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324 Cards in this Set
- Front
- Back
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What things cause lower GI bleeds?
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diverticular disease, angiodysplasia, hemorrhoids, cancer, IBD, diarrhea
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If you see bright red blood per rectum, is it upper or lower GI?
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it could be both!
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What are the treatments for peptic ulcer disease?
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1st- acid supression
2nd- endoscopic cogaulation/clips 3rd- surgery cut it out |
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What is the presentation of mallory weiss?
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hx of non bloody vomit....THEN later blood streaks
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how likely is it a person with a bleeding esophageal varice will have it stop on its own?
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about 50%
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how likely is it for esophageal varacies to bleed again later?
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very likely, usually occurs within the first few days, but can be up to 6 weeks
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How do you restore fluids into a person who has serious blood loss?**
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two large bore IV's in the periphery, giving normal sailne and blood products
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What is the main drug given to treat esophageal varcies?**
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Octerotide**
this decreases intravaraceal pressure within seconds |
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what is the DEFINITIVE treatment for active variceal hemorrhage***
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endoscopy- band ligation
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what is the most common cause of lower GI bleeding***?
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diverticulosis
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What type of vessels are involved in agniodysplasia?
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VENOUS ones
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What MUST be done to evaluate signs of colorectal cancer?
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full colonoscopy
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What are the signs of LEFT sided colon cancers?
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change in bowel habits (poop is solid by then, so can be obstructed)
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What are the signs of RIGHT sided colon cancers?
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blood loss, fatigue, anemia
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What is the most common cause of small bowel obstruction?
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surgical adhesions
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how do you diagnose small bowel obstruction?
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plain film, showing air fluid levels (sitting up)
CT is used to delineate better |
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What is the treatment for small bowel obstruction
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NPO
IV antiemetics SURGERY** |
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What is the MOST common cause of large bowel obstruction?
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malignancies
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What NEVER causes large bowel obstructions?
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surgical adhesions
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what causes cecal volvulus?
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congenital peritoneum defect
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who gets sigmoid volvulus?
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older disabled people in instiutions
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how do you BEST treat volvulus?
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surgery
or ram a sigmoidoscope through it (beware the poo coming out!) |
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What causes diverticulosis?
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muscular hypertrophy of the colonic wall
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What part of the colon is most likely to have diverticulosis
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the sigmoid colon
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does the bleeding usually stop on its own in diverticulosis?
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yes it does is 75-95% of cases
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in diverticulosis, what type of vessel ends up bleeding (think of this in opposition of angiodysplasia)
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ARTERIES bleed here
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what part of the colon does diverticular bleeding usually occur?
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on the RIGHT side
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what part of the colon does diverticulosis usually occur?
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the LEFT colon
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what is the most common complication of diverticular disease?
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diverticulITIS - infected diverticula
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What is the required diagnostic test for rectal/anal abscess?
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CT of pelvis with contrast
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What is the treatment for rectal/anal abscess?
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PROMPT surgery
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What complication occurs in 1/2 of all anal abscess pts?
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a chronic fistula
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What is an anal fistual?
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this connects the anal canal with the skin, and is lined with epithelium and graunlation tissue
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what is the definitive treatment for anal fistulas?
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surgery
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what is a type 1 rectal prolapse?
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only the mucosa comes out- not much protrusion
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what is a type 2 rectal prolapse?
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your whole ass falls out- full thickness
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How do you treat rectal prolapse?
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manual reduction
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what typically causes blunt abdominal trauma?
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car accidents
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what usually gets damaged in blunt abdominal trauma?
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the kidney is #1
(others are spleen and liver) |
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What may be the initial presentation of blunt abdominal trauma?
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may have NO complaints
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What is the most common sign of blunt abdominal trauma?
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hypotension- from bleeding out
Seat belt sign- a seat belt bruise |
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what is the best exam for finding blunt abdominal trauma?
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FAST exam- focused assesment with sonography for trauma
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How do you determine a blunt abdominal trauma bleed if the CT cant find it?
