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AHN 568 Unit #5 > GI system > Flashcards

GI system Flashcards

1
Q

Cholecystitis is…

A

Inflammation of the gall bladder

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2
Q

What is the cause of cholecystitis in 95% of cases

A

Gall stones

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3
Q

Risk factors for cholecystitis

A 
Female
Fat
Fourty
Fertile
Rapid weight loss
Medications: Thiazides, birth control pills, lipid lowering agents
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4
Q

Cause of Black stones

A

Bilirubin and calcium

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5
Q

Cause of Brown stones

A

Cholesterol and bacteria

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6
Q

Signs and symptoms of cholecystitis

A

Pain after a fatty mean
N/V- very common 70% of cases and causes temporary relief of pain
Right scapula referred pain
Low grade temp

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7
Q

Physical findings of Cholecystitis

A 
RUQ tenderness, guarding
Rebound tenderness
Epigastric pain
\+ Murphy's sign
Charcots triad
Courvoisers sign
Jaundice
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8
Q

Murphys sign

A

Deep pain on inspiration, fingers under rib cage when they breathe they have severe pain

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9
Q

Charcots triad

A

RUQ pain
Jaundice
Fever

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10
Q

Courvoisers sign

A

Palpable enlarged gall bladder that is contender- unlikely to be gall stones

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11
Q

Lab findings of cholecystitis

A

Leukocytosis

Elevated bilirubin, ALT, AST, Alk phos, and serum amylase

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12
Q

Diagnostic findings of cholecystitis

A

Ultrasound is best for looking for stones
Radiograph- may see radiopaque stones
Cholangiogram- will see bile duct obstruction
HIDA scan- Also for visualization of obstruction

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13
Q

Treatment for Cholecystitis

A 
NPO or a low fat, low volume diet
Think about NGT to LIS
IV fluids- they need volume
Pain control
ABX
Surgery- treatment of choice for most cases
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14
Q

ABX for cholecystitis

A

Third generation cephalosporins (Cefazolin, cefuroxime, ceftriaxone) and metronidazole

For severe cases:
Fluoroquinolones (ciprofloxacin) plus metronidazole

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15
Q

Appendicitis is…

A

Inflammation of the appendix

Most common surgical emergency

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16
Q

Causes of appendicitis

A

Low fiber diets, fecaliths, strictures, neoplasms

More common in males

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17
Q

Signs and symptoms of appendicitis

A 
Nausea
Anorexia
Fever
Periumbilical pain that moves to the RLQ
Severe constipation
Rupture- you will have a sudden decrease in pain severity
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18
Q

Lab findings for appendicitis

A

Leukocystosis
Urine- hematuria, pyuria
Ultrasound- 98% accurate to detect, CT to detect perforation or abscess

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19
Q

Treatment for appendicitis

A

Surgery
IV fluids
Pain control
ABX

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20
Q

Physical findings of appendicitis

A 
Fever
Tachycardia
Rebound tenderness in RLQ
Pain at mcBurneys point
Psoas sign
Rovsigs sign
Obturator sign
Muscle rigidity and guarding
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21
Q

Psoas sign

A

Pain with right thigh extendion

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22
Q

Rovsigs sign

A

Right LQ pain on palpation of LLQ

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23
Q

Obturator sign

A

Pain with internal rotation of the flexed right thing

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24
Q

ABX for appendicitis

A

Prior to surgery- cefoxitin, cefotan
Gangrenous or perforation- single or combination therapy with flagyl
Immunocompromised or elderly- carbapenem plus flagyl

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25
Q

Diverticulitis is…

A

Inflammation of a diverticulum in the intestinal tract, causing stagnation of feces in little distended sacs of colon and pain
Usually in the descending or transverse colon except in asian populations more common in ascending colon

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26
Q

Causes of Diverticulitis

A

low fiber diets
Defects of colon wall
Adults over 50

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27
Q

signs and symptoms of diverticulitis

A 
diffuse LLQ pain
Fever
Constipation/diarrhea
Distention
hyperactive BT with obstruction
Hypoactive BT more common
Frequency and dysuria
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28
Q

Physical findings of diverticulitis

A

Tachycardia
Guarding
Fever
LLQ tenderness

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29
Q

Lab findings of diverticulitis

A

Elevated ESR, Procalcitonin and CRP

+ Guiac

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30
Q

Diagnostic findings in diverticulitis

A

Plain radiograph to look for free air, ileum, distention, obstruction
CT scan- diagnostic test of choice for acute illness, may also reveal abscessed cavity or fistula
Barium enema- but do not use in acute setting, may cause perforation

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31
Q

C-reactive peptide elevated
Over 50
LLQ pain
No vomitting think

A

Diverticulitis

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32
Q

Treatment for mild diverticulitis

A

Mild w/o perforation can be managed outpatient
Oral ABX
clear liquids advanced to low fiber diet

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33
Q

ABX for severe diverticulitis

A

Inpatient: (7-10 days of IV ABX but can switch to oral if improved after 5 days).

