Poop Flashcards
1
Q
What is the most common complaint seen in the ED?
A
Stomach and abdominal pain, cramps, or spasms
2
Q
What is the biggest thing that drives the evaluation of an abdominal complaint?
A
LOCATION
3
Q
Pain responders in the abdomen respond to what two types of stimuli?
A
Mechanical stimuli (stretch, distention, contraction, traction, compression, torsion)
Chemical stimuli (due to inflammation or ischemia)
4
Q
There are 3 types of pain (according to Hoffman)
Visceral, Parietal, and Referred. How would visceral pain be described?
A
Dull, aching, can be colicky, poorly localized; arises from distention of hollow organ (eg, bowel obstruction)
Gallbladder hurting
Probably have to palpate deep
5
Q
Sharp, very well localized. People can point exactly where it hurts. This is what kind of pain?
A
Parietal
think appendictis
6
Q
Aching, perceived to be near surface of body–this is what kind of pain?
A
Referred
think cholecystitis and right scapula
7
Q
Left lower quadrant pain in a young sexually active female. What do we have to rule out!?
A
Ectopic pregancy
8
Q
Epigastric pain – what do we HAVE to rule out?
A
Myocardial infarction
9
Q
Periumbilical pain– what do we HAVE to rule out?
A
Ruptured aortic aneurysm
10
Q
Diffuse abdominal pain – what do we HAVE to rule out?
A
Mesenteric ischemia
11
Q
What needs to be on our differential if a patient complains of pain radiating to groin?
A
Renal colic
12
Q
What should we think of when we hear, “steady, rapid increase in pain”
A
Pancreatitis
13
Q
What should we think of when we hear, “pain several days prior to presentation”
A
Diverticulitis
14
Q
For clin assess sake, what should we think of when we see “pain with empty stomach”
A
PUD
15
Q
Pain worse with movement?
A
Peritonitis
16
Q
Pain resolved with sitting up or leaning forward?
A
Pancreatitis
17
Q
Hyperactive, “high-pitched” bowel sounds–think of?
A
Small bowel obstruction
18
Q
Decreased bowel sounds – think of?
A
Lots of things…
Peritonitis, ileus, mesenteric infarction, narcotic use
19
Q
Name the special tests for Appendicitis
A
- McBurney’s point
- Rovsing’s sign
- Psoas sign
- Obturator sign
20
Q
Name the special tests for Gallbladder disease
A
Murphy’s sign
21
Q
Name the special tests for ascites?
A
Shifting dullness and fluid wave
22
Q
I say, Pain out of proportion,
you say?
A
Mesenteric Ischemia
23
Q
Child who is writhing to get into a comfortable position, you should think of?
A
Intussusception or renal colic
24
Q
When might we get a plain radiograph?
A
Screening for obstruction (dilated loops of bowel), sigmoid volvulus, perforation (free air), or severe constipation
25
AST to ALT ratio > 2:1, think of?
Alcoholic liver disease! cirrhosis!
26
AST and ALT > 4 times normal?
Nonalcoholic liver disease
27
AST and ALT > 25 times normal?
Hepatitis/Toxin-related disease
28
AST and ALT > 50 times normal?
Ischemic hepatopathy -- liver is failing
29
What is our imaging of choice for diverticulitis?
CT scan, not colonoscopy. Although DiverticuLOSIS is often found during routine colonoscopies.
30
Difficult initiating the swallowing reflex. Usually occurs as a result of neuromuscular disorders causing weakness or lack of coordination of the muscles involved in swallowing?
Oropharyngeal dysphagia
31
Sharp substernal pain on swallowing
Odynophagia
32
When the LES, upper part of stomach moves up into the chest through a small opening in the diaphragm
Hiatal hernia
33
What is the most common disorder of the esophagus?
GERD
34
M/C symptom of GERD?
Heartburn-- 30 to 60 minutes after a meal
35
If a person is >50, has melena, has difficulty swallowing, and is an alcoholic, what should we do?
Go straight to an EGD
36
Metaplastic changes in which stratified squamous epithelium is replaced by intestinal columnar epithelium cells
Barrett's esophagus
37
How do we manage someone with Barrett's esophagus?
