GI CIS high yield handout 1 Flashcards
annual screening of tnf-a inhib
ppd, hepatitis panel, derm exam
what is reynold’s pentad
charcots plus mental status changes and hypotension
what is ascending cholangitits
infection of biliary tract secondary to bile duct obstruction or bile stasis
courvoisiers sign
enlarged non tender GB secondary to pancreatic disease or cancer
what is the treatment of ascending cholangitis
urgent ERCP (within 12-24 hrs) -sphincterotomy (cut spchincter of oddi slightly) with stone removal or stent placement
antibitoics
supportive care like IV fluids
pancreas level
T5-11
protective of gallstones
low carb diet physical activity caffeinated coffee (in women) high intake of Mg and polyunsat and monunsat fats (men) high fiber diet and statin therapy ASA and NSAIDs
espohagus level
T2-8
gallbladder level
T6-9
grey turner sign
flank ecchymosis secondary to hemmorrhage
when do you suspect choledocholithiasis on ultrasound
how big
normal in non eldery
elderly can get up to
when common bile duct is over 6mm
normal in non eldery with an intact GB is 3-6mm
eldery or post cholecystemcoty can get up to 10mm
murphys sign tests for
acute cholecystitis or cholelithiasis
what are some possible complications status post ERCP
pancreatitis
ascending cholangitis
hemobilia, perforation, bile leaks (less common these 3)
what labs should be ordered for cholantitis
AST/ALT, alk phos, fractionated bilirubin, amylase/lipase
pre-procdeure INR
follow up on blood culture and bile culture that were ordered and pending
possible side effects of TNF-a inhibtiors
infections: bacgerial infections (pneumonia) zoster, TB, opportunisitc
cutaneous rxn: at injection site or psoriasis, eczema, SLE, lichen planus
malignancy (lymphma and skin cancer)
induction of autoimmunity: autoimmune hepatitis, drug induced SLE, psoriatic skin lesion, intersitial lung disease, MS, sarcoid
parasyp levels upper portion
esophagus through transverse colon
OA,AA (vagus n)
alternative empiric regimen for cholangitis
fluorquin plus metronidazole
cipro or levoflox plus metronidazole
monotherpay with carbapenem
lab screening TNF-a inhib
CNC with differential, CMP every 2 months
septic shock
sepsis induced hypotension despite adequate fluid resuscitaion
risk factors for gallstones
female older american indians>mexican americans>nonhispanic whites>af americans obestiy rapid weight loss DM high intake carbs hypertriglyceridemia M>W when have cirrhosis and hep C chrons disease prolonged fasting pregnancy HRT/OCs
systemic inflammatory response syndrome definition
2 or more or following conditions
temp above 100.4 or below 96.8
HR over 90
RR over 20 or PaCO2 under 32 mmhg
WBC count over 12,000 or under 4000 or >10% immature (band) forms
causes of ascending cholangitis
choledolithiaisis
pancreatic/billy neoplasm
postop stricture
choledocal cysts
appendix level
T12
what is charcot’s triad
jaundice
fever over 102
RUQ pain
obturator muscle test
flex pts right thigh at hip, with knee bent, rotate leg internallyu
right hypogastric pain is a postiive test
means irritation of obturator m from inflammed appendix
rebound tenderness tests for
peritoneal inflammation
TNF-a inhibitors used for
administered how
treatment of inflammatory conditions like RA and IBD
-injectable or infused (rxn at site possible)q
multiple organ dysfunction syndrome
presence of altered organ dysfunction in an acutely ill pt
stomach level
T5-9
liver level
T6-9
severe sepsis
sepsis assocaited with organ dysfunction, hypoperfusion or hypotension
what is mirizzi syndrome
common hepatic duct obsturcion from extrinsic compression from impacted stone in cystic duct
-may be presence of cholecytoenteric fistula bc stone in cystic duct can result in narrowing of common hepatic duct which can lead to fistuala providing exit route for gallstones
ogransisms involed in ascending cholangitis
gram negative (e coli, klebsiella pneum, enterobacter) gram positive (enterococcus) anaerobes (bacteroides fragilis and clostridia)
first choice therapy for cholangitis
empiric treatment for gram neg and anaerobic pathogens
monotherapy:
amp-sulbact
piper-tazobactam
ticarcillin-clavulanate
combo of ceftriazone plus metronidazole
colon level
T10-L2
Fs for factors of gallstones
fair fat fam history female fertile forty
small intestine level
T9-11
diaphragmatic exursion
determine level of dullness on full expiration and level of dullness on full inspiration
normal is 3-5.5 cm
what do you have to consider when giving a biliary pt opioids
NSAIDs are preferred but opiods can be given if NSAIDs are contraindicated or pain is uncontrolled
all opiods increase sphincter of oddi pressure, could worsen underlying problem and pain (especially morphine) but this is insufficient data
opiods slow digestive tract so possible ileus, constipation
rovsings sign
pain in RLQ during left sided pressure
-appendicitis
parasymp lower portion
descendin colon, sigmoid, rectum S2-S4 (pelvic splanchinic n)
cullen sign
ecchyosis around umbilicus secondary to hemorrhage
sepsis defintion
systemic response to infection defined by 2 or more SIRS criteria as result of infection
iliopsoas muscle test
pt flex hip against resistance
increased abdominal pain is positive test
means irritation of psoas muscle from inflammation of appendix
lab changes in ascending cholangitis
hyperbili
leukocytosis
transaminitis
alk phos elevation
