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CPD 2 > GI Part 3 > Flashcards

GI Part 3 Flashcards

1
Q

What are the two main causes of Acute Mesenteric Ischemia?

A
  1. diminished bowel perfusion due to low CO (CHF, drugs or, most commonly, shock)
  2. occlusive disease of the vascular supply of the bowel (thrombosis or embolism)
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2
Q

SSX: Acute Mesenteric Ischemia

A

sever abdominal pain with minimal physical finding
sudden onset = arterial embolism
gradual onset = venous thrombosis
abd tenderness, guarding, absent bowel sounds with necrosis

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3
Q

When should Acute Mesenteric Ischemia be suspected?

A

pt > 50 with predisposing conditions and sudden onset of sever abdominal pain

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4
Q

T/F. Acute Mesenteric Ischemia is considered an emergency.

A

true

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5
Q

Imaging: Acute Mesenteric Ischemia

A

mesenteric angiography

abd plain film or ct

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6
Q

How is ischemic colitis different than Acute Mesenteric Ischemia?

A

episodic and transient from small vessel atherosclerosis
milder, slower onset sx: LLQ pain and rectal bleeding
not as emergent

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7
Q

When is a hernia of the abdominal wall an emergency?

A

when strangulated

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8
Q

When does hernia of the abdominal wall have sxs?

A

when strangulated

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9
Q

How is intestinal obstruction classified?

A

complete/partial
simple/strangulated
location
onset: acute/gradual

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10
Q

Name 5 causes of intestinal obstruction.

A 
adhesions
hernia
tumor
diverticulities
foregin body
volvulus
intussusception
fecal impation
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11
Q

SSX: intestinal obstruction (small intestine)

A

sudden onset periumbilical/epigastric cramping
vomiting
non-tender abdomen (w/o strangulation)
maybe dilated loops of bowel

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12
Q

What are ssx complete small intestinal obstruction?

A

obstipation

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13
Q

What are ssx partial small intestinal obstruction?

A

diarrhea

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14
Q

SSX: intestinal obstruction (colon)

A 
gradual onset of pain
obstipation
vomiting
abd. distension
non-tender
borborygmi
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15
Q

5 Causes of ileus

A 
post-surgical
appendicitis
diverticulitis
perforation
AAA
hypokalemia
drugs
MI
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16
Q

SSX: ileus

A 
distention
vomiting
abdominal discomfort
colicky pain
watery stool
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17
Q

PE: ileus

A

absent bowel sounds

non-tender abdomen

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18
Q

Imaging: ileus

A

xray/ct: free air seen in colon

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19
Q

What some causes of acute intestinal perforation in the SI?

A

duodenal ulcer
corrosives
strangulation of bowel
acute appendicitis

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20
Q

What some causes of acute intestinal perforation in the colon?

A

obstruction
diverticulities
IBD
toxic megacolon

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21
Q

SSX: acute intestinal perforation

A 
sudden and catastrophic
severe generalized abd pain
tenderness
signs of shock
n/v
anorexia
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22
Q

PE: acute intestinal perforation

A

quiet to absent bowel sounds

peritoneal signs: guarding, rigidity

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23
Q

Imaging: acute intestinal perforation

A

xray/CT: free air seen in small intestine

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24
Q

What history questions do you want to ask specifically for gastroenteritis?

A

ingestion of potentially contaminated food or water, travel, contact with similarly ill person, medication use

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25
Q

General sxs: gastroenteritis

A 
sudden onset nausea
vomiting
anorexia
abd. cramps
diarrhea
maybe malaise, myalgia
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26
Q

What work-up do you want to do if for gastroenteritis?

A

stool testing- hemoccult, fecal, WBC, O&P, culture
rapid enzyme assays: viral antigens, shiga toxin
CBC, CMP

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27
Q

What is the most common cause of diarrhea worldwide?

A

Rotavirus

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28
Q

Compare Rotavirus and Norovirus in terms of presentation.

A

Rotavirus: vomiting, fever >102, sxs last 5-7 days
Norovirus: abd. cramps, diarrhea, HA, lasts 1-2 days

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29
Q

What part of the year does Rotavirus incidence peak?

A

winter months

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30
Q

Who’s most affected by enteric adenovirus and what is the pt. picture?

A

kids < 2 yo

diarrhea for 1-2 wks, mild vomiting

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31
Q

What sx does all viral gastroenteritis illnesses have?

A

vomiting

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32
Q

What is the most common food poisoning and what foods are associated with it?

