Gastrointestinal Exam 2 Flashcards

Question

Management of chronic pancreatitis

Answer 1

Low fat, stop smoking, alcohol Pain management - careful with opioids Treat complications

Answer 2

Pain relief for dilated duct - attach intestines to pancreas

Answer 3

Resection of part of the pancreas

Answer 4

Head of the pancreas

Answer 5

Over 45 Late onset diabetes Smoking BRACA gene

Answer 6

Gnawing insidious pain like gastritis Painless jaundice with nontender palpable gallbladder = Courvasier's sign Sister Mary Joseph Nodule

Answer 7

CT = First line ERCP if uncertain CT

Answer 8

T1 and T2 confined to pancreas, others not

Answer 9

Exploratory laparoscopy followed by whipple procedure is suitable

Answer 10

If 1st degree relative - get a CT 10 years before onset in the relative

Answer 11

More invasive with sedation Diagnostic AND therapeutic

Answer 12

Like an MRI, less invasive Only diagnostic

Answer 13

Medial common hepatic duct Inferior cystic duct Superior-inferior surface of the liver Landmark in cholecystectomy allowing for ligation of cystic duct and artery - need to protect common bile duct

Answer 14

Cholecystokinin - Stimulates gall bladder contraction and sphincter of Oti relaxation

Answer 15

High cholesterol High Billirubin Sedentary Gall Bladder

Answer 16

Low carb or mediterranean diet Caffeinated coffee

Answer 17

Stones stay in the bottom of gall bladder and do not cause pain by blocking the duct

Answer 18

RUQ pain to right shoulder blade After fatty meals Dull with nausea and sweating Not ill-appearing

Answer 19

No peritoneal sx, no rebounds tenderness Pretty benign

Answer 20

Abd US is procedure of choice - RUQ Could also use CT or XR

Answer 21

NSAIDS for pain Laparoscopic cholecystectomy Don't need to treat if asymptomatic

Answer 22

Calcified gall bladder 3cm or greater stones Native American

Answer 23

Try to wait until 2nd trimester Need labor and delivery and NICU there

Answer 24

Xray with catheter in bile duct to help with surgeon visualization - used to check for nicking of common bile duct

Answer 25

Urosodiol - Ursodeoxycholic acid Bile salt PO

Answer 26

Acute Calculus - due to gallstones and MC Acute acalculous - Gallbladder stasis ischemia - major surgeries Chronic cholecystitis - Episodic billiary cholic

Answer 27

Appear Ill - Unlike cholic Pain with fatty meal lasting over 6 hours!!! Peritoneal signs

Answer 28

Cholecystitis - Inspiration stops with pressing down in RUQ

Answer 29

Leukocytosis w/ Left shift No elevation of liver enzymes

Answer 30

Thickening of gallbladder wall Stones Use an US HIDA scan if inconclusive

Answer 31

IV contrast that travels into bile ducts - look for transit time Non-visualized gallbladder = Cholecystitis

Answer 32

CCK injection Ejection fraction of gallbladder under 35

Answer 33

Gangrene of gallbladder Gallbladder perforation Hydrops of gallbladder - distended Mirizzi syndrome - Jaundice from common hepatic duct compression Percelain gallbladder - calcified

Answer 34

Abx for E coli - Pip and Taz or 2nd or 3rd gen chep or cipro and metro NPO w/ NG tube Demerol or NSAID for pain Cholecystectomy w/in 24-48 hours

Answer 35

Cholecystotomy for drainage Alternative if they can't handle a cholecystecomy

Answer 36

Common bile duct

Answer 37

Gallstone in common bile duct - uncomplicated RUQ pain up to scapula Jaundice Epigastric tenderness

Answer 38

Elevated liver enzymes with bilirubinemia

Answer 39

ERCP with spincterotomy and stent placement with Cholecystectomy after MRCP used first for low risk - just cholecytectomy if no stone

Answer 40

Bacterial infection with stone in common bile duct

Answer 41

Charcot triad RUQ pain Fever Jaundice Reynolds Pentad Add - Hypotension and Mental status changes

