Systems - GI - 1st half

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jonas112
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232513
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Systems - GI - 1st half
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2014-05-07 18:26:04
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Systems GI 1st half
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Systems - GI - 1st half
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  1. Five red flags in Chronic Abd. Pain
    • weight loss
    • fever
    • electrolyte abnormalities
    • signs of GI blood loss
    • anemia
    • (also listed: malnutrition, chronic diarrhea, dysphagia, vomiting)
  2. Some causes of chronic abdominal pain
    • -Intermittent SBO
    • -Chronic pancreatitis
    • -mesenteric ischemia
    • -PUD
    • -abdominal wall pain
    • -biliary disease
    • -GERD
    • -IBS
  3. What are the Rome III criterion for IBS?
    • 1) Need to have had symptoms for the past three months with them starting at least 6 months ago
    • 2) abd pain and discomfort for 3 days/month with 2 of the following:
    •   -improvement with defecation
    •   -associated with a change in stool freq
    •   -associated with a change in stool appearance
  4. Rare causes of chronic abd. pain
    • -Celiac artery compression syndrome: usually associated with epigastric bruit and weight loss
    • -Narcotic bowel syndrome: happens when using narcotics
    • -Painful rib syndrome: tenderness over the costal margins
    • - Eosinophlic Gastroenteritis: due to eosinophlic infiltration
    • - sickle cell anemia can cause abdominal pain because of vaso-occlusive crises
  5. Symptoms of esophageal disease
    • -dysphagia
    • -odynophagia
    • -esophageal colic
    • -heartburn
    • -regurgitation/aspiration
    • -hematemesis
  6. 4 questions for esophageal dysphagia
    • progressive vs non-progressive
    • painful vs painless
    • intermittent vs continuous
    • solid vs liquid
  7. agents that reduce LES tone
    Dietary: Caffiene, fatty meal, chocolate, peppermint, smoking, alcohol

    Meds: morphine, Ca++ channel blocker, nitrates, anticholinergics
  8. Red flags of GERD
    • Dysphagia
    • Odynophagia 
    • Hematemesis 
    • Melena (black stool)
    • Anemia
    • Weight loss
    • Refractory to therapy
  9. What are some of the complications of GERD
    • esophagitis/ulceration
    • aspiration
    • stricture
    • bleeding
    • Barrett's
    • adenocarcenoma
  10. Tx for GERD
    • 1) Lifestyle mods: diet, don't eat just before bed, physchosocial stress?
    • 2) Prokinetics
    • 3) acid reduction: PPIs, H2
    • 4) surgery: fundoplication
    • 5) endoscopic
  11. top 3 UGI/ top 3 LGI causes of bleeding
    UGI: duodenal/gastric ulcer, gastritis/esophagitis, esophageal varices, (also Mallory-Weis tear)

    LGI: angiodysplasia, diverticulosis, cancer
  12. UGI bleeding DDX (8)
    • -duodenal ulcer
    • -gastric ulcer
    • -gastric erosions
    • -ulcerative esophagitis
    • -eso. varices
    • -M-W tear
    • -Carcinoma/lymphoma
    • -angiodysplasia
  13. LGI bleeding DDX (8)
    • -hemorrhoids/anal fissures
    • -carcinoma
    • -angiodysplasia
    • -Crohn's
    • -diverticular disease
    • -ischemic colitis
    • -bacterial infections
    • -Meckel's diverticulum
  14. Signs and Symptoms of acute and chronic bleeds
    acute: fatigue (weakness), shock, MI, renal failure