A

staphylococcus aureus

custard, milk products, potato salad, salad dressing, coleslaw, processed meat/fish

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33
Q

Compare SSX of S. aureus and C. perfringens

A 
S. aureus: 
sudden abrupt severe vomiting 2-6 hr. after ingesting
explosive diarrhea, abd. cramps
sxs last 3-6 hrs.
rarely fever

C. perfringens:
watery diarrhea, smelly, crampy adb. pain, 8-16 hrs after ingestion
resolves in 24-36 hrs

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34
Q

What are the most common sources of Bacillus cereus?

A

contaminated rice or meat

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35
Q

SSX: Bacillus cereus

A

emesis (2-6 hours after eating)
diarrhea (8-16 hours): smelly, profuse, nausea
resolves in 12-24 hours

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36
Q

What are the most common sources of Clostridium perfringens?

A

beef and poultry

foods not adequately cooked and then reheated

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37
Q

Which bacteria produce exotoxin?

A

s. aureus
b. cereus
c. perfringens
c. botulinum

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38
Q

What is the most common source of Clostridium botulinum?

A

home-canned goods

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39
Q

SSX: Clostridium botulinum

A

incubation 4-8 hrs after ingesting
phase 1: vague
phase 2: visual
phase 3: neurological

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40
Q

What is the course of a clostridium botulinum infection?

A

65% mortality

2-9 days following ingestion

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41
Q

SSX: cholera

A

sudden, painless, profuse large volume, water diarrhea
no blood/mucus
no fever, abd. pain, vomiting or tenesmus
cold
hypotension, tachycardia
recovery in 7-10 days with adequate rehydration

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42
Q

SSx: Enterotoxigenic E. coli

A

profuse watery diarrhea for 3-5 days

incubation 1-3 days

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43
Q

Common causes of C. diff.

A

nosocomial or iatrogenic (antibx use)

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44
Q

SSX: C. diff

A

water diarrhea
cramping
abd. pain
no n/v usually

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45
Q

Complication of C. diff

A

TOXIC MEGACOLON

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46
Q

SSX: toxic megacolon

A

dilated colon
fever
abd. pain
tachycardia

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47
Q

PE: toxic megacolon

A

tender abd.

absent bowel sounds

48
Q

Work up: toxic megacolon

A

elevated WBCs
distended bowel seen on xray
don’t do a colonoscopy!

49
Q

Causes of Salmonella poisoning.

A

undercooked chicken or eggs
unpasteurized milk
reptiles

50
Q

Compare salmonella and c. jejuni in terms of presentation

A 
salmonella: water diarrhea, maybe bloody
HA
malaise
N/V
abd. pain 6-48 hr after ingestion
maybe fever
sxs usually last 1 week
c. jejuni: prodrome of HA
myalgia
malaise for 12-24 hrs
then, severe abd. pain, high fever, profuse water diarrhea
then, bloody diarrhea
sxs usually last 7-10 days
51
Q

What is the most common bacterial cause of bloody diarrhea in the US?

A

Campylobacter jejuni

52
Q

Sources of Campylobacter jejuni

A

pork, lamb, beef, milk products, water, infected pets

53
Q

Which bacteria use mucosal invasion?

A 
salmonella
c. jejuni
shigella
enterohemorrhagic e. coli
y. enterocolitica
54
Q

Who most commonly gets Shigella?

A

children 6mo-5 years

55
Q

SSX: Shigella

A

lower abd. pain
diarrhea
fever (50%)
maybe biphasic: first presents with above sxs, then develops rectal burning, tenesmus, bloody

56
Q

Which other virus presents like Rotavirus?

A

astrovirus

57
Q

Which bacteria produce enterotoxins?

A

cholera (vibrio)
enterotoxigenic e. coli
c. diff

58
Q

What the the main source for E. coli 0157:H7?

A

undercooked beef or unpasteurized milk

also fecal-oral (mostly with toddlers)

59
Q

How does enterohemorrhagic e. coli present?

A

acute onset of abd. cramps
watery diarrhea > 16 hrs after ingestion
becomes blood within 24 hours

60
Q

Complications of enterohemorrhagic e. coli

A

HUS: hemolytic anemia, thrombocytopenia, acute renal failure
TTP: HUS, fever, neurological deficits

61
Q

What are the main sources of Y. enterocolitica infection?

A

undercooked pork, unpasteurized milk, contaminated water

62
Q

SSX: Y. enterocolitica

A

watery/bloody diarrhea and fever

may look like appendicitis if in terminal ileum

63
Q

Compare Giardia lamblia and Crytosporidium parvum in terms of presentation.

A

giardia: incubation 7 days
maybe asx or watery diarrhea, abd. bloating, cramps, flatulence for 1-3 wks. stools bulky, foul smelling
could be self limiting or recurrent

c. parvum:
profuse, watery diarrhea, anorexia, low-grade fever 5 days after ingestion. self-limiting ~2 weeks

64
Q

What does c. parvum look like in an immunocompromised pt.?

