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USMLE Step 2 CK > GastroIntestinal > Flashcards

GastroIntestinal Flashcards

Know G.I.

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USMLE® Step 1 flashcards
1
Q

Dysphagia

A

Difficulty swallowing

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2
Q

Odynophagia

A

Pain with swallowing

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3
Q

Esophageal Webs

A
  • Associated with Iron Deficiency Anemia
  • Glossitis

(Plummer-Vinson Syndrome)

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4
Q

Dysphagia

Dx

A

Esophageal Dysphagia:

  • Barium Swallow followed by
  • endoscopy

If obstructive lesion shows then BIOPSY

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5
Q

Diffuse Esophageal Spasm

A

Motility disorder which normal peristalsis is periodically interrupted by high amplitude nonperistaltic contractions

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6
Q

Diffuse Esophageal Spasms

HX / PE

A
  • Chest Pain
  • Dysphagia
  • Odynophagia
  • Precipitated by ingestion of hot or cold liquids
  • relieved by nitroglycerin
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7
Q

Diffuse Esophageal Spasms

Dx & Tx

A

Dx- Barium Swallow (cork screw esophagus)

Tx- Nitrates and CCB’s
- Surgery for SEVERE problems

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8
Q

Achalasia

A

Impaired relaxation of lower esophageal sphincter (LES)

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9
Q

Achalasia

Hx / PE

A
  • Progressive dysphagia
  • Chest pain
  • Regurgitation of undigested food
  • Weight loss
  • Nocturnal cough
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10
Q

Achalasia

Dx

A

1st- Barium Swallow : shows dilation, “birds beak”

  • Manometry shows increase resting LES pressure
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11
Q

Achalasia

Tx

A

Nitrates
CCB’s
Inject botulinum into LES
Pneumatic balloon dilation or surgical myotomy

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12
Q

Esophageal Cancer

A
  • Squamous Cell Carcinoma (SCC) is most common.

- Adenocarcinoma is most prevalent in USA (Barrett’s Esophagus)

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13
Q

Esophageal Cancer

Hx / PE

A
  • Progressive dysphagia (solids first then liquid)
  • Weight Loss
  • GERD
  • GI Bleeding
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14
Q

Esophageal Cancer

Dx

A

1st- Barium Study
2nd- Biopsy confirms
- CT and Endoscopic used for staging

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15
Q

Esophageal Cancer

Tx

A
  • ChemoRadiation and surgical resection if definitive tx
  • Prognosis is poor

Cancer Metastasizes early because esophagus lacks a serosa

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16
Q

GastroEsophageal Reflux Disease (GERD)

A

Reflux of gastric contents into the esophagus

  • from transient LES relaxtion
  • due to incompetent LES, Gastroparesis or Hiatal hernia
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17
Q

GERD

Dx

A

Hx and Clinical impression

  • Trial of lifestyle modification and tx attempted first
  • Studies maybe a Barium Swallow to look for Hiatal hernia
  • EGD with biospy should be done in pt with symptoms unresponsive to initial therapy
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18
Q

GERD Tx

A

Liftstyle Change

  • Weight loss
  • Head of bed elevation
  • Reduce meal size
  • Avoid Noctural meals

Pharm

  • Antacids
  • H2 antagonists (cimdetidine) or PPI (omeprazole) in chronic and frequent symptoms
  • Surgical (Nissen Fundoplication) for SEVERE disease
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19
Q

GERD Avoid what types of food

A
  • Caffeine
  • Alcohol
  • Chocolate
  • Garlic
  • Onions
  • Mints
  • Nicotine
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20
Q

Hiatal Hernia

A

Herniation of a Portion of stomach upwards into the chest through a diaphragmatic opening

  • Sliding (95%)- Gastroesophageal junction and portion of stomach displaced above diaphram
  • Paraesophageal (5%)- Gastroesophgeal remains below diaphram, but portion of fundus goes into mediastinum
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21
Q

Hiatal Hernia

Dx / PE

A

May be asymptomatic

Sliding may present with GERD

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22
Q

Hiatal Hernia

Dx a& Tx

A

Dx- Commonly incidental finding on CXR
- DX by Barium Swallow or EGD

Tx-
Sliding- Medical Therapy and life style mods
to decrease GERD

Paraesophageal- Surgical gastropexy (Attach stomach to rectus sheath and closure of hiatus)

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23
Q

Gastritis

A

Inflammation of the stomach lining

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24
Q

Gastritis

Subtypes (3)

A

Acute: rapid develop

  • Due to NSAIDS
  • Alcohol
  • H. Pylori
  • Stress

Chronic Type A (10%)

  • Occurs in Fundus
  • Due to Autoantibodies of parietal cells
    - causes Pernicious anemia

Chronic Type B (90%)

  • Occurs in Antrum
  • Due to NSAIDS or H. Pylori
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25
Q

Gastritis

Hx / PE

A

Maybe Asymptomatic

  • epigastric pain
  • Nausea
  • Vomiting
  • Hematemesis
  • Melena
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26
Q

Gastritis

Dx

A

Upper Endoscopy visulizes gastric lining

H. Pylori detect by Urease Breath Test
- IgG indicates exposure

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27
Q

Gastritis

Tx

A
  • Antacids, H2 blockers, PPI
  • Triple Therapy
    (Amoxicillin, Clarithromycin, Omeprazole)
  • Prophylactic H2 or PPI for risk of stress ulcers
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28
Q

Gastric Cancer

A

Tumors generally Adenocarcinoma

2 types

  • Intestinal: arises by H. pylori
  • Diffuse- Signet Sing Cells seen
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29
Q

Gastric Cancer

Hx / PE

A

Early Signs

  • Indigestion
  • Loss Appetite

Advanced

  • Ab pain
  • Weight loss
  • Upper GI bleed
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30
Q

Gastric Cancer

Dx & Tx

A

Early
- discovered serendipitously with endoscopic exam

Tx- successful tx rests on early detection and surgical removal

5 year survival rate <10% in advanced disease

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31
Q

Peptic Ulcer Disease (PUD)

A

Damage to gastric or duodenal mucose

caused by impaired mucosal defense and/or gastric contents

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32
Q

PUD

Hx / PE

A

Duodenal Ulcers

  • Dull
  • Buring epigastric pain
  • Improves with means

Gastric
- Pain right after meals

  • “Coffee ground emesis)
  • Blood in stool
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33
Q

Gastric Cancer

Has Virchow’s Node

what is it located

A

Enlarged Left SupraClavicular Lymph Node

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34
Q

PUD

PE

A
  • Exam reveal epigastric tenderness
    • Stool guaiac
  • Acute perforation can present with rigid abdomen
  • rebound tenderness
  • Guarding
  • peritoneal irritation
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35
Q

PUD

DX

A
  • AXR rule out perforation (free air under diaphram)
  • CBC assess for GI bleed (Low hematocrit)
  • Upper Endoscopy with biopsy to confirm PUD
  • H. Pylori test
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36
Q

PUD

Tx

A

Acute

  • rule out active bleed with Serial Hematocrits
  • Rectal exam with stool guaiac
  • Monitor B.P.
  • Perforation- SURGICAL

Pharm
- Protect Mucosa

Mild

  • Antacids
  • Misoprostal for mucosal production
  • Pt with H. Pylori (give triple antiobiotics)
  • Dicontinue exacerbating agents

Endoscopy and Surgery
- Symptoms for > 2 months and refractory

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37
Q

Diarrhea

4 etiologic mechanisms?

A

Production of > 200 g of feces per day along with increase frequency or decrease consistency of stool

4 etiologic mechanisms

  • Increase motility
  • Increase Secretion
  • Increase luminal osmolarity
  • Increase inflammation
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38
Q

Diarrhea

He / PE

A

Acute

  • < 2 weeks of symptoms
  • usually infectious and self limited

Preformed Toxins

  • S. Aureus
  • Bacillus

Non-invasive

  • E-coli
  • Vibrio
  • C. Difficle
Invasive
- Enteroinvasive E-Coli
- Salmonella
- Singella
Campylobacter

Parasite

  • Giardia
  • Entamoeba Histolitica

Peds
- Rotavirus (common during winter)

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39
Q

Chronic Diarrhea

A

Insidious onset
>4 week of symptoms

Due to increase secretion (carcinoid, vipoma)

Malabsorption/osmotic

  • Bacterial overgrowth
  • Pancreatic insufficiency
  • lactose intolerance

Inflammatory Bowel Disease

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40
Q

Diarrhea

DX

A

Acute

  • No lab required
  • No investigation unless high fever, blood and > 5 days
  • Consider SIGMOIDOSCOPY in patients with bloody diarrhea
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41
Q

Diarrhea

TX

A

Acute

  • no bacterial infection
    • treat with antidiarrheal (loperamide) and ORAL rehydration

Chronic

  • Identify underlying cause
  • tx symptoms
    • loperamide
    • opioids

Peds

  • Hospitalize
  • IV fluids
  • repleate Electrolytes
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42
Q

Carcinoid Syndrome

A

Due to liver metastasis of Carcinoid Tumors

Arise from Ileum and Appendix

Produce vasoactive substances like serotonin and substance P.

