Gi Idc

Front 1

The stomach can be stretched to accommodate up to how many liters a of food

Back 1

6.4

Front 2

What are the layers that form the gastrointestinal tract

Back 2

(1) Mucosa
(2) Submucosa - contains blood and lymphatic vessels
(3) Muscularis
(4) Serosa (visceral peritoneum)

Front 3

What is the Muscular tube, lined with stratified squamous epithelium; lies posterior to the trachea

Back 3

The esophagus

Front 4

What is the function of the tongue

Back 4

maneuver food for chewing, forces food to the back
of the mouth to be swallowed.

Front 5

What is the function of the teeth

Back 5

They perform mechanical digestion by chewing and breaking down food into
small pieces.

Front 6

What are the three branches The pharynx is divided into

Back 6

(a) Nasopharynx; that is involved in respiration
(b) Oropharynx; located at the back of the mouth
(c) Laryngophrynx; which helps to propel food into the esophagus

Front 7

What is the function of the pancreas

Back 7

(1)Lies behind the stomach
(2) Passes secretions into the duodenum via the pancreatic duct

Front 8

What is the function of the gallbladder

Back 8

The gallbladder- pear-shaped sac that hangs from the front margin of the liver that performs metabolic, secretary and endocrine functions
(1) Supplies bile to the small intestine
(2) Aids in chemical digestion.

Front 9

What are the three different segments of the small intestine divided into

Back 9

(1) Most of the absorption and digestive events occur here.
(a) Duodenum
(b) Jejunum
(c) Ileum

Front 10

What are the four regions of the large intestine

Back 10

(a) Cecum
(b) Colon
(c) Rectum
(d) Anal canal

Front 11

Upon Inspection of an abdominal examination you Note:
1. bluish periumbilical discoloration, What is this called and what does it indicate
2. Purplish striae is indicative of

Back 11

(1) (Cullen sign) suggests intraabdominal
bleeding, striae of recent origin are pink or blue but turn silvery gray/white over time.
(2) (Cushing disease) Pearl-like umbilical node suggests intraabdominal lymphoma.

Front 12

In The Management of a Patient with BLUNT abdominal trauma DIRECT BLOW common injuries include

Back 12

splenic rupture and liver fractures

Front 13

In The Management of a Patient with BLUNT abdominal trauma DECELERATION INJURY - Associated with high speed MVA’s and falls from heights-common injuries include

Back 13

duodenal and aortic rupture

Front 14

In The Management of a Patient with PENETRATING abdominal trauma from direct penetration can result from

Back 14

Gunshot and Stab wounds

Front 15

Which organ supplies bile to small intestine?

Back 15

Gallbladder

Front 16

Where is chyme released in the body?

Back 16

Duodenum

Front 17

Describe a healthy prostate

Back 17

diameter of approx 4 cm with less than 1 cm protrusion into
the rectum

Front 18

What are the sounds of Venus hums that can be heard with the bell of the stethoscope

Back 18

soft low pitched and continuous

Front 19

What labs are associated with The Management of a Patient with Appendicitis

Back 19

(1) CBC/DIFF: Moderate leukocytosis (10-20K) and neutrophilia is common.
(2) Routine/micro UA: May see hematuria and pyuria on micro.
(3) Occult blood

Front 20

What are the General Considerations in Determining the management of a patient with acute peritonitis

Back 20

General Considerations
(1) The five most common causes of acute peritonitis are appendicitis, cholecystitis, diverticulitis, pancreatitis, and bowel perforation.
(2) Most common symptoms are fever and abdominal pain.

Front 21

What are some Clinical Findings in the management of a patient with acute peritonitis

Back 21

Signs and Symptoms:
(a) Inspection: Patient in fetal position
(b) Auscultation: Absence of bowel sounds in all four quadrants
(c) Palpation: board-like abdomen is unmistakable

Front 22

What labs are used in Determining the management of a patient with acute peritonitis

Back 22

Labs
(1) CBC/DIFF: Moderate leukocytosis (10-20K) and neutrophilia is common.
(2) Urinalysis
(3) Blood cultures for infection

Front 23

What is the Treatment for the management of a patient with acute peritonitis

Back 23

:Treatment:
(1) NG tube with intermittent suction
(2) NPO
(3) IV antibiotics

Front 24

What is the Differential Diagnosis in Determining the management of a patient with acute peritonitis

