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General Surgery > GI (50%) > Flashcards

GI (50%) Flashcards

1
Q

Features of High Risk Abdominal Pain

A 
> 65 yo
Immunocompromised
CVD
Major comorbidities (cancer, IBD, pancreatitis, renal failure)
Recent GI surgery
Early pregnancy (ectopic)
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2
Q

High Risk Abd Exam findings

A
  • Tense or rigid abdomen
  • Involuntary guarding
  • Signs of shock (pallor, tachycardia, tachypnea, diaphoresis, AMS)
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3
Q

Acute Hepatitis signs / symptoms

A
  • RUQ pain + fatigue
  • N/V
  • Anorexia
  • Jaunidce
  • clay colored stools
  • dark urine
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4
Q

Hepatitis A

A

Fecal-oral transmission
Dx = serum IgM anti-HA
Tx: self-limited

Prophylaxis for family members bc contagious 1st week of jaundice –> IV-IGG

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5
Q

Hepatitis B transmission & Symptoms

A

Bodily fluids
-Needles, sex, close contact, mother-to-baby

Flu-like symptoms + jaundice…may progress to liver failure

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6
Q

Hep B labs:

  • Acute infxn
  • Early acute infxn
  • Chromic infxn
  • Resolved acute HBV
  • Hep B vaccine
A

Acute Hep B = + IgM & + HBsAG

Early acute = only HBsAG +

Chronic Hep B infxn

  • Anti-HBc IgG +
  • HBsAG +

Resolved acute HBV

  • Anti-HB’s +
  • Anti-HBc IgG +

Hep B vaccine
-Only anti-HB’s +

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7
Q

Hepatitis C infxn

A

Blood-to-blood contact
IV drug users

85% develop chronic infxn

Increased risk of hepatocellular carcinoma

Dx= Anti-HCV +

Tx: Sofosbuvir, Grazoprevir, Declatasvir

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8
Q

Hepatitis D

A

Only occurs w/ hep B

Leads to more severe hepatitis & faster progression to cirrhosis

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9
Q

Hepatitis E

A

Fecal-oral transmission
-waterborne outbreaks

Self-limited infection

Dx = anti-HEV IgM

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10
Q

Pilonidal Cyst ABX

A

Indicated if significant cellulitis

Cefazolin + Metronidazole
OR Augmentin

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11
Q

MC type of Colon Cancer

A

Adenocarcinoma

Most precarious lesion –> adenomatous polyp

3rd leading cause of cancer death in US

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12
Q

Risk Factors for colon cancer

A
  • Elderly
  • Smoker + ETOH
  • Obesity
  • Low Fiber, High animal fat
  • 1st degree relative
  • Crohn’s Dz
  • Ulcerative colitis
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13
Q

Colonoscopy Guidelines

A

Average risk person w/o symptoms–> start getting at 50 yo & repeat q 10 years

Increased risk factors (adenomatous polyp or 1st degree relative) –> Start at age 40 or 10 years younger than diagnosis of family member

High Risk (Crohn’s or UC >8 years; Genetic disorder) –> Colonoscopy at any age

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14
Q

Tumor marker for colon cancer

A

CEA = carcinoembryonic antigen

Valuable for following after treatment

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15
Q

Hesselbach’s Triangle

A
  • Rectus abdominis
  • Inferior Epigastric vessels
  • Inguinal ligament

**Direct hernia passes through triangle

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16
Q

Anorectal abscess formation

A

Obstructed anal crypt gland

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17
Q

Where do anorectal abscesses usually occur?

A

within 3 cm of the anal margin

Intersphincteric & transphincteric are most common

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18
Q

Pectinate/Dentate line epithelium? Vessels? Lymph nodes? Innervation?

A

Above = columnar epithelium

  • superior rectal vessels
  • Internal iliac lymph nodes
  • Inferior hypogastric plexus

Below = squamous epithelium

  • Inferior rectal vessels
  • Superficial inguinal lymph nodes
  • Pudendal nerve
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19
Q

MC location for an anal fissure

A

Posterior midline = 90%

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20
Q

What is a sentinel pile?

