Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Acute Care 2 > GI > Flashcards

GI Flashcards

1
Q

bowel obstruction definition

A

Blockage of the lumen of small bowel; can perforate if necrosis present

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

bowel obstruction causes and risk factors

A

-Adhesions from prior surgery
-Strictures from Crohns, XRT or ischemia
-Hernia
-Hematoma
-Volvus/intussusception
-LBO
-Tumor, foreign body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

bowel obstruction presentation and workup

A

Leukocytosis, dehydration

KUB: ladder-like pattern w/ air fluid levels on upright. Thickening of abd wall (thumbprinting)

CT w/ oral contrast w/ follow through

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

bowel obstruction treatment

A

Surgical consult

NGT to LIWS
IV fluids
Pain control

ABX IF: strangulation/necrosis suspected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

cholecystitis definition

A

Inflammation of gallbladder

Cholelithiasis= stones in gallbladder
Choledocholithiasis = stones in CBD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

cholecystitis causes and risk factors

A

-Cholelithiasis, Acalculous cholecystitis
-Bacteria
-Neoplasm
-Ischemia, torsion, strictures
-Obesity, pregnancy

4 Fs = female, fat, 40, fertile
-Female, advanced age, rapid wt loss, fad diets, high cholesterol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

cholecystitis presentation

A

NV, bloating, gas, belching, previous episodes, RUQ pain, radiating pain to shoulder and scapula, Fever, jaundice
(+) Murphy’s sign

Mild leukocytosis, mild bili elevation, LFTs elevated (ALK PHOS)
Amylase > 500 consider pancreatitis also

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

cholecystitis diagnostic imaging

A

RUQ US = visualize stones
EKG = r/o cards issues
HIDA/PIPIDA scan = how well gallbladder is squeezing

ERCP: invasive but can place stent/remove stones and look at bili and pancr ducts
MRCP = non-invasive but non interventional

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

cholecystitis surgical and medical treatment

A

-NPO/NGT if severe NV
IV fluids
-Pain control including antispasmodics (Robinul)
-antiemetics
-ABX if infection suspected
-Sx or GI consult

Medical Tx if Sx not an option
-ursodiol for 12-24 months
-chenodeoxycholic acid
-dissolve stones w/ an ether placed directly into the gallbladder via percutaneous route

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Crohns definition

A

Chronic inflammatory disease of bowel and digestive system that can effect any level of digestive systems

-transmural process (all layers) r/I ABD pain, perforations, abscess and strictures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Crohns presentation and workup

A

Labs: anemia d/t micro blood loss, B12 deficiency, inflammatory markers high, poor nutritional markers

(-) stool studies

Biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Crohns management

A

-STOP SMOKING
-Nutritional support: maybe TPN
-Surgical consult
-ABX: flagyl, cipro, rifaximin

Steroids: IV initial then PO
-Entocort (for 1 yr)
-Pred is better but want to avoid systemic

Immunomodulating drugs: azathioprine, mercaptopurine, MTX
-Anti TNF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

UC definition

A

Unknown etiology but characterized by intermittent bouts of inflammation of the mucosa in part of or the entire colon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

UC presentation

A

S/s: bloody diarrhea, fever, ABD pain, wt loss, cramping

Extra colon s/s: arthralgias, ocular complications, skin disorders, liver disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

UC workup

A

Labs: leukocytosis, anemia, lytes d/t diarrhea, elevated LFTs, stool Cx (-)

KUB: r/o or confirm megacolon; can help w/ disease severity by looking for feces in colon

Sigmoidoscopy/ colonoscopy w/ Bx for Dx

Can do barium enema but not as good and can’t be done during a flair

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

UC treatment

A

5-ASA: sulfasalazine, mesalamine, balsalazide
-sulfasalazine: wean on for acute flair up to 4-6 gm/day and then wean down to 2 gm/day for maintenance dosing
-supplement w/ folate

Step up to hydrocortisone
-foam enemas first
-step up to oral steroids Pred 20-30 BID taper slowly over 4-8 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

UC: when to hospitalize and hospital management

A

-NPO
-NGT if obstruction or toxic megacolon
-IV fluids
-Lytes
-TPN if wasting
-Stool sample for infection, leukocytes, occult blood
-KUB for toxic megacolon, free air and stool in colon
-SM 48-60 md/day
-ACTH 120 unit/day if not responding to SM
-cyclosporine is no response
-Surgery for removal and to cure disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Celiacs defintion

A

Malabsorptive disease 2nd to intolerance of gluten that affects the small intestinal mucosa

