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Gastrointestinal > MDT Upper GI 2 > Flashcards

MDT Upper GI 2 Flashcards

1
Q

What is diverticula/diverticulum?

A

Sac-like protrusion of the colonic wall

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2
Q

What is Diverticulosis?

A
  • Defined by the presence of diverticula

- May be asymptomatic or symptomatic

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3
Q

What is diverticular bleeding?

A

Characterized by painless hematochezia due to segmental weakness of the vasa recta associated with a diverticulum

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4
Q

How is diverticulitis defined?

A

Inflammation of a diverticulum

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5
Q

Symptoms of diverticulosis/diverticulitis?

A
  • Localized inflammation or infection report mild to moderate aching in LLQ
  • Constipation or loose stools
  • Nausea/vomiting
  • Low grade fever
  • LLQ tenderness
  • Possible palpable mass
  • Stool occult common, hematochezia uncommon
  • Mild to moderate leukocytosis
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6
Q

Labs for diverticulosis/diverticulitis?

A

CBC w/ Dif

Occult blood

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7
Q

Rad for diverticulosis/diverticulitis?

A
  • Colonoscopy after resolution of clinical symptoms
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8
Q

Treatment for mild symptoms of diverticulosis/diverticulitis?

A
  • Clear liquid diet and broad spectrum oral antibiotics
  • Amoxicillin and Clavulanate (Augmentin) or Metronidazole
    AND
  • Ciprofloxacin or Trimethoprim-sulfamethoxazole (Bactrim)
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9
Q

When do patients require hospitalization for diverticulosis/diverticulitis?

A
  • Fever
  • Increased pain
  • Inability to tolerate oral fluids
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10
Q

Treatment of severe diverticulitis (high fever, leukocytosis, peritoneal signs), immunosuppressed, or elderly?

A
  • Acute hospitalization
  • NPO
  • IV fluids
  • If ileus present, NG tube
  • IV antibiotics
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11
Q

Diverticulitis recurs in how many patients and warrant want?

A
  • 10-30%

- Warrants elective surgical resection

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12
Q

Disposition diverticulosis/diverticulitis?

A

MEDEVAC

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13
Q

General considerations for appendicitis?

A
  • Most common abdominal surgical emergency
  • most common between 20-35
  • Common between 10-35
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14
Q

Why does appendicitis typically manifest?

A

Some sort of blockage of the lumen of the appendix

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15
Q

The majority of lumen blockages in appendicitis are due to?

A
  • Fecalith
  • Immune response/expansion of lymph tissue (viral infections or vaccinations)
  • Neoplasms
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16
Q

Presentation of appendicitis?

A
  • Gradual onset RLQ pain
  • Post exams
  • RLQ pain during bearing down/coughing
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17
Q

Atypical symptoms of appendicitis?

A
  • Pain in flank
  • Lower back pain
  • Groin pain
  • Tenesmus
  • Non-specific lower abdominal pain
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18
Q

Gold standard for diagnosis of appendicitis?

A

CT scan of the abdomen

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19
Q

Labs for appendicitis?

A

CBC
Fecal Occult
UA

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20
Q

Antibiotic treatment of appendicitis?

A
  • Ampicillin-sulfabactam

- Ertapenem

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21
Q

What are the two types of gallstones?

A
  • Cholesterol gallstones (most common)

- Pigmented gallstones

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22
Q

Flow of bile

A
  • Created in liver
  • Stored in gallbladder
  • Ejected into cystic duct
  • Travels to common bile duct
  • Flows into duodenum
  • Works in duodenum to emulsify fats
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23
Q

What does the gallbladder do for bile?

A
  • Acts as a reservoir for bile

- Stores excess bile

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24
Q

Two main components of bile?

A
  • Bile salts

- Cholesterol and bilirubin

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25
Q

Common situations that cause an increase in cholesterol in circulation resulting in gallstones?

A
  • Increased estrogen in pregnancy
  • Increased total circulating cholesterol due to:
  • poor diet
  • rapid weight loss
  • fatty acids
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26
Q

How are pigmented gallstones formed?

A

Formed by the precipitation of bilirubin( a metabolite of hemoglobin)

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27
Q

How do precipitates (stones) form?