A

thickened mucosa due to fissure – usually seen below fissure

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21
Q

Tx for anal fissures

A

Topical nitroglycerine or nifedipine

Stool softeners

Sitz baths

Surgery = Lateral internal sphincterotomy

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22
Q

What percentage of anorectal abscesses will result in a fistula?

A

50%

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23
Q

What is a positive Boas sign?

A

Right subscapular pain due to phrenic nerve irritation from cholecystitis

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24
Q

What is the Gold Standard test for cholecystitis?

A

HIDA scan

-Ordered when ultrasound is equivocal + high suspicion

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25
Q

What are some ultrasound findings for acute cholecystitis?

A
  • Stones
  • Thickened gallbladder wall >3 mm
  • Pericholecystic fluid
  • Distended GB
  • Sonographic Murphy’s sign
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26
Q

Cholelithiasis definition

A

Gallstones in the gallbladder (no inflammation)
Stones
-90% = cholesterol
10% = pigmented

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27
Q

Which ABX is a major cause of biliary sludge?

A

Ceftriaxone

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28
Q

Charcot’s Triad & Reynold’s Pentad

A

Cholangitis

Triad

  • RUQ pain
  • Fever
  • Jaundice

Pentad
+ confusion
+hypotension

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29
Q

Sliding Hiatal Hernia vs. Paraesophageal Hiatal Hernia

A

Sliding = MC! 90%

  • displaced gastroesophageal junction
  • GERD symptoms

Paraesophageal

  • displacement of stomach fundus through defect…does not include GE junction
  • can become strangulated!
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30
Q

Treatment of Type I Hiatal Hernia vs. Type II

A

Type I = Sliding

  • GERD treatment
  • 15% require Nissen Fundoplication

Type II = Paraesophageal
-Nissen fundoplication

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31
Q

Drugs that can cause GERD

A
  • Anticholinergics
  • Antihistamines
  • Tricyclic antidepressants
  • CCBs
  • Progesterone
  • Nitrates
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32
Q

Complications of GERD

A
  • Esophagitis
  • Strictures
  • Barrett’s
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33
Q

GERD Treatment

A
  1. H2 blockers / PPI
  2. If not medically managed order Endoscopy
  3. pH probe = GOLD STANDARD
  4. Consider Nissen Fundoplication for refractory pts
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34
Q

Barrett’s esophagus

A

Complication of chronic GERD

Normal stratisfied squamous epithelium of esophagus is replaced with columnar epithelium
–> increased risk of esophageal adenocarcinoma

Once identified screen pts q 3-5 years with upper endoscopy

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35
Q

Esophagitis - Infectious vs. Noninfectious

A

Infection –> painful swallowing!

  • Candida albicans
  • Herpes simplex
  • CMV
  • *immunocompromised pts**

Non-Infectious

  • REflux
  • Meds –> NSAIDs, bisphosphonates
  • Radiation
  • Corrosive agents – attempted suicide
36
Q

Symptoms & Dx of Esophagitis

A

Symptoms

  • Painful, difficult swallowing
  • Chest pain when eating

Dx:
-Endoscopy + biopsy

37
Q

Gastritis - Acute vs. Chronic

A

Inflammation of stomach lining

Acute –> gastric antrum

  • NSAIDs
  • ETOH
  • Stress
  • H. pylori infxn
  • CMV

Chronic –> risk for gastric carcinoma

38
Q

Gastritis symptoms

A
  • Epigastric pain
  • N/V
  • Worsened by eating
39
Q

Gastritis Dx & Tx

A

Dx= endoscopy + biopsy
-H. pylori testing

Tx = treat underlying condition

40
Q

H. pylori triple therapy

A

“CAP”

  • Clarithromycin
  • Amoxicillin
  • PPI
41
Q

Peptic Ulcer Disease

A

Ulcer of the upper GI tract mucosa- involving stomach & proximal duodenum

Duodenum = 90%
Gastric = 10%
42
Q

MCC of non-hemorrhagic GI bleed leading to melena?

