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EOR - Emergency Medicine > GI/Nutrition > Flashcards

GI/Nutrition Flashcards

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1
Q

causes of RUQ pain

A

biliary colic
acute cholecystitis
acute cholangitis
sphincter of oddi dysfxn
acute hepatitis
perihepatitis (fitz hugh curtis)
liver abscess
budd-chiari
portal vein thrombosis

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2
Q

acute cholangitis triad

A

fever
jaundice
RUQ pain

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3
Q

intense, dull discomfort in RUQ or epigastrum - n/v, diaphoresis - lasts 30 min, plateaus w.in 1 hr - benign PE

A

biliary colic

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4
Q

> 4-6 hr RUQ or epigastric pain, fever - abdominal guarding and murphy’s sign

A

acute cholecystitis

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5
Q

RUQ pain w. fatigue, malaise, n/v, anorexia - +/- jaundice, dark urine, light colored stools

A

acute hepatitis

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6
Q

RUQ pain with pleuritic component - pain may radiate to right shoulder

A

fitz hugh curtiz syndrome

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7
Q

2 mc sx of liver abscess

A

fever
abdominal pain

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8
Q

fever, abd pain w. distension, lower extremity edema, jaundice, GI bleeding, +/- hepatic encephalopathy

A

budd chiari syndrome

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9
Q

3 symptoms of portal vein thrombosis

A

abd pain
dyspepsia
GI bleed

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10
Q

causes of epigastric abd pain

A

acute MI
acute/chronic pancreatitis
PUD
GERD
gastritis/gastropathy
functional dyspepsia
gastroparesis

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11
Q

acute onset persistent upper abd pain radiating to the back

A

acute pancreatitis

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12
Q

mc sx of PUD

A

epigastric pain

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13
Q

epigastric pain w. heartburn, regurgitation, dysphagia

A

GERD

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14
Q

epigastric pain, heartburn, nausea, vomiting, hematemesis

A

gastritis/gastropathy

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15
Q

what is functional dyspepsia

A

one or more of the following:

postprandial fullness
early satiety
epigastric pain or burning

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16
Q

n/v, vomiting, abd pain, early satiety, bloating

A

gastroparesis

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17
Q

causes of LUQ pain

A

splenomegaly
splenic infarct
splenic abscess
splenic rupture

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18
Q

pain/discomfort in LUQ, left shoulder pain, early satiety

A

splenomegaly

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19
Q

severe LUQ pain

A

splenic infarct

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20
Q

fever, LUQ tenderness

A

splenic abscess

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21
Q

LUQ pain, left chest wall or left shoulder pain - worse w. inspiration

A

splenic rupture

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22
Q

causes of lower abdominal pain

A

appendicitis
diverticulitis
nephrolithiasis
pyelonephritis
acute urinary retention
cystitis
infectious colitis

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23
Q

describe appendicitis pain

A

intially periumbilical -> radiates to RLQ
plus anorexia, n/v

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24
Q

describe diverticulitis pain

A

LLQ, constant for several days, +/- n/v

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25
Q

diverticulitis is mc in what pt pop

A

asian

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26
Q

lower quadrant pain w. dysuria, frequency, urgency, hematuria, f/c, CVA tenderness

