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EOR Exam - Family Medicine > Gastrointestinal Part 1 > Flashcards

Gastrointestinal Part 1 Flashcards

1
Q

Define anal fissure and describe the surface that will become involved if it is untreated.

A

Painful, linear lesions in the distal anal canal –> may involve full thickness of the mucosa if untreated.

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2
Q

State the most common location of an anal fissure and describe common S/S.

A

Location: posterior midline.

S/S: pain on defecation, hematochezia, skin tags if chronic

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3
Q

What testing is done to diagnose anal fissure?

A

None, it is a clinical diagnosis –> rectal pain, constipation, bright red blood on DRE.

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4
Q

What counseling should be provided to a patient with an anal fissure?

A

High fiber diet.

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5
Q

T/F: All anal fissures require pharmacotherapy.

A

False: 80% resolve on their own.

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6
Q

Describe 1st and 2nd line treatment options for anal fissure.

A

1: Sitz bath, bulking agents, inc fluids (loosen stool)
2: Topical NTG, topical silver nitrate, gentian violet solution, nifedipine ointment, botox.

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7
Q

Define appendicitis and state the most common causes.

A

Def: Inflammtion/infection of the appendix caused by obstruction
Causes: Fecalith (most common), inflammation, malignancy, foreign body

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8
Q

What is the most common surgical emergency?

A

Appendicitis

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9
Q

Describe S/S of appendicitis.

A

Anorexia, periumbilical pain that migrates to RLQ, N/V, rebound tenderness, low fever

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10
Q

How common is perforation in appendicitis and what are the S/S of its occurrence?

A

20% of cases –> high fever, generalized abdominal pain, increased leukocytosis

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11
Q

In what age patients is appendicitis most common?

A

10 - 30

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12
Q

Describe Rovsing’s, Obturator, Psoas, and McBurney’s signs that indicate appendicitis.

A

R: RLQ pain with LLQ palpation
O: Internal hip rotation with bent knee causes RLQ pain
P: Raising leg against resistance causes RLQ pain.
M: Point tenderness 1/3 of distance from ASIS to umbilicus.

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13
Q

What imaging studies are used to diagnose appendicitis?

A

US initially –> CT is more sensitive and will help identify abnormally placed appendix.

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14
Q

What abnormal lab value is expected in appendicitis?

A

Leukocytosis 10,000 - 20,000 –> higher if perforation

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15
Q

How is appendicitis managed?

A

Surgery –> broad spectrum abx before and after if perforation is suspected.

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16
Q

What are the common causes of small and large bowel obstruction?

A

Sm: adhesions or hernias (most common), neoplasms, IBD, volvulus
Lg: neoplasm (most common), strictures, hernias, volvulus, intussusception, fecal impaction

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17
Q

What is primary concern s/p strangulation of bowel?

A

Infarction, necrosis, peritonitis

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18
Q

What are the cardinal S/S of bowel obstruction?

A

Abdominal pain and distension

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19
Q

Describe three H&P findings that indicate late or severe small bowel obstruction.

A

High pitched tinkles on auscultation
Visible peristalsis
Absent bowel sounds

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20
Q

Define obstipation and state what condition it is associated with.

A

Severe constipation –> associated with severe small bowel obstruction

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21
Q

What S/S are associated with small bowel obstruction that is less severe?

A

Crampy pain followed by vomiting, diarrhea

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22
Q

What may be found on labs or H&P in a bowel obstruction?

A

Dehydration and electrolyte imbalance

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23
Q

What imaging is used to diagnose bowel obstruction and what is the hallmark finding?

A

Abdominal X-ray –> air fluid levels in stepladder pattern and dilated loops of bowel.
CT with contrast if X-ray is not definitive.

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24
Q

Describe the management of bowel obstruction.

A

NPO, IV fluids, pain management.
Partial: Nasogastric suctioning
Complete: surgery –> esp if large bowel or strangulated

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25
Q

Define cholecystitis.

A

Infection or inflammation of the gallbladder –> usually s/p obstruction by a stone.

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26
Q

What pathogen is most commonly responsible for cholecystitis?

A

E. Coli

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27
Q

What S/S are most commonly associated with cholecystitis?

A

Post-prandial RUQ pain, N/V, low fever.

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28
Q

Define Murphy’s Sign and Boas Sign as signs of cholecystitis.

A

Murph: Push on GB during exhalation and maintain during inhalation –> positive if pain on inspiration.
Boas Referred pain to subscapular area

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29
Q

What imaging studies are used to diagnose cholecystitis and what are positive findings?

A

US: initial TOC –> thickened GB, stones, etc.
Abdominal X-ray: 10% of stones seen
HIDA scan: gold standard –> nonvisualization of GB
ERCP: to determine cause, location, and extent of obstruction

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30
Q

What narcotic is preferred for pain control in cholecystitis and why?

A

Meperidine –> morphine associated with increasing tone at sphincter of Oddi.

