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GEN MED GI > Gen Med Lower GI & Accessory organs > Flashcards

Gen Med Lower GI & Accessory organs Flashcards

1
Q

Bruising around the umbilicus

Name & Indication

A

Cullen’s Sign

Acute Pancreatitis

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2
Q

Pt points to area midway between Rt hip & umbilicus

Name & Indication

A

McBirney’s Sign

Acute Appendicitis

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3
Q

Pain in RLQ on release after palpation of LLQ

A

Rovsing Sign, a type of rebound

Acute Appendicitis

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4
Q

Rebound Tenderness

A

Pain on release of palpation anywhere on and

Peritonitis Esp w/guarding & Rigidity

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5
Q

Murphy’s Sign Describe & Indication

A

For Cholecystitis/Cholelithiasis

Pt inhales & you slip fingers under edge of liver
Pain is positive Murphy sign

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6
Q

Appendicitis signs

A

Murphy Sign
Rovsing Sign
McBirney Point as pt descriptor of pain loc in LLQ

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7
Q

Peritonitis signs

A

Guarding, Rebound Tenderness & rigid abdomen

Fever

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8
Q

Pencil Thin Stool

A

Obstruction in colon: Tumor or Polyps

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9
Q

Painless Jaundice

A

Pancreatic Cancer until otherwise proven

yellow & feels fine, no hepatomegaly/tenderness

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10
Q

Corvosier’s Sign

A

Palpable painless GB on Murphy Test

Cancer of Pancreatic Head, Liver, Liver Mets

GB enlarges slowly in cancer & the tumor is elsewhere so the GB is not directly painful

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11
Q

Trousseau’s Sign of Malignancy

A

Migratory thrombophlebitis

Hyper coagulability associated with :
Pancreatic Cancer &/or Gastric Cancer

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12
Q

Blumer’s Shelf

A

Mass palpable on Digital Rectal Exam

Indicates Tumor Mets in rectovesicle/rectouterine Pouch

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13
Q

Skin signs of Biliary Stasis

A

Jaundice: Skin/Sclera

Itching

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14
Q

St Mary Joseph Sign Describe & Indication

A

Belly Button Malignancy

Pancreatic, Gastric, Colon, Ovarian, Uterine Cancer

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15
Q

Whipple’s Procedure

A

Rx Cancer of pancreatic head, Common Bile Duct, Proximal Duodenum

Remove antrum, Duod, GB, Pancreatic Head. Attach stomach to duod and lead Hepatic Bile Duct and remaining Pancreatic Duct into remaining Duod.

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16
Q

Enzyme to Test for if suspect Pancreatitis/cancer

A

Pancreatic Lipase, order Amylase to but lipase rises w/in 4-8 hrs and stays elevated 8-14 days. May not elevate if cancer is in the tail.

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17
Q

Whipples Triad What for & define

A

For Insulinoma

Low Glucose (under 50)
CNS Hypoglycemia signs
Eating carbs relieves CNS hypoglycemia Signs

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18
Q

Necrolytic Migratory Erythema

A

Sign of Glucagonoma

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19
Q

Islet Cell Tumor secretes VIP

A

Vipoma (pancreatic tumor of non-beta islets)

Xtreme watery diarrhea
Low K+ (from diarrhea)
Low Gastric Acid

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20
Q

1st degree relative had colon cancer @ age 55. When to get 1st colonoscopy & follow ups

A

1st: 45 yrs
Follow ups every 3-5 yrs

It takes 3 yrs to grow a polyp, +/- 1 year thereafter to become malignant.

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21
Q

Tenesmus

A

Feeling that rectum has not been emptied

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22
Q

BM urgency
Tenesmus
Bleeding
Pain

A

Rectal Cancer

MRI best test for rectal cancer

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23
Q

Steatorrhea
Malnutrition
Weight Loss
Duodenal Ulcers

But no infection/pain

A

Pancreatic Insufficiency

Do Secretin Cerulean Test to see if secretin causes a normal release of pancreatic enzymes & bicarb into the duos.

If not, supplement enzymes & give PPI to reduce gastric acid

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24
Q

Colon cancer Mets to:

A

Liver & Lung then elsewhere

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25
Q

Dx test of choice for colon cancer

A

Colonoscopy if cancer found:
CT of Chest/Abd & Pelvis looking for mets
Ultrasound better for liver mets, if suspicious

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26
Q

Toxic Mega Colon is full of

A

GAS - RUPTURE RISK HIGH 911!!!!

Dx w/KUB
NG Tube w/suction ASAP (w/in 24 hrs or surgury!)