Answer 42

CBC leukocytosis Liver enzymes Prolonged PT ERCP is the most accurate imaging - Diagnostic procedure of choice, will likely do an US first

Answer 43

NPO, prep for surgery, IV fluids, Pain control ERCP for stone extraction

Answer 44

Mild/Mod - Cipro and flagyl Severe - Zosyn(Pip and Taz) and Flagyl

Answer 45

Related to UC and IBD No cure Leads to obstructive symptoms - fibrosis

Answer 46

Jaundice Pruritis Hepatosplenomegaly

Answer 47

Elevated LFTs Increased P-ANCA antibodies (specific to injuries of billiary tree)

Answer 48

MRCP - ERCP if inconclusive Beads on a string seen is indicative - Segmental fibrosis Liver biopsy with "onion skinning" if those are inconclusive

Answer 49

No cure Cipro for episodes Immune suppressants and Ursodeoxycholic acid are being studied ERCP with stent Liver transplant Resection of carcinoma - complication

Answer 50

Choleangiocarcinoma

Answer 51

Chronic infection - Salmonella Gallbladder polyp Calcification of gallbladder Often invades liver

Answer 52

Confluence of R/L hepatic ducts

Answer 53

RUQ tenderness Courvoisier sign Ascites

Answer 54

ERCP w/ biopsy or US guided biopsy

Answer 55

Resect Roux en Y if non-resectable to bypass bile duct -bile drains fromthe liver to the duodenum

Answer 56

Hepatic artery, Portal vein, and hepatic duct - between the four lobes

Answer 57

Indirect bilirubin that has NOT been processed by the liver. made from protoporphyrin Binds to albumin, lipid soluble

Answer 58

Made by uridine glucuronyl transferase Water soluble - has been processed by the liver Goes to bile ducts

Answer 59

Goes to SI, urobilinogen sent to urine, cobilin sent to feces

Answer 60

Pale urine and stools as opposed to unconjugated hyperbilirubinemia Post hepatic jaundice

Answer 61

III,IV, and VIII - not effected by liver disease

Answer 62

Insert catheter to get pressure

Answer 63

Ascites Bleeding Caput Medusae Diminished liver function Enlarged spleen

Answer 64

Liver failure leads to kidney failure - portal hypertension causes poor perfusion of kidneys

Answer 65

Due to ammonia buildup - ammonia can't be made to urea

Answer 66

AST, ALT, LDH ALT is the most specific to the liver

Answer 67

8-25x normal range AST>ALT (ratio over two - chronic alcohol, under two non-alcoholic) ALT>AST - Acute Liver Trauma

Answer 68

Alkaline phosphatase (4x elevation is cholestasis) AND Gamma-glutamyl transpeptidase BOTH is indicative of obstruction Also 5'-nucleotidase specific to the liver

Answer 69

Albumin levels If other LFTs are normal consider malnutrition PT time See above note

Answer 70

Insidious onset to sudden attack presentation Precipitated by viral illness, pregnancy, drug exposure May have a history of autoimmune - Positive ANA, pANCA, anti-SLA Liver biopsy for diagnosis

Answer 71

Prednisone long term Azathioprine - second line Liver transplant if they fail therapy

Answer 72

Acetominophe Isoniazid Tetracyclines

Answer 73

ALT > AST May require a liver transplant

Answer 74

Adults - 4g (4000mg) Kids - 80mg/kg

Answer 75

.5-24 hours - N/V, diaphoresis, pallor lethargy w/ normal labs

Answer 76

24-72 hours Symptoms resolve but labs get worse RUQ pain PT and billirubin elevated

Answer 77

72-96 Jaundice, confusion Elevated enzymes Many die

Answer 78

4 days to 2 weeks Recovery May have AKI Symptoms and lab values begin to normalize

Answer 79

Measure acetominophen level with the blood N-acetylcysteine (activated charcoal) if possible within 1-2 hours of ingestion - give if we don't know when they took it

Answer 80

2 drinks per day for men, 1 per day for women Fatty liver to alcoholic hepatitis to cirrhosis 50g daily for 10 years is the threshold Often an incidental finding of labs in the fatty liver stage