  1. Fluoroquinolones, cipro or levofloxacin plus metrondiazole
  2. 3 or 4 generation cephalosporin (cefotaxime, ceftriaxone or cefepime) plus metronidazole
  3. Zosyn
  4. Timentin
  5. Imipenem: for immunocompromised patients
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34
Q

ABX for mild diverticulitis

A

Acute uncomplicated: oral ABX for 7-10 days. Cipro, Bactrim or Levo plus flagyl or Amoxicillin and clavulanate

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35
Q

Treatment for severe diverticulitis

A 
IV ABX
Bowel rest
may need TPN
NGT for ileum
IVFs
Surgery
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36
Q

Diverticulitis symptoms in females think…

A

Ectopic pregnancy
STDs
PID

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37
Q

Pancreatitis is…

A

Acute inflammatory, auto digestive process of the pancreas

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38
Q

Causes of pancreatitis

A 
Alcohol
Gall stones
post ERCP
Hypoperfusion
Abdominal trauma
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39
Q

signs and symptoms of pancreatitis

A 
Epigastric pain
abrupt onset
severe
N/V
Weakness, sweating
Absent or hypoactive BT
Fever
Tachycardia
Hypotension
Tachypnea
Jaundice
Ascites
RUQ mass
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40
Q

If hemorrhagic pancreas…

A

Grey turner sign

Cullens sign

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41
Q

Grey turner sign

A

Flank discoloration

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42
Q

Cullens sign

A

Umbilical discoloration

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43
Q

Lab findings for pancreatitis

A

Amylase and lipase (lipase is more specific and stay elevated longer)
Leukocytosis
Trypsin will be positive in absence of renal disease
HCT may be elevated except with hemorrhage
Hyperglycemia in severe disease
Elevated BUN
AST and LDH may be elevated (tissue necrosis)
Bilirubin and alk pos may increase as a result of common bile duct obstruction
Hypocalcemia in severe cases
Low albumin

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44
Q

Diagnostics for pancreatitis

A

MRI/MRCP has great advantages to evaluate the biliary and pancreatic ducts

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45
Q

Treatment for pancreatitis

A 
Pain control
IV hydration (hypovolemia and shock are a major cause of death)
NPO until clinically improved then frequent small meals (low cholesterol, high protein, low fat, bland)
NGT for ileum and vomiting
Monitor CA and replace as needed
Monitor pulmonary function
ABX if necessary
TPN
Surgery
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46
Q

Need for surgery in pancreatitis

A

Perforation
Gall stones
Cyst
Abscess

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47
Q

ABX will be necessary for pancreatitis in

A

Septicemia
Abscess
Pseudocyst

48
Q

ABX for pancreatitis

A

Imipenem

Cefuroxime

49
Q

Ransons criteria

A

Calculates the risk for complications and death in pancreatitis

50
Q

Ranson risk scores

A

< 3 risk factors: 1% mortality
3-4 risk factors: 15% mortality
5-6 risk factors: 40% mortality
>7 risk factors: close to 100% mortality

51
Q

Risk factors on admission for ransons criteria

A
  1. > 55 years old
  2. WBC: 16000
  3. Glucose: > 200
  4. LDH: > 350
  5. AST: > 250
52
Q

Risk factors at 48 hours for ransons criteria

A
  1. Hct drops > 10%
  2. BUN increases > 5
  3. Calcium < 8
  4. Arterial O2 < 60
  5. Base deficit > 4
    Estimated fluid sequestration > 6000 ml
53
Q

Peritonitis is…

A

An acute inflammation of the peritoneum

54
Q

Clinical manifestations in peritonitis

A

Acute diffuse abdominal pain, exacerbated by motion
Fever
N/V
Constipation

55
Q

Treatment of Peritonitis

A

IVF

ABX- 10 day therapy

56
Q

ABX for peritonitis

A

3rd generation cephalosporin

Ampicillin for enterococcus

57
Q

Small bowel obstruction definition

A

Blockage of the lumen of the intestine- not allowing normal functioning results in distention and fluid loss from the gut
Necrosis, toxicity and perforation may occur
Fluid and electrolyte imbalances