Repeat endoscopy every 2 years
38
How long should we try H2's before we try PPI's?
Try H2's for 6 weeks before considering PPI
39
Nutcracker esophagus should make you think of?
Esophageal spasm
40
How do we treat esophageal spasm?
Nitrates, calcium channel blockers
41
Achalasia will have ______ relaxation of LES
Nutcracker esophagus will have _______ of LES
no relaxation
hypercontractility
42
Most common cause of esophagitis?
GERD
43
Multiple bouts of vomiting and retching followed by hematemesis (painless)?
Mallory-Weiss
44
A ring of tissue located at the junction of the esophagus and stomach
Schatzki's ring
45
Where do esophageal webs occur in the esophagus?
Mid to upper esophagus
46
Plummer-Vinson Syndrome should make you think of?
1. Webs
2. Iron deficiency anemia
3. Glossitis
47
How do we diagnose Plummer-Vinson Syndrome?
Barium esophagram
48
Dilated submucosal veins that develop in patients with portal hypertension
Esophageal varices
49
Most common cause of portal hypertension?
Cirrhosis
50
Most common site of esophageal varices?
Distal esophagus
51
What causes Achalasia?
Damage to nerves of the esophagus. infection (Chagas disease), hereditary functions
52
Most common symptom of Achalasia?
Dysphagia
53
How do we treat Achalasia?
Nitrates/calcium channel blockers, Botox, Pneumatic dilation
54
What should we think of ordering when we have elderly patients with recurrent pneumonia?
Modified barium swallow
55
Incidence of SCC is increasing or decreasing in the US?
Decreasing
56
History of smoking, alcohol consumption, and diets low in fruits and vegetables are more commonly associated with adeno or squamous cell esophageal cancer?
Squamous cell carcinoma
57
Is alcohol an important risk factor for adenocarcinoma of the esophagus?
Most likely not
58
True or False:
Obesity has been associated with AC but not SCC
True
59
Is smoking a risk for for both squamous and adenocarcinoma of the esophagus?
Yes.
60
Gastrin comes from what kind of cells?
G cells
61
Secretin comes from what kind of cells?
S cells
62
Secretin inhibits what?
Gastric secretion
63
What does Cholecystokinin do?
Stimulates contraction the gallbladder and secretion of pancreatic enzymes; slows gastric emptying, inhibits food intake
64
Parietal cells secrete?
Secrete HCl/gastric acid and intrinsic factor
65
Chief cells secrete?
Secrete pepsinogen -- which breaks down proteins
66
Fancy term for dyspepsia?
Indigestion
67
Number one cause of PUD?
H. pylori
68
Duodenal ulcers are ____ times more likely than gastric
Five times
69
Most gastric ulcers occur in this part of the stomach
Antrum
70
If we don't eradicate H. pylori how high are the chances that the ulcer will come back?
85%
71
How is the pain with PUD often described?
Burning, gnawing, aching, "hunger-like"
72
Best diagnostic tool for PUD?
EGD
73
When should we test for H. pylori eradication?
Four weeks after abx have been discontinued, 2 weeks after H2 or PPI's have stopped
74
If we do an EGD and find a gastric ulcer, what MUST we do?
Biopsy.
75
Selective COX-2 agents decrease our risk of ulcers/gastritis but they are associated with what?
Increased risk of CV events
76
What is bile made up of?
Bile salts (from cholesterol), bilirubin (waste product from old worn-out RBCs), and alkaline fluids
77
Most gallstones are made up of?
Cholesterol
78
Risk factors for Cholelithiasis? 5 F's
Female, fat, forty, fair, and fertile
79
How do we treat cholelithiasis?
"it hurts" take it out
"it doesn't hurt" leave it in
80
Signs and symptoms of acute cholecystitis?
Symptoms: RUQ and epigastric pain, R scapula/shoulder radiation, nausea/vomiting, fever/chills
Signs: Tenderness, Murphy's sign positive, Jaundice (perhaps)
81
How do we diagnose cholecystitis?
Ultrasound--good test
HIDA scan is gold standard
82
How do we treat cholecystitis?
Take it out
83
How do we diagnose and treat Choledocolithiasis?
