Abd Pain Flashcards
Dosing of Zosyn for ABD pain?
3.375g
Dosing of Cipro + Flagyl for acute appy or other ABD pain?
500mg for both
When is clinical jaundice evident? Where?
Total serum bilirubin > 2.5 mg/dL seen sublingually or conjuctiva or hard palate
Direct bili > indirect with v elevated ALP and normal/mild liver enzymes suggests what?
DDx?
Obstructive process
Choledocholithiasis
Intrinsic bile duct disease —> cholangitis, AIDS, strictures, neoplasm
Ext biliary compression
Indirect bili > direct bili indicates what? Will have what other values?
DDx?
Hematologic process
Normal LFTs, ALP, INR
Hemolytic disorder, ineffective erythropoiesis, Gilbert’s syndrome
What drug should be stopped in pts with SBP bc it increases mortality?
Beta blockers
Vomiting is coordinated by what?
Located where?
Vomiting center
Lateral reticular formation of the medulla
Where is the chemoreceptor trigger zone located?
What receptors?
Area postrema, floor of 4th ventricle outside the BB barrier
D2 and serotonin receptors
MOA of Compazine? Dosing?
MOA of phenergan? Dosing?
D1, D2 antagonist at CTZ
2.5-10mg q4
H1 antagonist in CTZ and minimal D2
12.5-25mg q4
Pt with N/V/HA should be treated with what 1st line?
Why?
Reglan
Zofran cause cause HA as a side effect
Pregnant pt with N/V, what is 1st line tx?
What to send home with?
Reglan 10mg IV
B6 and ginger
How does severe Vomiting effect Cl, K, acid/base?
Hypo Cl
Hypo K
Metabolic alkalosis
Where is the principal site of action for Zofran? Receptors?
Area postrema, in the lateral reticular formation of the medulla
5-HT3 antagonist
Reglan MOA?
D2 and 5HT3 in CTZ
D2 in stomach and LES
BUN/Cr ratio greater than what has a 90% sensitivity of GIB (with no evidence of renal failure)?
36
What is the dosing for PPI omeprazole bolus and infusion in upper GI bleed?
Alternate dosing for pantoprazole?
80mg bolus omeprazole followed by 8 mg/hr continuous IV infusion
40mg IV bid
Dosing of Octreotide?
50 microgram bolus followed by 50 microgram/hr continuous IV
What is the #1 treatment for C diff infection?
PO vancomycin 125mg 4x/day for 10-14 days
Kids who attend daycare are at greater risk of getting diarrhea from what source?
Shigella, Giardia, Rotavirus
What is the Abx treatment for ill-appearing pt w/diarrhea?
Cipro bid or levofloxacin qd 500m for 3-5 days
Mineral oil should be used in whom?
What else can help?
Potential adverse SE?
Pts w/acute painful perianal lesions
Glycerin suppositories
Lipid PNA d/t risk of aspiration in certain pt populations
Where does food bolus entrapment occur in peds?
Adults?
Cricopharyngeus
UES
What objects in the stomach require endoscopic retrieval?
Longer than 5cm or wider than 2.5cm in diameter
All sharp and pointed objects d/t risk of intestinal perforation
Dose of sucralfate?
Special property?
1g q6 hours
SAFE in pregnancy
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
Dose of thiamine for alcoholics?
100mg IV
When to give albumin in SBP?
Dose?
PMN of fluid > 250 cells, BUN > 30 or Cr > 1
1 g/kg
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
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
What common drugs can lower serum protein levels d/t high protein binding profiles?
Phenytoin
Morphine
B-lactams
Glyco/lipopeptides
Dosing of lactulose?
What med may be added? What dose?
30-60g daily
Neomycin 250mg bid-qid
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
What presents with gas in the GB wall?
RFs?
Emphysematous cholecystitis
Diabetic, male
What lab value in the setting of acute pancreatitis has a 95% PPV for a biliary pancreatitis?
ALT
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
What are the MC causes of pancreatitis in children?
Trauma
Viruses - coxsackie and mumps
When to do CT in setting of pancreatitis?
Acute deterioration
Diagnosis is uncertain
Fever and leukocytosis are present
What surgery puts you at risk for internal hernia?
Roux-en-Y or other bariatric surgery
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
What demographic develops obturator hernias?
Older women that have lost a lot of weight in a short period of time
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!!!
Treatment for nonperforated appendicitis?
Cipro 400 + Metro 500
Rocephin 1g + Metro 500
Unasyn 3g
Abx for Peforated Appendicitis?
Zoster 3.375g
Cefepime 2g
What causes a metallic, bitter, or peppery taste?
Scombroid
What foodborne illness causes facial flushing, diarrhea, severe HA, palpitations, and abdominal cramps within 20 minutes after ingestion?
Treatment?
Scombroid
50mg Benadryl
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
When does C. Diff poisoning occur?
What symptom is rare to have with it?
3-4 weeks after Abx usage (Clinda, FQ)
Vomiting
What do you need to be aware of in pts with IBD?
Coagulaopathic —> DVT/PE
What meds are associated with colonic ischemia?
Digoxin
Sumatriptan
Pseudophedrine
What are some SEs of prolonged steroid use?
GI mucosal injury
Delayed wound healing
Osteopenia, osteonecrosis
What blood vessel supplies hemorrhoids and is responsible for bleeding?
Superior rectal artery —> bright red blood
