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23 Cards in this Set

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What are some differences between Crohn's disease and ulcerative colitis?
Crohn's classically involves the teriminal ileum but can involve the entire bowel from mouth to anus. Crohn's can be full thickness and is characterized by skip lesions, fistulas, and abscesses. Ulcerative colitis involves only the large bowel, does not involve deep layers of bowel, and is treated by colectomy.
If a duodenal ulcer erodes posteriorly, what is the classic complication?
Bleeding. Classically it will erode into the posterior duodenal artery.
If a duodenal ulcer erodes anteriorly, what is the classic complication?
Free perforation
What are some causes of pancreatitis?
Gallstone pancreatitis (most common cause of acute pancreatitis), alcohol pancreatitis (most common cause of chronic pancreatitis), hypertriglyceridemia, hypercalcemia, scorpion bites.
Describe the difference between vicsceral and peritoneal pain.
Visceral pain is carried on autonomic fibers. It is poorly localized, often midline. Peritoneal pain is sharp and localized.
Name a cause of transfer dysphagia.
Previous CVA, parkinson's disease, myasthenia gravis
A patient has dysphagia for solids but not liquids. What are some causes?
Esophageal tumor, web, stricture, diverticulum.
A patient has dysphagia for both solids and liquids. What are some classic causes?
Achalasia, scleroderma, dermatomyositis
A patient had upper endoscopy for reflux symptoms. She now has severe chest pain and you hear a crunching rub on auscultation. How should you evaluate and treat her?
The patient has an esophageal perforation, and requires emergent cardiothoracic surgery consultation. Diagnosis is suspected on clinical exam, and a CT of the chest can confirm. Broad spectrum antibiotics should be initiated and IV fluids given.
You perform anoscopy on a patient for GI bleeding. You find a non-tender bulge at 9:00 with some fresh blood. What is the diagnosis?
Internal hemorrhoid. These are non-tender, and located at 2:00, 5:00, and 9:00.
What are some risk factors for gallstone formation?
sickle cell disease or other diseases with red cell destruction (pigment stones), obesity, rapid weight loss, pregnancy, female gender
True or false. Most patients with cholecystitis have an elevated white blood cell count.
True, but a normal WBC count cannot be used to exclude cholecystitis, as only about 70% have it.
A 55 year old man presents with left lower quadrant pain, nausea, and pain when moving his bowels. he has tenderness and guarding in his left lower quadrant. What are some risk factors for his likely diagnosis, what are some complications, and what is the appropriate treatment if there are no complications?
the patient likely has diverticulitis. risk factors include increased luminal pressure from chronic constipation and low fiber diet, as well as family history. complications include perforation, abscess formation, and fistulization. If the patient has none of these, treatment is conservative with antibiotics that cover gram negative and anaerobic bacteria.
A patient presents with a massive upper GI bleed. In addition to blood products and fluids, what medications may be given to decrease the bleeding?
octreotide, PPI, and potentially beta blockers if the patient is hemodynamically stable.
An elderly patient presents with severe abdominal pain. His stool is heme positive. His abdominal exam is otherwise benign. he has thumbprinting on his abdominal x-ray. what is the treatment for the likely diagnosis?
The patient has mesenteric ischemia, and should get fluid and blood resuscitation, broad spectrum antibiotics, and emergent surgical consultation.
This patient has free air under the diaphragm. you should call a surgical consult, volume resuscitate the patient, and administer antibiotics.
You have a patient with abdominal pain, and this is his chest x-ray. what do you see, and what should you do?
True or false: It is safe to place an NG tube in someone with esophageal varices.
True. However, NGT aspirate is not a very helpful test. It is specific, which means if it's positive, the patient needs endoscopy. but it's not sensitive, so if it's negative, the patient may still have a bleed and still needs endoscopy.
What shape objects, when swallowed, are less likely to pass spontaneously?
long objects and objects with sharp or irregular edges are less likely to pass spontaneously.
True or false: pyloric stenosis is a medical emergency
false. pyloric stenosis is not even a surgical disease. in europe, patients are given IV nutrition, and they wait. the stenosis resolves as the child grows. the emergency in pyloric stenosis is dehydration.
Which duodenal ulcers are more likely to bleed, posterior or anterior?
posterior. these erode into the gastroduodenal artery. anterior ulcers are more likely to present with free air.
a patient is jaundiced. she has an elevated total bilirubin and a normal direct bilirubin. does she need a hepatitis workup?
no. she needs a hemolysis workup.
what is the most common cause of elevated conjugated bilirubin in chidren?
hepatitis A
a patient is immunized against hepatitis B. will he have anti IgG hepatitis b core?
no. he'll have anti surface antibody.