Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Family Medicine Rotation > Gastrointestinal/Nutritional > Flashcards

Gastrointestinal/Nutritional Flashcards

1
Q

LFTs for alcoholic liver

A

AST 2x> ALT

think alcohol makes an aSS out of yourself

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the most important test to assess for liver disease

A

PT/INR

these maybe deranged before LFTs elevate in patients with liver disease, hepatitis, HCC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Charcot’s triad

A

fever
RUQ abdominal pain
jaundice
(cholangitis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q 
Cholelithiasis 
Path:
Pt:
Dx:
Tx:
A

Path: Gallstones in gallbladder (NO inflammation)

Pt: Fat, fair, fertile, female, 40s (TPN another risk factor)
Biliary colic: RUQ pain lasting 30 mins- few hrs precipitated by fatty foods or large meals

Dx:
U/S
CT or MRI

Tx:
Asx-> observation
Elective cholecystectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q 
Cholecystitis 
Path:
Pt:
Dx:
Tx:
A

Path: Obstruction by a gallstone

Pt: Fat, Fertile, Female, 40s
Colicky, steadily inc RUQ/epigastric pain after eating fatty foods
PE: Fever
Murphy’s sign-> inspiratory arrest w/ palpation of gallbladder
Boas sign->referred pain R shoulder

Dx:
(GS): HIDA scan (cholescintigraphy scan)-> nonvisualization of the gallbladder
Labs-> inc WBCs, inc bilirubin, inc Alk Phos, and inc LFTs
Initial: U/S
Thickened gallbladder; distended gallbladder, sludge, gallstones, pericholecystic fluid, + sonographic Murphy’s sign

Tx:
NPO, IVF, abx-> ceftriaxone + metronidazole
Pain-> NSAIDs, narcotics
Cholecystectomy
Cholecystostomy tube (if surgery contraindicated)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q 
Peptic ulcer disease
Path:
Pt:
Dx:
Tx:
A

Path: H. Pylori infection or NSAID use
Duodenal: pain alleviated by ingesting food
Gastric: pain exacerbated by ingesting food

Pt: Gnawing epigastric pain

Dx:
Endoscopy
H. Pylori infection made by H. Pylori fecal antigen or urea breath test

Tx:
H. Pylori negative: PPI, H2 blocker, misoprostol, antacids, bismuth compounds, sucralfate
H. Pylori eradication:
Triple Therapy: Clarithromycin, amoxicillin (metronidazole), PPI (think CAP)
Quadruple therapy: Tetracycline, metronidazole, PPI, bismuth subsalicylate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q 
Acute pancreatitis 
Path:
Pt:
Dx:
Tx:
Complications
A

Path: GET SMASHED
gallstones, ethanol, trauma, steroids, mumps, autoimmune, scorpion stings, HLD/hyper Ca+, ERCP, Drugs

Pt: epigastric pain radiates to back, N/V
Grey-Turner Sign
Cullen Sign

Dx: elevated lipase
RUQ U/S-> gallstone obstruction
Abd CT-> non-obstructive origin

Tx: NPO, IVF

Complications: GA-LAW >/=3 severe pancreatitis 
glucose >200
Age >55
LDH >350
AST >250
WBC >16k
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q 
Chronic Pancreatitis 
Path:
Pt:
Dx:
Tx:
A

Path: ETOH most common

Pt: Glucose intolerance
Abdominal pain radiating to back
Malabsorption, steatorrhea

Dx: CT/ Abdominal XR: calcifications

Tx:
small, low fat meals
Pain: TCAs, narcotics
NPO-> acute exacerbations 
Pancreatic enzymes
Replace fat soluble vitamins and cyanocobalamin-> steatorrhea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q 
Viral Hepatitis
Path: 
Pt:
Dx:
acute infection
recovered
immunized 
early marker for infection, positive in window period 
best marker for prior Hep B
high infectivity
low infectivity 
Tx:
A

Path: Hep A, E: fecal oral
Hep B infectious
Hep C: IVDA, chronic, cirrhosis, carcinoma, carrier
Hep D: dependent on Hep B co-infection

Pt: N/V, RUQ abd pain
PE-> tender enlarged liver +/- jaundice

Dx: 
HBsAg: acute infection
Anti-HBs: recovered or immunized 
Anti-HBc IgM: early marker of infection, positive in window period 
Anti-HBc IgG: best marker for prior HBV
HBeAg: high infectivity 
Anti-HBeAb: low infectivity

Tx: Supportive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Diarrhea after ingestion of… Name the pathogen:

  • proteinaceous foods
  • fried rice
  • water, shellfish
  • recent abx use
  • raw veggies, water
A 
proteinaceous foods:
-chicken: salmonella 
-beef or poultry: clostridium perfringens 
fried rice: bacillus cereus 
water, shellfish: vibrio cholera  
recent abx use: C diff
raw veggies, water: Shigella
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q 
Diarrhea recently ate poultry, meat or eggs 
Path:
Pt:
Dx:
Tx:
A

Path: Salmonella
Pt: fever, diarrhea (possibly bloody in children), abdominal cramping
Dx:
labs-> fecal WBCs
stool culture
Tx: HYDRATION!
can consider cipro, bactrim if patient toxic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q 
Colorectal cancer
Path: risk factors
Pt: 
Dx:
Tx:
A

