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CCFP(EM) Omar > GIT > Flashcards

GIT Flashcards

1
Q

Features of FB that will not pass the GIT

A

Irregular<br></br>Sharp<br></br>Wide objects (wider than 2.5 cm or longer than 6 cm)<br></br>

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2
Q

Complications of stuck FB

A

Airway obstruction<br></br>Stricture<br></br>Perforation<br></br>Corrosion<br></br>Erosion<br></br>Aspiration pneumonia/pneumonitis

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3
Q

Indications for urgent endoscopy in FB

A

Sharp objects<br></br>Multiple FBs<br></br>Button batteries<br></br>Perforation<br></br>Coin at the level of cricopharyngeus in children<br></br>Airway compromise<br></br>FB for > 24 hrs

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4
Q

Causes of Massive UGIB

A

PUD<br></br>Esophageal varices<br></br>Aorto-enteric fistula

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5
Q

Indication for massive transfusion in UGIB

A

Hemodynamic instability<br></br>Shock index (HR/SBP)>1<br></br>Pt presented with presyncope<br></br>Brisk bleeding<br></br>Co-morbidities (CAD, coagulopathy)

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6
Q

Tests to order during an MTP

A

CBC for plt count<br></br>INR (correct if > 1.8)<br></br>PTT<br></br>Fibrenogen (to assess the need for cryoppt)

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7
Q

<strong>Contraindications to tranexamic acid</strong>

A

<ul><li>History of coronary stent(s)</li><li>History of active hematuria (it is thought that administration of TXA in the patient with hematuria may cause a clot resulting in obstructive uropathy)</li><li>History of venous thromboembolic disease</li></ul>

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8
Q

“<h3><span><strong>Order of priority of IV medications in upper GI bleed emergencies</strong></span></h3>”

A

<ol><li><strong>Ceftriaxone</strong>1 g IV for all cirrhotics</li><li><strong>Octreotide 50</strong><strong>μ</strong><strong>g bolus + 50</strong><strong>μ</strong><strong>g/hr infusion</strong>for all UGIB patients</li><li><strong>Erythromycin250mg,</strong>30 minutes prior to endoscopy for suspected peptic ulcer</li><li><strong>PPI e.g. Pantaprazole 80 mg IV bolus</strong>(no infusion necessary) –once you’ve given everything else, if the endoscopist asks for it</li></ol>

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9
Q

Mx of GIT bleeding

A

“<img></img>”

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10
Q

What historical factors that can help sorting out reasons for GIT bleeding?

A

Medication<br></br>Substance abuse<br></br>Constitutional symp<br></br>Stigmata of liver dis<br></br>Coagulopathy

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11
Q

Initial Mx of UGIB

A

“<img></img>”

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12
Q

The patient’s vitals do not improve, what is your next steps in management

A

• Massive Transfusion Protocol<br></br>• Reverse coagulopathy <br></br>• Place nasogastric tube<br></br>• Consult gastroenterologist (GI) for emergent (EGD)<br></br>• If unstable consider Blakemore tube

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13
Q

DDX for blood in stool

A

• PUD<br></br>• Gastritis<br></br>• Esophageal or gastric varices<br></br>• Mallory Weiss syndrome<br></br>• Dielafoy lesions<br></br>• Avm malformations<br></br>• Malignancy<br></br>• Zollinger Ellison Syndrome: gastrin tumor

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14
Q

Risk Factors ofPUD

A

• EtOH <br></br>• H. Pylori<br></br>• NSAIDS<br></br>• Steroids<br></br>• Aortic graft

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15
Q

Meds in GIT bleeding

A

• Octeotide 50mcg/50mcg/hr<br></br>• PPI 80 mg bolus and then 40 mg IV BID<br></br>• ABX - for patients with Cirrhosis: Ceftriaxone or Cipro<br></br>• Consider Erythromycin 3mg/kg IV over 30 min, 30 min prior to scope

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16
Q

Ind of D/C of UGIB

A

If Glasgow Blachford Score=0:<br></br>No co-morbid dis<br></br>Normal VS<br></br>Normal Hb<br></br>Neg or trac FOB<br></br>Good home support<br></br>Competent/reliable pt<br></br>F/U within 24 hrs

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17
Q

Meat is stuck in the esophagus, what can be done before endoscopy?

