ToL EM GI/Nutrition Flashcards
Name 4 physical exam signs that may be seen in acute appendicitis.
Mcburney’s sign
Rovsing’s sign
Obturator sign
Iliopsoas sign
What is the initial imaging for suspected appedicitis?
U
What is the confirmatory imaging for acute appendicitis?
Contrast CT
What bacteria is most commonly implicated in cholescystitis?
E. coli
What can precipitate RUQ pain in cholecystitis?
Fatty foods or large meals
What physical exam special tests would you expect to be positive in cholecystitis?
Murphy’s sign
Boas sign
What is the initial diagnostic test of chouce for cholecystitis?
US
What US findings are consistent with cholecystitis?
Thickened GB, distended GB, gal sludge, gallstones, pericholecystic fluid, sonographic murphys sign.
What is the gold standard diagnostic test for cholecystitis?
HIDA( heptoiminodiacetic acid) scan
What is concerning about a porcelain gallbladder?
It is a premalignant condition
What analgesic is preferred for treatment of cholecysitis?
Meperidine, because morphine is associated with sphincter of oddi spasms
What are the risk factors for cholelithiasis?
Fat, Fair, Female, Forty, Fertile
What is the first line diagnostic tool for choledocolithiasis?
MRCP
What is the treatment for choledocolithiasis?
Stone extraction via ERCP
What is the name of the rare condition causing autoimmune progressive cholestasis with fibrosis of intrahepatic and extrahepatic ducts?
Primary sclerosing cholangitis
What is the most common comorbid condition with primary schlerosing cholangitis?
inflammatory bowel disease.
What is Charcot’s triad, and what is it a sign of?
Charcot’s triad: Fever/chills, RUQ pain, Jaundice/elevated liver enzymes
It indicates ascending cholangitis
What is Reynold’s pentad, and what does it indicate?
Reynold’s pentad = Charcot’s triad + shock and AMS
It indicates severe ascending cholangitis
What is the treatment of ascending cholangitis?
PCN + aminoglycoside
Decompression of biliary tree via ERCP stone extraction
What two types of hepatitis are fecal-orally transmitted?
Hep A and E
What type of hepatitis can only occur with hepatitis B coninfection?
Hepatitis D
What is the most common cause of pancreatitis?
Cholelithiasis
What is the second most common cause of pancreatitis?
Alcohol abuse
What cause of pancreatitis might you find in routine lab work?
Hypertriglyceridemia
What two physical exam findings are associated with hemorrhagic pancreatitis?
Grey turner sign (flank bruising) and Cullen sign (periumbilical bruising)
What lab finding is most sensitive for pancreatitis?
Lipase 3x greater than upper limit of normal
What is the diagnostic test of choice for pancreatitis?
CT abdomen
What is the treatment for pancreatitis?
90% recover with fluid resuscitation, NPO, and supportive measures
What is the most common location for an anal fissure?
Posterior midline
What is the first line treatment for anal fissures?.
Analgesics, sitz bath, bulking agents and increased fluids to avoid straining
What is the most common cause of cirrhosis?
Chronic hepatitis
What is the second most common cause of chirrhosis?
Alcohol
What physical exam finding in cirrhosis patients is characterized by a flapping like motion of the hands when arms are abducted?
Asterixis
What diagnosis should you consider in a cirrhosis patient with fever and abdominal pain?
Spontaneous bacterial peritonitis
What is the treatment spontaneous bacterial peritonitis?
Ceftriaxone or cefotaxime
What is the prophylactic treatment for spontaneous bacterial peritonitis?
Norfloxacin or bactrim
