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PANCE 2.0 > GI #9 > Flashcards

GI #9 Flashcards

1
Q

What is the most accurate test for nonalcoholic fatty liver disease?

A

Biopsy: micro vesicular fatty deposits similar to alcoholic liver disease without the history of heavy alcohol consumption

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2
Q

Review Primary Biliary Cirrhosis and Primary Sclerosing Cholangitis

A
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3
Q

What is Wilson’s Disease?

A

-Autosomal recessive disorder leading to copper accumulation in the body (liver, brain, kidney, joints, and cornea)

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4
Q

What is the pathophysiology of Wilson’s Disease?

A

-Defect in chromosome 13 leads to decreased biliary copper excretion due to decreased ceruloplasmin

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5
Q

Symptoms of Wilson’s Disease

A
  • Liver: Hepatitis, cirrhosis, liver failure
  • CNS: Dysarthria (MC), dystonia, tremor, rigidity, dementia, seizures, ataxia
  • Psychiatric: Behavioral changes, psychosis, delusions
  • Joints: arthralgias
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6
Q

What is unique and seen on physical exam with Wilson’s Disease?

A

Kayser-Fleischer rings: brown or green pigmented rings due to copper deposition in cornea

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7
Q

How to diagnose Wilson’s Disease?

A
  • Decreased serum ceruloplasmin
  • Liver biopsy: Definitive
  • Molecular genetic testing for ATP7B
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8
Q

Treatment for Wilson’s Disease

A

-Copper-chelating agents: Trientine (less side effects) or D-Penicillamine

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9
Q

What is given with D-Penicillamine and why?

A

Pyridoxine (B6) to prevent B6 deficiency

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10
Q

What is also given to patient’s with Wilson’s Disease and what does it do?

A

Zinc supplementation because it interferes with intestinal copper absorption

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11
Q

Where does an indirect inguinal hernia occur?

A

-Lateral to inferior epigastric artery

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12
Q

True or False: an indirect inguinal hernia is the MC type of hernia in both sexes, young children, and young adults?

A

True

Indirect is the MC type

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13
Q

What is the pathophysiology of an indirect inguinal hernia?

A
  • Often congenital due to a persistent patent process vaginalis
  • Increase in abdominal pressure may force intestines through internal ring into inguinal canal and may follow testicle tract into scrotum
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14
Q

Symptoms of an indirect inguinal hernia

A
  • Swelling or fullness at site
  • Scrotal swelling
  • Enlarges with standing or pressure
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15
Q

Symptoms of an incarcerated hernia

A
  • Painful enlargement of an irreducible hernia

- Nausea, vomiting

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16
Q

Symptoms of a strangulated hernia

A
  • Systemic toxicity (irreducible with compromised blood supply)
  • Severe painful bowel movement (may refrain defecation)
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17
Q

How do you initially diagnose an inguinal hernia?

A

Groin US

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18
Q

Treatment for inguinal hernia?

A

Often require surgical intervention

-Strangulated hernias are a surgical emergency

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19
Q

Where do direct inguinal hernias occur?

A

-Medial to inferior epigastric artery within Hesselbach’s triangle

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20
Q

What are the components of Hesselbach’s Triangle?

A

-RIP

  • Rectus abdominus (medial)
  • Inferior epigastric (lateral)
  • Poupart’s Ligament (inferior)
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21
Q

Femoral hernias are MC found in ______ and because the femoral ring is smaller, they often become ________

A

Women

Incarcerated or strangulated

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22
Q

Treatment for umbilical hernias

A
  • Usually resolve by 2 years of age

- Surgical repair may be indicated if still persistent by 5 years of age to avoid strangulation or incarceration

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23
Q

Incisional hernias MC occur with what type of incisions and in what patients?

A
  • Vertical incisons

- Obese patients

24
Q

What are the four mainstays of treatment for diarrhea?

A
  • Fluid repletion: oral hydration preferred (IV saline, sports drinks, Pedialyte)
  • Diet: bland, low-residue diet (BRAT Bananas, Rice, Applesauce, Toast)
  • Anti-Motility Agents: Bismuth-Subsalicylate, Loperamide
  • Antiemetics: Ondansetron, Dolasetron, Promethazine, Metoclopramide
25
Q

With diarrhea, what is vomiting usually from?

