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35 Cards in this Set

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Tx. for suspected nephrolithiasis
Noncontrast helical abdominal CT.
Tx for suspected abdominal perforation
Supine and upright radiographs. Acute abdomen refers to sever pain less than 24 hrs in duration.
Dx rebound tenderness and severe diffuse abdominal pain
Acute abdomen with peritonitis.
Dx.severe abdominal pain with syncope, leukocytosis, anemia, and low BP
ruptured AAA
Dx. pain w defecation, new onset of amount of stool or a change in consistency of the stool
irritable bowel syndrome.
Dx. crampy abdominal pain and bloody stool in a patient w atherosclerotic disease.
Ischemic colitis. Also seen is a CT scan indicating thickening of the bowel wal in a segmental pattern. Also seen in crohns disease.
Dx. left lower quadrant pain, fever, and elevated leuks.
Diverticulitis. Dont use colonoscopy for fear of perf. Use contrast CT.
HUS causes
Usually caused by infection from shiga toxin in EColi O157.
Dx patient with diarrhea and tenesmus 6 weeks after radiation therapy
Radiation proctitis. Tx is flexible sigmoidoscopy. Also see are mucosal telangiectasias and mucosal fibrosis.
Dx. patient positive for antiendomysial antibodies.
Celiac disease.
Dx pt. w colitis, diarrhea of 10-15 times er day, lower abdominal pain, cramping, fever, and leukocytosis.
C. difficile. Common in patient after antibiotic administration. Two toxins a and b, both are strong. Treat w oral vanc and flagyl.
Tx for salmonella gastroenteritis
Symptomatic, it resolved by itself. Tx only for immunocompromised, if they are less than 2 or over 50, if they are hospitalized, if they have chance for endocarditis
Elevated alk phos levels
Is the only way to really differentiate cholestatic injuries from hepatocellular. Hepatocellular can give you AST ALT elevations as well as hyperbillirubin.
Dx indirect hyperbillirubinemia in an asymptomaptic patient w normal hemoglobin levels.
Gilbert syndrome, you dont have to do anything about it. Impaired billirubin conjugation.
Tx for patient w symptomatic gallstones
Always cholecystectomy. the only time you use ERCP is if there is biliary obstruction due to choledocholithiasis, it literally cant get to the gallbladder.
Dx. elevation of bilirubin and alk phos levels.
PSC. 85% of patients also have IBD
dx patient w antimitochondrial antibody
Dx. biliary colic, leukocytosis, positive murphy sign, and gallstones, and pericholecystic fluid, thickening of the gallbladder
acute cholecytitis
Dx. ruq pain, fever, and JAUNDICE
Charcot triad for acute cholangitis. Need biliary obstructin.
Tx for acute cholangitis
Remove teh stone by ERCP
Sensitivity of ultrasanogrophy for a choledocholithiasis
only 50-75%, if it smells like it, go with clinical instinct.
Therapy for patients w pancreatic necrosis
Imipenam therapy. Decreases incidence of sepsis, and other complications.
Alarm symptoms of GERD
namely dysphagia, odynophagia, hematemesis.
Tx of choice for erosive or severe esophagitis
Tx strategy for a gastric ulcer
Biopsy alwasy for gastric ulcers. Duodenal ulcers
Dx painless lower GI bleeding.
Most common source is diverticulosis, or vasula extasia
Screening test for hepatocellular carcinoma
Ultrasound plus alpha fetoprotein.
Dx fatigue, nausea, vomiting, jaundice, and ALT/AST greater than 1000
hep A
Dx anti smooth muscle antibody, ANA, elevated LFTs,
think autoimmune hepatitis. Drug induced not associated with ANAs.
What is first line therapy for hepatic encephalopathy.
Lactulose. Steroids have no role. TIPS has no role.
Most common cutaneous manifestation of IBD
erythema nodosum. This is most common with crohns. Pyoderma gangrenosum is more common w UC.
Dx a histology of cryptitis, crypt abscesses, and crypt architecture distortion. Erythema of rectum to splenic flexture.
UC. Crohns is patchy (cobblestone) and spares the rectum.
What is the first line therapy for UC
mesalamine or other 5-aminosalicylate agent such as sulfasalazine, mesalamine. Prednisone is 2nd line.
Dx chronic watery diarrhea wo bleeding. Colonoscopy is normal.
Microscopic colitis. Can exclude cdiff based on the normal colonoscopy. This would show raised yellow or off white plaques in the colorectal mucosa. Two types of microscopic colitis, collagenous or lymphocytic, these may be seein in biopsy.
Dx Diarrhea w colonoscopy of Flattening of the vili and inflammation of the small intestine associated with travel
Tropical sprue . Treat with doxy or bactrim and vit b 12 and folic acid.