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149 Cards in this Set
- Front
- Back
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Four causes of acalculous cholecystitis (4)
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1) Trauma pt
2) Burn pt 3) TPN 4) chronic cholecystitis |
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RUQ pain + fever: dgn?
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Acute cholangitis
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1) Findings in ascending cholangitis? (3)
2) Name for this triad? |
1) RUQ pain + fever/chills + jaundice
2) Charcot's triad |
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Treatment for ascending cholangitis?
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1) ICU --> hydration
2) pressors (if needed) 3) IV Abx |
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Five findings in Reynold's pentad?
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RUQ pain+fever/chills+jaundice+shock+ altered mental status
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Lab findings in patients with cholangitis (3)
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1) Inc WBC
2) Inc amylase 3) Inc LFT's |
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Tx for acute cholecystitis (3)
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1) IV abx
2) fluids 3) electrolyte replacement |
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Pt has fatigue, pruritus and fat malabsorption, has similar FHx, and is female: dgn?
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Primary biliary cirrhosis
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Tx for primary biliary cirrhosis AND primary sclerosing cholangitis? (3)
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1) ursodeoxycholic acid
2) cholestyramine - for pruritus 3) fat soluble vitamins add: for PSC stents |
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What GI disease is primary sclerosing cholangitis assoc with?
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IBD
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What finding will be seen on ERCP with primary sclerosing cholangitis?
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Beaded bile duct strictures
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1) Which colonic polyp has lowest risk for cancer?
2) Which has the highest? |
1) TA (10%)
2) Villous (33%) |
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How soon does the pt need to have another colonoscopy post TA diagnosis?
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3 years.
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What does + methylene blue stool study indicate?
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Presence of leukocytes in the stool = inflammatory diarrhea
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What organism causes secretory diarrhea?
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Vibrio cholera
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How would the sm bowel obstruction be seen on the radiograph?
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dilated loops of bowel with circular folds.
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Iron ContraIndications
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Pt. w/ liver dz, secondary to propensity to develope hemosiderosis
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What is the dgn in pt w/ recent history of cholecystectomy who presents w/ watery diarrhea?
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Salt induced diarrhea
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How should be treated salt-induced diarrhea in pt w/ recent history of cholecystectomy?
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Bile-acid binding resins such as Cholestyramine
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What laboratory abnormality (in lipid profile) can be caused by HRT?
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Hypertriglyceridemia --> tx: D/C HRT
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Drugs that causes of pancreatitis:
1) diuretics 2) IBD drugs 3) Immunosupressors 4) seizure/bipolar meds 5) Aids 6) Abx |
diuretics - furosemide, thazides
IBD drugs - sulfalazine, 5-ASA Immuno supression: L-asparginase, azathioprine seizures/bipolar: valproic acid AIDS pt: didanosine, pentamidine abx: metronidazole, tetracycline |
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what can cause isolated inc in Alk phos, esp w/ history of wt loss and fatigue?
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infiltrative liver dz: TB or lymphoma
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What stains should be ordered in pt w/ suspected autoimmune hepatitis (mildly elevated AST/ALT, nl Alk phos; h/o hypothyroidism (2)
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antinuclear antibody, and antismooth muscle antibodies
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What is the best tx for hemochromatosis?
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Phlebotomy, because it's cheaper and more effective than deferoxamine
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What vaccine should the pt w/ Hep C get?
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HAV & HBV vaccines for anyone with liver disease
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What AST and ALT levels will be seen in alcoholic pt?
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AST/ALT >2.5 (disproportional inc in AST)
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Pill video endoscopy +/-
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+ can tell more about small bowel
- limited view of esophagus/stomach |
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Aconite S/E
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Cardiotoxicity [ventricular arrythmias -> death]
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Kava S/E
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Hepatotoxicity
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Ginkgo biloba S/E
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bleeding
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Ginseng S/E
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SJS and psychosis
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What should be the first test done in suspected pancreatitis?
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LFT w/ amylase and lipase
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What diet should the pt have after cholecystectomy?
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no restrictions, usually
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What is the imaging of choice for acute diverticulitis?
