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GI/GU > GI/GU > Flashcards

GI/GU Flashcards

1
Q

Bilious is a surgical emergency and warrants what?

A

An UGI w/ contrast immediately

Worried about Volvulus/acute malrotation

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2
Q

Bradley is a newborn w/ Trisomy 21. He has not passed meconium and it’s been 24 hours since birth. He has no stool in his rectal vault and her abdomen is distended. He has a palpable fecal mass in her LL abdominal quadrant. What diagnostic test would you order?

A

Suction rectal biopsy

Worried about Hirschprung disease.

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3
Q

Treatment for Hirschprung’s prior to surgery….

A

Decompress abdomen w/ NGT

Rectal irrigations

Surgery: Bowel resection

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4
Q

What is a lethal side effect of Hirschprung Disease?

A

Enterocolitis

Fever, abdominal pain, diarrhea

ENTEROCOLITIS UNTIL PROVEN OTHERWISE

Most occur within 2 years of surgery.

T21 more at risk

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5
Q

Susie is an 8 month old female. Mother brings her into your ED. You palpate a sausage-shaped mass in RUQ. Mother states that she’s been having currant jelly stools and has been intermittently colicky, bringing her knees to her chest. What is your next step?

A

Barium or Air Contrast enema

NO X-RAY, NO ULTRASOUND

Risk of re-intussussception highest in 1st 24 hours

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6
Q

Henry is a 4 week old male who p/w nonbilious projectile vomiting. He is hungry after feeds and you palpate a 2cm olive-shaped mass in the mid epigastric area. You also notice +gastric peristaltic waves. What electrolyte imbalance are you most concerned about and how would you treat it?

A

Hypochloremic metabolic alkalosis

pH=7.5, CO2=35, BiCarb=10, Cl=80

Correct alkalosis w/ NSS bolus (20ml/kg) and start on 1.5 maintenance IVF with NaCL and add K when they pee

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7
Q

If we suspect pyloric stenosis, what would we find on US?

A

The pylorus is >4mms

Common in 1st born males

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8
Q

Mcburney point tenderness

A

RLQ pain with rebound tenderness (appendicitis)

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9
Q

Obturator sign

A

Pain on flexion and internal rotation of right hip, patient is lying on their back (appendicitis)

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10
Q

Psoas sign

A

Pain on extension of right hip, patient is lying on left side (appendicitis)

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11
Q

Rovig’s sign

A

Pain in RLQ when you palpate the left. (appendicitis)

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12
Q

Jenny is 13 years old and comes in with nausea, back pain and anorexia. She has a positive Psoas sign. What imaging would you order?

A

Abdominal CT is choice imaging (but US is often effective)

Not ruptured: Urgent surgery

Infection prevention if ruptured – broad spectrum abx – ceftriaxone, Flagyl, Zosyn

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13
Q

What is the electrolyte disturbance we would expect in a patient w/ toxic megacolon?

A

Hypokalemia
Hypoalbuminemia
Leukocytosis

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14
Q

What is toxic megacolon?

A

Children/adolescents w/ IBD, associated w/ infection, antidiarrheal agents, electrolyte disturbances. Marked dilation of the colon.

X-ray, CBC

Tx: Abx, fluid and electrolyte management

Surgery: Colectomy

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15
Q

Catherine comes in w/ acute abdominal pain. She is hemodynamically unstable and acidotic. Abdominal x-ray reveals air in the abdominal cavity. Abdomen is rigid and tender on exam. She just spiked a fever. What do you think?

A

Bowel perforation.

MEDICAL EMERGENCY

Treatment: Bleeding, infection, abscess, broad spectrum abx, fluid/metabolic stabilization.

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16
Q

Richard (Dick) is a 2 year old male. Mom says he is complaining of painless rectal bleeding. What test would you order?

A

Meckles scan

Treatment: Resection. Surgical reanastamosis

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17
Q

You have a patient who you suspect has IBD, how do you diagnose?

A

Endoscopy

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18
Q

Management for IBD

A

Salicylates, abx, steroids, hospital admission for severe exacerbation, bowel rest w/ IV nutrition/diagnostic procedures.

Flagyl/Cipro

19
Q

Crohn Disease??

A

Involves any segment of GI tract, mouth to anus, malabsorption of Fe, Zn, Folate, Vit B12

Clinical findings: abd pain, diarrhea, rectal bleeding, fissures/tags, fisgulas, anorexia, weight loss

20
Q

Ulcerative Colitis

A

nocolonstillrollin

Limited to the colon. Starts in rectum and ascends continuously

Findings: *****bloody mucoid diarrhea, urgency to defecate

21
Q

Pancreatitis presentation

A

Sharp epigastric pain. Radiates to left side and back. +Nausea and vomiting.

22
Q

Normal Amylase

A

28-85

Rises early, lasts 3-5 days

23
Q

Normal Lipase

A

0-160

More sensitive

24
Q

Diagnostic w/u for pancreatitis

A

Amylase levels rise early and last 3-5 days, lipase is more specific and elevated longer.
Increase in CRP (0-1 normal)- highest at 48 hours
Abdominal X-ray
CXR to r/o pleural effusion
Abd US (repeat Q3-4 days)

25
Q

Management for pancreatitis

A 
NG decompression
IVF
pain control (Dilaudid PCA, Morphine)
IV nutrition
Low fat diet (no cheese steaks)/NPO
26
Q

What do we need to diagnose a UTI??

