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GI Flashcards

1
Q

Dysphagia
solid only tends to be
solids and liquids tends to be
oropharyngeal dysphagia tends to be

A

Solid: mechanical
solid and liquid: motility disorder
oropharyngeal: neuromuscular disorder

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2
Q

Dysphagia, underlined cause
infectious
immunologic
motor/nerve dysfunction (2)

A

infectious: botulism
immunologic: myasthenia gravis
motor/nerve dysfunction (2): achalasia and cranial nerve palsy’s

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3
Q

Esophageal rupture
most common cause
Mallory Weiss tear
most common location

A

Most esophageal ruptures are iatrogenic
Mallory Weiss: GE junction

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4
Q

Boerhaave’s syndrome

age, sex
physical finding with eponym
chest x-ray findings(4)

A

age, sex: male, 40 to 60
physical finding with eponym: mediastinal air with Hamman’s crunch
chest x-ray findings: mediastinal air, left pleural effusion, pneumothorax, widened mediastinum

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5
Q
A

Pneumomediastinum with subcutaneous emphysema

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6
Q

Esophageal foreign body

levels of narrowing (4)

coin x-rays, AP versus transverse orientation

A

–Cricopharyngeus muscle (C6)

–Aortic arch (T4)

–Tracheal bifurcation (T6)

Gastroesophageal junction (T11)

Coin xrays: AP-coin in trachea, transverse-coin in esophagus (eg round aspect facing you on AP xray)

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7
Q
A

Esophageal foreign body

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8
Q

Swallowed battery, management when located in
esophagus (2)
stomach
pylorus

A

esophagus: immediate removal. Antibiotics
stomach and pylorus: only removed when not passing spontaneously within 72 hours

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9
Q

Esophageal food impaction

medical management (3)

avoid

A

medical management (3): glucagon, nifedipine, carbonated beverage

avoid: meet tenderizer-papain

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10
Q

Caustic ingestions

best diagnostic method
indication for dilution
indication for neutralization

A

best diagnostic method: endoscopy
indication for dilution: only solid alkali ingestion
indication for neutralization: only hydrofluoric acid (milk of Mag Citrate)

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11
Q

Peptic ulcer disease

rare risk factor
less known medical treatment option

A

Zollinger Ellison syndrome

surface protectant: sucralfate

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12
Q

UGIB

predictors of need for severe intervention (3)

A

Red blood on lavage
tachycardia
hemoglobin < 8

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13
Q

UGIB

most common cause
because more common in pregnancy

A

most common cause: PUD, usually duodenal
because more common in pregnancy: esophagitis

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14
Q

UGIB

therapy for variceal hemorrhage (3) (non-endoscopy)

Linton tube?

A

Octreotide, vasopressin, Blakemore tube

Linton tube - for gastric varices

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15
Q

Bilirubin

increased unconjugated (2)
increased conjugated (3)
A

increased unconjugated: hemolysis or Gilbert’s syndrome
increased conjugated: hepatocellular disease, obstruction, CHF

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16
Q

Hepatitis A

mitigation options (2)

A

Prophylaxis with vaccine, immunoglobulin within two weeks of exposure

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17
Q

Hepatitis B marker significance

HBsAg

HBsAb

HBeAg

HBcAb

A

HBsAg: positive early, active infection
HBsAb: positive after clearance of HBsAg, best marker for immunity to HBV
HBeAg: implies high infectivity

HBcAb: best indicator of history of hepatitis B infection

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18
Q

Hepatitis B, postexposure prophylaxis for

previously unvaccinated
vaccinated, incomplete
vaccinated

A

previously unvaccinated: hepatitis B immunoglobulin, vaccination
vaccinated, incomplete: booster
vaccinated: test for HBsAb - if adequate titers, no treatment, otherwise HBIG and booster

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19
Q

Hepatitis C

cirrhosis/cancer risk

seroconversion risk after needlestick

A

cirrhosis/cancer risk: 50% versus 10% for hepatitis B

seroconversion risk after needlestick: 2%

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20
Q

Hepatitis-other types, description/transmission mechanism

Delta

E

G

A

Delta: blood-borne,IVDU, homosexual higher risk

E: fecal oral, found in Asia, Africa, Russia

G: blood-borne and STD

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21
Q

Hepatitis - indications for hospitalization (7)

A

Encephalopathy,

PT/INR significantly increased,

dehydration,

hypoglycemia,

bilirubin over 20,

age over 45,

immunosuppression

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22
Q

Hepatic encephalopathy treatment

avoid

precipitants

A

neomycin, lactulose, decrease dietary protein,

avoid sedatives, avoid bicarbonate

precipitants: LIVER = Librium [sedatives], Infection, Volume loss, Electrolytes disorders, Red blood cells in the gut

AND dietary protein access, worsening liver function

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23
Q

SBP

common agents (2)

diagnosis

A

common agents (2): E. coli, enterococcus

diagnosis: PMN greater than 250

24
Q

Acute liver failure

most common cause worldwide and US
most common etiology of death

A

most common cause worldwide and US: hepatitis A and E; Tylenol overdose
most common etiology of death: intracranial hypertension, cerebral edema -> treat with mannitol and indomethacin

