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55 Cards in this Set
- Front
- Back
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what is SBP?
what are the signs? |
spontaneous bacterial paratinitis.
- fever, pain, decreased mental status - often minimal symps- malaise, anorexia. - caused by e. coli, klebsiella, strep pneumo. - Rx is a 3rd generation cephalosporin |
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what is the difference between spontaneous and 2ry bacterial paratenitis?
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spontaneous- from infected ascites
secondary- perfed bowel (surgical emergency) |
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how does one differentiate ascites?
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paracentesis
albumin- 1.1. above is more likely hydrostatic- RHF, cirrhosis/pulm htn, budd-chiari, hepatic mets, myxedema below 1.1- TB, cancer, pancreatitis, nephrotic syndrome |
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what are risk factors for liver disease?
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alcohol- 80 grams of alcohol daily for 10-20 yrs (8 beers, 1/2 bottle of hard liqour)
viral- C and B, transfusions, needle sharing, cocaine, tattoos, acupuncture. homos, injection drug users, dialysis, HIV biliary disease cardiac disease autoimmune hepatitis Genes- hemochromatosis, Wilson's, alpha-antitrypsin deficiency) Non-alcoholic steatohepatitis. |
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what is non-alcoholic steatohepatitis?
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condition characterized by lobular inflammation and some degree of pericellular fibrosis.
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what is hemochromatosis?
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AR disorder- increased iron absorption, depostiion of iron in certain organs.
liver, heart, gonadal failure. pancreatic failure, skin pigmentation. (2ry- from thalassemia) |
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What is wilson's disease?
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AR disorder of copper excretion- increased accumulation of copper in the liver and brain. Pts may present w/ fulminant or chronic hepatitis, cirrhosis, psychiatric involvment or neuro disease
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what is alpha anti-trypsin disease?
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AR disorder characterized by abnormal alleles of antitrypsin- causes emphysema and asymptomatic cirrhosis
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what causes ascites?
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pulm htn
decreased albumin increased na resorption from kidney malignancy (pancreas, ovary) Nephrotic syndrome Cardiac failure peritoneal tuberculosis peritoneal mesothelioma |
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what are esophageal varices?
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collateral veins in GE junction- causes hematemisis, melena.
(need to confirm w/ endoscopy since gastritis, PUD are also common w/ cirrhosis) |
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what is hepatic encephalopathy?
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confusion, personality changes, asterixis. may be caused by nh4 levels. may be due to aminobutyric acid.
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what is asterixis?
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bilateral flapping tremor of the wrist, metacarpophalangeal, and hip joint. also seen in tongue, foot, skeletal muscle
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what are common PEX findings in cirrhosis?
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splenomegaly, internal hemorrhoids, and caput medusae
skin- jaundice, spinder telangiectases, clubbing, palmar erythema, dupuytren's contracture (permanent flexion of the 2rd or fourth metacarpal. |
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what labs are seen in cirrhosis?
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hyponatremia (increased ADH)
decreased BUN (malunutrition, decreased protein production) decreased albumin increased bili Heme- increased PT, macrocytic anemia, thrombocytopenia |
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what is the Rx for ascites?
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na restriction
diuretics- k sparing. large volume paracentesis peritoneovenous shunt- peritoneum-venacaval shunt. (thrombosis, infection, DIC can all occur) |
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how do you treat esophageal varices
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replace the blood
vasopressin- constrict portal blood flow and controls bleeding - sclerotherapy- band ligation; immediate treatment reduces rebleeding rates. - TIPS- transhepatic IVC-> portal shunt B-blockers |
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what si the treatment of hepatic encephalopathy
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correction of infection, GI bleed, excess dietary protein, hpokalemia, hypovolemia, alkalosis, and drugs.
lactulose- (decrease ammonia absorption - neomycin- broad-spectrum antibiotic- decreases ammonia production from GI tract. |
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what is the common agent in CAP?
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strep pneumo
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how do you treat CAP?
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ceftrioxone
azithromycin |
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what are the two nervous systems involved in controlling the heart?
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renin-angiotensin
sympathetic nervous system |
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What is the role of cocaine and B-blockers?
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beta-blockers can allow unapposed alpha. which can cause vaso-constriction-> hypertension.
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what are the types of adenomas in colon cancer?
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tubular- 80-85%
tubulovillous- 8-16% villous- 3-15% only 5% change into cancer |
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What are the factors associated w/ malignant transformation of a polyp?
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increasing size- 2cm (10%)
Villous histology |
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what are the two key events to cause colon cancer?
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activation of the ras oncogene
inactivation of the APC, dcc and p53 genes. |
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what causes DNA damage in colon cancer?
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endogenous- oxidizing and alkylating products of cellular metabolism
exogenous- carcinogens, viruses, rads |
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what are risk factors for colon cancer?
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hx of polyps
IBD- UC FAP, HNPCC Personal history of another malignancy Family Hx of colon cancer Diet- high animal fat low fiber obesity ethanol refined sugar cigarettes. |
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what is the role of fecal occult blood testing in colon cancer screening?
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sensitivity and specificity of 50%
- inexpensive, easy to do. poor sensitivity and specificity; does not localize upper vs. lower |
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what is the roal of sigmoidoscopy in colon cancer screening?
