GI/Renal Cases Flashcards
what renal/GI conditions is a KUB useful in diagnosing (6)
SBO
constipation
calcification
perforated viscous
+/- nephrolithiasis > 5mm
+/- gallstones (in ~20% of people)
mc cause of perforated viscous
gastric ulcer
t/f: all cholangitis patients need US prior to ERCP
t!
no surgeon will touch them without imaging
what type of gallstones are visible on US
all! regardless of composition
what imaging do you need to evaluate the extent of pancreatitis
CT
2 complications of pancreatitis
necrosis
abscess
besides US, what test do cholangitis pt’s need prior to ERCP
EKG
what labs would you order for a pt with suspected gallstone pancreatitis (3)
CMP
Ca
lipids
what is cholecystitis
inflammation of the gallbladder
what is cholelithiasis
gallstones
what is cholangitis
redness and swelling/inflammation of the bile duct system
what is choledocholithiasis
gallstones w.in CBD
difference between cholecystitis and cholangitis
cholangitis presents w. RUQ pain, fever, leukocytosis, or jaundice
cholecystitis presents w. RUQ pain and less e.o infxn
meds for pain control for pancreatitis
IV opioids:
IV morphine
vs
Fentanyl
vs
Dilaudid
gs choice for nausea control in pancreatitis
zofran 4 mg
if EKG shows QT prolongation -> compazine or raglan
fluids for pancreatitis pt
normal saline TKO
are abx needed for pancreatitis
per GI consult
what is Charcot’s triad
fever
jaundice
RUQ pain
what does elevated direct (conjugated) bilirubin indicate
liver pathology
what does elevated indirect (unconjugated) bilirubin indicate
pathology outside of liver -> ex hemolytic anemia
body is not clearing RBC
what is Reynold’s pentad
fever
jaundice
RUQ pain
confusion
shock
which is more sensitive for pancreatitis: amylase or lipase
lipase
how elevated is lipase in pancreatitis
> 3 x nl
what are the 4 f’s of cholelithiasis
fat
forty
female
fertile
mc cause of pancreatitis
gallstone pancreatitis
what LFT abnormalities suggest a cholestatic pattern
elevated alk phos
direct bilirubin
what LFT abnormality suggests alcohol related pathology
elevated AST
what is functional rectal retention
constipation in peds
what imaging is best for eval of constipation
KUB
what lab may be useful in constipation work up
UA
med for pediatric constipation
miralax 0.4-0.8 g/kg/day
max: 17 g/day
what antidiarrheal meds are safe for peds
dicyclomine 10 mg po TID-QID
loperamide 2 mg PO x 1 after each loose stool
your patient has a BUN:Cr ratio > 30 - are you thinking upper GIB or lower GIB
upper GIB
gs test for h.pylori
urea breath
if urea breath test is positive for h.pylori, what is you next step
start PPI
2nd line test for h.pylori if urea breath is not available
serum
PPI can affect which h.pylori test
urea breath
do test before starting PPI
do you need to endoscopy a pt w. PUD who tests positive for h.pylori
not necessarily
can just do PPI trial
what med can cause false positive on FOBT
pesto bismol
tell pt to take tums instead
2 tx for arthritis if pt can not take NSAIDs
PT
votaren gel
5 causes of lower GI bleeds
malignancy
hemorrhoids
polyps
fissures
diverticulitis
causes of upper GI bleeds
gastric ulcer
other stomach pathology
what do you suspect when you see elevated BUN w. nl Cr
GI bleed
which type of ulcer is improved with food
duodenal
which type of ulcer is worse with food
gastric
what med do you give a pt with a confirmed and actively bleeding ulcer
H2 blocker:
famotidine
cimetidine
what med is best for chronic management of ulcers
PPI
presentation of upper GI bleed
hematemesis and/or melena (black/tarry stool)
BUN:Cr > 30
presentation of lower GI bleed
hematochezia (BRBPR)
rf for neonatal jaundice
jaundice w.in 1st 24 hr of life
a sibling w. jaundice as neonate
unrecognized hemolysis
non-optimal sucking/nursing
deficiency of g6pd
infxn
cephalohematoma/bruising (birth trauma)
east asian/north indian
management of breast milk jaundice
-reassurance
-education that jaundice is commonly seen in neonates 2-3 weeks old
-sclera can take a while to go back to normal
-let baby eat!! increases liver activity
-repeat vitals/weight
breast milk jaundice is due to ___ production in some breast milk jaundice
beta-glucoronidase
__% of babies develop breast milk jaundice
60
what labs are helpful in work up of neonatal jaundice
TSB (total serum biluribin)
direct serum bilirubin
CBC
reticulocyte count
DAT (direct antiglobulin) if concern for Rh incompatibility
serum albumin
BMP
G6PD
big do not miss with neonatal jaundice
kernicterus
sx of kernicterus
AMS
floppy baby
poor feeding
first sign of neonatal jaundice
icterus of sclera
sclera icterus occurs around __ mg/dL bilirubin
3
2 deadly genetic conditions related to neonatal jaundice
criggler-najaar
dubin-johnson
what anatomic feature separates upper GI from lower GI
ligament of treitz