1:100 people

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Celiacs presentation and workup

A

s/s: stunted growth and s/s of malnutrition

IgA endomysial antibody
IgA tTG antibody tests
>90% sens and 95% specific screening

EGD w/ Bx for official Dx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Celiacs management

A

Remove all wheat, rye and barley products from diet

Can be refractory = very poor prognosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

PUD definition

A

Chronic disorder w/ lifelong tendency

Loss of enteric surface epithelium that extends deeply enough to penetrate muscularis mucosa (common duodenum and stomach)

Natural defense: mucosal barrier, good blood supply, competent sphincters

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

PUD risk factors

A

Gastric acid, pepsin, bile acids, decreased blood flow, incompetent sphincters, NSAIDS, ASA, steroids, smoking, tumors, stress, alcohol, low bicarb, H. pylori

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

PUD labs and results

A

-CBC: anemia, macrocytosis, leukocytosis if perf
-CMP: looking for liver disease, hypercalcemia, elevated BUN, dehydration
-Lipase and amylase
-Serum gastrin levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

PUD diagnostic tests

A

-H pylori testing: biopsy from EGD, serum test can show acute or past infection, breath test is better but cannot have ABX/antacids/pepto for 4 weeks AND no PPI for 2 weeks before test. Can do fecal test to check for cure

-CXR check for: asp PNA, effusions, eso or vicus perforation, ileus
-CT abd check for: fistula, inflammatory changes, cholecystitis, free air, liver disease

-EGD is best since it’s most accurate and can do interventions to fix condition
-UGI barium: if positive will likely still need EGD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

PUD medical management

A

Medical Management
-IV PPI and wean to oral PPI
-can do antacids and antimetics
-H2
-carafate if not using H2 blockers
-eradicate h. pylori

H pylori regimens
-3 ABX: Clarithromycin, Amoxicillin, Metronidazole
-PPI: omeprazole
-Regimens: MOC, MOA, COA

Regimen w/ Bismuth
-QID dosing
-Bismuth, metronidazole, omeprazole, tetracycline
-Regimen: BMT or TOMB

26
Q

PUD follow up care

A

Follow up Care
-duodenal ulcer no f/u if asymptomatic after 8 weeks of therapy
-gastric ulcer: repeat EGD in 4-6 weeks.
-Partially healed and no evidence of cancer = 6 more weeks therapy then rescope
-Partially healed and CA = surgery
-Partially healed < 50% = surgery consult

27
Q

PUD complications (3) and the management

A

Complications
UGI bleed
-stabilize fluids, RBC, PLT, fibrinogen, PPI gtt 80 mg bolus then 8mg/hr for 48-72 hrs, NGT to empty stomach and protect airway
-sandostatin can be used until EGD is done and varicies are r/o
-vasopressin for vasoconstriction. Do not use in coronary or PAD

Perforation
-pain, rigid abd, shock, leukocytosis, amylase elevated maybe, KUB w/ free air
-UGI w/ water soluble contrast only
-Sx and GI consult
-Abx:

Gastric outlet obstruction
-d/t edema or narrowing of pylorus or duodenal bulb
-NV, anorexia, early satiety, wt loss
-UGI barium, gastric emptying study
-NGT to allow edema to improve (this may be all you need to do)
-possible EGD for Dx and dilation
-TPN if NPO for a while, or can do DH tube

28
Q

Peritonitis definition and types

A

Acute inflammation of visceral and parietal peritoneum

Primary = SBP. Complication of cirrhosis, ascites, PD. Causes: e.coli, kleb, pneumococcus, entero

Secondary = trauma (abd sx, ruptured appy, PUD, panc rupture ) or perforation

Ascites = cirrhosis, portal HTN, renal failure, low albumin, PD, panc cyst rupture, CHF

29
Q

peritonitis risk factors

A

Cirrhosis, trauma involving abd cavity
PD
Bowel perforation
TB
Familial Mediterranean fever

30
Q

peritonitis s/s and labs

A

s/s: gen abd pain, rigid abd, distention, low bowel sounds, hyperresonance, NV, fever

Labs: leukocytosis
-Check: CBC, CMP, CRP
-May do: UA, BNP

31
Q

peritonitis imaging and diagnostics. SBP vs 2ndBP

A

Imaging
-KUB: free air, dilation
-CXR: elevated diaphragm
-CT/US: ascites, intra abd mass

Peritoneal fluid = order protein, cell count, stain, C&S, lactic acid, glucose, LDH