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diagnostic peritoneal lavage - invasive
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what is the most common cause of esophageal perforation?
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medical instruments or paraesophageal surgery
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whats the most commonly ingested foreign body?
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coins
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what is the first test for foreign body? (two angles)
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CXR- AP for esophagus
Lateral projection for trachea** |
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what do you examine first with foreign body?
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airway and breathing
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why is eating flat batteries so bad?
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these will cause necrosis of the stomach
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if you stuff drugs in your butt, why is this more dangerous than carefully wrapping them?
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they can get into your system and kill you
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before what gestational age is a pregnancy called an embryo?
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before 10 weeks
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what is the most important risk factor for spontaneous abortion?
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advanced maternal age
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what are the signs of threatened abortion?
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bleeding through a closed OS in the first 1/2 of pregnancy.
as long as fetal cardiac activity is cool- babys fine |
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what is an incomplete abortion?
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after 12 weeks, most of the bits come out, but not parts of the placenta
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What are the classical signs of GERD?
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heartburn- postprandial/nocuturnal
aggivated by change in position (lying down) prompt relief by antacids |
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What is the atypical presentation of GERD?
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laryngitis
hoarsness throat cleaning chronic cough asthma |
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What are the complications of GERD?
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barretts
ulcer stricture |
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What are the 'alarm symptoms' for GERD (and its progression)
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older than 55
anemia dysphagia respiratory problems early satiety weight loss persistant symptoms despite treatment |
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What type of esophageal cancer is becoming alot more common?
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adenocarcinoma
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What is the BEST first phase treatments for GERD?
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lifestyle changes!!
stop smoking weight loss elevate head of bed no food/drink after 6pm |
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what is the geneotype for celiac disease?
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DQ2 and DQ8
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What is needed for a diagnosis of celiac disease?
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tissue transgluatminase anitbodies
villous artrophy |
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What are the GI symptoms of celiac disease?
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bulky foul smelling stool
pain flatulence (basically malabsoprtion signs) |
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What diseases can manifest from celiac disease related to fat soluble vitamin malabsoprtion (AEDK)
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night blindness
rickets, osteoporosis peripheral neruopathy excessive bleeding anemia |
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What are some of the external signs of Celiac disease?
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Infertility
dermatitis herpetiformis |
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What diseases have an increased mortality with Celiac disease?
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adenocarinoma
t- cell lymphomas |
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What is the treatment of Celiac disease?
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strictly delete the wheat
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what thickness of inflammation does crohns have?
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this is full thickness
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What are the hallmarks of crohns?
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focal areas of ulceration, skip lesions
often has structures, fistulas |
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What are the diagnostic studies for crohns?**
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small bowel capsule endoscopy
CT or MRI enterography looks for "String Sign"** |
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What are the colonoscopy hallmarks for crohns?
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cobble stone appearance
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what are the colonoscopy hallmarks for ulcerative colitis?
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crypt abscesses
pseduopolyps continuious involvement NO skips |
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what is the major complication of ulcerative colitis?
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cancer (after about 8-10 years of UC)
and maybe toxic megacolon |
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What are the extra intestinal complications of Inflammatory Bowel Disease***
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uveitis
erythema nodosmu pyoderma gangrenosum arthritis apthous ulcers primary sclerosing colangitis (seen with UC)** |
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what is irritable bowel syndrome?
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abdominal pain and altered bowel habits in the absence of any organic cause
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What are the ROME III diagnostic criteria for irritable bowel syndrome?
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abdominal pain, at leas 3 days per month for last 3 months
improves with defecation onset associated with change in frequency onest associated with change in form of poo |
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What are the predominant symptoms of irritable bowel syndrome?
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constipation
diarrhea alternating of constipation and diarrhea abdominal pain bloating |
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Who usually gets irritable bowel syndrome?
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young women
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What bugs usually cause post infectious irritable bowel syndrome
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campylobacter and E coli
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What are the red flags assocaited with irritable bowel syndrome?