A

PUD

43
Q

MCC & MC site of Duodenal ulcer vs. Gastric Ulcer

A

Duodenal

  • H. pylori
  • Anterior duodenum

Gastric

  • H. pylori
  • LESSER curvature of antrum
44
Q

Duodenal Ulcer Symptoms vs. Gastric Ulcer Symptoms

A

Duodenal

  • Better w/ meals
  • Post-prandial pain 1-2 hours later
  • Awakens pt at night

Gastric

  • Worse with meals
  • Early satiety
  • Better a few hours later
45
Q

Treatment of PUD

A

High dose PPI – 20-40mg omeprazole for x4-8 weeks

If H. pylori is present

  • Clarithormycin
  • Amoxicillin
  • PPI
46
Q

MCC of acute vs. chronic pancreatitis

A

Acute = gallstones

Chronic = ETOH

47
Q

Diagnosis of pancreatitis requires 2/3 of which criteria?

A
  1. Lipase >3x normal limit
  2. Abdominal pain
  3. Finding on CT or MRI
48
Q

S/S pancreatitis

A
  • Epigastric pain with N/V
  • Mild jaundice
  • Fatty stools
  • Low grade fever
  • Abdominal pain that is decreased by sitting up & leaning forward
49
Q

Cullen’s sign vs. Grey Turner’s sign

A

Dx for pancreatitis

Cullens = bruising around umbilicus

Grey-Turner’s = flank bruising

50
Q

Diagnosis of Pancreatitis

A
  • Lipase & amylase
  • Abdominal CT scan

Can see sentinel loops on Xray from inflammation of pancreas

51
Q

Ranson’s Criteria for predicting ______ severity

A

Pancreatitis…3 or > = more severe course

At admission

  • > 55
  • Leukocytes > 16
  • Glucose > 200
  • LDH > 350
  • AST > 250
52
Q

Tx for pancreatitis

A
  • NPO
  • fluids
  • analgesics
  • antiemetics
  • bowel rest
  • ABX not typically used

Address underlying problem if chronic pancreatitis –> ETOH + low fat diet

53
Q

Potential Causes of Hematemesis

A

Peptic Ulcer
- Upper abdominal pain

Esophageal ulcer

  • Odynophagia (pain)
  • GERD
  • Dysphagia (difficulty)

Mallory-Weiss tear
- Emesis, retching or coughing prior to hematemesis

Variceal hemorrhage
-	Ascites 
•	Malignancy 
-	Dysphagia
-	Early satiety 
-	Involuntary weight loss Due to portal hypertension
-	Jaundice
54
Q

what is a volvulus?

A

Obstruction due to twisting or knotting of the GI tract

  • Older adults w/ constipation
  • Kids w/ malrotation
55
Q

Causes of intussuseption in kids & adults?

A

Kids = following viral infxn

Adults = neoplasm

56
Q

X-ray findings for intussuseption

A
  • Cresent sign

- Bull’s eye sign / target sign

57
Q

Post-op ileus

A

Obstipation & intolerance of oral intake due to nonmechanical factors that disrupt normal coordinated propulsive motor activity in GI tract

Some degree post op is normal & self limited (0-72 hours)

> 3 days is termed paralytic ileus

58
Q

S/S + physical exam findings of post-op ileus

A

S/S

  • Abdominal distention / bloating
  • Diffuse persistent abd pain
  • N/V
  • Delayed passage of gas / inability
  • Inability to tolerate oral diet

Physical Exam

  • Absent/reduced bowel sounds
  • Tympany on percussion
  • Diffuse tenderness
59
Q

Treatment of post-op ileus

A

Physiologic ileus spontaneously resolves within 2-3 days

  • IV fluids
  • Stop opioids / use sparingly
  • Bowel rest = allowed clear fluids
  • NG tube = bowel decompression
  • Serial abd exams
60
Q

Common Cause & Symptoms of Gastroparesis

A

Cause= Diabetes!