A

pyelonephritis

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27
Q

mc sx of infectious colitis

A

diarrhea

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28
Q

what PE exam finding suggests appendicitis has spread to the peritoneum

A

mcburney point rebound tenderness

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29
Q

what 3 signs are associated w. appendicitis

A

rovsing
obturator
psoas

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30
Q

RLQ pain w. palpation of LLQ

A

rovsing sign

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31
Q

RLQ pain w. internal rotation of the hop

A

obturator sign

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32
Q

RLQ pain w. hip extension

A

psoas sign

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33
Q

what lab finding is suggestive of appendicitis

A

neutrophilia

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34
Q

gallstones w.in gallbladder

A

cholelithiasis

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35
Q

inflammation of the CBD, often caused by infxn or choledocholithiasis

A

cholangitis

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36
Q

inflammation of the gallbladder

A

cholecystitis

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37
Q

gallstones that have migrated from the gallbladder into the CBD

A

choledocholithiasis

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38
Q

3 lab findings suggestive of acute cholecystitis

A

elevated WBC
elevated alk phos
elevated bilirubin

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39
Q

when does pain w. cholelithasis mc occur

A

after eating
at night

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40
Q

what sign is associated w. cholelithiasis

A

boas - referred right subscapular pain

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41
Q

what are the 5 f’s of cholecystitis

A

female
fat
forty
fertile
fair

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42
Q

what sign is associated w. acute cholecystitis

A

murphy’s

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43
Q

3 sx of cholecystitis

A

fever
leukocytosis
jaundice

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44
Q

preferred initial imaging for cholecystitis

A

US

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45
Q

3 US findings of cholecystitis

A

gallbladder wall > 3 mm
pericholecystic fluid
gallstones

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46
Q

gs imaging for cholecystitis when US is inconclusive

A

HIDA

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47
Q

3 lab findings of cholecystitis

A

elevated alk phos
elevated GGT
elevated conjugated bilirubin

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48
Q

porcelain gallbladder is a complication of

A

chronic cholecystitis

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49
Q

gs imaging for choledocholithiasis

A

ERCP

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50
Q

tx for cholecystitis

A

cholecystectomy w.in 24-48 hr

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51
Q

32 yo G2P1 female, 32 weeks gestation in ED w. severe abd pain, fatigue, nausea - profound jaundice, ttp of RUQ - just returned from india

A

acute hepatitis

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52
Q

6 causes of acute hepatitis

A

viral hepatitides (A, B, C)
parasites (toxoplasmosis)
etoh/drugs
autoimmune hepatitis
steatohepatitis
metabolic dz

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53
Q

2 history clues for acute hepatitis

A

recent travel
sudden jaundice

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54
Q

prodrome of acute hepatitis

A

flu like symptoms

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55
Q

5 PE findings of acute hepatitis

A

RUQ pain
jaundice
slceral icterus
hepatomegaly
splenomegaly
fever

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56
Q

initial imaging for acute hepatitis

A

US

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57
Q

2 US findings of acute hepatitis

A

hepatomegaly -> most sensitive
gallbladder wall thickening

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58
Q

3 lab findings of acute hepatitis

A

elevated WBC w. atypical lymphocytes
hyperbilirubinemia
very high ALT/AST (ALT higher)

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59
Q

AST:ALT > 2 makes you suspect

A

etoh hepatitis

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60
Q

IgM abs indicate

A

early infxn

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61
Q

IgG abs indicate

A

chronic infxn

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62
Q

(+) IgG, (-) IgM indicates

A

pt is immune via prior ifxn or vaccination

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63
Q

4 serology markers for hepatitis B

A

anti HBc IgM
anti HBc IgG
HBSAg
anti HBs

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64
Q

(+) anti HBc IgM and HBsAg

A

acute HBV

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65
Q

(+) HBsAg

A

early acute HBV infxn

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66
Q

(+) anti HBc IgG and anti HBs

A

resolved acute HBV

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67
Q

(+) anti HBs

A

HBV vaccine/immunity

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68
Q

(+) anti HBc IgG and HBsAg

A

chronic HBV

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69
Q

2 hepatitis C serology markers

A

HCV RNA
anti HCV

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70
Q

(+) HCV RNA and anti-HCV

A

chronic HCV

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71
Q

(+) HCV RNA +/- anti HCV

A

acute HCV

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72
Q

(-) HCV RNA, (+) anti HCV

A

resolved HCV

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73
Q

when is antiviral therapy used for hepatitis

A

severe hep B

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74
Q

antiviral tx for severe hep B

A

nucleoside analogs: entecavir

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75
Q

pharm for severe alcoholic hepatitis

A

pentoxifylline
steroids

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76
Q

what is this showing

A

grey-turner sign

flank ecchymosis -> acute pancreatitis

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77
Q

what is this showing

A

dilation of upper duodenum
fluid in left leural cavity

pancreatitis

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78
Q

where does pancreatitis pain radiate

A

back

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79
Q

causes of pancreatitis

A

GET SMASHED

gallstones
etoh
trauma
steroids
mumps
autoimmune
scorpion sting
hypercalcemia
hyperlipidemia
ercp
drugs

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80
Q

imaging of choice for pancreatitis

A

CT

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81
Q

most sensitive imaging for chronic pancreatitis

A

ERCP

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82
Q

what is this showing

A

periumbilical ecchymosis

acute pancreatitis

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83
Q

ranson’s criteria for poor prognosis w. pancreatitis

A

at admit:
age > 55
leukocytes > 16,000
glucose > 200
LDH > 350
AST > 250

at 48 hr:
arterial PO2 < 60
HCO3 < 20
Ca < 8.0
BUN increase by 1.8+
Hct decrease by > 10%
fluid sequestration > 6 L

this is 100% one of my sacrificial lambs

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84
Q

complication of pancreatitis

A

pancreatic pseudocyst: pancreatic enzymes, blood, necrotic tissue

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85
Q

anal issues to know

A

fissure
fistula
abscess

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86
Q

chronic complication of anorectal abscess

A

anal fistula

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87
Q

t/f: fever is uncommon w. anal abscess

A

t!

