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PCM III Final DF > GI CIS high yield handout 1 > Flashcards

GI CIS high yield handout 1 Flashcards

1
Q

annual screening of tnf-a inhib

A

ppd, hepatitis panel, derm exam

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2
Q

what is reynold’s pentad

A

charcots plus mental status changes and hypotension

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3
Q

what is ascending cholangitits

A

infection of biliary tract secondary to bile duct obstruction or bile stasis

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4
Q

courvoisiers sign

A

enlarged non tender GB secondary to pancreatic disease or cancer

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5
Q

what is the treatment of ascending cholangitis

A 
urgent ERCP (within 12-24 hrs)
-sphincterotomy (cut spchincter of oddi slightly) with stone removal or stent placement

antibitoics
supportive care like IV fluids

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6
Q

pancreas level

A

T5-11

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7
Q

protective of gallstones

A 
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
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8
Q

espohagus level

A

T2-8

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9
Q

gallbladder level

A

T6-9

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10
Q

grey turner sign

A

flank ecchymosis secondary to hemmorrhage

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11
Q

when do you suspect choledocholithiasis on ultrasound
how big
normal in non eldery
elderly can get up to

A

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

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12
Q

murphys sign tests for

A

acute cholecystitis or cholelithiasis

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13
Q

what are some possible complications status post ERCP

A

pancreatitis
ascending cholangitis
hemobilia, perforation, bile leaks (less common these 3)

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14
Q

what labs should be ordered for cholantitis

A

AST/ALT, alk phos, fractionated bilirubin, amylase/lipase

pre-procdeure INR
follow up on blood culture and bile culture that were ordered and pending

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15
Q

possible side effects of TNF-a inhibtiors

A

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

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16
Q

parasyp levels upper portion

A

esophagus through transverse colon

OA,AA (vagus n)

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17
Q

alternative empiric regimen for cholangitis

A

fluorquin plus metronidazole
cipro or levoflox plus metronidazole

monotherpay with carbapenem

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18
Q

lab screening TNF-a inhib

A

CNC with differential, CMP every 2 months

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19
Q

septic shock

A

sepsis induced hypotension despite adequate fluid resuscitaion

20
Q

risk factors for gallstones

A 
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
21
Q

systemic inflammatory response syndrome definition

A

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

22
Q

causes of ascending cholangitis

A

choledolithiaisis
pancreatic/billy neoplasm
postop stricture
choledocal cysts

23
Q

appendix level

A

T12

24
Q

what is charcot’s triad

A

jaundice
fever over 102
RUQ pain

25
Q

obturator muscle test

A

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

26
Q

rebound tenderness tests for

A

peritoneal inflammation

27
Q

TNF-a inhibitors used for

administered how

A

treatment of inflammatory conditions like RA and IBD

-injectable or infused (rxn at site possible)q

28
Q

multiple organ dysfunction syndrome

A

presence of altered organ dysfunction in an acutely ill pt

29
Q

stomach level

A

T5-9

30
Q

liver level

A

T6-9

31
Q

severe sepsis

A

sepsis assocaited with organ dysfunction, hypoperfusion or hypotension

32
Q

what is mirizzi syndrome

A

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

33
Q

ogransisms involed in ascending cholangitis

A 
gram negative (e coli, klebsiella pneum, enterobacter)
gram positive (enterococcus)
anaerobes (bacteroides fragilis and clostridia)
34
Q

first choice therapy for cholangitis

A

empiric treatment for gram neg and anaerobic pathogens

monotherapy:

amp-sulbact
piper-tazobactam
ticarcillin-clavulanate
combo of ceftriazone plus metronidazole

35
Q

colon level

A

T10-L2

36
Q

Fs for factors of gallstones

A 
fair
fat
fam history
female
fertile
forty
37
Q

small intestine level

A

T9-11

38
Q

diaphragmatic exursion

A

determine level of dullness on full expiration and level of dullness on full inspiration

normal is 3-5.5 cm

39
Q

what do you have to consider when giving a biliary pt opioids

A

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

40
Q

rovsings sign

A

pain in RLQ during left sided pressure

-appendicitis

41
Q

parasymp lower portion

A

descendin colon, sigmoid, rectum S2-S4 (pelvic splanchinic n)

42
Q

cullen sign

A

ecchyosis around umbilicus secondary to hemorrhage

43
Q

sepsis defintion

A

systemic response to infection defined by 2 or more SIRS criteria as result of infection

44
Q

iliopsoas muscle test

A

pt flex hip against resistance
increased abdominal pain is positive test
means irritation of psoas muscle from inflammation of appendix

45
Q

lab changes in ascending cholangitis

A

hyperbili
leukocytosis
transaminitis
alk phos elevation

PCM III Final DF (6 decks)

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