Uworld GI 9/26 Flashcards
patient has had anorexia, fatigue, and weight loss for 6 months. Soft abdomen mildly tender. BR 6.7, ALP 647, elevated LFTs. AMA negative, has mild dilation of the common bile duct. US shows no stones in the GB and no GB thickening. What is the next best step? and why
Abdominal CT. Patient most likely has a cancer in the pancreatic head. You would do an ERCP AFTER us and Ct.Because ERCP is very invasive.
When would you use Percutaneous Transhepatic Cholangiogram.
Drainage of infected bile, or those who are not candidates for ERCP.
What would differentiate Aortic Dissection presentation from Esophageal perforation. if there is a pleural effusion?
Esophogeal perforation would have a high amylase content. Esophogeal perforation PF would be EXUDATIVE, with LOW ph and HIGH amylase due to esophogeal and saliva contents.
Boerhave Syndrome vs Mallory Weiss Tear.
MWT: Upper GI mucosal tear, forceful wretching, SUPERFISIAL, from a bing drinking episode.
Boerhaaves: complete perforation, fluid leakage into other areas like the pleural, subcutaneous emphysema, Gastrograffin St would confirm dx.
Lady is highly suspect of Lactose Intolerance diarrhea. Would there be a stool osmolar gap?
Yes, a HIGH one.
What would confirm lactose intolerance?
Positive hydrogen breath test.
What kind of diarrhea is a low stool osmolar gap?
secretory, defined as a gap of <50
What kind of diarrhea is a high stool osmolar gap?
Osmolar >50-100
Patient has bloody emesis with a history of idiopathic cirrhosos She already had a variceal band ligation. Her BP would not imporve after normal saline infusion. She is barely arousable. She continues to have bloody emesis. What is the next step? and what later steps must be taken?
Endotracheal Intubation. Because they are still vomiting blood but barely arousable. Then, upper endoscopy, then prophylactice abx and to prevent spontaneous bacterial peritonitis.
What complications would be seen in primary biliary cholangitis?
Malabsorption of fat soluble vitamines, Metabolic bone disease (like osteoporosis, osteomalacia), hepatocellular carcinoma, fatigue, pruritis, xanthomas and xanthelasmas
patient has new onset lethargy and confusion, history of cirrhosos from alcoholism. Has a fever, tachycardic, and has a flapping tremor of his hands when held out. Has shifting dullness and diffuse tenderness to palpation. Has low BR, increased LFTs, and has small and large bowels WITHOUT air fluid levels. What do they have, and what is the next best step?
Spontaneous Bacterial Peritonitis. the next step would be Diagnostic Paracentesis
Presentation of Spontaneous Bacterial Paritonitis?
Fever, abdominal pain, AMS, Hypotension, hypothermia, and paralytic ileus. The paralytic ileaus is key. Thats when thers dilated bowels. Cant poo yo.
What would be in the ascitic fluid of SBP?
> 250 PMNs, positive cultures of bacteria, Protein <1, SAAG >1.1
What is tested in serology to diagnose Hep B infection?
HBsAg, and IgM Anti-Hbc. –> the S antigen, and the C antibody. “S”ee the bad, “C”onfirm the Ab.
Why is HBcAg not important?
not detectable in serum.
