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GEN MED GI > Gen Med Lower GI & Accessory organs > Flashcards

Gen Med Lower GI & Accessory organs Flashcards

(70 cards)

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1
Q

Bruising around the umbilicus

Name & Indication

A

Cullen’s Sign

Acute Pancreatitis

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2
Q

Pt points to area midway between Rt hip & umbilicus

Name & Indication

A

McBirney’s Sign

Acute Appendicitis

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3
Q

Pain in RLQ on release after palpation of LLQ

A

Rovsing Sign, a type of rebound

Acute Appendicitis

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4
Q

Rebound Tenderness

A

Pain on release of palpation anywhere on and

Peritonitis Esp w/guarding & Rigidity

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5
Q

Murphy’s Sign Describe & Indication

A

For Cholecystitis/Cholelithiasis

Pt inhales & you slip fingers under edge of liver
Pain is positive Murphy sign

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6
Q

Appendicitis signs

A

Murphy Sign
Rovsing Sign
McBirney Point as pt descriptor of pain loc in LLQ

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7
Q

Peritonitis signs

A

Guarding, Rebound Tenderness & rigid abdomen

Fever

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8
Q

Pencil Thin Stool

A

Obstruction in colon: Tumor or Polyps

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9
Q

Painless Jaundice

A

Pancreatic Cancer until otherwise proven

yellow & feels fine, no hepatomegaly/tenderness

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10
Q

Corvosier’s Sign

A

Palpable painless GB on Murphy Test

Cancer of Pancreatic Head, Liver, Liver Mets

GB enlarges slowly in cancer & the tumor is elsewhere so the GB is not directly painful

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11
Q

Trousseau’s Sign of Malignancy

A

Migratory thrombophlebitis

Hyper coagulability associated with :
Pancreatic Cancer &/or Gastric Cancer

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12
Q

Blumer’s Shelf

A

Mass palpable on Digital Rectal Exam

Indicates Tumor Mets in rectovesicle/rectouterine Pouch

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13
Q

Skin signs of Biliary Stasis

A

Jaundice: Skin/Sclera

Itching

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14
Q

St Mary Joseph Sign Describe & Indication

A

Belly Button Malignancy

Pancreatic, Gastric, Colon, Ovarian, Uterine Cancer

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15
Q

Whipple’s Procedure

A

Rx Cancer of pancreatic head, Common Bile Duct, Proximal Duodenum

Remove antrum, Duod, GB, Pancreatic Head. Attach stomach to duod and lead Hepatic Bile Duct and remaining Pancreatic Duct into remaining Duod.

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16
Q

Enzyme to Test for if suspect Pancreatitis/cancer

A

Pancreatic Lipase, order Amylase to but lipase rises w/in 4-8 hrs and stays elevated 8-14 days. May not elevate if cancer is in the tail.

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17
Q

Whipples Triad What for & define

A

For Insulinoma

Low Glucose (under 50)
CNS Hypoglycemia signs
Eating carbs relieves CNS hypoglycemia Signs

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18
Q

Necrolytic Migratory Erythema

A

Sign of Glucagonoma

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19
Q

Islet Cell Tumor secretes VIP

A

Vipoma (pancreatic tumor of non-beta islets)

Xtreme watery diarrhea
Low K+ (from diarrhea)
Low Gastric Acid

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20
Q

1st degree relative had colon cancer @ age 55. When to get 1st colonoscopy & follow ups

A

1st: 45 yrs
Follow ups every 3-5 yrs

It takes 3 yrs to grow a polyp, +/- 1 year thereafter to become malignant.

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21
Q

Tenesmus

A

Feeling that rectum has not been emptied

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22
Q

BM urgency
Tenesmus
Bleeding
Pain

A

Rectal Cancer

MRI best test for rectal cancer

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23
Q

Steatorrhea
Malnutrition
Weight Loss
Duodenal Ulcers

But no infection/pain

A

Pancreatic Insufficiency

Do Secretin Cerulean Test to see if secretin causes a normal release of pancreatic enzymes & bicarb into the duos.

