gi Flashcards
win
constipation
causes
tx
• Persistent, difficult, infrequent or seemingly incomplete defecation
• Causes: IBS, medications, endocrine disorders, psych disorders, MS, neuro
disorders, malignancy, hemorrhoids, stricture, ischemia, inflammatory
diarrhea
causes
Causes: can be acute or chronic
• Acute (< 2 weeks): infection, medications
• Chronic (>4 weeks): medications, toxins, malabsorption, hormones, cancer,
dysmotility disorders, eating disorders, bariatric surgery, cholecystectomy
ileus
definition
causes
dx
tx
• Functional obstruction, dysmotility prevents intestinal contents from
being propelled distally, not a mechanical blockage
• Causes: surgery, electrolyte abnormalities (low K, low mag, low Na),
medications, intestinal ischemia, GI bleed, sepsis,
hyperparathyroidism, LL pneumonias, Ogilvie’s Syndrome, collagen
vascular disease (SLE or scleroderma)
• S/S: abdominal pain, distention, emesis, obstipation
• Diagnostics: CBC, CMP, x-ray first
SBO
causes
S/S
DX
TX
Mechanical obstruction • Causes: adhesions, malignancy, hernia, inflammation, intussception, volvulus • S/S: same as ileus • Exam: oliguric, hypotension, tachycardic, fever, decreased bowel sounds • Diagnostics: same as ileus • Treatment: supportive care, NGT, IVF fluids, foley, admit to ICU, resection if conservative efforts unsuccessful
S/S: abdominal pain, distention, emesis, obstipation
• Diagnostics: CBC, CMP, x-ray first then CT scan
large bowel Obstruction
definition s/s exam dx tx
Blockage in the large bowel • Causes: malignancy, diverticulosis, volvulus • S/S: abdominal pain, n/v • Exam: Abdominal swelling and pain • Diagnostics: abdominal x-ray or CT scan • Treatment: surgical emergency
gastroparesis
definition
causes
s/s
Delayed gastric emptying in the absence of mechanical obstruction,
due to vagus nerve damage, food is unable to move through the
digestive system appropriately
• Causes: diabetes, gastric surgery, medication
• S/S: n/v, delayed gastric emptying, signs of malabsorption
gastroparesis
exam
dx
tx
Upper GI Series – excludes mechanical obstruction, retention of
barium without obstruction is diagnostic
• Endoscopy – highly suggestive
• Gastric emptying study – solids more sensitive than liquids
• Treatment: Reglan, erythromycin, botox, surgery
appenndicitis
Inflammation of the appendix leading to infection
• Older adult at risk for perforation, pain > 48 hours
increases risk
• Etiology not completely understood
• Symptoms: RLQ pain, anorexia, constipation, diarrhea,
fever, nausea, vomiting, radiates to right flank or RUQ, pain
progressively worsens, urinary symptoms
• Exam: RLQ tenderness, rebound tenderness, rectal pain,
rigidity, psoas sign, obturator sign, Rovsing’s sign, palpable mass (less common)
• Diagnostics: CBC, UA, amylase, lipase, pregnancy test, CT
scan (but may not always show inflammation)
• Treatment: appendectomy
acute cholecystitis
definition
causes
s/s
dx
tx
Acute inflammation of the gallbladder
• Causes: obstructed gallstone
• Inflammatory response
• 1. mechanical inflammation – increased intraluminal pressure and distention resulting in ischemia
• 2. chemical inflammation – lysolecithin release
• 3. bacterial inflammation – E. coli, Klebsiella, Strep, Clostridium
• S/S: fever, chills, rigors, RUQ pain , n/v, palpable mass, rebound tenderness,
distention, hypoactive bowel sounds if ileus,
• Diagnostics: CBC, LFTs, US to identify gallstones, HIDA scan to confirm, H
and P (fever, leukocytosis, RUQ pain)
• Treatment: cholecystectomy, cholecystomy
cirrhosis /chronic liver disease
definiton causes exam dx tx
Liver fibrosis causes distortion decreasing hepatocellular mass
resulting in decreased function and blood flow
• Causes: alcoholism, hepatitis, congenital, nonalcoholic
steatohepatitis
• S/S: nonspecific symptoms, to RUQ pain, fever, nausea, vomiting,
diarrhea, anorexia, malaise, ascites, edema, UGI bleed, palmer
erythema
• Exam: hepatosplenomegaly
• Diagnostics: LFTs, CMP, liver biopsy (no ETOH x 6 months)
• Treatment: abstinence, supportive care, treat underlying cause
acute hepatic failure
• Rapid liver failure, usually with no history of liver disease
• Causes: acetaminophen overdose, medications, herbals, hepatitis,
toxins, autoimmune, vascular abnormalities, cancer, sepsis
• S/S: jaundice, RUQ pain, abd swelling, n/v, malaise, AMS, lethargy
• Complications: bleeding (not making clotting factors), cerebral
edema, infections, renal failure
• Treatment: stop cause, liver transplant
acute viral hepatitis
• Systemic infection affecting the liver • Causes: Hep A, Hep B, Hep C, Hep D, or Hep E (All RNA viruses except Hep B) • Diagnostics: LFTs, CMP, CBC, see next slide
Hep A/E
S/S
transmission is
vowel comes from the bowel
A va E no vax
S/S RUQ pain
NV anorexia
weight loss
fever, chills jaundice dark urine history of exposure
transmission is fecal oral
hep C transmission and vax
blood / Semen no vax
hepatitis all type tx and dx
rest, activity as tolerated, nutrition and hydration
dx is presence of specific antibody/antigen in the serum
hep B Vax and transmission
blood, semen, saliva, yes vax
hep D is what, vax ?
Hepatitis superinfection on top of HBV, transmission is blood.
hep testing first antibody to appear in response to atigen
Reminder: IgM is first antibody to appear in response to an antigen
acute hep b testing
• Acute hep B: + HBsAg, + IgM Anti-HBc
chronic hep B antigen
Chronic hep B: + HBsAg
Acute hep A on chronic hep B
Acute hep A on chronic hep B: +HBsAg, +IgM Anti-HAV
Acute hep A and hep B
+HBsAg, +IgM Anti-HAV, IgM Anti-HBc
Acute hep C
+Anti-HCV
Hep A
acute onset
causes
prophylazis
tx
Acute onset with 15-45 days incubation
• Causes: fecal oral transmission (eating or drinking), sexual activity
• Prophylaxis: inactivated vaccine
• Treatment: rehydration, rest, avoid alcohol, time
