GI Flashcards
What are the main causes of peptic ulcer disease
H. Pylori is 1
NSAIDS, Aspirin, Steroids, Smoker, stress
Are younger patients more likely to have duodenal or gastric ulcers?
Duodenal
What are the s/s of peptic ulcer disease?
Gnawing pain from the inside out, relief of pain w/ food is duodenal, worse with food is gastric, GIB, melena, hematesis, coffee ground emesis
S/S of bowel perforation
Board-like abdomen, quiet bowel sounds, rigidity
Diagnostic testing for peptic ulcer disease
Endoscopy
Peptic ulcer disease treatment
PPI (watch for rebound GERD), sucrafate
What xray results indicate pneumoperitoneum
Free air
What x ray result indicates a bowel perf?
Air under the diaphragm
Hep ABC transmission
A: Oral fecal
Hep B: blood born
Hep C: Blood IV drug use
Which type of hepatitis can be chronic
B and C
General management of Hepatitis infection
Supprotive, IVF, avoid alcohol, low to no protein diet, serex, vitamin K, lactulose
Who is diverticulitis more common amungst
Women and those with low dietary fiber
S/s of diverticulitis
Mild to moderate LLQ aching and pain, constipation or loose stools, N/V, low grade fever
Labs and Diagnostics of Diverticulitis
Labs: leukocytosis, ESR, positive heme occult
CT abdomen: colonic diverticula and >4cm wall thickening
Treatment of diverticulitis
NPO, bowel rest, IVF, ? Surgery
S/S of cholecystitis
Precipitated by a large fatty meal
RUQ/epigastric pain, vomiting, +murphy’s sign, fever, leukocytosis, elevated bili/LDH/Alk phos/AST/ALT/Amylase
What scan can be used to find a gallbladder stone in kidney patients
HIDA
What is the treatment for cholecystitis
ERCP, IVF, pain management, lap Chole, NPO
ABX: Rocephin and Flagyl
What is Choledocholithiasis
Gall stone in the common bile duct
Dx and TX for Choledocholithiasis
MRCP/ ERCP, lap Chole, sphinceterotomy
ABX: Unasyn OR Zosyn OR Rocephin if infection
Causes of pancreatitis
ETOH, trauma, Chole
S/s of pancreatitis
Abrupt onset of epigastric pain with radiation to the back
N/V, pain worse lying flat, tripod positioning, tender to palpation, no rebound pain, fever, tachycardia
Pancreatitis work up
Elevated amylase and lipase
Hypocalcemia
Elevated CRP
CT ABD
What is cullens and grey turners sign
Hemorrhagic pancreatitis
Cullens sign: umbilical discoloration
Grey Turners sign: Flank discoloration
Pancreatitis treatment
Bedrest, NPO, LR, pain medications
Pancreatitis complications
Azotemia
Necrotic to MODS
Pleural effusion
What does a bowel obstruction show on XRay
Dilated bowel loops with air fluid levels \
Called Frame pattern
Why does a mesenteric infarct occur
Inadequate blood flow tend ischemia/gangrene of the bowel
Arterial venous embolus, smoking, athlerosclerosis, post cardiac/thorasic surgery
S/s of mesenteric infarct
Sudden onset of abdominal cramps, colicky abd pain out of proportion to exam, N/V, hyperactive bowel sounds, shock, Afib with post parandial abdominal pain
Labs and diagnostics for mesenteric infarct
Leukocytosis
CT
What are the causes of appendicitis
Undigested food particles or neoplasms that get stuck
S/s of appendicitis
Starts as umbilical pain and progresses to RLQ with rebound tenderness
N/V
Psoas: right thigh extension pain
Obturator: pain in the opposite side of the abdomen that is palpated
H pylori treatment for patients with NO PCN allergy and have not had a macrolide
ECA: PPI, Clarithromycin, Amoxicillin
EBMT: PPI, Bismuth, Metronidazole, Tetracycline
ECAM: PPI, clarithromycin, amoxicillin, metronidazole
What is the h pylori treatment for a patient who has a PCN allergy and is unable to tolerate bismuth
ECM: PPI, clarithromycin, metronidazole
H pylori treatment for patients who are allergic to PCN and previously had a macrolide
EBMT: PPI, Bismuth, Metronidazole, Tetracycline
GERD treatment
H2 blocker
Hep A serology Active vs Recovered
Active: Anti-HAV, IgM
Recovered: Anti-HAV, IgG
Hep B Active, Chronic, and Recovered serology (HBsAg, HBeAg, Anti-HBC, Anti HBe, Anti HBs, IgM, IgG)
Active: HBsAg, HBeAg, Anti-HBc, IgM
Chronic: HBsAg, Anti-HBC, Anti-HBe, IGM, IgG
Recovered: Anti HBc, anti HBs
Acute vs Chronic Hep C serology
Acute: Anti-HCV, HCV RNA
Chronic: Anti HCV, HVC RNA
Need a PCR to determine differences
What is the gold standard imaging for cholecystitis
ABD US
Major complications of ERCP
Pancreatitis, perforation, hemorrhage, cholangitis
What is Ranson’s criteria
Evaluate prognosis of pancreatitis
At Admission: George Washington Got Lazy After
->55 yrs old, WBC >16, Glucose >200, LDH > 350, AST> 250
48 hours: He Broke CABE
-Hct Drop >10, BUN >5, Ca <8, A O2 <60, Base deficit <4, fluid sequestration >6K
5-6 risk factors= 40% mortality
>7= 100% mortality
What bowel sounds are present in a bowel obstruction
High pitched tinkling sounds
What is the hallmark sign of ulcerative colitis
Bloody diarrhea
Treatment of UC
Mesalamine and hydrocortisone suppositories
What happens to untreated appendicitis
Gangrene and perf
What is Mc burney’s point
Tenderness 1/3 of the way between umbilical and iliac crest indicative of appendicitis
What is the Psoas sign
Pain with right thigh extension sign of appendicitis
Obturator sign
Pain with internal rotation of flexed right thigh indicative of appendicits
What is a Rovsing sign
RLQ pain when LLQ is palpated sign of appendicitis
What should not be used to treat diverticulitis
Enemas
A patient who is 85 with renal history asks if he should have colorectal cancer screening
No
At what age should a patient be offered if they want to or not for colorectal cancer screening
75