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88
Q

sx of anal abscess

A

pain
swelling/erythema
painful defecation
fluctuance

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89
Q

tx for anal abscess

A

surgical drainage
warm water cleanse
analgesics
stool softener
high fiber diet
abx for high risk

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90
Q

open tract btw two epithelium lined areas - associated w. deeper anorectal abscesses

A

anorectal fistula

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91
Q

tx for anorectal fistula

A

surgery bro

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92
Q

tearing rectal pain and bleeding shortly after defecation, BRBPR - pain lasts several hours and subsides until next BM

A

anal fissure

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93
Q

tx for anal fissure

A

sitz bath
high fiber/water
stool softeners/laxatives
botox for persistent

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94
Q

how long do anal fissures take to heal

A

6 weeks

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95
Q

Smarty PANCE really wants us to associate anorexia w.

A

appendicitis

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96
Q

timeline of appendicitis progression

A
  1. periumbilical pain (intermittent/crampy)
  2. n/v
  3. anorexia
  4. pain migrates to RLQ (constant/intense)
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97
Q

besides appendicitis, other GI causes of anorexia

A

gastric/duodenal ulcers
gastric ca
lower GI bleed
gallbladder carcinoma
pancreatic carcinoma
meds
thyroid dz

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98
Q

epigastric pain, worse with food, vomiting, anorexia, nausea

A

gastric ulcers

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99
Q

epigastric pain, burning/aching several hr after meals, back pain, nausea, vomiting, anorexia

relieved by food

A

duodenal ulcers

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100
Q

sx of gastric cancer

A

weapon:

wt loss
emesis
anorexia
pain/epigastric discomfort
obstruction
nausea

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101
Q

hematochezia +/- pain, melena, anorexia, fatigue, syncope, SOB, shock

A

lower GIB

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102
Q

biliary colic, wt loss, anorexia, +/- cholecystitis

A

gallbladder carcinoma

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103
Q

painless jaundice, obstruction of CBD, wt loss, abd pain, back pain, weakness, pruritis, anorexia, acholic stools, dark urine, DM

A

pancreatic carcinoma

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104
Q

what sign is associated w. pancreatic carcinoma

A

courvoisier’s sign: enlarged, palpable gallbladder w. jaundice

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105
Q

what meds are associated w. anorexia

A

sedatives
digoxin
laxatives
thiazides
narcotics
abx

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106
Q

pathologic causes of constipation/obstipation

A

colorectal ca
bowel obstruction
volvulus
ileus
gastroparesis

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107
Q

what is obstipation

A

severe/complete constipation

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108
Q

consier _ in all pt’s > 50 yo w. constipation

A

colorectal ca

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109
Q

XR findings of bowel obstruction

A

air fluid levels
dilated loops of bowel

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110
Q

obstruction due to twisting/knotting of GIT - belly pain/bloating, nausea, hematochezia, constipation

A

volvulus

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111
Q

XR finding of volvulus

A

colonic distension

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112
Q

hypomobility of the GIT in absence of mechanical obstruction, absent bowel sounds

A

ileus

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113
Q

vomiting, abd pain, fullness after eating small amounts, associated w. DM

A

gastroparesis

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114
Q

causes of diarrhea

A

infectious
toxic
diet
GI dz

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115
Q

bloody diarrhea indicates (2)

A

invasive organism
IBD

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116
Q

infxn of biliary tract 2/2 obstruction - leads to biliary stasis and bacterial overgrowth

A

cholangitis

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117
Q

_ accounts for 60% of cholangitis

A

choledocholithiasis

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118
Q

besides choledocholithiasis, other causes of cholangitis

A

pancreatic/biliary neoplasm
post op strictures
ERCP/PTC
choledochal cysts

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119
Q

4 organisms associated w. cholangitis

A

e. coli
enterococcus
klebsiella
enterobacter

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120
Q

what is charcot’s triad

A

RUQ tenderness
jaundice
fever

cholangitis

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121
Q

what is reynold’s pentad

A

charcot’s triad
PLUS
AMS
hypotension

septic/ascending cholangitis

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122
Q

initial and gs imaging for cholangitis

A

initial: US
gs: ERCP

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123
Q

tx for cholangitis

A

stone removal (ercp)
cipro + metro
fluids
analgesia
cholecystectomy (post acute)

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124
Q

2 sx of primary sclerosing cholangitis

A

jaundice
pruritis

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125
Q

primary sclerosing cholangitis is associated w. what 4 diseases

A

IBD
cholangiocarcinoma
pancreatic ca
colorectal ca

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126
Q

what is primary sclerosing cholangitis

A

inflammation of bile ducts -> scarring -> narrowing -> liver dysfxn

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127
Q

2 mc cause of cirrhosis

A
  1. etoh
  2. hep C/B
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128
Q

what is the LFT ratio for cirrhosis

A

AST > ALT

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129
Q

complication of cirrhosis that occurs in 10-25% of pt’s

A

hepatocellular carcinoma

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130
Q

lab to monitor for HCC in cirrhotic pt’s

A

AFP

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131
Q

hepatic vein thrombosis is same same

A

budd chiari syndrome

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132
Q

budd chiari syndrome triad

A

abd pain
ascites
hepatomegaly

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133
Q

7 complications of cirrhosis

A

potal HTN
ascites
peripheral edema
esophageal varices
hepatorenal syndrome
hepatic encephalopathy
HCC

