Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
61 Cards in this Set
- Front
- Back
|
WHAT IS CHOLELITHIASIS? |
FORMATION OF GALLSTONES
|
|
|
WHAT IS CHOLECYSTITIS? |
INFLAMMATION OF GALLBLADDER 90% DUE TO OBSTRUCTION BY STONES |
|
|
WHAT IS ACUTE CHOLECYSTITIS? |
MOST HAVE REMISSION OF INFLAMMATION OF GALLBLADDER IN 1-5 DAYS 20% REQUIRE SURGERY |
|
|
WHAT IS CHRONIC CHOLECYSTITIS? |
REPEATED SYMPTOMATIC ATTACKS ASSOCIATED WITH BILIARY SLUDGE |
|
|
WHAT IS ACALCULOUS CHOLECYSTITS? |
INFLAMMATION OF THE GALLBLADDER IN THE ABSENCE OF STONES |
|
|
WHAT ARE NON-MODIFIBLE RISKS FACTORS FOR CHOLECYSTITIS?
|
AGE GREATER THAN 50 WOMEN TWICE AS COMMON GENETIC FACTORS FAMILY HISTORY PREGNANCY |
|
|
WHAT ARE MODIFIBLE RISKS FACTORS FOR CHOLECYSTITIS?
|
OBESITY RAPID WEIGHT LOSS HYPERALIMENTATION |
|
|
WHAT ARE COMORBITIES AND SURGICAL RISKS FACTORS FOR CHOLECYSTITIS? |
DM CROHNS DX ALCOHOLIC AND BILIARY CIRRHOSIS H/O RAPID WEIGHT LOSS |
|
|
WHAT IS THE PATHOGENESIS OF CHOLECYSTITIS?
|
BILE STATSIS / BACTERIAL INFECTION (E.COLI, KLEBSIELLA, ENTEROCOCCI) /OBSTRUCTION BY GALLSTONE / INFLAMMATION OF GALLBLADDER DUE TO BLOCKAGE OF CYSTIC OR COMMON BILE DUCT/ RESOULTION IN 2 MONTHS OR --> ISCHEMIA, GANGRENE, OR PERFORATION POSSIBLE
|
|
|
WHAT IS THE ETIOLOGY OF GALLSTONES?
|
FORMED FROM BILE CRYSTALS CHOLESTEROL OR CHOLESTEROL DOMINANT --> CHOLESTEROL SUPERSATURATES THE BILE IN THE GALLBLADDER & PRECIPITATES OUT OF THE BILE |
|
|
WHAT IS THE PRESENTATION OF CHRONIC CHOLECYSTITIS?
|
**RADIATION TO POSTERIOR RIGHT SHOULDER OR SCAPULA** RECURRENT RUQ OR EPIGASTRIC ADOMINAL PAIN -- EPISODES INCREASE IN FREQ ONSET USUALLY WITHIN 1 HR OF EATING MEAL (ASSOCIATED WITH EATING FATTY FOODS) COLICKY PAIN MAY LAST 1-6 HR AFTER EATING N/V |
|
|
WHAT IS THE PRESENTATION OF ACUTE CHOLECYSTITIS?
|
ONSET: FOLLOW A MEAL RUQ PAIN: SHARP, LAST > 6HR SYMPTOMS: ANOREXIA, NAUSEA, VOMITING >70%, FEVER, CHILLS CHARCOT'S TRIAD |
|
|
WHAT IS CHARCOT'S TRIAD?
|
RUQ PAIN FEVER JAUNDICE, IF STONE IS LODGED IN COMMON BILE DUCT |
|
|
WHAT IS ACUTE ACALCULOUS CHOLECYTITIS PRESENTATION?
|
GENERALIZED COMPLAINTS, FEVER, NAUSEA, VOMITING, LOSS OF APPETTITE, RUQ PAIN, TYPICALLY CRITICALLY ILL, REQUIRE HOSPITALIZATION. |
|
|
WHAT IS MURPHY'S SIGN IN ACUTE CHOLE EXAM?
|
PAIN ON DEEP INSPIRATION WITH RUQ PALPATION --- THE EXAMINER'S FINGERS ARE ON THE APPROXIMATE LOCATION OF THE GALLBLADDER |
|
|
WHAT FINDINGS MAY BE PRESENT IN AN ACUTE CHOLE EXAM?
|
VS: FEVER, TACHYCARDIA ABDOMEN: RUQ TENDERNESS, GUARDING, RIGIDITY MURPHY'S SIGN JAUNDICE DEHYDRATION |
|
|
WHAT IS PANCREATITIS?
|
INFLAMMATORY PROCESS OF PANCREAS ACUTE OR CHRONIC RANGES FROM: MILD DX TO ACUTE (LIFE THREATENING- MULTIORGAN FAILURE & SEPSIS) |
|
|
WHAT ARE COMMON RISK FACTORS FOR PANCREATITIS?
