GI system Flashcards
1
Q
Cholecystitis is…
A
Inflammation of the gall bladder
2
Q
What is the cause of cholecystitis in 95% of cases
A
Gall stones
3
Q
Risk factors for cholecystitis
A
Female Fat Fourty Fertile Rapid weight loss Medications: Thiazides, birth control pills, lipid lowering agents
4
Q
Cause of Black stones
A
Bilirubin and calcium
5
Q
Cause of Brown stones
A
Cholesterol and bacteria
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
7
Q
Physical findings of Cholecystitis
A
RUQ tenderness, guarding Rebound tenderness Epigastric pain \+ Murphy's sign Charcots triad Courvoisers sign Jaundice
8
Q
Murphys sign
A
Deep pain on inspiration, fingers under rib cage when they breathe they have severe pain
9
Q
Charcots triad
A
RUQ pain
Jaundice
Fever
10
Q
Courvoisers sign
A
Palpable enlarged gall bladder that is contender- unlikely to be gall stones
11
Q
Lab findings of cholecystitis
A
Leukocytosis
Elevated bilirubin, ALT, AST, Alk phos, and serum amylase
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
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
14
Q
ABX for cholecystitis
A
Third generation cephalosporins (Cefazolin, cefuroxime, ceftriaxone) and metronidazole
For severe cases:
Fluoroquinolones (ciprofloxacin) plus metronidazole
15
Q
Appendicitis is…
A
Inflammation of the appendix
Most common surgical emergency
16
Q
Causes of appendicitis
A
Low fiber diets, fecaliths, strictures, neoplasms
More common in males
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
18
Q
Lab findings for appendicitis
A
Leukocystosis
Urine- hematuria, pyuria
Ultrasound- 98% accurate to detect, CT to detect perforation or abscess
19
Q
Treatment for appendicitis
A
Surgery
IV fluids
Pain control
ABX
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
21
Q
Psoas sign
A
Pain with right thigh extendion
22
Q
Rovsigs sign
A
Right LQ pain on palpation of LLQ
23
Q
Obturator sign
A
Pain with internal rotation of the flexed right thing
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
25
Diverticulitis is...
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
26
Causes of Diverticulitis
low fiber diets
Defects of colon wall
Adults over 50
27
signs and symptoms of diverticulitis
```
diffuse LLQ pain
Fever
Constipation/diarrhea
Distention
hyperactive BT with obstruction
Hypoactive BT more common
Frequency and dysuria
```
28
Physical findings of diverticulitis
Tachycardia
Guarding
Fever
LLQ tenderness
29
Lab findings of diverticulitis
Elevated ESR, Procalcitonin and CRP
| + Guiac
30
Diagnostic findings in diverticulitis
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
31
C-reactive peptide elevated
Over 50
LLQ pain
No vomitting think
Diverticulitis
32
Treatment for mild diverticulitis
Mild w/o perforation can be managed outpatient
Oral ABX
clear liquids advanced to low fiber diet
33
ABX for severe diverticulitis
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
34
ABX for mild diverticulitis
Acute uncomplicated: oral ABX for 7-10 days. Cipro, Bactrim or Levo plus flagyl or Amoxicillin and clavulanate
35
Treatment for severe diverticulitis
```
IV ABX
Bowel rest
may need TPN
NGT for ileum
IVFs
Surgery
```
36
Diverticulitis symptoms in females think...
Ectopic pregnancy
STDs
PID
37
Pancreatitis is...
Acute inflammatory, auto digestive process of the pancreas
38
Causes of pancreatitis
```
Alcohol
Gall stones
post ERCP
Hypoperfusion
Abdominal trauma
```
39
signs and symptoms of pancreatitis
```
Epigastric pain
abrupt onset
severe
N/V
Weakness, sweating
Absent or hypoactive BT
Fever
Tachycardia
Hypotension
Tachypnea
Jaundice
Ascites
RUQ mass
```
40
If hemorrhagic pancreas...
Grey turner sign
| Cullens sign
41
Grey turner sign
Flank discoloration
42
Cullens sign
Umbilical discoloration
43
Lab findings for pancreatitis
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
44
Diagnostics for pancreatitis
MRI/MRCP has great advantages to evaluate the biliary and pancreatic ducts
45
Treatment for pancreatitis
```
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
```
46
Need for surgery in pancreatitis
Perforation
Gall stones
Cyst
Abscess
47
ABX will be necessary for pancreatitis in
Septicemia
Abscess
Pseudocyst
48
ABX for pancreatitis
Imipenem
| Cefuroxime
49
Ransons criteria
Calculates the risk for complications and death in pancreatitis
50
Ranson risk scores
< 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
Risk factors on admission for ransons criteria
1. > 55 years old
2. WBC: 16000
3. Glucose: > 200
4. LDH: > 350
5. AST: > 250
52
Risk factors at 48 hours for ransons criteria
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
Peritonitis is...
An acute inflammation of the peritoneum
54
Clinical manifestations in peritonitis
Acute diffuse abdominal pain, exacerbated by motion
Fever
N/V
Constipation
55
Treatment of Peritonitis
IVF
| ABX- 10 day therapy
56
ABX for peritonitis
3rd generation cephalosporin
| Ampicillin for enterococcus
57
Small bowel obstruction definition
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
Causes of SBO
```
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
Clinical manifestations of SBO
```
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
High SBO
Upper abdominal pain
| Profuse vomiting
61
Middle or distal SBO
Cramping colicky, diffuse pain
| distention and episodic vomiting
62
Feculent vomiting and increase in NGT output in SBO means
more distal SBO
63
Lab findings in SBO
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
Management of SBO
```
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
Colonic obstruction is..
