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51 Cards in this Set

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Q500. Diarrhea - Tx
A500. infectious - self-limited; mild - oral fluids & electrolytes; severe - IV fluids & oral Antibiotics, initial empiric- ciprofloxacin; invasive - TMP-SMX or ciprofloxacin; giardia - metro; c. diff - metro; campylobacter - erythromycin; scombroid - antihistamine; cryptosporidium - control underlying HIV with antiretrovirals
Q501. IBS - What is it
A501. abdominal pain; changes in bowel habits; increased with stress; relieved by BM; 1/2 of patients. have comorbid psych disorders
Q502. IBS - History/PE
A502. Symptoms for at least 3 mos. usually absent at night; abdominal pain; change in bowel habits; abdominal distention; stools with mucus; relief of pain with a BM
Q503. IBS - Dx
A503. Dx of exclusion; rule out - lactose intolerance, IBD, hypo- or hyperthyroidism; always flexible sigmoidoscopy if patient > 40 y/o
Q504. IBS - Tx
A504. fiber supplements; TCAs, antidiarrheals, antispasmodics; tegaserod - constipation-predominant.
Q505. SMALL BOWEL OBSTRUCTION - History/PE
A505. cramping - crescendo-descrendo every 5-10 min. vomiting: bilious – early, feculent - distal; partial obstruction - flatus, no stool; complete obstruction - no flatus or stool; T/D (accumulation of gas and fluid); prior surgical scars; high-pitched tinkles; peristaltic rushes; later, peristalsis disappears
Q506. SMALL BOWEL OBSTRUCTION - Causes
A506. adhesions from prior abdom; surgery (60%); hernias; neoplasms; intussusception; gallstone ileus; stricture from IBD; volvulus; CF
Q507. SMALL BOWEL OBSTRUCTION - Dx
A507. - leukocytosis - if strangulation; dehydration (vomiting); metab. alkalosis (vomiting); lactic acidosis - if necrotic bowel; need emergency surgery; radiopaque in cecum - gallstone ileus; XR - stepladder pattern; air-fluid levels
Q508. SMALL BOWEL OBSTRUCTION - Tx
A508. partial -, NPO, NG suction, IV hydration, correct electrolytes, Foley; surgery if complete obstruction, necrotic bowel, Symptom > 3D with no resolution; exploratory laparotomy
Q509. Ileus; what is it; Risk factors
A509. temp arrest of intestinal peristalsis Risk factors; recent surgery/GI procedures; immobility; hypokalemia; hypothyroidism; DM; meds (anticholinergics, opioids); After every abdominal operation for 24-48 hours Due to - sympathetic overeaction, bowel manipulation, K+ depletion (preop vomiting), peritoneal irritation from blood or peritonitis, atony of colon & stomach
Q510. Ileus - History/PE
A510. abdominal discomfort; n/v; no flatus or BM; abdominal distention; decreased or no bowel sounds; rectal exam if elderly to rule out fecal impaction
Q511. Ileus - Dx
A511. AXR - distended loops, air-fluid levels (upright); gastrografin - rule out partial obstruction; CT - rule out neoplasm
Q512. Ileus - Tx
A512. decrease meds that reduce; bowel motility; decrease/discont. oral feeds; NG suction; parenteral feeds; replete electrolytes
Q513. Carcinoid Syndrome - What causes it
A513. Carcinoid tumors; neuroendrocrine cells; enterochromaffin cells; usually from ileum, appendix
Q514. Carcinoid Syndrome - What do they secrete
A514. serotonin; tryptophan; tachykinin (substance P); ACTH, gastrin; secrete high levels => depletion of tryptophan => pellagra (niacin def.); levels do not get metabolized by liver due to liver mets; MC found incidentally during appendectomy
Q515. Carcinoid Syndrome - History/PE
A515. flushing; diarrhea; wheezing; right-sided valvular disease
Q516. Carcinoid Syndrome - Dx
A516. high urine levels of 5-HIAA - diagnostic; chest and abdominal CT
Q517. Carcinoid Syndrome - Tx
A517. octreotide (for symptoms); surgery
Q518. Diverticular Disease - What is it
A518. Outpouching of mucosa and submucosa that herniate in areas of high intraluminal pressure; common in sigmoid colon; MCC of acute lower GI bleeding in patients. > 40
Q519. Diverticular Disease - Risk factors
A519. low-fiber and high-fat diet; advanced age; connective tissue disorders (Ehlers-Danlos, Marfans)
Q520. Diverticular Disease - History/PE
A520. LLQ abdominal pain; abnormal bowel habits; bleeding painless and sudden; usually hematochezia; Symptom of anemia
Q521. Diverticulitis - PE
A521. LLQ pain; fever; n/v; perforation - complication
Q522. Diverticular Disease - Dx
A522. CBC (leukocytosis); AXR; colonoscopy or barium enema; avoid invasive techniques in early diverticulitis - risk of perforation; CT - check for abscess, free air after acute episode if >50 y/o; flexible sigmoidoscopy (rule out perforating colon cancer)
Q523. Diverticular Disease - Tx for uncomplicated disease
A523. high-fiber diet
Q524. Diverticular Disease - Tx for bleeding
A524. bleeding usually stops spontaneously; transfuse and hydrate; if bleeding doesn't stop - angiography with embolization; surgery
Q525. Diverticular Disease - Tx for diverticulitis
