Positive Murphy's sign
pain felt when taking a deep breath when the examiner's fingers are on the approximate location of the inflamed
... [Show More] gallbladder
Murphy's sign
pain with palpation of the RUQ during inspiration, indicative of cholecystitis
McBurney's point
Pain in RLQ with appendicitis
McBurney's sign
rebound tenderness associated with appendicitis
Gold standard diagnostic tool for gallbladder disease
Ultrasound
The harder the gallbladder works, the _________ it gets.
Thicker
Muscle becomes bigger causing thickening
What could cause dilated loops of bowel?
Obstruction
What diagnostic test determines level of obstruction?
CT
Name the initial diagnostic test for suspected divirtuculitis
CT abd
Which antibiotics treat diverticulitis?
Flagyl and cipro
What protects the lining of the stomach from the acid within it?
Prostaglandins
True negative
Specificity
True positive
Sensitivity
What class of medications work the quickest to relieve GERD?
antacids
How long to antacids last?
30 minutes
What class of medications decrease acid production?
H2 antagonists
How long do H2 antagonists work?
6-12 hours
How long does it take for H2 antagonists to work?
60-120 minutes
Name some examples of H2 antagonists
Cimetidine (Tagamet)
Ranitidine (Zantac) * pulled off market
Famotidine (Pepcid)
Nizatidine (Axid)
What class of medications reduce gastric secretion?
PPIs
How long to prescribe PPIs
4-8 weeks
If symptoms return after PPI trial?
EGD
Name some examples of PPIs
Omeprazole (Prilosec)
Lansoprazole (Prevacid)
Rabeprazole (Aciphex)
Esomeprazole (Nexium)
Pantoprazole (Protonix)
Do Bulk laxatives cause dependence? Name a few.
NO
psyllium (metamucil)
methylcellulose (citrucel)
Fibercon
What might bloody noctural diarrhea indicate?
Inflammatory bowel disease
Name 2 inflammatory bowel diseases
chrons and ulcerative colitis
How to diagnose ulcerative colitis
colonoscopy
Symptoms of IBD (inflammatory bowel disease)
bloody diarrhea, fatigue, fever, abdominal pain
adenomatous polyps
1. Most common neoplasm of the intestine
2. Benign neoplasms coming from the intestinal epithelium
3. Most cases of colorectal cancer begin as adenomatous colonic polyps
Hyperplastic polyps
a benign polyp of the colon
How long does it take a polyp in the colon to become cancerous?
10 years
How often is a FIT recommended?
Annually
How often is the cologuard recommended
1-3 years
What is the gold standard for colon cancer screening?
colonoscopy
What lab measures the liver integrity?
AST/ALT
What lab measures the synthetic activity of the liver?
PT/Albumin
What lab measures the excretory function of the liver?
Bilirubin, ALP
What could an elevation of the AST/ALT indicate?
Liver injury
hepatitis
NAFLD
Acute liver failure
What could an elevation of the ALP indicate?
Bone disease
liver disease
obstructed bile ducts
What could an elevation in the bilirubin indicate?
Red cell destruction
liver disease
bile duct obstruction
gilberts disease
What could an elevated PT/INR indicate (in the setting of abnormal LFTs)
Cirrhosis, cancer of the liver
Where is bilirubin stored?
In the RBC
What happens to the bilirubin when the RBC dies?
It spills out of the RBC
What happens with the spilled bilirubin from the dead RBC?
The liver grabs it to recycle it. It the liver is sick, it cant catch all of the bilirubin, thus the bilirubin levels build up.
The alkaline phosphatase (ALP) will be elevated in patients that present with issues such as-
prostate cancer (poss mets to bone) causing bone breakdown= elevation in ALP
and
old adults that have potential/likely bone breakdown and slowed regeneratioin
In viral hepatitis will the AST or ALT usually be higher?
ALT
Which forms of hepatitis causes chronic hepatitis?
B,C,D
IgM vs IgG
IgM: antibody in INITIAL immune response; IgG: antibody in REPEATED exposure to the same antigen
First immunoglobulin during acute infection-
IgM
Immunoglobulin produced when immune (after infection is gone)
IgG
What does it mean if + anti-HAV IgG
Immune
What does it mean if + anti-HAV IgM
Infected (acute)
- anti HAV IgM and - IgG
no infection, no immunity. consider vax
HBsAg
What does it mean?
hepatitis B surface antigen
Infected! Current or past
anti-HBs
Hepatitis B surface antibody
indicates immunity to HBV, either natural or vaccinated
anti-HBc
Totally hepatitis B core antibody. Indicates current or previous infection.
IgM anti-HBc
acute hep B
BUT ...
** can persist 3-6 month or more and reappear with flare-ups of chronic hep B
Zollinger-Ellison syndrome
Gastrin-secreting tumor associated with ulcers of the stomach or duodenum
Symptoms in infant including olive shaped mass located in the RUQ abdomen, projectile vomiting after eating, weight loss, irritability, dehydration.
Pyloric stenosis
How is pyloric stenosis diagnosed?
abdominal ultrasound
Rovsing's sign
palpation of the left lower quadrant causes right lower quadrant pain that may indicate appendicitis
celiac disease
an inherited autoimmune disorder characterized by a severe reaction to foods containing gluten
Antigliadin antibodies
Celiac disease
Which NSAID do less damage to the GI tract? WHy?
Celecoxib (Celebrex)
Because the only block COX 2 (they are selective nsaid)
McBurney's point
Pain in RLQ with appendicitis
Which GI disruption causes diarrhea and is common among backpackers, campers?
Giardiasis
What is the incubation period of giardias?
7-14 days
How long do the symptoms of giardiasis last?
2-4 weeks
Treatment of Giardiasis
- Tinidazole: 80-100% cure rate
- Metronidazole: metallic taste with n/v
- Nitazoxanide: no bitter taste so take
with food to avoid GI upset [Show Less]