Fat, forty, female, fertile w/ RUQ pain |
|
Cholelithiasis or Cholecystitis |
| |
Fever, RUQ pain, radiation to back |
|
Cholecystitis |
| |
Elevated Alkaline phosphatase, urinary
bilirubin |
|
Cholecystitis |
| |
F, RUQ pain, Jaundice, gallstones & dilated
common duct on US |
|
Ascending cholangitis (Charcot’s triad) |
| |
Hx IBD, progressive RUQ pain, wt loss, F, jaundice & pruritis. Elevated bilrubin & alkaline
phosphate. ERCP with bile duct stenosis,
dilatation |
|
Primary sclerosing cholangitis (diffuse intra- and extrahepatic duct
sclerosing and dilatation) |
| |
Elevated AST, ALT, indirect bilirubin |
|
hepatitis |
| |
Isolated elevated indirect bilirubin |
|
Gilbert’s syndrome |
| |
Elevated indirect bilirubin w/ defective glucuronyl transferase |
|
Crigler-Najjar Dz |
| |
Photosensitivity, abd pain w/ neurologic dysfunction, erythema or skin
fragility |
|
porphyria |
| |
H.pylori gastritis |
|
2antibiotics & PPI |
| |
Chronic cough, bitter taste in mouth or throat, dyspepsia |
|
GERD |
| |
Multiple or constant GI ulcer pain despite medications |
|
Zollinger-Ellison Syndrome |
| |
Peri-umbilical
or flank ecchymosis |
|
Acute pancreatitis (Cullen & Grey Turner’s Sign) |
| |
N/V, epigastric abdominal pain, worse supine, caused by alcohol
ingestion, or following fatty meals |
|
Acute pancreatitis |
| |
Abdominal distension, bloating, intermittent, colicky pain, high-pitched
rushes & tinkles |
|
SBO |
| |
Air fluid levels on upright abd plain film |
|
SBO |
| |
Air under diaphragm, rigid board-like abdomen |
|
Perforated viscus, perforated ulcer |
| |
>60yo F, LLQ pain |
|
Diverticulitis. IV Abx, fluids,
NPO. |
| |
Elderly, Hx atherosclerosis. Dull
crampy periumbilical pain post-prandial |
|
Mesenteric ischemia |
| |
Neonate w/ projectile vomiting.
Olive sized mass. |
|
Pyloric stenosis |
| |
Choking, cyanosis, respiratory distress, increased secretions in 1st
hours of life |
|
Tracheoesophageal fistula |
| |
Painless rectal bleeding in pediatrics |
|
Meckel’s diverticulum |
| |
Alcoholic with massive hemoptysis |
|
Esophageal varicies (Tx w/ octreotide) |
| |
Female with recurrent abdominal pain, alternating diarrhea,
constipation. Pain relieved with
defecation. |
|
IBS. TCA’s (nortriptyline) good
if diarrhea predominant symptom |
| |
Bloody Diarrhea |
|
Ulcerative colitis |
| |
Supraclavicular LAD (L > R) |
|
Virchow’s node – metastatic abdominal cancer |
| |
Hard periumbilical nodule |
|
Sister mary Joseph nodule = indicates metastatic gastric and pancreatic
cancers |
| |
PUD, Pernicious anemia (Type A Gastritis), H. pylori |
|
Gastric Ca |
| |
Apple core lesion |
|
Colon Cancer |
| |
Elderly with positive hemmocult. |
|
Colon Cancer – get colonoscopy |
| |
CEA |
|
Colon Carcinoma |
| |
Family history of young age colon cancer, multiple polyps found on
colonoscopy |
|
Familial adenomatous polyposis (Gardner’s syndrome) |
| |
AFP |
|
Hepatocellular carcinoma, testicular seminoma (germ cell tumor) |
| |
CA 19-9 |
|
Pancreatic Ca |
| |
CA-125 |
|
Ovarian Carcinoma |
| |
Chemotherapy induced N&V |
|
Treat with Ondansetron (Zofran) (5-HT3 blockers) |
| |
Traveler’s Diarrhea |
|
E. coli is cause. Hydration &
Cipro to treat |
| |
Greasy, foul smelling, floating stools.
