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129 Cards in this Set
- Front
- Back
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Q. Name 4 NON GI Causes of VOMITTING?
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i. Infants and toddlers with UTIs – they can vomit mucus
ii. With projectile vomiting (since this isn’t normal) has there been trauma? iii. Increased ICP – meningitis, trauma iv. Stress/abuse |
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Q. Name 4 NON GI Causes of ABDOMINAL PAIN?
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i. School phobia
ii. Pneumonia iii. Abuse iv. Trauma |
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Q. In PREMATURE INFANTS what is the cause of GERD?
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Decrease in lower esophageal sphincter (LES) tone
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Q. How do you TREAT GERD in premature infant?
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Thicken the feedings with rice cereal and elevate the head of the baby’s bed about 30 degrees and baby can sleep in a sling for crib
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Q. What is the Cx of Pyloric Stenosis?
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Due to hypertrophy and hyperplasia of the pylorus. This blocks the lumen and obstruction occurs, so food has a hard time entering intestines
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Q. What is the onset of Pyloric Stenosis?
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Usually in 2nd to 3rd WEEK of life
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Q. Name 3 Symptoms of Pyloric Stenosis?
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1. Increased PROJECTILE vomitting.
2. Palpation of "OLIVE" in abdomen 3. Decreased stools, increased hunger, 105 temp |
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Q. How would you diagnose pyloric stenosis?
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Ultrasound
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Q. How would you treat pyloric stenosis?
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Surgical (Pylorectomy)
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Q. What age range would you see patients with intussusception?
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5-9 months old
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Q. What are 3 Sx of intussusception?
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1. Sudden onset of paroxysmal pain--CRYING AND STRAINING.
2. FREQUENT VOMMITING with PAIN 3. CURRANT JELLY STOLS |
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Q. What is an important PE of intussusception?
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Sausage-shaped mass in the RUQ
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Q. What is a good Tx of Intussusception?
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Barium Enema
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Q. What is the cause of Hirschprungs Dz?
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Absence of innervation of bowel wall
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Q. What are Sx of hirchsprungs Dz
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Variable (failure to pass meconium)
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Q. How is Dx made on Hirschsprung Dz?
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Biopsy
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Q. 3 stages of GB disease?
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i. GB colic
ii. Acute cholecystitis iii. Asymptomatic (60-80%) |
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Q. Name 4 types of individuals who would have GB disease?
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i. 4 F’s (fat, female, fertile, forty, fair skinned)
ii. Northern Europeans, Hispanics, and Pima Indians iii. Increased risk with some types of oral contraceptives predisposes for sludge iv.Pregnant women |
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Q. What are 4 clinical presentations for Gallbladder Cholic?
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Temporary Colic.
1. Lasts less than 4-6 hrs, Constricting, dull constricting pain, pt move around to get comfortable 2. May be worse after a large and fatty meal 3. Pt will usually move around trying to get comfortable 4. Associated w/ nausea and diaphoresis |
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Q. What are 4 clinical presentations of Acute Cholecystitis?
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1. Often 6-8 hours after a meal. May wake the pt up at night. 2. May radiate to R SCAPULA. 3. May develop low grade fever. 4. Sweat soaking wet
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Q. What are 4 PE findings of Gall bladder DZ?
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i. RUQ tenderness, usually w/ guarding
ii. Murphy’s sign iii. Peritoneal signs (rebound, tenderness etc) iv. Jaundice in 20% of pt from CBD obstruction |
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Q. What are the 3 imaging studies for GB dz?
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i.Ultrasound- #1 Diagnostic test for Screening!!!!! When you know it is galbladder.
ii. HIDA scan (Visualize biliary tree) iii. CT scan when unsure of dx |
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Q. 1. What will the labs be with Bilary Colic?
2. What will the labs be with Cholesitis? 3. What is Billi, ALT, AST, Alk phos be with bile duct obstruct? |
1. Normal
2. Elevated WBC (SHIFT TO LEFT) 3. Billi, ALT, AST, alk pos all significantly |
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Q. What should always be checked for with Gall Bladder Dz?
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PREGO
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Q. What should be the 3 pre Hospital Care for GB Dz?
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i. Monitoring- cardiac, pulse etc.
ii. Stabilization (O2 or IV= incase of septic shock iv is ready) iii. Rapid transport |
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Q. What are 5 Sx of Appendicitis?
