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GI Review by Minnie: AH Version > Clinical Medicine > Flashcards

Clinical Medicine Flashcards

1
Q

Fluid wave is highly indicative of which disease process?

A

Ascites

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2
Q

How do you test for Murphy’s sign?

What constitutes a postive Murphy’s Sign?

A

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%

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3
Q
A

E

Remember, that tenderness at McBurney’s Point is highly suggestive of appendicitis

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4
Q

A postive Murphy’s sign is suggestive of…

A

Cholecystitis

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5
Q

Which physical exam finding has the highest likelihood ratio for detecting peritonitis?

A

Rigidity

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6
Q

What are the most likely causes of RUQ pain?

A
  • Biliary Disease
  • Cholecystitis (inflamed gallbladder/galstones)
  • Renal Colic
  • Pancreatitis
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7
Q

What is the most likely cause of ascites?

What will you find on exam?

A

Cirrhosis of the liver

Positive fluid wave, positive shifting dullness

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8
Q

Which blood tests would be abnormal in the setting of hepatocyte damage?

A

ALT
AST
GGT

(All elevated)

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9
Q

Which tests would be abnormal in the setting of cholestasis?

A

Alk-phos
GGT
Bilirubin

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10
Q

Which tests would be abnormal in the setting of impaired synthetic or metabolic function of the liver?

A

Albumin
Bilirubin
Prothrombin time

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11
Q

What kind of cells are hepatocytes?

A

Epithelial

  • Tumors derived from hepatocytes are adenomas (benign) or adenocarcinomas (malignant)
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12
Q

What color is AST?

What is the significance of its location in the hepatocyte?

A

Purple (cytosolic) or blue (mitochondrial)

In the cytosol => elevated when hepatocytes die

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13
Q

What color is ALT?

What is the significance of its location in the hepatocyte?

A

Red

In the cytosol => elevated when hepatocytes die

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14
Q

What color is Alk-phos?

A

Green

  • Hangs out with GGT near the bile canaliculus = both are elevated in bile duct pathologies
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15
Q

What color is GGT?

What is the significance of its location in the hepatocyte?

A

Yellow

  • Hangs out with Alk-Phos near the canaliculus => both are released if anything is wrong with the bile ducts
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16
Q

What kind of liver injury will cause the largest elevation in GGT?

Under what conditions do we usually check GGT?

A

Intrahepatic cholestasis

(mild elevation in extrahepatic cholestais)

Usually GGT is checked when alk-phos is high; elevated GGT in the setting of elevated alk-phos confirms bile duct issue

17
Q

A 59 year old male presents with ALT of 44 IU/L (1.3xULN) and AST of 92 IU/L

Which of the following would be most predictive of alcoholic liver disease?

  1. Elevated GGT
  2. Clinical history of alcohol use disorder
  3. Liver biopsy with fatty change
  4. Elevated alkaline phosphatase
A

b. Clinical history of alcohol use disorder

  • No test/assay is specific for alcoholic liver disease
    • AST:ALT > 2:1 wtih elevated GGT is suggestive, but may be present in other late-stage liver disease
  • Biopsy cannot distinguish
18
Q

Which image shows a normal liver?

What is wrong with the one that isn’t normal?

A

Left is normal

Right is a fatty liver (more pixelated)

19
Q
A

I-VINDICATE

Idiopathic

Vascular

Infectious//Inflammatory/Invasive

Neoplastic

Degenerative

Iatrogenic (drugs/toxins)

Congenital (and hereditary)

Allergic/autoimmune

Trauma

Endocrine/metabolic

20
Q

You are seeing a 20 year old man with right lower quandrant pain and fever. On exam, you note he has tenderness, but does not have guarding. Guarding is 90% specific for appendicitis. You decide appendicitis is much less likely and send the patient home. What is wrong with this reasoning?

A

Guarding is faily specific, but not sensitive.

The odds in this patient were really high to begin with, so absence of guarding is not enough to rule out appendicitis.

21
Q

What is the proper order for examination of thea abdomen?

A

Inspection, Auscultation, Percusion, Palpation

Auscultate earlier because palpation/percussion may change bowel sounds.

22
Q

You are in the ED assessing a patient with abdominal pain and fever. Which of the following is NOT a peritoneal sign?

  1. Rebound tenderness
  2. Involuntary guarding
  3. Rigidity
  4. Voluntary guarding
A

4- VOLUNTARY GUARDING

Peritoneal signs seen in ruptured appendix and peritonitis

23
Q

What conditions present with LRQ pain?

A

Appendicitis

Ovarian disease

PID (pelvic inflammatory disease)

Ruptured ectopic pregnancy

24
Q

Where does diverticulitis present?

A

Left lower quadrant

GI Review by Minnie: AH Version (38 decks)

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