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43
Q

Carcinoid Syndrome

HX / PE

A
  • Cutaneous flushing
  • Diarrhea
  • Ab cramps
  • Wheezing
  • Right sided valvular heart lesions
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44
Q

Carcinoid Dx

A

High urine levels of

5-HIAA (serotonin Metabolite)

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45
Q

Carcinoid Tx

A

Octreotide (for symptoms)

Debulking of tumor mass

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46
Q

Small Bowel Obstruction (SBO)

A

Blocked passage of bowl contents through the small bowel.

Leading to fluid and electrolyte imbalances, ab discomfort

Obstruction can be

  • Complete
  • Partial

&

  • Ischemic
  • Necrosis
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47
Q

SBO

occur due to what?

A
  • Adhesions (60%)
  • Hernia (20%)
  • Neoplasms (20%)
  • Intussusception
  • Gallstone Ileus
  • Stricture
48
Q

SBO

HX / PE

A
  • Cram ab pain with crescendo-decrescendo pattern 5 - 10 min intervals
  • Vomiting
  • Partial (no stool but has faltulance)
  • Complete (no stool or flatulance)
  • Bowel sounds: high pitch tinckles
49
Q

SBO

DX

A

CBC
- Leukocytosis (if ischemic or necrosis)

Labs

  • Dehyration
  • Metabolic Alkalosis (due to vomit)
  • Lactic Acidosis (necrotic bowel)

AXR

  • Stepladder pattern of dilated small bowel loops
  • Air fluid levels

Children
- Hernia

Adults
- Adhesions

50
Q

SBO

Tx

A

Partial

  • Supportive care
  • NPO
  • NG suction
  • IV hydration
  • Correct electrolytes
  • Foley Cath to monitor fluid

Surgery

  • required of complete SBO
  • Vascular compromise
  • > 3 days without improvements
51
Q

Ileus

A

Loss of peristalsis without structural obstruction

52
Q

Ileus

Risks

A
  • Recent surgery
  • Recent GI procedure
  • Severe Medical Illness
  • Immobility
  • Hypokalemia
  • Hypothyroid
  • DM
  • Meds that slow GI motility
53
Q

Ilieus

Hx / PE

A

Symptoms

  • Diffuse, constant, moderate ab discomfort
  • N/V, especially with eating
  • Absence of flatulence or BM

Exam

  • Tenderness
  • Ab distention
  • No peritoneal signs
  • Decrease or abscent bowel sounds
54
Q

Ilieus

Dx & Tx

A
  • Distended loops of small and large bowel on supine AXR with airfluid levels on upright view

Tx

  • Discontinue meds
  • Temporary discontinue oral feels
  • Initiate NG suction
  • Replete Electrolytes
55
Q

Mesenteric Ischemia

A

Decrease blood supply leading to insufficient perfustion to intestinal tissue and ischemic injury

56
Q

Mesenteric Ischemia

HX / PE

A
  • Severe ab pain out of proportion to the exam
  • Older people
  • Ab exam is unremarkable
  • N/V/D
  • Bloody stools
57
Q

Mesenteric Ischemia

Dx / Tx

A

Dx

  • Leukocytosis
  • Metabolic Acidosis with
  • increase lactate
  • Increase amylast
  • Increase LDH and CK

Tx

  • Volume resuscitation
  • Broad spectrum antibiotics
  • Avoid vasoconstrictors
  • Anticoagulation
58
Q

Diverticular Disease

A

Outpouching of mucosa and submucosa that herniate through the colonic muscle layers of high intraluminal pressure.

Found in Sigmoid most common

59
Q

Diverticulosis

Seen mostly in what age?

Risks?

A
  • > 40
  • Most common cause of acute lower GI bleed

Risks

  • Low fiber
  • high fat diet
60
Q

Diverticulitis

A

Inflammation and potentially perforation of diverticulum secondary to fecalith impaction

61
Q

Diverticular

HX / PE

Diverticulitis HX/PE?

