Clinical Medicine Flashcards
Fluid wave is highly indicative of which disease process?
Ascites
How do you test for Murphy’s sign?
What constitutes a postive Murphy’s Sign?
Push in the RUQ
Hold pressure while you ask the patient to take a breath in
If the patient takes a sharp breath in and stops abruptly, they have a positive Murphy’s sign
Suggestive of Acute Cholecystitis
Sensitivity 97% Specificity 48%
E
Remember, that tenderness at McBurney’s Point is highly suggestive of appendicitis
A postive Murphy’s sign is suggestive of…
Cholecystitis
Which physical exam finding has the highest likelihood ratio for detecting peritonitis?
Rigidity
What are the most likely causes of RUQ pain?
- Biliary Disease
- Cholecystitis (inflamed gallbladder/galstones)
- Renal Colic
- Pancreatitis
What is the most likely cause of ascites?
What will you find on exam?
Cirrhosis of the liver
Positive fluid wave, positive shifting dullness
Which blood tests would be abnormal in the setting of hepatocyte damage?
ALT
AST
GGT
(All elevated)
Which tests would be abnormal in the setting of cholestasis?
Alk-phos
GGT
Bilirubin
Which tests would be abnormal in the setting of impaired synthetic or metabolic function of the liver?
Albumin
Bilirubin
Prothrombin time
What kind of cells are hepatocytes?
Epithelial
- Tumors derived from hepatocytes are adenomas (benign) or adenocarcinomas (malignant)
What color is AST?
What is the significance of its location in the hepatocyte?
Purple (cytosolic) or blue (mitochondrial)
In the cytosol => elevated when hepatocytes die
What color is ALT?
What is the significance of its location in the hepatocyte?
Red
In the cytosol => elevated when hepatocytes die
What color is Alk-phos?
Green
- Hangs out with GGT near the bile canaliculus = both are elevated in bile duct pathologies
What color is GGT?
What is the significance of its location in the hepatocyte?
Yellow
- Hangs out with Alk-Phos near the canaliculus => both are released if anything is wrong with the bile ducts