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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
Q

What is used to diagnose biliary dyskinesia?

What is a normal vs. abnormal result?

A

HIDA scan

Normal: Gb visualized within 1 hr
Abn: Gb not seen -> stone in cystic duct or cholecystitis

26
Q

What EF should indicate cholecystectomy in biliary dyskinesia?

A

EF of 35-38%

27
Q

3 major etiologies of acute hepatitis

A

Viral infection
Drugs
Ischemia (shock)

28
Q

What is evident on PE in a patient with acute hepatitis?

A 
RUQ pain (tenderness over liver)
Jaundice
Hepatomegaly
Skin changes
Abdominal pain
29
Q

What 3 diagnostics should be done in acute hepatitis?

A

CMP
PT/INR
Acetaminophen level

30
Q

What can cause acute pancreatitis? (2 major causes)

A

Gallstones <5mm in the biliary tract

Heavy EtOH use

31
Q

Symptoms of acute pancreatitis

A

Epigastric abdominal pain (constant pain that penetrates to the back)
May present similar to Gb pathology

32
Q

What is required for a Dx of acute pancreatitis?

A

2 of the following 3:
Epigastric pain
Lipase 3x normal limit
CT changes consitent with pancreatitis

33
Q

What signs are positive in acute pancreatitis?

A

Gray Turners sign (ecchymosis of flank)

Cullen sign (ecchymosis of umbilicus)

34
Q

What might be seen on XR in acute pancreatitis?

A

“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
Q

What level of the APACHE II criteria suggests a higher mortality?

A

> 8

36
Q

What is HAPS?

A

“Harmless acute pancreatitis score”

Predicts non-severe course w/ 98% accuracy

  • no tenderness or guarding
  • NL Hct
  • NL serum creatinine
37
Q

What are some complications of acute pancreatitis? (5)

A

Intravascular volume depletion - 3rd spacing and pre-renal azotemia

Pleural effusions (fluid collections)

Necrosis and infection

Pseudocysts

ARDS

Pancreatic ascites

38
Q

What is emphysematous pancreatitis?

What 3 bugs can cause it?

A

Infected pancreatic necrosis with secondary gas formation

C. perfringens
Enterobacter aerogenes
E. faecilis

39
Q

Decreased fecal elastase (<100 mcg/g) suggests:

A

Chronic pancreatitis

40
Q

CT findings in chronic pancreatitis (3)

A

Ductal dilation
Heterogeneity/atrophy of the pancreas
“Tumefactive chronic pancreatitis” = concern for pancreatic cancer

41
Q

Etiologies of chronic pancreatitis (6)

A

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
Q

2 major complications of chronic pancreatitis

A

Brittle DM: >80% of adults develop DM within 25 years after the onset

Pancreatic cancer

43
Q

Avoid opioids in…

A

Chronic pancreatitis

44
Q

4 pancreatic function tests

A

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
Q

What ethnicity of patients are at highest risk for pancreatic cancer?

A

> 65 y/o, black ethnicity

Gastrointestinal II Exam #1 (19 decks)

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