RUQ and Epigastric Abd pain DSA Flashcards
What are the two types of gallstones?
- Cholesterol - more common, 50%+ cholesterol monohydrate
- Pigment stones - <20% cholesterol, mainly calcium bilirubinate
What are the sx of gallstones?
often asx
biliary colic: severe stead ache in RUQ or epigastrium; often after meals; can radiate to right scapula or back
N/V
What are lab and imagins like with gallstones?
labs - normal typically
imaging -
US can show stones
HIDA can be used to assess the patency of the cystic duct and gallbladder emptying function
When are men more likely to get gallstones over women?
cirrhosis or hep C
What are the two types of pigment stones?
a. black
b. brown - form in bile ducts due to bacterial infection
What is a unique sx of acute cholecystitis?
tea colored urine and/or acholic stools
What US findings suggest acute cholecystitis?
GB thickening, pericholecystic fluid, sonographic murphy sign
What are complications of acute cholecystitis?
gangrene of GB
emphysematous cholecystitis
empyema
hydrops
fistulization
gallstone ileus
porcelain GB
What is essential to dx of choledocholithiasis?
stones in common bile duct
What is the charcot triad? reynold pentad?
- RUQ pain + fever (and chills) + jaundice
- Charcot Triad + altered mental status (confusion) and hypotension –> signifies acute suppurative cholangitis and is an endoscopic emergency
*both considerations in ascending cholangitis
What organisms are often present with ascending cholangitis?
- E. coli*
- Klebsiella*
- Enterococcus*
What is seen on US for biliary dyskinesia?
normal US
also have normal liver enzymes, conjugated bilirubin, amylase/lipase
*use Rome III diagnostic criteria for functional GB
What are lab tests like with chronic cholecystitis typically?
normal
US - usually shows gallstones within contracted GB
What is porcelain GB? courvoisier’s GB?
If you suspect a pt of acute pancreatitis, what diagnositc tool should be avoided when serum Cr > 1.5 mg/dL?
rapid bolus intravenous contrast enhanced CT
What APACHE II score is associated with higher mortality of acute pancreatitis pts?
>8
What is the first step in tx of acute pancreatitis?
fluid resuscitation - LOTS
What is seen here? associated condition?
Sentinel loop or localized ileus
acute pancreatitis
What conditions can elevated amylase be present in?
Pancreatitis
High intestinal obstruction
Gastroenteritis
Mumps (salivary amylase)
Ectopic pregnancy
Administration of opioids
After abdominal surgery
What is the cardinal sx in chronic pancreatitis?
pain
What are diagnostic tests for chronic pancreatitis?
Tumefactive chronic pancreatitis is a concern for?
pancreatic cancer
what is the main cause of death in chronic pancreatitis pts?
pancreatis CA
What are the four pancreatitc function tests?
What is a unique aspect about the pain associated with pancreatic cancer?
worse at night due to lying flat on back
What are the risk factors for pancreatic CA?
Smoking
Obesity
Male
African American
>65 yo
Diabetes Mellitus
Chronic pancreatitis
Liver cirrhosis (alcohol)
Family history
When might you do a urine antigen chest in the setting of epigastric pain?
to check for causes of pneumonia
specifically Strep pneumo and Legionella
What is the drawback in checking IgA abs when looking for H. Pylori?
the Abs can stick around for about 2 yrs after irradication - have to know pt’s hx
What is an immune-related bowel dz with ASCA Abs?
Crohn’s dz
When would you do a HIDA scan w/ CCK?
to look for decreased biliary ejection fraction = biliary dyskinesia
When do you use ROME IV criteria?
IBS eval
When do you use Rumack-Matthew Nomogram?
in setting of acute acetaminophen toxicity to eval risk of liver toxicity
What GI drug can have a side effect of tardive dyskinesia?
metaclopramide (D2 antagonist)
According to Ranson criteria, what predicts a severe course of pancreatitis w/ necrosis w/ sensitivity of 60-80%
3 or more of the following:
age > 55
WBC > 16x10^3/mcL
Blood glucose > 200
serum LDH > 350
AST > 250
What are the Ranson Criteria?
When do you do a georgia Law assessment?
What is it?
At admission for assessing acute pancreatitis severity
When do you do a Calvin and Hobbes assessment and what is it?
48 hrs after admission to assess severity of acute pancreatitis
What is the BISAP score and when do you use it?
To assess severity of acute pancreatitis at admission or within 24 h
BUN > 25
Impaired mental status
SIRS >/= 2 of 4 present
Age > 60
Pleural Effusion
When might you see low fecal chymotrypsin?
in chronic pancreatic insufficiency
What are SIRS criteria and when are they used?
the “S” in BISAP score for eval of acute pancreatitis
(need 2-4 to meet criteria in BISAP)
Core temp <36 C or > 38
HR > 90
RR > 20 or PCO2 <32
WBC > 12000, <4000, or 10% bands
What do you call the initial episode of acute pancreatitis that starts chronic pancreatitis?
SAPE
sentinel acute pancreatitis event
When do you see CA 19-9?
pancreatic cancer
