GI Flashcards
What are peritoneal sxs?
guarding, muscle spasm, rebound tender
What are our standard special tests for GI?
Obturator, psoas, rovsing’s, mcburney’s
Pt has RLQ pain with N/V and + peritoneal sxs. You’re thinking appendicitis. What would you see on CT for appendicitis?
preappendiceal fat stranding
If it’s a non-perforated appendix how do we treat?
Cipro + Flagyl abx x24hours after appendectomy
If stones are in the gallbladder what is it called?
Cholelithiasis
What are the classic sxs of cholelithiasis?
colicky abd pain, worse with fatty foods, radiates to the shoulder, Five F’s
If the stone is in the cystic duct what is it called?
Cholecystitis
Ultrasound shows thickened gallbladder wall with no stone – dx?
Cholecystitis
What if you are very suspicious of cholecystitis and the U/S is normal what do you do?
HIDA scan
If the stone is in the common bile duct – dx?
Choledocolithiasis
How do we treat choledocolithiasis?
ERCP → Lap chole
If a stone is in the common bile duct and the patient has an infection -dx?
Cholangitis
What is the Charcot’s Triad?
RUQ pain, jaundice, fever
What is the Reynold’s Pentad?
Hypotension + AMS
RUQ< jaundice, fever
How do you treat cholangitis?
ERCP
While removing a gallbladder the dissection must be done very carefully as to not cut what?
Common bile duct – BIG PROBLEM
If we see free air on an abdominal x-ray what does that mean?
Perforated
Where does diverticulitis most commonly occur?
sigmoid colon
What are some risk factors for diverticulitis?
Low fiber diets & chronic constipation
How would you diagnose diverticulitis?
Labs = elevated WBC
CT (NO colonoscopy)
R/O cancer
How do we treat diverticulitis?
IV fluids, NPO, Cipro + Flagyl
When do we operate on someone with diverticulitis?
Obstruction, fistula, perforation, sepsis, failed/deteriorated conservative treatment
A patient presents with epigastric pain that radiates, almost boring to the back, Dx?
Acute pancreatitis
What would a pt often say about their pain with acute pancreatitis?
Feels better with sitting up & hunched over
Worse lying flat
How do we diagnose acute pancreatitis?
LIPASE (better than amylase) will be 3x normal
CT when enzymes are negative (usually best for complications)
How do we treat acute pancreatitis?
NPO, IVF, pain meds
When do you do surgery for pancreatitis?
Necrotizing, Abscess (I&D), Pseduocyst
How do we treat chronic pancreatitis?
NO SURGERY
Pain meds, enzymes, and control diabetes
Describe the location of a direct hernia?
Located within Hesselbach’s triangle
Describe the location of an indirect hernia?
Lateral to Hasselbach’s triangle
Through the internal ring & can enter the scrotum
Which type of hernia is more common in adults vs babies?
Babies = Indirect
Adults = Direct
What causes a direct hernia?
Weak abdominal muscles
What causes an indirect inguinal hernia?
Congenital
Where is a femoral hernia located? Who gets them?
down the femoral canal & medial to the femoral vessels
MC in women & pregnancy
When would you see a ventral hernia?
Generally post-op patients
How do hernias present?
Abdominal bulge
If a pt is unable to move their bowels after surgery, what is it known as?
Ileus
A pt has colicky abdominal pain and distention. They are passing flatus, and leaky/thin bowel movements – Dx?
Small bowel obstruction
What is the cause of SBO?
adhesions (prior surgery) or hernias
How do we diagnose SBO?
upright KUB (air fluid levels)
CT with contrast (to tell if it’s complete or not)
How do we treat SBO?
incomplete (contrast gets to the rectum) watch & wait + NG tube, IV fluids, and make sure K is stable
Complete = surgery
A pt has BRB per rectum and you note an anal mass/prolapse – what must you do to dx & r/o?
Should always get a colonoscopy to R/O colon/anal cancer
Which type of hemorrhoid is painful?
External
The grading system of hemorrhoids is for what type of hemorrhoid?
INTERNAL
If a hemorrhoid does not prolapse down – what degree?
1st
If a hemorrhoid does prolapse but return on it’s own – what degree?
2nd
if a hemorrhoid requires manual reduction – what degree?
3rd
How do we initially treat hemorrhoids?
High-fiber, anal hygiene, topical steroids, and sitz baths
if patient has pain in the anus, with excruciating pain during BM, with blood present, and you note a tear in the skin on exam – dx?
Anal fissure
How do we treat an anal fissure?
Sitz baths, stool softeners, high fiber diet, excellent hygiene, topical nifedipine or Botox
Pain out of proportion on exam should make you think of what? What is it often associated with?
Ischemic bowel
Consider pts with Afib & post AAA surgery
Fistulas and skip lesions are associated with what?
Chron’s – AKA ANYWHERE in the intestines (transmural)
Continuous inflammation of the colon?
Ulcerative colitis
Involves the superficial mucosa
When do we start colonoscopies?
Start at age 50, Every 10 years (if normal)
Besides every 10 years, when else should we do a colonoscopy?
Postmenopausal woman or man with iron def anemia
Change in caliber of stools, alternating bowel habits, and weight loss
if a pt is found to have 1-2 benign polyps on colonscopy – when do you repeat?
Colonoscopy in 5 years
If a pt is found to have a premalignant colonscopy – when do you repeat colonscopy?
3 years
if a pt is found to have lots of polyps or dysplasia when do you repeat colonoscopy?
1 year
What are some descriptive terms for bad polyps?
Sessile, no stalk, large, villous
If polyps are found to be pedunculated or tubular – are they good or bad?
Good
What is often times the cause of anal cancer?
HPV
How do we treat pilonidal cyst?
I&D or resect the cyst
A pt epigastric pain that is worse when he lies flat & better with being upright & anti-acids – Dx?
GERD
When you suspect GERD what should you ask about?
Nocturnal sxs
How do we treat GERD?
Avoid caffeine, peppermint, chocolate
PPI
EHOB
If you’re thinking a pt has GERD but they also mention sxs of N/V/weight loss or anemia – what should you think?
Alarming symptoms!
What is the pathology behind GERD?
weakened LES → Acid Reflux → Burn
What is the pathology behind achalasia?
LES won’t relax
How do you diagnose achalasia?
1st barium swallow – see BIRDS BEAK
2nd manometry
3rd endoscopy
How do you treat achalasia?
Dilation
What types of cancers cause upper vs lower esophageal?
upper 1/3 = SCC
Lower = Adeno (due to GERD)
What is the classic difference between duodenal & gastric ulcer sxs as related to food ingestion?
Duodenal = decreased with food
Gastric = increased with food
If a pt has excessive vomiting and then begin to vomit blood/bile – Dx?
Mallory Weiss tear
A pt that is a career vomiter (eating disorder) is susceptible to what type of disorder? Dx? Tx?
Boerhaave’s
Dx = CXR with air in the mediastinum
Tx = OR ASAP!
