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25 Cards in this Set
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Gibert's Syndrome
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Unconjugated bilirubinemia during times of stress. Defect is in glucoronyl transferase.
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Perforated Peptic Ulcer
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worsening abdominal pain, development of board like rigidity, voluntary guarding;
potentially pericholecystic fluids. Dx: Abdominal X-Rays |
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Acute Cholecystitis - dx and tx
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RUQ pain, Murphy's sign, fever, leukocytosis.
HIDA scan, or hepatobiliary scan (high sensitivity). |
Antibiotics, delayed cholecystectomy (within 72hrs)
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External Hemorrhoids - thrombosed vs not, tx
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Thrombosed (blue) - incission, evacuation of hemorrhoid, and pressure to control bleeding
Not Thrombosed -sitz baths, topical steroid, fiber, stool softeners. |
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GI Bleed (colon, e.g. diverticula) tx?
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dx w/angiography
tx w/ vasopressing infusion to mesenteric circulation. If fails, use arterial embolization but higher risk for infarction. |
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Gallstone Pancreatitis
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NPO / IV hydration
Delayed cholecystectomy (7 weeks) |
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Cavernous Hemangioma of Liver
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Well circumscribed density w, hypodense area in middle (created from expanding hamartomatous blood vessel),
Tx w/radiological observation. High risk of bleeding if bx. |
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Zenker's Diverticulum
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Risk: hypertrophied cricopharyngeus muscle causing indentation of posterior cervical esophagus.
Etiology - arises in transition zone betw oblique fibers of thyropharyngeus and horizontal fibers of cricopharyngeus. |
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Alcoholic Hepatitis
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AST > ALT, usually by 2:1
Larger liver |
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Viral Heapatitis
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ALT > AST, usually by 2:1
Normal/small liver |
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Acute intermittent porphyria - sx and dx
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Severe abdominal pain, nonspecific, transient. Also other strange sx like n/v/paresthesias.
Familial, onset after puberty, more often in women. Results from defect in heme synthesis. Dx via urinary ALA. |
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Paroxysmal nocturnal hemoglobinuria
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Intermittent hemolysis at night, may present as fatigue and dark urine.
Etiology: cell membrane defect lacking anticomplement protein. At night, oxidative stress results from normal increase in pCO2 -->Cell lysis Dx w/ Ham acidification test --> lysis |
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dumping syndrome
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often post GI surgical procedure removing pylorus;
Sx include diarrhea, cramps, palpitations, flushing. Tx - +fat, -CHO in diet. If refractory, somatostatin. |
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Cholelithiasis
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Crampy RUQ pains, often follows fatty meal. N/V.
No signs of inf: fever, chills, leukocytosis. Dx - US may show gallstones. |
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Cholecystitis -- calculous
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Fever, n,v, RUQ pains, Murphy's sign, leukocytosis
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GERD Workup
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Treat if suspicious
Endoscopy / Biopsy for barrets Esophageal manometry 24-hr pH monitoring |
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Ischemic Bowel
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(LLQ) Pain, precipitated by hypotension or illness, green mucosa and isolated depigmented patches,
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Diverticulitis
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LLQ paiins, older pt, fever/chills, leukocytosis; If recurrent admissions, or pneumaturia (from colovesicular fistula), surgery is indicated.
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Upper GI Ulcer
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Be sure to do repeat endoscopy in 6-8 weeks, rule out gastric cancer (non-healing)
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Essophageal varicies treatment
1a-2b? 3 (high grade) Actively bleeding |
1-2b --> Non-selective Beta Blocker
3 --> esophageal banding Bleeding? Sclerotherapy |
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Chronic Pancreatitis - approach
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1. Low fat diet
2. Non-enteric coated pancreatic enzymes and H2 blocker if unresponsive 3. Octreotide for pain relief 4. Medium chain triglycerides if 1/2 fail |
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IBD Surveillance
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Annual colo, esp for UC, but also for Crohn's (esp if it involves the colon). If chron's involves colon, risk for colon cancer increases significantly.
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Hepatorenal syndrome
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Findings of renal and liver failure. It may be difficult to differentiate from prerenal azotemia. If urine sodium is 10-20mEq/L, suspect prerenal azo. If <10, suspect hepatorenal syndrome.
TREAT: Removal of ascites, mild fluid recussitation, *Liver Transplant* |
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Acute Cholangitis
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Charcot's Triad - fever, RUQ pain, jaundice.
Pain is due to gallbladder extension. Fever due to gram negatives infiltrating. |
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Upper GI Bleed workup
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1. NG Tube
2. If clear, must do upper endoscopy to evaluate for missed UGIB past pylorus 3. If still negative, Angigraphy can be used to find bleeding as slow as 0.5mL/min. Embolization may also be used. |
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