Answer 81

2:1 or greater AST to ALT ratio

Answer 82

Abstinence from alcohol Folic acid, zinc, thiamine Prednisone for about a month

Answer 83

Greater than 9 is an indication for steroid treatment

Answer 84

Fatty liver w/o alcohol us Can still lead to cirrhosis Fatty liver is without inflammation RUQ discomfort - vague symptoms Biopsy to diagnose

Answer 85

Lifestyle modification Hepatitis vaccines Vitamin E, Thiazolidenediones, Metformin

Answer 86

Portal hypertension Pruritis Spider angiomas ED, Gyencomastia Palmar erythemia Jaundice - later in the disease

Answer 87

Minimal elevations in liver enzymes early in the disease cours DDx - Liver biopsy FL - US of Liver

Answer 88

TRANSPLANT Avoid alcohol Hepatitis vaccination Spironolactose and Furosemide TIPS - Shunt Paracentesis

Answer 89

MC w/ E. coli Treat with cefotaxime

Answer 90

Reduce protein intake Give lactulose ABX - Rifamixin and Flagyl to reduce ammonia producing bacteria

Answer 91

Give FFP, Ferrou sulfate for anemia

Answer 92

Band, Ballon, Tamponade Octreotide for bleeding Beta blocker for maintainence

Answer 93

Assesses for appropriateness for liver transplant 14 or higher qualifies for a liver transplant

Answer 94

Chronic autoimmune destruction of the bile ducts Common in women 40-60 Fatigue and itchiness are MC symptoms Fat deposits in the fingers Positive ANAD

Answer 95

Elevated ALP and cholesterol Baseline US biopsy not needed Ursodeoxycholic acid is tx CHolestyramine for itching Liver transplant is definitive

Answer 96

Fecal Oral route Incubates for TWO weeks No chronic carrier state

Answer 97

More severe in adults Distaste for smoking N/V/D RUQ pain gets worse with movement Jaundice and acholic stools Hepatomegaly

Answer 98

Jaundice with known risk for Hep A Established by IgM anti HAV antibodies - peak during symptoms ALT>AST Imaging not indicated

Answer 99

Symptomatic treatment - fluids and rest Avoid alcohol Prevent via handwashing and vaccination

Answer 100

HBcAg - Core antigen HBeAg - Secreted BY the core HBsAg - HBV surface antigen

Answer 101

Bloodborne Sexual activity, mother to baby, healthcare workers, IVDU, incarceration, previous STD

Answer 102

6 week to 6 month incubation Recurrent fever RUQ pain Jaundice Subsides in a few weeks

Answer 103

First to elevate - persists throughout clinical illness - presence for >6 months indicates chronic illness

Answer 104

Indicates recovery when coupled with decline of HBsAg Indicates vaccine response and immunity when no HBsAG is present

Answer 105

One month after HBsAG is detected Indicates declining acute hepatitis B 3-6 month persistence Acute flares of chronic disease

Answer 106

Persists indefinitely With Anti-HBs = recovery With HBsAG = Chronic disease

Answer 107

Elevated with infectivity - helps us know how infectious it is Appearance of antibody indicates reduction in infectivity Parallelled by HBV DNA

Answer 108

ALT greater than AST - more marked than HAV

Answer 109

Avoid alcohol and activity Antiviral therapy only if chronic HBIG for prophylaxis within 7 days of exposure and newborns with HBV positive mothers

Answer 110

Can lead to hepatocellular carcinoma and cirrhosis Nucleoside and nucleotide analogs - 1st line Interferon treatment - 2nd line

Answer 111

IVDU, Sexually transmitted, Healthcare, often co-infected with HIV

Answer 112

6-7 week incubation period Often a mild presentation Often becomes chronic Anti-HCV antibodies - RNA indicates a CURRENT infection, only Ab's indicate a past infection

Answer 113

No vaccine Safe sex and needle use

Answer 114

Harvoni - combo drug of ledipasvir/sofosbusir

Answer 115

8 week course Prevent viral replication

Answer 116

Only associated with Hepatitis B infection!! Mainly in IVDU Anti-HDV antibodies in serum

