GI Flashcards
What is a palpable spleen indicative of?
mono, sickle cell anemia
What are signs of an Acute Abdomen?
Involuntary guarding Abdominal Wall Rigidity Rebound tenderness Progressive severe abdominal pain Bile stained or feculent vomitus
What are the + signs indicative of acute appendiciits?
Psoas Sign
Obturator Sign
Rovsings Sign
Psoas Sign
RLQ pain on passive leg extension
Obturator Sign
Internal rotation of right hip causes RLQ pain
Rovsing’s sign
Palpation of LLQ will caused referred pain in RLQ
Markle Test
Heel Jar
Pelvic/ abdominal pain when pt drops heel on floor
or when pt jumps up and down
+ = PID, or acute Appendicitis
McBurney’s Point
the landing point of pain with a person with appendicits,
its is midway btw right anterior iliac crest and umbilicus
Presentation of Acute Cholecystitis / Biliary Dx
recurrent Colicky pain located in the RUQ
attacks come after a fatty meal
pain may radiate to Right shoulder or under scapula
+ murphy sign
what are gallstones called
cholelithiasis
For Acute Cholecystitis / Biliary Dx what is the imaging and labd
transabdominal US / Liver gallbladder US
elevated bili, and ALK phos
should refer to surgeon
who is in the high risk group for gallbladder dx
Mexicans, Pima Tribe, NA Ages 40-60 Females, Obese, Preg, DM, OC
Presentation of Acute Pancreatitis and PE and signs
LUQ pain, hx of alcohol abuse, acute onset of mid-epigastric boring abdomial pain that radiates to the back
PE: tenderness to palpation, mid-epigastric w/ guarding and rigidity, decreased bowel sounds
+ cullen’s sign = periumbical brusing, discoloration
+ Grey-turner sign = bruising on flank
sensitive tests for pancreatisis:
- amylase and lipase
Acute Colonic Diverticulitis presentation, risks, labs
LLQ pain
older/adult w/ sudden onset of mild to moderate abdominal pain and a mass on LLQ. Will have fever and anorexia
Risks: Low fiber / age 40 or older / western society
Labs : elevated WBC, nuetrophils, and bands
Complication of diverticulalitis
infected - abscess - perforation and bleeding
what is diverticula?
sac-like herniations on the colonic wall ( not infected)
Management for diverticulsis
MILD cases only
Clear liquids only, close follow up 2-3 days
Mild = not toxic, no peritoneal signs
Cipro po BID + Metronidazole po BID x 7-10 days
Augmentin
Bactrim
moderate/severe - ED
Peptic Ulcer Duondenal ulcer DX presentation, TX, bacteria
recurrent episodes of gnawing and buring epigastic pain within 2-5 hours after meals
pain present when stomach is empty or hungry
feels better after eating and relief w/ antiacids
90% are positive for H.pylori ( most common type of ulcer)
TX: OTC antacids, H2 Blockers, or PPI’s
Gastic Ulcers presentation
epigastric pain with worsens with eating, postprandial belching, earlu saitety, nausea, pain may radiate to back
higher risk of cancer with these ulcers
Who can you tx in a PCP?
under 55 yrs old
no alarming symtpoms (no early satiety, dysphagia, anorexia, weight loss, anemia, blood in stools)
older people and high risk should go to GI for upper endosocopy
Who should be tested for H.pylori infections
Active PUD
Hx of PUD ( w/o hx of previous H.pylori )
On chronic ASA or NSAID therapy
Labs for PUD
H.plyori
CBC (iron deficiency anemia means bleeding)
Fecal Occult blood test
When to use H.pylori Titer test
For testing of dx
IgM and IgG will be + if active infection
IgG will stay + for years
Urea Breath Test or stool antigen test is very specific as well
How do you confirm eradication of H.pylori?
urea breath test 4 or more weeks post treatment
What is the gold standard for dx of H.pylori?
upper endoscopy w/ biopsies and H. pylori testing
what is the #1 tx for H.pyloir
Think “ BMT” + PPI “ QUAD THERAPY”
Bismuth (pepto-bismol) + Metronidazole (flagyl) + tetracyline QID + PPI 10-14 days
what is the #2 rx for H.pylori?
Clarithromycin , Amox + PPI x 14 days ( may have some resistance)
What are examples of PPI”s
Omeprazole Prilosec
Esomeprazole Nexium
Lansoprazole Prevacid
Zollinger-Ellison Syndrome
TRAID: high level of gastric secretion, PUD and gastrinoma
can be benign or related to multiple endocrine neoplasia
symptom may be multiple ulcers
TX: PPI’s
Labs : fasting gastrin level increased ( hold PPI for 7 days prior to test)
Ulcer Perforation
acute onset of mid-epigastric pain that radiates to the right shoulder
Vomits frank blood to cofee-ground emesis
tachy, clammy, shock
What organs do NSAIDS effect?
GI tract, Kidneys, the CV system
What is the effect on GI system?what NSAID highest problem rate?
