Ross GI study guide - Exam 3 Flashcards
What patient population presenting with abd pain is at high risk for serious pathology?
Elderly population
Patients with bowel obstructions present with what type of pain?
Diffuse colicky pain
Patients with mesenteric ischemia present with what type of pain?
Pain out of proportion to exam
Patients with pancreatitis present with what type of pain?
Epigastric pain radiating to back left shoulderblade
Patients with appendicitis present with what type of pain?
periumbilical to RLQ pain
Children can have rectal pain
CT is useful to determine what abd conditions?
Perforation, abscess, obstruction, or mass.
Patients over age 65 have a ____ threshold to CT scan?
Low
What bacteria is related to peptic ulcer disease?
Helicobacter pylori
Other than H. pylori, what are some common causes of peptic ulcer disease?
NSAIDs, alcohol use, stress
Patients negative for H. pylori who do not use NSAIDs or alcohol should be worked up for _____.
Gastric carinoma
What other signs and symptoms are suggestive of gastric carcinoma?
Weight loss, no response to PPI.
Other than ulcers, what condition can be caused by H. pylori?
Gastric carcinoma
What tests can be done for H. pylori?
Which is best?
Serum antibody, stool antigen, or urea breath test.
Urea breath test is best
What is the treatment for patients with suspected PUD who do not use NSAIDs or alcohol?
PPI, clarithromycin, amoxicillin
What test is indicated in patients over 50 presenting with PUD symptoms or dyspepsia?
Endoscopy to R/O gastric carcinoma
Any time you see _____ on XR, it is a surgical emergency.
Free air
Signs/Symptoms of perforated ulcer?
Intense pain, peritoneal signs, vomiting, abnormal vital signs
What imaging study should be ordered when a perforated ulcer is suspected?
KUB checking for free air
Acute appendicitis typical patient age?
Teens and early 20s
Classic presentation of appedicitis?
Umbilical pain the migrates to the RLQ over hours. Pain precedes vomiting.
Treatment for appendicits?
Surgical
How might symptoms of appendicitis change in a pregnant patient?
May have RUQ pain due to upward shifting of the appendix.
Atypical pain for appendicitis is back pain. Patients who have this have a ____ appendix.
Retrocecal appendix
Typical exam findings of appendicitis?
Psoas, obturator, Rovsing’s are typically positive.
You examine a patient and find a positive psoas, obturator, and Rovsing sign. They have typical appendicitis symptoms. What should you do next.
CT with contrast.
Physical exam findings not specific enough to call surgery.
What imaging study should be considered in peds you suspect for appendicitis?
US of RLQ
Patients with appendicitis should get what meds pre-op?
Antibiotics and pain management
What are common causes of mesenteric ischemia?
Arterial emboli or thrombus
Less common cause of mesenteric ischemia?
Hypotension
Lab findings in mesenteric ischemia?
Leukocytosis and metabolic acidosis
Imaging study of choice for suspected mesenteric ischemia?
Abdominal CT with contrast
Treatment for mesenteric ischemia?
Aggressive fluid resuscitation, antibiotics, and early surgical evaluation
What are the types of bowel obstruction?
Non-Mechanical
Mechanical
Non-mechanical obstructions are caused by an ileus. What is an ileus?
A section of paralyzed intestine where the bowel does not have paristalsis.
What are the causes of an ileus?
Electrolyte imbalance, infections, spinal cord injury, and bowel surgery.
Physical exam findings of an ileus?
Hypoactive bowel sounds and mild tenderness
What are common causes of mechanical bowel obstructions?
Adhesions, hernias, and cancers.
Exam findings of mechanical bowel obstructions?
Diffuse abdominal pain, distension, and sometimes vomitting.
Can patients with mechanical bowel obstructions pass gas or feces?
No
Auscultation of a mechanical bowel obstruction would reveal _______.
High pitched hyperactive tinkling.
Common cause of large bowel obstructions?
Cancer or volvulus.
Imaging studies for bowel obstruction?
XR can be helpful but CT more sensitive.
Treatment for SBO?
Replace electrolytes and fluids. Decompress stomach (controversial).
