GI

Question 1

Alpha cell

Answer 1

Secrete Glucagon

Question 2

Beta cell

Answer 2

Secrete insulin

Question 3

Delta cell

Answer 3

Inhibit alpha and beta cells from releasing glucagon and insulin

Question 4

Pancreas secretes

Answer 4

Bicarbonate for stomach acid
Water
Na and K
Digest enzymes trypsin, amylase, lipase

Question 5

Acute panc s/s

Answer 5

Boring abd pain, all quads and lumbar 
Rigid abd no rebound tenderness
BL crackles, L pleura effus L lobe collapse
Raised diaphragm
Amylase⬆️
Lipase⬆️
Calcium⬇️
Bg ⬆️
Surfactant⬇️from💀alveolar cells

Question 6

Cullen sign

Answer 6

Blue discolor and bruising of umbilicus from methylalbumin formation from acute panc, intraperitoneal bleed

Question 7

Grey Turner sign

Answer 7

Bruised flank, can be retro bleed, from acute panc

Question 8

Acute panc tx

Answer 8

Fluids
Ca++,K+,Mg++
H2 blocker or PPI
NG suct 
TF below duodenum
Monitor for ARDS, diaphragm elevation, atelectasis, and l sd plearual effus

Question 9

Upper GIB tx

Answer 9

Address cause
Fluids
PRBC
Clotting factor replacement
Vasopressin-constrict spleen art bed, ⬇️portal vein HTN
Octeotride -⬇️spleen blood flow GI motil
Lactulose-excrete nitrous content pvn ammonia
Bblocker -⬇️portal vein flow

Question 10

Hepatic failure labs

Answer 10

Protein⬇️
Albumin⬇️
Ascites
Ammonia⬆️
Pancytopenia
Coagulopathy
AST/ALT⬆️
Bilirubin⬆️
BG⬇️
RR⬆️
Creatinine⬆️

Question 11

Hepatic failure s/s

Answer 11

AMS
Asterixis (flapping hand tremor)
Ascites
Jaundice
Renal fail
Sepsis
Liver starts inflamed then shrinks

Question 12

Factors increasing serum ammonia

Answer 12

K⬇️
BUN⬆️
LA⬆️
Protein⬆️

Question 13

Manage Hepatic failure

Answer 13

K sparing diuretic(Aldactone)
Neomycin to kill NH3 gut bacteria
Lactulose for NH3
Prevent ⬆️BUN, GIB, acid buildup 
Tips procedure

Question 14

Spleen

Answer 14

Hx of splenectomy has poor immune fn, kehr sign, abdominal distention no bowel sounds, LUQ

Question 15

Kehr Sign

Answer 15

Sharp L shoulder pain associated with ruptured spleen

Question 16

Intrabdominal hypertension IAH

Answer 16

12-15mmHg

Question 17

Abdominal perfusion pressure APP

Answer 17

MAP-IAP; >60 ideal

Question 18

Abdominal compartment syndrome ACS

Answer 18

Sustained IAP >20, with or without APP of 60

Question 19

IAH tx

Answer 19

If IAP >12 reverse trend, restrict fluid, NGT, rectal tube

IAP>20 decompressive surgery

Question 20

Small intestine is perfumed by

Answer 20

Superior messnteric artery

Question 21

SBO s/s

Answer 21

Sharp episodic pain
Early vomiting 
K⬇️
High pitch BS
dilated loops on KUB
Hypovolemia(3rd spacing)

Question 22

LBO S/s

Answer 22

Dull pain
Bowel habit change
Vomiting (late)
Distention 
Low pitch BS
dilated loops KUB

Question 23

Bowel perf causes

Answer 23

PUD
BO
appendicitis
UC
Wound

Question 24

Bowel perf s/s

Answer 24

NV, temp, ⬆️HR, ⬆️RR
Abd tenderness c coughing hip flex
Rigid abd
Rebound tender
⬇️BS
air in peritoneum in KUB

Question 25

Bowel perf tx

Answer 25

NGT
fluids
ABX
Surgery and possible bowel diversion for healing

Question 26

Gastritis pain

Answer 26

Epigastric, indigestion, NV

Question 27

Peptic ulcer pain

Answer 27

Epigastric or RUQ
burning
Tenderness, Melena or BRB vomit

Question 28

Pancreatitis pain

Answer 28

Epigastric or LUQ
boring
Temp, NV

Question 29

Cholecystitis pain

Answer 29

Epigastric or RUQ
Cramping
NV tenderness

Question 30

Appendicitis pain

Answer 30

Epigastric then RUQ periumbilical
Dull or sharp
NV anorrhexia, fever, leukocytosis rebound tenderness

Question 31

SBO pain

Answer 31

Across abd in waves
Cramping, sharp
Abd distention, K⬇️, BS⬇️

Question 32

Ruptured spleen pain

Answer 32

Kehr sign
Sharp
Abd distention no BS

Question 33

Peritonitis pain

Answer 33

General pain
Dull then sharp
Rigid board like, rebound tenderness, BS⬇️