Adult Flashcards
Barium enemas
Dx:
CI:
DX:
-diverticulitis-> leakage of barium from a sac, stricture, or presence of pericolic inflammatory mass
- Hirschsprung disease (pedi)
- used to help rule in IBS
CI: IBD -> may cause toxic megacolon
Diverticulitis
Path:
Pt:
Dx:
Tx:
Path: out-pouching due to herniation of mucous into the wall of the colon along natural openings at vasa recta of colon. Sigmoid MC
Pt: LLQ abdominal pain, fever, N/V/D, constipation, flatulence, bloating
Dx:
- CT
- Barium enema not done in acute phase
Tx:
litis-> clear liquid diet, abx (cipro or bactrim + metronidazole)
osis-> high fiber diet
Hirschsprung
path:
pt:
dx:
tx:
Path: Absence of ganglion cells-> functional obstruction. MC in distal colon & rectum; MC in males and Down syndrome
Pt: pedi early onset constipation (delayed passage of meconium, >48hrs), bilious vomiting, abd distension
Dx:
- Anorectal manometry, often initial screening
- Barium enema-> transition zone ‘caliber change’ at area between normal and affect bowel (can be falsely negative)
- Rectal Bx, definitive dx
Tx: Surgical resection of affected bowel
Silhouette sign
Water density process in the lung (i.e. pneumonia) is next to a water density structure (i.e. heart), the border between them is lost
Kerly B sign
small horizontal lines seen in periphery of the lung. Seen in inc fluid density material in the interlobular septa often pulmonary edema (CHF) or speed of tumors through the lymphatic system (lymphangitic carcinomatosis)
Esophagram
Dx
- Esophagitis
- Achalasia -> bird beak
- Diffuse Esophageal Spasm-> corkscrew
- Zenker’s Diverticulum -> collection of dye behind esophagus
- Boerhaave Syndrome -> +leakage
- Esophageal webs and rings
Esophagitis
Path
Pt
Dx
Tx
Path: GERD (MC), infectious in immunocomp, radiation therapy/meds/corrosive ingestion, eosinophilic
Pt: odynophagia, dysphagia, retrosternal chest pain
Dx
- upper endoscopy
- double-contrast esophagram
Tx underlying cause
Achalasia
Path
Pt
Dx
Tx
Path: idiopathic proximal loss of Auerbach’s plexus -> inc LES pressure leading to obstruction and lack of peristalsis
Pt: Dysphagia to BOTH solids and liquids
Dx:
- Esophageal manometry (GS) -> inc LES pressure >40mmHg
- Esophagram -> Bird’s beak appearance of LES w/ proximal esophageal dilation
- Endoscopy-> r/o esophageal carcinoma
Tx dec LES pressure
- Botox
- Nitrites
- CCB
- pneumatic dilation of LES
- esophagomyomectomy
Diffuse Esophageal Spasm
path:
pt:
dx:
tx:
path: strong non-peristaltic esophageal contractions
pt: stabbing, chest pain worse w/ hot or cold liquids/foods
dx:
- esophagram: “corkscrew” esophagus
- endoscopy
- manometry
tx: nitrates, CCB
Zenker’s Diverticulum
path:
pt:
dx:
tx:
path: pharyngoesophgeal pouch (false diverticulum-only involved mucosa)
pt: dysphagia, regurg of food, cough, feeling of lump in neck, halitosis
dx: Barium esophagram-> collection of dye behind esophagus @ pharyngoesophgeal junction
tx: divertricculectomy, crioccopharyngeal myotomy vs observe if small
Boerhaave Syndrome
path:
pt:
dx:
tx:
path: full thickness rupture of distal esophagus from repeated forceful vomiting (bulimia) or iatrogenic perf of esophagus during endoscopy
pt: retrosternal chest pain worse w/ deep breathing & swallowing, hematemesis; crepitus on chest auscultation due to pneumomediastinum
dx:
- Chest CT/CXR -> pneumomedistinum, esophageal thickening. Left sided hydropneumothorax
- Esophagram (define dx) -> leakage. Gastrografin swallow preferred
tx:
- small: IVF, NPO, abx, H2 blockers
- large: surgical repair
Esophageal Webs and Rings
path:
pt:
dx:
tx:
path: thin membranes in the mid-upper esophagus
Plummer-Vinson Syndrome: 1. dysphagia, 2. esophageal webs, 3. iron def anemia
pt: dysphagia especially to solids
dx: Barium esophagram (swallow) diagnostic test of choice, more sensitive than manometry
tx: endoscopic dilation of the areas if sx w/o reflux. antireflux surgery if reflux present
Normal CSF findings
opening pressure: <180 mmH2O
WBC: <5
PMN: none
Protein: <45
Glucose >40
Gram stain: neg
Antigen detection: neg
PCR: neg
Bacterial CSF findings in Meningitis
opening pressure: >180 mmH2O
WBC: >1000
PMN: >50% neutrophils
Protein: >100
Glucose <40 or ratio of <50% of systemic glucose
Gram stain: pos 80%
Antigen detection: capsular polysaccharides (not routinely done)
PCR: not routine
Reasons to get head CT prior to LP
Immunocompromised
hx of CNS dz
new onset seizure
papilledema
AMS
focal neurologic deficit
delay in performance of dx LP
BCX -> Dex + Empiric Abx -> head CT, if neg-> LP