A

HX

  • Often asymptomatic
  • Bleeding is painless and sudden

Diverticulitis

  • LLQ ab pain
  • Fever
  • N/V/C
62
Q

Diverticulum

DX & TX

A

Dx
CBC
- Leukocytosis
- AXR

Tx
Uncomplicated Diverticulosis
- Followed up and given high fiber diet

Diverticular Bleed

  • Bleeds stop spontaneous
  • Transfuse and rehydrate as needed

Diverticulitis

  • Bowel Rest (NPO)
  • NG tube
  • Broad Spectrum Antibiotics (Metronidazole and Quinilone or 2-3 gen ceph)

AVOID Sigmoidoscopy’s

63
Q

Colon Cancer

A

Second leading cause of cancer mortality in the USA after lung Cancer

Increase incidence with Age

Peak incidence @ 70 y/o

64
Q

Colon Cancer

HX / PE

A 
Hx
Right sided lesions
- Often bulky
- Ulcerating masses
- Weight loss
- Anorexia
- Diarrhea
- Vague Ab Pain

Left- Sided

  • Apple core
  • Obstructing mass
  • Change in bowel Habits
  • Colicky Ab pain
65
Q

Colon Cancer

Dx

A
  • CBC
  • Sigmoidscopy (Evaluate rectal bleed and left sided lesions)
  • Colonoscopy (right sided lesions)
  • Determine degree of invasion in Rectal Canacer with endorectal u/s

Metastatic Workup

  • CXR
  • LFT
  • AB/Pelvic CT
66
Q

Colon Cancer

Tx

A
  • Surgical Resection
  • Reginal Lymph node resection for staging
  • Adjuvant Chemo
  • used in colon cancer with + lymph nodes
  • Follow with serial CEA
67
Q

Ischemic Colitis

A

Lack of arterial blood supply to the colon

Severity ranges from superficial to full thickness necrosis

68
Q

Ischemic Colitis

Most common affected

A
  • Splenic Flexure (watershed area)
69
Q

Ischemic Colitis

Hx / PE

A
  • Crampy
  • Lower ab pain
  • Bloody Diarrhea
70
Q

Ischemic Colitis

DX and Tx

A

Dx
CBC
- Leukocytosis
- Sigmoidoscopy or colonoscopy to assess colonic mucosa

Tx

  • Bowel Rest
  • IV
  • Broad spectrum Antibiotics
  • Surgery with resection indicated for infarction
71
Q

Inguinal Hernia’s

A

Abdormal protrusions of Abdominal contents (usually small intestine) into the inguinal region.

  • Direct
  • Indirect

Based on their relationship to inguinal canal

72
Q

Indirect Hernia

A

Herniation of abdominal contents through the internal and then external inguinal rings and into the scrotum.

MD don’t LIE

Due to congential patent processus vaginalis

  • Lateral to Inferior epigastic vessel
73
Q

Direct hernia

A

Herniation of abdominal contents through floor of Hesselback’s triangle

  • Protudes MEDIAL to epigastic vessel

MD don’t LIE

Hernial sac contents do not transverse the internal inguinal ring. Stay in external oblique muscle

  • Acquired defect in transversalis fascia from mechanical breakdown through age
74
Q

Hernia Tx

A

Risk of Incarceration and Strangulation Surgical management indicated unless specific contraindications.

75
Q

Hesselback’s Triangle

A
  • Inguinal ligament
  • Inferior epigastric artery
  • Rectus Abdominis
76
Q

Triangle of Calot

What passes through structure

A
  • Cystic Artery

traingle made up of

  • Common hepatic duct
  • Cystic Duct
  • Inferior border of liver
77
Q

Abnormal Liver Disease

3 patterns

A

Hepatocellular Injury
- Increase AST and ALT

Cholestasis
- Increase Alkaline phosphatse and Bilirubin

Isolated Hyperbilirubinemia
- Increase bilirubin

Jaundice- seen in all 3, shows up when bilirubin >2.5 mg/dL

78
Q

Hepatitis

A

Inflammation of the liver leading to liver cell injury and necrosis

79
Q

Cause of Acute Hepatitis

A

Virus (HAV, HBV, HCV)

Drugs (alcohol, acetaminophen, INH)

80
Q

Causes of Chronic Hepatitis

A

Virus (HBC, HCV, HDV)
Alcoholic Hepatitis
Autoimmune Hepatitis
Hereditary (Wilsons, Hemochromatosis)

81
Q

HAV and HEV

Transmitted?

