10: Right Abdomen Flashcards
Onset of jaundice occurs in what relation to pulse and fever in Hep A and B?
Jaundice occurs when fever breaks + alongside elevated pulse
ROME Criteria of IBS abdominal pain.. must have 2 of what 3?
- Related to defecation
- Associated with change in stool frequency
- Associated with change in form/appearance of stool
Appendicitis pain in pregnancy
Uterine displaces appendix -> moves pain superiorly
Elderly appendicitis
Dxed later due to vague/mild sx
Retrocecal appendicitis
Less pain, poorly localized, may be left sided or flank pain
Pelvic appendicitis
Pelvic pain, urge to urinate/defecate, tenderness on rectal/pelvic exam
Complications of Hep A
Acute chole, pancreatitis, AKI, arthritis, vasculitis, aplastic anemia
DDx for Hepatitis**
- The other two hepatitis’s (A, B, C)
- Mono, CMV, HSV
- Flu, Ebola
- Spirochete or rickettsia infection
What % of chronic hep B develops into cirrhosis?
40%
What two hepatitis’s together are synergistically bad
Hep B + D
Complications of Hepatitis C**
- Membranoproliferative glomerulonephritis
- Lichen planus
- Autoimmune thyroiditis
- Lymphocytic sialadenitis
- Idiopathic pulmonary fibrosis
- Sporadic porphyria cutanea tarda
- Monoclonal gammopathy especially
- Increased risk of non Hodgkin lymphoma
- Increased risk of ESRD
- Hepatic steatosis
What % of the time does acute Hep C become chronic?
85% of the time
Two condiitons that Hep C can lead to
- Cirrhosis
2. Hepatocellular carcinoma
DDx for cholecystitis
Perforated peptic ulcer, pancreatitis, high appendicitis, liver abscess, hepatitis, PNA, MI, CA of hepatic flexure, hepatocellular jaundice
Four labs/imaging to do for IBS American GI Association Guidelines and what theyre for
- CBC -> anemia?
- Fecal calprotein-> IBD?
- Serum TG IgA -> Celiac?
- Stool specimen in daycare workers, foreign travelers, campers -> parasite?
DDx for IBS
- Colon neoplasia
- IBD
- Bile acid diarrhea
- Thyroid issues
- Parasites
- Malabsorption
- Carcinoid
- Gynecological issues
- Depression/anxiety
Antispasmodic drug for IBS
Anticholinergic drugs
Two anti-constipation drugs for IBS
- Polyethylene glycol
2. Lactulose/sorbitol
Two types of psychotropic agents for IBS
- Low dose tricyclic antidepressants: alter motility and sensitivity (only for IBS diarrhea)
- SSRIs: increase GI transit (only for IBS constipation)
When are serotonin receptor antagonists used in IBS
Diarrhea
Example of a non-absorbable Abx
Rifaximin
Three types of psychological treatment for IBS
- Cognitive behavioral therapy
- Relaxation
- Hypnotherapy
Two major complications in appendicitis
- Perforation
2. Thrombophlebitis of the portal system
Signs of appendix perforation
High fever, diffuse tenderness, palpable mass, elevated WBC, sx for 36+ hours
