GI - 50% Flashcards
45-year-old woman with RUQ pain for 12 hours, fever, and leukocytosis
Acute cholecystistis
What is murphys sign?
RUQ pain with GB palpation on inspiration
What is first line diagnostics for cholecystitis and what is definitive dx?
Ultrasound = 1st line = Shows Gallbladder wall >3 mm, pericholecystic fluid, gallstones
HIDA is the best test (Gold Standard) (porcelain gallbladder = chronic cholecystitis)
Most common etiology for acute pancreatitis?
Cholelithiasis or alcohol abuse
What is Ransons criteria?
Prognosis for pancreatitis
Admit if: Age >55, Leukocyte >16,000, Glucose >200, LDH >350, AST >250
Tx of acute pancreatitis
Treatment: IV fluids (best), analgesics, bowel rest
Classic triad of chronic pancreatitis
the classic triad of pancreatic calcification (plain abdominal x-ray), steatorrhea (high fecal fat), and diabetes mellitus
Most common types of anal fissures
Vertical = MC
Horizontal = Chrons dz, HIV,
Gastric cancer
“WEAPON”: Weight loss, Emesis, Anorexia, Pain/epigastric discomfort, Obstruction, Nausea
Bariatric surgery guidelines
- BMI > 40 (basically, 100 pounds above ideal body weight) or
- BMI > 35 with a medical problem related to morbid obesity
- Individuals must have failed other non-surgical weight loss programs.
- They must be psychologically stable and able to follow post-op instructions.
- Obesity is not caused by a medical disease such as endocrine disorders.
4 cardinal signs of strangulated bowel
The 4 cardinal signs of strangulated bowel: fever, tachycardia, leukocytosis, and localized abdominal tenderness.
Colicky abdominal pain, nausea, bilious vomiting, obstipation, abdominal distention, hyperactive bowel sounds (early) or hypoactive bowel sounds (late), prior abdominal surgery
Small bowel obstruction
Cholangitis sx
- Charcot’s triad: RUQ tenderness, jaundice, fever
- Reynold’s pentad: Charcot’s triad + altered mental status and hypotension
complication of gallstones with symptoms secondary to an infected obstruction of the common bile duct (E.coli is the #1 cause)
Cholangitis
Dx and tx of cholangitis
ERCP is the optimal procedure both for diagnosis and for treatment
Painless rectal bleeding and a change in bowel habits in a patient 50-80 years of age
Colorectal carcinoma
Tumor marker for colorectal carcinoma
- Tumor Marker: CEA
severe form of constipation, where a person cannot pass stool or gas
Obstipation
What is an ileus
Hypomotility of the gastrointestinal tract in the absence of mechanical bowel obstruction AKA lack of muscle contractions in intestines
Ileus that persists for more than 3 days
persists for more than 3 d following surgery is termed postoperative adynamic ileus or paralytic ileus
stomach muscles and prevents proper stomach emptying
Gastroparesis
Tx of c diff
- IV metronidazole OR PO vancomycin (this is the only use for oral vancomycin)
Difference in diverticulosis and diverticulitis
The presence of the pouches themselves is called diverticulosis. When they become inflamed, the condition is known as diverticulitis.
Tx of diverticular disease
Ciprofloxacin or Augmentin/ + Metronidazole (Flagyl)
MC location of diverticular disease
Sigmoid colon
Progressive dysphagia to solid foods along with weight loss, reflux, and hematemesis
Esophageal cancer
complication of Barrett’s esophagus (screen Barrett’s patients every 3-5 years with endoscopy), affects distal (lower) 1/3rd of the esophagus
Adenocarcinoma
Solid food dysphagia in a patient with a history of GERD
Esophageal stricture
primary esophageal motility disorder characterized by the absence of lower esophageal peristalsis.
Esophageal achlelasia
Dx of esophageal achalasia
Barium swallow shows there is acute tapering at the lower esophageal sphincter and narrowing at the gastroesophageal junction, producing a “Bird’s beak” or “rat’s tail” appearance - distal 2/3 most common
Tx of esophageal achalasia
- Esophageal manometry is the best test to diagnosis shows the absence of esophageal peristalsis
esophageal webs + dysphagia + iron deficiency anemia
Plummer vinson
Risk factors of adenocarcinoma gastric cancer
-
Risk factors for gastric cancer:
- a family history of gastric cancer
- gastric ulcers
-
Helicobacter pylori
- pernicious anemia
Dx and tx of gastric cancer
-
DX: EGD (esophagogastroduodenoscopy) and biopsy showing gastric cancer
- a CBC showing microcytic/hypochromic anemia
- positive guaiac
- Treatment = Radiation therapy and chemotherapy can be beneficial but the prognosis is poor
3 causes of gastritis (heartburn/dyspepsia)
Autoimmune or hypersensitivity reaction
Infection (h. pylori)
Inflammation (NSAID or alcohol)
How do NSAIDs cause gastric inflammation?
cause gastric injury by diminishing local prostaglandin production in the stomach and duodenum.
