GI GU Flashcards
cullen
pancreatitic ruptured spleen umbilicus ecchomosis
turner
pancreatitic ruptured spleen flank ecchomosis
Murphy
Cholecystitis (gallbladder), press on costal margin
rovsing
press deeplyin left lower quadrant positive RLQ pain appendicitis
psoas
push down on leg while they push up pain in rlq + appendicitis
LFT
markers of hepatocyte injury or dysfunction.
Elevation of ALP and GGTP
liver dysfunction
; Elevated GGT: normal ALP
bone etiology, ETOH within 24 hours of testing will elevate the result and so it has been used as a marker of sobriety
lipase and amylase
Amylase and Lipase usually done together because an elevated lipase with normal amylase is not likely in conditions such as pancreatitis
FAST exam
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
US
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
KUB
Helps differentiate obstruction vs. ileus
Pneumoperitoneum (possible present w/ perforation)
Renal Calculi (90% of stones are radiopaque)
Contraindication: pregnancy
Iv contrast
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
ct
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)
MRI
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
MRI
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
PET
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
Messenteric angiography
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
Upper GI Study
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
Barium Swallow study
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
Barium Enema
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
Gastric emptying study (radionucleotide)
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
Hepatic iminodiacetic acid (HIDA) scan
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
Endoscopic retrograde choangiopancreatography (ERCP)
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
EGD
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
colonoscopy
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
Sigmoidoscopy
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
hepatojugular
apply pressure overliver observe jvp raise4 cm +