Back 24

(1) Appendicitis
(2) Cholecystitis
(3) Pancreatitis

Front 25

What is the disposition in the management of a patient with acute peritonitis

Back 25

Disposition
(1) Medevac
(2) Refer to General Surgery

Front 26

Multifactorial Causes of a patient with constipation could be what

Back 26

(a) Diminishing intake of fiber associated with decreased fluid intake
(b) Exercise, medical conditions, and medications (calcium-channel blockers, iron, narcotic analgesics, and antipsychotics)
(c) Hypothyroidism, hyperparathyroidism, lead poisoning, and chronic neurologic disorders

Front 27

Patient Complains of what in the Determining the management of a patient with constipation

Back 27

(a) Excessive straining,
(b) Sense of incomplete evacuation

Front 28

What X-rays will you get with the management of a patient with constipation

Back 28

(a) Upright chest film and abdominal flat and erect films
(b) Presence or absence of intestinal obstruction
(c) Abdominal films to assess stool burden

Front 29

What are treatment options with the management of a patient with constipation

Back 29

(1) Strict dietary and exercise regimen
(2) Fiber - Metamucil tsp tid (psyillum)
(3) Emollient - Docusate sodium 100 mg qd bid
(4) Stimulants - Bisacodyl 10 mg PR tid
(5) Saline laxative- Milk of magnesia 15-30 mL qd/bid (caution w/renal impairment)
(6) Suppository - Glycerin suppository PR qd
(7) Enemas – Fleets enema
(8) Fecal Disimpaction
(a) Manual disimpaction may be facilitated by IV or IM administration of a narcotic or
anxiolytic.
(b) Have the patient in a left decubitus position with the hips and knees flexed to the
chest.

Front 30

What are the Differential Diagnosis/Complications with the management of a patient with constipation

Back 30

(1) Fecal impaction
(INABILITY TO POOP X 5 DAYS WITH FIRM FECES DURING DIGITAL RECTAL EXAM)
(2) Patients with fecal impaction must be disimpacted manually (COLONOSCOPIC OR SURGICAL INTERVENTION)
(3) Intestinal pseudo-obstruction – consult with surgery

Front 31

What is the Disposition in the management of a patient with constipation

Back 31

(1) Uncomplicated cases- Retain onboard
(2) Complicated / Chronic Cases – Refer to gastroenterologist

Front 32

What are some General Considerations in Determining the management of a patient with Irritable Bowel Syndrome

Back 32

General Considerations
(1) Chronic (more than 3 months) abdominal pain or discomfort that occurs in association with altered bowel habits.
(2) Other symptoms supporting the diagnosis include abnormal stool frequency; abnormal stool form (lumpy or hard; loose or watery); abnormal stool passage (straining, urgency, or feeling of incomplete evacuation); passage of mucus; and bloating or a feeling of abdominal distention.

Front 33

What are Alarm symptoms that suggest a diagnosis other than irritable bowel syndrome

Back 33

Patients who have a family history of cancer, inflammatory BOWEL DISEASE, or celiac disease should undergo additional evaluation.

Front 34

What is TX OF CHOICE in the management of a patient with Irritable Bowel Syndrome

Back 34

(1) Diet - Fatty foods and caffeine exacerbate bloating, flatulence, and diarrhea
(a) Note: high-fiber diet and fiber supplements appears to be of little value

Front 35

What are Antidiarrheal agents used in the management of patients with Irritable bowel syndrome

Back 35

(a) Loperamide (2 mg orally three or four times daily)
(b) Psychotropic agents: Nortriptyline, DESIPRAMINE 20mg, or imipramine, may be started at a low dosage of 10 mg at bedtime and increased gradually to 50-150 mg as tolerated

Front 36

Acute symptoms of neasea and vommiting WITHOUT abdominal pain are typically caused by

Back 36

food poisoning, infectious gastroenteritis, drugs, or systemic illness.
(A) Inquiry should be made into recent changes in medications, diet, other intestinal symptoms, or similar illnesses in family members.

Front 37

What are Special Examinations Labs in for nausea / vommiting

Back 37

(a) Serum electrolytes for hypokalemia, azotemia, or metabolic alkalosis.
(b) Liver function tests for elevated amylase or lipase suggesting pancreaticobiliary
disease.