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CT abdomen
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What GI test is contraindicated in acute diverticulitis?
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Colonoscopy
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What is the most common cause of massive rectal bleeding in elderly?
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angiodysplasia or diverticuLOSIS
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With what cardiac disease does the angiodysplasia of the colon associated? (aka vascular ectasia)
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Aortic stenosis
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What is the side effect of metochlopramide for upper GI troubles?
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acute dystonic reaction in which pt presents w/ torticolis, and tongue fasciculations
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What should be given to pt on metochlorpramine who have acute dystocin reaction to the drug?
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Diphenhydramine IV
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What is the antidote of choice in cases of ethylene glycol (antifreeze) or methanol intoxication?
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Fomeprizole NOT ethanol
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What kind of nystagmus can be seen in pt w/ PCP intoxication?
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verticle nystagmus
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Where should the patients w/ PCP intoxication be placed?
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Low-sensory environment
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In which toxic substance can you feel petroleum smell?
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Organophosphates
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What test should be done to confirm organophosphate toxicity?
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Plasma cholinesterase
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What is Scombroid poisoning?
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Flushing, throbbing headache, palpitations, abd cramps, due to improperly stored fish; start 20-30 min post ingestion, self-limiting
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How is carboxyhemoglobin measured?
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co-oximetry
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How do you need to treat dry chemical burn first?
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Brush off the skin
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What is the main tx for heat stroke?
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Augmentation of evaporative cooling -> naked patient should be sprayed w/ a tepid water mist
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What kind of toxicity can develop if nitroprusside is given without infussion pump or too rapidly?
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Cyanide toxicity
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How does cyanide toxicity present?
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Tachy, lactic acidosis, generalized seizures
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How is the cyanide toxicity tx if airways are secured?
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IV phenytoin, sodium thyosulphate
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What kind of foods are difficult to consume in the dysmotility syndrome (achalasia)?
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Both solids and liquids. If pt has only solid food dysphagia - think esophageal stricture
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What should you do in a pt that you suspect C.diff colitis whose immunoassay for C. diff comes back as negative?
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Repeat the assay, because sensitivity is only ~70%, however specificity is close to 100%
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The pt. w/ C.diff suffers a relapse of C. diff after the successful tx w/ metro. What drug should you give now?
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Metro AGAIN! (vanco only after the relapse after the relapse)
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What is the tx for non-bleeding Mallory-Weiss tear?
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Observation only
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What is the most common anatomical predisposing factor in developing Mallory-Weiss tear?
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Hiatal hernia
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When should the colonoscopy be scheduled if pt is found to have polyps on the sigmoidoscopy?
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Immediately!
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What is the cause of chronic recurrent pancreatitis in a pt w/ isolated gastric varices (no esophageal varices)?
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Splenic vein thrombosis
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If the pt gets a dgn of polyp ( >2 cm) how soon should they get a colonoscopy?
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In 3 years
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What test should be performed in a pt w/ new onset ascites or clinical deterioration in pt w/ ascites and liver cirrhosis
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abdominal parasenthesis to r/o spontaneous bacterial peritonitis
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What is the tx for severe acute exacerbation of ulcerative colitis?
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IV corticosteroids
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What other dz may develope in the pt w/ prodromal Hep B?
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Serum-sickness like syndrome which presents w/ fever, rash (polyarteritis nodosa), and glomerulonephritis
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What complication is seen in ~50% of pt admitted w/ esophageal variceal bleeding?
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Spontaneous bacterial peritonitis
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What is the dgn in the asymptomatic pt who has positive anti-HCV antibody test?
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More testing is needed, because the result may indicate either current infection, passed infection or false positive
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How many calories/day should be in the TPN?
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35-40 cal/kg
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What is the protein requirement per day?
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1.5 gm/kg/day
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TPN complications
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Thrombosis, acalculous cholecystitis (bile stasis), liver failure [with long term TPN, due to fatty liver]
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When evaluating acute pancreatitis, what criteria needs to be used?
