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215 Cards in this Set
- Front
- Back
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DYSPEPSIA
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PERSISTENT OR RECURRENT PAIN OR DISCOMFORT CENTERED IN THE UPPER ABDOMEN
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IMPRECISE TERM THAT CAN MEAN DISCOMFORT, FULLNESS, INDIGESTION; BLOATING, EARLY SATIETY, REGURGITATION
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DYSPEPSIA
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FOOD/DRUG INTOLERANCE AS A ETIOLOGY OF DYSPEPSIA INCLUDES
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EATING TOO FAST, HIGH FAT FOODS, AND OVEREATING; DRUGS- ASA, NSAIDS, ANTIBIOTICS
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GASTRIC TRACT DYSFUNCTION AS AN ETIOLOGY OF DYSPEPSIA INCLUDES
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GASTROPARESIS, LACTOSE INTOLERANCE, MALABSORPTION, PARASITES
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GASTROPARESIS
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S/S OF OBSTRUCTION, BUT THERE IS NO ACTUAL OBSTRUCTION
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WHAT PARASITIC INFECTION CAN CAUSE DYSPEPSIA?
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HELICOBACTER PYLORI INFECTION
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TYPES OF PANCREATIC CONDITIONS THAT CAN CAUSE DYSPEPSIA
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CANCER, CHRONIC PANCREATITIS
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TYPES OF BILIARY CONDITIONS THAT CAN CAUSE DYSPEPSIA
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CHOLELITHIASIS (GALLSTONE); CHOLEDOCHOLITHIASIS (GALLSTONE IN THE COMMON BILE DUCT)
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WHY DOES PREGNANCY CAUSE DYSPEPSIA?
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GROWTH- CAUSES PRESSURE ON STOMACH CAUSING REFLUX
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WHAT IS THE MOST COMMON DYSPEPSIA?
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FUNCTIONAL DYSPEPSIA- NO OBVIOUS ORGANIC CAUSE; MAY BE PSYCHOSOCIAL
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ALARMING SYMPTOMS IN DYSPEPSIA INCLUDE THESE
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ANEMIA, ODYNOPHAGIA, HEMATEMESIS, MELENA (BLACK TARRY STOOLS OR VOMIT), HEMATOCHEZIA, OCCULT BLOOD, UNINTENTIONAL WEIGHT LOSS, PERSISTENT VOMITING, ABDOMINAL MASS
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ODYNOPHAGIA
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PAINFUL SWALLOWING
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NON ULCER PATIENTS- DESCRIBE
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YOUNGER, HAVE VARIETY OF SYMPTOMS (ABDOMINAL/GI COMPLAINTS), ANXIETY AND DEPRESSION ARE TRIGGERS
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ULCER PATIENTS- DESCRIBE
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OLDER THAN 55, SMOKERS, HAVE PAIN ASSOCIATED WITH FOOD OR MEDS
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DYSPEPSIA WORK UP INCLUDES
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PE- ABDOMINAL AND RECTAL EXAM (DRE ON ALL); LABS- CBC, CHEM PANEL TO INCLUDE CA, LFT, TFT, AMYLASE AND LIPASE; PREGNANCY FOR FEMALES ALWAYS
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COMPLETE BLOOD COUNT CHECKING WHAT?
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HEMOGLOBIN AND HEMATOCRIT IMPORTANT WITH GI COMPLAINTS; WBC, RBC WITH DIFFERENTIALS, PLATELETS
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IN WHAT PATIENT POPULATION DO YOU BEGIN WITH NON INVASIVE H PYLORI TESTING?
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IN YOUNGER PATIENTS
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IF H. PYLORI IS POSITIVE, WHAT DO YOU DO TO TREAT?
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TREAT WITH ABX, FOLLOWED WITH 4-6 WEEKS OF PPI'S; IF SYMPTOMS RETURN AFTER COMPLETING PPI'S THEN SCOPE TO RULE OUT OTHER DISEASE
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H. PYLORI IS ASSOCIATED WITH 80% OF WHAT?
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PEPTIC ULCERS (THERE IS LESS THAN 1% CHANCE OF GETTING AN ULCER IF A PATIENT DOESN'T HAVE H. PYLORI OR ISN'T CHRONICALLY USING NSAID'S)
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UPPER ENDOSCOPY IS THE STUDY OF CHOICE IN WHAT POPULATION?
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IN ALL PATIENTS 45 AND OLDER WITH NEW ONSET DYSPEPSIA AND ALL PATIENTS WITH ALARMING SYMPTOMS
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THIS STUDY IS INFERIOR TO ENDOSCOPY IN THE EVALUATION OF DYSPEPSIA.