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134
Q

portal htn leads to (4)

A

ascites
peripheral edema
splenomegaly
varicosity of veins

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135
Q

2 causes of ascites

A

portal htn
hypoalbuminemia

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136
Q

mc complication of cirrhosis

A

ascites

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137
Q

work up for ascites

A

US
diagnostic paracentesis
serum albumin gradient

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138
Q

tx for ascites

A

Na restriction
furosemide/spironolactone
paracentesis

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139
Q

3 indications for paracentesis w. ascites

A

tense ascites
SOB
early satiety

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140
Q

5 sx of esophageal varices

A

dilated submucosal veins
retching
dyspepsia
hypotension
tachycardia

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141
Q

3 sx of hepatorenal syndrome

A

azotemia
oliguria
hypotension

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142
Q

pathology behind hepatorenal syndrome

A

renal hypoperfusion

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143
Q

pathology behind hepatic encephalopathy

A

ammonia accumulates -> travels to brain -> decreased mental fxn

144
Q

PE findings of hepatic encephalopathy

A

asterixis
dysarthria
delirium
coma

145
Q

what is asterixis

A

flapping tremor

have pt flex hands

146
Q

lab finding indicative of severe cirrhosis

A

prolonged PT/PTT -> tx is fresh frozen plasma

147
Q

skin/nail changes associated w. cirrhosis

A

terry’s nails
spider angiomata
palmar erythema
jaundice
slceral icterus
caput medusa
hyperpigmentation

148
Q

what is this

A

spider angioma -> cirrhosis

149
Q

what does this make you think

A

palmar erythema -> cirrhosis

150
Q

what is this

A

caput medusa -> cirrhosis

151
Q

what is this

A

terry’s nails -> cirrhosis

152
Q

HCC screening recs

A

US q 6-12 months for pt’s w. cirrhosis

153
Q

dx for HCC

A

CT guided bx

154
Q

constipation is defined as

A

< 3 BM/week

155
Q

rome III criteria for functional constipation

A

any 2 of the following x 3 months w. symptom onset 6 months prior to dx :

straining
lumpy hard stools
incomplete evacuation
digital maneuvers
sensation of obstruction/blockage
decrease in stool frequency (<3/week)

156
Q

secondary causes of constipation

A

opioids
DM
hypothyroidism
dehydration
MS

157
Q

work up for constipation should include

A

DRE

imaging not really recommended in geriatrics

158
Q

tx for constipation

A

first line: bulk forming laxatives
osmotic laxatives
stimulant laxatives
stool softeners/suppositories

159
Q

what are the bulk forming laxatives

A

psyllium seed (metamucil)
methylcellulos (citrucel)
Ca polycarbophil (FiberCon)
wheat dextrin (benefiber)

160
Q

name a osmotic laxatives

A

polyethylene glycol (PEG)

161
Q

what are the stimulant laxatives

A

bisacodyl
senna
sodium picosulfate

162
Q

when should you do work up for constipation

A

after 2 weeks of refractory

163
Q

infectious diarrhea assocaited w. daycare centers

A

rotavirus
cryptosporidium
giardia
shigella

164
Q

if you see daycare center, think

A

rotavirus

165
Q

infectious diarrhea assocaited w. composed salads (ex egg salad)

A

s. aureus

166
Q

infectious diarrhea assocaited w. seafood/shellfish

A

vibrio cholerae
vibrio parahaemollyticus

167
Q

infectious diarrhea associated w. raw ground beef or sprouts

A

e.coli 0157

168
Q

infectious diarrhea associated w. poultry/pork

A

salmonella

169
Q

infectious diarrhea associated w. undercooked beef/pork/poultry

A

s. aureus
clostridium perfringens
salmonella
listeria
e.coli 0157 (shiga producing)
b.cereus
yersinia
campylobacter

170
Q

which pathogen is associated w. travelers diarrhea

A

enterotoxigenic e.coli (ETEC)

