your patient is a 44 year old obese whit female who is complaining of periumbilical pain that is progressively getting worse. She states that she has no
... [Show More] appitite. Her temperature is 100.1. She has a positive psoas and obturator sign. what is your diagnosis
appendicitis
your patient is a 44 year old obese white female who is complaining of right upper quad pain after eating. She reports that the pain often radiates to the left shoulder and is accompained by nausea and vomiting. what is your probable diagnosis
acute cholecystitis
what are the risk factors for acute diverticulitis
increased age
constipation
low dietary fiber intake,
obesity
lack of exercise
frequent nonsteroidal anti inflammatory drugs
what are the signs and symptoms of acute diverticulitis
rebound tenderness
positive rovsings sign
board like abdomen
leukocytosis with neutrophilia and a left shift
Betty a 62 year old female complains of a nausea, vomiting, and abdominal pain that radiates to the mid back. Upon assessment she has a fever of 101.6 which she states started today, she has significant gaurding when the epigastric region of the abdomen is palpated. Additionally, She is very worried about bruising that appeared around her umbilicus. What is your probable diagnosis?
acute pancrititis
this inflammatory bowel disease is the only one that fistual formation and anal disease may occur in
chron's disease
patients with this disorder have severe squeezing or cramping pain locted on the left side of the abdomen with bloating and gas. Symptoms may increase after eating. Patient may be febrile and have fatigue and weight loss. Bloody stools are common. what is a probable diagnosis
ulcerative colitis
this inflammatory bowel disease is frequently accompanied by arthalgias and arthritis of the large joints, sacrum and ankylosing spondylitis. Patients may also be anemic and are at risk for toxic megacolon
ulcerative colitis
this disorder causes the pancrease or stomach to secrete excessive gastrin resulting in ulcers in the stomach and duodenum. what is this disorder and what tests would you order to confirm
Zollinger-Ellison Syndrome- fasting serum gastrin levels
these organs maybe responsible for right upper quadrant pain
liver, gallbladder, ascending colon, kidney, pancrease (small portion).
these organs maybe responsible for left upper quadrant pain
stomach, pancreas, descending colon, kidney
these organs maybe responsible for right lower quadrant pain
appendix, ileum, cecum, overy
these organs maybe responsible for left lower quadrant pain
sigmoid colon, overy
these organs maybe responsible suprapubic pain
bladder, uterus, rectum
deep palpation of the left lower quadrant of the abdomen resuls in reffered pain to the RLQ. what is this menuver called
Rovsing sign
flex hip 90 degrees, ask the patietn to push against resistance and to striaghten leg. A positive finding would be if right lower quad ado pain occurs. what is this test called
psoas or iliopsoas sign
inward rotation of the hip causes RLQ pain. Rotate righ hip through full range of motion. Positve sign is pain with the movement or flexion of the hip.
obturator sign
are located between the superior iliac crest and umbbilicus in the RLQ. Pain at this sight may indicated what?
McBurneys point, appendicitis
pressing deeply on the RUQ under the costal border during inspiration cause midinspitory arrest
Murphys meneuver
what are some worrisome for a 52 year old male with a history of long term gerd
progressive dysphagia, iron dificiency anemia, weight loss, hemoccult positive stools.
what lifestyle factors can you teach to a patient with GERD to reduce occurance?
decrease coffee, caffeine, no mints, stop smoking, avoid NSAIDS and ASA.
what is cullen sign
bruising around the umbilicus that idicated bleeding related to pancreatitis
what is grey turner sign?
bruising in the flanks that may indicate bleeding related to pancreatitis.
what is the treatment for irritable bowel disease
increase dietary fiber- supplement with metamucil or methylcellulose (citrucel) or benefiber.
avoid gas producing foods such as beans, onions, cabbage and high fuctose corn syrup.
Decrease life stress
rule out ameebic parasitic or bacterial infections. check stool for ova and parasites. culture stool.
duodenal ulcers are more common in this disease
Peptic ulcer disease (PUD)
what is the most common causative agent of both duodenal and gastric ulcers.
H pylori (gram negative bacterium)
what are some common causes of gastric or duodenal ulcers
H. pylore #1
chronic NSAID usage
bisphosphonates
what are some worrisome symptoms of gastric or duodenal ulcers
early satiety, anorexia, anemia, recurrent vomiting, hematemesis, weight loss.
s/s of gastric ulcers
dull aching epigastric pain that is episodic. described as gnawing or burning. Pain relieved by eating or antacids with recurrence 2-4 hours after a meal. pain reocur when hungry. black tarry stools or red/maroon blood in stools. coffee ground emesis, iron deficiency anemia.
patients with gastric or duodenal ulcers must be tested for what condition?
H pylori
what are the two tests that can be done to confirm the erradication of H. Pylore
urea breath test and stool antigen
gold standard for diagnosis of H pylori
upper endoscopy and biopsy
If the patient has multiple gastric lesions what test should be completed?
fasting gastrin levels to rule out Zollinger-Ellison syndrome
what is the treatment for H pylori positive gastic ulcers
Triple therapy-
clarithromycin (biaxin) 500 BID
Amoxicillin 1gm BID or flagyl 500mg BID x 14 day
PPI for 4-8 weeks
Quadruple therapy
bismuth subsalicylate 600 qid
flagyl 250 qid
tetracycline 500 qid x 2 weeks
PPI 4-8 weeks
elevated triglycerides places the patient at risk for what complication
acute pancreatitis for triglycerides > 800
what labs should be drawn in a patient suspected to have acute pancreatitis
amalyse, lipase, and trypsin, AST, ALT and GGT, bilirubin, leuocyte count. Ultrasound may be helpful in diagnosis
your patient has C-diff, what will the CBC likely show
leukocytosis > 15,000
IgG is what
the patient was once infected but now its gone not active
IgM
shows up the minute you get infected
HBsAg
hepatitis B surface antigen-
means the patient is infeccted
currently or in the past
Anti-HBs
hepatitis B surface antigen-
Immune
either via vaccine or recovery from disease.
HbeAg
active viral replication, maybe highly infectious. Presistence of the "E" antigen indicates chronic hepatitis B
Anti HCV
screening for Hep C. may indication current infection or that the patients a carrier
ALT is found mainly where ? elevation of the ALT may indicate what
found in the liver, may indicate liver inflammation
AST/ALT Ratio of 2.0 of higher maybe indicative of what?
alcohol abuse
GGT maybe elevated in what?
ETOH abuse, liver disease and acute pancreatitis
alkaline phosphate can be elevated from what sources
liver, bone, kidneys, gi tract and placenta. High levels are seen in children during growth spurts.
how is hepatitis A transmitted
fecal oral route from contaminated food or drinks.
how is Hep B transmitted
sexual activity, blood and blood products
verticle transmisstion from mother to infant
what are the treatments for Hep B
pegylated interferon
entecavir
tenofavir diopraxil fumarate
how is Hepatitis C transmitted
sharing needles, blood transfusions, mother to infant, needle stick injuries, sexual contact, sharing of personal items like toothbrushes
what is the most common cause of liver cancer in the US
hepatitis C
what is the treatment for hepatitis C
antiviral drugs such as ledipasvir-sofosbuvir
ribavirin
pegyulated interferon alpha 2a/2b
use liver biopsy to stage disease [Show Less]