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UPPER GI (BARIUM ENHANCED X-RAYS); YOU WILL SEE EVERYTHING WITH AN ENDOSCOPY
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TREATMENT OF DYSPEPSIA BEGINS WITH LIFESTYLE CHANGES THAT INCLUDE
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REASSURANCE, REDUCE OR D/C ALCOHOL, CAFFEINE, FATTY FOODS; TRY A FOOD DIARY- ID FOOD/DRINKS WHICH WORSEN SYMPTOMS
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DRUGS FOR TX OF DYSPEPSIA
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THEY HAVE ALREADY TAKEN TUMS, ETC---H2 BLOCKERS- ZANTAC, TAGAMET, PEPCID; PPI'S- NEXIUM AND PRILOSEC; PROKINETIC AGENTS- REGLAN- SPEEDS GASTRIC EMPTYING; H PYLORI TREATMENT- ONLY AFTER TESTING
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WE KNOW THAT PATIENTS HAVE USED TUMS ETC., BUT ASK IF THEY HAVE BOUGHT WHAT OTC ALSO?
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H2 BLOCKERS LIKE ZANTAC, PEPCID, TAGAMET
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DOC FOR TREATMENT OF DYSPEPSIA
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PROTON PUMP INHIBITORS LIKE NEXIUM AND PRILOSEC
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NAUSEA
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A VAGUE INTENSELY DISAGREEABLE SENSATION OF SICKNESS OR QUEASINESS THAT MAY OR MAY NOT BE FOLLOWED BY VOMITING
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VOMITING
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FORCEFUL EXPULSION OF GASTRIC CONTENTS
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STIMULATORS OF VOMITING
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GA VISCERA, VESTIVULAR SYSTEM, HIGHER CNS, CHEMORECEPTOR TRIGGER ZONE
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IF YOU SUSPECT A CNS CAUSE OF VOMITING THAT YOU CANNOT CURE WITH 24 HRS, WHAT DO YOU ORDER?
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CT SCAN
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THREE GENERAL SYMPTOMS SETS OF N AND V
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ACUTE SYMPTOMS W/O PAIN; ACUTE SYMPTOMS W/ PAIN; CHRONIC VOMITING
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POSSIBLE REASONS FOR CHRONIC VOMITING
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PREGNANCY, GASTRIC OUTLET OBSTRUCTION, GASTROPARESIS, INTESTINAL DYSMOTILITY, PSYCHOGENIC, CNS/SYSTEMIC DISORDERS
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COMPLICATIONS OF VOMITING
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DEHYDRATION, HYPOKALEMIA, METABOLIC ACIDOSIS, ASPIRATION, BOERHAVE'S SYNDROME, MALLORY-WEISS SYNDROME
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QUICK TEST FOR DEHYDRATION
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CAPILLARY REFILL; REFILL ON HEELS OF CHILDREN
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ACUTE N & V SYMPTOMS WITHOUT PAIN- CAUSES
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FOOD POISONING, GASTROENTERITIS, DRUG REACTIONS, VESTIBULAR RESPONSES
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BOERHAAVE'S SYNDROME
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PERFORATION IN THE ESOPHAGUS
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SPECIAL EXAMINATIONS FOR N/V
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VITALS AND TILTS; AAS- LOOKING FOR DILATED LOOPS, AIR/FLUID LEVELS; LAB STUDIES; CNS STUDIES- CT/MRI
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CAUSES OF N/V WITH ACUTE SYMPTOMS WITH PAIN
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PERITONITIS, OBSTRUCTION, PANCREATIC OR BILIARY DISEASE
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TILTS
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ORTHOSTATIC BP MEASUREMENTS- STANDING, SITTING, LYING; ALSO PULSE; LOOKING FOR CHANGES
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WHAT DO YOU LOOK FOR IN AAS?
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ACUTE ABDOMINAL SERIES- LOOKING FOR DILATED LOOPS, AIR/FLUID LEVELS
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AAS
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ACUTE ABDOMINAL SERIES
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MOST CAUSES OF ACUTE VOMITING ARE MILD, SELF-____________, AND REQUIRE NO _____________.
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LIMITING; SPECIFIC TREATMENT
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BRAT DIET
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BANANAS, RICE, APPLESAUCE, TOAST; PATIENTS RESPOND TO REPEATED SMALL SIPS OF CLEAR ORAL FLUIDS AND SMALL FEEDINGS OF BRAT DIET
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MEDICATIONS FOR VOMITING
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5HT3 ANTAGONISTS (ZOFRAN); DOPAMINE ANTAGONISTS (PHENERGAN, TIGAN); ANTIHISTAMINES/ANTICHOLINERGICS (MECLIZINE. SCOPOLAMINE), STEROIDS (DEXAMETHASONE)
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DOPAMINE ANTAGONISTS USED FOR VOMITING
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PHENERGAN AND TIGAN
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5HT3 ANTAGONISTS USED FOR VOMITING
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ZOFRAN
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ANTIHISTAMINES AND ANTICHOLINERGICS GIVEN FOR VOMITING
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MECLIZINE, SCOPOLAMINE
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STEROID USED FOR VOMITING
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DEXAMETHASONE
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SCOPOLAMINE
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ANTICHOLINERGIC USED FOR VOMITING
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MECLIZINE
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ANTIHISTAMINE USED FOR VOMITING
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ZOFRAN
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5HT3 ANTAGONIST USED FOR VOMITING
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DEXAMETHASONE
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STEROID USED FOR VOMITING
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PHENERGAN AND TIGAN
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DOPAMINE ANTAGONISTS USED FOR VOMITING
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REFERS TO STOOL THAT IS TOO HARD, SMALL, INFREQUENT, THE ACT OF STRAINING TO DEFECATE OR A SENSE OF INCOMPLETE EVACUATION
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CONSTIPATION
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THE NORMAL FREQUENCY OF BM
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3 TO 12 BM PER WEEK
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CAUSES OF CONSTIPATION
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DIET (INADEQUATE FIBER); STRUCTURAL ABNORMALITIES (OBSTRUCTING COLONIC LESIONS); SYSTEMIC DISEASES (NEUROLOGICAL DYSFUNCTIOON, ENDOCRINE DISORDERS, ELECTROLYTE ABNORMALITIES)
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MOST COMMON CAUSE OF CONSTIPATION
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INADEQUATE FIBER INTAKE
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REFRACTORY CAUSES OF CONSTIPATION
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SLOW COLONIC TRANSIT (NORMAL TRANSIT IS 35 HRS; LONGER THAN 72 IS NOT NORMAL); PELVIC FLOOR DYSFUNCTION; IRRITABLE BOWEL SYNDROME
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HOW DOES PELVIC FLOOR DYSFUNCTION CAUSE CONSTIPATION?
