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monster management > GI > Flashcards

GI Flashcards

1
Q

appendicitis

A

chronic or acute inflammation of vermiform appendix - obstruction by fecalith, foreign body, neoplasm

MOST COMMON ABD SURG EMERGENCY

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2
Q

appendicitis s/s

A

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)

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3
Q

appendicitis tx

A

NO PAIN MED UNTIL SURGICAL EVAL

cefoxitin

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4
Q

cholecystitis

A

inflammation of gallbladder - 90% d/t gallstones impacted in cystic duct (inflammation behind obstruction)

acute can dev r/t infection, ex: CMV

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5
Q

cholecystitis s/s

A

murphy sign: abrupt cessation of inspiration upon palpation of RUQ

referred pain to R shoulder

rebound pain, elevated WBC/AST/ALT

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6
Q

cholecystitis tx

A

NPO, IVF, abx (2/3g ceph)

pain: morphine
NEVER DEMEROL

laparoscopic chole

monitor for gallbladder gangrene, post-op ileus

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7
Q

pancreatitis

A

inflammation of gal bladder - assoc w dysfxn of exocrine fxn - autodigestion!

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8
Q

most common abd surgical emergency

A

appendicitis

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9
Q

pancreatitis s/s

A
  • 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
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10
Q

pancreatitis diagnostics

A

abd xray: colon cutoff sign (gas filled transverse abruptly cut off d/t inflamed pancreas)

CT scan: DIAGNOSTIC! enlarged pancreas or pseudocyst

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11
Q

diagnostic for pancreatitis

A

CT scan! enlarged or pseudocyst

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12
Q

pancreatitis labs

A 
↑ 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)
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13
Q

pancreatitis Ca significance

A

↓ serum Ca s/t ↓ albumin (3rd spacing d/t autodigestion)

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14
Q

ischemic bowel syndrome

A

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

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15
Q

ischemic bowel s/s

A 
steady epigastric pain
elevated WBC
bloody diarrhea
abd distension
METABOLIC ACIDOSIS
hypotension
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16
Q

GI surgical emergencies

A

appendicitis (most common)

ischemic bowel

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17
Q

ischemic bowel tx

A

surgical emergency!!!!!!

ampicillin, aminoglycoside, clindamycin

monitor for sepsis, MODS, extension of ischemia/infarct

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18
Q

2 out of 3 buys you a ticket to the OR

A

+ history
+ physical exam
+ labs, imaging

DON’T LET THE SUN RISE OR SET ON A COMPLETE SMALL BOWEL OBSTRUCTION

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19
Q

GERD

A

constellation of sx r/t repeated exposure of esophageal mucosa to gastric contents → breakdown of mucosal barrier

RELAXATION OF ESOPHAGEAL SPHINCTER

20
Q

GERD mgmt

A

lifestyle modification, Nissen fundoplication

  • PPI: -prazoles, Protonix, Prevacid, Nexium etc
  • eliminate/reduce sx
21
Q

peptic ulcer disease

A

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

22
Q

PUD sx both v gastric v duodenal

A

both: burning/gnawing pain, epigastric region dyspepsia, sx clusters/free periods

gastric - eating may ↑ pain

duodenal - ↓ pain after eating, ⅔ nocturnal pain

23
Q

PUD tx

A

sx controlled, assess for GIB

24
Q

dumping syndrome

A

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

25
Q

diverticulitis

A

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

26
Q

diverticulitis presentation

A

mild LLQ tenderness, rebound tenderness, + stool guaiac!!!

older folks

MILD MILD MILD

27
Q

diverticulitis dx

A

CT scan: diverticuli or fistula

colonoscopy: not definitive but can r/o other causes

28
Q

diverticulitis tx

A

abx: keflex, flagyl, cipro, bactrim
spasms: bentyl, buspar

pain relief: avoid morphine (increased intraluminal pressure in colon can lead to perf)

29
Q

avoid morphine in diverticulitis why?

A

increased intraluminal pressure in colon can lead to perf

30
Q

ulcerative colitis

A

colon(ly) - diffuse mucosal inflamation aka regional enteritis

31
Q

clinical hallmark of ulcerative colitis

A

BLOODY DIARRHEA! may present with urgency

32
Q

UC work up

A

colonoscopy with biopsy or sigmoidoscopy

33
Q

UC dx based on

A 
hx blood diarrhea!
lower abd cramps w urgency
microcytic anemia
↓ serum albumin
- stool cultures
\+ colonoscopy or sigmoidoscopy
34
Q

UC tx

A

prednisone!! avoid prolonged

sulfasalazine (also anti-inflammatory)

35
Q

beware toxic megacolon

A

UC & Crohn’s

36
Q

Crohn’s disease

A

bow-all. any or all layers of the bowel, not just the colon - transmural

37
Q

Crohn’s visualization

A
  • 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)
38
Q

Crohn’s clinical presentation

A

RLQ pain/mass

semiliquid stool/diarrhea, fistulas, flatulence

39
Q

Crohn’s labs

A

CBC, CMP

  • anemia (iron or B12) which also presents as neuropathy
  • hypoalbuminemia
  • leukocytosis
40
Q

IBS

A

3mo+ lower abd sx & bowel complaints (Δ freq or characteristics)
may be continuous or intermittent

also called “spastic colon”

POO’D = GOOD

41
Q

IBS H&P shows no

A

fever, bloody diarrhea, leukocytosis

42
Q

IBS tx

A

antispasmodic: bentyl

lomotil, imodium

assess for relief of sx

43
Q

C Diff

A 
abx associated colitis: FACC'd up bowels
fluoroquinolone
ampicillin
cephs
clindamycin
44
Q

difficult to differentiate until OR…

A

Crohn’s & UC

45
Q

C Diff tx

A

Flagyl (metronidazole), vanc, colectomy, hand washing!!!

monster management (29 decks)

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