Ross Flashcards
1
Q
mc reason for ED visits
A
abd pain
2
Q
why are elderly at higher risk for mortality and serious GI pathology
A
blunting of physiologic responses →
not spiking fever
not becoming tachycardic or hypotensive
weakened abd wall
3
Q
elderly populations don’t develop peritoneal signs bc
A
weakened abdominal wall
4
Q
bowel obstructions present w
A
diffuse colicky pain
5
Q
mesenteric ischemia presents w.
A
pain out of proportion to exam
6
Q
pancreatitis pain is located __
and radiates to __
A
epigastric
back left shoulder blade
7
Q
appendicits pain is __ in adults
and __ in children
A
periumbilical to RLQ
rectal
8
Q
what imaging should you order if you suspect perforation, abscess, obstruction, or mass
A
CT
9
Q
CT should only be used as shotgun answer for
A
elderly
10
Q
have a low threshold for CT in pt >
A
65 yo
11
Q
GI CT’s use contrast, so you must check __
with __
A
kidney fxn
GFR
12
Q
infectious non inflammatory diarrhea is characterized by
A
watery stools
13
Q
infectious inflammatory diarrhea is characterized by
A
bloody pus stools
14
Q
what pathogen is mc in outbreaks of diarrhea in close quarters like daycare, nursing homes, cruise ships
A
rotavirus
15
Q
if you have a pt w. infectious diarrhea that recently drank from a stream, you should think (2)
A
giardia
cryptosporidium
16
Q
toxigenic infections result in symptoms w.in
A
12 hr
17
Q
example of toxigenic bacteria
A
s.aureus
18
Q
non preformed bacteria result in symptoms w.in
A
24 hr
19
Q
some bacteria cause bloody diarrhea dt invasion of
A
mucosa
20
Q
abx for diarrhea should only be used for (5)
A
symptoms > 5 days
elderly
immunocompromised
fever >101.5
severe illness defined by dehydration
21
Q
PUD is typically associated w. (3)
A
etoh
NSAIDs
stress
22
Q
stress induced PUD is called
A
erosive gastritis
23
Q
almost all non-NSAID and etoh related ulcers are dt
A
h. pylori
24
Q
if a pt w. PUD has negative h.pylori and no hx etoh or NSAIDs, you should think
A
carcinoma
25
sx of gastric carcinoma
refractory PUD → non responsive to PPI trial
wt loss
26
testing for h.pylori
serum abs
stool antigen
urea breath test
27
best test for h.pylori
urea breath
28
NSAIDs inhibit
prostaglandins
29
principle enzyme involved w. mucosal cytoprotection
COX-1
30
selective NSAIDs preferentially inhibit
COX-2
31
test for h.pylori if (2)
PUD
new onset dyspepsia
32
1st line tx if pt is h.pylori (+)
triple therapy x 14 days:
PPI
PLUS
clarithromycin AND amoxicillin
33
after 14 days of first line tx for h.pylori, you should
stop treatment x 1 month → then retest
34
if still positive for h.pylori after retest, you should
treat again w. 2nd line
35
if still positive for h.pylori after 2nd round of tx you should (2)
scope
refer
36
dt h.pylori resistance in CO, many patients need to go straight to
quadruple therapy
37
what is quadruple therapy for h.pyori
PPI
PLUS
metronidazole AND TCN AND bismuth
38
pt's \> 45 yo w. dyspepsia or PUD sx need \_\_
dt higher risk for \_\_
endoscopy
gastric ca
39
what do you think when you see, intense pain, abnormal vitals, vomiting
perforated ulcer
40
what is the reason for abnormal vitals in perforated ulcer
peritonitis
41
pt w. perforated ulcer needs (2)
admit
surgery/GI consult
42
all pt's w. free air on KUB need
surgical consult
43
if no free air on KUB, consider __ consult
before __ consult
GI
surgical
44
free air on KUB is a
surgical emergency
45
hepatitis is easily confused w.