    chronic: anemia, weakness, fatigue
  15. Recall the 4 grades of hemorrhoids
    • 1) bleeding
    • 2) prolapse, but retract by themselves
    • 3) prolapse, but need manipulation to reduce
    • 4) incarcerated
  16. describe 4 common clinical manifestations of congenital intestinal obstruction
    • 1) bilious emesis
    • 2) abdominal distention
    • 3) failure to pass meconium (should happen in 1st 48 hours)
    • 4) maternal h/o polyhydroamnios
  17. What is the most common EA/TEF presentation?
    EA with distal TEF
  18. What is on the DDx for "double bubble"
    • duodenal atresia
    • annular pancreas
    • intestinal malrotation
  19. How to initially manage peds bowel obstruction
    • 1) Hx and PE
    • 2) NG tube
    • 3) correct fluids/lytes
    • 4) Abs
    • 5) AXR
  20. What anomalies to think of if you see one on a newborn?
    • VACTERL
    • -vertebrae
    • -anal
    • -cardiac
    • -trachea
    • -esophagus
    • -renal
    • -limb
  21. What is the electrolyte balance you expect to see in pyloric stenosis
    • -vomiting a ton! so....
    • -hypocholeremia (low Cl-)
    • -metabolic alkalosis (losing stomach acid)
    • -hypokalemia (low K+ as it is exchanged in the kidneys to try and overcome the alkalosis)
  22. What is the rule of 2's for Meckel's diverticulum?
    • 2% of population affected->2% become symptomatic
    • 2 feet from terminal ileum
    • 2" long
    • usually present by age 2
  23. 5 things to ask when dealing with uninvestigated dyspepsia
    • 1) upper GI: cardiac, dietary related
    • 2) alarm bells: VBAD (vomiting, bleeding, abdominal pain and weight loss, dysphagia)
    • 3) NSAIDS
    • 4) H. pylori
    • 5) reflux
  24. Name 5 symptoms that support IBS Dx
    • abnormal stool freq
    • abnormal stool form
    • abnormal stool passage (e.g. tenesmus)
    • passage of mucus
    • bloating or abdominal distension
  25. What red flags to watch out for in IBS diagnosis
    • weight loss
    • rectal bleeding
    • arthritis, skin rash
    • nighttime symptoms
    • family Hx
    • age greater than 50
    • abnormal PE or lab findings
  26. list 8 common GI-associated Hx symptoms
    • pain
    • onset: gradual to acute
    • nausea/vomiting
    • anorexia
    • bloating
    • change in BM
    • diarrhea
    • recent travel
  27. list 8 common GI associated PE signs
    • fever
    • tachycardia
    • hypotension
    • abd. tenderness
    • guarding/rebound
    • absent bowel signs
    • jaundice
    • ascites
  28. What is Barrett's esophagus?
    normal squamous epithelium replaced by metastatic, columnar, or glandular epithelium due to GERD usually
  29. When do we offer a scope to someone with GERD
    • -severe GERD
    • -patients with red flags
    • -PPIs for more than ten years
  30. Gastric Ca S&S
    • late
    • non-specific
    • GI bleeding
    • early satiety
    • wt loss
    • epigastric/back pain
  31. Recurrent abdominal pain criteria
    • greater than 3 yo
    • at least 3 attacks of pain
    • recur over a 3 month period
    • severe enough to affect activity
  32. red flags in kids for abdominal pain (8)
    • persistent RUQ or RLQ pain
    • dysphagia
    • persistent vomiting
    • GI blood loss
    • nocturnal diarrhea
    • family Hx of IBD, celiac, or PUD
    • pain that wakes them up at night
    • arthritis
    • (others)
  33. major etiology for PUD
  34. What is the Tx for H. Pylori
    • 3-2-1 Tx
    • 3 drugs (PPI+1000mg amoxicillin+500 mg clarithromycin)
    • 2 times a day for
    • 1 week
  35. Red flags when looking at functional constipation in kids
    • Weight loss/failure to thrive
    • Bilious vomiting
    • fever
    • bloody stool
    • large thyroid
    • abnormal neuro exam

    Basically ruling out the organic causes: neuro, endocrine, intestinal obstruction
  36. What are the red flags that make you think about gastric cancer?
    • weight loss
    • anemia
    • bleeding
    • dysphagia
  37. What is the diagnostic criteria for functional constipation?
    • History longer than 8 weeks PLUS any 2 of the following:
    • -stool freq < 3x/week
    • -large stool in rectum or palpable on abdo exam
    • -fecal incontinence 1x per week or more
    • -toilet obstruction
    • -retentive posturing
    • -painful defecation
  38. What does it mean if the rectum to colon ratio is less than 1 (i.e. colon diameter is bigger than rectum diameter)
    Hirschsprung's disease. #1 cause of intestinal obstruction in newborn
  39. Most common cause of intestinal obstruction in kids < 2yo
    intussusseption
  40. Red flags for people with intestinal symptoms (6)
    • -new onset
    • -weight loss
    • -nocturnal symptoms
    • -fever
    • -anemia
    • -vomiting
  41. 4 categories of diarrhea
    • malabsorption/osmotic
    • secretory
    • inflammatory/infectious
    • increased motility

  42. Iron deficiency anemia is WHAT until proven otherwise?
    CRC
  43. What are the 4 F's in biliary colic?
    • Female
    • Fertile
    • Fat
    • Forty
  44. How is the inflammation pattern different in Crohn's and UC?
    UC: continuous from rectum, only in colon, only mucosa and submucosa

    CD: skip lesions, gum to bum, transmural (fistulas)
  45. What is a common extra-intestinal manifestation of UC?
    primary sclerosing cholangitis
  46. What is first line tmt in IBD?
    5-ASA agents
  47. What is Charcot's triad? What does it suggest?
    RUQ pain, fever/chills, jaundice

    suggests ascending cholangitis
  48. If you have intermittent abdo pain precipitated by eating food. What 3 things should you be thinking of?
    • 1) obstruction (SBO, gastric outlet)
    • 2) Pancreatitis
    • 3) ischemic bowel
  49. What are some foods that aggravate GERD?
    • Fried/fatty foods
    • Spicy foods
    • Citrus
    • Caffeine 
    • chocolate
    • peppermint
    • tobacco
  50. What is the 6F's that can cause abdominal distention?
    • Fat
    • Fluid (ascites)
    • Fecal matter
    • Fetus
    • Flatus
    • Fatal growth
  51. Go through the approach to esophageal dysphagia (solid vs solid and liquid, progressive vs intermittent, etc)
  52. Describe the effects of histamines, gastrin, ACh, and prostaglandins on H+ secretion in the stomach
  53. What must you ALWAYS do with a gastric ulcer that you dont need to do with a duodenal ulcer
    Biopsy it!! (duodenal ones are rarely malignant)
  54. When looking at bleeding in CRC, what side would you expect to see melena, hematochezia
    • melena -> right sided
    • hema-> left sided

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