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unintentional weight loss
onset in older people blood loss labs bleeding |
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What are the route causes of irritable bowel syndrome?
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altered GI motility
visercal hypersensitivity microscopic inflammation post infection psychosocial |
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What do people with psychosocial irritable bowel syndrome present with?
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anxiety, depression, phobias, somatization
Hx of abuse |
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What is the major concern of Long term ulcerative colitis?
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colon cancer
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what is the major difference between regional enteritis and ulcerative colitis?
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regional enteritis is full thickness, while UC is only mucosa
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What is the normal range for AST
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10-40
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What is the normal range for ALT
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15-40
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What is the normal range for alkaline phosphatase
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25-165
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what is the normal range for total bilirubin?
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0.5-1.0
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What things increase unconjugated bilirubin production
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hemolysis, ineffective erythropoiesis, muscle injury, hematomas
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what things increase conjugated bilirubin in the blood?
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liver disease or obstruction
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What doe elevated GGT a sensitive indicator of?
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hepatobiliary source of elevated alkaline phosphatase- as in chronic drinking
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What clotting measurement is prolonged in liver failure?**
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Prothrombin time
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What can be conjugated bilirubin levels be used as a measure of?
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these can be used as a prognostic measurement depending on the severity of their elevation
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What labs are very elevated with Cholestatis/ infiltrative liver disease?
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alkaline phosphatse and GGT are very high
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What labs are very elecated with hepatocellular disease
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ALT and AST are very elevated
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What two types of hepatitis do NOT cause chronic infection?
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hep A and E
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What two types of hepatitis are from feces?
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hep A and E
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What are the serum signs of hepatitis A infection?
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initially high ALT levels, then increased anti-HAV
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how do you get hepatitis A?
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close personal contact
contaminated food/water blood exposure |
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what is the course of hep A?
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self limited
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Who should get Hep A vaccine
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everyone
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If you get ONLY the hepatitis vaccine, what type of antibodies do you make?
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ONLY anti-HBs (hep b surface)
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If you get immunized against hep B, but still get infected, what antibodies do you make?
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anti-HBs (surface) and anti-HBc (Core)
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what age do you get hep B, and have the greatest risk of chronic illness?
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under 5
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What percent of people get a chronic hep C infection?
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60-85%
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What can be a severe consequence of long term Hep C infection?
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hepatocellular carcinoma
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What things cause faster hep C progression
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booze
over 40 @ time of infection HIV |
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While in both chronic and acute HCV infection anti HCV will increase over time. what two factors will spike again later with chronic HCV infection?
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HCV RNA and ALT
anti-HCV will stay high after the first infection no matter what |
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What are the causes of HCV infection?
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IV drugs
transfusion occupational exposure latrogenic sex |
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How effective is occupation needle stick at transmitting HCV?
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low, about 1.8%
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What is the treatment for HCV?
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Ribavirin + something else
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What MUST you have first in order to get hepatitis D?
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hep B
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How do you get hep D?
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IV drugs and sex
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What is the treatment for hepatitis A?
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supportive care
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what kind of hepatitis do you get from tattoos?
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HCV
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What is the first sign of alcoholic liver damage (from a normal liver)
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a fatty liver change
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Do most pts who abuse alcohol progress to liver injury?
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nope only a small percent
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What are the lab ratios for alcoholic fatty liver?**
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AST > ALT**
typically asymptomatic |
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What are the lab ratios for NONalcoholic fatty liver?**
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ALT> AST **
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what are the causes of nonalcoholic fatty liver?
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obesity
massive weight loss TPN diabetes |
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What is the presentation of alcoholic hepatitis?
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anorexia
modest fever hepatomegaly jaundice dark urine clay colored stools |
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While in alcoholic hepatitis, AST>ALT, what level is neither one much higher than?
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neither is much greater than 200
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what really improves survival in alcoholic cirrhosis?
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abstinence
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what are the physical findings in alcoholic cirrhosis?
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temporal wasting
spider angiomata jaundice firm liver edge palpable spleen ascities asterixis |
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What are the liver function tests like for Liver Cirrhosis?
