Gastrointestinal and Nutritional Flashcards
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
biliary colic
prolonged (>4 to 6 hours)) RUQ or epigastric pain, fever. with abdominal guarding and murphys sign.
what is the most likely diagnosis
acute cholecystitis
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
acute appendicitis
what is the most common etiology of acute appendicitis
fecalith
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
acute cholecystitis
what is the gold standard diagnostic test for cholecystitis
HIDA scan
what is the gold standard diagnostic test for choledocholithiasis
ERCP
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?
Acute hepatitis
what is the best initial diagnostic test for acute hepatitis
ultrasound to rule out other causes of abdominal pain
what does it mean if a patient is IgM positive
acte early infection
what does it mean if a patietn is IgG positive
antibodies are present and remain after recovery
what does it mean if a patient is positive for IgG but negative for IgM?
patient is immune via either prior infection or vaccination
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?
acute pancreatitis
what sign presents as flank ecchymosis
Grey-Turner’s Sign of pancreatitis
what is the mnemonic GET SMASHHED useful for
most common causes of pancreatitis
Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune disease, Scorpion stiing, Hypercalcemia, Hyperlipidema, ERCP, and Drugs
what is the diagnostic test of choice for pancreatitis
Abdominal CT - requred to differentiate from necrotic pancreatitis
what test is most sensitive for chronic pancreatitis
ERCP
what is Ranson’s criteria and what is it used for?
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
what is the treatment for pancreatitis
IV fluids (Best), analgesics, bowel rest
what is the treatment of anorectal abscess
requires surgical drainage followed by warm-water cleansing, analgesics, stool softeners and a high fiber diet
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?
Cholangitis
what is an infection of the biliary tract, secondary to obstruction/statiss?
cholangitis
what is Charcot’s triad
RUQ tenderness, jaundice and fever
(used for cholangitis)
what is Reynold’s pentad?
RUQ tenderness, jaundice, fever, AMS and hypotension
(used for cholangitis)
what is the initial imaging used for cholangitis
ultrasound
what is the best diagnostic test for cholangitis
ERCP
what is the presentation of primary sclerosing cholangitis
jaundice and pruritus
associated with IBD, cholangiocarcoma, pancreatic cancer and colorectal cancer
what is the most common cause of cirrhosis
alcoholic liver disease
what is Budd Chiari Syndrome
hepatic vein thrombosis: triad of abdominal pian, ascites and hepatomegaly
what is the treatment for cirrhosis
avoid alchohol, restrict salt, transplant
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?
diverticulosis
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?
diverticulitis
what is the most common location for diverticulitar disease
sigmoid colon
what is seen on CT when assessing for diverticular disease
fat stranding and bowel wall thickening
what is eosinophilic esophagitis
pt with asthma and GERD not responsive to antacitds.
how is eosinophilic esophagitis diagnosed
biopsy
barium swallow will show a ribbed esophagus and multiple corrugated rings
what are three causes of gastritis
infectious
inflammation
autoimmune/hypersensitivity
what are common indicators of gastritis
dyspepsia and abdominal pain
what are the diagnostic tests for H.Pylori gastritis
urea breath test or fecal antigen
what is the treatment of upper GI bleed
supportive care: NPO, IV access, oxygen, IV fluids
Transfuse for hemodynamic instability
treat wtih IV PPI
surgery
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?
Giardiasis
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
Tinidazole (first line)
Flagyl (metronidazole)
what is the treatment of tapeworm
praziquantel
what is the treatment of amebiasis
iodoquinol or paromomycin and flagyl for liver abscess
what is the gold standard diagnostic test for heart burn
endoscopy with biopsy
what is the treatment of heart burn
lifestyle modificiation and acid suppression
what is the treatment of h.pylori infection
triple therapy PPI + clarithromycin + amoxicillin +/- metronidazole
what is the most common inguinal hernia
indirect inguuinal hernia
what is the presentation indirect hernia
passage of intestine through the internal inguinal ring down the inguinal canal - may pass into the scrotum.
what is the presentation of direct inguinal hernia
passage of intestine through external inguinal ring at hesselbach triagle - rarely enters the scrotum
what inflammatory bowel disease is isolated to the colon
ulcerative colitis
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?
toxic megacolon
what is the gold standard diagnostic of ischemic bowel disease
mesenteric angiography
what is seen on abdominal xray with ischemic bowel disease
“thumb-printing” of small bowel or right colon due to submucosal bleeding
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?
mallory-weiss tear
what is the treatment of mallory-weiss tear
supportive.
may cauterize or inject epinephrine if needed
