GI brief Flashcards
Describe the first step in the management of a patient with hematemesis.
Establish an IV line and administer normal saline.
If pt needs blood: hametestmessis
packed RBCs.
What is the investigation of choice for hematemesis?
Upper GI endoscopy.
What is the diagnosis for an infant with persistent non-bilious vomiting starting at 2-6 weeks, marked dehydration, and weight loss?
Congenital hypertrophic pyloric stenosis (CHPS).
Inv of choice of CHPS:
US.
What is the treatment of CHPS?
First correct dehydration and electrolyte imbalance, then consider surgery.
- Vomiting at 2-6 Ws+ marked dehydration, bad general condition:
CHPS.
- Vomiting at 2-6 Ws+ NO dehydration, good general condition:
GERD.
Describe the presentation of a patient with acquired pyloric stenosis.
Long-standing history of peptic ulcer disease, recurrent vomiting occurring 1 hour after a meal, and a succussion splash on physical exam.
What is the first most common cause of peptic ulcer disease (PUD)?
H. pylori infection.
What is the second most common cause of PUD?
Smoking (other causes include stress, alcohol, NSAIDs).
Inv of choice of PUD:
upper GI endoscopy (biopsy only from gastric cancer).
What is the regimen for eradicating H. pylori?
Amoxicillin, clarithromycin, proton pump inhibitor (PPI).
Why is metronidazole removed from the regimen for H. pylori eradication?
Due to bacterial resistance.
What is the follow-up test after treatment for H. pylori infection?
Urea breath test.
What is the best advice for a patient with PUD?
Stop smoking.
TTT of Pt with PUD develops hematemesis:
1st step: IV line& normal saline. If need blood: packed RBCs.
Then: endoscopy& injection of adrenaline or heat probe if visible bleeding.
Describe the first step in the treatment of a patient with PUD who develops hematemesis.
Establish an IV line, administer normal saline, and consider packed red blood cells if needed. Then proceed to endoscopy and consider injection of adrenaline or heat probe if visible bleeding.
Pt with PUD develops severe abdominal pain referred to back:
perforation.
What is the first step investigation in suspected perforation in a patient with PUD?
Perform an erect x-ray to check for air under the diaphragm.
TTT of perforation:
resuscitation 1st & then surgery.
What are the symptoms of early dumping syndrome?
Nausea, abdominal pain, fullness, diarrhea, and flushing within 1 hour after a meal. mainly due to hypovelemia
What are the symptoms of late dumping syndrome?
Symptoms occurring 1-3 hours after eating, mainly due to hypoglycemia.
What is the treatment for dumping syndrome?
Diet modification, including light frequent meals with decreased carbohydrate content.
Describe the treatment of choice for morbid obesity with a BMI over 35.
Surgery, specifically gastric band ligation.
What is the diagnosis when a patient with a history of gastric band ligation presents with severe vomiting?
Band slip.
What is the preferred investigation for band slip after gastric band ligation?
Barium meal.
How is band slip typically treated?
Surgery.
Define the prophylaxis for bleeding of esophageal varices.
Beta-blockers (BBs).
What is the treatment for ruptured esophageal varices, similar to upper GI bleeding, along with Fresh Frozen Plasma (FFP)?
Same as upper GI bleeding + FFP.
Describe the likely condition when an exam shows peri-anal swelling in a patient with bleeding per rectum and the bleeding is painless.
Piles.
What is the probable diagnosis when an exam reveals peri-anal swelling in a patient with painful bleeding per rectum?
Peri-anal hematoma.
Old pt with bleeding per rectum DT piles:
colonoscopy is a MUST.
How should recurrent pilo-nidal sinus be managed effectively?
Radical excision.
Define the most common cause of peri-anal fistula.
Anal abscess.
What is the most common cause of recurrent peri-anal fistula?
Crohn’s disease.
MCC of multiple anal fissures:
chrone’s disease.
Describe the most important examination for a patient with an anal fissure.
Just inspection (No digital rectal examination).
What is the primary treatment for an anal fissure?
Local glyceryl trinitrate cream.
How should an anal fissure in Crohn’s disease be managed?
Infliximab.
What is the most likely cause when a mother reports finding blood in her infant’s diaper?
Anal fissure.
Describe the most common causes of bleeding per rectum overall.
Piles and fissure.
What is the most common cause of bleeding per rectum in infants?
Anal fissure.
MCC in adult: bleeding per rectum
upper GIT bleeding (peptic ulcer).
Another MCC in adult:bleeding
MCC in adult: diverticulosis (cancer must be excluded).
BPR in pt with AF:
ischemic colitis.
1st episode of BPR in old pt: investigation.
colonoscopy is a MUST
How should bleeding per rectum be managed initially?
IV line and normal saline; administer packed RBCs if needed.
What is the next step if upper GI endoscopy and colonoscopy fail to reveal the site of bleeding?
Capsule endoscopy.
Define the most common hernia to complicate.
femoral
What is a significant sign indicating a complication of a hernia?
No impulse on cough.
Describe the diagnosis when a patient with a hernia develops vomiting, absolute constipation, and abdominal distension.
Intestinal obstruction.
What is the initial step in suspected intestinal obstruction?
Abdominal x-ray followed by surgery
What condition is likely when abdominal swelling is observed below the scar of a previous surgery?
Incisional hernia.
MC PF of incisional:
hematoma.
Examination of incisional hernia:
ask pt to stand and cough.
Describe the management of an infant with an irreducible inguinal hernia.
Surgery as soon as possible.
- If obstruction or strangulation:
immediate surgery.
What is the ‘rule of 6-2’ in the treatment of reducible inguinal hernias in infants?
Birth to 6 weeks: surgery in 2 days. 6 weeks to 6 months: in 2 weeks. More than 6 months: in 2 months.
Umbilical hernia in pediatric:
observe if< 4 ys & surgery if > 4 ys.