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168 Cards in this Set

  • Front
  • Back
what do pigmented gallstones result from?
test for suspected cholelithiasis?
RUQ ultrasound
what do you use to remove common bile duct stones?
postprandial abdominal pain that radiates to right subscapular area or epigastrum
RUQ pain, nausea, low-grade fever, vomiting
acute cholecystitis
what happens in acute cholecystitis?
prolonged blockage of the cystic duct, usually by an impacted stone that leads to obstructive distention, inflammation, superinfection, and possibly gangrene of the gallbladder
in what patients do you see acalculous cholecystitis?
occurs in absence of cholelithiasis in chronically debilitated patients, those on TPN, and trauma or burn victims
Murphy's sign
inspiratory arrest during deep palpation of hte RUQ
test to order for suspected cholecystitis when ultrasound is equivocal
HIDA scan
what finding on HIDA scan suggests acute cholecystitis?
non-visualization of gallbladder
treatment for acute cholecystitis?
IV antibiotics and IV fluids, early cholecystectomy (within 72 hours) with prerop ERCP or intraop cholangiogram to r/o common bile duct stones
how does treatment for cholecystitis differ for patients with significant medical problems (including DM)?
you can delay teatment 4-6 weeks until acute inflammation resolves
what is choledocholithiasis?
stones in the common bile duct
what are the hallmark abnormal lab values in choledocholithiasis?
increased alkaline phosphatase and increased total bilirubin
how does choledocholithiasis present?
sometimes asymptomatic, but often with biliary pain, jaundice, episodic colic, fever, pancreatitis
progressive inflammation of the biliary tree associated with ulcerative colitis
primary sclerosing cholangitis
acute bacterial infection of the biliary tree
acute cholangitis
what are commonly identified pathogens in acute cholangitis?
gram negative enterics: e. coli, enterobacter, pseudomonas
what is charcot's triad?
fever/chills, RUQ pain, and jaundice: classic for acute cholangitis
what is Reynold's pentad?
Charcot's triad plus shock and altered mental status - may be present in acute suppurative cholangitis and suggests sepsis
leukocytosis, increased bilirubin, and increased alk phos
acute cholangitis
steps when you suspect acute cholangitis?
blood cultures, ultrasound or CT but dx is often clinical
what is both diagnostic and therapeutic for acute cholangitis?
ERCP (biliary drainage)
treatment for patients with acute supurative cholangitis?
emergent bile duct decompression via ERCP sphincterotom, percutaneous transhepatic drainage, or open decompression
how is diarrhea defined?
>200 g of feces/d along with change in stool consistency
in what patients should antimotility treatments be avoided?
bloody diarrhea, high fever, or systemic toxicity
what is IBS?
idiopathic functional disorder characterizedby abdominal pain and changes in bowel habits that increase with stress and are relieved by BMs
when does IBS most commonly present?
2nd-3rd decades
half of all IBS patients have what?
comorbid psychiatric disorders
tests to order in suspected IBS
rule out other GI causes: CBC, TSH, electrolytes, stool cultures, abdominal films, barium contrast studies
treatment for IBS patients
reassurance, fiber supplements (psyllium), TCAs, antidiarheals (loperamide, antispasmodics (dicyclomin, antcholinergics
treatment for patients iwth constipation-predominant IBS?
what is the leading cause of SBO in adults? in kids?
adhesions; hernias
cramping abdominal pain with a recurrent crescendo-decrescendo pattern at 5-10 minute intervals
what will CBC show if there is strangulation of bowel?
what does lactic acidosis suggest in SBO?
necrotic bowel and need for emergent surgical intervention
what is the presence of radiopaque material at cecum suggestive of?
gallstone ileus
risk factors for ileus
recent surgery/GI procedures, severe medical illness, immobility, hypokalemia, hypothyroidism, DM, meds that slow GI motility (anticholinergics, opiods)
diffuse, constant, moderate abdominal discomfort, N&V, absence of flatulence of bowel movements
air throughout the small and large bowel on AXR
most common manifestations fo carcinoid tumors
cutaneous flushing, diarrhea, wheezing, cardiac valvular lesions
from where do carcinoid tumors most commonly arise?
ileum and appendix
diagnosis of carcinoid syndrome?
high urine levels of serotonin metabolite 5-HIAA; chest and abdominal CT scans can localize tumor
treatment for carcinod syndrome?
octreotide for sx and surgical removal of tumor
most common cause of acute lower GI bleed in adults over 40
diverticular disease
treatment of uncomplicated diverticular disease
follow and place on high-fiber diet
treamtent for diverticular bleeding
usually stops spontaneously; transfuse/hydrate prn; if doesn't stop then angio with ebolization or surgery
treatment for diverticulitis
NPO, NG tube, broad-spectrum antibiotics (metronidazole and fluoroquinolone or 2nd/3rd gen cephalosporin)
what should you avoid in suspected diverticulitis?
