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Flashcards in GI Deck (44):
1

acute pancreatitis

rapid onset abdomina pain radiates TO BACK.
+ cullen's sign (blue at umbilicus)
+ grey turner (blue at flanks)
ED

2

acute diverticulitis

Left lower quadrant pain
Rovsing's sign.
If palpation of the left lower quadrant of a person's abdomen increases the pain felt in the right lower quadrant, the patient is said to have a positive Rovsing's sign

3

acute appendicitis

umbilical pain.
+ psoas sign
+obturator sign
+mcburnye's point
markle test



Psoas sign—pain on extension of right thigh
Obturator sign—pain on internal rotation of right thigh
Rovsing's sign—pain in right lower quadrant with palpation of left lower quadrant
Dunphy's sign—increased pain with coughing
Flank tenderness in right lower quadrant (retroperitoneal retrocecal appendix)

Patient maintains hip flexion with knees drawn up for comfort

4

mc burneys point

McBurney's point is the name given to the point over the right side of the abdomen that is one-third of the distance from the anterior superior iliac spine to the umbilicus (navel). This point roughly corresponds to the most common location of the base of the appendix where it is attached to the cecum.

seen in appendicitis

5

cholecysitis

epigastric pain after eating fatty meal
pain radiates to RIGHT shoulder
overweight female
requires hospitalization dt risk of gangrene of the gall bladder

6

colon cancer

>50 yo, blood in stool

7

zollinger ellison syndrome

increased gastrin level =ulcers

8

chron's disease

higher risk for colon cancer
right lower quadrant pain, diarrhea with mucus,

9

cdif

watery diarrhea 10-15 stools/day, fever.
appears 5-10 days after antibiotics
clindaymcin, fluroquinolones, cephalopsorin/pcn

10

murphys sign

positive in cholestitis
press deeply on the RIGHT quadrant under costal boarder during inspiration

11

GERD

may result in barrets esophagus (pre cancer)

gold standard- esophageal motility study (upper endoscopy)
tx:
1) lifestyle (avoid large/fatty meals)
2) OTC antiacids/h2 blockers

3) prescribe
h2 blockers: ranitidiine or PPI omeprazole/prlosec

12

lifestyle changes for gerd

no mints, avoid caffeine, etc

13

cullens/gray turner

pancreatitis

14

mid epigastric pain radiate to back

pancreatitis

15

rovsings sign

Pain on RIGHT (rovsings= right) when palpate to the left

acute diverticulitis

16

IBS

chronic disorder of the colon. stress makes it worse

17

class case of ibs

young adult female cramping pain on left lower quadrant, bloating, relief after defecation.

increase fiber (metamucil/psyllium)
antispasmodics (bentyl) prn

18

PUD disease, duodenal/gastric ulcers

duodenal more common
gastric >risk for cancer
H. pylori
chronic nsaids, chronic bisphosphanates (fosamax, actonel)

PAIN relieved by food or antacids

upper endoscopy
r/o zollinger ellison

tx: ppi and h2 blockers

19

TRIPLE therapy for H. pylori

1) clairithroymycin (biaxin)
2) amoxicillin
3) PPI - 6-8 wks

(CAP)


20

quadruple therapy h. pylori

busmuth subsalicylate (pepto)
metronidazole (flagyl)
tetracycline
PPI: (pineapple-zole)


ie
omeprozole (prilosec)
exomeprazole (nexium)

21

h pylori negative ulcer tx

4-6 wks treatments

H2:
ranitidine (zantac)
cimetidine (tagamet)

PPI: (pineapple-zole)
omeprozole (prilosec)
exomeprazole (nexium)

22

diverticulitis

postive rosvings sign ( pain on right, when press on left )
LLQ pain
pain
rebound tenderness

herniation on colon, lack of FIBER

if elder and fever= ED can bleed

23

diverticulosis

physical exam normal, no mass, no tenderness

24

tx plan for diverticulosis

cipro/metronidazole ( flagyl)

25

acute pancreatitis

alcohol, gallastones (+murphys),

triglycerites >800mg= high risk .

26

tx for cdif

metronidazole ( flagyl)
AVOID anti motility agents (loperamide/immodium) or opiates.

27

HbsAG (hep b surface antigen)

screening test for hep B
+= has the virus AND INFECTIOUS
how: acute infection or chronic hep B

28

igG anti-HAV (hepatitis A antibody) positive

IMMUNE, non infectious
G=good
how: hx of hep A infection or vaccination (havrix)

29

igM anti-HAV (hep A antibody) positive

infected and CONTAGIOUS!
M= miserable

30

anti-HB (Hep B surface antibody) +

immunie
past infection or vaccination

31

chronic hepatitis 2 types

1) chronic with mildly >LFT
chronic and active (ELEVATE LFT)= active viral replication

high risk for liver failture/cirrhosis

32

anti -HCV

screen test for Hep C
**up to 85% become carriers , may indicated current infection !!

MAY STILL BE INFECTIOUS ( unlike hep a/hep b antibody)

order HCV RNA or PCR (polymerase chain reaction ) r/o chronic infection
if Positive, refer

33

hep D (delta virus)

requires HEPATITIS B
B plus D increases risk for livery damage

34

LIVER fuction tests

AST. ALT

35

ast normal values

0-45mg/dl
aka: serum glutamic oxaloacetic transaminase (SGOT)
not specific to liver (also heart, muscle, lungs, etc)

36

ALT

aka SGPT
0-40mg/dl
Liver specific

37

AST/ALT ratio

sgot/sgpt ratio
a ratio of 2.0 or higher=alcohol abuse

38

GGT elevated when

alcohol abuse
liver disease
pancreatitis

39

HEP A

transmission: oral route; fecal, food/drink
self limiting, traveler
vaccine Havrix
no chronic or carrier state

40

HEP B

blood, sex (semen, vaginal secretion, saliva), vertical transmission

41

Hep C

IV drugs, blood, sex
IV (50%), drug use
HIGHEST risk for chronic infection and cirrhosis, liver cancer

tx: alpha interferon injections, ribavirin, biospy

42

acute hepatitis (liver) causes

viral infection
statins
alcohol

43

class case of hepatitis

new sex partner, dark colored urine, fatigue/nausea
skin/sclera yellow (jaundice)
tender liver
ALT/AST: elevated 10x
bilirubin and GGT elevated

tx: supportive
avoid statins (prevastatin/pravachol)

44

HbEag

"e"
active viral replication, infectious.
positive= chronic HEP B