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Adult medicine > GI / abd pain > Flashcards

GI / abd pain Flashcards

1
Q

Can’t miss diagnosis of abd pain?

A

AAA, mestenteric ischemia, SBO, ectopic pregnancy, ovarian torsion, appendicitis, MI, cholangitis

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2
Q

What is the classic triad seen in 50% of AAA patients?

A

hypotension/syncope, pulsatile mass, dull abd pain

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3
Q

What is the imaging to assess AAA?

A

abd bedside US or abd CT with contrast

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4
Q

When to use abd US for appendicitis eval?

A

young non-obese, pregnant

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5
Q

When to use abd CT for appendicitis?

A

everyone else! use oral contrast if broad ddx, and IV if thin

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6
Q

What are the cutoffs for making C diff severe disease?

A

age > 65, Cr > 1.5x baseline, wbc > 15

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7
Q

What is a surgical emergency associated with c Diff?

A

colonic ileus / toxic megacolon

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8
Q

What are RF for c diff coliits?

A

recent abx, recurrence, PPI, chemo, IBD

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9
Q

What is the branch point for diverticulitis in terms of mgmt?

A

uncomplicated (microperforation) vs complicated (macroperforation) - abscess, peritonitis, fistula formation, obstruction (from inflammation)

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10
Q

What is the outpt mgmt for divertculitis if pt meets criteria?

A

cipro and flagyl for 10-14 days

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11
Q

What are the criteria needed for diagnosis of pancreatitis?

A

Epigastric characteristic pain; lipase > 3x normal; abd imaging

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12
Q

What are things to check for pancreatitis?

A

TG, RUQUS, alcohol levels (if unclear story)

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13
Q

What is the imaging needed for ovarian torsion?

A

TVUS

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14
Q

What are the RF for mesenteric ischemia?

A

PVD, Afib, CAD, valvular disease, AAA

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15
Q

What is definitive imaging for Mestenteric ischemia?

A

CT angiography

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16
Q

What are the four main systems for abd pain?

A

think GI; think GU/gyne; think cardiac. Also think vascular.

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17
Q

What are the indications for an ERCP when suspecting CBD stone?

A

high risk of CBD

If imaging shows CBD stone OR
cholangitis OR
bilirubin > 4mg/dl AND
Dilated CBD (>6mm/8mm)

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18
Q

What about approach to intermediate risk of CBD stone?

A

EUS or MRCP or lap chole with intraop cholangiogram

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19
Q

Charcot’s triad vs Reynold’s pentad

A

RUQ pain, fever, jaundice

+/0 AMS and hypotension

not seen in more than half of cholangitis patients

20
Q

What are other guidelines that can be used for Acute cholangitis?

A

Tokyo guidelines!

21
Q

Immediate treatment of acute cholangitis?

A

IV fluids and IV abx

cipro +/- flagyl (GNR + enteroccocus)

22
Q

2 out of 3 criteria for acute pancreatitis diagnosis?

A

1) lab - lipase 3x greater than normal
2) epigastric pain
3) CT imaging

single best imaging is abd ultrasound!

23
Q

When is abd CT helpful in pancreatitis?

A

diagnosis unclear, not improving after 48-72 hr

24
Q

What are labs and imaging you can get in pancreatitis?

A

labs - lipase, liver labs, TG (looking for dx)

imaging: CT esp if over 40 to look for mass if not sure about diagnosis

25
Q

What are predictors of mortality in acute panreatitis?

A

BUN if greater than 20 or rising more than 2 in 24 hours

26
Q

what is harmless acute pancreatitis score

A

normal hct; normal Cr; no abd guarding and/or rebound - 99% PPV of it’ll go ok!

27
Q

What are fluid treatment requirements in pancreatitis?

A

Bolus 10cc/kg then 1.5 cc/kg/hr

1.5 cc / kg/hr

WATERFALL 2022 NEJM study

28
Q

Nutrition for pancreatitis ?

A

start within 24-48 hours
do not NEED to start with clear liquids (low fat, normal fat, soft or normal diets are fine)
NGT or NJT > TPN

29
Q

when should CCY timing happen in mild gallstone pancreatitis?

A

BEFORE DISCHARGE

30
Q

etiology of pancreatitis? three most frequent

A

smoking! remember that. also gallstone, alcohol

31
Q

when to do early ERCP in gallstone pancreaitis?

A

if cholangitis OR retained CBD stone

32
Q

what score can help with determinine discharge for pancreatitis?

A

PASS score can help prevent early re-admission

33
Q

When does survival drop off re: MELD score?

A

Up until about 18-19

34
Q

SAAG > = 1.1

A

diagnostic for portal hypertension!

35
Q

Treatment for patients with cirrhosis

A
  • Na resrricted diet 2gm per day
  • dual diuretics - spiro/furosemide 100/40 to balance potassium levels

Fluid restriction not necessiary unless soidum < 125 mmol/L

36
Q

What ismgmt option with refractory ascites?

A

1) serial large volume para + albumin 6-8g/L removed VS
2) TIPS (ideal for patients with MELD < 18)

bridge to transplant

37
Q

What are the key criteria for HRS?

A

1) AKI definition - rise by .3 in 48 hours or > 50% in prior 7 days
2) no Cr improvement after 2 days diuretic withdrawal
3) no Cr improvement after 2 days of albumin

No signs of structural kidney injury, has bland urine sediment; absence of shock, nephrotoxins

38
Q

What are the medicines that are useful for HRS>?

A

terlipressin + albumin (vasoconstrictor)

OR cocktail - albumin/octretide/midodrine

STOP NSBB, TRY albumin on day 1 and day 3

39
Q

Tx for SBP?

A

1) CTX for 5 days
2) Albumin if BUN > 30, Cr > 1, serum bili > 4
3) stop NSBB

40
Q

What are main tx for HE?

A

high protein diet

lactulose +/- rifaximin

treat underlying trigger (SBP, etc)

41
Q

Acute bleeding management in cirrhosis

A

1) if non variceal - vit K, transfuse plt > 50K, fibrinogen > 100-120, consider anti-fibrinolytic

2) if variceal - management upper endoscopy within 12 hours, maintain Hgb 7-9 (higher can incvrease risk of bleeding)

Also IV CTX antibiotic prophylaxis

42
Q

With variceal bleeding, consider what meds class

A

NSBB (after octreotide acutely)

43
Q

timing for referal for LT?

A

clinical decompensation (HE, ascites, varicael hemorrhage, HCC, HRS)+ biochemical decompsensation (MELD > 15)

44
Q

what is the MELD?

A

MELD-Na since 2016, used since 2002 for liver allocation

MELD > 15 is threshold survival benefit

MELD inititally to predict survival post-TIPS

45
Q

What scores to look at for peri-op clearnece for cirrhohtics?

A

CP score b/c > 30/80% risk of mortality

MELD 12-15 - 25% risk of 30/90 day mortality

Adult medicine (13 decks)

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