Gastrointestinal/Nutritional Flashcards
etiology of anal fissures
constipation
Where is the MC location of anal fissure
posterior midline
s/s of anal fissures
rectal bleeding and pain
When do anal fissures raise concern for pathologic etiology?
fissures oriented laterally
tx of anal fissures
proper toileting
topical nifedipine or nitroglycerin
topical analgesics
stool softener
sitz bath
fiber
etiology of appendicitis
fecalith
s/s of appendicitis
-periumbilical pain that localizes in the RLQ
-mcburneys point tenderness
-rosving sign
-psoas sign
diagnosis of appendicitis
CT
treatment of appendicitis
appendectomy
MC type of volvus
sigmoid
s/s of sigmoid volvus
-slow onset abdominal pain, nausea, abdominal distension, and constipation
-tenderness to palpation
dx of volvulus
-whirlwind sign of CT
-coffee bean/comma sign on Xray
treatment of volvulus
rigid sigmoidoscope
etiology of small bowel obstruction
surgical adhesions
s/s of small bowel obstruction
-n/v
-colicky abdominal pain
-abdominal distention
-hypoactive bowel sounds
diagnosis of SBO
-ladder appearance of Xray
treatment of SBO
-NG tube decompression
etiology of gallstones
cholesterol or alcohol
s/s of cholelithiasis
biliary colic
diagnosis of cholelithiasis
US
treatment of cholelithiasis
-none for asymptomatic
-if symptomatic, lap chole
etiology of cholecystitis
gallstones
s/s of cholecystitis
-RUQ pain
-murphy sign
-fever, nausea, vomiting, anorexia
diagnosis of cholecystitis
-US
-HIDA if inconclusive
treatment of cholecystitis
-IV abx
low risk community acquired intra-abdominal infection:
single agent regimen: pip/taz
or
combo regimen with flagyl:
cefazolin or cefuroxime or ceftriaxone or cefotaxime or cipro or levo + flagyl
high risk community acquired:
single agent: imipenem/cilastatin
meropenem
doripenem
pip/taz
or
combo regimen with flagyl:
cefepime or ceftazidime + flagyl
-lap chole
etiologies of cirrhosis
alcohol and hepatitis C
s/s of cirrhosis
-fatigue
-abd pain
-hepatomegaly
-spider angiomas
-ascites
-jaundice
cirrhosis can lead to portal hypertension….how can that present… the gut, the butt, and the caput!
esophageal varices
anorectal hemorrhoids
caput medusae
dx of cirrhosis
US first
liver bx
treatment of cirrhosis
-liver transplant
-treat symptoms
MC type of polyp
adenomatous
diagnosis of colon polyps
colonoscopy
treatment of colon polyps
removal
s/s of colon cancer
-asymptomatic
-change in bowel habits
diagnosis of colon cancer
colonoscopy with biopsy
treatment of colon cancer
-surgery
-chemo/radiation
MC population for infection esophagitis
patients with HIV
MC pathogen for esophagitis
candida
s/s of esophagitis
-odynophagia
-dysphagia
-dyspepsia
-nausea
-postprandial worsening of symptoms
diagnosis of esophagitis
endoscopy with biopsy
etiologies of erosive gastritis
-meds
-alcohol
-stress
s/s of erosive gastritis
-epigastric pain
-heartburn
-nausea
-vomiting
diagnosis of erosive gastritis
egd
treatment of erosive gastritis
-PPI
-discontinue NSAIDs
etiology of nonerosive gastritis
-h.pylori
treatment of Hpylori gastritis
omeprazole
amoxicillin
clarithromycin
diagnosis of hpylori
urea breath test
s/s of gastroenteritis
diarrhea, nausea, vomiting
treatment of gastroenteritis
fluids and rest
s/s of GERD
-heartburn
-regurgitation
-dysphagia
treatment of GERD
-H2 blockers if mild
-PPI
etiology of giardiasis
-fecal oral
-contaminated water
s/s of giardiasis
-watery diarrhea
-dehydration
diagnosis of giardiasis
-stool antigen assay
-stool PCR
treatment of giardiasis
Tinidazole
Metronidazole
etiology of hemorrhoids
increased pressure
s/s of hemorrhoids
-rectal bleeding
staging of hemorrhoids
I: confined to anal canal
II: protrude from anal canal, but reduce
III: require manual reduction after BM
IV: chronically protruding and risk strangulation
treatment of hemorrhoids
-stage 1 and 2: proper toileting
-stage 3 and 4: banding or sclerotherapy
s/s of hiatal hernia
GERD
treatment of hiatal hernia
-lifestyle modifications
-surgery if severe
s/s of chrons disease
-RLQ pain
-nonbloody diarrhea
-steatorrhea
-cobblestoning and skip lesions
-can affect any part but MC in terminal ileum
MC location for chrons
terminal ileum
diagnosis of chrons disease
colonoscopy with biopsy
treatment of chrons disease
-steroids (enteric coated budesonide is 1st line to induce remission)
-immunomodulators and TNFa blockers
MC area for ulcerative colitis
rectum and sigmoid colon
s/s of ulcerative colitis
-bloody diarrhea
-crampy lower abdominal pain
diagnosis of ulcerative colitis
sigmoidoscopy
treatment of ulcerative colitis
-distal colon: topical mesalamine
-extends past sigmoid colon: oral mesalamine or steroids
s/s of IBS
-change in bowel habits
-crampy lower abdominal pain
-bloating
treatment of IBS
-lifestyle modifications
-antispasmodics
etiology of acute pancreatitis
-gallstones
-alcohol
s/s of acute pancreatitis
-epigastric pain that radiates to the back
-improves when leaning forward
-cullen and grey turner sign
diagnosis of acute pancreatitis
-amylase and lipase
treatment of pancreatitis
-fluids
-rest
-NPO
-demerol
s/s of PUD
-gnawing epigastric pain
-relief with eating
-nocturnal pain
diagnosis of PUD
endoscopy
treatment of PUD
omeprazole
s/s of viral hepatitis
-fatigue
-distaste for smoking
-RUQ pain
-fever
-n/v
-jaundice
treatment of Hep A, B, and D
supportive
treatment of Hep C
harvoni
interferon
treatment of Hep E
ribavirin
