditary or acquire hepatic venous outflow obstruction, RUQ Pain, jaundice, ascites

160
Q

Budd-Chiari diagnosis

A

Doppler US
Can move on to an MRI

161
Q

Tx for BC syndrome

A

Lovenox if clotting problem
TIPS - shunt
Pericentesis

162
Q

Kernicterus

A

Crigler Najjar syndrome
Brain damage from high bilirubin levels in a baby’s blood

163
Q

MC Hepatocellular carcinoma

A

Parenchymal cell carcinoma d/t cirrhosis

164
Q

Lab findings for hepatocellular carcinoma

A

Alpha fetoprotein
CT/MRI for mass
Liver biopsy

165
Q

Screening for hepatocellular cancer

A

Liver US Q 6 months

166
Q

Carnett’s sign

A

If a patient’s pain on palpation worsens when flexing the abdominal muscles the pain is located in the abdomenal wall rather than the abdomen itself

167
Q

Murphy’s sign

A

Inspiratory arrest during deep palpation of the RUQ - good indicator for Gallbladder inflammation

168
Q

Rovsing sign

A

Indirect tenderness RLQ pain with LLQ palpation - indicates appendicitis

169
Q

Psoas sign

A

Patient flexes the thigh against resistance of the examiner’s hand - on left side - Pain is indicative of appendicitis

170
Q

Obturator sign

A

Flexion and internal and then external rotation of the thigh causes pain - appendicitis, diverticulitis, PID

171
Q

Cough test

A

Indicative of peritoneal irritation

172
Q

Volvulus

A

Torsion of segment of bowel
MC - sigmoid
Obstruction and strangulation - often in older adults 70+
Chronic constipation is a risk factor

173
Q

Presentation of volvulus

A

Insidious onset of abdominal pain
Abdominal distension
Severe and colicky
Tympany on exam w/ tenderness
Fever and tachycardia after perforation

174
Q

Diagnosis of volvulus

A

CT to establish diagnosis
Whirl pattern and bird beak appearance
Abdominal X-ray can also be performed

175
Q

Treatment of volvulus

A

IV fluids
Endoscopic detorsion - advance scope through twisted segment
Elective resection if there is a risk of recurrence or major necrosis

176
Q
A
177
Q

Cecal volvulus

A

More rare than Sigmoid volvulus
Can be caused by violent coughing, tumor, or pregnancy

178
Q

Presentation of cecal volvulus

A

Highly variable
Gradual onset of pain with N/V

179
Q

Diagnosis of cecal colvulus

A

CT - first line
Whirlwind and birds beak
Coffee bean and comma sign with Abdominal X ray

180
Q

Treatment for cecal volvulus

A

Can’t do endoscopic - must do open
Ileocecal detorsion if possible - if not possible cecopexy to anchor cecum to the wall

181
Q

Intussusception

A

Bowel folds back into itself
6 months-3 years
more common in males and in the ileocolic area
Mostly idiopathic

182
Q

Presentation of instussusception

A

Intermittent severe abdominal pain, 15-20 minute attacks
Current jelly stools
Sausage shaped mass in the right side of the abdomen
Tender and distended abdomen

183
Q

Diagnosis and tx of instussusception

A

Utrasound is number 1 - coiled spring
Barium enema confirmatory- can be CURATIVE
Sonogrophy guided non-surgical reduction with saline or pneumatic reduction - air is less dangerous

184
Q

Tx for intussusception if you suspect a perforation

A

Pneumatic reduction is better than barium

185
Q

Presentation of appendicitis

A

MC between 10-30
MCC is a fecalith
Vague, colicky pain localizing the the RLQ within 12 hours
Pt can localize pain upon coughing
Rebound tenderness
McBurney’s point tenderness

186
Q

Diagnosis of appendicitis

A

Mostly clinical
CT to confirm diagnosis
US can confirm but not exclude diagnosis

187
Q

Management for appendicitis

A

Laparoscopic appendectomy
Hydration
Cefoxitin or Ampacillin-Sulbactam

188
Q

Toxic megacolon

A

Complication of IBD or Crohns
Non-obstructive dilation of 6+ cm with systemic symptoms

