GI 2 highlights Flashcards
What are 2 etiologies of PUD?
NSAIDs & chronic H. pylori infection
PUD:
1) What is an important complaint during history?
2) What is a main Sx?
1) Dyspepsia
2) Improvement with milk/food/antacids (duodenal), worse with food (gastric)
Coffee-ground emesis is a primary Sx of what PUD complication?
GI hemorrhage (up to 15%):
PUD Tx: What specific therapy should you use from the H. pylori eradication agents category?
Quadruple therapy: bismuth/TCN/PPI/metronidazole
(highlighted)
What are the 3 categories of PUD Tx?
Acid anti-secretory agents, mucosal protective agents, & H. pylori eradication agents
PUD Tx: You should confirm eradication of what 4 weeks after completion of therapy (urea breath test or fecal antigen test)?
H. pylori-associated ulcers
PUD Tx: For H. pylori Tx, the pt should adhere to strict alcohol avoidance with __________________
metronidazole
PUD: For NSAID-induced ulcers, what is a main part of Tx?
D/c offending agent
Who should you give parenteral feedings when able?
Critically ill and mechanically ventilated patients w. gastritis
What is the most common form of perirectal abscess?
Perianal abscess
Perirectal abscess:
1) What is the Tx for all patients?
2) What is a complication of perirectal abscesses?
1) Incision & drainage for ALL abscesses
2) Anorectal fistula
For anorectal fistula, what is an important finding on a physical exam?
External opening
Intense pain with defecation is a primary Sx of what?
Anal fissures
Hemorrhoids involve severe pain with _________________
thrombosis
What is the Tx for an anorectal fistula?
Surgery is mainstay (fistulotomy); seton placement in setting of abscess or inflammation
Excision within 48 hours should be done for which hemorrhoids?
Thrombosed external
90% of anal fissures occur where?
At posterior midline
There is a concern for Crohn’s, infections (TB, HIV/AIDS, syphilis) with ___________ anal fissures
lateral
A sentinel tag is a sign of what?
Chronic anal fissure
Medications are a potential ____________ cause of constipation
secondary
Constipation:
1) Most common causes?
2) Name a systemic disease that can cause it
3) Name 2 medications that can cause it
1) Inadequate fiber & fluid intake, poor bowel habits
2) Hypothyroidism
3) Opioids + iron
1) Name a structural abnormality that can cause constipation
2) Can IBS cause constipation?
1) Mass
2) Yes
If a pt with constipation has one of the following, what should you do?: > 50 y/o, severe constipation, signs of organic disorder, alarm symptoms, FHx colon cancer or IBD.
Further diagnostic testing
On the Bristol stool chart, which type is the gbest?
Type 4 (“like a smooth sausage”)
What is a key part of chronic constipation Tx?
Adequate fluid & fiber intake
What category of chronic constipation Tx can the body get addicted to?
Stimulants ( bisacodyl (Dulcolax), senna)
Seeds, nuts, popcorn, caffeine, & alcohol _______ associated with increased risk for diverticular disease
NOT
Acute diverticulitis:
1) Abdominal imaging _____________ (CT with oral & IV contrast)
2) No role for ______________ & should avoid due to risk of perforation
1) required
2) colonoscopy
Is diverticular bleeding typically painful or painless?
Painless
Diverticular bleeding: ______________ is test of choice for HD stable patients when bleeding abates
Colonoscopy
IBDs: Differentiate between Crohn’s and ulcerative colitis
1) Crohn’s can involve any part of GI tract from mouth to anus
2) UC affects only the colon
IBD: Crohn disease (Crohn’s):
1) What is often seen?
2) What is possibly seen in Crohn’s that’s not seen in UC?
1) Skip areas
2) Possible fibrosis & strictures leading to obstruction
IBD: Crohn disease (Crohn’s):
1) Possibly has sinus tracts leading to microperforations & ___________ formation
2) Most commonly seen in what 2 locations?
1) fistula formation
2) Terminal ileum & proximal colon
List the most important external manifestations of Crohn’s disease (an IBD). Include which is most frequent.
1) Arthritis (most freq)
2) Pyoderma gangrenosum & erythema nodosum
3) Oral ulcers
Ulcerative colitis (UC; an IBD):
1) Limited to mucosal layer of __________
2) Almost always involves _____________.
1) Colon
2) Rectum
Ulcerative colitis (UC; an IBD): List the most important external manifestations
1) Arthritis (most frequent extraintestinal manifestations in IBD)
2) Skin: erythema nodosum & pyoderma gangrenosum
3) Oral ulcers
What is the goal of IBD management?
remission