58
Q

Causes of SBO

A 
Adhesion- most common
Hernias internal and external
Volvulus- twisting of bowel on itself
Strictures- r/t crohns disease, radiation, ischemia
Hematomas r/t trauma; anticoagulation
Intussusception
Feces
Tumors
Foreign bodies
59
Q

Clinical manifestations of SBO

A 
Periumbilical Cramping that is sporadic
As distention develops pain becomes continuous and diffuse
Ostipation- complete obstruction
Watery diarrhea in partial obstruction
Tenderness
High pitched "tinkling" bowel sounds
visible peristalsis
dehydration
60
Q

High SBO

A

Upper abdominal pain

Profuse vomiting

61
Q

Middle or distal SBO

A

Cramping colicky, diffuse pain

distention and episodic vomiting

62
Q

Feculent vomiting and increase in NGT output in SBO means

A

more distal SBO

63
Q

Lab findings in SBO

A

leukocytosis
Hemoconcentration and electrolyte imbalances (decreased K, metabolic alkalosis)
Supine and upright CXR- dilated bowel, little or no air in colon, thickening of intestinal wall, pneumatosis (sign of ischemia),
Barium radiography confirms diagnosis
US- Accurate in the diagnosis of SBO

64
Q

Management of SBO

A 
Bowel rest, NPO
IV fluids and electrolyte replacement
NGT to LIS
Possible broad spectrum ABX
Surgical consultation for complete obstruction that does not improve
65
Q

Colonic obstruction is..

A

Emergency requires early identification and swift surgical intervention
Due to infectious, inflammatory, neoplastic or mechanical pathology

66
Q

Colonic obstruction causes

A

tumors
diverticulitis- hypertrophy of colonic wall, lumen narrowing
Intussusception
Ogilvie syndrome- those who have diabetes or pain meds. Loss of peristalsis. Obstruction not evident but colon becomes significantly and dangerously dilated

67
Q

Colonic obstruction Meds

A

Broad spectrum ABX early; Clindamycin, flagyl

68
Q

Lab studies for colonic obstruction

A

CBC, electrolytes, PT, Type and crossmatch

69
Q

Diagnostic tests in colonic obstruction

A

upright chest xray- look for free air and volvulus

CT scan with IV and rectal contrast

70
Q

Management of colonic obstruction

A

NPO
NGT
IVF
Early consult to general surgery

71
Q

Paralytic ileus is..

A

an ileus that is a nontechnical obstruction

72
Q

Causes of paralytic ileus

A 
Medications- narcotis
Infections
Mesenteric ischemia
Injury to blood supply
Post intra-abdominal surgery
Metabolic disturbances
73
Q

Management of paralytic ileus

A

Continuous decompression

Neostigmine

74
Q

Increased portal pressures causes…

A

esophageal varices

75
Q

Esophageal varies cause…

A
  • Cirrhosis
  • Portal venous hypertension of at least 12 mm Hg (normal 2-6)
  • Occurs in the distal 5 cm of the esophagus and upper portion of the stomach
76
Q

Clinical manifestations of Esophageal varices

A 
Hematemesis
Melena
Abdominal Pain
Hypovolemic shock
Hematochezia (a lot of blood in the stool, maroon color)
77
Q

Lab findings in esophageal varices

A 
H/H decreases
WBC elevated
Platelets decreased
Potassium decreases then increases
Sodium decreases then increases
Calcium decreases
Hyperglycemia
BUN/Cr elevates
Elevated lactate
Liver enzymes abnormal
low albumin
78
Q

Diagnostic findings in esophageal varices

A

Endoscopy- after stabilization

Barium studies define the presence of Peptic ulcers, bleeding sites, tumors, and inflammation

79
Q

Management of esophageal varices

A 
insert 2 large bore IVs
Type and Cross
pt/ptt, CBC, Electrolyte panel, LFT, RFT
Crysatlloids pending products
Maintain SBP > 110, CVP < 10 and pcwp < 8
FFP for coagulapathies
Foley
NPO
Consult surgeon or GI
Admit to ICU
60-80% stop spontaneously
Octreotide
Balloon tamponade
80
Q

Complications of balloon tamponade

A

Gastric balloon rupture
Esophageal rupture
Ulcerations of the esophageal and gastric mucosa