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DIFFICULTY IN MOVING STOOL OUT OF RECTUM OR PELVIS DUE TO CONTRACTION OF THE ANAL SPHINCTER AND PELVIC FLOOR
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WHAT IS CONSIDERED SLOW COLONIC TRANSIT?
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LONGER THAN 72 HOURS
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NORMAL TRANSIT TIME THROUGH PIPE SYSTEM
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35 HOURS
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FIRST LEVEL EVAL OF CONSTIPATION INCLUDES WHAT?
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PE WITH DRE, STOOL TESTING FOR OCCULT BLOOD, IF ALARM SYMPTOMS, CHECK CBC, ELECTROLYTES, GLUCOSE, TSH, C-SCOPE OR FLEX SIG
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SECOND LEVEL EVAL OF CONSTIPATION INCLUDES WHAT?
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COLON STUDIES, COLONIC TRANSIT TIME STUDIES, DEFECOGRAPHY, RECTAL ULTRASOUND, NERVE CONDUCTION STUDIES
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RADIOGRAPHIC EXAMINATION OF THE OPERATION OF THE DEFECATION PROCESS UNDER FLUOROSCOPY IN WHICH A THICKENED BARIUM CONTRAST IS INJECTED INTO THE RECTUM AND THEN EXCRETED WHILE THE RADIOLOGIST LOOKS ON
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DEFECOGRAPHY
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PE WITH DRE, STOOL TESTING FOR OCCULT BLOOD, IF ALARM SYMPTOMS, CHECK CBC, ELECTROLYTES, GLUCOSE, TSH, C-SCOPE OR FLEX SIG---- DONE IN INITIAL EVAL OF WHAT CONDITION OR SYMPTOM?
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CONSTIPATION
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COLON STUDIES, COLONIC TRANSIT TIME STUDIES, DEFECOGRAPHY, RECTAL ULTRASOUND, NERVE CONDUCTION STUDIES---STEPS IN SECOND LEVEL EVAL OF WHAT CONDITION/SYMPTOM?
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CONSTIPATION
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DIETARY MEASURES TAKEN FOR CONSTIPATION
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FIBER- BULKING AGENTS LIKE METAMUCIL, BRAN AND FIBER FOODS, REINFORCE IMPORTANCE OF FLUIDS
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DRUGS FOR CONSTIPATION
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STOOL SOFTENERS (COLACE), SALINE LAXATIVES, MAGNESIUM HYDROXIDE**CAUSES DIARRHEA**, NONABSORBABLE SUGARS (SORBITOL), STIMULANTS (BISACODYL), POLYETHYLENE GLYCOL (MIRALAX OR GOLYTELY)
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PREDISPOSING FACTORS FOR FECAL IMPACTION
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SEVERE PSYCHIATRIC DISEASE, BED RIDDEN, NEUROGENIC DISEASE OF COLON/SPINE
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FECAL IMPACTION
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SEVERE IMPACTION OF STOOL THAT RESULTS IN OBSTRUCTION
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CLINICAL PRESENTATION OF FECAL IMPACTION
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DECREASED APPETITE, NAUSEA, VOMITING, ABDOMINAL PAIN AND DISTENTION, DIARRHEA
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DECREASED APPETITE, NAUSEA, VOMITING, ABDOMINAL PAIN AND DISTENTION, DIARRHEA
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CLINICAL PRESENTATION OF FECAL IMPACTION
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STUDIES THAT YOU DO IF FECAL IMPACTION IS SUSPECTED
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DIGITAL EXAM (DIAGNOSTIC AND THERAPEUTIC), RADIOGRAPHS (SHOW MEGARECTUM--EXTREME DILATION OR FECALOMA- STONE MADE OF FECES), AIR CONTRAST BARIUM ENEMA (ACBE)
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WHY DO YOU HAVE DIARRHEA IN FECAL IMPACTION?
