Clinical Case Correlations Flashcards
(107 cards)
1
Q
absence of secretion of bile
A
acholic
2
Q
lack of appetite
A
anorexia
3
Q
a rumbling noise caused by propulsion of gas through the intestines
A
borborygmi
4
Q
a profound and marked state of constitutional disorder; general ill health and malnutrition
A
cachexia
5
Q
stoppage or suppression of bile flow
A
cholestasis
6
Q
denotes blood congealed and separated within gastric contents that takes the form of coffee grounds when in contact with acidic environm,ent
A
coffee-ground emesis
7
Q
enlarged non-tender gallbladder secondary to pancreatic disease or cancer
A
courvoisier’s sign
8
Q
ecchymosis around the umbilicus (periumbilical) secondary to hemorrhage
A
cullen sign
9
Q
a peptic ulcer of the duodenum in a patient wiht extensive superficial burns
A
curling ulcer
10
Q
peptic ulcer occuring from severe head injury or with other lesions to the CNS
A
cushings ulcer
11
Q
postprandial epigastric discomfort
A
dyspepsia
12
Q
difficulty swallowing
A
dysphagia
13
Q
abnormal tissue development, alteration in size, shape, and organization or cells
A
dysplasia
14
Q
having no teeth
A
edentulous
15
Q
ERCP
A
endoscopic retrograde cholangiopancreatography
16
Q
EUS
A
endoscopic ultrasound
17
Q
inflammation of the stomach with distinctive histologic and endoscopic features
A
gastritis
18
Q
gastric conditions where there is epithelial or endothelial damage without inflammation
A
gastropahty
19
Q
GGT
A
gamma-glutamyl transferase, used to determine the cause of elevated alkaline phosphatase (ALP)
20
Q
if GGT and ALP are both elevated, what should you suspect?
A
liver disease
21
Q
if ALP is elevated but GGT is normal, what should you suspect?
A
not liver disease (usually bone)
22
Q
flank ecchymosis secondary to hemorrhage
A
grey turner sign
23
Q
foreign body sensation localized in the neck that does not interfere with swallwoing is sometimes relieved by swallowing
A
Globus pharyngeus
24
Q
patient su[pine, doc strikes patient’s heel. pain upon striking may indicate what
A
appendicitis
peritonitis
heel strike test
25
vomiting blood
hematamesis
26
passage of bright red blood or maroon stools
hematochezia
27
yellowish staining of the integument, sclera, and deeper tissues and of the excretions with bile pigments, which are increased in plasma
jaundice (icterus)
28
patient flexes hip against resistance, increased abdominal pain indicates what
irritation of the psoas muscle from inflammation of the appendix
29
KUB xray
kidneys ureters bladder
| plain abdominal xray
30
LGIB
lower gastrointestinal bleeding
31
gently tapping the costovertebral angle (CVA) and eliciting pain in the patient indicates
infeciton around the kidney or kidney stone
32
dark colored stool consistent with broken down hemosiderin in bowel, typically malodorous, sticky, thick like paste - "tarry"
melena
| melenic stools
33
lower abdominal pain in the middle of the menstruation cycle (feel ovulation) no rebound tenderness
mittelschmerz
34
MRCP
magnetic resonance cholangiopancreatography
35
deep palpation under right costal margin during inspiration observing for pain/sudden halting of inspiration
murphy sign
| tests for acute cholecystitis or cholelithiasis
36
severe intractable constipationcaused by intestinal obstruction
obstipation
37
flex patients thigh at hip and internally rotate leg at the hip. test for right hopgastric pain
obturator test
| suggests irritation of the obturator muscle from an inflamed appendix
38
odynophagia
painful swallowing
39
pneumobilia
abnormal presence of gas in the biliary system/ bile ducts
40
pneumomediastinum
abnormal presence of air or gas in the mediastinum, may interfere iwth respiration and circulation, may lead to pneumothorax or pneumopericardiu, occur spontaneously or as a result of trauma or pathology or after diagnostic procedure
41
pneumoperitoneum
abnormal presence of air or gas in the peritoneal cavity
42
RLQ pain with passive right hip extension
psoas sign
43
pyrosis
substernal burning sensation
| heartburn
44
pain upon removal of pressure, rather than application of pressure ot the abdomen
rebound tenderness test
| assesses peritoneal inflammation/acute abdomen
45
effortless reflux of liquid or gastric or esophgeal food contents in teh absence of N/V
regurgitation
46
peristalsis of the stomach and esophagus conducted with a closed glottis
retching
47
pain in the RLQ during pressure to LLQ
rosvings sign
48
fat, greasy stools
steatorrhea
49
ineffectual and painful straining at stool or urination