Front 38

What is an accessory organ that aids in digestion

Back 38

Pancreas
gallbladder
liver

All come together to form the common bile duct

Front 39

What are complications in the management of patients with nausea and vommiting

Back 39

Complications
(1) Mallory-Weiss syndrome

Front 40

What GENERAL MEASURES in management of patients with nausea / vommiting

Back 40

Ingest clear liquids (broths, tea, soups, carbonated beverages)

Front 41

What treatment of choice in management of patients with SEVERE ACUTE nausea / vommiting

Back 41

(a) Intravenous 0.45% saline solution with 20 mEq/L of potassium chloride is given in
most cases to maintain hydration.
(b) A nasogastric suction tube for gastric decompression

Front 42

What is treatment of choice that are antihistamines and anticholinergics and may be valuable in the prevention of vomiting arising from stimulation of the labyrinth, ie, motion sickness, vertigo, and migraines.

Back 42

ANTIEMETIC
ZOFRAN / Meclizine

Sedatives
(a) Benzodiazepines are used in psychogenic and anticipatory vomiting.

Front 43

What are some general considerations in Determining the management of a patient with gastrophageal Reflux disease

Back 43

(1) Heartburn; may be exacerbated by meals, bending, or recumbency.

Front 44

What are some signs and symptons in the management of a patient with gastrophageal Reflux disease

Back 44

(a) Heartburn. Occurs 30-60 minutes after meals and upon reclining (EATING FATTY / SPICY FOODS, ETOH, VS WNL)
(b) Patients may complain of regurgitation the spontaneous reflux of sour or bitter gastric contents into the mouth
(e) "Atypical" or "extraesophageal" manifestations of gastroesophageal disease may occur, including chronic cough & sore throat

Front 45

What are complications in the management of a patient with gastrophageal Reflux disease

Back 45

(1) Barrett Esophagus
(a) This is a condition in which the squamous epithelium of the esophagus is replaced by metaplastic columnar epithelium containing goblet and columnar cells
(specialized intestinal metaplasia). Present in up to 10% of patients with chronic
reflux, it arises from chronic reflux-induced injury to the esophageal squamous
epithelium.
(b) Barrett esophagus does not provoke specific symptoms but gastroesophageal reflux
does. Most patients have a long history of reflux symptoms, such as heartburn and regurgitation.
(c) The most serious complication of Barrett esophagus is esophageal adenocarcinoma.
It is believed that most adenocarcinomas of the esophagus and many such tumors of the gastric cardia arise from dysplastic epithelium in Barrett esophagus.
(2) Peptic Stricture
(a) Stricture formation occurs in about 5% of patients with esophagitis. It is manifested
by the gradual development of solid food dysphagia progressive over months to
years. Often there is a reduction in heartburn because the stricture acts as a barrier to reflux. Most strictures are located at the gastroesophageal junction.

Front 46

What is the treatment for the management of a patient with gastrophageal Reflux disease

Back 46

(1) elimination of acidic foods
(2) Weight loss should be recommended for overweight patients
(3) Patients with nocturnal symptoms should be advised to avoid lying down within 3 hours
after meals, the period of greatest reflux, and to elevate the head of the bed on 6-inch
blocks or a foam wedge to reduce reflux and enhance esophageal clearance

Front 47

What are Essentials of Diagnosis with The Management of a Patient with Gastritis

Back 47

Gastritis - ACUTE OR CHRONIC INFLAMMATION OF GASTRIC MUCOSA
(a) Three categories:
1) Erosive and hemorrhagic “gastritis” (gastropathy)
2) Nonerosive, nonspecific (histologic) gastritis
3) Specific types of gastritis, characterized by distinctive histologic and endoscopic
features diagnostic of specific disorders.
(b) Most commonly seen in alcoholics, critically ill patients, or patients taking NSAIDs

Front 48

What are General Considerations in The Management of a Patient with Gastritis

Back 48

(1) Common Causes
(a) Drugs (especially NSAIDs)
(b) Alcohol
(c) Stress due to severe medical or surgical illness

(2) Uncommon causes:
(a) Erosive and hemorrhagic gastropathy typically are diagnosed at endoscopy, often being performed because of dyspepsia or upper gastrointestinal bleeding.
(b) Major risk factors for stress gastritis include trauma, burns, shock

Front 49

What are Signs and Symptoms in the management of a patient with gastritis

Back 49

(a) Erosive gastropathy is usually asymptomatic
(b) The most common clinical manifestation of erosive gastritis is upper gastrointestinal bleeding, which presents as hematemesis, "coffee grounds" emesis, or as melena.

Front 50

Differential Diagnosis in The Management of a Patient with Gastritis

Back 50

With severe pain, one should consider:
Ruptured aortic aneurysm

Front 51

What are Specific Causes & Treatment in the management of a patient with gastritis

Back 51

(a) Treatment: Once bleeding occurs, patients should receive continuous infusions of a proton pump inhibitor (esomeprazole or pantoprazole, 80 mg intravenous bolus, followed by 8 mg/h continuous infusion) as well as sucralfate suspension.

