CIS7 Flashcards
RUQ US
GB etiology
ECRP (Endoscopic Retrograde Cholangiopancreatography)
GB etiology if the common bile duct is blocked => which can lead to ascending cholangitis
shows a dilated CBD
ECG
MI
FOBT
- screen for colon cancer
Urine antigen
pneumonia (strep and legionnarie)
Hydrogen breath test
lactate deficiency (lactose intolerance)
Fecal antigen
H.pylori
what can lead to esophgeal perforation
2 things we can see in PE
Boerhaves, (spontanous transmural tear that follows chronic throwing up)
PE: subQ emphysema, Hamans sign
H.pylori can leads to what 2 cancers
MALToma
gastric adenocarcinoma
secondary achalasia is caused by
chagas = trypanaoma cruzi
Acute cholecytisits
where is the stone PE labs imaging complications
PE = murphys sign
Imaging: RUQ US = acoustic shadow, GB wall thickening, sonographic murphys sign, fluid around GB
if plain film = not all will show.
Labs: increase bilirubin, leukocytosis, ALP
Complication: perforation, emphysematous cholecystasisis = seen in uncontrolled DB
Cholodocolithiasis
where is the stone
labs
imaging
complications
- CBD
- proximal stone = back up into GB and liver ( high AST/ ALT, bilibubin, lipase and amylase, leukocytosis)
- distal (lipase and amylase)
Imaging = Emergent ECRP with sphinectomy and removal of stone; Abdominal US (Dilated CBD);
complication: ascending cholantitis
before doing an ECRP, we want to do what?
CHECK COAGULATION: INR
acholic stools =
acute hepatitis
can lead to tea colored urine
coffee ground emesis
PUD; increase risk with gastric bypass
olgavie syndrome
sponantous pseudoobstruction in colon in ICU patients
burn patient + NG tube + coffee ground emesis + mild anemia
curling ulcer
burn ICU patient with high ALP, WBC, AST, lipase
acute acholescytis
Charcots triad
RUQ pain + fever chills + janducice
ascending cholangitis =>
if + AMS + hyptoension => endoscopic MRGC
before any invasive study we need rto do what
Check INR (cogaulation)
emergent cholectesctomy
perform in acute cholecytisis
serial troponins
ECG + check every 6 hours if MI is suspected
Reynauds triad
if + AMS + hyptoension => endoscopic MRGC
In a patient with ascending cholangitis + Reynauds pentatd, what is the most common diagnostic study
blood cultures => before ABX
check when Fasting lipid panal
acute pancreatitis bc we get hyperglycemia
check Tylenol level
acute liver failure/ acute hepatitis (really high AST/ALT)
check ammonia levels
hepatic encephalopthy (cirrhosis pts who come in confuseD)
PT has chronic cholestitis (intermittant pain for years, more common at NIGHT after fatty meals); CBC, CMP and lipase are NL; on plain field XR we can seE __________= increase risk of _______
porcelain gallbladder
GB cancer
when might we see cholangiocarcinom or bile duct cancer
primary sclerosing cholangitis (beads on a string appearance)
what can lead to food bolus impaction
- EOSINOPHILIC ESPHAGITIS
HIDA scan + CCK
bilary dyskenisia (gallbladder pain on PE but everything else is NL)
- RUQ US = NL => HIDA CCK => cholecytemoy
ECRP
choledocolithiasis
ascending cholangitis
Lipase
acute pancreatitis = dx when 3x NL limit
Blood cultures
bacteremia in ascending cholangitis
KUB XR
chronic GB (porcalean GB);
pt has RUQ and ate a bottle of acetominophem on a dare. What test do you run is AST/ALT is high, INR is high
Ruman MAtthew Nomogram
Ranson Criteria
acute pancreatiits
ROME 4 Criteria
IBD
BISAP score
acute pancreatitis
HAPS
acute pancreatitis
severe boring epigastric pain that shoots straight through his back; lipase levels 600 UL. Has jerking otion on his face when his facial N is tapped. What does he have, what is the sign and etiology behind
has acute pancreatitis
Chovets sign => hypocalemia due to saponification
Migratory thrombophlebitis
seen in pancreatic cancer
tardive dyskeninsia
repetitive lip smacking due with metclopromide for gastroparesis
complication of ERCP for choledocolithaisis. what is a complication
pancreatitis; to to check => check lipase levels and do ransons criteria
fecal chymotrpyin and elastase***
chronic pancreatiits
BISAP for acute pancreatitis
BUN Impaired mental statis SIRs criter Age >60 Pleural effusion = ausculatate diminesh breath sounds
CT evidence of a pseudocysts hints what?
acute pancreatitis
how to treat mild acute cholecystitsi
if severe
FLUID REUSUCATIONS IV (LOTS Vigoursous hydration (IV NS at 250 cc/hr) = can result in ARDS
if severe = ICU
band ligation
esophageal varices
pantopraxole 40 mg IV q day
PUD
What is the initial episode of chronic pancreatitis called?
SAPE (senintal acute pancreatitis) = inflammatory response that results in injury and fibrosis (IgG4 AI pancreatiis)
TIGAR -O
causes of chronic pancreatiis
T- toxnic metabolic (alholic)
Idiopathic (get CP at 23 or 62 YO)
G (genetic = CF = get CP less than 30 YO)
AI (IgG4 mediated = hypergammaglobeminia)
Recurrent
Obstruction (stricture/stone/tumor)
80% of people with chronic pancreatitis will develop
T2 DM = high Hemoglobin A1C (14%
High fasting gastrin level
ZE
Herniation of kilians triangles
Zenkers diverticulum
Pt comes in + H.pylori and hematemesis.
- Two large IVs are placed and fluid resucitpation is initated. What is the next step?
Emergent EGD + biopsy to rule out malignany bc of hematemesis
Intravenous octreotide is done with
variceal bleeds to decrease portal pressuer
coffee ground emesis
PUD
Complication of gastric ulcer
perforamtion => free air under the diagrpahm or air in mediastium seen on CT or plain XR (pneumoperiteum- below diarphram and pneumoediatium (above diapgram)
requires NP, IV ABXC, preop and MRGC surgery
perforated viscus happens where
any hollow organ
Pain bgan 3 days ago; pt has uncontroll DM ; if ALP and bilirubin are elevated higher than AST/ALT, what is the problem
GB!!!!
emphsemtatous GB
New onset DB in orlder people= what do we think?
What can we use to dx?
pancreatic cancer
CA-19-9;
prolong PT INR
liver failure; partof the liver function test
CA 19-9
pancreatic cancer is no biliary source is found
