CLIN Flashcards
UGIB vs LGIB Cr/BUN
UGIB: 30:1 (and increased INR)
LGIB normal
renal 20: 1
what pathology is associated with “rapid bolus IV contrast CT 3 days after to assess necrosis”
acute pancreatitis
RF of cholelithiasis
F’s
-female, forty, fertile, fat, FH, fair
and crohns
protective- low fat diet, PA, caffeine, Mg+, Polyunsat fats, high fiber, statin tx, and ASA
what is the estimated fecal osmolarity gap
<50
*high osm gap (>75) seen in osmotic but not secretory diarrhea
hematochezia/melena (LGIB indicator) ddx
- IBD (UC)
- <50 yo (infectious colitis, anorectal dz: fissures/hemorhhoids, MECKEL DIVERTICULUM)
- > 50 yo (malignancy, diverticulosis, ischemic colitis, angiodysplasia
hx associated with gastroparesis
early satiety, N/V 1-3 pp, ab pain
most common noninfectious cause of acute diarrhea
meds (ABX most common)
*but 90% is infectious cause
when is lympgranuloma venerum (fever bloody diarrhea, painful perianal ulcers, and bubobes-inguinal adenopathy) seen
chlaymdia infection of anorectic (proctitis)
what is seen on US of acute cholecystitis
GB thickening, pericholecystic fluid, sonographic murphys sign
physical exam findings of PUD
PE: hyperactive bowels sounds, mild localized tenderness on deep palpation
sx and causes of proctitis
(anorectal infection/inflammation)
sx: anorectal discomfort, tenesmus, constipation, mucus, bloody discharge, psuedodiarrhea
causes: sexually transmitted during anal sex: gonorrhea, clamydia, herpes, or treponema pallidum
what is condylomata accuminata
genital warts due to HPV
should distinguish from condylomata lata in secondary syphilis
dx for acute pancreatitis
2/3 needed
- epigastric pain
- lipase/amylase 3x UL
- CT changes of pancreatitis
sx of AVM
(angioectasias)
- sx: painless bleeding from melena (UGIB) to hematochezia/occult blood (LGIB) seen in patients >70 yo with chronic renal failure or aortic stenosis
sx of N/V (feculent, dirty) constipation and distention and PE of high pitched tinkling bowel sounds
acute small bowel obstruction caused by adhesions
-RF: multiple surgery, diverticulosis, Crohns
two causes of bile salt malabsorption and associated sx
- crohns associated ileal resection
- bacterial overgrowth (tested with breath tests)
sx: mild steatorrhea, secretory diarrhea, minimal weight loss, bleeding tendency (Loss of ADEK), osteoporosis, and hypocalcemia
must stop ___ before fecal antigen test or urea breath test for dx of PPI for fear of false ___
stop PPI to prevent false negative
all celiac patients get ____ due to known complication
get dual energy X-ray densitometry scans to asses for osteoporosis
sx, labs, and PE of acute cholecystitis
sx: fever, severe RUQ pain/tenderness, N/V
PE: jaundice, Murphys sign, palpable GB
labs: increased AST/ALKP/GGT/ serum amylase
when is saponification seen
acute pancreatitis (because decreased calcium)
imaging and DX of ischemic colitis
imaging - x-ray shows “thumb printing” colonic dilation and edema
dx: CT angio = gold standard
3 types of presentation associated with IBS
- spastic colon ( chronic pain, constipation )
- alternating diarrhea/constipation
- chronic painless diarrhea
when do you need to further eval chronic diarhhea for more than just common causes
- nocturnal diarrhea
- wt loss
- anemia
4 +FOBT
*FAWN
causes of perianal pruritus (pruritus ani)
poor anal hygiene or extreme hygiene causing irritation
sx: perianal itch, discomfort
- dx of exclusion
sx of ischemic colitis
sudden onset of cramping which is worse after food = “food fear” ; LLQ pain, desire to defecate, blood diarrhea, N/V , periumbilical pain unproportional to tenderness