81
Q

Prevention of rebreeding in esophageal varices

A 
Long-term follow up with endoscopy
Beta blockers
TIPS (stent)
Portosystemic shunt
liver transplantation
82
Q

Definition of upper GI bleed

A

loss of blood anywhere from the upper esophagus to the duodenum (above the ligament of trees)

83
Q

Causes of UGI bleed

A

Mallory weiss tear
Esophageal varices
Peptic ulcer disease
Neoplasm

84
Q

Manifestations of UGI bleed

A

Abdominal pain
hematemesis (bright red or coffee ground)
Melena (dark tarry stool)

85
Q

signs and symptoms of UGI bleed

A 
Hypovolemic shock (>40% blood volume)
Skin pallor
Orthostatic changes (20% loss)
signs of liver disease (spider angiomata, palmar erythema, icterus)
NGT- BRB or Coffee ground
86
Q

Labs of UGI bleed

A 
T/C for 4 units PRBC
H/H
pt, ptt, plt, electrolyte, BUN/Cr, Liver enzymes
EKG (ischemia related to blood loss)
Endoscopy
87
Q

Managments of UGI bleed

A 
Intubate if needed
Consult surgery and GI
Emergency resuscitation- blood transfusions
NGT
Endoscopy
PPI
Octreotide
Balloon tamponade (rare)
Surgery
88
Q

Definition of Lower GI bleed

A

Bleeding that comes from Below the ligament of trees, small intestine, or colon

89
Q

Causes of Lower GIB

A 
Diverticulitis (40 %)
Neoplasm
IBS
Anal-rectal disease
ischemic colitis
90
Q

Clinical manifestations of Lower GIB

A

Hematochezia or melena

Pallor, Tachycardia, postural hypotension- in chronic blood loss

91
Q

Labs for Lower GIB

A

R/O UGIB with NGT
CBC
Iron, TIBC, Ferritin
Fecal Occult blood

92
Q

Management of Lower GIB

A

Resuscitate
DC ASA and NSAIDS
Colonoscopy- within 6-24 hours from admissionArteriography
Surgery if indicated

93
Q

Hepatitis is

A

Inflammation of the liver

94
Q

Causes of hepatitis

A 
Virus (Most common)
Drugs (alcohol)
Chemicals
Autoimmune hepatitis
Genetic diseases
Metabolic abnormalities
95
Q

The main cause of inflammation of liver cells and liver damage in hepatitis is because of…

A

Cell apoptosis

96
Q

Classic symptoms of progression of hepatitis

A 
Fever
Malaise
Nausea
Hepatomegaly
Pain
ALT, AST increase in blood
Increase in atypical lymphocytes
Jaundice
Dark urine
Increase urobilinogen
97
Q

Which liver test will be higher and stay elevated longer in viral hepatitis?

98
Q

Hepatitis infection for < 6 months

A

Acute hepatitis

99
Q

Hepatitis infection > 6 months

A

Chronic hepatitis

100
Q

Hepatitis A is acquired

A

Fecal-oral, contaminated food

Acute- no chronic

101
Q

Hepatitis E is acquired

A

Fecal-oral, undercooked sea food or contaminated water

Acute- no chronic

102
Q

Hepatitis C is acquired

A 
Via the blood
Childbirth
Sex
IV drug use
Acute and chronic
103
Q

Hepatitis B is acquired

A 
Via the blood
Childbirth
Sex
IV drug use
Acute- only becomes chronic in 20% of cases
Linked to liver cancer
104
Q

Hepatitis D is a virus that…

A

Can only infect a host if a host is infected with HBV

105
Q

Types of hepatitis

A

A, B, C, D, E

106
Q

Hepatitis A is a…

107
Q

Hepatitis B is a…

108
Q

Hepatitis C is a…

109
Q

Hepatitis D is a…

A

Defective RNA virus (delta virus)

110
Q

Hepatitis E is a…

111
Q

acute phase of hepatitis

A

phase of maximal infectivity

lasts 1-4 months

112
Q

Pruritis in hepatitis

A

accumulation of bile salts under the skin

113
Q

Complications of hepatitis

A

acute liver failure
Chronic hepatitis
Cirrhosis
Hepatocellular carcinoma

114
Q

True or false the resolution of jaundice in hepatitis means resolution of infection

115
Q

Lab testing for hepatitis

A

testing for the specific antigen and or antibody for each type of hepatitis

AHN 568 Unit #5 (14 decks)

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