GI GU

Question 1

cullen

Answer 1

pancreatitic ruptured spleen umbilicus ecchomosis

Question 2

turner

Answer 2

pancreatitic ruptured spleen flank ecchomosis

Question 3

Murphy

Answer 3

Cholecystitis (gallbladder), press on costal margin

Question 4

rovsing

Answer 4

press deeplyin left lower quadrant positive RLQ pain appendicitis

Question 5

psoas

Answer 5

push down on leg while they push up pain in rlq + appendicitis

Question 6

LFT

Answer 6

markers of hepatocyte injury or dysfunction.

Question 7

Elevation of ALP and GGTP

Answer 7

liver dysfunction

Question 8

; Elevated GGT: normal ALP

Answer 8

bone etiology, ETOH within 24 hours of testing will elevate the result and so it has been used as a marker of sobriety

Question 9

lipase and amylase

Answer 9

Amylase and Lipase usually done together because an elevated lipase with normal amylase is not likely in conditions such as pancreatitis

Question 10

FAST exam

Answer 10

Used in the ER typically for a quick assessment of a Blunt abdominal trauma (BAT), stable penetrating trauma or assessment of intraperitoneal free fluid
Advantages: Non-invasive, Safe in all populations and can decrease time to diagnosis of a hemoperitoneum

Question 11

US

Answer 11

NPO x 6 hr
Differentiates between fluid (cystic) and solid lesions, stones, and fluid
Evaluate AAA
Ascites 
Size or inflammation of organs eg: Appendicitis
Gall bladder size/stones/gangrenous
Presence of tumor or metastasis
Contraindication: none

Question 12

KUB

Answer 12

Helps differentiate obstruction vs. ileus
Pneumoperitoneum (possible present w/ perforation)
Renal Calculi (90% of stones are radiopaque)
Contraindication: pregnancy

Question 13

Iv contrast

Answer 13

Approximately 90% of absorbed metformin is excreted by the kidneys within 24 hours. The risk of developing metabolic acidosis with metformin use is rare, but is higher in persons with chronic renal disease or transient impairment of renal function. There is no direct interaction between metformin and IV radiologic contrast agents. However, IV radiologic contrast may cause transient alteration in renal function, which could impair metformin clearance, leading to a higher risk of metabolic acidosis. The U.S. Food and Drug Administration advises that metformin should be withheld at the time of IV contrast administration and for 48 hours afterward, and resumed only after reevaluation of renal status (i.e., return to baseline serum creatinine level).13

Question 14

ct

Answer 14

Prefer NPO 4-6 hr (if possible)
A recent serum creatinine [Cr.]
Evaluates abdominal organs; vasculature if CT angiography
Oral and or IV contrast
No contrast needed for stone protocols
Contraindications:
Pregnancy
Metformin use (90% of absorbed metformin is excreted by the kidneys within 24 hours)
Radioactive iodine treatment for thyroid disease
Chronic or acutely worsening renal disease Avoid IV contrast)

Question 15

MRI

Answer 15

Differentiates benign vs. malignant tumors
Stages cancers
Complementary to CT
Contraindication:
pacemaker
postsurgical metallic bodies (intraocular foreign bodies, IC Aneurysm, cochlear implants, select heart valves)
for contrast: gadolinium contrast allergy, renal dysfunction or pregnancy

Question 16

MRI

Answer 16

Differentiates benign vs. malignant tumors
Stages cancers
Complementary to CT
Contraindication:
pacemaker
postsurgical metallic bodies (intraocular foreign bodies, IC Aneurysm, cochlear implants, select heart valves)
for contrast: gadolinium contrast allergy, renal dysfunction or pregnancy Gadolinium compound Contraindicated in renal dsyfunction due to risk of nephrogenic systemic fibrosis

Question 17

PET

Answer 17

NPO x 2 hr
recent Cr.
Evaluation of malignancy/metastasis, benign vs. malignant
May be combined with CT scan (PET/CT)
Contraindication: pregnancy, allergy to the radiotracer, renal dysfunction