S/S

  • N/V
  • Early satiety
  • Belching
  • Upper abdominal pain out of proportion to physical exam findings
61
Q

Diagnosis of Gastroparesis

A

Gastric emptying scan

CT/MRI/upper endoscopy to r/o mechanical obstruction

62
Q

Treatment of Gastroparesis

A

Smaller meals spaced out 2-3 hours apart…low fiber & low fat diet (harder to digest)

**Metoclopramide (Reglan)

63
Q

C. diff infection commonly occurs after…

A

Treatment with ABX!
-Clindamycin

Seen in elderly hospitalized pts

64
Q

S/S of C. diff infection

A

Mild, watery foul-smelling diarrhea
>3 but <20 times per day

Crampy abd pain

Fever

65
Q

Dx of C. Diff

A

PCR identification of C. diff toxin
**Tox B is clinically important*

Stool culture

66
Q

C. diff treatment

A

IV metronidazole
OR
PO vancomycin

67
Q

Celiac Disease definition

A

Autoimmune disorder causing malabsorption & chronic fatty diarrhea

Causes crypt hyperplasia & villous atrophy –> malabsorption

68
Q

Celiac Dz serology antibodies

A

Anti-endomysial Ab

Anti-tissue transglutaminase Ab

69
Q

Other conditions/problems associated with Celiac Dz?

A

Dermatitis herpetiformis

Osteoporosis

Iron deficiency anemia

70
Q

Esophageal webs

A

thin membranes in mid-upper esophagus

Congenital or acquired

71
Q

Esophageal strictures

A

Scarring in esophagus

  • GERD
  • infectious esophagitis
72
Q

Diagnosis of esophageal webs & strictures

A

Barium swallow study

73
Q

Esophageal cancer

  • MC type
  • MC location
A

MC type in US = Adenocarcinoma

Worldwide MC type = squamous cell

MC site = lower 1/3

74
Q

Gastric Cancer

  • MC type
  • Risk Factors
A

MC type = Adenocarcinoma

Risk Factors

  • FmHx
  • Gastric ulcers
  • H. pylori
  • Pernicious anemia
75
Q

Gastric Carcinoma

-S/S

A
  • Abdominal fullness/pain
  • Anemia
  • Melena

Virchow’s node

Sister-Mary Joseph nodule - umbilical lesion indicating abd malignancy

76
Q

Gastric Carcinoma Tx & prognosis

A

Gastrectomy is only tx option

overall prognosis is poor

77
Q

Hepatic carcinoma

  • MC type
  • Risk Factors
A

MC type = Hepatocellular carcinoma
-aggressive

Risk Factors

  • Hep B
  • Chronic hep C
  • Hereditary hemochromatosis
  • Cirrhosis
78
Q

Lab test for hepatic carcinoma

A

elevated serum alpha-fetoprotein

79
Q

Pancreatic cancer risk factors

A
  • increased risk with age
  • Smoking
  • ETOH
  • Pancreatitis
  • Diabetes mellitus
  • Obesity
  • Men > women
80
Q

Pancreatic cancer MC type & location

A

MC = ductal adenocarcinoma in head of pancreas

81
Q

Courvoisier’s sign

A

palpable non-tender gallbladder…associated with pancreatic cancer

82
Q

Whipple procedure

A

for pancreatic cancer – only 20% can be removed at the time of diagnosis

Remove antrum of stomach + part of duodenum + head of pancreas + gallbladder

83
Q

Ulcerative Colitis

-Antibodies test?

A

Only involved colon!!!

Mucosa & submucosa involvement

p-ANCA (antineutrophil cytoplasmic antibodies)

colonoscopy = lead pipe (loss of haustra)

84
Q

Crohn’s disease

-Antibodies test?

A

Mouth to anus
*terminal ileum & proximal colon most commonly affected

Transmural involvement

Colonoscopy = cobblestone + skip lesions

+ ASCA (anti-saccharomyces cerevisiae antibodies)

85
Q

MCC of acute gastritis?

A

H. pylori

86
Q

Gastritis Tx

A

Avoid any causative agent
Eradicate H. pylori
PPI
Parenteral B12 –> pernicious anemia due to gastric parietal cell destruction

General Surgery (1 decks)

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