Flashcards in MKSAP-GI Deck (39):
Suspect nephrolithiasis – test?
Noncontrast helical abdominal CT
Patient with acute abdomen – test?
Supine and upright abdominal radiographs (Although CT scan will be likely be necessary eventually)
Typical initial symptoms of ruptured AAA? CBC findings?
Sudden, severe pain and near syncope
Leukocytosis and anemia
Clinical criteria for IBS?
Rome III criteria:
1. Pain relieved with defecation
2. Change in stool frequency
3. Change in stool consistency
Also need no alarm indicators (old age, male, nocturnal awakenings, bleeding, weight loss, family history of colon cancer)
Patient with constipation due to IBS – first and second line treatment?
1. High-fiber diet
2. Laxative (poly ethylene glycol)
Patient with suspected ischemic colitis – important history? Typical colonoscopy finding?
Thickening of the bowel wall in segmental pattern
Patient with suspected diverticulitis – test?
Contrast enhanced CT scan
Suspected HUS – test? Tx?
Peripheral blood smear; supportive
Suspected radiation proctitis – Sx? test and confirmatory findings?
Diarrhea and tenesmus Six weeks after radiation treatment
Flexible sigmoidoscopy sees mucosal telangiectasia, submucosal fibrosis and arterial Endarteritis
Suspect chronic pancreatitis – test?
Marker for celiac disease?
Symptoms of Clostridium diff?
Diarrhea 10 to 15 times daily, fever, leukocytosis, abdominal pain
Treatment for salmonella gastroenteritis?
Supportive - Antibiotics slow clearance of salmonella from the stool and antidiarrheal agents increase chance of invasion
When to treat salmonella gastroenteritis?
1. Age 50
2. Patients with severe illness requiring hospitalization
3. Patients with atherosclerotic plaques or bone prosthesis (possible seeding)
Hepatocellular injury versus cholestatic injury?
Elevations in AST, ALT, and conjugated bilirubin
Elevation in alkaline phosphatase and small elevations in AST and a penalty
Diseases that can cause a mixed hepatocellular and cholestatic injury?
Hepatitis B and C
Gilbert syndrome a.k.a.?
Constitutional hepatic dysfunction and familial nonhemolytic jaundice
Effect of OCP on liver function?
Conjugated hyperbilirubinemia and elevated alkaline phosphatase
When to use cholecystectomy versus ursodeoxycholic acid?
If previously symptomatic vs if cannot undergo surgery (can only prevent new stone formation)
Acute cholangitis - tx?
Immediate broad spectrum antibiotics followed by ERCP-sphincterotomy
Gallstone pancreatitis - tx?
Pt with pancreatitis - general management?
If pancreatic necrosis?
Jegunal Enteral tube feeds > TPN
Imipenem and debridement
GERD - tx? Test if unresponsive? Tx with alarm symptoms?
PPI; esophageal pH monitoring; EGD
Errosive esophagitis - tx?
PPI > H2-blocker
Pt with gastric ulcer - next step?
Functional dyspepsia? Tx?
Discomfort in epigastrum without organic cause.
Acute mesenteric colitis vs ischemic colitis? And tx?
Small bowl, very painful, caused by embolic event
Large bowl, bloody stool an cramping, caused by hypoperfusion
How to diagnose a hepatocellular CA without a biopsy?
Suggestive Ultrasound with AFP>500
Typical pt with non-alcoholic steatohepatitis? Diagnose with?
Obese woman with hx of HTN, HLD
US, CT, MRI
Treatment of hepatic encephalopathy?
Lactulose titrated to achieve 2 to 3 stools per day with a pH<6
UC - all treatments?
2. Other 5-aminosalicylates (-salazines)
3. Oral prednisone
4. Azathioprine and 6MP
Upper GI bleed - steps?
3. If variceal veins - octreotide
Or if arterial, arteriography
NG tube is reliable in ruling out upper G.I. bleed if?
Aspirate contains bile (indicates tube went beyond pylorus)
What exposures Increase risk of acute hepatitis A?
Traveling, daycare, homosexual sex, raw shellfish
AST/ALT levels in acute hepatitis? Alcoholic hepatitis?
In the thousands
Most common blood-borne infection in the United States? Tests?
Screening test – anti-HCV antibody test
Extent of active infection – HCV RNA test
Definition of hepatorenal syndrome?
Kidney dysfunction in patients with portal hypertension
Also must have excluded prerenal azotemia, renal parenchymal disease and obstruction
Eruption of erythema nodosum preceded by?
Prodrome of fever and arthralgia