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CSI Exam 6 > GIT > Flashcards

GIT Flashcards

1
Q

Why is surgical Hx important with regard to the abdomen?

A

Adhesions may cause strangulation, bowel obstruction, etc

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2
Q

What medications may cause GIT side effects?

A

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

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3
Q

Tx for Infectious Mononucleosis

A

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

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4
Q

ROME III definition of dyspepsia

A

epigastric pain or burning, early satiety, or postprandial fullness

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5
Q

The most common cause of dyspepsia

A

functional dyspepsia (discomfort w/o any organic findings)

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6
Q

Other causes of dyspepsia

A

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

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7
Q

McBurneys Sign definition

A

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

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8
Q

McBurneys Sign is associated w/ what condition

A

Acute appendicitis

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9
Q

Lloyd’s Sign definition

A

costovertebral angle tenderness (rib 12)

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10
Q

Lloyd’s Sign is often indicative of

A

renal calculi, nephritis, etc

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11
Q

Murphy’s Sign definition

A

Abrupt cessation of inspiration on palpation of gallbladder

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12
Q

Definition of biliary colic

A

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

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13
Q

Biliary colic presentation

A

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

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14
Q

Who is most at risk for cholelithiasis & biliary colic?

A

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

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15
Q

Why does biliary colic occur after eating?

A

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

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16
Q

Treatment for biliary colic

A

Lifestyle changes, bland diet, NSAIDs or Dicyclomine, Cholecystectomy

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17
Q

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

A

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

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18
Q

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

A

IM Ketorolac or Diclofenac

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19
Q

Most common cause of Pancreatitis?

A

Gallstones & Alcoholics

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20
Q

Murphy’s Sign is indicative of what condition

A

Acute cholecystitis

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21
Q

What is the most specific serum marker for acute pancreatitis?

A

Lipase

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22
Q

Acute Pancreatitis definition (pathogenesis)

A

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

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23
Q

Clinical presentation of acute pancreatitis

A

Severe epigastric pain, radiating to back, anorexia, nausea

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24
Q

What serum markers may suggest gallstone pancreatitis?

A

↑↑ in bilirubin, AP, ALT, AST

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25
Q

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

A

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

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26
Q

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

A

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

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27
Q

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

A

1%

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28
Q

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

A

16%

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29
Q

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

A

40%

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30
Q

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

A

100%

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31
Q

Treatment for mild acute pancreatitis

A

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

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32
Q

Red Flag Sx

A

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

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33
Q

Most common cause of upper GI bleed

A

PUD (50% of cases)

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34
Q

Drugs that increase risk for upper GI bleed

A

NSAIDs/ASA, corticosteroids, anticoagulants

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35
Q

Initial Tx for Upper GI Bleed

A

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

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36
Q

Medical Tx for Upper GI Bleed

A

Acid lowering agent - IV PPI for 72h

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37
Q

Octreotide

A

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

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38
Q

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

A

acid interferes w/ the clotting process of ulcers/lesions

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39
Q

Endoscopy findings for low risk pts w/ upper GI bleed

A

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

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40
Q

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

A

Erythromycin (cleans stomach out - prokinetic agent)

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41
Q

Gold Standard procedure for upper GI bleed

A

Endoscopy

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42
Q

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

A

Epinephrine injection

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43
Q

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

A

Endoclips, cauterization, electrocoagulation

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44
Q

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

A

Angiography

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45
Q

Most common causes in the US of PUD

A

NSAID use & H. pylori

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46
Q

Triple Therapy for H. pylori infection

A
  1. Amoxicillin or Metronidazole
  2. Clarithromycin
  3. PPI
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47
Q

Follow-up management of upper GI bleed

A

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

48
Q

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

A

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

49
Q

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

A

Non-selective b-blockers (propanolol, nadolol)

b-blockers -> vasodilation -> lowered risk of bleeding by 50%

50
Q

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

A

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

51
Q

Management of acute variceal bleeding?

A

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

52
Q

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

A

Transjugular Intrahepatic Portosystemic Shunt (TIPS)

53
Q

Treatment for low platelet count or coagulopathy?

A

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

54
Q

Goal INR before performing endoscopy?

A

< 1.5

55
Q

Would you see hematochezia in an upper GI bleed?

A

You could if there was brisk bleeding!

56
Q

Describe the clinical presentation of diverticulosis?

