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PANCE/EOC > GI #1 > Flashcards

GI #1 Flashcards

1
Q

Diagnostics for cholecystitis

A
  • US: initial test

- HIDA: most accurate

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2
Q

Treatment for Cholecystitis

A
  • NPO, IVF

- ABX (Ceftriaxone + Metro) then Cholecystectomy

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3
Q

MCC of Acute Cholecystitis

A

E. Coli

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4
Q

Symptoms of Cholangitis

A
  • Charcot’s Triad: Fever, chills, RUQ pain

- Reynold’s Pentad: AMS, Hypotension

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5
Q

What is the cause of Cholangitis

A

Biliary tract infection secondary to obstruction of the common bile duct (gallstones, E. Coli, Malignancy)

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6
Q

Diagnostics for Cholangitis

A
  • Labs: Leukocytosis, Increased Alk Phos & GGT, increased bilirubin
  • US: Initial
  • Cholangiography: via ERCP (Gold standard)
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7
Q

Treatment for Cholangitis

A
  • IV ABX (Ceftriaxone + Metro, Unasyn)

- ERCP

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8
Q

MC of cholelithiasis

A

Cholesterol

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9
Q

Risk Factors for Cholelithiasis

A

-Female, Fat, Forty, Fertile, Fair

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10
Q

Symptoms of cholelithiasis

A

-Biliary colic: episodic abrupt RUQ lasting 30 min - hours after fatty or large meals

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11
Q

Gallstones in the common bile duct

A

Choledocolithiasis

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12
Q

Physiologic jaundice presents on days _____ of life

A

3-5

Bilirubin levels fall in about 50% of neonates during first week of life

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13
Q

jaundice is associated with bilirubin levels > _____ mg/dL

A

> 5.0 mg/dL

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14
Q

Kernicterus, which is _________ and due to bilirubin in the brain tissue, is associated with bilirubin levels > ______

A

Cerebral dysfunction and encephalopathy

> 20 mg/dL

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15
Q

Treatment for neonatal jaundice

A
  • Phototherapy initial management of choice.
  • -Done if > 12 at 24 hours of life, > 15 at 48 hours or > 18 at 72 hours of life
  • Exchange transfusion in severe cases (hemolysis, Rh immunization)
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16
Q

Symptoms of Gilbert’s Syndrome

A

-Transient episodes of jaundice during periods of stress, fasting, alcohol, or illness

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17
Q

How to diagnose Gilbert’s Syndrome

A
  • Increase in isolated indirect bilirubin level with otherwise normal LFT’s
  • No treatment needed (mild, benign disease)
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18
Q

Treatment options for fecal impaction

A
  • Digital disimpaction followed by warm water enema with mineral oil
  • Polyethylene Glycol
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19
Q

Anorectal Abscess and Fistula MCC

A

-Staph A

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20
Q

MC location for anorectal abscess and Fistula

A

Posterior wall

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21
Q

Symptoms of anorectal abscess or Fistula

A
  • Swelling, pain that is worse with sitting/coughing/defecation
  • Febrile
  • Focal edema, induration, and fluctuance on eam
22
Q

Treatment for anorectal abscess and Fistula

A
  • Incision and drainage

- WASH: warm water cleansing, analgesics, sitz baths, high fiber diet

23
Q

Symptoms of an Anal fissure

A
  • BRBPR
  • Pain with bowel movements
  • Longitudinal tear in posterior midline
  • Skin tags seen in chronic fissures
24
Q

Treatment for Anal Fissures

A
  • Most resolve spontaneously
  • Supportive measures are first line
  • Topical vasodilators, Nitroglycerin
  • Botox injections
25
Q

Symptoms of internal hemorrhoids

A
  • Bleed and painless
  • Originate above the dentate line
  • Intermittent rectal bleeding, Painless BRBPR
  • Rectal itching and fullness
26
Q

Four grades of Internal Hemorrhoids

A
  • 1: does not prolapse (confined to anal canal). May bleed with defecation
  • 2: prolapses with defecation but spontaneously reduces
  • 3: prolapses with defecation with requires manual reduction
  • 4: irreducible and may strangulate
27
Q

Symptoms of external hemorrhoids

A
  • Do not bleed, but are painful
  • Originate below the dentate line
  • Perianal pain worse with defecation
28
Q

Treatment for hemorrhoids

A
  • High fiber diet, increased fluids, warm sitz baths
  • Rubber band ligation (for strangulated), Sclerotherapy, Excision
  • Hemorrhoidectomy for Stage IV if no response to other therapies
29
Q