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i.HIGHLY VARIABLE
ii.Anorexia for 1-2 days before abdominal pain iii. Develop periumbilical pain iv. Localized to RLQ v. Diarrhea |
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Q. What are 4 PE findings of Appendicitis?
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b. Rovsing sign = pain in RLQ when palpating the LLQ
c.Psoas sign – pain in RLQ w/ extension of the right hip d. Typically lay in ball on right side and do not want to move e. Rebound tendernous |
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Q. What are the imaging studies of appendicitis?
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CT Scan
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Q. What will the LABS show in Appendicitis?
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i. 80-85% of pt have WBC > 10,000 w/ Left shift
ii. UA culture and sensitivity and complete Metobolic profile |
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Q. What is the etiology of Pancreatitis?
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ALCOHOL & GALLSTONES.
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Q. What are the systemic effects of Pancreatitis?
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i.Inflammation --> cytokine release--> vasodilation--> shock
ii. Increased Permeability of blood vessels--> 3rd spacing or fluid (blood vessels leak fluid --> acites) acid fluid = tea colored acidic fluid in abdomen iii. Fat necrosis --> release of free FA bind w/ Ca --> Ca soap formation --> Hypocalcemia iv. Beta cell injury = hyperglycemia (Type I Diabetes) v. ARDS |
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Q. What are the 3 Sx of Pancreatitis?
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i. Steady boring Pain in epigastric area, that radiates to the back
ii. Sit up and forward to take pressure off iii. N/V associated w/ pain |
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Q. What are the 6 PE findings of Pancreatitis?
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i. Vital signs = tachecardia, tachypnea, bp
ii. Fever iii. Abdominal distentension, guarding iv. Distant or absent bowel sounds v. Grey-Turner sign (hemorrhagic pancititis) vi. Cullen sing |
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Q. What will Labs show in Pancreatitis?
i. WBC? ii. Glycemia & Calcimia? iii. Amylase? iv. Lipase? v. Hct? |
i. WBC > 12,000
ii.Hyperglycemia, hypocalcimia iii. Amylase = 3x normal iv. Lipase elevated v.Hct > 50% due to 3rd spacing |
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Q. What are the 2 diagnostic imaging studies?
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i. KUB
ii. CT Scan (MOST RELIABLE METHOD) |
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Q. What is the definition of DiverticuLOSIS?
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Mucosal projection in colon
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Q. Dietary Cx of DiverticuLOSIS?
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LOW FIBER DIET
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Q. What are the 3 Sx of DiverticuLITIS?
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1. Tenderness, and aching pain in LLQ
2. Fever, N/V 3.Pain may be relieved by defecation |
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Q. What is the Dx of DiverticuLITIS?
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CT Scan
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Q. What are the 3 indications for surgery in DiverticuLITIS?
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i. Abscesses and or peritonitis
ii. Bowel obstruction iii. 2 PREVIOUS episodes of Diverticulitis |
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Q. What are 3 etiologies of Sm Bowel Obstruction?
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a. Adhesions
b. Malignancy c. Hernias, Crohn’s disease |
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Q. Name 2 symptoms of Sm Bowel Obstruction?
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a. Vomit/Diaherra early in course
b.Severe spasmodic rhythmic pain from epigastric area to umbilical area |
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Q. Name 3 PE findings of Sm Bowel Obstruction?
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i. Diffuse abdominal tenderness
ii. Hyperactive bowel sounds early--> high pitch iii. Hypoactive or absent sounds later (peritonitis --> no bowel sounds) |
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Q. What are 2 diagnosis of Sm Bowel Obstruction?
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a. Supine and upright plain films of abdomen
b. CT scan is exam of choice when there is: FEVER, localized pain, and increased WBCs |
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Q. What is the Definition of Oropharyngeal Dysphagia?
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Difficulty in with initiating swallowing or transferring food from the mouth to the upper esophagus.
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Q. What is the definition of Esophageal Dysphagia?
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Difficulty in passage of food somewhere from suprasternal notch to xyphoid.
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Q. What is the definition of Achlasia?
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Achalasia is a disorder of the tube that carries food from the mouth to the stomach (esophagus), which affects the ability of the esophagus to move food toward the stomach.
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Q. What are 2 symptoms of Achlasia?
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i. Gradual dysphagia for solids and liquids
ii. Regurgitation, chest pain, nocturnal coughDx |
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Q. What are 2 Dx of Achlasia?
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i.Barium swallow
ii. Esophageal manometry shows absence of peristalsis |
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Q. What are 5 etiology findings of GERD?
