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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
Q

Name a few indications for urgent endoscopy for ingestion of foreign body

A

Coin in proximal esophagus
Button battery in esophagus (not stomach)
Impactions that do no pass after 24 hours

26
Q

Dose of thiamine for alcoholics?

A

100mg IV

27
Q

When to give albumin in SBP?

Dose?

A

PMN of fluid > 250 cells, BUN > 30 or Cr > 1

1 g/kg

28
Q

What are the 2 types of Hepatorenal syndrome?

A

Type 1 - Cr > 2.5 mg/dL and is more severe

In general, RF in setting of cirrhosis w/out obvious renal pathology

29
Q

Dosing of ocreotide for GI bleed?

Somatostatin?

Vasopressin?

A

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
Q

What common drugs can lower serum protein levels d/t high protein binding profiles?

A

Phenytoin
Morphine
B-lactams
Glyco/lipopeptides

31
Q

Dosing of lactulose?

What med may be added? What dose?

A

30-60g daily

Neomycin 250mg bid-qid

32
Q

What are the high risk factors for a pt that has ascites to also have SBP?

A

Ascetic fluid protein level < 1 g/dL
Serum bilirubin > 3.2
Plt < 98,000
Previous hx of SBP

33
Q

What presents with gas in the GB wall?

RFs?

A

Emphysematous cholecystitis

Diabetic, male

34
Q

What lab value in the setting of acute pancreatitis has a 95% PPV for a biliary pancreatitis?

A

ALT

35
Q

What fluids to give in pancreatitis? Why?

A

LR

NS causes hyperchloremic metabolic acidosis —> low pH activates trypsinogen which makes pancreatic acinar cells more prone to injury

36
Q

What are the MC causes of pancreatitis in children?

A

Trauma

Viruses - coxsackie and mumps

37
Q

When to do CT in setting of pancreatitis?

A

Acute deterioration
Diagnosis is uncertain
Fever and leukocytosis are present

38
Q

What surgery puts you at risk for internal hernia?

A

Roux-en-Y or other bariatric surgery

39
Q

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?

A

Mesenteric venous thrombosis

Heparin ALONE

40
Q

What demographic develops obturator hernias?

A

Older women that have lost a lot of weight in a short period of time

41
Q

What labs can be used to help diagnose appendicitis?

What levels and what combined + LR?

A

Wbc > 10,000 + CRP > 8 has a + LR of 23!!!

42
Q

Treatment for nonperforated appendicitis?

A

Cipro 400 + Metro 500

Rocephin 1g + Metro 500

Unasyn 3g

43
Q

Abx for Peforated Appendicitis?

A

Zoster 3.375g

Cefepime 2g

44
Q

What causes a metallic, bitter, or peppery taste?

A

Scombroid

45
Q

What foodborne illness causes facial flushing, diarrhea, severe HA, palpitations, and abdominal cramps within 20 minutes after ingestion?

Treatment?

A

Scombroid

50mg Benadryl

46
Q

Ingestion of what causes GI symptoms first followed by Neuro symptoms (paresthesias, temperature distortions, teeth aching) afterwards?

Treatment?

A

Ciguatera

Mainly supportive but can give atropine and dopamine or Amitriptyline as it lasts about 2 weeks

47
Q

When does C. Diff poisoning occur?

What symptom is rare to have with it?

A

3-4 weeks after Abx usage (Clinda, FQ)

Vomiting

48
Q

What do you need to be aware of in pts with IBD?

A

Coagulaopathic —> DVT/PE

49
Q

What meds are associated with colonic ischemia?

A

Digoxin
Sumatriptan
Pseudophedrine

50
Q

What are some SEs of prolonged steroid use?

A

GI mucosal injury
Delayed wound healing
Osteopenia, osteonecrosis

51
Q

What blood vessel supplies hemorrhoids and is responsible for bleeding?

A

Superior rectal artery —> bright red blood

A - Rosen's GI (1 decks)

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