171
Q

infectious diarrhea from poorly canned home foods

A

c perfingens

172
Q

infectious diarrhea from fried rice

A

bacillus cereus

173
Q

infectious diarrhea from raw milk

A

salmonella
campylobacter
e.coli 0157
listeria

174
Q

infectious diarrhea associated w. camping

A

giardia

175
Q

incubation period and sx of girardia

A

incubation: 1-3 weeks

sx: foul smelling, bulky stool, may wax/wane for weeks

176
Q

infectious diarrhea associated w. receptive anal intercourse

A

HSV
chlamydia
gonorrhea
syphilis

177
Q

infectious diarrhea in HIV/immuncompromised pt’s

A

cryptosporidium
microsporidia
isospora
CMV
mycobacterium
listeria

178
Q

rice water scools

A

v. cholerae

179
Q

bloody stools

A

salmonella
shigella
campylobacter
e.coli 0157
c.diff
entamoeba
yersinia

180
Q

afebrile abd pain w. bloody stools

A

e.coli 0157

181
Q

67 yo M, chronic constipation presents w. steadly LLQ pain, low grade fever, abd distension - stool guiac negative - CBC shows absolute neutrophilic leukocytosis w. left shift

A

diverticulitis

182
Q

63 yo M w. painless BRBPR x 2 hr and LLQ pain

A

diverticulosis

183
Q

inflammation of an abnormal pouch (diverticulum) in the intestinal wall - mc large intestines

A

diverticular dz

184
Q

the presence of diverticulum is called

A

diverticulosis

185
Q

inflammation of diverticulum is called

A

diverticulitis

186
Q

mc location for diverticular dz

A

sigmoid colon

187
Q

sx of diverticulitis

A

f/c
n/v
LLQ pain

188
Q

dx for diverticulitis

A

-CT w. oral/rectal/IV contrast
-colonoscopy 1-3 months after episode

189
Q

CT findings of diverticulitis (2)

A

fat stranding
bowel wall thickening

190
Q

tx for diverticulitis

A

pain control
liquid diet x 2-3 days followed by high fiber diet
+/- abx
+/- US guided drainage/surgical resection

191
Q

indications for colon resection w. diverticular dz

A

recurrent attacks
perforation
fistula
abscess

192
Q

54 yo F w. odynophagia, dysphagia, retrosternal CP

A

esophagitis

193
Q

2 types of esophagitis

A

non infectious
infectious

194
Q

5 types of non infectious esophagitis

A

reflux
medication-induced
eosinophilic
radiation
corrosive

195
Q

2 meds associated w. esophagitis

A

NSAIDs
bisposphanates

196
Q

asthma sx and GERD not responsive to antacids

A

eosinophilic esophagitis

197
Q

dx for eosinophilic esophagitis

A

bx

198
Q

barium swallow findings of eosinophilic esophagitis

A

ribbed esophagus
multiple corrugated rings

199
Q

4 radiosensitizing drugs associated w. esophagitis

A

doxorubicin
bleomycin
cyclophosphamide
cisplatin

200
Q

t/f: dysphagia can lasts months after xrt therapy

A

t!

201
Q

corrosive esophagitis is associated w.

A

medication attempted suicide

202
Q

hallmark sign of infectious esophagitis

A

pain while swallowing food/liquids

203
Q

pt pop mc affected by infectious esophagitis

A

immune compromised

204
Q

pathogens associated w. infectious esophagitis

A

candida albicans
HSV
CMV

205
Q

linear yellow-white plaques w. odynophagia or pain w. swallowing

A

candidal esophagitis

206
Q

tx for candidal esophagitis

A

daily PO fluconazole

207
Q

shallow punched out lesions on EGD

A

HSV esophagitis

208
Q

tx for HSV esophagitis

A

acyclovir

209
Q

large solitary ulcers or erosions on EGD

A

CMV esophagitis

210
Q

tx for CMV esophagitis

A

ganciclovir

211
Q

other pathogens associated w. infectious esophagitis

A

EBV
myobacterium tuberculosis
myobacterium avium

212
Q

dx for infectious esophagitis

A

endoscopy/bx
double contrast esophagram
culture

213
Q

tx for corrosive esophagitis

A

steroids

214
Q

tx for eosinophilic esophagitis

A

remove triggers
ICS

215
Q

3 causes of gastritis

A

h.pylori -> mc
inflammation of stomach lining
autoimmune or hypersensitivity

216
Q

location of h.pylori gastritis

A

antrum
body

217
Q

dx for h pylori

A

urea breath
fecal antigen

218
Q

2 causes of inflammation related gastritis

A

NSAIDs
etoh

219
Q

how do NSAIDs cause gastritis

A

they diminish local PG production in stomach and duodenum

220
Q

you sould associate autoimmune/hypersensitivity gastritis w.