biliary tract dz
46
what can help you distinguish hepatic dz from biliary tract dz
liver enzymes
47
in hepatitis, \_\_
will be elevated more than \_\_
aminotransferases
alk phos
48
mc presentation of biliary dz
cholelithiasis w.o infxn
49
what is biliary colic
persistent RUQ pain lasting up to 6 hr
associated w. fatty meal
50
biliary colicky pain is associated w.
obstruction of cystic duct by gallstone
51
\_\_% of pt's w. cystic duct stone will progress to acute cholecystitis
30
52
what is choledocholithiasis
sone in common bile duct
53
complications of choledocholithiasis
pancreatitis
cholecystitis
54
what special test is 97% sensitive for acute cholecystitis
murphy's sign
55
best imaging for cholecystitis
US
56
diagnostic US findings of cholecystitis
presence of stone
wall thickening \>3 mm
pericholecystic fluid
CBD \> 6 mm
57
acute appendicitis mc affects
teens
early 20s
58
in appendicitis, the \_\_
becomes obstructed by a \_\_,
causing __ (2)
appendiceal lumen
fecalith
bacterial overgrowth, dilation of appendix
59
what do you think when you see, umbilical pain that migrates to RLQ over hours
appendicitis
60
what is a likely predictor for surgery w. appendicitis
pain before vomiting
61
where might appendicitis pain present in a pregnant woman
RQU → appendix is shifted superiorly
62
what is a normal anatomical appendix variation that might cause back pain in appendicitis
retrocecal appendix
63
t/f psoas, obturator, and rovsing signs are sensitive and specific enough to dx appendicitis
F!
*but they are best PE findings to point you towards appendicitis*
64
imaging of choice for adult appendicitis
CT w. contrast
65
best imaging for peds appendicitis
US of RLQ
66
pre op for appendectomy
abx
pain management
67
mesenteric pain may be
generalized
68
mesenteric ischemia is mc in
elderly w. atherosclerotic dz
69
mesenteric ischemia is usually caused by
arterial emboli
thrombus in mesenteric art
70
less common cause of mesenteric ischemia
hypoperfusion dt hypotn
71
major rf for mesenteric ischemia
elderly w. afib
72
dx for mesenteric ischemia (2)
contrasted abd CT
labs showing leukocytosis and metabolic acidosis
73
what lab do you need to dx metabolic acidosis
lactate
74
tx for mesenteric ischemia
aggressive fluids
**early** abx
surgical consult
75
what is a non mechanical bowel obstruction
ileus
76
what do you think when you see, paralyzed intestine and absent peristalsis
ileus
77
mc cause of sbo
ileus
78
ileus is caused by (4)
electrolyte imbalance
infxn
spinal cord injury
bowel surgery
79
abd exam findings for functional sbo
hypoactive bs
mild tenderness
80
mechanical sbo causes (3)
adhesions
hernias
cancers
81
sbo pain will be
diffuse
82
sbo pt will have abd pain, and may also have
distension
vomiting
83
sbo pt will have decreased \_\_
and no __ (2)
peristalsis
gas, feces
84
auscultation findings in obstuctive sbo
high pitched **hyperactive tinkling**
85
what is the problem w. plain films in sbo
may miss early dz
86
\_\_ is more sensitive than plain films for sbo,
and it can also __ the obstruction
CT
locate cause of
87
tx for sbo
admit!
lytes/fluids
+/- NGT
surgical consult
88
large bowel obstructions are commonly caused by
mass/ca
sometimes volvulus
89
imaging for large bowel obstruction will show
no bowel in iliac fossa
90
tx for large bowel obstruction
admit
surgical consult
91
what do you think when you see, diffuse, non-specific pain w. slow onset over 1-2 days, that eventually localizes to LLQ
diverticulitis
92
diverticulitis mc affects (2)
descending colon
sigmoid colon
93
imaging choice for diverticulitis (esp w. first presentation)
CT w. IV contrast
94
do you need to re-image every bout of diverticulitis
no!