A

Fecal-Oral Route

82
Q

HBV and HCV

Transmitted

A

Bodily Fluids

Risk of acquiring HCV sexually is very low

83
Q

Hepatitis

HX / PE

A

Hx

  • Nonspecific Symptoms
  • N/V
  • Joint pain
  • Malaise
  • Fever
  • Jaundice and RUQ tenderness

Exam

  • Jaundice
  • Scleral Icterus
  • Tender Hepatomegaly
  • Lymphadenopathy
84
Q

Hepatitis

DX

A
  • Increase in AST and ALT
  • Increase Bilirubin / Alkaline Phosphatase

Chronic Hep
- ALT and AST increased >6 months

Diagnosis
- Hepatitis serology

85
Q

Hepatitis

TX

Alcoholic
Immunosuppressive

A

Steroids for Alcoholic Hepatitis

Immunosuppression and steroids for Autoimmune

  • Liver transplant for end stage liver failure
  • IFN, Lamivudine for chronic HBV
  • Peginterferon and Ribavirin HCV
86
Q

Cirrhosis

A

Fibrosis and nodular regeneration resulting in hepatocellular injury.

87
Q

Cirrhosis

Hx / PE

A

Presents with:

  • Jaundice
  • Ascites
  • Bacterial Peritonitis
  • Hepatic Encephalopthy
  • Gastroesophageal Varices
  • Renal Dysfunction

Exam:

  • Enlarged, palpable or firm liver
  • Portal HTN
88
Q

Cirrhosis

DX

A
  • Decrease Albumin
  • Increase PT/PTT
  • Increase Bilirubin

Abdominal U/S/

  • Assess liver size
  • Ascites
  • Patency of splenic and hepatic veins
89
Q

Cirrhosis

Tx

A

Ascites:

  • NA restriction and Diuretics
  • Rule out infections and neoplastic causes
Spontaneous Bacterial Peritonitis
- Fever
- Ab pain
- Altered Mental Status
- Check Peritoneal fluid
    Fluid + if >250 PMNs/Ml or >500 WBC
- Treat IV antibiotics (3rd Gen Ceph)

Hepatorenal Syndrome

  • Diagnosis of exlusion
  • Needs Dialysis

Hepatic Encephalopathy

  • Due to decrease clearance of ammonia
  • Tx with protein restriction
    • Lactulose
    • Rifaximin
90
Q

Primary Biliary Cirrhosis

A

Autoimmune disorder characterized by:

  • destruction of intrahepatic bile ducts
  • Middle aged women with other autoimmune disorders
91
Q

Primary Biliary Cirrhosis

DX / PE

A

Presents:

  • Progressive jaundice
  • Pruritis
  • Malabsorption of Fat Soluable
92
Q

Primary Biliary Cirrhosis

Dx and Tx

A

Dx

  • Increase Alkaline Phosphatse
  • Increase Bilirubin
    • anti-Mitochondrial Antibody
  • Increase Cholesterol

Tx

  • Ursodeoxycholic Acid (slows diease)
  • Cholestyramine (pruritis)
  • Liver Transplant
93
Q

Hepatocellular Carcinoma

A

Risk Factors

  • Cirrhosis
  • Chronic Hepatitis (HCV)
  • Aflatoxins
  • HBV inections
94
Q

Hepatocellular Carcinoma

HX / PE

A

Presents

  • RUQ Tenderness
  • Ab distention
  • Signs of chronic liver diesase
    • Jaundice
    • Easy Bruise
    • Coagulopathy

PE
- Enlarged liver

95
Q

Hepatocellular Carcinoma

DX & TX

A

Dx

  • U/S or CT
  • Liver Biopsy Definitive Diagnosis

Tx

  • Small Tumors
    • Aggressive Tumor resection
    • Orthotopic liver transpantation

Chemo and Radiation NOT effective

  • Monitor recurrence with serial AFP leverls
96
Q

Hemochromatosis

A

Hyperabsorption of Iron with parenchymal hemosiderin accumulation in the liver, pancreas, heart, adrenals, testes, pituitary, and kidneys

97
Q

Hemochromatosis

is what type of recessive disease

A

Autosomal recessive

Can be seen in Alcoholics as well, since alcohol increase iron absorption

98
Q

Hemochromatosis

Hx / PE

A

Presents:

  • Ab pain
  • Symptoms of DM
  • Hypogonadism
  • Arthropathy of MCP joints
  • Heart Failure
  • Cirrhosis
Exam:
- Bronze Skin
- Pancreatic dysfunction
- Cardiac Dysfunctoin
- Hepatomegaly
_ Testicular Atriphy
99
Q