189
Q

Presentation of toxic megacolon

A

ABdominal pain and distension
Severe bloody diarrhea
Toxic appearing
Dehydrated
Recent travel, abx use, use of antimotility agents

190
Q

Diagnosis of toxic megacolon

A

Radiographic evidence of colonic distension on CT or XR - CT preferred
PLUS 3 of:
Fever 100.4+
HR 120+
Leukocytosis over 10,500
Anemia
PLUS 1 of:
Dehydration
Altered mental status
Electrolyte disturbances
Hypotension

191
Q

Most effected area in toxic megacolon

A

Transverse colon

192
Q

Treatment for toxic megacolon

A

NG tube to decompress colon
Stop medications
PPI for stress ulcer prevention
Bowel rest - NPO
Serial CMP, BMP, Radiograph

193
Q

Indications for surgery in toxic megacolon- 5

A

Surgery for perforation, necrosis, ischemia, hypertension, or compartment syndrome

194
Q

Pharm for toxic megacolon

A

Amp, gent, metronidazole OR 3rd Gen Ceph w/ metronidazole
Corticosteroids

195
Q

Acute mesenteric ischemia

A

Ischemia of the SMALL bowel
Occlusive or non-occlusive
MC in the SMA

196
Q

Presentation of acute mesenteric ischemia

A

Abdominal pain out of proportion to findings
Severe, sudden, perumbilical
Fecalant breath odor

197
Q

Labs and Dx for diagnosis for acute mesenteric ischemia

A

Metabolic acidosis - is indicative until proven otherwise
Mesenteric arteriography - dx of choice
CT/MRI are nonspecific

198
Q

Tx for acute mesenteric ischemia

A

Opioids for pain control
Broad spectrum abx and NG tube
Anticoagulation and Nitroglycerin
Abdominal exploration d/t intestinal ischemia

199
Q

MCC of upper GI bleeding

A

Peptic ulcer disease

200
Q

MCC of lower GI bleed

A

Bleeding diverticulum

201
Q

Presentation of GI bleed

A

Melena
Hematochezia
Coffee ground emesis
Blood y emesis
Weight loss suggests malignancy
Jaundice suggests liver problem

202
Q

Things that can mimic GI bleeding

A

Iron or Bismuth - Melena
Beets - Hematochezia
Cefdinir - Red Stools

203
Q

Division between upper and lower GI

A

Ligament of treitz

204
Q

Risk factors for umbilical hernea

A

Pregnancies
Ascites
Obesity
Intra-abdominal hernia

205
Q

Treatment for umbilical hernia

A

Surgical repair
Open or Mesh depending on size (open if larger)

206
Q

Features of hernia associated with strangulation

A

Firm
Severe tenderness
Abdominal distension

207
Q

Treatment of ventral hernia

A

Any hernia in abdominal area
Does not require surgery or is a poor surgical candidate or hernia is not emergent - can use an abdominal binder

208
Q

X ray colors

A

Bone - White
Tissue - gray
Air - Black

209
Q

Indication of air in the peritoneal cavity

A

Air UNDER the diaphragm - may be a bowel perforation or air expansion from laparoscopy

210
Q

Feces on X ray

A

Soft tissue with opacities

211
Q

Colors on US

A

Hypoechoic - Dense muscle and connective tissue
Hyperechoic - Bright - Air fat and gas
Anechoic - Fluid and blood filled structures appear more black

212
Q

Contrast use for abdominal CT

A

IV - best for tumors, vascular abnormalities, urinary tract
Oral - Best for visualizing the bowel lumen, esophagus, stomach
Non-contrast - Best for evaluating stones

213
Q

Pros/Cons of CT

A

Helps enhance and delineate between organs
Takes a while, renal failure can cause an allergic reaction or flushing

214
Q

Barium swallow

A

Used with X ray
Continue images as it passes through the small bowel
Can also do a barium enema

215
Q

MC complication of ERCP

A

Pancreatitis

GI/GU (4 decks)

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