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Gastrointestinal II Exam #1 > RUQ and Epigastric Abdominal Pain > Flashcards

RUQ and Epigastric Abdominal Pain Flashcards

1
Q

+ Murphy’s sign =

A

Pain or inspiratory arrest is induced with deep inspiration or cough during palpation of the RUQ

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2
Q

Major SX of cholelithiasis

A

Biliary colic - severe steady ache in the RUQ or epigastrium that begins suddenly (30-90 min. post meals)
-pain radiates to the right scapula

Nausea and vomiting

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3
Q

What lab changes may occur in cholelithiaisis?

What is the best imaging tool?

A

Mild/transient elevations in BR

US (only 10% show up on XR)

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4
Q

What are 3 complications of cholelithiasis?

A

Cholecystitis
Pancreatitis
Cholangitis

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5
Q

In what setting are men more likely to have cholelithiasis than women?

A

In patients with cirrhosis and/or hep C

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6
Q

What ethnicities are most likely to have gallstones?

A

NAs > Mexicans > whites > blacks

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7
Q

Acute calculous gallstones occur as a result of:

A

> 90% cases

Occur as a result of blockage of cystic duct, inflammation develops behind obstruction

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8
Q

Acute acalculous gallstones is NOt due to…

A

Not due to stones - “true cholecystitis”

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9
Q

What is the appearance of urine/stools in acute cholecystitis?

A

Tea-colored urine and/or acholic stools

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10
Q

What are some lab findings in acute cholecystitis? (5)

A 
Leukocytosis
Bilirubinemia
Increased AST
Increased ALP
Increased GGT
Increased serum amylase
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11
Q

What findings on US suggest acute cholecystitis? (3)

A

Gb wall thickening, pericholecystic fluid and sonographic Murphy’s sign

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12
Q

2 major complications of the Gb in acute cholecystitis

A

Gangrene of the Gb - from ischemia, necrosis, Gb perforation

Emphysematous cholecystitis - secondary to infection; warrants urgent cholecystectomy

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13
Q

Where are stones found in choledocholithiasis?

A

Common bile duct

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14
Q

Essentials of Dx in choledocholithiasis (3)

A

H/O biliary pain +/- jaundice
N/V
Stones in CBD

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15
Q

What tests can detect choledocholithiasis?

A

ERCP or EUS

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16
Q

SX of choledocholithiasis (3)

A

Frequent attacks of sever RUQ pain for hours

Chills and fevers associated with pain

H/O of jaundice associated with episodes of abdominal pain

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17
Q

What is the procedure of choice for choledocholithiasis?

A

ERCP w/ sphincterotomy and stone extraction

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18
Q

When should ascending cholangitis be suspected?

A

Fever followed by hypothermia and G- shock, jaundice and leukocytosis

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19
Q

What is Charcot triad?

A

RUQ pain + fever/chills + jaundice

May be present in ascending cholangitis

20
Q

What is Reynold pentad?

What might it suggest?

A 
Charcot triad (RUQ pain + fever/chills + jaundice) + altered mental status + hypotension
May be present in ascending cholangitis

Signifies acute suppurative cholangitis and is an endoscopic emergency

21
Q

What cultures may be positive in ascending cholangitis? (3)

A

E. coli
Klebsiella
Enterococcus

22
Q

What is the etiology of biliary dyskinesia?

What are the symptoms?

A

Unknown etiology

Very similar to biliary colic: episodic RUQ pain, pain that limits dailynliving, nausea

23
Q

A normal US is seen in what Gb disease?

What labs are normal? (3)

A

Biliary dyskinesia

NL liver enzymes, conjugated BR, amylase/lipase

24
Q

What should be considered in patients with biliary dyskinesia?

A

Rome III diagnostic criteria for functional Gb

25
What is used to diagnose biliary dyskinesia? What is a normal vs. abnormal result?
HIDA scan Normal: Gb visualized within 1 hr Abn: Gb not seen -> stone in cystic duct or cholecystitis
26
What EF should indicate cholecystectomy in biliary dyskinesia?
EF of 35-38%
27
3 major etiologies of acute hepatitis
Viral infection Drugs Ischemia (shock)
28
What is evident on PE in a patient with acute hepatitis?
``` RUQ pain (tenderness over liver) Jaundice Hepatomegaly Skin changes Abdominal pain ```
29
What 3 diagnostics should be done in acute hepatitis?
CMP PT/INR Acetaminophen level
30
What can cause acute pancreatitis? (2 major causes)
Gallstones <5mm in the biliary tract | Heavy EtOH use
31
Symptoms of acute pancreatitis
Epigastric abdominal pain (constant pain that penetrates to the back) May present similar to Gb pathology
32
What is required for a Dx of acute pancreatitis?
2 of the following 3: Epigastric pain Lipase 3x normal limit CT changes consitent with pancreatitis
33
What signs are positive in acute pancreatitis?
Gray Turners sign (ecchymosis of flank) Cullen sign (ecchymosis of umbilicus)
34
What might be seen on XR in acute pancreatitis?
"Sentinel loop" - segment of air-filled SI (LUQ). Signals the presence of an adjacent irritative or inflammatory process "Colon cutoff sign" - gas-filled segment of transverse colon abruptly ending at the site of pancreatic inflammation and focal atelectasis of the LL of the lungs
35
What level of the APACHE II criteria suggests a higher mortality?
> 8
36
What is HAPS?
"Harmless acute pancreatitis score" Predicts non-severe course w/ 98% accuracy - no tenderness or guarding - NL Hct - NL serum creatinine
37
What are some complications of acute pancreatitis? (5)
Intravascular volume depletion - 3rd spacing and pre-renal azotemia Pleural effusions (fluid collections) Necrosis and infection Pseudocysts ARDS Pancreatic ascites
38
What is emphysematous pancreatitis? What 3 bugs can cause it?
Infected pancreatic necrosis with secondary gas formation C. perfringens Enterobacter aerogenes E. faecilis
39
Decreased fecal elastase (<100 mcg/g) suggests:
Chronic pancreatitis
40
CT findings in chronic pancreatitis (3)
Ductal dilation Heterogeneity/atrophy of the pancreas "Tumefactive chronic pancreatitis" = concern for pancreatic cancer
41
Etiologies of chronic pancreatitis (6)
TIGAR-O ``` T - toxic-mediated: EtOH I - idiopathic (smoking is risk factor) G - genetic (CFTR, PRSS1, SPINK1, etc.) A - autoimmune (IgG4 - hypergammaglobinemia) R - recurrent acute pancreatitis O - obstruction ```
42
2 major complications of chronic pancreatitis
Brittle DM: >80% of adults develop DM within 25 years after the onset Pancreatic cancer
43
Avoid opioids in...
Chronic pancreatitis
44
4 pancreatic function tests
Trypsinogen: low levels cause steatorrhea (<20) Fecal elastase: low in pancreatic insufficiency Pancreatic malabsorption: when enzyme secretion is <5-10%; takes > 5 years to develop Stimulation tests: CCK/secretin
45
What ethnicity of patients are at highest risk for pancreatic cancer?
>65 y/o, black ethnicity

Gastrointestinal II Exam #1 (19 decks)

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