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BECAUSE THERE IS A BLOCKAGE SO THAT ONLY LIQUID CAN PASS
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WHAT CAN PROVIDE IMPACTION RELIEF IN FECAL IMPACTION?
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DRE, ENEMA
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WHAT IS LONG TERM TREATMENT OF FECAL IMPACTION AIMED AT?
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AIMED AT KEEPING STOOLS SOFT AND REGULAR
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INVOLUNTARY OR VOLUNTARY RELEASE OF GAS FROM THE STOMACH OR ESOPHAGUS
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BELCHING (ERUCTATION)
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AEROPHAGIA
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SWALLOWED AIR
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ERUCTATION
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BELCHING
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FLATUS
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GI GAS
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EXCESSIVE AMOUNTS OF FLATUS MAY BE INDICATIVE OF WHAT?
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MALABSORPTION
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TREATMENT FOR GASTROINTESTINAL GAS
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LACTOSE-FREE DIET SHOULD BE TRIED; COMMON GAS PRODUCING FOODS SHOULD BE AVOIDED; BEANO REDUCES GAS ASSOCIATED WITH BEANS
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PATIENTS USE THIS TERM TO REFER TO INCREASED FREQUENCY OF BOWEL MOVEMENTS, INCREASED STOOL LIQUIDITY, A SENSE OF FECAL URGENCY, OR FECAL INCONTINENCE
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DIARRHEA
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INCREASED STOOL FREQUENCY (MORE THAN 2 OR 3 BM'S) OF LIQUID FECES
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YOUR DEFINITION OF DIARRHEA
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ACUTE DIARRHEA HAS BEEN ONGOING FOR HOW LONG?
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LESS THAN 3 WEEKS
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MOST COMMON CAUSE OF DIARRHEA
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VIRAL INFECTION
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C. DIFICIL CAN OCCUR FROM USE OF THIS DRUG
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ANTIBIOTICS
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GONORRHEA IS NORMALLY SECONDARY TO WHAT?
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ANAL INTERCOURSE
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WHAT TYPE OF DIARRHEA- FEVER, BLOODY, COLON
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INFLAMMATORY
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WHAT TYPE OF DIARRHEA- SMALL BOWEL, WATERY, NON CRAMPING, NO FEVER
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NONINFLAMMATORY
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WHAT TYPE OF DIARRHEA WOULD YOU SUSPECT IN AIDS PATIENTS, CMV, ELDERLY, CANCER PATIENTS?
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INFLAMMATORY
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TREATMENT FOR TRAVELER'S DISEASE?
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SINGLE DOSE CIPRO
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32 Y/O FEMALE WHO RECENTLY TRAVELED TO FOREIGN COUNTRY COMPLAINING OF DIARRHEA
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VIRAL DIARRHEA SECONDARY TO E COLI FROM CONTAMINATED WATER
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IF DIARRHEA HAS BEEN LONGER THAN 7 DAYS, WHAT DO YOU DO?
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CHECK SCHOOL CULTURE, O AND P, FECAL LEUKOCYTES
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WHEN YOU SEE BLOODY DIARRHEA, FEVER, OR ABDOMINAL PAIN, WHAT DO YOU DO?
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FULL WORK UP
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TREATMENT FOR MOST DIARRHEA THAT LASTS LESS THAN 7 DAYS
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DIET, REHYDRATION, ANTI-DIARRHEAL AGENTS LIKE IMMODIUM, ANTIBIOTICS IN SELECT PATIENTS
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WHY DOES "BRAT" DIET WORK WELL FOR DIARRHEA?
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IT IS LOW IN FIBER AND DIGESTIVE RESIDUE
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WHAT SHOULD REHYDRATION INCLUDE?
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GLUCOSE, SODIUM, CHLORIDE, POTASSIUM, AND BICARBONATE OR CITRATE (USE IV IF SEVERE)
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COMMON ANTI-DIARRHEAL AGENTS
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IMMODIUM, PEPTO-BISMOL
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TESTS FOR CHRONIC DIARRHEA INCLUDE WHAT?
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CBC- TO CHECK WHITE COUNT, H AND H- ANEMIA OR BLEED; STOOL CULTURES, O AND P; TSH- MIMICS EVERYTHING; FLEX SIG AND C SCOPE OR BIOPSY, UGI OR BE
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CLUE TO OSMOTIC CAUSE OF CHRONIC DIARRHEA
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STOOL VOLUME DECREASES WITH FASTING
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CAUSES OF OSMOTIC CHRONIC DIARRHEA
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MEDICATIONS (USUAL ABUSE OF ANTACIDS, ALSO SORBITOL), DISACCHARIDE DEFICIENCY- LACTULOSE INTOLERANCE, FACTITIOUS DIARRHEA- MAGNESIUM USE
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CLUE FOR SECRETORY CHRONIC DIARRHEA
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LARGE VOLUMES; LITTLE CHANGES WITH FASTING
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CAUSES OF SECRETORY CHRONIC DIARRHEA
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HORMONAL, MEDICATIONS ESP. ANTACIDS, FACTITIOUS DIARRHEA LAXATIVE ABUSE, VILLOUS ADENOMA, BILE SALT MALABSORPTION
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CLUES FOR INFLAMMATORY DIARRHEA
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HEMATOCHEZIA, ABDOMINAL PAIN
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CAUSES OF INFLAMMATORY CHRONIC DIARRHEA
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ULCERATIVE COLITIS, CROHN'S DISEASE, MALIGNANCIES- LYPHOMA, ADENOMA, RADIATION ENTERITIS
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FOR IT TO BE MALABSORPTION DIARRHEA, WHAT MUST BE PRESENT?