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slightly up ALT/AST, with VERY HIGH AP and GGT
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should you do elective surgery on a person with cirrhosis?**
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no
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what is the only defined treatment for cirrhosis?
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liver transplant
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what is primary biliary cirrhosis?
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an autoimmune liver disease that generally affects middle aged women
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What are the typical signs of primary biliary cirrhosis?
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fatigue and pruritis (tired itchy people)
RUQ pain Anorexia jaundice |
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What are the skin signs of primary biliary cirrhosis?
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hyperpigmentation
xanthomas |
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what are the abdominal signs of primary biliary cirrhosis?
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striking hepatomegaly
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What are the serologic hallmarks of primary biliary cirrhosis?- key**
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elevated AP and GGTP
AMA (anti-mitochondiral antibodies)*** DIAGNOSTIC |
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What is the best treatment for primary biliary cirrhosis?
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ursodeoxycholic acid
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What is the definition of acute liver failure?
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onset of hepatic encephalopahy either:
-less than 8 weeks after onset of liver disease in previously healthy liver or- less than 2 weeks after jaundice onset in person with underlying disease |
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What are the main causes of acute liver failure?
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toxins/drugs
hep B vascular infarcts |
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What are the MAIN complications of acute liver failure?
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encephalopathy
cerebral edema (due to high NH4 levels) lactic acidosis, renal faiure |
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what is the most common manifestation of liver decompensation?
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ascities
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what is the prognosis of ascities?
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poor
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what is the recurrence rate of spontaneous bacterial peritonitis?
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about 70% at one year
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what is the major danger associated wtih transjugular intrahepatic protosystemic shunt?
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major risk of hepatic encephalopathy as NH4 now directly enters the blood stream from the gut
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what usually causes chronic pancreatitis?
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alcoholism
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What is mild acute pancreatitis associated with?
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minimal organ damage and uneventful recovery
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what is severe acute pancreatitis associated with?
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necrosis, organ failure, and death
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what are the most common causes of pancreatitis ?
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gallstones and alcohol abuse
but in 10-25% NO cause is found |
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What is the etiology mnemonic for things that cause pancreatitis ?
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Trauma
Hypertriglyceridermia Idiopathic Scorpion bites (is) Biliary Alcohol Drugs |
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what race gets more pancreatitis ?
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blacks
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what disease has a very high rate of pancreatitis
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AIDS
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What enzymes get activated to cause pancreatitis
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trypsinogen, zymogens, and lipase
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what is the typical clinical presentation of pancreatitis
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sudden onset epigastric abdominal pain,
radiating to back and flanks. usually dull constant and boring *improves my leaning forward* |
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what are the lab tests for pancreatitis
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amylase and lipase
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What test suggest gallstone pancreatitis?
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ALT greater than 150
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what test suggest severe necrotizing pancreatitis?
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HCT greater than 47%
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What CRP value indicates severe pancreatitis
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CRP above 150
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What are the principles of treatment for acute pancreatitis ?**
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Fluid replacement**
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when does infection occur with pancreatitis ?
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usually in the second week of pancreatic necrosis
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What is the treatment for infected pancreatitis necrosis?**
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Fine needle aspiration
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what is chronic pancreatitis ?
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inflammation, fibrosis, and cell loss due to ductal obstruction from strictures due to a proteinaceous plug
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what are the signs of chronic pancreatitis ?
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chronic intermittent abdominal pain radiating to back
N/V steatorrhea |
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What is the most common tracheoesophagela fistual?
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esophageal atresa, with a distal tracheoesophageal fistual
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What is the defect associated with esophageal atresia? (and its mnemonic)
|
VACTERL
Vertebral anomalies Anal atresia Cardiac anomalies TEf Renal anomalies Limb anomalies |
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what is the classic lab finding in hypertrophic pyloric stenosis?
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hypochloremic metabolic alkalosis (you puke up all your acid= alkalosis)
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what xray sign is used to diagnose pyloric sphincter
|
String sign
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what is the character of functional abdominal pain?
