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P3.2 > GI CIS > Flashcards

GI CIS Flashcards

1
Q

risk factors for gallstones

A
  • FH, fair, fat, female, fertile, forty!!
  • female
  • age
  • American indians
  • obesity
  • rapid weight loss
  • CD
  • pregnancy
  • oral contraceptives
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2
Q

protective factors for gallstones

A
  • low carb diet
  • physical activity
  • cardiorespiratory fitness
  • coffee
  • Mg and polyunsaturated fats
  • high fiber diet
  • ASA and NSAIDs
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3
Q

what is ascending cholangitis- lab

A
  • infection of biliary tract secondary to bile duct obstruction or bile stasis
  • hyperbilirubinemia, leukocytosis, transaminitis, alk phos elevation
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4
Q

asc cholangitis- causes

A

-choledolithiasis, pancreatic/biliary neoplasm, postop strictures, choledocal cysts

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5
Q

asc cholangitis- organisms involved

A

Gram neg- E coli (most common), Klebsiella pneumoniae, Enterobacter

  • Gram +- Enterococcus
  • Anaerobes- Bacteroides fragilis, Clostridia
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6
Q

Charcot’s Triad

A
  • Jaundice
  • fever (>102F)
  • RUQ pain
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7
Q

reynold’s pentad

A

(assoc with morbidity and mortality!!)

  • Charcot’s triad
  • mental status changes
  • hypotension
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8
Q

treatment of asc cholangitis

A
  • Urgent ERCP- sphincterotomy with stone removal or stent placement
  • abx- aerobes and anaerobes
  • supportive care like IVF (treat sepsis and shock)
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9
Q

Abx for treating cholangitis

A

Ampicillin-sulbactam

-ceftriaxone PLUS metronidazole

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10
Q

cholangitis- what tests should be ordered?

A
  • AST/ALT, Alk phos, fractionated bilirubin, amylase/lipase (pancreatitis from choledocholithiasis vs post ERCP pancreatitis)
  • pre-procedure INR
  • follow up on blood cultures and bile cultures
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11
Q

complications post ERCP

A
  • pancreatitis
  • asc cholangitis
  • less commonly- hemobilia, perforation, bile seaks
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12
Q

Mirizzi syndrome

A
  • common hepatic duct obstruction caused by an extrinsic compression from an impacted stone in the cystic duct
  • there may be a cholecystoenteric fistula- when a stone is impacted in cystic duct- causes narrowing of common hepatic duct- can lead to a cholecysenteric fistula
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13
Q

TNF alpha inhibitors- used for? SE

A
  • treat infl conditions
  • quality of life improving for many pts
  • injectable or infused
  • SE- infections!!!, cutaneous reactions, malignancy, induction of autoimmunity
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14
Q

TNF alpha inhibitors- annual screening; lab screening

A
  • PPD, hepatitis panel, dermatology exam

- CBC with differential, CMP every 2 months

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15
Q

diaphragmatic excursion

A
  • distance b/w level of dullness on full expiration and level of dullness on full inspiration
  • normal= 3 to 5.5 cm
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16
Q

bronchophony

A

“99”- spoken words become louder and clearer

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17
Q

egophony

A

“ee” sounds like an A

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18
Q

whispered pectoriloquy

A

-whispers are heard louder and clearer

19
Q

iliopsoas m test

A
  • flex hip against resistance- inc abd pain!!

- irritation of the psoas m from infl of the appendix

20
Q

obturator m test

A
  • flex pts right thigh at hip, knee bent, rotate leg internally at hip- right hypogastric pain!!
  • irritation of the obturator m from an inflamed appendix
21
Q

when do you suspect choledocholithiasis on US?

A
  • common bile duct > 6 mm

- elderly or post cholecystectomy- can get up to 10 mm

22
Q

what do you consider when giving a biliary pt opioids?

A
  • NSAIDs are preferred, but opioids can be given if NSAIDS are contraindicated or pain is uncontrolled
  • inc sphincter of Oddi pressure- can worsen the problem and cause more pain- but insufficient data to suggest that morphine should be avoided!!!
23
Q

Systemic Inflammatory Response Syndrome

A

2 of the following:

  • T > 38 (100.4)
  • HR > 90
  • RR > 20 or PaCO2 < 32
  • WBC > 12,000
24
Q

Sepsis; severe sepsis

A
  • sepsis -systemic response to an infection- 2 or more SIRS criteria
  • severe sepsis- organ dysfxn, hypoperfusion/hypotension
25
Q

signs of hypovolemia

A
  • mild/moderate- resting tachycardia
  • blood volume loss at least 15%- orthostatic hypotension (dec in sBP more than 20 and/or inc in HR of 20)
  • blood volume loss at least 40%- supine hypotension
26
Q

smoking- UC?

A

stopping smoking- risk factor!!!

27
Q

BUN:Cr ratio in an upper GIB?

A

30:1

28
Q

AST:ALT ratio in an alcoholic

A

-2:1

29
Q

anatomic division of upper GI vs lower GIB

A

ligament of treitz

30
Q

what can abruptly stopping a beta blocker do?

A

-rebound tachycardia

31
Q

diagnostics for lower GIB

A
  • radionuclide imaging
  • CT angiography
  • angiography
  • colonoscopy
32
Q

diagnostics for upper GIB

A
  • high suspicion- EGD (must stabilize pts with IVF and blood)
  • moderate suspicion- nasogastric tube with lavage
  • positive UGIB = coffee-ground material or bright red blood
33
Q

initial management of acute lower GI bleed?

A
  • supportive- IV access, O2, IVF, blood products, assessment of coagulopathies
  • if ongoing bleeding or high-risk clinical features- colonoscopy within 24 hrs
34
Q

considerations for blood transfusions with packed RBC’s

A
  • first type and screen if hg is stable and no acute bleed
  • type and cross (young pts may not need transfusion until hg < 7; older pts with severe comorbid illness (CAD) require when Hg >9)- pts with active bleeding and hypovolemia may require a transfusion despite normal Hg!!!
  • obtain iron studies before transfusion
35
Q

complications of UC

A
  • toxic megacolon- emergency!- surgery for colectomy
  • PSC
  • ankylosing spondylitis
  • pyoderma gangrenosum
36
Q

complications of CD

A
  • fistulas/strictures
  • fissures
  • pigmented gallstones
  • malabsorption
37
Q

complications of both UC and CD

A
  • colon cancer

- DVT

38
Q

how fast can KCl be given thru a peripheral IV

A

10mEq per hr (otherwise irritating to vein)

39
Q

how many g/dL would you expect the Hg to raise from 1 unit of packed RBCs?

A

giving 1 unit of PRBCs- inc Hgb by 1 g/dL

40
Q

acute IBD flare- treatment?

A

-corticosteroids (IV or PO)

41
Q

Colorectal cancer screening

A

->50 -colonoscopy every 10 yrs; CT colonography every 5 yrs; fecal immunochemical test annually; flex sig every 10 yrs

42
Q

colorectal cancer screening- stool based tests

A
  • gFOBT- every ry
  • FIT- every yr
  • FIT-DNA- 1-3 yrs
43
Q

colorectal cancer screening- direct visualization- gold standard?

A

-colonoscopy!!- every 10 yrs

P3.2 (11 decks)

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