SP Prep Flashcards
Appendicitis
RLQ pain loss of appetite N/V Fever 2nd/3rd decade of life
labs: CBC –> leukocytosis
Imaging: CT with IV/PO contrast
Tx: NPO, admit –> surgery within the next 24 hours with close monitoring of pain and changes in pain
Ulcerative Colitis
age 15-30
Bloody diarrhea
Crohn’s Disease
age 15-30
RLQ pain
Large Intestine Diarrhea
small mucoid amounts commonly with blood
E. choli
Shigella
Enatomoeba
Small Intestine Diarrhea
LARGE amounts, watery, no blood
E. COli Cholerae Toravirus Norwalk virus Giardia
Weight loss
Cancer Malabsorption -vitamins -celiac -lactose Chronic Pancreatitis Cirrhosis
Ask about:
- diet
- excessive brusing
- diarrhea
- steatorrhea
Get:
-CBC - anemia, leukocytosis
GERD
typically older age
heartburn typically after eating that’s worse with lying down
dysphasia
be alarmed if they have:
odnyophagia
weight loss
bleeding
dx: endocsopy
tx: life style modifications (smaller meals, don’t lay down after eating, decrease fat, EtOH, loose weight, stop smoking)
PUD
H. Pylori or NSAID use
dyspepsia –epigastric pain
worse at night
GI bleed (PUD is the MC cause of upper GI bleeds)
dx: endoscopy
urea breath test –H. pylori
stool antigen test for H. Pylori
CBC - anemia
tx: If H. pylori –> triple therapy = clarithromycin and amoxicllin and PPI (CAP)
ABXs for 2 weeks
PPI for two months
follow up in 2.5 months for check up on eradication of H. Pylori
Gastric Carcinoma
H. pylori common cause
typically males greater than 40
FAP family hx
dyspepsia weight loss Fe anemia N/V dysphasia
dx:
cbc - anemia
-endoscopy with biopsy
tx: chemo + surgery
Weight loss
Cirrhosis Gastric Carcinoma Malabsorption (protein, vitamins, lactose, gluten) Chronic Pancreatitis Pancreatic Carcinoma
Abdominal Pain
PUD (epigastric)
GERD (heartburn)
Cholelithiasis (RUQ and epigastric)
Cholangitis (RUQ pain)
Cholecystitis (RUQ/epigastric pain)
Hep A
Acute Pancreatitis (epigastric constant pain - radiating to the back)
Chronic pancreatitis (epigastric +/- back pain)
Pancreatic Carcinoma (abdominal pain radiating to the back)
Cholelithiasis
gallstone (cholesterol MC type)
RUQ pain/epigastric
episodic
associated with fatty meals
dx: ultrasound
tx: cholecystectomy if symptomatic or DM or immunocompromised
Cholangitis
an infection in the biliary tract secondary to gallstone
Charcot’s triad:
- fever
- RUQ pain
- Jaundice
dx:
- ultrasound
- CBC - leukocytosis
- CMP - AlkP and GGT and bilirubin elevated
tx: admit to the hospital
ABX (zosyn (pip/tazo))
blood cultures
Cholecystitis
RUQ/epigastric CONTNUOUS pain
might radiate to shoulder
+ murphey’s sign
fever
dx: US
CBC - leukocytosis
tx: NPO, ABX (metronidazole and ceftriaxone)
- -> cholecystectomy within next 3 days
Hepatitis A
TRAVEL
jaundice (+/-) fatigue anorexia N/V decreased smoking FEVER flu like sxs abdominal pain loss of apetite hepatomegaly
dark urine
pale feces
dx:
IgM HAV Ab
CMP - ALT >AST
UA - bilirubinuria
Hep E
similar to hep A
dx: IgM anti-HEV
Cirrhosis
EtOH hx
or chronic hepatitis
weight loss
fatigue
muscle cramps
ascites gynecomastia spider angiomas jaundice palmar erythema hepatospelnomegaly PRURITIS
dx: CBC - anemia, infection?? CMP - AST > ALT US liver biopsy
Tx:
sxs treat pruritus - cholestyramide
possibly getting them on transplant list?
Acute Pancreatitis
epigastric CONSTANT pain radiating to the back
relieved by leaning forward
N/V
fever
tachycardia
cullens sign
grey turner sign
dx:
Amylase blood test (will see sooner than lipase) – expecting to see 3X the normal limit
Abdominal CT
tx: supportive, bowel rest, NPO
Chronic Pancreatitis
EtOH abuse
weight loss
epigastric pain +/- back pain
steatorrhea
DM
dx:
amylase and lipase probably ‘normal’ - not elevated like you’d think —leading to steatorrhea
Abdominal XRay –> calcifications
tx: pancreatic enzyme replacement
manage pain
stop EtOH
manage DM
F/U for cancer screening
Pancreatic Carcinoma
smoking hx abdominal pain radiating to the back weight loss PAINELSS JAUNDICE pruritus (d/t bile salts in the blood) lymph node involvement
dx: CT scan
tx: resection if possible? supportive? bad prognosis?
Celiac disease
weight loss steatorrhea abdominal pain diarrhea \+/- skin rash
dx:
endomysial IgA ab
NOT DONE HERE
Lactose intolerance
abdominal pain
flatulence
loose stools
dx: hydrogen breath test
NOT DONE HERE
Diverticulosis
painless bloody stool
NOT DONE HERE
Diverticulitis
LLQ pain
fever
CBC - leukocytosis
NOT DONE HERE
