Gallbladder, Appendicits, Stomach

Question 1

Murphy’s sign

Answer 1

RUQ

Gallbladder test

Question 2

Cholecystitis and cholelithiasis

Answer 2

Female 
Multiparous 
Flatulence 
Distention
Obese
Right scapular pain
Jaundice 
Steatorrhea

Question 3

Appendicitis

Answer 3

WBC 17,500
Neutrophilia
Schillings shift = increase WBC’s rapidly
RLQ pain

Question 4

Appendicitis pain/test

Answer 4

Periumbilical => McBurney’s => relief (burst) => peritonitis (rebound tenderness)

Question 5

Appendicitis tests continued

Answer 5

Psoas test
Blumberg’s (rebound tenderness)
Rosvings (pressure LLQ)
Markle (heel jar) => up on toes, drop hard to heels

Question 6

Stomach location

Answer 6

Epigastric region

Question 7

Peptic ulcers two types

Answer 7

Gastric and duodenal

Duodenal = more common; pain 2 hours after eating

Question 8

Peptic ulcers

Answer 8

• barium study
• infection
• H. Pylori

Question 9

Stomach cancer

Answer 9

• virchow’s node on left
• occult blood
• pt reports: “eating and losing weight”

Question 10

Gastritis

Answer 10

Elderly
Alcohol
B12 absorption problems
PLS (posterolateral sclerosis)

Question 11

B12 story

Answer 11

1. Extrinsic factor, diet (animal products) = cyanocobalamin
2. Gut has parietal cells that secrete HCL and intrinsic factor (makes B12 absorbable)

Question 12

B12 (cobalt) responsibilities

Answer 12

1. RBC maturation (reticulocyte is big, immature RBC)

2. Myelination of nerves (demyelination is sclerosis)

Question 13

B12 pathology progression

Answer 13

Chronic gastritis (parietal cell degradation) from chronic diet abuse, proton inhibitory pump, meds (Nexium)

Pernicious anemia (reticulocytosis); pale and fatigue

Posterolateral sclerosis (combined systems disease), stocking and glove paresthesia

Question 14

B12 tests

Answer 14

B12 assay
Schillings test: confirmatory test
Achlorhydria

Question 15

B12 treatment

Answer 15

B12 intramuscular injections