Pear-shaped flagellated protozoan w/ 2 “eyes”. Water, travel, camping history |
|
Giardia |
| |
Afebrile, watery or loose stool.
No blood or mucus |
|
Viral Gastroenteritis |
| |
Abdominal pain, diarrhea after picnic/party. Eaten ham, cream, custards, mayonnaise |
|
Staphylococcus aureus infectious diarrhea |
| |
Acute bacterial diarrhea w/ prodrome of HA, F, then crampy abd pain
& diarrhea |
|
Campylobacter jejuni – most common cause of acute bacterial diarrhea |
| |
Painless rectal bleeding. Bulging
perianal mass w/ straining |
|
Internal hemorrhoids |
| |
Pediatric with perianal pruritis esp. at PM. Positive cellophane tape test |
|
Pruritis ani – Pinworms (enterobiasis).
Tx is Mebendazole |
| |
Weight loss, recurrent greasy stools (steatorrhea) mixed with diarrhea
after certain foods |
|
Celiac Sprue |
| |
Anti-endomysial antibodies |
|
Celiac Sprue |
| |
Beriberi |
|
Thiamine; Alcoholics, Neuro Sx |
| |
Pellagra |
|
Niacin (4D’s dermatitis, diarrhea, dementia, death), bright red tongue |
| |
Scurvy |
|
Vit C (easy bleeding, bruising, hair & tooth loss, joint pain &
swelling) |
| |
Rickets |
|
Vit D (Osteomalacia) |
| |
Night blindness |
|
Vit A deficiency |
| |
Magenta tongue |
|
Riboflavin deficiency (B2) |
| |
s/p gastric bypass surgery or gastric surgery. N, abd cramping, dizziness after eating. No
masses, bleeding |
|
Dumping syndrome |
| |
crampy abdominal pain, increased high pitched bowel sounds, gas only in the small intestine |
|
Small bowel obstruction |
| |
gas with obstipation and failure to pass flatus |
|
Paralytic ileus |
| |
hypocalcemia in ESRD |
|
deficiency of vitamin D |
| |
somatostatin receptor scintography |
|
ze study of choice |
| |
Two top causes of hypercalcemia |
|
Primary hyperparathyroidism and malignancy account for 90% of all cases of hypercalcemia. Ten to twenty percent of patients with cancer develop hypercalcemia, most commonly because of breast, lung, kidney, head and neck carcinomas, and multiple myeloma and lymphoma. |
| |
soft tissue thickening of the pericolic fat, diverticula, and thickening of the bowel wall |
|
CT findings consistent with diverticulitis |
| |
haustral markings |
|
haustral markings= LARGE BOWEL. |
| |
cause of LBO |
|
cancer, diverticulum, volvulus |
| |
causes of SBO |
|
adhesions, hernia |
| |
Rx indicated for prevention of NSAID ulcers |
|
omeprazole |
| |
Trx systemic htn/ascites |
|
start sprinolactone. if refractory can do paracentesis or tips |
| |
the best visualization of an esopahgeal web or ring. |
|
barium esophagram |
| |
Barium studies contraindication |
|
patients with a possible perforation |
| |
acute performation |
|
perform hartmann procedure, if scheduled colectomy and primary anastomosis is considered. |
| |
PUD imaging |
|
upper endoscopy |
| |
absence of ganglion cells in the colon and typically presents early in life with failure to pass meconium, followed by vomiting and abdominal distension. |
|
Hirschsprung disease |
| |
pyloric stenosis imaging |
|
upper GI with barium |
| |
inner tube or coffee bean on imaging |
|
volvulus |
| |
The treatment of choice for diarrhea caused by Giardia |
|
metronidazole 250 to 750 mg po three times per day. |
| |
cholera DOC |
|
doxycycline or tetracycline |
| |
drug used to treat Campylobacter. |
|
Erythromycin |
| |
drug used to treat cholera and shigellosis. |
|
Quinolones |
| |
at what size do cecal obstructions require surgery |
|
>12cm require surgical intervention |
| |
d/c what drug prior to fecal and urea breath testing. |
|
no PPI 1-2 weeks prior to fecal and urea breath testing. |
| |
increased serum ammonia |
|
