GIT Flashcards by Jennifer Becker

Why is surgical Hx important with regard to the abdomen?

Adhesions may cause strangulation, bowel obstruction, etc

How well did you know this?

Not at all

Perfectly

What medications may cause GIT side effects?

ABX - disrupt NF (clindamycin, ampicillin)
NSAIDs - ulcer formation
Opioids - constipation
Many others…

How well did you know this?

Not at all

Perfectly

Tx for Infectious Mononucleosis

Supportive, no contact sports for at least 6 weeks (splenic rupture risk)

How well did you know this?

Not at all

Perfectly

ROME III definition of dyspepsia

epigastric pain or burning, early satiety, or postprandial fullness

How well did you know this?

Not at all

Perfectly

The most common cause of dyspepsia

functional dyspepsia (discomfort w/o any organic findings)

How well did you know this?

Not at all

Perfectly

Other causes of dyspepsia

food/drug intolerance, luminal GIT dysfunctions (ulcer, cancer, etc), H. pylori (PUD), pancreatic dysfunctions, biliary tract disease, etc

How well did you know this?

Not at all

Perfectly

McBurneys Sign definition

Severe RLQ pain with rebound tenderness (2/3 the way from umbilicus to Right ASIS)

How well did you know this?

Not at all

Perfectly

McBurneys Sign is associated w/ what condition

Acute appendicitis

How well did you know this?

Not at all

Perfectly

Lloyd’s Sign definition

costovertebral angle tenderness (rib 12)

How well did you know this?

Not at all

Perfectly

Lloyd’s Sign is often indicative of

renal calculi, nephritis, etc

How well did you know this?

Not at all

Perfectly

Murphy’s Sign definition

Abrupt cessation of inspiration on palpation of gallbladder

How well did you know this?

Not at all

Perfectly

Definition of biliary colic

pain related to the transient obstruction of the cystic duct by a gallstone & the gallbladder contracts

How well did you know this?

Not at all

Perfectly

Biliary colic presentation

severe RUQ pain >1hr after eaten, may radiate to R. scapula, & lasts 30m - 1h; associated w/ n/v

How well did you know this?

Not at all

Perfectly

Who is most at risk for cholelithiasis & biliary colic?

Females, 40+, Fat (obesity or rapid wt loss), Fertile (pregnant), Family Hx

How well did you know this?

Not at all

Perfectly

Why does biliary colic occur after eating?

Neurohormonal activation (CCK after a fatty meal) triggers contraction of the gallbladder, forcing a stone into the cystic duct

How well did you know this?

Not at all

Perfectly

Treatment for biliary colic

Lifestyle changes, bland diet, NSAIDs or Dicyclomine, Cholecystectomy

How well did you know this?

Not at all

Perfectly

What if pt w/ Biliary Colic is a poor candidate for surgery, how could we treat them?

Oral dissolution Bile acid therapy (Cheno- and ursodexycholic acids (bile salts))

How well did you know this?

Not at all

Perfectly

What NSAIDs would be preferred for a patient w/ severe pain d/t Biliary Colic?

IM Ketorolac or Diclofenac

How well did you know this?

Not at all

Perfectly

Most common cause of Pancreatitis?

Gallstones & Alcoholics

How well did you know this?

Not at all

Perfectly

Murphy’s Sign is indicative of what condition

Acute cholecystitis

How well did you know this?

Not at all

Perfectly

What is the most specific serum marker for acute pancreatitis?

Lipase

How well did you know this?

Not at all

Perfectly

Acute Pancreatitis definition (pathogenesis)

autodigestion of the pancreas by pancreatic enzymes (most often d/t obstruction of pancreatic duct)

How well did you know this?

Not at all

Perfectly

Clinical presentation of acute pancreatitis

Severe epigastric pain, radiating to back, anorexia, nausea

How well did you know this?

Not at all

Perfectly

What serum markers may suggest gallstone pancreatitis?

↑↑ in bilirubin, AP, ALT, AST

How well did you know this?

Not at all

Perfectly

Ranson Criteria help predict the outcome of acute pancreatitis, >3 risk factors indicate severe course w/ risk of pancreatic necrosis, the risks include:

>55-y/o, WBC>16000, Glucose >200, LDH >350, AST >250

What factors w/in the 1st 48hrs of acute pancreatitis are associated w/ worsening prognosis

HCT 5, PaO2 < 8, Base deficit >4, fluid sequestration >6

Mortality of an acute pancreatitis patient w/ <2 Ranson Criteria

Mortality of an acute pancreatitis patient w/ 3-4 Ranson Criteria

16%

Mortality of an acute pancreatitis patient w/ 5-6 Ranson Criteria

40%

Mortality of an acute pancreatitis patient w/ 7-8 Ranson Criteria

100%

Treatment for mild acute pancreatitis

Rest, NPO, Fluids (lactated ringers), Meperdine IM for pain

Red Flag Sx

pregnancy, fever/hypotension/tachycardia/tachypnea, dehydration, trauma, guarding or rebound tenderness, distention, weight loss

