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PANCE 2.0 > GI #2 > Flashcards

GI #2 Flashcards

1
Q

Management of fecal impaction

A
  • Digital disimpaction followed by warm-water enema with mineral oil
  • Polyethylene Glycol
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2
Q

MCC of anorectal abscess

A

-Staphyloccus Aureus

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3
Q

MC site of anorectal abscess

A

Posterior rectal wall

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4
Q

Symptoms of an anorectal abscess

A
  • Swelling
  • Rectal pain worse with sitting, coughing, defecation
  • Focal edema, induration, and fluctuance
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5
Q

Treatment for anorectal abscess/fistula

A
  • Incision and drainage

- -Followed by WASH (warm water cleaning, analgesic, sitz baths, high-fiber diet)

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6
Q

Causes of anal fissures

A
  • Low-fiber diet
  • Passage of large hard stools
  • Constipation
  • Other anal trauma
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7
Q

Symptoms of anal fissures

A
  • Severe rectal pain with bowel movements

- bright red blood per rectum

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8
Q

Describe the MC type and location of anal fissure

A

-Longitudinal tear at posterior midline

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9
Q

True or False: 80% of anal fissures resolve spontaneously

A

True

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10
Q

However, what is the treatment for an anal fissure if it does not resolve?

A

Supportive measures (warm water sitz baths, analgesics, high fiber diet, laxatives, mineral oil)

-Topical vasodilators, Nitroglycerin, Botox injections, Surgery for refractory cases

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11
Q

Internal hemorrhoids originate from ________ and what symptoms do they have?

A

Proximal (above) the dentate line

-Bleed and are painless

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12
Q

Describe the four grades of internal hemorrhoids

A
  • Grade I: does not prolapse
  • Grade II: prolapses with defecation but spontaneously reduces
  • Grade III: Requires manual reduction
  • Grade IV: Irreducible and may strangulate
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13
Q

External hemorrhoids originate from ________ and have symptoms such as

A
  • Distal (below) dentate line

- Do not bleed and are painful

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14
Q

Management of hemorrhoids

A
  • Conservative treatment: high fiber, increased fluids, warm sitz baths, topical corticosteroids
  • Rubber band ligation, sclerotherapy, infrared coagulation
  • Hemorrhoidectomy: for Stage IV or non responsive to other therapy, or external hemorrhoids
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15
Q

Regarding diverticulosis, what is the MC area for occurrence and what is the MC area for bleeding?

A
  • Left colon (MC in incidence)

- Right colon (MC in bleeding)

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16
Q

Risk factors for diverticulosis

A
  • Low fiber diet
  • Constipation
  • Obesity
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17
Q

What is the MCC of acute lower GI bleeding (Painless hematochezia) in adults?

A

Diverticulosis

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18
Q

What is the diagnostic of choice for diverticulosis?

A

Colonoscopy

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19
Q

If bleeding is not visualized on colonoscopy for diverticulosis, what is the next diagnostic step?

A

Radionuclide imaging followed by arteriography

20
Q

In most cases of diverticulosis, the bleeding stops spontaneously. However, if it does not, what should you do?

A

-Resuscitation (2 large bore IVs, fluids, blood products)

21
Q

Asymptomatic diverticulosis can be followed by (3 things)

A
  • High fiber diet
  • Psyllium
  • Use of Bran
22
Q

MC area of diverticulitis

A

-Sigmoid colon (due to high intraluminal pressure)

23
Q

Symptoms of diverticulitis

A
  • LLQ abdominal pain
  • Low grade fever
  • Nausea, vomiting
  • Constipation, Diarrhea
  • Changes in bowel habits
24
Q

Diagnostic of choice for diverticulitis

A

-CT scan (initial)

25
Q

What is the criteria for admission with diverticulitis?

A
  • Perforation, abscess, obstruction or fistula

- High fever, sepsis, immunocompromised, increased age, unable to tolerate oral intake

26
Q

Treatment for uncomplicated diverticulitis

A
  • Treat as outpatient with oral antibiotics (Metronidazole + Ciprofloxacin or Levofloxacin) for 7-10 days
  • Metro + Bactrim (alternative)
27
Q

What is toxic megacolon?

A

-Nonobstructive, extreme colon dilation > 6 cm + signs of systemic toxicity

28
Q

What are some common etiologies of toxic megacolon?

