GI Flashcards by Brooke Bekkedahl

What are peritoneal sxs?

guarding, muscle spasm, rebound tender

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What are our standard special tests for GI?

Obturator, psoas, rovsing’s, mcburney’s

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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

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If it’s a non-perforated appendix how do we treat?

Cipro + Flagyl abx x24hours after appendectomy

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If stones are in the gallbladder what is it called?

Cholelithiasis

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What are the classic sxs of cholelithiasis?

colicky abd pain, worse with fatty foods, radiates to the shoulder, Five F’s

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If the stone is in the cystic duct what is it called?

Cholecystitis

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Ultrasound shows thickened gallbladder wall with no stone – dx?

Cholecystitis

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What if you are very suspicious of cholecystitis and the U/S is normal what do you do?

HIDA scan

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If the stone is in the common bile duct – dx?

Choledocolithiasis

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How do we treat choledocolithiasis?

ERCP → Lap chole

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If a stone is in the common bile duct and the patient has an infection -dx?

Cholangitis

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What is the Charcot’s Triad?

RUQ pain, jaundice, fever

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What is the Reynold’s Pentad?

Hypotension + AMS

RUQ< jaundice, fever

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How do you treat cholangitis?

ERCP

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While removing a gallbladder the dissection must be done very carefully as to not cut what?

Common bile duct – BIG PROBLEM

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If we see free air on an abdominal x-ray what does that mean?

Perforated

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Where does diverticulitis most commonly occur?

sigmoid colon

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What are some risk factors for diverticulitis?

Low fiber diets & chronic constipation

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How would you diagnose diverticulitis?

Labs = elevated WBC

CT (NO colonoscopy)

R/O cancer

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How do we treat diverticulitis?

IV fluids, NPO, Cipro + Flagyl

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When do we operate on someone with diverticulitis?

Obstruction, fistula, perforation, sepsis, failed/deteriorated conservative treatment

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A patient presents with epigastric pain that radiates, almost boring to the back, Dx?

Acute pancreatitis

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What would a pt often say about their pain with acute pancreatitis?

Feels better with sitting up & hunched over

Worse lying flat

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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!

GI Flashcards

(74 cards)