Most common cause of upper GI bleed

PUD (50% of cases)

Drugs that increase risk for upper GI bleed

NSAIDs/ASA, corticosteroids, anticoagulants

Initial Tx for Upper GI Bleed

IV fluids, packed RBCs if Hgb <7, NG tube aspiration, low threshold for intubation

Medical Tx for Upper GI Bleed

Acid lowering agent - IV PPI for 72h

Octreotide

vasoconstricting drug used in the initial treatment of upper GI variceal bleeding

Why is it important to lower the acid in the stomach while treating a upper GI bleed?

acid interferes w/ the clotting process of ulcers/lesions

Endoscopy findings for low risk pts w/ upper GI bleed

clean ulcer base or flat spot (may give oral PPI)

What medication should be given prior to endoscopy to increase visibility?

Erythromycin (cleans stomach out - prokinetic agent)

Gold Standard procedure for upper GI bleed

Endoscopy

What drug can be administered during an endoscopy to stop active bleeding?

Epinephrine injection

What mechanical methods are used during an endoscopy to stop active bleeding?

Endoclips, cauterization, electrocoagulation

If endoscopy fails to reveal the bleeding site of an upper GI bleed, what may be done?

Angiography

Most common causes in the US of PUD

NSAID use & H. pylori

Triple Therapy for H. pylori infection

1. Amoxicillin or Metronidazole 2. Clarithromycin 3. PPI

Follow-up management of upper GI bleed

PPI for 6-8wks, eradicate H. pylori if +

If patient has CAD & upper GI bleed, should you discontinue NSAIDs?

No, must remain on anticoagulants, just give PPI for life

Which medication can be given to decrease risk of variceal bleed or rebleeding?

Non-selective b-blockers (propanolol, nadolol) | b-blockers -> vasodilation -> lowered risk of bleeding by 50%

Which procedure can be done to decrease risk of variceal bleed?

Endoscopic variceal ligation (lowered risk of bleeding by 50%)

Management of acute variceal bleeding?

ICU, packed RBCs, ABX prophylaxis (aspiration risk), Octreotide, endoscopy

Management of recurrent vatical bleeding, despite b-blockers & endoscopic variceal ligation?

Transjugular Intrahepatic Portosystemic Shunt (TIPS)

Treatment for low platelet count or coagulopathy?

Fresh Frozen Plasma (FFP), platelets, or Vitamin K (takes 24-72h)

Goal INR before performing endoscopy?

< 1.5

Would you see hematochezia in an upper GI bleed?

You could if there was brisk bleeding!

Describe the clinical presentation of diverticulosis?

PAINLESS BRIGHT red blood in stool (painless hematochezia)

Ischemic bowel clinical persentation

PAINFUL BRIGHT red blood in stool (painful hematochezia)

Heyde's Syndrome

aortic stenosis, AVM, bleeding from rectum

Tx for Heyde's Syndrome

Aortic valve replacement

Other than gallstones & alcoholism, what are some causes of acute pancreatitis?

Drugs (Hydrochlorothiazide, antipsychotics, Sulfa drugs), Steroids, Mumps, Trauma, Autoimmune, Hypercalcemia, Hypertriglyceridemia

What is the first enzyme to become activated in acute pancreatitis?

Trypsinogen -> trypsin

Must be 2 out of the 3 signs present to diagnose acute pancreatitis, the 3 signs are:

epigastric pain radiating to the back, lipase levels >3X normal, CT findings showing inflammation, edema, etc

What lab tests can be used to evaluate the severity of acute pancreatitis?

Hemoconcentration (HCT), BUN

Q: Patient comes in with massive hemotemesis, hypertensive, tachycardic, Hgb of 7. What is the first step in treating this patient?

A: Fluid resuscitation – IV fluids, packed RBCs

Q: Patient comes in with massive bleeding, Hx of Afib, mitral valve, BP 120/85, HR 90, tenderness to palpation, Hgb is 12.5, INR 2.3. What would you do for this patient?

A: Perform upper endoscopy, bc patient is stable

Q: Patient comes in w/ SOB, rectal bleeding, AVM, aortic stenosis (Heyde’s Syndrome). How do you treat this patient?

A: Aortic valve replacement

Q: What condition would cause PAINLESS bright red blood from the rectum? What would be your first step in treating this patient?

A: Diverticulosis; Colonoscopy

Q: What is the most reliable routine lab test to predict the severity of acute pancreatitis?

