GI #4 Flashcards
MCC of acute pancreatitis
Gallstones and alcohol abuse
Symptoms of pancreatitis
- Epigastric pain: constant, boring and radiates to the back
- Exacerbated if supine, relieved with leaning forward
- N/V, fever
- Epigastric tenderness
- Cullen’s Sign (periumbilical ecchymosis)
- Grey Turner Sign (flank ecchymosis)
Labs for acute pancreatitis
- Increased amylase and lipase (initial)
- ALT elevated is highly suggestive of gallstone
- Hypocalcemia
Diagnostics for acute pancreatitis
- Abdominal CT (imaging of choice)
- Abdominal radiograph: Sentinel loop, localized ileus of segment of small bowel
Treatment for acute pancreatitis
- Supportive: NPO, high IV fluid resuscitation, Analgesia
- ABX not routinely used
Symptoms of Pancreatic Carcinoma
- Painless jaundice
- Courvosier’s Sign: palpable, nontender gallbladder
- Pruritus
- Dark urine
- Weight loss
Diagnostic for Pancreatic Carcinoma
CT scan (initial) -If negative endoscopic US with biopsy
70% of pancreatic carcinoma are found where
In head of Pancreas
-Adenocarcinoma MC
Tumor marker for pancreatic carcinoma
CA 19-9
Treatment for Pancreatic Carcinoma
Whipple Procedure. Post op Chemo or Radiotherapy
Diagnostic for volvulus
Abdominal CT: bird beak appearance at site of volvulus
Treatment for Volvulus
- Endoscopic decompression (proctosigmoidoscopy)
- Decompression followed by elective surgery due to high rate of recurrence
MC etiology of small bowel obstruction
Post-surgical adhesions
4 hallmark symptoms of small bowel obstruction (CAVO)
Crampy abdominal pain
Abdominal distention
Vomiting
Obstipation (no flatus)
Abdominal radiographs for a small bowel obstruction show
Multiple air-fluid levels in a step ladder appearance, dilated bowel loops
A CT scan for a small bowel obstruction is better because it shows
Transition zone from dilated loops of bowel with contrast to an area of no contrast
Treatment for small bowel obstruction
- NPO, IVF
- Bowel decompression
Symptoms of Intussusception
Vomiting + Abdominal pain + Passage of blood per rectum (currant jelly stools)
-Sausage shaped mass in RUQ and emptiness in RLQ (Dance’s Sign)
Diagnostics for intussusception
- US (initial)
- Air or contrast enema (both diagnostic and therapeutic)
Treatment for intussusception
- Fluid and electrolyte replacement
- Pneumatic or hydrostatic decompression
- Admit for observation
Pathophysiology of Hirschsprung Disease
-Congenital megacolon due to absence of ganglion cells, leading to a functional obstruction
Definitive diagnostic for Hirschsprung Disease
-Rectal biopsy
Symptoms of Hirschsprung Disease
- Meconium Ileus
- Bilious vomiting
- Abdominal distention
- Failure to thrive
Three factors of pathophysiology of IBS
- Abnormal motility: chemical imbalance in intestine
- Visceral hypersensitivity: lowered pain threshold to abdominal distention
- Psychosocial interactions: altered CNS processing
Diagnostic imaging of choice for appendicitis
CT scan
What labs are positive in primary biliary cirrhosis?
- Increased alkaline phosphatase and GGT
- Antimitochondrial antibody
What diagnostic is the gold standard to diagnose primary biliary cirrhosis?
Liver biopsy
What exactly is primary biliary cirrhosis?
-Idiopathic autoimmune disorder of intrahepatic small bile ducts that leads to decreased bile salt excretion, Cirrhosis, and end stage liver disease in women 30-60 years old
Long-term use of PPI should be supplemented with what vitamin?
B12
