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1
Q

s/s of acute pancreatitis

A

fever, N/V, epigastric abd pain that radiates to the back

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2
Q

clinical signs of pancreatitis

A

Cullen’s sign (bluish discoloration around umbilicus) and Grey-Turner sign (blue around flank)

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3
Q

s/s of diverticulitis

A

fever, N/V, anorexia, LLQ abd pain, positive Rovsing sign, boardlike abd

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4
Q

s/s of appendicitis

A

periumbilical pain –> RLQ pain –> anorexia, vomiting, fever

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5
Q

s/s of cholecystitis

A

severe RUQ or epigastric pain that occur within 1 hour after eating a fatty meal; may radiate to right shoulder; N/V, anorexia

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6
Q

risk factors for colon cx

A

age greater than 40, hx of multiple polyps, IBD, consumption of red meat, obesity, smoking, alcohol

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7
Q

A gastrinoma located in the pancreas or stomach that secretes gastrin and high levels of acid causing ulcers

A

Zollinger-Ellison Syndrome

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8
Q

s/s of Zollinger-Ellison Syndrome

A

epigastric abd pain, tarry stools

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9
Q

labs for Zollinger-Ellison Syndrome

A

serum fasting gastrin level

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10
Q

s/s of Crohn’s disease

A

intermittent RLQ pain that occurs 1 hour after eating; diarrhea with mucus, fever, malaise

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11
Q

s/s of Cdiff

A

watery diarrhea 10-15 times a day with lower abd pain and cramping; fever

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12
Q

causes of Cdiff

A

abtx, PPI

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13
Q

route of food from mouth

A

esophagus –> stomach –> duodenum –> jejunum –> ileum –> colon –> cecum –> rectum –> anus

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14
Q

organs in LUQ

A

stomach, pancreas, descending colon, left kidney

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15
Q

organs in RUQ

A

liver, gallbladder, ascending colon, right kidney

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16
Q

organs in LLQ

A

sigmoid colon

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17
Q

organs in RLQ

A

appendix, ileum, cecum

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18
Q

psoas sign

A

patient is supine, bend knee 90 degrees and ask patient to push against hand to straighten leg

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19
Q

obturator sign

A

patient lies supine, rotate right hip, positive if pain

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20
Q

rovsing’s sign

A

deep palpation on LLQ causes pain in RLQ

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21
Q

Markle (Heel Jar) test

A

ask patient to jump in place

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22
Q

Murphy’s sign

A

pressing into the RUQ during inspiration causes the patient to gasp for air

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23
Q

associated with acidic or sour odor to breath

A

GERD

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24
Q

gold standard for diagnosing GERD

A

esophageal motility study

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25
trial of PPI for GERD
omeprazole x 4-6 weeks
26
untreated GERD can lead to
Barrett's esophagus (precancerous)
27
Barrett's esophagus is diagnosed by
upper endoscopy with biopsy
28
avoid these foods in GERD
mints, alcohol, caffeine
29
s/s of IBS
cramping, bloating, gas, relief after pooping
30
cause of duodenal and gastric ulcers
H. pylori, chronic NSAIDs, biphosphonates
31
s/s of duodenal ulcer
burning epigastric pain relieved by foods; pain occurs mostly at night
32
s/s of gastric ulcer
N/V, pain worse with eating, weight loss
33
quad therapy trx for H. pylori ulcers
Bismuth tab 600 mg QID + metronidazole 250 mg QID + tetracycline 500 mg QID x 2 weeks + PPI daily x 4-6 weeks
34
trx for diverticulitis
cipro 500 mg bid + metronidazole 500 mg tid x 10-14 days
35
diagnostics for acute pancreatitis
amylase, lipase, trypsin; AST/ALT; CBC; abd US
36
trx for nonsevere C.diff
metronidazole tid x 10-14 days; avoid antimotility agents
37
IgG Anti-HAV positive means
the patient is immune to hep A
38
IgM Anti-HAV positive means
acute infection with Hep A; patient is contagious
39
Anti-HCV
screening test for Hep C
40
If a patient is positive Anti-HCV, next step is
order HCV RIBA; if positive then patient has Hep C
41
If a patient is positive Anti-HCV and has negative RIBA, then
it is a false positive.
42
Hepatitis D requires the presence of
Hep B
43
this liver enzyme is present in liver, heart, skeletal, kidney, and lung
AST
44
this liver enzyme is liver specific
ALT
45
AST/ALT ratio may be indicative of alcohol abuse
greater than 2.0
46
sensitive indicator of alcohol abuse
serum GGT
47
an enzyme derived from bone, liver, gallbladder, kidney, GI tract, and placenta
alkaline phosphatase
48
High levels of this during growth spurts in children and teens
alkaline phosphatase
49
transmission of Hep A
fecal/oral route
50
transmission of Hep B
sexual, blood
51
transmission of Hep C
IV drug use, blood, sex
52
Anti-HAV means
the patient has antibodies to Hep A; the patient had a previous hep A infection or received vaccination
53
HbsAg positive means
the patient has a current Hep A infeciton
54
this type of hepatitis has highest risk of cirrhosis and liver cancer
Hep C
55
olive shaped mass in RUQ
pyloric stenosis
56
most children with fecal incontinence have
underlying constipation
57
a chronic inflammatory condition characterized by relapsing and remitting episodes of inflammation limited to the mucosal layer of the colon
Ulcerative colitis
58
characterized by transmural inflammation and by skip lesions.
Crohn's disease
59
IBD that mostly involves the rectum
ulcerative colitis
60
IBD that may involve the whole colon
Crohn's disease
61
s/s of pyloric stenosis
projectile vomiting
62
imaging for pyloric stenosis
US
63
trx for pyloric stenosis
pyloromyotomy
64
what medication may worsen symptoms of GERD?
amlodipine
65
Risk of long term PPI use
decreases absorption of vitamins and iron (anemia, B12 deficiency)
66
diarrhea alarm symptoms
rectal bleeding, weight loss, nocturnal abd pain, anemia
67
recommended screening for colorectal cancer
colonoscopy every 10 years, flex sigmoidoscopy every 5 years, barium enema every 5 years, FOBT annually
68
When ALT is greater than AST, think
viral hepatitis
69
When AST is greater than ALT, think
acetaminophen, statins, tequila
70
anti-HAV IgG
immunity to Hep A
71
anti-HAV IgM
current Hep A infection
72
HBsAg is
antigen = infection
73
Anti-HBs is
antibody = immunity
74
Rule for Hep B surface markers
can either have surface antigen or antibody, not both.
75
+Anti-HBs, + Anti-HBc IgG means
patient is immune through previous infection
76
+Anti-HBs, - Anti-HBc IgG means
patient immune through vaccine
77
imaging study of choice for cholecystitis
US of RUQ
78
s/s of bowel obstruction
dilated loop of bowel, tinkling bowel sounds, abd pain
79
Elevated bilirubin but normal LFTs
Gilbert's disease
80
painful bleeding with BMs
anal fissure

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