95
indications for CT w. diverticulitis
first presentation
suspect perforation or abscess
96
tx for simple diverticulitis
PO abx
pain management
97
tx for complicated diverticulitis
IVF
abx
bowel rest
98
indications for admit w. diverticulitis
co-morbidities
no ability to f.u
99
what divides GI bleeds into upper vs lower
ligament of treitz
100
the ligament of treitz supports and connects the end of the \_\_
with the beginning of the \_\_
end of the duodenum
beginning of the jejunum
101
hematemesis involves __ blood
and the __ GI
dark/black blood/coffee grounds
upper
102
melena involves bleeding per \_\_
and __ blood
rectum
dark/tarry
103
if a pt has melanotic stools, think
upper GI bleed →
PUD w. perforation
esophageal varices
104
any pt vomiting blood needs
high level of care
105
if you are unsure pf GI bleed or if you suspect mallory weiss tear, consider
cbc
orthostatic vitals
stool guaiac
NGT
106
is a mallory weiss tear superficial or deep
superficial
107
if a pt is actively vomiting blood and has abnormal vitals, consider
2 IV's
fluid resuscitation
+/- transfusion
**EGD per GI**
108
EGD is both
diagnostic
and
therapeutic
109
if pt is negative for orthostatic changes, stool guaiac, and blood per NGT, consider
PUD w.o perforation → obs for a few hours, then d.c w. GI referral
110
lower GI bleeds will present w. __ blood
or \_\_
bright red
hematochezia
111
common causes of lower GI bleed (6)
**hemorrhoids**
polyps
ca
IBD
infectious diarrhea
colitis
112
pe for lower GI should include
direct visualization of anus → hemorrhoids
113
imaging for hemorrhoids
anoscopy
114
mc cause of lower GI bleed
hemorrhoids
115
what do you think when you see, engorged vascular plexus of veins
hemorrhoids
116
internal hemorrhoids arise
above dentate line
117
internal hemorrhoids are not covered by \_\_
and are not \_\_
mucosa
palpable
118
both types of hemorrhoid present w.
brbpr
119
tx for both types of hemorrhoids
stool softeners
high fiber
localized topical anesthetics
120
soft hemorrhoids can be \_\_
thrombosed hemorrhoids need \_\_
reduced
removal
121
hemorrroidectomy may need to be done
outpatient
122
what do you think when you see, sharp, severe, persistent abd pain that radiates to the back w. n/v
pancreatitis
123
labs for pancreatitis will show elevations of
lipase
amylase
124
in pancreatitis, lipase will be elevated __ x higher than normal
2-3
125
which is more reliable for pancreatitis, lipase or amylase
lipase
126
pancreatitis in men is mc caused by \_\_
and in women, it is mc caused by \_\_
etoh
gallstones
127
2 presentations of pancreatitis
acute vs chronic
128
acute pancreatitis work up
CT w. IV contrast
aggressive fluids
admit
129
considerations for admit in chronic pancreatitis
able to tolerate po
pain level
130
what is a do not miss for cause of pancreatitis
obstructing stone
131
what are 2 special tests for severe (hemorrhagic) pancreatitis
cullen's
grey-turner
132
what is ranson's criteria used to assess
severity of pancreatitis
133
can one lipase r.o pancreatitis
yes!
