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73 Cards in this Set
- Front
- Back
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Patients with peptic ulcer disease describes the pain as |
Gnawing |
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Number one cause of peptic ulcer disease |
H pie Laurie |
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Causes of peptic ulcer disease |
h pylori Use of NSAIDs aspirin and corticoids |
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Duodenal ulcers are common in
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Young
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This alcohol and dietary factors play a role in peptic ulcer disease
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No
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Describe the pain when given peptic ulcer disease patients food duodebnal versus gastric
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Duodenal ulcers feels better with food gastric ulcers feels worse
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What are the complications of the peptic ulcer disease
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G.I. bleed and perforation
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Signs of perforation
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Severe epigastric pain
Bored like abdomen No bowel sounds Rigidity |
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Outpatient management of peptic ulcer disease
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H2 receptor antagonist at night
That increased H2 receptor antagonist twice a day Then switched to a proton pump inhibitor |
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What is important to understand when given mucosal protective agents
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You have to give them two hours apart from other medications avoid antacids and H2 blockers because it needs an acidic environment
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Benefits of Carafate
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Associated with decreasing nosocomial pneumonia
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This mucosal protective agent has a direct antibacterial action against H. pylori
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Pepto-Bismol
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Use as a prophylaxis against nsaid induced o ulcers
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Misoprostol (citotec)
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If the patient cannot discontinue NSAIDs and begins to have ulcers what medication should you
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Proton pump inhibitor
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These medications do not prevent nsaid inducedo ulcers
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H2-blockers Carafate and antacids
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What are the benefits of antacids
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They do not reduce the amount of gastric acidity they're just symptomatic relief
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Why is it important that you use combination therapy for H pylori
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Because resistance develops quickly to Flagyl and clarithromycin but does not develop resistance against amoxicillin or tetracycline
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What are the combination options for treatment of H. pylori
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MOC. AOC. MOA
flagyl omeprazole clarithromycin Amoxicillin omeprazole clarithromycin Flagyl omeprazole amoxicillin After the antibiotics are finished you want to continue proton pump inhibitor for seven weeks or H2 blocker or carafet for 16 weeks |
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What are the treatment options for H pie Laurie when giving bismut
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bmt, bmt+omeprazole bismuth flagyl and tetracycline ^^ plus omeprazole |
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Causes of gerd
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Incompetent lower esophageal specter or delayed gastric emptying
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First line management in reflux
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H2 blocker's first and proton pump inhibitors if they're ineffective
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Hepatitis A is transmitted by
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Fecal oral contaminated water and food sewerage shellfish hurricane areas sexual contact
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Facts about hepatitis A
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Blood in stool or infectious for 2 to 6 weeks
Mortality is rare and fulminant hepatitis merely occurs |
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Cause of hepatitis b
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Blood borne in serum saliva semen vaginal secretions transmitted by blood and blood products sexual activity mother and fetus
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What's the difference between hepatitis B and hepatitis C
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Hepatitis B is a DNA virus hepatitis C is an RNA virus
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Who is at risk for hepatitis C
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IV drug users blood transfusions
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Pre icteric phase
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Tired and weak anorexia nausea vomiting headache this is the flulike symptoms
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Icteric phase
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Weight loss jaundice pruritis right upper quadrant pain Clay colored stools because they can't conjugate Billy Rubin dark urine hepatosplenomegaly
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Labs with hepatitis
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Urine has protein and bilirubin
Elevated AST ALT (500-2000) LDH Billy Rubin alkaline phosphatase PT normal or slightly elevated |
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Normal AST a LT
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Less than 35 to 40
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Acute hepatitis A serology
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Anti-hav igM
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Pre-exposure non-infective immunity and hepatitis A serology
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Anti-HAV- IgG |
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HbsAG
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First evidence of hepatitis B infection will remain positive and asymptomatic and chronic hepatitis B patients |
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Anti--hbc
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Occurs with IgM after surface antigen disappears and before antibody appears
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HbeAg |
Indicates a circulating hepatitis B virus and highly infectious serum this is found only in positive patients indicates viral replication and infectivity
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Anti-hbe
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Appears after infectious state it signifies diminished viral replication of decreases activity
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Active hepatitis B serology
