Appendicitis/gallbladder/pancreatitis Flashcards
Psoas sign is described as?
abdominal pain elicited by passive extension of the hip
abdominal palpation that yields rebound tenderness is?
positive blumbergs
obturator sign is?
abdominal pain elicited by passive flexion and internal rotation of the hip
signs of appendicitis?
epigastric and periumbicilical pain with discomfort shifting rRLQ over 12 hours. worsened by coughin or walking. N/V late signs.
diagnostics appendicitis?
total WBC and differential - left shift. leukocytosis, neutrophilia (elevated > 7000), bandemia (elevation in young neutrophils), ABC > 500. rule out pregnancy hcg. can do CRP. CT image of choice. can do US if worried about exposure. limited use of US in pregnant women due to changes.
signs of severe infection?
bandemia wont exist in severe infection. instead myelocytes and metamyleocytes are omnious marker of life threatening infection.
signs appendiceal perforation?
leukocytosis > 20,000 - 30,000, fever > 102, syptoms > 48 hours. ill defined borders, dull percussion.
treatment appendicitis?
laproscopy or laparatomy. if rupture with localized abscess and peritonitis, CT with abscess aspriation can be done first. and ectomy after antimicrobrial therapy.
common form of stones in gallbladder?
cholesterol.
what is cholethiasis
formation of calculi or gallstones but wihrouth presence of gallbladder or associated structure.
signs of gallstones?
intermittent discomfort, sudden onset, post prandial after 1 hour of meal, particularly fatty meal. RUQ or epigastric occassionally radiates to scapula . last 1-5 hours. n/v. biliary colic.
What is collins sign?
radiation of gallstone pain from RUQ or epigastric to right scapula.
what is acute cholecystitis?
acute inflamm of gallbladder, often caused by gallstones. ocassional fever, RUQ pain, vomiting, tenderness of palpatino. murphy’s sign, palpable gallbladder rarely noted.
labs with cholecystitis
leukocytosis > 12,000 - 20,000, elevated hepatic enzymes.
diagnostic testing for gallstones?
RUQ ultrasound. HID scan more sensitive to reveal obstructed duct.
tx cholexystitis?
low fat diet, clear fluids, analgesics. antimicrobial therapy. cholecystectomy considered for recurrance.
complications of gallstone disease?
pancreatitis and spesis.
What is ALT?
measure of hepatic cellcular enzymes in circulation, elevated when hepatocellular damage present.
what is AST?
elevated hepatic cellular enzymes when hepatic damage, also high in skeletal muscle and myocardium.
AST:ALT ratio interpretation
AST: ALT>/1 - alchol damage
ALT:AST > 1 nonalcohol damage, hepatitis.
what is ALP?
elevated with acute cholecystits (along with ALT and AST) increae in response to biliart obstrction.
what is GGT?
enzyme involve din transfer of AA across cell membranes. marked elevation in obstructive jaundice, hepatic mestastasis, intra hepatic cholestatsis.
What is pancreatitis?
acute or chronic inflammation of organ, common cause is biliary tract disease (think gallbladder stones, elevated TG, etoh intake)
RF of pancreatitis?
alcoholism, opioids, corticosteroids, thiazide diuretics, viral infection, blunt abdominal trauma.
Labs in acute pancreatitis?
amylase elevated + lipase elevated (usually 3 x limit and no gut perforation noted)
Daignostics/imaging for pancreatitis?
Ct scan (US will just tell you if gallbladder dx also present)
Criteria for diagnosing pancreatitis?
2 of the 3:
- characteristic severe abdominal pain
- serum amylase and or lipase exceeding 3 times limit
- Positive imaging
managment of pancreatitis?
parenteral hydration, analgesics, and gut rtest.
tx underlying disorder as well.
Ranson criteria for ranking pancreatitis?
review of WBC, blood glucose, AST, LDH, hematocrit, serum Ca, BUN
0-2 - 1% mortality
3-4 - 15 %
5-6 - 40%
> 6 - 100%
signs of pancreatitis?
WBC elevated, abdominal pain sudden onset.
signs of pancreatic cancer?
nausea, vomiting, boring pain sudden and steady. worsens with walking and lying supie. improves with sitting and leaning forward. weakness, sweating, and anxiety.
upper abdomen tender w/o gaurding, rigidity or gaurding with distension. fever, tachy, hotn, pallow, cool, clammy skin, mild jaundice. sometimes palpable mass noted. acute renal injury may be present.
what are pancreatic pseudocysts?
benign pockets of fluid lined with scar or inflamm tissue. asympomatic but can include abdominal pain that may radiate to back. mass felt in upper abdomen. n/v.
diagnost pancreatic pseudocysts?
MRi and CT can help diff. but fluid collection test for signs of cacner.
management of pseudocysts?
- no signs of symptoms - left alone, monitor
- 10mm require US endoscopy
- bothersome - drain vis US endoscopy with guided fine needle aspiration. surgery may be needed.
Diagnostic for pancreatic cancer?
CT scan, also ACD anemia. elevated total ad direct bilirubin and ALK.
nonpancratic amylase sources?
salivary glands, ovarian cysts, ovarian tumors, tubo-ovarian abscess, ruptured ectopic preg, lung cancer
- usually due to cholelithiasiss and etoh pancreatitis.
nonpancreatic sources for elevated lipase
renal failure, perf duodonal ulcer, bowel obstruction, bowel infarction
