Appendicitis/gallbladder/pancreatitis

Question 1

Psoas sign is described as?

Answer 1

abdominal pain elicited by passive extension of the hip

Question 2

abdominal palpation that yields rebound tenderness is?

Answer 2

positive blumbergs

Question 3

obturator sign is?

Answer 3

abdominal pain elicited by passive flexion and internal rotation of the hip

Question 4

signs of appendicitis?

Answer 4

epigastric and periumbicilical pain with discomfort shifting rRLQ over 12 hours. worsened by coughin or walking. N/V late signs.

Question 5

diagnostics appendicitis?

Answer 5

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.

Question 6

signs of severe infection?

Answer 6

bandemia wont exist in severe infection. instead myelocytes and metamyleocytes are omnious marker of life threatening infection.

Question 7

signs appendiceal perforation?

Answer 7

leukocytosis > 20,000 - 30,000, fever > 102, syptoms > 48 hours. ill defined borders, dull percussion.

Question 8

treatment appendicitis?

Answer 8

laproscopy or laparatomy. if rupture with localized abscess and peritonitis, CT with abscess aspriation can be done first. and ectomy after antimicrobrial therapy.

Question 9

common form of stones in gallbladder?

Answer 9

cholesterol.

Question 10

what is cholethiasis

Answer 10

formation of calculi or gallstones but wihrouth presence of gallbladder or associated structure.

Question 11

signs of gallstones?

Answer 11

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.

Question 12

What is collins sign?

Answer 12

radiation of gallstone pain from RUQ or epigastric to right scapula.

Question 13

what is acute cholecystitis?

Answer 13

acute inflamm of gallbladder, often caused by gallstones. ocassional fever, RUQ pain, vomiting, tenderness of palpatino. murphy’s sign, palpable gallbladder rarely noted.

Question 14

labs with cholecystitis

Answer 14

leukocytosis > 12,000 - 20,000, elevated hepatic enzymes.

Question 15

diagnostic testing for gallstones?

Answer 15

RUQ ultrasound. HID scan more sensitive to reveal obstructed duct.

Question 16

tx cholexystitis?

Answer 16

low fat diet, clear fluids, analgesics. antimicrobial therapy. cholecystectomy considered for recurrance.

Question 17

complications of gallstone disease?

Answer 17

pancreatitis and spesis.

Question 18

What is ALT?

Answer 18

measure of hepatic cellcular enzymes in circulation, elevated when hepatocellular damage present.

Question 19

what is AST?

Answer 19

elevated hepatic cellular enzymes when hepatic damage, also high in skeletal muscle and myocardium.

Question 20

AST:ALT ratio interpretation

Answer 20

AST: ALT>/1 - alchol damage
ALT:AST > 1 nonalcohol damage, hepatitis.

Question 21

what is ALP?

Answer 21

elevated with acute cholecystits (along with ALT and AST) increae in response to biliart obstrction.

Question 22

what is GGT?

Answer 22

enzyme involve din transfer of AA across cell membranes. marked elevation in obstructive jaundice, hepatic mestastasis, intra hepatic cholestatsis.

Question 23

What is pancreatitis?

Answer 23

acute or chronic inflammation of organ, common cause is biliary tract disease (think gallbladder stones, elevated TG, etoh intake)

Question 24

RF of pancreatitis?

Answer 24

alcoholism, opioids, corticosteroids, thiazide diuretics, viral infection, blunt abdominal trauma.

Question 25

Labs in acute pancreatitis?

Answer 25

amylase elevated + lipase elevated (usually 3 x limit and no gut perforation noted)

Question 26

Daignostics/imaging for pancreatitis?

Answer 26

Ct scan (US will just tell you if gallbladder dx also present)

Question 27

Criteria for diagnosing pancreatitis?

Answer 27

2 of the 3:

1. characteristic severe abdominal pain
2. serum amylase and or lipase exceeding 3 times limit
3. Positive imaging

Question 28

managment of pancreatitis?

Answer 28

parenteral hydration, analgesics, and gut rtest.

tx underlying disorder as well.

Question 29

Ranson criteria for ranking pancreatitis?

Answer 29

review of WBC, blood glucose, AST, LDH, hematocrit, serum Ca, BUN

0-2 - 1% mortality
3-4 - 15 %
5-6 - 40%
> 6 - 100%

Question 30

signs of pancreatitis?

Answer 30

WBC elevated, abdominal pain sudden onset.

Question 31

signs of pancreatic cancer?

Answer 31

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.

Question 32

what are pancreatic pseudocysts?

Answer 32

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.

Question 33

diagnost pancreatic pseudocysts?

Answer 33

MRi and CT can help diff. but fluid collection test for signs of cacner.

Question 34

management of pseudocysts?

Answer 34

1. no signs of symptoms - left alone, monitor
2. 10mm require US endoscopy
3. bothersome - drain vis US endoscopy with guided fine needle aspiration. surgery may be needed.

Question 35

Diagnostic for pancreatic cancer?

Answer 35

CT scan, also ACD anemia. elevated total ad direct bilirubin and ALK.

Question 36

nonpancratic amylase sources?

Answer 36

salivary glands, ovarian cysts, ovarian tumors, tubo-ovarian abscess, ruptured ectopic preg, lung cancer

• usually due to cholelithiasiss and etoh pancreatitis.

Question 37

nonpancreatic sources for elevated lipase

Answer 37

renal failure, perf duodonal ulcer, bowel obstruction, bowel infarction