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GI 1 Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

MC abdominal surgical emergency

A

appendicitis

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2
Q

dx appendicitis

A

labs: leukocytosis with neutrophilia

CT preferred in adults
US in pregnancy and kids

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3
Q

MCC appendicitis adults vs kids

A

adults - fecalith
kids - lymphoid hyperplasia

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4
Q

what is cholecystitis

A

inflammation/infection of the gallbladder due to obstruction of the CYSTIC DUCT by gallstones

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5
Q

MC infectious organism cholecystitis

A

E coli

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6
Q

sx cholecystitis

A

RUQ pain
may radiate to right shoulder
precipitated by fatty foods/large meals

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7
Q

PE cholecystitis

A

FEVER
Murphys sign - RUQ pain or inspiratory arrest w palpation of gallbladder
Boas sign - referred pain to right shoulder sub scapular area

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8
Q

Dx cholecystitis (include labs)

A

Increased WBC (this is an infection)
Abdominal US - gallbladder wall thickening
Radionuclide cholescintigraphy (HIDA) - standard; nonvisualization of the gallbladder

there is no increase in LFTs

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9
Q

tx cholecystitis

A

pain control w NSAIDs
abx - metronidazole + Cef or fluoroquinolone
cholecystectomy

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10
Q

what is ascending cholangitis

A

inflammation/infection secondary to obstruction of the COMMON BILE DUCT

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11
Q

MCC ascending cholangitis

A

choledocholithiasis

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12
Q

Charcot’s triad for ascending cholangitis

A

spiking fever w chills + RUQ pain + jaundice

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13
Q

Reynold’s pentad for ascending cholangitis

A

spiking fever w chills + RUQ pain + jaundice + hypotension or shock + AMS

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14
Q

Dx ascending cholangitis

A

leukocytosis with neutrophil dominance
Increased alk phos and GGT + increased bilirubin >/=2 (mostly conjugated)
AST and ALT may be mildly elevated
RUQ US - common bile duct dilation
Abdominal CT if US normal
Cholangiography (ERCP or PTC)- gold standard

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15
Q

tx ascending cholangitis

A

IV abx (similar to cholecystitis)
ERCP or PTC w stone extraction/stent insertion

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16
Q

transmission of hepatitis A

A

fecal-oral

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17
Q

SX hepatitis

A

hepatomegaly
RUQ tenderness
jaundice/scleral icterus
dark urine
pale stools
pruritus

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18
Q

Dx hepatitis

A

Elevated ALT and AST (strikingly)
ALT > AST

acute - positive IgM anti-HAV antibodies
past exposure/immunity - IgG HAV Ab with negative IgM

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19
Q

how is Hepatitis E transmitted

A

fecal-oral

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20
Q

MCC acute viral hepatitis

A

Hepatitis E

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21
Q

who is most at risk for fulminant hepatitis E

A

pregnant
malnourished
preexisting liver dz

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22
Q

dx is same as for hep A

A

:)

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23
Q

how is hepatitis B transmitted

A

percutaneous
sexual
parenteral
perinatal

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24
Q

serologies - acute hepatitis

A

positive HBsAg
positive anti-HBc (IgM)

may have positive HbeAg, anti-Hbe

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25
Q

serologies - recovery/resolved

A

positive anti-HBs
positive anti-HBc (IgG)

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26
Q

serologies - immunization

A

positive anti-HBs

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27
Q

serologies - chronic hepatitis

A

Positive HBsAg
positive anti-HBc (IgG)
Positive HbeAg or Anti-Hbe

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28
Q

Hep D is always dually infected with

A

Hep B

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29
Q

coinfection vs superinfection Hep D

A

superinfection - chronic hep B + HDV infection –> more likely to become decompensated & develop HCC

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30
Q

what does Hep B vax protect against

A

Hep B
Hep D

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31
Q

MC infectious cause of chronic liver dz

A

Hep C

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32
Q

MCC cirrhosis

A

Hep C

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33
Q

Tx cirrhosis

A

ascites/edema:
sodium restriction, diuretics

pruritus:
cholestyramine

HCC:
US q 6 mos +/- alpha-fetoprotein

liver transplant definitive

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34
Q

what is pancreatitis

A

intracellular activation of pancreatic enzymes –> auto digestion of pancreas

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35
Q

MCC causes of pancreatitis

A

gallstones (MC) and alcohol abuse

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36
Q

sx pancreatitis

A

epigastric pain that radiates to the back
pain worse with supine, eating; better leaning forward, sitting, fetal position

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37
Q

Cullen’s sign vs grey turner’s sign

A

Cullen - umbilical ecchymosis
grey turners - flank ecchymosis

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38
Q

dx pancreatitis

A

Increased amylase and lipase
hypocalcemia
abdominal CT

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39
Q

anorectal abscess vs fistula

A

abscess = acute
fistula = chronic

40
Q

MC infectious cause of anorectal abscess/fistula

A

staph aureus

41
Q

sx anorectal abscess vs fistula

A

abscess - severe constant rectal pain worse w sitting, coughing, defecating
fistula - discharge and pain

42
Q

MC site for anorectal abscess

A

posterior rectal wall

43
Q

tx anorectal abscess/fistula

A

I & D plus abx (augmentin or cipro + metronidazole)

WASH - warm-water cleansing, analgesics, situ bath, high fiber diet

44
Q

what is an anal fissure

A

painful linear tear/crack within the distal half of the anal canal - posterior midline of the anal canal