A525. NPO; NGT; metro and fluoroquinolone or cephalosporin if perforation - resect; anastomosis or temp colostomy
Q526. LOWER BOWEL OBSTRUCTION - History
A526. constipation; cramping abdominal pain; n/v; feculent vomiting; tenderness; significant distention; tympany; high-pitched tinkly BS; later, no BS
Q527. LOWER BOWEL OBSTRUCTION - Causes
A527. colon cancer; benign tumors; diverticulitis; volvulus; fecal impaction; assume colon ca until proven otherwise
Q528. LOWER BOWEL OBSTRUCTION - Tx
A528. tx obstruction with - gastrograffin enema; colonoscopy; rectal tube; surgery usually needed; tx underlying cause
Q529. Colon and Rectal Cancer - History/PE
A529. presents with symptom after long period of silent growth; abdominal pain and symptom based on location; right-sided lesion - stool is liquid, ca can get large before symptom, lesions commonly ulcerate => chronic blood loss, can bleed intermittently; left-sided lesion - stool more concentrated, apple-core lesions; rectal – BRBPR, rectal pain, can coexist with hemorrhoids, so rule out in all patients with rectal bleeding
Q530. Colon and Rectal Cancer - Dx
A530. CBC (anemia); guiac; sigmoidoscopy - left; colonoscopy/barium enema - right; US (how much invaded); CT/MRI (to stage); CXR, LFT, abdominal CT - metas
Q531. Colon and Rectal Cancer - How does mets spread
A531. direct; hematogenous - liver primary; lymphatic -pelvic lymph nodes
Q532. Colon and Rectal Cancer - Tx
A532. bowel prep - Golytely, Antibiotics; colon - resect colon, lymph, mesentery, anastomosis; rectum - if < 10cm from anal verge, abdominoperineal resection, rectum and anus resected, permanent colostomy; if > 10cm, low anterior resection, anastomosis between colon & rectum; wide local excise - low stage; also chemo - colon with nodes; also radiation - rectum; Followup with CEA, colonoscopy, LFTs, CXR, abdominal CT Duke classification; surgery - stages A&B; stages C1 & C2 - surgery and chemo, 5-FU and leucovorin
Q533. Colon and Rectal Cancer - Risk factors
A533. age; hereditary - FAP, Gardner's, HNPCC; APC gene, p54; Strep bovis bacteremia; family History; UC; adenomatous polyps; past History of colorectal ca; high-fat, low-fiber diet
Q534. Colon and Rectal Cancer - Screening
A534. DRE yearly > 50 y/o; guaiac yearly > 50 y/o; colonoscopy every 10 yrs > 50 or sigmoidoscopy every 3-5 > 50 or colonoscopy every 10 yrs > 40 with family history of ca/polyp or 10 yrs prior to age of dx of youngest family member with colorectal ca
Q535. Dysphagia - What is it
A535. Difficulty swallowing due to abnormalities of the oropharynx or esophagus.
Q536. Odynophagia - What is it
A536. Pain with swallowing due to abnormalities of the oropharynx or esophagus.
Q537. Dysphagia; Etiologic factors; (Caused by)
A537. Achalasia; peptic stricture; esophageal webs or rings; carcinoma; Scleroderma; spastic motility disorders; Sjogren's; meds; radiation injury
Q538. Dysphagia - PE
A538. examine for masses (goiter, tumor); examine for anatomical defects
Q539. Dysphagia - Dx
A539. oropharyngeal - cine-esophagram; esophageal - barium swallow then endoscopy, manometry, pH monitoring; odynophagia - upper endoscopy
Q540. Dysphagia; Tx; Tx for Achalasia
A540. Etiology dependent; achalasia - botulinum toxin, calcium channel blockers, balloon dilatation; all 3 temporizing measures; esophageal myotomy for long-term tx
Q541. Esophageal Cancer - What is it
A541. squamous cell ca – midesophagus from smoking and alcohol, can develop fistulas to bronchi; adenocarcinoma - barrett's esophagus, columnar metaplasia replaces squamous distal esophagus, secondary to chronic GERD
Q542. Esophageal Cancer - Risk factors
A542. achalasia; barrett's; cigarettes; etoh; webs; male gender
Q543. Esophageal Cancer - History/PE
A543. progressive dysphagia - first solids then liquids; weight loss; GERD; GI bleeding; vomiting
Q544. Esophageal Cancer - Dx
A544. barium swallow 1st; EGD; biopsy – confirm; (MRI/CT - evaluate for mets)
Q545. Esophageal Cancer - Tx
A545. surgery if local; metastatic - cisplatin, 5-FU & radiation; chemoradiation - poor prognosis; esophageal stent - palliation
Q546. GERD - What is it
A546. transient LES relaxation from; incompetent LES; gastroparesis; hiatal hernia
Q547. GERD - Risk factors
A547. increased intra-abdominal pressure (obesity, pregnancy); scleroderma; alcohol; caffeine; nicotine; chocolate; fatty foods
Q548. GERD - History/PE
A548. heartburn 30-90 min post meal; pain worse with reclining; pain better with antacids,; sitting, standing; sour taste ("water brash")
Q549. GERD - Dx
A549. Based largely on History; confirm - respond to Tx; 24hr pH monitor- gold standard; Bernstein test - confirms origin of pain
Q550. GERD - Tx
A550. - lifestyle - weight loss, head-of-bed elevation, stop eating 3 hrs before bed, eat small meals; monitor for barretts/adenoca, serial EGD, Biopsy; antacids - if intermittent; H2 blockers and PPI; surgery - nissen fundoplication