25
Most common cause of surgical abdominal pain in the elderly and the agents (2) Gallstone ileus-what
Cholecystitis, E. coli, Klebsiella gallstone obstructing the ileocecal valve
26
Acalculus cholecystitis common etiology Ascending cholangitis what Triad
Acalculus cholecystitis common etiology: complication of another process-trauma, burn, postpartum, postoperative, narcotics Ascending cholangitis what: infection spreading throughout the biliary tree Triad - Charcot's: jaundice, fever, right upper quadrant pain
27
Pancreatitis, causes drugs metabolic viral bacterial
* Drugs: thiazides, estrogens, salicylates, acetaminophen, antibiotics * Metabolic disorders: hyperlipidemias, hypercalcemia DKA, uremia * Viral infections: mumps, Coxsackie B, hepatitis, adenovirus, EBV * Bacterial infections: Salmonella, Streptococcus, Mycoplasma, Legionella
28
Pancreatitis significance of calcifications
Can indicate chronic pancreatitis
29
Sentinel loop- air in small bowel loop overlying the pancreas
30
Ranson's criteria on ED admission (5) severe disease = ?
–Age \> 55 –Glucose \> 200 mg/dL –WBC \> 16,000 –SGOT(AST) \> 250 –LDH \> 350 severe disease if three or more positives
31
Pancreatitis -complications localized (3) electrolyte (2) metabolic (2) systemic (3)
–Pseudocyst, necrosis, GI bleed –Hyperglycemia, hypocalcemia –Volume loss, acidosis –ARDS, DIC, renal failure
32
Ileus: air throughout intestines, fluid levels not as prominent
33
Large bowel obstruction etiology (3) and most common
Cancer number one, volvulus, diverticulitis
34
Volvulus, sigmoid versus cecal age/setting x-ray treatment
sigmoid age/setting: elderly, debilitated, insidious sigmoid x-ray: inverted view, loops project obliquely to right upper quadrant sigmoid treatment: sigmoidoscopy cecal age/setting: young (20-40), acute onset, can be a/w pregnancy cecal x-ray: kidney shaped loop in left upper quadrant, bird beak cecal treatment: surgical
35
Sigmoid volvulus
36
Cecal volvulus
37
Hernias incarcerated versus strangulated; more common in \*\*\* hernia direct versus indirect
Incarcerated-irreducible; strangulated-irreducible with vascular compromise; m ore common in femoral hernias indirect goes through the inguinal canal to scrotum, more common in boys direct goes for the abdominal wall, middle-aged men
38
Hernias, rarer types, description Spigelian Obturator and sx pearl Richter
* Spigelian: lateral edge of rectus abdominis. Difficult to diagnose (CT, ultrasound) * Obturator (rare): through obturator foramen. More common in woman. Presents as obstruction, pain in medial thigh (obturator nerve) * Richter: only a portion of the bowel herniates. Even if the hernia is incarcerated or strangulated, the bowel may not be obstructed
39
Most common cause of this finding
Free air from bowel perforation Peptic ulcer disease
40
Bowel perforation
41
Constipation less known medication causes (3) endocrine causes (3)
less known medication causes: calcium channel blockers, psych medications, antacids, iron endocrine causes: hypothyroid, hypoparathyroid
42
Inflammatory bowel disease associated worst complication extra intestinal manifestations (4)
Colon cancer with disease greater than 10 years duration •arthritis, dermatologic (erythema nodosum, pyoderma gangrenosum), hepatobiliary disease, vasculitis, uveitis
43
Inflammatory bowel disease medical management (4)
sulfasalazine, mesalamine, prednisone, abx (metronidazole, ciprofloxacin)
44
Crohn's disease Distribution characteristic features (4)
Throughout entire G.I. tract and involves entire intestinal wall; gross blood RARE compared to ulcerative colitis SBO, enteric fistula, perforation Anorectal pathology: perianal fissures, fistulas and abscesses, rectal prolapse, toxic megacolon calcium oxalate kidney stones from increased oxalate absorption
45
Ulcerative colitis major finding major complications (2)
Buddy diarrhea complications toxic megacolon (transfers: greater than 6 cm) with systemic toxicity 30 fold increase in the rate of colon cancer
46
Mesenteric ischemia the main causes characteristic laboratory abnormalities (2) avoid these medications (3)
he main causes: embolic, thrombotic characteristic laboratory abnormalities: leukocytosis, lactic acidosis avoid these medications: beta-blockers, laser pressers, digoxin (decrease splanchnic blood flow)
47
Thumb printing from mesenteric ischemia
48
thump printing from mesenteric ischemia
49
50
Seen in setting of mesenteric ischemia
51
Appendicitis Most common age groups for perforation
children and elderly
52
Diverticular disease
53
Diverticulitis Most common location
–Steady, deep, LLQ location (Western world) –RLQ Japan-Hawaii
54
Rectal prolapse Differentiation from internal hemorrhoids and intussusception
–Intussusception: can place finger between protruding rectum and anus –Internal hemorrhoids: fold of mucosa radiates out like spoke on a wheel –Rectal prolapse: folds of mucosa are circular
55
56
Rectal prolapse - note circular ring like appearance
57
Anal fissure appearance caveat Tx (5)
Non-midline fissures suggest more serious conditions (IBD, CA, sexual abuse) Tx: WASH regimen\*, NTG ointment, anal dilatation, surgical intervention, BOTOX \*Warm water, analgesics, stool softeners, high fiber diet

EM Board exam (18 decks)

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