A

Imbalance of serotonin, acetylcholine, dopamine, and histamine

26
Q

Side effects of Pepto-Bismol (Bismuth-Subsalicylate)

A

-Dark colored stools, darkening of tongue

DO NOT GIVE TO CHILDREN WITH VIRAL ILLNESS: RISK OF REYE SYNDROME

27
Q

What are important side effects of Metoclopramide?

A

-Extrapyramidal effects: rigidity, bradykinesia, tremor, akathisia (restlessness)

28
Q

If the patient is having extrapyramidal side effects from Metoclopramide, what is the treatment?

A

-Diphenhydramine IV

29
Q

What is the MC overall cause of gastroenteritis in adults in North America and MCC of viral gastroenteritis worldwide?

A

Norovirus Gastroenteritis

30
Q

Transmission of Norovirus

A
  • Fecal-oral route
  • Contaminated food and water

-Outbreaks (cruise ships, hospitals, restaurants)

31
Q

Symptoms of Norovirus Gastroenteritis

A
  • Vomiting is predominant symptom
  • Nausea
  • Non-bloody diarrhea that lacks mucus
  • Generalized symptoms
32
Q

Treatment for Norovirus Gastroenteritis

A

-Fluid replacement (oral preferred)

33
Q

Rotavirus gastroenteritis is MC seen in what population?

A

-Young, unimmunized children between 6 months and 2 years of age

34
Q

To diagnose Rotavirus, you can do which test?

A

PCR testing

35
Q

Treatment for rotavirus gastroenteritis

A

-Oral rehydration

36
Q

Explain what Staph-A gastroenteritis is

A

-Infection due to heat-stable enterotoxin B

37
Q

What is the incubation period for Staph-A gastroenteritis

A

-Short: within 6 hours

38
Q

Source of Staph-A gastroenteritis

A
  • Food contamination (dairy products, mayo, meats, eggs, salads) especially at room temperature
  • Common at picnics
39
Q

Sources of bacillus cereus gastroenteritis

A
  • Contaminated food (such as fried rice)

- Enterotoxin that can survive reheating

40
Q

What is the MCC of traveler’s diarrhea?

A

Enterotoxigenic E. Coli

41
Q

Transmission of enterotoxigenic E. coli

A

-Contaminated food and water (includes unpeeled fruits washed in the water)

42
Q

Symptoms of Enterotoxigenic E. Coli

A

-Abrupt onset of watery, non-bloody diarrhea, abdominal cramping, vomiting

43
Q

Vibrio Cholerae is what shape? How is it transmitted?

A
  • Gram-negative, comma shaped rod

- Contaminated food and water

44
Q

Outbreaks of Vibrio Cholerae occur where?

A

-During poor sanitation and overcrowding conditions (especially abroad)

45
Q

What is the pathophysiology of vibrio cholerae?

A

Exotoxin causes secretory diarrhea (inhibition of water, sodium, and chloride absorption) which may cause profound dehydration and hypovolemia

46
Q

Symptoms of vibrio cholerae diarrhea

A
  • Vomiting
  • Abdominal pain
  • Copious watery diarrhea (rice water stools) that have grey flecks of mucous and may have a fishy odor but no fecal odor, blood, or pus
47
Q

Treatment for vibrio cholerae?

A
  • Oral rehydration therapy mainstay

- Tetracyclines if needed (Tetra, Doxy, Mino)

48
Q

Prevention of vibrio cholerae in areas where it is endemic

A
  • Use bottled water
  • Wash hands often with soap
  • Use chemical toilets
  • Cook food thoroughly
49
Q

How are vibrio parahaemolyticus and vulnificus transmitted?

A

-Raw or undercooked shellfish consumption and seawater especially during summer months

50
Q

Vibrio parahaemolyticus causes gastroenteritis primarily; however, what does vibrio vulnificus cause?

A

Gastroenteritis, necrotizing fasciitis, cellulitis

51
Q

Vibrio Vulnificus is the MCC of

A

death from seafood consumption in the US

52
Q

Risk factors for bacteremia with vibrio parahaemolyticus and vibrio vulnificus?

A

Underlying liver disease (alcoholism, cirrhosis, hemachromatosis)
Immunocompromised (DM)

53
Q

Cellulitis from vibrio vulnificus occurs due to

A

wound exposure to seawater

54
Q

For cellulitis associated with vibrio vulnificus, what is the treatment?

A

Tetracyclines (Tetra, Mino, Doxy)

55
Q

For necrotizing fasciitis associated with vibrio vulnificus, what is the treatment?

A

Emergent surgical debridement + broad spectrum ABX

PANCE 2.0 (62 decks)

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