A

chronic watery diarrhea up to 17 days

65
Q

What are the ssx of severe entamoeba histolytica infection?

A 
bloody diarrhea
abd. pain
tenesmus
fever
toxic megacolon
66
Q

How do the lesions of Crohn’s and UC compare?

A

Crohn’s: transmural, skip lesion, granulomatous
can be found anywhere along the GI tract
UC: continuous lesions involving only the mucosa
restricted to the colon and rectum (always involves rectum)

67
Q

Risk factors of Crohn’s

A 
unknown, possibly genetic
smoking
OCP
diet
dysbiosis
appendectomy early in life
68
Q

What is the location and quality of the pain with Crohn’s compared to UC?

A

Crohn’s: RLQ, constant, no relieved by BM

UC: cramping pain, lower abdomen, relieved by BM

69
Q

What is the difference in stool appearance in crohn’s and UC?

A

Crohn’s: not grossly bloody

UC: bloody

70
Q

How does Crohn’s present?

A 
abd. pain localized in RLQ
occult blood common 
usually formed, maybe loose
fat malabsorption
1/3 pt. with perianal dz
71
Q

How does UC present?

A

Cramping abd. pain
series of attack of bloody diarrhea with asx intervals
increased urgency, lower abd. cramps, blood, mucus
stools become looser as more proximal colon is involved
may also have systemic sx: fever, malaise, wt. loss, anemia

72
Q

What is the pattern of Crohn’s?

A
  1. inflammation
  2. obstruction
  3. diffuse jejunoileitis
  4. abd. fistulas and abscesses
73
Q

What do you find on PE with Crohn’s?

A

RLQ tenderness with fullness/mass (no mass in UC)
abd. distension
fever
wt. loss

74
Q

Complications of Crohn’s

A 
intestinal obstruction
fistula
abscess
perforation/hemorrhage
increased risk for SCC
75
Q

What labs would you want to run if you suspect Crohn’s?

A

CBC: anemia, leukocytosis
Increased ESR, elevated CRP (higher in UC)
low serum iron and b12
+ fecal lysozyme
serology: ASCA (higher in crohn’s), ANCA (higher in UC)

76
Q

Imaging for Crohn’s

A

plain film with double contrast barium contrast
single contrast for upper GI: irregularity, stiffness, thickening of terminal ileum
CT and double contrast for small bowel
US and MRI if radiation exposure is an issue
colonoscopy: “skip areas” and “cobble stone appearance”
granulomas seen in intestinal wall in 50% pts.

77
Q

Risk factors for UC

A 
maybe AI
genetic susceptibility
environmental factors
dietary factors
NOT SMOKING (unlike crohn's)
78
Q

Who’s at greatest risk for developing UC?

A

Jewish 2-4x
caucasians
males
15-25yrs and 55-65yrs

79
Q

Complications of UC

A

Hemorrhage (most common)
Toxic megacolon
increased risk of colon cancer

80
Q

Labs for UC

A

CBC: anemia, platelet count >350,000
elevated ESR and C-reactive protein
CMP: hypoalbuminemia, hypokalemia, hypomagnesemia, elevated alk phos
stool analysis for organisms

81
Q

Imaging: UC

A

plain film: colonic dilation (if severe)
barium enema appropriate in mild cases: narrow, tubular, short colon with loss of haustral folds, psuedopolyps, lead pipe appearance
flexible sigmoidoscopy (can dx)
colonoscopy with biopsy confirms dx

82
Q

What extra-intestinal manifestations are seen only with Crohn’s?

A

cholelithiasis
renal oxalate stones
vitamin b12 deficiency
aphthous ulcers

83
Q

Name 5 other extra-intestinal manifestations that can be see with both Crohn’s and UC.

A 
erythema nodosum
conjunctivitis
fatty liver
hepatitis
pyelonephritis
84
Q

Red Flags features of IBS

A 
sx onset after age 50
severe unrelenting diarrhea
nocturnal sxs
unintentional weight loss
hematochezia
fam hx of organic GI dz
85
Q

What is the Rome III criteria for dx of IBS

A

recurrent abdominal pain for at least 3 days/month during previous 3 months associated with 2 or more of the following:

  1. relieved by defecation
  2. onset associated with a change in stool frequency
  3. onset associated with a change in stool form/appearance
86
Q

clinical picture of IBS

A 
crampy abd. pain
constipation/diarrhea both or alternating
increased colonic mucus production
flatulence, bloating, nausea, anorexia
anxiety/depression
stress related sx
appearance of health
87
Q

PE findings IBS

A

diffuse abd. tenderness over colon

88
Q

What labs would you run for IBS?