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daily pain not associated with meals or relived by defection
often associated with anxiety and perfectionism |
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what are the warning signs with recurrent abdominal pain?
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vomiting
fever growth failure pain awakening kid from sleep weight loss location away from periumbilical region blood in stool/emesis |
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what is given to manage IBS symptomes?
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fiber supplements
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what is the classic late finding in intussusception?
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currant jelly stools
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what is the most common location for intussusception in kids?
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ileocolonic
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what is the clinical manifestations of intussusception?
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suddent onset crampy abdominal main- infants knees draw up, cries out, exhibits pallor with a colicky pattern every 15-20 min
refuses feedings |
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What is the unexpected clinical feature of intussusception?
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Lethargy**
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What is the best way to treat intussusception?
|
contrast enema
fluid resuscitation |
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What are the most common food causes of anaphylaxis in kids in descending order?
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peanuts (most common)
tree nuts milk eggs fish shellfish seeds fruits grains |
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While most childhood allergies to food are outgrown, which are not?
|
peanuts, tree nuts, fish, shellfish
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When must liver disease in a kid be suspected?
|
mild jaundice, but dark colored urine and light colored stools
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What does green onion sign associated with?
|
obstructiong ureterocele
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should you be worried about UTI's in children?
|
yes you should, because they dont usually get them
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Should you be worried about recurrent UTI's in adults?
|
yes- suspect Stasis or obstruction
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What does loss of a psoas shadow mean?
|
retroperitoneal pathology on that side
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What does loss of BOTH psoas shadows mean?
|
ascities
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What should you be worried of if the ureter runs more midline, rather than lateral?
|
an obstructing mass
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Is hydronephorsis ok in pregnancy?
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yes it i- goes away afterwards
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How do you recognize neovasuclar tumors of the kidneys?
|
look for new branching arteries, and smudging on arteriograms
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How do you kill neovascular tumors in the kidney?
|
embolize them
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What is the presentation of renal carcinoma?
|
gross hematuria
vauge upper abdominal pain fatigue, weight loss, anemia (typical caner signs) most are found by chance.. |
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How good is the survival of renal cell carcinoma?
|
pretty danm good until it breaks out of the capsule (stages 1-2)
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Where are the common metastasis sites of Renal carcinoma?*
|
to the BONE*
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What is the best treatment for renal cell carcinoma?
|
take the kidney out
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What will you automatically have after a 50 pack year hx of smoking?
|
GU cancer
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What is the sign of retroperiotenal fibrosis?
|
medial deviation of mid ureters
|
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What are the main causes of retroperiotenal fibrosis?
|
idiopathic
methysergide cancers |
|
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why is it important to always retract the foreskin?
|
to look for cancers
|
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What are the four indications to insert a foley cath?
|
relieve bladder distension
collect uncontaminated urine monitor urine output bladder tests (cytogram/urodynamics) |
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what are the three contraindications for foley catheters?
|
blood from urethra or urethral disruption
acute prostatitis Hx of urethral strictures |
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What is the golden rule of inflating foley cath?
|
dont inflate unless you see urine first
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what is the chirstmas tree bladder a sign of?
|
neruogenic bladder
|
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What is the most significant symptom of obstructive prostatic hyperplasia?
|
Nocturia 2-3 times a nigh
|
|
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what shape do the ureters make in obstructive benign prostate hyperplasia ?
|
a J shape
|
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What shape does the bladder take on in obstructive benign prostate hyperplasia?
|
trabeculation
|
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What is the gold standard treatment for obstructive benign prostate hyperplasia?
|
TURP- transurethral resectoscope prostetomy
|
|
|
what is Post TURP syndrome?
|
the irrigation fluids used in TURP have low sodium, so this causes water intoxication in the pt.
