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33 Cards in this Set
- Front
- Back
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Acute Cholecystitis |
inflammation/infection of gallbladder, commonly a blockage of CBD, resulting in pressure on ductal system. Gangrene or perf could result S/Sx for acute: biliary colic >4-6 hours, anorexia, fever, chills, Charcot triad: RUQ abd pain, fever, jaundice PE In distress, RUQ tenderness, tachycardia, fever, muscle guarding, rebound tenderness, rigidity, distended tender BG, hypoactive bowel sounds, dehydration, jaundice, Murphy's sign (RCM) CBC with diff, CMP, LFT, amylase, lipase, HCG, EKG (WBC, bili, amylase, lipase elevated), alkaline phosphatase Ultrasound (gold standard), CT with contrast (Hidascan) Surgery, IV hydration, antispasmodics, antiemetics, NG tube, Ketorolac Fat, female 40, flatulent, fertile, fat intolerant, dieting, statins, elevated triglycerides, DM, oral contraceptives, Native america, family hx, cirrhosis, gastric bypass surgery, hyperalimentation, Crohn's hyperparathyroidism |
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Acalculous chole |
Without gallstone (stasis and hypoperfusion) upper abd pain, n/v/SOB, diarrhea, fever, chills, fatigue, elevated WBC usually in hospital |
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Chronic cholecystitis |
symptoms >3 months Avoid high fat foods, antiemetics, antispasmodics/NSAIDS, IVF, referral, medications May be normal WBC |
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Symptomatic cholelithiasis |
Biliary colic, RUQ may radiate to right posterior shoulder, may have n/v, usually occurs within 1 hour of eating (high fat meal), lasts 1-6 hours |
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Pancreatitis what is it? diagnostic criteria, tests |
inflammation of pancreas, tissue destruction due to autodigestion; can cause SIRS and multi system organ failure Causes: alcohol, autoimmune disorders, arteritis, Biliary, blunt trauma, congenital, drugs, ercp, eosinophilia, formations, genetic, hyperlipidemia, hypercalcemia, idiopathic (HIV, IBD) Risk alcohol, autoimmune disorder, arthritis, Diagnostic criteria: 2/3 abdominal pain suggestive of pancreatitis, serum amylase or lipase levels at least 3x normal, characteristic findings on imaging Epigastric tenderness, elevated VS, hypotension, tachycardia, jaundice, unable to take deep breaths, Cullen(periumbilicus), Turner (flank) CT with contrast |
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Pancreatitis what is it? diagnostic criteria, tests |
inflammation of pancreas, tissue destruction due to autodigestion; can cause SIRS and multi system organ failure Causes: alcohol, autoimmune disorders, arteritis, Biliary, blunt trauma, congenital, drugs, ercp, eosinophilia, formations, genetic, hyperlipidemia, hypercalcemia, idiopathic (HIV, IBD) Risk alcohol, autoimmune disorder, arthritis, Diagnostic criteria: 2/3 abdominal pain suggestive of pancreatitis, serum amylase or lipase levels at least 3x normal, characteristic findings on imaging Epigastric tenderness, elevated VS, hypotension, tachycardia, jaundice, unable to take deep breaths, Cullen(periumbilicus), Turner (flank) CT with contrast |
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Red flags for pancreatitis |
older than 50, new onset DM, neg ETOH or GB hx, weight loss, change in bowel habits, constitutional symptoms |
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Pancreatitis what is it? diagnostic criteria, tests |
inflammation of pancreas, tissue destruction due to autodigestion; can cause SIRS and multi system organ failure Causes: alcohol, autoimmune disorders, arteritis, Biliary, blunt trauma, congenital, drugs, ercp, eosinophilia, formations, genetic, hyperlipidemia, hypercalcemia, idiopathic (HIV, IBD) Risk alcohol, autoimmune disorder, arthritis, Diagnostic criteria: 2/3 abdominal pain suggestive of pancreatitis, serum amylase or lipase levels at least 3x normal, characteristic findings on imaging Epigastric tenderness, elevated VS, hypotension, tachycardia, jaundice, unable to take deep breaths, Cullen(periumbilicus), Turner (flank) CT with contrast high amylase (>200, elevated lipase), hyperglycemia, hypocalcemia, hyperlipidemia |
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Red flags for pancreatitis |
older than 50, new onset DM, neg ETOH or GB hx, weight loss, change in bowel habits, constitutional symptoms |
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Chronic pancreatitis causes, presentation, management |
Inflammatory changes, alcohol/smoking presentation: upper abd pain, n/v, losing weight without trying, oily, smelly stools (steatorrhea) CBC, CMP, amylase, lipase, alk phos, bili, imaging (endoscopic ultrasound) if between 20-40 eval for cystic fibrosis Pain control, nutritional support, pancreatic enzymes, GI referral, low fat, high protein diet |