If not, supplement enzymes & give PPI to reduce gastric acid

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24
Q

Colon cancer Mets to:

A

Liver & Lung then elsewhere

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25
Dx test of choice for colon cancer
Colonoscopy if cancer found: CT of Chest/Abd & Pelvis looking for mets Ultrasound better for liver mets, if suspicious
26
Toxic Mega Colon is full of
GAS - RUPTURE RISK HIGH 911!!!! Dx w/KUB NG Tube w/suction ASAP (w/in 24 hrs or surgury!) If KUB shows air under diaphragm, it has ruptured Peritonitis & Death Follow Rx is Decompression IV Fluids Prophylactic IV Cipro + Flagyl + Vanco ``` Caused by severe constipation Impaction Twist Anticholinergics Narcotics Antidiarrheals ```
27
Lipase is elevated in pt w/epigastric pain & cullen sign but pt is not alcoholic, Dx/Rx of choice?
ERCP - endoscopy to visualize Ampulla of Vader & Sphincer of Oddi and remove stone if seen
28
Best Inflammation marker in Pancreatitis
C-Reactive Protein CRP Better than Sed Rate ESR in pancreatitis
29
Worst case complication of Pancreatitis
ARDS - pancreatic enzymes get into blood & go digest the lungs & breaks down surfactant Dyspnea Hypoxia refractory to high flow 02 Widespread Bilateral Infiltrates on CXR ARDS is cause of 50-90% of all Pancreatitis deaths
30
Pancreatitis Tests to order
``` Lipase/Amylase CBC w/dif CRP Liver Panel (ALK Phos may be high & ALT) Ca++ usually low in pancreatitis ```
31
Pancreatitis Severity Rating Scales
Ranson Criteria (only for non-stone situation) Glascow (PANCREAS Acronym) Apache III
32
3rd Spacing of Fluids
Moving from blood vessels into interstitial spaces In Pancreatitis due to pancreatic enzyme digestion of proteins in blood and hypocalcemia leading to low osmolarity not sure why hypocalcemia causes fluid migration.
33
Pseudocyst
Pancreatitis granuloma, can harbor infectious agents for weeks post acute phase. Do sonogram to follow If shrinking over time, leave. If not, remove
34
Pancreatic Calcifications on KUB/CT/MRI Steatorrhea Diabetes
Pancreatitis Triad
35
Pancreatitis Triad
Pancreatic calcifications Steatorrhea Diabetes
36
Main Causes of CHRONIC Pancreatitis
Alcoholism Super High Triglycerides (over 1000) Peptic Ulcer Complication of Gallstone Surgury
37
CHRONIC Pancreatitis signs sxs:
Jaundice / Pallor Alcoholic w/wo epigastric pain (acute always has pain) ALK Phos & Bilirubin Elevated Do Secretin Cerulean Test (SCT) Order KUB & check for calcifications ERCP is the most sensitive imaging test for this Rx: Life long pancreatic enzyme supplementation Hospitalize w/IV & NG tube, manage DTs May need Insulin Resect pseudocysts High cancer risk due to chronic inflammation
38
Pancreatic Enzyme Replacement Meds
Pancreaze Creon Ultresa ZenPep
39
NSAID w/Protection
Sedemel | NSAID dipped in PPI
40
Hypogastric/LLQ Pain Gassy/Bloaty Worse w/food; Relieved by Defecation
Irritable Bowel Syndrome No known pathology Increase Fiber/Fluid/Exercise Reduce Stress: Yoga, Meditation
41
Rule these out before making IBS the Dx
``` Lactose intolerance- lactase test Cholecystitis-Murphy & pain pattern Chronic pancreatitis-lipase test Intestinal obstruction- KUB Pancreatic CA Stomach cancer Celiac disease ```
42
Flank Bruising
Turner Sign of RetroPeritoneal Bleeding Acute Pancreatitis - enzymes escaped from retroperitoneal part of inflamed pancreas digest blood migrates through the retroperitoneal space to flanks - Takes 24-48 hrs to develop so if you find Turners with other signs of pancreatitis: hypogastric thru to back pain/Cullens Sign you already have an emergency on your hands- Admit him Blunt Force Trauma to Retroperitoneum/Kidney Retroperitoneal Hemorrhage Ruptured Ectopic Pregnancy
43
Synthetic Disaccharide that can relieve constipation in 8-10 hrs AND can treat Hepatic Encepalopathy due to Hyperamonemia
Lactulose High dose can cause "irresistible Bowel Movement" Binds Ammonia in the bowel so it doesn't get to the brain.
44
Pain/Bleeding on BM w/Constipation
