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Nu 639 > GI > Flashcards

GI Flashcards

1
Q

Dx Cirrhosis

A

Liver US, MRI, CT, biopsy or fibroscan

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2
Q

LFT elevations

A

Mild elevations 20ULN seen in acute viral hepatitis, drug reactions, toxins, tumor or ischemic injury

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3
Q

Hepatocellular enzymes

A

ALT and AST

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4
Q

markers of cholestasis

A

about bile, ALP, GGT 5 nucleotidase

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5
Q

liver excretion

A

bilirubin (direct and indirect)

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6
Q

liver synthetic function

A

INR, PT

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7
Q

ALT/AST

A

mild elevations occur in statin, ALT more specific to the liver, AST also seen in heart and muscle tissue more sensitive to liver dz.
Elevations common in ETOH, meds, occupation exposure, obesity, viruses such as mono and hepatitis, if elevated repeat to confirm, and work up if >3x normal

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8
Q

LFTs in ETOH use

A

for more than 4-6 drinks a day, AST:ALT >2:1 ratio

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9
Q

ALP (alk phos)

A

from liver, biliary, bone, can fractionate into isoenzymes.
represents an elevation from cholestasis (stone, stricture, tumor) or dysfunction (drugs dis) If there is liver dz, the GGT will be elevated

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10
Q

GGT

A

specific to liver, also reflects chronic alcohol use

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11
Q

bilirubin

A

total = direct (conjugated) - indirect (unconjugated)

liver dz is related to conjugated bilirubin elevation

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12
Q

jaundice

A

total bili 2 x ULN

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13
Q

albumin and INR

A

not sensitvie, but helps she monitoring for chronic liver dz, must have >90% dysfunction to be affected

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14
Q

nonalcholic fatty liver

A

ALT and AST >30 UL without hx of ETOH abuse, associated with obesity, insulin resistance and metabolic syndrome,
SS can be asymptomatic, fatigue, RUQ discomfort, acanthuses nigricans,
Labs: hepatitis profile, FE, ANA, antimitochondrial ab, ceruloplasmin levels, FBS, lipids
Dx biopsy, ultrasound
can progress to cirrhosis, treat with lifestyle modification

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15
Q

NAFLD vs NASH

A

NAFLD - fat deposits in liver, 10-20% of americans
NASH - nonalcoholic steatohepatitis, fatty despots with inflammation and liver cell damage, affects only 2-5% of americans

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16
Q

Nausea and Vomiting

A

many causes, including meds, food poisoning, pregnancy, acute abdomen, migraines, increased ICP
Hx: onset duration frequency quantity quality, associated sx lil eras, fever, chronic dz, meds, food history, affected contacts, LMP, travel history and exposure to reptiles

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17
Q

Assess N/V

A

wt, ortho signs, rash, lymphaednoptahy, neuro change, labs urine spec grav, BUN/creat, lytes, HCG, LFTs, CBC

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18
Q

Nausea Vomiting Red Flags

A

severe pain, severe dehydration, rigid abdomen, septic appearance, neuro changes, metabolic imbalance, absent BS

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19
Q

Acute abdomen: surgical emergency Red Flags

A 
acute pain
septic and toxic
board-like abdomen
absent BS
WBC>25,000
Free air under diaphragm
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20
Q

Causes of surgical acute abdomen

A 
appendicitis
choleycystitis
obstruction
peritonitis
diverticulitis
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21
Q

Non surgical causes of acute abdominal pain

A 
mesenteric adenitis
acute enteric infection
acute enteric poisonings
inflammatory bowel disease
pancreatitis (usually)
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22
Q

RUQ abdominal pain

A

chest cavity, liver, GB, stomach, bowel, R kidney/ureter, choleycystitis, DU

23
Q

LUQ abdominal pain

A

heart or chest, spleen, stomach, pancreas, L kidney/ureter

24
Q

LLQ abdominal pain

A

bowel, L ureter, pelvis, most commonly diverticulitis

25
Q

RLQ abdominal pain

A

appendix, bowel, R ureter, pelvis, most commonly appendicitis

26
Q

contant aching abdominal pain

A

typically distention of a capsule around an organ

27
Q

intermittent colicky abdominal pain

A

obstruction

28
Q

steady abdominal pain that increases with cough or movement

A

irritation like a peritonitis

29
Q

appendicitis

A

inflammation of appendix from obstruction of orifice and secondary bacterial infection.
S/S perimbuilical colicky pain which localizes to RLQ, anorexia, N/V, localized tenderness, fever, guarding, rebound, rectal tenderness and mass,. + psoas and obturator signs, WBC>10,000-16,000

30
Q

obdurator sign

A

in appendicitis, when you passively rotate the right leg and flex the hip and knee, with pain