ERCP
84
What is Charcot's triad?
Abdominal pain, jaundice, fever
85
What is Charcot's triad associated with?
Acute cholangitis
86
Acinar cells make up what percentage of the pancreas?
95%
87
Islets of Langehans make up what percentage of the pancreas?
1-2%
88
Acute pancreatitis are caused by these two things
1. Gallstones 45%
| 2. Alcohol 35%
89
Symptoms of acute pancreatitis
Abdominal pain: upper/epigastric area, may radiate to back. Rapid onset! lasts longer than biliary colic. Pain is usually worse when supine, better leaning forward
90
What is Cullen's sign?
periumbilical ecchymosis associated with pancreatitis
91
Grey-Turner's sign?
flank ecchymosis associated with pancreatitis
92
Best imaging for acute pancreatitis?
CT
scoring system "A" not bad through "E" bad
93
Ranson's criteria is associated with?
Pancreatitis
Just know more severe disease and increased chance of death with a higher score
94
How do we treat acute pancreatitis?
NPO, Pain control, correct electrolyte abnormalities
Basically supportive
95
Number 1 cause of chronic pancreatitis?
Alcohol -- nonobstructive chronic pancreatitis
96
Obstructive pancreatitis would be due to?
Benign (sphincter of oddi dysfunction)
Neoplasm
Chronic pancreatitis is NOT caused by gallstones
97
Gold standard test for diagnosing chronic pancreatitis?
Secretin stimulation test
98
How do we treat chronic pancreatitis?
Pancreatic enzyme supplements (such as Viokase and Pancrease)
Pain control, stop alcohol
99
This type of cancer is the 4th leading cause of cancer death
Pancreatic
100
Signs and symptoms of pancreatic cancer
PAINLESS jaundice, pain, pale stool, weight loss, dark urine, Virchow's node, Trousseau's node
101
Tumor marker for pancreatic cancer
CA19-9
102
Diagnostic testing for pancreatic cancer?
CT scan dual phase helical (non-invasive)
| Dx: ERCP head of pancreas
103
Elevated direct bilirubin and elevated alk phos is indicative of?
Pancreatic cancer
104
Abdominal pain, bloating, and alterations in bowel habits should make you think of?
IBS
105
When you are doing a work-up for IBS, what labs are very important to get?
Well there are lots, BUT
make sure you check stool for occult blood and thyroid levels
106
What word means twisting of the intestine?
Volvulus
107
What word means telescoping of the intestine?
Intussception
108
Severe cramping abdominal pain, nausea/vomiting, inability to pass stool/gas, and increased bowel sounds should make you think of?
Bowel obstruction
109
Whats the best diagnostic tool for bowel obstruction?
X-ray
110
How do we treat a bowel obstruction?
Relieve pressure via nasal to stomach cannula -- NG tube
| Surgery is often required
111
Inflammation and injury to the small intestine resulting in decreased blood flow is known as?
Mesenteric colitis
112
Bowel wall edema is characteristic of?
Ischemic bowel
113
Inflammation and injury to the large intestine resulting in decreased blood flow is known as?
Ischemic colitis
114
Connective tissue disorders, low fiber diet, and too little exercise are risk factors for?
Diverticular disorders
115
Best test to diagnose diverticulosis?
CT
116
Crohn's or UC, pain more common in RLQ
Crohn's
117
Crohn's or UC
"cobblestone" appearance
Crohn's
118
Crohn's or UC
urgency of need for BM
UC
119
What is considered a cure for UC?
Colectomy
120
Bleeding VERY common is more UC or Crohn's
UC
can still have bloody stool with Crohn's.
121
3 goals of management with toxic megacolon
1. Reduce distension
2. Correct fluid/electrolytes
3. Treat toxemia
122
True or False
Due to risk of perforation and resultant sepsis, surgical intervention is required for the majority of patients with toxic megacolon
True
123
This is caused by leakage of cecum contents, causing a blockage
Appendicitis
124
Sudden onset of abdominal pain--typically lower right quadrant, think of?
Appendicitis
125
What is the standard of care for appendicitis?
Take it out
126
What is an autoimmune disorder of the small intestine that manifests as abdominal pain, intermittent diarrhea, constipation, fatigue, and and anemia.
