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GI > appy/pancreas > Flashcards

appy/pancreas Flashcards

1
Q

appendicitis

age

gender

% of population

A

age between 10-30 years old

male 2 fold

affects 10% of population

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2
Q

2 most common causes of appendicitis

A

hypertrophied lymphoid tissue(55-65%)

fecalith(35%)

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3
Q

organisms that can cause appendicitis

and 2 other less common causes

A

CMV, adenovirus, histoplasma

collagen vascular disease and inflammatory bowel disease

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4
Q

mcburneys point

A

12 hrs after appencitis pain starts then localizes at RLQ then pain becomes constant and worse with movement

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5
Q

fever in appendicitis?

A

low grade

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6
Q

psoas sign

A

pt supine and attempts to raise leg against resistance. do for appendicitis

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7
Q

obturator sign

A

pt supine and attempts to flex and internally rotate right hip with knee bent. do in appendicitis

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8
Q

dx of appendicitis (lab results and imaging)

A

leukocytosis(10,000 to 20,000), maybe hematuria and pyuria

and abdominal CT is preferred to locate the appendix

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9
Q

most common abdominal emergency in the US

A

appendicitis

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10
Q

presentation of 20% [of painful] appendicitis

A

perforation and peritonitis

causing high grade fever, generalized pain, and increased leukocytosis

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11
Q

initial symptom of appendicitis

then what

other presentating symptoms

A

periumbilical or epigastric pain

then in 12 hours, pain localizes to RLQ(mcburney pt) and becomes constant

worsened by movement, leading to rebound tenderness on exam

N/V and low fever are common

diarrhea and high fever are uncommon

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12
Q

what if a pt has retrocecel appendicitis

A

then pain will occur with on a rectal exam

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13
Q

treatment of appendicitis

and perforation

A

appy

if perforation, do broad spectrum antibiotics before and after surgery

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14
Q

hamburger sign

A

if a pt wants to eat, consider a dx other than appendicitis

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15
Q

rovsing sign

A

deep palpation of LLQ leading to RLQ pain

acute appendicitis

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16
Q

hyperlipidemia(esp hyper-triglyceridemia)

cholelithiasis, alcohol abuse, autoimmune disease

trauma, drugs, hypercalcemia, penetrating PUD

A

causes of pancreatitis

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17
Q

antiretroviral drugs for HIV can be assoc with what

A

acute pancreatitis

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18
Q

sx of epigastric pain radiating to the back. pain lessens when pt leans forward or lies in fetal position

N/V and sweats

A

acute pancreatitis

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19
Q

amylase vs lipase for acute pancreatitis

A

serum lipase more sensitive and specific, only with elevations 3fold or higher

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20
Q

tx of acute pancreatitis

A

stop oral intake (to prevent continued secretion of pancreatic juices),

fluid volume must be restored and maintained. parenteral hyperailmentation should be started early to prevent nutritional depletion

ERCP with spincterotomy if gallstones are the cause

pain management with opiods

consider antibiotics

21
Q

what is ransons criteria for

leukocyte count

blood glucose level

LDH and AST

arterial Po2

base deficit

calcium and BUN

A

poor prognosis of acute pancreatitis

leukocyte count >16,000

blood glucose level >200

LDH >350 and AST >250

arterial Po2 <60

base deficit > 4

calcium falling and BUN rising

22
Q

classic triad of chronic pancreatitis

A

pancreatic calcification, steatorrhea, DM. occurs in 20% of pts

23
Q

labs of chr pancreatitis

A

amylase may be elevated early but will decrease with each episode of pancreatitis and cease to be a useful marker.

abdominal pain film xray-to see calicifications in 20-30% of pts; gallstones may be seen

U/S: “chain of lakes”

24
Q

5th leading cause of death

A

pancreatic cancer

25
Q

courvoisier sign

A

jaundice and palpable gallbladder with cancer of pancreatic head

26
Q

dx pancreatic neoplasm

A

CT to delineate disease and search for metastases and

angiography to look for vascular invasion

27
Q

tx for pancreatic neoplasm

radiation/chemo?

