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Pance Re-Up > GI Precision & Pearls #3 > Flashcards

GI Precision & Pearls #3 Flashcards

1
Q

What is the best diagnostic test for lactose intolerance?

A

Hydrogen breath test: hydrogen from bacteria fermenting undigested lactose

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2
Q

Hemorrhoids are engorgement of venous plexuses. Explain where an internal hemorrhoid occurs, symptoms, and the four grades of this type.

A

Proximal (above) dentate line, from superior hemorrhoid vein

Painless bleeding, rectal itching, non palpable

Grade I: does not prolapse
Grade II: prolapse with defecation, reduces spontaneously
Grade III: requires manual reduction
Grade IV: irreducible and may strangulate

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3
Q

On the other hand, explain where an external hemorrhoid occurs and symptoms of this type

A

Distal (below) dentate line, from inferior hemorrhoid vein

Perianal pain worse with defecation, but no bleeding. Tender, palpable mass

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4
Q

Although hemorrhoids can be visualized for diagnosis, what can also be done for internal hemorrhoids?

What is the treatment for each type of hemorrhoid?

A

Anoscopy for internal

Treatment:
–Conservative: high fiber diet, increase fluids, situ baths, topical rectal steroids (lidocaine)
–Rubber band ligation (MC), sclerotherapy, excision, coagulation
–Hemorrhoidectomy if failed or external

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5
Q

What are symptoms of an anal fissure?

A

-Severe rectal pain with bowel movement
-Refrain from defecation
-Bright red blood per rectum
-MC at posterior midline, skin tags

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6
Q

Treatment for an anal fissure

A

-Most resolve spontaneously, supportive treatment
-Topical nitroglycerin, Botox Injections, Sphincterotomy

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7
Q

An anorectal abscess is a bacterial infection at the dentate line. Where is the MC site and what is the MC bacteria that causes this?

What are some symptoms of an anorectal abscess?

A

Posterior rectal wall MC

Staph Aureus MC

-Swelling, pain worse with sitting, coughing, defecation
-Fluctuance on exam

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8
Q

On the other hand, a fistula is what?

What are some symptoms?

A

An open tract between 2 epithelium-lined areas

Anal discharge and pain

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9
Q

Treatment for an anorectal abscess and fistula are similar. What is it?

A

Incision and drainage and then WASH (Warm water, analgesics, sitz baths, high fiber diet)

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10
Q

Risk factors for rectal cancer (there is one that is a significant risk factor).

A

HPV infection (multiple partners, MSM, anal sex)
age >50, smoking, immunosuppression

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11
Q

A hernia is when tissue goes where it shouldn’t. A hiatal hernia is when the stomach goes through the esophageal hiatus. Name the two types of hiatal hernias and differentiate them.

A

-Sliding (Type I) MC: GEJ slides into mediastinum
-Paraesophageal (Type II): fundus of stomach goes through diaphragm. GEJ remains in anatomical position

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12
Q

What are symptoms of a hiatal hernia?

A

Postprandial fullness, GERD, n/v

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13
Q

Management for each type of hiatal hernia

A

-Type I: PPI + weight loss
-Type II: surgery if complications

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14
Q

An incisional hernia occurs due to what type of incision MC, and can it occur at any surgical site?

A

Vertical incisions

Yes, it can occur at any surgical site.

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15
Q

Femoral hernias, when the contents of the abdominal cavity go through femoral canal (below inguinal ligament), occur MC in who, why?

A

Women, due to wider pelvis

They are often strangulated or incarcerated

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16
Q

On the other hand, inguinal hernias, come in two types as well. Which type is MC? Explain this type and symptoms of it.

A

Indirect inguinal hernia (MC type)

-bowel protrusion at internal inguinal ring. Lateral to inferior epigastric artery.

Symptoms: scrotal swelling, fullness at the site

17
Q

Why is an indirect inguinal hernia commonly congenital?

A

Due to persistent patent process vaginalis (increase in abdominal pressure causes the hernia to happen)

18
Q

What are symptoms if the inguinal hernia is incarcerated? How about strangulated?

A

Incarcerated: painful, irreducible, n/v

Strangulated: ischemia with systemic toxicity, painful bowel movement

19
Q

What diagnostic can be done for an inguinal hernia, other than a clinical exam?

A

Scrotal US

20
Q

Explain a direct inguinal hernia (where it occurs for the most part).