|
GALLSTONES - OVER 45% ALCOHOL - 1/3 ELEVATED TRIGLYCERIDES - LEVELS >1000 HYPERCALCEMIA - HYPERPARATHYROIDISM ABDOMINAL TRAUMA / SX IATROGENIC - POST ERCP (ENDOSCOPIS RETROGRADE CHOLANGIOPANCREATOGRAPHY) INFECTIONS - HIV, PARASITIC |
|
|
WHAT ARE CAUSES OF CHRONIC PANCREATITIS?
|
HISTOLOGIC CHANGES IN PANCREAS AUTO-DIGESTION: PANCREATIC ENZYMES ACTIVATED IN PANCREAS INSTEAD OF INTESTINE EXOCRINE & ENDOCRINE FUNCTIONS IMPAIRED: HYPERGLYCEMIA, MALABSORPTON ALCOHOL: 3/4 OF CASES IDIOPATHIC: 20% OVER 40YR: CONSIDER PANCREATIC CANCER |
|
|
WHAT IS THE PRESENTATION OF ACUTE PANCREATITIS? |
ONSET: SUDDEN LOCATION: POORLY LOCALIZED ABD PAIN PAIN: CONSTANT KNIFELIKE RADIATES TO BACK |
|
|
WHAT IS THE PRESENTATION OF CHRONIC PANCREATITIS? |
ONSET: WORSE WITH ALCOHOL OR FATTY FOOD LOCATION: EPIGASTRIC, REFERRED TO UPPER BACK, ANTERIOR CHEST OR FLANK PAIN: VARIED S/S: NAUSEA & VOMITING FAT MALABSORPTION- WEIGHT LOSS, DIARRHEA, OILY STOOL |
|
|
WHAT IS THE PHYSICAL EXAM OF ACUTE PANCREATITIS? |
PAIN WORSE SUPINE S/S DEHYDRATION ABDOMINAL DISTENSION PALPATION OF A MASS W/ PSEUDOCYST CULLEN SIGN (PERIUMBILICAL BRUISING) GREY TURNER SIGN (FLANK BRUISING) |
|
|
WHAT IS THE PHYSICAL EXAM OF CHRONIC PANCREATITIS?
|
WILD FEVER WEIGHT LOSS ABDOMINAL TENDERNESS JAUNDICE - UNCOMMON |
|
|
TURNER & CULLEN SIGN ARE SPECIFIC FOR?
|
PANCREATITIS WITH HEMORRHAGE RARE INCREASED MORTALITY |
|
|
WHAT IS AN OVERVIEW OF HEPATITIS: CAUSE AND REPERCUSSIONS?
|
-C AUSE: INFLAMMATION OF THE LIVER -ORIGIN: VIRAL, ALCOHOLIC, DRUG, INDUCED, AUTOIMMUNE, METABOLIC DEFECT -VIRAL: A, B, C, D (CO-INFECTION W. B), E -REPERCUSSIONS: CHRONIC - CONTINUES FOR 6 MONTHS --> CAN LEAD TO: CIRRHOSIS (SCARRING/DEATH OF HEPATOCYTES) / LIVER FAILURE & DEATH / HEPATOCELLULAR CARCINOMA |
|
|
WHAT IS THE TRANSMISSION OF HEPATITIS A?
|
PERSON TO PERSON THROUGH FECAL ORAL TRANSMISSION EXPOSURE TO FECAL-CONTAMINATED FOOD & WATER |
|
|
WHO IS AT RISK FOR HEPATITIS A?
|
TRAVELERS TO COUNTRIES WITH POOR SANITATON
|
|
|
HOW LONG DOES HEPATITIS A INCUBATE AND IS IT LIFE THREATENING?
|
INCUBATION: 2-6 WEEKS (15-50 DAYS) GREATEST INFECTIVITY WHEN ASYMPTOMATIC, 2 WEEKS BEFORE ONSET OF CLINICAL ILLNESS SELF-LIMITING, DOES NOT PROGRESS TO CHRONIC HEPATITIS |
|
|
WHAT IS THE PATHOGENESIS OF HEPATITIS A?
|
INGESTION --> REPLICATION IN THE OROPHARYNX/GI TRACT --> TRANSPORT TO LIVER - MAJOR SITE OF REPLICATION --> SHED IN BILE, TRANSPORTED TO INTESTINES --> SHED IN FECES --> BRIEF VIREMIA -->CELLULAR IMMUNE RESPONSE: CLINICAL DISEASE & CONTROL
|
|
|
HOW CAN HEPATITIS A VIRUS BE INACTIVATED?
|
BOILING FOR 1 MINUTE
|
|
|
WHAT IS THE TRANSMISSION OF HEPATITIS B?
