ICM Test 3: GI

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ICM Test 3: GI
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2012-12-11 10:37:03
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GI
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  1. Retrosternal from xiphoid to neck is symptom of?
    Esophagus
  2. Difficulty swallowing
    Dysphagia
  3. Painful swalling
    Odonophagia
  4. Dysphagia to both solids and liquids at same time?
    Esophageal motility problem

    (Growing mass usually first has dysphagia for solids which progresses to include liquids)
  5. LES persistent contraction
    Increased risk of esophageal cancer
    Achalasia
  6. Diagnose achalasia with (2)
    • Barium swallo
    • Confrimation w/ manometry
  7. Water brash?
    Burping up stuff
  8. GERD
    Gastroesophageal esophageal reflux disease
  9. Heartburn, water brash, epigastric pain (obese patient lying flat w/ water brash and substernal burning after meals)
    GERD
  10. Increased risk of
    1)  Achalasia
    2)  GERD
    • 1)  Esophageal cancer
    • 2)Barrett's cancer
  11. GERD tx?
    PPI
  12. In GERD, where is the Z line located?
    Located above the Gastroesophageal junction
  13. Odynophagia in an HIV pt. w/ fever
    Esophageal candidiasis
  14. 2 things indicated with esophageal candidiasis
    • AIDS-defining illness (CD4<200)
    • Can alsso occur w/ hematologic malignancies
  15. Esophageal candidiasis tx?
    Fluconazole
  16. Dysphagia w/ solids progressing to liquids w/ 20 lb weight loss
    Adenocarcinoma of esophagus
  17. Name 3 risk factors for adenocarcinoma
    • Nitrates (Asia)
    • Smoking
    • EtOH
  18. Dysphagia w/ solids and Iron Deficiency Anemia
    • Plummer Vinson Syndrome
    • (Hypopharyngeal web= dysphagia)
  19. Where is the web located in Plummer Vinson Syndrome?
    Upper esophagus
  20. Intensive vomitting w/ sudden retrosternal pain radiation to the back
    • Mallory-Weiss Syndrome (longitudinal mucosal lacerations in the distal esophagus and proximal stomach)
    • Etiology:  Forceful wretching
  21. Boerhave's
    • Etiology:  Forceful wretching
    • Associated w/ massive hematemesis
  22. Mallory-Weiss Syndrome
    Longitudinal mucosal lacerations in teh distal esophagus and proximal stock due to forceful wretching
  23. Alcoholic with intermittent hematemesis; no coffee grounds
    Esophageal varices
  24. 2 things associated w/ Esophageal Varices
    • Increased portal HTN
    • Most common etiology ETOH/cirrhosis
  25. 4 techniques of Abdominal Exam
    • Observation
    • AUSCULTATION
    • Palpation
    • Percussion
  26. Cupid's bow demonstrates
    Adynamic ileus
  27. How long should you listen to the abdomen?
    At least 30 seconds
  28. Where do you start palpations?
    Start in quadrant furthest from symptoms
  29. Guarding tells us?
    There is peritoneal inflammation present
  30. Percussion tells us (3 things)
    • Organ size
    • Organ location
    • Abnormal masses
  31. Stomach pain occurs in the
    epigastrum
  32. History of NSAIDs, smoker w/ coffee ground emesis
    PUD/Gastritis

