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77 Cards in this Set
- Front
- Back
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What area does a CT and U/S of abdomen include
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Covers abdomen to the ASIS, if you want below, need to order a pelvic too
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What types of conditions can be seen on U/S
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Simple cysts, Abdominal Aortic aneurisms
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Low back pain
Pulsation in the abdomen Bruit on auscultation of abdomen near midline all suggest what |
Abdominal Aortic aneurisms
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What types of conditions are flouroscopy used for
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motility issues
obstruction |
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What do all H2 blockers end in
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idine
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What is ranitidine?
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H2 inhibitor
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What do proton pump inhibitors end in
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-prazole
pr for proton pump inhibitor! Not to be confused with antivirals that end in azole |
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What is a side affect of proton pump on absorption in minerals
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decreases ionization and therefore leads to dec abs of Ca, Mg ect
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What is metoclopramide? What is it used for? Side effects?
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it increases GI motility and is used to tx GERD, pre-op gastric emptying, dec N/V with chemo drugs.
Etrapyramidal side effects Diarrhea, restlessness, anxiety, fatigue, seizure, HA, drowsiness |
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What are the 3 strategies to laxatives
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Dec surface tension of stool - inc water
Osmotic laxatives - inc water Cathartic laxatives - activates mm in colon and therefore more adictive |
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What is the DDX for generalized abdominal pain
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Acute pancreatitis
Ruptured gallbladder Peritonitis Intestinal obstruction Perforated appendicitis Ruptured spleen Pnuemonea with gastric dialation Perforated ulcer Uremea Ruptured abd aneurismf |
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What conditions cause pn in the celiac or central area in abdomen
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Acute / Early API
Acute small bowel obstruction Acute gastritis Acute pancreatitis May also be Epigastric Acute intestinal colic |
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What should be on a DDX of chest pain
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- Esophageal spasm (may respond to nitrates or calcium-channel blockers)
- Gastritis/esophagitis Burning chest pain Anxiety and hyperventilation May have chest pain, SOB, feeling as though will die Acute MI Substernal pressure with radiation to arms, neck, jaw, dyspnea, diaphoresis; occurs with exertion Musculoskeletal Usually tender over specific point that reproduces pain |
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What is a key lab finding in pancreatitis
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very elevated amylase and lipase, if these are low and its not a spleen rupture it is the stomach causing the pain most likely
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What is melena
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black feses caused by blood
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How does cholelithiasis usually present
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pain in RUQ after eating wiht radiation to R shoulder
Sn/Sx: - Nausea, vomiting, abdominal pain, RUQ tenderness - Variable fever, leukocytosis, mild elevation of bilirubin, elevated alkaline phosphatase Post McMurphys |
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What is indirect bilirubin, high levels suggest
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pre-hepatic
toxic mushrooms acute hepatitis Acetaminophen toxicity |
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What are the two acute hepatitis and what did you consume to get them
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Hep A and E - consumed poop
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What are the long term sequele of Hep B & C
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Cirrhosis and Hepatocarcinoma
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What is a CI in the tx of toxin producing microbes in the GI?
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Antibiotics - will cause everything to die at once and pt will get even sicker
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What is the big tip off with Giardiasis
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Foul smelling gas, watery diarrhea - confirm with stool test
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What are the classic sn/sx of UC
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Effects the rectum
Proximally Inflammation is of the mucosa and submucosa Will have bloody diarrhea Complications are Hemorrhage or toxic megacolon Marked increased risk for colon cancer |
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What are classic sn/sx of Crohn's dz
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Usually effects the termium illium
Skip lesions Inflammation is transmural Crampy abdominal pain Complications are fistulas, obstructions and abcesses |
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What does >48 hours of no stool in a pt
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lower bowel obstruction!!!
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What is loperamide
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It is an anti-diarrhea medication
at high doses it is hepatotoxic |
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What is Prochlorperazine
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It is an anti-psychotic med that can also be used at low doses as an Antiemetic.
It needs to be used with caution as it can have Extrapyramidal Side Effects! |
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What is Docusate and what should never be used with it
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It is a stool softener (anti-constipation) It is toxic with concomitant mineral oil use.
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What do extrapyramidal side effects include:
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Tremor
Akathisia Slurred speech Dystonia Bradyphrenia Bradykinesia Muscular rigidity |
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Where dose referred pain from the stomach go
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5th Rib (Left) - to - Mid Lumbar Region, Midline to Left Lateral Border : Dorsal & Ventral Epigastric area
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Where does referred pain from the liver go
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Dorsal and Ventral. Right Scapula.