Emergency requires early identification and swift surgical intervention
Due to infectious, inflammatory, neoplastic or mechanical pathology
66
Colonic obstruction causes
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
Colonic obstruction Meds
Broad spectrum ABX early; Clindamycin, flagyl
68
Lab studies for colonic obstruction
CBC, electrolytes, PT, Type and crossmatch
69
Diagnostic tests in colonic obstruction
upright chest xray- look for free air and volvulus
| CT scan with IV and rectal contrast
70
Management of colonic obstruction
NPO
NGT
IVF
Early consult to general surgery
71
Paralytic ileus is..
an ileus that is a nontechnical obstruction
72
Causes of paralytic ileus
```
Medications- narcotis
Infections
Mesenteric ischemia
Injury to blood supply
Post intra-abdominal surgery
Metabolic disturbances
```
73
Management of paralytic ileus
Continuous decompression
| Neostigmine
74
Increased portal pressures causes...
esophageal varices
75
Esophageal varies cause...
- 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
Clinical manifestations of Esophageal varices
```
Hematemesis
Melena
Abdominal Pain
Hypovolemic shock
Hematochezia (a lot of blood in the stool, maroon color)
```
77
Lab findings in esophageal varices
```
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
Diagnostic findings in esophageal varices
Endoscopy- after stabilization
| Barium studies define the presence of Peptic ulcers, bleeding sites, tumors, and inflammation
79
Management of esophageal varices
```
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
Complications of balloon tamponade
Gastric balloon rupture
Esophageal rupture
Ulcerations of the esophageal and gastric mucosa
81
Prevention of rebreeding in esophageal varices
```
Long-term follow up with endoscopy
Beta blockers
TIPS (stent)
Portosystemic shunt
liver transplantation
```
82
Definition of upper GI bleed
loss of blood anywhere from the upper esophagus to the duodenum (above the ligament of trees)
83
Causes of UGI bleed
Mallory weiss tear
Esophageal varices
Peptic ulcer disease
Neoplasm
84
Manifestations of UGI bleed
Abdominal pain
hematemesis (bright red or coffee ground)
Melena (dark tarry stool)
85
signs and symptoms of UGI bleed
```
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
Labs of UGI bleed
```
T/C for 4 units PRBC
H/H
pt, ptt, plt, electrolyte, BUN/Cr, Liver enzymes
EKG (ischemia related to blood loss)
Endoscopy
```
87
Managments of UGI bleed
```
Intubate if needed
Consult surgery and GI
Emergency resuscitation- blood transfusions
NGT
Endoscopy
PPI
Octreotide
Balloon tamponade (rare)
Surgery
```
88
Definition of Lower GI bleed
Bleeding that comes from Below the ligament of trees, small intestine, or colon
89
Causes of Lower GIB
```
Diverticulitis (40 %)
Neoplasm
IBS
Anal-rectal disease
ischemic colitis
```
90
Clinical manifestations of Lower GIB
Hematochezia or melena
| Pallor, Tachycardia, postural hypotension- in chronic blood loss
91
Labs for Lower GIB
R/O UGIB with NGT
CBC
Iron, TIBC, Ferritin
Fecal Occult blood
92
Management of Lower GIB
Resuscitate
DC ASA and NSAIDS
Colonoscopy- within 6-24 hours from admissionArteriography
Surgery if indicated
93
Hepatitis is
Inflammation of the liver
94
Causes of hepatitis
```
Virus (Most common)
Drugs (alcohol)
Chemicals
Autoimmune hepatitis
Genetic diseases
Metabolic abnormalities
```
95
The main cause of inflammation of liver cells and liver damage in hepatitis is because of...
Cell apoptosis
96
Classic symptoms of progression of hepatitis
```
Fever
Malaise
Nausea
Hepatomegaly
Pain
ALT, AST increase in blood
Increase in atypical lymphocytes
Jaundice
Dark urine
Increase urobilinogen
```
97
Which liver test will be higher and stay elevated longer in viral hepatitis?
ALT
98
Hepatitis infection for < 6 months
Acute hepatitis
99
Hepatitis infection > 6 months
Chronic hepatitis
100
Hepatitis A is acquired
Fecal-oral, contaminated food
| Acute- no chronic
101
Hepatitis E is acquired
Fecal-oral, undercooked sea food or contaminated water
| Acute- no chronic
102
Hepatitis C is acquired
```
Via the blood
Childbirth
Sex
IV drug use
Acute and chronic
```
103
Hepatitis B is acquired
```
Via the blood
Childbirth
Sex
IV drug use
Acute- only becomes chronic in 20% of cases
Linked to liver cancer
```
104
Hepatitis D is a virus that...
Can only infect a host if a host is infected with HBV
105
Types of hepatitis
A, B, C, D, E
106
Hepatitis A is a...
RNA virus
107
Hepatitis B is a...
DNA virus
108
Hepatitis C is a...
RNA virus
109
Hepatitis D is a...
Defective RNA virus (delta virus)
110
Hepatitis E is a...
RNA virus
111
acute phase of hepatitis
phase of maximal infectivity
| lasts 1-4 months
112
Pruritis in hepatitis
accumulation of bile salts under the skin
113
Complications of hepatitis
acute liver failure
Chronic hepatitis
Cirrhosis
Hepatocellular carcinoma
114
True or false the resolution of jaundice in hepatitis means resolution of infection
false
115
Lab testing for hepatitis
testing for the specific antigen and or antibody for each type of hepatitis