BUN

Tx for acute pancreatitis

FLUIDS! (early aggressive fluid resuscitation EAFR)

Complication of acute pancreatitis

pseudocyst, splenic v. thrombosis, DM

Causes of Chronic Pancreatitis

EtOH, Tobacco, CF, tumor, neoplas, recurrent acute pancreatitis, autoimmune, etc

typical findings on cross-sectional imaging for chronic pancreatitis include

calcifications, ductal dilatations

Chronic pancreatitis defined as

irreversibel destruction of the pancreatic parenchyma

Management of chronic pancreatitis

pain control, pancreatic enzyme supplementation w/ meals, fat-soluble vitamin supplements (A, D, E, K), insulin

Trousseau syndrome definition

Migratory thrombophlebitis—redness and tenderness on palpation of extremities

Trousseau syndrome is a sign of

Pancreatic adenocarcinoma

Risk factors for Pancreatic adenocarcinoma

>50-y/o, smoker, chronic pancreatitis, diabetes, etc

Courvoisier sign definition

Obstructive jaundice with palpable, nontender gallbladder

Courvoisier sign is associated with

Pancreatic adenocarcinoma (esp if tumor is in the pancreatic head)

High insulin + hypoglycemia

insulinoma; diagnose with EUS

Treatment for autoimmune pancreatitis

steroids

Painless jaundice, top of your ddx should be:

pancreatic adenocarcinoma; diagnose w/ EUS

The vestibular apparatus can cause nausea & is mediated by

ACh & Histamine receptors

Obstruction on the lower GIT cause cause n/v & is mediated by

Mechano & chemo receptors

nausea w/ head movement is a problem w/

the vestibular apparatus

Constipation + nausea is a problem w/

obstruction, GI & vagus n.

Dysmotility agents can cause nausea, these include

opioids, anticholinergics, clonidine

Treatment for vestibular apparatus related nausea

promethazine, scopolamine (antihistamine), cyclizine

CNS (emotional, cognitive) causes of nausea can be treated with

Lorazepam, Appetite stimulants (megestrol, steroids, cannibinoids)

Other causes of dysmotility

bowel obstruction, inflammation/infiltration of GIT, Scleroderma, gastroparesis, DM

Treatment for dysmotility

Metoclopramide, Erythromycin, Senna

Inflammation, infection, or irritation of GIT or adjacent organs may cause nausea mediated by

histamine, serotonin, ACh

Treatment for nausea d/t irritation of GIT or adjacent organ

anticholinergic, antihistamine

"VOMIT" acronym for nausea/vomiting

Vestibular, Obstruction/Opioids, Mind/dysMotility, Infection/Irritation, Toxins

What are some physical exam signs of dehydration

tachycardia, tachypnea, slow cap refill, sunken eyes, depresses anterior fontanelle, dark urine, dry tongue & mucous membranes

Erythromycin, Reglan, & Metoclopramide are examples of

promotility & anti-nausea agents

Finigran, Scopolamine, Ildasterone are examples of

anti-nausea agents that are not promotility agents

Charcot's Triad are Sx indicative of

Ascending cholangitis

Charcot's Triad Sx include:

fever, RUQ pain, jaundice

Gallstone ileus pathology

large gallstone causing obstruction of the ILEOCECAL valve (often d/t a cholecysto-enteric fistula)

Mirizzi Syndrome

common hepatic duct obstruction caused by extrinsic compression from impacted stone in cystic duct

Acute diarrhea definition

lasts < 4wks

Chronic diarrhea definition

lasts longer than 4 wks

infectious colitis Sx

fever, tenesmus, dysentery (stools w/ blood & mucus)

Noninfectious diarrhea Sx

diarrhea w/o constitutional Sx

Causes of Noninfectious diarrhea

Sorbitol, mannitol, fructose, fiber, Mg-containing meds (antacids, laxatives), malabsorption, lactose intolerance, Metformin, ABX (augmentin, erythromycin), digoxin, SSRI

Bacterial causes of diarrhea

Vibrio, E. coli, Campylobacter, Salmonella

Dysentery

stools w/ blood & mucus

Viral causes of diarrhea

rotovirus, norovirus

Rectal hemorrhage clinical presentation

bright red blood clots, red blood on TP, Hx of HTN, polycythemia vera (variceal risk + clotting disorder)

Ulcerative Colitis clinical presentation

intermittent bloody stools, diffuse abdominal pain, body aches

bloody stools & abdominal cramping following a dental procedure

Infectious Diarrhea

Bacteria (Toxin-mediated) causes of diarrhea

S. aurea, C. perfringens, B. cereus, E. coli

What type of lesions may cause blood loss from GIT structures, but can not be visualized by endoscopy/colonoscopy?

AVMs

Immunocompromised pt complaining of odynophagia & substernal pain...

Esophagitis d/t infection

Most likely causative agents of Infectious esophagitis

Candida, CMV, HSV