Week 7 GI Flashcards by Darlena Thach

GI red flags

Orthostatic hypotension
Weight loss
Iron deficiency anemia
New onset pain
> 50 years old
Early satiety
Palpable mass
Fever
Change in bowel habits
Fecal incontinence
melena/coffee ground emesis
Guaiac positive stools
Dysphagia
Odynophagia
Long term NSAID use
Persistent hoarseness
Chest pain
Smoker / hx of smoking
Hx heavy ETOH use
Failure to improve w treatment
Pain out of proportion to exam
Abdominal distension
Increase LFT/jaundice
Abnormal PE

How well did you know this?

Not at all

Perfectly

pediatric red flags

bilious vomit

fever

bloody diarrhea

weight loss/poor weight gain

nocturnal pain or diarrhea

lethargic

toxic appearing

How well did you know this?

Not at all

Perfectly

gold standard imaging for appendicitis

CT scan

How well did you know this?

Not at all

Perfectly

Ultrasound imaging for what GI issues

cholecystitis, pyloric stenosis, intussusception, pancreatitis

How well did you know this?

Not at all

Perfectly

2-3 weeks of age, projectile nonbilious vomiting immediately after feeding, Caucasian 1st born males

pyloric stenosis

insatiable appetite, weight loss, dehydration, constipation

get ultrasound

manage with fluid/electrolytes, surgery

How well did you know this?

Not at all

Perfectly

burning, aching, gnawing pain 2-5 hours after last meal

relieved by food or antacids

epigastric pain

peptic ulcer disease: mucosal defect in gastric area
H pylori
tx: antibiotics and PPI first line
complications: bleeding ulcer/perforation

How well did you know this?

Not at all

Perfectly

gold standard test for h pylori?

gold standard imaging?

urea breath test (stop PPI 1 week prior)
or stool antigen testing (stop PPI 4 wks prior
both shows active infxn
(antibodies useless bc it lasts for years so doesn’t tell us active infection)

imaging: EGD (esophagogastroduodenoscopy)

How well did you know this?

Not at all

Perfectly

Eradication therapy for Helicobacter pylori in children

amoxicillin

clarithromycin

PPI - omeprazole/ranitidine

BID

How well did you know this?

Not at all

Perfectly

common causes of acute pancreatitis

I GET SMASHED

Idiopathic
Gallstones *2nd common
Ethanol *1st common
Trauma
Steroids
Mumps/malignancy
Autoimmune
Scorpion sting
Hypertriglycerides/lipidemia or Hypercalcemia
ERCP
Drugs

How well did you know this?

Not at all

Perfectly

first line imaging for acute pancreatitis

abdominal ultrasound

How well did you know this?

Not at all

Perfectly

Diagnosis of pancreatitis

2 or more:

epigastric pain consistent with pancreatitis
Serum lipase and amylase > 3 times upper limit of normal
Abd Ultrasound

How well did you know this?

Not at all

Perfectly

clinical presentation of acute pancreatitis

severe sudden onset of constant, sharp, poorly localized abdominal pain radiating to back (pancreas retroperitoneal)
Epigastric or LUQ pain, worse when lying down
Cullen sign (bruising around umbilicus)
Grey turner (bruising of flank)
rebound tenderness = late sign

How well did you know this?

Not at all

Perfectly

cholelithiasis clinical manifestations

[gallstones]
RUQ pain/tenderness
biliary colic with intermittent or steady pain radiates to R posterior shoulder after 1 hour eating a large meal esp high fat
mild to severe; lasts 1-6 hrs
n/v

How well did you know this?

Not at all

Perfectly

acute cholecystitis clinical manifestations

biliary colic lasts longer 4-6 hrs
sharper RUQ pain, radiates to R shoulder/scapula esp after eating fatty foods
Charcot triad: RUQ pain, fever, jaundice
muscle guarding/rigidity
distended tender gallbladder (confirms)
hypoactive bowel sounds
Murphy’s sign (inability to take deep breath from discomfort during palpation under right costal margin)
sometimes jaundice if biliary obstruction

How well did you know this?

Not at all

Perfectly

risk factors for cholelithiasis

increasing age (> 45 yrs)
obese, rapid weight loss
pregnancy
fibrates, OC, estrogen, progesteron, ceftriaxone
females
TPN, fasting
metabolic dz (crohns, cirrhosis, DM etc)

How well did you know this?

