GI Flashcards
appendicitis
chronic or acute inflammation of vermiform appendix - obstruction by fecalith, foreign body, neoplasm
MOST COMMON ABD SURG EMERGENCY
appendicitis s/s
McBurney’s
Rovsing: RLQ pain intensified by LLQ palp
Markle: heel jar
Obturator: inward rotation of hip = kick
Psoas: lifting thigh against resistance = pain
moderate leukocytosis (10-18)
appendicitis tx
NO PAIN MED UNTIL SURGICAL EVAL
cefoxitin
cholecystitis
inflammation of gallbladder - 90% d/t gallstones impacted in cystic duct (inflammation behind obstruction)
acute can dev r/t infection, ex: CMV
cholecystitis s/s
murphy sign: abrupt cessation of inspiration upon palpation of RUQ
referred pain to R shoulder
rebound pain, elevated WBC/AST/ALT
cholecystitis tx
NPO, IVF, abx (2/3g ceph)
pain: morphine
NEVER DEMEROL
laparoscopic chole
monitor for gallbladder gangrene, post-op ileus
pancreatitis
inflammation of gal bladder - assoc w dysfxn of exocrine fxn - autodigestion!
most common abd surgical emergency
appendicitis
pancreatitis s/s
- supine: panc makes soup out of your insides = hurts when supine (sitting = relief)
- shock
- chvostek’s: cheek spasm
- trousseau: BP cuff spasm
- cullen (bluish periumbilical)
- grey turner: bluish flanks
- pleural effusion
pancreatitis diagnostics
abd xray: colon cutoff sign (gas filled transverse abruptly cut off d/t inflamed pancreas)
CT scan: DIAGNOSTIC! enlarged pancreas or pseudocyst
diagnostic for pancreatitis
CT scan! enlarged or pseudocyst
pancreatitis labs
↑ amylase (4x nl suggests panc) ↑ lipase (more dxic but slower) ↑ HCT (d/t hemoconcentration) ↑ PT, INR ↑ WBC 10-30 proteinuria, glycosuria, hyperglycemia ↓ serum Ca s/t ↓ albumin (3rd spacing d/t autodigestion)
pancreatitis Ca significance
↓ serum Ca s/t ↓ albumin (3rd spacing d/t autodigestion)
ischemic bowel syndrome
chronic: *atherosclerosis sup or inf mesenteric arts, celiac → ↓ intestinal blood flow
acute: d/t abrupt ↓ blood flow:
* shock
* embolus
* sm bowel obstruction
- trauma
- CHF (drastically diuresed)
- colon resection w reanastomosis
SURGICAL EMEGENCY
ischemic bowel s/s
steady epigastric pain elevated WBC bloody diarrhea abd distension METABOLIC ACIDOSIS hypotension
GI surgical emergencies
appendicitis (most common)
ischemic bowel
ischemic bowel tx
surgical emergency!!!!!!
ampicillin, aminoglycoside, clindamycin
monitor for sepsis, MODS, extension of ischemia/infarct
2 out of 3 buys you a ticket to the OR
+ history
+ physical exam
+ labs, imaging
DON’T LET THE SUN RISE OR SET ON A COMPLETE SMALL BOWEL OBSTRUCTION
GERD
constellation of sx r/t repeated exposure of esophageal mucosa to gastric contents → breakdown of mucosal barrier
RELAXATION OF ESOPHAGEAL SPHINCTER
GERD mgmt
lifestyle modification, Nissen fundoplication
- PPI: -prazoles, Protonix, Prevacid, Nexium etc
- eliminate/reduce sx
peptic ulcer disease
gastric & duodenal ulcers - break in surface mucosa of stomach/duodenum → exposes tissue to damaging effects of acid & pepsin
usually consider an area > 5mm
H. PYLORI IS A BIGGY! NSAIDS, syndromes
PUD sx both v gastric v duodenal
both: burning/gnawing pain, epigastric region dyspepsia, sx clusters/free periods
gastric - eating may ↑ pain
duodenal - ↓ pain after eating, ⅔ nocturnal pain
PUD tx
sx controlled, assess for GIB
dumping syndrome
20% PUD - hyperosmolar chyme (CHO) enters sm int, ↑ osmotic gradient & pulling fluid into the gut
GI discomfort, n, v, d, cramps
vasomotor response: diaphoresis, palpitations, flushing
diverticulitis
inflammatory changes w/in diverticular mucosa - diverticuli in DESCENDING & SIGMOID
pouch-like protrusions of intestinal mucosa in descending & sigmoid colon
MOST ASX!! / sxatic if: inflamed, bleed, perforate
diverticulitis presentation
mild LLQ tenderness, rebound tenderness, + stool guaiac!!!
older folks
MILD MILD MILD
diverticulitis dx
CT scan: diverticuli or fistula
colonoscopy: not definitive but can r/o other causes
diverticulitis tx
abx: keflex, flagyl, cipro, bactrim
spasms: bentyl, buspar
pain relief: avoid morphine (increased intraluminal pressure in colon can lead to perf)
avoid morphine in diverticulitis why?
increased intraluminal pressure in colon can lead to perf
ulcerative colitis
colon(ly) - diffuse mucosal inflamation aka regional enteritis
clinical hallmark of ulcerative colitis
BLOODY DIARRHEA! may present with urgency
UC work up
colonoscopy with biopsy or sigmoidoscopy
UC dx based on
hx blood diarrhea! lower abd cramps w urgency microcytic anemia ↓ serum albumin - stool cultures \+ colonoscopy or sigmoidoscopy
UC tx
prednisone!! avoid prolonged
sulfasalazine (also anti-inflammatory)
beware toxic megacolon
UC & Crohn’s
Crohn’s disease
bow-all. any or all layers of the bowel, not just the colon - transmural
Crohn’s visualization
- mucosal inflammation
ulceration (peyer’s patches) - x-ray “cobblestone appearance”
- develop strictures & subsequent obstrctn
narrowing of lumen, loops adhering to each other - high risk for bowel obstruction (50% dx req surgery)
Crohn’s clinical presentation
RLQ pain/mass
semiliquid stool/diarrhea, fistulas, flatulence
Crohn’s labs
CBC, CMP
- anemia (iron or B12) which also presents as neuropathy
- hypoalbuminemia
- leukocytosis
IBS
3mo+ lower abd sx & bowel complaints (Δ freq or characteristics)
may be continuous or intermittent
also called “spastic colon”
POO’D = GOOD
IBS H&P shows no
fever, bloody diarrhea, leukocytosis
IBS tx
antispasmodic: bentyl
lomotil, imodium
assess for relief of sx
C Diff
abx associated colitis: FACC'd up bowels fluoroquinolone ampicillin cephs clindamycin
difficult to differentiate until OR…
Crohn’s & UC
C Diff tx
Flagyl (metronidazole), vanc, colectomy, hand washing!!!