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Where does referred pn from the gallbladder go
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Murphy's Point, Right Upper Quadrant, Right Scapula
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Positive McBurney’s Point, Right Lower Quadrant pn, Right Dorsal Flank pn or Celiac area pn an all indicated a problem with what
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apendix
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Where do the small intestines and colon refer pain to
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Celiac, Local area of Large Intestine
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Where does the rectum refer pain to
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Suprapubic area, Sacral area
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Where do the kidneys refer pain to
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Costovertebral Area, Bilateral Dorsal Flanks, Right & Left Dorsal Iliac Crests
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Where do the ureters refer pain to
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Left Inferior Iliac Crest, Left Inguinal Area, Left Labia/Testicle
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RUQ / Right Hypochondrium
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Pleuritic pain
Acute API (high organ) Acute cholecystitis Leaking duodenal ulcer Subphrenic abscess |
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LUQ / Left Hypochondrium
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Subphrenic abscess
Perforated gastric ulcer Jejunal diverticulitis Spleen Pain Rupture Artery aneurysm |
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RIght iliac pain
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Major:
-API -Crohn’s -Mesenteric Adenitis -Leaking duodenal ulcer Less Common: -Cholecystitis (low GB) -Biliary peritonitis -Acute pancreatitis -Inflammed Meckel’s -diverticulum |
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Left iliac pain
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DIVERTICULITIS
Peritonitis (spreading) Pericolitis (around colon cancer) |
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What are ways you can tell the difference btw gastric and duodenal ulcer
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The gastric ulcer will have pain immediately after eating and will loose wt b/c they will put off eating
The duodenal ulcer will not will graze all day b/c when they become hungry (1-3 hrs after eating) they get the pain |
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How is pancreatitis diagnosed
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There will be elevated amylase and lipase - is confirmed by a abdominal CT
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What are the sn/sx of pancreatitis
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boring pain in epigastric region
N/V, anorexia Better sitting up or fetal position Worse movement Most commonly associated with alcohol and gallstones |
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What are the sn/sx seen in cholelithiasis
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Nausea, vomiting, abdominal pain, RUQ tenderness
Variable fever, leukocytosis, mild elevation of bilirubin, elevated alkaline phosphatase |
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What does uncongigated/indirect bilirubin elevation indicate
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“Pre-hepatic” elevated in hemolytic conditions, or Gilbert’ syndrome.
Think poor glucuronidation or excessive RBC lysis |
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What are things that block the glucuronidation pathway
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Toxic mushrooms
Acute Hepatitis Acetaminophen toxicity |
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What is indicated with elevated Direct / Conjugated
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Hepatocellular disease (normally with increased ALT)
Biliary obstruction (Often with increased Amylase) |
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What are the 1st two things to think of in ascities
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CHF
Abdominal mass |
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What are the risks for colon cancer
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Over 50 years of age
History of polyps in the colon Ulcerative colitis Crohn's disease Family history of colon cancer or familial polyposis syndrome A diet high in fat and low in fiber Smoking Alcoholic beverages Inactive lifestyle |
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What is a severe complication of infectious diarrhea where the pathogen produces a toxin
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hemolytic uremia syndrome - causes hemolytic syndrome that then gums up the kidneys and causes kidney failure
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What organisms can cause bloody diarrhea
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Hemmorrhagic E Coli
C Diff Salmonella Campylobacter Shigella Entemoebia histalytica |
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What does minimal bloody diarrhea leading to lots of blood in the diarrhea
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0157:H7 E Coli
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How does Vibro Cholera present
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Starts with vague abdominal fullness followed by cold hands and feet, light headedness, rapidly progressing effortless vomiting, massive painless watery purging, leg muscle cramps, and urine shutdown
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What organism causes rapid diarrhea most commonly
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Staph
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What organisms cause slower starting diarrhea
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Salmonella
Vibro |
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What is characteristic of botulism neurological sx
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B/L symmetrical paralysis usually beginning in the Cranial Nerves
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What is the classic radiographic finding in crohn's dz
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string sign on barium x-ray
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What is the classic radiographic finding in UC
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lead pipe colon on barium x-ray
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When a question asks for the "most specific" image what should you always go with if it is an option
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MRI - this is specific to NPLEX - not real life :)
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What is the most common cause of portal hypertension
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Cirrhosis
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What is the classic triad of symptoms in a pt with Budd-Chiari syndrome
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Abdominal pain
Ascities Hepatomegaly |
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What is Cushing's triad of intracranial pressure
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widening pulse pressure HTN/ bradycardia
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Triad of biotin def
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glossitis
aloecia add from notes |
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What is Turner's and Cullen's signs
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They are pecticea in the periumbilical area indicative of an acute pancreatitis
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What is schatzki's ring
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congenital malformation of the esophagus
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What stool condition is caused by the following - small intestine bacterial overgrowth, intestinal lymphoma, lipase deficiency
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steatorreah
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What labs are used in the consideration of celiac dz
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anti gliadin antibody
anti endomyclelia tissue transgluaminase Ant TTG |
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What does "sensitive" mean in relation to a sx/sn
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Pt's with a specific condition will almost all have this finding
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In alcoholic cirrhosis what condition is most likely associated with vomiting of blood
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Mallory-Weiss - tear in esophagus near the esophgogastric jnx
Varicose |
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What is seen on biopsy of IBS pts
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Normal
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What foods lower esophageal tone
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see notes
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What is odynophagia
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pain with swallowing
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What does CREST stand for
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Calcinosis
Raynaud's phenomenon Esophageal dysmotility Sclerdactoly Telangiectasia |
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What does Gottron's papules, heliotrope eyelids adn skin rash are classic features in
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dermatomyositis
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What kind of drug is it if ends in prazole
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proton pump inhibitors
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Hirschusprung's dz
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Consistently emptying rectum w/hx of constipation - person lacking in auribach plexus and therefore un able to move the bowels.
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Crohn's
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Fistula, fisure, HLA B27
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