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105 Cards in this Set

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Quad for UC, Chron's dx, Diverticulitis, Duodenal Ulcer, Gastric Ulcer, Cholecytitis?
UC and diverticulitis: LLQ
Chron's dx: RLQ
Cholecystitis: RUQ
Gastric ulcer: stomach
Duodenal ulcer : LUQ (PUD's usually in the LUQ, can be in epigastric area.
ALT
(SGPT)

in liver
inflammation
more specific than AST
AST
(SGOT)
Not injury specific

1 in liver
2 heart
3 muscle
4 kidney
5 lung
AST/ALT
Normal ratio: AST/ALT = 0.8
ETOH abuse/ Alcoholic hepatitis ratio may be AST/ALT 2:1 or over
When ALT is very elevated, think infectious hepatitis
GTT
sensitive for ETOH abuse
liver dx
acute pancreatitis
ALP
in bone and liver
ALP's elevated with what conditions?
healing cancer &
osteomalacia
IgM
M=Miserable- Active

Diagnostic of acute Hepatitis A

Peaks during first week of clinical illness and disappear in 3-6 months.
IgG
G= Gone


It indicates previous exposure, noninfectivity, and immunity to recurring HAV infection.
Anti-HAV
antibody for hepatitis A or hx of immunization
Serology for Active Hepatitis A
Anti-HAV, IgM (M=miserable)
Serology for Recovered Hepatitis A
Anti HAV, IgG
G=gone
Hepatitis B surface antigen?
HBsAg
Significance of HBsAg?
is the first evidence of HBV infection; will remain positive in asymptomatic carriers and chronic hepatitis B pts
Viremia
Viremia viruses enter the bloodstream and hence have access to the rest of the body.
can also indicate an elevation of virus levels occurring
It is similar to bacteremia, a condition where bacteria enter the bloodstream.
HBsAg
Ag= always growing
HBeAg
eAg= extra contagious, always growing
Anti-HBc
antibody to HBcAg

doesn't mean much
HBeAg
Extra Growing, Extra Contagious

protein derived from HBV core, indicating circulating HBV and highly infectious sera) is found only in HBsAg positive ser. Its presence indicated viral replication and infectivity.
Anti-HBe
often appears after HBeAg disappears. It signifies diminished viral replication and decreased infectivity
An enzyme immunoassay detects the presence of antibodies to Hepatitis C, sensitivity and specificity are low, and when highly suspected, which assay detects antibodies to HCV antigens?
RIBA assay detects antibodies to HCV antigens
To differentiate prior exposure from current viremia for Hep C, use?
PCR
Polymerase chain reaction
HBsAg, Anti-HBc, Anti-HBe, IgM, IgG?
Chronic Hep B

IgG and IgM at the same time-indicates chronic
AntiHBe- diminished viral load
HBsAg, HBeAg, Anti-HBc, IgM?
Active Hep B
Anti-HBc, Anti-HBsAg?
Recovered Hep B
Anti-HCV, HCV RNA
Acute Hep C
Chronic Hep C
Serologies are the same, so have to order a PCR TO DIFFERNTIATE PRIOR EXPOSURE FROM CURRENT VIREMIA
Anti-HAV, IgG
Recovered Hep A
Anti-HAV
never had hep A, still susceptible
Name the acute Hep B markers?
HBsAg
HBeAg
Anti-HAV, IgM
Active Hep A
Active viremia
is caused by the replication of viruses which results in viruses being introduced into the bloodstream. Examples include the measles, in which primary viremia occurs in the epithelial lining of the respiratory tract before replicating and budding out of the cell basal layer (viral shedding), resulting in viruses budding into capillaries and blood vessels.
HBsAb
Anti-HBs
B=bye, no HBV on board,

hx of immunization OR a protective antibody, unable to get HBV in the future
HBsAg neg, Anti-HBc neg, HBsAb (Anti-HBs neg)
still susceptible to hepatitis B nfection
HBsAg, HepD IgM
Hep B&D
usually with markedly elevated hepatic enzymes

