Constipation. Dumping. Gastroparesis. Acute Pancreatitis.

Front 1

241. Management of constipation?

Back 1

a. Correcting the underlying cause.
b. Therefore, knowing the etiology is the key to determining the treatment.

Front 2

242. Possible causes of constipation?

Back 2

1. Dehydration (insufficient fluid intake): look for decreased skin turgor, an elderly patient with an increased BUN to creatinine ratio (>20:1)

2. lack of dietary fiber

The two above are the most common

3. calcium channel blockers
4. narcotic use
5. hypothyroidism
6. diabetes
7. ferrous sulfate, iron replacement
8. anti–cornered medications

Front 3

243. pathophysiology of diabetes as the cause of constipation?

Back 3

Loss of sensation in the bowels leads to decreased detection, obstruction of bowel, which is one of the main stimulants of G.I. Motility.

Front 4

244. Clue that ferrous sulfate, iron replacement is the cause of constipation?

Back 4

a. The stool is BLACK and can look as though there is upper G.I. Bleeding.
b. Blood is cathartic and will usually produce rapid bowel movement (diarrhea)!
c. Ferrous sulfate is constipated and it is also heme–negative when one tests for occult blood.

Front 5

245. Which antidepresant with anti–cholinergic effect cause constipation?

Back 5

Note: anti–cholinergic medications which cause constipation include tricyclic antidepressants.

Front 6

246. Treatment of constipation?

Back 6

a. Hydration and increased fiber is always a good option.
b. You may consider prescribing a bell regimen with Senokot and docusate.

Front 7

247. Dumping syndrome?

Back 7

Dumbing syndrome is a relatively rare disorder related to prior gastric surgery, usually done for ulcer disease

Front 8

Two phenomena that cause Dumping syndrome?

Back 8

1. Rapid release of hypertonic chyme into the duodenum, which acts as an osmotic draw into the duodenum, causing intravascular volume depletion.

2. Sudden peak in glucose levels in the blood because of the rapid release of food into the small intestine. This is followed by the rapid release of insulin in response to this high glucose level, which then causes hypoglycemia to develop.

Front 9

249. Presentation of dumping syndrome?

Back 9

a. Shaking, sweating, and weakness.
b. There may be hypertension resulting from the rapid release of the gastric contents into the duodenum, which causes an osmotic draw into the bowel.
c. The other reason is a rapid rise in blood glucose resulting in a reactive hypoglycemia.

Front 10

Treatment of dumping syndrome

Back 10

Frequent small meals.

Front 11

Presentation of gastroparesis.

Back 11

1. early satiety,

2. bloating,

3. postprandial nausea,

4. constipation as well as diarrhea

5. general sense of increased abdominal fullness.

Front 12

The most common association for gastroparesis.

Back 12

DM

Front 13

Other causes of gastroparesis.

Back 13

Electrolyte problems with:

1.potassium,

2. magnesium,

3. calcium

These can also weaken the musculature of the bowel wall.

Front 14

Diagnostic test for gastroparesis.

Back 14

Gastric-emptying study can be done with the ingestion of radioisotopelabeled food, this is rarely necessary.

Go STRAIGHT to Tx.

Front 15

251. Treatment of diabetic gastroparesis?

Back 15

Erythromycin or metoclopramide.

Front 16

252. How does erythromycin help with diabetic gastroparesis?

Back 16

It increases motilin in the gut–a hormone that stimulates gastric motility.

Front 17

253. Presentation of acute pancreatitis?

Back 17

a. Severe medically gastric abdominal pain and tenderness in an alcoholic or someone with gallstones.
b. Other symptoms include:
1. vomiting without blood
2. anorexia
3. tenderness in the epigastric area

Front 18

254. symptoms of severe acute pancreatitis?

Back 18

1. Hypotension
2. metabolic acidosis
3. leukocytosis
4. hemoconcentration
5. hyperglycemia
6. hypocalcemia caused by fat malabsorption
7. hypoxia.

Front 19

Signs of Severe Necrotizing Pancreatitis?

Back 19

• Cullen sign: blue discoloration around umbilicus → due to hemoperitoneum

• Turner’s sign: Bluish purple discoloration of the
flanks → tissue catabolism of Hb.

Front 20

255. Other causes of acute pancreatitis?

Back 20

a. Hypertriglyceridemia
b. trauma
c. infection
d. ERCP
e. medications.

Front 21

256. Medications which cause acute pancreatitis (4)?!?

Back 21

1. Thiazide
2. didanosine
3. Stavudine
4. azathioprine

Front 22

Gastric varices but no esophageal varices. Dx?

Back 22

Splenic vein thrombosis, a complication of Pancreatitis.

Front 23

257. what is the best initial diagnostic test for acute pancreatitis?

Back 23

Amylase and lipase (lipase has higher specificity)

Front 24

258. most accurate test for acute pancreatitis?

Back 24

Abdominal CT.
A CT can detect dilated bile ducts and even comment on intra–hepatic ducts.

Front 25

259. Utility of MRCP for acute pancreatitis?

Back 25

Detects causes of biliary and pancreatic duct obstruction not found on a CT scan.

Front 26

260. If there is dilation of the common bile duct without a pancreatic head mass, what should you consider?

Back 26

a. ERCP (endoscopic retrograde cholangiopancreatography).
b. The ERCP can be used to detect the presence of stones or strictures in the pancreatic duct system.
c. ERCP can also remove stones and dilate strictures.

Front 27

Test to predict severity in acute pancreatitis?

Back 27

Urinary assay of trypsinogen activation peptide (TAP)

Front 28

261. Trypsinogen activation peptide?

Back 28

a. This is a urinary tests that can be used to determine the severity of pancreatitis.
b. Pancreatitis seems to arise from the premature activation of trypsinogen while it is still within the pancreas instead of when it reaches the duodenum
c. hence, the trypsin starts to digest and inflame the pancreas.

Front 29

262. Treatment of acute pancreatitis?

Back 29

1. No feeding (bowel rest)
2. hydration
3. pain medications
b. we do not have a medication to reverse pancreatitis.

Front 30

263. Tools to diagnose acute pancreatitis?

Back 30

a. Ultrasound, CT, and MRCP
b. treat with ERCP

Front 31

264. What has replaced Ranson's criteria is the most precise method of determining the severity of the necrotic pancreatitis?

Back 31

CT scan.

Front 32

265. Utility of Ranson's criteria?

Back 32

Operative criteria to see who needs pancreatic debridement.

Front 33

When there is necrotic pancreatitis?

Back 33

When the CT shows > 30% necrosis of the pancreas

Front 34

266. Treatment of necrotic pancreatitis?

Back 34

When the CT shows > 30% necrosis of the pancreas, the patient should:
1. receive antibiotic, such as imipenem; and
2. undergo percutaneous CT guided biopsy

Front 35

What is the next step if the percutaneous CT guided biopsy shows infected, necrotic pancreatitis?

Back 35

surgical debridement of the pancreas.

Front 36

When Pseudocysts develop in pancreatitis?

Back 36

2 to 4 weeks after the episode of pancreatitis.

Front 37

When Tx for Pseudocysts of pancreas is indicated?

Back 37

Pseudocysts should be drained if there is pain, fistula formation, and rupture or if the pseudocyst is expanding in size.

Asymptomatic pseudocysts do not need to be drained.