Leading cause of gastritis
Alcohol
How does pernicious anemia affect gastritis
- Pernicious anemia: + schilling test + ↓ intrinsic factor and parietal cell antibodies
What type of ulcer improves with food & which type worsens with foods?
- Duodenal ulcer- pain improves with food*
- Gastric ulcer- pain worsens with food
Tx of hemorrhoids
Stool softeners Corticosteroid Sitz baths. Internal hemorrhoids=rubber band ligation
Indirect hernia (MC type) is medial or lateral to inferior epigastric arteries
Medial = Direct
Lateral = Indirect
MDs Dont Lie
Involves protrusion of the stomach through the diaphragm via the esophageal hiatus.
Hiatal hernia
-
“skip areas” with transmural (full-thickness)
- young adults (20-40) 2 to 3 times more common in Jews
- Pathology: antibodies against intestinal epithelial cells.
- Appearance leading to the typical “cobblestone”
Crohns dz
Complications of crohn’s disease
- Obstruction, fistulas, abscesses, and perforation. Malabsorption of B12, megaloblastic anemia. ??Arthritis and uveitis??
Tx of Crohn’s
TX: Maintenance meds: sulfasalazine (Azulfidine®)
- Mesalamine (Pentasa®, Asacol ®) DMAR/NSAIDs
-
Prednisone during flare-up
- Restrict fiber in the diet
- Mucosal surface shows superficial ulcerations area is greatly thickened and rigid “lead pipe”
UC
Sx and complications of Ulcerative colitis
- N/V, abdominal pain, spastic rectum, and anus
- anemia (Fe++ deficiency)
- coagulation defects due to Vit K deficiency,
- erythema nodosum, uveitis, Toxic Megacolon
Tx of UC
Maintenance meds: sulfasalazine (Azulfidine®)
- Mesalamine (Pentasa ® Asacol ®,) NSAIDs
-
Prednisone during flare-up
- Antispasmodics only used for patients with frequent and troublesome diarrhea may precipitate Toxic Megacolon
At what bili level is jaundice?
bilirubin > 2.5 mg/dl
Causes of melena vs hematochezia
Melena: black tarry stool - upper GI bleed →Gastric cancer, duodenal ulcers, right-sided colon cancer, portal hypertension with esophageal varices, severe erosive esophagitis, Mallory-Weiss syndrome.
Hematochezia: bright red blood per rectum (BRBPR) - lower GI bleed → Hemorrhoids, anal fissures, polyps, proctitis, rectal ulcers, and colorectal cancer. Diverticulosis is generally an incidental finding, since diverticular bleeding is usually of greater volume.
What is Courvoisier’s sign & what is the MCC?
describes an enlarged, palpable gallbladder in patients with obstructive jaundice caused by tumors of the biliary tree or by pancreatic head tumors. This kind of biliary obstruction evolves slowly.
MCC = Pancreatic carcinoma
MC type of pancreatic carcinoma
- Most commonly ductal adenocarcinoma located at the pancreatic head
What type of carcinoma is virchows node seen in?
Pancreatic carcinoma
Sx of pancreatic cancer
- weight loss/epigastric abdominal pain, clay-colored stools
- Jaundice + palpable non-tender gallbladder (Courvoisier’s sign)
- Virchow’s node (or signal node) is a lymph node in the left supraclavicular fossa (the area above the left clavicle) that is associated with pancreatic cancer
Dx of pancreatic cancer
- ERCP
- abdominal CT scan: 75% show tumor at the head of the pancreas, 25% at the tail
- pancreatic Bx
- abdominal MRI
- elevated serum bilirubin
- abnormal liver function tests
- CA 19-9 is present in about 80% of patients who have pancreatic cancer
Pancreatitis and a palpable epigastric mass
Pancreatic pseudocyst
Study of choice for palpable epigastric mass presenting 2-3 wks after acute pancreatitis
CT scan is the study of choice → Pancreatic psuedocyst
Pain worsens with which type of ulcer? Pain improves with which type of ulcer?
Duodenal ulcer (food classically decreases pain think Duodenum = Decreased pain with food)
Gastric ulcer (food classically causes pain)
MCC of duodenal ulcer
- Duodenal ulcers are most commonly caused by H. pylori (95%)
Sx of gastric ulcer
- Pain is described as gnawing or burning and usually radiates to the back
The most common presenting symptom of a small bowel tumor is
abdominal pain- typically intermittent and crampy in nature
24-year-old man with ulcerative colitis receives Lomotil for excessive diarrhea and develops fever, abdominal pain and tenderness, and a massively dilated colon on abdominal x-ray.
Toxic megacolon
Tx of toxic megacolon
Decompression of the colon is required
- In some cases, colostomy or even complete colonic resection may be required