N/V/CHF tx diruetics |
|
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When is it best to treat post TURP syndrome?
|
before acute retention occurs
|
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What are the less invasive treatments of obstructive benign prostate hyperplasia?
|
Urolume stent
green light laser various ablation techiques |
|
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where are the three common locations for kidney stones?
|
renal pelvis
where it crosses the pelvis going into the bladder |
|
|
How common is recurrence of kidney stones?
|
about 50%
|
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What bug causes staghorn stones, or recurrent kidney stones?
|
Proteus
|
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What are the inducations of uroogical intervention with urinary stones?
|
intractable pain
high grade obstruction |
|
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What is the BEST radiographic technique for diagnosing urolithiasis?
|
unenhanced helical computed tomorpgrahy (CT)
|
|
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What is the best way to remove simple renal caculi?
|
shock wave lithotripsy
|
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What is the best treatment for complex renal stones?
|
percutaneous nephrostomy
|
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When is ureterocopy the best treatment for small stones?
|
shock wave failes
pregnant pt obese pt is a bleeder |
|
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What are the four types of incontinenece?
|
Stress
Urge (sudden need/loss of bladder control) Overflow (neuro) Mixed |
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How many people have stress urinary incontinence?
|
13 million people
|
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What part of the urinary system is the "zone of continence"?
|
the proximal 2/3rd of urethra and bladder neck
|
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What history suggests Stress incontinence
|
multiparous women, pelvic surgery, activity related
|
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What history suggest urge incontinence?
|
UTI, new Rx, hematuria, CVA
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What history suggest overflow incontinence?
|
diabetic, never feels empty, back problems, surgery
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does a cystocele cause incontinence ?
|
nope
|
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does a cystourethrocele mean incontinence?
|
yes it does
|
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What does the marshall test for incontinence do?
|
this looks for failure of the zone of continence
|
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|
What do young men with ED need a work up for?
|
cardiovascular eval, maybe have severe asymptomatic coronary artery disease
|
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|
what test is given before giving viagra?
|
two flights of stairs test
|
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what is THE BEST treatment for ED?
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inflatable penile implants- 98% couples satisfaction
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does prostate cancer cause bone mets?
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Yes, but they are osteoBLASTIC
unlike renal cell- which is osteolytic |
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What are the symptoms of prostate cancer?
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same as obstructive benign prostate hyperplasia
increased PSA velocity, Low% free PSA is bad |
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What are the signs of bladder cancer?
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gross hematuria
change in voiding pattern |
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how do you treat superficial bladder cancer?
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tranurethral resection of tumor, with lots of check ups
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what is the treatment for invasive bladder cancer?
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radical cystectomy
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Where does testicular cancer metastasis to?
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lung, liver, bone
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What is the most common type of testicular cancer?
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pure seminoma
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What is the treatment for a pure seminoma?
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xray therapy
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what nodes does testes cancer go to first?
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retroperitoneal lymph nodes
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What are the risk factors for penile cancer?
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uncircumcised
VD HPV Smoking |
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What are the signs of fourniers gangrene?
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dead/discolored tissue on scrotom
fever/drosiness genital pain and redness odor |
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What is the Tx for fourniers gangrene?
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CUT IT ALL OUT
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What is the BEST treatment for internal hemorrhoids?
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rubber band ligation
dont pack the anal canal. |
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What is a pilonidal cyst?
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a cyst or abscess near or in the upper intergluteal cleft- usually has hair and skin debris in it
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who gets pilonidal cysts?
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hairy butted men- with prolonged sitting
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how do you treat pilonidal cyst
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BIG time complete excision - and dont close it just let it fill in from the outside
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what kind of hernia produces bowel perforation without obstruction?
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richter hernia
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What is the risk of having anesthesia withing 3 months of an MI?
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risk of re-infarction
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what is an acceptable pre-op Hgb in healthy people
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8gms
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What is Newhoffs law?
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if you dont get out of bed, you dont get any pain meds
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what do hiccups indicate post surgery?
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that its too early for oral intake of foods
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how do you fix post of ileus due to gastric atony?
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an N.G feeding tube
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What is the most likely cause of fever post op in the first 24-48?