A

pernicious anemia

221
Q

location of pernicious anemia related gastritis

A

body of fundus

222
Q

triad of pernicious anemia

A

positive schilling test
decreased intrinsic factor
parietal cell abs

223
Q

tx/dx for gastritis

A
  1. stop NSAIDs
  2. PPI x 4-8 weeks
  3. if no response -> upper GI endo w. bx and US
  4. test for h.pylori
224
Q

triple and quadruple therapy for h. pylori

A

triple: clarithromycin, amoxicillin, omeprazole +/- metro

quadruple:: tetracycline, omeprazole, metro, bismuth

225
Q

upper GI bleeding originates where

A

proximal to the ligament of treitz

226
Q

vomiting of blood or coffee ground emesis

A

hematemesis

227
Q

black tarry stool

A

melena

228
Q

ddx for hypotn, tachycardia, abd tenderness

A

peptic ulcer
esophageal ulcer
mallory weiss tear
esophageal varices
malignancy
severe erosive esophagitis

229
Q

emesis, retching, coughing prior to hematemesis

A

mallory weiss tear

230
Q

odynophagia, dysphagia, retrosternal CP

A

severe erosive esophagitis

231
Q

tx for upper GIB

A

NPO, IV, O2
isotonic crystalloids
IV PPI
+/- transfusion
+/- surgery

232
Q

indications for transfusion: high risk vs low risk pt

A

high risk (elderly, CAD): Hgb < 9
low risk: Hgb < 7

233
Q

passage of BRPBP

A

hematochezia

234
Q

ddx for hematochezia

A

hemorrhoids
anal fissure
proctitis
polyps
colorectal ca
diverticulosis

235
Q

painless bleeding w. blood on toilet paper

A

hemorrhoids

236
Q

severe rectal pain w. defecation

A

anal fissure

237
Q

rectal bleeding PLUS abd pain

A

proctitis

238
Q

large volume of BRBPR

A

diverticulosis

239
Q

what are the parasitic GI infxns
(besides my least favorite topic)

A

giardia
pinworm
tapeworm
hookworm
roundworm
amebiasis
schistosomiasis

240
Q

diarrhea 1-3 weeks after a camping trip
waxing/waning foul smelling bulky stool

A

giardia

241
Q

tx for giardia

A

1st line: tinidazole
alt: metro

242
Q

perianal pruritis that is worst at night

A

pinworm (enterobios vermicularis)

243
Q

dx for pinworm

A

sctoch tape test early in the AM
eggs under microscopy

244
Q

tx for pinworm

A

mebendazole

245
Q

-transmission from raw or undercooked meat
-B12 deficiency
-GI sx PLUS wt loss

A

tapeworm

246
Q

dx for tapeworm

A

tape test for diphyllobothrium latum
stool sample for eggs

247
Q

tx for tapeworm

A

praziquantel

248
Q

-cough, wt loss, anemia, eosinophilia, recent travel
-larvae invade the skin -> travel to lung -> cough/swallow -> reside in intestines

A

hookworm

249
Q

dx for hookworm

A

stool sample -> adult worms

250
Q

tx for hookworm

A

mebendazole or pyrantel

251
Q

mc intestinal helminth worldwide
contaminated soil

A

roundworm

252
Q

small roundworm load can be asymptomatic, what are the sx of a large roundworm load

A

pancreatic duct/CBD/bowel obstruction

253
Q

dx for roundworm

A

stool sample -> eggs vs adult worms

254
Q

tx for roundworm

A

albendazole
mebendazole
pyrantel pamoate

255
Q

-fecal/oral, contaminated water/food
-bloody diarrhea, tenesmus, abd pain, liver abscess

A

amebiasis (entamoeba histolytica)

256
Q

dx for amebiasis

A

stool sample -> trophozoites

257
Q

tx for amebiasis

A

iodoquinol or paromycin
if liver abscess: add metro

258
Q

-parasitic flatworms
-aka snail fever or bilharzia
-contaminated freshwater -> penetrate skin -> migrate to liver/intestines -> rash, abd pain, bloody diarrhea, hematuria

A

schistosomiasis

259
Q

dx for schistosomiasis

A

eggs in urine or feces

260
Q

tx for schistosomiasis

A

praziquantel

261
Q

when is heartburn worst

A

night
lying down

262
Q

causes of heartburn

A

GERD
food intolerance
esophagitis
gastritis
hiatal hernia
PUD

263
Q

heartburn frequency that indicates GERD

A

more than twice weekly

264
Q

emergency sx of esophagitis

A

food stuck in esophagus
prolonged chest pain

265
Q

part of. thestomach pushes up thru the diaphragm

A

hiatal hernia

266
Q

-post prandial burning abd pain, n/v, bloating
-hx PPI/H2 blocker
-not associated w. wt loss
-hx h.pylori and/or chronic NSAIDs

A

PUD

267
Q

who should undergo work up for heartburn

A

-longstanding or atypical sx: wheezing/cough/hoarseness
-refractory to max dose PPI/H2 blocker

268
Q

standard work up prior to surgical antireflux procedure (4)

A

endoscopy w. bx
manometry
24 hr ambulatory pH testing
barium esophagography

269
Q

gs dx for GERD/heartburn stuff

A

endoscopy w. bx

270
Q

tx for zollinger ellison

A

PPI
tumor resection

271
Q

ddx for hematemesis

A

PUD
esophageal varices
etoh
mallory-weiss
coagulation d.o
esophageal ca
malignany

