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GI Flashcards

1
Q

What are the dimensions over which a FB is unlikely to pass through the GI tract spontaneously?

A

2.5 x 6 cm

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2
Q

Sudden inability or refusal to eat in a child is suspicious for what pathology?

A

FB

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3
Q

How much time do you have to retrieve a button battery from the esophagus?

A

6 hours

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4
Q

What are the three major measures that are used in esophageal food bolus impactions?

A
  • Glucagon
  • carbonated drinks
  • Endoscopy
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5
Q

After how many hours is an endoscopy indicated for a food bolus that has not passed?

A

12 hours

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6
Q

What kind of necrosis occurs with acidic and alkali ingestions respectively?

A 
Acidic = coagulative
Alkali = liquefactive
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7
Q

What is the treatment for HF acid ingestion?

A

Mag citrate

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8
Q

Endoscopy is indicated within what timeframe after a caustic substance ingestion?

A

less than 12 hours

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9
Q

What is the most common cause of esophageal perforations?

A

Iatrogenic

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10
Q

What is the most common location in the esophagus for Boerhaave’s syndrome to occur?

A

Left posterior distal esophagus

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11
Q

What anatomic structure defines upper and lower GI?

A

Ligament of treitz

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12
Q

What is the prognosis for mallory-weiss tears?

A

Usually self limiting

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13
Q

What is the pressor that can be used with esophageal variceal rupture?

A

Vasopressin

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14
Q

What is the most common cause of lower GI bleeds?

A

Diverticulosis

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15
Q

What is the toxicity caused by amanita phalloides? What does this mushroom look like? What is the treatment?

A
  • Liver failure
  • Like mario mushroom
  • NAC
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16
Q

When can the immune globulin be given for hepatitis A exposure? Hep B?

A

2 weeks d/t incubation period for both

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17
Q

Does Hep A progress to chronic hepatitis? What is the treatment for hep A?

A
  • Negative

- Symptomatic treatment

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18
Q

When is a booster hep B vaccine indicated in exposures?

A

If never had or if ab titers are low

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19
Q

Which surface antigen is needed for Hep D to infect someone?

A

Hep B (no B no D!)

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20
Q

Rising creatinine in a patient with cirrhosis or liver failure is concerning for what complication?

A

Hepatorenal syndrome

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21
Q

What is the survival rate of patients who develop hepatorenal syndrome?

A

Bad

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22
Q

Any patient with a history of ascites and what complaint should be assumed to have SBP? (4)

A
  • GI bleed
  • Encephalopathy
  • Fever
  • Abd pain
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23
Q

How many WBC and PMNs in an ascites aspirate is diagnostic of SBP?

A

More than 1000 WBCs or 250 PMNs

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24
Q

What are the four major precipitants of hepatic encephalopathy?

A
  • infx
  • GI bleed (from reabsorb)
  • Electrolytes
  • Medication non-adherence
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25
Q

What are the components of the SHiNE SKiS mnemonic for

A

Strep pneumonia
Haemophilus influenza
Neisseria meningitidis
E. coli

Salmonella
Klebsiella
GBS

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26
Q

What is post splenectomy syndrome, and why do you care?

A

flu-like-illness after splenectomy, that rapidly progresses to fulminant sepsis and death

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27
Q

What are the abx of choice for splenectomy sepsis? (2)

A

Ceftriaxone

Vanco

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28
Q

When does post splenectomy syndrome occur? Why don’t we see this more often?

A

Within 1-2 years after splenectomy

-Vaccinations (pneumovax, meningitis, hib vaccine)

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29
Q

What are the components of the SPLEEN mnemonic for causes of splenomegaly?

A
  • Sequestration
  • Proliferation
  • Lipid deposition
  • Endowment
  • Engorgement
  • Neoplasm
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30
Q

Why is there splenomegaly with cirrhosis?

A

portal HTN, backs up blood into spleen

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31
Q

How long should someone with splenomegaly 2/2 EBV not participate in contact sports?

A

3 weeks

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32
Q

What are the diagnostic criteria for SCD splenic sequestration?

A
  • Splenomegaly
  • Drop in Hb by more than 2 g/dL
  • Thrombocytopenia
  • Reticulocytosis
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33
Q

What is the treatment for SCD sequestration?