SBP lab results
-polys cell count > 500
-Grm stain = bacteria
-C&S GN usually
-Lactic acid > 32
-glucose > 50 (opp in 2ndary peritonitis)
-LDH < 225 (opposite)
-protein > 1 (opposite)

Sec. SBP results
-leukocytosis > 10k
-LDH > 225
-Protein < 1
-Glucose < 1

32
Q

peritonitis management

A

Infectious workup and management
-IV fluids, ABX, pan culture
-ABX: cefotaxime, ceftriaxone, ampicillin or Unasyn. Possible aminoglycosides + metronidazole for anaerobic coverage. Ceftazidime for pseudomonas

Surgical consult

33
Q

hepatitis defintion and types

A

Inflammation of the liver caused by viral, bacterial, fungal, parasitic infections or alcohol, drugs, autoimmune disease or metabolic diseases

Viral ABCDEG

34
Q

hepatitis presentation and workup

A

s/s: fatigue, fever, low appetite, NV, clay stools, dark urine, joint pain, jaundice

-surface antigen: current infection and able to infect.
-surface antibody: immune to hep infection and cannot pass on to other
-total antibody to core antigen: has or has had Hep infection now or sometime in the past. Includes IgM and IgG
-IgM: current or recent acute infection. “miserable”
-IgG: has had hep but “gone”

35
Q

hepatitis general management

A

Bed rest until jaundice is gone
No heavy lifting or strenuous activity
High calorie, high carb, low protein, low fat
NO ALCOHOL
Antiemetics
Review and dose meds

HOSPITALIZE IF: encephalopathy or dehydration

36
Q

Diverticulitis definition

A

Inflammation or localized perforation of diverticulum w/ abscess formation

Can rupture and cause peritonitis. Can bleed w/o rupture

37
Q

diverticulitis risk factors

A

Weakness in bowel wall, constipation, low fiber diet, change in diet

38
Q

diverticulitis presentation and workup

A

s/s: LLQ pain, fever, constipation, NV, cramping, hypoactive BS, rectal bleeding

Labs
-CBC: leukocytosis, anemia
-CMP: lyte issues d/t NV
-sepsis/inflamm: ESR, CRP, procal, lactate
-UA to r/o pyelo or UTI
-Beta hCg for all females

Dx
-CT: free air = rupture
-flexsig: usually outpt
-colonoscopy/BE: usually outpt also
-angiography to locate bleeding vessel

39
Q

diverticulitis management

A

Can be managed outpatient

Mild: home w/ bowel rest; low residue or CL diet 24-48 hours, no laxatives/enemas

Hospital management
-NPO
-ABX (sometimes): Zosyn, ertapenem, impipenem, merrem, ticarcillin clavulanate
-pain control: No ASA or NSAIDS
-Sx consult if no improvement w/in 72 hours or decompensation, free air, abscess on CT, peritonitis
-Possible reversible colostomy

40
Q

appendicitis definition

A

Acute inflammation 2nd to occlusion of the lumen from fecaliths, inflammation, foreign bodes, worms, strictures, tumors

41
Q

appendicitis presentation and workup

A

s/s: RLQ pain, + Psoas sign, + obtutator sign, + Rovsings sign, + McBurneys point, periumbilical pain, fever, constipation, diarrhea, NV

Labs
-UA: looking hematuria, pyuria, albuminuria
-leukocytosis

Dx
-US: can Dx but painful
-CT: BEST

42
Q

appendicitis management

A

Sx is still mainstay

IV fluids/ABX (GN, anaerobic)
-Cefoxitin if not ruptured
-rupture/gangrenous: Unasyn, gentamycin, clindamycin, flagyl, imipenem/cilastatin
-Pain control

Rupture: leave wound open, pack it and let close by secondary intention

43
Q

pancreatitis definition

A

Acute, inflammatory autodigestive process of the pancreas

44
Q

pancreatitis risk factors

A

Alcoholism, biliary tract disease, hyperlipidemia, cancer, hypercalcemia, ABD trauma/surgery, ERCP, viral infections, ischemia, PUD, pregnancy
Congenital: pancrease divisum
Drugs: Monjaro, Victoza

45
Q

pancreatitis presentation and staging

A

2 of the following: amylase/lipase 3 x normal, radiographic evidence, characteristic abd pain

Staging
-Mild (80%): interstitial edema pancreas w/o organ failure
-Moderately severe = w/ transient organ failure (failure last < 48 hrs & pancreatitis resolves w/in 1 week)
-Severe = organ failure > 48 hrs

s/s: NV, fever, sweating, anxiety, low bowel sounds, jaundice, steatorrhea, ascites, pl. eff, tachypnea, sharp shooting to back pain in epigastric area

