GI CIS high yield handout 1

Question 1

annual screening of tnf-a inhib

Answer 1

ppd, hepatitis panel, derm exam

Question 2

what is reynold’s pentad

Answer 2

charcots plus mental status changes and hypotension

Question 3

what is ascending cholangitits

Answer 3

infection of biliary tract secondary to bile duct obstruction or bile stasis

Question 4

courvoisiers sign

Answer 4

enlarged non tender GB secondary to pancreatic disease or cancer

Question 5

what is the treatment of ascending cholangitis

Answer 5

urgent ERCP (within 12-24 hrs)
-sphincterotomy (cut spchincter of oddi slightly) with stone removal or stent placement

antibitoics
supportive care like IV fluids

Question 6

pancreas level

Answer 6

T5-11

Question 7

protective of gallstones

Answer 7

low carb diet
physical activity
caffeinated coffee (in women)
high intake of Mg and polyunsat and monunsat fats (men)
high fiber diet and statin therapy
ASA and NSAIDs

Question 8

espohagus level

Answer 8

T2-8

Question 9

gallbladder level

Answer 9

T6-9

Question 10

grey turner sign

Answer 10

flank ecchymosis secondary to hemmorrhage

Question 11

when do you suspect choledocholithiasis on ultrasound
how big
normal in non eldery
elderly can get up to

Answer 11

when common bile duct is over 6mm
normal in non eldery with an intact GB is 3-6mm
eldery or post cholecystemcoty can get up to 10mm

Question 12

murphys sign tests for

Answer 12

acute cholecystitis or cholelithiasis

Question 13

what are some possible complications status post ERCP

Answer 13

pancreatitis
ascending cholangitis
hemobilia, perforation, bile leaks (less common these 3)

Question 14

what labs should be ordered for cholantitis

Answer 14

AST/ALT, alk phos, fractionated bilirubin, amylase/lipase

pre-procdeure INR
follow up on blood culture and bile culture that were ordered and pending

Question 15

possible side effects of TNF-a inhibtiors

Answer 15

infections: bacgerial infections (pneumonia) zoster, TB, opportunisitc

cutaneous rxn: at injection site or psoriasis, eczema, SLE, lichen planus

malignancy (lymphma and skin cancer)

induction of autoimmunity: autoimmune hepatitis, drug induced SLE, psoriatic skin lesion, intersitial lung disease, MS, sarcoid

Question 16

parasyp levels upper portion

Answer 16

esophagus through transverse colon

OA,AA (vagus n)

Question 17

alternative empiric regimen for cholangitis

Answer 17

fluorquin plus metronidazole
cipro or levoflox plus metronidazole

monotherpay with carbapenem

Question 18

lab screening TNF-a inhib

Answer 18

CNC with differential, CMP every 2 months

Question 19

septic shock

Answer 19

sepsis induced hypotension despite adequate fluid resuscitaion

Question 20

risk factors for gallstones

Answer 20

female
older
american indians>mexican americans>nonhispanic whites>af americans
obestiy
rapid weight loss
DM
high intake carbs
hypertriglyceridemia
M>W when have cirrhosis and hep C
chrons disease 
prolonged fasting
pregnancy
HRT/OCs

Question 21

systemic inflammatory response syndrome definition

Answer 21

2 or more or following conditions

temp above 100.4 or below 96.8
HR over 90
RR over 20 or PaCO2 under 32 mmhg
WBC count over 12,000 or under 4000 or >10% immature (band) forms

Question 22

causes of ascending cholangitis

Answer 22

choledolithiaisis
pancreatic/billy neoplasm
postop stricture
choledocal cysts

Question 23

appendix level

Answer 23

T12

Question 24

what is charcot’s triad

Answer 24

jaundice
fever over 102
RUQ pain

Question 25

obturator muscle test

Answer 25

flex pts right thigh at hip, with knee bent, rotate leg internallyu right hypogastric pain is a postiive test means irritation of obturator m from inflammed appendix

Question 26

rebound tenderness tests for

Answer 26

peritoneal inflammation

Question 27

TNF-a inhibitors used for | administered how

Answer 27

treatment of inflammatory conditions like RA and IBD -injectable or infused (rxn at site possible)q

Question 28

multiple organ dysfunction syndrome

Answer 28

presence of altered organ dysfunction in an acutely ill pt

Question 29

stomach level

Answer 29

T5-9

Question 30

liver level

Answer 30

T6-9

Question 31

severe sepsis

Answer 31

sepsis assocaited with organ dysfunction, hypoperfusion or hypotension

Question 32

what is mirizzi syndrome

Answer 32

common hepatic duct obsturcion from extrinsic compression from impacted stone in cystic duct -may be presence of cholecytoenteric fistula bc stone in cystic duct can result in narrowing of common hepatic duct which can lead to fistuala providing exit route for gallstones

Question 33

ogransisms involed in ascending cholangitis

Answer 33

``` gram negative (e coli, klebsiella pneum, enterobacter) gram positive (enterococcus) anaerobes (bacteroides fragilis and clostridia) ```

Question 34

first choice therapy for cholangitis

Answer 34

empiric treatment for gram neg and anaerobic pathogens monotherapy: amp-sulbact piper-tazobactam ticarcillin-clavulanate combo of ceftriazone plus metronidazole

Question 35

colon level

Answer 35

T10-L2

Question 36

Fs for factors of gallstones

Answer 36

``` fair fat fam history female fertile forty ```

Question 37

small intestine level

Answer 37

T9-11

Question 38

diaphragmatic exursion

Answer 38

determine level of dullness on full expiration and level of dullness on full inspiration normal is 3-5.5 cm

Question 39

what do you have to consider when giving a biliary pt opioids

Answer 39

NSAIDs are preferred but opiods can be given if NSAIDs are contraindicated or pain is uncontrolled all opiods increase sphincter of oddi pressure, could worsen underlying problem and pain (especially morphine) but this is insufficient data opiods slow digestive tract so possible ileus, constipation

Question 40

rovsings sign

Answer 40

pain in RLQ during left sided pressure | -appendicitis

Question 41

parasymp lower portion

Answer 41

descendin colon, sigmoid, rectum S2-S4 (pelvic splanchinic n)

Question 42

cullen sign

Answer 42

ecchyosis around umbilicus secondary to hemorrhage

Question 43

sepsis defintion

Answer 43

systemic response to infection defined by 2 or more SIRS criteria as result of infection

Question 44

iliopsoas muscle test

Answer 44

pt flex hip against resistance increased abdominal pain is positive test means irritation of psoas muscle from inflammation of appendix

Question 45

lab changes in ascending cholangitis

Answer 45

hyperbili leukocytosis transaminitis alk phos elevation