GI #1 Flashcards
Diagnostics for cholecystitis
- US: initial test
- HIDA: most accurate
Treatment for Cholecystitis
- NPO, IVF
- ABX (Ceftriaxone + Metro) then Cholecystectomy
MCC of Acute Cholecystitis
E. Coli
Symptoms of Cholangitis
- Charcot’s Triad: Fever, chills, RUQ pain
- Reynold’s Pentad: AMS, Hypotension
What is the cause of Cholangitis
Biliary tract infection secondary to obstruction of the common bile duct (gallstones, E. Coli, Malignancy)
Diagnostics for Cholangitis
- Labs: Leukocytosis, Increased Alk Phos & GGT, increased bilirubin
- US: Initial
- Cholangiography: via ERCP (Gold standard)
Treatment for Cholangitis
- IV ABX (Ceftriaxone + Metro, Unasyn)
- ERCP
MC of cholelithiasis
Cholesterol
Risk Factors for Cholelithiasis
-Female, Fat, Forty, Fertile, Fair
Symptoms of cholelithiasis
-Biliary colic: episodic abrupt RUQ lasting 30 min - hours after fatty or large meals
Gallstones in the common bile duct
Choledocolithiasis
Physiologic jaundice presents on days _____ of life
3-5
Bilirubin levels fall in about 50% of neonates during first week of life
jaundice is associated with bilirubin levels > _____ mg/dL
> 5.0 mg/dL
Kernicterus, which is _________ and due to bilirubin in the brain tissue, is associated with bilirubin levels > ______
Cerebral dysfunction and encephalopathy
> 20 mg/dL
Treatment for neonatal jaundice
- 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)
Symptoms of Gilbert’s Syndrome
-Transient episodes of jaundice during periods of stress, fasting, alcohol, or illness
How to diagnose Gilbert’s Syndrome
- Increase in isolated indirect bilirubin level with otherwise normal LFT’s
- No treatment needed (mild, benign disease)
Treatment options for fecal impaction
- Digital disimpaction followed by warm water enema with mineral oil
- Polyethylene Glycol
Anorectal Abscess and Fistula MCC
-Staph A
MC location for anorectal abscess and Fistula
Posterior wall
Symptoms of anorectal abscess or Fistula
- Swelling, pain that is worse with sitting/coughing/defecation
- Febrile
- Focal edema, induration, and fluctuance on eam
Treatment for anorectal abscess and Fistula
- Incision and drainage
- WASH: warm water cleansing, analgesics, sitz baths, high fiber diet
Symptoms of an Anal fissure
- BRBPR
- Pain with bowel movements
- Longitudinal tear in posterior midline
- Skin tags seen in chronic fissures
Treatment for Anal Fissures
- Most resolve spontaneously
- Supportive measures are first line
- Topical vasodilators, Nitroglycerin
- Botox injections
Symptoms of internal hemorrhoids
- Bleed and painless
- Originate above the dentate line
- Intermittent rectal bleeding, Painless BRBPR
- Rectal itching and fullness
Four grades of Internal Hemorrhoids
- 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
Symptoms of external hemorrhoids
- Do not bleed, but are painful
- Originate below the dentate line
- Perianal pain worse with defecation
Treatment for hemorrhoids
- 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
MCC of acute lower GI bleeding
Diverticulosis
Diagnostic of choice for diverticulosis
Colonoscopy
-Radionuclide imaging if bleeding not visualized on colonoscopy
MC area for diverticulosis
Sigmoid area
Symptoms of Diverticulosis
- Usually asymptomatic (incidental finding most times)
- Painless hematochezia
Diagnostic for Diverticulitis
- CT scan: initial
- Labs: Leukocytosis
Do NOT use colonoscopy and barium enema due to risk of perforation
Treatment for diverticulitis
-Metronidazole + Cipro/Levofloxacin for 7-10 days
What is the definition of toxic megacolon?
-Colon dilation > 6 cm + signs of systemic toxicity
Causes of Toxic Megacolon
- Ulcerative colitis
- C. Diff
- Radiation
- Diverticulitis
Symptoms of Toxic Megacolon
- Profound bloody diarrhea
- Distention
- Signs of toxicity: AMS, fever, tachycardia, hypotension, dehydration
Initial imaging of choice for toxic megacolon
Abdominal radiographs
Treatment for Toxic Megacolon
-Supportive is mainstay (bowel rest, bowel decompression with NG tube, Metro + Ceftriaxone)
What is Olgivie Syndrome?
Acute dilation of the colon in the absence of any mechanical obstruction (colonic pseudo-obstruction)
Causes of Olgivie Syndrome
- Postoperative state
- Opiates
- Hypokalemia, Hypercalcemia
- Hypothyroidism
- DM
Treatment for Olgivie Syndrome
- IVF and electrolyte repletion
- Neostigmine for decompression if failed conservative therapy
- Surgical decompression as a last resort if failed other treatment modalities
Risk Factors for IBD
- Ashkenazi Jews
- 15-35 years old
- Genetics
- Diet
- Infections
- Meds: NSAIDs, OCP
- Gender: CD in females, UC in males
- Smoking: protective in UC
Extra-Intestinal Manifestations of IBD
- Rheumatologic: MSK pain, arthritis, ALS, osteoporosis
- Dermatologic: Erythema Nodosum
- Ocular: anterior uveitis, iritis, conjunctivitis
- Hematologic: B12 and Iron Deficiency, risk of thromboembolism
Facts about Ulcerative Colitis
- 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
Facts about Crohn’s Disease
- 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
Treatment for Crohn’s Disease
- 5-ASA (Mesalamine) or oral Glucocorticoids
- Severe & Refractory: Azathioprine, Methotrexate, anti-TNF agents
Treatment for UC
-Topical 5-aminosaliyclic Acid (ASA) first line
Surgical resection in some cases
MC occlusion in acute mesenteric ischemia
Superior mesenteric artery
Symptoms of acute mesenteric ischemia
- Severe abdominal pain out of proportion to exam findings
- Pain poorly localized
- N/v
- Diarrhea
Diagnostics for acute mesenteric ischemia
- CT angiography (initial)
- Conventional arteriography: definitive
- Labs: lactic acidosis, leukocytosis
Treatment for acute mesenteric ischemia
-Surgical revascularization