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60 com flexible scope
- direct visualization, safer than colonoscopy, performed in the office, no anesthesia. - doesn't look at the proximal colon. |
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what is the role of barium enema for screening of colon cancer?
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sensitivity of 80-90% for lesions > 1cm.
50-75% for less than 1cm. Allows visualization of the proximal and distal colon. minimal discomfort. can't biopsy |
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what is the role of colonoscopy in colon cancer screening?
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goald standard.
high cost, increased risk uncomfortable. |
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what are the screening guidelines for colon ca?
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start at age 50; flex sig fecal occult, dre every 3-5 yrs. or colonoscopy every 10
if w/ UC- colonoscopy after 8-10 yrs of disease, surveillance every 1-2 yrs adenomatous polyps- 3-5 yrs after excission. every 1-3 if multiple large, villous, or malignant polyps FAP- genetic couseling, screening; flex sig by age 10 HNPCC- colonoscopy by age 35-40- 10 yrs younger, surveillance every 3-5 yrs. |
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what is virchow's triad?
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stasis, alt in blood vessels, hypercoagulability
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what are some forms of stasis that contribue to PEs?
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surgery
heart failure chronic venous stasis immobility |
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what are some alterations in blood vessels that contribute to PE?
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fractures or surgery of lower extremity
major trauma |
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what can cause hypercoagulability?
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postpartum period
malignancy oral contraceptives deficiencies of protein S, C, antithrombin III lupus anticoagulant activated protein C resistance (factor V leiden Prothrombin gene mutations hyperhomocysteinemisa. |
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what are the symps of PE?
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sudden onset of unexplained dyspnea
Pleuriticchest pain Cough Hemptysis other presentations syncopy, SVTs, and worsening of underlying heart failure or lung disease. |
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what is seen on PEX of a PE?
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tachycardia
tachypnea may have right sided heart strain- loud pulmonic component of second heart sound S3 right ventricular heave |
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what is teh DDx for PE?
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pneumothorax
MI Pericarditis Asthma Pneumonia hypotension- MI w/ shock tamponade tension pneumo |
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what can be seen on CXR in PE?
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atelectasis
increased lung lucency in the area of the embolus abrupt cutoff of vessel wedge-shaped pleural-based infiltrate Pleural effusion which if sampled by thoacentesis is often hemorrhagic. |
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What are well's criteira?
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clinical DVT symps
Other Dx less likely than PE HR >100 Immobilization Previous DVT/PE Hemoptysis Malignancy > 6 means |
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what are the indications for an IVC filter?
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contraindication to anticoagulation
thrombosis despite antigcoag large burden of thrombosis in LE that could be fatal if embolized. |
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What ar ethe causes of atrial fibrillation?
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PIRATES
Pulmonary disease- infection Ischemia, Hypertension Rheumatic heart disease Anemia Thyrotoxicosis Ethanol Sepsis/Stimulants |
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What can cause Torsades de Pointes?
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POINTES
Phenothiazines Other meds (tricyclics) Intracranial bleed No known cause Type I antidyrhythmics Electrolyte abnlties Syndrome of prolonged QT |
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What is the Rx for Torsades?
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MgIV
Overdrive pacing Beta blockers for prolonged QT syndrome |
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What are the common causes of pericarditis
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Viral- happens after recent viral URI
Bacterial- TB, strep, staph Mets- lung or breast MI- Immediate post-mi- 24 hrs of a transmural infarct. Drssler's syndrome- pericarditis occurring one wk to months after an MI due to an autoimmune response to infarcted myocardium Uremia- chronic renal failure Rads Drugs- hydralazine, procainamide, isoniazid Collagen vascular tissue- SLE, scleroderma Myxedema Trauma- postpericardiotomy syndrome Idiopathic |
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What is ITP?
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Immune mediated thrombocytopenia
development of antibodies against platelet surface antiget. |
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what is the treatment of ITP?
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corticosteroids, IvIg, platelet transfusion
splenectomy |
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what is the TTP pentad?
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Fat RN
Fever Anemia Thrombocytopenia Renal dysfunction Neurologic dysfunction. (altered mental status) |
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what is the etiology of TTP?
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malignancy
infection antiplatelet agents, chemo, contraceptives autoimmune disorders preggers |
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what is the diagnosis of TTP?
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Hemolysis: schistocytes on perpheral smear, decreaseed haptoglobin, elevated LDH, elevated total bili
Renal failure: elevated BUN, Cr Fever, confusion normal PT, PTT |
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what is the treatment of TTP?
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plasmapharesis
may give FFP |
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What is DIC?
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acquired coag defect that results in consumption of coag factors I, V, VIII, and XIII-> bleeding and thrombosis
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what is the etiology of DIC?
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obstetric problems- dead fetus, abruptio placentae, 2nd trimester abortion, amniotic fluid embolism
spesis- RMSF, HUS, malaria Local tissue damage- snake bites, burns, frostbite Chronic illness: Malignancy, liver disease |
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what are the signs and symps of DIC?
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Petechiae
purpura mucosal bleeding chronic DIC may only have lab abnlties |
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what is the Dx of TTP?
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thrombocytopenia
increased PT, aPTT, and TT Decreased fibrinogen Presence of fibrin split products hemolysis on peripheral smear. |
