GI Part II Flashcards
What is the treatment for most Mallory-Weiss Tear?
Watchful waiting, these will typically
resolve within 48 hours
Causes of Constipation?
Low Fiber Decreased fluid intake Poor Toilet habits Inability to toilet Decreased exercise
Diverticulosis occurs when?
the vasa recta penetrate the circular muscle layers between the taenia colia. Can lead to Divertulitis (20%)
SS Diverticulosis?
may present with intermittent cramping abd pain in the LLQ, mild LLQ tenderness
Dx modality for Diverticulosis?
Barium Enema
multiple diverticula, typically involving the descending and sigmoid colon
Tx Diverticulosis?
Pain control, increase dietary fiber, decrease fats, no nuts or seeds, usu no surgery needed
Acute Diverticulitis is the…?
Perforation of the diverticulum causing an acute infection
S/S Diverticulitis?
Left lower quadrant pain and tenderness +/- anorexia, nausea, and vomiting may have fever
Can you do a barium enema with Diverticulitis?
No, contraindicated
CT with Diverticulitis shows?
Inflammation and thickening of bowel wall, abcess formation, diverticula
** No Endoscopy or Barium Enema
TX of Diverticulitis?
Pain control
Hydration tx
Broad spectrum abx
May need Colectomy. at risk of Fistula, colonic obstruction, abscess formation, peritonitis, Hemorrhage
What can diverticulitis lead to?
Diverticular Hemorrhage
Most common cause of Peptic Ulcer Disease?
H Pylori
A one year old presents with bilious vomiting without abdominal distention, think?
Duodenal atresia:
Double bubble sign on X ray
Tx with Decompression, IV fluids, and duodenoduodensostomy surger
What is inflammation confined to the mucosa and submucosa of the colon called?
Ulcerative Colitis
Surgery curative for UC or Chron’s?
Ulcerative Colitis
What is the major symptom of Ulcerative Colitis?
Bloody Diarrhea–Also with urgency and fecal incontinence
May have high ESR, anemia, and Leukocytosis
Gold standard for Bile Duct stones?
ERCP
Most specific test for acute choleycistitis?
HIDA
What does Barium swallow show with UC?
Loss of haustra markings, narrowing of lumen, and straightening of colon
Inflammation that begins in the rectum and extends proximally a certain distance and then stops is?
Ulcerative Colitis
TX of Ulcerative Colitis
Antidiarrheal Aminosalicylates Corticosteriouds Immunomodulator Poss Colectomy
What 2 things can ulcerative colitis lead to?
Toxic Megacolon and Colon Cancer
Fasting Gastrin levels > 150?
Gastrinoma
What disease is defined as an immunologic
response to gluten?
Celiac Disease
List two common offending agents for pill induced
esophagitis
NSAIDS, KCL, iron, antibiotics
A thirty year old African American woman presents
with dysphagia. You notice she also has thickened
skin. A barium swallow demonstrates the absence
of peristalsis. What is the most likely diagnosis?
Sleroderma
Onion ring fibrosis from a bile duct biopsy should
make you think of what diagnosis?
Primary sclerosing cholangitis
Currant jelly stool should make you think of what
diagnosis?
Intussusception
What is the most common vessel blocked with
intestinal ischemia?
Superior mesenteric artery
Should diverticulitis always be admitted?
No mild cases can be treated with rest and clear fluids
What is the #1 cause of small bowel obstruction?
Postoperative adhesions
Inflammation that extends through the intestinal wall from mucosa to serosa and can appear anywhere in the GI tract but distal and small bowel commonly affected is called?
Chron’s disease
Major presenting symptoms in Crohn’s disease?
Abd pain, diarrhea, wt loss, tender painful perianal disease common
Barium enema with Crohn’s shows?
Aphthous ulcers with cobblestone appearance
TX for Crohn’s?
Antidiarrheals Aminosalicylates Corticosteroids Immunomodulators (Azathioprine and 6 mercaptoprine) Antiboiotics Infliximab (Antibody directed and TNF) Surgery---Segmental resection
What is an invaginatin of one part of the bowel into itself called?
Intussusception
What is the most common cause of intestinal obstruction in first 2 years of life?
Intussusception
Current Jelly stool with Sausage shaped abd mass?
Intussusception Dx with Barium Enema
Describe how to perform the psoas sign.
The patient is supine and attempts
to raise right leg against resistance.
Describe how to perform the obturator sign.
The patient is supine and attempts to
flex and internally rotate right hip.
What is the best imaging study for acute
appendicitis?
CT
What treatment should be started for
asymptomatic diverticulosis?
None
What two blood test can be used to diagnose
celiac?
IgA endomysial antibody and IgA tTG
antibody.
What is the term for an abscess in the
sacrococcygeal cleft?
Pilonidal disease
Postprandial cramps relieved by defecation?
IBS Females greater than males age 30-50
IBS
Chronic condition characterized by abd pain and bowel disfunction. Pain often relieved by defectation
Criteria of IBS
3 months of the following
1) Abd pain relieved by defecation
2) Altered stool form
3) Altered stool passage
4) Passage of mucus
5) Bloating and abd distention
What is the most common ischemic injury of the GI tract?
Ischemic colitis
IBS is a …..
Bowel Motility disorder
Malabsorption is?
Impaired transport across the mucosa
Impaired luminal hydrolysis
impaired mucosal fxn
Impaired removal of nutrients
Typical presentation of malabsorption?
Steatorrhea (pale, bulky, greasy, tends to flaot)
Gluten if found in
Wheat, Barley, Rye and Oats
Biopsy of the villi in the small intestine with Celiac Sprue show…?
Atrophy of the villi
