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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
Abdo pain work up?
- CBC - CMP - Lipase - UA - UCG (urine pregnancy test)
26
Appendicitis Imaging
- CT test of choice in adults - Incr use of US in kids- very operator dependent
27
Appendicitis Tx
- 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
28
Appendicitis Complications
- Abscess - Gangrene - Perforation (high risk if symptoms not tx in 36 hours of onset)
29
What is the most common surgical disorder of the small intestine?
Obstruction
30
What is an Ileus?
a small bowel blockage Functional or paralysis
31
Describe ileus causes
- Paralysis or decr movement - Decr blood supply - Postop - Infx
32
Types of obstructions
- Adhesions (most common) - Neoplasms - Incarcerated hernia - Intussusception - Volvulus - Cystic Fibrosis
33
Adhesion obstructions Tx
lysis of adhesion
34
What are incarcerated hernias?
cannot be reduced
35
What are strangulated hernias?
loses the blood supply
36
Ventral Hernias
- Epigastric - Umbilical - Spigelian
37
Groin Hernias
- Obturator - Femoral - Inguinal
38
Hernia obstruction Tx
Surg
39
Are Intussusception obstructions rare or common in adults?
Rare - more common in kids
40
Describe an Intussusception obstruction
invagination of one loop of intestine into another
41
Intussusception obstructions Tx
surg
42
Describe Volvulus obstructions
rotation of bowel around a fixed point
43
Volvulus obstruction Tx
surg
44
Describe CF obstruction
Incr intestinal secretions causes obstruction in small bowel
45
CF obstruction Tx
Surg
46
Obstruction S/S
- Proximal: vomiting, abdo pain - Mid or distal obstruction: vomiting, distension, constipation - Abnormal VSs as obstruction progresses
47
Obstruction PE
- Diffuse or localized abdo tenderness - Guarding - Dry mucous membranes if dehydrated
48
Obstruction Dx
- Leukocytosis - Electrolyte abnormalities Imaging: - Supine & upright films - CT scan for more info (w/ oral contrast)
49
Obstruction Tx
- NG suction - Fluid & electrolyte replenishment - If partial obstruction, may do bowel rest - If moderate or complete, surgery
50
Most polyps are benign but this type has the potential to be malignant.
Adenomatous polyps
51
Polyps: complications
obstruction & bleeding
52
List several types of small bowel neoplasms.
1. Adenocarcinoma 2. NET 3. Lymphoma 4. Sarcoma
53
NOTE
small bowel neoplasm is rare compared to colon cancer
54
Mean age at dx for small bowel neoplasms
65 yo
55
Small bowel neoplasms RFs
- Familial cancer syndromes (familial adenomatous polyposis) - Male - Age >60 - Celiac Disease - Crohn’s Disease
56
Small bowel neoplasm S/S
- Abdo pain - Weight loss - N/V - Obstruction - GI bleeding
57
Small bowel neoplasm Dx
- Barium swallow - CT - Surg w/ biopsy/resection
58
Small bowel neoplasm Tx
- Surgical resection - Chemo
59
What is the cutaneous variant of celiac dz?
dermatitis herpetiformis
60
Celiac dz aka
celiac sprue
61
What is celiac dz?
a chronic dietary disorder caused by an immune response to gluten
62
Celiac Dz RFs
- Female - Diabetics - FHx
63
Celiac Dz pathophys
64
Celiac Dz S/S
- Diarrhea - Steatorrhea - Weight loss - Abdo distension - Growth retardation (in children) - Muscle wasting
65
Celiac Dz atypical S/S in older adults & young kids
- Fatigue - Depression - Anemia - Amenorrhea - Decr fertility - Kids (malabsorption/malnutrition)
66
Celiac Dz PE
- May be normal
67
Severe Case of Celiac Dz PE
- Malabsorption - Loss of muscle mass, subcutaneous fat - Pallor - Easy bruising - Distension w/ hypoactive bowel sounds - Dermatitis herpetiformis in < 10%
68
Celiac Dz Labs
- 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 B12 malabsorption - IgA tissue transglutaminase (IgA tTG)
69
Serologic tests for Celiac dz become negative (undetectable) occurs how longs after avoiding gluten?
3-12 months
70
Celiac Dz diagnostic procedures
- Mucosal biopsy: endoscopic mucosal biopsy of the proximal duodenum or distal duodenum confirms diagnosis
71
Celiac Dz Tx
- Remove all gluten from diet - Supplements as needed (folate, iron, B12) - If severe malnutrition, TPN may be needed
72
What is acute mesenteric ischemia?
Thromboembolic occlusion of mesenteric arteries, mesenteric venous thrombosis, or aortic dissection that leads to mesenteric ischemia
73
List causes of acute mesenteric ischemia
- arterial occlusive dz - nonocclusive mesenteric ischemia - mesenteric venous thrombosis
74
What is the most common cause of acute mesenteric ischemia?
arterial occlusive dz
75
Acute Mesenteric ischemia Pathophys
76
Acute Mesenteric ischemia S/S
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
Acute Mesenteric ischemia PE
minimal tenderness to palpation until transmural involvement of bowel patients with acute mesenteric ischemia may have distention may present with acute abdomen
78
Acute Mesenteric ischemia Dx
complete blood count with differential, comprehensive metabolic panel, amylase, lipase, blood cultures, blood gas, and lactate CT angiography (NOT A REGULAR CT)
79
Acute Mesenteric ischemia Tx
- 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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