asterixis; consider hepatic encephalopathy- give lactulose |
| |
autoimmune heptatitis |
|
corticosteroids |
| |
Celiac diet (abstain from eating) |
|
BROW: Barley Rye Oats Wheat |
| |
lead pipe colon, thumbprinting, loss of haustral markings |
|
ulcerative colitis |
| |
Double bubble on Xray |
|
represents duodenal atresia (related to Down Syndrome) |
| |
most common complication associated with acute pancreatitis. |
|
Pancreatic pseudocysts suspected for a patient who has continued abdominal pain, the development of an abdominal mass, and continued elevations of amylase or lipase levels following an episode of acute pancreatitis. |
| |
alendronate (fosamax), which is known to cause what ADR |
|
esophagitis |
| |
hypochloremic alkalosis with potassium depletion. |
|
pyloric stenosis |
| |
hallmark of peptic ulcer disease |
|
Dyspepsia (epigastric pain) |
| |
variceal hemorrhage prophylaxis |
|
Beta blocker |
| |
affects women typically between ages 40 and 60. It is often discovered incidentally when the serum alkaline phosphatase level is found to be elevated. |
|
Primary biliary cirrhosis |
| |
Calcification of the gall bladder, frequently referred to as a porcelain gall bladder, and single, solitary, large, gall stone |
|
gall bladder cancer |
| |
A significantly elevated PT/INR as well as bilirubin > 10 mg/dl |
|
indicators of severe alcoholic hepatitis and increased mortality requiring hospitalization |
| |
hematemesis with severe retrosternal tearing pain |
|
boerhaave's syndrome- get esophogram and emergent surgical consult |
| |
esophagram with "birds beak" |
|
achalasia- tx botox, myotomy |
| |
smooth circumferential structure in the distal esophagus |
|
schatzki ring- get esophagram |
| |
dysphagia with regurgitation of food especially in the am; older patients |
|
zenker's diverticulum; get barium esophagram, surgery in severe cases |
| |
esophageal web may develop from what deficiency? |
|
iron deficiency (plummer vinson syndrome) |
| |
when to take PPIs |
|
take 30 minutes before meals |
| |
complication of GERD |
|
barrett's esophagus (which has an increased risk adenocarcinoma); tx long term PPI |
| |
serum gastrin level >150 |
|
consider ZES |
| |
ulcer disease- weight loss versus weight gain |
|
GUS- weight loss DUS- weight gain |
| |
two main causes indirect unconjugated bilirubinemia |
|
hemolysis, inherited (gilbert, crigler) |
| |
biliary colic, n/v, jaundice, ELEVATED LFTs |
|
choledolithiasis |
| |
fever, RUQ pain, jaundice |
|
charcot's triad |
| |
risk of pancreatitis with what procedure |
|
ERCP |
| |
women (40-50) with fatigue, jaundice, pruritis, hepatomegaly, elevated alk phos, AMA + |
|
Primary biliary cirrhosis; treat with bile acid sequestrant, cure is transplant |
| |
Gold standard dx biliary cirrhosis |
|
liver biopsy |
| |
womean 30-50 with fatigue, anorexia, arthralgias, +ANA, +ASMA |
|
Autoimmune hepatitis, get liver biopsy |
| |
fatigue, jaundice, pruritis, pain; associated with ulcerative colitis |
|
primary sclerosing cholangitis |
| |
nontender palpable gall bladder with hx weight loss |
|
klatskin tumor/cholangiocarcionoma |
| |
rx causes acute pancreatitis |
|
azothioprine, pentamide, valproate, thiazides |
| |
Ranson Criteria |
|
At admission: "GA LAW" (Glucose 200, Age>55, LDH >350, AST>250, WBCcount>16) * At 48 hours: "C HOBBS" (as in Calvin and Hobbes): (Calcium, Hematocrit, O2, BUN, Basedeficit, Sequestration (of fluid) greater than 6 L |
| |
most common cause chronic pancreatitis |
|
alcohol abuse -other causes CF, hyperparathyroidism, hx acute panc. |
| |
imaging of choice chronic pancreatitis |
|
CT- look for calcifications |