A

CBC, CMP, homoccult, stool examination, hydrogen breath test, celiac testing

89
Q

How is IBS ultimately Diagnosed?

A 
identify typical symptoms
complete physical examination
exclude alarm features
r/o celiac
colonoscopy in pts. >50yo to r/o CA
90
Q

Causes of SIBO

A

anatomical anomalies
insufficient enzymes
abnormal motility
abnormal communication btw sm. and large bowel
immunocompromise, alcholism. cirrhosis, pancreatitis

91
Q

What hx findings would make you think SIBO?

A

sxs improve after a antibiotic use
worsening of IBS with probiotic/prebiotic use
worsening of IBS with increased fiber intake

92
Q

SSX: SIBO

A

abd. pain, cramping, borborygmus, erctation, flatulence, bloating, watery diarrhea may alternate with constipation
vomiting, heartburn, wt. loss, steatorrhea, systemic sxs

93
Q

PE finding for SIBO

A

abd. distension

succussion splash

94
Q

Work-up SIBO

A

CBC: anemia
Glucose breath hydrogen analysis
[14C]-d-xylose breath test (methane)
Jejunal aspirate during endoscopy

95
Q

What causes diverticulitis?

A 
low fiber diet
high refined carbohydrates
genetic
aging
meds
colonic segmentation
defects in colonic wall strength
96
Q

SSX: diverticulosis

A

asx
maybe chronic LLQ abdominal pain, constipation
maybe rectal bleeding

97
Q

Complications of diverticulitis

A

obstruction

dangerous perforation

98
Q

SSX: diverticulitis

A

abd. pain: LLQ, steady, deep
fever/chills
colick and diffuse abd. pain with flatulence
altered bowel habits
n/v
rectal bleeding: bright red or wine colored

99
Q

Concomintant sxs of diverticulitis

A

dysuria
pyuria
urinary frequency

100
Q

What are some SSX of complications of diverticulitis

A

pneumaturia or recurrent UTI
feculent vaginal d/c
severe and generalized abd. pain, absent bowel sounds, fever
back or lower extremity pain

101
Q

What are expected PE findings of diverticulitis?

A 
localized abd. tenderness
rebound tenderness, maybe mass
low-grade fever
DRE shows tenderness, stool color changes and extent of GI bleeding
proctoscopic exam may show mass
102
Q

Imaging: diverticulitis

A

sigmoidoscopy: narrowing and inflammation

NO BARIUM X-RAY

103
Q

SSX lactose intolerance

A

varies from minor abd. discomfort and bloating to severe diarrhea
watery diarrhea, abd. bloating and pain, flatulence, nausea

104
Q

Labs: lactose intolerance

A

hydrogen breath test

dietary elimination

105
Q

SSX: tropical sprue

A

acute phase: diarrhea with fever and malaise

chronic: diarrhea, nausea, vomiting, abd. cramps….

106
Q

PE: tropical sprue

A

vitamin deficiency signs

glossitis, stomatitis, cheilosis, cutaneous hyperpigmentation…

107
Q

Work-up: tropical sprue

A

no definitive markers exist

60% pt.s have megaloblastic anemia

108
Q

Where is prevalence of celiac dz highest?

A

people with GI sxs and a first degree relative with celiac
any age
females

109
Q

Who might you consider to screen for celiac dz?

A

those with unexplained iron deficiency, early onset osteopenia, unexplained epilepsy, failure to thrive, poor glucose control, chronic diarrhea, infertility, miscarriage, elevated liver enzymes

110
Q

Classic celiac sxs

A

diarrhea, steatorrhea, bloating, flatulence, vit/min deficiencies

111
Q

How might infants present with celiac disease beyond the classic sxs?

A 
failure to thrive
anorexia
vomiting
psychomotor impairment
hypoproteinemia
acidosis
112
Q

What atypical sxs may present with celiac dz in adulthood?

A 
aphthous ulcers
dyspepsia
fatigue
infertility
neuropsychiatric 
bone pain
weakness
dermatitis
113
Q

Work-up: celiac disease

A 
CBC
CMP
Serology: Serum IgA quantitation, Serum IgA anti-endomysial Abs
IgA tissue transglutaminase Abs
Deamidated gliadin peptide IgA and IgA
114
Q

Procedures for celiac dz

A

small bowel biopsy is confirmatory

115
Q

4 DDX for celiac dz

A 
crohn's
giardia
HIV
IBS
intestinal lymphoma
116
Q

What are some differences in sxs of IgE and non-IgE mediated food allergies

A

IgE: variable, dermatologic, ophthalmologic, GI, CV (multisystem) n/v, cramping, diarrhea, pruritis, edema
non-IgE: chronic vomiting, diarrhea, reflux, failure to thrive, atopic derm

CPD 2 (5 decks)

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