Gastrointestional Flashcards
A pt presents w/ sudden onset of severe, diffuse abd pain. Exam reveals peritoneal signs, and AXR reveals free air under the diaphragm. Management?
Emergent laparotomy to repair a perforated viscus.
The most likely cause of acute lower GI bleed in pts >40 years of age.
Diverticulosis
Diagnostic modality used when U/S is equivocal for cholecystitis
HIDA scan
Risk factors for cholelithiasis
Fat, female, fertile, forty, flatulent
Inspiratory arrest during palpation of the RUQ
Murphy’s sign, seen in acute cholecystitis
The MCC of small bowel obstruction (SBO) in pts w/ no hx of abd surgery
Hernia
The MCC of SBO in pts w/ a hx of abd surgery
Adhesions
Most common organism causing diarrhea
Campylobacter
Diarrhea in recent abx use
Clostridium difficile
Diarrhea and camping
Giardia
Traveler’s diarrhea
ETEC
Diarrhea and church picnics/mayonnaise
S aureus
Diarrhea and uncooked hamburgers
E coli O157:H7
Diarrhea and Fried rice
Bacillus cereus
Diarrhea and poultry/eggs
Salmonella
Diarrhea and raw seafood
Vibrio, HAV
Diarrhea and AIDS
Isospora, Cryptosporidium, Mycobacterium avium complex (MAC)
Diarrhea and pseudoappendicitis
Yersinia
A 25 y/o Jewish man presents w/ pain and watery diarrhea after meals. Examination shows fistulas b/w the bowel and skin and nodular lesions on his tibias
Crohn’s dz
Inflammatory dz of colon w/ an increased risk of colon cancer
Ulcerative colitis (greater risk than Crohn’s)
Extraintestinal manifestations of IBD
Uveitis, ankylosing spondylitis, pyoderma gangrenosum, erythema nodosum, primary sclerosing cholangitis
Medical tx for IBD
5-ASA agents and steroids during acute exacerbation
Difference b/w Mallory-Weiss and Boerhaave tears
Mallory-Weiss - superficial tear in the esophageal mucosa; Boerhaave - full thickness esophageal rupture
Charcot’s triad
RUQ pain, jaundice, and fever/chills - signs of ascending cholangitis
Reynolds’ pentad
Charcot’s triad plus shock and mental status changes - signs of suppurative ascending cholangitis
Medical tx for hepatic encephalopathy
Decreased protein intake, lactulose, rifaximin
The first step in the management of a pt with an acute GI bleed.
Manage ABCs
A 4 y/o child presents with oliguria, petechiae, and jaundice following an illness w/ bloody diarrhea. Most likely diagnosis and cause?
Hemolytic- uremic syndrome (HUS) due to E coli O157:H7
Post-HBV exposure tx
HBV immunoglobulin
Classic causes of drug-induced hepatitis
TB medications (INH, rifampin, pyrazinaminde), acetaminophen, and tetracycline
A 40 y/o obese woman with elevated alk phos, elevated bilirubin, pruritus, dark urine, and clay-colored stools
Biliary tract obstruction
Hernia w/ highest risk of incarceration - indirect, direct or femoral?
Femoral hernia
A 50 y/o man w/ a hx of alcohol abuse presents w/ boring epigastric pain that radiates to the back and is relieved by sitting forward. Management?
Confirm the dx of acute pancreatitis w/ elevated amylase and lipase. Make the patient NPO and give IV fluids, O2, analgesia, and “tincture of time”
