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
Hep B
incubation period
causes
prophylaxis
tx
Insidious or acute onset with a 1-6 month incubation
• Causes: percutaneous, perinatal, sexual
• Prophylaxis: HBIG vaccine, screen high risk populations
• Treatment: interferon, lamivudine, adefovir, pegylated interferon,
entecavir, telbivudine, tenofovir
Hep C
onset
causes
vax
tx
Insidious onset with 15 days to 4 months incubation
• Causes: percutaneous, sexual
• No vaccine, screen high risk individuals
• Treatment: Pegylated interferon plus ribavirin, telaprevir, boceprevir
Hep D
where is it found incubation period causes prophylaxis tx
Usually found in Mediterranean countries, in US found in those with
frequent blood transfusions
• Insidious or acute with 1 – 6 month incubation period
• Causes: percutaneous, perinatal, sexual
• Prophylaxis: HBV vaccine
• Treatment: Pegylated interferon
Hep E
where found
transmitted
acute onset/incubation prophylaxis
tx
Found in India, Asia, Africa, Middle East, Central America.
• Transmitted through water contamination
• Acute onset with 2 week to 2 months incubation
• Prophylaxis: vaccine only in China
• No treatment
Acute Pancreatitis
definition causes S/S Exam Dx
Pancreatic inflammation
• Causes: Gallstones, ETOH, hypertriglycideremia (> 1000 mg/dl),
ERCP, medications, trauma, post-op abd surgery, connective tissue
disorders, Ca, inc calcium, cystic fibrosis, autoimmune, idiopathic
• S/S: abdominal pain, n/v, abdominal distention
• Exam: fever, tachy, hypotension, shock
• Diagnostics: amylase (elevated for 3-7 days), lipase (elevated for 7-14
days), CBC (inc WBC), hyperglycemia, hypocalcemia, inc LFTs, abd US
in ED
early acute phase of pancreatitis
Early acute phase – less than 2 weeks, most patients have SIRS and
will become septic if not recognized early, older, obese and multiple
comorbid conditions put patient at greater risk
Late acute phase of acute pancreatitis
• Late acute phase – greater than 2 weeks, complications arise from
early acute phase and now need to be treated
Severity of acute pancreatitis
Severity of acute pancreatitis
• Mild – no local complications or organ failure, resolves 3-7 days with
treatment
• Moderate – transient organ failure resolving in less than 48 hours
• Severe – persistent organ failure, > 48 hours, local complications noted
Tyes of pancreatitis by ct Interstitial
Diffuse gland enlargement • Homogenous contrast enhancement • Mild inflammatory changes • Peripancreatic stranding
types of pancreatitis by CT necrotizing
Necrotizing • Takes several days to evolve • Lack of pancreatic parenchymal enhancement with IV contrast on CT • Peripancreatic necrosis
treatment of acute pancreatitis
Mild severity – full liquid diet once nausea and vomiting subside, low fat diet
• Aggressive IV fluids in the ED – LR or NS 15-20cc/kg bolused then 3mg/kg and hour afterwards, expect a drop in hct to determine if fluids are working
• Maintain UO at 0.5 c/kg/hour
• NPO
• IV pain meds
• Oxygen via NC
• ICU admission
• Treat underlying cause – gallstones > ERCP, inc trig > insulin, heparin or
plasmapheresis
complications of acute pancreatitis
Local
Local • Necrosis • Fluid collections • Pseudocyst • Ascites • Splenic vein or portal vein thrombosis • Bowel infarction • Obstructive jaundice
complications of acute pancreatitis systemic
Systemic • Pulmonary • CV • DIC • GI bleed • Renal – ATN, oliguria, thrombosis • AMS • Metabolic - encephalopathy
chronic pancreatitis
definition
causes TIGAR-O
Irreversible damage to the pancreas from reversible changes in acute pancreatitis • Causes: TIGAR-O classification • T = toxic-metabolic • I = idiopathic • G = genetic • A = autoimmune • R = recurrent pancreatitis • 0 = obstructive
chronic pancreatits
s/s
D/x
TX
Complications
S/S: see acute slide • Diagnostics: see acute slide in addition, CT then MRI, secretin test has best sens/spec • Treatment: Pancreatic enzymes • Complications: chronic pain, narcotic addiction, DM, gastroparesis, malabsorption, jaundice, retinopathy, pancreatic CA, cirrhosis, metabolic bone ds
chrons disease
can effect.... s/s dx exam tx complications
Can affect any part of the GI tract, rectum is spared, transmural
process, aphthoid ulcerations and focal crypt abscesses with loose
aggregations of macrophages
• S/S: acute or chronic bowel inflammation, RLQ pain, diarrhea, colicky,
low grade fever, weight loss, fear of eating, anorexia
• Exam: inflammatory mass palpated, urinary obstruction
• Diagnostics: CBC, CRP, CMP, ESR, endoscopy (capsule is best),
• Treatment: IV fluids and bowel rest, replace electrolytes
• Complications: fistulas, adhesions, perforation
UC
mucosa is…
s/s
dx
complications
Mucosal disease involving the rectum and all parts of the colon
• Mucosa is erythematous and resembles sandpaper, severe cases
hemorrhage is present, edematous and ulcerated
• S/S: rectal bleeding, tenesmus, passage of mucus, crampy abd pain,
proctitis
• Diagnostics: similar to Crohn’s, barium enema, sigmoidoscopy during
flare, colonoscopy if in remission
• Complications: toxic colitis, megacolon, perforation
diverticulitis or osis
…..herniation
complicacated
uncomplicated
tx
surgical management
Saclike herniation in the bowel wall, generally left and sigmoid colon,
causing inflammation
• Determine if complicated or uncomplicated
• Uncomplicated: abdominal pain, fever, leukocytosis, anorexia
• Complicated: abscess, perforation, stricture, fistula
• Treatment: diet alterations and increase fiber for uncomplicated,
bowel rest and Bactrim or Cipro and Flagyl for complicated
• Surgical management: Diverting colostomy, Hartman’s procedure,
patients who are not responding medically
GIB
causes s/s exam dx tx
Hematemesis or hematochezia
• Causes:
• UGI: PUD, gastritis, varices, Mallory-Weiss Tear (retching), AV malformation, malignancy, liver disease
• LGI: hemorrhoids, diverticulosis, AV malformation, colitis
• S/S: bright red blood, coffee ground, clots, retching, melena, blood in toilet, black
stool
• Exam: orthostatic, fatigue, exertional dyspnea, cool, clammy skin, pallor
• Diagnostics: fecal occult blood test, CBC, CMP, coags, Type and cross, LFTs, EGD, colonoscopy*, bleeding scan
• Treatment: stop bleeding, NGT unless contraindicated, blood transfusion, large
bore IV for fluids, foley • Varices: octreotide, banding, TIPS (shunt), balloon tamponade, IV PPI, empiric abx
GERD
defnition causes s/s dx tx complications
• Refluxed gastric acid and pepsin cause necrosis of the esophageal
mucosa causing erosions and ulcers.
