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Nu 639 > GI > Flashcards

GI Flashcards

(54 cards)

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1
Q

Dx Cirrhosis

A

Liver US, MRI, CT, biopsy or fibroscan

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2
Q

LFT elevations

A

Mild elevations 20ULN seen in acute viral hepatitis, drug reactions, toxins, tumor or ischemic injury

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3
Q

Hepatocellular enzymes

A

ALT and AST

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4
Q

markers of cholestasis

A

about bile, ALP, GGT 5 nucleotidase

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5
Q

liver excretion

A

bilirubin (direct and indirect)

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6
Q

liver synthetic function

A

INR, PT

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7
Q

ALT/AST

A

mild elevations occur in statin, ALT more specific to the liver, AST also seen in heart and muscle tissue more sensitive to liver dz.
Elevations common in ETOH, meds, occupation exposure, obesity, viruses such as mono and hepatitis, if elevated repeat to confirm, and work up if >3x normal

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8
Q

LFTs in ETOH use

A

for more than 4-6 drinks a day, AST:ALT >2:1 ratio

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9
Q

ALP (alk phos)

A

from liver, biliary, bone, can fractionate into isoenzymes.
represents an elevation from cholestasis (stone, stricture, tumor) or dysfunction (drugs dis) If there is liver dz, the GGT will be elevated

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10
Q

GGT

A

specific to liver, also reflects chronic alcohol use

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11
Q

bilirubin

A

total = direct (conjugated) - indirect (unconjugated)

liver dz is related to conjugated bilirubin elevation

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12
Q

jaundice

A

total bili 2 x ULN

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13
Q

albumin and INR

A

not sensitvie, but helps she monitoring for chronic liver dz, must have >90% dysfunction to be affected

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14
Q

nonalcholic fatty liver

A

ALT and AST >30 UL without hx of ETOH abuse, associated with obesity, insulin resistance and metabolic syndrome,
SS can be asymptomatic, fatigue, RUQ discomfort, acanthuses nigricans,
Labs: hepatitis profile, FE, ANA, antimitochondrial ab, ceruloplasmin levels, FBS, lipids
Dx biopsy, ultrasound
can progress to cirrhosis, treat with lifestyle modification

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15
Q

NAFLD vs NASH

A

NAFLD - fat deposits in liver, 10-20% of americans
NASH - nonalcoholic steatohepatitis, fatty despots with inflammation and liver cell damage, affects only 2-5% of americans

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16
Q

Nausea and Vomiting

A

many causes, including meds, food poisoning, pregnancy, acute abdomen, migraines, increased ICP
Hx: onset duration frequency quantity quality, associated sx lil eras, fever, chronic dz, meds, food history, affected contacts, LMP, travel history and exposure to reptiles

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17
Q

Assess N/V

A

wt, ortho signs, rash, lymphaednoptahy, neuro change, labs urine spec grav, BUN/creat, lytes, HCG, LFTs, CBC

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18
Q

Nausea Vomiting Red Flags

A

severe pain, severe dehydration, rigid abdomen, septic appearance, neuro changes, metabolic imbalance, absent BS

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19
Q

Acute abdomen: surgical emergency Red Flags

A 
acute pain
septic and toxic
board-like abdomen
absent BS
WBC>25,000
Free air under diaphragm
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20
Q

Causes of surgical acute abdomen

A 
appendicitis
choleycystitis
obstruction
peritonitis
diverticulitis
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21
Q

Non surgical causes of acute abdominal pain

A 
mesenteric adenitis
acute enteric infection
acute enteric poisonings
inflammatory bowel disease
pancreatitis (usually)
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22
Q