Not at all

Perfectly

when to send to ER for cholelithiasis

severe pain or bilirubin elevated

Labs for cholelithiasis/cystitis

CBC

LFT

electrolytes, BUN, Cr

intussusception clinical manifestations

3 months - 3 years old
sudden RLQ pain, palpable mass sausage shaped
classic triad:
- intermittent colickly (crampy) abdominal pain
- non bilious vomiting
- currant jelly mucous stools / + guaiac stools

intussusception diagnostics and management

Dx: abd US
Dx & tx: air contract enema
management:
- emergency management and consult with pediatric radiologist and surgeon
- rehydration
- surgery if perforation, peritonitis, hypovolemic shock
- observe 12-18 hrs

LLQ, colicky abdominal pain with no inflammatory process (spasms of sigmoid colon)
<102F
leukocytosis
constipation
hyperactive bowel sounds
peritonitis if have abdomen tenderness

diverticulosis

diverticulosis labs

CBC, ESR, UA, stool for occult, Sed Rate, BMP

what imaging for diverticulosis? when is it warranted?

NO imaging needed if pt has classic sx’s (LLQ, intermittent pain, low grade temp) and not septic

want imaging if signs of peritonitis (rigid abdomen, bloody stool, 102+F) = abdomen CT

diverticulosis management

Mild leukocytosis, low fever, minimum and tenderness: outpatient
- Clear liquid diet x 2-3 days
- Metronidazole + Cipro if >101F or elevated leukocytosis
- f/u few days
Moderate to severe complications
- High fever, septic, abscess, rectal bleeding = HOSPITALIZE! Can get complications like sepsis
Educate: 30-35g fiber/day, nuts and seeds okay
f/u GI 4-6 wks later for underlying cancer

diverticulosis vs diverticulitis

diverticulosis is out pouching saclike hernias of mucosa wall from increased pressure gradient/wall weakness

Diverticulitis is from stagnant fecal in single diverticulum = pressure necrosis = inflammation = can cause perforation

hemorrhoids

masses of vascular tissue that cushion in submucosal layer of anal canal maintain anal closure and continence normal anatomic structures until they cause symptoms

hemorrhoids sx's (internal vs external)

* bleeding, pruritic, protrusion, pain * internal: painless, bright red rectal bleeding; blood on toilet paper/water/ on stool * external: less likely to bleed; asymptomatic unless thrombosis develops; anal irritation, pruritic, palpable nodule

hemorrhoid management

conservatively or little/no tx high fiber, increase fluid intake bulk forming agents/stool stiffeners sitz baths oral analgesics for inflammation

hemorrhoid management

conservatively or little/no tx high fiber, increase fluid intake bulk forming agents/stool stiffeners sitz baths oral analgesics for inflammation

pediatric dehydration volume repletion (mild, moderate, severe)

* **Oral pedialyte preferred than sports drink /apple juice** * Mild: 50mL/kg over 4 hours * Moderate: 100mL/kg over 4 hours * Severe: NS or LR IV 20mL/kg boluses

gastroenteritis

* norovirus * severe diarrhea young children * fecal-oral * watery diarrhea x 3-8 days, cramps, chills, dehydration

gastroenteritis management

* NO antibiotic; tx is oral rehydration therapy * should resolve in 1 week * serious infxn sx's: * food borne illness * bloody diarrhea, weight loss, severe abdominal pain, high fever * neuro involvement * if diarrhea \> 2 weeks + sx's above: get labs * stool culture and examination for parasites * CBC * electrolytes

severe rectal pain with bowel movement burning, tearing, bright red bleeding on toilet/tissue

anal fissure can be from trauma from large hard stool

anal fissure management

* if chronic → nitrates/nitroglycerin = inc blood flow to this area to heal better * Refer for surgery conservative therapy don’t work * educate: 6 weeks to heal * keep stools soft w/ high fiber diet, increase fluid, possible laxatives, sitz bath, lidocaine cream, stool softeners

epigastric/periumbilical pain migrating to RLQ, abdominal rigidity *after* pain occurs, these sx's occurs: n/v, anorexia, constipation, low fever

appendicitis Refer ASAP! Hospitalization and surgery may be needed

appendicitis signs

* elevated WBC * rebound tenderness, guarding * **rovsing sign** - pressing LLQ causes pain in RLQ * **obturator sign** - passive rotate R leg with R hip and knee flexed while supine * **psoas sign** - supine, raise straightened R leg against resistance by me * **mc Burney's sign** - pain when pressing down midpoint of RLQ

appendicitis imaging for adult vs children

adult: CT abdomen/pelvis with contrast children: Ultrasound

appendicitis management

treatment: appendectomy w/in 24 hrs of sx onset to prevent perforation/peritonitis (NPO, IV fluids, e- repletion) if appendix perforated = antibiotic therapy to cover