GI Flashcards
What condition has this clinical picture?
- Overweight female
- Severe RUQ or epigastric pain, may radiate to R shoulder
- Within 1 hour of eating fatty meal
- Nausea and vomiting, anorexia
Cholecystitis
What condition has this clinical picture?
Elderly patient with acute onset high fever, anorexia, nausea/vomiting, LLQ pain
Diverticulitis
Risk factors for diverticulitis
Risk factors: age, constipation, low fibre, obesity, lack of exercise, NSAID use
Diverticulitis
CBC will show?
leukocytosis
neutrophilia
shift to left (bands - immature neutrophils)
What condition has this clinical picture?
- Acute onset fever, nausea, vomiting
- onset of pain “boring”/radiating to midback, epigastric
- Guarding and tenderness over epigastric area or upper abdomen
- Cullen’s sign (blue discoloration around umbilicus)
- Turner’s sign: blue discolouration on flanks
Acute pancreatitis
What is Cullen’s sign?
blue discoloration around umbilicus
What is Turner’s sign?
blue discolouration on flanks
Crohn’s or UC?
- mouth to anus
- may or may not have bloody/mucous in diarrhea
- Fever, anorexia, weight loss, dehydration, fatigue
- abdo pain periumbilical to RLQ
Crohn’s
Crohn’s or UC?
fistula formation and anal disease
Crohn’s
Crohn’s or UC?
increased risk of lymphoma if treated with azathioprine
Crohn’s
Crohn’s or UC?
- bloody diarrhea with mucus
- LLQ squeezing/cramping pain with bloating and gas
- fever, anorexia, weight loss, fatigue
- arthralgia and arthritis
UC
What syndrome causes multiple and severe ulcers in stomach and duodenum?
Zollinger-Ellison Syndrome
What type of pain and stool occurs with Zollinger-Ellison Syndrome?
epigastric to midabdminal pain
tarry stools
what medications increase risk of GERD?
what food increases risk of GERD?
NSAID CCB nitrates anticholinergics (TCA) diazepam alpha-adrenergic receptor agonists, iron supps, bisphosphonates
ETOH, chocolate, peppermint, caffeine, carbonated drinks, fatty foods
Risks associated with long term PPI use?
PPI carries risk of OP, bone/hip fractures, acute interstitial nephritis, hypomagnesemia, C diff, reduced calcium absorption
Alarm features for GERD
- unintentional weight loss (>5% over 6-12 months)
- progressive dysphagia
- odynophagia
- persistent vomiting
- black stool/blood in vomit
- IDA
- abdo mass
risk factors for Barrett’s esophagus?
- Caucasian
- age >50
- current or past smoking
- central obesity
- family hx barrett’s or esophageal cancer
treatment for C. diff associated diarrhea? (mild initial episode)
vancomycin 125 mg po QID x 10 days
what does reactive anti-HAV IgM indicate?
reactive anti-HAV IgG?
IgM anti-HAV REACTIVE = active infection, patient is contagious
IgG anti-HAV = lifelong immunity, not infectious
what does the following indicate?
HBsAg positive?
Anti-HBs (surface antibody)?
HBeAg?
Anti-HBc (core antibody)?
HBsAg positive = acute or chronic hep B, infectious
Anti-HBs (surface antibody): IMMUNITY from past infection or vaccination
Hep B “e” Antigen (HBeAg) = marker for actively replicating hep B –> highly infectious
Total Hep B Core Antibody (anti-HBc): appears at onset of symptoms in acute hep B –> persists for life
hepatitis D
- co-exists with…?
- risks of hep D?
- transmission?
co-infection with hep B
risk: fulminant hepatitis, cirrhosis, severe liver damage
transmission: same pattern as hep B
Anal fissures
most are located in which location?
posteriorly midline
If transverse, irregular –> consider DDx of Crohn’s anal squamous cell cancer, anal warts
Anal fissures
first line treatment
Treatment: • Avoid triggers/contributing factors • Prevent constipation ○ Increase dietary fibre • Mineral oil can lubricate stool ○ Long term use discouraged • Sitz baths, cool compresses
Why is long term use of mineral oil to treat anal fissures discouraged?
potentially impairs absorption of fat soluble vitamins (ADEK) and essential fatty acids