272
Q

tear in the lining of the stomach just above esophagus caused by violent retching or vomiting

A

mallory weiss syndrome

273
Q

progressive dysphagia to solids, weight loss, reflux, hematemesis

A

esophageal ca

274
Q

varicose veins of anus/rectum

A

hemorrhoids

275
Q

rf for hemorrhoids

A

constipation/straining
pregnancy
portal HTN
obesity
prolonged sitting/standing/anal intercourse

276
Q

indications for anoscopy w. hemorrhoids

A

BRBPR
suspected thrombosis

277
Q

classifications of hemorrhoids

A

external
internal

278
Q

sx of thrombosed hemorrhoid

A

significant pain
pruritis
no bleeding
purplish palpable perianal mass

279
Q

what type of hemorrhoid requires excision

A

thrombosed external

280
Q

tx for non thrombosed hemorrhoids

A

fiber
sitz bath
ice packs
bed rest
stool softeners
topical steroids
+/- rubber band ligation or hemorrhoidectomy

281
Q

indications for rubber band ligation for hemorrhoids

A

protrudes w. defecation
enlargement
intermittent bleeding

282
Q

indication for hemorrhoidectomy

A

permanently prolapsed

283
Q

types of hernias

A

hiatal
ventral/incisional
umbilical
inguinal

you missed her didn’t you

284
Q

which type of hernia is generally congenital and appears at birth

A

umbilical

285
Q

when should you refer to surgery for umblical hernia

A

persists beyond 2 yo

286
Q

2 types of inguinal hernias

A

indirect -> mc
direct

287
Q

passage of intestine thru internal inguinal ring down the inguinal canal +/- to the scrotum

A

indirect hernia

288
Q

passage of intestine thru external inguinal ring at hesselbach triangle - rarely enters scrotum

A

direct hernia

289
Q

complications of hernias

A

strangulation
obstruction
incarceration

290
Q

irreducible hernia that does not interfere w. blood supply to bowel

A

obstructed hernia/incarcerated

291
Q

hernia so occluded that it can not be reduced and blood supply to bowel is impaired

A

strangulated

292
Q

what are the 2 IBD’s

A

UC
Crohn’s

293
Q

characteristics of UC (7)

A

continuous lesions
mucosal surface only
hematochezia
pus filled diarrhea
fever
tenesmus
anorexia/wt loss

294
Q

barium enema findings of UC

A

loss of haustral markings -> lead pipe appearance

295
Q

tx for UC

A

prednisone and masalamine
colectomy

296
Q

chracteristics of crohn’s (8)

A

mouth to anus
transmural
skip lesions
transmural thickening
aphtous ulcers
wt loss
nonbloody diarrhea

297
Q

what is this showing

A

cobblestoning -> crohn’s

298
Q

what is this showing

A

lead pipe appearnce -> UC

299
Q

tx for crohn’s: flares vs maintenance

A

flares: prednisone +/- mesalamine, metro, cipro
maintenance: mesalamine

300
Q

t/f: surgery is curative for UC, but not for crohn’s

A

t!

301
Q

continuous lesions, mucosal surface, lead pipe

A

UC

302
Q

transmural, skip lesions, cobblestoning, fistulas and ulcers

A

crohn’s

303
Q

24 yo M w. UC receives lomotil for excessive diarrhea -> develops fever, abd pain, tenderness

A

toxic megacolon

304
Q

what is this showing

A

massively dilated colon -> toxic megacolon

305
Q

toxic megacolon is mc w. which dz

A

UC

306
Q

tx for toxic megacolon

A

decmpression of colon
+/- complete colonic resection

307
Q

71 yo M, hx afib - sudden onset severe abd pain q 10 min after eating - normal PE except for minimal pain w, palpation - stool guaiac positive - leukocytosis w. elevated lactate, amylase, LDH

A

ischemic bowel dz

308
Q

artery mc affected by ischemic bowel dz

A

superior mesenteric

309
Q

hallmark of ischemic bowel dz

A

pain out of proportion to findings

310
Q

pain w. ischemic bowel dz begins _ and is relieved by _

A

10-30 min after eating
relieved by lying down or squatting

311
Q

gs imaging for ischemic bowel dz

A

mestenteric angiography

312
Q

CT/XR findings of ischemic bowel dz

A

bowel edema
pneumotasosis intestinalis
portal venous gas

313
Q

what is pneumatosis intestinalis

A

gas w.in the bowel

314
Q

tx for ischemic bowel dz, including gold standard

A

bowel rest
fluids
abx
+/- resection
gs: revascularization

315
Q

first sign of jaundice

A

scleral icterus

316
Q

bilirubin > _ is a sign of jaundice related dz

A

2.5

317
Q

causes of jaundice (lots!)

