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77 Cards in this Set

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