GI Flashcards
common causes of gastric outlet obstruction
gastric malignancy, peptic ulcer disease, Crohn disease, strictures secondary ot ingestion of causting agennts and gastric bezoars (even 6-12 months after)
diabetic gatroparesis - when
10 years after DM
psoas abscess - clinical presentation
- sabacute feve, abd/flank pain radiating to groin
- anorexia / weight loss
- abd pain with hip eptension (psoas sign)
psoas abscess - diagnosis
CT scan of abdomen + pelvis
leukocytosis, elevated inl markers
blood + abscess cultures
psoas abscess - treatment
drainage
broad spectrum antibiotcs
management of gallstones
- without symptoms: no treatment
- biliary colic symptoms: elevtice laparoscopic cholecystectomy
- complicaed gallstone diseae (acute cholecystitis, choledocholithiasis, gallstone pancreatitis: cholecystecomy within 72 hours
colonic iscemia - pathophysiology
nonocclusive watershed ischemia (splenic flexure + rectosigmoid area)
underlying atherosc disease
state of low blood flow
colonic ischemia - clinical features
moderate abd pain + tenderness
hematoschezia, diarrhea
leukocytosis, lactic acidosis
colonic iscemia - diagnosis
CT scan: colonic wall thickening, air in wall (pneumatosis), fat stranding
endoscopy: edematous + friable mucosa
colonic ischemia - management
IV fluids + bowel rest
antibiotcs wit enteric coverage
colonic resection in necrosis develop
diagnosis of scurvy / how long of def causes symptoms
plasma or leukocytes vit C
- 3 months
Pancreatic ca - RF
- smoking
- hereditary pancreatitis
- nonhereditary chronic pancreatitis
- obesity + lack of physical activity
pancreatic ca - clinical presentation
- systemic symptoms (weight loss, anorexia) (more than 85%)
- abdominal pain / back pain (80%)
- jaundice (56%)
- recent onset of atypical DM
- unexplained migratory superficial thrombophlebitis
- Hepatomegaly + ascites with metastasis
pancreatic ca - Labs
- cholestasis (elevated ALP + direct bilirubin)
- CA 19-9
- Abd U/S (if jaundice) or CT scan if no jaundice
acute mesenteric ishemia - presentation
rapid onset of periumbilical pain (often severe)
pain out of proportion to examination findings
hematoschezia (late)
acute mesenteric ishemia - RF
atherosclerosis (acute on chronic)
embolic source (thrombus, vegetations
hypercoagulable disorders
acute mesenteric ischemia - Labs
leukocytosis
elevated amylase + phosphate level
metab acidosis
acute mesenteric ischemia - diagnosis
- CT (preferred) or MR angiography
- mesenteric angiography (if diagnosis unclear, gold standard)
anal fissures - etiolgy
local rauma (eg. constipation, prolonged diarrhea, anal sex)
IBD
malignancy
anal fissure - clinical presentation
pain with bowel movement
bright red blood on toilet paper or stool surface
most common at posterior anal midline
chronic fissure may have skin tag at distal end
anal fissure - treatment
high fiber diet + fluids stool softeners sitz baths topical anestetics (vasodilators (nifedipine, NO) - if refractory: surgical intervention
management of blunt abdominal trauma in hemodynamically stable patients
normal mental status?
NO: serial abd exams +/- CT
YES: FAST: if negative to serial abd exams (+/- CT scan), if (+) do CT
sphincter of Oddi dysfunction - gold standard to diagnose and treatment
- Oddi manometry
- sphincterotomy (avoid opioids)
small bowel obstruction - clinical presentation
- colicky abd pain, vomiting
- inability to pass flatus or stool if compete
- hyperactive and then absent bowel sounds
- distended + tympanic abdomen
small bowel obstruction - diagnosis
dilated loops of bowel with air-fluid levels on plain film or CT
partial air in colon
complete: transition point, no air in colon
small bowel obstruction - complications
ischemia/necrosis
bowel perforation
small bowel obstruction - management
bowel rest, nasogastric tube, IV fluids
if signs of complication or unstable surgical exploration
pilonidal disease?
