GI Flashcards
Parietal pain
sharp localized
colicky pain is usually felt with which problems?
intestinal obstruction, renal calculi
where does pancreatitis radiate?
to the back
where does renal calculi radiate?
to the groin
when does mesenteric ischemia begin?
within one hour of eating
How can a person relieve pancreatitis pain without medical intervention?
sit up and lean foreward
What is a normal AAA size?
2cm
How big does a AAA get for it to be considered dilated?
> 3cm
How big can a AAA get for it to be at risk for rupture?
> or equal to 5cm
what test do you do in order to diagnose a AAA?
CT test
How often do you do ultrasounds for a stable AAA >4cm?
q2 years
How often do you do ultrasounds for a AAA > or equal to 5cm?
q6months
When should you refer a AAA to a thoracic surgeon?
> 5.5cm
which in office tests should you do for appendicitis?
psoas sign, mcBurneys point, Rovsing sign, orbturator sign
what kind of lab work should you do for appendicitis?
CBC and CRP
Rosvings sign
pain in right lower quadrant when the left lower quadrant is palpated (appendicitis)
Orbturator sign
rotate hip inwardly while knee slightly bent (appendicitis)
Psoas sign
Lift leg while your hand is on the thigh, create resistance (appendicitis)
Murphys sign
palpate under rib cage while patient takes a deep breath, will elicit pain if gallbladder
McBurneys point
pain felt at umbilicus when RLQ pushed
2 main causes for a bowel obstruction
#1 Adhesions from surgery #2 Groin hernia incarceration
patient s/s of bowel obstruction
crampy, periumbilical or diffuse pain, unable to have BM or flatus, N/V sensation of fullness
physical findings of bowel obstruction
distention, tympany, absent, high pitched or tinkling bowel sounds
WBC greater than what suggests bowel necrosis or abscess or peritonitis?
> 20,000
What will an xray show with a bowel obstruction?
air fluid levels, dilated loops of bowel, lack of gas in distal bowel and rectum
What is the treatment for a bowel obstruction?
fluid resuscitation, NGT, surgical consult
what kind of lab work/tests should you do to diagnose a bowel obstruction?
abdominal xray series or CT scan
your chances of getting diverticulitis increase q___years starting at age 40
10 years
Diverticulitis treatment
- ) Cipro + flagyl
- ) Bactrim + flagyl
- ) Augmentin
- ) Moxifloxacin
which antibiotic should you avoid with renal patients and the elderly?
Bactrim
with severe diverticulitis what test should you do to determine severity? and what other thing might you have to do?
CT scan and hospitalization
s/s of cholecystitis/Cholelithiasis (patient may not have all symptoms)
n/v, sudden sharp pain in URQ, fever, positive Murphy sign, jaundice, palpable gallbladder
a positive murphys sign helps to diagnose what problem?
cholecystitis/Cholelithiasis
what lab findings will show with cholecystitis/Cholelithiasis
elevated WBC, elevated bilirubin, elevated serum aminotransferase and alk phos.
A hepatobiliary (HIDA) scan is helpful for which problems
liver, gallbladder and bile ducts
which type of scan is used to evaluate the rate at which bile is released from the gallbladder?
HIDA scan
if radioactive tracer moves through the bile duct very slowly, what does this indicate?
there may be a blockage or obstruction or a problem with the liver function
If the radioactive tracer isnt seen in your gallbladder, this may indicate what?
acute inflammation (acute cholecystitis)
If the amount of radiotracer leaving the gallbladder is low after giving the medication CCK, what may this indicate?
chronic inflammation (chronic cholecystitis)
if the radioactive tracer is found in other areas outside the biliary system, what could this indicate?
a leak
Cholelithiasis
gallstones
cholecystitis
gallbladder
Treatment for acute Cholelithiasis
laparoscopic cholecystectomy
Treatment for cholecystitis
will subside on own (will come back),need to go on a low fat diet. Cipro and flagyl BID with low grade fever
first line treatment for GERD
antacids
antacids
maalox, mylanta, tums, gelusil
function of H2 receptors and PPIs
they block acid production
H2 receptors
cimetidine (tagament), famotideine (pepcid), ranitidine (zantac)
PPI
lansoprazole (prevacid), omeprazole (prilosec)
what kind of drugs put a patient at risk for pancreatitis
amiodarone, antivirals, diuretics, NSAIDS, antibiotics
risk factors for pancreatitis
alcohol, gallstones, severe hyperlipidemia, certain drugs
s/s of pancreatitis
epigastric pain, constant boring pain, radiates to back, severe, n/v, bloating
physical findings of pancreatitis
low grade fever, tachycardia, hypotension, respiratory symptoms such as pleural effusion, atelectasis, illeus
late physical finding of pancreatitis
peritonitis
cullens sign
bluish discoloration around the umbilicus
grey turner sign
bluish discoloration of the flanks
what lab are indicative of pancreatitis and what lab is not
lipase, level will be 2 times elevated, amylase is not specific..dont bother with it
what kinds of tests can you do for pancreatitis
RUQ ultrasound, CT scan (not necessary to diagnose pancreatitis, not useful in the early stages, helpful in evaluating complications)
what are the pros and cons of a CT scan for pancreatitis
not necessary to diagnose pancreatitis, not useful in the early stages, helpful in evaluating complications
Pancreatitis treatment
NPO, fluid resuscitation, maintain urine output of 100cc/hr, no antibiotics unless severe
antibiotics for pancreatitis treatment in severe cases
imipenem or cipro with flagyl
mild disease treatment for pancreatitis
discharge on liquid diet, follow up in 24-48 hours, all others admit
are gastric ulcers relieved by food or do they feel worse after eating?
worse after eating
which ulcers are associated with obstruction (bloating, N/V) which are caused by edema and scarring?
pyloric channel ulcers
are duodenal ulcers relieved by food or do they feel worse after eating?
relieved by food, hurts again 2-3 hours after meal
when do duodenal ulcers usually appear?
mid morning, usually awakens a patient at night
what do serologic assays show? but what are the negatives about this test?
antibodies to H.pylori BUT these tests can be positive for up to 3 years after treatment of an infection and antibody levels don’t decline for up to 6-12 months after treatment these tests aren’t used
why are PPIs good for use of H.pylori treatment?
they suppress H.pylori, they decrease acid production causing an increase in stomach pH which is a hostile environment for H.pylori
antibiotic treatment for H.pylori
PPI (Prilosec or prevacid) plus clarithromycin (Biaxin) plus amoxicillin (or flagyl if allergic to PCN) for 14 days
most common GI surgical emergency in elderly?
acute cholecystitis
a lack of free airon chest xray does or does not rule out perforation?
does not
what do you suspect if patient has biliary colic that lasts more than 6 hours?
early cholecystitis
what do you have to rule out in the elderly that have renal colic symptoms?
AAA
ovarian torsion s/s
tachycardia, decreased bowel sounds, fever, acute rigid abdomen, peritonitis
do ovarian torsions have an acute onset?
yes
when does a testicular torsion need to be repaired in order to salvage the testicle?
6 hours
treatment for testicular torsion
emergent urology consult, ultrasound with doppler
ovarian torsion treatment
GYN consult, IV fluids, NPO, pain medications, ultrasound
