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Clin Med: GI (block 3) > Small Intestine Disorders > Flashcards

Small Intestine Disorders Flashcards

1
Q

What are duodenal ulcers a part of?

A

PUD

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2
Q

Duodenal ulcers usually occur…

A

in the 1st few cm of the duodenum

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3
Q

Which is more common duodenal ulcers or gastric ulcers?

A

duodenal ulcers

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4
Q

Most common causes of duodenal ulcers

A

H. pylori & NSAID

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5
Q

Duodenal ulcers pathophys

A
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6
Q

Duodenal ulcers S/S

A
  • Pain relieved w/ food
  • Pain may awake pt at night
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7
Q

Duodenal ulcers PE

A
  • May have epigastric tenderness
  • If ulcer perforated, will have peritoneal signs
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8
Q

Duodenal ulcers Dx

A
  • May have anemia
  • Fecal occult test may be (+)
  • H. Pylori testing
  • Endoscopy w/ biopsy may be needed to make dx
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9
Q

Duodenal ulcers Tx

A

Acid-anti secretory agents (1st line)
–> PPI
–> H2 Receptor Antagonists (AKA H2 blockers)

Agents enhancing mucosal defenses (not 1st line)
–>Sucralfate
–>Antacids
–>Misoprostol

H.pylori eradication

Surgery

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10
Q

What is vagotomy?

A

surgical ligation of the vagus nerve to decr the secretion of gastric acid

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11
Q

What is pyloroplasty?

A

surgical dilatation of the pyloric sphincter to incr the rate of gastric emptying

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12
Q

What is antrectomy?

A

antrum (lower half) of the stomach makes almost all the acid, removal of this portion decr acid production

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13
Q

What is the appendix?

A

appendage at the ileocecal valve

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14
Q

What happens during appendicitis?

A

become inflamed & risks perforating/rupture if not tx fast

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15
Q

Appendicitis is most common between what ages?

A

10-30yo

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16
Q

Gender and race predominance in Appendicitis

A

> male
white

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17
Q

Appendicitis S/S

A
  • abdo pain begins in central abdo (periumbilical abdo pain) & migrates to LRQ as the inflammatory process progresses, intensifying over 24 hrs
  • tenderness to palpation
  • N/V
  • mild leukocytosis
  • low-grade fever
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18
Q

Appendicitis classic PE findings

A
  • Rovsing sign
  • Obturator sign
  • Psoas sign
  • McBurney’s point tenderness
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19
Q

Describe Rovsing sign

A

RLQ pain w/ LLQ palpation

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20
Q

Describe Obturator sign

A

RLQ pain w/ internal & external rotation of flexed hip

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21
Q

Describe Psoas sign

A

RLQ pain w/ raising leg against resistance

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22
Q

Describe McBurney’s point

A

the point 1/3 the distance from the anterior superior iliac spine & naval

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23
Q

Appendicitis other PE findings

A
  • Fever
  • Guarding
  • Rebound
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24
Q

Appendicitis Labs

A
  • CBC may show elevated WBC
  • CMP can help to rule out other issues (gallbladder, liver, pancreas)
  • UA/UCG
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25
Q

Abdo pain work up?

A
  • CBC
  • CMP
  • Lipase
  • UA
  • UCG (urine pregnancy test)
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26
Q

Appendicitis Imaging

A
  • CT test of choice in adults
  • Incr use of US in kids- very operator dependent
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27
Q

Appendicitis Tx

A
  • Pain & nausea control
  • Appendectomy
  • All pts should get perioperative abx
  • Starting to see some management w/ JUST abx- brand new & not common, will be used for pts that can’t undergo surgery
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28
Q

Appendicitis Complications

A
  • Abscess
  • Gangrene
  • Perforation (high risk if symptoms not tx in 36 hours of onset)
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29
Q

What is the most common surgical disorder of the small intestine?

A

Obstruction

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30
Q

What is an Ileus?

A

a small bowel blockage
Functional or paralysis

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31
Q

Describe ileus causes

A
  • Paralysis or decr movement
  • Decr blood supply
  • Postop
  • Infx
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32
Q

Types of obstructions

A
  • Adhesions (most common)
  • Neoplasms
  • Incarcerated hernia
  • Intussusception
  • Volvulus
  • Cystic Fibrosis
33
Q

Adhesion obstructions Tx

A

lysis of adhesion

34
Q

What are incarcerated hernias?

A

cannot be reduced

35
Q

What are strangulated hernias?

A

loses the blood supply

36
Q

Ventral Hernias

A
  • Epigastric
  • Umbilical
  • Spigelian
37
Q

Groin Hernias

A
  • Obturator
  • Femoral
  • Inguinal
38
Q

Hernia obstruction Tx

A

Surg

39
Q

Are Intussusception obstructions rare or common in adults?