    PUD= Peptic Ulcer Disease
  33. 3 things that can cause PUD/Gastritis?
    • H. pylori
    • NSAIDS
    • Sterols
  34. Poorly controlled diabetic w/ nausea, vomitting, abdominal pain, and bloating
    Gastroparesis:  Abnormal emptying of gastrin of stomach
  35. Gastroparesis is associated with 3 things
    • Diabetes Mellitus
    • Scleroderma/connective tissue diseases
    • Drugs (Narcotics, CCB's, dopamine agonists)
  36. Diabetes mellitus is associated with?
    Gastroparesis
  37. Diagnose Gastroparesis
    Gastric emptying study
  38. Periumbilical symptoms with radiation is a sign of a disorder with the?
    Small intestine
  39. Child w/ painless hematochezia
    Meckel's Diverticulum
  40. Incomplete obliteration of hte omphalomesenteric duct
    Meckel's Diverticulum
  41. Meckel's Diverticulum:  Rules of 2
    • 2% of population
    • Within 2 ft. of ileocecal valve
    • 2 in. long
  42. Child w/ painful hematochezia; currant jelly stool
    Intussuiception
  43. Previous abdominal surgery w/ nausea, bilious vomitting, and abdominal pain
    SBO (Small Bowel Obstruction)
  44. Physical exam of small bowel obstruction
    tympany, high pitched sounds, rebound tenderness
  45. 4 causes of Large Bowel Obstruction (LBO)
    • Diverticulitis- large sausage in left upper/lower quadrant
    • Volvolus
    • Hischsprung's Disease
    • Colon Ca
  46. Pt. w/ atherosclerosis, anorexia, wt. loss, and posprandial abdominal pain
    • Ischemic Colitis
    • (Atherosclerotic Disease)
  47. Atherosclerotic disease
    Microscopic hematochezia
    Bloody diarrhea
    Post-prandial abdominal cramping in LUQ/LLQ
    Ischemic colitis
  48. 6 F's of Abdominal Distention
    • Fat
    • Food
    • Feces
    • Fetus
    • Fluid
    • Fatus
  49. Epigastric pain w/ radiation to back, frequently w/ peritoneal signs (guarding)
    Pancreas
  50. Risk Factors of Pancreatitis
    • Drugs (HIV), thiazides
    • ETOH
    • Duplication
    • Trauma
    • Gallstones
  51. Pancreatitis tx?
    • Bowel rest- Pt. should be NPO
    • Pain reflief
    • Aggressive fluid management and electrolyte replacement
  52. Which criteria diagnose the severity of pancreatitis?
    Ranson's Disease
  53. Islet cell destruction (Type I DM)
    Fat vitamin malabsorption (no lipase)

    These are complications of
    Pancreatitis
  54. 3 Signs of Pancreatitis
    • Cullens
    • Grey-Turner
    • Sentinel Loop- air-filled small intestine in LUQ
  55. What is Cullen/Turner's sign
    • Cullens Periumbilical hemorrhage
    • Turner's Flank hemorrhage