with acute or chronic hepatitis B (HBsAg) markers
Anti-HCV present
HCV viral RNA
Elevated hepatic enzymes
Acute Hep C marker
Anti-HCV present
HCV viral RNA
Normal to slightly elevated hepatic enzymes
Chronic Hep C marker
Anti-HCV present
non protective antibody
Anti-HCV present
HCV RNA absent
Normalized hepatic enzymes
Hep C in the past
IZ (immunizations) are available for which hepatitis?
Hep A & Hep B and post exposure prophylaxis with IG for close contacts (Hep B=HBIG)
HBV surface antigen abbreviation?
Definition?
(HBsAg) is the surface protein of HBV. The HBsAg itself is not an infectious agent but its existence shows that there is HBV in the body of the patient. (It has the same meaning as having detectable HBV DNA in the blood.) HBsAg can exist in blood, saliva, breast milk, sweat, tears, nasal secretions, semen, and vaginal secretions.
When does the HBV surface antigen become positive in the serum?
within 2 to 6 months of the initial HBV infection and usually two to eight weeks before ALT and AST elevation. In acute HBV infections, it can turn negative in the early stage of the disease course. In chronic hepatitis B patients, this marker can be persistently positive.
The HBV surface antibody abbreviation?
Definition?
(HBsAb) is the product of the body’s immune reaction to the HBV infection. It is an immune globulin secreted by B lymph cells that can combine with the HBsAg to neutralize it. Along with other immune reactions, the HbsAb protective antibody can eradicate the invading HBV from the body.
What can cause the HBsAb marker to be positive?
Either an HBV infection or HBV vaccination can cause the HBsAb marker to be positive.
How long will the HBsAb exist?
This antibody can exist in the blood for a long time, gradually decreasing with age. If the HBV infection happened during the infancy period, it is likely to become chronic since the infant is unable produce this antibody at that time.
The HBV e antigen abbreviation?
Definition?
(HBeAg) comes from the core of the HBV and is a portion of the core. When the core of the HBV degrades in the serum, this antigen is created and can be detected. Because HBcAg will be totally degraded in the serum, it is not detectable in the serum.
Significance of the HBV e antigen?
Thus, when the HBeAg marker becomes positive, it is equivalent to a positive HbcAg marker and shows that the Hepatitis B virus is replicating actively and the patient is infectious.
The HBV e antibody abbreviation?
Definition?
(HBeAb) is the body’s immune reaction to the HBeAg and like HbsAb, it can combine with the HbeAg. It usually appears after the HBeAg turns to negative, which also means that the HBV replication activities have decreased and the patient is less infectious or not infectious at all.
IgM, Anti-HAV?
acute infection
HAVsAg?
Virus is present
+ surface antigen=?
active dx
+ core of Hep A or Hep B=?
active dx
Active dx can be noted by?
1 IgM
2 + surface antigen
3 + core Hep A or + core Hep B
Vaccine for Hep A?
Havrix vaccine
Ig, Anti-HAV +
Immunity
IgM, Anti-HAV +
Acute infection
Labs that may be elevated with Hep B?
-ALT and AST (levels peak 400- several thous)
-serum bilirubin normal to-markedly elevated
-prothrombin time: if prolonged, may indicate serious dx
-CBC may reveal an increased # of atypical appearing lymphocytes
U/A may be + for protein and bilirubin
-serologic tests for viral hepatitis
Causes of abdominal distension?

8
1 Fat
2 Flatulent
3 Female with a
4 fetus who drank too much
5 fluid and now has a
6 full bladder
7 feces & a
8 fatal tumor
5 f's for Cholelithiasis?
Fat fair females who are forty and flatuent
Cholecystitis
Common pain referrals?
Laterally to rt scapula
Pancreatitis
Common pain referrals?
Through the middle of the back
Diaphragm
Common pain referrals?
Superior surface of the ipsilateral shoulder
Duodenal ulcer
Common pain referrals?
Midback discomfort
Biliary tree
Common pain referrals?
Rt shoulder or rt posterior chest
Back Pain
Common pain referrals?
Peptic ulcer
Pancreatitis
Cancer
Chronic Prostatitis
Endometriosis
Dissecting Aortic Aneurysm
Name sign elicited by gently but deeply palpating an area of abdominal tenderness then rapidly releasing the pressure, pain is typically worse wit release, indicating abdominal wall and/ or peritoneal inflammation?
Blumberg (rebound tenderness)
Name sign elicited when pain referred to the right when direct pressure applied to LLQ?
+ Rovsing's sign
Name of sign elicited if pain when pt raises rt leg against resistance?
Suggestive of peritoneal inflammation (appendicitis)
+ Psoas sign
Name sign elicited when pain when the rt hip and knee are flexed and thigh is rotated inward?
Suggestive of peritoneal inflammation (appendicitis)
+ Obdurator sign
Mc Burney's point
the name given to the point over the right side of the abdomen that is one-third of the distance from the anterior superior iliac spine to the navel. This point roughly corresponds to the most common location of the base of the appendix where it is attached to the cecum
Name sign elicited when pain when pt is asked to stand on tiptoes, then lets body weight fall quickly onto the heels. The sign is positive if abdominal pan increases and localizes with the maneuver and suggestive of peritoneal inflammation.
Markel's sign
Cullen's sign
superficial edema and bruising in the subcutaneous fatty tissue around the umbilicus.
This sign takes 24-48 hours to appear and can predict acute pancreatitis. Also seen in ruptured ectopic pregnancy
Grey Turner's sign
Grey Turner's sign (bruising of the flank), which may then be indicative of pancreatic necrosis with retroperitoneal or intraabdominal bleeding.
It is useful for differentiating pain in the right upper quadrant. Painful arrest of inspiration triggered by palpating edge of inflamed gallbladder. Typically, it is positive in cholecystitis, but negative in choledocholithiasis, pyelonephritis and ascending cholangitis.
Murphy's sign
Ways to elicit rebound tenderness?
1 lay hands on abdomen and have pt cough
2 Markels sign
3 Ask pt to jump-watch face when lands
4 Tap heels of supine pt
5 Shake the pelvis/bed