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Management Diverticular disease |
non pharm: increase fiber, exercise pharm anticholinergic, antispasmodics Narcotics discouraged Hosp: if fever >101.3, marked tenderness, peritonitis, obstruction, abscess, immunosuppressed, DM, CKD, older |
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Crohn's disease definition and risk factors |
chronic relapsing, mouth to rectum, transmural inflammation, skip pattern/patchy, colon and small bowel, cecum and ileum smokers, genetics cramping, abd pain and diarrhea, blood, fatigue, weight loss, anorexia, fever, chills, n/v, joint pain, mouth sores, intestinal obstruction, vomiting, bloating, no stool, perianal disease, possible fever, weight loss, blood stools in colon, RLQ tenderness colonoscopy, endoscopy, sigmoidoscopy, CBC smoking cessation, alcohol consmption, avoid spicy foods |
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Management of IBD |
non pharm: smoking cessation, reduce alcohol, avoid spicy and fried and oily food, fiber rich diet as tolerated, more Omega 3 fats |
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UC Meds |
Mild: 5-ASA Mod: 5 ASA, Infliximab Severe: Glucocorticoid, Cyclosporine, Infliximab Refractory: Glucocorticoid, Azathioprine, Mercaptopurine In remission: 5-ASA, Azathioprine, Mercaptopurine |
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Crohn's dz meds |
Mild: mesalamine, metronidazole, budenoside, cipro mod: glucocorticoid, azathioprine, mercaptopurine, infliximab severe: glucocorticoid, methotrexate, infliximab refractory: infliximab in remission mesalamine, azathioprine, mercaptopurine, infliximab |
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Colorectal cancer screening |
all adults starting at age 45 gFOBT or FIT every year sDNA Fit every 1-3 yrs CT colonography: every 5 yrs Flex sig q5 yrs colonoscopy q10yr |
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Colorectal cancer staging |
1: mucosal (colonoscopy) 2: submucosal: in muscle (surgery) 3: lymph nodes (surgery, chemo) 4: mets |
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High risk colorectal cancer |
age >50, family hx, DM, men, African Americans prior colorectal ca, ulcerative colitis, hereditary and genetic factors, familial polyposis syndromes, LT cig smoking, high fat high calorie diet physical activity, obesity, high consumption of red meats, low consumption of fruit and veg, etoh, tobacco, HRT, statins, garlic smoking |
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sx colon ca |
left side cramping, stool caliner, melena (anemia), constipation or diarrhea, decreased app, weight loss, sign of ascites, hepatomegaly, lymph, rectal exam, 10 yrs prior dx of family angina, SOB, gas pain, colicky pain after meals |
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Colon cancer anticipatory guidance |
high fiber/low fat diet, exercise, smoking cessation, decrease etoh, counseling/spport groups |
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Liver disease subjective findings |
fever, fatigue, dark urine, clay colored stool, abd pain, loss of app, n/v, joint pain, jaundice, itching PE jaundice, spide veins, palmar erythema, enlarged parotids, ascites, hepatosplenomegaly |
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Liver disease diagnostics |
LFT, IgG, IgM, bilirubin, CBC, PT/INR, albumin, liver biopsy, AST/ALT |
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IgG HAV positive |
Antibodies present, no virus present |
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Alkaline phosphatase |
Enzyme from bone liver gallbladder kidneys GI tract |
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IgM HAV positive |
Acute infection |
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HbsAg |
Screening for hepb, infectious |
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Anti-HBS positive |
Hep b immune |
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HbeAg |
Hep b e antigen Active viral replication, may be highly infectious Chronic infection |
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Anti-HCV |
Hep c screening If positive, order HCV rna |
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Ast aspartate aminotransferase |
0-45 Liver heart muscle skeletal muscle kidney and lung |
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Alanine aminotransferase ALT |
0-40 Mainly in liver, liver inflammation |
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AST/ALT ratio |
Indicates 2.0 ratio: indicative of alcohol abuse |
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Serum GGT |
Indicator of alcohol abuse |
