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Outpatient Medicine > Pancreatitis, gastroenteritis > Flashcards

Pancreatitis, gastroenteritis Flashcards

1
Q

How do you diagnose a patient with suspected kidney stones (Left sided colicky pain in LUQ/LLQ, microscopic hematuria)?

A

noncontrast helical CT scan to look for kidney stones

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2
Q

How many patients with kidney stones have hematuria on UA?

A

almost 90%

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3
Q

how small of a kidney stone can noncontrast helical CT pick up?

A

1 mm diameter

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4
Q

Are x-rays good tests for picking up kidney stones?

A

Not really; They have low sensitivity (not pick up small stones or radiolucent stones) and low specificity (vascular calcifications)

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5
Q

what is the #2 choice for evaluating kidney stones if you can’t do noncontrast helical CT scan?

A

IV pyelography. It is sensitive and specific. But, it requires bowel prep and iodine contrast so you can’t use in those with AKI or CKD

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6
Q

What is an “acute abdomen”?

A

Sudden severe abdominal pain (less than 24 hrs)

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7
Q

How do you evaluate an acute abdomen? Why?

A

supine and upright CXR!!

To exclude bowel obstruction (air-fluid levels) or perforation (free peritoneal air)

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8
Q

What are 2 signs of peritonitis?

A
  1. Rebound tenderness

2. Severe diffuse abdominal pain

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9
Q

What are the 3 categories of etiologies of acute abdominal pain?

A
  1. Infectious
  2. Ischemic
  3. Inflammatory

*memory: Think of the roman number III (three I’s)

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10
Q

All patients with acute abdominal pain should have what lab test done?

A

Lipase and amylase

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11
Q

What are the 3 herald signs of AAA rupture?

A

Sudden abdominal pain, back pain, and syncope

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12
Q

What 2 things MUST be present to diagnose hemolytic uremic syndrome (E. Coli O157:H7, shiga toxin, undercooked beef)?

A
  1. Thrombocytopenia (platelet count)
  2. Hemolytic anemia (blood smear)

^This shows thrombotic microangiopathy

AKI and headache/confusion may also be seen but are not required for diagnosis

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13
Q

How do you treat hemolytic uremic syndrome in children?

A

Not antibiotics!! No benefit in children. Treatment with supportive (fluids, CBC, BMP daily, dialysis if renal failure).

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14
Q

What do routine stool cultures test for?

A

Salmonella, shigella, campylobacter

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15
Q

What are the 3 classic findings of chronic pancreatitis?

A
  1. Mid-epigastric abdominal pain
  2. Postprandial diarrhea
  3. Diabetes mellitus
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16
Q

How do you diagnose chronic pancreatitis?

A

Symptoms can be enough. If symptoms unclear (ex: diffuse abdominal pain, normal pancreatic enzyme levels) then look for calcifications on abdominal X-ray (30% sensitive) or CT scanning (90% sensitive)

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17
Q

Symptoms of C. Difficile infection

A
  • Diarrhea 10-15xday
  • lower abdominal pain
  • cramping
  • fever
  • WBC >15,000
18
Q

How do you treat severe C. Difficile infection?

A

Oral vancomycin and IV metronidazole

19
Q

How do you treat salmonella gastroenteritis?

A

Usually self-limited requiring no treatment. If he gets dehydrated, replace fluids and electrolytes. Do not give loperamide/imodium, because its a potentially invasive species and you want it out

20
Q

How do you treat salmonella gastroenteritis for pts 50 yrs old?

A

Ciprofloxacin

21
Q

Which groups requiring more aggressive salmonella treatment?

A
  1. Immunocompromised (ex: on steroids)
  2. 50 yrs old
  3. Hospitalized bc sick for another reason
  4. Have atherosclerotic plaques (salmonlla can seed there)
  5. Have bone prosthesis (salmonlla can seed there)
22
Q

When would you need jejunal enteral feedings in a patient with pancreatitis?

A

If expect the patient wont be able to eat for a long time

23
Q

What are the 2 most common causes of pancreatitis?

A
  1. Gallstones
  2. Alcohol

Together these make up 80% of cases

24
Q

A patient has pancreatitis but no stone is seen in the CBD. What findings would cause you to think gallstone pancreatitis is the cause ANYWAY?

A
  • stones in the gallbladder
  • dilated bile duct
  • elevated ALT and AST

Ultrasound is only 50% sensitive for choleDOCHOlithiasis (although almost 100% sensitive for cholelithiasis) so keep in mind a stone could STILL be there even though you dont see it

25
Q

What are findings seen in autoimmune pancreatitis?

A
  • hypergammaglobulinemia
  • diffuse pancreatic enlargement
  • mass lesion in the pancreas
  • irregular main pancreatic duct
  • presence of ANA or other autoantibodies
  • only mild symptoms
26
Q

In a patient with severe acute pancreatitis, where should a feeding tube (enteral nutrition) be advanced to in the gut?

A

Past the ligament of treitz (so past the duodenum) so the pancreas doesn’t get stimulated

27
Q

What must be present in order for you to believe a nasogastric tube lavage is truly negative for blood?

A

Bile must be present, because that means the tube did make it past the pylorus into the duodenum

28
Q

What are indications for hemodialysis?

A

Severe acidosis
Hyperkalemia
Renal failure with hypervolemia

29
Q

What is seen on colonoscopy in C. Difficile infeciton?

A

Pseudomembranes (raised yellow or off-white plaques scattered all over the colorectal mucosa)

30
Q

What symptom is present in >85% of pancreatitis cases (besides epigastric pain)?

A

vomiting. If the patient is not vomiting, you should consider another diagnosis

31
Q

What is more sensitive for pancreatitis: Lipase or amylase?

A

Lipase. And its usually 3X normal

32
Q

Does degree of lipase/amylase elevation correlate with severity of disease?

A

no

33
Q

What is Grey-turner sign?

A

Flank ecchymosis. A sign of retroperitoneal bleeding. Can be seen occasionally in pancreatitis.

34
Q

What would you suspect with a positive psoas sign (pain when extend right thigh while laying on left side)?

A

appendicitis

35
Q

How do you diagnose appenditicis?

A

Abdominal CT, even in pregnant patients

but up to date says ultrasound or MRI

36
Q

What defines acute diarrhea?

A

Lasting 7 days.

37
Q

When should you suspect bile acid malabsorption rather than bile acid deficiency?

A

malaborption: 100 cm small bowel removed. Excess fecal fat.

38
Q

When would you suspect dumping syndrome?

A

Patient with gastric bypass surgery who gets postprandial diarrhea, flushing, and rachycardia

39
Q

How high does fecal fat content have to be to indicate fat malabsorption?

A

> 10g in 24 hours

40
Q

What happens to B12 and folate in bacterial overgrowth?

A

B12 goes down (bacteria cleave it from intrinsic factor)

Folate goes up

Outpatient Medicine (16 decks)

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