Path: Progression of adenomatous polyp into malignancy (adenocarcinoma)
Risk factors-> age>50, IBD, adenomatous polyps, diet (low fiber, high red meat), ETOH, african americans, family hx CRC
-genetics: familial adenomatous polyposis (APC gene mutation), lynch syndrome, Peutz-Jehgers
Pt: Iron deficiency anemia, rectal bleeding, abd pain, change in bowel habits
Large bowel obstruction (MC cause in adults)

Dx: Colonoscopy w/ bx (GS)
Barium enema: apple core lesion classic
Inc CEA; monitored during tx
CBC-> iron deficiency anemia

Tx:
Localized (stage I-III): surgical resection
Stage III and Mets: chemo mainstay (5FU/fluorouracil)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Rovsing sign

A

Appendicitis

RLQ pain w/ LLQ palpation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Obturator sign

A

Appendicitis

RLQ pain w/ internal and external hip rotation w/ flexed knee

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Psoas sign

A

Appendicitis

RLQ pain w/ right hip flexion/extension (raise leg against resistance)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

McBurney’s point tenderness

A

Appendicitis

point 1/3 the distance from the anterior superior iliac spine and naval

17
Q 
Esophagitis- Infectious 
Path:
Pt:
Dx:
Tx:
A 
Path: Infection an inflammation of esophagus
MC in immunocompromised 
Fungal- candida, other fungi
Viral- CMV, HSV, HIV, EBV, HPV
Parasitic- cryptosporidum, PCP
Mycobacterium- TB, MAC
Bacterial- rare

Pt: Acute onset of odynophagia, dysphagia, chest pain, B symptoms

Dx: EDG w/ biopsy- apperance depends on infection

Tx: Appropriate antimicrobial therapy
+/- steroids for inflammation
Hydration

18
Q

Esophagitis- Radiation
Pt:
Dx:
Tx:

A

Pt:
Early/acute: dysphagia, odynophagia, snub-sternal discomfort
Late (3-6m s/p therapy): dysphagia and odynophagia due to stricture/altered motility 2/2 fibrosis/muscular/nerve damage

Dx: EGD w/ bx

Tx:
Viscous lidocaine
Indomethacin
Dilatation 
\+/- feeding tube
Resolves w/ cessation of radiation therapy
19
Q 
Esophagitis- Eosinophilic
Path:
Pt:
Dx:
Tx:
A

Path: Eosinophilic predominate inflammation of the esophagus 2/2 to a trigger

Pt: Teenage caucasian males w/ hx of environmental allergies, GERD sxs, dysphagia, anorexia

Dx: EDG w/ bx w/ >15 eosinophils/HPF

Tx:
PPI
Topical steroids
Dietary elimination

20
Q 
Esophagitis- Corrosive 
Path:
Pt:
Dx:
Tx:
A

Path: Chemical trauma to esophagus resulting in scarring (stricture)

Pt: Dependent on corrosive agent and severity of injury

Dx: Clx

Tx:
observation/supportive care
Potential G/J tube placement
Once healded dilation/esophagectomy prn

21
Q 
Esophagitis- Pill Induced  
Path:
Pt:
Dx:
Tx:
A

Path:
Abx
NSAIDs
Bisphosphonates

Pt:
Retrosternal pain/heartburn
Odynophagia
dysphagia

Dx: Clx
EDG w/ signs of injury

Tx:
Instruction to take pills upright w/ lots of water to prevent further injury
Medication changes

22
Q 
Gastritis 
Path:
Pt:
Dx:
Tx:
A

Path:
Acute: NSAIDS>alcohol
Type A chronic: pernicious anemia
Type B chronic: H. Pylori

Pt: Hematemesis

Dx: Upper endoscopy (EGD)

Tx:
Triple therapy
Clarithromycin, amoxicillin (metronidazole), PPI

Quadruple therapy
Bismuth subcitrate potassium, metronidazole, tetracycline, PPI

23
Q

GERD
Dx:
Tx:
Complications:

A

Dx: Clx
Endoscopy
Esophageal manometry-> dec LES pressure
24hr ambulatory pH monitoring: GOLD STANDARD

Tx:
Lifestyle modifications: Elevation of HOB, Avoid recumbency for 3 hours after eating, Eat small meals, Avoid certain foods-> fatty, spicy, citrus, chocolate, caffeinated products, peppermint , Decrease fat & ETOH, Weight loss, Smoking cessation

Meds:
Antacids, H2 blockers, PPIs

Nissen fundoplication if refractory

Complications:
Esophagitis
Stricture
Barrett’s esophagus
Esophageal squamous epithelium replaced by precancerous metaplastic columnar cells from the cardia of stomach
Esophageal adenocarcinoma
24
Q

Hemorrhoids
Classification: internal hemorrhoids
Tx:

A

Classification:

1st: do not protrude through the anus
2nd: prolapse but reduce spontaneously
3rd: prolapse and require manual reduction
4th: cannot be reduced, may strangulate

Tx: Lifestyle modifications, sitz baths, analgesic creams,
surgical excision (thrombosed)
External: <72 hrs elliptical excision
Internal: Infrared coagulation, Rubber band ligation

Family Medicine Rotation (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions