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
    Image Upload
  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)
    Image Upload
  52. Describe the effects of histamines, gastrin, ACh, and prostaglandins on H+ secretion in the stomach
    Image Upload
  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
Author:
jonas112
ID:
232513
Card Set:
Systems - GI - 1st half
Updated:
2014-05-07 22:26:04
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Systems GI 1st half
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Systems - GI - 1st half
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