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LMCC > Abdo > Flashcards

Abdo Flashcards

1
Q

Charcot’s Triad

A
  1. Fever
  2. Abdo pain
  3. Jaundice
    Suggestive of ascending acute cholangitis
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2
Q

Gold standard for GERD

A

24h pH monitor

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3
Q

Therapy for peptic ulcer disease

A

Triple therapy: clarithro + amox + ppi

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4
Q

Pancreatitis dx

A

2/3 of:

  1. classic epigastric pain
  2. lipase >3x ULN
  3. Evidence of pancreatitis on imaging
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5
Q

Pancreatitis tx

A
  1. Fluid resuscitation (aggressive)
  2. Analgesia (IV opioids)
  3. Gut rest/NPO with slow advancement
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6
Q

Who to treat with asymptomatic bacteruria

A

Pregnant patients

Patients with upcoming Uro surgery

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7
Q

Complicated UTI

A

Males
Females >55 with Uro complications
SCI

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8
Q

Most common type of ureteral stone

A

Ca-Oxalate or Ca-Phosphate

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9
Q

Non radio-opaque renal stones

A

Uric acid

Indinavir (HIV drug)

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10
Q

CT findings for appendicitis

A
  1. Enlarged appendix >6mm with occluded lumen
  2. Wall thickening >2mm
  3. Potential fecolith or obstructing structure
  4. Fat stranding
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11
Q

Diverticulitis recurrence rates

A

1/3 will have second attack

1/3 of those will have third attack

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12
Q

Pancreatitis mortality measurement

A

Ranson’s Criteria

  • At admission:
    • Age in years >55yo
    • WBC >16 x10^9
    • Blood glucose >10mmol/L
    • Serum AST >250 U/L
    • Serum LDH >350 U/L
  • At 48h
    • Calcium (serum <2)
    • Hematocrit fall >10%
    • Oxygen (hypoxemia PO2 < 60mmHg)
    • BUN increased by 1.8 or more mmol/L after IV fluid hydration
    • Base deficit >4 mEq/L
    • Sequestration of fluids >6L
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13
Q

Vitamin A deficiency symptoms

A

Night blindness and corneal drying

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14
Q

Vitamin B3/Niacin deficiency symptoms

A

Diarrhea, dermatitis, dementia

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15
Q

Vitamin B12/Cobalamin deficiency symptoms

A

Tingling, numbness and spastic paresis

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16
Q

Vitamin C deficiency

A

Gingival bleeding and hyperkeratosis

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17
Q

Vitamin B2/Riboflavin deficiency

A

Stomatitis, glossitis, seborrheic dermatitis

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18
Q

Most consistent physical exam finding in patients with portal hypertension

A

Splenomegaly

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19
Q

Zollinger-Ellison Syndrome

A

Non-beta islet cell, gastrin-secreting tumour of pancreas
Gastrin –> increase influx of acid into stomach = ulcerative disease
Large multiple ulcers typically in distal duodenum or jejunum
Dx: endoscopy and fasting serum gastrin
Persistent high gastrin despite infusion of secretin (which normally inhibits gastrin secretion)
Tx: high dose PPI and curative sx

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20
Q

Reynaud’s Pentad

A 
RUQ pain 
Fever
jaundice 
Hypotension
Altered mental status 
Suggestive of suppurative cholangitis
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21
Q

Treatment for primary biliary cirrhosis

A

Transplant

Ursodeoxycholic Acid can help slow progression (bile acid that helps move bile through the liver)

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22
Q

Crohn’s disease

A

Transmural
Entire gut (most common location = ileum and ascending colon)
Abdo cramps, non-bloody diarrhea, weight loss
Endoscopy: cobblestoning, ulcers
Histo: Non-caseating granulomas, glands intact
AXR: String sign
Colon CA increase risk if >30% colon involved

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23
Q

Crohn’s disease acute tx

A

Prednisone 40mg OD

IV methylpred if severe

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24
Q

Crohn’s disease maintenance

A

5-aminosalycilic acid (Mesalazine)

Cipro or Flagyl in pts who don’t tolerate 5-ASA

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25
Q

Refractory Crohn’s disease tx

A

Immunosuppression
- Azathioprine
- 6-MP
- MTX
Immunomodulators
- TNF-antagonists: Infliximab, adalimumab
Combo infliximab + azathioprine proven to be more effective together

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26
Q

Derm condition a/w IBD

A

Erythema nodosum (CD > UC)

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27
Q

Ulcerative colitis tx

A

5-ASA (mesalamine) for maintenance
Steroids for acute attack
Infliximab (immunosuppresant) + steroid if severe
Azathioprine used in combo therapies typically for maintenance
Colectomy for curative tx

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28
Q

Virchow’s node

A

Left supraclavicular node a/w gastric CA (Also gallbladder, pancreas, kidneys, testicles, ovaries or prostate CA)
Typically felt in advanced stage