Question 18

Messenteric angiography

Answer 18

NPO 4-6hr
under conscious sedation
recent Cr.
Evaluation and possible embolization of GI hemorrhage not amenable to endoscopic treatment
Contraindication: allergy to iodine, pregnancy, renal dysfunction

Question 19

Upper GI Study

Answer 19

NPO 8 hours
Looks at the upper and middle sectionsof GI tract
Double contrast barium study allows evaluation of mucosal inflammation
Single contrast assesses GI motility, obstruction (find swallowed objects)
Water soluble gastrographin contrast for GI perforation or surgical anastamotic leaks when endoscopy not available
Small bowel follow-through can be ordered to evaluate small bowel disease
Contraindication: pregnancy; use sparingly in those of childbearing potential, children; avoid barium if perforation suspected

Question 20

Barium Swallow study

Answer 20

NPO 4-6 hr
Often includes fluoroscopy
SLP administers
Evaluates for dysphagia, aspiration, GERD, achalasia, varices, strictures/tumors and spasms
Contraindication: 
Pregnancy
Esophageal perforation
Bowel obstruction
known aspiration
Inability to swallow

Question 21

Barium Enema

Answer 21

Colon clean prep
Occasional IV glucagon to inhibit spasm
Double contrast to evaluate colon mucosa;
Single contrast to evaluate fistulas, leaks, obstruction
Can be therapeutic and diagnostic (intussusception)
Contraindication:
toxic megacolon immediately post colon biopsy

Question 22

Gastric emptying study (radionucleotide)

Answer 22

NPO 6 hr
Nuclear medicine test - ingestion of a meal containing small amounts of radioactive material
Evaluates functional transit time of fluid and/or food through the stomach
Identifies upper gastric motility problems, gastroduodenal disease, dumping syndrome, and causes for vomiting Contraindication:
Pregnancy
unable to consume a meal with fluids

Question 23

Hepatic iminodiacetic acid (HIDA) scan

Answer 23

NPO x 4 hours
A radioactive tracer is injected IV and is taken up by bile-producing cells in the liver
The tracer then travels with the bile into the gallbladder and through the bile ducts to the small intestine
A nuclear medicine scanner (gamma camera) tracks the flow
May pre-medicate with Cholecystokinin to prevent false+)
Evaluates suspected cholecystitis or common bile duct obstruction; assesses hepatobiliary function
Contraindications: pregnancy, breast feeding

Question 24

Endoscopic retrograde choangiopancreatography (ERCP)

Answer 24

NPO x 6 hours
Requires sedation
Evaluates biliary obstruction
Can be therapeutic but can cause pancreatitis
Contraindication: 
pregnancy
acute pancreatitis within 6 weeks 
patients with history of Roux-en-Y hepaticojejunostomy

Question 25

EGD

Answer 25

NPO after midnight
Requires sedation
Allows direct visualization of the upper GI tract
Surveillance for GI cancers in high risk conditions
Can be therapeutic
removal of FB – eg: food/coins/toys
Allows diagnostic biopsies
Contraindication:
perforation, medically unstable patient
Relative: anticoagulation, pharyngeal diverticulum, head and neck surgery

Question 26

colonoscopy

Answer 26

Bowel prep 24 hours prior
Requires sedation
Allows direct visualization of the large intestine
Allows diagnostic biopsy
Can be therapeutic (sigmoid volvulus)
Contraindication: 
intestinal perforation
toxic megacolon
fulminant colitis 	
Relative: acute diverticulitis, large AAA, immediately postop, recent MI, PE, hemodynamic instability, coagulopathy

Question 27

Sigmoidoscopy

Answer 27

Bowel prep 24 hours prior
Requires sedation
Allows direct visualization of the large intestine
Does not allow for biopsy
can be therapeutic (sigmoid volvulus)
Contraindication: colonoscopy

Question 28

hepatojugular

Answer 28

apply pressure overliver observe jvp raise4 cm +