Hemochromatosis

DX

A
  • Increase serum Iron
  • Decrease Serum Transferrin
  • TRANSFER SATURATION most SENSITIVE
  • Glucose intolerence
  • LIVER BIOPSY
  • Hepatic MRI
100
Q

Hemochromatosis

TX

A
  • Weekly phlebotomy (ever 2-4 months)

- Deferoxamine

101
Q

Wilson’s Disease

Hepatolenticular Degeneration

A
  • Decrease Ceruloplasmin
  • Excessive deposition of Copper in liver and brine
  • AR on Chromosome 13
  • < 30
102
Q

Wilson’s Disease

Hx / PE

A

Hx

  • present with Hemolytic Anemia
  • Liver Abnormalities
  • Neurologic
  • Psychiatric abnormalities

PE
- Kayser-Fleischer Rings (Green to brown deposits of copper)

103
Q

Wilson’s Disease

Dx & Tx

A
  • Decrease Serum Ceruloplasmin
  • Increase urinary copper excretion
  • Increase hepatic copper

Tx

  • Dietary Copper restriction (avoid liver, shell fish)
  • Penicillamine
104
Q

Wilson’s ABCCCD

A 
Asterixis
Basal Ganglia Deterioration
Ceruloplasmin Decrease
Cirrhosis
Copper Increase
Carcinoma of Liver
Choreiform movements
Dementia
105
Q

Pancreatic Cancer

Risks
what part of the pancreas

A

75% are adenocarcinom of the head of the pancreas

Risks

  • Smoking
  • Chronic Pancreatitis
  • 1st degree relative with Pancreatic cancer
  • High fat diet
106
Q

Pancreatic Cancer

Hx / PE

A

Presents

  • Ab pain radiates toward back
  • Obstructive jaundice
  • Loss of apetite
  • N/V
  • Weight loss
  • Indigestion
  • Asymptomatic

EXAM:

  • palpable nontender gallbladder (Courvoisier’s Sign)
  • Migratory thrombophlebitis (Trousseau’s Sign)
107
Q

Pancreatic Cancer

DX & Tx

A

Dx

  • CT to detect Mass
  • If NO mass use ERCP
  • CA 19-9 elevated

Tx

  • Treatment is Palliative
  • 20% have no metastasis use Whipple procedure
  • Chemo with 5-FU and Gemcitabine may improve short term survival (5-10% survival 5 years)
108
Q

Ranson’s Criteria

On Admission

A

“GA LAW”

Glucose >200 mg/dL
Age >55
LDH >350
AST >250
WBC >16 000
109
Q

Ranson’s Criteria

After 48 hr

A

C HOBBS

Ca < 60 mmHg
Base excess >4
BUN increase by 5
Sequestered fluid >6L

110
Q

Ranson’s Criteria

How it works

A

Ranson’s predicts mortality associated with acute pancreatitis.

20% with 3-4 signs
40% with 5-6 signs
100% with >7 signs

111
Q

Cholelithiasis & Biliary Colic

Risks

A

Colic results from Tansient cystic duct blockage from impacted stones

Risks- 4 F’s

  • Fat
  • Female
  • Fertile
  • Forty
112
Q

Cholelithiasis & Biliary Colic

Hx / PE

A

Presents
- Postprandial ab pain (RUQ) and radiates to the right subscapular area or Epigastrium

  • Pain Abrupt followed by gradual relief
  • N / V
  • Fatty Food intolerance
  • Dyspepsia
  • Flatulence

PE

  • 80% asymptomatic
  • Exam RUQ tenderness
  • Palpaple gallbladder
113
Q

Cholelithiasis & Biliary Colic

Dx and Tx

A

Dx
- RUQ U/S

Tx

  • Cholecystectomy curative
  • Asymptomatic needs nothing

Patients may need
- Endoscopic Retrograde Cholangiopancrreatograpthy (ERCP) for common bile duct stone

114
Q

Choledocholithiasis

A

Gallstone in Common Bile DUCT

Symptoms vary according to degree of obstruction

115
Q

Choledocholithiasis

Hx / PE & Tx

A

Hx

  • Presents with
  • Biliary colic
  • Jaundice
  • Fever
  • Pancreatitis
  • Increase Alkaline Phosphatse
  • Increase Total Bilirubin

Tx
- ERCP and Cholecystectomy

USMLE Step 2 CK (5 decks)

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