GI Flashcards
Intussception
Currant jelly stools (blood and mucus from the necrosed bowel wall)
Intermittent pain
Sausage shaped mass
Diagnosis - Target Sign on Ultra Sound GOLD STANDRD for diagnosis. US has a 100% sensitivity and specificity.
Treatment - Air enema
Risk factors: Hypertrophied Pyers patches Rotavirus vaccination! Viral illness Henoch schonlein purpura
Infant is cyanotic and tachypneic at rest.
Turns pink when he cries.
Cyanosis worsens when he tries to feed.
what is the diagnosis?
CHOANAL ATRESIA!!!
Unilateral Choanal Atresia may remain un-diagnosed until the development of a first upper resp infection.
FAILURE to PASS a CATHETER through the nares into the oropharynx is suggestive of choanal atresia.
diagnosis - CONFIRMED with CT scan.
Tracheoesophageal FIstula
Cause feeding problems IMMEDIATELY after birth as feeds CANNOT PASS the esophagus and end up in the airway.
Tehse patients have coughing, respiratory distress, and adventitious lung sounds in addition to CYANOSIS.
Necrotizing Enterocolitis signs and symptoms
Premature babies or very LOW BIRTH weight babies (less than 3.3lbs) are at risk for NEC.
Babies who are fed formula over breast milk are also at risk.
Clinical features:
Vital sign instability, Lethargy, BILLIOUS EMESIS, BLOODY STOOLS, Abdominal distension
X-ray - PNEUMATOSIS INTESTINALIS, portal venous gas, PNEUMOPERITONEUM.
Treatment - Bowel rest, parenteral nutrition, Broad spec IV antibiotics, SURGERY!
Abdominal pain related to eating, and that DOES NOT respond to PPIs.
Eosinophilic Esophagitis.
Caused by esophageal inflammation triggered by food allergens.
These patients will present with ECZEMA or other allergic conditions (ASTHMA, RHINITIS etc..)
Presentation includes –> DYSPHAGIA, mid-chest and EPIGASTRIC PAIN, VOMITING and FOOD IMPACTION.
Diagnosis and treatment:
2 month trial of PPIs.. if no improvement then must do ENDOSCOPY with ESOPHAGEAL BIOPSY.
CIRCULAR RINGS and ESOPHAGEAL FURROWS are non-specific findings on biopsy.
Diagnosis is confirmed with > 15 EOSINOPHILS per high-power field on histology.
Skin discoloration, anorexia, unintentional weight loss, dark urine, and PALE stoos.
Enlarged nontender galbladder.
what is the diagnosis and what iwll u see on abdominal imaging
PANCRATIC CANCER
on imaging - intra and extrahepatic billiary tract dilation.
Management of gallstones
gallstones with NO SYMPTOMS - No treatment.
Gallstones with Typical biliary colic - Elective lap choley.. or in poor surgical candidates - ursodeoxycholic acid
Complicated gallstone disease - CHOLECYSTECTOMY within 72 hrs.
Giardia confirmatory test?
Stool Antigen Assay (direct immunofluorescence or ELISA)
Treatment - metro
asymptomatic carriers DO NOT need treatment
12 year old receives Blunt abdominal trauma and then has Postprandial, COLICKY abdominal pain and BILIOUS VOMITING.
Tenderness in epigastric area
Duodenal Hematomas
Commonly occur after Blunt abdominal trauma. Most commonly seen in children. Caused by blunt force pushing the duodenum against the vertebral column… –> following this trauma.. BLOOD COLLECTS between the submucosal AND muscular layers of the duodenum causing a PARTIAL OR COMPLETE OBSTRUCTION.
Patinets present with pain 24-36 hours later due to inability to pass gastric contents beyond the obstructing hematoma.
Confirm Diangosis with CT of the abdomen.
Treatment - resolve in 1-2 weeks most of the time. Manage by putting in NG tube and decompressing, and providing parenteral nutrition.
Following Blunt Abdominal Trauma, patient has RUQ tenderness, Free INTRAPERITONEAL FLUID, HEMOdynamic INstability and abnomral CBC
what is the diagnosis?