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31
Q

Describe the medical management of cholecystitis and name the meds if appropriate.

A

NPO, IV fluids, Abx –> 3rd gen ceph + metronidazole

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32
Q

Define acalculous cholecystitis and describe its severity.

A

Cholecystitis not caused by a stone –> usually more severe than that caused by a stone.

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33
Q

Describe two exam findings of chronic cholecystitis with gallstones.

A

Strawberry GB: surface looks like the surface of a strawberry s/p cholesterol aggregatiokn –> can be seen on US
Porcelain GB: inner wall is crusted with Ca –> seen on US/CT/X-ray and considered to be pre-malignant

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34
Q

Define cholelithiasis.

A

Stones in the GB with no inflammation –> 90% are made up of cholesterol.

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35
Q

Describe 5 risk factors associated with cholelithiasis.

A

Five F’s: fair, fat, female, forty, fertile

36
Q

What are the common S/S associated with cholelithiasis?

A

Usually asymptomatic –> incidental finding

37
Q

What imaging is used to diagnose cholelithiasis?

A

US –> test of choice

38
Q

Describe the management of cholelithiasis.

A

Asymptomatic: observe
Symptomatic: cholecystectomy

39
Q

List and define two complications of cholelithiasis (other than cholecystitis).

A

Choledocolithiasis: Gall stones in biliary tree
Cholangitis: Biliary tract infection s/p obstruction by gall stone

40
Q

What is the treatment for choledocolithiasis?

A

Stone removal by ERCP

41
Q

How is cholangitis diagnosed and treated?

A

Dx: ERCP
Tx: ERCP stone extraction and Abx –> PCN + aminoglycoside

42
Q

What is Charcot’s Triad and Reynold’s pentad for acute cholangitis?

A

Char: fever, RUQ pain, jaundice
Reyn: Charcot + shock and ALOC

43
Q

Define cirrhosis.

A

Irreversible fibrosis and nodular regeneration throughout the liver

44
Q

What is the most common cause of cirrhosis and what are some other causes?

A

MC = ETOH. Other: Hep B/C, NAFD (obesity, DM, inc triglycerides), autoimmune, sclerosing cholangitis, drug toxicity

45
Q

What skin manifestations are associated with cirrhosis?

A

spider angioma, caput medusa, palmar erythema, jaundice, muscle wasting

46
Q

What S/S are most commonly associated with early cirrhosis?

A

Weakness, fatigue, hepatomegaly, weight loss, muscle cramps, anorexia

47
Q

What S/S are more commonly associated with late stage cirrhosis?

A

Ascites, preural effusion, peripheral edema, esophageal varices, hepatic encephalopathy.

48
Q

Describe the pathophysiology of hepatic encephalopathy and state the S/S.

A

Inc serum ammonia s/p the cirrhotic liver unable to breakdown ammonia into urea. S/S = confusion, lethargy, fetor hepaticus (strong, musty smell of breath), asterixis (liver flaps), tremor, dysarthria

49
Q

What modalities are used in the diagnosis of cirrhosis?

A

Serums labs are near normal until late in disease
CBC –> anemia is common
US/CT/MRI to determine size and number of nodules and eval for carcinoma
Biopsy

50
Q

What abnormalities in serum labs are expected in cirrhosis?

A

All minimally abnormal –> inc AST, inc alk-phos, inc gamma globulin, dec albumin, abnormal coags.

51
Q

What may be used in the management of cirrhosis?

A

Cease ETOH use
Lactulose and neomycin for encephalopathy
Na restriction and paracentesis for ascites
Cholestyramine for pruritis
Spironolactone 100mg QD for diuresis
Liver transplant in select patients

52
Q

What screening should be performed on patients diagnosed with cirrhosis?

A

Screen for carcinoma every 6 months

53
Q

List risk factors for colorectal cancer.

A

Age > 50 (peak at 65), US/Crohn’s, polyps, genetics, diet (low fiber, high red meat), smoking, ETOH, Lynch syndrome.

54
Q

What is the most common cause of inherited colorectal cancer?

A

Lynch Syndrome –> AKA hereditary non-polyposis colorectal cancer (HNPCC)

55
Q

What gene mutation leads to a 100% chance a patient will develop colorectal cancer by age 40?

A

Mutation of APC gene (familial polyposis)

56
Q

What is peutz-jehgers syndrome?

A

Genetic development of hamartomatous polyps early in life that have a high risk of developing to cancer.

57
Q

Differentiate the presentation of right sided (proximal) colorectal lesions from that of left sided (distal lesions).

A

Rt: tend to bleed and cause diarrhea
Lt: present later and cause bowel obstruction

58
Q

Identify important staging benchmarks for colorectal cancer and the associated prognosis of each.

A

I: only mucosa involved –> 90% survival at 5 years
II: transmural lesion or regional lymph node involvement –> 70-80% survival at 5 years
IV: Distant mets –> 5% survival at 5 years

59
Q

What modalities are used in the diagnosis of colorectal cancer?

