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Clinical: Emergency Medicine > Gastrointestinal and Nutritional > Flashcards

Gastrointestinal and Nutritional Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

intense, dull discomfort located in the RUQ or epigastrum. associated with nausea, vomiting and diaphrosesis usually lasting at least 30 minutes, with benign abdominal exam
what is the most likely diagnosis

A

biliary colic

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2
Q

prolonged (>4 to 6 hours)) RUQ or epigastric pain, fever. with abdominal guarding and murphys sign.
what is the most likely diagnosis

A

acute cholecystitis

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3
Q

pt is a 14yo boy with nausea, vomiting, constipation and periumbilical pain that has settled into LRQ. pts mom gave him a piece of toast and some water about 5 hours ago but the patient vomited 30 minutes after eating. PE he has tenderness and guarding in LRQ, bloo dtests reveal leukocytosis with a shift to the left.
What is the most likely diagnosis

A

acute appendicitis

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4
Q

what is the most common etiology of acute appendicitis

A

fecalith

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5
Q

patient is a 49yo female with 2 day hx of RUQ, colicky abdominal pain, as well as nausea and vomiting. exam shows signifant pain with palpation in RUQ. lab show elevated WBC count, alk phos and bilirubin levels.
what is the most likely diagnosis

A

acute cholecystitis

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6
Q

what is the gold standard diagnostic test for cholecystitis

A

HIDA scan

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7
Q

what is the gold standard diagnostic test for choledocholithiasis

A

ERCP

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8
Q

patient is a 32yo G2P1 at 32 weeks gestation presenting to the ED wtih complains of severe abdominal pian, fatigue an nausea. PE reveals profound jaundice and tednerenss to palpation of RUQ. pt returned 2 weeks ago from a 1 month trip to india
what is the most likely diagnosis?

A

Acute hepatitis

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9
Q

what is the best initial diagnostic test for acute hepatitis

A

ultrasound to rule out other causes of abdominal pain

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10
Q

what does it mean if a patient is IgM positive

A

acte early infection

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11
Q

what does it mean if a patietn is IgG positive

A

antibodies are present and remain after recovery

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12
Q

what does it mean if a patient is positive for IgG but negative for IgM?

A

patient is immune via either prior infection or vaccination

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13
Q

37yo male presents complainin of rapid onset of severe mid-epigastric pain with radiation to the back after eating a large meal. the pain typically lessens when the patient leans foward or lies in the fetal position. PE shows low grade fever. epigastric tenderness, diminished bowel sounds and bruising of the flanks.
what is the most likely diagnosis?

A

acute pancreatitis

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14
Q

what sign presents as flank ecchymosis

A

Grey-Turner’s Sign of pancreatitis

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15
Q

what is the mnemonic GET SMASHHED useful for

A

most common causes of pancreatitis
Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune disease, Scorpion stiing, Hypercalcemia, Hyperlipidema, ERCP, and Drugs

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16
Q

what is the diagnostic test of choice for pancreatitis

A

Abdominal CT - requred to differentiate from necrotic pancreatitis

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17
Q

what test is most sensitive for chronic pancreatitis

A

ERCP

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18
Q

what is Ranson’s criteria and what is it used for?

A

for poor prognosis of pancreatitis
At admit: >55yo, Leukocyte > 16,000, glucose >200, LDH>350, AST>250
At 48hours: arterial PO2 <60, HCO3 <20, Calcium <8.0, BUN increased by 1.8+, Hct decreased by >10%, fluid sequestration>6L

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19
Q

what is the treatment for pancreatitis

A

IV fluids (Best), analgesics, bowel rest

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20
Q

what is the treatment of anorectal abscess

A

requires surgical drainage followed by warm-water cleansing, analgesics, stool softeners and a high fiber diet

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21
Q

58yo male presents with acute onset of abdominal pain associated wtih fever and shaking chills. pt is hypotensive and febrile with a temp of 102.2. he is confused and disoriented but complains of RUQ pain during palpation of the abdomin. sclerae are icteric and skin is jaundiced.
what is the most likely diagnosis?

A

Cholangitis

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22
Q

what is an infection of the biliary tract, secondary to obstruction/statiss?

A

cholangitis

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23
Q

what is Charcot’s triad

A

RUQ tenderness, jaundice and fever
(used for cholangitis)

24
Q

what is Reynold’s pentad?

