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Gastrointestinal > Primary care presentations of Gallbladder disease > Flashcards

Primary care presentations of Gallbladder disease Flashcards

1
Q

What are the organs that are in the retroperitoneal space?

A 
Suprarenal glands
Aorta
Duodenum
Pancreas
Ureters
Colon (ascending and descending)
Kidneys
Esophagus
Rectum
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2
Q

What is reflux?

A

Effortless, backward flow of stomach contents into the esophagus and higher

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3
Q

What is regurgitation?

A

to expel small amounts of previously consumed material from stomach

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4
Q

What are Zenker diverticula?

A

False diverticula between the cricoid and thyroid cartilage.

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5
Q

What is the difference between a false and true diverticulum?

A

True involve the entire thickness of the GI tract

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6
Q

What bean is ricin from? MOA?

A

Castor beans

rRNA N-glycosylase activity that is responsible for the cleavage of a glycosidic bond within the large rRNA of the 60S subunit of eukaryotic ribosomes

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7
Q

What are the two most common viral causes of gastroenteritis?

A

Norovirus

Rotavirus

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8
Q

Wild swings of BGs in DM pts may cause what?

A

Gastroparesis

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9
Q

Projectile vomiting in kids = ?

A

Pyloric stenosis

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10
Q

What is the PE finding for kids with pyloric stenosis?

A

Olive feeling

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11
Q

Coffee ground emesis is suggestive of what?

A

GI bleed

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12
Q

Fresh blood in vomit is suggestive of what?

A

Arterial rupture

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13
Q

What is Boerhaave’s syndrome?

A

Rupture of the esophageal wall, usually iatrogenic in nature

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14
Q

What are the red flags of n/v? (age, CNS ssx, type of vomit, motility)

A

older than 55
AMS
Feculent vomiting
Progressive dysphagia

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15
Q

Feculent vomiting is suggestive of what?

A

BO

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16
Q

What is the definition of acute diarrhea? Chronic?

A

3- 14 days of loose stool

Chronic is >14 days

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17
Q

What are the pertinent HPI bits to evaluate for diarrhea? (3)

A

Recent travel
Loose vs diarrhea
Recent sick contacts

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18
Q

What two drug types are associated with C.diff?

A

PPIs

abx

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19
Q

Oily diarrhea = ?

A

Steatorrhea (think Giardia or pancreatic insufficiency)

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20
Q

Pain with diarrhea=?

A

Usually indicates an invasive process

21
Q

How do you differentiate salmonella and shigella? (3)

A

Salmonella has:

  1. Motility
  2. H2S
  3. Glucose fermentation
22
Q

Turtles carry what bacteria?

A

Salmonella

23
Q

What are the non-obvious parts of the work up for diarrhea, besides obvious? (3)

A

Stool pH
Leukocytes
Enzyme assays for viruses

24
Q

What are the red flags of diarrhea? (6)

A
  1. Bloody/tarry
  2. Extremes of age
  3. Recent travel
  4. Unintentional weight loss
  5. High fever
  6. Volume of stool
25
Q

What is the cause of hemolytic uremic syndrome?

A

EHEC OH157:H7

26
Q

What are the hormonal causes of constipation?

A

Hypothyroidism

27
Q

What is the Bristol stool chart? What are the normal types?

A

Type 1 - 7, with 1 being hard lumps to 7 being complete liquid

(3 and 4 are about normal)

28
Q

Constipation alternating with diarrhea suggests what etiology?

A

IBS

29
Q

Inability to pass gas is suggestive of what?

A

BO

30
Q

Bloating in a diurnal pattern suggests what?

A

Ovarian cancer or ascites

31
Q

In whom is gastric carcinoma common?

A

Japanese

32
Q

What is the main factor that changes the workup of a pt with abdominal pain?

A

Location of the pain

33
Q

True or false: the only reason not to do a DRE is blah blah blah

A

False– just adds discomfort.

34
Q

What is Rovsing’s sign?

A

a sign of appendicitis. If palpation of the left lower quadrant of a person’s abdomen increases the pain felt in the right lower quadrant, the patient is said to have a positive Rovsing’s sign and may have appendicitis.

35
Q

What is Carnett’s sign?

A

a finding on clinical examination in which (acute) abdominal pain remains unchanged or increases when the muscles of the abdominal wall are tensed. A positive test increases the likelihood that the abdominal wall and not the abdominal cavity is the source of the pain

36
Q

What is the psoas sign?

A

indicates irritation to the iliopsoas group of hip flexors in the abdomen, and consequently indicates that the inflamed appendix is retrocaecal in orientation (as the iliopsoas muscle is retroperitoneal). It is elicited by performing the psoas test by passively extending the thigh of a patient lying on his side with knees extended, or asking the patient to actively flex his thigh at the hip.

37
Q

RLQ pain is associated with what disease?

A

Crohn’s

38
Q

LUQ pain is associated with what?

A

Splenic rupture

39
Q

Where does UC usually start?

A

Sigmoid colon

40
Q

What are the three common etiologies of LLQ pain?

A

Diverticulitis
UC
IBS

41
Q

Does IBS wake you from sleep? IBD?

A

IBS no, IBD yes

42
Q

What are the three common etiologies of periumbilical pain?

A

BO
Early appy
Aortic dissection

43
Q

Right or Left LQ pain is suggestive of what?

A

Ureterolithiasis
Ectopic prego
Ruptured ovarian cyst

44
Q

Suprapubic pain is suggestive of what?

A

Cystitis

PID

45
Q

What is the chandelier sign? What does this suggest?

A

Small movement of the cervix causes extreme pain. Suggestive of PID

46
Q

What is Kehr’s sign?

A

The occurrence of acute pain in the tip of the shoulder due to the presence of blood or other irritants in the peritoneal cavity when a person is lying down and the legs are elevated. Kehr’s sign in the left shoulder is considered a classical symptom of a ruptured spleen

47
Q

What are the abx that particularly cause n/v? What are the drugs that are in this class?

A

macrolides
Erythromycin
Azithromycin
Clarithromycin

48
Q

What are the alarm features of bloating? (5)

A 
Age
Anemia
Fluid/mass
Visible distension
Co-existing n/v
49
Q

What are the FODMAPS?

A

Short chain carbs that are poorly absorbed in the intestines:

Fermentable
Oligo
Di
Mono saccharides
and Polyols

Gastrointestinal (42 decks)

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