45
Q

sx anal fissure

A

cycles of severe pain esp with BM –> refrain from BM
BRBPR
skin tags if chronic

46
Q

tx anal fissure

A

supportive (WASH)
topical vasodilators - topical nitroglycerin or nifedipine

47
Q

what are hemorrhoids

A

engorgement of the venous plexuses

48
Q

where do internal hemorrhoids originate from

A

superior hemorrhoid vein
proximal to the dentate line

49
Q

where do external hemorrhoids originate from

A

inferior hemorrhoid vein
distal (below) to the dentate line

50
Q

classification of internal hemorrhoids

A

I - does not prolapse
II - prolapses w defecation or straining but reduces spontaneously
III - prolapses w defecation/straining, requires manual reduction
IV - irreducible and may strangulate

51
Q

Tx hemorrhoids

A

supportive - increase fluids and fiber
rubber band ligation - internal
hemorrhoidectomy

52
Q

what are diverticula

A

out pouchings due to herniation or the mucosa and submucosa

53
Q

which side of the colon is MC affected by diverticulosis

A

left

54
Q

MCC acute lower GI bleeding

A

Diverticulosis

55
Q

MCC part of colon for diverticulitis

A

sigmoid colon + descending colon

56
Q

sx diverticulitis

A

LLQ pain
low grade fever

57
Q

tx diverticulitis

A

metronidazole + Cipro or Levo

58
Q

MCC infectious esophagitis

A

candidiasis

59
Q

upper endoscopy for esophageal candidiasis

A

white-yellow mucosal plaque-like lesions or exudates
budding yeast, pseudo hyphae on bx

60
Q

tx for esophageal candidiasis

A

systemic antifungals (fluconazole)

61
Q

upper endoscopy for HSV esophagitis

A

small erosions/ulcers
punched out or volcano like

eosinophilic (cowards type a inclusions)

62
Q

tx hsv esophagitis

A

acyclovir

63
Q

upper endoscopy for CMV esophagitis

A

large erosions/punched out ulcers

bx - large cells (cytomegalovirus) with enlarged nuclei - basophilic inclusions

64
Q

tx CMV esophagitis

A

Ganciclovir

65
Q

what is boerhaave syndrome

A

full thickness rupture of the esophagus

66
Q

sx boerhaave syndrome

A

severe restrosternal chest pain or upper abdominal pain
dyspnea
vomiting

67
Q

PE Boerhaave syndrome

A

crepitus on chest auscultation or palpation (subq emphysema)

Amman’s sign - mediastinal crackle or crunch accompanying every heart beat

68
Q

dx boerhaave syndrome

A

CT esophagram (INITIAL) - leakage of contrast material

Chest CT - detects mediastinal air

69
Q

tx boerhaave syndrome

A

IV abx (ticarcillin-clavulanate)
IV PPI
parenteral nutrition

surgery if severe

70
Q

what is mallory Weiss tear

A

longitudinal superficial mucosal lacerations

71
Q

sx mallory weiss tear

A

upper GI bleed - hematemesis, Selena, Hematochezia
retching/vomiting

72
Q

dx mallory weiss tear

A

upper endoscopy - superficial longitudinal mucosal erosions

73
Q

tx mallory weiss tear

A

not bleeding - supportive - PPI!!!!

severe bleeding - hemoclips, endoscopic band ligation

74
Q

MCC gastritis and PUD

A

h pylori

75
Q

sx PUD

A

dyspepsia - hunger like, dull epigastric pain

duodenal - better with food
gastric - worse with food

76
Q

dx PUD

A

upper endoscopy + tissue bx for h pylori and malignancy

77
Q

tx PUD

A

h pylori positive - bismuth subsalicylate + tetracycline + metronidazole + PPI x 14 days

h pylori negative - PPI or H2RA

surveillance therapy w upper endoscopy for gastric ulcers after 8-12 weeks of tx

78
Q

dx SBO

A

abdominal XR
CT scan

79
Q

what is toxic megacolon

A

colon dilation > 6 cm + signs of systemic toxicity

80
Q

causes of toxic megacolon

A

Ulcerative colitis
C diff
CMV

81
Q

sx toxic megacolon

A

profound bloody diarrhea > 10 bloody stools per day

lower abdominal tenderness and distention
signs of toxicity (AMS, fever,tachy, hypotension)

82
Q

dx toxic megacolon

A

Abdominal XR or CT

83
Q

tx toxic megacolon

A

supportive
add IV steroids if ulcerative colitis

84
Q

dx volvulus

A

same as SBO
Abdominal XR or CT

85
Q

tx volvulus

A

decompression - sigmoidoscopy or other surgery

86
Q

characteristics of Crohn dz

A

transmural inflammation that affects any part of the GI tract

skip areas of involvement

87
Q

sx Crohn dz

A

crampy abdominal pain (RLQ)
intermittent diarrhea with or without gross blood

88
Q

what segment is MC involved in Crohn dz

A

terminal ileum

89
Q

dx Crohn dz

A

ileocolonoscopy + bx (noncaseating granulomas)

ASCA

B12 deficiency

upper GI series - string sign

90
Q

tx Crohn dz

A

oral steroids or oral 5-aminosalicylates (Mesalamine)

if severe - immunomodulations (Azathioprine, 6-mercaptopurine, methotrexate) or biologics like anti-TNF agents (Adalimumab, Infliximab)

91
Q

characteristics of UC

A

inflammation of the colon limited to the mucosal and submucosal layers

usually involves the rectum

92
Q

sx UC

A

hematochezia
diarrhea
abdominal pain (LLQ)

93
Q

dx UC

A

flexible sigmoidoscopy or colonoscopy - not if active bleeding

bx

double contrast barium enema - stovepipe or lead pipe sign

PANCA

94
Q

tx UC

A

topical 5 aminosalicylic acid - mesalamine
can add topical steroids

if severe - TNF inhibitors (Adalimumab, Infliximab) and thiopurines (6-mercaptopurine, azathioprine)

IV STEROIDS IN HOSPITAL

95
Q
A

ER EOR (28 decks)

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