Gastro in class Flashcards
ALP elevation can indicate disease in ___, mild elevations can be seen in __
GGT elevations in ___ as well as ___
Helps to support that __ is from liver/biliary system and not ____
Very abnormal to see __ in the urine
INR/PT assess extrinisc path factors such as
best prognostic lab value for
Liver dz usually has __ albumin
biliary tract, parenchymal liver dz
biliary dz, drugs/alcohol
inc ALP, bone
direct bilirubin
2, 7, 9, 10
fulminant hepatic failure
low
Biliary colic due to ___ lodged in ___ such as ___
findings
Constant ___
__ usually present
may mimic acute ___
w progression, pain should be ___, localize to ___, sx include __ and __,, indicating
Uncomplicated biliary colic does not have ___ or ___
Liver fxn tests are
gallstone, biliary system, cystic duct
epigastric, RUQ
NV
acute MI
sharp, RUQ, fever/leukocytosis, acute cholecystitis
fever, peritoneal inflam
normal
Ab pain from ___ is ___, not
caused by ____
ab wall pain is __ and ___
somatic pain occurs following ___ such as __ progressing to ___
localized sensation caused by inflam of ___
visceral pain often seen in __, meaning exams are __
visceral organs, vague, sharp
bowel distension, contraction, ischemia
focal, tender
progression of process, biliary colic-acute cholecystitis
peritoneal surface
center of ab, paramount
Biliary colic presentation w abnormal LFTs should indicate C, C, M, E
Esophageal ca main sx __ and ___
Predisposing factors include T/A, L, B
Gerd cardinal sx ___, can lead to ___
malignant change usually occurs in ___
Nasal regurg, weakness, dysphagia seen in __ such as ___
cholangitis, choledocholithiasis, Mirizzis syndrome, emphysematous cholecystitis
progressive dysphagia, wl
Tobacco, alcohol, lye, barrett’s esophagus
pyrosis, Barrett’s epithelium, distal esophagus
neuro disorder, ALS
Gynecomastia- diff from
can be __ in adolescence
usually due to __ such as C, H, U, D
AA w/out diffuse peritonitis (no __) has only ____ via inflamed appendix touching ___
best test for this
__ and __ only seen w diffuse irritation
fatty tissue (lipomastia) physio
inc estrogen, cirrhosis, hormone prod tumors, unrecognized ingestion, drugs
RT, focal inflammation, membrane
rovsings sign
psoas/obturator sign
Rectus sheath hematoma
spontaneous/traumatic bleeding into ___ causing __ ab pain
usually occurs in setting of __ (look for___)
should not have findings of ___
Therapy for __ and __
Psoas sign can be seen in ___ and __ and ___
many cases of AA are
Reticuloendothelial splenomegaly infections such as
Gradnulomatous dz such as
__ dz
muscle sheath, focal
bleeding do, anticoag
visceral ab pain
bleeding do, pain
posterior pointing appendicitis, abscess, diverticulitis
not positive
mono, parasites, fungal
sarcoid
deposition dz
Free intraperitoneal air must be differentiated from ____
usually indicates rupture of
findings should show
Benign free air can occur ___, extension of
Reason for upright chest in acute ab xray series
Duodenal ulcer related to
More common than
Sx relieved by
Comps inc perf w __ or ___ or ___
No __ potential
normal gastric/colonic gas
stomach/intestine
ab pain, diffuse peritonitis
post ab surgery. pneumomediastinum
perf duodenal ulcer w intra-peritoneal air
H pylori, NSAIDs
gastric ulcer
food
peritonitis, panc, hemorrhage
malignant
Wilsons dz copper deposition due to congenital lack of ___
inheritance
Involves L, E, K, B, B/J
High serum copper can produce ___
cobalt overload leads to
Fulminant hepatic failure from ___ ingestion (amanita phylloides)
predisposition to mesenteric ischemia
ceruloplasmin
AR
liver, eye, kidney, basal ganglia, bone/joint
hemolytic anemia
heart failure
toxic mushroom
heart disease, Afib
Hemochromatosis inheritance
Fe overload leads to __ and ___, ___, ___
arthritis usually seen in
high risk for ___
alcohol use exacerbates ___
buzzword
Acute blood loss leads to minimal change in
Hemodilution only occurs w
Judge blood loss via __
AR
cirrhosis, skin discolored, endocrine dz, heart dz
2/3 digits at MCP
secondary hepatoma
liver dz
bronze diabetes
hct
fluid shift from extravascular space
vitals (HR/BP)
Conjugated bilirubin usually not seen in ___, but when present, is filtered by kidney, showing ___