(Palpating deeply and quickly pulling back can cause a catecholamine rush in elderly- MI)
fecolith
stone in wall have an 8 hr window with appendix- surgical consult
leukocytosis
WBCl count (the leukocyte count) above the normal range in the blood.It is frequently a sign of an inflammatory response, most commonly the result of infection, and is observed in certain parasitic infections. It may also occur after strenuous exercise, convulsions such as epilepsy, emotional stress, pregnancy and labour, anesthesia, and epinephrine administration.
diverticulosis
Diverticula/ diverticulum present
Diverticulitis
Diverticula/ diverticulum inflammed
Zollinger-Ellison
(gastrinoma)
tumor that secretes gastric acid

syndrome is a triad of gastric acid hypersecretion, severe peptic ulceration, and non-beta cell islet tumor of pancreas (gastrinoma).
When should you f/u for PUD
2 weeks after initiation & again after completion of therapy

b/t 4-12 weeks
Epigastric pain that radiates to the back. Distended abdomen. Hypertympanic sounds. Hypoactive BS. Drinks beer.
This is most likely?
Pancreatitis
Where are duodenal ulcers are typically found?
LUQ

PUD usually LUQ or epigastric area
In r/t food, when do duodenal ulcers cause pain?
Feed duodenal ulcers & they feel better.
Discomfort 1-3 hrs after meals, may awaken pt @ HS,
relieved by antacids & vomiting
Where are gastric ulcers are typically found?
In the stomach
What age group typically gets gastric ulcers?
Geros= Gastric

Younger= Duodenal
In r/t food, when do gastric ulcers cause pain?
Gastric ulcers feel worse when you feed it.

The acid from the stomach worsens the pain, whereas food usually relieves duodenal ulcers, because, by the time the acid gets to the duodenum, it's already buffered.
Peptic ulcer
a sore on the lining of the stomach or duodenum, the beginning of the small intestine
hematemesis
bright red blood in vomitus

it's implied that it didn't reach the level of the duodenum as it's still bright red
coffee colored stool implies
it was beyond the level of the duodenum, as the food was partially digested
melena
melena (tarry, foul-smelling feces due to oxidized iron from hemoglobin);
Erosive gastritis
Erosive gastritis is a type of gastritis that often does not cause significant inflammation but can wear away the stomach lining. Erosive gastritis can cause bleeding, erosions, or ulcers. Erosive gastritis may be acute or chronic.
Where's Chron's dx typically found?
RLQ
anywhere in GI tract, but most commonly in the terminal illeum and proximal colon
Where's UC (ulcerative coliitis) typically found?
Blood diarrhea (classic sympt)
LLQ crampy ab pain relieved by defecation
Type of pain with PUD
gnawing
Type of pain with GERD
burning
Where's diverticulitis typically found?
LLQ
Where's cholecytitis typically found?
RUQ
Pharm tx for eradication of H pylori?
2 A/B + PPI
continue antiulcer tx for 3-7 wks after a/b combo tx completed to ensure ulcers healed.

AOC (Amoxicillin + Omeprazole + Clariththromycin)
AOM (Amoxicillin + Omeprazole +Metronidazole)
COM (Clarithromycin + Ommeprazole +Metronidazole)
3 reasons for peritonitis?
PUD
Ruptured Divertic
Appendicitis
Proton Pump Inhibitors end in what suffix?
-zoles
H2 blockers end in what suffix?
-tidines
Ratio of liver enzymes elevation with ETOH abuse?
With ETOH abuse AST is usually more than 2 times greater than the ALT. In pts who abuse ETOH daily, the ALT and AST may be normal. GGT (gamma-glutamyl transferase, is often elevated even when ALT and AST are normal.
Hirschsprung's dx is characterized by?
no meconium w/i forst 48 hrs of life
aganglionic megacolon
the affected segment of the colon is absent of ganglia that's responsible for producing peristalsis. Not diagnosed until 48 hrs of life
S/S of Hirschsprung's?
Tx?
Emesis
abdominal distension
failure to pass stool
abd x ray will demonstrate distal intestinal obstruction wiht dilated bowel loops
should be referred for surgery to remove the diseased part of the colon
Pyloric stenosis?
more common in males
usually diagnosed b4 the child is 12 weeks old.
infant who vomits immed after eating
Knot in the ab typically olive shaped mass palpable at the lateral edge of the rectus abdominus muscle in the RUQ of the abdomen. Mass is best palpated immed after vomiting