barium enema and flex sig because of perforation risk
most common presenting symptom of colon CA
abdominal pain
causes of large bowel obstruction
colon CA, diverticulitis, volvulus, fecal impactino, benign tumors
where does colon CA most often spread?
which type of IBD carries a higher risk for colon CA?
ulcerative colitis
screening for patients with a family hx of colon CA?
colonoscopy every 10 years after age 40 or 10 years prior to age at dx of younges family member with colorectal CA
what type of esophageal cancer is associated with alcohol and smoking?
squamous cell
does oropharyngeal dysphagia usually involve liquids or solids?
does esophageal dysphagia usually involve liquids or solids?
solids more than liquids
how does achalasia present
both liquid and solid dysphagia
what are esophageal webs associated with?
iron deficiency anemia - plummer-vinson syndrome
diagnosis of esophageal dysphagia
barium swallow followed by endoscopy, manometry, and/or pH monitoring
diagnosis of oropharyngeal dysphagia
what type of esophageal cancer is associated with Barrett's esophagus?
what is Barrett's esophagus
columnar metaplasia of the distal esophagus secondary to chronic GERD
what is the most common cause of GERD?
transient LES relaxation
risk factors for GERD?
increased intra-abdominal pressure, hiatal hernia, scleroderma, alcohol, caffeine, nicotine, chocolate, fatty foods
type of hernia in which GE junction and portion of stomach are displaced above diaphragm
sliding hiatal hernia
type of hernia in which GE junction remains below the diaphram while a neighboring pnortion of the fundus herniates into the mediastinum
paraesophageal hiatal hernia
treatment for paraesophageal hernias
surgical gastropexy (attachment of the stomach to the rectus sheath and closure of the hiatus) - prevent gastric volvulus
where does type A gastritis occur? what is it due to?
fundus; autoantibodies to parietal cells
what is type A gastritis associated with?
other AI disorders - pernicious anemia and thyroiditis - also increased risk of gastric adenocarcinoma
where does type B gastritis occur? what is it due to?
antrum; may be caused by NSAID use or H. pylori infection
treatment for H. pylori
triple therapy: amoxicillin, clarithromycin, omeprazole
what does the intestinal type of gastric cancer arise from?
intestinal metaplasia of gastric mucosal cells
risk factors for intestinal type of gastric CA?
diet high in nitrites and salt and low in fresh vegetables
what do you do in cases of GERD that are refractory to medical management?
rule out Z-E syndrome with serum gastrin levels
what can help patients with PUD who require NSAIDS
what is the most selective and preferred surgical approach for PUD?
parietal cell vagotomy
Zollinger-Ellison is associated with which MEN in 25-50% of cases?
treatment for Zollinger-Ellison
H2 blockers ineffective but mod-high does of PPI often controls sx
Hesselbach's triangle
area bounded by inguinal ligament, inferior epigastric artery, and recus abdominis (iligaram)
most common type of hernia
what is the cause of an indirect hernia
patent processus vaginalis
indirect hernia
herniation of abdominal contents through the internal and external inguinal rings and eventually into scrotum (in males)
direct hernia
herniation of abdominal contents through the floor of Hesselbach's triangle
what are direct hernias most often due to?
acquired defect in transversalis fascia from mechanical breakdown that increases with age
in this type of hernia, sac contents do not traveres the internal inguinal ring - they go through the abdominal wall and are contained within the aponeurosis of the external oblique
direct hernia
loss of haustra on AXR
ulcerative colitis
transmural inflammation in what type of IBD
bloody diarrhea in what type of IBD
IBD associated with toxic megacolon
IBD associated with nephrolithiasis
IBD with pseudopolyps
total colectomy is curative for what type of IBD
major clinical feature associated with hepatitis
what percent of patients with HCV will develop chronic hepatitis?
normal WBC count with relative leukocytosis, dramatically increased ALT and AST, and incnreased bili/alk phos
acute hepatitis
what clotting factors are produced by the liver?
all except for factor VIII
treatment for chronic HBV infection?
IFN-alpha, lamivudine (3TC), and adefovir
treatment for chronic HCV?
peginterferon and ribavirin
best test to detect active hepatitis A
antigen found on surface of HBV; presence indicated carrier state
antibody to HBsAg; provides immunity to HBV
antgen associated with core of HBV
antibody to HBcAg; positive during window period
antigenic determinant in HBV core; important indicator of transmissibility
indicates low transmissibility in HBV
definition of portal HTN
portal pressure 5 mmHg greater than the pressure in the IVC
Budd-Chiari syndrome
hepatic vein thrombosis secondrary to hypercoagulability
treatment for Budd-Chiari
clot lysis, TIPS, or hepatic transplantation
how do you determine the etiology of ascites
SAAG: serum-ascites albumin gradient = ascites albumin - serum albumin
ascites due to imbalance between hydrostatic and oncotic pressures: chronic liver disease, massive hepatic metastases, CHF
ascites due to protein leakage: nephrotic syndrome, TB, malignancy (e.g. ovarian CA)
diagnosis of SBP
250 PMNs/ml or >500 WBCs in ascitic fluid
treatment for SBP
IV antibiotics (3rd gen cephalosporin) to cover both gram+ (enterococcus) and gram- (e. coli, klebsiella)
primary risk factors for development of HCC
cirrhosis and chronc hepatitis
risk factor for HCC in developing countries
increased LFTS and significantly increased AFP levels
how is hemochromatosis inherited
autosomal recessive
in what patients is secondary hemochromatosis common?