A

If the amount of cholesterol or bilirubin exceeds the among of bile salts

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28
Q

What are the common disease processes when precipitates occlude ducts within the biliary tract

A
  • Asymptomatic Cholelithiasis
  • Biliary colic
  • Cholecystitis
  • Choledocholithiasis
  • Cholangitis
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29
Q

What does Asymptomatic Cholelithiasis refer to?

A

A condition in which a Pt has gallstones present but has not had any Sx’s

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30
Q

What does Biliary colic refer to?

A

Situation in which gallstones have formed in the Pt’s gallbladder and intermittently obstruct the lumen of the cystic duct

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31
Q

Signs/symptoms of biliary colic?

A
  • Sx’s last less than 6 hours

- No S/Sx of inflammatory process

32
Q

What is Cholecystitis?

A

Inflammation of the gallbladder

33
Q

Signs/symptoms of cholecystitis?

A
  • Sx’s must be present for over 6 hours

- Have S/Sx’s of inflammatory process (possible fever)

34
Q

What is Choledocholithiasis?

A

Inflammation of the gallbladder caused by obstruction of the common bile duct

35
Q

Signs/symptoms of Choledocholithiasis?

A
  • Have S/Sx’s of inflammatory process (possible fever)
  • Increased conjugated bilirubin
  • May have jaundice
  • Impossible to differentiate between cholecystitis and choledocholithiasis
36
Q

What is Cholangitis?

A

Bacterial infection of the biliary tract

  • Believed to be caused due to an ascending infection into the biliary tract from the duodenum
  • Pt tends to be very sick
37
Q

Signs/Symptoms of Cholangitis?

A
  • Same as Choledocholithiasis
  • Also Charcot’s Triad:
  • RUQ pain
  • Fever
  • Jaundice
38
Q

Presentation of biliary colic?

A
  • Acute onset of intermittent, sharp, RUQ pain

- Precipitated by meals

39
Q

Treatment/disposition of biliary colic?

A
  • Change in diet
  • Close monitoring and strict return precautions
  • Sx usually self limiting
40
Q

What is Acalculous cholecystitis?

A

No radiological evidence of gallstones in gallbladder or biliary tract

  • Have had major surgery within past 2-4 weeks
  • Are NPO
41
Q

Cholecystitis secondary to viral infection may be caused by what?

A

AIDS

42
Q

6 F’s of cholecystitis?

A 
Fat
Fertile
40
Female
Flatulence
Fever
43
Q

Presentation of cholecystitis?

A
  • S/Sx consistent with obstruction
  • Sudden onset RUQ pain following high fat meal
    • murphy’s sign
44
Q

Diagnosis cholecystitis?

A 
CBC
LFT
Lipase
Bilirubin
RUQ Ultrasound (gold standard)
45
Q

Treatment and disposition of cholecystitis/choledocholithiasis?

A
  • Cholecystectomy is mainstay
  • Antibiotics
  • NPO
  • MEDEVAC
46
Q

Mild to moderate cholecystitis/choledocholithiasis antibiotics?

A

Ertapenem

Ceftriaxone

47
Q

Severe cholecystitis/choledocholithiasis antibiotics?

A

Piperacillin-tazobactam and metronidazole

48
Q

Presentation of choledocholithiasis?

A
  • Same as cholecystitis
  • 6 F’s
  • May have jaundice
49
Q

Radiology/imaging for choledocholithiasis?

A
  • RUQ Ultrasound (gold standard)

- ERCP

50
Q

Disposition of Cholangitis?

A
  • Diagnostic work up and management same as cholecystitis
  • Pt’s tend to be much more ill and require fluid resuscitation and close monitoring
  • MEDEVAC
51
Q

What is pancreatitis

A

Inflammation in the pancreas

- Sensitive structure that is crucial to the regulation of blood sugars and digestion of nutrients

52
Q

Most common causes of pancreatitis?

A
  • Alcohol
  • Gallstones
  • Other
  • ERCP, Trauma, hyperlipidemia, infections, certain drugs
53
Q

Presentation of Pt pancreatitis?

A
  • May have Hx of cholelithiasis and/or cholecystitis treated without surgery
  • Hx of alcoholism
  • May have described having similar episodes
54
Q

Symptoms of pancreatitis?

A
  • Abrupt onset epigastric abdominal pain
  • Steady, boring, severe abdominal pain worse with walking/lying
  • Pt’s describe feeling of relief with sitting upright and leaning forward
  • Pain typically radiates to the back
  • Mild jaundice common
  • Nausea/vomiting
  • Weakness, fever, anxiety
  • Possible upper abdominal mass
55
Q

Gold standard of diagnosis of pancreatitis?

A

Serum lipase for lab

CT Scan for rads

56
Q

Management/Treatment of pancreatitis?

A
  • Pt’s tend to be very sick and require constant monitoring
  • NPO
  • Aggressive fluid resuscitation (gold standard)
  • Ileus (moderate to severe pain)
  • Abdominal distension
  • Vomiting (consider NG Tube)
57
Q

Hallmark of therapy for Pancreatitis?

A
  • Fluid resuscitation
  • Early resuscitation shown to reduce frequency of Systemic Inflammatory Response Syndrome (SIRS)
  • LR preferred over NS
  • 5-10ml/kg/hr initially
    ICU monitoring required in severe patients where aggressive hydration needed
58
Q

Pain Control for pancreatitis?

A

Ketorolac
Hydrocodone
Morphine

59
Q

Disposition of pancreatitis?

A

Hx of pancreatitis DQ for submarine duty

MEDEVAC

60
Q

Hasselbach’s triangle for inguinal hernia?

A
  • Inferior epigastric vessels (superior border)
  • Lateral aspect of rectus abdominas (medial border)
  • Inguinal ligament (inferior border)
61
Q

What is a hernia?

A

Defined as a protrusion of any body part through a cavity.

  • Can be internal or external
  • Types:
  • inguinal, femoral, hiatal, umbilical (most common)
  • Obturator, lumbar (less common)
62
Q

What accounts for approx 75-80% of all hernias?

A

Inguinal

63
Q

What are direct hernias?

A

Abdominal contents herniate directly through Hasselbach’s triangle

64
Q

What are indirect hernias?

A

Abdominal contents herniate through inguinal canal

65
Q

Indirect hernia facts?

A
  • Most common R>L

- Frequently incarcerate and strangulate

66
Q

Direct hernia facts?

A
  • Due to muscular weakness in Hasselbach’s triangle
  • Acquired defects
  • Occur predominately in adults
67
Q

Typical congenital hernias (umbilical hernia)?

A
  • Outy belly button
  • Increased prevalence in African-Americans
  • In children, majority resolve by 5
68
Q

Presentation of hernias?

A
  • All hernias have ability to present as small bowel obstruction
  • Bulging mass at site of hernia
  • Direct: Lower anterior mass
  • Indirect: Scrotal mass
  • Umbilical: Outy belly button
  • Mass may or may not reduce spontaneously
  • Variable amounts of pain at site of mass
69
Q

Presence of incarcerated hernias?

A
  • May have bruising or overlying redness at location of hernia
  • Present with tachycardia and +/- fever with extreme pain with palpation
70
Q

Pt may be toxic if what happens to a hernia?

A

Strangulation?

71
Q

Unrelieved strangulation of a hernia may lead to?

A
  • Perforation
  • Abscess formation
  • Peritonitis
  • Septic shock
72
Q

Management of incarcerated hernias?

A
  • Require immediate attention
  • If there is a reliable Hx of incarceration recently ( within 24 hours), an attempt may be made to reduce hernia
  • Do not attempt reduction if there is any question of duration
  • Surgical fixation for incarcerated hernia that cannot be manually manipulated
73
Q

What to do if strangulation is suspected or shock is present?

A
  • Broad-spectrum antibiotics (ertapenum)

- Fluid resuscitation

74
Q

Closed passive reduction technique?

A
  • Morphine for pain
  • Diazapam for muscle relaxation
  • Pt in supine trendelenburg position
75
Q

Closed active reduction technique?

A
  • Only if passive ineffective
  • Place one hand to guide neck of hernia sack into peritoneal cavity
  • Use other hand to provide gentle and steady compression over hernia
76
Q

Disposition of Hernia?

A
  • Acutely irreducible incarcerated hernia: MEDEVAC for immediate surgical repair
  • Adult Pt’s with reducible hernias: Refer to Gen surg, avoid situations that increase intra-abdominal pressure
77
Q

What may Pt’s who do need operative care be fitted with?

A

Trusses

Gastrointestinal (6 decks)

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