tenesmus
50
UGIB
upper gastrointestinal bleeding
51
local defect, or excavation of the surface of an organ or tissue that is produced by the sloughing of inflamed necrotic tissue
ulcer
52
stone from kidney making its way thorugh ureter to bladder
ureterolithaisis
53
palpable mass, lymph node, in the left supraclavicular/sternoclavicular fossa
virchow's node
54
vomiting reflex is coordinated by what area of the CNS
medulla
55
nerve impulses for vomiting reflex are transmited via what nerves
vagus and sympathetic afferents
56
events in vomiting (7)
```
reverse peristalsis in SI
stomach and pylorus relaxation
forced inspiration to increase intrabdominal pressure
movement of the larynx
LES relaxation
glottis closes
forceful expulsion fo gastric contents
```
57
gastric outlet obstruction, peptic ulcer disease, malignancy, gastric volvulus, SI obstruction, adhesions, hernias, volvulus, crohn disease, carcinomatosis all are what causes of N/V
mechanical obstructions leading to N/V
58
gastroparesis, diabetic, postviral, postvagotomy, SI, scleroderma, amyloidosis, chronic . intestinal pseudoosbsruction can all cause N/V in what manner
dysmotility leading to N/V
59
visceral afferents can be stimulated by what mechanisms leading to N/V
```
infections
mechanical obstruction
dysmotility
peritoneal infetion
hepatobiliary or pancreatic disorders
topical gastrointestinal irritants
postoperative
```
60
what types of vestibular disorders can lead to N/V
labyrhinthitis, meniere syndrome, motion sickness
61
what types of CNS disorders can lead to N/V
increased intracranial pressure (from tumors, subdural or subarachnoid hemorrhage)
migraine
inffections (meningitis, encephalitis)
psychogenic (anticipatory vomiting, anorexia nervosa and bulemia, psychiatric disorders)
62
what types of irritations to the chemoreceptor trigger zone can lead to N/V
antitumor chemotherapy
medications and drugs
radiation therapy
systemic disorders (DKA, Uremia, adrenocortical crisis, pregnancy, PTH disease)
63
oropharyngeal dysphagia
trouble initiating swallowing
64
causes of oropharyngeal dysphagia
```
neurologic disorders
muscular and rheumatologic disoders
metabolic disorders
infectious disease
structural borders
motility disorders
```
65
example of motility disorders leading to oropharyngeal dysphagia
UES dysfunction
66
examples of neurologic disorders leading to oropharyngeal dysphagia
brainstem cerebrovascular accident, mass lesion
amyotrophic lateral sclerosis, multiple sclerosis, psuedobulbar palsy, post-polio syndrome, guillain barre syndrome
parkinson disease
huntington disease
dementia
tardive dyskinesia
67
examples of muscular or rheumatologic disorders leading to oropharyngeal dysphagia
myopathies, polymyositis
oculopharyngeal dystrophy
sjogren syndrome
68
examples of metabolic disorders leading to oropharyngeal dysphagia
thyrotoxiicosis, amyloidosis, cushing disease, wilson disease
medications side effect (anticholinergics, phenothiazines)
69
examples of infectious disease disorders leading to oropharyngeal dysphagia
```
polio
diptheria
botulism
lyme disease
syphilis
mucositis
```
70
examples of structural disorders leading to oropharyngeal dysphagia
zenker diverticulum
cervical osteophytes, cricopharyngeal bar proximal esophageal webs'oropharyngeal tumors
postsurgical or radiation changes
pill-induced injury
71
questions to ask if you suspect esophageal dysphagia
```
solids or liquids (or both)
solids - think mechanical obstruction
both think motility disorders
worsening (progressive) or staying the same (not progressive)
constant vs intermittent
```
72
examples of mechanical obstructions leading to esophageal dysphagia
schatzki ring
peptic structure
esophageal cancer
eosinophilic esophagitis
73
examples of motility disorders leading to esophageal dysphagia
achalasia
diffuse esophageal spasm
scleroderma
ineffective esophageal motility
74
loss of peristalsis in the distal two thirds of the esophagus due to 1) impaired relaxation of the LES secondary to denervation of the esophagus from loss of NO producing inhibitory neurons in the myenteric plexus
achalasia
75
bird's beak in distal esophagus is indicative of
achalasia
76
what test should be performed to confirm diagnosis of achalasia
esophageal manometry
complete absence of normal peristalsis and incomplete LES relaxation with swallowing will be monitored by the manometry device by pressure
77
secondary achalasia results from what
parasite trypanosoma cruzi
indistinguishable otherwise from primary achalasia