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atelectasis
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how are HgB and Hct affected by acute bleeding?
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they are misleadingly high
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What is the problem with the jejunoileal bypass?
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LOTS of metabolic issues
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What is the most effective weight loss surgery?
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roux en Y subtotal gastrectomy
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how much per cent excess weight is lost with roux en Y subtotal gastectormy?
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60-80%
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What disease (other than being fat) is often cured with gastric bypass surgery?
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type 2 DM
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what part of the history does a living will and religious restriction go into?
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Social Hx
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Who should not be given lactated ringers solution?
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pts with renal insufficiency
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What is nonspecific abdominal pain?
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no organic cause found
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what is the most likely origin of rapid onset severe abdominal pain?
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vascular, rupture, stones, cysts
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What is the most likely origin of slow insidious onset abdominal pain?
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inflammatory processes
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What is the classic finding for mesenteric ischemia or pancratitis?
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pain out of proportion to physical findings
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what kind of abdominal pain is relived with eating?
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ulcers
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what kind of abdominal pain is worse after eating
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biliary colic
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what xray position is best for looking for free air under the diaphragm (as in a perforation)
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sitting upright xray
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What are the major risks of causes gall stones?
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native american woman.
fat crohns disease drugs |
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What are the 5 "F"s of gallstones?
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Fat
Female forty fertile fiar skin |
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What type of gallstone is usually found in adults, as a solitary stone?
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cholesterol stones
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what type of gallstone is usually found in kids, as multiple stones?
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pigmented stones
due to high unconjugated bilirubin |
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What is the pain of gallstones like?
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intense dull pressure in the RUQ
intolerance of fatty foods, nausea, vomiting, flatuence |
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What does the diagnosis change to if gallstone pain lasts longer than 6 hours?
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this is the onset of cholecystitis (inflammation)
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What is the normal ejection fraction for the gallbladder when adminstering CCK?
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at least 50% is normal
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what NSAID has been shown to stop the progression of gallstones to cholecystitis?
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IM diclofenac
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What is the best therapy for symptomatic gallstones?
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cut it out
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What is the best therapy for asymptomatic gallstones?
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observation and NO surgery
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what is the most common complication of laparoscopic cholecystectomy?
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common bile duct injury
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What kind of pt gets oral bile acids to dissolve stones, rather than surgery?
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functional gallbladder
small stones -and have a comorbid condition that prevents surgery |
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when do you hospitalize a pt with gallstones?
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intractable pain
evidence of cholecystitis, cholangitis, pancreatitis, choledocholithiasis (stones in bile duct) |
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what is cholecystitis?
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this is acute inflammation of the gallbaldder, usually caused by migration of gall stones into the cystic duct
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What are the main infective organisms seen in acute cholecystitis?
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E coli, klebsiella, enterococci
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What is the KEY sign for acute cholecystitis?
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murphy's sign
hand under ribs, breathing in makes gallbladder poke hand and hurt |
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what is the initial test for cholecystitis, even though its not very sensitive?
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ultrasound
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What are the ultrasound signs of cholecystitis?
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thicked gallbladder wall, distended gallbladder and a cystic duct with stones in it
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what is a positive HIDA scan result like?
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the gallbladder is NOT visualized, because the cystic duct is blocked
only see isotope in biliary tree and duodenum |
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What is the treatment of acute cholecystitis?
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NG tube, and early cholecystectomy- dont wait for inflammation to subside
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what is the most common complication of acute cholecystitis?
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gangrene
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what causes ephysematous cholecystitis?
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secondary infection of the gallbladder with gas forming organisms (clostridum)
shows as crepitus of abdominal wall next to gallbladder |
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what are the signs of choledocholithiasis (common bile duct stone)
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Hx colicky pain, but sudden onset severe RUQ pain.
N/V/ cholangitis obstructive jaundice** (elevated GGT) |
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What is charcot triad?
what disease does it indicate? |
RUQ pain
Jaundice and fever rigors this indicates acute cholangitis- infection of bile duct |
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what is an antalgic gait?