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Hbsag, HbeAG anti HBc, IgM |
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Chronic hepatitis B serology
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HbsAG, anti-HBc, anti-HBe, IgM, IgG |
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Recovered hepatitis B serology
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Anit HBc, anti-HBsAG |
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The serology for hepatitis C is the same for acute and chronic how do you differentiate from current exposure |
You have to do a polymer's chain reaction to differentiate prior exposure from current
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Management of hepatitis
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Supportive
Fluids rest No alcohol or drugs to talk suffice by the liver No protein oxazepam (serax) if sedation is necessary Vitamin K if PT is limited in 15 seconds Lactulose For an elevated ammonia levels signs of encephalopathy |
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What can predispose you for diverticulitis
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Low fiber diet
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Management of diverticulitis
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NPO
Fluids Antibiotics Flagyl cipro clindamycin ampicillin Surgical consult |
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Signs of cholecystitis
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Vomiting to help with the pain usually after larger fatty meal pain in the epigastric or right upper quadrant
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Labs for cholecystitis
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Billy Rubin is elevated
AST ALT LDH alkaline phosphate elevated amylase elevated |
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Management of cholecystitis
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Pain
NPO Crystalloids piperacillin Surgical consult |
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Causes of pancreatitis
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Alcohol
Gallbladder Hypercalcemia Hyperlipidemia meds like sulfa thiazides lasix estrogen or azathioprine |
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Size of pancreatitis
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Epigastric pain worse by walking or laying down
Better by sitting and leaning forward Radiates to the back Nausea and vomiting |
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Hemorrhagic pancreatitis sign
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Great Turner-flank
Cullin- umbilical |
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Labs for acute pancreatitis
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What color elevated
Hyperglycemia LDH AST elevated Emilys lipase elevated bun coagualtion elevated Hypocalcemia <7= tetany chvostek and trousseau |
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Best test for a cute pancreatitis
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CT scan
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Electrolyte imbalance with pancreatitis
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Hypocalcemia
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Elevated C- reactive protein in the presence of pancreatitis will suggest
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Pancreatic Necrosis
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The ransom criteria is for which disease
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Pancreatitis
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What is the ransom criteria
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It helps evaluate prognosis in pancreatitis 5vto six risk factors 40% mortality
seven and over risk factors hundred percent mortality |
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What are the prognostic signs at admission for the ransom criteria
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George Washington got lazy after
Greater than 55 years old White count greater than 16 G glucose greater than 200 LDH greater than 350 AST greater than 250 |
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Prognostic signs after 40 hours for the ransom criteria
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He broke cabe
He Metacritic drop greater than 10 BUN increase>5 Calcium less than eight Arterial 02 less than sixty Base deficit greater than 4 Estimated fluency sequestion >6 L |
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Number one cause of ball instruction
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Adhesions you should ask about history of surgical procedures
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In a patient with bowel obstructions that has no fever what can you infer
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does not have perforation
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Physical founder of Bal obstruction
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High-pitched tingling sounds unable to pass gas or stool
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Horizontal patterns of loops of bowel air Field fluids
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Small bowel instruction
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Frame pattern of dilated loops of foul an air fluid levels
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Large bowel obstruction
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Difference between ulcerative colitis and Crohn's
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Crohn's has upper bowel malabsorption syndrome which will lead to have an ileostomy ulcerative colitis involves the rectum and Max stands upward involving the whole colon
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Hallmark side of ulcerative colitis
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Bloody diarrhea
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How did diagnose ulcerative colitis
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Sigmoidoscopy
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Cheat me in for ulcerative colitis
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Masala mine suppositories enemas hydrocortisone suppositories for animals
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Cost of mesenteric infarcts
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Embolus rhombus arthrosclerosis smoking coagulopathy after surgery increases risk
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If a patient is having pain that's out of proportion to the physical exam what would you suspect
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Mesenteric infarcts
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Should patients with appendicitis have a lot of vomiting
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No they may have one or two episodes of vomiting but more vomiting suggest another diagnosis
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psoas sign |
Pain with right thigh extension
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Obturator sign
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Pain with internal rotation of the flexed right thigh
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Positive rovsig a sign
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Right lower quadrant pain when put pressure to the left lower quadrant
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Size of appendicitis with high-grade fever
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Perforation or another diagnosis
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