may extend to heart and other smooht muscle
78
alarm features of dyspepsia and epigastric pain
```
dysphagia
odynophagia
hematemesis
melena
unintentional weight loss
persistent vomiting
constant/severe pain
unexplained iron deficiency
palpable mass
lymphadenopathy
family history of upper GI cancer
```
79
PUD
peptic ulcer disease
ulcers extend through the muscularis mucosae and are usually over 5mm in diameter
signs: coffee ground emesisk, hematemesis, melena, hematochezia
80
h. pylori produce what enzyme that allows them to colonize the stomach
urease - neutralizes gastric acid
| in the antral mucosa
81
h. pylori infections are associated with
PUD (moreso duodenal)
chronic gastritis
gastric adenocarcinoma
gastric MALT lymphoma
82
risk factors of h pylori infection
```
poverty
overcrowding
limited education
ethnicity
rural
birth outside US
```
83
methods for the detection of the h. pylori infection
urea breath test (great first line)
fecal antigen test (first line, sensitive, specific, inexpensive)
upper endoscopy
patients must stop PPI medication 14 days before fecal/breath tests
84
strains of h pylori with what toxin significantly increase the risk of ulceration
Cag-A toxin
85
peptic ulcer disease falls into what two categories
gastric (NSAIDs/h pylori infection ==> lowers acid secretion)
duodenal (more common, increases gastric acid secretion)
86
MoA of NSAIDs damage of gastric mucosa
inhibits COX 1 and 2
inhibits prostaglandins
inhibits NO
leads to decreased protective measures in gastric/duodenal mucosa
87
if ulcerations are intractable/recurrent/severe, what diagnosis should be examined
zollinger-ellison syndrome
| gastric secreting tumors often in the duodenum
88
Zollinger ellison syndrome is associated with what mutation?
MEN 1 (multiple endocrine neoplasia)
89
comfirmatory diagnosis for ZE syndrome
serum gastrin > 1000 ng/L
| positive secretin stimulation test (negative in other causes of hypergastrinemia)
90
describe the secretin stimulation test
secretin administration normally inhibits gastrin release
| in gastrinomas, gastrin secretion causes a paradoxical increase in gastrin release
91
differential Dx of epigastric pain
```
PUD
functional dyspepsia
atypical gastroesophageal reflux
gastric cancer
food poisoning
viral gastroenteritis
biliary tract disease
```
92
UGIB differentials
```
PUD
erosive gastritis
arteriovenous malformations/angioectasias
mallory-weiss tear
esophageal varices
```
93
EGD
```
upper endoscopy (esophagogastroduodenoscopy)
study of choice for evaluating persistent heartburn, dysphagia, odynophagia, structural abnormalities detecte don barium esophagograpy
```
94
barium xrays are useful in differentiating what
mechanical lesions and motility disorders
barium study is more sensitive for detecting subtle esophageal narrowing due to rings, achalasia, and proximal esophageal lesions
95
manometry is useful for diagnosing what disorders
esophageal motility
| establishes etiology of dysphagia in patients in whom a mechanical obstruction cannot be found
96
CT has no part in ____ detection of gastric ulcers
primary detection, use CT to detect collections in subphrenic and other collections to look for perforation
97
HIDA stands for what and is used to detect function in what organ
hydroxy iminodiacetic acid scan
| gallbladder function/presence/obstruction
98
ERCP can be replaced by what procedure and offers what benefits
magnetic resonance cholangiopancreatography
noninvasive but cant biopsy/other stuff
99
LFTs
PT/INR
Albumin
Cholesterol
100
whats in a CBC
```
WBC
hemoglobin
hematocrit
MCH (mean corpuscular hemoglboin)
MCHC (mean corpuscular hemoglobin concentration)
RDW (red cell distribution width)
RBC
Platelet count
```
101
whats in a CBC with differential
everything in a CBC but includes a percentage and absolute diffferntial counts (PMN, Lymph, Baso, Eos, Mono)
102
BMP
```
BUN
BUN: Creatinine
Ca
CO2
Chloride
creatinine
eGFR calculation
glucose
potassium
sodium
```
103
CMP
```
albumin:globulin (A:G)
albumin
alkaline pohsphatase
AST
ALT
bilirubin (total)
protein
globulin
and BMP
```
104
AST and ALT are severely elevated in what diseases
```
acute viral hepatitis
medications/toxins
ischemic hepatitis
autoimmune hepatitis
wilson disease
acute bile duct obstruction
acute budd-chiari syndrome
Hepatic artery ligation
```
105
labs to assess the pancreas
lipase
| amylase
106
labs to assess the liver
GGT
fractionate bilirubin
PT/INR
107
labs to assess zoligner ellison gastrinoma
fasting gastrin
| secretin stimulation test