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WEIGHT LOSS AND DIARRHEA
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NUMBER ONE CAUSE OF MOTILITY DISORDER DIARRHEA
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IRRITABLE BOWEL SYNDROME
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CAUSES OF MOTILITY DISORDER CAUSING CHRONIC DIARRHEA
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POST SURGICAL, SYSTEMIC DISORDERS LIKE DM AND HYPERTHYROIDISM, ISB
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CLUE FOR CHRONIC INFECTION CAUSING CHRONIC DIARRHEA
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IMMUNOSUPPRESSED PATIENTS
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PARASITIC CAUSES OF CHRONIC INFECTION CAUSING CHRONIC DIARRHEA
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GIARDIA LAMLIA, ENTAMOEBA HISTOLYTICA, CYCLOSPORA
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AIDS RELATED DIARRHEA CAUSES BY WHAT VIRUSES
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CMV AND HIV
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DIAGNOSTIC TESTS FOR CHRONIC DIARRHEA
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CBC, ELECTROLYTES, LFT, TSH, AND PTT
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IF YOU SUSPECT SPRUE, WHAT TEST IS ALSO DONE?
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SEROLOGIC TEST
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IF YOU SEE CALCIFICATION ON PLAIN FILM, WHAT DO YOU DO?
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CT
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IF YOU SUSPECT SECRETORY DIARRHEA DUE TO TUMORS, WHAT TESTS DO YOU DO?
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VIP (VASOACTIVE INTESTINAL PEPTIDE), CALCITONIN, GASTRIN, GLUCAGON, VMA (URINARY CATECHOLAMINE), METANEPHRINE
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DRUG TREATMENT FOR CHRONIC DIARRHEA
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LOPERAMIDE (IMODIUM, MAALOX), DIPHENOXYLATE WITH ATROPINE (LOMOTIL), CLONIDINE THAT INHIBITS ELECTROLYTE SECRETION
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MOST IMPORTANT IN THE TREATMENT OF DIARRHEA
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TREAT THE UNDERLYING CONDITION, NOT JUST THE SYMPTOMS
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ACUTE DIARRHEA IS NORMALLY ____________.
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SELF LIMITING
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YOU MUST ALWAYS RULE OUT ________ AS A CAUSE OF DIARRHEA.
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SELF-LIMITING
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IF INFLAMMATORY BOWEL SYNDROME IS SUSPECTED, DO WHAT TYPE OF ENDOSCOPIC EVALUATION
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FLEX SIG/C-SCOPE
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CALCIFICATION OF THE PANCREAS MAY SHOW UP WHEN WHAT IS DONE?
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PLAIN ABDOMINAL RADIOGRAPHS
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YOU WILL DO A UGI WITH SMALL BOWEL FOLLOW THROUGH IF WHAT CONDITIONS ARE SUSPECTED?
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LYMPHOMA, CROHN'S, CARCINOID
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IF MALABSORPTION IS SUSPECTED, WHAT ENDOSCOPIC EVALUATION CAN BE DONE?
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UPPER ENDOSCOPY WITH BX
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THE STOOL ANALYSIS TESTS THAT CAN BE DONE FOR CHRONIC DIARRHEA INCLUDE WHAT?
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STOOL LAXATIVE SCREEN, STOOL OSMOLALITY, FECAL LEUKOCYTES, STOOL FOR O & P, STOOL CULTURES
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VIRAL CAUSES OF DIARRHEA IN AN AIDS PATIENT MAY INCLUDE
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CMV
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BACTERIAL CAUSES OF DIARRHEA IN AIDS PATIENTS MAY INCLUDE WHAT?
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CLOSTRIDIUM DIFICILE AND MYCOBACTERIUM AVIUM
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PROTOZOAL CAUSES OF DIARRHEA IN AIDS PATIENTS MAY INCLUDE WHAT?
