GI Flashcards
Hgb to give RBC transfusion
<7
<9 w/ ACS
If the PT is in hemorrhagic shock
Pt w s/s appendicitis
Just get them an appy they don’t need diagnostic imaging
Kid swallows a foreign body
If asymptomatic can observe for 24 h then repeat XR, flex endoscope
Liver probs in a preggo
Acute cholangitis: beck’s triad (RUQ pain, jaundice, fever) will have slightly elevated AST and ALT, not like acute fatty liver dz which will be super super high
Intrahepatic cholestasis of pregnancy=3rd tri, itchy palms and soles, high bile acids>10 (IUFD>100), tx ursodeoxycholic acid
Acute fatty liver disease of pregnancy=jaundice, FULMINANT LIVER FAILURE—>plt<100k, hypoglycemia, microvesicular intrahepatic emergency 3rd tri get baby out
HELLP=HTN, plt<100k
Pre-eclampsia=HTN
Diarrhea
Inflammatory (bloody)
Osmotic (Stool Osmotic Gradient>125)
Secretory (SOG<50, PT with prior abd surgery, >1L/day, diarrhea when fasting)
Critically ill patients with RUQ pain
Acalculus cholecystitis, high suspicion in ICU, shock, 2/2 ischemia leading to infection
Hepatic cyst
NOT BILIARY ATRESIA (infants), kids <10 yo, high LFTs, pain, jaundice, abdominal mass
Tracheoesophageal fistual
most common is distal fistula = abdominal distentsion, stomach acids into lungs = pneumonia
diverticulosis
MC cause of bright red poop, arterial bleeding, hemodynamic instability/lightheadedness
iron deficiency anemia in an old person
GI bleed, negative FOBT does not rule out, need scope
Spontaneous bacterial peritonitis
Ascites, protein<1, SAAG>1.1, PMNs>250, +clx, bact extravasation, paralytic ileus=severe, give abx
Zenker diverticulum
Barium swallow DO NOT SCOPE RISK OF PERF, caused by UPPER sphincter dysfxn +esophageal dysmotility, herniation between cricopharyngeal muscles
Porcelain gallbladder
Chronic inflammation, inc risk of adenocarcinoma
Post op ileus
> 3 days, no flatus, distended small AND large bowel, opiates, ondansetron worsen
Ddx mech bowel obstruction weeks-yrs after abd surgery
GERD - when to go right to scope
Alarm sx (anemia, vom, odynophagia/dysphagia, weight loss, bleeding), male >50 yo, >5 y sx, cancer RFs
Pancreatitis shock
Increased vascular permeability, CT calcifications=chronic
Acute liver failure
LFTs>1000, encephalopathy, PT>100, renal probs, need transplant
Celiac dz
ttg, but will be low in cases of selective IgA def, get total IgA, urine d-xylose to dx absorbed in proximal small intestine, can be low in SIBO small intestinal bacterial overgrowth give 4 weeks of rifamaxin and retest
Diverticulitis
Hx of constipation low fiber diet, abd CT to dx, XR nonspecific
Hematemesis causes
Boerrhave=Transmural tear, chest pain, L sided pleural effusion amylase+
Mallory-Weiss=mucosal tear
Pancreatitis=epigastric pain
Gastric mucosal erosion=aspirin + alcohol, cocaine
Esophageal varices=cirrhosis, give fluids abx octreotide then endoscopy, balloon tamponade if uncontrolled bleeding then repeat endo, Bb ppx, give plt <70k, PRBCs <9
PUD=coffee ground
Pt w PUD
MC causes are NSAIDs or h pylori, if no hx of NSAID use give triple therapy
Hyperbili adult
Conjugated (always pathologic):
Dubin-Johnson (hepatocytes can’t excrete bili, jaundice when stressed, black liver on bx)
Unconjugated:
Gilbert (not severe, benign elevated bili)
Crigler-Najjar (more severe)
Pancreatic cancer
Obstructive (alk phos, conj bili), dx CT CT CT CT CT CT ca19-9 is better for tracking post-op, palliative endoscopic stent
Where is the stone?
