Gastroenterology

Question 1

Gray Turner’s sign

Answer 1

Blood tracking along the intercostal space, is indicative of hemorrhage in the retroperitoneal space.
hemorrhagic acute pancreatitis.

Question 2

Hollow viscus injury.

Answer 2

a spectrum of bowel injury ranging from hematomas to full thickness defects in the walls of the stomach, small, or large intestines.

Question 3

Meconium ileus

Answer 3

it commonly present in Cystic fibrosis.
Bilious vomiting, distended loops of bowel on radiography, and failure to pass meconium.

Question 4

Achalasia diagnosis

Answer 4

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.

Question 5

Spontaneous Bacterial Peritonitis

Answer 5

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.

Question 6

Patient with acute liver failure who has a substantial decrease in her transaminases (AST, ALT) and an increase in her prothrombin time (PT) suggest?

Answer 6

Progression to fulminant hepatitis.

Question 7

Ranson’s Criteria

Answer 7

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)

Question 8

Type A gastritis

Answer 8

An autoimmune metaplasic atrophic gastritis that can target the gastric corpus, destroying parietal cells.