Gastroenterology Flashcards
Gray Turner’s sign
Blood tracking along the intercostal space, is indicative of hemorrhage in the retroperitoneal space.
hemorrhagic acute pancreatitis.
Hollow viscus injury.
a spectrum of bowel injury ranging from hematomas to full thickness defects in the walls of the stomach, small, or large intestines.
Meconium ileus
it commonly present in Cystic fibrosis.
Bilious vomiting, distended loops of bowel on radiography, and failure to pass meconium.
Achalasia diagnosis
Barium swallow is often the first diagnostic test ordered in the workup of dysphagia.
EGD: to rule out a stricture (i.e. one caused by cancer), these tests are not sufficient to make the diagnosis.
To make a formal diagnosis of achalasia, esophageal manometry must be performed. Classic findings: increased LES tone, failure of LES relaxation on deglutition, and aperistalsis at the distal esophagus.
Spontaneous Bacterial Peritonitis
The diagnosis is based on presence of ascitic fluid with polymorphonuclear cell count greater than 250 cells/uL or positive Gram stain and culture.
Typical causative organisms include E. coli, Klebsiella, streptococcus, and staphylococcus.
First-line treatment is with cefotaxime, a third-generation cephalosporin with activity against many gram-positive and gram-negative bacteria.
Patient with acute liver failure who has a substantial decrease in her transaminases (AST, ALT) and an increase in her prothrombin time (PT) suggest?
Progression to fulminant hepatitis.
Ranson’s Criteria
Estimates mortality of patients with pancreatitis, based on initial and 48-hour lab values.
WBC >16k
Age >55 years
Glucose >200 mg/dL (>11.1 mmol/L)
Type A gastritis
An autoimmune metaplasic atrophic gastritis that can target the gastric corpus, destroying parietal cells.
Primary biliary cirrhosis
-Autoimmune, cholestatic liver disease ——–Progressive destruction of interlobular bile ducts leading to cirrhosis.
-90% of PBC patients have a positive anti-mitochondrial antibody titer.
-Alkaline phosphatase greater than 1.5 times the upper limit and interlobular bile duct destruction on liver biopsy.
-Ursodeoxycholic acid functions to protect cholangiocytes and hepatocytes from the cytotoxic effects of bile acids. It is currently the only FDA-approved therapy for PBC.
Patient with a cholestatic pattern, history of inflammatory bowel disease, and an ERCP that demonstrates intermittent strictures. These findings are highly suggestive of?
Primary Sclerosing Cholangitis
Primary Sclerosing Cholangitis
Chronic cholestatic liver disease
Inflammation, destruction, fibrosis, progressive narrowing, and saccular dilatations of the bile ducts.
Autoimmune condition that is closely linked with IBD, in particular ulcerative colitis. Cholestatic pattern (elevated GGT and Alkaline Phosphatase), elevation in AST and ALT. hyperbilirubinemia is rare.
Definitive diagnosis is obtained through imaging of the biliary tree.
Hydrogen breath test
The hydrogen breath test is performed by administering a small amount of lactose and measuring hydrogen breath levels every 15, 30 or 60 minutes for three hours. If the level of hydrogen rises above 20 ppm, the patient is diagnosed with lactose intolerance.
Acute acalculous cholecystitis
Inflammation of the gallbladder without evidence of gallstones: caused by bile stasis which occurs in severe illness due to lack of oral intake, often observed in very ill patients with sepsis, trauma, or severe burns.
Carries a mortality rate of approximately 30%, most likely due its ability to progress rapidly to perforation and gangrene.
Hepatic adenoma
Right upper quadrant pain, elevated alkaline phosphatase and GGT, and a solid liver lesion with peripheral enhancement. Prolonged oral contraceptive use is a risk factor.
