GI #1 Flashcards by Tyler Cichowski

Diagnostics for cholecystitis

US: initial test

- HIDA: most accurate

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Treatment for Cholecystitis

NPO, IVF

- ABX (Ceftriaxone + Metro) then Cholecystectomy

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MCC of Acute Cholecystitis

E. Coli

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Symptoms of Cholangitis

Charcot’s Triad: Fever, chills, RUQ pain

- Reynold’s Pentad: AMS, Hypotension

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What is the cause of Cholangitis

Biliary tract infection secondary to obstruction of the common bile duct (gallstones, E. Coli, Malignancy)

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Diagnostics for Cholangitis

Labs: Leukocytosis, Increased Alk Phos & GGT, increased bilirubin
US: Initial
Cholangiography: via ERCP (Gold standard)

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Treatment for Cholangitis

IV ABX (Ceftriaxone + Metro, Unasyn)

- ERCP

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MC of cholelithiasis

Cholesterol

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Risk Factors for Cholelithiasis

-Female, Fat, Forty, Fertile, Fair

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Symptoms of cholelithiasis

-Biliary colic: episodic abrupt RUQ lasting 30 min - hours after fatty or large meals

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Gallstones in the common bile duct

Choledocolithiasis

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Physiologic jaundice presents on days _____ of life

3-5

Bilirubin levels fall in about 50% of neonates during first week of life

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jaundice is associated with bilirubin levels > _____ mg/dL

> 5.0 mg/dL

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Kernicterus, which is _________ and due to bilirubin in the brain tissue, is associated with bilirubin levels > ______

Cerebral dysfunction and encephalopathy

> 20 mg/dL

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Treatment for neonatal jaundice

Phototherapy initial management of choice.
-Done if > 12 at 24 hours of life, > 15 at 48 hours or > 18 at 72 hours of life
Exchange transfusion in severe cases (hemolysis, Rh immunization)

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Symptoms of Gilbert’s Syndrome

-Transient episodes of jaundice during periods of stress, fasting, alcohol, or illness

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How to diagnose Gilbert’s Syndrome

Increase in isolated indirect bilirubin level with otherwise normal LFT’s
No treatment needed (mild, benign disease)

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Treatment options for fecal impaction

Digital disimpaction followed by warm water enema with mineral oil
Polyethylene Glycol

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Anorectal Abscess and Fistula MCC

-Staph A

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MC location for anorectal abscess and Fistula

Posterior wall

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Symptoms of anorectal abscess or Fistula

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Swelling, pain that is worse with sitting/coughing/defecation
Febrile
Focal edema, induration, and fluctuance on eam

Treatment for anorectal abscess and Fistula

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Incision and drainage

- WASH: warm water cleansing, analgesics, sitz baths, high fiber diet

Symptoms of an Anal fissure

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BRBPR
Pain with bowel movements
Longitudinal tear in posterior midline
Skin tags seen in chronic fissures

Treatment for Anal Fissures

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Most resolve spontaneously
Supportive measures are first line
Topical vasodilators, Nitroglycerin
Botox injections

Symptoms of internal hemorrhoids

- Bleed and painless - Originate above the dentate line - Intermittent rectal bleeding, Painless BRBPR - Rectal itching and fullness

Four grades of Internal Hemorrhoids

- 1: does not prolapse (confined to anal canal). May bleed with defecation - 2: prolapses with defecation but spontaneously reduces - 3: prolapses with defecation with requires manual reduction - 4: irreducible and may strangulate

Symptoms of external hemorrhoids

- Do not bleed, but are painful - Originate below the dentate line - Perianal pain worse with defecation

Treatment for hemorrhoids

- High fiber diet, increased fluids, warm sitz baths - Rubber band ligation (for strangulated), Sclerotherapy, Excision - Hemorrhoidectomy for Stage IV if no response to other therapies

MCC of acute lower GI bleeding

Diverticulosis

Diagnostic of choice for diverticulosis

Colonoscopy | -Radionuclide imaging if bleeding not visualized on colonoscopy

MC area for diverticulosis

Sigmoid area

Symptoms of Diverticulosis

- Usually asymptomatic (incidental finding most times) | - Painless hematochezia

Diagnostic for Diverticulitis

- CT scan: initial - Labs: Leukocytosis Do NOT use colonoscopy and barium enema due to risk of perforation

Treatment for diverticulitis

-Metronidazole + Cipro/Levofloxacin for 7-10 days

What is the definition of toxic megacolon?

-Colon dilation > 6 cm + signs of systemic toxicity

Causes of Toxic Megacolon

- Ulcerative colitis - C. Diff - Radiation - Diverticulitis

Symptoms of Toxic Megacolon

- Profound bloody diarrhea - Distention - Signs of toxicity: AMS, fever, tachycardia, hypotension, dehydration

Initial imaging of choice for toxic megacolon

Abdominal radiographs

Treatment for Toxic Megacolon

-Supportive is mainstay (bowel rest, bowel decompression with NG tube, Metro + Ceftriaxone)

What is Olgivie Syndrome?

Acute dilation of the colon in the absence of any mechanical obstruction (colonic pseudo-obstruction)

Causes of Olgivie Syndrome

- Postoperative state - Opiates - Hypokalemia, Hypercalcemia - Hypothyroidism - DM

Treatment for Olgivie Syndrome

- IVF and electrolyte repletion - Neostigmine for decompression if failed conservative therapy - Surgical decompression as a last resort if failed other treatment modalities

Risk Factors for IBD

- Ashkenazi Jews - 15-35 years old - Genetics - Diet - Infections - Meds: NSAIDs, OCP - Gender: CD in females, UC in males - Smoking: protective in UC

Extra-Intestinal Manifestations of IBD

- Rheumatologic: MSK pain, arthritis, ALS, osteoporosis - Dermatologic: Erythema Nodosum - Ocular: anterior uveitis, iritis, conjunctivitis - Hematologic: B12 and Iron Deficiency, risk of thromboembolism

Facts about Ulcerative Colitis

- Limited to colon (contiguous spread proximally) - Rectum always involved - Mucosa and Submucosa ONLY - LLQ pain, bloody diarrhea - Smoking protective - Uniform inflammation on colonoscopy - Stovepipe Sign (loss of haustral markings) on Barium study - P-ANCA lab - Surgery curative

Facts about Crohn's Disease

- Any segment of the GI tract from mouth to anus effected - MC in Terminal Ileum - Transmural - RLQ pain, non-bloody diarrhea - Fistulas, B12 deficiency, and abscesses more common - Skip lesions and cobblestone appearance on colonoscopy - string sign on barium studies - ASCA lab - Surgery is noncurative

Treatment for Crohn's Disease

- 5-ASA (Mesalamine) or oral Glucocorticoids | - Severe & Refractory: Azathioprine, Methotrexate, anti-TNF agents

Treatment for UC

-Topical 5-aminosaliyclic Acid (ASA) first line | Surgical resection in some cases

MC occlusion in acute mesenteric ischemia

Superior mesenteric artery

Symptoms of acute mesenteric ischemia

- Severe abdominal pain out of proportion to exam findings - Pain poorly localized - N/v - Diarrhea

Diagnostics for acute mesenteric ischemia

- CT angiography (initial) - Conventional arteriography: definitive - Labs: lactic acidosis, leukocytosis

Treatment for acute mesenteric ischemia

-Surgical revascularization

GI #1 Flashcards

(52 cards)