Celiac
127
Dermatitis Herpetiformis is associated with?
Celiac
128
How do we treat Celiac disease?
Gluten free diet
Abx for dermatitis herpetiformis
129
What is defined as difficulty passing stool in greater than 25% of defecation attempts for greater than 3 months with no obstructive peristasis
Constipation
130
Neoplasms of the small intestine account for what percent of GI cancers?
2 percent
131
What is the most common GI cancer?
Colon
132
How does colon cancer present?
Colic type abdominal pain, anorexia, thin appearance, pallor
133
"Apple core" on x-ray should make you think of?
Colon cancer
134
With no risk factors, when do we start colonoscopies?
50
135
If your patient is african american with no risk factors when do we start colonoscopies?
45
136
You have an older patients, and they have a GI bleed. You've ruled out essentially everything -- no hemorrhoids, IBD, fissures, what could it be!?
Angiodysplasia -- aging and degeneration of structure and blood vessels causes formation of arteriovenous malformation (AVM)
137
How do we diagnose and treat angiodysplasia?
Dx: Colonoscopy, CT scan, angiography
Tx: overwhelming majority will stop bleeding w/out intervention, if not--colonoscopy
138
Above or below the dentate line we have pain?
Below
139
The internal sphincter is made up of what kind of muscle?
Smooth muscle
140
External sphincter is made up of what kind of muscle?
Skeletal muscle
141
What percentage of anal fissures are posterior?
90%
142
What is the most common cause of painful rectal bleeding?
Anal fissures
143
How do we treat anal fissures?
Anusol HC (hydrocortisone Cm, 2.5% and suppository)
144
What are some common organisms that cause anorectal abscesses and fistulas?
1. Staph
2. Bacteroides
3. Proteus
4. Strep
145
From the anal crypts infection can spread...
How?
1. Superficially to the external sphincter resulting in perianal abscess (most common)
2. Deep thru the external sphincter into the fat of the ischiorectal fossa (usually resulting in large abscess)
146
What is Goodsall's rule?
Fistulas with an external opening ANTERIORLY track internally via STRAIGHT line
Fistulas with an external opening POSTERIORLY track internally via a CURVED line
147
How do we diagnose a anorectal abscess?
Need a CT to make sure that its really a perianal abscess
148
What is worse with sitting, coughing, and defecating
Anorectal abscess
149
We have a patient that presents with persistent, embarrassing drainage. Its painless but itches like mad. What do we have here?
Anorectal FISTULA
150
Internal hemorrhoids are painful or painless?
Painless
151
How would we describe a grade 3 internal hemorrhoid?
Bleed and prolapse and require manual reduction
152
What is often located in the midline post-- sacral intergluteal fold superior to the anus?
Pilonidal cyst
153
What causes sudden watery diarrhea in a patient who has had chronic constipation?
Fecal impaction
154
How do we treat a pilonidal cyst?
I and D and then abx vs surgery
155
What types of polyps are most likely to be cancerous?
Villous adenomas
156
What types of polyps are most common?
Tubular adenomas
157
AST is elevated in acute or chronic conditions?
Acute
158
ALT is elevated in acute or chronic conditions?
Chronic
159
95% of bile is secreted into the ______
duodenum
160
What test do we order to determine if elevated alk phos is from the liver?
GGTP
161
What kind of imaging do we almost always start with when working up the liver?
U/S with doppler!
162
If we do a CT while working up the liver, what kind do we get?
Triple phase with and without contrast
163
If we suspect hepatocellular carcinoma, what's our best imaging?
MRI
164
What is the most common hereditary cause of increased bilirubin?
Gilbert's disease
165
Will the ALT be greater or less than the AST in nonalcoholic fatty liver disease?
ALT
166
What is an autosomal recessive genetic disorder that results in iron deposition in organs?
Hemochromatosis
167
How does someone with Hemochromatosis present?
Arthralgias, hepatomegaly, gray skin, cardiomegaly
168
What type of disease leads to the inability to excrete copper?
Wilson's disease
169
What labs will you get if suspecting Wilson's disease?