A

-Complications of IBD, C. diff, radiation, volvulus

29
Q

Symptoms of toxic megacolon

A
  • Profound bloody diarrhea
  • Lower abdominal tenderness
  • Distention
  • Signs of toxicity: AMS, fever, tachycardia, hypotension, dehydration
30
Q

What is the initial imaging of choice for toxic megacolon?

A

Abdominal radiographs

31
Q

What do the abdominal radiographs for toxic megacolon usually show?

A

-Radiologic evidence of colon > 6 cm

32
Q

Treatment for toxic megacolon

A

Supportive mainstay: bowel rest, bowel decompression with NG tube, Ceftriaxone + Metro, fluid and electrolyte replacement

33
Q

What is Olgivie Syndrome?

A

-Colonic pseudo-obstruction (no mechanical obstruction present)

34
Q

What are some etiologies of olgivie syndrome?

A
  • Postoperative state
  • Medications (opiates)
  • Metabolic (hypokalemia, hypercalcemia)
  • Hypothyroidism
  • DM
35
Q

Symptoms of Olgivie Syndrome

A
  • Abdominal distention!

- Tympanitic abdomen

36
Q

Although abdominal radiographs are the initial test for Olgivie Syndrome, what is the most accurate test?

A

CT scan

37
Q

Treatment for Olgivie Syndrome

A
  • Conservative: electrolyte and fluid repletion (if < 12 cm)
  • Medical decompression: Neostigmine (if > 12 cm or failed 24-48 hours of conservative)
  • Colonoscopic decompression: if failed conservative and Neostigmine
  • Surgical decompression: if all other options fail
38
Q

Name risk factors for IBD

A
  • Jewish population, Caucasians
  • 15-35 years old
  • UC in males, Crohn’s in females
  • Smoking bad for Crohn’s and protective in UC
  • Western diet
  • Medications: NSAIDs, OCP
39
Q

Name some extra-intestinal manifestations for IBD

A
  • Anterior uveitis/iritis
  • B12 and iron deficiency
  • Increased risk of thromboembolism
  • Arthritis, osteoporosis
40
Q

Name 8 factors about UC

A
  • Limited to colon, rectum always involved, contiguous spread
  • Mucosa and submucosa only
  • LLQ pain, bloody diarrhea
  • Smoking decreases risk
  • Uniform inflammation and pseudopolyps (colonoscopy)
  • Stovepipe sign (barium studies) - no haustral markings
  • P-ANCA labs
  • Surgery is curative
41
Q

Name 8 factors about Crohn’s Disease

A
  • Any segment of GI tract, MC in terminal ileum
  • Transmural
  • RLQ pain, no bloody diarrhea
  • Smoking does not decrease risk
  • Perianal disease (fistulas, abscesses, granulomas) and B12/Fe deficiency common
  • Skip lesions and cobblestone appearance (Colonoscopy)
  • String sign (barium studies)
  • ASCA (labs)
  • Surgery is noncurative
42
Q

Initial test of choice for Crohn’s Disease and UC

A

-Upper GI series

43
Q

Treatment for Crohn’s Disease

A
  • Limited ileocolonic disease: 5-ASA (Mesalamine) or oral glucocorticoids
  • Ileal and proximal: Glucocorticoids (Pred, Budesonide)
  • Severe: Azathioprine, Methotrexate, Infliximab
44
Q

What is shown on the following imaging studies for Crohn’s Disease?

  • Upper GI series:
  • Endoscopy:
  • Biopsy:
  • Labs:
A
  • Upper GI series: string sign
  • Endoscopy: Skip areas, cobbles-toning
  • Biopsy: Transmural inflammation, noncaseating granulomas
  • Labs: ASCA, B12 and Iron Deficiency
45
Q

What is shown on the following diagnostics for UC?

  • Flexible sigmoidoscopy:
  • Biopsy:
  • Barium Enema:
  • Labs:
A
  • Flexible sigmoidoscopy: uniform erythema and ulceration
  • Biopsy: crypt abscesses and atrophy, contiguous involvement
  • Barium Enema: stovepipe or leadpipe sign
  • Labs: P-ANCA
46
Q

What are some maintenance therapy options for Crohn’s and UC?

A
  • Azathioprine
  • Methotrexate
  • Cyclosporine
  • Tacrolimus
  • Anti-TNF agents (Infliximab, Adalimumab)
47
Q

For mild to moderate UC and Crohn’s, what is the first-line therapy?

A

-5-ASA (Mesalamine) Topical

Oral if needed, can be added

PANCE 2.0 (62 decks)

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