GI Flashcards
acute pancreatitis
rapid onset abdomina pain radiates TO BACK.
+ cullen’s sign (blue at umbilicus)
+ grey turner (blue at flanks)
ED
acute diverticulitis
Left lower quadrant pain
Rovsing’s sign.
If palpation of the left lower quadrant of a person’s abdomen increases the pain felt in the right lower quadrant, the patient is said to have a positive Rovsing’s sign
acute appendicitis
umbilical pain. \+ psoas sign \+obturator sign \+mcburnye's point markle test
Psoas sign—pain on extension of right thigh
Obturator sign—pain on internal rotation of right thigh
Rovsing’s sign—pain in right lower quadrant with palpation of left lower quadrant
Dunphy’s sign—increased pain with coughing
Flank tenderness in right lower quadrant (retroperitoneal retrocecal appendix)
Patient maintains hip flexion with knees drawn up for comfort
mc burneys point
McBurney’s point is the name given to the point over the right side of the abdomen that is one-third of the distance from the anterior superior iliac spine to the umbilicus (navel). This point roughly corresponds to the most common location of the base of the appendix where it is attached to the cecum.
seen in appendicitis
cholecysitis
epigastric pain after eating fatty meal
pain radiates to RIGHT shoulder
overweight female
requires hospitalization dt risk of gangrene of the gall bladder
colon cancer
> 50 yo, blood in stool
zollinger ellison syndrome
increased gastrin level =ulcers
chron’s disease
higher risk for colon cancer
right lower quadrant pain, diarrhea with mucus,
cdif
watery diarrhea 10-15 stools/day, fever.
appears 5-10 days after antibiotics
clindaymcin, fluroquinolones, cephalopsorin/pcn
murphys sign
positive in cholestitis
press deeply on the RIGHT quadrant under costal boarder during inspiration
GERD
may result in barrets esophagus (pre cancer)
gold standard- esophageal motility study (upper endoscopy)
tx:
1) lifestyle (avoid large/fatty meals)
2) OTC antiacids/h2 blockers
3) prescribe
h2 blockers: ranitidiine or PPI omeprazole/prlosec
lifestyle changes for gerd
no mints, avoid caffeine, etc
cullens/gray turner
pancreatitis
mid epigastric pain radiate to back
pancreatitis
rovsings sign
Pain on RIGHT (rovsings= right) when palpate to the left
acute diverticulitis
IBS
chronic disorder of the colon. stress makes it worse
class case of ibs
young adult female cramping pain on left lower quadrant, bloating, relief after defecation.
increase fiber (metamucil/psyllium) antispasmodics (bentyl) prn
PUD disease, duodenal/gastric ulcers
duodenal more common
gastric >risk for cancer
H. pylori
chronic nsaids, chronic bisphosphanates (fosamax, actonel)
PAIN relieved by food or antacids
upper endoscopy
r/o zollinger ellison
tx: ppi and h2 blockers
TRIPLE therapy for H. pylori
1) clairithroymycin (biaxin)
2) amoxicillin
3) PPI - 6-8 wks
(CAP)
quadruple therapy h. pylori
busmuth subsalicylate (pepto)
metronidazole (flagyl)
tetracycline
PPI: (pineapple-zole)
ie
omeprozole (prilosec)
exomeprazole (nexium)
h pylori negative ulcer tx
4-6 wks treatments
H2:
ranitidine (zantac)
cimetidine (tagamet)
PPI: (pineapple-zole)
omeprozole (prilosec)
exomeprazole (nexium)
diverticulitis
postive rosvings sign ( pain on right, when press on left )
LLQ pain
pain
rebound tenderness
herniation on colon, lack of FIBER
if elder and fever= ED can bleed
diverticulosis
physical exam normal, no mass, no tenderness
tx plan for diverticulosis
cipro/metronidazole ( flagyl)
acute pancreatitis
alcohol, gallastones (+murphys),
triglycerites >800mg= high risk .
tx for cdif
metronidazole ( flagyl)
AVOID anti motility agents (loperamide/immodium) or opiates.
HbsAG (hep b surface antigen)
screening test for hep B
+= has the virus AND INFECTIOUS
how: acute infection or chronic hep B
igG anti-HAV (hepatitis A antibody) positive
IMMUNE, non infectious
G=good
how: hx of hep A infection or vaccination (havrix)
igM anti-HAV (hep A antibody) positive
infected and CONTAGIOUS!
M= miserable
anti-HB (Hep B surface antibody) +
immunie
past infection or vaccination
chronic hepatitis 2 types
1) chronic with mildly >LFT
chronic and active (ELEVATE LFT)= active viral replication
high risk for liver failture/cirrhosis
anti -HCV
screen test for Hep C
**up to 85% become carriers , may indicated current infection !!
MAY STILL BE INFECTIOUS ( unlike hep a/hep b antibody)
order HCV RNA or PCR (polymerase chain reaction ) r/o chronic infection
if Positive, refer
hep D (delta virus)
requires HEPATITIS B
B plus D increases risk for livery damage
LIVER fuction tests
AST. ALT
ast normal values
0-45mg/dl
aka: serum glutamic oxaloacetic transaminase (SGOT)
not specific to liver (also heart, muscle, lungs, etc)
ALT
aka SGPT
0-40mg/dl
Liver specific
AST/ALT ratio
sgot/sgpt ratio
a ratio of 2.0 or higher=alcohol abuse
GGT elevated when
alcohol abuse
liver disease
pancreatitis
HEP A
transmission: oral route; fecal, food/drink
self limiting, traveler
vaccine Havrix
no chronic or carrier state
HEP B
blood, sex (semen, vaginal secretion, saliva), vertical transmission
Hep C
IV drugs, blood, sex
IV (50%), drug use
HIGHEST risk for chronic infection and cirrhosis, liver cancer
tx: alpha interferon injections, ribavirin, biospy
acute hepatitis (liver) causes
viral infection
statins
alcohol
class case of hepatitis
new sex partner, dark colored urine, fatigue/nausea skin/sclera yellow (jaundice) tender liver ALT/AST: elevated 10x bilirubin and GGT elevated
tx: supportive avoid statins (prevastatin/pravachol)
HbEag
“e”
active viral replication, infectious.
positive= chronic HEP B
