Test #15 (EGR Week 2 Block 1: GI) Flashcards
Acute erosive gastropathy: (1) factors causing it (2) definition of erosion (3) complication
(1) NSAID drug use, head trauma, severe burns, acute stress, and alcohol or tobacco use (2) Erosions defined as mucosal defects that do not fully extend through muscularis mucosa (3) Can cause upper GI hemorrhage that leads to melena
(1) Dx: 2 yo girl with black, tarry, guaiac positive (hemoccult test) stool, 99mTc-pertechnetate accumulation in right lower ab quadrant on radionucleotide scan (2) Mechanism behind Dx (3) Explain Dx
(1) Meckel diverticulum (2) Failed obliteration of omphalomesenteric (vitelline) duct (3) Lower GI bleeding one of most common presentations of Meckel diverticulum. This div. often contains ectopic gastric mucosa which produces acid causing possible ulceration and bleeding. 99mmTc-pertechnetate scan identifies ectopic gastric epithelium and helps dx Meckel div.
(1) Retroperitoneal hematoma in stable patient likely due to damage of what strx (2) Presentation options (3) Dx modality of choice (4) Tx approach
(1) Pancreatic injury (2) May present with mild sx, be asymptomatic or be masked by sx from other injuries related to trauma (3) Abdominal CT (4) Frequently nonexpanding hematomas in this location tx conservatively (ie, non-operatively)
(1) Dx/Explain: 30 yo Caucasian male, recent onset of fever, bloody diarrhea, and abdominal distention, dx w/ ulcerative colitis one year ago but not compliant with meds, PE significantly distended and tender abdomen, bp 100/70, hr 130/min (2) Other typical s/sx (3) Method of dx (4) Contraindicated methods of dx & why
(1) Toxic megacolon is well-recognized complication of ulcerative colitis (2) Ab pain and distention, along with fever, diarrhea, and signs of shock are typical (3) Plain abdominal X-ray (4) Barium contrast studies and colonoscopy contraindicated due to risk of perforation
(1) Dx: 32 yo female, severe nausea, recurrent bilious vomiting, began as postpandrial epigastric pain & early satiety but progressed over last 2 weeks, recently lost 25 lbs on crash diet, ab tender & slightly distended w/ high pitched bowel sounds (2) Explain
(1) Superior mesenteric artery syndrome (occurs when transverse portion of duodenum entrapped between SMA and aorta), (2) causing sx of intestinal obstruction. Occurs when aortomesenteric angle critically decreases, secondary to diminished mesenteric fat (ie, weight loss in this pt), pronounced lordosis, or surgical correction of scoliosis
(1) Dx/Etiology: 2 day old neonate develops persistent bilious vomiting, laparotomy shows cecum fixed to right upper ab quadrant (2) Explain
(1) Intestinal malrotation - Failed midgut rotation around superior mesenteric artery (2) 2 main manifestations of this condition: (1) Intestinal obstruction (due to compression by adhesive bands; cecum found in upper right upper quadrant, fixed with fibrous, or Ladd’s, bands to second portion of duodenum & entire midgut fixed to SMA) (2) Midgut volvulus (intestinal ischemia due to twisting around vessels)
(1) Likely Dx: 45 yo female with Crohn’s ileocolitis experiences recurrent colicky right upper ab pain (2) Mechanism
(1) Gallstones - Patients with Crohn’s disease affecting terminal ileum prone to development of gallstones. (2) Decreased bile acid reabsorption and its loss via feces increases lithogenicity of bile. Cholesterol precipitates and forms gallstones.