|
PERCUTANEOUS PUNCTURE MUCOSAL CONTACT W. INFECTED BLOOD OR BODY FLUIDS INFANTS BORN TO INFECTED MOTHER |
|
|
HOW LONG CAN HEPATITIS B SURVIVE OUTSIDE THE BODY?
|
7 DAYS USE BLEACH FOR DISINFECTING |
|
|
WHO IS AT RISK FOR HEPATITIS B?
|
SEX PARTNERS OF INFECTED PERSONS INJECTION DRUG USERS HOUSEHOLD CONTACTS OF THOSE WITH CHRONIC HBV HEALTHCARE & PUBLIC SAFETY WORKERS AT RISK FOR EXPOSURE TO BLOOD HEMODIALYSIS PATIENTS |
|
|
HOW LONG IS THE INCUBATION PERIOD FOR HEPATITIS B?
|
90 DAYS 2-5 MONTHS |
|
|
WHAT DISTINGUISHES CHRONIC HEPATITIS B CARRIERS?
|
PERINATAL & PRENATAL EXPOSURE NEGATIVE: IgM anti-HBc POSITIVE: HBsAg |
|
|
HOW IS HEPATITIS C TRANSMITTED?
|
BLOOD BORNE -INJECTION DRUG USE -BLOOD PRODUCT TRANSFUSION PRIOR TO 1992 - NEEDLE STICK INJURY IN HEALTHCARE - NOSOCOMIAL TRANSMISSION: COLONSCOPY, DIALYSIS, SURGERY -INFANTS BORN TO INFECTED MOTHER |
|
|
WHAT IS THE INCUBATION PERIOD FOR HCV?
|
2-24 WEEKS |
|
|
WHAT IS THE DIFFERENCE OF ACUTE VS. CHRONIC INFECTION WITH HEPATITIS?
|
ACUTE: ASYMPTOMATIC CHRONIC: 75-85% OF HCV WILL BECOME CHRONIC 5-20% WITH CHRONIC WILL DEVELOP CIRRHOSIS |
|
|
GENERALLY AFTER 15 YR TO 30 YR INFECTION WITH WHAT VIRUS CAN PATIENTS DEVELOP A HEPATOCELLULAR CARCINOMA?
|
HBV 10% - 20% |
|
|
WHAT IS THE PATHWAY OF DEVELOPING HEPATOCELLULAR CARCINOMA WITH HCV?
|
CHRONIC LIVER DAMAGE --> CIRRHOSIS (LEDING CAUSE IN USA, EUROPE, JAPAN)--> GENETIC ALTERATIONS --> HCC (HEPATOCELLULAR CARCINOMA)
|
|
|
WHAT IS HEPATITIS D (HDV) INFECTION?
|
REQUIRES CO-INFECTION WITH HEPATITIS B FOR REPLICATION OCCURS ONLY CONCURRENTLY IN PRESENCE OF HEPATITIS B SUPERINFECTION IN CHRONIC HBV |
|
|
HOW IS HEPATITIS D (HDV) INFECTION TRANSIMITTED?
|
PARENTERAL VIA: BLOOD OR BLOOD PRODUCTS INJECTION DRUGS SEXUAL CONTACT DX: anti-HDV antibody |
|
|
WHERE DOES HEPATITIS E (HEV) PREDOMINANTLY OCCUR?
|
MEXICO, ASIA (INDIA), NORTHEAST AFRICA, & MIDDLE EAST |
|
|
HOW IS HEV TRANSMITTED?
|
FECAL ORAL ACUTE ILLNESS, DOES NOT APPEAR CHRONIC MORE COMMON IN ADULTS INCUBATION: 2-9 WEEKS |
|
|
WHAT IS THE PATHOGENESIS OF HEPATITIS?
|
-IMMUNOLOGIC -INFECTIONS (VIRUSES, BACTERIA, FUNGI, PROTOZOA) -TOXIC DAMAGE (ALCOHOL, DRUGS, POISONS/CHEMICALS) |
|
|
WHAT LOCATION IS PAINFUL WITH VIRAL HEPATITIS A-E?
|
RIGHT UPPER ABDOMINAL TENDERNESS W/O REBOUND |
|
|
WHAT ARE S/S IN THE CLINICAL PRESENTATION OF VIRAL HEPATITIS?
|
FATIGUE ANOREXIA, NAUSEA DARK URINE, CLAY COLORED STOOL LOW GRADE FEVER MYALGIA, ARTHRALGIA JAUNDICE (MORE COMMON W/ HBV) -- SOME ASYMPTOMATIC |
|
|
WHAT ARE THE CAUSES OF CIRRHOSIS?