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Ranson's - age>55, LDH, Gluc, hypocalcemia, WBC, High AST
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H Pylori Tx 1st & 2nd
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PPI, clarithromycin, amoxicillin (or metro if PCN allergy) for 2 wks
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What should be the tx for persistent H. pylori infection?
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Quadruple therapy: BMT + PPI
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What drug should be given to pt w/ esophageal variceal bleed in order to prevent future occurences?
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Propranolol or nadolol (none-selective beta-blocker)
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What is the next step in managing colonic polyp w/ focal adenocarcinoma, but not involving base and surrounding mucosa?
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Repeat colonoscopy in 3 years
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What is the Ogilvie's syndrome
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Acute colonic pseudoobstruction involving right side of the colon and cecum
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Hepatitis B Tx
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INFa, Lamivudine [3TC], adefovir, tenofovir
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Chronic hep C Tx?
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Interferon and ribavirin
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How many pt w/ hep B become chronically infected?
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<10% (good prognosis, if PT remains nl, but worse if it gets elevated)
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How many infant pt w/ hep B infection will have chronic hep B?
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90%
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After dgn of Barrett's how soon should the pt get their f/u EGD?
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1-3 years
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Why do diverticuli bleed most commonly?
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Because erosion of the artery
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For which patients pancreatic enzymes are not helpful in case of chronic pancreatitis?
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In males and in pt w/ alcoholic pancreatitis.
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How do you treat chronic pancreatitis that presents as calcs on X-ray?
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Low fat diet, to decrease steatorrhea
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What are the pt w/ sprue at risk of developing?
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Intestinal T cell lymphoma
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If the esophageal lesion is suspected what imaging test should be done first?
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Barium swallow - because it is safer than endoscopy!
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What are the peristaltic waves and LES tone in Achalasia?
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abcent waves and increased tone
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What are the peristaltic waves and LES tone in scleroderma?
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abcent waves and decreased tone
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What laxative is indicated in pt w/ chronic constipation?
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Psyllium [Metamucil] or methylcellulose [both stool bulkners, i.e. "fibers"]
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What form of feeding should be initiated in pt w/ ALS and dysphagia?
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Peg tube (percutaneous gastostomy)
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What is the gold standard in detecting chronic mesenteric ischemia?
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Splanchnic angiography, but it only is performed after initial test with MESENTERIC DUPLEX US shows evidence of chronic mesenteric ischemia
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Ampulla of Vader aka
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Hepatopancreatic Duct
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Antigliadin antibodies
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Celiac disease
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Antimitochondrial antibodies
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1° biliary cirrhosis
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Biliary tract dz, a/w ulcerative colitis
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1o sclerosing cholangitis (histo onion skin fibrosis of bile ducts)
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Chronic atrophic gastritis
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Predisposition to gastric carcinoma
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Colon polyposis with hyperpigmented mouth, lips, hands and genatalia
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Peutz-Jeghers Syn, AD polyposis a/w risk of CRC and other solid organ Ca
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Courvoiser Law
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Courvoiser Law: painless jaundice & palpable gallblader is probably tumor (Pancreas head Ca or biliary ducts/ampula of Vater)
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Curlings ulcer
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Acute gastric ulcer associated with severe burns
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Cushings ulcer
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Acute gastric ulcer associated with CNS injury
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Describe Ampulla of Vader
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Formed by Common Bile Duct+Pancreatic Duct, it drains into duodenum via Spincter of Oddi
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Describe Common Bile Duct
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Forms by Cystic Duct+Common Hepatic Duct, meets Pancreatic Duct to form Ampulla of Vader
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Describe Cystic Duct
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Drains gallblader, meets Common Hepatic Duct to form Common Bile Duct
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Fat female, forty and fertile
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acute cholecystitis (highest risk category)
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GI Skip lesions
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Crohns
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Gardners syndrome
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FAP with osteomas and soft tissue tumors
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Infection a/w Intussusception
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Adenovirus (causes hyperplasia of Peyers patches)
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Low serum ceruloplasmin
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Wilsons disease
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Mallory bodies
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Alcoholic liver disease
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Mallory-Weiss syndrome
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Esophageal lacerations due to traumatic vomitting
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McBurneys sign
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Appendicitis
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Necrotizing Enterocolitis epidemiology
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Occurs within first 2 weeks of life, MC in premies
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Obese multiparous woman with fat intolerance
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Cholelithiasis (gallstones)
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Painless jaundice
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Courvoisier's Law: painless jaundice with palpable gallblader is probably Pancreatic cancer (head)
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Peutz-Jeghers syndrome
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Benign polyposis with hyperpigmented mout, lips, hand; a/w risk of CRC and other solid organ Ca
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Plummer-Vinson syndrome
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IDA, atrophic glossitis, and esophageal webs (10% -> SCC)
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Signet-ring cells
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Gastric carcinoma
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String sign on x-ray
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Crohns disease
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What is Meconium Ileus and what disease is it a/w?