If KUB shows air under diaphragm, it has ruptured
Peritonitis & Death Follow

Rx is Decompression
IV Fluids
Prophylactic IV Cipro + Flagyl + Vanco

Caused by severe constipation
  Impaction
  Twist
  Anticholinergics
  Narcotics
  Antidiarrheals
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27
Q

Lipase is elevated in pt w/epigastric pain & cullen sign but pt is not alcoholic, Dx/Rx of choice?

A

ERCP - endoscopy to visualize Ampulla of Vader & Sphincer of Oddi and remove stone if seen

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28
Q

Best Inflammation marker in Pancreatitis

A

C-Reactive Protein CRP

Better than Sed Rate ESR in pancreatitis

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29
Q

Worst case complication of Pancreatitis

A

ARDS - pancreatic enzymes get into blood & go digest the lungs & breaks down surfactant

Dyspnea
Hypoxia refractory to high flow 02
Widespread Bilateral Infiltrates on CXR

ARDS is cause of 50-90% of all Pancreatitis deaths

30
Q

Pancreatitis Tests to order

A 
Lipase/Amylase
CBC w/dif
CRP
Liver Panel (ALK Phos may be high & ALT)
Ca++ usually low in pancreatitis
31
Q

Pancreatitis Severity Rating Scales

A

Ranson Criteria (only for non-stone situation)

Glascow (PANCREAS Acronym)

Apache III

32
Q

3rd Spacing of Fluids

A

Moving from blood vessels into interstitial spaces

In Pancreatitis due to pancreatic enzyme digestion of proteins in blood and hypocalcemia leading to low osmolarity not sure why hypocalcemia causes fluid migration.

33
Q

Pseudocyst

A

Pancreatitis granuloma, can harbor infectious agents for weeks post acute phase.

Do sonogram to follow

If shrinking over time, leave. If not, remove

34
Q

Pancreatic Calcifications on KUB/CT/MRI
Steatorrhea
Diabetes

A

Pancreatitis Triad

35
Q

Pancreatitis Triad

A

Pancreatic calcifications
Steatorrhea
Diabetes

36
Q

Main Causes of CHRONIC Pancreatitis

A

Alcoholism
Super High Triglycerides (over 1000)
Peptic Ulcer
Complication of Gallstone Surgury

37
Q

CHRONIC Pancreatitis signs sxs:

A

Jaundice / Pallor
Alcoholic
w/wo epigastric pain (acute always has pain)

ALK Phos & Bilirubin Elevated

Do Secretin Cerulean Test (SCT)
Order KUB & check for calcifications
ERCP is the most sensitive imaging test for this

Rx: Life long pancreatic enzyme supplementation

Hospitalize w/IV & NG tube, manage DTs
May need Insulin
Resect pseudocysts
High cancer risk due to chronic inflammation

38
Q

Pancreatic Enzyme Replacement Meds

A

Pancreaze
Creon
Ultresa
ZenPep

39
Q

NSAID w/Protection

A

Sedemel

NSAID dipped in PPI

40
Q

Hypogastric/LLQ Pain

Gassy/Bloaty

Worse w/food; Relieved by Defecation

A

Irritable Bowel Syndrome

No known pathology

Increase Fiber/Fluid/Exercise
Reduce Stress: Yoga, Meditation

41
Q

Rule these out before making IBS the Dx

A 
Lactose intolerance- lactase test
Cholecystitis-Murphy & pain pattern
Chronic pancreatitis-lipase test
Intestinal obstruction- KUB
Pancreatic CA
Stomach cancer
Celiac disease
42
Q

Flank Bruising

A

Turner Sign of RetroPeritoneal Bleeding

Acute Pancreatitis - enzymes escaped from retroperitoneal part of inflamed pancreas digest blood migrates through the retroperitoneal space to flanks - Takes 24-48 hrs to develop so if you find Turners with other signs of pancreatitis: hypogastric thru to back pain/Cullens Sign you already have an emergency on your hands- Admit him

Blunt Force Trauma to Retroperitoneum/Kidney

Retroperitoneal Hemorrhage

Ruptured Ectopic Pregnancy

43
Q

Synthetic Disaccharide that can relieve constipation in 8-10 hrs AND can treat Hepatic Encepalopathy due to Hyperamonemia

A

Lactulose

High dose can cause “irresistible Bowel Movement”

Binds Ammonia in the bowel so it doesn’t get to the brain.

44
Q

Pain/Bleeding on BM w/Constipation

A

Anal Fissue

If you can’t see it, use anoscope to look inside, it’s essentially a clear speculum.

Address Constipation via diet
Sitz baths to relieve & bring blood flow
Zinc Oxide Ointment to protect/heal

Rx: Topical Nitroglycerine or Nifedapine to dilate vessels and improve bloodflow for healing.