46
Q

pancreatitis labs and imaging

A

Labs
-CBC: WBC > 10, Hct elevated d/t dehydration
-CMP: hypocalcemia, high or low K, low albumin
-Lipase/amylase: lipase more specific. P-amylase is more specific than amylase
-Lactate, LDH, CRP, procal
-Trigs
-High glucose d/t islet cell damage
-AST/LDH elevated if tissue necrosis
-Bili and Alk phos = CBD obstruction

Imaging
-KUB: gallstones, calcif of pancreas, ileus, free air
-US: gallstones, panc pseudocyst
-CT w/ contrast: better than US but c/f renal damage in severe ill pts
-MRCP

47
Q

pancreatitis management

A

Treat the cause

May need lap/choley to prevent recurrence

Pain control
Fluids: NS or LR (better)

NGT if uncontrolled NV.
Resume diet slowly; enteral feeds preferred over parenteral

Glucose management: get A1c on admit

Trend labs for improvement

ERCP is not routinely recommended

ABX if severe: GN and anaerobic coverage (zosyn, merrem)

CT guided aspiration for fluid to get C&S if not getting any better

Prognostic indicators
-Atlanta revised criteria is preferred

48
Q

Mesenteric ischemia definition

A

Failure of blood supply to mesentery to carry enough oxygen to meet intestinal needs

1/3: arterial embolism (moving)
1/3: arterial thrombus (stationary)
1/3: low flow states (shock, pressors etc)

49
Q

mesenteric ischemia risk factors

A

PAD
surgical accidents
ABD trauma
Tumor
TTP, DIC
SLE
polyarteritis nodosa

50
Q

mesenteric presentation and workup

A

s/s: cramping, abd pain, possible rectal bleed
-HOTN and abd distention signals infarct

Labs
-leukocytosis
-lactic acidosis

Imaging
-US w/ doppler
-mesenteric arteriography
-BE: thumbprinting or xray
-MRA w contrast
-CT w contrast

51
Q

mesenteric ischemia management

A

Vascular or general Sx consult: stent, bypass. May need colon resection

Increase blood flow, increase oxygenation

Declot: surgery or drugs

52
Q

GIB risk factors for UGI and LGI bleed

A

UGI: esophagus, stomach or duodenum
-varices, Mallory Weiss tear or PUD

LGI: diverticulitis, hemorrhoids, cancer, ischemic colitis, inflammatory colitis, post XRT injuries

53
Q

GIB presentation and workup

A

Labs
-CBC w/ serial H&H
-PT/INR
-CMP
-EKG

INR/PT/PTT: if INR 1.5-2 can consider endoscopy. INR > 2.5 and on anticoag then reversal agents

54
Q

GIB general management

A

General Treatment
-IV fluids
-Consider O2
-GI consult
-Hgb > 9 if massive bleeding, significant comorbities, delay in treatment. Otherwise Hgb > 7
-PLT and plasma transfusion consider in pts getting massive RBC
-4 factor prothrombin complex concentrate > FFP

Consider reversal agent and hold anticoagulants initially
-Vit K and FFP for coumadin
-idarucizumab = dabigatran
-andexanet alfa = apixaban/rivaroxaban

ASA for high-risk CV pts should be restarted ASAP or w/in 7 days.
PTs w/ ACS in last 90 days, or stent in last 30 days should not DC anticoag

No NSAIDS

55
Q

Basics of Hepatitis A

A

A = acute
fecal/oral transmission from food/water, restaurants, shellfish.
VERY CONTAGIOUS.
IG shot for temporary immunity for 2-3 mo
Vaccine (Havrix, VAQTA) for high risk travel and after exposure. Combo w/ hep B. 2 shots.

56
Q

Hep B basics

A

B = BAD
-percutaneous/mucosal contact w/ virus through blood, semen or vaginal secretions.
-90 day incubation
-Vaccine: recombivax, engerix for 3 does.
-No cure just remission. Can cause cirrhosis and liver Ca
-Worse if combo infxn w HDV
-Tx: interferon, lamivudine, adefovir, tenofovir, entecavir, telbivudine

57
Q

Hep C basics

A

C = cure
-blood or tissue contact
Worse if also have HBV or HIV
-20-30 yrs for serious damange
-70% cure w/ protease inhibitors, interferon, ribavirin

58
Q

Hep D basics

A

need Hep B to replicate
Can be prevented w/ vaccine

59
Q

Hep E basics

A

fecal/oral route
not common in US, check if recent travel

60
Q
A

Acute Care 2 (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions