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T2 GI > MOD (esoph, acute abd, listeria/actin) > Flashcards

MOD (esoph, acute abd, listeria/actin) Flashcards

1
Q

What might gradual vs sudden onset of abdominal pain (with unknown etio) indicate?

  • Steady vs crampy?
  • right shoulder/scapula vs flank/groin?
A
  • gradual may be organ distension or peritoneal irrigation, sudden may be perforation/ hemorrahage/ infarct
  • steady may be inflammation like appendicitis, crampy may be obstructive process
  • right shoulder/scapula may be right side stuff like gb, liver spleen etc, falnk or groin may be kidney/ureter
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2
Q

What is mittelschmerz?

A

one sided abd pain due to ovulation (not med emergency)

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3
Q

What might distended abd indicate? rigidity

A

-distended abdomen may mean obstruction or ascities, rigid may be peritonitis (decr movement)

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4
Q

What 3 bowel sounds do you listen for and what migh tthey indicate?

A

absent- paralytic ileus
increased sounds (borborygmi)- mech obstruction
bruit-vascular disease

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5
Q

Obturator/psoas sign?

A

can use to detect appendix inflam(?), rotate right leg or stretch psoas to see if appendix is impinged

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6
Q

~7 ACUTE abodomen issues that need immediate surgery?

A 
Ischemic bowel disease
acute Appendicitis
acute Pancreatitis 
chronic Pancreatitis 
bowel Obstruction
bowel Perforation
Mesenteric Lymphadenitis
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7
Q

4 mechs of ischemic bowel disease?

A

(mucosa impacted first)
1 acute emboli
2 chronic atherosclerosis
3 non-occlusive mestnteric ischemia (severe hypotension)
4 venous thrombosis (outflow issue causing congestion)

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8
Q

Histo in emboli vs athero plaque?

A

emboli cause patchy necrosis due to occlusion, athero plaque is more central and diffuse

foregut-celiac, sma-midgut

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9
Q

Emboli and ather clinical pres

A

older female w colon pain, sudden cramping, left lwoer abd pain, desire to defecate, bloody stool/diarrhea

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10
Q

What predisposes to venous thrombosis?

A

hypercoag state, estrogen/steorids/afib

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11
Q

differential Ddx for RLQ pain?

A

diverticulitis, ectopic preg, ovulation/ovarian cyst, colitis, chrons (terminal ileum first)

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12
Q 
Acute PANCREATITIS clinical pres?
What things are elevated in order? What is decr?
What might be the cause?
Clinical course?
Histo?
A
  • abd pain constant/intense upper/epigastric refers to back or shoulder,
  • Elev triglyerides, hypocalcemia
  • Can be caused by alc (M) or gallstones (F)
  • interstit inflam/edema, proteolysis, fat necr/hemorr
  • amy elev first, then lipase
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13
Q

Chronic pancreatitis? Cause

A

irrev dmg to exocrine pnacr parenchyma and FIBROSIS, usually from alc, inccr cancer risk, severe chronic abd pain

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14
Q

Bowel obstruction? causes?

-what does tympanic abd mean?

A

Can be from herniation, adhesion (post surgical), volvulus, intussusception, tumor
-tympanic abd means lots of air in it, eg from volvuluus (sigmoid or cecal in elderly)

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15
Q

Bowel perforation? 3-4 causes? CT? Hinchley classes?

A

Peritonitis that req immed surgery

  • can be from peptic ulcer/pylori, appendiciits causing abcess, diverticulutis (operate on hinchley II/IV, I/II ABX <5cm abcess), or iatrogenic (eg colonoscopy)
  • CT: faciform ligament w air in peritoneum (black space on xs)
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16
Q

Mesenteric lymphadenitis?
pop?
what is it similar to?
org?

A
  • self limit inflam that mimics appendicitis/intuss
  • may be due to Yersenia
  • mroe common in kids
  • resolves
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17
Q

What can GERD proceed to?

A

ulcer bleeding, stricture, barrets

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18
Q

causes for reflux

A

inflam of esoph mucosa (ph<4)
incompetent lower esoph sphincter, transient LES relaxation, delayed esoph clearance, gastric stasis where P in stomach greater than sphincter barrier (loss of receptive relaxation), disruption to esoph via meds, chem, etc, hiatal hernia, short LES
-esophagitis can also be from candida and herpes etc

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19
Q

Hiatal hernia

A

gastric reflux w chest pain, herniation of stomach thru diaph, tx with anti reflux or surg

20
Q

short LES with distention causes?

A

risk factors: motility disorders, decr saliv, epith dmg due to alc, hot liquid (incr perm of gap jxn) (shorter spinchter means can cause esoph)

21
Q

GERD tx and pathology?

A

monitor, but usu use PPI
-chronic inflam > epith hyperplasia > introduces inflam cells causing ulceration/erosion of mucosa, elong of dermal papillae (histo)

22
Q 
Stricture in esoph? 
Sx?
Tx?
Cause?
Path?
A

“lump in throat” often in oropharynx

  • sx: dysphagia
  • tx: dilation of stricture via stent
  • path: complication of reflux! (fibrosis and narrowing) use PPI etc
23
Q 
Barrett's esophagus?
pop?
what histo changes happen?
color of mucosa?
what can it progress to? (what type)
A

oftentimes middle aged men, conseq of GERD

  • metaplasia of squamous epith into intestinal cells (non cil columnar with goblet cells), ulceration and replacement of cells
  • salmon color mucosa
  • can go from metaplasia to dysplasia to adenocarcinoma (intervene @ low grade dysplasia, metaplasia usu doesnt progress to this)
24
Q

Squamous cell carcinoma risk factors? pop?