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Meconium Ileus is neonatal constipation, a/w cystic fibrosis
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Xerostomia + arthritis + keratoconjunctivitis sicca
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Sjogren's syndrome (risk of CRF or lymphomas)
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Zenker's diverticulum
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Upper GI false-diverticulum causing halitosis & dysphagia in elderly
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HBSAb
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Means Immunity due to previous HBV or Hep Vaccine
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When do you treat HBV?
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Tx with symptomatic chronic infection, or serious acute infection (INR > 1.5, severe ALF)
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HBcAg
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Means active infection
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HBeAg
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Means highly infectious
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Acute pancreatitis etiologies
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Alcohol, cholelithiasis, drugs (ceftriaxone, valproic acid, HIV HAART)
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Celiac Sprue dx
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Initial: IgA tissue transglutaminase antibodies & IgA endomysial antibodies; Dx: 2nd Duodenum Bx
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Zenker's Diverticulum Dx
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Barium swallow [NOT endoscopy d/t risk of perforation]
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Zenker's Diverticulum Tx
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Endoscopic stapling OR surgical incision of cricopharyngeous mm
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Dumping Syn S/Sx
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syncope, palpitations & GI upset after eating [d/t gastrectomy]
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Heyde Syn S/Sx
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Angiodysplaia with aortic stenosis
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Angiodysplasia etiology
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Abn small BV due to aging, MC in cecum/ascending colon
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Angiodysplasia Tx
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Supportive care, correct coagulopathies, endoscopic Tx if unable to stabalize [bleeding usually stops spontaneously]
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GI Bleeding MCC in elderly
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Diverticulosis followed by angiodysplasia
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Cholangitis Dx
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Initial: U/S or CT, then ERCP both for Dx & Tx [dilated intra & extra hepatic ducts]
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Cholangitis etiology
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CBD blockage and infection with Gm(-) enterics
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Cholangitis Tx
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IVF, ABX, if unstable Biliary decompression ERCP/Spincterotomy
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Barrett's Esophagus etiology
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GERD causing squamous to columnar metaplasia
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Barrett's Esophagus monitoring
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Yearly EGD with Bx
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Klatskin tumor description
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Tumor that occurs at R & L hepatic bile ducts
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Klatskin tumor prognosis
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Poor, biliary cancer sucks
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Choledocholithiasis etiology
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stone in the CBD
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Choledocholithiasis complications
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Cholangitis, pancreatitis, biliary colic
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Alk Phos isoforms
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Liver (biliary tree), Bone, Leukocyte, Placenta
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Intussusception etiology
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Telescoping of ileocecal junction in 3-36 mos of age
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Intussusception S/Sx
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Palpable sausage shape, red currant stool, billous vomitting
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Intussusception Dx
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U/S if diagnosis remain in Q, otherwise pneumatic enema is Dx & Tx
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Intussusception Tx
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Pneumatic enema
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Chronic Pancreatitis etiology
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biliary (MCC) & alcohol
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Chronic Pancreatitis S/Sx
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Steatorrhea, wt loss, epigastric pain
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Chronic Pancreatitis Dx
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CT scan shows calcified pancreas, diabetes, wt loss
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Chronic Pancreatitis Tx
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Low fat diet, lipase supplements, & vitamin A, D, E, K
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