    These are signs of hemorrhagic pancreatitis
  56. Steatorrhea, wt loss in pt. with CF
    Exocrine pancreas deficiency
  57. Kehr Sign
    Pain radiation to left shoulder, indicative of spleen problem
  58. Where is spleen pain
    • LUQ/flank distribution
    • can radiatie to L shoulder (Kehr sign)
  59. Should you feel a spleen on abdominal palpation?
    No
  60. RUQ paiin w/ radiation to right should
    Biliary tract
  61. Murphy Sign
    Tenderness to palpation, mid-clavicular line at right costal margin
  62. Tenderness to palpation, mid-clavicular line at right costal margin
    Murph's Sign
  63. Painless mass in RUQ w/ jaundice
    • Biliary tract carcinoma or carcinoma in head of pancreas
    • Cousovier's sign- enlarged palpable gallbladder w/ jaundice
  64. Enlarged palpable gallbladder w/ jaundice
    Courvosier's Sign
  65. RUQ pain after fatty meal w/ radiation to right should
    Cholecystitis
  66. 4 F's for Cholecystitis
    Fat, Female, Fertile, Forty
  67. Cholangitis:  Chargot triad
    • Biliary pain
    • Fever
    • Jaundice
  68. Biliary pain
    Fever
    Jaundice
    Cholangitis:  Chargot's Triad
  69. Raynold's Pentad
    • Charcot triad (biliary pain, fever, jaundice)
    • Mental confusion
    • Refractory sepsis (hypotension)
  70. Liver pain?
    RUQ, can be refferred and diffuse
  71. Woman with pruritus, asymptomatic cholestasis
    Primary biliary cirrhosis
  72. What kind of antibodies are present in primary biliary cirrhosis?
    Antimitochondiral Ab's
  73. Progressive neurologic impairment, cirrhosis, and eye findings
    Wilson's Disease (Kaiser-Fleischer rings)
  74. Progresive multifocal arthritis, dark skin, and new-onset DM
    Hemachromatosis (Iron overload)
  75. Recurrent duodenal ulcers and family history of pancreatic, parathyroid, and pituitary tumors (3 P's)
    • Zollinger-Ellison Syndrome
    • Gastrinomas
  76. Jaundice, ETOH abuse, asterixis, and fetor hepaticus
    • Cirrhosis
    • ETOH, viral
    • Asterixis
    • Fetor hepaticus
    • Caput medusa
    • Spider hemangiomata
  77. Collateral Venous Drainage:
    1) Toward lower abd-
    2)  Toward upper abd-
    3)  Bidirectional flow-
    • 1)  Superior vena cava obs
    • 2)  Inf. vena cava obs
    • 3)  Portal obstruction
  78. Patient w/ early emphasematous lung changes and cirrhosis
    Alpha I-antitrypsin deficiency
  79. PE:
    Abdominal fluid wave
    • Have pt. turn to side, intestines float, fluid goes to bottom
    • Results in shifting dullness
  80. Most common malignancy of liver
    Metastatic
  81. Hyperbilirubinemia
    • Gilbert's
    • Dubin-Johnson
    • Rotor Syndrome
    • Criglar-Najar
  82. Mild elevation inbili w/ illness
    Gilbert's (10%)
  83. Jaundice w/ stress
    • Dubin-Johnson
    • Black pigment in hepatocytes
    • Rotor-no pigment in hepatocytes
  84. Severe Jaundice in an infant w/ early death
    • Crigler-Najjar Type I- abscence of glucuronosyltransferase
    • Type 2- deficiency, milder course
  85. IBD peak age?
    15-25
  86. Chron's and UC are both examples of
    IBD
  87. Skip lesions, rectal sparing, mouth to anus
    Chron's Disease (IBD)
  88. IBD:  Colonic involvement, Sclerosing cholangitis
    UC
  89. Hiker in Colorado w/ watery diarrhea
    Giardiasis
  90. Flatulence, bloating, diarrhea, FE def anemia, low albumin
    Celiac sprue (gluten sensitivity)
  91. Celiac sprue has decreased (2 C's_
    • Carotene
    • Cholesterol
  92. Pt. w/ arthralgias, weight loss, diarrhea, and neuro disease
    • Whipple's Disease
    • Treat with:  Ceftriaxone, bactrim
  93. Diarrhea, wt loss, low albumin; previous missionary to tropics
    Tropical sprue (long lag time to onset)
  94. 30 y/o w/ colon CA and dark spots on lips
    • Peutz-Jegher's
    • Hamartomas in small bowel
  95. 32 y/o w/ colon CA; several relatives w/ early colon CA
    • Gardner's Syndrome
    • Familial adenomatous polyposis syndrome
  96. Sausage mass in LLQ w/ pain, fecal occult blood, and fever
    Diverticulitis


    Comparison:  Diverticulosis (Noinfections, no fever, no mass)
  97. Courvosier
    Painless, palpable GB
  98. Dance
    Absence of bowel sounds in RLQ
  99. Mcburney's point
    RLQ point tenderness; appendix
  100. Iliopsoas, Obturator
    Retro signs
  101. Markel
    Heel jar test
  102. Rovsing
    LLQ pain to RLQ
  103. Blumburg
    Rebound sign
  104. Sister Mary Joseph nodule (node)
    Colon CA

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