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a. Pregnancy>80%
b. Hiatal hernia c. Incompetent LES (i)abnormal frequent relaxation of sphincter (ii) or chronic hypotensive sphincter d. EtOH, caffeine, tobacco, fatty or spicy foods e. Beta blockers and calcium channel blockers |
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Q. What are 3 Sx of GERD?
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1. Heart Burn
2. Dysphagia 3. Sour Taste |
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Q. 2 Dx measures of GERD?
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1. Endoscopy
2. Esophageal pH Monitoring |
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Q. What is the definition of IBS (Irratable Bowel Syndrome)?
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Functional motility disorder
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Q. What are 3 precipitating factors of IBS?
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1. Diet
2. Drugs 3. Stress |
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Q. What are 3 Sx of IBS?
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a. Pain that is relieved by defecation
b. Diarrhea alt w/ constipation c. Loose stools after meals or in the am |
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Q. What is the definition of Crohns Disease?
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Transmural inflammatory disease of the bowel
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Q. What areas are involved in Crohns Disease?
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Most commonly involves the ILEUM and COLON, but can affect anywhere in GI
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Q. What are the Sx in children with Crohns Disease?
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More extraintestinal than Gi
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Q. What is the pathophysiology of Crohns Disease?
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1. Earliest lesion: tiny, discrete erosions over lymphoid follicles
2. Development of linear and interconnected mucosal ulcers 3. Deep ulceration with transmural inflammation develops 4. 50% form noncaseating granulomas 5. rectal sparing |
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Q. What are 4 extraintestinal manifestations that parallel intestinal activity?
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1. Peripheral arthritis
2. Erythema nodosum 3. Pyoderma gangrenosum – sores on extremities 4. Aphthous stomatitis – canker sores |
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Q. What are 3 Extraintestinal manifestations that run an independent course?
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1. Ankylosing spondylitis
2. Uveitis 3. Primary sclerosing cholangitis |
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Q. What imaging technique would be used for Crohns Disease?
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Endoscopy with biopsy, Barium studies
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Q. What are 2 pathologies of Ulcerative Colitis?
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1. Confined to the mucosa (NOT TRANSMURAL)
2. Begins in rectosigmoid area and (NO RECTAL SPARRING) spreads to the entire colon |
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Q. What are 4 Sx of Ulcerative COlitis?
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1. Asymptomatic intervals alternate with insidious or fulminant attacks
2. Fulminant attacks: high fever, urgency, cramping, and bloody diarrhea 3. Stools may become entirely blood and pus 4. Anemia, hypoalbuminemia (legs get swollen), and wt. loss |
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Q. What are 3 complications of ulcerative Colitis?
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1. Toxic megacolon
2. Toxic colitis with ileus and peritonitis 3. Severe bleeding |
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Q. What are 2 things which increase the risk of cancer?
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1. 10 yrs. with disease
2. If entire colon involved |
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Q. Give 3 Sx of Peptic Ulcer Dz?
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i. Hx of heartburn
ii. Ab pain – epigastric or RUQ iii. Belching, bloating |
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Q. What are 3 etiology of PUD?
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i. Often multifactorial
ii. Tends to run in families iii. Common mucosal damaging factors |
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Q. What are 2 Dx workups for PUD?
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1. Endoscopy
2. Upper GI Series |
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Q. What are 4 complications of PUD?
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i.Hemorrhage most common
ii. Hematemesis – fresh blood iii. Melena – black tarry stools iv. 3-6x increased risk for gastric carcinoma w/ H pylori infection |
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Q. What are 2 causes of Esophageal Varices?
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i. Associated w/portal HTN secondary to cirrhosis
ii. First described in alcoholics |
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Q. What are 3-5 Sx of Esophageal Varices?
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i. May be asymptomatic for long periods of time
ii. Painless large volume hematemesis or melena iii. Minimal ab pain iv. Volume depletion --> shock v. Anemia |
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Q. What are 2 ways to Dx Esophageal Varices?
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i. Visualize bleeding source
ii. EGD (THE BEST) |
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Q. What is the Etiology of Mallory Weiss Syndrome?
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Laceration of distal esophagus and prox stomach during FORCEFUL VOMMITING or retching – bleeding from arterial blood
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Q. Name 2 Sx of Mallory Weiss Syndrome?
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i. Pt usually has one or more episodes of nonbloody vomiting followed by bright red blood
ii. GI hemorrhage from arterial site |
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Q. What are 2 ways to Dx Mallory Weiss Syndrome?
