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59 Cards in this Set

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Cholycystitis Tx (besides cholecystectomy)
– Pre-op ERCP or intraop cholangiogram
– IV Abx and fluids
– if medical problems, wait 4-6 weeks
Choledocolithiasis Tx
– ERCP w/ sphincterotomy then remove gallbladder
Cholangitis Tx
– ICU w/ IV abx
– will need to immediate decompression
– can do ERCP w/ sphincterotomy, a tube, or open decompression
Campylobactur special stuff and Tx
– r/o appendicitis and IBD
– Erythromycin
Entamoeba special stuff and Tx
– can incubate up to 3 months
– mimicks IBD
– give metro and avoid steroids (can cause perf)
E coli diarrhea special stuff and Tx
– Avoid Abx!
Salmonella special stuff and Tx
– sepsis is common and only fecal WBCs
– TMP-SMX if bacteremia or at risk
Shigella special stuff and Tx
– Seizures
– TMP/SMX
When do you do surgery w/ SBO?
– complete, necrotic, or Sx > 3 days
Who is at increased risk for diverticular disease?
– CT disorders like Ehlers danlos or marfans
Diverticulitis Tx
– bowel rest w/ metro and quinolone or 2nd/3rd gen ceph
Colon cancer, colon lesions Tx
– 3-5 cm margins
– get lympatics and mesentary
– radiation doesn’t work
– chemo if + nodes
Colon cancer, rectal lesions Tx
– APR if < 10 cm from verge (will need colostomy)
– LAR if > 10 cm (can do anastamosis)
– chemo if + nodes or radiation
What studies do you do for Oropharyngeal dysphasia, esophageal dysphasia, and odyonophasia
– Cine-esophogram
– Barium swallow then endoscopy (unless you suspect obstructive)
– endoscopy
Chronic gastiris types
– Type A is fundus and from antibodies
– type B is antrum and from H pylori and NSAIDS and all that stuff
Gastric cancer types
– intestinal type is metaplasia of gastric mucosa cells (normal type)
– diffuse is poorly differentiated and we don’t know RFs
Posterior ulcers vs. anterior ulcers
– bleeding (gastroduodenal artery) and perforation
Direct hernias where are they contained?
– aponeurosis of external oblique
UC things to remember
– mucosa only
– Sulfasalazie or 5-ASA (mesalamine)
Crohn’s things to remember
– transmural
– creeping fat
– do sulfasalazie and steroids (if no improvement)
What drugs can cause hepatitis?
– INH, methyldopa, and Tylenol
Autoimmune hepatitis Antibodies and Tx
– smooth muscle, mitochondrial, and ANA
– steroids and azathioprine
Chronic HBV vs. HCV Tx
– IFN-a, lamivudine, and adefovir
– peginterferon and ribavirin
SAAG > 1.1 and < 1.1
– hydrostatic imbalance (chronic liver disease, massive hepatic mets, and CHF)
– protein leakage (nephrotic syndrome, TB, and malignancy like ovarian cancer)
SBP dx and tx
– > 350 PMNs and > 500 WBCs
– 3rd gen ceph for both gram negative and +
Hemocromatosis genetics, associations, Sx, Dx
– AR, C282Y mutation
– increased in alcoholics (EtOH increases iron secretion)
– get MCP arthirits
– dx w/ fasting transferring sat (>45%)
– C282Y mutation
Wilsons genetics, Sx, and Tx
– AR, chromosome 13
– hemolytic anemia
– avoid shellfish, liver, and legumes)
– penicillamine (copper chelator) w/ B6 and oral zinc (increase fecal excretion)
Grey Turner sign and Cullens sign
– in pancreatitis w/ flank discoloration and periumbilical discoloration
Chronic pancreatitis
– chain of lakes on CT
– give exogenous lipase/trypsin and medium chain fatty acids
Ranson’s criteria
– glucose > 200
– age > 55
– LDH > 350
– AST > 250
– CA < 8
– Hematocrit decreased > 10%
- PaO2 < 60
– base excess > 4
– Bun increase > 5
– Sequestered fulid > 6 L
Pancreatic cancer chemo
– 5-FU and gemcitabine
Intrahepatic cholestasis of pregnancy
– increased total bili and pruritis
Acute fatty liver of preganancy
– occurs with pre-eclampsia
1o biliary cirrhosis
– anit-mitochondrial Ab
– big increase in AP and cholesterol w/ intense pruritis
Where does mesenteric ischemia usually occur
– at splenic flexure
Conjugated hyperbili Dx
– always from some obstruction
– first do abdominal u/s
– then try ERCP or PCT
Cirrhotic ascites
– treat with spironolactone
– can augment with lasix
Angiodysplasia
– aka vascular ectasia
– associated w/ AS
– will not have colonoscopy findings
Scleroderma esophagus
– absent peristalsis in lower 2/3 and decrease in LES tone (unlike achalasia)
When do you go straight to upper endoscopy?
– wt loss, N and V, >1-2 years of Sx, and no response to PPIs
Reye’s syndrome histo
– fulminant failure w/ extensive vacuolization of the liver
Amebic abscess
– draws back anchovy paste
– don’t aspirate, give metro
Viral hepatitis and Isoniazid liver histo
– panlobular w/ monocytes and necrosis
Zenker’s diverticulum
– can lead to aspiration pneumonia
– will have nck mass and dysphasia
– get esophogram (why you always get this before endoscopy)
What else can go along w/ Hep C
– B cell lymphoma
– plasmacytomas
– auto immune (sjogrens and thyroiditis)
– Lichen Planus
– porphyria cutanea tarda
– ITP
ZES Dx
– serum gastrin (> 1000 is dx)
– if not dx, can try secretin stimulation (should decrease gastrin)
Hepatorenal syndrome tx
– careful volume loading and stop lasix and spironolactone
– may need dialysis
What is the best way to dx acute diverticulitis
– CT
Carcinoid location frequency
– more in appendix, but you if you have Sx, more likely in SI
Rotor’s syndrome
– like Gilbert’s but conjugated
– there will also be bili in urine b/c only conjugated gets into urine
Cirrhosis Screening
– endoscopy for varices
Tropical Sprue histo
– villi blunting and inflammatory cells
When should you suspect giradiasis and give metro
– anyone from a developing country or the rockey mountains w/ diarrhea
Malabsorption after abdominal surgery is likely?
– bacterial overgrowth
Primary sclerosing cholagitis
– increased AP and bili
– normal LFTs
– sometimes p-ANCA
Lactose intolerance Dx
– hydrogen breath tests
– clinitest for reducing substances
– increased osmotic gap
Most common causes of cirrhosis
– EtOH then Hep C
– dx hep c with HCV RNA
Blood transfusion and hepatitis
– before 1992 is Hep C
– before 1986 is Hep B
Dig tox
– w/ verapimil
– mainly abdominal Sx