A

NOT related to barretts!

risk factors, occurs more ww, AA, alc/smoking, env

25
Mallory Weiss syndrome? what could it progress to? tx?
tearing of mucosa/sub and maybe mm of esoph, due to vomiting usu from alc or bulemia -can progress to boorhave's--rupture of esoph leading to air in mediastinum and subcut emphysema (surg emergency), tx by stopping bleeding
26
Achalasia sx? tx?
denervation of inhib nerves of LES so cant relax, dilated and spastic esoph, cant swallow, weight lsos, aspiration, tx with surg
27
esophageal varices? cause? can progress to? tx>
dilated submucosal blood vessels secondary to HTN - can rupture leading to bleeding - tx with meds, shunts to lower portal pressure, endoscop injxn etc
28
Esoph web? (syndr assoc?) ring? tx?
Esoph web-thin mucusal fold in upper esoph which may cause dysphagia -assoc with vinson plummer syndrome (iron def anemia, esoph web and BEEFY RED TONGUE) (what else causes this?) -ring-distal esoph tx is dilation
29
Esoph diverticulum? type? tx? sx? path? site?
weakening of muscle in esoph, can cause dysphagia, aspiration and bad/rotting breath, tx is surg - can be zenker's diverticulum--prolapse of esoph thru killians triangle - sx: bad breath, mass in neck, aspiration, gurgling/regurg
30
Esoph atresia? can progress to (compl)? tx?
congenital narrowing, may proceeded to aspiration pneumoitis, tx with surg -high lifetime risk for dysmotility, aspiration and squamous cell carc
31
``` Listeria monocytogenes Pop? o2 req gram hemolysis motility sources ```
"santas list" - neonates, preg women, elderly, immunosupr - can cause life threatening bacteremia and CNS infxn - small fac anaerobic gram + rod, beta hemolytic, exhibits tumbling motility - can be mistakenly reported as diphteroids - soil, decaying veg, raw meats/deli/veg/milk and soft cheeses
32
Listeria transm? what increases risk? mech?
not human-human except mat-fetal, transm via contam foods - H2 blockers and antiacids incr risk (ulcers) bc alklainize - org gets into blood and is endocytosed by epith cells in gastric mucosa
33
How does Listeria spread/ VFs?
invades cells by producing surface prot internalin which interacts with e caderin receptors on epith cells causing endocytosis. produces listeriolysin O VF which allows escape of orgs, migrate to cell memb to form filopods has surface prot actin A that allows cell to cell dissem (w.o being exposed dir to immuno defense_ iron is VF bc enhances growth, so in pts with iron overload like hemochrom or transfusion
34
How are ppl resistant to LM?
cell mediated immunity (if impaired more likely to get listeria), eg imunosuppr, transplant, preg, aids etc, low cd4
35
brain abcess with immunosuppr may indicate?
listeria
36
2 forms of neonatal listeria?
early sepsis and premature (infxn amniotic fluid, conjunctiva etc, intrauterine), late onset meningitis after birth from vag orgs during deliv
37
3 forms of CNS listeriosis?
meningitis, cerebritis, and abscess | meningitis is most common, CSF will have gram NEG stains! normal glucose levels, seizures etc
38
Gi form of listeria is?
self limiting!
39
Major listeria infections? (~5)
pregnancy (fever followed by stillbirth), neonatal early (amni) and late (mening), CNS in immunodef or elderly, GI self limiting, endocarditis
40
In which clinical settings should we suspect listeriosis>
neonatal sepsis or menin mening or CNS abcess in immunsup or elderly diphteroids on gram stain food borne GI with neg cultures(???)
41
complications (~3) of invasive listeriosis?
DIC, ARDS, rhabdomyolysis with ARF
42
``` Actinomyces israelli? source/host? granules gram/O2 reqs? shape? ```
"israelii soldier" humans an animal host, source is plants and soil -sulfur granules (yellow popcorn granules in suppurative inflam) -gram positive branching filamentous rods, NO acid fast, anaerobes
43
main sx of actinomyces? incr risk in? histo?
cervicofacial, and later abd (from appendicitis) or pelv(IUD)/thor (aspiration secondary) issue, IC pts NOT at incr risk! (GI issues incr risk) - lumpy jaw is most common, following dental procedure, abcess draining sinus, prululent exudate with sulfur granules, can dissem - histo: hard to culture, supp inflam, sufur, periph edges with club shaped projxn, basophilic granular structures centrally amorphas, gram + branching filamentous rods
44
Nocardia? stain/O2 sx what is it similar to/how do you distinguish?
"No card game for old men" | -similar clinical to actinomycosis, but aerobic, partially acid fast, and gram pos branching filaments
45
ddx for actino?
include nocardia and bortrymycosis (not branching filaments)
46
Tx for actinomycoses?
Penecillin

T2 GI (6 decks)

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