4) GI

Question 1

Ranson’s Criteria for prediction of mortality in pancreatitis at presentation

Answer 1

Age >55yr
WBC > 16,000
Glucose >200
LDH >350
AST >250

Question 2

Ranson’s Criteria for prediction of mortality in pancreatitis at 48h

Answer 2

Fall in HCT >10%
Increase in BUN >5mg/dL
Calcium 4
Fluid deficit >6

Question 3

Salmonella bacterial diarrhea characteristic

Answer 3

-gram negative rods
-occurs after ingestion of contaminated eggs, dairy or poultry
-diarrhea is bloody and is accompanied by tenesmus, fever, abdominal pain
(Symp resolve spontaneously in 10-14 days)

Question 4

Shigella bacterial diarrhea characteristics

Answer 4

• highly pathogenic, as few as 10 organisms can cause disease
• typically pred by fecal-oral contact or contaminated foods
• severe bloody profuse diarrhea

Question 5

Campylobacter jejuni diarrhea characteristics

Answer 5

acquired from eating undercooked poultry or contaminated natural water sources

• abdominal cramping and profuse bloody diarrhea begin
• myalgias, headache, and vominting also commonly accompany infection
• causative agent of Guillian-Barre Syndrome

Question 6

Yersenia diarrhea characteristics

Answer 6

• spread via fecal oral route
• fever, abdominal pain, profuse watery or bloody diarrhea and vomiting
• clinical syndrome is commonly mistaken for acute appendicitis

Question 7

E. Coli diarrhea characteristics

Answer 7

• eating undercooked beef = most common
• hemolytic uremic syndrome and rhrombotic thrombocytopenic purpura are two of the most serious complications of infection

Question 8

Giardia lamblia diarrhea characteristics

Answer 8

-spread by ingestion of contaminated water sources
-protozoa
-common in rocky mountain areas of US
-frequent, explosive, foul smelling diarrhea commonly lasts 7-10 days and reinfection is common unless antibiotic therapy is initiated
Tx: Metronidazole

Question 9

Rx for bacterial diarrhea

Answer 9

Quinolones BID

Question 10

Rx for variceal bleeding

Answer 10

Vassopressin and octreotide constrict dilated esophageal vessels (but no proven reduction in mortality)

Question 11

Diagnostic procedure of choice in upper GIB

Answer 11

endoscopy

Question 12

What rx is a risk factor for ischemic bowel?

Answer 12

Digoxin: potent splanchnic vasoconstrictive effects

Question 13

Mesenteric ischemia on imaging

Answer 13

Gold standard = angiography (may provide route for infusion of vasodilatory drugs)
Plain x-ray = bowel wall thickening or pneumatosis intesinalis
Ct = pneumatosis and bowel thickening
CT angio w/ IV contrast = sensitive and specific

Question 14

Tx of mesenteric ischemia

Answer 14

• supplemental o2, cardiac monitor, IV access
• volume resuscitation w/ NS or Lr
• broad spectrum abx
• NG to decompress stomach

Question 15

Most common type of stones in cholecystitis

Answer 15

Cholesterol stones

-formed when cholesterol is supersaturated in bile and precipitates out

Question 16

Most common cause of symptomatic cholelithiasis

Answer 16

obstructing stone

Question 17

Typical pathogens of cholecystitis

Answer 17

gram negatives
streptococci
anaerobes

Question 18

Most common cause of appendicitis

Answer 18

obstruction by fecaliths or tumor (older patients)

viral (children)

Question 19

Most common bacteria when necrosis of appendix

Answer 19

• bacteroides fragilis

- e.coli

Question 20

Diagnostic procedure of choice for appendicitis

Answer 20

CT w/ IV plus oral or rectal contrast