A

RUQ tenderness, jaundice, fever, AMS and hypotension
(used for cholangitis)

25
Q

what is the initial imaging used for cholangitis

A

ultrasound

26
Q

what is the best diagnostic test for cholangitis

A

ERCP

27
Q

what is the presentation of primary sclerosing cholangitis

A

jaundice and pruritus
associated with IBD, cholangiocarcoma, pancreatic cancer and colorectal cancer

28
Q

what is the most common cause of cirrhosis

A

alcoholic liver disease

29
Q

what is Budd Chiari Syndrome

A

hepatic vein thrombosis: triad of abdominal pian, ascites and hepatomegaly

30
Q

what is the treatment for cirrhosis

A

avoid alchohol, restrict salt, transplant

31
Q

63yo male presents to the ED for an episode of painless bright red blood per rectum for two hours, what is the most likely diagnosis?

A

diverticulosis

32
Q

67yo male with long history of constipation presents with steady LLQ pain. PE reveals low grade fever, midabdominal distention and LLW tenderness. stool guaiac is negative. left shift noted in CBC.
what is the most likely diagnosis?

A

diverticulitis

33
Q

what is the most common location for diverticulitar disease

A

sigmoid colon

34
Q

what is seen on CT when assessing for diverticular disease

A

fat stranding and bowel wall thickening

35
Q

what is eosinophilic esophagitis

A

pt with asthma and GERD not responsive to antacitds.

36
Q

how is eosinophilic esophagitis diagnosed

A

biopsy
barium swallow will show a ribbed esophagus and multiple corrugated rings

37
Q

what are three causes of gastritis

A

infectious
inflammation
autoimmune/hypersensitivity

38
Q

what are common indicators of gastritis

A

dyspepsia and abdominal pain

39
Q

what are the diagnostic tests for H.Pylori gastritis

A

urea breath test or fecal antigen

40
Q

what is the treatment of upper GI bleed

A

supportive care: NPO, IV access, oxygen, IV fluids
Transfuse for hemodynamic instability
treat wtih IV PPI
surgery

41
Q

27yo female presents with one-week history of foul-smelling, greasy diarrhea, abdominal bloating, and cramps. she recently returned from a hiking trip where she drank untreated stream water. on exam, she is mildly dehydrated but otherwise stable.
what is the most likely diagnosis?

A

Giardiasis

42
Q

27yo female presents with one-week history of foul-smelling, greasy diarrhea, abdominal bloating, and cramps. she recently returned from a hiking trip where she drank untreated stream water. on exam, she is mildly dehydrated but otherwise stable.
given the most likely diagnosis, what is the treatment

A

Tinidazole (first line)
Flagyl (metronidazole)

43
Q

what is the treatment of tapeworm

A

praziquantel

44
Q

what is the treatment of amebiasis

A

iodoquinol or paromomycin and flagyl for liver abscess

45
Q

what is the gold standard diagnostic test for heart burn

A

endoscopy with biopsy

46
Q

what is the treatment of heart burn

A

lifestyle modificiation and acid suppression

47
Q

what is the treatment of h.pylori infection

A

triple therapy PPI + clarithromycin + amoxicillin +/- metronidazole

48
Q

what is the most common inguinal hernia

A

indirect inguuinal hernia

49
Q

what is the presentation indirect hernia

A

passage of intestine through the internal inguinal ring down the inguinal canal - may pass into the scrotum.

50
Q

what is the presentation of direct inguinal hernia

A

passage of intestine through external inguinal ring at hesselbach triagle - rarely enters the scrotum

51
Q

what inflammatory bowel disease is isolated to the colon

A

ulcerative colitis

52
Q

pt is brought to the ED appearing quite ill. he has a fever of 103.2, dry skin, and oral mucosal membranes and abdominal distrention and tednerness. pt has a history of UC.
what is the most likely diagnosis?

A

toxic megacolon

53
Q

what is the gold standard diagnostic of ischemic bowel disease

A

mesenteric angiography

54
Q

what is seen on abdominal xray with ischemic bowel disease

A

“thumb-printing” of small bowel or right colon due to submucosal bleeding

55
Q

21yo male with hematemesis. he is brought by his gf who reports that he and his buddies have been out drinking every night last week in celebration of his 21st birthday. he report having vomited each night, but tonight when he started vomiting, he noticed that there was streaking of blood.
given the presentation, what is the most likely diagnosis?

A

mallory-weiss tear

56
Q

what is the treatment of mallory-weiss tear

A

supportive.
may cauterize or inject epinephrine if needed

Clinical: Emergency Medicine (13 decks)

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