Dit - Gastrointestinal Part 3

Front 1

What treatments are available for crohn's disease

Back 1

5-ASA agents
Mesalamine, Sulfasalazine (5-ASA+Sulfa abx) <--activated in colon only
Azothioprine or Mercaptopurine> Methotrexate
Anti-TNFa (infliximab, adalimumab) <-- good for HLA-B27
Steroids

Front 2

What are the MC causes for Small Bowel Obx?

Back 2

ABC

Adhesions
Bulge (hernia)
Carcinoma (MCly colorectal)

Front 3

What is the MC benign small bowel tumor?

What is the MC malignant small bowel tumor?

Back 3

Benign: Leiomyoma. Same for uterine

Malignant: Adenocarcinoma

Front 4

HYQ: what is the next step in the management of a pt that comes to the ER with severe ab pain and AXR shows free air in the abdomen?

Back 4

Free air in ab= Perforation

immediate laprotomy

Front 5

HYQ: A recent cuban immigrant with symptoms of malabsorption is found to have megaloblastic anemia.

What is the disease and what is the treatment?

Back 5

Tropical Sprue

Folate, Abx (tetracycline, sulfa) for 3-6 mo

Front 6

HYQ: what is the classic time frame for which post-op ileus resolves in the different parts of the gut?

Back 6

Stomach: 48-72hr
Small Intestine: 24
Large Intestine: 3-5d

Front 7

Elderly pt presents to the ER with vomiting and abdominal pain and distention. ABX shows two distinct but sequential portions of bowel in the sigmoid colon that are distended with air. What is the treatment?

Back 7

Volvulus

Colonoscopy

Front 8

Describe the diff signs that might be seen in appendicitis?

Back 8

Psosas sign: Pain with passive hip extention
Obturator sign : Pain with passive internal rotation of flexed hip
Rovsings sign: RLQ on palpation of LLQ

Front 9

Pain out of proportion to the abdominal exam is classic for what?

Back 9

Acute Mesenteric Ischemia**

Front 10

What characteristics ARE and which ARE NOT a/w IBS?

Back 10

IBS: 12wks/yr, pain relieved with defication, a/w change in stool frequency or form

NOT IBS: sxs of malabsorption, wt loss or anorexia, progressively worsening pain, pain preventing sleep

Front 11

What tumors (4) can cause a secretory diarrhea?

Back 11

Carcinoid
VIPoma
Gastrinoma
Medullary thyroid CA

Front 12

What is the most likely cause of malabsorption in a pt with a (+) sudan stain in the stool sample and normal D-xylose test?

Back 12

Pancreatic Insuficiency

(+) sudan indicates steattorhea
(+) D-Xylose indicates that the intestinal villi are intact and can abs carbs

Front 13

What is the TX for Whipple disease?

Back 13

TMP-SMX or Ceftriaxone for at least 12-mo

Front 14

What serum antibodies are seen in cases of celiac sprue?

What's the buzz phrase?

Back 14

Anti-gliaden, Anti-endomycial

"blunting of the villi"
gluten intolerance
common in downs
dermatitis herpatiformis

Front 15

What serum lab findings might help you distinguish Crohn's from UC?

Back 15

(+)ASCA = chron's
(+) pANCA = UC

Front 16

Jejunal biopsy shows Foamy macrophages on PAS

Back 16

Whipple dz

TMP-SMX or Ceftriaxone for 12mo

Front 17

QH: ____ is the MCC of acute diarrhea in children

Back 17

Rotavirus

Front 18

QH: 1/2 of pts with IBS have comorbid _____

Back 18

Psychiatric Sxs, Depression, Anxiety

Front 19

"Thumb Printing" and CT showing air within bowel wall and bowel wall thickining

Back 19

Ichemic Colitis

More Common on the left, but sparing the rectum b/c of colorectal circulation

Front 20

HLA-B27

Back 20

PAIR

Psoriatic Arthritis
Ankylosing spondylitis
IBD
Reitter's syndrome

Front 21

Treatment for Ileus?

Back 21

NPO until bowel sounds return

Motility agents: Erythromycin, Neostigmine, Metoclopromide (reglan)

Front 22

"Double Bubble" and "Birds Beak" on ABX

Back 22

Volvulus

occurs in elderly and infants
H/P: Obstipation