GI 3 highlights Flashcards
______% of mechanical intestinal obstructions involve small bowel
80
Complete SBO almost always results in bowel ischemia leading to _____________ & __________
necrosis & perforation
Mechanical SBO results in progressive dilation __________ to obstruction, & decompression _________ to obstruction
proximal; distal
What is the result of a proximal mechanical SBO?
Hypovolemia
What is the most common cause of mechanical SBO?
Intraperitoneal adhesions
Are mechanical SBOs most commonly acute or chronic?
Acute
What is a characteristic sign of SBO on a plain radiograph?
Dilated loops of bowel with air-fluid levels
Give the main points on how to perform a CT abdomen with contrast if a pt has an acute mechanical SBO
1) Perform with PO/IV contrast (if not contraindicated)
2) Omit oral contrast if complete bowel obstruction
-When looking at CT, identify specific site (transition point)
What is the initial diet for someone with an SBO?
NPO
What kind of atrophy is characteristic of Celiac disease?
Villous atrophy
Celiac disease pathophys:
1) 90-95% affected carry __________.
2) >90% of remaining 5-10% carry ____________.
1) HLA-DQ2
2) HLA-DQ8
What are found in >99% Celiac patients?
HLA-DQ2 and/or HLA-DQ8
True or false: Subclinical/ non-classic Celiac is asymptomatic
True
What Serologic evaluation for Celiac disease should you do?
While on gluten diet:
1) Tissue transglutaminase (tTG)-IgA: preferred test
2) If total IgA deficiency: Endomysial Ab (EMA)-IgA
What are the genetic markers for Celiac?
HLA-DQ2 & DQ8
What is the gold standard for diagnosing someone with Celiac disease?
(starred slide/ probs on test)
Mucosal intestinal biopsy of duodenal bulb, distal duodenum or proximal jejunum with clinical response to dietary withdrawal of gluten
What will be seen on histology with Celiac disease?
blunted or complete loss of villi
What is the main part of Celiac disease mgmt?
Gluten-free diet
List 3 etiologies of acute pancreatitis
Gallstones (40-70%)
Alcohol (25-35%)
Idiopathic (15-25% after inconclusive work-up)
List 2 risk factors for acute pancreatitis
Alcohol and smoking
List 2 things you may see on an acute pancreatitis Hx
1) Heavy alcohol intake
2) Pain often radiates to back
Acute pancreatitis: ___________ onset severe, steady, boring epigastric pain
Sudden
List some labs for acute pancreatitis
1) Sr lipase (& amylase) >3x ULN
2) Lipase elevated longer and more accurate for diagnosis
3) Elevated bilirubin
Ranson Criteria is used to figure out the severity of what?
Acute pancreatitis
What imaging should you get for acute pancreatitis?
IV Contrasted CT abdomen
Mild acute pancreatitis: When can you use a clear liquid diet?
When pain free & bowel sounds present
Acute pancreatitis: The presence of ___ to ____ Ranson criteria represents mild pancreatitis; the mortality rate rises significantly with ______ or more criteria
1 to 3; 4
Chronic pancreatitis occurs in _____% of all patients with recurrent acute pancreatitis
36%
List some important S/Sx of chronic pancreatitis
1) Epigastric/LUQ pain through to back
2) Steatorrhea (pancreatic insufficiency)
Name one important lab for chronic pancreatitis
Lipase
What are 2 forms of imaging you should get for chronic pancreatitis? Which is most sensitive?
1) CT
2) ERCP: most sensitive study
Chronic pancreatitis: What is a main Sx of Exocrine pancreatic insufficiency (EPI)?
Steatorrhea that sticks to sides of bowl
What is a key part of chronic pancreatitis management?
Absolute cessation from alcohol
What are the 2 main parts of acute appendicitis pathogenesis?
1) Luminal obstruction
2) Inflammatory process
Define McBurney’s Point tenderness for acute appendicitis
Maximal tenderness 1.5-2 cm from ASIS on straight line from ASIS to umbilicus
“Non-compressible” is a positive ultrasound finding for what?
Acute appendicitis
Interventional radiation for either perforated or non-perforated acute appendicitis:
CT-guided drainage & IV antibiotics for _________ found on imaging; appendectomy follows
abscess
What skin condition may be seen with Celiac disease?
Dermatitis herpetiformis
What 3 labs should you draw for alcoholic hepatitis?
AST, ALT, GGT