Ceruloplasmin -- which will be LOW
| and a 24 hour urine copper, which will be elevated
170
How do we treat Wilson's disease?
Copper chelators like zinc
171
Kayser-Fleisher ring around iris, think of?
Wilson's disease
172
What is the most common cause of alcoholic hepatitis?
Cirrhosis
173
How can we diagnose toxic megacolon without imaging?
3 out of these 4: temp > 101.5, HR >120 bpm, leukocytosis >10.5, anemia
1 of the following -- dehydration, altered mental status, electrolyte abnormality, and hypotension
174
Tylenol overdose accounts for what percentage of cases of acute hepatitis?
45%
175
"beading of bile ducts" on MRCP makes you think of?
Primary Biliary Cirrhosis
176
How do we diagnose autoimmune hepatitis?
Biopsy
177
What is the most common type of hepatitis in the US?
Hep A
178
How is Hep A transmitted?
Fecal-oral
179
What is fulminant hepatitis?
They have hepatitis but they also develop altered mental status. Can be very serious.
180
Since hep B serology was confusing as F*#$ during lecture, what does "s" mean?
Immunity
181
What does "c" mean for Hep B serology?
Core -- exposure is acute or chronic
182
What does "e" mean for Hep B serology?
Envelope is active replication-- treat these people!
183
What is the most common chronic blood-borne infection in the US?
Hep C
184
In order to have Hep D you must have?
Hep B
185
Pregnant woman in a 3rd world country should make you think of what type of hepatitis?
Hep E
186
How is Hep E transmitted?
Fecal oral
187
Chronic end stage disease of the liver marked by degeneration of cells from inflammation resulting in thickening of tissue
Cirrhosis
188
Difference between compensated and decompensated cirrhosis?
Compensated: although fibrotic can still perform essential functions
Decompensated: fibrotic with loss of essential function
189
how do we diagnose cirrhosis?
Abdominal ultrasound with doppler
can do liver biopsy if we don't know the cause of their fibrosis
190
Portal hypertension can be classified in 3 ways:
1. Presinusoidal: splenic/portal vein, thrombosis, or occlusion
2. Sinusoidal: cirrhosis
3. Postsinusoidal: vascular outflow problem
191
what drug can we use for portal HTN?
Propranolol
192
With a cirrhosis patient, how often do we check for HCC?
every 6 months
193
80% of HCC is caused by?
Hep B
194
What is the MELD score?
Model for End-Stage Liver Disease
195
How do we diagnose HCC?
Triple phase CT scan or MRI
196
What is our tumor marker for liver cancer?
AFP
197
What is death due to in HCC?
Cachexia, hepatic failure, bleeding
198
Virtually every abdominal plain film x-ray is an AP or PA film?
AP
199
Gas will be what color on x-ray?
Black
200
Fat is what color on x-ray?
Dark grey
201
Soft tissue/fluid is what color on x-ray?
Light grey
202
What color is metal on x-ray?
Intense white
203
What is a pelvic phleboliths?
Normal finding on x-ray
Calcification that forms within the abdomen
204
Intramural gas on x-ray should make you think of?
Ischemic colitis
205
Intraperitoneal gas on x-ray should make you think of?
Perforated viscus or penetrating abdominal injury
206
The three D's: diarrhea, dementia, and dermatitis should make you think of what vitamin deficiency?
Vitamin B3 Niacin
207
Wernicke's encephalopathy, Beriberi, and Karsakoff's dermatitis should make you think of what vitamin deficiency?
Vitamin B1 Thiamine
208
Night blindness, dry skin, and dry eyes should make you think of what vitamin deficiency?
Vitamin A
209
Scurvy, what vitamin deficiency?
Vitamin C
210
3 H's: hyperkeratosis, hemorrhage, and hematologic should make you think of what vitamin deficiency?
C
211
Oral, ocular, and genital symptoms should make you think of what vitamin deficiency?
Vitamin B2 Riboflavin
212
Rickets and osteomalacia should make you think of what vitamin deficiency?
Vitamin D
213
Bleeding! What vitamin deficiency?
Vitamin K
214
Megaloblastic anemia, sore tongue, diarrhea, and mental disorders. What vitamin deficiency?
Folate
