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50 Cards in this Set
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- Back
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first thing you do when someone comes in with an overdose of acetaminophin with history of booze and drug use and suicide
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obtain serum acetaminophen lvl
serum EtOH lvl Serum Salicylate level Urine drug screen |
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If you know the time of ingestion when do you draw the 1st tylenol level?
If time of ingestion is unknown or uncertain when do draw the 1st tylenol level? |
If you know the time of ingestion when do you draw the 1st tylenol level= 4 hr
If time of ingestion is unknown or uncertain when do draw the 1st tylenol level= On arrival in ER |
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effects of alcohol on acetaminophen poisoning
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chronic alcoholic- worse
acute alcoholism- better (affects CYP system) |
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3 mechs to break down acteominophin..which damages the liver?
***TEST |
Renal excretion (conjugation with sulfate=sulfation)
Glutahione reduction (conjugation with glucuronide=glucuronidation; can excrete to nontoxic NAPQI) when glutathione/sulfa pathways are saturated you must use the P450 system...which produces a hepatotoxic free NAPQI this hurts the liver when it accumulates |
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Which of the following is considered a toxic dose of acetaminophen in adults after a single ingestion?
4g 7.5g 15.5g 25 |
>7.5mg
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What is a lethal dose of acetaminophin?
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>25g
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describe phase one of acteaminophin tox... duration? symptoms? labs?
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starts at ingestion...lasts 24 hours
nausea, asymptommatic, mimics gastroenteritis labs: subclinical increases in serum transaminases |
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describe phase two of acteaminophin tox... duration? symptoms? labs?
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18-72 hours
symptoms: feel like they are getting better (but they arent!), can get RUQ pain labs: serum transaminases going up, PT goes up other info: may start to see changes in renal fxn, decreased output, changes in BUN, etc...with proper antidote it is rare for pts to progress past phase 2 |
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describe phase three of acteaminophin tox... duration? symptoms? labs?
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begins after 3-5 days
symptoms: start getting sick again, signs of hepatic failure (fulminant->jaundice, coagulation issues, liver starts shrinking), can get pancreatitis, death Labs: INR increases |
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describe phase 4 of acteaminophin tox... duration? symptoms? labs?
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occurs 5-14 days post ingestion...can last up to 21 days
complete resolution of symptoms complete resolution of organ failure |
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tx for acetaminophin overdose
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supportive therapy
Labs Contact poison control ACTIVATED CHARCOAL up to 4 hours N-acetylcyseine (NAC)-antidote |
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when get you give activated charcoal for Tylenol overdose? how does it work?
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up to 4 hours after ingestion
avidly absorbs acetaminophen |
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What is N-acetylcysteine (NAC)?
administered? |
precursor of glutathione....that can restore the normal pathways of acetaminophen elimination...it is the ANTIDOTE
IV |
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note that NAC (the antidote) is given before 24 hours
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but even after you give it to them
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pt presents to the ER after having ingested a ton of acetaminophen 5 hours before... there plasma conc of acetaminophen is 180. What, if anything, should you do?
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you know the time of ingestion (it was > than 4 hours so your draw for plasma conc is good)
this is above the line, so treat with NAC immediately!! |
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medical definition for diarrhea
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>3 loose watery stools in 24 hours
increase in water content that increases output of >200-250g/24 hours |
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Acute diarrhea
Define |
less than 2 weeks
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chronic diarrhea
Define |
greater than 30 days
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persistent diarrhea
Define |
14-30 days
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osmotic diarrhea...define
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increased osmotic load
often volume of stool produced <1L/d stops during fast or removal of offending substance |
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Secretory Diarrhea
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cholera toxin is key
cAMP increased (electrolyte imbalance) |
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Inflammatory Diarrhea
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blood in stool
mucosal lining inflamed damage to mucosal lining or brush border stool pos for WBC sloughing of mucosa |
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Motility releated diarrhea
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increased transit time
decreased time for absorption |
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Paradoxical diarrhea
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Oozing of stool around fecal impaction
common in kids, debilitated or demented adult |
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NEVER GIVE ANTIDIARRHEALS IN PTS with what?
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Blood Diarrhea
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what age is commonly affected with U.C?
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BIMODAL distribution
in young people...and old people |
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CD vs UC
Transmural |
CD
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risk of colon CA is greater in UC or CD?
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UC
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Skip lesions?
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CD
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Smoking is protective for UC, CD or both?
***TEST |
UC
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initial tx to induce remission of UC?
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Corticosteroids induce remission
5-ASA retains remission |
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extraintestinal manifestations of IBD include all of the following except
alopecia arthritis sclerosing cholangitis uveitis cholelithiasis |
Alopecia
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Sclerosing cholangitis is associated with?
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UC in young men
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when do you start a screening colonoscopy when a pt is diagnosed with IBD
***TEST |
8-10 years after diagnosis
then every 1-2 years after |
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OPP uses in IBD?
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open diaphragms
MYENTERIC LIFT |
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pt presents to the ER and the mother says they found the girl overdosed on an unknown amount of acetaminophen...You ask her how long ago it was that the daughter ingested the pills and the mom says she was gone for about 9 hours, so it was sometime in that period. What should you do?
**** |
Its is best to start NAC w/in 8hr, but if time of ingestion not known need to start NAC regardless of level on the nomogram
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pt came in with serious acetaminophen OD and you treated quickly with NAC. The next day her liver function tests looked good. Is it appropriate to take her off the NAC?
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NO! still have free radicals
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pt is on vent, what levels of the spinal cord would you want to work on to help tx pneumonia?
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T2-7
respiratory rib raising, etc |
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the tx for most diarrhea is?
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rehydration...
most are viral and self resolve, only use Abx if you culture |
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crypt abscess/distortion, acute on chronic inflammation, mucosal ulcerations...
what is this? |
UC
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All of the following characteristics differentiate U.C. from C.D. EXCEPT:
The risk of colon CA is greater in U.C. than C.D. Histologically, U.C. appears as transmural ds, whereas C.D. involves only the mucosal and submucosal layers. U.C. almost always involves the rectum, whereas C.D. may or may not. In U.C. the diseased segments are continuous, while “skip” areas of healthy bowel are seen in C.D. |
Histologically, U.C. appears as transmural ds, whereas C.D. involves only the mucosal and submucosal layers.
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Which side (left/right) of the colon are typically affected in UC and CD respectively?
**** |
UC: left
CD: right |
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halmark finding of UC?
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bloody diarrhea
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OMM can be helpful with pts with Chron's because they often get what sequele
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they can develop arthritic problems
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Where are the sympathetics that go to the colon and rectum located?
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T8-L2
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Tell me about:
Sympathetics - Parasympathetics- How do they affect the GI system? |
↑ Sympathetics = ↓motility & ↓secretions
↑Parasympathetics= ↑motility & ↑secretions OMT can fix stuff here.... |
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_____ lesions can affect the bowels through parasympathetics
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Sacral Lesions
(Sacral Plexus) |
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The ____ nerve controls the parasympathetics for the ascending colon
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Vagus Nerve
(emerges at OA and AA) |
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You are performing a colonoscopy and see punctate ulcerations straight up from rectum to the transverse colon. What might this indicate?
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UC
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Your patient is having to get up at least 2 or 3 times each night with bloody diarrhea and often is unable to make it to the bathroom. What are you thinking?
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She has an organic GI dysfunction
Probably an infection |