31
Q

psoas sign

A

when supine, flex right leg, and there will be pain

32
Q

Small bowel obstruction

A

caused by blockage of lumen or by paralysis of musculature (adhesions, hernia, tumor, abscess, IBD, radiation enteritis, volvulus, utussesception) S/S cramping and pain, vomiting, obstination, distention, fever, relief through vomit or movement through intestine
Exam high pitches BS, stool of mass in rectum, tacky and hypotensive, distended and tender abdomen

33
Q

peritonitis

A

primary - occurs from spread of bacteria through the gut wall, occrs often in cirrhosis with portal hypertension
Secondary - via rupture of organ with contamination into peritoneum
SS fever, diffuse abd pain, N/V, decrease BS, rebound and guarding, tachy and hypotensive late

34
Q

cholethithiasis

A

gallstones; # Fs at risk (female, fat, over 40) common in DM, Crohns and cirrhosis

35
Q

cholecystitis

A

gallbladder inflammation, large gallstones obstruct common bile duct, cause pain, NV from inflamed gallbladder, decreased ability to digest fat
SS gallstones are asymptomatic in many or episodic RUQ pain after fatty foods 1-6 hours

36
Q

Murphy’s sign

A

RUQ pain when pressing and they inhale indicative of cholecystitis

37
Q

Charcot’s Triad

A

common bile duct stone ss - pain, jaundice and chills

38
Q

Mgmt of cholecystitis

A

rehydrate, pain management, ABX, antispasmodic, antiemetic, surgical consult if unresolved 4-6 hours

39
Q

acute pancreatitis

A

Main causes gallstones or ETOH

also drugs, high TGs, trauma, tumor or infections
SS: sudden onset epigastric or periubilical pain, radiating to shoulder worse when supine, N/V, tender LUQ, cullen’s sign, tachycardia, hypotension, lipase, amylase, TGs WBCs, hospitalize if vomiting

40
Q

Cullen’s sign

A

blue hue in periumbilical area, suggestive of severe necrotizing illness

41
Q

diverticulosis

A

asymptomatic out pouching of colonic wall

42
Q

diverticulitis

A

more acute inflammation infection abscess of diverticular caused by stagnation of fecal material or undigested food particles, caused by refined diet with incidence increasing with age, not r/t nuts popcorn, seeds, corn (curse of the western diet)
S/S: intermittent pain, Usually LLQ, irregular BMS, bloating, flatulence, with abscess persistent pain, fever, tender mass i Xray to r/o ileum, CT scan for confirmation

43
Q

treatment of diverticular dz

A

mile: clear liquids, bactrim DS or cipro 500 bid with flagyl 500 TID for 2 weeks,
Acute: with sepsis, peritonitis, fever >101, or DM must be hospitalized

44
Q

acute diarrhea

A

an increase in daily stool weight above 200gm, increase in fluidity, differential from incontinence and IBS or obstruction.
Acute 2weeks

45
Q

4 mechanisms of diarrhea

A

secretory: bowel increases secretion of water into the lumen to dilute toxins
osmotic: passive movement of water into lumen in response to increased conc. of fiber
exudative diarrhea: inflamed mucosa causes mucous, blood, pus to leak into lumen (IBD)
Motility disturbance: small frequent stools (IBS, hyper thyroids)

46
Q

common causes of acute diarrhea

A

gastroenteritis, dietary (nonabsorbable sugar substitutes, food intolerance, excess caffeine), animals (livestock, turtles, reptiles), drugs, visceral causes

47
Q

Infectious diarrhea

A

bacteria - campylobacter, enterotoxigenic eColi, shigella, salmonella, cdiff
viral - rotavirus, norwalk, enterovirus
parasits - guiardia

48
Q

actue gastroenteritis

A

usually self limiting, r/o fever, orthostasis, blood in stool, or work up with severe pain, toxicity, disorientation, dehydration or no improvement in 24 hours

49
Q

inflammatory type acute diarrhea

A

SS fever, blood stool with leucocytes, low volume <1L/24 hrs

Shigella, salmonella, amebiasis, cdiff, ecoli, ischemia, UC, crohns, cmv

50
Q

acute non-inflammatory diarrhea

A

watery with N/V, high volume >1L/24hrs,

Norwalk and rota virus, giardia, staph aureus, cholera, ecoli, bile acid, laxatives, malabsorption

51
Q

diarrhea workup

A

CBC, lytes, glucose, BUN/creatinine, stool culture oval and parasites if immune compromised, fever ,bloody diarrhea, severe pain,

52
Q

cdiff red flags

A

if on recent ABX use, chemo or other risks

53
Q

sigmoidoscopy

A

for pts with bloody diarrhea, useful in IBS, shigellosis, amebic dysentery

54
Q

abdominal radiographs (flat and upright)

A

obtain with abdominal distention, severe pain, obstructive symptoms, or suspected perforation

Nu 639 (3 decks)

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