PPI's have demonstrated superiority for healing of NSAID-related ulcers in the setting of continued NSAID use. Therefore, an empiric 2-4 week trial of an oral proton pump inhibitor (omeprazole, rabeprazole, or esomeprazole 20-40 mg/d; lansoprazole, 30 mg/d; pantoprazole, 40 mg/d) is recommended for patients with NSAID-related dyspepsia,

Front 52

What is based on histologic assessment of mucosal biopsies

Back 52

Nonerosive gastritis

Front 53

What is Noninvasive Testing for H pylori

Back 53

quantitative serologic ELISA tests

Front 54

What term is suggestive colonic involvement by invasive bacteria or parasites or by toxin production

Back 54

inflammatory diarrhea

Front 55

Hospitalization is required in patients with severe dehydration, toxicity, or marked abdominal pain. & Stool specimens should be sent for examination for bacterial cultures SECONDARY In the treatment of patients with what diagnosis

Back 55

GastroENTERitis

Front 56

Treatment in the management of patients with GastroENTERitis

Back 56

(1) Avoid high-fiber foods, fats, milk products, caffeine, and alcohol
(2) Intravenous fluids (lactated Ringer injection) are preferred in patients with severe dehydration.
(3) Loperamide (Imodium) is preferred, in a dosage of 4 mg initially, followed by 2 mg
after each loose stool (maximum: 16 mg/24 h).

Front 57

What is a break in the gastric or duodenal mucosa that arises when the normal
mucosal defensive factors are impaired or are overwhelmed by aggressive luminal factors such as acid and pepsin.

Back 57

Peptic ulcer

Front 58

What are three major causes of peptic ulcer disease

Back 58

NSAIDs, chronic H pylori
infection, and acid hypersecretory states.

Front 59

What is the procedure of choice for the diagnosis of duodenal and gastric
ulcers.

Back 59

Upper endoscopy

Front 60

An elevated serum amylase in a patient with severe epigastric pain suggests what

Back 60

ulcer penetration into the pancreas

Front 61

What are the Treatment of choice for active ulcer- h. Pylori

Back 61

Amoxicillin 1 g orally twice daily (OR metronidazole 500 mg orally twice daily, if penicillin allergic)

After completion of course of H pylori eradication therapy, continue treatment with proton pump inhibitor once daily for 4-6 weeks if ulcer is large (> 1 cm) or complicated

Front 62

What is Inflammation of a diverticulum, especially of the
small pockets in the wall of the colon which fill with stagnant fecal material and
become inflamed

Back 62

Diverticulitis (is believed to arise after many years of a diet deficient in fiber.)

Front 63

How are Diverticula best seen

Back 63

on barium enema

Front 64

What is a less sensitive means of detecting diverticula.

Back 64

Colonoscopy

Front 65

What is the diagnosis?
32 y/o male c/o epigastric px, hurts to walk and lying down, can’t get comfortable, nauseated and vomiting, yellow eyes, skin cool and clammy 101 t 100/74 100p resp 20

Back 65

pancreatitis

Front 66

What term includes ulcerative colitis and Crohn disease

Back 66

inflammatory bowel disease

Front 67

What are Essentials of Diagnosis in the management of a Patient with Inflammatory Bowel Disease

Back 67

Perianal disease - One-third of patients with either large or small bowel involvement develop perianal disease manifested by large painful skin tags, anal fissures, perianal abscesses, and fistulas

Cigarette smoking is strongly associated with the development of Crohn disease, resistance to medical therapy, and early disease relapse

Front 68

What are Complications in the management of a patient with Inflammatory Bowel Disease

Back 68

(1) The presence of a tender abdominal mass with fever and leukocytosis suggests an
abscess. Emergent CT of the abdomen is necessary to confirm the diagnosis.

Front 69

Essentials of Diagnosis in patients with Ulcerative Colitis

Back 69

(a) Bloody diarrhea is the hallmark
(b) Lower abdominal cramps and fecal urgency
(c) Ulcerative colitis is an idiopathic inflammatory condition that involves the mucosal surface of the colon, resulting in diffuse friability and erosions with bleeding.

Front 70

What is the most common cause of Small Bowel Obstruction

Back 70

adhesions following abdominal surgery

Front 71

What is the second most common cause of Small Bowel Obstruction

Back 71

incarceration of a groin hernia

Front 72

What is the difference between Ulcerative colitis and Crohns disease

Back 72

Crohns can be all over the GI, smoking makes it worse.