Urine w high bilirubin rxn and no urobilinogen indicates inc ___ w bilrubin blocked from ___
dx is
Cirrhosis has ___ urine billirubin and ___ urobilinogen
Hemolysis has __ urine urobilinogen and __ blood rxn of hb from inc __, but ___ bilirubin rxn
blood, dark urine (+ rxn)
serum conj bilirubin, gut
choledocholithiasis
+. +
+. +. -
Pt w jaundice, pruritis, cholestatic labs has process involving ___. such as __ and __
or small ducts such as ___ or ___ or ___
use __ to differentiate
Carotenemia can produce
normal sized spleen should be found ___
hepatomegaly usually indicated by > ___ on MCL
large biliary ducts, cholangiocarcinoma, panc cancer
PBC, infiltrative dz, drugs
imaging
yellowing of skin
posterior to mid axillary line
12cm
Enlarged liver can be due to H, P, C, C, H
Epigastric pain could be
duodenal ulcer/ruptured spleen can radiate to
biliar colic can radiate to
acute panc/renal colic can radiate to
uterine/rectal pain can radaite to
hep, passive congestion, cancer, cirrhosis, hep vein thrombosis (Budd Chiaria syndrome)
peptic ulcer, GB dz, panc, MI
right shoulder
r scapula
midback
sacrum
Hep LFT is __ and hyperbilirubinemia is __
Chronic active HepB pt usually has __ progressing to__ and at risk for __
Hep C risk factos I, S
Dx test is
Malaria leads to
potential causes of chemical hepatitis W, A, M, S, C
Number 1 cause of cirrhosis leading to liver transplant
Number 1 cause of cirrhosis
inc, mixed
mild, const complains, cirrhosis, hepatoma
IV drugs, sex w infected person
IgM antibody to HepC
indirect hyperbilirubinemia
wilsons dz, A1AT, Mono, syphillis, CMV infection
HepC
alcohol
Narcotics should not produce
Shock liver can have ___ LFTs
should have hx of ___ or ___
Very high LFTs should check for ____
levels normal early, ___ later
fulminant liver failure, progressively rising __ indicate poor prog
also ___ showing liver regen
fulminant liver dz
extreme inc
hypoTN, heart dz
acetominophen, inc drastically
PT/INR
high serum AFP
Wilson dz most common in
best test is low __
best screening test for Hemochromatosis ___. should be ___
test for chronic, active, AI hep ___
if A1AT def suspected, look for ___ and order ___, should be __
Screen for hepatoma w ___ should be __, important cause of ___ in cirrhosis pt
YM, ceruloplasmin
serum iron/TIBC
high
ANA, ASMA
lung dz, A1AT enzyme levels
low
AFP, high
decompensation
Massive tropical splenomegaly T, M, C, V, C, L
Schistosomiasis from M, M, J
S haematobium involves __
pt presents w __ and ___
feared complication is
GERD rf H, O, O, A/A, S
Pathogenesis
Pyrosis caused by __ contacting inflamed mucosa (esophagitis)
other sx
Dysphagia + GERD suggests
comps
thalassemia, myelofibrosis, chronic malaria, visceral leishmaniasis, CML, lymphoma
Mansoni, mekongi, japonicum
urinary tract
terminal hematuria, dysuria
bladder ca (SCC)
Hiatal hernia, obesity, older, alcohol/tob, scleroderma
reflux
cough, hoarse, chest pain, aspiration
peptic stricture
cancer in distal esoph (adenocarc) and esoph stric
AA pathogenesis
Sequence of findings
EP, ANV, D, F, L
Diverticulitis seen in __ colon usually
impacted fecalith leads to __ and __ or __
Age Pain located No Bowel habit Fever/leuko is Later pain/tenderness in
obstructing fecalith
epigastric pain, ANV, deep tenderness, fever, leukocytosis
left
ischemia, abscess, rupture
older hypogastric NV diarrhea pronounced LLQ/suprapubic
PUD commonest sx, described as
location
comps
Gastric/Duodenal
Age
Effect of food
Cancer potential
pain/discomfort (gnawing/burning/sharp)
Epigastric, LUQ
bleeding, perf, panc, GOO
G- 6th decade, less reliable, yes
D- younger, relief, no
Acute panc assc w
Pain located __ and assc w
Acute Pyelonephritis
cause- ___ of UBUK, __ or ___
PF D, M, U, R
Sx
Urethral
bladder
kidney
Pain is ___ and __ due to stretching of __
may radiate to __
other sx D, F, U, C, O
Exam findings
alcohol abuse, gallstone
epigastric/back, NV
ascending infection, urethra/bladder/ureter/kidney
diabetes, multiple sex partners, URI, renal stone
dysuria
suprapubic pain
cva pain
dull, steady, renal capsule
umbilicus
Dysuria, freq, urgent, cloudy, odor
CVA tenderness, suprapubic tenderness