A

ABC<br></br>Glucagon<br></br>Nitro<br></br>Carbonation (pepsi)

18
Q

GERD red flags

A

Dysphagia<br></br>Wt loss<br></br>Anemia<br></br>Prolonged sym<br></br>Blood in stool/melena<br></br>>50<br></br>Sympt concerning other DDx(MI)<br></br>Early satiety<br></br>FHx of GI malignancy

19
Q

H pylori testing:

A

Rapid urase test<br></br>Biopsy<br></br>Serology<br></br>Urea breath test

20
Q

GERD complications:

A

Hge<br></br>Perforation<br></br>Stricture/obstruction<br></br>Barrett esophagus and Ca

21
Q

Causes of EsophagiJs

A

• Infectious - Immunocompromised (primarily Candida Albans, <br></br>also viral (CMV and HSV)<br></br>• Pill esophagitis - Iron, potassium, bisphosphonates, NSAIDS, <br></br>tetracycline<br></br>• Reflux esophagitis - barrett’s<br></br>• Other: Radiation, Autoimmune, Eosinophilic Esophagitis, <br></br>• Caustic ingestion

22
Q

Dysphagia (Neuro-Muscular) causes

A

• <b>Infectious</b>: botulism, diphtheria, polio, tetanus<br></br>• <b>Immunologic</b>: scleroderma, Multiple Slerosis, myasthenia gravis, polymyositis<br></br>• <b>Motor/nerve dysfunction: </b>Achalasia, Cranial nerve palsies

23
Q

Extra-intesanal manifestaaons of IBD

A

arthrias (Ankylosing spondylitis)<br></br>erythema nodosum, <br></br>pyoderma gangrenous, <br></br>hepatobiliary disease (sclerosing cholangitis), <br></br>vasculitis, <br></br>uveias, <br></br>aphthous ulcers<br></br>

24
Q

Possible causes of lateral anal fissure

A

“HIV<br></br>Crohn’s<br></br>Ca<br></br>TB<br></br>FB<br></br>Syphilis<br></br>Sexual abuse/child abuse”

25
Q

Indications of ABs in pancreatitis

A

infected pancreatic necrosis, <br></br>pancreatic abscess, <br></br>infected peripancreatic fluid, or <br></br>infected pseudocyst

26
Q

Indication for admission of any hepatitis:

A

INR >1.3, <br></br>elevated Bili, <br></br>dehydration, <br></br>hypoglycemia, <br></br>age over 45, <br></br>immunosuppressed, <br></br>encephalopathy

27
Q

SBP

A

• 30% asymptomatic<br></br>• WBC >1000/mm3 or > 250 PMNs/mm3 or Bacteria on Gram Stain<br></br>• E Coli and Streptococcus<br></br>• Ceftriaxone 2g IV q24

28
Q

Hepatic EncephalopathyPrecipitants

A

• infection<br></br>• sedative meds<br></br>• nitrogen load (protein, GI bleed)<br></br>• Hypoglycemia<br></br>• constipation<br></br>• Dehydration<br></br>• Electrolyte abnormalities.

29
Q

Intussusception causes

A

Viral inf<br></br>HSP<br></br>CF<br></br>Meckles<br></br>Idiopathic

30
Q

Complications of Meckles diverticulum

A

Diverticulitis (=appendicitis)<br></br>Intussusception<br></br>SBO<br></br>Bleeding<br></br>Stricture<br></br>Perforation<br></br>Volvulus

31
Q

Diarrhea - Viral

A

• Winter and Spring season<br></br>• Sick contacts - daycare<br></br>• Rotovirus, adenovirus, enterovirus, norwalk, norovirus<br></br>• no blood or WBC’s in stool

32
Q

Diarrhea - Invasive

A

• Blood and WBC’s<br></br>• E.Coli 0156:H7 - Uncooked hamburger, petting zoo, raw milk, <br></br>untreated water. <br></br>• Causes HUS in children (increased risk with ABX) and TTP in Adults

33
Q

Diarrhea - Invasive 2

A

• Shigella - febrile seizure with bloody diarrhea<br></br>• Salmonella - turtles, eggs, cafeteria, osteomyelitis in Sickle Cell <br></br>disease <br></br>• Campylobacter - chicken, bad food/water, associated with Guillain-<br></br>Barre<br></br>• Vibrio Parahaemolyticus/vulnificus - shellfish <br></br>• Yersinia Enterocolitica - (mimics Appendicitis)<br></br>• TX : CIPRO

34
Q

Diarrhea - Bacterial

A

• Staph - toxin - symp within 6 hours, N/V/D, afebrile<br></br>• E. Coli - travelers diarrhea<br></br>• Clostridium Perfringens - Toxin - 6-24 hrs to onset, ++diarrhea<br></br>• Vibrio Cholera - rice water, electrolyte abnormalities, rehydration<br></br>• Bacillus Cereus - spores - Cooked Rice, N/V/D<br></br>• Other: Scombroid poisoning (deep ocean fish) - Histamine like reaction,Ciguatera (reef fish) - muscle weakness, paresthesia, reversed temp sense, vomiting, diarrhea