Ulcerative colitis limited to the colon only, quiting smoking makes it worse / bloody diarrhea

Front 73

Where is the pain typically located for small bowel obstruction

Back 73

it may be periumbilical
or more diffuse.

Front 74

How do you confirm the diagnosis of small bowel obstruction

Back 74

An abdominal radiograph can confirm the diagnosis, identify free air or masses, and
localize the site to large or small bowel

Front 75

For edematous, prolapsed hemorrhoids, gentle manual reduction may be supplemented by what suppositories

Back 75

Anusol with or without hydrocortisone

Front 76

In regards to Pilonidal Cyst what is formed by the penetration of the skin by ingrowing hair, which causes a foreign body granuloma reaction

Back 76

Sinus

Front 77

In regards to Pilonidal Cyst and Abscess during early stages of wound healing, the wound is packed with what

Back 77

moistened gauze sponge changed twice daily

Front 78

Most anal fissures are believed to arise from what?

Back 78

trauma to the anal canal during defecation, caused by
straining, constipation, or high internal sphincter tone

Patients will complain of severe, tearing pain during defecation followed by throbbing discomfort that may lead to constipation due to fear of recurrent pain

Front 79

What is the treatment for anal fissure

Back 79

(1) Management is directed at promoting effortless, painless bowel movements.
(2) Fiber supplements and sitz baths
(3) Topical anesthetics may provide temporary relief.

Front 80

What are General Considerations in Acute Upper Gastrointestinal Bleeding

Back 80

(a) Hematemesis (bright red blood or "coffee grounds").
(b) Melena in most cases; hematochezia in massive upper gastrointestinal bleeds.
(c) Endoscopy diagnostic and may be therapeutic

Front 81

Gastric mucosal erosions are due to what

Back 81

NSAIDs, alcohol, or severe medical or surgical illness (stress-related mucosal disease).

Front 82

What are Lacerations of the gastroesophageal junction cause 5-10% of cases of upper gastrointestinal bleeding. Many patients report a history of heavy alcohol use or
retching. Less than 10% have continued or recurrent bleeding.

Back 82

Mallory-Weiss Tears

Front 83

The initial step in Upper GI is what

Back 83

assessment of the hemodynamic status.

A systolic blood pressure
less than 100 mm Hg identifies a high-risk patient with severe acute bleeding

Front 84

What are General Considerations in Acute Lower Gastrointestinal Bleeding

Back 84

Hematochezia usually present

BROWN STOOL MIXED WITH BLOOD SOURCE OF BLEEDING IS RECTOSIGMOID OR ANUS

Front 85

What is is the goal of therapy for Acute Upper gastrointestinal bleeding

Back 85

Treating the underlying cause

Initial stabilization, blood replacement, and triage

Front 86

What is an inflammation of the gallbladder

Back 86

Cholecystitis

It occurs when a stone becomes impacted in the cystic duct and inflammation develops behind the obstruction

Front 87

What is characterized by the
sudden appearance of steady pain localized to the epigastrium or right hypochondrium,
which may gradually subside over a period of 12-18 hours

Back 87

Cholecystitis

Front 88

What is most often due to alcohol abuse or gallstones, with the incidence
depending largely on age.

Back 88

Acute pancreatitis

Patients over the age of 50 most often have biliary
pancreatitis, while younger patients almost always have alcoholic pancreatitis

Front 89

What presents with Epigastric abdominal pain, generally abrupt in onset, is steady, boring, and severe and
often made worse by walking and lying supine and made better by sitting and leaning
forward

Back 89

Patient with Pancreatitis

Mild jaundice is common

Front 90

What is the goal therapy of pancreatitis

Back 90

Adequate pain control should be the goal

Keterolac, Hydrocodone, or Morphine, as needed.

Subsides spontaneously within several days by a regimen
of withholding food and liquids by mouth, bed rest

Front 91

When is Aggressive intravenous hydration crucial IRT pancreatitis

Back 91

In more severe pancreatitis

Front 92

Latent passage of contents
through a persistent patent processus vaginalis along the inguinal canal is called what?

Back 92

Indirect Inguinal Hernia

Front 93

What is protrusions directly through the transversalis
fascia and the external inguinal ring, medial to the inferior epigastric vessels

Back 93

Direct Inguinal Hernia

Most common in right side

Front 94

If strangulation is not suspected in hernia, the clinician may attempt closed reduction how

Back 94

(a) Place the patient in the supine Trendelenburg position.

This allows gravity to assist with hernia reduction