Answer 117

In non-US contries more often - fecal-oral Most severe among young pregnant women May be spread by swine Test for IgM anti-HEV in serum Treat with oral ribovirin to treat

Answer 118

Autosomal recessive Increased iron absorption from the duodenum and storage in the liver Usually don't present until older than 50 "bronze diabetes"

Answer 119

Mild LFT elevationElevated serum Iron and serum ferritin Test first degree family members Genetic testing available

Answer 120

Weekly phlebotomy for 2-3 years Chelating agents if unable to tolerate phlebotomy - Defaroxamin Liver transplant for cirrhosis

Answer 121

Autosomal recessive disorder Presents before age 40 Excessive absorption of copper and decreased excretion by the liver leading to low ceruloplasmin Deposition of copper in liver and brain

Answer 122

Kayser Fleischer copper rings around iris - pathognomic Parkinsonianism, Dysphagia Personality changes

Answer 123

Urine copper Low serum ceruloplasmin levels Liver biopsy to assess chronic hepatitis/cirrhosis

Answer 124

Restrict copper - nuts chocolate shellfish Penicillamin - Drug of choice - Chelating agent and increases urinary excretion B6 - antimetabolite of copper Zinc promotes fecal copper excretion Liver transplant if not caught early

Answer 125

Mild unconjugated hyperbilirubinemia Familial Reduced activity of glucuronyl transferase Random outbreaks of jaundice Bilirubin above 3mg/dL Benign, educate about flare-ups

Answer 126

Infantile jaundice Glucuronyl transferase deficiency Autosomal recessive Rapid and severe Does not go away after 2-3 weeks

Answer 127

Type I - 20-50mg/dL Type II <20mg/dL High levels definitive for diagnosis

Answer 128

Phototherapy under fluorescent light Plasmapheresis Liver transplant - curative Phenobarbital for type II

Answer 129

Genetic Conjugated bilirubin not sent to bile ducts Intermittent jaundice and fatigue Elevated conjugated bilirubin Black liver Benign - can be exacerbated by illlness or pregnancy

Answer 130

Rare genetic disorder Stored bilirubin leaks back into the blood stream Inject dye for a transport study to differentiate from Dubin Johnson Benign

Answer 131

Hereditary or acquire hepatic venous outflow obstruction, RUQ Pain, jaundice, ascites

Answer 132

Doppler US Can move on to an MRI

Answer 133

Lovenox if clotting problem TIPS - shunt Pericentesis

Answer 134

Crigler Najjar syndrome Brain damage from high bilirubin levels in a baby's blood

Answer 135

Parenchymal cell carcinoma d/t cirrhosis

Answer 136

Alpha fetoprotein CT/MRI for mass Liver biopsy

Answer 137

Liver US Q 6 months

Answer 138

If a patient's pain on palpation worsens when flexing the abdominal muscles the pain is located in the abdomenal wall rather than the abdomen itself

Answer 139

Inspiratory arrest during deep palpation of the RUQ - good indicator for Gallbladder inflammation

Answer 140

Indirect tenderness RLQ pain with LLQ palpation - indicates appendicitis

Answer 141

Patient flexes the thigh against resistance of the examiner's hand - on left side - Pain is indicative of appendicitis

Answer 142

Flexion and internal and then external rotation of the thigh causes pain - appendicitis, diverticulitis, PID

Answer 143

Indicative of peritoneal irritation

Answer 144

Torsion of segment of bowel MC - sigmoid Obstruction and strangulation - often in older adults 70+ Chronic constipation is a risk factor

Answer 145

Insidious onset of abdominal pain Abdominal distension Severe and colicky Tympany on exam w/ tenderness Fever and tachycardia after perforation

Answer 146

CT to establish diagnosis Whirl pattern and bird beak appearance Abdominal X-ray can also be performed

Answer 147

IV fluids Endoscopic detorsion - advance scope through twisted segment Elective resection if there is a risk of recurrence or major necrosis

Answer 148

More rare than Sigmoid volvulus Can be caused by violent coughing, tumor, or pregnancy

Answer 149

Highly variable Gradual onset of pain with N/V

Answer 150

CT - first line Whirlwind and birds beak Coffee bean and comma sign with Abdominal X ray

