GI exam

Question 1

Melena

Answer 1

black tarry stools
50-60ml of blood in the stomach
above the Ligament of treitz

Question 2

Hematochezia

Answer 2

blood unchanged by passage thru gut, level of colon or lower

blood in the bowel is cathartic
blood mixed w/ stool suggest colon, blood outside stool suggests anus

Question 3

Unconjugated hyperbilirubinemia

Answer 3

Hemolysis
Red cell defects – sickle cell
Ineffective erythropoiesis
Deficient hepatic uptake
Deficient hepatic conjugation – hepatitis

Question 4

Conjugated Hyperbilirubinemia

Answer 4

Serum alkaline phosphatase is elevated out of proportion to the transaminases.

Intrahepatic cholestasis – hepatocellular disease, drugs, sepsis, primary biliary cirrhosis
Extrahepatic obstruction – gallstones, biliary carcinoma, sclerosing cholangitis, parasites, pancreatic cancer, pancreatitis

Question 5

painless jaundice

Answer 5

is pancreatic cancer until proven otherwise

bad px

Question 6

most common cause of ascites

Answer 6

(ETOH) Cirrhosis> malignancy>CHF

Question 7

tests for liver funciton

Answer 7

Bili
Albumin
PT

Question 8

Very elevated alk phos, slightly elevated AST ALT

Answer 8

extrahepatic cause (obsturction)

Question 9

very elevated AST/ALT, slightly elevated ALK PHOS

Answer 9

look for hepatic

Question 10

turner’s sign

Answer 10

discoloration around flanks d/t hemorrhagic pancreatitis

Question 11

Cullen’s sign

Answer 11

discoloration around the umbilicus d/t hemorrhagic pancreatitis