UWORLD GI Flashcards
Tx pregnancy and gallstones
Asymptomatic: no treatment.
pregnancy-related gallstones resolve spontaneously within 2 months of delivery.
Symptomatic treated with IV fluids and pain control. if persistent: cholecystectomy during the second trimester.
Anal Abscess Sxs
severe, constant pain
fever or malaise.
PE: Erythematous, indurated skin or a fluctuant mass over the perianal or ischiorectal space.possibly Purulent drainage
Anal Abscess Tx
Most important: prompt incision and drainage (I&D) of the abscess
Oral antibiotics for pt with DMs, immunosuppression, extensive cellulitis, or valvular heart disease. Abx after I&D
Admit not necessary for localized infection
Anal abscess vs fistula
Anal abscess is an infection within one or more of the anal spaces
Anal fistula is a tunneling between the anus or rectum and another epithelial lined space (eg, the skin overlying the drainage site).
Anal fistula SXS and Tx
Typically present with an anal abscess that persists or with a pustule-like lesion in the perianal or ischiorectal area that continually drains.
Surgical repair is usually necessary to eliminate the fistula while preserving fecal continence.
GERD vs H. Pylori infection
Helicobacter pylori presentas as dyspepsia ( epigastric burning and symptoms of bloating, nausea, or early satiety)
GERD- substernal burning and regurgitation, sour taste
Drug induced pancreatitis
“Daily” drugs
Antihypertensive: thiazides, furosemide, enalapril, losartan
Antiepileptic: valproate acids, carbamazepine
Immunosuppressants: azathioprine, mercaptopurine, corticosteroids
Drug Induced Pancreatitis
“Occasional/ event” drugs
Antibiotics: Isoniazid, Tetracyclins, metronidazole, TMP-SMX
Antivirals: lamivudine, didanosine
Analgesics: NSAID, Acetaminophen, Pilates, mesalamine, sulfasalazine
Mechanism of Drug induced pancreatitis
-Hypersensitivity sulfonamide
-Ischemia due to decreases intravascular volume
-Increased viscosity of pancreatic secretions
White by baccal lesions that can be scrapped of leaving hyperremic spots
Oral thrush.
Plaques can be removed (even if difficult)
Residual area of inflammation normal after plaque removal
Small Flat Cherry-red Lesions in the colon
Angiodysplasia (vascular ecstasies or AV malformations)
Vascular anomalies composed of multiple aberrant blood located in GI tract. Frequent cause of occult bleeding.
Pathogenesis: chronic occlusion of submucosal veins- congestions- AV collaterals
Bleeding GI angiodysplasia associated with?
Small percent bleed. ^ bleeding associated with:
-ESRD
-Aortic stenosis
- Von Willebrand
Chronic Diarrhea MCC
IBS, IBD
Chronic Infection
Malabsorption Syndrome
Evaluation of Chronic Diarrhea
Complete Hx of Sxs
Routine Lab Tests
Electrolytes
Stool Analysis
Microscopic Stool examination (leukocytes, parasites, occult blood,pH, fat)
Stool Osmotic gap
Stool findings in celiacs
Increased stool osmotic gap
Micro cystic anemia, iron deficiency
Villous atrophy
Lactose intolerance stool findings
Diarrhea after lactose
Increased stool osmotic gap
Decreased stool pH
+ lactose hydrogen breath test
Collagenous Colitis
Chronic watery diarrhea associated with fecal urgency and nocturnal diarrhea
Secretory diarrhea (decreased stool osmotic gap)
Thick subepithelial collagen band
Further Management of celiacs (in addition initial tx: diet)
Monitor: iron, folate, calcium, and other vitamins (A, D, E, B12) monitored.
DXA scan to evaluate for bone loss (due to vitamin D deficiency)
pneumococcal vaccine due to associated hyposplenism.
Eosinophilia Esophagitis
pathogenesis
Th2- mediated inflammatory response triggered by food antigen exposure
Conor bid atopic disease (asthma, eczema, food allergies)
Eosinophilia esophagitis Sxs and Dx
Dysphasia
Heartburn & epigastric pain
Regurgitation
Food impaction
Dx: endoscopy and biopsy (eosinophils >15)
Eosinophilic esophagitis Tx
Elimination diet (primary)
PPI
Topical glucocorticoids
Risk factors infantile hypertrophic pyloric stenosis
Firstborn Male
Macrolide antibiotic exposure (< 2 weeks age)
Infantile hypertrophic pyloric stenosis Tx
IV Fluids
Surgical Pyloromyotomy
Infantile hypertrophic pyloric stenosis Sxs
Age 3-6 weeks
Projectile nonbilious emesis (immediate)
Hungry VOmiter
Visible peristalsis
Dehydration
Hypochloremic Hypokalemic metabolic alkalosis
Indirect hyperbilirubinemia
Initial studies of suspected esophageal mural injury
Malloy Weiss: UpperGI endoscopy
Boerhaave: CXR (pneumothorax, pneumomediastinum, pleural effusion). CT water soluble contrast
Mallory Weiss vs Boerhaave
bothe present with hematemisis.
Boerhaave: fever, chest pain, mediastinitis, pleural effusion, hemodynamic instability
Complications of untreated celiac disease
At risk for Entropy they associated T cell Lymphoma.
Poor prognosis due to late presentation: 10 months
Sxs of Enteropathy associciated T-cell Lymphoma
(Aggressive hematologist malignancy that affects the jejunum)
And Pain
B Symptoms
Bowel obstruction/ perforation
GI bleed
pathogenesis of intussuscption
MCC: involves hyperplasia of intestinal lymphoid follicles (Peyer patches) in the ileocecal region following viral infection in children age 6 months to 3 years;
intussusception due to a pathologic lead point (eg, Meckel diverticulum)
clinical findings in intussusception
- Sudden, intermittent abdominal pain & vomiting
- Sausage-shaped mass in right abdomen
- Currant jelly stools
- Lethargy or altered mental status
next step in management of intussusception
- Classic presentation: Air or water-soluble both diagnostic and therapeutic.
- Atypical presentation (eg, lethargy alone): Ultrasonography is the diagnostic reveals a target sign. An enema can be performed once the diagnosis is confirmed.
colon cancer screening with family
Colonoscopy at age 40 (or 10 years prior to age of diagnosis in FDR, whichever comes first)Repeat every 5 years (every 10 years if FDR diagnosed at age >60)
