Inservice Deck 2 - GI Flashcards
Most sensitive symptom for appy?
RLQ pain
20 year old with constipation has BRPBR and painful BM. Pain lasts 1-2 hours after BM. What is the diagnosis and tx?
anal fissure
- not hemorrhoid, pain continues after BM
Tx - WASH
warm soaks, analgesics, stool softener, high fiber diet
Name a possible appropriate tx for esophageal foreign body?
IV glucagon
nitro/nifedipine or CO2 may also work
dx of patient with history of AAA repair with pain and massive hematemsis?
aorto enteric fistula
Kehr’s sign, hemolysis, and leuk may indicate?
splenic rupture
diagnostic criteria for spontaneous bacterial peritonitis?
ascites with PMN > 250
- diagnostic with 93% sens
WBC > 1000
- diagnostic less sens
abx coverage for SBP should include what main organisms?
gram neg (enterobacteria/enterococci) and strep pneumo
tx - 3rd gen cephalosporin or amp/sulbactam
most common cause of acute hepatic encephalopathy in cirrhotic?
GI bleed
LIVER L - librium (or sedatives) I - infection/sepsis V - volume loss E - electrolytes (hypoK, hypo Na R - RBCs in stool (GI bleed is #1 cause
60 year old patient presents with AMS, exam reveals gynecomastia and spider angioma. What medication is indicated?
lactulose
Most common area of esophageal foreign body in child? In adult?
cricopharyngeus
lower esophageal sphincter
type of incision should be made when excising a thrombosed hemorrhoid?
elliptical
Risk factors associated qwith coffee bean shaped bowel on abd XR?
sigmoid volvulus
- elderly, bed ridden patients or patients of any age with neuro illness with history of severe chronic constipation
most common type of hernia in adults?
indirect inguinal
test used to diagnose pinworm?
scotch tape test
abd pain in the elderly is more often a medical or surgical emergency?
surgical
construction worker with painless lower GI bleed and normal external exam most likely has what?
internal hemorrhoids
name a medication indicated for intractible hiccups?
chlorpromazine
What are the markerds of acute infection in hep B?
HbSAg and HbcAb (IgM)
core ab is seen in window period with acute infection
healthcare worker who has had hep B vaccine gets needlestick from HepB positive patient. What should be done next?
test worker for anti-HBs (antibody to HbsAg) if adequate do not treat. If inadequate administer HBIG and vaccine booster
Test done in ED for patient with cirrhosis, painful abd fluid wave,a nd fever?
paracentesis
- fluid for WBC and diff, glucose, and protein, GM stain and cx
lab marker indicates poor prognosis in alcoholic hepatitis?
PT (> 8 sec)
indicates failing not just injured liver
alcoholic with vomiting, now streaked with blood has what dx? where do most of the tears occur?
mallory weiss tear
GE junction
pt has epigastric pain that awakens him at night and is relieved by food. Dx?
duodenal ulcer
gastric ulcer worse with food
most common presenting sx of gi angiodysplasia (AVM)
painless lower GI bleed
U - upper gi bleed D - diverticulosis R - rectal causes, hemorrhoids, fissures A - AVM, aorto-enteric fistula I - infection, IBD N - neoplam
tx for child who began vomiting 4 hours after eating at a picnic?
hydration, antiemetic
NO abx - likely staph
patient presents with vomiting and diarrhea after eating oysters. Etiology?
vibrio cholera (or vulnificus)
6 week old presents with bloody diarrhea tinged with mucus, generalized seizure in the ED. Possible etiology?
shigella
patient develops vomiting and diarrhea one wk after being tx for pneumonia. Most likely etiology?
c difficile
- diagnose by stool toxin not culture
patient with rectal pain, surrounding induration, and fever may have?
rectal abscess
40 year old presents with severe vomiting, now with increasing pain. CXR is unrevealing. What is the next test to rule out esophageal rupture?
gastrograffin before endo
50 year old has intermittent difficulty initiating swallowing of solids. Most likely cause?
achalasia
mech sx - difficulty swallowing solids and liquids vs obstructive cause - difficulty swallowing solids, then liquids later (tumor)
patient with caustic ingestion requires what diagnostic evaluating study?
endoscopy
source of melenal is where, with relationship to the ligament of treitz
prox to it
GI study that can localize bleeding at rate of 0.1 ml/min
scintigraphy
tx for 30 year old with sore throat and difficulty breathing, has normal oropharynx and lung exams, is febrile with otherwise normal vitals, and thumbprinting on lateral soft tissue neck?
epiglottis
tx - abx/iv pain control, ent consult
backpacker gets diarrhea 2 weeks after trip. How is this diagnosed and tx?
giardia
ova and parasite smear on fecal sample
tx metronidazole
HIV patient gets diarrhea after fishing on a fresh water lake. What parasite cause is associated with drinking untreated water in this patient?
cryptosporidium
diagnostic test for hematuria if CT not available
IVP
disposition for patient with RUQ US, fever, and pain
OR
all patients who are discharged with painless lower GI bleed require what subsequent study?
colonoscopy
Most likely cause of SBO in 66 year old who has only had a chole?
adhesions
small vs large bowel obstruction?
SBO has stair step pattern and air fluid levels
LBO can see large bowel
60 year old on digoxin present with severe abd. Pain with minimal tenderness. Dx?
mesenteric infarction
- pain out of proportion
what is the next diagnostic test indicated for 60 year old with a fib and abd pain with minimal tenderness?
angiography
- rule out mesenteric infarction
25 year old female has abd pain, lower gi bleed, and joint pain. most likely dx?
crohns
effects joints, eyes, liver, skin
pt presents with RUQ pain, subsequent US shows air in GB wall. Disposition?
emergent chole
ephysematous chole
contracted GB with all walls outlined. Dx? Tx? risk?
porcelain GB
urgent surgery, cancer risk
6 month old with intermittent severe abdominal pain requires what diagnostic tets?
air enema (barium)
intussusception - plain film = soft tissue mass RUQ and absent liver edge. US - telescoping bowel
poor prognostic indicators in patient with pancreatitis?
at admission
GLOWS (glucose > 200, LDH > 700, > 55 years, WBC . 16,000, SGOT (AST) > 250)
48 hours: hct decr by 10%, BUN rise > 5, Ca < 8, PaO2 < 60, base deficit > 4, fluid > 6L
tx is next indicated for patient with known alcoholic liver failure who presents with hematemesis?
IV octreotide
Next step for patient who presents with a button battery stuck in the esophagus? What about in stomach?
prepare for immediate removal in esophagus
serial XR in stomach
40 year old patient with history of PUD presents with early satiety, vomiting after every meal, and weight loss has what complication?
gastric outlet obstruction
hemorrhage, perforation, and penetration
20 year old female presents with multiple episodes of abd pain and constipation, occasional non-bloody diarrhea. pain improves with BM. most likely etiology?
irritable bowel syndrome