GI/LIVER Flashcards
Protracted PPI use adverse effects
micronutrient malabsorption (vitamin B12, calcium, mag, iron), increase fracture, pneumonia, C-Diff, and rebound hyperacidity possible after 8 weeks.
Common GERD Triggers
chocolate, caffeine, alcohol, acidic foods
Common symptoms of GERD
heartburn, regurgitation, voice hoarseness, a recurrent cough, chronic pharyngitis.
Alarm symptoms of GERD
anemia, involuntary weight loss, anorexia, recent onset of progressive symptoms, Selena or hematemesis, swallowing difficulty (dysphagia or odynophagia)
Most likely cause of duodenal ulcer
H. Pylori
WBC (leukocytosis >10,000) interpretration
Neutrophillia - bacterial
Lymphocytosis - virus
Monocytosis - Debris (elevation after severe illness)
Eosinophillia - allergens, parasites, worms and weird diseases
Basophillia - Anaphylaxis, rare
typical symptoms of acute appendicitis
leukocytosis with neutrophillia and bandemia (immature neutrophils)
Positive Obturator and Psoas sign
12 hour history epigastric discomfort, anorexia that gradually shifts to nausea and right lower quadrant pain
rebound tenderness
Obturator sign
with knee and ankle at 90 degrees internally rotate the hip by moving ankle away from body. Keeping knee in place. The appendix lays on obturator muscles. A positive sign if it illicit pain.
+Appendicitis
Psoas sign
with patient lying on left side and legs straight out. Extend leg backward with hips square. A positive sign if it illicit pain.
+Appendicitis
Blumberg sign
Rebond tenderness
+Peritonitis
+Appendicitis
Duodenal ulcer presentation
intermittent upper abdominal pain. epigastric burning, gnawing pain about 2-3 hours post meal. Pain relieved by food and antacids. Pain awakens pt at night at 1-2 am.
Objective: tenderness at epigastrium, LUQ, slightly hyperactive bowel sounds.
Test for H.Pylori via stool or urea breath test
Murphy’s sign
deep RUQ palpation of gallbladder during deep inspiration, positive if illicits pain
+cholecystitis
Hepatitis serology markers
HBsAg - A = Always growing (persistent in acute or chronic hep b disease)
HBsAb - b = bye, past infection or hx of Immunization of hep b
HAV IgM - M = miserable, acute hep A disease
Anti-HAV IgG - G = Gone, hep A previously or hx of immunization
Anti-HCV = marker for Hep C
HCV- RNA = if positive evidence of current hep C infection
modest elevation of AST/ALT with hepatitis, ALT>AST
Chron’s
mouth to anus - diffuse areas of inflm
GI symptoms and presence of : rectal bleeding diarrhea, weight loss, fever, elevated CRP and ESR (inflm markers), leukocytosis especially during flares.
tx: lifestyle mod, anti-inflam meds, biologics, surgical intervention, continuous monitoring of for GI CA.
Ulcerative colitis
colon only
GI symptoms and presence of : rectal bleeding diarrhea, weight loss, fever, elevated CRP and ESR (inflm markers), leukocytosis especially during flares.
tx: lifestyle mod, anti-inflam meds, biologics, surgical intervention, continuous monitoring of for GI CA.