Answer 151

Can't do endoscopic - must do open Ileocecal detorsion if possible - if not possible cecopexy to anchor cecum to the wall

Answer 152

Bowel folds back into itself 6 months-3 years more common in males and in the ileocolic area Mostly idiopathic

Answer 153

Intermittent severe abdominal pain, 15-20 minute attacks Current jelly stools Sausage shaped mass in the right side of the abdomen Tender and distended abdomen

Answer 154

Utrasound is number 1 - coiled spring Barium enema confirmatory- can be CURATIVE Sonogrophy guided non-surgical reduction with saline or pneumatic reduction - air is less dangerous

Answer 155

Pneumatic reduction is better than barium

Answer 156

MC between 10-30 MCC is a fecalith Vague, colicky pain localizing the the RLQ within 12 hours Pt can localize pain upon coughing Rebound tenderness McBurney's point tenderness

Answer 157

Mostly clinical CT to confirm diagnosis US can confirm but not exclude diagnosis

Answer 158

Laparoscopic appendectomy Hydration Cefoxitin or Ampacillin-Sulbactam

Answer 159

Complication of IBD or Crohns Non-obstructive dilation of 6+ cm with systemic symptoms

Answer 160

ABdominal pain and distension Severe bloody diarrhea Toxic appearing Dehydrated Recent travel, abx use, use of antimotility agents

Answer 161

Radiographic evidence of colonic distension on CT or XR - CT preferred PLUS 3 of: Fever 100.4+ HR 120+ Leukocytosis over 10,500 Anemia PLUS 1 of: Dehydration Altered mental status Electrolyte disturbances Hypotension

Answer 162

Transverse colon

Answer 163

NG tube to decompress colon Stop medications PPI for stress ulcer prevention Bowel rest - NPO Serial CMP, BMP, Radiograph

Answer 164

Surgery for perforation, necrosis, ischemia, hypertension, or compartment syndrome

Answer 165

Amp, gent, metronidazole OR 3rd Gen Ceph w/ metronidazole Corticosteroids

Answer 166

Ischemia of the SMALL bowel Occlusive or non-occlusive MC in the SMA

Answer 167

Abdominal pain out of proportion to findings Severe, sudden, perumbilical Fecalant breath odor

Answer 168

Metabolic acidosis - is indicative until proven otherwise Mesenteric arteriography - dx of choice CT/MRI are nonspecific

Answer 169

Opioids for pain control Broad spectrum abx and NG tube Anticoagulation and Nitroglycerin Abdominal exploration d/t intestinal ischemia

Answer 170

Peptic ulcer disease

Answer 171

Bleeding diverticulum

Answer 172

Melena Hematochezia Coffee ground emesis Blood y emesis Weight loss suggests malignancy Jaundice suggests liver problem

Answer 173

Iron or Bismuth - Melena Beets - Hematochezia Cefdinir - Red Stools

Answer 174

Ligament of treitz

Answer 175

Pregnancies Ascites Obesity Intra-abdominal hernia

Answer 176

Surgical repair Open or Mesh depending on size (open if larger)

Answer 177

Firm Severe tenderness Abdominal distension

Answer 178

Any hernia in abdominal area Does not require surgery or is a poor surgical candidate or hernia is not emergent - can use an abdominal binder

Answer 179

Bone - White Tissue - gray Air - Black

Answer 180

Air UNDER the diaphragm - may be a bowel perforation or air expansion from laparoscopy

Answer 181

Soft tissue with opacities

Answer 182

Hypoechoic - Dense muscle and connective tissue Hyperechoic - Bright - Air fat and gas Anechoic - Fluid and blood filled structures appear more black

Answer 183

IV - best for tumors, vascular abnormalities, urinary tract Oral - Best for visualizing the bowel lumen, esophagus, stomach Non-contrast - Best for evaluating stones

Answer 184

Helps enhance and delineate between organs Takes a while, renal failure can cause an allergic reaction or flushing

Answer 185

Used with X ray Continue images as it passes through the small bowel Can also do a barium enema

Answer 186

Pancreatitis

Gastrointestinal Exam 2 Flashcards

(215 cards)