45
Q

Zollinger-Ellison

A

Pancreatic Non-Beta Gastrinoma
Hyper H+ secretion in stomach ulcerates upper GI

  • First get Gastrin Level
  • If High, Do Secretin challenge. Secretin will suppress gastrin unless there is a Gastrinoma, which will be immune to secretin.
46
Q

Bird Beak Barium Swallow

A

Achalasia

Lower Esophageal Sphincter Paralysis

CXR shows massive dilation of esophagus above sphincter.

47
Q

Megacolon in baby
Baby fails to pass meconium
“Spurt Sign”

A

Hirshsprungs Colon/rectum lacks enteric nerves
Dx: Rectal Biopsy (gold std is suction biopsy)
Rx: Section out numb portion

48
Q

Unclean water & undercooked shellfish

which Hep?

A

Hepatitis A and E

49
Q

Black race, Male, Diet high in fat/red meat, IBD and over 50 are risks for

A

Colon cancer

50
Q

Candida Esophagitis

A

Fluconozole

51
Q

Rx Gastroparesis

A

Reglan (Metachlopramide)

52
Q

Rx Mild IBD: Crohns / UC

A

Mesalamine /Sulfasalazine aminosalycilates

suppress eicosanoids & inflammatory cytokines
Also for arthritis

Not as good as corticosteroids though

53
Q

IBD Rx progression

A

Mesalamine/Sulfasalazine

Corticosteroids for acute attack refractory to Mesalamine. Try to maintain on melamine or go to the Mabs

Mabs: Infliximab Anti-TNF antibodies

54
Q

Cirrhosis Encephalopathy Rx

A

Lactulose

  • Reduces gut bacterial production of NH3
  • Hydrolyzes NH3 to NH4 which doesn’t bother CNS
  • 3X/day aim for 3-5 soft stools /day with stool pH @ +/-6
55
Q

IBS meds

A

SLOW it down!!! Fix Depression Block Serotonin:

anticholinergics (anti sludge) BENTYL
antidiarrheals, tricyclic antidepressants, prokinetics (REGLAN speed it up?)
bulk-forming laxatives, serotonin receptor antagonists,

56
Q

Alternating Diarrhea & Constipation
Abdominal Cramps/Gassy/Tenesmus
Relieved by BM

A

IBS

57
Q

c Dif Rx

A

Flagyl (Metronidazole) and

Oral Vanco

58
Q

Cyst on hairy coccyx

A

Pilonidal Cyst

REFER!!!

59
Q

Normal Squamous Epithelium Transform to Columnar under stress:

A

Barrett’s Esophagus

Stress is GERD/ACID

60
Q

Both disorders present with dysphagia to solids AND liquids at advanced stages

A

Achalasia (lack of enteric nerves)

Esophageal Cancer (obstruction)

61
Q

superficial mucosal tears at gastro-esophageal junction

created by vomiting

A

Mallory weiss tears

62
Q

Monitor H. Pylori eradication

A

Urea Breath Test
Biopsy
Fecal Antigen Test

Serum antibody will be detectable for years, perhaps life and won’t help determine presence of H. Pylori after the first treatment

63
Q

Causes of Erosive Gastritis

A 
H. Pylori
Alcohol
NSAIDS
Stress
Portal Hypertension
64
Q

Portal Hypertensive Gastropathy

A

Portal backup makes varicose veins in the stomach, they rupture and cause bleeding, hematemesis and melena

65
Q

IgA Endomesial Ab
and
IgA tTG Ab

A

Celiac Antibodies to glutin antigens

66
Q

Maldigestion vs Malabsorption

A

Fecal fat test shows maldigestion (lipase deficiency)

Xylose Test - Xylose doesn’t require enzymatic breakdown for absorption, only an intact mucosa. If it isn’t present in urine 6+ hrs later, it wasn’t absorbed meaning the mucosa isn’t intact

67
Q

Dx Lactose intolerance

A

Hydrogen Breath Test

Give Lactase to Rx

68
Q

Acecetaminophen Antidote

A

Mucomyst

ABCs, Charcoal and a 4-Hr Acetaminophen level (it can take 4 hrs for level to peak so don’t take it early, use the charcoal)

If it is before 8 hrs from overdose, you can use mucomyst to completely cure. So, if you know you have time, get the 4Hr NAC level (acetaminophen peak) and treat with mucomyst if levels exceed acceptable. If you don’t know your time frame, just give the mucomyst. If unsure - give the mucomyst

If over the max level,

69
Q

White nail beds

A

Terry’s nails
80% occurrence in liver failure

also in Kidney failure and CHF, decreased blood flow and increased fibrosis of connective tissue

70
Q

Alpha Fetoprotein (AFP)

A

up in Heptatocellular Carcinoma

Follow it for progression of Dz

GEN MED GI (4 decks)

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