A
  • resus
  • half pRBCs
  • Admit with hematology consult
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34
Q

What are the two types of general types of malignancy that can cause splenomegaly?

A
  • Myeloproliferative

- Lymphoproliferative

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35
Q

What is erythromelalgia?

A

vascular congestion in the hand and feet that occurs several times a day
-can be seen primarily, or 2/2 other diseases (polycythemia vera)

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36
Q

What are the causes of splenic infarction?

A
  • hematologic malignancy
  • septic emboli
  • thrombosis/embolus
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37
Q

What is the diagnostic modality for splenic infarction?

A

CT

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38
Q

What are the 4 basic mechanisms of diarrhea?

A
  • Decreased absorption
  • Increased secretions
  • Increased osmotic load
  • Abnormal motility
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39
Q

What is the mechanism of bacteria that causes bloody vs non-bloody diarrhea?

A 
Bloody = invasive
Non-bloody = toxin secretion (noninvasive)
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40
Q

What is the vector and treatment for enteroinvasive e.coli?

A

Raw, ground beef

Supportive

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41
Q

What is the vector and treatment for campylobacter?

A
  • Raw poultry, milk

- cipro or azithro

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42
Q

What is the vector and treatment for salmonella?

A

Eggs, poultry, dairy

-Cipro

43
Q

What is the vector and treatment for shigella?

A

Contaminated food or water

Cipro

44
Q

What is the vector and treatment for vibrio vulnificus?

A

undercooked/raw shellfish

cipro

45
Q

What is the vector and treatment for vibrio parahaemolyticus?

A

Undercooked/raw shellfish

Cipro

46
Q

What is the vector and treatment for yersinia enterocolitica?

A

Undercooked pork/tofu

Supportive`

47
Q

Rose patches/salmon patches + diarrhea = ?

A

Salmonella

48
Q

What is the bacteria that causes a diarrheal illness that can mimic appendicitis?

A

Yersinia enterocolitica

49
Q

What is the vector and treatment for staph aureus diarrhea?

A

dairy, eggs

Supportive care

50
Q

What is the vector and treatment for bacillus cereus?

A

fried rice

supportive

51
Q

What is the vector and treatment for clostridium perfringens?

A

Meats

Supportive

52
Q

What is the vector and treatment for enterotoxigenic e.coli?

A

contaminated water

bactrim cipro

53
Q

What is the vector and treatment for vibrio cholerae?

A

Contaminated water

Cipro, hydration

54
Q

What is the vector and treatment for listeria?

A

Deli meats, fresh soft cheeses

Bactrim

55
Q

What is the vector and treatment for scromboid? HOw does this present?

A
  • unrefrigerated fish-heat stable toxin
  • Histamine-like rxn within 30 minutes
  • H1 and H2 blockers
56
Q

What is the vector and treatment for ciguatera?

A
  • Reef fish contaminated with gambierdiscus toxicus
  • n/v/d within a few hours
  • Paresthesias, heat/cold reversal, muscle weakness for years
  • brady/hypotension
  • Mannitol for severe cases
57
Q

What is the treatment for giardia?

58
Q

What are the s/sx and treatment for entamoeba histolytica? Vector?

A
  • Diarrhea +/- blood and extraintestinal symptoms
  • From contaminated water
  • Flagyl
59
Q

What are the s/sx and treatment for cryptosporidium ? Vector?

A
  • Watery diarrhea x1 week
  • contaminated water
  • Common in AIDS pts. Treatment with azithromycin and paramomycin
60
Q

What is the most common area affected with crohn’s disease?

61
Q

Does crohn’s disease have bloody or nonbloody diarrhea? Ulcerative colitis?

A 
Crohn's = non
UC = bloody
62
Q

How much is GI CA risk increased with Crohn’s disease? UC?

A 
CD = 3x increase
UC = 30x
63
Q

What is the treatment for crohn’s?

A
  • Steroids
  • Sulfasalazine
  • Antidiarrheals
64
Q

What is the treatment for perianal Crohn’s disease?

65
Q

What is the treatment for ulcerative colitis?

A
  • Steroids

- Oral and topical mesalamine

66
Q

Why should you avoid antidiarrheals with ulcerative colitis?

A

Toxic megacolon

67
Q

What is the treatment for toxic megacolon?