RUQ abdominal pain

Study These Flashcards
A

chest cavity, liver, GB, stomach, bowel, R kidney/ureter, choleycystitis, DU

23
Q

LUQ abdominal pain

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A

heart or chest, spleen, stomach, pancreas, L kidney/ureter

24
Q

LLQ abdominal pain

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A

bowel, L ureter, pelvis, most commonly diverticulitis

25
RLQ abdominal pain
appendix, bowel, R ureter, pelvis, most commonly appendicitis
26
contant aching abdominal pain
typically distention of a capsule around an organ
27
intermittent colicky abdominal pain
obstruction
28
steady abdominal pain that increases with cough or movement
irritation like a peritonitis
29
appendicitis
inflammation of appendix from obstruction of orifice and secondary bacterial infection. S/S perimbuilical colicky pain which localizes to RLQ, anorexia, N/V, localized tenderness, fever, guarding, rebound, rectal tenderness and mass,. + psoas and obturator signs, WBC>10,000-16,000
30
obdurator sign
in appendicitis, when you passively rotate the right leg and flex the hip and knee, with pain
31
psoas sign
when supine, flex right leg, and there will be pain
32
Small bowel obstruction
caused by blockage of lumen or by paralysis of musculature (adhesions, hernia, tumor, abscess, IBD, radiation enteritis, volvulus, utussesception) S/S cramping and pain, vomiting, obstination, distention, fever, relief through vomit or movement through intestine Exam high pitches BS, stool of mass in rectum, tacky and hypotensive, distended and tender abdomen
33
peritonitis
primary - occurs from spread of bacteria through the gut wall, occrs often in cirrhosis with portal hypertension Secondary - via rupture of organ with contamination into peritoneum SS fever, diffuse abd pain, N/V, decrease BS, rebound and guarding, tachy and hypotensive late
34
cholethithiasis
gallstones; # Fs at risk (female, fat, over 40) common in DM, Crohns and cirrhosis
35
cholecystitis
gallbladder inflammation, large gallstones obstruct common bile duct, cause pain, NV from inflamed gallbladder, decreased ability to digest fat SS gallstones are asymptomatic in many or episodic RUQ pain after fatty foods 1-6 hours
36
Murphy's sign
RUQ pain when pressing and they inhale indicative of cholecystitis
37
Charcot's Triad
common bile duct stone ss - pain, jaundice and chills
38
Mgmt of cholecystitis
rehydrate, pain management, ABX, antispasmodic, antiemetic, surgical consult if unresolved 4-6 hours
39
acute pancreatitis
Main causes gallstones or ETOH also drugs, high TGs, trauma, tumor or infections SS: sudden onset epigastric or periubilical pain, radiating to shoulder worse when supine, N/V, tender LUQ, cullen's sign, tachycardia, hypotension, lipase, amylase, TGs WBCs, hospitalize if vomiting
40
Cullen's sign
blue hue in periumbilical area, suggestive of severe necrotizing illness
41
diverticulosis
asymptomatic out pouching of colonic wall
42
diverticulitis
more acute inflammation infection abscess of diverticular caused by stagnation of fecal material or undigested food particles, caused by refined diet with incidence increasing with age, not r/t nuts popcorn, seeds, corn (curse of the western diet) S/S: intermittent pain, Usually LLQ, irregular BMS, bloating, flatulence, with abscess persistent pain, fever, tender mass i Xray to r/o ileum, CT scan for confirmation
43
treatment of diverticular dz
mile: clear liquids, bactrim DS or cipro 500 bid with flagyl 500 TID for 2 weeks, Acute: with sepsis, peritonitis, fever >101, or DM must be hospitalized
44
acute diarrhea
an increase in daily stool weight above 200gm, increase in fluidity, differential from incontinence and IBS or obstruction. Acute 2weeks
45
4 mechanisms of diarrhea
secretory: bowel increases secretion of water into the lumen to dilute toxins osmotic: passive movement of water into lumen in response to increased conc. of fiber exudative diarrhea: inflamed mucosa causes mucous, blood, pus to leak into lumen (IBD) Motility disturbance: small frequent stools (IBS, hyper thyroids)
46
common causes of acute diarrhea
gastroenteritis, dietary (nonabsorbable sugar substitutes, food intolerance, excess caffeine), animals (livestock, turtles, reptiles), drugs, visceral causes
47
Infectious diarrhea
bacteria - campylobacter, enterotoxigenic eColi, shigella, salmonella, cdiff viral - rotavirus, norwalk, enterovirus parasits - guiardia
48
actue gastroenteritis
usually self limiting, r/o fever, orthostasis, blood in stool, or work up with severe pain, toxicity, disorientation, dehydration or no improvement in 24 hours
49
inflammatory type acute diarrhea
SS fever, blood stool with leucocytes, low volume <1L/24 hrs | Shigella, salmonella, amebiasis, cdiff, ecoli, ischemia, UC, crohns, cmv
50
acute non-inflammatory diarrhea
watery with N/V, high volume >1L/24hrs, | Norwalk and rota virus, giardia, staph aureus, cholera, ecoli, bile acid, laxatives, malabsorption
51
diarrhea workup
CBC, lytes, glucose, BUN/creatinine, stool culture oval and parasites if immune compromised, fever ,bloody diarrhea, severe pain,
52
cdiff red flags
if on recent ABX use, chemo or other risks
53
sigmoidoscopy
for pts with bloody diarrhea, useful in IBS, shigellosis, amebic dysentery
54
abdominal radiographs (flat and upright)
obtain with abdominal distention, severe pain, obstructive symptoms, or suspected perforation

Nu 639 (3 decks)

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