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MICROSPORIDIA, CRYPTOSPORIDIUM
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CAUSES OF CHRONIC DIARRHEA DUE TO MALABSORPTION INCLUDE
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SMALL BOWEL MUCOSA DISEASE (SPRUE, CROHN'S, WHIPPLE'S, SHORT BOWEL SYNDROME); LYMPHATIC OBSTRUCTION, PANCREATIC DISEASE, BACTERIAL OVERGROWTH
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SMALL BOWEL MUCOSA DISEASE LIKE SPRUE, CROHN'S, WHIPPLE'S, AND SHORT BOWEL SYNDROME MAY CAUSE WHAT TYPE OF CHRONIC DIARRHEA
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MALABSORPTION
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CHRONIC PANCREATITIS AND PANCREATIC CARCINOMA MAY CAUSE WHAT TYPE OF CHRONIC DIARRHEA
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MALABSORPTION
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ULCERATIVE COLITIS MAY CAUSE WHAT TYPE OF DIARRHEA
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CHRONIC INFLAMMATORY
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IRRITABLE BOWEL SYNDROME MAY CAUSE WHAT TYPE OF CHRONIC DIARRHEA
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MOTILITY
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LOPERAMIDE, DIPHENOXYLATE WITH ATROPINE, AND CLONIDINE MAY BE USED TO TREAT WHAT
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DIARRHEA
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WEIGHT LOSS AND FECAL FAT ARE CLUES IN WHAT TYPE OF CHRONIC DIARRHEA
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MALABSORPTION
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FEVER, HEMATOCHEZIA, AND ABDOMINAL PAIN ARE CLUES IN WHAT TYPE OF CHRONIC DIARRHEA?
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INFLAMMATORY
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THIS TYPE OF DIARRHEA INVOLVES LARGE VOLUMES (MORE THAN A LITER A DAY) THAT HAVE LITTLE CHANGE WITH FASTING
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SECRETORY
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CONSIDER AN ENDOCRINE TUMOR WITH WHAT TYPE OF CHRONIC DIARRHEA
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SECRETORY
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MELENA
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50-100 ML BLOOD LOSS IN UPPER GI TRACT
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50-100 ML BLOOD LOSS IN UPPER GI TRACT
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MELENA
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MOST COMMON CAUSE OF UPPER GI BLEED
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PEPTIC ULCER DISEASE
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WHAT DO YOU WANT TO RULE OUT IN CHRONIC DIARRHEA?
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ACUTE DIARRHEA CAUSES, LACTOSE INTOLERANCE, PREVIOUS GASTRIC SURGERY, PARASITES, MEDICATIONS, SYSTEMIC DISEASE
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UPPER GI BLEED HAS A MORTALITY RATE OF ______%
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7-10%
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BRBPR
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BRIGHT RED BLOOD PER RECTUM
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PEPTIC ULCER DISEASE IS THE MOST COMMON CAUSE OF WHAT?
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UPPER GI BLEED
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PORTAL HYPERTENSION CAN CAUSE WHAT THAT LEADS TO GI BLEEDING?
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ESOPHAGEAL BLEEDING
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CAUSES OF UPPER GI BLEEDS
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PEPTIC ULCER DISEASE, PORTAL HTN, MALLORY WEISS TEARS, VASCULAR ECTASIAS, GASTRIC NEOPLASMS, EROSIVE GASTRITIS/ESOPHAGITIS
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INCIDENCE OF PEPTIC ULCER DISEASE DECREASES WITH WHAT?
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USE OF NEW NSAIDS, DECREASE OF ALCOHOL USE, AND WHEN TREATED FOR H. PYLORI WHEN YOU TEST POSITIVE
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IF THE BLEED IS IN THE DUODENUM, THE PATIENT MAY VOMIT AND IT MAY NOT HAVE WHAT?
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BLOOD IN IT
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IF A PATIENT SAYS THEY HAVE CHRONIC LIVER DISEASE AND THEY ARE HAVING SYMPTOMS OF A UPPER GI BLEED, WHAT DO YOU SUSPECT AS THE CAUSE?
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PORTAL HYPERTENSION
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MALLORY-WEISS TEARS IN THE DISTAL ESOPHAGUS ARE NORMALLY SECONDARY TO WHAT?
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ALCOHOL ABUSE
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IF YOU SUSPECT A BLEED IN THE STOMACH OR ESOPHAGUS, WHAT IS CONTRAINDICATED?
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THE USE OF A NG TUBE
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HOW DO YOU DETERMINE HEMODYNAMIC STATUS?
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ORTHOSTATIC BLOOD PRESSURE AND PULSE
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TREATMENT IN GI BLEED- WHY DO WE DO ENDOSCOPY?
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IDENTIFY SOURCE OF BLEED; DETERMINE RISK OF REBLEEDING; RENDER ENDOSCOPIC THERAPY (CAUTERY, CLIPS, INJECTION OF EPI)
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HIGH CHANCE OF UPPER GI BLEED IN PATIENTS WITH DISEASE OF THIS ORGAN
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LIVER
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PHARMACOLOGIC TREATMENT OF UPPER GI BLEED
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PPI'S BY PO OR IV; SANDOSTATIN (OCTREOTIDE)
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PURPOSE OF PPI'S IN PATIENTS WITH UPPER GI BLEED
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STOPS ACUTE BLEEDING AND PREVENTS REBLEEDING AFTER ENDOSCOPY
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WHAT IS THE PURPOSE OF OCTREOTIDE (SANDOSTATIN) IN UPPER GI BLEED?