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compensatory to pain, shorter Stance phase on hurt leg
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what is a steppage gait?
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loss of ability to dorsiflex the foot, swing leg to swing foot up in air
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What is equinus gait?
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toe walking- due to cerebral palsy, tight achilles, hurt heal
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is a trendelenberg gait painful?
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no it is not
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What is the most common cause of antalgic gait in a toddler?
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toddlers fracture (a spiral fracture of the tibia)
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what is the most common cause of trendelenberg gait in a toddler?
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cerebreal palsy
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What is the most common cause of antalgic gait in kids 4-10?
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legg calve perthe disease
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What is the most common cause of antalgic gait in kids 11 yrs+
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SCFE
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What should be suspected with bone pain at rest?
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tumors!
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What are the Xray angles used for a limping kid?
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AP, Lateral, and FROG LEG**
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What lab tests should be ordered for a limping kid?
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CBC, C reactive protein, cultures
to rule out infectious causes |
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what is the typical pt of Legg Calve Perthes disease?
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idiopathic avasular necrosis of femoral head
BOYS, 5-9, kids who are lower percentiles of height for age |
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What makes an LCP limp worse?
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activity, limp worse at end of day
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what range of motion is limited in LCP?
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abduction of the hip is limited on involved side
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What does the leg musculature look like in LCP?
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the affected leg will atrophy a bit
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what is the xray sign for LCP?
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crescent sign
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What type of fracture is a slipped cap femoral epiphysis?
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a salter harris type 1
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What is the most sensitive and specific physical finding for SCFE?
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loss of hip internal rotation
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what is the xray finding for SCFE?
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a positive klein line
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What is the most likely cause of transient synovitis?
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recent URI
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what are the sings of transient synovitis?
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pt awakens with a limp and refuses to walk. localized pain to groin or proximal thigh
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what is the Tx of transient synovitis?
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NSIADS and bed rest
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What is the most common agent in septic arthritis?
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staph aureus
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what is the presentation of growing pains?
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mild to moderate pain, more noticeable during rest
no limp during day. |
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What is the presentation of a DKA pt?
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Kusmmal breathing
fruity odor to breath altered mental status |
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What are the defining labs for DKA?
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glucose above 300
ketonemia above 1:2 acidemia lower than 7.30 |
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How can the white count be affected in DKA?
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it may be elevated by stress alone
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what happens to potassium levels in DKA upon treatment with insulin?
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they will TANK, must give KCL
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What is the FIRST treatment of DKA?
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give them fluid!!
this will help with the acidosis AND the blood glucose levels |
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After blood sugar drops with fluids in DKA tx, what do you give them next?
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add dextrose, as you dont want to tank their blood sugars
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What is the first thing we do in hyperosmolar hyperglycemic state?
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give them fluids!
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what is hyperosmloar hyperglycemic state?
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lack of insulin, but not enough to cause DKA-
ends up causing neurological deficits |
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how is serum sodium affected in DKA?
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it is falsely lowered by the high sugars
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what is used to clear the ketones and fatty acids in DKA?
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insulin and fluids only
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What things are required for internal validity?
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random assignment
groups similar at start Similar length of follow up complete follow up were pts analyzed in the same groups as which they were put into? were the people reading the results blind to treatment groups? |
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What is a P value?
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a measure of how likely that a difference between groups in non random
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are pts who never actually received their assigned treatment excluded from analyses?
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No they are not
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How do you compute absolute risk
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this is risk without therapy. so what % of control group had a bad outcome
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how do you compute absolute risk reduction
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this is the risk of NOT having treatment, minus the risk of having treatment
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how do you compute relative risk
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risk with therapy/ risk without therapy
if less than 1, treatment is good |
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how do you compute NNT?
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this is 1/over the absolute risk reduction
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What is a confidence interval
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this is an interval that the realtive risk should fall within in order for it to be a good test
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What is an intention to treat protocol
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this puts all people into the original group they were assigned, regardless of what treatment they ended up getting
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