Anal Fissue If you can't see it, use anoscope to look inside, it's essentially a clear speculum. Address Constipation via diet Sitz baths to relieve & bring blood flow Zinc Oxide Ointment to protect/heal Rx: Topical Nitroglycerine or Nifedapine to dilate vessels and improve bloodflow for healing.
45
Zollinger-Ellison
Pancreatic Non-Beta Gastrinoma Hyper H+ secretion in stomach ulcerates upper GI - First get Gastrin Level - If High, Do Secretin challenge. Secretin will suppress gastrin unless there is a Gastrinoma, which will be immune to secretin.
46
Bird Beak Barium Swallow
Achalasia Lower Esophageal Sphincter Paralysis CXR shows massive dilation of esophagus above sphincter.
47
Megacolon in baby Baby fails to pass meconium "Spurt Sign"
Hirshsprungs Colon/rectum lacks enteric nerves Dx: Rectal Biopsy (gold std is suction biopsy) Rx: Section out numb portion
48
Unclean water & undercooked shellfish | which Hep?
Hepatitis A and E
49
Black race, Male, Diet high in fat/red meat, IBD and over 50 are risks for
Colon cancer
50
Candida Esophagitis
Fluconozole
51
Rx Gastroparesis
Reglan (Metachlopramide)
52
Rx Mild IBD: Crohns / UC
Mesalamine /Sulfasalazine aminosalycilates suppress eicosanoids & inflammatory cytokines Also for arthritis Not as good as corticosteroids though
53
IBD Rx progression
Mesalamine/Sulfasalazine Corticosteroids for acute attack refractory to Mesalamine. Try to maintain on melamine or go to the Mabs Mabs: Infliximab Anti-TNF antibodies
54
Cirrhosis Encephalopathy Rx
Lactulose - Reduces gut bacterial production of NH3 - Hydrolyzes NH3 to NH4 which doesn't bother CNS - 3X/day aim for 3-5 soft stools /day with stool pH @ +/-6
55
IBS meds
SLOW it down!!! Fix Depression Block Serotonin: anticholinergics (anti sludge) BENTYL antidiarrheals, tricyclic antidepressants, prokinetics (REGLAN speed it up?) bulk-forming laxatives, serotonin receptor antagonists,
56
Alternating Diarrhea & Constipation Abdominal Cramps/Gassy/Tenesmus Relieved by BM
IBS
57
c Dif Rx
Flagyl (Metronidazole) and | Oral Vanco
58
Cyst on hairy coccyx
Pilonidal Cyst REFER!!!
59
Normal Squamous Epithelium Transform to Columnar under stress:
Barrett's Esophagus Stress is GERD/ACID
60
Both disorders present with dysphagia to solids AND liquids at advanced stages
Achalasia (lack of enteric nerves) Esophageal Cancer (obstruction)
61
superficial mucosal tears at gastro-esophageal junction created by vomiting
Mallory weiss tears
62
Monitor H. Pylori eradication
Urea Breath Test Biopsy Fecal Antigen Test Serum antibody will be detectable for years, perhaps life and won't help determine presence of H. Pylori after the first treatment
63
Causes of Erosive Gastritis
``` H. Pylori Alcohol NSAIDS Stress Portal Hypertension ```
64
Portal Hypertensive Gastropathy
Portal backup makes varicose veins in the stomach, they rupture and cause bleeding, hematemesis and melena
65
IgA Endomesial Ab and IgA tTG Ab
Celiac Antibodies to glutin antigens
66
Maldigestion vs Malabsorption
Fecal fat test shows maldigestion (lipase deficiency) Xylose Test - Xylose doesn't require enzymatic breakdown for absorption, only an intact mucosa. If it isn't present in urine 6+ hrs later, it wasn't absorbed meaning the mucosa isn't intact
67
Dx Lactose intolerance
Hydrogen Breath Test Give Lactase to Rx
68
Acecetaminophen Antidote
Mucomyst ABCs, Charcoal and a 4-Hr Acetaminophen level (it can take 4 hrs for level to peak so don't take it early, use the charcoal) If it is before 8 hrs from overdose, you can use mucomyst to completely cure. So, if you know you have time, get the 4Hr NAC level (acetaminophen peak) and treat with mucomyst if levels exceed acceptable. If you don't know your time frame, just give the mucomyst. If unsure - give the mucomyst If over the max level,
69
White nail beds
Terry's nails 80% occurrence in liver failure also in Kidney failure and CHF, decreased blood flow and increased fibrosis of connective tissue
70
Alpha Fetoprotein (AFP)
up in Heptatocellular Carcinoma Follow it for progression of Dz

GEN MED GI (4 decks)

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