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# US GI2 Test 1 > RUQ and Epigastric Abd pain DSA > Flashcards

RUQ and Epigastric Abd pain DSA Flashcards

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1
Q

What are the two types of gallstones?

A
  1. Cholesterol - more common, 50%+ cholesterol monohydrate
  2. Pigment stones - <20% cholesterol, mainly calcium bilirubinate
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2
Q

What are the sx of gallstones?

A

often asx

biliary colic: severe stead ache in RUQ or epigastrium; often after meals; can radiate to right scapula or back

N/V

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3
Q

What are lab and imagins like with gallstones?

A

labs - normal typically

imaging -

US can show stones

HIDA can be used to assess the patency of the cystic duct and gallbladder emptying function

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4
Q

When are men more likely to get gallstones over women?

A

cirrhosis or hep C

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5
Q

What are the two types of pigment stones?

A

a. black
b. brown - form in bile ducts due to bacterial infection

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6
Q

What is a unique sx of acute cholecystitis?

A

tea colored urine and/or acholic stools

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7
Q

What US findings suggest acute cholecystitis?

A

GB thickening, pericholecystic fluid, sonographic murphy sign

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8
Q

What are complications of acute cholecystitis?

A

gangrene of GB

emphysematous cholecystitis

empyema

hydrops

fistulization

gallstone ileus

porcelain GB

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9
Q

What is essential to dx of choledocholithiasis?

A

stones in common bile duct

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10
Q

What is the charcot triad? reynold pentad?

A
  1. RUQ pain + fever (and chills) + jaundice
  2. Charcot Triad + altered mental status (confusion) and hypotension –> signifies acute suppurative cholangitis and is an endoscopic emergency

*both considerations in ascending cholangitis

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11
Q

What organisms are often present with ascending cholangitis?

A
  • E. coli*
  • Klebsiella*
  • Enterococcus*
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12
Q

What is seen on US for biliary dyskinesia?

A

normal US

also have normal liver enzymes, conjugated bilirubin, amylase/lipase

*use Rome III diagnostic criteria for functional GB

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13
Q

What are lab tests like with chronic cholecystitis typically?

A

normal

US - usually shows gallstones within contracted GB

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14
Q

What is porcelain GB? courvoisier’s GB?

A
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15
Q

If you suspect a pt of acute pancreatitis, what diagnositc tool should be avoided when serum Cr > 1.5 mg/dL?

A

rapid bolus intravenous contrast enhanced CT

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16
Q

What APACHE II score is associated with higher mortality of acute pancreatitis pts?

A

>8

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17
Q

What is the first step in tx of acute pancreatitis?

A

fluid resuscitation - LOTS

18
Q

What is seen here? associated condition?

A

Sentinel loop or localized ileus

acute pancreatitis

19
Q

What conditions can elevated amylase be present in?

A

Pancreatitis

High intestinal obstruction

Gastroenteritis

Mumps (salivary amylase)

Ectopic pregnancy

Administration of opioids

After abdominal surgery

20
Q

What is the cardinal sx in chronic pancreatitis?

A

pain

21
Q

What are diagnostic tests for chronic pancreatitis?

A
22
Q

Tumefactive chronic pancreatitis is a concern for?

A

pancreatic cancer

23
Q

what is the main cause of death in chronic pancreatitis pts?

A

pancreatis CA

24
Q

What are the four pancreatitc function tests?

A
25
Q

What is a unique aspect about the pain associated with pancreatic cancer?

A

worse at night due to lying flat on back

26
Q

What are the risk factors for pancreatic CA?

A

Smoking

Obesity

Male

African American

>65 yo

Diabetes Mellitus

Chronic pancreatitis

Liver cirrhosis (alcohol)

Family history

27
Q

When might you do a urine antigen chest in the setting of epigastric pain?

A

to check for causes of pneumonia

specifically Strep pneumo and Legionella

28
Q

What is the drawback in checking IgA abs when looking for H. Pylori?

A

the Abs can stick around for about 2 yrs after irradication - have to know pt’s hx

29
Q

What is an immune-related bowel dz with ASCA Abs?

A

Crohn’s dz

30
Q

When would you do a HIDA scan w/ CCK?

A

to look for decreased biliary ejection fraction = biliary dyskinesia

31
Q

When do you use ROME IV criteria?

A

IBS eval

32
Q

When do you use Rumack-Matthew Nomogram?

A

in setting of acute acetaminophen toxicity to eval risk of liver toxicity

33
Q

What GI drug can have a side effect of tardive dyskinesia?

A

metaclopramide (D2 antagonist)

34
Q

According to Ranson criteria, what predicts a severe course of pancreatitis w/ necrosis w/ sensitivity of 60-80%

A

3 or more of the following:

age > 55

WBC > 16x10^3/mcL

Blood glucose > 200

serum LDH > 350

AST > 250

35
Q

What are the Ranson Criteria?

A
36
Q

When do you do a georgia Law assessment?

What is it?

A

At admission for assessing acute pancreatitis severity

37
Q

When do you do a Calvin and Hobbes assessment and what is it?

A

48 hrs after admission to assess severity of acute pancreatitis

38
Q

What is the BISAP score and when do you use it?

A

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

39
Q

When might you see low fecal chymotrypsin?

A

in chronic pancreatic insufficiency

40
Q

What are SIRS criteria and when are they used?

A

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

41
Q

What do you call the initial episode of acute pancreatitis that starts chronic pancreatitis?

A

SAPE

sentinel acute pancreatitis event

42
Q

When do you see CA 19-9?

A

pancreatic cancer

# US GI2 Test 1 (25 decks)

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