patients receiving chronic transfusion therapy (e.g. for alpha thal) or alcoholics (alcohol increases iron absorption)
symptoms of DM, hypogonadism, arthropathy of MCP joints, heart failure
what is the most sensitive diagnostc test for hemochromatosis?
fasting transferrin saturaion >45% (serum iron divided by transferrin)
treatment for hemochromatosis
weekly phlebotomy initially, then when serum iron levels decrease, maintenance phlebotomoy every 2-4 mos
what med can be used for maintenance therapy in hemochromatosis?
complications of hemochromatosis
cirrhosis, HCC, cardiomegaly, DM, impotence, arthropathy, hypopituitarism
how do patients with Wilson's disease present?
hemolytic anemia, liver abnormalities, neruo and psych sx
green-to-brown deposits of copper in Decemet's membrane
Kayser-Fleischer rings
treatment for Wilson's
dietary copper restriction, penicillamine, oral zinc
what foods are high in copper?
shellfish, liver, legumes
how does penicillamine work?
copper chelator that increases urinary copper excretion
what should you give with penicillamine?
absence of peristaltic waves in lower 2/3 of esophagus and significant decrease in LES tone
esophageal dysmotility associated with scleroderma
young man from endemic area with tender solitary abscess in RLL of liver
amebic liver abscess
Rx for amebic liver abscess
PO flagyl
what is 'porcelain gallbladder' associated with?
gallbladder CA
if someone is traveling within 4 weeks what should they get to protect them against HAV?
serum Ig to HAV
newborn of mom with active HBV?
should get Hep B immunoglobulin plus HBV vaccine
with what kidney disease is chronic HCV associated?
membranous glomerulonephritis
with what hematologic malignancy is HCV associated?
B cell lymphoma
what organism are hyatid cysts related to? what animal?
echinococcus granulosus; dogs
eggcell calcification of hepatic cyst is a what
hyatid cyst
drug of choice for treating cirrhotic ascites?
in what settings does post-op cholesasis occur?
prolonged surgery characterized by hypotension, extensive blood loss into tissues, and massive blood replacement
define fulminant hepatic failure
hepatic encephalopathy that develops within 8 weeks of acute liver failure
sentinel loop or cutoff sign on AXR
grey turner sign
flank discoloration in pancreatitis
cullen's sign
periumbilical discoloration in pancreatitis
mortality secondary to acute pancreatitis can be predicted by what?
ranson's criteria
most common form of pancreatic cancer
pancreatic head adenocarcinomas (90%)
courvoisier's sign
palpaple, nontender gallbladder in pancreatic CA
Trousseau's sign
migratory thrombophlebitis in pancreatic cancer
classic presentation of pancreatic cancer
painless, progressive jaundice
causes of drug-induced pancreatitis
furosemide, thiazides, sulfasalazine, 5-ASA, azathioprine, L-asparaginase, valproic acid, didanosine, pentamidine, metronidazole, tetracycline
dysphagia to both solids and liquids
how do you diagnose achalasia?
fatty liver with encephalopathy
Reye syndrome
oropharyngeal dysphagia and neck mass
Zenker's diverticulum
what causes Zenker's diverticulum?
esophageal muscles fail to relax properlyl, which leads to herniation of mucosa through fibers of cricopharyngeal muscle
confirmatory test for Zenker's diverticulum
barium esophagography
sequelae of hyperestrogenism in cirrhosis
gynecomastia, palmar erythema, spider angiomas, testicular atrophy, decreased body hair
risk factors for pancreatic CA
male, >50, black, smoking, chronic pancreatitis, DM, obesity
most consistent reversible risk factor for pancreatitis?
second most common cause of painless GI bleeding in an adult?
what is angiodysplasia associated with?
aortic stenosis, renal failure
what lab should you check in suspected chronic pancreatitis?
stool elastase - diagnoses pancreatic exocrine failure
progression to liver failure in patients with HCV is faster in whom?
male, over 40, longer infection, co-infection with HBV or HIV, immunosuppression, liver comorbidities
primary hyperparathyroidism, pituitary tumors, enteropancreatic tumors
which IBD are non-caseating granulomas pathognomonic for?
define achalasia
inability of LES to relax during swallowing