A

Rare
- more common in kids

40
Q

Describe an Intussusception obstruction

A

invagination of one loop of intestine into another

41
Q

Intussusception obstructions Tx

A

surg

42
Q

Describe Volvulus obstructions

A

rotation of bowel around a fixed point

43
Q

Volvulus obstruction Tx

A

surg

44
Q

Describe CF obstruction

A

Incr intestinal secretions causes obstruction in small bowel

45
Q

CF obstruction Tx

A

Surg

46
Q

Obstruction S/S

A
  • Proximal: vomiting, abdo pain
  • Mid or distal obstruction: vomiting, distension, constipation
  • Abnormal VSs as obstruction progresses
47
Q

Obstruction PE

A
  • Diffuse or localized abdo tenderness
  • Guarding
  • Dry mucous membranes if dehydrated
48
Q

Obstruction Dx

A
  • Leukocytosis
  • Electrolyte abnormalities

Imaging:
- Supine & upright films
- CT scan for more info (w/ oral contrast)

49
Q

Obstruction Tx

A
  • NG suction
  • Fluid & electrolyte replenishment
  • If partial obstruction, may do bowel rest
  • If moderate or complete, surgery
50
Q

Most polyps are benign but this type has the potential to be malignant.

A

Adenomatous polyps

51
Q

Polyps: complications

A

obstruction & bleeding

52
Q

List several types of small bowel neoplasms.

A
  1. Adenocarcinoma
  2. NET
  3. Lymphoma
  4. Sarcoma
53
Q

NOTE

A

small bowel neoplasm is rare compared to colon cancer

54
Q

Mean age at dx for small bowel neoplasms

A

65 yo

55
Q

Small bowel neoplasms RFs

A
  • Familial cancer syndromes (familial adenomatous polyposis)
  • Male
  • Age >60
  • Celiac Disease
  • Crohn’s Disease
56
Q

Small bowel neoplasm S/S

A
  • Abdo pain
  • Weight loss
  • N/V
  • Obstruction
  • GI bleeding
57
Q

Small bowel neoplasm Dx

A
  • Barium swallow
  • CT
  • Surg w/ biopsy/resection
58
Q

Small bowel neoplasm Tx

A
  • Surgical resection
  • Chemo
59
Q

What is the cutaneous variant of celiac dz?

A

dermatitis herpetiformis

60
Q

Celiac dz aka

A

celiac sprue

61
Q

What is celiac dz?

A

a chronic dietary disorder caused by an immune response to gluten

62
Q

Celiac Dz RFs

A
  • Female
  • Diabetics
  • FHx
63
Q

Celiac Dz pathophys

A
64
Q

Celiac Dz S/S

A
  • Diarrhea
  • Steatorrhea
  • Weight loss
  • Abdo distension
  • Growth retardation (in children)
  • Muscle wasting
65
Q

Celiac Dz atypical S/S in older adults & young kids

A
  • Fatigue
  • Depression
  • Anemia
  • Amenorrhea
  • Decr fertility
  • Kids (malabsorption/malnutrition)
66
Q

Celiac Dz PE

A
  • May be normal
67
Q

Severe Case of Celiac Dz PE

A
  • Malabsorption
  • Loss of muscle mass, subcutaneous fat
  • Pallor
  • Easy bruising
  • Distension w/ hypoactive bowel sounds
  • Dermatitis herpetiformis in < 10%
68
Q

Celiac Dz Labs

A
  • Obtain CBC, serum albumin, iron or ferritin, Ca++, alkaline phosphatase, folate,B12, & D levels
  • Iron deficiency or megaloblastic anemia occurs b/c of iron or folate or vitamin B12malabsorption
  • IgA tissue transglutaminase (IgA tTG)
69
Q

Serologic tests for Celiac dz become negative (undetectable) occurs how longs after avoiding gluten?

A

3-12 months

70
Q

Celiac Dz diagnostic procedures

A
  • Mucosal biopsy: endoscopic mucosal biopsy of the proximal duodenum or distal duodenum confirms diagnosis
71
Q

Celiac Dz Tx

A
  • Remove all gluten from diet
  • Supplements as needed (folate, iron, B12)
  • If severe malnutrition, TPN may be needed
72
Q

What is acute mesenteric ischemia?

A

Thromboembolic occlusion of mesenteric arteries, mesenteric venous thrombosis, or aortic dissection that leads to mesenteric ischemia

73
Q

List causes of acute mesenteric ischemia

A
  • arterial occlusive dz
  • nonocclusive mesenteric ischemia
  • mesenteric venous thrombosis
74
Q

What is the most common cause of acute mesenteric ischemia?

A

arterial occlusive dz

75
Q

Acute Mesenteric ischemia Pathophys

A
76
Q

Acute Mesenteric ischemia S/S

A

severe abdominal pain out of proportion to physical exam findings (textbook)
typical symptoms may include
abdominal pain, which may be followed by forceful bowel evacuation
vomiting
diarrhea
distention

77
Q

Acute Mesenteric ischemia PE

A

minimal tenderness to palpation until transmural involvement of bowel
patients with acute mesenteric ischemia may have distention
may present with acute abdomen

78
Q

Acute Mesenteric ischemia Dx

A

complete blood count with differential, comprehensive metabolic panel, amylase, lipase, blood cultures, blood gas, and lactate
CT angiography (NOT A REGULAR CT)

79
Q

Acute Mesenteric ischemia Tx

A
  • Emergent revascularization
  • surg resection of necrotic bowel
  • Broad-spectrum abx
  • Volume resuscitation
  • Preop & postop anticoag to prevent thrombus propagation

Clin Med: GI (block 3) (8 decks)

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