A

PAINLESS BRIGHT red blood in stool (painless hematochezia)

57
Q

Ischemic bowel clinical persentation

A

PAINFUL BRIGHT red blood in stool (painful hematochezia)

58
Q

Heyde’s Syndrome

A

aortic stenosis, AVM, bleeding from rectum

59
Q

Tx for Heyde’s Syndrome

A

Aortic valve replacement

60
Q

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

A

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

61
Q

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

A

Trypsinogen -> trypsin

62
Q

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

A

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

63
Q

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

A

Hemoconcentration (HCT), BUN

64
Q

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

A

A: Fluid resuscitation – IV fluids, packed RBCs

65
Q

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

A: Perform upper endoscopy, bc patient is stable

66
Q

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

A

A: Aortic valve replacement

67
Q

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

A

A: Diverticulosis; Colonoscopy

68
Q

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

A

BUN

69
Q

Tx for acute pancreatitis

A

FLUIDS! (early aggressive fluid resuscitation EAFR)

70
Q

Complication of acute pancreatitis

A

pseudocyst, splenic v. thrombosis, DM

71
Q

Causes of Chronic Pancreatitis

A

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

72
Q

typical findings on cross-sectional imaging for chronic pancreatitis include

A

calcifications, ductal dilatations

73
Q

Chronic pancreatitis defined as

A

irreversibel destruction of the pancreatic parenchyma

74
Q

Management of chronic pancreatitis

A

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

75
Q

Trousseau syndrome definition

A

Migratory thrombophlebitis—redness and tenderness on palpation of extremities

76
Q

Trousseau syndrome is a sign of

A

Pancreatic adenocarcinoma

77
Q

Risk factors for Pancreatic adenocarcinoma

A

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

78
Q

Courvoisier sign definition

A

Obstructive jaundice with palpable, nontender gallbladder

79
Q

Courvoisier sign is associated with

A

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

80
Q

High insulin + hypoglycemia

A

insulinoma; diagnose with EUS

81
Q

Treatment for autoimmune pancreatitis

A

steroids

82
Q

Painless jaundice, top of your ddx should be:

A

pancreatic adenocarcinoma; diagnose w/ EUS

83
Q

The vestibular apparatus can cause nausea & is mediated by

A

ACh & Histamine receptors

84
Q

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

A

Mechano & chemo receptors

85
Q

nausea w/ head movement is a problem w/

A

the vestibular apparatus

86
Q

Constipation + nausea is a problem w/

A

obstruction, GI & vagus n.

87
Q

Dysmotility agents can cause nausea, these include

A

opioids, anticholinergics, clonidine

88
Q

Treatment for vestibular apparatus related nausea

A

promethazine, scopolamine (antihistamine), cyclizine

89
Q

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

A

Lorazepam, Appetite stimulants (megestrol, steroids, cannibinoids)

90
Q

Other causes of dysmotility

A

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

91
Q

Treatment for dysmotility

A

Metoclopramide, Erythromycin, Senna

92
Q

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

A

histamine, serotonin, ACh

93
Q

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

A

anticholinergic, antihistamine

94
Q

“VOMIT” acronym for nausea/vomiting

A

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

95
Q

What are some physical exam signs of dehydration

A

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

96
Q

Erythromycin, Reglan, & Metoclopramide are examples of

A

promotility & anti-nausea agents

97
Q

Finigran, Scopolamine, Ildasterone are examples of

A

anti-nausea agents that are not promotility agents

98
Q

Charcot’s Triad are Sx indicative of

A

Ascending cholangitis

99
Q

Charcot’s Triad Sx include:

A

fever, RUQ pain, jaundice

100
Q

Gallstone ileus pathology

A

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

101
Q

Mirizzi Syndrome

A

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

102
Q

Acute diarrhea definition

A

lasts < 4wks

103
Q

Chronic diarrhea definition

A

lasts longer than 4 wks

104
Q

infectious colitis Sx

A

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

105
Q

Noninfectious diarrhea Sx

A

diarrhea w/o constitutional Sx

106
Q

Causes of Noninfectious diarrhea

A

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

107
Q

Bacterial causes of diarrhea

A

Vibrio, E. coli, Campylobacter, Salmonella

108
Q

Dysentery

A

stools w/ blood & mucus

109
Q

Viral causes of diarrhea

A

rotovirus, norovirus

110
Q

Rectal hemorrhage clinical presentation

A

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

111
Q

Ulcerative Colitis clinical presentation

A

intermittent bloody stools, diffuse abdominal pain, body aches

112
Q

bloody stools & abdominal cramping following a dental procedure

A

Infectious Diarrhea

113
Q

Bacteria (Toxin-mediated) causes of diarrhea

A

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

114
Q

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

A

AVMs

115
Q

Immunocompromised pt complaining of odynophagia & substernal pain…

A

Esophagitis d/t infection

116
Q

Most likely causative agents of Infectious esophagitis

A

Candida, CMV, HSV

CSI Exam 6 (2 decks)

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