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A - Rosen's GI > Abd Pain > Flashcards

Abd Pain Flashcards

1
Q

Dosing of Zosyn for ABD pain?

A

3.375g

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2
Q

Dosing of Cipro + Flagyl for acute appy or other ABD pain?

A

500mg for both

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3
Q

When is clinical jaundice evident? Where?

A

Total serum bilirubin > 2.5 mg/dL seen sublingually or conjuctiva or hard palate

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4
Q

Direct bili > indirect with v elevated ALP and normal/mild liver enzymes suggests what?

DDx?

A

Obstructive process

Choledocholithiasis
Intrinsic bile duct disease —> cholangitis, AIDS, strictures, neoplasm
Ext biliary compression

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5
Q

Indirect bili > direct bili indicates what? Will have what other values?

DDx?

A

Hematologic process
Normal LFTs, ALP, INR

Hemolytic disorder, ineffective erythropoiesis, Gilbert’s syndrome

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6
Q

What drug should be stopped in pts with SBP bc it increases mortality?

A

Beta blockers

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7
Q

Vomiting is coordinated by what?

Located where?

A

Vomiting center

Lateral reticular formation of the medulla

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8
Q

Where is the chemoreceptor trigger zone located?

What receptors?

A

Area postrema, floor of 4th ventricle outside the BB barrier

D2 and serotonin receptors

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9
Q

MOA of Compazine? Dosing?

MOA of phenergan? Dosing?

A

D1, D2 antagonist at CTZ
2.5-10mg q4

H1 antagonist in CTZ and minimal D2
12.5-25mg q4

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10
Q

Pt with N/V/HA should be treated with what 1st line?

Why?

A

Reglan

Zofran cause cause HA as a side effect

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11
Q

Pregnant pt with N/V, what is 1st line tx?

What to send home with?

A

Reglan 10mg IV

B6 and ginger

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12
Q

How does severe Vomiting effect Cl, K, acid/base?

A

Hypo Cl
Hypo K
Metabolic alkalosis

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13
Q

Where is the principal site of action for Zofran? Receptors?

A

Area postrema, in the lateral reticular formation of the medulla
5-HT3 antagonist

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14
Q

Reglan MOA?

A

D2 and 5HT3 in CTZ

D2 in stomach and LES

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15
Q

BUN/Cr ratio greater than what has a 90% sensitivity of GIB (with no evidence of renal failure)?

A

36

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16
Q

What is the dosing for PPI omeprazole bolus and infusion in upper GI bleed?

Alternate dosing for pantoprazole?

A

80mg bolus omeprazole followed by 8 mg/hr continuous IV infusion

40mg IV bid

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17
Q

Dosing of Octreotide?

A

50 microgram bolus followed by 50 microgram/hr continuous IV

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18
Q

What is the #1 treatment for C diff infection?

A

PO vancomycin 125mg 4x/day for 10-14 days

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19
Q

Kids who attend daycare are at greater risk of getting diarrhea from what source?

A

Shigella, Giardia, Rotavirus

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20
Q

What is the Abx treatment for ill-appearing pt w/diarrhea?

A

Cipro bid or levofloxacin qd 500m for 3-5 days

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21
Q

Mineral oil should be used in whom?

What else can help?

Potential adverse SE?

A

Pts w/acute painful perianal lesions

Glycerin suppositories

Lipid PNA d/t risk of aspiration in certain pt populations

22
Q

Where does food bolus entrapment occur in peds?

Adults?

A

Cricopharyngeus

UES

23
Q

What objects in the stomach require endoscopic retrieval?

A

Longer than 5cm or wider than 2.5cm in diameter

All sharp and pointed objects d/t risk of intestinal perforation

24
Q

Dose of sucralfate?

Special property?

A

1g q6 hours

SAFE in pregnancy

25
Name a few indications for urgent endoscopy for ingestion of foreign body
Coin in proximal esophagus Button battery in esophagus (not stomach) Impactions that do no pass after 24 hours
26
Dose of thiamine for alcoholics?
100mg IV
27
When to give albumin in SBP? Dose?
PMN of fluid > 250 cells, BUN > 30 or Cr > 1 1 g/kg
28
What are the 2 types of Hepatorenal syndrome?
Type 1 - Cr > 2.5 mg/dL and is more severe In general, RF in setting of cirrhosis w/out obvious renal pathology
29
Dosing of ocreotide for GI bleed? Somatostatin? Vasopressin?
50 microgram bolus then 25-50 infusion /hr 250 microgram bolus then 250 infusion/hr 0.4 unit bolus then 0.4-1 unit/minute infusion
30
What common drugs can lower serum protein levels d/t high protein binding profiles?
Phenytoin Morphine B-lactams Glyco/lipopeptides
31
Dosing of lactulose? What med may be added? What dose?
30-60g daily Neomycin 250mg bid-qid
32
What are the high risk factors for a pt that has ascites to also have SBP?
Ascetic fluid protein level < 1 g/dL Serum bilirubin > 3.2 Plt < 98,000 Previous hx of SBP
33
What presents with gas in the GB wall? RFs?
Emphysematous cholecystitis Diabetic, male
34
What lab value in the setting of acute pancreatitis has a 95% PPV for a biliary pancreatitis?
ALT
35
What fluids to give in pancreatitis? Why?
LR NS causes hyperchloremic metabolic acidosis —> low pH activates trypsinogen which makes pancreatic acinar cells more prone to injury
36
What are the MC causes of pancreatitis in children?
Trauma | Viruses - coxsackie and mumps
37
When to do CT in setting of pancreatitis?
Acute deterioration Diagnosis is uncertain Fever and leukocytosis are present
38
What surgery puts you at risk for internal hernia?
Roux-en-Y or other bariatric surgery
39
Younger woman who smokes and is on ocp that has 2 days of worsening diffuse abd pain with no peritoneal findings can have what? Treatment?
Mesenteric venous thrombosis Heparin ALONE
40
What demographic develops obturator hernias?
Older women that have lost a lot of weight in a short period of time
41
What labs can be used to help diagnose appendicitis? What levels and what combined + LR?
Wbc > 10,000 + CRP > 8 has a + LR of 23!!!
42
Treatment for nonperforated appendicitis?
Cipro 400 + Metro 500 Rocephin 1g + Metro 500 Unasyn 3g
43
Abx for Peforated Appendicitis?
Zoster 3.375g | Cefepime 2g
44
What causes a metallic, bitter, or peppery taste?
Scombroid
45
What foodborne illness causes facial flushing, diarrhea, severe HA, palpitations, and abdominal cramps within 20 minutes after ingestion? Treatment?
Scombroid 50mg Benadryl
46
Ingestion of what causes GI symptoms first followed by Neuro symptoms (paresthesias, temperature distortions, teeth aching) afterwards? Treatment?
Ciguatera Mainly supportive but can give atropine and dopamine or Amitriptyline as it lasts about 2 weeks
47
When does C. Diff poisoning occur? What symptom is rare to have with it?
3-4 weeks after Abx usage (Clinda, FQ) Vomiting
48
What do you need to be aware of in pts with IBD?
Coagulaopathic —> DVT/PE
49
What meds are associated with colonic ischemia?
Digoxin Sumatriptan Pseudophedrine
50
What are some SEs of prolonged steroid use?
GI mucosal injury Delayed wound healing Osteopenia, osteonecrosis
51
What blood vessel supplies hemorrhoids and is responsible for bleeding?
Superior rectal artery —> bright red blood

A - Rosen's GI (1 decks)

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