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29
Q

Right supraclavicular node

A

Drains thoracic malignancies

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30
Q

Dubin-Johnson Syndrome

A

Benign liver dz distinguished by direct hyperbilirubinemia

31
Q

Gilbert syndrome

A 
Hereditary dz (auto dom or recessive)
Indirect hyperbilirubinemia caused by glucuronosyl transferase activity
32
Q

Primary sclerosing cholangitis biomarker

A

ANCA+

33
Q

Primary biliary cirrhosis biomarker

A

AMA+

IgM increased

34
Q

Primary sclerosing cholangitis often a/w ____

A

ulcerative colitis

35
Q

PSC tx

A

Transplant

ERCP for strictures

36
Q

Wilson’s disease lab finding

A

Low ceruloplasmin (copper carrying protein)

37
Q

Wilson’s disease tx

A

Chelation with D-penicillamine

Maintenance with zinc

38
Q 
HBsAG + 
Anti-HBc + 
IgM Anti-HBc + 
anti-HBs neg
HBeAg+ 
Anti-HBe -
A

Acutely infected

39
Q

HBsAg neg
Anti HBc neg
Anti HBs neg

A

Susceptible

40
Q 
HBsAg +
Anti-HBc IgG +
IgM anti-HBc neg 
anti-HBs neg
HBeAg+ 
Anti-HBe -
A

Chronically infected (high infectivity)

41
Q

HBsAg neg
anti-HBc pos
anti-HBs pos

A

Immune due to natural infection

42
Q 
HBsAg neg
Anti-HBc neg
Anti-HBs pos 
HBeAg -
Anti-HBe -
A

Immune due to vaccination

43
Q

Treatment for ascending acute cholangitis

A

ERCP sphincterectomy

44
Q

Smoking and Crohn’s

A

Bad

45
Q

Smoking and UC

A

Good

But still advise them to quit

46
Q

Zollinger Ellison imaging

A

Somatostatin receptor scintigraphy = detects primary or metastatic lesions in ZES
Gastrinoma a/w increased number of somatostain receptors which can be detected through this test

47
Q

Radiologic sign of CD

A

String sign

48
Q

Radiologic sign of midgut volvulus

A

Whirlpool sign

49
Q

Pharmaco tx for alcoholic hepatitis

A

Steroids

Pentoxyfyllin

50
Q

PBC serum markers

A

IgM

AMA+

51
Q

AI hepatitis serum marers

A

AST/ALTs in thousands
IgG
ANA+
ASMA+

52
Q

Hereditary hemochromatosis tx

A

Venesection and phlebotomy
Chelation with desferrioxamine (usually last line)
Avoid Vit C

53
Q

PSC serum markers

A

ANCA+
IGG
AMA

54
Q

SAAG > 11

A

Portal HTN related

55
Q

SAAG < 11

A

Non-portal HTN related (infection, pancreatitis, TB)

56
Q

SBP indications

A

T > 37.8
Abdo pain
Change in mental status
Ascitic fluid PMN count >250 cells/mm3

57
Q

SBP tx

A

Discontinue BB
Empiric tx (3rd gen cephalosporin ie. cefotax or CTX)
Tailor tx once cultures back
Typically 5d
IV albumin to decrease renal failure risk

58
Q

Long-term abx prophylaxis against SBP for these types of patients

A 
Cirrhosis and GI bleeding 
> 1 epi of SBP
Cirrhosis and ascites + impaired renal function or liver failure 
Can use septra, cipro, norfloxacin
Acutely can use Ceftriaxone IV
59
Q

SAAG > 11 with total protein >25g/L

A

Cardiac portal HTN

60
Q

SAAG > 11 with total protein <25g/L

A

Cirrhosis portal HTN

61
Q

Abx of choice for gastric paresis secondary to diabetes

A

Erythromycin

62
Q 
HBsAg + 
Anti-HBs - 
HBeAg - 
Anti- HBe + 
Anti-HBc IgG
A

Chronic HBV (low infectivity)

63
Q

Osmotic agents tx for constipation

A

Lactulose
Peg 3350
Sorbitol
Mg salts

64
Q

Stimulant tx for constipation

A

Senna

Bisacodyl

65
Q

Bulking agent tx for constipation

A

Metamucil

66
Q

Preferred dx modality for PSC

A

MRCP

67
Q

Primary biliary cholangitis

A

AI destruction of INTRAhepatic bile ductules
Unknown cause
Gradual progression to cirrhosis

68
Q

Primary sclerosing cholangitis

A

AI inflammation of biliary tract
Unknown cause
Increased incidence of cholangiocarcinoma

69
Q

Location of bile acid resorption

A

Terminal ileum

70
Q

Location of dietary fat resorption

A

Jejunum

71
Q

Diagnostic test for achalasia

A

Esophageal manometry

72
Q

Barrett’s esophagus follow-up if no dysplasia

A

Repeat endoscopy q3-5yr

73
Q

Barrett’s esophagus follow-up if high-grade dysplasia

A

Regular/frequent surveillance with intensive biopsy, endoscopy ablation/resection or esophagectomy

74
Q

Barrett’s esophagus follow-up if low-grade dysplasia

A

Surveillance q6mo-1yr and endoscopic ablation/resection

LMCC (22 decks)

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