A

-Bowel protrusion medial to inferior epigastric artery in Hesselbach’s Triangle

21
Q

Name the components of Hesselbach’s Triangle

A

RIP

-Rectus Abdominus (Medial)
-Inferior Epigastric Vessels (Lateral)
-Poupart’s Ligament (Inferior)

22
Q

If the inguinal hernia is strangulated what do you do?

A

This is an emergency! Surgical intervention immediately!

23
Q

Acute cholecystitis is inflammation and infection of the gallbladder due to…..

What is the MCC?

Symptoms of acute cholecystitis include… (there are two specific findings with names)

A

Obstruction of cystic duct by gallstones

E.Coli

-RUQ or epigastric pain worse with fatty foods or large meals
-N/v, guarding, anorexia
-Fever, enlarged/palpable gallbladder
-Boas Sign: referred right shoulder pain
-Murphy Sign: RUQ pain with inspiration

24
Q

Why does Boas Sign occur in cholecystitis?

A

Phrenic Nerve irritation

25
Q

Initial diagnostic done for cholecystitis

What do labs show?

Most accurate diagnostic for cholecystitis

A

-US

-Leukocytosis (high WBC), High bilirubin, high Alk Phos

-HIDA scan/cholescintigraphy

26
Q

What is the treatment for acute cholecystitis?

A

-NPO, IVF, ABX (Ceftriaxone + Metronidazole) THEN cholecystectomy within 72 hours

27
Q

Chronic cholecystitis is fibrosis and thickening of the gallbladder due to chronic inflammatory cell infiltration. This almost always occurs due to….

What is the treatment?

A

Gallstones

Laparoscopic cholecystectomy

28
Q

What is acute acalculous cholecystitis?

What are some risk factors (who should you expect to get this?)

A

Inflammation not due to gallstones. Gallbladder stasis and ischemia –> inflammation

Current hospitalization, critically ill. Look for a very sick person (that is likely who will have it on the test)

29
Q

On US, the diagnostic done for the gallbladder, what is seen with acute acalculous cholecystitis?

A

Distended gallbladder without calcifications

30
Q

Treatment for acute acalculous cholecystitis?

A

Supportive: IVF, bowel rest, pain control

31
Q

What is cholelithiasis?

What is the MC type?

Name the risk factors for this condition (think F).

A

Gallstones in biliary tract without inflammation

Cholesterol is the MC type

-Female, forty, fat, fair, fertile (estrogen, OCPs)
-Native American, IBD, high triglycerides

32
Q

Even though a patient with cholelithiasis can be asymptomatic, what symptoms CAN they have?

What diagnostic should be done?

A

-Biliary colic: episodic RUQ pain lasting 30 minutes - hours
-N/v worse with fatty foods

US is the diagnostic done for gallbladder

33
Q

Treatment for cholelithiasis

A

Observation if asymptomatic

Ursodeoxycholic acid to dissolve the stone or cholecystectomy

34
Q

On the other hand, what is choledocolithiasis?

What are the symptoms of THIS condition?

A

Gallstones in the common bile duct –> cholestasis

Prolonged biliary colic, RUQ pain, jaundice

35
Q

What diagnostics are done for choledocolithiasis? One of them is therapeutic and diagnostic (is the treatment for this problem).

A

US (initial)
Labs: high Alk Phos + GGT (cholestasis causes this)
ERCP to remove stone (diagnostic and therapeutic)

36
Q

What is acute ascending cholangitis?

What is the MCC?

In other words, what turns into this?

A

Biliary tract infection secondary to obstruction of common bile duct from gallstones

E. Coli

Choledocolithiasis turns into this

37
Q

Symptoms of acute ascending cholangitis? (There is a Triad and a Pentad)

A

Charcot’s Triad: fever/chills + RUQ pain + jaundice

Reynaud’s Pentad: Triad above + AMS + hypotension/shock

38
Q

Diagnostics for acute ascending cholangitis are similar to the other gallbladder tests. What are they? What is the most accurate? What is the gold standard?

A

Labs: Leukocytosis (high WBC), High Alk Phos and GGT, high bilirubin

US (initial)

MRCP most accurate

Cholangiography via ERCP (GOLD STANDARD)

39
Q

Treatment for acute ascending cholangitis?

A

IV ABV + common bile duct decompression + stone extraction (ERCP)

-Ampicillin/Sulbactam, Piperacillin/Tazobactam

Pance Re-Up (76 decks)

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