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1. Endoscopy
2. Arteriography |
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Q. What are 3-5 risk factors for colon cancer?
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1. Hereditary polyposis syndrome (IMPORTANT)
2. IBD 3. Family hx of cancer 4. High Fat Diet 5. Beer Drinking |
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Q. What are 3 clinical presents in Right Sided Colon Cancers?
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1. Anemia – Fe def
2. Dull vague and uncharacteristic ab pain or NO symptoms 3. occult blood |
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Q. What are clinical presents in Left Sided Colon Cancers?
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1. Change in bowel habits
2. Rectal Bleeding |
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Q. What are 4 Imaging tools in Colon Cancer?
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1. (COMMON) COLONOSCOPY/ w biopsy
2. CT Scan of ABd 3. Chest X-Ray 4. Air Contrast Barium Enema |
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Q. What are 3 clinical findings of Colon Polyps?
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1. most asymptomatic
2. Hematochezia (maroon stools) 3. Occult blood test + |
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Q. What are 3 Characteristics of polyps that increase the risk for development of Cancer?
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1. Less 5% become carcinoma
2. Important polyp factors for Transformation to carcinomas 3. LARGE |
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Q. Where is the location of Meckels Diverticulum?
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Located 100 cm proximal to cecum
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Q. What are 4 Sx of Meckels Diverticulum?
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i. Asymptomatic (80-95%)
ii. Painless lower GI bleeding (4%) iii. Intestinal obstruction (6%) iv.Meckel’s diverticulitis, mimics acute appendicitis (5%) |
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Q. What is the definition of Internal Hemorroids?
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Are derived from the internal hemorrhoidal plexus and are covered by RECTAL MUCOSA.
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Q. What is the definition of External Hemorroids?
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Are derived from the external hemorrhoidal plexus and are covered by STRATIFIED SQUAMOUS EPITHILIUM
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Q. What are 4 Differential Dx of Pruritus Ani?
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1. Can be caused by liver disease, scabies
2. Can be pre-cancerous Dz like Pagets or Bowen’s 3. Can be caused by PINWORMS 4. Can be a Dermatologic Sx |
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Q. Name 4 risk factors for Gastric Cancer?
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i.Has had an infection of the stomach caused by Helicobacter pylori- a risk factor.
ii. Is an OLDER MALE iii. smokes cigarettes iv. Diet that includes lots of dry, salted foods |
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Q. Name 3 Sx of Gastric Cancer?
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i. Unintended weight loss and lack of appetite
ii. Abdominal pain iii. Vague discomfort in the abdomen |
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Q. Name 2 IMPORTANT SIGNS of Gastric Cancer?
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i. Sister Mary Joseph node
ii. Virchow nodes |
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Q. Where do Adenocarcinomas of the exocrine pancreas arise from nine times more often?
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Duct Cells more often then acinar cells
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Q. Where do 80% of pancreatic cancer arise from?
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HEAD
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Q. What are 5 risk factors for pancreatic Cancer?
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1. Usually occur over age 55
2. Smoking 3. Diabetes 4. MALE 5. If a person's mother, father, sister, or brother had the disease. |
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Q. What are 3 Sx of Pancreatic Cancer?
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1. "Silent Disease" Often no Sx
2. Pain in the upper abdomen or upper back 3. Yellow skin and eyes, and dark urine from jaundice |
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Q. What is the prognosis of Pancreatic Cancer?
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NOT GOOD. 5 yr SURVIVAL LESS THEN 2%
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Q. What is the pathogenisis of Pseudomembranous Colitis?
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Clostridium difficile toxin
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Q. Name 3-5 Sx of Pseudomembranous Colitis?
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Usually begin during course of antibiotics.
i. Loose stools ii. Diarrhea, ab pain iii. Fever, leukocytosis iv. Toxic Megacolon |
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Q. What are 4 ways we diagnose Pseudomembranous Colitis?
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i. History of diarrhea after antibiotic use
ii.Endoscopy or colonoscopy iii.Do NOT do barium enema during active phase iv. C.difficile in stool |
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Q. Define Primary Biliary Cirrhosis?
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Chronic, progressive inflamm dz of liver
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Q. What is the association of Primary Biliary Cirrhosis with HLA Antigens?
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NONE
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Q. What is the incidence of Primary Biliary Cirrhosis?
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Primarily WOMEN 35-65
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Q. What are 3-5 Sx of Primary Biliary Cirrhosis?
