GI system Flashcards
Cholecystitis is…
Inflammation of the gall bladder
What is the cause of cholecystitis in 95% of cases
Gall stones
Risk factors for cholecystitis
Female Fat Fourty Fertile Rapid weight loss Medications: Thiazides, birth control pills, lipid lowering agents
Cause of Black stones
Bilirubin and calcium
Cause of Brown stones
Cholesterol and bacteria
Signs and symptoms of cholecystitis
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
Physical findings of Cholecystitis
RUQ tenderness, guarding Rebound tenderness Epigastric pain \+ Murphy's sign Charcots triad Courvoisers sign Jaundice
Murphys sign
Deep pain on inspiration, fingers under rib cage when they breathe they have severe pain
Charcots triad
RUQ pain
Jaundice
Fever
Courvoisers sign
Palpable enlarged gall bladder that is contender- unlikely to be gall stones
Lab findings of cholecystitis
Leukocytosis
Elevated bilirubin, ALT, AST, Alk phos, and serum amylase
Diagnostic findings of cholecystitis
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
Treatment for Cholecystitis
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
ABX for cholecystitis
Third generation cephalosporins (Cefazolin, cefuroxime, ceftriaxone) and metronidazole
For severe cases:
Fluoroquinolones (ciprofloxacin) plus metronidazole
Appendicitis is…
Inflammation of the appendix
Most common surgical emergency
Causes of appendicitis
Low fiber diets, fecaliths, strictures, neoplasms
More common in males
Signs and symptoms of appendicitis
Nausea Anorexia Fever Periumbilical pain that moves to the RLQ Severe constipation Rupture- you will have a sudden decrease in pain severity
Lab findings for appendicitis
Leukocystosis
Urine- hematuria, pyuria
Ultrasound- 98% accurate to detect, CT to detect perforation or abscess
Treatment for appendicitis
Surgery
IV fluids
Pain control
ABX
Physical findings of appendicitis
Fever Tachycardia Rebound tenderness in RLQ Pain at mcBurneys point Psoas sign Rovsigs sign Obturator sign Muscle rigidity and guarding
Psoas sign
Pain with right thigh extendion
Rovsigs sign
Right LQ pain on palpation of LLQ
Obturator sign
Pain with internal rotation of the flexed right thing
ABX for appendicitis
Prior to surgery- cefoxitin, cefotan
Gangrenous or perforation- single or combination therapy with flagyl
Immunocompromised or elderly- carbapenem plus flagyl
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
Causes of Diverticulitis
low fiber diets
Defects of colon wall
Adults over 50
signs and symptoms of diverticulitis
diffuse LLQ pain Fever Constipation/diarrhea Distention hyperactive BT with obstruction Hypoactive BT more common Frequency and dysuria
Physical findings of diverticulitis
Tachycardia
Guarding
Fever
LLQ tenderness
Lab findings of diverticulitis
Elevated ESR, Procalcitonin and CRP
+ Guiac
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
C-reactive peptide elevated
Over 50
LLQ pain
No vomitting think
Diverticulitis
Treatment for mild diverticulitis
Mild w/o perforation can be managed outpatient
Oral ABX
clear liquids advanced to low fiber diet
ABX for severe diverticulitis
Inpatient: (7-10 days of IV ABX but can switch to oral if improved after 5 days).
- Fluoroquinolones, cipro or levofloxacin plus metrondiazole
- 3 or 4 generation cephalosporin (cefotaxime, ceftriaxone or cefepime) plus metronidazole
- Zosyn
- Timentin
- Imipenem: for immunocompromised patients
ABX for mild diverticulitis
Acute uncomplicated: oral ABX for 7-10 days. Cipro, Bactrim or Levo plus flagyl or Amoxicillin and clavulanate
Treatment for severe diverticulitis
IV ABX Bowel rest may need TPN NGT for ileum IVFs Surgery
Diverticulitis symptoms in females think…
Ectopic pregnancy
STDs
PID
Pancreatitis is…
Acute inflammatory, auto digestive process of the pancreas
Causes of pancreatitis
Alcohol Gall stones post ERCP Hypoperfusion Abdominal trauma
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
If hemorrhagic pancreas…
Grey turner sign
Cullens sign
Grey turner sign
Flank discoloration
Cullens sign
Umbilical discoloration
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
Diagnostics for pancreatitis
MRI/MRCP has great advantages to evaluate the biliary and pancreatic ducts
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
Need for surgery in pancreatitis
Perforation
Gall stones
Cyst
Abscess