35
Q

Diarrhea - Protozoan

A

• Giardia - Water born, backpackers, fecal-oral, 1-4 wk incubation, <br></br>floating frothy foul diarrhea<br></br>• Entamoeba histolytica - contagious, bloody diarrhea, (liver abscess, <br></br>pericarditis, pulmonary and CNS) continuum asymptomatic cyst <br></br>passer to colitis to fatal cerebral amebiasis<br></br>• TX - METRONIDAZOLE

36
Q

C. Diff/Pseudomembranous Enterocolitis

A

• Neonatal, post-op, antibiotic related<br></br>• overgrowth of toxin producing C.diff<br></br>• can begin days to weeks after Abx<br></br>• profuse foul diarrhea<br></br>• Can be present febrile and toxic<br></br>• no anti-diarrheals, stop offending Abx<br></br>• PO metronidazole/vancomycin

37
Q

Imaging for acute pancreatitis

A

Abdominal ultrasound to rule out gallstone pancreatitis<br></br><i>Note: you do not require an imaging study to diagnose pancreatitis. The US is to rule in/out a common, contributing cause (gallstones) that would change your management.<br></br></i><br></br>-CT Abdo/Pelvis<br></br>-ERCP<br></br>-HIDA Scan

38
Q

Risk factors for C.diff

A

Meds:<br></br> AB<br></br> Antiviral<br></br> ChemoRx<br></br> PPI<br></br>Previous C.diff inf<br></br>Close contact with pt with C.diff<br></br>Hospitalization<br></br>Nursing home/long-term care facility<br></br>Advanced age<br></br>Immunosuppression<br></br>GIT surgery<br></br>IBD

39
Q

Causes of Pancreatitis

A

<b>Most common:</b><br></br><ul><li><i>GS</i></li><li><i>ETOH</i></li></ul><u>Other causes:</u><br></br><b>Infections:</b><br></br><ul><li><i>Bacterial (Legionella, Mycoplasma)</i></li><li><i>Viral (mumps, CMV, HBV)</i></li><li><i>Parasitic (Ascaris, Toxoplasmosis)</i></li></ul><br></br><b>Medication (Lasix)<br></br>Autoimmune (SLE)<br></br>Metabolic:</b><br></br><ul><li><i>Hypertriglyceridemia</i></li><li><i>HyperCa</i></li><li><i>Hyperparathyroidism</i></li></ul><br></br><b>Trauma<br></br>Surgical procedures:</b><br></br><ul><li><i>ERCP</i></li></ul><b>Postop compl (abd/cardiac)<br></br>Tumors (pancreatic/ampulary)<br></br>Post. penetrating PUD<br></br>Sph of Oddi dysfunction<br></br>Toxins<br></br>Idiopathic</b><br></br><br></br>

40
Q

Risk Factors for GI Bleeding

A

<b>Advanced age<br></br>PHM:</b><br></br><ul><li><i>Malignancy</i></li><li><i>Liver dis</i></li><li><i>H.Pylori infection</i></li><li><i>Previous GI Bleeding</i></li><li><i>Hx of AAA repair</i></li></ul><br></br><b>SH:</b><br></br><ul><li><i>Smoking</i></li><li><i>ETOH</i></li><li><i>Substance abuse</i></li></ul><b>Medication:</b><br></br><ul><li><i>NSAIDs</i></li><li><i>Steroids</i></li><li><i>AntiPlt/AntiCoag</i></li></ul>

41
Q

“<span>List 4 extra-abdominal causes for severe abdominal pain</span>”

A

-ACS/ MI<br></br>-Pericarditis, myocarditis<br></br>-Pneumonia<br></br>-PE<br></br>-Testicular torsion<br></br>-DKA<br></br>-Toxic ingestions<br></br>-Sepsis/ Bacteremia<br></br>-Sickle cell crisis

42
Q

“<span>You obtain the following abdominal XR. What are 3 features of toxic megacolon that may be seen on abdo XR?<br></br></span><img></img><span><br></br></span>”

A

-Dilation of colon > 5.5-6 cm<br></br>-Loss of haustral pointings<br></br>-Black arrow: ‘thumbprint sign’ – bowel wall edema<br></br>-Pseudopolyps often extending into the lumen<br></br>-White arrow: pneumatosis intestinalis - intramural gas<br></br>-Pneumoperitoneum, if perforation

CCFP(EM) Omar (27 decks)

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