Q16$ Flashcards
Small bowel resection for chrons and has been receiving TPN. Now has epigastric and RUQ pain. US shows gallstones which weren’t there w years ago
Cause of gallstones
Gallbladder stasis
- no enteral nutrition so CK isn’t being released so gallbladder doesn’t contract leading to gallbladder stasis . Gallbladder doesn’t absorb water creating gallstones
Chrons and small bowel resection - if damaged or ileum is absent there’s decreased bile acid reabsorption somehow form gallstones
Digital block with lidocaine and sodium bicarbonate.
Purpose of sodium bicarb
Decrease pain during the injection of the anesthetic
- lidocaine in acidic form is painful therefore I buffering with NAHCO3 helps decreases pain. Alkaline NAHCO3 increases onset of analgesia and converts analgesic to its uncharged active form
Epinephrine with analgesic (vasoconstriction so don’t use if have digital ischemia predisposition like raynaud
- Dec bleed during wound repair. It prevents lidocaine from going systemically so Dec risk of toxicity, prolongs it’s duration
Parkinson’s vs Lewy body
P- Parkinsonism occurs >1 yr before dementia
L- cognitive impairment before or at same time as Parkinsonism
16 yo boy on oral isotretiniin for severe acne now has throbbing headache in am with associated nausea vomiting and blurry vision which occurred during football practice. Eye exam shows optic disc edema bilaterallly and decreased visual acuity
Cause
Medication effect- isotretinoinimpaired CSF reabsorption therefore ICP (idiopathic intracranial hypertension)
- initial sign is throbbing headache especially when laying flat bc elevated ICP and gets Better with standing
- optic disc edema indicated ICH
- dx: MRI with MR venography to rule out mass
LP- elevated opening pressure >250
- Tx - stop drug to resolve symtoksb
Multiple peptic ulcers (duodenal and jejunal), diarrhea , steatorhea, burning epigastric pain without any relief with antacids histamine and PPI .
Cause of impaired fat malabsorption
Dx-
Pancreatic enzyme inactivation
- zollinger elllison - gastrin producing tumor on pancreas or duodenum . Gastric acid can impact the small intestine and cause diarrhea and steatorrhea because Pancreatic enzyme inactivation
Dx- severely elevated gastrin in presence of normal gastric acid (<4
CT MRI AND SOMATOSTATIN RECEPTOR scintigraphy can identify pancreatic tumors and metastic disease
Man with alcoholic cirrhosis has SOBoE , cough pleuritic chest pain hypoxemia and fatigue for past several weeks. Treated for ascites recently. Decreased breath sounds and fullness on right.
Cause of current symptoms
Treatment
Fluid passage through diaphragmatic defects
- patients with cirrhosis and portal hypertension who ascites and peripheral edema (extra cellular fluid volume regulation is abnormal because of low albumin
- they can get hepatic hydro thorax which causes a transudative pleural effusions because it creates a small defect in diaphragm on the right
Tx: salt restriction and diuretic
Definitive is liver transplant
No chest tube please
53 yo women with pelvic pain , bloating and decrease appetite with a complex adnexal mass (solid and separations with ascites
Explanation of symptoms
Abnormal proliferation of tubal or ovarian epithelium - epithelial ovarian cancer
4 day old male with bilious vomiting abdominal distensión dilated loops of bowel without pneumatosis and hasn’t pooped since 2 days old. Anal canal is tight
NBSIM
Contrast enema - Hirschprung
- signs of obstruction (bilious vomiting abdominal distensión, dilated loops of bowel)
Algorithm for bilious emesis in neonate
Unstable - emergency laparotomy
Stable- first do abdominal exam
Free air -emergency laparotomy
Dilated loops of bowel and absent gas- any increased rectal tone and or FTPM ; if no do upper GI series and is right sided ligament of tremors it’s malrotation. If yes do contrast enema (micro colon obstruction - meconium ileus ; recto sigmoid transition zone hirsch
Normal -do upper GI series and is right sided ligament of tremors it’s malrotation.
Double bubble sign - duodenal atresia
Someone with IBD and now in shock with increased pain and leukocytosis . CXR - dilated colon with loss of haustral folds
What treatment at this time
iv methyl prednisolone
(Also bowel rest ( ivf , electrolyte replace mt- supportive ) , decompression
And antibiotics
- toxic megacolon induced by IBD
Elderly lady with painless right sided neck swelling for a month. 2cm nontender hard cervical lymph node. Fna- SCCC
how to establish the primary source of the patients malignancy?
Laryngopharyngoscopy
- head and nexk scc with palpable cervical lymph node indicated metastasis from a regional area so do the scope of nasopharyngeal oral cavity oropharynx larynx
4 week old with acholic (pale stools) dark urine and jaundice has a subhepatic mass.
Diagnosis
Treatment
Complication or sequelae
How would it present in older kids
Biliary cyst
- most common in cystic dilation of the CBD; impaired bile excretion so can’t get to stool hence pale and since it’s conjugated bile it can go to urine so dark
Kids - abdominal pain, jaundice and RUQ Mass
- Tx: remove cyst ; roux en Y hepaticojejunostomy
- complication - cholangiocarcinoma if cyst is not removed
Guy got discharged after splenic rupture.
What should be given to this patient and what timeframe
And if he develops a fever what should be done
Splenectomy
Give amox- clavulanate or if allergic to penicillin (Levofloxacin)
- > 2 weeks after splenectomy give vaccines against SHiN, 13 and 23 pneumococcal , H. Influenza type b, quadrivalent and monovalente meningococcal, yearly influenza to prevent secondary bacterial infection with a pneumoniae following influenza
Unprovoked DVT. Thrombopholos workup is ordered. Which drug would affect the work up and how
Warfarin - decrease levels of protein s and therefor incorrect diagnosis of inherited protein s deficiency so dc warfarin 2 weeks prior to evaluating protein s levels
6 weeks ago guy had cabs done and now has sharp chest pain exacerbated by deep breathing , leukocytosis . Echo shows sinus tachycardia with non specific st segment changes. Small pleural effusions
Diagnosis
Pathophysiology
Treatment
Post cardiac injury syndrome lead to pericarditis
- this can occurs after mi (dressier), cardiac surgery or Percutaneous coronary intervention
- pathophysiology- immune complex deposition. In the pericardium and pleura because immune system can be exposed to cardiac antigens
Tx: NSAIDs and colchicine (if doesn’t work use steroids
Prophylaxis following cardiac surgery is colchicine