Cystic duct=alk phos IS NORMAL, transaminases can be a little elevated
Common bile duct=jaundice, high LFTs
Liver lesions
Hepatic adenocarcinoma=young women OCPs, abd US hyperechoic CAN RUPTURE hemorrhage
Hepatocellular carcinoma=mass w satellite lesions, RFs chronic liver dz hepatitis
Hydatid cyst=echinococcus cystic not solid mass, egg shell calcifications, septations/daughter cysts drain + albendazole
Nodular hyperplasia=also young women, arterial supply, US shows blood flow
Nodular regeneration=cirrhosis
Multiple lesions=mets most likely
Abscess=DM peritonitis, abx drain
Entamoeba histolytica=travel bloody diarrhea metro+paroromycin
Hepatic encephalopathy
Causes=SBP, nitrites (hemolysis, protein), hypovolemia, give fluids, REPLETE K, lactulose, if NOT RESPONSIVE TO LACTULOSE try rifamaxin, then try neomycin
LACTULOSE TO HELP MENTAL STATUS
Upper GI bleeding
High BUN (NOT high w lower GI)
Gall stone ileus
Sort of an SBO picture that comes and goes then eventually gets bad, air in hepatic ducts NOT EMPHYSEMATOUS CHOLECYSTITIS (=infx w gas producing organisms), tx surgery
Drugs that can cause pancreatitis
HI DIA HIV Immunosuppressants Diuretics IBD Anti-seizure/antibiotics
Difference between liver ischemia and acalculus cholecystitis
Both can happen in critically ill PT/shock/hypotension—>ischemia, hepatic ischemia will have HIGH HIGH HIGH AST/ALT and pretty nl alk phos and bili, cholecystitis will have high alk phos and bili, nl/slightly elevated AST/ALT
Causes of dysphagia
Oropharyneal vs esophageal
Oro=neuro probs, age, get videofluoroscopic barium swallow
Esophageal=dysmotility (achasia, can’t swallow solids or liquids at onset) or obstruction (progressive, stricture cancer etc, barium swallow or straight to EGD)
Esophageal spasm
Hot/cold foods, better w nitro, manometry
Psoas abscess
CT! Can’t diagnose w ultrasound
Crohn dz
Transmural
Primary biliary cholangitis
Middle age women, +AMA, itching, xanthomas, bone dz, tx ursodeoxycholic acid
Primary sclerosing cholangitis
Men, ulcerative colitis, +p-ANCA
Risk factor for c diff
Abx, decreased gastric acid
Colon cancer screening
> 50, 10 y before FDR age at diagnosis, 8-10 y after dx of UC
Toxic megacolon
acute infx (C diff) OR may be first presentation of IBD!!, abd distention, bloody diarrhea, pt looks sick, Get abd XR
Gallstones tx
Asymptomatic=nothing
Biliary colic=elective surg, ursodeoxycholic acid if poor surg candidate
Infx=72 hr surg
Lactose intolerance
Malabsorption, dx hydrogen breath test
Femoral hernia
Surgery even if not incarcerated! Higher risk
Need to correct INR before surgery
Give FFP
Hep B
Serology during acute illness=HBsAg + IgM anti-HBc
FAP screening
10 yo sigmoidoscopy Q1, colonoscopy Q1 after first polyp, elective proctocolectomy
Trousseau’s syndrome
Migratory thrombophlebitis a/w cancer (pancreatic)
NAFLD
Insulin resistance causes increased FFA
Cholelithiasis preggo
Intermittent RUQ pain inc risk (estrogen + prog), conservative tx surgery only if severe recurrent
Cholangitis + pancreatitis
Charcot triad (RUQ pain, fever, jaundice) Dilated common bile duct on US, ERCP
SIBO
Roux-en-Y, steatorrhea and malabsorption of ADEK and B12 (may see macrocytic anemia) NOT DUMPING
Hemochromatosis
Men >40 women postmenopause
Cardiomyopathy, Heberden nodes (DIPs), Arthropathy, Liver (HSM, cirr), a/w LYVer=lysteria, yersenia, vibrio vulnificans, dx Fe studies tx phlebotomy
Eosinophilic esophagitis
Men 20-30, intermittent meat food impaction, dx bx eos>15, tx diet + topical glucocorticoid
Liver tplant allograft rejection
12d post-op, bx PNM, eos in hepatic triads
Splenic rupture
atraumatic hem ca, EBV, infl (SLE, pancreatitis) + AC
Parenteral nutrition
<2w central line infx, >2w cholelithiasis
SBO
adhesions, NO AIR IN RECTUM
Esophageal rupture
+- widened mediastinum, pleural effusion GREEN, stable esophagography unstable surg, TRAUMA PT
Ulcerative colitis
Mild <4 poops a day, mesalamine can do enema if rectosig only, mod-severe TNFa inh (infliximab)
ERCP complications
Pancreatitis (SOD) dx 2/3 epig pain lipase/amylase>3x nl imaging, ascending infx cholangitis, perf
Lap chole complications
Biliary leakage 2-10d alk phos bili nl ducts on imaging
Retained gallstone dilation
Thoracic gun shot wound
Below nipple T4 FAST equivocal + hemodynamic instability ex lap
Gastric cancer
Chinese IDA, mets to liver, DX EGD
Splenic abscess
Lap chole, IC or DM, LUQ pain, fever, can be 2/2 IE (esp pt w known valve dz), dx CT tx SPLENECTOMY
Niemann-Pick
sphingomyelin, tay-sachs +HSM +hyper-reflexia (tay sachs areflexia)
Ogilvie syndrome vs SBO
Ogilvie’s: COLON, trauma/surg/infx/neuro probs, autonomic dysfxn, hypoK hypoMg, NG tube, neostigmine >48h >12cm
SBO: SMALL BOWEL
Vascular ring
Extra aortic arch biphasic stridor dysphagia T3-4
Cirrhosis
HypoCa, Mg, albumin
Vomiting electrolytes
HypoCl, hypoK, metabolic alkalosis (high bicarb)
Ischemic hepatic injury
Hypotension (pt w shock) —> ^^^LFTs rapid onset
Bilious nonbilious vom <1mo
Bilious volvulus XR—>EGD
Nonbil—>pyloric stenosis