MCC of acute lower GI bleeding

A

Diverticulosis

30
Q

Diagnostic of choice for diverticulosis

A

Colonoscopy

-Radionuclide imaging if bleeding not visualized on colonoscopy

31
Q

MC area for diverticulosis

A

Sigmoid area

32
Q

Symptoms of Diverticulosis

A
  • Usually asymptomatic (incidental finding most times)

- Painless hematochezia

33
Q

Diagnostic for Diverticulitis

A
  • CT scan: initial
  • Labs: Leukocytosis

Do NOT use colonoscopy and barium enema due to risk of perforation

34
Q

Treatment for diverticulitis

A

-Metronidazole + Cipro/Levofloxacin for 7-10 days

35
Q

What is the definition of toxic megacolon?

A

-Colon dilation > 6 cm + signs of systemic toxicity

36
Q

Causes of Toxic Megacolon

A
  • Ulcerative colitis
  • C. Diff
  • Radiation
  • Diverticulitis
37
Q

Symptoms of Toxic Megacolon

A
  • Profound bloody diarrhea
  • Distention
  • Signs of toxicity: AMS, fever, tachycardia, hypotension, dehydration
38
Q

Initial imaging of choice for toxic megacolon

A

Abdominal radiographs

39
Q

Treatment for Toxic Megacolon

A

-Supportive is mainstay (bowel rest, bowel decompression with NG tube, Metro + Ceftriaxone)

40
Q

What is Olgivie Syndrome?

A

Acute dilation of the colon in the absence of any mechanical obstruction (colonic pseudo-obstruction)

41
Q

Causes of Olgivie Syndrome

A
  • Postoperative state
  • Opiates
  • Hypokalemia, Hypercalcemia
  • Hypothyroidism
  • DM
42
Q

Treatment for Olgivie Syndrome

A
  • IVF and electrolyte repletion
  • Neostigmine for decompression if failed conservative therapy
  • Surgical decompression as a last resort if failed other treatment modalities
43
Q

Risk Factors for IBD

A
  • Ashkenazi Jews
  • 15-35 years old
  • Genetics
  • Diet
  • Infections
  • Meds: NSAIDs, OCP
  • Gender: CD in females, UC in males
  • Smoking: protective in UC
44
Q

Extra-Intestinal Manifestations of IBD

A
  • Rheumatologic: MSK pain, arthritis, ALS, osteoporosis
  • Dermatologic: Erythema Nodosum
  • Ocular: anterior uveitis, iritis, conjunctivitis
  • Hematologic: B12 and Iron Deficiency, risk of thromboembolism
45
Q

Facts about Ulcerative Colitis

A
  • Limited to colon (contiguous spread proximally)
  • Rectum always involved
  • Mucosa and Submucosa ONLY
  • LLQ pain, bloody diarrhea
  • Smoking protective
  • Uniform inflammation on colonoscopy
  • Stovepipe Sign (loss of haustral markings) on Barium study
  • P-ANCA lab
  • Surgery curative
46
Q

Facts about Crohn’s Disease

A
  • Any segment of the GI tract from mouth to anus effected
  • MC in Terminal Ileum
  • Transmural
  • RLQ pain, non-bloody diarrhea
  • Fistulas, B12 deficiency, and abscesses more common
  • Skip lesions and cobblestone appearance on colonoscopy
  • string sign on barium studies
  • ASCA lab
  • Surgery is noncurative
47
Q

Treatment for Crohn’s Disease

A
  • 5-ASA (Mesalamine) or oral Glucocorticoids

- Severe & Refractory: Azathioprine, Methotrexate, anti-TNF agents

48
Q

Treatment for UC

A

-Topical 5-aminosaliyclic Acid (ASA) first line

Surgical resection in some cases

49
Q

MC occlusion in acute mesenteric ischemia

A

Superior mesenteric artery

50
Q

Symptoms of acute mesenteric ischemia

A
  • Severe abdominal pain out of proportion to exam findings
  • Pain poorly localized
  • N/v
  • Diarrhea
51
Q

Diagnostics for acute mesenteric ischemia

A
  • CT angiography (initial)
  • Conventional arteriography: definitive
  • Labs: lactic acidosis, leukocytosis
52
Q

Treatment for acute mesenteric ischemia

A

-Surgical revascularization

PANCE/EOC (63 decks)

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