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GIVEN TO ALL PATIENTS WITH BOTH GI BLEED AND LIVER DISEASE OR PORTAL HTN UNTIL CAUSE OF BLEED CAN BE DETERMINED; REDUCES SPLANCHIC BLOOD FLOW AND PORTAL HTN
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DEFINED AS BLEEDING ARISING BELOW THE LIGAMENT OF TREITZ
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LOWER GI BLEED
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WHICH IS LESS LIKELY TO HAVE ORTHOSTATIS OR REQUIRE TRANSFUSIONS- UPPER OR LOWER GI BLEED?
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ACUTE LOWER GI BLEED
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85% OF THESE SPONTANEOUSLY RESOLVE
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ACUTE LOWER GI BLEEDS
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ACUTE GI BLEEDS USUALLY OCCUR IN PEOPLE OVER THE AGE OF WHAT?
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50
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DIVERTICULOSIS, VASCULAR ECTASIAS, NEOPLASMS HAPPEN IN WHAT AGE GROUP
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OVER 50
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IBS, ANORECTAL DISEASE, ISCHEMIC COLITIS HAPPEN IN WHAT AGE GROUP
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UNDER 50
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MOST COMMON CAUSE OF MAJOR GI BLEEDING
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DIVERTICULOSIS
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MOST DIVERTICULA ARE ON WHAT PART OF THE COLON
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DESCENDING COLON (LEFT SIDED DISCOMFORT)
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MOST DIVERTICULAR BLEEDING COMES FROM WHAT SIDE?
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RIGHT COLON
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PRESENTATION OF DIVERTICULOSIS?
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ACUTE, PAINLESS, LARGE VOLUME BRBPR
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ANOTHER COMMON CAUSE OF BLEEDING IN LARGE INTESTINE
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NSAIDS
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VASCULAR ECTASIAS OCCUR WHERE?
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THROUGHOUT ENTIRE GI TRACT
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VASCULAR ECTASIAS ARE USUALLY PAINFUL. T OR F
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FALSE
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CALLED SPIDER VEINS OF THE LOWER GI TRACT
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VASCULAR ECTASIAS
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MOST COMMON POPULATION WHERE YOU WILL FIND VASCULAR ECTASIAS
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GREATER THAN 7O YEAR OLDS AND IN CHRONIC RENAL FAILURE
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THESE TYPES OF LOWER GI BLEEDS NORMALLY CAUSE CHRONIC, OCCULT BLOOD LOSS
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NEOPLASMS
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YOU WILL SEE VARIABLE AMOUNTS OF HEMATICHEZIA IN THIS CONDITION THAT CAUSES LOWER GI BLEED
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INFLAMMATORY BOWEL
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DIFFICULTY WITH BM
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TENESMUS
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SIGNS OF INFLAMMATORY BOWEL ACUTE LOWER GI BLEED
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ABDOMINAL PAIN, TENESMUS, AND URGENCY
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INTERNAL HEMORRHOIDS MAY CAUSE WHAT?
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PAINLESS BLEEDING
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WHAT DOES PAIN WITH BM SUGGEST?
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ANAL FISSURE
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THOSE PATIENTS WITH ANORECTAL DISEASE WILL REPORT WHAT?
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SMALL AMOUNT OF BLOOD ON TOILET PAPER, OR STREAKING ON STOOL
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ISCHEMIC COLITIS IS MOST COMMON IN WHAT PATIENTS?
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OLDER PATIENTS ESPECIALLY THOSE WITH ATHEROSCLEROTIC DISEASE
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IN YOUNG PATIENTS WHAT DO YOU LOOK FOR WHEN EVALUATING ISCHEMIC COLITIS THAT CAUSE ACUTE LOWER GI BLEED?
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VASCULITIS, COAG DISORDERS, ESTROGEN, LONG DISTANCE RUNNERS
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THE BLEEDING IN ISCHEMIC COLITIS IS USUALLY ___________ AND ________.
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MILD AND SELF LIMITED
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MAROON BLOOD SUGGESTS WHAT?
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RIGHT COLON OR SMALL INTESTINE BLEED
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BLACK BLOOD IN EVALUATION OF LOWER GI BLEED SUGGESTS WHAT?
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BLEED FROM ABOVE THE LIGAMENT OF TREITZ
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WHAT DOES A LARGE VOLUME OF BRBPR SUGGEST?
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COLONIC SOURCE
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IN WHAT PATIENTS IS A COLONOSCOPY DONE AS EVALUATION?
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DONE ON PATIENTS GREATER THAN 45 OR WITH ANEMIA
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IN WHAT PATIENTS IS A ANOSCOPY OR SIGMOIDOSCOPY DONE?
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IF NO ANEMIA AND AGE LESS THAN 45
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PREP FOR SURGERY ON ACUTE LOWER GI BLEED IN WHAT CIRCUMSTANCES?
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PATIENT REQUIRES MORE THAN 4 UNITS BLOOD IN 24 HRS OR MORE THAN 10 TOTAL UNITS
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HOW IS OCCULT BLOOD IDENTIFIED?
