More Fitzgerald Flashcards
Testing for H. pylori
Histology (requires EGD) and Serology
Urea breath test good for early follow-up
rapid urease
H. pylori Testing if patient on PPI
Histology
Serology
H. Pylori testing if previously infected and concerned for reinfection
fecal antigen testing
can have false negative with recent PPI use
Treatment of H. pylori
10 days of PPI, amoxicillin, and clarithromycin
Pretreatment of H. pylori
7-10 days PPI plus levofloxacin plus amoxicillin
Perforated ulcer
duodenal ulcers tend to perforate into pancreas causing acute pancreatitis
emergent surgical consult
begin enteric covering antibiotics
bleeding ulcer
80 percent resolve spontaneously
FFP if coagulopathic
platelets if less than 50K
lavage pending GI or surgical consult
Gerd diagnosis is based on
clinically diagnosed by symptoms
Pyrosis must be present with other symptoms
endoscopy if no response to PPI
If patient fails PPI therapy with GERD
manometry
Can add what if no response to PPI throughout the day
Add PPI before dinner
IF this doesn’t work, refer to GI
Incubation period for Hep A and E
2-6 weeks
Incubation period for Hep B and C
6 weeks to 6 months
Serology for Hep A
Anti-HAV and Immunoglobulin IgG IgM
Serology for Hep C
Anti-HCV and HCV RNA means active disease
Hepatitis D indications
must have hepatitis B plus Hepatitis D IgM
Hepatitis E
no serology
Hepatitis G
Only serology is HGV RNA
IgG and IgM time frame
IgG previously infected longer than 6 months ago
IgM based on incubation period less than 6 months
Immune due to Hep B vaccine
Anti-HBs
Acutely infected Hep B
HBsAg, Anti-HBc, IgM anti-HBc,
Chronically infected
HBsAg, Anti-HBc No IgM
Hepatitis B e antigen HBeAg
serum found during acute and chronic Hepatitis B
means virus is replicating and has high levels of HBV
Hepatitis B e antibody HBeAB or anti-HBe
produced by immune system during acute HBV infection
predictor of long term clearance of HBV undergoing antiviral therapy and indicates lower levels of HBV
Patients with hepatitis are hospitalized due to
complications from chronic infection or progression of chronic infection
Treatment of hepatitis
supportive hydrate 3-4 liters a day lactulose for increased ammonia levels loop diuretics for ascites paracentesis to relieve intraabdominal pressure replace albumin losses chemotherapeutic options for hep B and C
In cholecysitits, leukocytosis for more than 24-48 hours suggests
severe infection and possible gangrene
in appendicitis start antibiotics
when decision to operate is made
can feel constipation in appendicitis
bowel obstructions caused by
mechanical or functional causes
tumore
strictures
ileus due to narcotics
clinical presentation of bowel obstruction
time between pain and vomiting suggests location of obstruction
starts with cramping periumbilical pain
Radiographic findings of obstruction
horizontal pattern in SBO
frame pattern in LBO
Management of obstruction
Fluids
treat medically with partial obstruction
surgical intervention complete obstruction
Perforated ulcer finding
leukocytosis
free air on radiographic findings
quiet, rigid abdomen with rebound tenderness
Autoimmune thrombocytopenia purpura
clotting impaired when platelets fall less than 50K
Steroid therapy to boost platelets
only give platelets when actively bleeding
Aspirin induced coagulopathy
inactivates platelets
HIT
induced by antibodies
treatment is to discontinue heparin and start direct thrombin inhibitors
uremia induced coagulopathy
platelets inactivated in uremic plasma
treatment DDAVP
DIC
preceded by trauma and sepsis release of thromboplastin clotting then bleeding use heparin treatment is evaluated by increased fibrinogen
Anticoagulation effect of warfarin observed when
3-5 days
Sideroblastic anemia
increased TIBC, ferritin, iron
low MCV
Thalessemia
Normal iron
low MCV
BP reduction in stoke only if BP is
above 185/110 if TPA is a candidate
above 220/110 if TPA is not a candidate
goal is to lower BP 15-25% in first 24 hours
National institutes of health stroke scale NIHSS
Determines if symptoms related to stroke
0 to 42
0 means no stroke
above 21 means stroke
Myasthenia Gravis
autoimmune going from top down
Edrophium helps symptoms
prednisone for treatmentt
plasmaphoresis and immune globulin
Guillain barre
bottom up
autonomic manifestations tachy and hypotension
IVIG
recovery often spontaneous
Do not perform LP with
increased ICP findings
papiledema
Autonomic dysreflexia
injury above T6
exaggerated response to stimulus
remove stimulus
Brown sequard syndrome
penetrating trauma ipsalateral motor and proprioception contralateral pain and temp immobilize give steroids
central cord syndrome
cervical spinal cord hyperextension
upper and lower weakness
ICU monitoring for autonomic dysreflexia
Cranial nerves
I olfactory- smell II optic- central and peripheral vision III Oculomotor- pupil response IV Trochlear- moves eye down V Trigeminal- tri forehead, cheek, jaw VI abducens- eye movement to sides VII facial- facial movements smile VIII acoustic- hearing IX glossopharyngeal- tongue movement X Vagus uvula XI spinal accessory- neck shoulders XII hypoglossal swallow, gag