prognosis

A

modified whipple procedure in those without metastases

susequent radiation and chemotherapy are controversial

poor prognosis

28
Q

range of presentation of pancreatitis

A

can range from mild episodes of deep epigastric pain with N/V to the sudden onset of severe pain with shock

29
Q

classic presentation of pancreatitis

A

epigastric pain that radiates to the back

the pain lesses when the pt leans forward or lies in a fetal position

N/V common

fever, leukocytosis, sterile peritonitis present

30
Q

what 3 things indicate a grave prognosis for pancreatitis

A

severe hypovolemia, ARDS,

tachycardia greater than 130 bpm

31
Q

grey turner sign

Cullen sign

A

hemorrhagic pancreatitis: bleeding into these areas

grey turner sign (flank)

Cullen sign (umbilical)

32
Q

serum amylase and serum lipase with acute pancreatitis

A

elevation of serum amylase occurs but may be transiet and can return to nml after 48-72 hours

serum lipase is more sensitive and specific then amylase for acute pancreatitis, but only with elevations of 3fold or higher

33
Q

acute pancreatitis

WBC

liver enzymes

bilirubin

sugars

electrolytes

A

WBC generally elevated and hemoconcentration may occur w/ 3rd spacing

liver enzymes may increase as a result of biliary obstruction

mild hyperbilirubinemia and bilirubinuria

hyperglycemia and hypocalcemia may occur

34
Q

imaging for pancreatitis

A

** CT best choice for diagnosis

ultrasound helpful to look for gallstones

plain films may reveal a “sentinal loop” or “colon Cutoff sign”

35
Q

monitor pancreatitis pts for what complications

A

pancreatic pseudocyst

renal failure

pleural effusion

hypocalcemia

pancreatic abscess

36
Q

cholelithiasis, PUD, hyperparathyroidism, hyperlipidemia

main cause

A

causes of chronic pancreatitis

main cause 90% of cases is alcohol abuse

37
Q

presentation of chronic pancreatitis

A

same as acute pancreatitis with the addition of fat malabsorption and steatorrhea late in the disease

fecal fat may be elevated if malabsorption is present

38
Q

tx of chronic pancreatitis

diet

pain

definitive tx

A

same as acute pancreatitis

low fat diet recommended at discharge

surgical removal of pancreas for pain control

** address the underlying cause: commonly alcohol

39
Q

increased age, obesity, tobacco, chronic pancreatitis, previous abdominal radiation, family hx

A

risk factors for pancreatic neoplasm

40
Q

exam of a pancreatitic neoplasm

A

abdominal pain common(epigastric that radiates to the back), depending on location of tumor, it can radiate

jaundice and palpable gallbladder may be seen in pts with cancer of the pancreatic head

41
Q

pancreatic cancer

kind

mean survival

diet risk factors

age

weight

A

95% adenocarcinoma

mean survival in most cases less than a year

low in fruits/veggies but high in red meats and sugars

over 60

obese

42
Q

% of pancreatic pts surgical candidates

major pancreatic surgery and survival rate

other surgery

A

20%

whipple procedure results in a 5 year survival rate of 20%

distal pancreatectomy depending on tumor location

43
Q

nontender, palpable gallbladder with jaundice

A

pancreatic cancer

44
Q

plain films may reveal a

“sentinal loop” or “colon cutoff sign”

“chain of lakes”

A

acute

chronic

45
Q

common cause of acute pancreatitis in kids

A

trauma

46
Q

4 complications of acute pancreatitis

A

pancreatic pseudocyst

fistula formation

hypocalcemia

renal failure

47
Q

** CT best choice for diagnosis

ultrasound helpful to look for gallstones

plain films may reveal a “sentinal loop” or “colon Cutoff sign”

A

imaging for pancreatitis

48
Q

U/S: “chain of lakes”

A

chr pancreatitis

GI (14 decks)

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