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BY FOBT (FECAL OCCULT BLOOD TEST) OR FE DEFICIENCY ANEMIA
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MAJOR CAUSES OF OCCULT GI BLEEDING
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NEOPLASMS, VASCULAR ABNORMALITIES, ACID PEPTIC LESIONS, INFECTIONS, MEDICATIONS LIKE NSAIDS, INFLAMMATORY BOWEL DISEASE
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WHEN DO YOU DO COLONOSCOPY?
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AT AGE 50 NORMALLY; OR WHEN THERE ARE ALARM SYMPTOMS, FH OF GI CANCER, ANEMIA DISPROPORTIONATE TO MENSTRUAL LOSS
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PATHOLOGICAL ACCUMULATION OF FLUID IN THE PERITONEAL CAVITY
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ASCITES
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SYMPTOMS OF ASCITES
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INCREASING ABDOMINAL GIRTH, RISK FACTORS FOR LIVER DISEASE (ETOH, TRANSFUSIONS, NEEDLE USE, HX OF VIRAL HEPATITIS, HISTORY OF CANCER, FEVER)
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SIGNS OF ASCITES
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JVD (RIGHT SIDED CHF AND CONSTRICTIVE PERICARDITIS), HEPATOMEGALY, LARGE ABDOMINAL WALL VEINS
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SIGNS OF CHRONIC LIVER DISEASE
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PALMAR ERYTHEMA, CUTANEOUS SPIDER ANGIOMAS, DUPUYTREN'S CONTRACTURE (THICKENING OF SKIN ON PALMS AND FINGERS)
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MOST DIVERTICULAR BLEEDING COMES FROM WHAT SIDE?
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RIGHT COLON
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PRESENTATION OF DIVERTICULOSIS?
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ACUTE, PAINLESS, LARGE VOLUME BRBPR
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ANOTHER COMMON CAUSE OF BLEEDING IN LARGE INTESTINE
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NSAIDS
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VASCULAR ECTASIAS OCCUR WHERE?
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THROUGHOUT ENTIRE GI TRACT
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VASCULAR ECTASIAS ARE USUALLY PAINFUL. T OR F
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FALSE
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CALLED SPIDER VEINS OF THE LOWER GI TRACT
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VASCULAR ECTASIAS
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MOST COMMON POPULATION WHERE YOU WILL FIND VASCULAR ECTASIAS
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GREATER THAN 7O YEAR OLDS AND IN CHRONIC RENAL FAILURE
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THESE TYPES OF LOWER GI BLEEDS NORMALLY CAUSE CHRONIC, OCCULT BLOOD LOSS
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NEOPLASMS
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YOU WILL SEE VARIABLE AMOUNTS OF HEMATICHEZIA IN THIS CONDITION THAT CAUSES LOWER GI BLEED
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INFLAMMATORY BOWEL
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FEELING OF NEED TO DEFECATE WITHOUT REALLY NEEDING TO PASS STOOL (OFTEN A SYMPTOM IN INFLAMMATORY CONDITIONS)
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TENESMUS
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CONDITION COMMON IN OLDER PATIENTS WITH ATHEROSCLEROSIS AND IN YOUNGER PATIENTS THAT HAVE VASCULITIS, COAG ORDERS, ESTROGEN DEFICIENCY, OR WHO ARE LONG DISTANCE RUNNERS
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ISCHEMIC COLITIS CAUSING ACUTE GI BLEED
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MANAGEMENT OF LOWER GI BLEED
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DISCONTINUE ASA AND NSAIDS, THERAPEUTIC COLONOSCOPY, INTRA-ARTERIAL VASOPRESSIN OR EMBOLIZATION, SURGERY FOR ONGOING BLEED
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EVALUATION OF OCCULT GI BLEED
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COLONOSCOPY OR EGD GREATER THAN AGE 40, ALARM SYMPTOMS, FH OF GI CANCER, ANEMIA DISPROPORTIONATE TO MENSTRUAL LOSS
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MOST COMMON CAUSE OF ASCITES
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PORTAL HYPERTENSION
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SIGNS AND SYMPTOMS OF ASCITES
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DILATED ABDOMINAL VEINS, LARGE ABDOMEN, CAPUT MEDUSA, JVD, HEPATOMEGALY
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WHAT IS BUDD CHIARI?
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HEPATIC VEIN OBSTRUCTION- CAUSES RUQ PAIN
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IF PORTAL HYPERTENSION IS THE CAUSE OF ASCITES, WHAT WILL SAAG BE?
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GREATER THAN 1.1
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IF THERE IS INCREASED SAAG AND ACIDIC PROTEIN*** IN ASCITES FLUID, WHAT IS INDICATED?
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CARDIAC DISEASE
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SIGNS ANS SYMPTOMS OF SPONTANEOUS BACTERIAL PERITONITIS
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FEVER, ABDOMINAL PAIN, MENTAL STATUS CHANGES, WORSENING OF RENAL FUNCTION
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DIAGNOSTIC TEST FOR SPONTANEOUS BACTERIAL PERITONITIS
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ABDOMINAL PARACENTESIS
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