Liver laceration.
one of the most common complications of Blunt abdominal trauma
abdominal succussion splash manuver is done to identify what?
Gastric outlet obstruction
After Appendectomy 10 days ago patient gets right upper quadrant pain, fever, leukocytosis and pulmonary manifestations (shortness of breath, hiccups, right sided effusion)
What diagnosis does this suggest?
SUBPHRENIC ABSCESS
Erythematous mass near the ANAL orfice associated with severe, CONSTANT pain and a low grade fever is what?
PERIANAL abscess
Caused by occlusion of anal crypt gland - which allows for BACTERIAL INFECTION.
Constant pain and can be associated with systemic manifestations such as FEVER.
Treatment - Incision and Drainage
anal fissure treatment
High fiber and adequate fluid intake
stool softners
sitz baths
Topical anesthetics and vasodilators (Nifedipine, nitroglycerin)
Multiple ulcers. Prominent gastric folds, 3 duodenal ulcers and upper jejunal ulcerations
Zolinger Ellison syndrome.
Endoscopy - THICKENED GASTRIC FOLDS, Multiple ulcers, abdominal pain, Refractory to PPIs or Ulcers distal to the duodenum.
FASTING SERUM GASTRIN level should be checked in suspected gastrinoma. a level above 1000 is diagnostic!
Gastrin levels below this are non-diagnostic and should be foolowed up with a SECRETIN STIMULATION test.
Laxative abuse presentation
Watery, Frequent, stools.
NOCTURNAL bowel movements and abdominal cramps.
DIarrhea normally causes metabolic acidosis..
However in Laxative abuse METABOLIC ALKALOSIS Is a classic finding!
Dark Brown Discoloration of the colon (melanosis coli) (seen on colonoscopy).
Diarrhea during FASTING and DEHYDRATION. TEA COLORED stools. What is the diagnosis?
VIPoma
DIarrhea + Cutaneous flushing + Venous Telangiectasia + BRONCHOSPASM + Valvular abnormalities (cardiac) what is the diagnosis?
Carcinoid - Elevated URINE 5 - HIAA
Carcinoid patients can end up with a NIACIN deficiency (dermatitis, dementia, diarrhea).. because all precursors are being used to develop serotonin.
Treatment;
Octreotide for symptomatic patients PRIOR to doing surgery.
SURGERY for liver mets.
Rapid onset Periumbilical pain (pain out of proportion to exam findings) + Hematochezia –> what is diagnosis?
Acute Mesenteric Ischemia
Risk factors:
- Atherosclerosis
- Embolism.. or hypercoag disorders.
Labs:
- METABOLIC ACIDOSIS (lactate elevated due to necrosis)
- elevated AMYLASE and PHOSPHATE levels
Diagnosis:
CT (1st line) or MR angiography
Opioid withdrawl bowel symptoms?
HYPERACTIVE bowel sounds.
History of DIarrhea and Intermittent abdominal cramps + Multiple BLOODY bowel movements containing mucus and blood + TENDERNESS in left lower quadrant + ERYTHEMATOUS FRIBABLE mucosa from RECTUM to SIGMOID colon + SHALLOW ULCERS on Flexible sigmoidoscopy –> what is the diagnosis?
Ulcerative Colitis
Pancreatic adenocarcinoma diagnosis
Cancers in the head of the pancrase –> JAUNDICE (due to CBD obstruction –> elevated alkphos and bilirubin)
FOr these patients use ABDOMINAL ULTRASOUND.
Cancers in the body or tail –> NO jaundice. Use Abdominal CT scan for these (cannot visualize with abdominal ultrasound)
Chronic Mesenteric Ischemia
Presents with CRAMPY POSTPRANDIAL EPIGASTRIC PAIN (intestinal angina), FOOD AVERSION and thus WEIGHT LOSS.
ATHEROSCLEROTIC narrowing of the celeiac or superior mesentaric arteries –> decreased blood supply to the stomach.
ABDOMINAL BRUIT present in 50% of patients.
CT ANGIO preffered choice for diagnosis.