A

FOBT = can be early marker
Inc carcinoembryonic antigen (CEA) is a risk factor
Colonoscopy, barium enema to evaluate masses
CT, X-ray to detect mets
Biopsy

60
Q

Describe the management of colorectal cancer.

A

Surgical resection
Chemo for stage III or higher
Monitor CEA

61
Q

State the screening recommendations for colorectal cancer.

A

No risk factors: Annual DRE and colonoscopy q 10 years starting at age 50
Family Dx age >60: Annual DRE and q10y colonoscopy starting at age 40
Family Dx < age 60: Annual DRE and q5y colonoscopy starting at age 40

62
Q

How long does it usually take an adenomatous polyp to develop into cancer (adenocarcinoma)?

A

10 - 20 years

63
Q

What are the three leading causes of cancer death in the US?

A
  1. Lung
  2. Skin
  3. Colorectal
64
Q

What procedure can significantly reduce the risk of colon cancer?

A

Removal of precancerous polyps

65
Q

Describe S/S associated with colon polyps.

A

Usually asymptomatic –> May cause bleeding which can cause iron deficiency anemia.

66
Q

Differentiate between hyperplastic and adenomatous polyps.

A

Hyp: Low risk of cancer –> 90% of all polyps
Aden: Pre-cancerous –> 10-20 years to progress to cancer.

67
Q

List and describe the three types of adenomatous polyps.

A

Tubulous: non-pedunculated –> most common
Villous: highest cancer risk, most are sessile (immobile)
Tubulovillous: mix of the above

68
Q

List the types of polyps from lowest cancer risk to highest.

A

Hyperplastic –> Tubulous –> Tubulovillous –> Villous

69
Q

What is the recommended frequency of follow up after polyps removal?

A

Villous = 3 years

All others = 5 years

70
Q

What information is particularly important to obtain in a patient with diarrhea?

A

Medications and illnesses of all people patient has recently shared a meal with
Travel history

71
Q

Differentiate between secretory and inflammatory diarrhea.

A

Sec: Large volume, non-inflammatory –> non-bloody. Caused by: infection, pancreatic insufficiency, laxative use, ingestion of pre-formed bacterial toxins.
Inf: diarrhea with blood and/or mucus (dysentery). Fever also usually present. Caused by: invasive organism or IBD.

72
Q

What is indicated by the finding of WBCs in the stool of a diarrhea patient?

A

Inflammatory process

73
Q

What diagnostic modalities are used to evaluate diarrhea?

A

Stool culture, microscopy for parasites

74
Q

What is the mainstay of treatment in diarrhea?

A

Fluid repletion –> PO preferred bu IV if necessary

75
Q

What are the diet recommendations for a diarrhea patient?

A

Bland, low residue foods –> crackers, applesauce, soups, boiled vegetables. Avoid spicy, fried, and processed foods.

76
Q

Which patients with diarrhea are candidates for therapy with anti-motility agents

A

Age < 65 with severe volume depletion

77
Q

What type of diarrhea should not be given anti-motility agents and why?

A

Patients with invasive (salmonella, shigella, campylobacter) diarrhea –> may cause toxicity from bacteria

78
Q

List three types of anti-motility agents used to treat diarrhea.

A

Bismuth Salicylate (Pepto/Kaopectate): dysentery
Opioid Agonists: noninvasive diarrhea
Anticholinergics

79
Q

What are contraindications for use of Bismuth-Salicylates and for Opioid Agonists in diarrhea patients?

A

B-S: children s/p Reyes Syndrome risk

Opioid: Dysentery

80
Q

What antibiotics are best for patients with severe infectious diarrhea from Shigella, campylobacter, C-diff, etc?

A

PO Vancomycin, metronidazole, fidaxomicin

81
Q

Define constipation in relation to normal bowel function.

A

Normal: 3 stools per day to 3 per week. Constipation is a decrease in volume and increase in firmness accompanied by straining.

82
Q

What is the primary concern in a patient older than 50 with new onset constipation?

A

Evaluate for colon cancer

83
Q

What is the best therapy for constipation?

A

Increase insoluble fiber and fluid intake with increased exercise.

84
Q

List causes of esophagitis.

A

GERD = most common
Infections in immunocompromised = 2nd MC
Radiation, ingestion of corrosive substances or some meds, eosinophilic (associated with food allergies and atopic disease/eczema)

85
Q

List risk factors for esophagitis.

A

Pregnancy, smoking, obesity, ETOH, chocolate, spicy foods, meds (NSAIDs, BBs, CCBs)

86
Q

Define two common symptoms associated with esophagitis.

A

Odynophagia: painful swallowing
Dysphagia: difficulty swallowing

87
Q

State diagnostic and therapeutic modalities used in esophagitis.

A

Dx: endoscopy, double contrast esophogram
Tx: treat underlying cause

EOR Exam - Family Medicine (15 decks)

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