|
--IRREVERSIBLE DISEASE FROM EXPOSURE TO PERSISTENT TOXINS CAUSING HEPATOCELLULAR INJURY --INHERITED / IDIOPATHIC --ALCOHOL & HBV, HCV, HDV --MEDICATIONS:ACETAMINOPHEN, AMIODARONE, CHEMOTHERAPEUTIC AGENTS, ANTIBIOTICS |
|
|
WHAT IS THE CIRRHOSIS PATHOPHYSIOLOGY?
|
TOXIN EXPOSURE--> HEPATOCELLULAR INJURY --> TOXEMIA, INFLAMMATION, ISCHEMIA, NECROSIS OF TISSUE --> DAMAGE STIMULATES REGENERATION --> DEVELOPS FIBROUS TISSUE, COLLAGEN BY FIBROBLASTS-->RIGID NODULES FORM --> DISORTS SUROUNDING TISSUE --> CHANGE IN BLOOD FOW--> PORTAL HTN--> COLLATERAL CIRCULATION DEVELOPS
|
|
|
WHAT IS MICRONODULAR CIRRHOSIS?
|
ETOH OR DRUG ORIGIN SMALL NODULES W. LIMITED FUNCTIONAL ABILITY COLLATERAL VESSELS HAVE VARICOSITIES PRONE TO RUPTURE |
|
|
WHAT IS MACRONODULAR CIRRHOSIS?
|
CARCINOMA 2-3 CM NODULES MAY CONTAIN THEIR OWN BLOOD SUPPLY RESEMBLE SCAR TISSUE LIMITED FUNCTIONAL ABILITY COLLATERAL VESSELS HAVE VARICOSITIES PRONE TO RUPTURE |
|
|
CAN CIRRHOSIS CAUSE CHEST PAIN?
|
YES, DUE TO CARDIOMEGALY
|
|
|
WHAT ARE S/S OF CIRRHOSIS PRESENTATION?
|
FATIGUE, WEAKNESS, MALAISE PRURITUS WEIGHT LOSS, ANOREXIA, N/V HEMATEMESIS ABD PAIN DUE TO ASCITIES MENSTRUAL ABN: IMPOTENCE, STERILITY DIFFCULTY CONCENTRATING, IRRITABILTY, CONFUSION |
|
|
WHAT FINDINGS MAY BE PRESENT IN PHYSICAL EXAMINATION OF CIRRHOSIS?
|
CLOTTING DYSFUNCTION, SPIDER ANGIOMAS LOW GRADE FEVER, SPLEEN ENLARGED ANOREXIA, JAUNDICE RUQ PAIN FLUID WAVE, ABD PAIN - ASCITIES VENOUS HUM OVER EPIGASTRIUM PERIPHERAL EDEMA - THIRD SPACING LIVER=NODULAR->FIRM->ENLARGE->SHRUNKEN |
|
|
WHAT IS NAUSEA?
|
UNPLEASANT OR QUEASY SENSATION OF BEING ABOUT TO VOMIT
|
|
|
WHAT IS VOMITING?
|
EXPULSION OF LIQUID OR FOOD FROM THE STOMACH -RETCHING -REGURGITATION |
|
|
HOW IS VOMITING INDUCED THROUGH STIMULATION OF VOMITING CENTER (VC)?
|
AFFERENT VAGAL & SYMPATHETIC VISCERAL PATHWAY STIMULATION: DELAYED STOMACH EMPTYING DISTENSION DRUGS EMOTIONS ISCHEMIA |
|
|
HOW IS VOMITING INDUCED THROUGH STIMULATION OF CHEMORECEPTOR TRIGGER ZONE (CTZ)?
|
IRRITATION FROM: METABOLIC DISORDERS RAPID CHANGE IN MOTION MEDICATIONS |
|
|
WHAT QUESTIONS SHOULD BE ASKED IN AN SUBJECTIVE ASSESSMENT?
|
ONSET, DURATION, SEVERITY ASSOCIATED SYMPTOMS: PAIN, HEADACHE, DIZZINESS, TINNITUS, DIARRHEA, FEVER, MENTAL STATUS CHANGE, ANXIETY, H/O PREGNANCY, CANCER, DIABETES, IBS CURRENT MEDICATION, RECENT SX RELATION TO FOOD, EMESIS: BLOOD, BILE, UNDIGESTED FOOD FORCE: PROJECTIVE VS. RETCHING |
|
|
WHAT SHOULD BE DONE IN AN OBJECTIVE ASSESSMENT?
|
VS: ORTHOSTATIC, WT, TEMP SKIN: TURGOR, MOISTURE, RASH HEENT: S/S DEHYDRATION, INFECTION NEURO: INCRASED INTRACRANIAL PRESSURE |
|
|
WHAT SHOULD BE DONE IN AN OBJECTIVE ABDOMINAL ASSESSMENT?
|
ABD / INCLUDE RECTAL EXAM: DISTENTION? PERISTALSIS? TENDERNESS? RIGIDITY? REBOUND? MASSES? FECAL IMPACTION? BLEEDING? |
