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NURP 532 > Week 7 GI > Flashcards

Week 7 GI Flashcards

1
Q

GI red flags

A

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

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2
Q

pediatric red flags

A

bilious vomit

fever

bloody diarrhea

weight loss/poor weight gain

nocturnal pain or diarrhea

lethargic

toxic appearing

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3
Q

gold standard imaging for appendicitis

A

CT scan

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4
Q

Ultrasound imaging for what GI issues

A

cholecystitis, pyloric stenosis, intussusception, pancreatitis

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5
Q

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

A

pyloric stenosis

insatiable appetite, weight loss, dehydration, constipation

get ultrasound

manage with fluid/electrolytes, surgery

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6
Q

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

relieved by food or antacids

epigastric pain

A
  • peptic ulcer disease: mucosal defect in gastric area
  • H pylori
  • tx: antibiotics and PPI first line
  • complications: bleeding ulcer/perforation
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7
Q

gold standard test for h pylori?

gold standard imaging?

A
  • 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)

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8
Q

Eradication therapy for Helicobacter pylori in children

A

amoxicillin

clarithromycin

PPI - omeprazole/ranitidine

BID

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9
Q

common causes of acute pancreatitis

A

I GET SMASHED

  • Idiopathic
  • Gallstones *2nd common
  • Ethanol *1st common
  • Trauma
  • Steroids
  • Mumps/malignancy
  • Autoimmune
  • Scorpion sting
  • Hypertriglycerides/lipidemia or Hypercalcemia
  • ERCP
  • Drugs
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10
Q

first line imaging for acute pancreatitis

A

abdominal ultrasound

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11
Q

Diagnosis of pancreatitis

A

2 or more:

  • epigastric pain consistent with pancreatitis
  • Serum lipase and amylase > 3 times upper limit of normal
  • Abd Ultrasound
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12
Q

clinical presentation of acute pancreatitis

A
  • 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
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13
Q

cholelithiasis clinical manifestations

A
  • [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
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14
Q

acute cholecystitis clinical manifestations

A
  • 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
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15
Q

risk factors for cholelithiasis

A
  • increasing age (> 45 yrs)
  • obese, rapid weight loss
  • pregnancy
  • fibrates, OC, estrogen, progesteron, ceftriaxone
  • females
  • TPN, fasting
  • metabolic dz (crohns, cirrhosis, DM etc)
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16
Q

when to send to ER for cholelithiasis

A

severe pain or bilirubin elevated

17
Q

Labs for cholelithiasis/cystitis

A

CBC

UA

LFT

electrolytes, BUN, Cr

18
Q

intussusception clinical manifestations

A
  • 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
19
Q

intussusception diagnostics and management

A
  • 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
20
Q
  • LLQ, colicky abdominal pain with no inflammatory process (spasms of sigmoid colon)
  • <102F
  • leukocytosis
  • constipation
  • hyperactive bowel sounds
  • peritonitis if have abdomen tenderness
A

diverticulosis

21
Q

diverticulosis labs

A

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

22
Q

what imaging for diverticulosis? when is it warranted?

A

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

23
Q

diverticulosis management

A
  • 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
24
Q

diverticulosis vs diverticulitis

A

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

25
Q

hemorrhoids

A

masses of vascular tissue that cushion in submucosal layer of anal canal

maintain anal closure and continence

normal anatomic structures until they cause symptoms

26
Q

hemorrhoids sx’s (internal vs external)

A
  • 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
27
Q

hemorrhoid management

A

conservatively or little/no tx

high fiber, increase fluid intake

bulk forming agents/stool stiffeners

sitz baths

oral analgesics for inflammation

27
Q

hemorrhoid management

A

conservatively or little/no tx

high fiber, increase fluid intake

bulk forming agents/stool stiffeners

sitz baths

oral analgesics for inflammation

28
Q

pediatric dehydration volume repletion (mild, moderate, severe)

A
  • 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
29
Q

gastroenteritis

A
  • norovirus
  • severe diarrhea young children
  • fecal-oral
  • watery diarrhea x 3-8 days, cramps, chills, dehydration
30
Q

gastroenteritis management

A
  • 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
30
Q

severe rectal pain with bowel movement

burning, tearing, bright red bleeding on toilet/tissue

A

anal fissure

can be from trauma from large hard stool

31
Q

anal fissure management

A
  • 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
32
Q

epigastric/periumbilical pain migrating to RLQ, abdominal rigidity

after pain occurs, these sx’s occurs: n/v, anorexia, constipation, low fever

A

appendicitis

Refer ASAP! Hospitalization and surgery may be needed

33
Q

appendicitis signs

A
  • 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
34
Q

appendicitis imaging for adult vs children

A

adult: CT abdomen/pelvis with contrast
children: Ultrasound

35
Q

appendicitis management

A

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

NURP 532 (13 decks)

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