Blocks prostaglandins which regulates flow of GI tract
most compliactions with indomethacin, then naproxen, then diclofenac
Ways to decrease NSAID toxicity?
combine NSAID w/ PPI, Stop use of NSAID’s, can also combine with misoprostol
What is the Key with toradol?
max number of days per “ episode” is 5 and you can give first dose IM or IV. Do not combine with other NSAID’s, anitcoagulants, ASA
GERD presentation
middle-age adult c/o of daily episode of epigastic to mid-sternal pain( heartburn).
symptoms of sour taste, chronic sore throat, dry cough, esophageal erosion
what is a red flag sign in GERD
Barett’s esophagus : precurser to esophageal cancer and it is dx by Biopsy
when to refer people to GI specialist?
chronic (years) hx of GERD to r/o Barretts Esophagus
GERD management first line
- lifestyle and dietary changes ( lose weight, stop eating 3-4 hours prior to bedtime, elevate HOB. Avoid aggrevating foods, alchol, smoking
Food to avoid with GERD
mints/gum (relaxes esopheageal sphincter), alcohol, coffee
GERD management medication
- Antacids PRN ( see effect in 30/60 min) Maalox, Roliads, Tums
- H2 recepter antagonists ( ranitidine, famitidine) if no releif stop and add
- PPI’s for up to 8 weeks omeprazole, esomeprazole, lansoprazole
What are the averse effects of PPI’s
headache, diarrhea, abd pain
reduced absoption of mg, iron, vit b12
increased fractures ( reduced ca absoption)
c.diff
pneumonia
cv disease
renal disease ( stimulates immune response)
IBS in adults
RLQ pain
functional disorder ( no change in colon)
Acute/recurrent abdominal pain w/ changes in stool and pain related to defecation
adult women
there are multiple types ( IBS w/ constipation, w/ diarrhea, w/ mixed)
does not increase colon cancer risk
Alarm features of IBS
older than 50 weight loss abdominal mass, melana nocturnal adominal pain iron-def anemia fam hx of colon cancer
what is the dx criteria for IBS
recurrent abdominal pain w/ 1 day/wk (previous 3 months) w at least two of following - pain w/ defacation - change in # of stools - change in stool form / appearance
IBS tx
life style
- fiber supplementation - Psyllium can increase stool bulk
- Food diary for triggers
- Low FODMAP diet
- Avoid high FODMAP: wheat, onion, garlic, fruits
- stress reduction
pain - hypocyamine for spasms sublingual
5HT-3 antagonist - Lotronex for severe diarrhea IBS who have failed other tx. must have specific degree to tx
Giardiasis presentation, labs and tx
sudden onset of foul-smelling fatty stools w/ explosive diarrhea w/ abdominal cramping, flatuence, and malaise. chronic infection may have malabsorption and weight loss
labs: c/s for parasites
tx; Tinidazole or Falgy
what does low caliber stools indicate?
thin and narrow stools
may be caused by colon ca, diarrhea, ibs
refer to GI
when can celiac dx erupt? presentation
any age or after a viral URI, preg
recurrent hc of abdominal pain, bloating/gas, fatigue, migraine, HA’s, anemia, joint pain weight loss
What to avoid in celiac dx
gluten, wheat, barely, rye, kamut, spelt, titracale
UC keys
colon and rectum only (always rectum), rectal bleeding and more common to see gross blood in feces **
DX : Colonoscopy
Chrons keys
most common in ileum, strictures, fissues, skip lesions, not so much in rectum. May involve mouth , small intestine. If distal ileum is involved : crampy RLQ abdominal pain
Dx. colonosopy
UC and Chrons sympts
fatigue, weight loss, prolonged diarrhea w/ abdominal pain, fever, gross bleeding
non GI sympt : arthtitis, anklyosing spondilitis (back pain), (eye)uveitis, (skin)erythema nodosum, (lung) chronic bronchitis
Hemmoriods presentation and tx
recurrent right red blood from anal area. Hx of constipation, may have anal itching or pain during flare
will see soft bulging ble verins in anal area
OTC remedies, sitz bath, increase fiber, dont sit on toilet too long
AST
liver function test, elevated after acute MI
will see it in lever, cardiac, skeletal muscle, kidney and lung
ALT
most specific for liver dx
present in heart and liver
AlK Phos
bone - growing children, teens, healing fractures
liver, gallbladder, kidneys, placenta
GGT
lone elevation in alcoholic
if elevated w/ alk phos helps determine if it from lever or bone
Alcoholic Hepatitis
will see elevated GGT and a 2:1 ration with AST to ALT = alochol abuse
when do you see acute hepatitis s/s, labs , avoid
2-6 weeks after exposure.
fever, fatigue, loss of apetit
jaundice, dark urine, clay-colored stools
labs
ALT and AST will be normal ( if high it is indicative of viral hep)
Bili= normal to high
Avoid heptaotoxic things: statins, tylenol, alcohol
Hepatitis A
Spread: fecal - oral route
post exposure prop - admin vaccine
screening test: IgM anti HAV
Havrix
hep A vaccine
dose : two ( 0-6 months after)
give to MSM, international travel (mexico, central and south america, middle east, africa, SE asia
Hep B
spread: semen, vaginal secretions, saliva, blood products
LFT’s will be elevated
HBsAG
surface antigen = infected or infectious, acute or chronic
if + = they have it
Anti-HBs
surface antibody = indicates immunity ( either recovered from infection or hep B vaccine)
IgM anti-HBc
Hep B core antigen = recent infection ( is pt infectious)
HbeAg
hep B envelop antigen = virus replication and high levels of hep B virus
Where is Hep B most endemic?
Africa, southeast asia, western pacific, central and south america and carribean
Hep C
spread: IVDU, blood products to baby boomers ( 1945-1965).
screening : anti- HCV if + = order a HCV RNA by PCR
if both + then pt has dx
Antiviral tx is - 96-99% effective
Hep D
must be infected B to get D