*pt young assoc with hx of cocaine use
what is the complication associated with secretory diarrhea
does not change with fasting,
the loss of lots of water can lead to electrolyte imbalances, decreased sodium, and metabolic acidosis
tx and complications of severe acute pancreatitis
tx: w/i 48 hour start nasogastric/jejenual tube feeding to decrease risk of multiorgan failure
complications: decreased blood volume due to 3rd spacing leading to ATN, prerenal azotemia in 24 hr ; pleural effusion, psedocysts
how to diagnose gonorrhea vs trepenoma in the cause of proctitis
gonorheea: swab and culture from pharynx too
chlamydia: dark field microscopy or flourescent Antibody test
pyrosis means
heart burn
3 causes of oropharyngeal dysphagia
- esophageal web (proximal type)
- Zenker Diverticulum
- Sjogrens ( dry mouth)
sx of anal fissures
severe pain during defecation with following throbbing, mild hematochezia,
complication associated with hemorrhoid
thrombosed external hemorrhoid (blueish perianal nodule covered with skin)
complication of acute cholecystitis
GB gangrene
dx f=of gastroparesis
use gastric scintigraphy
- use low fat/ solid meals (eggs)
- gastric retention 60% 2 pp or >10% 4 hr pp = ABNL
what is lynch syndrome
HNPCC
how is cholelithiasis dx
US (stones cast an “acoustic shadow”)
what is PTEN multiple harmatoma syndrome
“cowden dz”
- hamatomous polyps, lipomas thru GI, trichilemmonas (face/neck), and cerebellar lesions
- high malignancy rate in thyroid breath and GU
x ray of acute pancreatitis
- “sentinel loop” LUQ air
2. “Colon cutoff sign” transverse colon gas with abrupt end and lower lung atelectasis
steps when patient presents to clinic with hematemisis (sign of UGIB)
- admit to ICU (sick? not sick/stable?)
- asses hemodynamic status (shock? confusion?)
- stabilize with 2 large bore IV lines (one in each arm)
- EGD within 24 hr (can be dx and tx)
- pharm: IV/oral PPI, octreotide (if portal HTN suspected)
- possible blood transfusion
sx and PE associate with cholelithiasis
(gall stones: cholesterol or pigment/bilirubin stones)
sx: biliary colic ( RUQ severe steady ache) 30-90 min pp, lasts hours and can radiate to RIGHT SCAPULA/BACK, N/V, jaundice
PE: RUQ tenderness
lactase deficiency cause __ type of diarrhea
osmotic
what is overflow diarrhea of liquids (“paradoxical diarrhea”) with overflow incontinence; on DRE find firm feces
fecal impaction (only liquids passing and obstruction is pressing on bladder causing incontinence)
what causes an “hour glass” stomach
sliding hiatal hernia
-associated with GERD and shatzki ring
what dz shows gas in SI/LI and what shows dilated loops of small bowel
gas = paralytic ileus loops= acute small bowel obstruction
what population is acute pancreatitis seen
- pts with gall stones <5mm
- heavy alcohol use
what causes “upside down stomach”, bowel sounds in lower lung fields, or lung hypoplasia
paraesophageal hiatal hernia
*GERD not associated
most common cause of chronic diarrhea
meds, IBS, lactose intolerance
complications, labs, sx chronic cholecystitis
complication: increased risk of GB cancer, PORCELAIN GB seen on X-ray (calcified lesions)
labs: NL
sx: sax for years but when it turns acute sx are RUQ pain, and dyspepsia
what is the cause of no peristalsis and ABNL GI motility in gastroparesis
vagus N. damage can be associated with diabetes, parkinson’s, surgery, MS, etc
2 causes of acute cholecystitis
- gallstones in cystic duct
2. no stones, associated with illness/infection