A
  • IVFs
  • abx
  • steroids
  • surgery
68
Q

How much dilation is diagnostic of toxic megacolon?

69
Q

What is an amyand hernia? De Garengeot?

A
  • Amyand = Appendix herniates through an indirect inguinal hernia
  • De Garengeot = femoral hernia with appendix
70
Q

Why are hernias caused by ascites more concerning than other types?

A

Increased risk of strangulation and death

71
Q

What is a spigelian hernia?

A

Lateral ventral hernia that arises lateral to the rectus muscle

72
Q

What is an obturator hernia, and how does it present?

A

Herniation of bowel contents through the obturator foramen, worse with internal rotation of the thigh, causing medial thigh pain. Usually presents as a bowel obstruction

73
Q

What is a Richter hernia?

A
  • Only part of the bowel wall has herniated through–lumen still patent
  • Increased risk of strangulation/gangrene
74
Q

What is the management for reducible, incarcerated, and strangulated hernias?

A
  • Reducible = reduce, refer
  • Incarcerated = reduce, call surgery if cannot
  • Strangulated - do NOT reduce (sepsis), call surgery and get IV abx
75
Q

What happens to the appendix with pregnancy? What is the clinical relevance of this?

A

Shifts up–can cause RUQ pain

76
Q

What is the role of CRP/ESR with appendicitis?

A

not sensitive nor specific

77
Q

Why can you have WBCs in urine with appendicitis?

A

Proximity of ureter to appendix

78
Q

Appendix of more than how many mm in width is diagnostic of appendicitis?

79
Q

What imaging modality can be used to diagnose appendicitis in pregnant patients, if US is nondiagnostic?

A

MRI w/o contrast

80
Q

What is stump appendicitis?

A

Infection/inflammation of the stump of the appendix after appendectomy

81
Q

How does an ileus present?

A

Dull, poorly localized abdominal pain with distension, decreased flatus

82
Q

How does an x-ray appear with an ileus?

A

Dilated loops of fluid filled bowel, that involves the ENTIRE bowel

83
Q

What is the treatment for an ileus?

A

NPO
IVF
Metoclopromide

84
Q

What is the second most common cause of a SBO?

A

incarcerated inguinal hernia

85
Q

How can you differentiate where an obstruction is (proximal vs distal) with an SBO, based on the emesis?

A
  • Bilious emesis = proximal

- Feculent = distal

86
Q

Dilated loops of bowel + air fluid levels on abd xr = ?

87
Q

What is the “classic” physical exam finding for sigmoid volvulus?

88
Q

What is the classic x-ray finding for sigmoid volvulus?

A

Bent inner tube or Coffee bean appearance

89
Q

What is the treatment for sigmoid volvulus?

A
  • Surgery if septic

- endoscopic if not

90
Q

What is the treatment for a cecal volvulus?

A

Fluid restriction, OR

91
Q

What is the CT finding associated with a cecal volvulus?

A

Bird beak and whirl sign

92
Q

Is elevated lactate a late or early finding of mesenteric ischemia?

93
Q

What are the three general etiologies for mesenteric ischemia?

A
  • Artery occluded (embolic)
  • Vein occluded (thrombolic, hypercoagulable)
  • Low flow (CHF, dialysis)
94
Q

What are the components of the WASH regimen for perianal abscess care?

A
  • Wash (sitz baths)
  • Anesthetic
  • Stool softeners
  • High fiber
95
Q

When are perianal abscesses not amenable to I+D?

A
  • If septic
  • If DM, old, immunocompromised
  • Have abd pain
96
Q

What is the treatment for a perirectal abscess?

97
Q

What are the causes of proctitis?

A
  • GC/Chlamydia
  • Radiation
  • Vasculitis, ischemia
98
Q

Where are most anal fissures located?

A

Posterior midline

99
Q

What is the treatment for anal fissures?

A
  • WASH regimen

- Topical NTG, hydrocortisone

100
Q

Anal fissures lasting longer than how long are an indication for surgical referral?

101
Q

When are external hemorrhoids painful? Internal?

A 
External = When thrombosed
Internal = when strangulated
102
Q

Within how long of onset is an external hemorrhoid amenable to I+D?

A

within 72 hours of symptom onset

103
Q

What is the treatment for a strangulated or incarcerated hemorrhoid?

Hippos (23 decks)

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