| |
most common location pancreatic cancer |
|
head |
| |
increased % transferrin sat |
|
hemochromatosis (autosomal recessive) |
| |
low serum ceruloplasmin, increased urine copper |
|
wilson's disease, treat with penicillamine |
| |
icterus, jaundince, malaise with ALT>AST (20x) |
|
Viral hepatitis |
| |
chronic hep B carriers are at risk for what? |
|
HCC |
| |
most common blood bourne infection |
|
hepatitis C |
| |
leading cause of chronic liver failure |
|
hepatitis C |
| |
diagnosis of hepatitis C |
|
screen with EIA, if positive use RIBA to confirm |
| |
hepatitis C treatment |
|
interferon plus ribavirin |
| |
factor that impact hep C trx |
|
genotype, race (AA males less likely to respond) |
| |
most common cause cirrhosis |
|
alcoholic hepatitis |
| |
non alcoholic versus alcoholic liver disease |
|
if AST/ALT >2.0 think ALCOHOL |
| |
most common metastatic cancer |
|
hepatocellular cancer |
| |
most common location crohn's disease |
|
terminal ileum |
| |
spares the rectum |
|
crohn's disease |
| |
skip lesions |
|
crohn's disease |
| |
colicky RLQ pain, diarrhea, low grade fever, weight loss |
|
crohn's disease |
| |
string sign |
|
crohn's disease |
| |
cobblestoning |
|
crohn's disease |
| |
what is malabsorbed with
crohn's disease |
|
vitamin B12 and Fat |
| |
most common complication
crohn's disease |
|
fistula |
| |
medical management
crohn's disease |
|
mesalamine, sulfasalazine; azathioprine; biologics (Humira) |
| |
>50 y/o with hx atherosclerotic disease sudden severe abdominal pain; post prandial |
|
mesenteric ischemia |
| |
celiac sprue diet (CAN EAT) |
|
CRAP (corn, rice, arrowroot, potatoes) |
| |
dematologic manifestation celiac sprue |
|
dermatitis herpetiformis (pruritic papulovesicles over extensor surfaces and trunk/neck) |
| |
mucosal biopsy: villous atrophy, blunting of villi duodenum |
|
findings with celiac sprue |
| |
crypt abscess |
|
ulcerative colitis |
| |
complications ulcerative colitis |
|
toxic megacolon, performation, cancer |
| |
treatment ulcerative colitis |
|
aminosalicylate, cortiocsteroids, immunosupperives, tnf COLECTOMY IS CURATIVE |
| |
most common cause lower GI bleed >50 y/o |
|
diverticulitis |
| |
acute painless large volume maroon or bright red blood in pt >50y/o |
|
diverticulosis |
| |
treatment diverticulitis |
|
often self resolving, elderly give metronidazole and cipro x 10-14 days if multiple attacks consider surgical consult |
| |
DRE: exquisite tenderness posterior midline position; anal skin tag |
|
anal fissure |
| |
dilation of vascular bed above dentate line |
|
internal hemorrhoids |
| |
dilation of vascular bed below dentate line |
|
external hemorrhoids |
| |
intermittent dysphagia for solids and liquids, especially cold |
|
diffuse esophageal spasm; treat with PPI |
| |
dysphagia to solids first, liquids later |
|
esophageal cancer |
| |
affects the lower 2/3 of the esophagus |
|
adenocarcinoma |
| |
foul smelling breath with oral regurgitation and coughing during meals, aspiration pneumonia |
|
zenker diverticulum; tx surgical repair and myotomy |
| |
bloating, cramping, abdominal discomfort, diarrhea after gastrectomy |
|
dumping syndrome early: overdistention from excess carbslate: hypoglycemia |
| |
sudden skin flushing, wheezing, diarrhea, plaque like fibrinous deposits on the heart |
|
carcinoid syndrome; treat with octeotride |
| |
recurrent crampy abdominal pain 3 day/month for the past 3 months associated with improvement with defecation, change in frequency or form of stool. |
|
IBS |
| |
what GI problem has high association with Hashimoto thyroiditis |
|
celiac disease |
| |