A

UA and culture

Culture must be from catheterized specimen, at least 50,000 CFUs/mL

UA will show +nitrates, white count >5, pyuria, leukoesterase (elevated WBC’s)

27
Q

Do we prophylactically treat a child after their first febrile UTI?

A

No

Unless they have VUR or an anomoly

28
Q

When is a VCUG indicated?

A

Not recommended after 1st UTI

If US is abnormal we can get a VCUG

VCUG performed if there is recurrent febrile UTI

29
Q

Normal specific gravity of urine

A

1.003 (dilute) to 1.030 (concentrated, dehydrated)

30
Q

Adam is a 6 year old male who complains of unilateral, acute scrotal pain. He has an absent crymesteric reflex. You know you must emergently consult what service?

A

SURGERY.

Ochiopexy – pin the opposite teste down so it doesn’t twist.

31
Q

What is Renal Tubular Acidosis

A

Defect in renal tubules

Resulting in a METABOLIC ACIDOSIS with a NORMAL anion gap

*Renal tubular acidosis (RTA) is a disease that occurs when the kidneys fail to excrete acids into the urine, which causes a person’s blood to remain too acidic. Without proper treatment, chronic acidity of the blood leads to growth retardation, kidney stones, bone disease, chronic kidney disease, and possibly total kidney failure.

32
Q

What is MUDPILES??

A 
M-methanol
U-Uremia (a raised level in the blood of urea and other nitrogenous waste compounds that are normally eliminated by the kidneys.)
D- DKA
P- Paraldeyhde
I-Iron/Isonizde
L-Lactic acidosis (volvulus)
E-Ethylene glycol
S-Salicylates (ASA)

Cause of metabolic acidosis with a HIGH anion gap (>12)

33
Q

Causes of Metabolic acidosis w/ normal anion gap

A 
Renal Tubular Acidosis
Diarrhea
GI fistula
Post hyperventilation
Post anion-gap acidosis
34
Q

Causes of pre-renal failure

A

Most common form

Decreased blood flow to the kidney through acute disease causing hypovolemia and some medications such as ACE inhibitors

Shock
GI problems
Diabetes
Ketoacidosis
Hypoproteinuria
Hemorrhage
Dehydration
Volume depletion
Poor perfusion
35
Q

Renally toxic meds

A

intrinsic renal failure

Aminoglycosides (gent)
Zantac
NSAIDS
Dyes
Myoglobin
36
Q

Pre Renal Failure LABS

A 
decreased u.o. (oliguria)
Normal sediment
Sp.gr. > 1.020 *** (concentrated)
Urine Na 15:1
FeNa(%)
37
Q

Intrinsic Renal Failure (ATN) Labs

A 
decreased/normal u.o. 
RBC casts, cellular debris
Sp.gr. 30mEq/L
Cr ratio(u:p) 2
Cr   elevated and increasing
BUN   elevated and increasing
38
Q

Indications for Dialysis

A 
Acidosis
High K
Low Ca
Azotemia (elevation in BUN >20)
Confusion
Bradycardia
Tamponade
39
Q

What is the treatment for nephrotic syndrome

A

**Corticosteroids*****
No salt added
Fluid restriction
Suppression with cyclosproin

40
Q

Nephrotic syndrome pearls

A

Etiology unknown
Thought to be immune mediated
Boys (2:1) ages 2-6
May follow recent URI

Symptoms: Periorbital edema, pitting of lower extremities, weight gain, acities, pleural effusions

Diagnosis: UA w/ +3/+4 protein ******
Microscopic hematuria 
Normal or reduced renal fx
Normal C3****
Protein excretion of >2g in 24hrs
Elevated cholesterol and triglycerides
Low albumin
Low Ca
41
Q

Post Strep Glomerulonephritis (PEARLS)

A

Follows Group A strep
Low C3
Hematuria
UA w/ RBCs and red casts

Treatment: diuretics (high dose lasix), anti HTN, penicillin x10 days, manage electrolytes

42
Q

HUS PEARLS

A

Hemolytic anemia
RBC’s break down, clog the kidney
Low RBC, low platelet

Caused by e.coli and shigella

BLOODY DIARRHEA ***!!!!!!!!!

Supportive care, replace RBCs, replace platelets, IVF

Tears up the kidney, rips it up (good outcome though w/ supportive care)

43
Q

ATN (phases)

A

Oliguric (don’t pee)
Diuretic (dumb kidney, pee alot)
Recovery (months to years)

44
Q

The metabolic acidosis that results from RTA may be caused either by failure to recover sufficient (alkaline) bicarbonate ions from the filtrate in the early portion of the nephron (proximal tubule) or by insufficient secretion of (acid) hydrogen ions into the latter portions of the nephron (distal tubule).

A

pearl

You dont reabsorb Bicarb

OR

You dont excrete H ions ( acid)

GI/GU (1 decks)

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