PANCE - GI review Flashcards
what antibiotic is a major cause of biliary sludge
ceftriaxone
boas sign
referred right subscapular pain of biliary colic
patho of cholangitis
ascending infxn due to an obstruction in the common bile duct
MC organism: E. coli
charcot’s triad
- RUQ pain
- fever
- jaundice
reynold’s pentad
- hypotension
- AMS
- RUQ pain
- fever
- jaundice
tx of cholangitis
ERCP + cipro + metronidazole
patho or primary sclerosing cholangitis
chronic liver dz characterized by inflammation and fibrosis of intrahepatic and extrahepatic bile ducts
primary sclerosing cholangitis is assoc with
UC
dx of primary sclerosing cholangitis
cholangiography
- fibrosis of bile ducts w dilation between strictures
tx of primary sclerosing cholangitis
liver transplant
primary sclerosing cholangitis presentation
pruritus + jaundice
anal fissure patho
develop secondary to local ischemia caused by hypertonia of internal sphincter
dx anal fissure
hx & visual inspection w anoscopy
tx of anal fissure
combo of supportive care AND topical vasodilator
- nifedipine or nitroglycerin
2nd line:
- topical CCB (diltiazem 2%)
- botox
failure of conservative tx & symptoms > 8 weeks
- lateral internal sphincterotomy
dx of anorectal fistula
anoscopy
tx of anorectal fistula
SURGERY
- fistulotomy w or w/out marsupialization
where does bleeding occur in diverticulosis
MCC of LOWER GI bleed
bleeding distal to the ligament of Treitz
MC location of diverticulosis
sigmoid (descending) colon
diverticulitis triad
- LLQ pain
- fever
- leukocytosis
how to dx diverticulitis
CT w oral and IV contrast
- fat stranding
- bowel wall thickening >4mm
clinical prediction rule for diverticulitis
- absence of vomiting
- CRP > 5 mg/dL
- LLQ pain
all 3 = positive result
diverticulitis complications
- abscess formation
- fistula formation
*bladder –> colon - SBO
MCC of rectal bleeding in pts < 50
hemorrhoids
internal hemorrhoids arise from
superior hemorrhoidal cushion
above dentate line and covered by columnar cells
how to dx internal hemorrhoids
anoscopy
internal hemorrhoid tx
symptomatic care:
- stool softeners
- warm sitz bath
- lidocaine ointment or witch hazel
bleeding internal hemorrhoid:
- sclerotherapy injection
prolapsed:
- rubber band ligation
grade IV hem:
- hemorrhoidectomy
inflammatory bowel diseases are MC in which population
Ashkenazi Jewish population
smoking in IBD
INCREASED risk of Crohn’s disease in smokers
*C for Cigarettes
DECREASES flares in UC
transmural inflammation meaning
affects ALL layers of intestinal mucosa
crohn’s affects ANY part of GI tract
*mouth to anus
what is spared in crohn’s
rectum!!!
crohn’s presentation
- RLQ pain
- NON-bloody diarrhea*
- aphthous ulcers*
- fistula
- B12 & iron def anemia
- weight loss due to malabsorption
colonoscopy findings for crohns
skip lesions (cobblestone appearance)
- NON-continuous areas of inflammation
creeping fat
- pathognomonic
- mesenteric fat that migrates to the bowel
biopsy findings for crohn’s
- transmural inflammation
- granuloma!!!
rectum is ALWAYS affected in what dz
UC!
Rome IV Criteria
- related to defecation
- change in freq of stool
- change in form of stool
abd pain at least once a wk for 3 consecutive months
tx for IBS-C
polyethylene glycol
lactulose
linaclotide
lubiprostone
tx for IBS-D
loperamide
cholestyramine
eluxadoline
tx for abd pain / bloating in IBS
dicyclomine
hyoscyamine
radiographic features of button battery
halo or double ring around the circular object
- seen on anteroposterior view
tx of button battery ingestion
emergency endoscopic removal
when to screen patients with UC for colon cancer
start screening 8-10 years AFTER dx
colonoscopy q 1-3 yrs
colon CA screening in patients with a positive 1st degree relative
colonoscopy at age 40 OR 10 years prior to age of diagnosis of FDR, whichever comes 1st
repeat q 5 years
colon CA screening
screen adults 45-75
OR
at age 40 OR 10 years prior to age of diagnosis of FDR, whichever comes 1st
MC type of colon CA
adenocarcinoma
patho:
- progression of adenomatous polyps into adenocarcinoma of colon or rectum
RIGHT sided (ascending) colon CA symptoms
- iron def anemia
- occult blood loss
- melena (upper GI bleed)
LEFT sided (descending) colon CA symptoms
- changes in bowel habits
- hematochezia (lower GI bleed)
- SBO
*left sided colon CA in MC than right sided
colon CA screening methods: when to repeat a FIT
q year
- antibodies are detected in blood
colon CA screening methods: when to repeat a FIT-DNA
q 1-3 years
colon CA screening methods: when to repeat a flexible sigmoidoscopy
q 5 years
only examines distal 3rd of colon
colon CA screening methods: when to repeat a CT colonography
q 5 years
patho of phenylketouria (PKU)
absent phenylalanine hydroxylase (PAH) enzyme activity
phenylalanine accumulates in CNS leading to mental retardation & mvmt d/o
PKU presentation
- blonde, blue eyed w fair skin
- mousy, musty odor
- wide spaced teeth
dx of PKU
newborn screen 24-48 hrs after 1st feed
- plasma phenylalanine levels > 20 mg/dL
tx of PKU
dietary phenylalanine restriction & increased dietary tyrosine intake