*but not one amylase*
134
what is ranson's criteria at admit
**3 or more on admit indicates severely ill:**
**GALAW:**
glucose \> 200 mg/dl
age \> 55 yo
LDH \> 3350 u/l
AST \> 250 u/l
WBC \> 16,000 mm3
135
reducible hernia only needs
pain management
+/- GI consult if ADLs impacted
136
imaging for hernia
US
137
what is an incarcerated hernia
part of abdominal wall or intestine that is trapped in the sac of the hernia
138
signs of incarcerated hernia are similar to \_\_
and include
sbo
139
incarcerated hernias may or may not be
reducible
140
peritoneal signs are usually associated w. a __ hernia
strangulated
141
what is a strangulated hernia
blood supply to herniated section of intestine is cut off
142
strangulated hernias are not \_\_
and are a \_\_
reducible
medical emergency
143
what lab value will be very high with necrotic tissue (ex strangulated hernia)
lactate
144
what other labs (besides lactate) can help you distinguish an incarcerated hernia from a strangulated hernia
cbc
cmp
145
both incarcerated and strangulated hernias require
abd CT w. IV contrast
surgical consult
146
femoral hernias are rare, but mc in
women
147
pe for a femoral hernia, you show
mass below the inguinal ligament
148
where do esophageal foreign bodies/impacted food boluses obstructions occur
anywhere with a narrowing:
stricture
carcinoma
lower esophageal ring
149
foreign bodies are best removed via
endoscopy
150
\_\_ might work to tx an impacted food bolus
glucagon
151
s.e of glucagon
nausea
vomiting
152
after clearance of an impacted food bolus in an elderly pt, you still need to \_\_
dt high chance of \_\_
scope
recurrence
153
elderly pt's w. impacted food bolus may also need
obs stay
GI consult
154
indication for ASAP endoscopy in non elderly pt w. impacted food bolus
drooling
155
button battery ingestion is very dangerous and mc occurs in (2)
kids
puppies :(
156
button batteries can cause
perforation
157
intussusception occurs in kids up to
5 yo
158
intussusception is telescoping of the a section of the intestines, and usually occurs post \_\_
due to \_\_
viral infxn
swollen lymph tissue (peyer's patches)
159
sx of intusussception
intermittent crying
blood/mucus stool → ***currant jelly*** in the diaper
160
dx and tx for intusussception is
barium air enema
161
what do you think when you see, sausage mass mid abdomen, diarrhea, currant jelly stool (mucus/blood)
intusussception
162
pyloric stenosis occurs in what peds age group
birth - 5mo
163
sx of pyloric stenosis
vomiting
wt loss
**olive shaped mass** mid epigastrum
visualized peristaltic waves
164
dx and tx for pyloric stenosis
dx: US
tx: surgery
165
cyclic vomiting usually occurs in
kids
166
cyclic vomiting can be triggered by __ (2)
and can last \_\_
THC, food allergies
days-weeks
167
cyclic vomiting is usually a __ issue
SNS nerve
168
work up for cyclic vomiting
electrogastrografic studies
GI referral
169
what is cannabinoid hyperemesis syndrome
daily smokers feel n/v for hours
170
what can alleviate cannabinoid syndrome
hot showers
171
what do you think when you see, early satiety, nausea, and postprandial vomiting of undigested food
gastroparesis
172
gastroparesis can be debilitating and can be caused by \_\_
DM → neuromuscular dysfxn
173
acute management of gastroparesis
anti-emetics
IVF
174
management of chronic gastroparesis
small meals
liquid nutrition
low fat diets
175
pt \>50 yo w. constipation needs work up for
cancer
176
complication of constipation in elderly
KUB full of stool → perforation → death
177
imaging for constipation in elderly
xray
178
what is this showing
**constipation**
small bowel w. circular folds
large bowel periphally located
179
tx for elderly constipation
bowel softeners
increase fluid
enema
PA
180
constipation \> 2 weeks may need
scope
181
opioid induced constipation you may use
methylnaltrexone (Relistor)
182
mallory weiss tear involves a mucus tear at the \_\_
2/2 to \_\_
gastroesophageal junction
forceful vomiting
183
common sx of mallory weiss tear
vomiting blood
184
tx for mallory weiss tear
none → heal on their own
185
what is this showing
cullen's sign → bruising around umbilicus → severe pancreatitis
186
what is this showing
gray turner's → bruising of the flanks → severe pancreatitis
