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GI 1 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
serologies - recovery/resolved
positive anti-HBs positive anti-HBc (IgG)
26
serologies - immunization
positive anti-HBs
27
serologies - chronic hepatitis
Positive HBsAg positive anti-HBc (IgG) Positive HbeAg or Anti-Hbe
28
Hep D is always dually infected with
Hep B
29
coinfection vs superinfection Hep D
superinfection - chronic hep B + HDV infection --> more likely to become decompensated & develop HCC
30
what does Hep B vax protect against
Hep B Hep D
31
MC infectious cause of chronic liver dz
Hep C
32
MCC cirrhosis
Hep C
33
Tx cirrhosis
ascites/edema: sodium restriction, diuretics pruritus: cholestyramine HCC: US q 6 mos +/- alpha-fetoprotein liver transplant definitive
34
what is pancreatitis
intracellular activation of pancreatic enzymes --> auto digestion of pancreas
35
MCC causes of pancreatitis
gallstones (MC) and alcohol abuse
36
sx pancreatitis
epigastric pain that radiates to the back pain worse with supine, eating; better leaning forward, sitting, fetal position
37
Cullen's sign vs grey turner's sign
Cullen - umbilical ecchymosis grey turners - flank ecchymosis
38
dx pancreatitis
Increased amylase and lipase hypocalcemia abdominal CT
39
anorectal abscess vs fistula
abscess = acute fistula = chronic
40
MC infectious cause of anorectal abscess/fistula
staph aureus
41
sx anorectal abscess vs fistula
abscess - severe constant rectal pain worse w sitting, coughing, defecating fistula - discharge and pain
42
MC site for anorectal abscess
posterior rectal wall
43
tx anorectal abscess/fistula
I & D plus abx (augmentin or cipro + metronidazole) WASH - warm-water cleansing, analgesics, situ bath, high fiber diet
44
what is an anal fissure
painful linear tear/crack within the distal half of the anal canal - posterior midline of the anal canal
45
sx anal fissure
cycles of severe pain esp with BM --> refrain from BM BRBPR skin tags if chronic
46
tx anal fissure
supportive (WASH) topical vasodilators - topical nitroglycerin or nifedipine
47
what are hemorrhoids
engorgement of the venous plexuses
48
where do internal hemorrhoids originate from
superior hemorrhoid vein proximal to the dentate line
49
where do external hemorrhoids originate from
inferior hemorrhoid vein distal (below) to the dentate line
50
classification of internal hemorrhoids
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
Tx hemorrhoids
supportive - increase fluids and fiber rubber band ligation - internal hemorrhoidectomy
52
what are diverticula
out pouchings due to herniation or the mucosa and submucosa
53
which side of the colon is MC affected by diverticulosis
left
54
MCC acute lower GI bleeding
Diverticulosis
55
MCC part of colon for diverticulitis
sigmoid colon + descending colon
56
sx diverticulitis
LLQ pain low grade fever
57
tx diverticulitis
metronidazole + Cipro or Levo
58
MCC infectious esophagitis
candidiasis
59
upper endoscopy for esophageal candidiasis
white-yellow mucosal plaque-like lesions or exudates budding yeast, pseudo hyphae on bx
60
tx for esophageal candidiasis
systemic antifungals (fluconazole)
61
upper endoscopy for HSV esophagitis
small erosions/ulcers punched out or volcano like eosinophilic (cowards type a inclusions)
62
tx hsv esophagitis
acyclovir
63
upper endoscopy for CMV esophagitis
large erosions/punched out ulcers bx - large cells (cytomegalovirus) with enlarged nuclei - basophilic inclusions
64
tx CMV esophagitis
Ganciclovir
65
what is boerhaave syndrome
full thickness rupture of the esophagus
66
sx boerhaave syndrome
severe restrosternal chest pain or upper abdominal pain dyspnea vomiting
67
PE Boerhaave syndrome
crepitus on chest auscultation or palpation (subq emphysema) Amman's sign - mediastinal crackle or crunch accompanying every heart beat
68
dx boerhaave syndrome
CT esophagram (INITIAL) - leakage of contrast material Chest CT - detects mediastinal air
69
tx boerhaave syndrome
IV abx (ticarcillin-clavulanate) IV PPI parenteral nutrition surgery if severe
70
what is mallory Weiss tear
longitudinal superficial mucosal lacerations
71
sx mallory weiss tear
upper GI bleed - hematemesis, Selena, Hematochezia retching/vomiting
72
dx mallory weiss tear
upper endoscopy - superficial longitudinal mucosal erosions
73
tx mallory weiss tear
not bleeding - supportive - PPI!!!! severe bleeding - hemoclips, endoscopic band ligation
74
MCC gastritis and PUD
h pylori
75
sx PUD
dyspepsia - hunger like, dull epigastric pain duodenal - better with food gastric - worse with food
76
dx PUD
upper endoscopy + tissue bx for h pylori and malignancy
77
tx PUD
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
dx SBO
abdominal XR CT scan
79
what is toxic megacolon
colon dilation > 6 cm + signs of systemic toxicity
80
causes of toxic megacolon
Ulcerative colitis C diff CMV
81
sx toxic megacolon
profound bloody diarrhea > 10 bloody stools per day lower abdominal tenderness and distention signs of toxicity (AMS, fever,tachy, hypotension)
82
dx toxic megacolon
Abdominal XR or CT
83
tx toxic megacolon
supportive add IV steroids if ulcerative colitis
84
dx volvulus
same as SBO Abdominal XR or CT
85
tx volvulus
decompression - sigmoidoscopy or other surgery
86
characteristics of Crohn dz
transmural inflammation that affects any part of the GI tract skip areas of involvement
87
sx Crohn dz
crampy abdominal pain (RLQ) intermittent diarrhea with or without gross blood
88
what segment is MC involved in Crohn dz
terminal ileum
89
dx Crohn dz
ileocolonoscopy + bx (noncaseating granulomas) ASCA B12 deficiency upper GI series - string sign
90
tx Crohn dz
oral steroids or oral 5-aminosalicylates (Mesalamine) if severe - immunomodulations (Azathioprine, 6-mercaptopurine, methotrexate) or biologics like anti-TNF agents (Adalimumab, Infliximab)
91
characteristics of UC
inflammation of the colon limited to the mucosal and submucosal layers usually involves the rectum
92
sx UC
hematochezia diarrhea abdominal pain (LLQ)
93
dx UC
flexible sigmoidoscopy or colonoscopy - not if active bleeding bx double contrast barium enema - stovepipe or lead pipe sign PANCA
94
tx UC
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

ER EOR (28 decks)

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