GI Case 1 Flashcards
Factors that are protective against gallstones
- low carb diet
- physical activity
- Cardiorespiratory fitness
- Coffee (in women)
- High intake of Mg and polyunsaturated fats (in Men)
- high fiber diet and statin therapy
- ASA and NSAIDs
Factors that are risk factors for gallstones
- Female
- increased age
- American Indians > mexican > nonhispanic whites > African Americans
- Obesity
- rapid wgt loss
- DM, glucose intolerance, insulin resistance
- high intake of carbs
- Hypertriglycerdemia
- M >M cirrhosis
- Prolonged fasting
- Pregnancy
- HRT/Oral contraceptives
_ is defined as infection of biliary tract secondary to bile duct obstruction or bile stasis
Ascending cholangitis
what lab changes are associated with ascending cholangitis
- hyperbilirubinemia
- leukocytosis
- transaminitis
- alk phos elevation
what are the causes of ascending cholangitis
- choledolithiasis
- pancreatic/biliary neoplasm
- postoperative strictures
- choledocal cysts
- E.coli infection (most common of infectious cause); Klebsiella, enterobacter; enterococcus; bacteroides, clostridia
What is chargot’s triad?
Signs of ascending cholangitis: Jaundice, fever (>102), and RUQ pain
What is Reynold’s Pentad/
Signs of ascending cholangitis: Chargot’s Triad + mental status changes and hypotention
How is ascneding Cholangitis treated?
- Urgent ERCP (12-24hrs); sphincterotomy and stone removal
- ABX
- Supportive care like IVF
what are the first choice ABX for infectious cause of ascending cholangitis
Monotherapy: Amphicillin/sulbactam; piperacillin-tazobactam; ticarcillin–clavulate
Combo: 3rd gen cephalosproin PLUS metronidazole
what labs should be followed in someone with ascending cholangitis
- AST/ALT, Alk phos, fractionated bili, amylase/lipase
- pre procedure INR
- FU on blood cultures and bile cultures
complications of post ERCP
- pancreatitis
- ascending cholangitis
- less commonly: hemobilia, perforation, bile leaks
What is mirizzi syndrome?
- common hepatic duct obstruction caused by extrinsic compression from an impacted stone in cystic duct
- cholecystoenteric fistula can occur
what AEs are associated with TNF-a inhibitors?
Used for RA and IBD. AE includes: infection (pneumonia, TB, opportunistic etc); injection site rxn; cutaneous reactions (psoriasis, eczema, SLE, Lichen planus),; malignancy; induction of autoimmunity (autoimmune hepatitis, SLE, psoriatic skin lesion, inflammatory eye disease, interstitial lung disease, MS, sarcoidosis, dermatomyositis
What is diaphragmatic excursion
Determine the distance between level of dullness on full expiration and level of dullness on full inspiration by progressive percussion down from resonance (lung parenchyma) to dullness (structures below diaphragm.
normal is 3-5.5 cm
what is branchophony?
when spoken words become louder and clearer. Indicates consolidation, effusion, mass etc
What is egophony?
patient says ee and sounds like A. (normally sounds muffled long E sound). Indicates consolidation, effusion etc)
what is whispered pectoriloquy?
whispers are heard louder and clearer during auscultation
what is grey turner sign
Flank ecchymosis secondary to hemorrhage
What is cullen sign
ecchymosis around the umbilicus (periumbilical) secondary to hemorrhage
what is Rovsing’s sign
Pain in RLQ during left-sided pressure-referred rebound tenderness seen in appendicitis
McBurney’s Point
rebound tenderness or pain 1/3 of the distance from ASIS to umbilicus (appendicitis/peritoneal irriation)
What is murphys sign
palpate deeply under right ostal margin during inspiration, and observe for pain and/or sudden stop in inspiratory effort. Tests for acute cholecystitis or cholelithiasis
what is Courvoisier’s sign
Enlarged non-tender gallbladder secondary to pancreatic disease or cancer
For each of the organ indicate the sympathetic levels involved: A. Esophagus B. Stomach C. Liver D. Gallbladder E. small intestine F. Colon G. Pancreas H. Appendix
A. T2-T8 B. T5-T9 C. T6-T9 D. T6-T9 E. T9-T11 F. T10-T12 G. T5-T11 H. T12
What is Iliopsoas muscle test testing for?
Irritation of psoas muscle from inflammation of the appendix. have pt flex hip against resistance, pain is positive test
What is Obturator muscle test
Flex pts right thigh at hip, with knee bent and rotate leg internally at hip. Right hypogastric pain is positive test = irritation of obturator muscle from inflamed appendix
when do you suspect choledocholithiasis on US
when common bile duct is >6mm. Normal is 3-6. Elderly or post cholecystectomy can be 10 mm.
what do you have to consider when giving a biliary patient opioids?
- NSAIDs are preferred but opioids can be give if NSAIDs are contraindicated.
- Opioids increases sphincter of Oddi pressure –> more pain
- opioids slows diestive tract –> possible ileus, constipation