• Causes: eosinophilia, infectious, herpetic, CMV
• S/S: heartburn, dysphagia, chest pain
• Diagnostics: endoscopy
• Treatment: lifestyle modifications, PPI, H2 blocker
• Complications: chronic esophagitis, adenocarcinoma, Barrett’s
esophagus
mesenteric ischemia
definition causes s/s exam dx tx
• Perfusion fails to meet the metabolic demands of the intestines
resulting in ischemia
• Causes: heart disease, shock, cocaine overdose
• S/S: abdominal pain, n/v, diarrhea, anorexia, bloody stools
• Exam: decreased bowel sounds, abdominal distention
• Diagnostics: CBC, CMP, coags, ABG, amylase, lipase, lactate, LFTs,
cardiac enzymes, CT angio, colonoscopy, spiral CT
• Treatment: ICU management, laparotomy, hydration, antibiotics,
oxygen
• Chronic: reduce risk factors
PUD
definitions causes s/s dx tx complicatons
Burning epigastric pain, worsened by fasting, relieved with eating
• Causes: H. Pylori, NSAIDs, COPD, CRI, tobacco use, older age, ETOH
use
• S/S: abdominal pain, bleeding, n/v, dyspepsia
• Exam: orthostatic, tachycardia, epigastric tenderness, rigid abdomen
• Diagnostics: barium swallow, endoscopy, H. pylori testing, biopsy
• Treatment: antacids, H2 blockers, PPI, sucralfate, bismuth,
prostaglandin analogue
• Complications: bleeding, perforation, obstruction
H Pylori tx
Bismuth, metronidazole, tetracycline
• Ranitidine bismuth citrate, tetracycline, clarithromycin or
metronidazole
• Omeprazole, clarithromycin, metronidazole or amoxicillin
• Omeprazole, bismuth, metronidazole, tetracycline
AKI
definition causes s/s dx tx complications
Sudden impairment of kidney function, retention of waste products
• Causes: Prerenal, Intrinsic, Post-renal (see next slide)
• S/S: related to cause
• Diagnostics: serum Cr, rise of at least 50% than baseline 1 week prior,
0.3 mg/dl in 48 hours, or UO less than 0.5 ml/kg/hr in 6 hours
• Treatment: IV fluids, remove nephrotoxic agent, optimize
hemodynamics, treat underlying causes
• Complications: ARF
pre-renal AKI
Prerenal • Hypovolemia • Decreased CO • CHF • Liver failure • NSAIDs • ACE • Cyclosporine
Intrinsic causes of AKI
Intrinsic • Sepsis • Ischemia • Nephrotoxins esp contrast • Acute glomerulonephritis, • Vasculitis • Malignant HTN • Post operative
post renal aki is
obstruction
CKD
causes
dx
tx
complications
Progressive decline in GFR
• Causes: small for gest weight, obesity, HTN, DM, autoimmune, older
adults, African ancestry, family history, AKI in the past, inherited
• Diagnostics: GFR needed to stage CKD
• Treatment: depending on stage, treat underlying cause, adjust
medications, dialysis for ESRD
• Complications: electrolyte imbalances, metabolic acidosis, anemia
CKD stake I
gfr >90
CKD II
GFR 60-90
CKD IIIa
GFR 45-59
CKD 3B
GFR 30-44
CKD 4
gfr 15-29
CKD stage 5
gfr <15
UTI causes
Can be symptomatic or asymptomatic • Asymptomatic bacteriuria • Cystitis • Prostatitis • Pyelonephritis • Uncomplicated vs complicated • CAUTI • Causes: sexual intercourse, DM, incontinence, catheter, diaphragm with spermicide, pregnancy, functional or anatomic abnormalities
UTI bacteria
Bacteria: E. coli is predominant, Pseudomonas, Klebsiella, Proteus, Citrobacter, Acinetobacter, Morganella
UTI
s/s
dx
tx
S/S: dysuria, urinary frequency, urgency, nocturia, hesitancy, pain, hematuria, fever, CVA pain
• Diagnostics: urine culture and urinalysis, CBC, blood culture
• Treatment: antibiotic based on cultures
