GI 7 Flashcards
In what 6 circumstances are minors considered medically emancipated?
- Parent/Pregnant
- Military
- Financially independent
- HS graduate
- Homeless
- Married
What types of care can you provide a minor without parental consent?
- Pregnancy (most states)
- Contraception
- Drug use (most states)
- STI
- Emergency
What is the management of Inguinal hernia in Children?
Surgical repair as early as possible.
What three single item lab values are predictors of disease severity in Pancreatitis?
- HCT > 44% on admission
- BUN > 20 on admission
- CRP > 150 (24-48 hours after admission)
Hemolytic Uremic Syndrome presents with a triad of?
- Other than the triad, what other symptom is a hallmark?
- What is the cause of this disease?
- What types of exposures are linked with this disease?
HUS TRIAD:
- Renal injury
- MAHA
- Thrombocytopenia
- Bloody diarrhea + Abd pain
- Shiga toxin mediated systemic insult from EHEC (O157:H7)
- Uncooked hamburger or exposure to infected cows.
How do you TREAT Hemolytic Uremic Syndrome?
Urgent Plasmapheresis/dialysis
Patient comes in with signs of bowel obstruction…what imaging finding points towards partial obstruction rather than complete?
What is the management of a partial small bowel obstruction?
Air in both small bowel and distal colon makes complete obstruction unlikely.
Management of partial small bowel obstruction:
- IVF
- NG tube decompression
- Correct electrolytes
- IF no improvement in 12-24 hours surgery
What are the three steps in working up symptoms of delayed gastric emptying?
- EGD to rule out mechanical obstruction (strictures, cancer, ext)
- Gastric Emptying test –> this definitely diagnoses delayed emptying.
- +/- Gastroduodenal manometry (this can distinguish neuropathic vs myopathic)
For bloody diarrhea, unless history points otherwise (IBD, ischemic colitis ext), you should think bacterial infection…
What three labs are important in work up?
- Facal WBC
- Stool culture
- Shiga toxin.
What is the threshold for packed RBC transfusion in:
- HD stable patient with GI bleed?
- IF CAD OR Surgery planned?
- Brisk bleed or HD instability?
- Hgb <7
- Hgn < 8
- Should set goal higher than 8 because Hgb may not accurately reflect changes in brisk bleed.
If a patient presents with hematochezia and HD instability, where should you suspect the bleed is coming from?
What is the management?
BRISK upper GI bleed.
TRX:
- volume resuscitation
- EGD
- Colonoscopy if EGD negative.
(IF at any time too HD unstable –> Angiography and embolization)
What two classes of medications are known to cause drug induced pancreatitis?
HIV meds
DIURETICS
Hepatic Adenoma is a benign epithelial tumor or Liver that is seen in what group?
Though they are usually asymptomatic, can present with.
How do you dx?
TRX?
What percentage has malignant transformation? What monitoring do you need?
Young women on OCP.
Mild abdominal discomfort.
DX = CT scan
TRX:
IF Asymptomatic and < 5 cm –> DC OCP
IF > 5 CM –> resection
10 % malignant transformation –> follow with serial imaging and AFP levels.
All patients with HCV should get vaccinated for?
HBV and HAV, because confection can cause rapid hepatic failure.
During pregnancy women develop gall stones because increased E levels increase cholesterol in bile and decrease gall bladder motility…
Normally no trx is needed but if symptoms are SEVERE, how do you trx?
2nd trimester cholecystectomy