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1. 50% asymptomatic
2. Pruritis (Itch) 3. Jaundice, Lipid Deposits 4. Weight Loss, RUQ pain 5. CREST |
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Q. Primary Biliary Cirrhosis Labs:
1. ALP? 2. Bilirubin? 3. IgM? 4. Vit K? 5. AMA? |
1. Elevated
2. Mild Elevations 3. Increased Igm 4. Malabsorption of Vit K 5. Greater then 95% |
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Q. How is Dx made in Primary Biliary Cirrhosis?
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Liver Biopsy
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Q. Define Primary Sclerosing Cholangitis?
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:Chronic cholestatic syndrome
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Q. Is there an association with HLA antigens in Primary Sclerosing Cholangitis?
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YES
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Q. What is the incidence in Primary Sclerosing Cholangitis?
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YOUNG MEN
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Q. Name 3 Sx of Primary Sclerosing Cholangitis?
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1. Fatigue, pruritis,
2. Jaundice – gradual and progressive 3. Hepatosplenomegaly |
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Q. Primary Sclerosing Cholangitis Labs:
1. ALP? 2. Transaminases? 3. Bilirubin? 4. AMA? |
1. Elevated ALP
2. Mildly increased transaminases 3. Bilirubin elevation 4. AMA test NEGATIVE |
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Q. What are 2 ways Dx is made in Primary Sclerosing Cholangitis?
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1. Direct cholangiography
2. Liver Biopsy |
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Q. What are the constitutional Sx of Liver Disease?
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Anorexia, fatigue and weakness
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Q. What are 3 Sx of Cirrhotic habitus in Liver Disease?
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a.Wasted extremities
b. Protuberant belly c. General deterioration in health |
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Q. What are 3 skin findings in Liver Disease?
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i. Spider nevus
ii. Palmar erythema iii. Hemochromatosis (Skin looks slight gray) |
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Q. What are 4 endocrine changes in Liver Disease?
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i. Glucose intolerance,
ii. Hyperinsulinemia (decreased hepatic degradation), iv. Insulin resistance, v. Hyperglucagonemia (increased secretion) |
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Q. What are 4 Hemotological changes in Liver Disease?
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1. Anemia
2. Leukopenia/leukocytosis 3. Thrombocytopenia 4. Coagulation disturbances |
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Q. Define celiac Sprue?
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A chronic disease characterized by
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Q. What are the Sx of Celiac Sprue in:
1. Children? 2. Adults? |
1. FTT failure to thrive – children and infants*** often first sign
2. Weight loss, fatigue, and diarrhea – adults* 3.Abdominal pain, nausea and vomiting are unusual* |
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Q. How do we diagnose Celiac Sprue?
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BIOPSY of small bowel to establish diagnosis***this is the GOLD STANDARD
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Q. What is the Incubation period of Sx in Hep A?
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Incubation 15-45 days
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Q. What are the 2 Sx of the Preicteric, prodromal phase 1-14 days in Hep A?
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1. Anorexia, malaise, nausea/vomiting, fever, headache, abdominal pain***
2. Jaundice >70%***- very common, begins in pre-icteric phase |
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Q. What are the 2 Sx of Icteric Phase of Hep A?
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1. Dark orange urine
2. CLay Colored Stools |
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Q. What is the Incidence in HEP C?
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***30-50 y/o MALE
(Most common chronic blood-borne infection in the US) |
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Q. What are 3 Sx of HEP C?
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1.Malaise
2. jaundice, 3. fatique (7-8 weeks after exposure) |
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Q. What are 2 Sx of E. Coli 0157?
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1. SEVERE CRAMPING
2. Grossly bloody diarrhea within 24 hrs after contact |
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Q. What are 2 complications in E. Coli 0157?
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1. Hemolytic Uremia Syndrome (HUS)
2. Renal failure in infants and children |
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Q. What are 3 forms of Botulism?
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1. Food Borne Form
2. Wound Form 3. Infantile Form |
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Q. What are 5 Sx of food borne Botulism?
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i. Bilateral descending weakness
ii. Diplopia, ptosis, decreased papillary reflex iii. Flaccid facial paralysis iv. Extremitiy and turnk weakness follow v. THEY CAN STOP BREATHING |
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Q. What is the etiology of Travelers Diarrhea?
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Entero Toxigenic E-COLI
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Q. What are 2 Sx of Travelers Diarrhea?
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1. N/V, 2. Diarrhea 12- 72 hours after exposure to contaminated water
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