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Side ASide B
Fat, forty, female, fertile w/ RUQ pain
Cholelithiasis or Cholecystitis
Fever, RUQ pain, radiation to back
Elevated Alkaline phosphatase, urinary bilirubin
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...
Primary sclerosing cholangitis (diffuse intra- and extrahepatic duct sclerosing and dilatation)
Elevated AST, ALT, indirect bilirubin
Isolated elevated indirect bilirubin
Elevated indirect bilirubin w/ defective glucuronyl transferase
Photosensitivity, abd pain w/ neurologic dysfunction, erythema or skin fragility
2antibiotics & PPI
Chronic cough, bitter taste in mouth or throat, dyspepsia
Multiple or constant GI ulcer pain despite medications
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...
Abdominal distension, bloating, intermittent, colicky pain, high-pitched rushes & tinkles
Air fluid levels on upright abd plain film
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
Neonate w/ projectile vomiting. Olive sized mass.
Choking, cyanosis, respiratory distress, increased secretions in 1st hours of life
Painless rectal bleeding in pediatrics
Alcoholic with massive hemoptysis
Esophageal varicies (Tx w/ octreotide)
Female with recurrent abdominal pain, alternating diarrhea, constipation. Pain relieved...
IBS. TCA’s (nortriptyline) good if diarrhea predominant symptom
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
Apple core lesion
Elderly with positive hemmocult.
Colon Cancer – get colonoscopy
Family history of young age colon cancer, multiple polyps found on colonoscopy
Familial adenomatous polyposis (Gardner’s syndrome)
Hepatocellular carcinoma, testicular seminoma (germ cell tumor)
Chemotherapy induced N&V
Treat with Ondansetron (Zofran) (5-HT3 blockers)
E. coli is cause. Hydration & Cipro to treat
Greasy, foul smelling, floating stools. Pear-shaped flagellated protozoan w/ 2 “eyes”. ...
Afebrile, watery or loose stool. No blood or mucus
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
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
Thiamine; Alcoholics, Neuro Sx
Niacin (4D’s dermatitis, diarrhea, dementia, death), bright red tongue
Vit C (easy bleeding, bruising, hair & tooth loss, joint pain & swelling)
Vit D (Osteomalacia)
Vit A deficiency
Riboflavin deficiency (B2)
s/p gastric bypass surgery or gastric surgery. N, abd cramping, dizziness after eating....
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
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....
soft tissue thickening of the pericolic fat, diverticula, and thickening of the bowel...
CT findings consistent with diverticulitis
haustral markings= LARGE BOWEL.
cause of LBO
cancer, diverticulum, volvulus
causes of SBO
Rx indicated for prevention of NSAID ulcers
Trx systemic htn/ascites
start sprinolactone. if refractory can do paracentesis or tips
the best visualization of an esopahgeal web or ring.
Barium studies contraindication
patients with a possible perforation
perform hartmann procedure, if scheduled colectomy and primary anastomosis is considered.
absence of ganglion cells in the colon and typically presents early in life with failure...
pyloric stenosis imaging
upper GI with barium
inner tube or coffee bean on imaging
The treatment of choice for diarrhea caused by Giardia
metronidazole 250 to 750 mg po three times per day.
doxycycline or tetracycline
drug used to treat Campylobacter.
drug used to treat cholera and shigellosis.
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
Celiac diet (abstain from eating)
BROW: Barley Rye Oats Wheat
lead pipe colon, thumbprinting, loss of haustral markings
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...
alendronate (fosamax), which is known to cause what ADR
hypochloremic alkalosis with potassium depletion.
hallmark of peptic ulcer disease
Dyspepsia (epigastric pain)
variceal hemorrhage prophylaxis
affects women typically between ages 40 and 60. It is often discovered incidentally when...
Primary biliary cirrhosis
Calcification of the gall bladder, frequently referred to as a porcelain gall bladder, and...
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
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
fever, RUQ pain, jaundice
risk of pancreatitis with what procedure
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
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
rx causes acute pancreatitis
azothioprine, pentamide, valproate, thiazides
At admission: "GA LAW" (Glucose 200, Age>55, LDH >350, AST>250, WBCcount>16)*...
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
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)
chronic hep B carriers are at risk for what?
most common blood bourne infection
leading cause of chronic liver failure
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
non alcoholic versus alcoholic liver disease
if AST/ALT >2.0 think ALCOHOL
most common metastatic cancer
most common location crohn's disease
spares the rectum
colicky RLQ pain, diarrhea, low grade fever, weight loss
what is malabsorbed with crohn's disease
vitamin B12 and Fat
most common complication crohn's disease
medical management crohn's disease
mesalamine, sulfasalazine; azathioprine; biologics (Humira)
>50 y/o with hx atherosclerotic disease sudden severe abdominal pain; post prandial
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
complications ulcerative colitis
toxic megacolon, performation, cancer
treatment ulcerative colitis
aminosalicylate, cortiocsteroids, immunosupperives, tnfCOLECTOMY IS CURATIVE
most common cause lower GI bleed >50 y/o
acute painless large volume maroon or bright red blood in pt >50y/o
often self resolving, elderly give metronidazole and cipro x 10-14 daysif multiple attacks...
DRE: exquisite tenderness posterior midline position; anal skin tag
dilation of vascular bed above dentate line
dilation of vascular bed below dentate line
intermittent dysphagia for solids and liquids, especially cold
diffuse esophageal spasm; treat with PPI
dysphagia to solids first, liquids later
affects the lower 2/3 of the esophagus
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 syndromeearly: 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...
what GI problem has high association with Hashimoto thyroiditis