males 15-30, esp obese, with sedentary lifestyles or occupations, and those with deep gluteal clefts
- pain, fluctuant mass 4-5 cm *mucoid, purulent or bloody drainage)
- despite longer healing times, open closure is preferred due to decrease recurrence rate
paralytic ileus - etiology
- abd surgery
- retroperitoneal/abd hemorrhage or inflammation
- intestinal ischemia
- electrolyte abnormalities
- morphine
Suspected esophageal variceal hemorrhage –> …
place 2 large-bore IV catheters –> give fluids, octreotide, antibiotics –> Urgent endoscopic therapy:
A. No further bleeding –> 2ry prophylaxis: β-blockers, endoscopic ligation 1-2 wks later
B. continued bleeding –> balloon tamponade –> TIPS or shunt surgery
C. early rebleeding –> repeat endoscopic therapy –> reccurent hemor –> TIPS or shunt surgery
lab associated with gallstone pancreatitis
ALT more than 150
Dumping syndrome - symptoms
- abd pain, diarrhea, nausea
- HYPOTENSION/TACHYCARDIA
- dizziness, confusion, fatique, diaphoresis
Dumping syndrome - onset / pathogenesis
15-30 mins after meal
rapid emptying of hypertonic gastric contents
Dumping syndrome - management
- small/frequent meals
- replace simplesugars with complex carbo
- incorporate (add) high fiber + protein rich foods
- if refractory: octreotide or reconstructive surgery
congenital umbilical hernia - pathophysiology
incomplete closure of abd muscles
congenital umbilical hernia - clinical features
- soft nontender bulge at umbilicus
- protrudes with increased abd pressure
- typically reducible
congenital umb hernia - management
observe (for spontaneous closure)
elective surgery at age 5
less likely to close if larger than 1.5 in diameter or other underlying medical problems
umbilical granuloma
umbilical cord has separated with a oist, red, pedunculated, friable umbilical mass
treatment: silver nitrate
emphysematous cholecystitis - RF
- DM
- Vascular compromise
- immunosprression
emphysematous cholecystitis - clinical presentation
- fever, RUQ pain, nausea, vomiting
2. crepitusn abd wall
emphysematous cholecystitis - diagnosis
- air fluid levels in gallbladder, gas in wall
- cultures with gas forming Clostiridium, E.coli
- uncongugated hyperbilirub (clostiridium induced hemolysis), mildly elebated aminotranferases
emphysematous cholecystitis - treatment
emergent cholecystectomy
broad spectrum antibiotcs with Clostiridium coverage (eg. ampicillin-sulbactam)
emergent surgery in patients on warfarin
fresh frozen plasma pre-operatively
duodenal hematomas
MC in paediatric
- following blant abd trauma
epigastric pain and vomiting 24-26 h after initial injury
managemet: gastric decompression + parental nutition
evaluation of blunt genitourinary trauna
urinalysis –> if hematuria:
- stable: Contrast CT
- unstable: IV pyelography –> surgical evaluation
pancreatic pseudocysts - treatment
- expectant management is preferred iniitally in patients with minimal or no symptoms and without complications
- endoscopic drainage is typically reerved for patients with significant symptoms, infected, or evidence of pseudoaneurysm
uncomplicated diverticulitis - treatment
- outpatient with bowel rest, oral antibiotcs, observation
- ihospitalization in elderly, immunosuppressed, high fever, significant leukocytosis, cormobitities
complicated diverticulitis - treatment
abscess smaller than 3 cm –> iv antibiotcs and observation –> worsening symptoms –> surgery
larger than 3 cm –> CT-guided perctuaneous drainage
–> if not controlled in 5 days –> surgical drainage and debridement
fistula, perforation, obstraction, recurrent attacks –> resection
appendicitis management
it is a clinical diagnosis –> immediate appendectomy (Imaging only if nonclassic symptoms, or delayed presentation
appendicitis - when to go consevatively
symptoms more than 5 days usually have a phlegmn with an abscess that was walled off (delayed appendectomy)
PSOAS SIGN POSITIVE
acalculous cholecystitis
in critically ill patients
similar presentation
image: wall thickening and distention + pericholecystic fluid
- antibiotcs + percutaneous chocystostomy, followed by cholecystectomy when medical condition stabilize
Surgery and hemorophilia A
Give desmopresin before
how to prevent paralytic ileus
- epidural anesethesia
- minimally invasive surgery
judicious perioperative use of IV fluids (to minimise GI edema)
adenoca in GERD if more than …. years
20
esoph stricture vs ca
ca is asymmetric narrowing of the lumen
stricture: symmetric, circumferential narrowing on barium swallow
gastric outlet obstruction clinical examination
abdominal succussion splash which is elicited by placing the stethoscope over the upper abdomen and rocking the patient back + forth at the hips
Scurvy - manifestation
cutaneous: petechiae, follicular hemorrhage, bruising, coiled hairs
2. gingivical: bleeding/receding gums + dental carries
3. constitutional: arthralgias, weakness, malaise, depression
4. impaired wound healing
5. vasomotor insttability (if severe/prolonged)
perforate viscus (eg. air under the diaphragm) - next step
urgent laparo
RFs for psas abscess
- HIV
- IV drug use
- DM
- Crohn
torus palatinus?
young individuals with fleshy immobile mass on the midline hard palate –> no medical or surgical therapy unless growth becomes symptomatic or interferes with speech or eating