A

bilirubin overproduction
hemolysis
ineffective erythropoiesis
decreased hepatic bilirubin uptake
impaired conjugation
biliary tract obstruction
viral hepatitis
physiologic jaundice. ofnewborn
gilbert syndrom
dubin johnson

318
Q

hemolytic jaundice is _ hepatic
obstructive jaundice is _ hepatic
hepatocellular jaundice is _ hepatic

A

hemolytic: pre hepatic
obstructive: post hepatic
hepatocellular: intra hepatic

319
Q

-increased indirect/unconjugated bilirubin
-mild hyperbilirubinemia
-dark urine dt hemoglobinuria, dark stool

A

hemolytic/prehepatic jaundice

320
Q

-increased direct/conjugated bilirubin
-dark urine, acholic stools

A

osbructive/post hepatic jaundice

321
Q

causes of obstructive/post hepatic jaundice

A

cholestasis
biliary obstruction

322
Q

lab findings associated w. obstructive/post hepatic jaundice

A

GGT/ALP elevated

323
Q

what are acholic stools

A

white stools -> biliary obstruction

324
Q

-increased indiret AND direct bilirubin
-dark urine

A

hepatocellular/intrahepatic jaundice

325
Q

lab findings of hepatocellular/intrahepatic jaundice

A

ALT/AST markedly elevated

326
Q

causes of hepatocellular jaundice

A

etoh hepatitis
acute hepatitis
chronic hepatitis

327
Q

AST > ALT 2:1

A

etoh hepatitis

328
Q

increased ALT and AST > 1,000
ALT > AST

A

acute hepatitis

329
Q

increased ALT:AST but < 500

A

chronic hepatitis

330
Q

what makes you suspect gilbert’s or dubin-johnson or hemolysis

A

bilirubin > 2.5 w.o increased LFTs

331
Q

21 yo M brought in by gf after drinking every night last week - reports having vomited each night - tonight after vomiting he noticed blood

A

mallory-weiss tear

332
Q

tear that occurs in the esophageal mucosa at the junction of the esophagus and stomach - caused by severe retching/vomiting and results in severe bleeding

A

mallory weiss tear

333
Q

hx clue for mallory weiss (besides vomiting)

A

etoh

334
Q

upper endo finding of mallory weiss

A

superficial longitudinal mucosal erosions

335
Q

tx for mallory weiss

A

supportive
+/- cauterize or epi

336
Q

BRBPR/hematochezia means what type of bleed

A

lower GI:

hemorrhoids
anal fissures
polyps
proctitis
diverticulitis

337
Q

ddx for n/v

A

gastroenteritis
migraines
food poisoning
influenza
pyloric stenosis
PUD
hiatal hernia
common cold

338
Q

infant w. projectile vomiting

A

pyloric stenosis

339
Q

hiatal hernia sx mimic

A

GERD

340
Q

name the anti emetics

A

scolpamine patch
dexamethasone
ondansetron
prochlorperazine
droperidol
GI cocktail

341
Q

what are the rescue antiemetics

A

prochlorperazine
droperidol

342
Q

what’s in a GI cocktail

A

maalox
visous lidocaine
droperidol

343
Q

4 cardinal signs of strangulated bowel

A

fever
tachycardia
leukocytosis
abd tenderness

344
Q

2 types of bowel obstruction

A

small
large

345
Q

colickly abd pain, nausea, bilious vomiting, obstipation, abd distension

A

SBO

346
Q

bowel sounds associated w. early vs late SBO

A

early: hyperactive
late: hypoactive

347
Q

mcc of SBO

A

adhesions
hernias
ca
IBD
volvulus
intussusception

348
Q

what is this showing

A

-dilated loops of bowel
-air fluid levels
little or no gas in colon

bowel obstruction

349
Q

vomiting partially digested food, severe abd distension

A

bowel obstruction

350
Q

gradually increasing abd pain w. longer intervals btw episodes of pain, abd distension, obstipation, less vomiting

A

large bowel obstruction

351
Q

which type of bowel obstruction is more common in elderly

A

large

352
Q

mcc of large bowel obstruction

A

cancer
stritures
hernias
volvulus
fecal impaction

353
Q

tx for bowel obstruction

A

bowel rest
NGT
+/- surgery

354
Q

defect in gastric or duodenal wall that extends thru the musularis mucosa into the deeper layers of the wall

A

PUD

355
Q

gs dx for PUD

A

endo w. bx

356
Q

tx for NSAID associated ulcers

A

PPI for a minimum of 8 weeks

357
Q

tx for ulcers that are not due to h.pylori or NSAIDs

A

PPI x 4-8 weeks

EOR - Emergency Medicine (13 decks)

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