Admission and surgical consult.
Describe the pain of diverticulitis.
Slow onset over 1-2 days. Diffuse and non-specific, migrating to LLQ.
Symptoms of diverticulitis?
Fever, vomiting, decreased appetite, abd pain.
Most common anatomical location for diverticulitis?
Descending and sigmoid colon
Imaging of choice for suspected diverticulitis?
CT with contrast for first presentation. Not necessary for repeated episodes, but should be repeated for suspected perf or abscess.
Treatment for simple diverticulitis?
PO antibiotics and pain management.
Treatment of complicated diverticulitis?
IVF, antibiotics, bowel rest.
+/- admission depending on comorbidities
What anatomical structure differentiates upper GI bleeds from lower GI bleeds?
Ligament of Treitz
Symptoms suggestive of upper GI bleed?
Vomiting blood or coffee ground emesis, melena.
Common causes of upper GI bleeds?
PUD with perf, esophageal varices, Mallory Weiss tear
What could help differentiate between Mallory Weiss tear and serious causes of upper GI bleeding?
CBC, orthostatic vitals, stool guaiac
You are called into a room with a patient actively vomiting blood. What is your first intervention?
2 large bore IVs - fluid resuscitation
What procedure done by GI is diagnostic and therapeutic for upper GI bleeds?
esophagogastroduodenoscopy
You are concerned your patient has an upper GI bleed. No orthostatic changes, stool guaiac is negative, NG tube shows no blood. PT may have PUD but it is not a bleeding ulcer. Can this patient be discharged?
Yes, with GI follow up
Common sign of lower GI bleeds?
Hematochezia
Common causes of lower GI bleeds?
Diverticulitis, polyps, cancer, IBD, infectious diarrhea, colitis, hemorrhoids
What MUST you do for a patient with hematochezia?
Directly visualize anus for hemorrhoids, consider anoscopy.
Most common cause of lower GI bleed?
Hemorrhoids
Internal hemorrhoids vs external hemorroids?
Internal arise above dentate line
External arise below dentate line.
Treatment for hemorrhoids?
Stool softeners, high fiber diet, topical anesthetics.
Most reliable lab in evaluation of pancreatisis?
Lipase
Describe the symptoms associated with pancreatitis?
Sharp, severe, persistent pain with nausea and vomiting
MCC of pancreatitis in men? In women?
Men: alcohol abuse
Women: gallstones
Patients with severe pancreatitis may show what signs?
Cullen’s and Grey-Turner’s signs
What criteria is used to access severity of pancreatitis ?
How often should it be done?
Ranson’s criteria.
Used at initial evaluation and every 24 hours after
What is the best procedure to remove foreign bodies of the esophagus?
endoscopy
Where can esophageal foreign bodies occur?
At any narrowing. Examples include stricture, carcinoma, lower esophageal ring
What are some pharmacologic interventions for an impacted food bolus?
Glucagon and nitroglycerin
They are smooth muscle relaxers
If a hernia is not reducible, what types could it be?
Incarcerated or strangulated
What is the difference between incarcerated and strangulated hernias?
Strangulated hernias has no blood supply, and will become nectrotic.
How can you differentiate between incarcerated and strangulated hernias?
Strangulated typically very tender, have peritoneal signs, high lactate.
Imaging study of choice for strangulated hernia?
CT abdomen with contrast
What locations can a patient have hernias?
Ventral, umbilical, femoral, inguinal
4 year old patient presents with crying, currant jelly stool, and a sausage mass mid abdomen. What is the likely diagnosis?
Intussusception
________ is both diagnostic and therapeutic for intussusception.
Barium air enema
Vomiting, weight loss, an olive shape mass mid epigastrium, and peristalic waves in an infant are suggestive of _______.
Pyloric stenosis
Pyloric stenosis is usually diagnosed by what age?
5 months
Diagnosis and treatment of pyloric stenosis?
Diagnose via US
Treatment is surgical repair.
What causes of abdominal pain should you be sure not to miss?
MI, AAA, mesenteric ischemia, ectopic pregnancy, bowel obstruction, perforation.
